Usmle World Sim Review 1

Front 1

Noninfectious watery diarrhea

Back 1

1. Hyperproduction of VIP (pancreatic cholera)
2. Carcinoid syndrome
3. Oral admin of non-absorbable osmotic agents

Front 2

TPN has which associated electrolyte disturbances?

Back 2

1. hypokalemia
2. hypomagnesemia
3. hypophosphatemia
(refeeding syndrome)

Front 3

Describe thyroid hormone and TSH changes during pregnancy

Back 3

1. Thyroid gland enlarges in size
2. Increased free T4 and T3 because of thyroid-stimulating activity of hCG
3. Incr T4 and T3 cause decr in TSH and TRH (decr by 10-20% NORMALLY in pregnancy)
4. Free T4 and T3 are in normal range during pregnancy

Front 4

What effect does estrogen have on thyroxine-binding globulin?

Back 4

Estrogen increases TBG which leads to incease in total T4 and T3 but free T4 and T3 remain the same

Front 5

Methanol poisoning (eg in windshield cleaning solution)

Back 5

Would cause visual disturbances

Front 6

Ethylene glycol poisoning

Back 6

metabolic acidosis
low pH
low bicarb
possibly low CO2 to compensate
will be gapped!

other sx: formation of calcium oxalate crystals, hematuria, flank pain

Front 7

Emphysema
Hypoventilation

Back 7

Respiratory acidosis
low pH
high CO2

Front 8

Hyperventilation

Back 8

Respiratory alkalosis
high pH
low CO2

Front 9

Vomiting
Diuretic use

Back 9

Metabolic alkalosis
high pH
incr bicarb

Front 10

Reactive NST

Back 10

Considered reactive if 2 or more HR accels of 15 bpm over the baseline that last for 15 seconds over a 20 minute interval

Front 11

Nonreactive NST

Back 11

Baby is sleeping so arouse with vibroacoustic stimulation.
If test remains nonreactive, then concern - possible placental insufficiency causing hypoxemia

Front 12

Ecthyma gangrenosum

Back 12

Associate with pseudomonas; initially erythematous and tender; then evolves to nontender nodules with central necrosis

Front 13

Syncope associated with preceding prodromal dizziness and blurred vision when getting up from supine to standing position is associated with?

Back 13

Orthostatic hypotension (antihypertensives or alpha-blockers for BPH are common cause)

Front 14

Vasovagal syncope with preceding prodromal nausea, pallor and diaphoresis that occurs after urinating?

Back 14

Micturation syncope

Front 15

Describe cardiac tamponade

Back 15

1. Pericardial fluid exerts pressure on heart
2. Thus, decrease CO
3. During deep inhalation, negative thoracic pressure allows for a pressure difference between the vena cava and the right atrium
4. Pulsus parodoxus (large decr in systolic blood pressure upon inspiration)
5. See loss of radial pulse during inspiration!

Front 16

in the setting of tamponade, what happens to systemic venous pressure?

Back 16

it increases because right atrial filling is impaired; however lungs sound clear!

Front 17

HSV encephalitis

Back 17

1. Fever
2. Headache
3. Confusion/agitation
4. Stupor
5. EEG shows abnormalities in frontotemporal region

Front 18

HSV encephalitis - CSF findings

Back 18

1. lymphocytic pleocytosis
2. normal glucose
3. normal protein
4. xanthochromia from increased RBC destruction/hemorrhage from frontotemporal lobes. (looks yellow)

Front 19

Bacterial meningitis

Back 19

1. low glucose
2. elevated protein
3. neutrophilic pleocytosis

Front 20

Chronic bacterial meningitis (M. tuberculosis)

Back 20

1. low glucose
2. elevated protein
3. lymphocytic pleocytosis

Front 21

Pseudoclaudication

Back 21

Pain when walking downhill
Pain with both walking and standing
(Exacerbated when walking downhill)

Commonly caused by spinal stenosis secondary to spinal osteoarthritis

Front 22

Polypeptide hormones

Back 22

ACTH

Front 23

Amino acid hormones

Back 23

Seratonin
DA
EPI

Front 24

Important prophylaxis for ALL HIV patients? (Prior to below 200 CD4 count?)

Back 24

Streptococcus pneumoniae

Front 25

Prophylaxis for Toxoplasmosis and Pneumocystis pneumonia when CD4 below 200?

Back 25

Bactrim

Front 26

Prophylaxis for MAC in pt with CD4 below 50?

Back 26

Azithromycin

Front 27

When to start antiretroviral drugs?

Back 27

When CD4 drops below 350

Front 28

Superior vena cava

Back 28

1. HA worse when leaning fwd
2. JVD with lack of edema
3. Facial and UE swelling
4. Conjunctival congestion

Front 29

Primary tx of SVC syndrome

Back 29

Radiation therapy

Front 30

Causes of SVC?

Back 30

1. Fibrosing mediastinitis from granulomatous infxn due to TB or Histo
2. Lung CA

Front 31

Signs and Sx of aspiration pneumonia

Back 31

1. Low-grade fever
2. Dyspnea
3. Productive cough
4. Malaise
5. Occurs over a few days
6. x-ray: posterior basal segment of right lung

Front 32

SBP findings in peritoneal fluid?

Back 32

>250 neutrophils in ascitic fluid

Front 33

Bullous pemphigoid

Back 33

1. Autoimmune blistering disease
2. Knee folds, axilla, groin (flexural areas)
3. Pruritis there
4. 1/3 of pts have oral lesions; usually >60 years of age.
5. Bx under light microscopy: subepidermal blisters; can also look for linear pattern of IgG deposition under IF

Front 34

MRI findings of brain in MS pts

Back 34

1. Ovoid plaques in periventricular region; corpus collosum, and deep white matter

Front 35

Black cohosh

Back 35

Botanical for menopausal and menstrual sx

Front 36

Max B12 for prego?

Low dose ASA CI in prego when?

Back 36

<2.6 mcg

Low-dose ASA CI in 3rd trimester

Front 37

Polymyositis

Back 37

Bilateral proximal muscle weakness (symmetric) with elevation of enzymes like LDH and CPK, and AST/ALT)

Front 38

Polymyalgia rheumatica

Back 38

Proximal muscle tenderness (no elev of enzymes)

Front 39

Todd's paralysis

Back 39

Transient post-ictal neuro sx

Front 40

Fever
Monoarticular joint pain

Back 40

Septic arthritis

Front 41

Conjunctivits
Urethritis

Back 41

Reactive arthritis (secondary to chlamydia or gonorrhea)

Front 42

Migratory/polyarticular/symmetric pain
Inflammatory pain
Knee and hand involvement
Renal disease
Photosensitivity

Back 42

SLE

Front 43

TX of wide-complex tachycardia?

Back 43

Amiodarone!

Front 44

TX of SVT?

Back 44

Adenosine
If not effective, verapamil

Front 45

Most feared complication of esophageal dilation (e.g. for achalsia)?

Back 45

Esophageal rupture leading to mediastinitis leading to sepsis!

Front 46

Signs and sx of mediastinitis secondary to esophageal rupture?

Back 46

1. Chest pain
2. SOB
3. N/V/retching
4. Emesis (with clotted blood)
5. L-sided pleural effusion
6. Pneumomediastinum

Front 47

Do you usually see hematemesis with PE?

Back 47

NO

Front 48

Primary hyperaldosternism (Conn's) - causes?

Back 48

Bilateral adrenal hyperplasia
or
Functioning adrenal adenoma

Front 49

TX of Conn's?

Back 49

Spironolactone

Front 50

Signs and SX of Conn's?

Back 50

1. HTN (secondary to sodium reabsorption and vol expansion)
2. Hypokalemia causing muscle weakness (b/c of potassium excretion)

Front 51

Cause of lethargy, confusion and coma in malignancy (or hyperparathyroid)?

Back 51

Hypercalcemia (>14)

Front 52

Mild or moderate elevated calcium can cause?

Back 52

GI problems (constipation, nausea)
Pancreatitis
Dehydration
Weakness
Kidney stones
Renal failure
Cardiac problems

Front 53

What diuretics worsen hypercalcemia?

Back 53

Thiazides! Because they decrease renal excretion of calcium

Front 54

prophylaxis for decreasing gallstones in gastric bypass?

Back 54

Ursodeoxycholic acid

Front 55

Renal osteodystrophy

Back 55

Chronic renal failure causes
1. phophate retention
2. abnormal vit d processing leads to hypocalcemia
3. secondary hyperparathyroidism with parathyroid hypertrophy

Front 56

SIADH

Back 56

1. Hyponatremia
2. Plasma is hypo-osm
3. Urine is hyper-osm
4. Urine has high sodium

Front 57

TX of overflow incontinence

Back 57

Cholinergic agonist (bethanecol)

Avoid TCA or beta agonist that can exacerbate

Front 58

Mainstay tx of stress incontinence

Back 58

Pelvic floor exercises

Front 59

TX to reduce risk of esophageal variceal hemorrhage?

Back 59

Non-selective b-blockers like propranolol or nadolol

Front 60

Iron poisoning

Back 60

Nausea
Vomiting (with blood)
Diarrhea (with blood; "dark, green stool")
Lactic (metabolic) acidosis
Hepatotox
Bowel Obstruction
Death

Front 61

Antibiotic prophylaxis for dental procedures for patients with the following are needed

Back 61

If high-risk:
1. Prothetic heart valve
2. Prior hx of IE
3. Unrepaired congenital heart disease

do not need if MVP, aortic valve disease (acquired), or bicuspid valve

Front 62

Causes of polyneuropathy

Back 62

1. DM
2. Alcoholism
3. Nutr def
4. Uremia
5. Charcot-Marie-Tooth
6. Acute intermittent porphyria

Front 63

TX to reverse extrapyramidal sx of muscle stiffness, rigidity

Back 63

diphenydramine
benztropine
trihexyphenidyl

Front 64

Vascular dementia shows

Back 64

Step-wise deterioration of cognitive functioning

Front 65

Renal failure (toxic effect of light chain casts on renal tubules)
Hypercalcemia
Anemia

Back 65

Multiple Myeloma

Front 66

Heterozygous alpha thalassemia minor

Back 66

2 deletions
Typically asymptomatic with mild fatigue
Mild hypochromic anemia
Severe microcytosis (very small MCV)
Target cells

Front 67

Facial flushing after spicy food or alcohol?
Telangiectasias?
Papules/pustules?

Back 67

Rosacea

Front 68

TX of Rosacea

Back 68

Metronidazole

Front 69

Candidiasis

Back 69

Dyspareunia
Vag pH is normal (4-4.5)
Curd-like vag discharge

Front 70

BV

Back 70

Discharge is thinner than candida
Vag pH is higher than normal
No dyspareunia

Front 71

Trichomonas infection

Back 71

Vag pH elevated
Malodorous, green frothy discharge