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Uworld2 Flashcards

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1
Q

who gets endoscopy with GERD

A

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

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2
Q

What type of bilirubin is increased in Gilbert disease

A

unconjugated

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3
Q

Drug choice of hepatic encephalopathy

A

1st: lactulose and rifaximin
2nd: Neomycin

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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)

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5
Q

Lamivudine

A

treats HIV and chronic HBV cofinfection

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6
Q

What is elevated in rotor syndrome

A

conjugated hyperbilirubinemia

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7
Q

positive urine bilirubin assay reflects?

A

build-up of conjugated bilirubin

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8
Q

Positive urine urobilinogen reflects?

A

unconjugated bilirubin excess

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9
Q

Caseating vs. non caseating granulomas

A

Caseating: TB
noncaseating: crohns, sarcoidosis

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10
Q

Treatment for toxic megacolon

A

conservative management and steroids (if IBD associated)

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11
Q

what is seen on biopsy for ulcerative colitis

A

Mucosal & submucosal inflammation

crypt abscesses

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12
Q

colonoscopy screening for UC patients

A

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

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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

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14
Q

associated neoplasm with Lynch syndrome

A

Colorectal
endometrial
ovarian cancer

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15
Q

MEN1

A

Parathyroid adenoma
Pituitary adenomas
Pancreatic adenomas

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16
Q

MEN2

A

Medullary thyroid
Pheochromocytoma
Parathyroid hyperplasis (2A)

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17
Q

bowel sounds during opioid withdrawal

A

increased bowel sounds

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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

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19
Q

Isoniazid can cause what vitamin deficiency?

A

Niacin

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20
Q

Most common patients to get nonalcohlic fatty liver disease

A

Diabetics and obese patients

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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.
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22
Q

how does cocaine cause peptic ulcer disease

A

vasoconstriction

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23
Q

how does aspirin and alcohol cause peptic ulcer disease

A

direct mucosal injury

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24
Q

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

A

gallbladder adenocarcinoma

cholecystectomy

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25
Characterize primary biliary cholangitis
destruction of intrahepatic bile ducts
26
Name 2 associated complications for primary biliary cholangitis
Osteoprosis/osteomalacia | Xanthelasmas
27
Next step in management for psoas abscess
CT to confirm diagnosis`
28
Which hereditary liver problem is associaed with UC
Primary sclerosing cholangitis
29
Refeeding syndrome
rapid electrolyte shifts when nutrition is reintroduced to malnourished patients
30
What is automotive antifreeze? what does it do in the body
ethylene glycol poisoning | Calcium oxalate crystals
31
Whipple disease
``` arthralgias weight loss fever diarrhea abdominal pain PAS positive material in lamina propria of small intestines ```
32
difference between tropical sprue and whipple disease
tropical sprue --> paitient should have lived in a tropical area for more than one month.
33
3 main categories of symtpoms for wilson's disease
hepatic neurologic psychiatric
34
some characteristics of zinc deficency
``` alopecia pustular skin rash hypogonadism impaired wound healing impaired taste immune dysfunction ```
35
what will endoscopy show for Zollinger Ellison syndrome
thickened gastric folds | multiple stomach ulcers
36
In Zollinger Ellison syndrome, which one happens? Inactivation of pancreatic enzymes or pancreatic exocrine deficiency?
Inactivation of pancreatic enyzmes by increased production of stomach acid may lead to malabsorption
37
FSH and LH levels in anabolic steroid use?
low
38
FSH and LH levels in Klinefelter syndrome
high
39
What is the preferred initial treatment for uncomplicated benign prostatic hyperplasia? what medication can be added?
alpha-1-blockers (Terazosin & Tamsulosin) | 5-alpha-reductase inhibitors (finasteride)
40
Side effects of terazosin and tamsulosin
orthostatic hypotension, dizziness
41
contraindications for phosphodiesterase-5 inhibitors
nitrates and alpha blockers
42
Second line treatment for erectile dysfunction
alprostadil (prostaglandin E1) --> induces vasodilation
43
Via what lymph node does testicular cancer spread
retroperitoneal lymph
44
triad for renal cell carcinoma
hematuria flank pain palpable abdominal mass
45
Leydig cell tumors
increase estrogen production
46
Yolk sac
increase serum AFP
47
What is the most common etiology for acute bronchitis
viral respiratory illness
48
acute heart failure and Co2 levels
hypocapnia and respiratory alkalosis
49
On the Vent, what value should FiO2 be at
less than 60%
50
On the vent, how do you change O2
FiO2 and PEEP
51
What is the hypoxemia value with acute respiratory syndrome
PaO2/FiO2 ratio
52
how does lung compliance change with ARDS
decrease in lung compliance
53
What do you change on the VENT to lower pulmonary pressures? why do you do this
low tidal volume ventilation | decreases the likehood of over distending alveoli
54
Hallmark imaging for asbestosis
Pleural plaques (often calcified)
55
When does pneumonitits present
hours after aspiration
56
Treatment for pneumonitis
supportive ( no abs)
57
Who is at risk for invasive asperigillosis?
Immunocompromised (neutropenic)
58
Who is at risk for chronic pulmonary asperigillosis?
Cavitary tuberculosis patients
59
what is CT scan of invasive asperigillosis
pulmonary nodules with surrounding ground-glass opaciites "halo sign"
60
What is the triad of symptoms for invasive aspirgillosis
fever chest pain hemoptysis
61
symptoms for chronic pulmonary asperigilosis
>3 months of weight loss cough hemoptysis fatigue
62
what are 2 causes of pneumonia due to septic emboli
bacteremia | endocarditis due to peridontal disease
63
side effects of albuterol
hypokalemia tremor palpitations headache
64
when do you intubate asthma exacerbation
normal or elevated CO2
65
treatment for aspirin-exacerbated respiratory disease
montelukast (leukotriene receptor antagonists)
66
MRI of brain cancer mets from lung cancer
vasogenic edema at the gray and white matter junction
67
Who usually gets primary central nervous system lymphoma ? MRI imaging shows?
HIV | periventricular lesion
68
define chronic cough
>8 weeks cough
69
3 causes of chronic cough in nonsmokers who do not have pulmonary disease
postnasal drip GERD asthmas
70
For patients with suspected post nasal drip, what is the initial treatment
oral first-generation antihistamine (chlorphenairamne)
71
when do you start long-term supplemental oxygen therapy for patients with COPD
1. less than or equal to 88% pulse O2 saturation | 2. PaO2 less than or equal to 59 mmHg
72
when do you start long-term O2 for patients with COPD and right CHF or increased hematoctir
3. SaO2 less than equal to 89% | 4. Hematocrit greater than 55%
73
What obstructive lung disease cause increase DLCO
asthma
74
What obstructive lung disease causes decrease DLCO
emphysema
75
Dullness to percussion Increased intensity of breath sounds increased tactile fremitus crackles are often heard
Lung consolidation
76
Name alpha 2 adrenergic agonists ? and what they are used for?
Clonidine and methyldopa = hypertension | Dexmedetomidine --> sedation in ICU
77
What causes increase work of breathing in COPD patients
flattening of diaphragm has difficulty expanding
78
COPD how does elasticity and compliance change
Elasticity decreases | compliance increase
79
What are fluid characteristics of empyema and complicated parapneumonic effusion
low pH and low glucose (<60)
80
Difference between nonseminomatous germ cell tumors and seminoma germ cell tumor
Nonseminomatous germ --> both alpha fetoprotein and hCG | Seminomas --> No alpha fetoprotein
81
How do you confirm the diagnosis of granulomatosis with polyangiitis
ANCA | tissue biopsy
82
what lung disease increases the risk of developing active TB
silicosis
83
Hypertrophic osteoarthropathy, what is it? first step?
clubbing of digits periosteal new bone formation arthritis get x-ray chest
84
Urine osmolality and urine sodium during hypovolemia
osmolality increased | sodium decreased
85
what are 2 causes of transudatvie plural effusion
``` CHF (increased hydrostatic pressure) nephrotic syndrome ( decreased oncotic pressure) ```
86
What syndrome is seen in pancoast tumor
hornor syndrome
87
what is the neuro involvment for pancoast tumor
weakness and/or atrophy of instrinsic hand muscles | pain and paresthesias of 4th and 5th digits, medial arm and forearm.
88
at what lung nodule size do you biopsy, CT scan, no risk
Biopsy: >_8mm CT scan: 5-7 mm no follow up:
89
Side effect of Nitrofurantoin? treatment
acute hypersensitivity pneumonitis CBC --> high eosinophils Stop meds and start steroids
90
difference in physical exam findings for allergic rhinitis and nonallergic rhinitis
allergic rhinitis: pale/bluish mucosa | nonallergic rhintitis: erythematous nasal mucosa
91
TB pleural fluid effusion
elevated protein lymphocytic leukocytosis low glucose levels
92
decreased breath sounds Decreased tactile fremitus Dullness to percussion over effusion
plerual effusion
93
cephalization of pulmonary veins
flash pulmonary edema
94
when does pulmonary contusion present
<24 hours after blunt thoracic trauma
95
differential diagnosis for pts with blunt thoracic trauma and hypoxia
1. pneumothorax 2. ARDS 3. flail chest 4. pulmonary contusion
96
What causes exudative effusions
capillary or pleural membrane permeability or disruptions to lymphatic flow
97
What is the initial evaluation for PE in pregnant women with normal chest x-ray.
V/Q scan is preferred over CT angiogram
98
Pregnant women with V/Q scan showing low probability for PE, what is the next step?
CT angiogram of chest
99
postoperative patient with hypotension, jugular venous distension and new-onset right bundle branch block likely has
massive PE
100
What is PaCO2 levels in PE
low, if they are high that is a concern

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