Uworld Int Med 6-20-2015

wumimimu's version from 2015-06-20 22:28


Question Answer
What are the sypmtoms of rubella?Conjunctivitis, coryza, cervical lymphadenopathy, fever, maculopapular rash that spread from head to trunk in 24 hours, and arthritis in women
What differentiates rubella from measles?IN measles, the rash spreads from head to trunk over longer time period, also fever is higher 104 or greater, and there is no arthritis
What constitutes a complicated peripneumonic effusion?exudative effusion: ph<7.2, glucose <60, elevated LDH; however, if the culture is positive/gram stain +, then empyema
Which types of effusions have same characteristics as complicated peripneumonic effusion?Drug-induced lupus effusion, rheaumatoid pleurisy, tuberculosis, malignancy,
what are the characteristics of pulm embolus caused effusion?Usually exudative, but normal pH and normal glucose
What are the three main drugs implciated in drug induced lupus?Hydralazine, procainamide, and INH
How is cat scratch disease treated?Most people will have resolution of sx on their own; but it is recommeded giving a 5-day course of azithromycin
Culture negative urethritis in sexually active male?chlamydial urethritis: treat with doxy or azithro
How is the diagnosis of chlamydial urtheritis made?First catch urine or more commonly, nucleic acid amplification
What are acute tx for migraine headaches?IV Antiemetics: chlorpromazine, prochlorperazine, and metoclopramide; triptans and NSAIDs, ergots
What are prophyalctic meds for migraine?Beta blockers, and TCA's,
When should vaccines be administered to asplenic patients?either >/= 14 days before splenectomy, or >14 days after splenectomy
What vaccines should be given to asplenic patients?First PCV13, and then PPSV23 8 weeks later (then every 5 years and then at age 65), meninococcal vaccine (every 5 years), Hib vaccine once, Hep A and B vaccines, Tdap vaccine and the Td vaccine every 10 years
What are the ABCDEs of melanoma?Assymetry, border, color (many), diameter >6mm, and evolving; family hx/personal hx, >10 nevi, hx of dysplastic atypical nevi, fair skin and frequent sunburns are also risk factors
What is a keratinacanthoma?A dome shaped nodule with a central keratin plug- benign tumor
CT scan showing pulm nodules w/ halo sign aspergillosis
How does cocciodomycosis infection present?Fever, malaise, dry cough,weight loss, and pleurtic chest pain: can present with erythema multiforme or nodosum and arthalgias
Blastomycosis what parts of body does it affect?Lungs, skins, joints, bones, and prostate,
What is the most common complciation of CABG?Afib
How is hemodynamically unstable afib treated? stable?DC cardioversion; if stable can be treated pharmocologically- rate control meds like digoxin
What is lidocaine used for?Ventricular arrythmias
What is transcutaneous pacing used for?symptomatic bradycardia
What are the sx of corneal abrasion?Severe eye pain, sensation of foreign body in the eye, photophobia with reluctance to open eye
What could cause trigeminal nerve dysfunction?tumor, trauma, prior herpes zoster infection
What is porcelain gallbladder caused by and what are the risks?Chronic cholecystitis and increased risk of gall bladder cancer
What is HIT type 1?Nonimmune degradation of platelets, usually occurs within 48 hours of therapy, platelets remain >100,000, not clinically significant
What is HIT type 2?Immune mediated reaction; platelet activation, thrombocytopenia, and pro-thrombotic state; antibodies to heparin-platelet-factor 4 complexes; usually 5-10 days after therapy; stop heparin therapy
What is the test we use to confirm HIT?Serotonin release assay q
How do we treat HIT?Stopping all heparin products, getting a serotonin release assay, switching to direct thrombin inhibitor, and then bridging to warfarin once platelet >150,000
What happens to SVR, CI, and LVEDV/P in LV systolic dysfunction?Reduced CO/CI, increased LVEDP, and increased SVR
What are the components of metabolic syndrome?Hypertension, HLD, glucose intolerance, HDL<40/50, TG>150, abd obesity: 3 of these 5 criteria
What is the most important pathogenic factor for metabolic syndrome?Insulin resistance
How do we treat ARDS?Mechanical ventilation, low tidal volumes, and PEEP with levels up to 15
What is ards?A form of non-cardiogenic pulm edema caused by leaky alveolar capillaries
What are the symptoms of wernicke's encephalopathy?Confusion, ataxia, and opthalmoplegia
When does hypertensive encephalopathy occur?BP >180/120, treat with labetalol or nitroprusside
Does a single negative FOBT in elderly with IDA rule out Gi bleed?no; must do colonscopy/endoscopy
How is pemphigus vulgaris treated?With steroids or immunosupressant agents such as azthioprine and methotrexate
How is OSA treated?weight reduction, avoidance of sedatives and alcohol, and avoidance of the supine position in sleep; CPAP and surgery can also be used
When is pulsus paradoxus seen?In tamponade/effusion; and also in severe asthma/COPD
What kind of meningitis are myalgias most common in?Meningococcal (also more severe)
How does encephalitis present?Focal neuro findings, AMS, fever
What are the most common drugs causing type 1 hypsens reactions?Beta-lactams, neuromusc blocking agents, antibodies, platinum chemo drugs, and quinolones
What can happen when infectious mono is treated with antibiotics?Maculopapular rash that develops after 24 hours
What else other than hereditary speherocytosis can present with spherocytes?Autoimmune hemolytic anemia
Compared to intravasc hemolysis, extravasc hemolysis presents with what?low to normal haptoglobin, slightly elevated LDH, and increased indirect bilirubin
When is pneumomediastinum seen?Rupture of the esophagus
Cancer of pancreas head presents with?Intra and extra hepatic bile duct dilation, enlarged nontended gall baldder, jaundice, abd pain and weight los
What is the most sig cause of morbidity in patients with TBI?Diffuse axonal injury
How does DAI occur and what are the findings sx?Acceleration-deceleration injury; blurring of the gray-white matter junction on CT/MRI, numerous punctuate hemorrhages; patients lose conciousness immediately and then are in persistent vegetative state
How is COPD exacerbation treated?Bronchodilators, Steroids, and furosemide if severe fluid back up from pulm HTN and cor pulmonale
What is the most common initital DMARD used in RA?Methotrexate
What are side effects of methotrexate?Hepatox, stomatitis, cytopenias, alopecia, and pulm tox
What is felty syndrome?Neutropenia and splenomegaly in patients with longstanding RA
NSAIDs and IDA in an old person?Look for GI bleed!
How do you treat agitation in elderly hospitalized patients?Haloperidol or other typical/atypical antipsychotics; avoid BZDs! also dont use typical antipsychotics in those with Lewy body dementia
What are the most common causes of ARRheumatic fever, congenital bicuspid aotic valve, and aortic root dilation
What are some secondary causes of Restless leg syndrome?IDA, diabetes, uremia, MS, meds, pregnancy, Parkinsons
What is the treatment for RLS?dopamine agonists, and gabapentin
How do we screen for diabetic nephropathy?Urine microalbumin to creatinine ratio
What are the signs of massive pE?Right heart strain (new RBBB, JVD) and hypotension, can lead to cardiogenic shock and death quickly