UWORLD Misc

Question 1

Vitiligo

Answer 1

• macular depigmentation around acral and peri-orificial areas
• autoimmune destruction of melanocytes
• few pts remit

Question 2

leprosy lesion

Answer 2

-areas of hypopigmentation with anesthesia

Question 3

Gram negative rod nosocomial pneumonia

Answer 3

• Pseudomonas!
• 4th generation cephalosporin (e.g. cefepime) or Pip-Tazo
• Ceftriazone NOT effective

Question 4

Molluscum contagiosum

Answer 4

• single or multiple round, dome shaped papules with central umbilication
• caused by poxvirus
• children: trunk and extremities
• adults: STI
• AIDS: disseminated, including face. diff to treat (CD4< 100)
• Tx: curettage or liquid nitrogen

Question 5

Lichen Planus

Answer 5

• inflammatory (autoimmune?) condition
• pruritic, violaceous, flat papules with fine white streaks
• Tx: retinoids, steroids

Question 6

Dermatitis herpetiformis

Answer 6

• uncommon disease with pruritus, papules, and vesicles over elbows, knees, buttocks, posterior neck, scalp
• Associated with HLA B8, DR3, DQw2
• associated with Celiac

Question 7

Pneumoconiosis

Answer 7

• occupational restrictive (normal or high FEV1/FVC with low VC) lung disease
• Can have pleural calcifications (asbestos)
• Decreased DLCO (ILD)

Question 8

Labs B12/Folate deficiency

Answer 8

• Both are involved in conversion of homocysteine to methionine. So deficiency will result in elevated homocysteine
• B12, unlike folate, converts methylmalonyl-CoA to Succinyl-CoA. So in B12 deficiency MMA will be elevated (normal in folate)

Question 9

Alpha-fetoprotein

Answer 9

elevated in testicular germ cell tumors, HCCs, other cancer

Question 10

Vanillylmandelic acid

Answer 10

elevated in urine of pts with Pheochromocytomas

Question 11

Ferritin levels

Answer 11

increased in iron deficiency anemia and elevated in hemochromatosis, sideroblastic anemia, and acute inflammatory states

Question 12

Tx aortic dissection

Answer 12

• BBs (labetolol): want to dec bp and HR, reduce stress on aorta
• Vasodilators can cause reflex tachycardia, used if refractory to BBs

Question 13

Nifedipine

Answer 13

• anti-HTN

- vasodilator

Question 14

Hydralizine

Answer 14

• anti-HTN

- vasodilator

Question 15

AVF (causes, signs)

Answer 15

• Congenital: PDA, angiomas, pulmonary AVF, CNS AVF
• Acquired: Trauma, Iatrogenic (e.g. femoral cath), atherosclerosis (e.g aortacaval fistula), cancer
• Signs: widened pulse pressure, brisk carotid upstroke, systolic flow murmur, tachycardia, flushed extremities
• Can develop LVH and HF (due to increased preload). CO is HIGH (high-output Cardiac failure).

Question 16

Causes of high-output cardiac failure

Answer 16

• AVF
• Thyrotoxicosis
• Paget disease
• Anemia
• Thiamine deficiency

Question 17

cyclophosphamide (MoA, use, SEs)

Answer 17

• alkylating agent used as immunosuppressant
• in SLE, reserved for pts with renal/neuro involvement
• SEs: hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression.

Question 18

Drugs causing cochlear dysfunction

Answer 18

cisplantin, carboplatin (testicular, ovarian, bladder cancer)
Aminoglycosides

Question 19

drugs causing optic neuritis

Answer 19

ethambutol (TB), hydroxychloroquine (antimalarial, SLE, RA, etc)

Question 20

drugs causing digital vasospasm (Raynaud’s)

Answer 20

BBs and ergotamine

Question 21

Drugs causing thyroid dysfunction

Answer 21

amiodarone and lithium

Question 22

PE findings consolidation of lung

Answer 22

dullness to percussion, bronchial breath sounds (as long as airways are patent). Egophany

Question 23

PE findings pleural effusion

Answer 23

decrease in chest wally movement, dullness to percussion, decreased breath sounds. Can have Egophany

Question 24

PE findings pneumothorax

Answer 24

hyper-resonance on percussion and decreased or absent breath sounds

Question 25

PE findings emphysema

Answer 25

hyper-resonance bilaterally, vesicular breath sounds which are significantly decreased. May have wheezing

Question 26

PE findings ILD

Answer 26

resonance on percussion, vesicular breath sounds, fine crackles at end inspiration

Question 27

Monitoring respiratory function in GBS

Answer 27

bedside VC! If it falls below 15 mL/kg and trending downward is v worrisome for resp failure

Question 28

Splenic abscess (RFs, presentation, organisms, Dx, Tx)

Answer 28

RF: Infection (e.g. endocarditis) w spread. Hemoglobinopathy (e.g. SCD), Immunosuppression, IVDU, Trauma - Sx: classic triad: fever, leukocytosis, LUQ pain. Can also have Left pleural effusion, splenomegaly. - Staph, Strep, Salmonella - Dx: Abd CT - Tx: broad-spectrum Abs, splenectomy. Percutaneous drainage in poor candidates.

Question 29

Presentation Pulm embolism

Answer 29

- Dyspnea, tachypnea, normal lung exam, right axis deviation - Ct angio - Perfusion defect on V-P scan

Question 30

Contraindications CT angio

Answer 30

contrast allergy, renal insufficiency

Question 31

Cryoprecipitate

Answer 31

used to replete fibrinogen

Question 32

RBC transfusion indications

Answer 32

-previously health pt: Hg <10

Question 33

TTP-HUS

Answer 33

Sx: pentad of neuro, renal, fever, thrombocytopenia, MAHA - pathogen: autoAbs or deficiency in ADAMTS13 --> vWF aggregates and PLT destruction - path: schistocytes on smere - Tx: plasma exchange to remove Abs/replete ADAMTS13

Question 34

Herpangina

Answer 34

- kids. Vesicles on tonsils/soft palate. - Sore throat, fever, pain w swallowing - Coxsackie A virus

Question 35

Diphtheria

Answer 35

- acute respiratory illness causing pseudomembranous pharyngitis - low-grade fever, unilateral nasal discharge, pharyngitis, cervical lymphadenopathy - Tx: maintain airway, Abs to prevent transmission

Question 36

Type 2 RTA

Answer 36

- Proximal - Urine pH can be s syndrome, amyloidosis, multiple myeloma, Paroxysmal nocturnal hemoglobinuria, Toxins (HAART, Ifosfamide, lead, cadmium)

Question 37

Kawasaki disease

Answer 37

Vasculitis of medium-sized arteries - Young children - Conjunctivitis, fever, lymphadenopathy, rash, erythema of lips/tongue/palate, peripheral edema. - Coronary Artery aneurysms - Tx: IVIG, SAS, c

Question 38

B12 deficiency (Sx, RFs)

Answer 38

- Anemia w neuro deficits | - strict vegans (stores last 3-4 yrs)

Question 39

Folate deficiency (Sx, RFs

Answer 39

- Anemia (alone, no neuro .. contrast B12) - "Tea and Toast" diet -- all cooked foods (heat-sensitive) - Stores last 4-5 months

Question 40

Vitamin C deficiency

Answer 40

Scurvy: perifollicular hemorrhage, swollen gums, poor wound healing

Question 41

Vitamin D deficiency

Answer 41

-Osteomalacia and hypocalcemic tetany

Question 42

Vitamin E deficiency

Answer 42

-RBC fragility, hyporeflexia, blindness

Question 43

Thyroid hormone resistance

Answer 43

- Rare AD mutx to T3/T4 Receptor | - Elevated T3/T4 with signs of hypothyroidism

Question 44

Graves

Answer 44

- Autoimmune d/o with stimulating Abs to TSH R | - TSH suppressed

Question 45

Hashimoto thyroiditis

Answer 45

- chronic autoimmune thyroiditis - Thyroid peroxidase Abs --> transient hyperthyroidism due to inflammatory destruction of follicles. - TSH suppressed

Question 46

Thyroidin pregnancy

Answer 46

- nml pregnancy --> upregulation of thyroid production due to stimulation of TSHRs by hCG - feedback intact, so TSH will be suppressed

Question 47

hypercoag vs hypocoag skin

Answer 47

- hypocoag: bruising/hemorrhage | - Hypercoag: necrosis

Question 48

Heterophile antibody test

Answer 48

-EBV test

Question 49

Primary HIV vs mononucleosis

Answer 49

- rash, diarrhea more common with HIV | - tonsillar exudates more common in mono