Uworld Int Med-5-21

wumimimu's version from 2015-05-22 02:58


Question Answer
What are the clinical features of anaphylactic reaction?Urticaria, angiodema, rapid onset of shock, and resp distress; occurs within few seconds to minutes after transfusion; recipient anti-IgA antibodies
What is transfusion related acute lung injury?Resp distress and signs of non-cardiogenic pulm edema; occurs within 6 hours of transfusion; donor anti-leukocyte antibodies
Why does primary hypotension reaction occur in transfusion?Patients who are on ACEi, transient hypotension, blood products contain bradykinin which cannot be broken down in these patients; occurs within minutes
What should be done to products given to IgA deficient patients?They should received washed red cell products and igA deficient plasma
What is the immediate treatment for anaphylaxis?Causative agent needs to be eliminated, intramuscular admin of epinephrine, perhaps vasopressors and ventilation suppor histamine blockers and glucocorticoids
What is febrile nonhemolytic transfusion reaction?Most common reaction to transfusion; Occurs within 1-6 hours; fever, chills, malaise; stored blood leukocytes release cytokines that accumulate
What are the recommendations for colon cancer screening for avg risk patient?Screening should begin at age 50, FOBT annually, flexible sigmoidscopy every 5 years/FOBT every 3 years, or colonoscopy every 10 years
Recommedations for a patient with first degree relative, colon cancer screening?10 years before the relatives age of dx.
Guidelines for lung cancer screening?Annual low-dose chest CT, patients age 55-80, with >= 30 pack-year history of smoking
What auscultory findings would be present in MS?Loud first heart sound, and opening snap after S2; low-pitched diastolic rumble heard at the cardiac apex
What arrythmia are chronic mitral stenosis patients prone to?atrial fibrillation (enlargement of the LA)
Which arrythmias can patients with interstitial lung disease present with?multifocal atrial tachycardia; frequent premature atrial beats
How does rheumatic heart disease present?Gradual and progressively worsening dyspnea and orthopnea
What can cause elevation of the left main bronchus on CXR?Left atrial enlargement (severe)
How are mild SIADH patients treated?fluid restriction <800 ml/day, maybe loop diuretics, Possible oral salt tablets
How are moderate SIADH patients treated?IV hypertonic saline in the frist 3-4 hours to inc Na>120,
How are severe SIADH patients treated?IV boluses of hypertonic saline until sx resolution, and vasopressin rec antagonists
What labs would you see hyponatremia in SIADH?Serum osm <290, urine osm >100, Urine sodium> 40
How long should a patient with idiopathic DVT be on warfarin, goal INR?6 months (3 months of reversible risk factor known), goal INR 2-3
What INR do we want in a patient with prosthetic heart valves?2.5-3.5
When does the risk of bleeding substantially increase in patient on warfarin?When INR increases abvoe 4
What are the major SE of radioiodine therapy for graves disease?hypothyroidism and worsening of graves opthalmopathy: can be treated with high dose steroids before and after treatment
What are the most common causes of anemia in lupus patients?ANemia of chronic disease, nephritis-caused, iron-deficiency(drugs like NSAIDs), autoimmune hemolytic
What are the most common causes of thromobocytopenia and leukopenia in lupus patients?autoimmune destruction
What is the most important prognostic factor in breast cancer?TMN staging, then ER, PR status, then Her-2/neu status, then histological grade
What changes are seen in the eye with papilledema?enlargement of the blind spot, transient vision loss with change in head position, may lead to permanent vision loss
When are headaches due to increased ICP the worst?in the morning
Morning headaches in young woman who is fat?Pseduotumor cerebri, ICH
What is amaurosis fugax?Transient monocular blindness that has vascular etiology: ex) embolus to opthalmic artery
How does ant uvetiis present and posterior?ANterior: redness, eye pain, posterior: floaters, painless, reduced visual acuity
What are the 5 P's of acute limb ischemia?Pain, pulselessness, pallor, paresthesias, poikilothermia
What is the treatment for patient with acute limb ischemia?intra-arterial thrombolysis or mechanical embolectomy.
cilostazol?inhibits platelet aggregation and causes vasodilation
Anterolateral femoral bowing is found on x-ray in what disease?Pagets disease of bone
What are some abn and sx of pagets disease?Osteoclast dysfunction, elevated alk phos, bone pain, skeletal deformities,and hearing loss
What are the common bones/areas affected by pagets?Pelvis, skull, long bones, and spine
Tenderness to gentle percussion over spinous process of vertebrate?Vertebral osteomyelitis!
What lab findings are seen in vertebral osteomyelitis?Grossly elevated ESR, high/normal WBC, elevated platelets
What is the most sensitive imaging to detect vertebral osteomyelitis?MRI
What are the major toxicities of cyclosporine?Nephrotoxicity, neurotox, malignancy, glucose intolerance, infection, hyperkalemia, hypertension, gum hypertrophy, hirsutism, and tremor
What are the major tox of tacrolimus?Nephrotox, hyperkalemia, hypertension and tremor (same as cyclosporine)
What are the tox of azthioprine?dose related diarrhea, leukopenia, and hepatotoxicity
What are the tox of mycophenolate?Bone marrow suppression!
What electrolyte abn can be seen in nephrotox induced by cyclosporine?Hyperkalemia, hyperuricemia, hypophosphotemia, and hypomagnesemia
What are the clinical manifestations of hemochromatosis?Hyperpigmentation, arthalgia, chondrocalcinosis, diabetes, hypothyroidism, secondary hypogonadism, cirrhosis, dilated and restrictive cardiomyopathy, and conduction abns, increased susc to infections by yersinia enterocolitica, vibrio vulnificus, and listeria
What is endocardial fibroelastosis?Diffuse fibroelastic thickening of the left ventricular endocardium, causes restrictive cardiomyopathy in the first 2 years of life
What is the only drug effective against mucormycosis, rhizopus?Amphotericin B, usually also need surgical debridement
What are the characteristics of cerebellar tremor?Usually associated with gait disturbance, ataxia, and dysmetria, tremor increases as hand steadily moves toward object
What kind of tumor is essential tremor?Action tremor, no other neurological signs in the patient; can get better with alcohol
Which anticonvulsants can be used to treat essential tremor?Topirimate and primidone
What is the most modifiable risk factor for OA?Obesity
What should be suspected in an alcoholic smoker with a palpable cervical lymph node?Squamous cell carcinoma
What is the first test that should be done if sq cell carcinoma is found at cervical lymph node?Panendoscopy to find source
What are the drugs that can induce idiopathic intracranial hypertension?Tetracyclines, growth hormones, hypervitaminosis A
What are the common sx of IIH?Headache, visual loss, pulsatile tinnitus, and diplopia
How can you dx IIH?LUmbar puncture, w/ opening pressure >250; MRI +/- MRV
What is the treatment of IIH?Weight loss and acetozolamide, stop the offending drugs
What are the EKG changes seen in HCM?Tall R wave in aVL and deep S wave in V3; repolarization changes seen in anterolateral leads
A decrease in preload causes what to HCM murmur?Increase in murmur intensity
An increase in preload or afterload does what to HCM murmur?Decreases murmur intensity
What are the two most common gene mutations in HCM?Cardiac myosin binding protein C and beta-myosin heavy chain gene
What kind of murmur is HCM murmur?crescendo, decrescendo murmur, at left sternal border or apexq
TMP-SMX is used as prophylaxis in which patients?HIV patients against PCP and toxoplasmosis
CD4 count for toxo?<100

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