Uworld/ Rx review Flashcards
(198 cards)
1
Q
What are the components of the CURB-65 criteria?
A
Confusion Uremic (BUN over 19) Respiratory rate above 30 bpm SBP less than 90 or DBP less than 60 Age over 65
2
Q
What are the three classic symptoms of Zn deficiency?
A
Dermatitis
Diarrhea
Alopecia
3
Q
What is the screening test, and what is the diagnostic test for acromegaly?
A
Screening = ICF-1 assay Diagnostic = glucose tolerance testing
4
Q
What is the role of Cr in the body?
A
Glucose tolerance–deficiencies will lead to glucose and lipid disturbances
5
Q
What is the risk of high and low Co in the body?
A
High = cardiotoxic Low = nothing
6
Q
What is the risk of high and low Cu in the body?
A
High = Wilson's disease Low = anemia, neutropenia
7
Q
What is the risk of low Se in the body?
A
Deficiency can lead to cardiomyopathy and skeletal muscle dysfunction
8
Q
An aneurysm of what artery can cause CN III palsies?
A
Posterior communicating artery
9
Q
What are the abx of choice for Neisseria Gonorrhoeae?
A
Cephalosporins
10
Q
What are the abx of choice for Chlamydia trachomatis?
A
Tetracyclines
11
Q
What is the treatment for BV?
A
Metronidazole
12
Q
What is the treatment for patient’s with a h/o PID, who want to become pregnant?
A
IVF
13
Q
What is the MOA and use of clomiphene?
A
Estrogen receptor modulator that increases gonadotropin release and induces ovulation
14
Q
What is the treatment for postmenopausal symptoms?
A
SSRIs (NOT estrogen/progesterone)
15
Q
What is the difference in laboratory findings between Ehrlichiosis and RMSF?
A
Leukopenia occurs with ehrlichiosis, while hyponatremia and thrombocytopenia may occur with RMSF
16
Q
What are the s/sx of tularemia?
A
Fever
pneumonia
Lung issues
17
Q
What is a kerion?
A
boggy, tender, and exudative nodule that may occur in response to gunal tinea capitis infection
18
Q
What is Black dot tinea capitis?
A
Tinea cause by Trichophyton tonsurans, causing scattered alopecia that does not resolve with topical antifungals, and causes hair to break off near the base of the hair
19
Q
What is the bacteria that most commonly infects human bites?
A
Eikenella corrodens
20
Q
What are the HACEK organisms?
A
haemophilus Actinobacteria Cardiobacterium Eikenella kingella
21
Q
Pain in lymph nodes following alcohol consumption is pathognomonic for what?
A
Hodgkin’s lymphoma
22
Q
What skin disease is associated with ulcerative colitis?
A
Pyoderma gangrenosum
23
Q
What is the characteristic EEG findings of an absence seizure?
A
3 hz spike and slow wave
24
Q
Periodic complexes, sharp EEG deflections occurring isolated, in pairs, or as triplets = ?
A
CJD
25
True or false: in cases of CO poisoning, arterial blood oxygen will be normal
True--CO does not affect the concentration of dissolved oxygen in the serum
26
What causes the increased anion gap with CO poisoning?
Lactic acid buildup
27
What is type I renal tubule acidosis?
Defect in distal hydrogen intercalated cells
28
What is type II renal tubule acidosis?
Defect in proximal bicarbonate resorption
Leads to acidemia and increased bone turnover
29
What is type IV renal tubule acidosis?
Deficiency of, or resistance to, aldosterone.
results in hyperkalemia
30
Amp B causes what type of kidney injury?
type I RTA
31
What is leukocytoclastic vasculitis?
Inflammatory reaction in small vessels, in organ systems like the skin and kidney.
32
What is the treatment for wet macular degeneration?
```
VEGF inhibitors (ranibizumab or bevacizumab)
Thermal laser photocoagulation
```
33
What is the role of flow cytometry in diagnosing myelogenous leukemia?
None--used to see monoclonality in LEUKOcytes
34
What is the classic presentation of CML?
Neutrophilic leukocytosis and a left shift
35
What are the relative levels of leukocyte esterase in CML vs a leukemoid reaction?
High in leukemoid rxn
| Low in CML
36
What is the treatment for CML?
Imatinib
37
Gynecomastia is associated with what type of lung cancer? How?
Adenocarcinoma
| Produces Beta-human chorionic gonadotropin
38
What is the diagnostic test of choice for a pheo if high clinical suspicion? Low?
```
High = Plasma fractionated free metanephrine levels
Low = 24-hour urine catecholamines/metanephrine
```
39
What drug is classically associated with membranous nephropathy?
Penicillamine
40
What are the classic side effects of methotrexate?
Pulmonary fibrosis
| Megaloblastic anemia
41
What is the confirmatory test for HIV?
HIV1/HIV2 antibody test--NOT western blot
42
What is the psychopathology of red man syndrome?
Direct stimulation of mast cells by vancomycin
43
What is the reversal agent for beta-blocker overdose in severe cases?
Glucagon
44
What is the first line treatment for beta blocker overdose?
Isoproterenol
| Atropine
45
What are the only two therapies that have proven survival benefit in COPD patients?
Oxygen and smoking cessation
46
What are the enzymatic and electrolyte changes associated with sarcoidosis?
Hypercalcemia
| Increased ACE
47
What causes the hypercalcemia in sarcoidosis?
Increased production of 1,25 vit D by macrophages in the granulomas
48
What is the treatment for Mycosis fungoides that is limited to the dermis/epidermis?
Local nitrogen mustards
49
What is the treatment for Sezary syndrome?
Systemic chemo
50
What happens to DLCO in restrictive lung disease 2/2 obesity? D/t rheumatoid?
Obesity has normal DLCO
| Rheumatoid has decreased DLCO
51
Optic gliomas are seen in NF1 or NF2?
NF1
52
Meningiomas are seen in MF1 or NF2?
NF2
53
What mm of induration for a PPD test is considered positive in a health care worker?
10 mm or greater
54
What are the indications for surgical intervention with PAD?
Rest pain
Nonhealing ulcers
Disabling claudication
55
When is a HIDA scan indicated in the work up of suspected cholecystitis?
If the US is equivocal
56
What is the most common bacteria to cause infective endocarditis with preexisting valve disease? What is the treatment for this?
Strep viridans
| PCN G
57
What is the usual group of bacteria that causes infective endocarditis on *prosthetic* valves? What is the treatment for this?
Coagulase negative staph
| Vancomycin
58
Enterococci infective endocarditis is seen in whom?
Patients with a h/o bowel surgery
59
What bacteria is implicated in infective valve disease associated with drug use?
Staph aureus
60
Which is more fatal: lymphocyte rich or poor Hodgkin's lymphoma?
Lymphocyte depleted
61
What are the first and second line treatments for symptomatic sarcoidosis?
Prednisone
| Methotrexate
62
What is the typical presentation of a Zenker's diverticulum? (3)
Severe halitosis
spitting up of pills with mucus
Slow, progressive dysphagia
63
Which generally presents with mouth ulcers: CD or UC?
CD
64
What is post-transplant lymphoproliferative disorder?
Lymphoid/plasmacytic proliferations that occur in organ or hematopoietic stem cell transplant 2/2 chronic immunosuppression
65
What is the MOA and use of rituximab?
Anti-CD-20 antibody used to immunosuppression
Binds to CD20 on B cells, causing complement activation and killing
66
What are the s/sx of conduction aphasia?
Impaired repetition, but intact fluency and comprehension
67
What are the of the brain is implicated in broca's aphasia? What vessel?
Right superior division of the middle cerebral artery
68
What metabolic disturbance is seen in sarcoidosis? Why?
Hypercalcemia
| Granuloma produces 1,25 vit D3
69
What is the treatment for hypercalcemia?
IVFs
| Calcitonin
70
What is the treatment for budd-chiari syndrome?
tPA and anticoagulation
71
What is the general presentation (labs wise) for budd-chiari syndrome?
Mildly elevated LFTs
Elevated alk phos
Tons of collateral veins in the liver on imaging
72
What is the best way to evaluate suspected bladder trauma?
Cystogram
73
What is the management for intraperitoneal vs extraperitoneal bladder rupture?
```
Intraperitoneal = surgical
Extraperitoneal = Indwelling foley
```
74
What is the major risk factor for medullary carcinoma of the thyroid?
Genetic predisposition (MEN2a/2B)
75
What are the effects on the bowel of hypercalcemia?
Constipation
76
What is the MOA and use of bosentan?
Competitive endothelin-1 antagonist used to alleviate the effects of systemic sclerosis pHTN
77
What is the first line treatment for CREST syndrome?
Amlodipine
78
What is the treatment of raynaud phenomenon?
CCBs
79
How long must one wait to be put on an organ transplant list after having chemo for a cancer?
5 years
Otherwise ABSOLUTE contraindication
80
What is the abx of choice for a human bite?
Augmentin
81
What is the general treatment for pericarditis?
NSAIDS + colchicine
82
When is drainage indicated for pericarditis?
More than 2 weeks duration, signs of tamponade, or purulent
83
What is the abx of choice for salmonella osteomyelitis in children?
Ceftriaxone
84
What is the problem with using fluoroquinolones in children?
Bone development problems
85
Why do some women develop transient hyperthyroidism early in pregnancy?
Increase beta-HCG activates TSH receptors (because CHG has a similar alpha subunit)
86
What is the effect of estrogen on thyroid binding globulin?
Increases production and decreases clearance (increases total T3/T4, but not free levels)
87
What is the drug of choice for trigeminal neuralgia?
Carbamazepine
88
What is the first line pharmacotherapy for BPH?
alpha antagonists
89
What is the chromosomal aberration in APML?
t(15;17)
90
Why is APL a medical emergency?
Hemorrhage from coagulopathy
91
What is the issue with treating APL with daunorubicin?
Increased risk of DIC
92
What happens to EF with restrictive cardiomyopathy?
Decreases
93
Is there any benefit of prophylactic abx for second degree burn?
No
94
When is amp B used to treat coccidioidomycosis?
Only if rapidly deteriorating, or affecting vital sites, like meninges, spine, etc. Otherwise azoles are first line
95
What are the three major cardiac damage markers, and when do they subside?
Myoglobin - few hours
CK - few days
Troponin - week
96
Where is Broca's area located?
Posterior inferior frontal gyrus
97
Where is Wernicke's area located?
Posterior superior temporal lobe
98
What are of the brain leads to conduction aphasia?
Arcuate fasciculus
99
What sort of ear discharge is associated with fungal otitis externa?
black (or white), fluffy exudates
100
What is the color of the exudate of pseudomonas otitis externa?
Greenish
101
What is the expected HCO3 change (renal compensation) with PaCO2 change?
d(HCO3) = 0.2 * d(PaCO2)
102
What is the role of [d(anion gap) / d(HCO3)] ?
If the value is greater than 2, there is combined anion gap metabolic acidosis , and concurrent metabolic alkalosis, because the reduction in bicarb is less than it should be
103
What pneumoconiosis increases the risk for TB?
Silicosis
104
What is the equation for corrected calcium?
Corrected Ca = serum Ca + 0.8(4-albumin)
105
What is the first step in treatment of hypercalcemia? Why?
- NS
| - Decreased volumes decreases ability of the kidney to excrete Ca
106
After NS administration, what is the second step for treating hypercalcemia?
Bisphosphonates
107
What is the MOA of -dronate drugs?
- Bisphosphonates
| - Inhibit osteoclast resorption of bone
108
What are the EKG findings of hyperkalemia? (3)
Tall, peaked T waves
Wide QRS
Flat P waves
109
What are the EKG findings of hypocalcemia?
QT prolongation
110
What is the PaO2:FiO2 ratio in ARDS?
Less than 200 mmHg
111
Which loop diuretic is not a sulfa drug?
Ethacrynic acid
112
When is treatment for CLL initiated?
Only when the patient becomes symptomatic, is anemic, or thrombocytopenic
113
What is the next step in treatment of acne if topical therapy fails?
Oral tetracyclines
114
What is the treatment for Wegener's granulomatosis (granulomatosis with polyangiitis)?
Oral cyclophosphamide and corticosteroids
115
Hypomagnesemia commonly causes what other electrolyte abnormality? How?
- Refractory hypokalemia
| - Magnesium deficiency impairs Na-K-ATPase, which would decrease cellular uptake of K
116
What is the basis of the secretin test in diagnosing gastrinomas?
Administering secretin should decrease gastrin secretion. If it does not (positive test), suggests gastrinoma
117
What is the abx of choice for S aureus endocarditis?
Gentamicin
118
What is the major risk of untreated subclinical hyperthyroidism in the elderly?
Cardiac dysrhythmias
119
What is the treatment for PCP?
TMP-SMX + prednisone
120
What is the DOC for CHF exacerbation?
Lasix (furosemide)
121
What are the drugs used to treat acute CHF exacerbation?
Lasix
Dobutamine
Nitroprusside
122
What is the role of HCTZ in the management of CHF?
Good for long term control, not indicated in acute exacerbations
123
What is the inheritance pattern of HD?
Autosomal dominant (but 50% chance of inheritance since two alleles)
124
What is the treatment for a PE?
Warfarin with enoxaparin bridging
125
When is embolectomy indicated for the treatment of a PE?
Hemodynamically unstable, and does not respond to medical therapy
126
When is tPA indicated for the treatment of a PE?
If hypotensive
127
Brown bone tumors are the result of what process?
HyperPTH
128
What is the treatment for AKI in multiple myeloma patients?
Aggressive hydration
129
What, generally, is the treatment for multiple myeloma?
Alkylating agents + prednisone
130
When is hemodialysis indicated fro AKI 2/2 multiple myeloma?
If aggressive hydration fails
131
What is the major adverse effect of penicillamine?
Aplasic anemia
132
What are the three major adverse effects of deferoxamine?
Urine discoloration
Growth retardation
Hearing loss
133
What is the treatment for GVHD?
Steroids
134
What is the best test to assess for ulnar nerve motor function?
Abduction of the second and third digits
135
Extension of the 5th digit is supplied by what nerve?
Radial nerve
136
What other major artery can possibly be affected by giant cell arteritis?
Aorta
137
When does common variable immunodeficiency usually present? What are the s/sx?
50-60s
Infections
LAD
138
What is the malignancy that patients with CVID are predisposed to?
Lymphoma
139
What is the treatment for impetigo?
Topical mupirocin x5 days
140
What is the treatment for optic neuritis for the acute phase?
IV methylprednisone
141
What is pulsus paradoxus indicative of?
Tamponade
142
What causes the flushing that occurs with niacin use, and what can be done to prevent it?
Increased prostaglandins
| ASA
143
What is Kluver-Bucy syndrome, and what are the s/sx?
Temporal lobe dementia
| Hyperorality, hypersexuality, apathy, amotivation
144
What is the treatment for tumor lysis syndrome?
IVFs and allopurinol
145
What extra heart sound is heard with restrictive cardiomyopathy?
S4
146
What is the Jarisch-Herxheimer reaction?
Sudden worsening of symptoms of secondary syphilis with the administration of PCN. Result of killed organisms releasing a pyrogen
147
Morning joint stiffness that lasts more than how long is suggestive of RA?
More than 30 minutes (less than this is c/w OA)
148
What are the s/sx of the JC virus?
UMN lesions and white matter lesions on MRI
149
What visual deficit may be seen with a lesion to Wernicke's area?
Superior quadrantanopia (damage to Meyer's loop)
150
Pure motor deficit stroke is associated with what type of lesion?
Lesion to the internal capsule
151
Pure sensory strokes are associated with a lesion where?
Thalamus
152
Infarct in the pons produces what symptoms?
Dysarthria and clumsiness of the hand that is most prominent when the patient is writing
153
What is the MOA and use of Leuprolide?
GnRH agonist that eventually reduces GnRH and testosterone/estrogen secretion
Prostate cancer and excessive androgens
154
What are the components of the hyperGLUC mnemonic for the side effects of HCTZ?
Hyperglycemia
HyperLipidemia
Hyperuricemia
Hypercalcemia
155
What is the MOA of pilocarpine in the treatment of open angle glaucoma?
Muscarinic agonist that causes miosis, and opens canal of schlemm
156
When does neuronal injury occur in status epilepticus?
After 30 minutes
157
What is the mortality rate of status epilepticus?
20%
158
True or false: patients in status epilepticus with minimal myoclonic activity are at low risk for neuronal damage
False
159
What infection is associated with polyarteritis nodosa?
Hep B
160
What are the s/sx of polyarteritis nodosa?
General B symptoms
Skin ulcers
Inflammation of medium sized arteries
161
What is the abx of choice for neisseria gonorrhea?
Azithromycin or doxycycline
162
What is the first line treatment for chlamydia?
Ceftriaxone
163
What is the pathophysiology and genetic inheritance of familial hypocalciuric, hypercalcemia?
AD inappropriate sensing of Ca by receptors in the PTH gland and the kidney
164
What is the screening and confirmatory test for Lyme disease?
```
Screening = ELISA
Confirmatory = Western blot
```
165
CNS lymphoma in an HIV patient is strongly associated with what infectious process?
EBV
166
What is the treatment for mucormycosis?
Amp B
167
What is the MOA and use of chlordiazepoxide?
Benzo
168
What is the definitive treatment for thrombocytopenia in pts 2/2 CLL?
Splenectomy
169
What are the two abx of choice for empiric treatment of teenage-adult-elderly meningitis?
Vancomycin and ceftriaxone
170
What is the abx that is added to vancomycin in neonatal meningitis to cover listeria?
Ampicillin
171
Where in the heart is BNP secreted?
Ventricles
172
What is the best imaging technique to evaluate for vesicoureteral reflux?
Tch 99 acid renal scan
173
Which type of brain herniation classically leads to respiratory failure?
Cerebellar tonsillar herniation into the forman magnum
174
Patients who have been treated for Hodgkin's lymphoma with alkylating agents are at risk for what hematologic disturbance later in life?
AML
175
What are the antibodies that cause the skin manifestations of celiac disease?
IgA towards endomysium
176
What is the treatment for dermatitis herpetiformis associated with celiac disease?
Dapsone
177
CLL, when left untreated, may progress to what?
Other lymphomas, most commonly diffuse large B cell lymphoma
178
What part of the middle cerebral artery supplies Wernicke's area?
Inferior division
179
Where are the lesions classically associated with scabies? When is the pruritus the worst?
```
Intertriginous areas (e.g. between toes, axillae, panniculus, etc)
At night
```
180
What is the treatment for nephrogenic DI? MOA?
Amiloride
Prevents accumulation of Li in the collecting duct cells by blocking the epithelial Na channels in the luminal membrane through which Li enters
181
What may appear on PBS of ITP?
Megathrombocytes
182
When is pharmacologic therapy indicated in children with ITP? What is the treatment?
If platelets are less than 30,000 and *mucosal* bleeding
IVIG
183
What part of vision is lost first with glaucoma: peripheral or central?
Peripheral
184
What is the treatment for open angled glaucoma? How does this work?
- Latanoprost
| - Prostaglandin increases uveoscleral outflow of aqueous humor, thereby lowering IOP.
185
What is the role of beta blockers like timolol in the treatment of open angle glaucoma?
No longer used as prostaglandins are more efficacious, but used to be used to decrease production of aqueous humor
186
What happens to EF with dilated cardiomyopathy?
Decreases
187
What is the treatment for dilated cardiomyopathy? (3)
ACEIs
Diuretics
Beta blockers
188
What is a major complication of diabetic nephropathy?
Coagulation of the renal vein, and subsequent ischemia/infarction
189
What is the treatment for renal vein thrombosis 2/2 diabetic nephropathy?
Heparin
190
What is the typical presentation of renal vein thrombosis 2/2 DM nephropathy?
Severe onset of flank pain, with hematuria, and proteinuria
191
Why should patients with electrical burns not be given Dextrose solutions?
Burns already lead to hyperglycemia from stress response
192
What is the first step in monitoring patients with severe electrical burns (Besides ABCs)?
Cardiac monitoring and Troponin
193
What causes hexagonal renal stones?
Cystinuria
194
What is the common adverse rxn to cyclosporine?
HTN
195
What is the MOA of cyclosporin?
Calcineurin inhibitor (prevents IL-2 transcription)
196
What syndrome is characterized by diffuse telangiectasias, AV malformations, and aneurysms? What is its inheritance pattern?
Osler-Weber-Rendu syndrome
| AD
197
What primary CNS tumor is associated with tuberous sclerosis?
Astrocytoma
198
Adenocarcinoma that arises from the anterior superior dome of the bladder is caused by what?
Urachal CA
