Uworld 7-2-2015

wumimimu's version from 2015-07-03 12:57


Question Answer
Where does afib usually originate from?The pulmonary veins.
Where does a flutter usually originate from?the tricucpid annulus
What are the alzheimers drugs?cholinesterase inhibitors: donepezil, galantamine, rivastigmine; and NMDA receptor antagonist: memantine
What is amantadine?Dopamine agonist used in the treatment of Parkinson's
What do HSV and VZV do to the eye in HIV patients?Rapidly progressing b/l necrotizing retinitis associated with keratitis/conjunctivitis; fundoscopic exam shows central retinal necrosis and pale peripheral lesions
How does CMV retinitis present differently from HSV/VZV retinitis?Painless, and not associated with keratitis/conjunctivitis, fundoscope exam shows fluffly, granular retinal lesions with hemorrhage
What is the initial treatment for RA?A DMARD!!! methotrexate usually; but other DMARds include azthioprine, leflunomide, sulfasazine, hydroxychloroquine) if not responsive after 6 months, then step up to a biologic agent
What is the most specific finding for dementia vs normal aging?Functional impairment in daily activities
What is De Quervains tenosynovitis?Classically affects new mothers who hold their babies with thumb extended/abducted. Inflammation of the tendons of abductor pollicis long and extensor pollicis brevis, as they pass through sheath at radial styloid process. Can confirm dx w/ finkelstein test
What is trigger thumb?Pain in the palmar area over the first MCP joint, and locking of the thumb in flexion
What is the standard of treatment for symptomatic PAC's?Beta blockers
What are reversible risk factors for PACs?Caffeine, tobacco, stress, and alcohol
How do you distiguish between leukomoid reaction and CML?The Leukocyte alkaline phophatase score is high in leukomoid reaction, usually low in CML
What are the criteria met to dx SIADH?Euvolemic volume status, serum osm <270, urine osm> serum osm, urine Na > 20,
EUvolemic hyponatremia with low urine osm?psychogenic polydypsia or beer potomania
Hypovolemic hyponatremia with low urine Na?Non renal losses: diarrhea, vomiting, dehydration
Hypovolemic hyponatremia with high urine Na?Renal losses: interstitial nephritis, diuretics, minerlocorticoid def, Ace inhibitor
What is the effect of hyperthyroidism on bone?causes bone loss over time
What are the common chemo drugs that cause peripheral neuropathy?Stocking-glove peripheral neuropathy: Vinca alkaloids, taxnes, and platinum based drugs
How do you treat hemodynamically stable/asymptomatic VT?IV amio, lidocaine, procainamide
How do you treat unstable SVT w/abberancy or unstable VT?electrical cardioversion
What are the causes of secondary hyperaldosteronism?Cushings syndrome, renovascular disease, renin-secreting tumor, diuretic use
Hypertension, hyperglycemia, and hypokalemia>Cushings!
How does CRVO present?Painless loss of vision, not as acute as CRAO; blood and thunder appearance on fundoscopic exam.
How is amaurosis fugax caused?Atheroemboli from carotid artery: usually only transient
What can ureteral colic do to the bowels?Through a vagal reaction,, can cause illeus
What are the symptoms of dig toxicity?Nausea, vomiting, diarrhea, decreased appetitie, confusion, vision changes, arrythmias,; remember, renally cleared!
What makes one susceptible to dig toxicity?Hypokalemia! diuretic use!
What is the rate of atrial flutter?250-350
What is the most common arrythmia caused by dig toxicity?Atrial tachycardia with AV block: fairly specific
What do lacunar strokes usually not present with?Cortical signs and mental status changes
Lesions in vertebrobasilar system supplying brainstem cause?Alternate syndrome: contralateral hemiplagia, ipsilateral CN involvement
A pure motor lacunar stroke usually has its origins where? The posterior limb of the internal capsule
A pure sensory lacunar stroke usually has its origins where?Thalamus
When are dendritic ulcers in the eye seen?Herpes simplex keratitis: The most common cause of corneal blindness in the US
Why does hypomagnesemis sometimes mimic hypocalcemia?It causes decreased PTH release and responsiveness to pTH
What is the initial manifestation of hypocalcemia?Hyperactive deep tendon reflexes
What are the sx of hypermagnesmia>Loss of deep tendon reflexes, muscle paralysis, apnea, and cardiac arrerst
How do loop diuretics cause VT?Hypokalemia and hypomagnesemia
How should acute pancreatitis be managed?NPO, iv fluids and analgesics (preferably, meperidine or fentanyl over morphine)
How is acute gout treated?NSAIDs,(indomethacin), colchicine, or steroids
How does alcohol cause gout?Ethanol is metabolized to lactate, and lactate competes with urate for excretion in the renal tubules
What is the most common cause of constrictive pericarditis in developing countries?Tuberculosis
What are the most common causes of secondary clubbing?LUng malignancies, right to left shunts, and cystic fibrosis
What condition commonly accompanies clubbing?HYpertrophic osteoarthropathy: Enlargement of joints, periostosis of long bones, and synovial effusionsn
What is Shy-Drager Syndrome (MSA)?Disorder with parkinonian sx, autonomic dysfunction, and widespread neurological dysfunction
What is RileyDay syndrome?Gross dysfunction of autn. nervous system, seen in children of ashkenazi jewish people
What separates an exertional heat stroke and exertional heat exhaustion In stroke there are CNS dysfunction signs along with temp>104,
Why is a nephrotic syndrome patient at risk for mI and stroke?They have abnormal lipid profiles: hypercholesterolemia and they are hypercoaguable.
What can GERD to in asthma?Worsen it, by increasing vagal tone, microaspiration, and increasing bronchial hyperreactivity
What are some signs of brain death?No pupillary light reaction or oculovestibular reflex, failed apnea test (no spont resp at PCO2 > 60), no inducable heart rate acceleration with atropine injection
What is one neuro sign that may be present in brain death?Deep tendon reflexes
Back pain, anemia, renal dysfunction, and elevated ESR in old person?Multiple myeloma!
What are the sx of hypercalcemia?Constipation, anorexia, vomiting, weakness, polyuria (Due to Nephrogenic DI), and mental status changes (neuro sx)
What is melanosis coli and when is it seen?brown discoloration of the colon with lymph follicles shining through as pale patches: seen in laxative abuse- factitious diarrhea
What is the most common pulm manifestation of diffuse SSc?Interstitial pulm fibrosis. pulm arterial HTn can also occur but is more commonly seen with the limited form
WHat is common long term treatment in relapsing-remitting MS?Beta interferon
What genetic mutation is seen in MEN2?RET protooncogene
in patient getting splenectomy, how long does the risk of sepsis from encapsulated organisms last?>30 years
What should be done for a splenectomyy patient?H. flu, pneumococcal, and meningococcal vaccine several weeks before splenectomy, and then penicillin prophy for 3-5 years after, or until they reach adulthood
How does vit D toxicity present?Hypercalcemia! Abd pain, constipation, polyuria, and polydypsia
What are the sx of angiodysplasia and when is it seenRecurrent, painless, occult GI bleeding, anemia: usually seen in the setting of AS or ESRD