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Flashcards in Uworld2 Deck (100)
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1
Q

who gets endoscopy with GERD

A

over age 50 with chronic symptoms and cancer risk factors (tobacco use).

2
Q

What type of bilirubin is increased in Gilbert disease

A

unconjugated

3
Q

Drug choice of hepatic encephalopathy

A

1st: lactulose and rifaximin
2nd: Neomycin

4
Q

what are 2 markers to use for diagnostic tests for acue hepatitis B

A

HBsAg

Anti-HBc (will remain elevated during window period)

5
Q

Lamivudine

A

treats HIV and chronic HBV cofinfection

6
Q

What is elevated in rotor syndrome

A

conjugated hyperbilirubinemia

7
Q

positive urine bilirubin assay reflects?

A

build-up of conjugated bilirubin

8
Q

Positive urine urobilinogen reflects?

A

unconjugated bilirubin excess

9
Q

Caseating vs. non caseating granulomas

A

Caseating: TB
noncaseating: crohns, sarcoidosis

10
Q

Treatment for toxic megacolon

A

conservative management and steroids (if IBD associated)

11
Q

what is seen on biopsy for ulcerative colitis

A

Mucosal & submucosal inflammation

crypt abscesses

12
Q

colonoscopy screening for UC patients

A

begin 8 hours after the initial diagnosis and repeat every 1-2 years

13
Q

Via lab values how do you tell the difference between ischemic hepatic injury and acute Hep A/B

A

both have extremely elevated AST/ALT

Hep A/B will also have elevated hyperbilirubinemia. this will be normal in ischemic hepatic injury

14
Q

associated neoplasm with Lynch syndrome

A

Colorectal
endometrial
ovarian cancer

15
Q

MEN1

A

Parathyroid adenoma
Pituitary adenomas
Pancreatic adenomas

16
Q

MEN2

A

Medullary thyroid
Pheochromocytoma
Parathyroid hyperplasis (2A)

17
Q

bowel sounds during opioid withdrawal

A

increased bowel sounds

18
Q

What does this patient most likely have?

abdominal pain, microcytic anemia, positive fecal occult blood, and hepatomegaly with a hard edge on liver palpation

A

GI malignancy with mets to liver

19
Q

Isoniazid can cause what vitamin deficiency?

A

Niacin

20
Q

Most common patients to get nonalcohlic fatty liver disease

A

Diabetics and obese patients

21
Q

Painless jaundice in a patient with conjugated hyperbilirubinemia and markedly elevated alkaline phosphatase should raise concern for what?

A
  1. biliary obstruction due to pancreatic or biliary cancer
  2. choledocholithiasis
  3. benign biliary stricutre.
22
Q

how does cocaine cause peptic ulcer disease

A

vasoconstriction

23
Q

how does aspirin and alcohol cause peptic ulcer disease

A

direct mucosal injury

24
Q

calcified rim in the gallbladd wall with a central bile-filled dark area is associated with? next step?

A

gallbladder adenocarcinoma

cholecystectomy

25
Q

Characterize primary biliary cholangitis

A

destruction of intrahepatic bile ducts

26
Q

Name 2 associated complications for primary biliary cholangitis

A

Osteoprosis/osteomalacia

Xanthelasmas

27
Q

Next step in management for psoas abscess

A

CT to confirm diagnosis`

28
Q

Which hereditary liver problem is associaed with UC

A

Primary sclerosing cholangitis

29
Q

Refeeding syndrome

A

rapid electrolyte shifts when nutrition is reintroduced to malnourished patients

30
Q

What is automotive antifreeze? what does it do in the body

A

ethylene glycol poisoning

Calcium oxalate crystals

31
Q

Whipple disease

A
arthralgias
weight loss
fever
diarrhea
abdominal pain 
PAS positive material in lamina propria of small intestines
32
Q

difference between tropical sprue and whipple disease

A

tropical sprue –> paitient should have lived in a tropical area for more than one month.

33
Q

3 main categories of symtpoms for wilson’s disease

A

hepatic
neurologic
psychiatric

34
Q

some characteristics of zinc deficency

A
alopecia
pustular skin rash 
hypogonadism
impaired wound healing
impaired taste
immune dysfunction
35
Q

what will endoscopy show for Zollinger Ellison syndrome

A

thickened gastric folds

multiple stomach ulcers

36
Q

In Zollinger Ellison syndrome, which one happens? Inactivation of pancreatic enzymes or pancreatic exocrine deficiency?

A

Inactivation of pancreatic enyzmes by increased production of stomach acid may lead to malabsorption

37
Q

FSH and LH levels in anabolic steroid use?

A

low

38
Q

FSH and LH levels in Klinefelter syndrome

A

high

39
Q

What is the preferred initial treatment for uncomplicated benign prostatic hyperplasia? what medication can be added?

A

alpha-1-blockers (Terazosin & Tamsulosin)

5-alpha-reductase inhibitors (finasteride)

40
Q

Side effects of terazosin and tamsulosin

A

orthostatic hypotension, dizziness

41
Q

contraindications for phosphodiesterase-5 inhibitors

A

nitrates and alpha blockers

42
Q

Second line treatment for erectile dysfunction

A

alprostadil (prostaglandin E1) –> induces vasodilation

43
Q

Via what lymph node does testicular cancer spread

A

retroperitoneal lymph

44
Q

triad for renal cell carcinoma

A

hematuria
flank pain
palpable abdominal mass

45
Q

Leydig cell tumors

A

increase estrogen production

46
Q

Yolk sac

A

increase serum AFP

47
Q

What is the most common etiology for acute bronchitis

A

viral respiratory illness

48
Q

acute heart failure and Co2 levels

A

hypocapnia and respiratory alkalosis

49
Q

On the Vent, what value should FiO2 be at

A

less than 60%

50
Q

On the vent, how do you change O2

A

FiO2 and PEEP

51
Q

What is the hypoxemia value with acute respiratory syndrome

A

PaO2/FiO2 ratio

52
Q

how does lung compliance change with ARDS

A

decrease in lung compliance

53
Q

What do you change on the VENT to lower pulmonary pressures? why do you do this

A

low tidal volume ventilation

decreases the likehood of over distending alveoli

54
Q

Hallmark imaging for asbestosis

A

Pleural plaques (often calcified)

55
Q

When does pneumonitits present

A

hours after aspiration

56
Q

Treatment for pneumonitis

A

supportive ( no abs)

57
Q

Who is at risk for invasive asperigillosis?

A

Immunocompromised (neutropenic)

58
Q

Who is at risk for chronic pulmonary asperigillosis?

A

Cavitary tuberculosis patients

59
Q

what is CT scan of invasive asperigillosis

A

pulmonary nodules with surrounding ground-glass opaciites “halo sign”

60
Q

What is the triad of symptoms for invasive aspirgillosis

A

fever
chest pain
hemoptysis

61
Q

symptoms for chronic pulmonary asperigilosis

A

> 3 months of weight loss
cough
hemoptysis
fatigue

62
Q

what are 2 causes of pneumonia due to septic emboli

A

bacteremia

endocarditis due to peridontal disease

63
Q

side effects of albuterol

A

hypokalemia
tremor
palpitations
headache

64
Q

when do you intubate asthma exacerbation

A

normal or elevated CO2

65
Q

treatment for aspirin-exacerbated respiratory disease

A

montelukast (leukotriene receptor antagonists)

66
Q

MRI of brain cancer mets from lung cancer

A

vasogenic edema at the gray and white matter junction

67
Q

Who usually gets primary central nervous system lymphoma ? MRI imaging shows?

A

HIV

periventricular lesion

68
Q

define chronic cough

A

> 8 weeks cough

69
Q

3 causes of chronic cough in nonsmokers who do not have pulmonary disease

A

postnasal drip
GERD
asthmas

70
Q

For patients with suspected post nasal drip, what is the initial treatment

A

oral first-generation antihistamine (chlorphenairamne)

71
Q

when do you start long-term supplemental oxygen therapy for patients with COPD

A
  1. less than or equal to 88% pulse O2 saturation

2. PaO2 less than or equal to 59 mmHg

72
Q

when do you start long-term O2 for patients with COPD and right CHF or increased hematoctir

A
  1. SaO2 less than equal to 89%

4. Hematocrit greater than 55%

73
Q

What obstructive lung disease cause increase DLCO

A

asthma

74
Q

What obstructive lung disease causes decrease DLCO

A

emphysema

75
Q

Dullness to percussion
Increased intensity of breath sounds
increased tactile fremitus
crackles are often heard

A

Lung consolidation

76
Q

Name alpha 2 adrenergic agonists ? and what they are used for?

A

Clonidine and methyldopa = hypertension

Dexmedetomidine –> sedation in ICU

77
Q

What causes increase work of breathing in COPD patients

A

flattening of diaphragm has difficulty expanding

78
Q

COPD how does elasticity and compliance change

A

Elasticity decreases

compliance increase

79
Q

What are fluid characteristics of empyema and complicated parapneumonic effusion

A

low pH and low glucose (<60)

80
Q

Difference between nonseminomatous germ cell tumors and seminoma germ cell tumor

A

Nonseminomatous germ –> both alpha fetoprotein and hCG

Seminomas –> No alpha fetoprotein

81
Q

How do you confirm the diagnosis of granulomatosis with polyangiitis

A

ANCA

tissue biopsy

82
Q

what lung disease increases the risk of developing active TB

A

silicosis

83
Q

Hypertrophic osteoarthropathy, what is it? first step?

A

clubbing of digits
periosteal new bone formation
arthritis
get x-ray chest

84
Q

Urine osmolality and urine sodium during hypovolemia

A

osmolality increased

sodium decreased

85
Q

what are 2 causes of transudatvie plural effusion

A
CHF (increased hydrostatic pressure)
nephrotic syndrome ( decreased oncotic pressure)
86
Q

What syndrome is seen in pancoast tumor

A

hornor syndrome

87
Q

what is the neuro involvment for pancoast tumor

A

weakness and/or atrophy of instrinsic hand muscles

pain and paresthesias of 4th and 5th digits, medial arm and forearm.

88
Q

at what lung nodule size do you biopsy, CT scan, no risk

A

Biopsy: >_8mm
CT scan: 5-7 mm
no follow up:

89
Q

Side effect of Nitrofurantoin? treatment

A

acute hypersensitivity pneumonitis
CBC –> high eosinophils
Stop meds and start steroids

90
Q

difference in physical exam findings for allergic rhinitis and nonallergic rhinitis

A

allergic rhinitis: pale/bluish mucosa

nonallergic rhintitis: erythematous nasal mucosa

91
Q

TB pleural fluid effusion

A

elevated protein
lymphocytic leukocytosis
low glucose levels

92
Q

decreased breath sounds
Decreased tactile fremitus
Dullness to percussion over effusion

A

plerual effusion

93
Q

cephalization of pulmonary veins

A

flash pulmonary edema

94
Q

when does pulmonary contusion present

A

<24 hours after blunt thoracic trauma

95
Q

differential diagnosis for pts with blunt thoracic trauma and hypoxia

A
  1. pneumothorax
  2. ARDS
  3. flail chest
  4. pulmonary contusion
96
Q

What causes exudative effusions

A

capillary or pleural membrane permeability or disruptions to lymphatic flow

97
Q

What is the initial evaluation for PE in pregnant women with normal chest x-ray.

A

V/Q scan is preferred over CT angiogram

98
Q

Pregnant women with V/Q scan showing low probability for PE, what is the next step?

A

CT angiogram of chest

99
Q

postoperative patient with hypotension, jugular venous distension and new-onset right bundle branch block likely has

A

massive PE

100
Q

What is PaCO2 levels in PE

A

low, if they are high that is a concern