Flashcards in UWorld Facts 5 Deck (107):
From where should lymph node biopsies be made to make a definitive diagnosis of sarcoidosis?
1) any palpable lymph node
2) subcutaneous nodule EXCEPT erythema nodosum
3) enlarged parotid
4) lacrimal gland
**if there is no easily accessible lesion, fiberoptic bronchoscopy with transbronchial lung biopsy is the procedure of choice
**nerve and liver biopsies are not recommended unless all other approaches fail
T/F: WPW is an uncommon cause of SCD in young athletes.
True (but anomalous origin of coronary artery, on the other hand...)
What is the side effect of gingko biloba? What is it used for?
used for "memory booster." Side effects include seizures and increasing the risk of bleeding, including inhibiting platelet-activation factor
What is aconite?
an ingredient in Chinese herbal medicines used to treat pain or heart failure. Can cause fatal arrhthmias, including VT or SVT, first degree heart block, BBB, TdP
Tinea versicolor is a non-invasive fungal infection of the skin caused by
Malassezia species (rash is more prominent in the summer)
How do you treat tinea versicolor?
topical antifungal: selenium sulfide, terbinafine, clotrimazole, and ketoconazole
The risk of transverse limb abnormality, complication of CVS, is greatest when age of gestation is __ weeks
GREATEST RISK: 11 weeks
Asymptomatic subclinical hypothyroidism does not require treatment. Treatment is warranted when:
1) antithyroid antibodies
2) abnormal lipid profile
3) sx of hypothyroidism
4) ovulatory and menstrual dysfunction
What types of viruses are the usual causes of viral meningitis or encephalitis in the pediatric population of the US?
enteroviruses or arboviruses (more common in the rural areas)
Urticarial plaques, papules and vesicles surrounding the umbilicus:
Papular urticarial papules and plaques of pregnancy is characterized by pruritic erythematous papules where?
within the striae gravidarum (abdominal striae; usually spares the periumbilical area)
What ist he Wolff-Chaikoff effect?
An impact of amiodarone on thyroid function -- high iodine content in amiodarone inhibits thyroid synthesis, leading to primary hypothyroidism
**can also decrease peripheral conversion of t4 to 53 and nl or mildly elevated TSH. Can also induce thyrotoxicosis
What is ginseng used for? What is the side effect?
Ginseng is used for improved mental performance. Side effect is increased bleeding risk
What is saw palmetto used for? What are the side effects?
Saw palmetto is used for BPH. Causes mild stomach discomfort nad increased bleeding risk
What is black cohosh used for? What are the side effects?
Black cohosh is used for postmenopausal symptoms (hot flashes and vaginal dryness). Causes hepatic injury and increased bleeding (antiplatelet properties)
What is St. John's wort used for? What are the side effects?
St John's wort used for depression and insomnia.
Side effects are drug interactions with antidepressants (serotonin syndrome), OCP, anticoagulants (decreased INR), digoxin.
Can also cause HYPERTENSIVE crisis
What is kava used for? Side effects?
Kava is used for anxiety and insomnia. Can cause severe liver damage.
What is licorice used for? What can it cause?
Licorice can cause stomach ulcers, bronchitis/viral infections. Can cause hypertension, hypokalemia.
What does the hook of hamate contain? How does its fracture present?
Hook of hamate contains the ulnar artery and nerve. Pain and swelling of the hypothenar eminence and ulnar aspect of the wrist occur with fracture.
CPRS can occur as a complication of distal radius fracture and in patients with wrist fracture splinted with palmar flexion >__*
A crescent-shaped hypoechoic region adjacent to the gestational sac (the most commonly identified source of first-trimester bleeding) is:
What is the most common congenital heart disease in children with Down's syndrome?
What are other common malformations?
endocardial cushion defect
other malformations that are common in Down's syndrome include duodenal atresia, Hirschsprung's disease, atlanto-axial instability, and hypothyroidism
What is the most well known anatomical predisposing factor for Mallory-Weiss syndrome?
hiatal hernia (transmural pressure gradient is greater within the hernia than the rest of the stomach)
How long should people be on antidepressants?
6m to a year, then can be stopped.
But in those who have had two or more episodes, they should be on the med chronically
What is the treatment of chronic urticaria?
second generation antihistamine: loratadine or cetirizine
**if no improvement, then first gen H1 blocker (hydroxyzine), montelukast, or h2 blocker, or a brief course of oral steroids
Carotid endarterctomies should be performed with stenosis >__ %
What is a visual defect disorder with mitochondrial inheritance?
Leber hereditary optic neuropathy
All children age _____ months with UTI should undergo renal and bladder ultrasound to evaluate for anatomic abnormalities that might predispose the child to a UTI.
Which kids should undergo a voiding cystourethrogram?
Kids age 2m to 2y with Abnormal renal and bladder ultrasound (hydronephrosis, reflux, obstruction) or recurrent UTIs.
What is a serum-sickness like syndrome? What type of hypersensitivity reaction is it?
Fever, rash, arthralgias--usually resolves with onset of jaundice. Type III reaction.
What are the extrahepatic manifestations of hep B infxn that can be caused by circulating immune complexes?
polyarteritis nodosa, glomerulonephritis (usually membrane nephropathy, less often membranoproliferative glomerulonephritis), and serum-sickness
Autoimmune hemolytic anemia is explained by what type of hypersensitivity reaction?
Type II--mediated by cytotoxic antibodies
Contact dermatitis is what type of hypersensitivity reaction?
For which patients is dronedarone NOT recommended?
severe heart failure (NYHA class III or IV), those with hospitalized HF within the past 4 weeks, and/or those with LV systolic dysfunction w/ EF
What are causes of TdP?
1) PVCs with compensatory pause
2) bradyarrhthmias (sinus bradycardia, or frequent pauses)
3) electrolyte imbalances (hypoM, hypoK, hypoCa)
4) SSRIs, macrolides, antipsychotics, FLQs, antifungals, amiodarone/antiarrthymics
6) HIV infxn
What class of antiarrhthmic is amiodarone?
What are classIB antiarrhthmics? How do they work?
lidocaine, phenytoin. Work by shortening the action potential duration
Which abx are most likely to causes seizurs?
penicillins, cephalosporins, monobactams, carbapenems, and FLQs
What should be suspected in patients with a history of Hashimoto's who have a rapidly enlarging thyroid gland and subsequent obstructive symptoms?
Acute pericarditis (infarction pericarditis) can occur within ________ of a transmural
How is it managed?
Manged with high dose aspirin
This complication of MI is not usually associated with chest pain, occurs as a late complication that develops over time, and is associated with persistent ST elevation.
Left ventricular aneurysm
When does papillary muscle rupture occur after MI? What does it cause?
occurs 2-7 days after infarction. Causes acute hemodynamic instability and acute pulmonary edema
What is Dressler's syndrome? How is it managed?
occurs in patients with MI after cardiac surgery; autoimmune mediated, develops weeks to months after acute MI
Presents with fever, leukocytosis, pleuritic chest pain, and a pericardial rub
Treated with NSAIDS, and then corticosteroids if NSAIDs fail to control (corticosteroids can increase incidence of ventricular aneurysm formation)
Why shouldn't you use ceftriaxone in neonates?
It can displace albumin-bound bilirubin in neonates, can increase risk of kernicterus
Why is bactrim avoided in neonates?
sulfa drugs worsen hyperbilirubinemia by displacing bili from albumin. Bactrim is also avoided in
What is the preferred regimen for serious bacterial infection in neonates?
Ampicillin and gentamicin (or cefotaxime, NOT ceftriaxone)
What is the drug of choice for prevention of cluster headaches with duration longer than 2 months?
verapamil (or lithium)
Which organisms can cause GBS?
C jejuni, CMV, EBV, or HSV
What is the systemic vascular resistance, mixed venous oxygen saturation, cardiac index, and PCWP in hypovolemic, cardiogenic, and septic shock?
hypovolemic: SVR elevated, MVO2 decreased, PCWP decrease
cardiac: SVR elevated, MVO2 decreased, PCWP elevated
septic: SVR elevated, MVO2 increased, PCWP decreased
All infants and children with drug-sensitive tuberculous meningitis should be treated for at least
(if drug-resistant infection, tx can be extended to 18-24 months)
When should a well-differentiated adenocarcinoma in the head of pedunculated colonic polyp withou involvement of the stalk or resection margins be followed up endoscopically?
2-3 months! (then again at 1, 4, and 9 years)
FAP is associated with a mutation in which gene?
Which anticoagulants can be used for afib?
warfarin, dabigatran, rivaroxaban, apixaban
How do you determine who needs AC in afib?
CHF, HTN, Age >75 (2pts), DM, Stroke (2 pts), Vascular disease, Age 64-75 (1 pt), Sex (f)
ERbs palsy involves which roots of the brachial plexus? What is a serious complication associated with it?
C5, C6, and C7. A serious complication is diaphragmatic paralysis due to phrenic nerve involvement
When should IV ceftriaxone be used for Lyme disease treatment?
if there is early disseminated disease consiting of carditis or neurologic symptoms beyond CN palsy
Glucose metabolism produces a larger quantity of CO2 for each liter of O2 consumed than the otehr two nutrient substrates in TPN. This can cause what in patients with severe lung disease?
carbon dioxide retention
The presence of left ventricular apical aneurysm in the absence of CAD is pathognomonic for
What does a SAAG >1.1 g/L signify?
Which conditions have high SAAG? Which have low?
SAAG > 1.1: Includes CHF, cirrhosis, alcoholic hepatitis, Budd Chiari
What is the goal diastolic pressure in hypertensive emergencies?
rapidly lower to 100-105mm over 2-6 hours, with total drop being no more than 25% of the initial value
When should toxicity should be suspected in patients on a nitroprusside infusion?
unexplained metabolic acidosis and AMS
What are the absolute contraindications to OCPs?
1) migraine with aura
2) > 15 cigs/d and age >=35
3) HTN >=160/100
4) hx of VTE
5) hx of stroke or ischemic heart diseas
6) breast CA (BUT decreases risk of ovarian and endometrial cancers!)
7) cirrhosis and liver CA
8) major surgery with prolonged immobilization
Why do pilot have to wait at least 6 hours after taking Viagra before flying?
affects blue-green color vision (3% of patients taking recommended doses experiences a blue haze)
What is the formula for corrected calcium?
(measured total calcium) + (0.8) ( 4 - measured serum albumin)
Pertussis is associated with lymphocyte-predominant leukocytosis with WBC >= _________
What is the treatment of RSV?
supportive care, UNLESS
1) preterm birth
When can HIV-associated thrombocytopenia occur?
at any stage of disease
Betamethasone (or dex) should be given to any pregnant woman from ___ to ___ weeks of gestation with intact membranes at high risk for preterm delivery.
24 to 34 weeks
Giant ulcersin the esophagus with no virus found on biopsy suggest _______, which is treated with?
aphthous ulcers, treated with prednisone
What does the McNemar test compare?
the difference between 2 paired proportions--patients serve as their own control! (ie: success vs failure)
This is to be contrasted with a paired t-test, which measures difference between 2 paired means (ie mean blood pressure)
What does a Fischer's exact text compare?
Both measure association between categorical variables (treatment succes/failure vs gender), but Fischer is for small N
What is well's criteria?
3 points: clinical signs and symptoms of DVT; PE is most likely diagnosis
1.5: HR greater than 100, immobilization for 3 days or surgery within past 4 weeks; previous PE or DVT
1: hemopytisis; malignancy treated within 6 months
*for scores less than or = to 4, do D dimer
* for scores greater than 4, go to CT spiral
What are the different stages of colon cancer and how are they treated?
Stage 0 = mucosa, carcinoma in situ. Endoscopic polypectomy
Stage 1 = submucosa or muscularis propria; surgery
Stage 2 = tumor invades to subserosa or direct invasion of nearby organs/structures. Surger +/- chemo
Stage 3 = surgery +/- chemo
Stage IV = surgery (usually pallliatve, except for limited liver or lung metastases) + chemo
**CEA every 3 months for stage 2 and 3; colo every 1 y, 3 y then every 5. Abd and chest CT every year for at least 3 years
WHat abx should be used prophylactcally before bowel surgery?
1) ceftriaxone AND flagyl; OR
2) ampicillin-sulbactam; OR
Patients who have difficulty dressing themselves are copying simple line drawings may have
construction apraxia, seen in lesions of the nondominant parietal lobe
Agraphia, right/left confusion, and acalculia are characteristic of
Gerstmann syndrome, damage to the dominant parietal lobe
What types of crystals are seen on arthrocentesis of patients with hemochromatosis?
CPPD crystals (pseudogout)
Reactive arthritis affects which joints in the hand? Which are spared?
affects DIP, spares the MCPs
T/F: Treatment of hemochromatosis will not treat the associated arthropathy.
What is the difference in distribution of ulcers in the mouth between aphthous stomatitis and herpangina?
anterior oral mucosa (lips, cheeks, ventrum of tongue) = aphthous stomatitis. (Herpes gingivostomatittis are also anteriorly distributed)
posterior = herpangina
What virus causes herpangina?
coxsackie group A virus. Usually seen during the summer; drooling, sore throat, painful posterior pharyngeal vesicles
Tx: saline gargles, analgesics, antipyretics, cold posicles
Pseudotumor cerebri commonly occurs in obese women of childbearing age, but can also occur secondary to ________ disorders and the usage of some medications, including ____________
endocrine disorders; acne treatments isotretinoin and minocycline; tetracycline; cimetidine; corticosteroids; tamoxifen; levo; lithium
Dysfunctional uterine bleeding is typically the cause of
What is the treatment of choice in dysfunctional uterine bleeding with hemorrhage?
high dose estrogen followed by progestin
Is there a role for D&C in dysfunctional uterine bleeding?
when patients can't take strogen (or IV) and in unstable patients with severe bleeding despite hormonal treatment
What is the target SBP in acute aortic dissection?
100-120 (use IV esmolol, labetolol, propanolol). If SBP remains above 100-120 despite beta blockade, then add nitroprusside
Which hypertensive medication should be used in patients with gouty arthritis?
Losartan! It has a modest uricosuric effect.
(hyperuricemia may be triggered by furosemide and HCTZ can raise serum uric acid levels)
Why don't you use aspirin (even low does) in treatment of gouty arthritis?
it decreases renal urate excretion
What are the "CHD risk equivalents"?
1. noncoronary atherosclerotic disease (carotid, peripheral artery, AAA)
What are the indications for maternal intrapartum antibiotic ppx?
1. GBS+ rectovaginal culture (35-37 weeks)
2. GBS bacteriuria during pregnancy
3. previous infant with GBS disease
4. unknown GBS status AND less than 37 weeks gestation; OR rupture of membranes over 18 hours; OR intrapartum fever over 38C
ampicillin, penicillin, or cefazolin should be given 4 hours or more before delivery
If an infant is born to a mom with GBS, they require a CBC and blood culture under which conditions?
1. less than 37 weeks gestation (preterm)
2. prolonged rupture of membranes (at or more than 18 hours)
ALL infants must be observed for 48 hours or more
Which patients should undergo FNA of their thyroid nodule?
Patients with normal or high TSH and a confirmed nodule greater than 1 cm in diameter on ultrasound
**Pts with low TSH should have a radionuclide thyroid scan first (and FNA if low activity)
What are the three main components of autoimmune metaplastic atrophic gastritis? (WHat is that, anyway?)
AMAG is a gastritis associated with pernicious anemia.
The three main components are
1) glandular atrophy (of gastric body and fundus)
2) intestinal metaplasia
Surgery is preferred for patients with rectal prolapse and what additional findings?
complete rectal prolapse (concentric mucosal rings); or prolapse with fecal incontinence and/or constipation
A prolapsed internal hemorrhoid presents as:
inflamed veins in the left lateral and right anterior/posterior walls of the anal canal
WHat is the etiology of breast milk jaundice? Peaks at 2 weeks
high beta glucuronidase activity in breast milk; deconjugates intestinal bilirubin.
(vs breastfeeding failure jaundice which presents in 1 week)
Spontaneous resolution by age 3 months if keep breastfeeding
The existence of a focal submandibular mass should raise concern for _____ in a patient with Sjogren's syndrome.
B-cell non-Hodgkin's lymphoma
Partial nephrectomy is a cure for renal cell carcinoma as long as...
the renal mass is confined within the renal capsule (stage I). If it extends beyond the renal capsule but not beyond Gerota's fascia (stage II), radical nephrectomy is the best treatment option. Can also be employed in invasion of major veings, abdominal LN, and adrenal glands--though it is technically more difficult
Flattening of the femoral head with joint space narrowing is characteristic of
stage 4 osteonecrosis. Requires total hip replacement.
Stage 1 or 2 (no femoral head collapse) can be treated with core decompression
Patients with dirty (dirt, feces, saliva) or severe (punctures, avulsions, crush injuries, burns, frostbite) wounds require what tetanus therapy?
Tetanus booster if last vaccination within 5 years (but no TIG).
If they are significantly immunocompromised or have uncertain tetanus vaccination status, then give TIG
Adverse effects of carbamazepine:
neutropenia, bone marrow suppression, SIADH (in elderly), mild anticholinergic effects
Which medications are associated with drug-induced lupus? Which antibodies would be elevated?
procainamide, hydralazine, minocycline, etanercept, and infliximab.
ANA and anti-histone antibodies are elevated
Zray findings of a solitary pulmonary nodule favoring malignancy include:
greater than 0.8 cm (especially greater than 2 cm), interval change in size, irregular border, and ground glass appearance.
Plasma renin activity ratio greater than ___ is suggestive of excessive aldosterone secretion from the adrenal gland.
Aldosterone level over ___ is required to intrepret the test correctly
PAR greater than 30
aldosterone greater than 15
Patients with hypokalemia and hypertension who have suppressed levels renin AND aldosterone activity may have
Angiodysplasia is associated with what other two pathologies?
aortic stenosis and ESRD