Uworld review 4 Flashcards
How can diuretic therapy lead to hepatic encephalopathy exacerbation?
Low intravascular volumes with hypokalemia and metabolic alkalosis
How can hypokalemia lead to hepatic encephalopathy?
Hypokalemia leads to intracellular acidosis (excreted intracellular K replaced by H+) causes increased NH3 production (E conversion) in the renal tubules
How can metabolic alkalosis exacerbate hepatic encephalopathy?
Promotes the conversion of NH4+, which cannot enter the CNS, into NH3, which can
What are the three major steps in treated hepatic encephalopathy?
- Volume resuscitation
- K replacement
- Lactulose
Why is proteins restriction not generally indicated for the treatment of hepatic encephalopathy 2/2 liver cirrhosis?
Generally, these pts are already malnourished
What is the role of neomycin in the treatment of hepatic encephalopathy?
Used when lactulose is not responsive, and cannot tolerate rifaximin
What is rifaximin used for?
hepatic encephalopathy
What major heart condition can TB cause?
Constrictive pericarditis
What are the s/sx of constrictive pericarditis, and why?
Signs of venous overload and decreased CO, since heart cannot fill properly
What is Kussmaul’s sign?
Lack of JVP decline with inspiration, which can be seen in pericarditis
What are the characteristic JVP tracings associated with constrictive pericarditis? Why?
Prominent X and Y descent
Loss of pressure from stiff pericardial walls during diastole**
What can be heard on cardiac auscultation of cor pulmonale?
Widely S2 split with harshed S2
What is the most important initial step in treating HONK? Why?
- Fluid replacement with NS
- Hyperglycemia has a diuretic effect, and can quickly lose fluid
What is the most common cause of a macrocytic anemia in alcoholics?
Folate deficiency
What lab abnormalities suggest ITP?
Thrombocytopenia, with normal labs otherwise
What is a common cause of ITP?
HIV, Hep C, or other chronic viral infx
What is the progression of symptoms with transverse myelitis?
Flaccid paralysis (spinal shock), followed by spastic hyperreflexia
What antibody is classically found in systemic sclerosis?
Anti-topoisomerase 1 (aka anti-scl-70)
What causes HTN with systemic sclerosis?
Renal involvement
What antibodies are found with antiphospholipid antibody syndrome?
Anti cardiolipin
Antimitochondrial antibodies are found in which disease?
Primary biliary cholangitis
What is granulomatosis with polyangiitis? What antibody is classic for this?
Wegener’s granulomatosis
ANti-neutrophil cytoplasmic antibodies
What is the key test to diagnosing bronchiectasis? What will it show?
High res CT
Bronchial wall thickening
What is the pathophysiology of bronchiectasis?
Recurrent cycle of infection, inflammation, and tissue damage
What are the classic symptoms of bronchiectasis?
Large amounts of purulent sputum
Dyspnea
sinus congestion
Hemoptysis
What parts of the body does Kaposi’s sarcoma classically present on?
Face
Legs
Oral cavity
Genitalia
What are the lesions of bacillary angiomatosis like?
Friable papules and plaques
What are the skin lesions of cryptococcosis like?
Multiple papules diffusely
What is the classic presentation of parvovirus B19 arthralgias?
Symmetric, polyarticular arthralgias, without overlying erythema, edema, or systemic symptoms.
True or false: in both SLE and RA, symptoms correspond to inflammatory markers like ESR
True
Crypt abscesses are classically found in which IBD?
UC
Pts with ulcerative colitis are at increased risk for developing which biliary issue?
Primary sclerosing cholangitis
An elevated serum alk phos in a pt with UC should be suspicious for what disease?
Primary sclerosing cholangitis
What cells comprise a pheochromocytoma?
Chromaffin cells
What drugs in particular can set off a hypertensive episode 2/2 pheochromocytoma?
Anesthetic agents
What is the first test in the workup of AKI in the setting of BPH?
US of the kidneys to r/o obstruction or other causes of hydronephrosis
What is a hepatic hydrothorax?
Pleural effusion that occurs from small defects in the diaphragm, that allow peritoneal fluid to pass into the pleural space. This is more common on the right side due to the less muscular hemidiaphragm
What is hepatopulmonary syndrome?
Hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilatations in patients with both chronic and far less common, acute liver failure. The mechanism is unknown but is thought to be due to increased liver production or decreased liver clearance of vasodilators, possibly involving nitric oxide.
What are the two classic symptoms of hepatopulmonary syndrome?
Platypnea (dyspnea while upright)
Orthodeoxia (O2 desat when upright)
Why should atropine be avoided in pts with acute angle closure glaucoma?
dilates the eye, worsening outflow obstruction
What is the MOA and use of pilocarpine?
Cholinergic agent used for acute angle closure glaucoma
What is the difference between herpes zoster ophthalmicus and herpes simplex keratitis?
Zoster will have shingles around the eye, whilst simplex with only involve the eye, without systemic s/sx
Under what CD4 count does PCP occur?
200
What are the indications for the use of steroids in addition to bactrim in the treatment of PCP pneumonia?
- Severe s/sx
- PaO2 less than 70 mmHg
- A-a gradient over 35 mmHg
What is the treatment for neurosyphilis?
10-14 days of IV PCN
What are the s/sx of spinal cord compression?
- Pain worse in the recumbent position
- Gradually worsening, severe local back pain
- Sudden weakness and anesthesia below level of lesion
What is the management of spinal cord compression?
- MRI
- Corticosteroids
- Rad-onc and neurosurgery consult
A sensory level at what anatomic landmark exclude cauda equina syndrome?
Umbilicus (T10)
what are the classic findings on XR of Charcot’s foot?
- effusions in several of the tarsometatarsal jts
- large osteophytes
- extra-articular bone fragments
How does primary sclerosing cholangitis commonly present?
- asymptomatic
- cholestatic pattern on liver test
What is the gross description of primary sclerosing cholangitis?
Short annular strictures alternating with normal bile duct
What happens to cardiac index and PCWP with a tension pneumothorax?
CI: low
PCWP: low
What happens to cardiac index and PCWP with a PE
CI: low
PCWP: normal to low
What are the s/sx of osteonecrosis of the proximal femur?
Hip pain
Limited internal rotation and abduction
How does sickle cell disease lead to osteonecrosis of the femur?
Disruption of microcirculation in the bone by sickling as well as increased intraosseous pressure d/t bone marrow hyperplasia
Why is the risk of femoral head necrosis increased later in life?
Initially, blood supply from ascending arteries and foveal artery. Foveal becomes obliterated later in life.
What labs are classically elevated in osteomyelitis? signs?
ESR
Typical infx symptoms
What happens to thyroglobulin levels with exogenous levothyroxine intake?
Decreased
What are the s/sx of subacute (de quervain’s) thyroiditis?
Fever
Neck pain
Thyroid TTP
Elevated ESR
What are the s/sx of Hashimoto’s thyroiditis?
Palpable goiter and clinical hypothyroidism.
What skin condition can manifest in pts with chronic Hep C infection?
Porphyria cutanea tarda
What are the s/sx of Takayasu arteritis?
Vasculitis of the aorta and its branches, with arterial occlusive s/sx, including pulse deficits, bruits, BP discrepancies
In whom is Takayasu’s arteritis most common in?
Asian Women under 40
What are the lab findings of Takayasu’s arteritis?
Elevated ESR and CRP
What is the treatment for Takayasu’s arteritis?
Steroids
What can imaging find with Takayasu’s arteritis?
Thickening of large artery walls and narrowing lumen
What abx should be prescribed prophylactically to solid organ transplant recipients? Why?
TMP-SMX (PCP)
What type of nerves cause the s/sx of peripheral neuropathy in DM?
- Small nerve fiber injury causes positive symptoms (tingling, allodynia, pain)
- Large fiber injury causes negative symptoms (numbness, loss of proprioception, diminished ankle reflex)
What are the symptoms of Cardiac myxoma?
Fever, weight loss, raynaud’s
What heart sound does myxomatous degeneration of the mitral valve cause?
Midsystolic click
What are the most common benign primary tumors of the heart? What sound does it cause?
Myxomas
Tumor plop
What are the complications of Cardiac myxomas?
- Embolization
- Valvular abnormalities
- HF 2/2 obstruction
- Lung invasion causes symptoms similar to bronchogenic CA
What is alanine converted into top enter the kreb’s cycle?
Pyruvate
What is lactate converted into top enter the Kreb’s cycle?
Pyruvate
What are triacylglycerols converted into to enter the Kreb’s cycle?
G3P
What is the treatment for gastroparesis 2/2 DM?
Metoclopramide or erythromycin
Small, frequent meals
Which promotility/antiemetic agent is associated with EPS?
Metoclopramide
What are the s/sx of gastroparesis 2/2 DM? (4)
ANorexia
n/v
Early satiety
Impaired glycemic control
Stroke symptoms that are abrupt and maximal at the start is generally of what etiology?
Embolic stroke
Stroke symptoms that fluctuate are generally of what etiology?
Thrombosis
Stroke symptoms that progress over minutes to hours, with early onset focal neurologic deficits, and later on s/sx of increased ICP are generally of what etiology?
Intracerebral hemorrhage
What are the s/sx of a spontaneous subarachnoid hemorrhage? (3)
- Severe HA at start
- Meningeal irritation
- Focal deficits uncommon
What are the characteristics of the HA with idiopathic intracranial HTN?
Pulsatile HA with pulsatile tinnitus
What medication classically causes idiopathic intracranial HTN?
Isotretinoin
What are the 6 classic s/sx of idiopathic intracranial HTN?
- Papilledema
- Peripheral visual defect
- CN VI palsy
- HA
- Pulsatile tinnitus
- Diplopia
What type of studies produce relative risk ratios?
Cohort studies
What type of studies produce Odds ratio?
Case-control
If a disease is rare, what can be said about RR and OR?
nearly equivalent
What are the common s/sx of Waldenstrom’s macroglobulinemia?
Hyperviscosity syndrome
HSM
What is the difference between multiple myeloma and Waldenstrom’s macroglobulinemia?
MM has “multiple” types of immunoglobin expansion, whereas WM has only IgM
What will bone marrow bx show in multiple myeloma vs Waldenstrom’s macroglobulinemia?
Both have over 10% monoclonal B cells
What is the process of diagnosing Hep C? Why?
HCV antibody and HCV DNA. Need DNA to assess whether the pt cleared it spontaneously, or is chronically infected
What causes hyponatremia in severe decompensated HF?
Decreased perfusions at baroreceptors and renal afferent arterioles causes release of Renin, NE, and ADH. All of these promote free water retention