Uworld Step 2 Ck Cards 151-250

Front 1

manifestations of hypercalcemia

Back 1

severe constipation, anorexia, weakness, neuro abdnormalities

Front 2

manifestations of multiple myloma

Back 2

back pain, anemia, renal dysfunction, elevated ESR, hypercalcemia

Front 3

acid-base status and seizures

Back 3

pt following tonic cloinc seizures often have postictal lactic acidosis and is seen as a transient anion gap metabolic acidosis that will resolve in 60-90 minutes post seizure

repeat the labs in 2 hours to reassess acid base status

Front 4

rotator cuff tendonitis vs tear

Back 4

tendonitis will resolve with injection of lidocaine into the joint

Front 5

lupus anticoag

Back 5

the antiphospholipid in lupus binds the phospholipids used in the PTT assay, so they have a prolonged PTT, though it is not a true reading of their coag status

Front 6

brain death

Back 6

absent CN reflexes, fixed/dilated pupils, no spont breaths

no medical causes that can mimic brain death, temp > 32C, and must be agreed upon by 2 docs

Front 7

immunity needed to clear molluscum contagiosum

Back 7

cellular immunity

Front 8

pt with DVT and hx of recent surgery, hemorrhagic stroke, bleeding diathesis, or active bleeding

Back 8

placement of IVC filter, as they would have contra indications for anticoag therapy

Front 9

what does an ateriovenous fistula do to circulation

Back 9

as volume is moved from the arterial side to venous side via shunting, cardiac preload is increased

will lead to high outpt failure as oxygen demands can not be met

Front 10

causes of AV fistula

Back 10

congenital: PDA, angoimas, pulmonary or CNS AVF

aquired: trauma, cancer, iatrogenic (as with femoral cath)

Front 11

Charcot's joint

Back 11

damage to joints from repeated joint trauma, seen in diabetics due loss of nerve sensation

also called neurogenic arthopathy

will occur in weight bearing joints and will show as deformity, DJD, loose bodies, and osteophytes on imaging

Front 12

treatment of prolactinoma

Back 12

first line are DA agonists like bromocriptine or cabergoline

2nd line is surgery

Front 13

Lights criteria for determination of pleural fluid as an exudate

Back 13

effusion/serum protein > 0.5

effusion/serum LDH > 0.6

complicated effusion listed as pH < 7.2, glucose < 60, or positive Gram stain or culture; complicated require chest tube and drainage

Front 14

MCC of thyroid cancer

Back 14

papillary thyroid is 70%
follicular cancer is 20%
anaplastic is 5%
medullary is 2%
lymphoma is < 2%

Front 15

lithium metabolism

Back 15

through the kidneys, so if there is kidney dysfunction, you can not give lithium ;for bipolar then give valproic acid

Front 16

MCC of foot drop

Back 16

neuropathy, L5 radiculopathy, and traumatic damage

Front 17

pica for ice

Back 17

called pagophagia, and is often seen in pt with Fe def anemia

Front 18

possible consequence of chemo and radio therapy for Hogkins

Back 18

3.2% will develop secondary malignancy in 20 years, the most common sites being lung and breast

Front 19

treatment of enuresis

Back 19

enuresis is recurrent invol voiding into clothses/bed after 5 y/o

1st line behavioral techniques
2nd line is desmopressin
3rd line is TCA imipramine (it is last due to safety profile)

Front 20

IBD

Back 20

UC vs Crohns

Front 21

treatment route for endocarditis

Back 21

must treat IV!!!

Front 22

kidney disease seen in pt with active HBV ifx

Back 22

PAN, membranoproliferative glomerulonephritis, and membranous glomerulonephritis

Front 23

lifestype modificiation to reduce BP

Back 23

reduce Na intake, weight loss, avoid excessive alcohol

Front 24

1st line treatment in OA

Back 24

acetaminphen

Front 25

charact of Waldenstrom's macrogloulinemia

Back 25

hyperviscosity do to excess IgM which will show as a spike on the SPE, increased spleen, liver, and LNs, tiredness, HA, neuropathies

Front 26

what to do with newly dx Lupus pt

Back 26

renal biopsy

note that SLE renal disease is one of the leading causes of mortality, up to 40-75% of pts

Front 27

ways that cancer can cause hypercalcemia

Back 27

metastatic solid tumors via cytokines

Hodgkin's via calcitrol

nonmetastatic tumors via PTHrP

Front 28

drugs used in stress testing when exercise is not an option

Back 28

dobamine or dipyridamole

Front 29

Somogyi effect in diabetics

Back 29

when there is hyperglycemia in the early morning due to counerregulatory hormones like Epi, NE, adn glucagon due to too much insulin at bedtime ;when the extra insulin is given at bedtime, there is hypoglycemia at like 3am that causes these hormones to kick in and increase glucose, but they overshoot

Front 30

treatment of Tourettes

Back 30

typical antipsychotics like haldol or pimozide

Front 31

Hawthorne effect

Back 31

when the study pop changes outcomes since they know they are being studied

Front 32

treatment of Paget's disease of bone

Back 32

only treat if symptomatic with bone pain, neuro defect, high output heart failure, or involement of weightbearing joints

Front 33

how to treat acute renal transplant rejection

Back 33

high dose IV steroids

Front 34

hepatitis problem that has waxing and waning ALT/AST lvls

Back 34

HCV

it also has arthralgias and myalgias

Front 35

triad of Meniere's disease

Back 35

dizziness, hearing loss, and tinnitus

Front 36

lung cancer with increased sercum Ca

Back 36

squamous cell that makes PTHrP

think aCa++mous

note that small cell associated with ACTH production

Front 37

trihexyphenidyl

Back 37

an anticholinergic used in Parkinson's, similar to benztropine

Front 38

Fe def anemia and arthritis

Back 38

if it is RA, this anemia of chronic disease

if it is OA, think NSAID use causing ulcers and GI bleeding

Front 39

dx of vasovagal syncope

Back 39

upright tilt table test

Front 40

what electrolyte is bad prognostic factor in CHF

Back 40

hyponatremia, as it shows a high lvl of the RAAS system and water retention trying to keep up CO

Front 41

primary CNS lymphoma

Back 41

seen in HIV pt

can cause altered mental status and can have EBV DNA in the CSF, MRI can show solitary, weakly ring-enhancing periventricular mass

Front 42

empyema

Back 42

infection of the pleural space
anything entering the pleural space can cause them, one common one is a hemothorax

reatment is surgery to remove pus, clotted blood, and fibrinous peel

Front 43

well known renal complication seen in Hodgkin's lymphoma

Back 43

minimal change disease

Front 44

s/s of glucagonma

Back 44

hyperglycemia, necrolytic migratory erythema, and diarrhea

Front 45

Gilbert's vs Crigler Najjar

Back 45

x

Front 46

treatment of cancer induced anorexia

Back 46

progestins like medasterol (megase)

Front 47

effect of current or previous dx of anorexia on preg

Back 47

increased risk for miscarriage, premie, small for gest age, hyperemesis gravidarum, postpartum depression

Front 48

trichinellosis

Back 48

suspect in pt with GI issues followed by triad of periorbital edema, myositis, and eosinophilia

can also have splinter and retinal hemorrhages

Front 49

podophyllin

Back 49

an antimitotic agent leading to cell death, used in condylomata acumiata caused by HPV

Front 50

treatment of HPV warts

Back 50

chemical agents: 5-FU, podophyllin

immune therapy: imiquimod, interferon alpha

surgery: cyro, laser, excisional

Front 51

SAAG

Back 51

Serum ascites albumin gradient found by different in albumin conc in serum vs ascites fluid

SAAG of 1.1 or greater shows transudative process consistent with portal HTN

Front 52

isoniazid and the liver

Back 52

isoniazid causes indosyncratic liver injury with histology that looks like viral hepatitis

this is NOT dose dependent

Front 53

what causes anion gap metabolic acidosis with an osmolar gap

Back 53

ethylene glycol, methanol, and ethanol intox

osmlar gap = observed osm - calculated osm

calculated = 2Na +Glu/18 + BUN/2.8

Front 54

how to calculate osmolar gap

Back 54

osmolar gap = observed osm - calc osm

calc osm = 2Na+ Glu/18 + BUN/2.8

Front 55

ethylene glycol poisoning

Back 55

will cause calcium oxalate crystals that are rectangular and envelope shaped

it causes anion gap met acidosis with osmolar gap

they will be stuporous, agitated , and disoriented

Front 56

Duke's criteria for infective endocarditis

Back 56

must have 2 major, one major and 3 minor, or 5 minor

major are: 2 positive blood cultures, endocardial involve on echo, new murmur

minor are: predispising condition, fever > 38C, septic emboli, immunologic phenom, one pos blood culture

Front 57

electrolyte changes in tumor lysis syndrome

Back 57

hyperkal and hyperphos from being released from intracell

excess phos binds Ca making hypocalcemia

cellular protein breakdown leads to hyperuricemia

Front 58

treatment of uncomplicated cystitis

Back 58

TMP-SMX or nitrofurantoin

Front 59

homocystenuria and pyridoxine

Back 59

x

Front 60

what causes the pain in a pulmonary embolism?

Back 60

associated minor to massive pulmonary infarctions

Front 61

colonoscopy recommendations in ulerative colitis pts

Back 61

start screen 8 years after the dx, then repeat every 1-2 years after

note: some say you can extend the 1st window if only the left colon is involved

Front 62

treatment of herpes zoster

Back 62

valacyclovir or acyclovir

postherpetic neuralgia can be treated with TCAs like amitriptyline

Front 63

UA results

Back 63

leukocyte esterase indicates pyuria

nitries indicate Enterobacteriaceae, like E. coli, the MCC of UTI

Front 64

tick-borne paralysis

Back 64

rapid ascending paralysis (hours to days), absence of fever or sensory abnormalities and normal CSF, treatement is removal of the tick

NOTE: Guillian Barre is days to weeks with sensory defict

Front 65

radiation therapy use in prostate CA

Back 65

radiation therapy is useful for managing bone pain in pts with prostate cancer s/p orchiectomy

Front 66

pt with organophosphate poisoning

Back 66

1st take off clothes and wash skin, as it is absorbed through the skin

treatment is then use atropine and pyridoxime

Front 67

area of the brain damaged in hemi-neglect

Back 67

the right (non-domiant) parietal lobe

Front 68

1st step in pt on heparin with drop in platelets

Back 68

pt has heparin induced thrombocytopenia (HIT) due to Ab against heparin-platelet factor 4

1st thing to do is stop the heparin

then start other form of anticoag like danaparoid or lepirudin

Front 69

recommened screening mammograms

Back 69

every 2 years for women 50 and older

Front 70

DeQuervain tenosynovitis

Back 70

inflammation of abd pollicis and extensor pollicis when mothers hold newborns with their thumbs outstretched

Front 71

blastomycosis s/s

Back 71

pulmonary infection with fever, sweats, productive cough, and weight loss

if it becomes systemic it can lead to ulcerated skin lesions and bone lesions

Front 72

accidental preg within 3 months of MMR vaccine

Back 72

you should wait 3 months to get preg after rubella vaccine, but if it happens, just reassure them, as there have been NO cases of congenital rebella syndrome from vaccinations

Front 73

osteomyelitis

Back 73

fever, chills, and elevated ESR

common in IVDA, and can include the spine

Front 74

disseminated histoplasmosis s/s and dx

Back 74

palatal ulcers, hepatoslpenomegaly, and pancytopenia

Front 75

treatment of essential tremors

Back 75

1st line is propranolol, but can not be give if contra as in bradycardia or COPD

2nd line is primidone an antiseizure that is converted to phenobarbital, SE of primidone is acute intermittent porphyria with abd pain, neuro and psych abd

Front 76

causes of acalculous cholecystitis

Back 76

extensive burns, severe trauma, prolonged TPN, prolonged fasting, mechanical ventilation

Front 77

cause of mortality in SAH

Back 77

vasospasm that induces infarction, occurs in 30% of pt s/p SAH

prevent with Ca channel blockers like nimodipine

Front 78

treatment of uric acid renal stones

Back 78

uric acid renal stones are 10% of renal stones and do not show up on xray

treat by alkalinization of the urine to pH > 6.5 with oral potassium bicarb or potassium citrate

Front 79

causes of renal colic that do not show on xray

Back 79

radiolucent stones like uric acid

Ca stones less than 3mm

nonstone causes like obstuction via tumor or clot

Front 80

potassium citrate

Back 80

used to alkalize the urine as it is metabolized into bicarb by the liver

Front 81

MCC of epiglottitis

Back 81

H. influ and strep pyogenes

Front 82

treatment of Lyme disease

Back 82

doxycycline, but if pt is preg it is contra so use amoxicillin

Front 83

Meniere's disease

Back 83

abnormal accumulation of endolymph in the inner ear

s/s are vertigo, tinnitus, hearing loss, or a sense of ear fullness

Front 84

dx of ARDS

Back 84

acute onset resp distress in setting of predisposing condition

PaO2/FiO2 ratio < 200

bilateral infiltrates and a normal PCWP (<18)

Front 85

electrolytes in OSA

Back 85

it can cause chronic hypercapnia and hypoxia causing resp acidosis

renal compensation increases bicarb and decreases chloride reabsorption

Front 86

thalamic stroke

Back 86

a painful stoke due to damage of the VPL that routes sensory information from the contralateral side of the body

Front 87

role of digoixin and furosemide in CHF

Back 87

they reduce symptoms and hospitalizations, but do NOT improve survivial

Front 88

psoriatic arthritis

Back 88

usually involves the DIP of the hand, morning stiffness, dactylitis (sausage digit), and nail involvement

Front 89

treatment of Grave's diesease

Back 89

radioactive iodine therapy unless contra by preg or severe ophthalmopathy

2nd line is antithyroid drugs like propthyouricil or methimidizole (sp?)

Front 90

SE of abrupt withdrawal for short acting benzos

Back 90

generalized seizures and confusion

Front 91

MCC of suspected brain abscess

Back 91

aerobic and anaerobic strep as well as Bacteroides (also anaerobic)

staph is only responsible for 15%

Front 92

amnioglycosides and the renal system

Back 92

they are used to treat gram neg infections and can be nephrotoxic

examples are gentamicin, neomycin, strptomycin, tobramycin, and amikacin

Front 93

soap bubble appearance in the epiphyseal of bones

Back 93

think giant cell tumor and needs referral to ortho surgeon

Front 94

electrolytes in Conn's

Back 94

primary hyperaldosteronsism leads to increased Na, decreased K, increased bicarb causing metaboic alkalosis

Front 95

what can cause S4 heart sound

Back 95

prolonged HTN causing left vent hypertrophy that causes decreased ventricular compliance

Front 96

risk of having bipolar disorder

Back 96

general population: 1%

if pt has 1st degree relative, risk is 5-10%

if both parents are, child is 60%

Front 97

ethylene glycol poisoning

Back 97

calcium oxalate in the kidneys, extra oxalate binds Ca, so hypocalcemia

treat with fomepizole or ethanol to reduce further metaboilsm of the ethylene glycol with alcohol dehydrogenase

Front 98

indication for removal of pleual fluid

Back 98

if the pH < 7.2 or glucose < 60, it is suggestive of empyema and needs to be drained via thoracostomy

Front 99

lumbar spinal stenosis

Back 99

pain termed "neuropathic claudication" is seen in lumbar spinal stenosis. Similar to pain with PVD, but this pain is position dependent, worse with standing

pain reduced by sitting or walking uphill

dx with MRI of the spine

Front 100

next step in a newly dx 1st degree heart block

Back 100

just observation if they are asymptomatic