Uworld Step 2 Ck Cards 251-350

Front 1

most common EKG finding from digitalis toxicity

Back 1

atrial tachycardia

digitalis causes increased atrial ectopy and increased vagal tone leading to atrial tach with AV blocking

Front 2

s/s of toxic megacolon

Back 2

colonic distention on xray plus 3 of:

fever, HR > 120, WBC>10.5, anemia

and at least one of: volume depletion, AMS, electrolytes disturb, hypotension

Front 3

acyclovir and kidneys

Back 3

used in high doses to treat HSV encephalitis, it is poorly water soluble and can cause renal tubular obstruction via crystal formation, especially in inadequately hydrated pts

labs will show oliguria with elevated BUN and Cr

Front 4

idiopathic pulmonary fibrosis

Back 4

restrictive lung disease, xray will show honeycomb and vascular congestion most evident in the hilum

there will be an A-a gradient due to reduced diffusing capacity

Front 5

MCC of pneumo in HIV pts

Back 5

encapsulated bact, specificaly Strep pneumo

suspect in pt with actue high grade fever adn pleural effusion

Front 6

low platelets and occlusion post starting anticoag

Back 6

think HIT after heparain start

Front 7

presbycusis

Back 7

age related sensorineural hearing loss

often noticed in the 60th decade of life with bilateral high freq hearing loss

Front 8

how is right vent failure caused in COPD?

Back 8

hypoxemia causes constriction of pulmonary arterial system, leading to pulmomary HTN, then RVH, then right heart failure

Front 9

pts with panic disorder have an increased incidence of what?

Back 9

depression, agoraphobia, GAD, and substane abuse

Front 10

cutaneous larva migrans

Back 10

pruritic, elevated serpiginous lesions on the skin due to dog/cat hookworm after contact with sand

called the creeping eruption since the lesions elongate several mm per day as the larvae migrate

Front 11

how to remove a tick

Back 11

grasp the tick's mouthparts with tweezers and apply constant slow pressure

Front 12

s/s of vit D toxicity

Back 12

constipation, abdominal pain, weight loss, polyuria, and polydipsia

Front 13

who gets the pneumovax

Back 13

adults over 65

any adult with chronic cardio, pulm, hepatic, renal, or metabolic disease, or immunosupp

they need a booster after 5 years

Front 14

cystinuria

Back 14

inherited disease in dibasic amino acid transport

stones are radioopague and hexagonal

cyandie nitroprusside detects elevated cystine lvl and used to screen

Front 15

what to do if spinal compression suspected?

Back 15

give glucocorticoids like dexamethasone to reduce swelling

then order an MRI

Front 16

hyperactive deep tendon reflexes s/p surgery

Back 16

think hypocalcemia associated with extensive transfusions, as the citrate binds Ca, leading to reduced serum Ca

Front 17

drug of choice for primary biliary cirrhosis

Back 17

ursodeoxycholic acid

Front 18

ursodeoxycholic acid

Back 18

a secondary bile acid used to treat primary biliary cirrhosis

it does this by reducing cholesterol absorption and reducing cholestasis

Front 19

MCC of elevated alk phos in elderly

Back 19

Paget's disease of the bone, aka: osteitis deformans

Front 20

MCC of pneumo in nursing home pts

Back 20

strep pneumo

its also the MCC of CAP

Front 21

what to suspect in young pt with chronic diarrhea, abdominal pain, and weight loss

Back 21

Crohn's

Front 22

creatinine value cut off for contrast dye

Back 22

Cr of > 1.5 is a contraindication for contrast dye

if contrast is absolutely needed, non-ionic contrast agent can be used

Front 23

treatment for narcolepsy

Back 23

daytime naps, psychostimulants, or combo of psychostims and antidepressants

Front 24

neuromuscular blocking agent safe in renal and liver dysfunction

Back 24

atracurium

it is metabolized by serum esterases, so is same in renal and liver dysfunction

Front 25

clearance of neuromuscular blocking drugs

Back 25

atracurium is unique as it is cleared in the serum

pancuronium and mivacurium by the kidneys

rocuronium cleared by the liver

Front 26

HAART med that causes crystal nephropathy

Back 26

indinavir

Front 27

side effect of didanosine

Back 27

a HAART med that can cause pancreatitis

Front 28

side effect of abacavir

Back 28

a HARRT med that can cause a hypersens syndrome

Front 29

side effect of indinavir

Back 29

A HARRT protease inhibitor that can cause crystal nephropathy

Front 30

side effect of NRTIs for HIV

Back 30

lactic acidosis and Steven's Johnson syndrome

Front 31

side effect of nevirapine

Back 31

a HARRT med that can cause liver failure

Front 32

sympathetic ophthalmia

Back 32

aka "spared eye injury"

when one eye is damaged by penetrating injury, uncovering "hidden antigens" leading to an immune response to the uninjured eye

s/s are anterior uveitis, panuveitis, papillary edema, and blindness

Front 33

CT of schizophrenic pts

Back 33

increased ventricular size

Front 34

isoniazid and the liver

Back 34

there will be mild transient increases in LFTs ;continue the meds and monitor

if there is hepatitis from the isoniazid with symptoms for LFTs > 100, d/c the meds

Front 35

prophylaxis vs treatment of toxo

Back 35

prophylaxis is TMP-SMX

treatment is sulfadiazine and pyrimethamine

Front 36

risk on radioiodine in Graves

Back 36

that the pt will become hypothyroid, as the entire thyroid is hyperfunctioning and will uptake the radioiodine

Front 37

s/s of opiod intox

Back 37

AMS, decreased RR, miosis, bradycardia, and hypotension

Front 38

prevention vs treatment of gout

Back 38

prevention of gout is with allopurinol or probenecid

treatment of acute attack with colchicine, NSAIDS, or steroids

Front 39

uremic percarditis

Back 39

x

Front 40

indications for hemodialysis

Back 40

refract hyperkalemia ;volume overload refract to diuretics

refract metab acidosis ;uremic pericarditic, encephalopathy, or neuropathy

coag due to renal failure

Front 41

MCC of renal stones

Back 41

calcium oxalate stones

Front 42

what other bone problems is associated with RA pts?

Back 42

osteoporosis adn osteopenia

Front 43

ichthyosis vulgaris

Back 43

dry and rough skin with horny plates usually born with normal skin, then occurs, often sparring the face and diaper areas

is worse in the winter
aka "lizard skin"

Front 44

how do OCPs increase clotting?

Back 44

decreases antithrombin III and increases factors 2,7,9,10

Front 45

one of the MCC of hyperkalemia

Back 45

meds like ACEi, spironolactone, and trimethoprim

Front 46

bact that causes necrotizign bronchopneumonia with pneumatocoeles

Back 46

only Straph aureus, usually 2/2 viral URI

pneumatoceoles seen as multiple thin walled cavities

Front 47

membranoproliferative glomerulonephritis, type 2

Back 47

unique in that caused by IgG antibodies to C3 convertase

leads to persistent complement activation and kidney damage

EM shows dense deposits within the GBM and immuno is pos for C3, NOT immunoglobulins

Front 48

how to prevent contrast induced nephropathy

Back 48

IV hydration with either IV NS or isotonic bicarb

Front 49

1st line treatment of Meniere's

Back 49

low salt diet of <2-3 g/day and avoidane of alcohol and caffine

if unsuccessful, diuretics, antihist, and antichol can be tried

Front 50

treatment of central retinal artery occlusion

Back 50

treat CRAO with ocular massage and high flow oxygen (95% or hyperbaric)

thrombolytics can be given in the 4-6 hr window and are admin intraARTERIALLY

Front 51

test for Zollinger Ellison

Back 51

serum gastrin conc, as it is from a gastrinoma, look for lvls > 1000pg/mL

if nondiagnostic, do a secretin stimulation test

Front 52

traid of infectious mono

Back 52

high fever, pharyngitis, and posterior cervial chain LAP

EBV is heterophile pos

Front 53

metabolic syndrome

Back 53

from insulin resistance, dx is 3 of the 5:
waist circum 40 in in men, 35 in women
FBG > 100-110
BP > 130/80
Tris > 150
HDL < 40 in men, <50 in women

Front 54

how does B12 def cause problems?

Back 54

needed for THF, so impaired DNA synthesis, specifically in purine formation

Front 55

what is contra in acute glaucome emerg?

Back 55

no NOT use atropine, as it causes mydriasis (pupil dilation) and can worsen the problem

Front 56

how the spleen fights encapul bact

Back 56

x

Front 57

most common SE of antithyroid meds? ;most serious SE?

Back 57

most common in 2% is allergic rxn

most serious in 0.3% is agranulocytosis

drugs are PTU and methimazole

Front 58

when to suspect SBP?

Back 58

suspect spontaneous bact peritonitis in pts with sirrhosis, ascites, and fever or change in mental status

dx with paracentesis

Front 59

malignant otitis externa

Back 59

seen in elderly diabetics can MCC is pseudo

s/s are ear pain, drainage, granulation tissue in the canal

can lead to osteomyelitis of the skull base and destruction of the facial nerve leading to facial palsy

Front 60

prophylaxis in HIV with CD < 50

Back 60

azithro to prevent MAC

Front 61

drug to prevent PCP in AIDS

Back 61

TMP-SMX

Front 62

systemic sclerosis

Back 62

widespread organ involvement with GERD, right heart failure from pulm HTN, and systemic HTN

labs show ANA-Ab and anti-top 1 antibodies

Front 63

treatment of hypercalcemia in malignancy

Back 63

hypercal due to increased bone turnover, treat with bisphosphonate like Zoledronic acid

Front 64

LDL goals and Tx based on CAD

Back 64

CHD for risk equiv: LDL goal < 100, 70 in very high risk
life mod, meds with >130

2 risk factors: goal 130, meds at 160

0 ro 1 risk factor: goal <160, meds at 190

Front 65

screening for bladder cancer

Back 65

NOT done, as it is not common and tests have low PPV

Front 66

difference in TEN and SJS

Back 66

SJS is < 10% of BSA affected ; ;TEN is more than 30%

between 10 and 30 is TEN/SJS overlap

Front 67

what to do with pyelo that does not respond to appropriate antibiotic therapy

Back 67

US or CT to look for other pathologies, like obstruction, septics stone, perirenal abscess, etc

Front 68

hyposthenuria

Back 68

inablility of the kidneys for conc urine, leads to nocturia ; ;seen in sickle cell disease and trait, sickled cells clog vasa reca and prevent conc of urine

Front 69

Behcet's syndrome

Back 69

recurrent oral and genital ulcers, skin lesions, seen in Turkish, Asian, and Middle Easterners

symptom relief with corticosteroids, but still progresses to dementia and blindness

Front 70

polymyositis

Back 70

inflam muscle disease presenting with progressive proxmial weakness of lower extremities

muscle biopsy will show mononuclear infiltrate surrounding necrotic and regenerating muscle fibers ;advanced disease shows replacement of muscle with fibrotic tissue

Front 71

latent period from infection to hematuria in post strep GN vs IgA nephropathy

Back 71

post strep GN is 10 days from phayngitis and 21 days for impetigo

IgA nephropathy is 5 days

Front 72

cause of Zenker's diverticulum

Back 72

motor dysfunction of the upper esophageal sphincter causing herniation through the cricopharyngeal muscle

Front 73

treatment of PCP pneumo

Back 73

TMP-SMX

add steroids if PaO2<70 or A-a gradient > 35 mmHg

Front 74

treatment of malignant otitis externa (MOE)

Back 74

caused by Pseudo, treat with IV cipro

Front 75

treatment of acetaminophen tox

Back 75

check levels at 4 hours, as that is when the first data point of evidence based medicine starts to calc the dose of needed NAC

outcome not affected as long as NAC given within the first 8 hrs

note that amount of acetamin and measured serum lvl often does NOT correlate!!!

Front 76

when can HIV pts get the MMR vacc?

Back 76

though it is a life vacc, they can get MMR as long as CD > 200 and there are NO AIDS defining illnesses

Front 77

porphyria cutanea tarda

Back 77

s/s are painless blisters, hypertrichpsis, and hyperpigmentation

often associated with HCV

can be triggered by ethanol or estrogens

Front 78

TPN and gallstones

Back 78

if pt is on TPN, there is no stim for CCK, so gall bladder does not contract, leading to stasis and conc of bile, increasing sludge that will turn into stones

Front 79

non-traumatic avascular necrosis of the femoral head

Back 79

s/s are pain without restriction of motion, normal xray

MCC are chronic corticosteroid use, alcoholism, and hemoglobinapathies.

dx with MRI

Front 80

meds that are ototoxic

Back 80

loop diuretics, aminoglycosides, chemotherapy agents, and ASA

Front 81

Men IIa

Back 81

medullary thyroid CA, seen with increased calcitonic

pheochromo with increased BP, and

hyperparathyroidism with increased calcium lvls

Front 82

colon cancer screening age

Back 82

start at age 50

if there is a 1st degree relative with colon CA, start screening at 40

Front 83

how to treat a chalazion

Back 83

1st do histopath to rule otu malignancy

Front 84

most sens test for vertebral osteomyelitis

Back 84

MRI of the spine

xray will not detect acute osteomyelitis

look for eleveate ESR as well

Front 85

treatment of pt with hyperkalemia and EKG changes

Back 85

rapid treatment with calcium gluconate

later treat with kayexelate

Front 86

senile purpura

Back 86

ecchymotic lesion in the elderly due to perivascular connective tissue atrophy

Front 87

what is considered a positive PPD test

Back 87

>5mm in HIV, recent TB contact, pos CXR, immunocomp

>10mm for pt from endemic area, IVDA, high risk setting (jail, shelter), comorbid (DM, CKD, CA)

>15mm in healthy adults

Front 88

MCC of post flu PNA?

Back 88

Staph aurues

Front 89

antipsychotics and prolactin

Back 89

antipsychotics are DA-antagonists, so less neg feedback on prolactin leads to hyperprolactinemia

Front 90

emphysematous cholecystitis

Back 90

common form of acute chole, often seen with elderly DM males
caused by infection of gallbladder wall with gas forming bact

treatment is cholecystectomy and antibiotics against gram positive anaerobic bact, like Amp-sul, piperacillin, or quinolone with clinda

Front 91

diff in primary hyperPTH and familial hypocalciruic hypercalemia

Back 91

both have hypercalcemia

look at urine calcium, primary hyperparathyroidism will have increased Ca in the urine

FHH will not

Front 92

dietary recommendations in pts with renal calculi

Back 92

decrase dietary protein, oxalate, and sodium

increase fluids and dietary calcium

note the increase in Ca++ seems odd, but is supported by data

Front 93

leprosy s/s and dx

Back 93

s/s are pt with history of malaise, headache, dry cough, then hypopigmented skin with decreased sensation, muscle atrophy

dx is skin biopsy showing the acid fast bacilli

Front 94

treatment of a pancreatic pseudocyst

Back 94

only observation ; ;only drain if persists more than 6 weeks, is greather than 5cm, or becomes infected

this caution is due to the risk of hemorrhage

Front 95

hepatorenal syndrome

Back 95

in pts with liver disease, portal HTN causes release of nitric oxide to vasodilate, this dilaties renal arteries and leads to renal hypoperfusion that can lead to renal failure

dx is suggested by elevated creatinine and low urine sodium (<10) and no protein or blood

Front 96

PPV and prevalence

Back 96

increase in prevalence increases the PPV

but increase in prevalence with decrease the NPV!!!

Front 97

malingering vs factitious disorder

Back 97

malingering is for secondary gain

factitious disorder is just to be admitted to hosp and play the sick role

Front 98

polymyalgia rheumatica (PMR)

Back 98

s/s: pain and stiffness in the neck, shoulders, and pelvic girdle in a pt over 50 in the morning lasting more that 1 hour, also have elevated ESR > 40, normal physical exam

treatment with low dose steroids

note: associated with temporal arteritis

Front 99

CLL prognosis

Back 99

a B-cell disease, prognosis based on stages:

1-lymphos only (good prog)
2-lymphs+adenopathy
3-splenomegaly
4-anemia
5-thrombocytopenia (poor prog)

Front 100

why pneuomnia causes hypoxia

Back 100

inflammation of alveoli leads to A-a graident increase due to V/Q mismatch