Uworld Int. Med 6-13-2015

wumimimu's version from 2015-06-13 22:07


Question Answer
What predisposes one to acute acalculous cholecystitis?Prolonged fasting, TPN, severe burns, trauma, mechanical ventilation. Basically very sick patiebnts
What are the criteria needed to diagnose ARDS?ARDS risk factors (infection, trauma, and massive transfusion), occuring within one week of initial insult, severe hypoxemia PF<300, resp distress, bilateral alveolar infiltrates, bilateral diffuse crackles, rule out of cardiac etiology, and rule out of hydrostatic pulm edema
What is respondent bias?When the outcome is obtained by the patient's response rather than objective diagnostic method
What is the initial test of choice in suspected toxic megacolon?Abd x-ray showing dilated colon greater than 6 cm
What are the criteria for diagnosing toxic megacolon?Radiographic evidence of colon distension + (at least 3 of the following): fever >38, PMN/leuko >10,500, heart rate >120,anemia + (at least on of the following): electrolyte disturbances, AMS, hypotension, volume depletion
What are the symptoms of spinal epidural abscess?Classic triad: severe focal spinal pain, fever, and neurologic deficits; eventually radiculopathy, motor and sensory loss, incontinence, and paralysis
How do you workup spinal epidural abscess?CBC, inflammatory markers, MRI with gad contrast, CT-guided aspiration/bx, antibiotics, and immediate surgery for decompression of cord
How does one present with glucogonoma?Weight loss, diarrhea, anemia, Mild diabetes/hyperglycemia, NME (necrotic migratory erythema on face, perineum, and extremities), and glucogon levels >500
What are the first steps taken when person arrives in the ED?ABC's = airway, breathing, and circulation!
When are anti-glutamic acid decarboxylase antibodies seen?In late onset, autoimmune diabetes type 1
What are the signs and sx of PE?Sudden onset dyspnea, pleuritic chest pain, cough, and hemoptysis; hampton's hump on CXR, wedge shaped lesion on CT,pulm artery filling defects in cont-enhanced CT, mild fever and leukocytosis may also be present
What are risk factors for group B endocarditis?Diabetes, alcoholism, IVDU, hepatic failure, carcinoma, elective abortion
What are the signs and sx of waldenstrom's macroglobulinemia?IgM spike on SPEP, hyperviscosity sx, enlargement of spleen, liver, and lymph nodes, anemia, night sweats, headaches, and dizziness, visual sx, tendency to bleed and bruise easily, ,and pain and numbness in ext (due to demyelination)
When is it possible to have celiac disease but negative antibodies?Concurrent selective IgA deficiency
How does acute MR affect the left side of the heart?Causes increased pressures in the :LA, and therefore, increased LVEDP too, this results in pulm edema
When should upper GI endoscopy be done for sx of dyspepsia?age >55, or alarm sx: weight loss, gross/occult bleeding, anemia, early satiety, dysphagia, or persistent vomiting
What kind of testicular tumor can cause in increase in testosterone and estrogen?Leydig cell tumors, can occur at any age. may present with precocious puberty or gynecomastia
What are the most common causes of AL amyloidosis and what does it consist of?mutiple myeloma, and waldenstroms' lambda light chains
What is the most common causes of AA amyloidosis and what does it consist of?Chronic infections, RA, IBD, and other chronic inflammatory conditions, beta 2 microglobulin, apolipoprotein, and transthyretin
How is amyloid seen in the kidneys?Congo red stain, apple green birefringence under polarized light, and thin fibirils randomly arranged on EM
How is central retinal artery occlusion treated?This is an emergency, and is treated with ocular massage and hyperbaric oxygen
what is seen on fundoscopic exam in CRAO?diffuse ischemic retinal whitening and cherry red spots
What are common causes of steppage gait?L5 radiculopathy (also associated with weakness in plantarflexion and inversion) and common peroneal neuropathy.
What is gait apraxia and what causes it ?Start and turn hesitation (magnetic gait), frontal lobe degeneration and NPH
What is the most common middle ear pathology in HIV/AIDS patients?Serous otitis media. usually from HIV lymphadenopathy/lymphoma, presents with middle ear effusion, conductive hearing loss, no active infusion; tympanic membrane is dull and hypomobile
Tight glycemic control in diabetes patients prevents what?Microvascular complications (nephropathy, retinopathy, etc)
What are the best initial screening tests for adrenal insufficiency?early morning cortisol, ACTH and cosyntropin stimulation test
How should lyme disease be treated in children <8 and pregnant women?amoxicillin, not doxy!
How does ethylene glycol tox present?hypocalcemia, tetany, calcium oxalate stone deposition in the kidneys: hematuria, flank pain, oliguria, severe anion gap metabollic acidosis
How do you treat ethylene glycol intoxication?Fomepizole, sodium bicarb for the acidosis, and perhaps, hemodialysis for end organ damage and severe acidosis
What is metoclopramide used for?Prokinetic dopamine antagonist used for nausea, vomiting and gastroparesis;
What are the side effects of metoclopramide and what is given for toxicity?Agitation, loose stools, and extrapyrimdal symptoms; stop the med and give benztropine or diphenhydramine q
WHat is the most common cause of B12 deficiency and what is it associated with?Pernicious anemia; chronic atropic gastritis- gastric cancer
What is the most common cause of new onset blood tinged sputum, in young person with recent URI and no malignancy risk factors?Acute bronchitis: probably vital etiology
When is defibrillation used?Pulseless VT and Vfib
When is cardioversion used?sustained/symptomatic monomorphic VT, afib w/RVR hemodynamically unstable
What is done in pulseless electrical activity or aystole?CPR and vasopressor support while trying to figure out cause (5h's and 5t's)
What are the 5h's and 5 T's? (reversible causes of PEA/asystole)Hypovolemia, hypoxia, H+ions, hypo/hyper kalemia, and hypothermia; tension pneumothorax, tamponade, toxins, thrombosis, and trauma
What does the typical bx of tropical sprue look like?Blunted villi in the small intestine with chronic inflamm cell infiltrate: plasma cells, lymphocytes, and eos'
What are some findings in sarcoidosis?Hilar lymphadenopathy, noncaseating granulomas on bx, elevated ACE levels
How is alcoholic hepatitis characterized on bx?Mallory bodies, PMN infiltration, liver cell necrosis, perivenular dist of inflammation
What are the signs and sx of HS?Hemolytic anemia, jaundice, splenomegaly, elevated MCHC, elevated bilirubin (juandice, dark urine, and pigment gall stones),
How are HS patients treated?splenectomy if needed, cholecystectomy if pigment gall stones, and folate supplementation
What should be done in pt with BPH and AKI?Creatinine measurement, UA, and renal ultrasound to look for hydronephrosis and other obs patholgy
WHat is sympathetic opthalmia?When injury to one eye occurs after penetrating injury to the other eye due to uncovering of hidden antigens
What are the meds for asthma?intermittent- beta-2 agonist, mild persistent- add on low dose inhaled corticosteroids, mod persistent- add on long acting beta-2 agonist, severe persistent- up the dosage of the inhaled corticosteroid q
What happens to calcium in PE?When you have a PE, you hyperventilate and create alkalosis, increased pH cuases H+ to dissociate from albumin more Ca2+ binds resulting in clinically evident hypocalcemia
What are the side effects of CCB;s?Peripheral edema(can be reduced with concurrent use of ACEi), headache, flushing, and dizziness