1
Q
recent URI followed by sudden onset of cardiac failure in an otherwise healthy pt – think?
A
Dilated cardiomyopathy (2dary to acute viral myocarditis)
2
Q
most common virus to cause myocarditis?
A
Coxsackievirus B
3
Q
Dilated ventricles w/ diffuse hypokinesia on echo - think?
A
Dilated cardiomyopathy
4
Q
asymmetric septal hypertrophy can be found in what?
A
Hypertrophic cardiomyopathy
5
Q
when is concentric hypertrophy of the heart seen?
A
Chronic pressure overload
- AS
- Untreated HTN
6
Q
Eccentric hypertrophy of heart dev when?
A
Chronic volume overload
- valve regurg
7
Q
mid-diastolic murmur w/ an opening snap?
A
Mitral Stenosis
8
Q
what is Mitral Stenosis effect on the R side of the heart?
A
- RVH
- RV heave 2dary to pulm HTN
9
Q
In primary pulm HTN what will not be present?
A
b/l crackles
10
Q
amiodarone side fx?
A
- Cardiac: sinus brady, heart blok, risk of QT prolong, & torsades
- Pulm: Chronic interstitial pneumonitis
- HypO/ERthyroid
- Elevated tansaminases, hepatitis
- Optic neuropathy, corneal microdeposits
- Blue-gray skin discoloration
- Peripheral neuropathy
11
Q
prior to starting Amiordarone be sure to get what tests?
A
- PFTs
- CXR
- Thyroid
- LFTs
- ECG
12
Q
childhood vax complete + minor scrape on fence + last booster
A
none
13
Q
childhood vax complete + minor scrape on fence + last booster >=10 yrs ago - what tetanus prophylaxis required?
A
Tetanus toxoid containing vaccine (Td or Tdap)
NO immuneglobulin
14
Q
complete childhood vaxs, deep dirty wound, booster >=5yrs ago - what tetanus prophylaxis required?
A
Tetanus toxoid vax (Td or Tdap)
NO immuneglobulin
15
Q
When do you give tetanus immuneglobulin?
A
when pt is unimmunized or immunecompromised
AND
wound is severe/dirty
16
Q
most severe mutation types/
A
- Nonsense
- Frameshift
17
Q
missense mutation is?
A
single nucleotide changed
18
Q
nonsense mutation is?
A
codon changed to a chain terminating codon –> severe mutation
19
Q
Hyper conjugated bilirubinemia w/ normal AST, ALT, and alk phos - think (2)?
A
- Rotor syndrome
- Dubin-Johnson syndrome
Defects in hepatic secretion of bili
20
Q
positive urine bilirubin - think?
A
1) It’s conjugated bili
2) Due to: hepatic dysfunction, biliary obstruction, or defect in hepatic bili secretion (ie rotor or dubin johnson)
21
Q
necrolytic migratory erythema – think?
A
Glucagonoma
22
Q
necrolytic migratory erythema looks like?
A
erythematous papules or plaques that coalesce to form a large, painful, and inflammatory blister/crusting w/ central clearing. Found commonly on perineum, extremities, and face.
23
Q
serum glucagon >500 – think?
A
glucagonoma
24
Q
erythematous plaque w/ central clearing + mild DM + Diarrhea + weight loss + normocytic, normochromic anemia - think?
A
Glucagonoma
25
episodic flushing = think?
carcinoid syndrome
26
episodic flushing, diarrhea, weight loss - think
carcinoid syndrome
27
low leukocyte alkaline phosphatase + leukocytosis w basophilia - think?
CML
28
leukocytosis + high leukocyte alkaline phosphatase (LAP) + metamyelocytes > myelocytes -- think?
Leukemoid rxn
29
metamyelocytes and bands are?
late/mature neutrophil precursors
| - found more in leukemoid rxn (compared to CML)
30
myelocytes and promyelocytes are?
early neutrophil precursors
| - found more in CML (compared to leukemoid rxn)
31
painless gross GI bleeding w/ cause missed on colonoscopy -- think?
Angiodysplasia
32
maroon stools + painless + nothing seen on colonoscopy -- think?
angiodysplasia (often missed on colonoscopy)
33
continuous abdominal bruit suggestive of?
renovascular disease
34
resistent HTN + diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulm edema, or serum creatinine >30% from baseline post ACE/ARB therapy -- think?
renovascular HTN
35
resistent HTN + abdominal bruit + recurrent flash pulm edema -- think?
renovascular HTN
36
Crigler Najjar syndrome type 2 can be treated w/ what to help reduce serum bili?
IV phenobarbital or clofibrate
37
In which crigler najjar does phenobarbital not help?
Crigler Najjar type 1 (severe)
- - phototherapy, plasmapheresis short term
- - long term needs liver transplant
type 2 is helped by phenobarbital
38
smudge cells - think?
CLL
39
lymphocytosis w/ small mature lymphocytes - think?
CLL
40
elderly pt + lymphadenopathy + hepatosplenomegaly + lymphocytosis w/ smudge cells - think
CLL
41
Hairy cell leukemia findings?
- pancytopenia
| - splenomegaly
42
painless lymphadenopathy + night sweats + fevers + nL CBC and blood smear - -think?
Hodgkin lymphoma
43
dead space means?
ventilation fine, but perfusion dec (ie PE)
44
physiological shunting in lung means?
perfusion fine, but ventilation dec --> shunting of deoxygenated bld to L heart
45
Pneumonia --> what type of v/q mismatch?
physiological shunting (vent dec, perfusion fine)
46
serum progesterone measurement for infertility should be done when?
mid-luteal phase
| (b/t ovulation --> menses)
47
conductive hearing loss ?
obstruction of external sound to inner ear
48
sensorineural hearing loss involves?
involves inner ear, chochlea, auditory nerve
49
rinne test?
tuning fork on mastoid bone --> abnl suggests CONDUCTIVE hearing loss
air conducting should be heard longer than bone (so nL AC>BC, abnl BC>AC)
50
abnl rinne test indicates?
CONDUCTIVE hearing loss
51
weber test?
tuning fork middle of forehead
* nL - same in both
* conductive - lateralize to obstructed/effected ear
* sensiorineural - lateralize to unaffected ear
52
abnl rinne test w/ weber laterilzes to same ear?
conductive hearing loss
53
shoulder pain radiating in an ulnar distribution where is leision?
pulm apex at thoracic inlet (superior sulcusl invade C8, T1 n.)-- > compress inf portion of brachial plexus --> Pancoast syndrome
54
normal rinne test b/l, weber lateralizes -- think?
sensorineural hearing loss
55
abl rinne in 1 ear, weber lateralizes to opposite ear - think?
mixed hearing loss
56
serous otitis media symp?
- middle ear effusion w/o evidence of acute infx
- conductive hearing loss
- hypomobile dull tympanic membrane
57
serous otitis media seen in what population?
AIDS/HIV
58
Pt w/ HIV w/ hypomobile, dull typmanic membrane and conductive hearing loss -- think?
serous otitis media (non-infx effusion)
59
expansile, eccentric lytic lesion on epiphysis - think?
Giant cell tumor of bone
| "soap-bubble appearance"
60
soap bubble appearance on XR of femur -- think?
giant cell tumor
61
popliteal synovial cyst is?
baker's cyst
| - enlarged gastrocnemius-semimembranous bursa in medial side of popliteal fossa
62
osgood schlatter disease is?
overuse injury caused by repetitive strain
| - typically young kids and adolescents who have recently undergone a rapid growth spurt
63
xray apperance of osgood schlatter disease?
avulsion of the apophysis of tibial tubercle
64
osteitis fibrosa cystica aka?
von recklinghausen disease of bone
65
osteitis fibrosa cystica commonly due to ?
hypERparathyroidism from parathyroid CA
66
osteitis fibrosa cystica (von recklinghausen) is?
osteoclastic resorption of bone --> replacement w/ fibrous tissue (brown tumors) --> bone pain
67
salt and pepper appearance of skull think?
osteitis fibrosa cystica
68
distal clavicular tapering + bone cysts + brown tumors - think?
osteitis fibrosa cystica
69
brown tumors in bone think?
osteitis fibrosa cystica
70
findings of OA (4)?
- joint space narrowing
- osteophyte formation
- subchondral sclerosis
- subchondral cysts
71
osteoid osteoma on xray?
sclerotic, cortical lesion w/ central nidus of lucency
72
giant cell tumor of bone most commonly effects?
epiphyseal regions of distal femur and proximal tibia
73
memory issues w/ weight gain, fatigue, constipation, and hoarseness - think?
hypOthyroidism
74
walking in normal pressure hydrocephalus?
broad-based, shuffling gait
75
wernicke korsakoff syndrome findings:?
Wernicke - ataxia, ophthalmoplegia, confusion
Korsakoff - confabulation and amnesia
76
vesicular rash on forehead on eye w/ dendriform ulcers on cornea and conjunctivitis + fever, malaise -- think?
Herpes zoster opthalmicus
77
treatment of herpes zoster opthalmicus?
w/in 72hrs --> high dose acyclovir
78
eye pain, photophobia, dec vision w/ clear vesicles on corneal epi and dendritic ulcers -- think?
Herpes simplex keratitis
| locally limited w/o rash -- distinguish from herpes zoster opthalmicus
79
dacrocystitis is?
infx of lacrimal sac due to obstruction of nasolacrimal duct
80
bacterial keratitis seen w/?
contact lens wearers following corneal trauma
81
hypopyon is?
inflammatory cells in ant chamber of eye --> leukocytic exudate
82
eye appearance in bacterial keratitis?
cornea appears hazy w/ central ulcer and adjacent stromal abscess
- hypopyon may also be seen
83
complication of giant cell arteritis?
aortic aneurysm
| --> pts should have serial CXR
84
headache, jaw claudication, muscle fatigue, visual distrubances, ESR >50, tender cord at temporal area -- think?
giant cell arteritis
85
confusion, wheezing, and aseizure post smoke inhalation -- think?
carbon monoxide poisoning
86
treatment of CO poisioning?
100% oxygen via nonrebreather facemask
- hyperbaric O2 if unresponsive to facemask
87
cardioversion and defibrillation have no role w/ which pts?
- Pulseless electrical activity
| - Asystole
88
reversible causes of pulseless electrical activity/asystole?
```
5H's and 5 T's
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
HypO/ERKalemia
HypOthermia
```
```
Tension pneumo
Tamponade
Toxins
Thrombosis
Trauma
```
89
pulselss VT or ventricular fibrillation - treat?
Defibrillation
90
pulseless electrical activity or asystole should be managed w/
uninterrupted CPR w/ vasopressor therapy
91
most common nephrotic syndrome in adults in US?
focal segmental glomerular sclerosis
92
FSGS associated w/?
HIV, heroin use, morbid obesity
*african american and hispanic
93
Membranous nephropathy associated w?
- Hep B
- adeocarcinoma (breast, lung)
- NSAIDs
- Lupus
94
Membranoproliferative GN - associated w/?
Hep C>>Hep B
| lipodystrophy
95
minimal change disease associated w/?
Kids
NSAIDs
lymphoma (often Hodgkin)
96
Amyloidosis in kidney associated w.?
- Multiple myeloma
| - chronic inflam disease (ie RA, bronchiectasis)
97
crystal induced nephropathy side effect of?
Indinavir (protease inhibitor; HIV treatment)
98
indinavir is ?
protease inhibitor
| - HIV treatment
99
indinavir side effect?
Crystal-induced nephropathy
| --> hematuria w/ needle-shaped crystals in sediment
100
main organ of concern w/ indinavir (protease inhibitor)?
Nephrotoxicity
| - due to crystal induced nephropathy
101
major rxns w/ HIV therapy? (6)
* Didanosine --> pancreatitis
* Abacavir --> hypersensitivity syndrome
* NRTIs --> lactic acidosis
* NNRTIs --> Steven-Johnson's syndrome
* Nevirapine --> Liver failure
* Indinavir - nephrotoxicity (crystals)
102
Main concern w/ didanosine?
pancreatitis
103
Main concern w/ Abacavir?
hypersensitivity syndrome
104
Main concern w/ NRTIs?
lactic acidosis
105
Main concern w/ NNRTIs?
Steven Johnson
106
Main concern w/ Nevirapine?
Liver failure
107
Most common causes of osteomyelitis in sickle cell disease? (2)
1) Salmonella
| 2) Staph
108
Empiric treatment of osteomyelitis for children w/ sickle cell disease?
- 3rd gen Cephalosporin (ie ceftriaxone, cover salmonella)
AND
- Anti-staph med (ie vanco, oxacillin, etc)
109
most common causes of osteomyelitis in children
- GBS
| - E.coli
110
most common cause of osteomyelitis in children 2mo-4yrs?
Kingella kingae (gram- bacillus)
111
most common cause of osteomyelitis >4yrs?
Staph aureus
112
bilateral trigeminal neuralgia - what is one of the main causes?
Multiple sclerosis
113
bilateral trigeminal neuralgia + eye issues + arm weakness -- think?
multiple sclerosis
114
Pill rolling tremor + bradykinesia + rigidity + mask-like face -- think?
parkinson
115
caudate atrophy found w/?
Huntington's
116
depression + choreiform movements + subcortical dementia - think?
Huntington's
117
aseptic meningitis usually happens when?
summer
118
aseptic meningitis often caused by?
Echovirus
119
young female bilateral trigeminal neuralgia -- concern for?
MS
120
pleural plaques - think
asbestosis
121
asbestos risk in what jobs?
- pipe work (plumbing)
- mining
- shipbuilding
- insulation
Uworld Buzz step2
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