Uworld Step 2 Ck Cards 351-500

Front 1

salicylate intox

Back 1

s/s are tinnitus, N/V, fever, AMS, and acid-base abn

treat wtih urine alkalinization with sodium bicarb

Front 2

diphenhydramine intox

Back 2

antichol s/s like dry mouth, dilated pupils, blurred vision, reduced bowel sounds, and urine retention

anti-hist s/s are drowsiness and confusion

treat with physostigmine, a cholinesterase inhibitor

Front 3

treatment of CNS crypoto infx in HIV pt

Back 3

IV amphotericin plus flucytosine

can switch to oral fluconazole with clinical improvement

Front 4

pneumovax makes what response?

Back 4

it is made of capsular polysaccs that induce a T-cell independent B-cell response

Front 5

initial labs for new HIV dx

Back 5

VDRL, PPD, Hep A and B serology, toxo anti titer, viral load, CD count, routine CBC and hematology

Front 6

causes of priapism

Back 6

sickle cell, trauma of the cavernour artery, spinal cord lesions, meds like trazodone and prazosin

Front 7

best way to dx chronic pancreatitis

Back 7

fecal elastase. as it measures malabsorption 2/2 pancreatic exocrine insufficiency

Front 8

treatment of ARDS

Back 8

adequate oxygen supplementation, often with PEEP to keep alveoli open

Front 9

meds that cause hyperkalemia

Back 9

beta blockers block intracellular K uptake ;digitalis by blocking Na-K-ATPase pump

NSAIDS decrease renal perfusion decreasing K delivery to collecting ducts

TMP-SMX: similar to K sparring diuretic

Front 10

liver risk in hemochromatosis

Back 10

hepatocellular carcinoma after the liver turns cirrhotic

Front 11

how acute pancreatitis causes hypotension

Back 11

intravascular volume loss 2/2 local and systemic endothelial injury leading to increased vascular permeability and plasma leakage

Front 12

possible side effects of loop diuretics

Back 12

hypokalemia, pre-renal renal failure, and metabolic alkalosis

Front 13

treatment for hairy cell leukemia

Back 13

Cladribine, a purine analog that is toxic to bone marrow

Front 14

melanosis coli

Back 14

dark brn discoloration of the wal of the colon with lymph follicles shinnig through, usually due to laxative abuse, like with bisacodyl or senna

Front 15

hepatolenticular degeneration

Back 15

aka: Wilson's disease

labs have decreased ceruloplasmin and increased urine copper excretion (from decreased copper excretion into the biliary system)

treat with penicillamine

Front 16

most common manifestations of hemophilia

Back 16

hemarthroses

treatment is replacement of the missing coag factor

Front 17

blood cultures in disseminated gonococcal infxn

Back 17

usually neg due to the growth requirements of N. gonorrhea

Front 18

dermatomyositis s/s

Back 18

violaceous poikiloderma over various parts of the body, periorbital edema (heliotrope sign), shawl sign on the neck/chest, and Gottron's sign of the knuckles, elbows, and knees

along with proximal muscle weakness

often in association with malignancy

Front 19

s/p bone marrow transplant pneumonitis and colitis

Back 19

think CMV

Front 20

best way to prevent UTI in pts cath'ed due to neurogenic bladder

Back 20

intermittent catheterization

Front 21

cause of bleeding in chronic renal failure pts

Back 21

platelet dysfunction due to chronic uremia

labs will show normal PT, PTT, and platelet count, but increased BT

treat with DDVAP

Front 22

treatment of OCD

Back 22

1st line is SSRI

2nd line is clomipramine

Front 23

fever and sore throat in pt on anti-thyroid pts

Back 23

due to agranulocytosis leading to immnosuppression

stop drug and do CBC

Front 24

dacryocystitis

Back 24

infection of the lacrimal sac, usually by staph aureus or beta-hemolytic strep

Front 25

non-seminomatous tumor markers

Back 25

both elevated bHCG and AFP

Front 26

what measure can be determined in case-controlled studies

Back 26

odds ratio

Front 27

recommended therapy in COPD exacerbation

Back 27

O2, DuoNeb, broad spectrum antibiotics, and 2-week tapered steroids

Front 28

USPSTF recommendations for AAA screening

Back 28

one time US screening in males 65-75 with a smoking history

Front 29

CRAO vs amaurosis fugax

Back 29

amaurosis fugax is transitent and fundoscopic exam is whitened, edematous retina following distribution of retinal arterioles

CRAO is still present and fundoscope shows pale optic disc, cherry red fova, adn segmentation of retinal arteries and veins

Front 30

fibromyalgia vs polymyalgia rheumatica

Back 30

x

Front 31

drug induced interstitial nephritis

Back 31

s/s: arthralgias, rash, renal failure, and urine has eosinophilia

causes: cephalos, PCN, sulfa, NSAIDS, rifampin, phenytoin, allopurinol

Front 32

treatment of acute pancreatitis

Back 32

conservatively with analgesics, IV fluids, and NPO

do NOT given antiboitics right away, even with elevated WBC

Front 33

echinococcosis

Back 33

parasitic tapeworm often causing a cyst in the liver

carried by dogs, but sheep are intermediate hosts

most commonly seen in areas where sheep are raised

Front 34

metformin and renal funct

Back 34

can only be given to men with Cr < 1.5 and women with Cr < 1.4

it pt is on metformin and renal funct starts to decline, d/c metformin

Front 35

factitious thyrotoxicosis

Back 35

from exogenous thyroid hormone; decreased TSH and increased T3/T4, and diffusely decreased iodine uptake

biopsy will shoe follicular atrophy ;often used for weight loss

Front 36

treatment of social phobia

Back 36

assertiveness training and SSRI

beta blockers are 2nd line

Front 37

G6PD lvls in G6PD def

Back 37

oddly, they can be normal in the hemolytic episode, so do not use normal lvl to r/o G6PD def

Front 38

best indicator of severity of intox by TCAs

Back 38

duration of the QRS as it can prolong the QRS and lead to arrythmia

other s/s are CNS depression, hypotension, hypertherm, and anticholinergic effects

Front 39

what is needed to dx follicular thyroid cancer

Back 39

invasion of the capsule and blood vessels

otherwise it can just be a follicular adeoma

Front 40

what to do after "bird's beak" is seen on barium swallow

Back 40

do endoscopy to make sure that the stricture is not pseudoachalasia 2/2 to neoplasm

Front 41

antiphospholipid antibody syndrome

Back 41

labs show false pos VDRL, prolonged PTT, and thrombocytopenia

can promote arterial and venous thromboses and lead to spont abortions

if preg, start on LMWH

Front 42

babesiosis

Back 42

tick born from NE United States

s/s vary, can include hemolytic anemia, renal failure, f/c, sweats
higher risk if no spleen or immunocomp

treatment is quinine-clinda OR atovaquone-azithro

Front 43

MCC of thyroid nodule

Back 43

most are benign

most common is colloid nodule

2nd most common is follicular adenoma

Front 44

Parkinsonism is associated with what skin disease?

Back 44

seborrheic dermatitis

Front 45

side effect of fluphenazine

Back 45

a very potent typical antipsychotic, it inhibits shivering and autonomic thermoregulation, so they are at risk for hypothermia

Front 46

most common source of liver mets

Back 46

GI, lung, and breast cancer

Front 47

children with Tourette's are at high risk to develop what?

Back 47

ADHD or OCD

Front 48

infectious mono complications

Back 48

spleen rupture, airway compression from tonsilar enlargement ;autoimmue hemolytic anemia and thrombocytopenia from cross rxn of anti-EBV abs

s/s are sore throat, fever, malaise, splenomegaly, and lymphadenopathy (especially posterior cervial chain)

Front 49

most common cause of death in acromegaly

Back 49

cardiovascular death

high incidence of coronary HD, cardiomyopathy, arrhythmias, and LVH

Front 50

treatment of suspected disc herniation

Back 50

if there is just pain with no neuro deficit, recommend early mobilization and NSAIDS, (bedrest is no longer recommended)

if pain persists past 4 weeks or there is neuro envolvement, oder MRI to look for compression

Front 51

multiple myeloma s/s

Back 51

CRAB: hyperCalcemia, Renal impairment, Anemia, and Bone pain

labs will also so increased protein in disproportion to allbumin ;monoclonal B-cells reduce production of normal B cells, so increased risk of infections

Front 52

what does excessive analgesic use do to the kidney

Back 52

analgesic-mediated vasoconstriction of vasa recta leading to ischemia and papillary necrosis

Front 53

s/s of neurofibromatosis type 1

Back 53

axillary freckling, cafe-au-lait spots, and optic glioma

lische nodules of the eyes, and mutltiple neurofibromas

Front 54

neurofibromatosis type 2

Back 54

has bilateral shwannomas, hearing defict and increased risk of menngiomas and ependymomas

Front 55

MCC of pulmonary complications in systemic sclerosis

Back 55

pullmonary fibrosis

Front 56

what causes the low glucose conc in exudative effusions

Back 56

high metabolic activity of WBC and/or bacteria

Front 57

USPSTF recommendations for mammography

Back 57

screening every 2 years from 50-74

nothing after 75

Front 58

3 causes of post cholecystectomy pain

Back 58

common bile duct stone, sphincter of Oddi dysfunction, or functional pain

Front 59

vision loss with "blood and thunder" fundoscopic findings

Back 59

central retinal Vein occlusion

risk factors are coag disorders, chronic glaucoma, atherosclerosis risk (age, DM, HTN)

fundoscope shows disk swelling, hemorrhage, dilated veins, cotton wool spots

Front 60

"neurogenic claudication" of spinal stenosis

Back 60

since pain in spinal stenosis increases with flexion of the spine, it is increased with standing and walking

decrased with sitting or lying down

differnent from claudiation of PVD because of presence of pulses

MCC is vertebral DJD

Front 61

cause of acute epididymitis

Back 61

in younger pt, think sexually transmitted Chlamydia or gonno

in older pt, think E.coli 1st, then pseudo

Front 62

treatment of acute and chronic anal fissures

Back 62

dietary modification, stool softeners, and local anesthetics

Front 63

best way to monitor metabolic recover in DKA

Back 63

decrease in serum anion gap

Front 64

rash of syphilis vs RMSF

Back 64

syphilis starts of the trunk and spreads to arms, legs, palms and soles

RMSF starts on ankle and wrists, then moves to trunk, palms, and soles.

both are maculopapular

Front 65

cerebral salt wasting

Back 65

subarachnoid hemorrhage can stim release of ADH and increased BNP, this leads to hyponatremia

Front 66

carcinoid syndrome can lead to a def of what?

Back 66

niacin, as tryptophan is needed for both niacin and seritonin, and carcinoid is overproducing seritonin, using up all of the tryptophan

this can lead to pelegra

Front 67

attributable risk equation

Back 67

ARP = (RR-1)/RR

ARP is the % of disease that can be attributed to the risk

Front 68

first renal change in DM

Back 68

glomerular hyperfiltration

Front 69

ACE inhibitors in DM

Back 69

ACE inhibitors dilate the efferent arteriole and reduces intraglomerular HTN, therefore decreasing damage

Front 70

reversibility of liver disease

Back 70

if due to alcohol consumption, if there is no or minimal fibrosis, complete recovery can be achieved with cessation of alcohol

Front 71

CMV mononuclesosis

Back 71

mononucleosis like symptoms without sore throat and lymphadenopathy, atypical lymphocytes on blood smear, and a neg monospot test

Front 72

enthesitis

Back 72

inflammation and pain in sites where tendons and ligaments attatch to bone, often HLA-B27, so is a common finding in ankylosing spondylitis

Front 73

treatment of migranines

Back 73

antiemetics like metoclopramide, chlorpromazine, or prochlorperazine

adjunct this with NSAIDS or triptans if needed

Front 74

evaluatin of liver damage in hepatitis: acute vs chronic

Back 74

acute damage can be based on LFTs and viral serology

chronic hepatitis damage is based on liver biopsy

Front 75

USPSTF recommendations for Chlamydia

Back 75

routine screening for sexually active women < 24

other asymptomatic women at increased risk for infection, like new or multiple partners

Front 76

Pickwickian syndrome

Back 76

aka: Obesity Hypoventilation Syndrome (OHS)

seen in severe obesity, decreased chest wall compliance will lead to hypercapnia, hypoxemia, resp acidosis

treatment is weight loss, ventilator suppoer, oxygen therapy, and progestins (resp stimulants)

Front 77

Lynch syndrome has what other associations?

Back 77

Lynch syndrome, aka: Hereditary Non-Polyposis colorectal cancer is a high risk for extracolonic tumors, the most common is endometrail carcinoma

Front 78

dx of Lynch syndrome

Back 78

aka: HNPCC
needs 3 relatives with colorectal cancer, one of which is a 1st degree relative
at least 2 generations
one case dx before age 50 ;FAP must be excluded

Front 79

most common complication of peptic ulcer disease

Back 79

hemorrhage

Front 80

sick euthyroid syndrome

Back 80

when there is a decrease in thyroid lvls, T3 first, in the setting of acute severe illness

this is NOT thyroid disease and will return to normal when acute illness passes

Front 81

simple renal cyst

Back 81

benign finding, often incidental and NO treatment

to be a simple cyst it must: be a singular mass

have thin regular walls, have no septae within, and no enhancement internally

Front 82

blood tinged sputum as solitary s/s

Back 82

if no fever, clear CXR, weight loss etc, think acute bronchitis of viral etiology and observe and follow up

Front 83

chronic corticosteroid use and bone

Back 83

can cause osteonecrosis (aka avascular necrosis) ;can take months to years

pain worse with use and progressive decrease in ROM

xray will be normal in early disease, MRI is most sens

Front 84

toxoplasmosis

Back 84

prevention in HIV with TMP-SMX

treat with pyrimethamine +/- sulfadiazine or clinda alone

Front 85

adrenal insuff and/or failure s/s

Back 85

as in Addison's disease:
nonspecific symptoms like anorexia, fatigue, GI complaints, weight loss, and hypotension

hyponatremia, hyperkalemia, and hyperpigmentation is seen

Front 86

treatment of pseudotumor cerebri

Back 86

1st weight loss
then acetazolamide
then try corticosteroids, repeated lumbar punctures
steroids are for rapid decrease in pressure for short term help

Front 87

Light's criteria

Back 87

used for transudate vs exudate:
exudate has fluid/serum protein ratio > 0.5

fluid/serum LDH > 0.6

Front 88

cause of pleural effusion: transudate vs exudate

Back 88

transudate from increased hydrostatic or decrease oncotic pressure, seen in CHF

exudate from increased capillary permeability seen in infection, autoimmune, neoplasm

Front 89

elevated lymphocyte count in exudative pleural effusion: causes

Back 89

TB, sarcoid, lymphoma, RA

Front 90

febrile reaction in RBC transfusion

Back 90

thought to be due to pt antibodies reacting with donor leukocytes

prevented by cell washing or filters for leukocyte depletion, but not done often due to cost

Front 91

hydatid cyst

Back 91

liver cyst due to Echinococcus whose definitive host are dogs
CT will should eggshell calcification
surgical resecion under cover of albendazole and alcohol inactivation

Front 92

drug of choice in DM neuropathy

Back 92

TCA's

2nd line is gabapentin

Front 93

PCP pneumo

Back 93

s/s are fever, dry cough, exertional dyspnea and b/l infiltrates on CXR, seen in HIV with CD4 < 200

treat with TMP-SMX

add prednisolone if PaO2<70

Front 94

labs in malabsorption in alcoholics

Back 94

due to chronic pancreatitis ;decrease in albumin

decreased in vit D absorption leads to decreased Ca and Phos

Front 95

MCC of septic joint in prosthetic joints

Back 95

staph aureus

Front 96

most common extra-articular manifestation of ankylosing spondylitis

Back 96

anterior uvetitis, seen in 25-40% of AS pts

Front 97

treatment of acute dystonia from use of antipsychotics

Back 97

benztropine or diphenhydramine

Front 98

mediastinal tumors based on chest location

Back 98

anterior mediatstinum: think thymoma
middle mediastinum: think bronchogenic cyst, usually benign
posterior mediastinum: think neurogenic tumors like meningocele, lymphomas, esophageal tumors, aortic aneurysms

Front 99

chronic bronchitis vs emphysema tests

Back 99

both have decreased FEV1/FVC

but emphysema will have decreased DLCO due to damaged alveoli

Front 100

what to do in new dx of BPH

Back 100

DRE to r/o cacner, then do urinalysis to r/o infection, obstruction, or hematuria

Front 101

hypothyroid and carpal tunnel

Back 101

hypothyroid can lead to mucopolysaccharide deposition made of mucin and matrix to tissues

this can lead to myxedema, it can also attach to nerves to cause carpal tunnel

Front 102

most common valve damaged in infective endocarditis

Back 102

in IVDA, it is tricuspid

in non-IVDA it is mitral

Front 103

treatment of fulminant hepatic failure (FHF)

Back 103

liver transplant

Front 104

hyperthyroid and calcium

Back 104

hyperthyroid can increase osteoclastic acitivty leading to increased bone resorption

this can will show as hypercalcemia, underlying is leading to bone loss

Front 105

course of treatment of hyperthyroid with I-131

Back 105

initally the radioactive iodine kills cells with increased uptake, and these killed cells can release excess hormone, making the hyperthyoid worse turning it into a thyrotoxic state

longterm it is curative ;to prevent the transient increase in thyroid hormones, pre-treat with an anti-thyroid like PTU or methimazole

Front 106

CML vs leukemoid rxn

Back 106

in CML leukocyte alk phos is low

in leukemoid rxn it is high

Front 107

TMP-SMX in transplant pts

Back 107

just like in AIDS, they are immunocomp so it helps prevent PCP pneumo, toxo, UTIs, etc

Front 108

labs in fulminant hepatitis

Back 108

while transaminases will decrease, INR will increase

this is due to lack of viable cells

Front 109

empiric treatment in neutropenic fever

Back 109

3rd gen ceph (ceftazidime) or 4th gen ceph (cefepime) or imipenem

Front 110

normal right atrial pressure and pulmomary artery pressure and PCWP

Back 110

normal right atrial pressure 4-6mmHg
pulm artery press <25/15mmHg
PCWP 6-12mmHg

an increase of right atrial to > 10 and pulm artery to > 40 systolic is dx of massive PE

Front 111

hepatorenal syndrome

Back 111

HRS in end stage liver with decreased GFR without effidence of shock, proteinura, or other renal dysfunction and fails to respond to 1.5L NS bolus

thought to be due to vasodilation mediators
only known treatment is liver transplant

Front 112

which cells are responsible for GVHD

Back 112

graft vs host disease in bone marrow transplants is from the donor T-cells reacting against the host HLA antigens

Front 113

reversal of warfarin

Back 113

IV Vit K works in 8-12 hours

fresh frozen plasma (FFP) works immediately and lasts a few hours

Front 114

screening tests prior to stating lithium

Back 114

creatinine and thyroid function as lithium can induce nephrogenic diabetes insipidus and hypothyroidism

Front 115

extra pulmonary manifestation of mycoplasma pneumonia

Back 115

erythema multiforme

Front 116

SBP

Back 116

spontaneous bacterial peritonitis

Front 117

visual acuity test for macular degen

Back 117

fine visual acuity where pt looks at straight grid lines and reports that the line are wavy and distorted, often the vertical lines are the ones distorted

Front 118

dx of MGUS

Back 118

must exclude multiple myloma with absence of anemia, renal insuff, hypercalcemia, and lytic bone lesions

Front 119

longterm guidelines of lithium in bipolar

Back 119

single manic epidsode uses lithium for 1 year, then can taper off

3 or more relapses require lifelong therapy

Front 120

side effects of levodopa/carbidopa

Back 120

most common side effects are hallucinations, dizzyness, headache, and agitation

after years of treatment, pts can start to have involuntary movements

Front 121

side effect of amantadine

Back 121

ankle edema and livedo reticularis (a mottled vascular pattern on lower extremities)

Front 122

most common cause of vanishing bile ducts

Back 122

primary biliary cirrhosis

Front 123

MCC of head and neck cancer

Back 123

squamous cell carcinoma

think of this in hard nontender nodule

Front 124

what kinda of pneumo do people with dementia get?

Back 124

aspiration pneumo from impaired epiglotic function

Front 125

most common complication of broncheictasis

Back 125

hemoptysis

Front 126

dx of broncheictasis

Back 126

permanently dilated bronchi can be seen on chest CT

Front 127

what to look for with unexplained elevation of serum creatine kinase and muscle myopathy

Back 127

check TSH to look for hypothyroidism

Front 128

well known complication of temporal arteritis

Back 128

blindess

but it can also involve branches of the aorta and lead to aortic aneurysm

Front 129

yellow white patches of retinal opacification in HIV pt

Back 129

CMV retinitis

Front 130

pt with hemochromatosis are at increased risk of what bacteria?

Back 130

Listeria, Yersenia, and vibro vulnificus

Listeria susceptibillity thought to be due to high serum iron that they like, impaired phagocytosis from iron overload in reticuloendothelial cells

Front 131

indicators of severe asthma attack

Back 131

speech difficulty, diaphoresis, AMS, cyanosis, "silent lungs", and normal or increased PCO2

the PCO2 is an indication because it should be decreased, normal or elevated indicated CO2 retention from either obstruction or resp muscle fatigue

Front 132

acid base disturbance from aspirin intox

Back 132

mixed resp alk from increased resp drive and met acidosis from salicylate and organic acid accumulation

Front 133

Shy-Drager syndrome

Back 133

multiple system atrophy with:
Parkinsonism

autonomic dysfunction seen with postural hypoten, bowel/bladder, impotence, abd salivation/lacrimation

and widespread neuro s/s of cerebellar, pyramdial or LMN

Front 134

labs seen in Paget's disease of the bone

Back 134

NORMAL Ca and Phos

increased alk phos and urinary bone turnover markers like urniary hydroxyproline

Front 135

nonpharm adjunct to schizophrenia

Back 135

relapses are decreased if conflicts and stressor in the home environment are kept to a minimum

Front 136

side effects of methotrexate

Back 136

stomatitis (inflammation of the musocas of the mouth including gums, lips, and tongue), nausea, anemia, and hepatotoxicity

Front 137

1st step in new undx pleural effusion

Back 137

diagnostic thoracentesis

Front 138

treatment of human bite

Back 138

amox-clavulanate

it covers gram +, gram - , and anaerobes

Front 139

indications for parathyroidectomy in asyptomatic pts

Back 139

one of the following:
serum Ca more than 1mg/dL above nomral

less than 50 y/o

BMD less than T-2.5 at any site

reduce renal function of GFR < 60

Front 140

empiric treatment of meningitis

Back 140

if over nonhosp adult: ceftriaxone, vanc, and ampicillin

cef and vanc in hosp pts

cefotaxime and amp in kids < 3months

Front 141

how does hypomagnesemia effect other electrolytes

Back 141

makes potassium and calcium correction hard to do

it is a cofactor in the uptake of potassium

Front 142

meds after splenectomy

Back 142

daily PCN for 3-5 years
and vaccines for Haem and Pneumovax

Front 143

increased pH does what to calcium

Back 143

increases the affinity of albumin for calcium, so more Ca is bound, decreasing free ionized Ca and leading to hypocalemia (crampy pain, paresthesias, carpopedal spasm)

Front 144

treatment of low grade gastric MALT

Back 144

as it is likely 2/2 H. pylori, treat the infection

this is treated wtih omeprazole, clarithromycin, and amoxicillin

Front 145

what association is with endocarditis by strep bovis?

Back 145

colorectal cancer, so do a colonoscopy when dx

Front 146

what does immobilization do to bones?

Back 146

increases osteoclastic activation leading to hypercalcemia

worse in pts with preexisting high bone turnover
help prevent with bisphosphonates

Front 147

MCC of erysipelas

Back 147

Group A strep (S. pyogenes)

Front 148

sideroblastic anemia

Back 148

X

Front 149

treatment of acne

Back 149

mild: topical retinoids
mild/mod: add topical antibiotics
mod/severe: add oral antibiotics
nodulocystic and scarring: add oral isotretinoin

Front 150

treatment of restless leg syndrome

Back 150

dopaminergic agonsts like pramipexole or ropinerole