Uworld Step 2 Ck Cards 351-500

Front 1

salicylate intox - s/s & tx

Back 1

s/s:
tinnitus, N/V, fever, AMS
met acidosis + resp alkalosis
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 crypto 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

T-cell independent B-cell response

Front 5

initial labs for new HIV dx

Back 5

VDRL
PPD
Hep A
Hep B
toxo ab 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
measures malabsorption 2/2 pancreatic exocrine insufficiency

Front 8

treatment of ARDS

Back 8

0xygen, often with PEEP to keep alveoli open

Front 9

meds that cause hyperkalemia

Back 9

Beta blockers block cellular K uptake
digitalis blocks Na-K-ATPase pump
NSAIDS decrease K delivery to collecting ducts
TMP-SMX: similar to K sparring diuretic

Front 10

liver risk in hemochromatosis

Back 10

hepatocellular carcinoma after cirrhosis

Front 11

how acute pancreatitis causes hypotension

Back 11

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

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

Front 15

hepatolenticular degeneration - aka, labs, tx

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

blood culture complication in disseminated gonococcal infxn

Back 16

usually neg due to the growth requirements of N. gonorrhea

Front 17

dermatomyositis s/s

Back 17

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

along with proximal muscle weakness

often in association with malignancy

Front 18

s/p bone marrow transplant pneumonitis and colitis

Back 18

think CMV

Front 19

cause of bleeding in chronic renal failure pts

Back 19

platelet dysfunction due to chronic uremia
labs will show normal PT, PTT, and platelet count, but increased BT
treat with DDVAP

Front 20

treatment of OCD 1st & 2nd line

Back 20

1st line is SSRI
2nd line is clomipramine

Front 21

dacryocystitis

Back 21

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

Front 22

odds ratio vs RR

Back 22

odds ratio=case control
RR= RCT or cohort

Front 23

recommended therapy in COPD exacerbation

Back 23

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

Front 24

USPSTF recommendations for AAA screening

Back 24

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

Front 25

CRAO vs amaurosis fugax

Back 25

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 26

treatment of acute pancreatitis

Back 26

conservatively with analgesics, IV fluids, and NPO

do NOT given antiboitics right away, even with elevated WBC

Front 27

echinococcosis

Back 27

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 28

metformin and renal funct

Back 28

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 29

what is needed to dx follicular thyroid cancer

Back 29

invasion of the capsule and blood vessels

otherwise it can just be a follicular adeoma

Front 30

antiphospholipid antibody syndrome - labs & key symptoms

Back 30

labs show false pos VDRL, prolonged PTT, and thrombocytopenia
A/V thromboses
spont abortions (if preg, start on LMWH)

Front 31

babesiosis - location + s&s

Back 31

tick born from NE United States
s/s vary, can include hemolytic anemia, renal failure, f/c, sweats
treatment is quinine-clinda OR atovaquone-azithro

Front 32

MCC of thyroid nodule

Back 32

most are benign
most common is colloid nodule
2nd most common is follicular adenoma

Front 33

side effect of fluphenazine

Back 33

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

Front 34

most common source of liver mets

Back 34

GI, lung, and breast cancer

Front 35

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

Back 35

ADHD or OCD

Front 36

infectious mono complications

Back 36

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

Front 37

most common cause of death in acromegaly

Back 37

cardiovascular death

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

Front 38

treatment of suspected disc herniation

Back 38

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 39

s/s of neurofibromatosis type 1

Back 39

axillary freckling
cafe-au-lait spots
optic glioma lische nodules of the eyes, and mutltiple neurofibromas

Front 40

neurofibromatosis type 2

Back 40

has bilateral shwannomas w/ hearing defict
increased risk of meningiomas and ependymomas

Front 41

USPSTF recommendations for mammography

Back 41

screening every 2 years from 50-74

nothing after 75

Front 42

3 causes of post cholecystectomy pain

Back 42

common bile duct stone
sphincter of Oddi dysfunction
functional pain

Front 43

vision loss with "blood and thunder" fundoscopic findings

Back 43

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 44

cause of acute epididymitis

Back 44

in younger pt, think sexually transmitted Chlamydia or gonno

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

Front 45

rash of syphilis vs RMSF

Back 45

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 46

carcinoid syndrome can lead to a def of what?

Back 46

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 47

attributable risk equation

Back 47

ARP = (RR-1)/RR

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

Front 48

first renal change in DM

Back 48

glomerular hyperfiltration

Front 49

CMV mononuclesosis

Back 49

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

Front 50

USPSTF recommendations for Chlamydia

Back 50

routine screening for sexually active women < 24

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

Front 51

Lynch syndrome has what other associations?

Back 51

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

Front 52

dx of Lynch syndrome

Back 52

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 53

sick euthyroid syndrome

Back 53

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 54

treatment of pseudotumor cerebri

Back 54

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

Front 55

elevated lymphocyte count in exudative pleural effusion: causes

Back 55

TB, sarcoid, lymphoma, RA

Front 56

febrile reaction in RBC transfusion

Back 56

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 57

hydatid cyst

Back 57

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 58

drug of choice in DM neuropathy

Back 58

TCA's

2nd line is gabapentin

Front 59

labs in malabsorption in alcoholics

Back 59

due to chronic pancreatitis ;decrease in albumin

decreased in vit D absorption leads to decreased Ca and Phos

Front 60

MCC of septic joint in prosthetic joints

Back 60

staph aureus

Front 61

most common extra-articular manifestation of ankylosing spondylitis

Back 61

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

Front 62

mediastinal tumors based on chest location

Back 62

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

Front 63

chronic bronchitis vs emphysema tests

Back 63

both have decreased FEV1/FVC

but emphysema will have decreased DLCO due to damaged alveoli

Front 64

what to do in new dx of BPH

Back 64

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

Front 65

hypothyroid and carpal tunnel

Back 65

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 66

most common valve damaged in infective endocarditis

Back 66

in IVDU, it is tricuspid
in non-IVDU, it is mitral

Front 67

TMP-SMX in transplant pts

Back 67

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

Front 68

labs in fulminant hepatitis

Back 68

while transaminases will decrease, INR will increase

this is due to lack of viable cells

Front 69

empiric treatment in neutropenic fever

Back 69

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

Front 70

normal right atrial pressure and pulmomary artery pressure and PCWP

Back 70

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 71

hepatorenal syndrome - definition

Back 71

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

Front 72

which cells are responsible for GVHD

Back 72

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

Front 73

reversal of warfarin - timing of reversal options

Back 73

IV Vit K works in 8-12 hours

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

Front 74

extra pulmonary manifestation of mycoplasma pneumonia

Back 74

erythema multiforme

Front 75

visual acuity test for macular degen

Back 75

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 76

longterm guidelines for use of lithium in bipolar

Back 76

single manic epidsode uses lithium for 1 year, then can taper off
3 or more relapses require lifelong therapy

Front 77

side effect of amantadine

Back 77

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

Front 78

most common complication of broncheictasis

Back 78

hemoptysis

Front 79

yellow white patches of retinal opacification in HIV pt

Back 79

CMV retinitis

Front 80

pt with hemochromatosis are at increased risk of what bacteria?

Back 80

Listeria, Yersenia, and vibro vulnificus

Front 81

indicators of severe asthma attack

Back 81

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

Front 82

Shy-Drager syndrome (multiple system atrophy)

Back 82

Parkinsonism + ANS dysfunction:
postural hypoten, bowel/bladder, impotence, abd salivation/lacrimation
and widespread neuro s/s of cerebellar, pyramdial or LMN

Front 83

labs seen in Paget's disease of the bone

Back 83

NORMAL Ca and Phos

increased alk phos and urinary bone turnover markers like urniary hydroxyproline

Front 84

side effects of methotrexate

Back 84

stomatitis , nausea, anemia, and hepatotoxicity

Front 85

indications for parathyroidectomy in asyptomatic pts

Back 85

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 86

how does hypomagnesemia effect other electrolytes

Back 86

makes potassium and calcium correction hard to do

it is a cofactor in the uptake of potassium

Front 87

meds after splenectomy

Back 87

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