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Flashcards in UWORLD6 Deck (95):
1

Dysphagia initially involving bot hsolids and liquids suggests

neuromuscular disorder

2

Structural lesions that lead to dysphagia in the pharynx and upper esophagus are visualized with

nasopharyngeal laryngoscopy

3

Cancers in the upper esophgaus are more likely to be

squamous cell carcinoma (vs adenocarcinoma, found primarily in the lower esophagus)

4

Trastuzumab is an antibody against

HER2

5

While anthracycline-associated cardiotoxicity may not be reversible after tx discontinuation (due to myocyte necrosis and replacement by fibrous tissue), that due to __________ is reversible

trastuzumab

6

A positive straight-leg raising test at a ___ degree angle or less is characteristic for nerve root irritation.

60

7

While scombroid poisoning symptoms include flushing, throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning; pufferfish poisoning is associated with

prominent neuro symptoms, including perioral tingling, incoordination, weakness

8

Red to flesh colored papules with slight central umbilication in HIV patient. Think this (in addition to Molluscum):

cutaneous cryptococcosis

9

Apple-jelly nodules with central atrophy and progression by peripheral extension:

cutaneous TB (lupus vulgaris)

10

How do you diagnose cutaneous crypto?

histopathologic examination

11

In whom is the warfarin INR goal 2.5-3.5?

MV replacement; AV replacement with presence of risk factors (afib, EF less than 30, prior VTE, hypercoagulable state)

12

Which tests are highly suggestive of patellofemoral pain syndrome?

pain elicited by extending the knee while compressing the patella; reproduction of pain with squatting

13

Episodic pain and tenderness at the inferior patella:

patellar tendonitis (jumper's knee; seen in volleyball, basketball)

14

Localized pain and tenderness at the medial aspect of the knee joint distal to the joint line. Symptoms are usually acute/episodic (vs chronic) and not felt at the anterior knee, usually:

anerine bursitis

15

What is "housemaid's knee"?

Common cause of anterior knee in patietns who work on their knees. Typically acute and HIGHLY localized with visible swelling anterior to the patella. Frequently complicated by secondary infection (septic arthritis) due to S aureus

16

T/F: Women less than age 30 should not be screened wit HPV

True; infection is transient

17

What are the features of ACL tear?

rapid deceleration or direction changes; pivoting with planted foot. Rapid onset severe pain; a "popping sensation" and significant swelling (effusion/hemarthrosis), jointinstability. Anterior laxity of tib relative to femur. Dx with MRI.

18

T/F: MCL injuries are not typically associated with significant hemarthrosis.

True.
Positive valgus stress test is consistent

19

T/F: Patients with a meiscal tear have effusions that develop slowly.

True
Hemarthrosis is rare

20

What comprises the latent stage of labor?

Stage 1. 0-6 cm cervical dilation

21

What comprises active stage of labor?

Stage 1. 6-10 cm cervical dilation

22

What is the 2nd stage of labor?

10cm (complete) cervical dilation to delivery

23

What is stage 3 of labor?

delivery of baby to expulsion of placenta

24

What is arrest of labor in the first satge?

Greater than 6 cm dilation, ruptured membranes, and
1) no cervical change for 4 hours despite ADEQUATE contractions; OR
2) no cervical change for 6 hours with INADEQUATE contractions

25

What is "adequate labor" in terms of Montevideo units?

200-250 units or greater

26

Which drug is used for cervical ripening and labor induction? What class of drug is it?

misoprostol! a prostaglandin

27

What are the indications for parathyroidectomy in patients with 2* or 3* hyperparathyroidism?

1) calcium levels over 10.5 not responding to conservative management
2) mod to severe hyperphos
3) PTH greater than 1000
4) intractable bone pain
5) intractable pruritus
6) episode of calciphylaxis
7) soft tissue calcification

28

Patients with alarm symptoms or older than age ___ should undergo endoscopy.

55
alarm symptoms = abdominal mass or LAN, unexplaind anemia, FH of gastric cancer, worsening dysphagia or odynophagia, persistent vomiting or hematemesis, unintentional weight loss

29

The major problem that leads to difficulties finding cross-matched blood in patients with a history of multiple transfusions is:

alloantibodies

30

Though premixed insulins (eg 70/30) can provide sometimes larger declines in hemoglobin a1c compared to long-acting basal insulins, they are also more likely to cause these two negative side effects:

1) higher risk of hypoglycemia
2) weight gain

31

Bile-salt induced diarrhea occurs in 5-10% of patients following cholecystectomy and in patients with short bowel syndrome. What is the treatment?

cholestyramine

32

What is the treatment of choice in cases of ethylene glycol and methanol intoxication?

Fomepizole

33

How does DIC affect D-dimer, PT, PTT, and fibrinogen?

D dimer = elevated (accelerated fibrinolysis)
PT and PTT: prolonged (depletion of clotting factors)
fibrinogen: low (due to consumption)

34

Which diabetes meds can cause nasopharyngitis?

DPP4 inhibitors, like sitagliptin or saxagliptin

35

Which diabetes meds cause diarrhea/flatulence?

a-glucosidase inhibitors, like acarbose and miglitol

36

Which diabetes meds cause weight gain and hypolgycemia?

sulfonylureas (like glyburide, glipizide, glimepiride) and meglitinides (nateglinide, repaglinide)

37

FLexible kyphosis is normal or slightly increased thoracic kyphosis seen on lateral radiographs, from which angles?

20-40

38

The radiographic finding of a "collar on the neck of the Scotty dog" is typical of

spondylolisthesis: an anterior slippage of the vertebral body, usually in the lower lumbar vertebrae

39

As long as structural kyphosis is not severe (less than ___ degrees), a Milwaukee brace can be used.

70-80 degrees.
In more severe cases (significant angulation, intractable pain, and neurological abnormalities), surgical correction is used.

40

What is the treatment for classic pneumonia in a kid?

high dose amoxicillin (for Strep pneumo)

41

What are the common causes of hepatic encephalopathy?

1. GIB
2. hypoK
3. hypovolemia
4. hypoxia
5. sedatives, tranquilizers
6. hypoglycemia
7. metabolic alkalosis
8. infection (including SBP)
9. high protein intake

42

Why isn't antenatal corticosteroid therapy given IV?

results in peaks and troughs. IM administration (of betamethasone, dexamethasone) provides stable and predictable concentrations

43

ICD placement is indicated for prevention of SCD in which patients with HCM?

high risk for malignant arrhthmias: ie 1) FH of SCD, 2) prior history of cardiac arrest or sustained, spontaneous VT; 3) recurrent or exertional syncope, 4) nonsustained VT, 5) hypotension with exercise, 6) extreme LVH)

44

What med is given for cat bites?

amox/clav OR doxy (if patient allergic to PCN)

45

What is the most common extraneural complication of myelomeningocele?

1) Bladder dysfunction! (lumbar region involvement can cause upper urinary tract involvement and renal dysfunction)
followed by GI involvement (S2-S3 --> fecal incontinence) and then lower extremity fractures

46

What is the only diagnostic marker for acute HBV infection in the "window period"?

IgM anti-HBc

47

What are the 3 situations in which isolated anti-HBc may be seen?

1) during the "Window period" of acute HBV infxn when HBsAg has fallen but anti-HBs has not risen (IgM anti-HBc positive, LFTs elevated)
2) years after recovery from acute HBV (IgM anti-HBC negative, LFTs nl);
3) chronic HBV infxn when HBsAg has fallen to undetectable level. Evidence of chronic liver disease and HBV DNA is detectable (IgM anti-HBC is negative)

48

Maculopapular rash that spreads caudally, low-grade fever, LAN involving posterior cervical and occipital lymph nodes, nonspecific symptoms (but less lick than measles):

rubella
**not as sick as rubeola (measles); also, measle's rash is more brick red

49

Describe measles:

cough, conjunctivits, coryza. Fever and photophobia are common. Blue-white Koplik spots found on buccal mucosa precede appearance of caudally spreading maculopapular rash
*also known as rubeola

50

Foot eversion is a function of which muscles, innervated by which nerves?

Fibularis longus and brevis (innervated by the superficial fibular nerve; also responsible for plantar flexion) and fibularis tertius (deep fibular nerve)

51

An effusion in the middle ear (normal appearing TM with decreased mobility on pneumatic otoscopy) can persist for up to __ months after an acute episode of otitis media.

up to 3 months. If it persists longer, hearing should be assessed

52

Otitis media is treated with amoxicillin. If that doesn't work, which antibiotics are used next?

1. amox-clav, 2. cerfuroxime, 3. ceftriaxone

53

Elevated levels of cathepsin D in breast cancer is associated with a (better/worse) prognosis

worse

54

How do you treat serotonin syndrome?

benzodiazepines, supportive measures, discontinuation of serotonergic drugs. In severe cases, cyproheptadine (serotonin antagonist) may be used

55

Neuroleptic malignant syndrome is similar to serotonin syndrome, but does not feature:

hyperreflexia or clonus.
In addition, it is characterized by bradykinesia and "lead pipe" muscular rigidity, differing from the hyperkinesia of serotonin syndrome

56

Which patients are considered for bacterial endocarditis prophylaxis?

prosthetic valves, hx of endocarditis, unrepaired cyanotic CHD, repaired CHD using prosthetic material in the first 6 months, repaired CHD with residual defects, heart transplant with valvular disease

57

In which scenarios do patients get bacterial endocarditis ppx?

high risk procedures: dental manipulation (amoxicillin/ampicillin),
respiratory tract procedures with incision or biopsy, procedures in patietns with established ongoing GI/GU infection (amoxicillin/ampicillin),
or infected skin or musculoskeletal tissue (vanc/clinda). OR cardiac surgery

58

How can you differentiate between TSH-secreting pituitary adenoma and thyroid resistance syndrome, both of which are characterized by elevated TSH, T3 and T4?

Though both have elevated TSH, T3, and T4, in TSH-secreting pituitary adenoma, there are increased a-subunit levels
ALSO, those with thyroid hormone resistance syndrome are likely to be hypothyroid.

59

What is familial dysalbuminemic hyperthyroxinemia?

These patients have increased T4 and normal T3 because abnormal albumin has a high affinity to T4 but not T3. These patients have normal TSH

60

Clinically, how can you differentiate between PMR and polymyositis?

Polymyositis is generally characterized by muscle weakness (not pain)

61

What are Forschheimer spots?

Patchy erythema on the soft palate (seen in rubella)

62

T/F: Management of saggital sinus thrombosis requires heparin anticoagulation, even when there is hemorrhagic infarction on CT

True! Hemorrhagic foci are 2/2 to venous hypertension in this case

63

Patients who are going to be treated with corticosteroids for more than 3 months (or more than 6 months at

baseline and every year

64

Treatment with what is beneficial for patients with hypertension and CKD who have proteinuria > 500-1000 mg/day

ACEI/ARB

65

The diagnosis of acute mesenteric ischemia is best made wiith?

CT angiogram

66

How does acute COLONIC ischemia present?

transient reudction in blood flow to colon due to hypovolemic states/ischemia to bowel. Watershed areas (splenic flexure, rectosigmoid). More lateralized abdominal pain followed by bloody diarrhea. Pain is mild to moderate

67

Symptomatic pulmonary disease is usually an indication for WHAT therapy in sarcoidosis (esp if accompanied by systemic symptoms like severe fatigue, fever, and hypercalcemia).

corticosteroid therapy

68

What are contraindications to the DTaP vaccine?

A hx of anaphylaxis or encephalopathy w/in 7 days of DTap are true contraindications. Temporary contraindications include moderate or severe illness (with fever); administer when fever resolves

69

Which meds are associated with development of Cdiff?

FLQs, enhanced spectrum PCNs, cephalosporins, and clinda

70

Syndeham's Chorea develops how long after streptococcal infection?

1-8 months! (carditis and arthritis develop within 3 weeks)
SC is characterized by emotional lability and irregular, rapid jerking movements of the face, hands and feet

71

What is tetrabenazine?

a dopamine antagonist used for Huntington disease

72

What are the major criteria for acute rheumatic fever? Minor criteria?

Major: JONES (migratory arthritis, carditis, subcutaneous nodules, erythema marginatum, syndenham chorea)
minor: fever, arthralgias, elevated ESR/CRP, prolonged PR

73

Describe "senile gait"

"walking on ice!" Feet wide apart, knees and hps flexed, arms flexed and extended as if expecting to fall

74

Describe spastic parapesis:

patient drags legs forward with every step. Characteristic circular leg movements, known as "scissoring gait"

75

What is the gait in cerebellar ataxia?

"drunken sailor gait." Jerky gait, zigzag partner, irregular rhythm of steps

76

What is the gait in distal LMN disease?

steppage gait, foot drop, excessive elevation of the legs during walking (toes touch the floor before heels)

77

What are the treatments for endometriosis?

medical: NSAIDs, GnRH analogs, danzol (synthetic androgen) and OCPs
surgical: removement of lesions through bipolar coagulation
**in a patient with severe symptoms (including infertility), laparascopy for establishing diagnosis must be performed first

78

Which patients with Hep C should be treated with interferon and ribavirin?

chronic Hep C having HCV RNA positive, consistently elevated ALT, and at least MODERATE inflammation on liver biopsy.
Normal ALT level and mild inflammation without fibrosis can be observed

79

Microhematuria and anemia are classic for which infective disease?

schistosoma haematobium. Diagnosed with urine microscopy to demonstrate parasite eggs in teh urine (or the stool)

80

What can prevent febrile nonhemolytic reaction?

leukoreduction

81

HSP is a nonblanchable nonpruritic vasculitis across legs and buttocks due to

IgA deposition

82

What is the intermittent and nausea in HSP due to?

small-bowel intussuception

83

What is antecedent to HSP in 50% of patients?

URI

84

What is the triad of HUS? What is the pentad of TTP?

HUS triad: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure
TTP pentad: microangiopathic hemolytic anemia, thrombocytopenia, renal failure, AND fever and neuro impairment (like confusion)

85

Who should get CTs for lung cancer? When?

low dose chest CT yearly, ages 55 - 80, and if patient has 30 pack years or more AND the patient is a current smoker or quit smoking in the last 15 years
STOP if patient over age 80, if they quit smoking for 15 years or more

86

Which conditions have increased carpal tunnel?

DM, RA, and hypothyroidism.
Also obesity, wrist trauma/fx, acromegaly, pregnancy, mmenopause, and ESRD

87

When is surgery indicated for carpal tunnel syndrome?

motor weakness, atrophy of the thenar eminence. Or when conservative treatments have failed

88

What are safety concerns of long term PPI use?

increased risk of osteoporosis and hip fracture. Increased enteric infections, hypo mag, interstitial nephritis, and decreased absoroption of B12 and iron

89

When do you swtich from IV insulin infusion to SQ in management of DKA and HHS?

able to eat, glucose less than 200, anion gap less than 12, HCO3 greater than or equal to 15

90

When is anterior shoulder pain seen?

patients with acromioclavicular or glenohumreal joint osteoarthritis and biceps tendonitis

91

When is lateral shoulder pain seen?

rotator cuff tendonitis

92

When is posterior shoulder pain seen?

referred from cervical spine (nerve impingement, spinal stenosis)

93

All patients initially diagnosed with Turner syndrome require:

visual and hearing assessment, renal ultrasound (predisposed to kidney amlformation like horseshoe shaped kidney), and TSH level measurement (predisposed to autoimmune endocrinopathy esp hypothyroidism)

94

Streak goands in Turner's syndrome increase a patient's chances for malignancy when...

there is an associated mosaicism with a Y chromosome

95

Most physicians begin prescribing hormone replacement therapy for Turner's patients when they reach ___ years of age

14 years of age