Flashcards in UWorld Question Review Deck (130):
Problem with amitriptyline in elderly men?
Anticholinergic activity can cause urinary retention, especially in elderly men because of BPH.
Prevents detrusor contraction and prevents urinary sphincter relaxation.
Most common complication of nephrotic syndrome?
Hypercoagulability due to loss of protein C and S, ATIII and platelet dysfunction.
Labs for paget's disease?
Ca, phos, alkphos, hydroxyproline
Ca and phos are normal
Alkphos and hydroxyproline are increased
How to distinguish CML neutrophils from leukemoid reaction neutrophils?
Decreased leukocyte alkaline phosphatase because they're functionally inactive.
Infection of gallbladder wall with gas forming bacteria (klebsiella, clostridium). Presents with gallbladder crepitus.
When to place IVC filter?
Contraindication to anticoagulation or anticoagulation failure in patients with DVT.
Can warfarin doses be restarted?
Yes if INR >2, no if less because will cause hypercoagulable state. Need to use heparin bridge.
How to treat central retinal artery occlusion?
Central retinal artery occlusion is caused by emboli from afib/cad/valvular disease, etc.
Treat with ocular massage and high flow oxygen.
How to evaluate a nonhealing ulcer that crusts at the margin of a former scar?
Probably squamous cell carcinoma, do a biopsy.
Arrhythmia pathognomonic for digitalis toxicity? Other symptoms?
Atrial tachycardia with AV block. Diarrhea, nausea, fatigue, yellow-green vision.
Cupping of the optic disk and loss of peripheral vision suggestive of?
Quick test to diagnose Addison's Disease?
Cosyntropin test. ACTH analog that should produce increase in cort but it doesnt if patient has addisons
Euthyroid sick syndrome
Asymptomatic decreased T3 after prolonged illness
Intensive glycemic control in type II diabetes has what effects?
Decreases microvascular complications, has no effect on macrovascular complications.
AIC less than 6 INCREASES all cause mortality.
Most common asbestos related malignancy?
How does cold water help stop paroxysmal superventricular tachycardia?
Causes increase in vagal tone, helps break the SVT
How to treat penicillin sensitive organisms that cause infectious endocarditis?
Ceftriaxone or IV penicillin. NOT oral penicillin.
Can cause multifocal atrial tachycardia, seizures/headache, nausea/vomiting especially in conjunction with cipro.
Side effect of erythropoetin in ESRD patients?
Worsening of hypertension in 30-50%, headaches in 15%
Hydroxychloroquine side effect?
Use hydroxychloroquine to treat for lupus.
Signs of AV shunting
High BP, huge pulse pressure, increased preload, increased cardiac output. High output cardiac failure because not enough circulating oxygen to meet demands.
Causes of secondary amyloidosis
Chronic inflammatory states
How to treat WPW?
Give Class 1 antiarrhythmic, don't give any nodal blockers, they can cause vfib.
Enthesitis? Common cause?
Pain where tendons attach to bone. Seen in ankylosing spondylitis.
Confusion, uremia, respiratory rate >30, Blood pressure 65. 4+ ICU, 2+ inpatient,
What type of lung injury is due to crush injury?
Flail chest, which is contiguous broken ribs causing respiratory distress.
Febrile nonhemolytic transfusion reaction
Occurs between 1-6 hours after transfusion associated with chills and malaise. Caused by residual leukocytes in the plasma. Prevent by leukoreducing.
Cardiac Index? How does it change in heart failure?
CI is SV/total body surface area. Decreases in heart failure.
/Acid-Base derangement induced by AKI?
Acid-base derangement induced by loop diuretics?
Symptoms of prostatitis? Treatment
Shaking chills, fever, dysuria, perineal pain.
Get a clean catch mid stream to isolate organism and treat, usually with bactrim or a fluoroquinolone for 4-6 weeks.
Acute limb ischemia post MI
Usually due to LV thrombi traveling to limb. Rule out LV mural thrombi with echocardiogram.
Distinguish chronic bronchitis from bronchiectasis? How to work up bronchiectasis?
Chronic bronchitis produces nonpurulent sputum. Bronchiectasis, the sputum is purulent and associated with fever, infections (pseudomonas), etc.
Work up with chest CT, then bronch/sputum analysis.
What is use dependence for antiarrhythmics
When heart rate increases, QRS complex will widen for people on class IC antiarrhythmics (Flecanide, Propafenone) because there is less time for drug to dissociate from Na channel.
Why isn't lidocaine used during ACS?
May prevent Vfib, but also increases the chance of asystole.
Why does Crohn's predispose to oxalate stones?
Because Fat malabsorption occurs, which binds Ca in gut stronger than oxylate, leaving oxylate unbound and free for increased absorption.
First change in diabetes nephropathy?
Glomerular hyperfiltration. First change that can be quantified is basement membrane expansion.
Frequent in elderly people with aortic stenosis or ESRD. Responsible for painless blood in stool and anemia.
Management of suspected PE: First step if PE likely?
Start IV heparin
Common side effect of CCBs?
Peripheral edema. Can give ACEi or ARB to lower risk of peripheral edema
Prognostic factor in TCA overdose?
Length of QRS
How to diagnose disseminated histoplasmosis?
With a urine antigen! Blood cultures used a confirmatory test because sensitivity is lower.
How to treat disseminated histoplasmosis?
Cause of diarrhea in scleroderma?
Small bowel bacterial overgrowth due to slowed GI motility.
What to give to patients with neutropenic fever?
Anti-pseudomonal monotherapy with piperacillin-tazobactam.
When to vaccinate a traveler for Hep A?
When going to Asia/Africa
Location of cysts in the mediastinum?
Thymoma is in anterior mediastinum
Bronchogenic cyst in middle mediastinum
Leiomyoma and neuroendocrine in posterior mediastinum.
HIV+ patient eye infections:
CMV: Fluffy retinal lesions
HSV: Keratoconjunctivitis, causes rapidly progressive vision loss. Very serious.
Causes of calcified adrenal glands leading to insufficiency?
How to distinguish thyroid follicular carcinoma from follicular adenoma?
Invasion into the surrounding capsule.
How to treat PBC?
Ursodeoxycholic acid. Cholestyramine can treat pruritis, but doesn't help with survival.
How to treat acute kidney rejection
Symptoms are lymphocytic infiltration with vascular involvement and intimal swelling
How to f/u compensated cirrhosis
Liver US for HCC surveillance +/- AFP Q6mos, and EGD.
Necrolytic migratory erythema
Erythematous papules or plaques that coalesce to form a painful large and inflammatory blister with a central clearing. Normally occurs in the perineum, extremities, and face. Caused by glucagonoma.
Best intervention for hypercalcemia of malignancy?
Common electrolyte abnormality after blood transfusions? Symptoms?
Hypocalcemia (due to chelation by citrate), increased DTRs.
Most common cause of restrictive cardiomyopathy?
How to check for androgen-producing adrenal tumors in females?
Check DHEA-S, which is produced in the adrenals and is converted to T.
How is dipyridamole used in stress testing.
By maximizing coronary steal. Normal vessels dilate, but disease vessels don't, creating angina.
How to treat symptoms of bony mets to spine from prostate cancer?
Side effect of HIV meds:
Abacavir hypersensitivity syndrome
NRTIs cause lactic acidosis
NNRTIs cause SJS
Nevirapine causes liver failure
Indinavir causes a crystal nephropathy
Complication of sickle cell disease that prevents kidney from being able to concentrate urine, causes diuresis.
What vaccines do you give for splenectomy? When?
Meningococcus, PCV-13, HiB.
2 weeks before or 2 weeks after.
Scleroderma renal crisis
Acute renal failure in patients with systemic sclerosis, accompanied by malignant hypertension and microangiopathic hemolytic anemia and thrombocytopenia
Painful bladder syndrome. Relieved by urination.
Increases PTT, causes thrombosis in vivo.
How to treat PE in patients with severe renal insufficiency?
Can't use fondaparinux, enoxaparin, or rivaroxaban if GFR
Pathognomonic sign of factitious diarrhea on colonoscopy
Brown discoloration of colon with prominent lymph follicles showing as pale patches. Signs of laxative abuse
Most sensitive test to evaluate esophageal dismotility disease?
Treatment of malignant hypertension in a patient with pheochromocytoma?
ALPHA BLOCKERS first, then beta blockers.
B without A causes increase in BP.
How do mets from cancer cause hypercalcemia?
By producing PTHrP. NOT by directly stimulating release from bone.
Two prominent causes of ITP that should be tested for whenever patient has thrombocytopenia?
HCV and HIV
Most important step in the management of HHNK?
Fluid replacement. Give NS.
Can give insulin if not responding.
How do large pericardial effusions present?
Water bottle heart with nonpalpable PMI. JVD seated.
How does estrogen affect requirement for levothyroxine?
Increases need because estrogen increases TBG.
Foot injury common in runners that causes numbness and pain between the 3rd and 4th toes. Also clicking sound. Not a true neuroma but due to degeneration of nerves.
Radiographic evidence of aortic dissection? Best diagnostic test?
Mediastinal widening. Diagnose with TEE.
TMP-SMX effect on kidney?
Inhibits ENac so can cause hyperkalemia. Also prevents tubular secretion of creatinine so can cause increase in serum creatinine without changing GFR.
How to treat reactive arthritis?
NSAIDS. Happens after GC is treated.
Most likely consequence of untreated hyperthyroidism?
Bone loss. Directly stimulates osteoclasts to resorb bone.
SJS vs TEN
SJS involves 30%
Lifestyle modification to prevent oxalate stones?
Decrease protein in diet
How to treat suspected TTP? Symptoms?
Hemolytic anemia, decreased platelets.
Treat with plasmaphoresis to remove antibody suspected.
How to treat hyponatremia due to SIADH?
Hypertonic saline if very severe.
Electrolyte abnormalities with tumor lysis syndrome?
Decreased calcium, increased phosphate, increased potassium, increased uric acid.
As cells lyse, K and phos are released. Phos binds calcium, which causes hypocalcemia.
Some drugs that can cause crystal induced nephropathy?
Acyclovir, indinavir, methotrexate, sulfonamides.
How to investigate esophageal spasm?
Esophageal spasm is precipitated by food and emotional stress, radiates to the back, and responds to nitrates.
What to do about renal cysts?
If single, simple, unilocular, just wait
If thick. irregular, loculated with septae, contrast enhancing, then follow up imaging.
Complication of high PEEP ventilation?
Disease acquired through contact with sandboxes?
Cutaneous larva migrans (ancylostoma braziliense). Causes pruritic elevated serpiginous lesions on skin.
Persistent left sided varicocele in older male concerning for? How to evaluate?
Renal cell carcinoma, evaluated with an abdominal CT scan
Femoral bowing a sign of what disease?
Paget's disease caused by osteoclast hyperfunction.
Complication of severe bronchiectasis?
Difficulty breathing in ankylosing spondylitis?
Due to chest wall movement abnormalities. PFTs show restrictive pattern.
PCWP and mixed venous O2 sat in septic shock
PCWP normal, MVO2 high because of decreased ability of tissues to extract O2 and improper distribution of cardiac output.
Poor prognostic sign for CLL? Characteristic cell?
Thrombocytopenia. Characteristic cell is the smudge cell.
How to diagnose OA on history alone (6 criteria)
Age>50, no morning stiffness, bony crepitus, bony enlargement, bony tenderness, no warmth at joint
How to test for G6PD deficiency?
Send an enzyme level, but may be false negative during an acute episode of hemolysis.
Common side effect of methimazole +propylthiouracil? Symptoms?
Agranulocytosis. Stop drug if patient develops fever and sore throat.
When to give PEP for rabies?
If bitten by a high risk animal (raccoon, bat, skunk, fox, coyote), or if by bitten by a dog, cat, or ferret that shows signs of rabies after 10 day quarantine.
Do not give PEP for low risk animal bites (squirrel, chipmunk, rat, mouse, rabbit).
How do thiazides affect glucose metabolism?
Cause metabolic syndrome and hyperglycemia.
pH of transudate vs exudate pleural effusions
How to treat dermatitis herpetiformis
Consequence of poorly treated Hashimoto's Thyroiditis?
Lymphoma of thyroid.
How to treat hairy cell?
Medication induced hypothyroidism:
CHF in young patient suggests?
Dilated cardiomyopathy due to cocksackie b
Long term complication of pernicious anemia?
Gastric cancer from atrophic gastritis
Symptoms of thyroid storm
fever, tachycardia, tremor, arrhythmias.
Generally happens after surgery, trauma, infection.
Next diagnostic step in recurrent pneumonias?
CT to assess for structural damage
How to treat uric acid stones?
Alkalinize the urine with potassium citrate.
Best drug for increasing appetite in cachectic patient?
Megestrol acetate (progesterone derivatives)
First step in work up for suspected BPH?
First step is to obtain urinalysis and get a PSA for men with life expectancy >10 years.
Which vitamin deficiency is caused by carcinoid syndrome (flushing, new murmur, diarrhea)?
Niacin deficiency because it's used to make 5-HT.
Causes pellagra (dermatitis, diarrhea, dementia).
Contraindication to succinylcholine use?
Hyperkalemia because succinylcholine causes K release
Best treatment for hyperthyroidism?
radioactive iodine ablation
Most common extraarticular manifestation of ankylosing spondylitis?
How to treat stemi patient who presents with pulmonary edema?
IV furosemide, avoid beta blockers in these patients.
Renal tubular acidosis IV
Causes a non-gap metabolic acidosis secondary due insensitivity to aldosterone in elderly men. This is normally due to poorly controlled diabetes.
How to treat lyme in a pregnant woman?
Symptoms of polymyalgia rheumatica? how to treat?
Elevated ESR, neck, shoulder, back pain
Treat with low dose steroids
What to do with new onset of SLE?
Kidney biopsy before any treatment
Symptoms of beta blocker overdose?
Bradycardia with first degree heart block and WHEEZING.
Treat with IVF and atropine. Refractory? Then use glucagon.
Cellulitis in the submandibular region from a tooth infection. Crepitus present.
Supplement for people with sickle cell?
Folate due to increased turnover and production of RBC.
What causes proximal muscle weakness with tremors?
Keratitis vs conjunctivitis?
Keratitis involves the cornea, conjunctivitis doesn't.
Renal vein thrombosis is seen most commonly in which nephrotic syndrome?
Dangerous side effect of furosemide?