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

idiopathic pulmonary fibrosis

Back 3

honeycomb xray
vascular congestion most evident in the hilum
A-a gradient

Front 4

MCC of pneumo in HIV pts

Back 4

encapsulated bact, specificaly Strep pneumo

suspect in pt with actue high grade fever adn pleural effusion

Front 5

cystinuria

Back 5

inherited defective dibasic amino acid transport

stones are radioopaque and hexagonal

cyandie nitroprusside detects elevated cystine lvl and used to screen

Front 6

hyperactive deep tendon reflexes s/p surgery

Back 6

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

Front 7

ursodeoxycholic acid

Back 7

a secondary bile acid used to treat primary biliary cirrhosis

it does this by reducing cholesterol absorption and reducing cholestasis

Front 8

MCC of pneumo in nursing home pts

Back 8

same as CAP - strep pneumo

Front 9

creatinine value cut off for contrast dye

Back 9

Cr of > 1.5 is a contraindication for contrast dye

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

Front 10

treatment for narcolepsy

Back 10

daytime naps, psychostimulants, or combo of psychostims and antidepressants

Front 11

neuromuscular blocking agent safe in renal and liver dysfunction

Back 11

atracurium

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

Front 12

clearance of neuromuscular blocking drugs

Back 12

atracurium is unique as it is cleared in the serum

pancuronium and mivacurium by the kidneys

rocuronium cleared by the liver

Front 13

HAART med that causes crystal nephropathy

Back 13

indinavir

Front 14

side effect of didanosine

Back 14

pancreatitis

Front 15

side effect of abacavir

Back 15

a HARRT med that can cause a hypersens syndrome

Front 16

side effect of NRTIs for HIV

Back 16

lactic acidosis
Steven's Johnson syndrome

Front 17

side effect of nevirapine

Back 17

liver failure

Front 18

sympathetic ophthalmia

Back 18

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 19

isoniazid and the liver

Back 19

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

Front 20

risk on radioiodine in Graves

Back 20

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

Front 21

prevention vs treatment of gout

Back 21

prevention of gout is with allopurinol or probenecid

treatment of acute attack with colchicine, NSAIDS, or steroids

Front 22

indications for hemodialysis

Back 22

refract metab acidosis
refract hyperkalemia
volume overload refract to diuretics
uremic pericarditic
encephalopathy
neuropathy

coag due to renal failure

Front 23

how do OCPs increase clotting?

Back 23

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

Front 24

MC meds causing hyperkalemia

Back 24

ACEi
spironolactone/ amiloride
trimethoprim

Front 25

bact that causes necrotizign bronchopneumonia with pneumatocoeles

Back 25

Straph aureus, usually 2/2 viral URI

pneumatoceoles seen as multiple thin walled cavities

Front 26

membranoproliferative glomerulonephritis, type 2

Back 26

unique in that caused by IgG antibodies to C3 convertase

leads to persistent complement activation

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

Front 27

1st line treatment of Meniere's

Back 27

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

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

Front 28

treatment of central retinal artery occlusion

Back 28

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 29

test for Zollinger Ellison

Back 29

1) serum gastrin conc > 1000pg/mL?

2) if nondiagnostic, do a secretin stimulation test

Front 30

traid of infectious mono

Back 30

high fever, pharyngitis, and posterior cervial chain lymphadenopathy

EBV is heterophile pos

Front 31

metabolic syndrome

Back 31

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

Front 32

when to suspect SBP?

Back 32

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

dx with paracentesis

Front 33

systemic sclerosis

Back 33

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

labs show ANA-Ab and anti-topoismerase 1 antibodies

Front 34

LDL goals and Tx based on CAD

Back 34

CAD or 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 35

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

Back 35

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

Front 36

hyposthenuria

Back 36

inablility of the kidneys for conc urine, leads to nocturia seen in sickle cell disease OR trait

Front 37

Behcet's syndrome

Back 37

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 38

polymyositis

Back 38

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 39

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

Back 39

post strep GN:
10 days after phayngitis
21 days after impetigo
IgA nephropathy: 5 days after strep

Front 40

treatment of PCP pneumo - when to add steroids

Back 40

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

Front 41

treatment of malignant otitis externa (MOE)

Back 41

IV cipro

Front 42

treatment of acetaminophen tox

Back 42

check levels at 4 hours
outcome not affected as long as NAC given within the first 8 hrs
amount of acetamin and measured serum lvl often does NOT correlate!!!

Front 43

when can HIV pts get the MMR vacc?

Back 43

CD > 200 and there are NO AIDS defining illnesses

Front 44

porphyria cutanea tarda s/s, associated condition

Back 44

s/s are painless blisters, hypertrichposis, and hyperpigmentation

associated with HCV

can be triggered by ethanol or estrogens

Front 45

TPN and gallstones

Back 45

no stim for CCK, so gall bladder does not contract, leading to stasis and stone formation

Front 46

meds that are ototoxic

Back 46

loop diuretics, aminoglycosides, chemotherapy agents, and ASA

Front 47

Men IIa

Back 47

medullary thyroid CA, seen with increased calcitonic

pheochromo with increased BP, and

hyperparathyroidism with increased calcium lvls

Front 48

how to treat a chalazion

Back 48

painless, subacute (as opposed to stye)
1st do histopath to rule out malignancy

Front 49

most sens test for vertebral osteomyelitis

Back 49

MRI of the spine
xray will not detect acute osteomyelitis

look for eleveate ESR as well

Front 50

what is considered a positive PPD test

Back 50

>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 51

MCC of post flu PNA?

Back 51

Staph aurues

Front 52

dietary recommendations in pts with renal calculi

Back 52

decrase protein, oxalate, and sodium

increase fluids and calcium

Front 53

treatment of a pancreatic pseudocyst

Back 53

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

Front 54

hepatorenal syndrome mechanism

Back 54

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 55

polymyalgia rheumatica (PMR) - s&s, tx

Back 55

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
associated with temporal arteritis

Front 56

CLL prognosis

Back 56

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 57

why pneuomnia causes hypoxia

Back 57

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