2nd Uworld assessment Flashcards
What problem related to lactation?
subareolar, mobile, well circumscribed , nontender, SOFT mass; no fever. typically occurs a few weeks to months after cessation of breastfeeding
Galactocele
Size of galactocele
up to 5 cm in size
What problem related to lactation?
small, FIRM, TENDER palpable lump due to inadequate breast drainage. Erythema may be present, but not fever
Plugged duct
Size of a plugged duct mass
2 cm or less
Patients with right sided heart failure (maybe COPD) are preload dependent and require CAREFUL diuresis as what can happen?
Intravascular volume depletion . . . prerenal azotemia
Amenorrhea in Progestin-containing IUD?
Copper?
- typical side effect of Progestin-containing IUD
- A patient with a copper IUD should maintain regular menses
Patients with low-grade fever, RUQ tenderness, N/V, leukocytosis, obstructive appearing liver enzymes after a recently lap chole
Bile leak, one of the most common complications
imaging of a post lap chole bile leak?
normal-appearing biliary ducts or only mild dilation (which can be from the postop state alone)
Retained gallstone would show what on imaging in post lap chole?
significant biliary dilation
Neurologic manifestations of Lyme disease often occur within the first several weeks of infection and may include what?
- lymphocytic meningitis
- Cranial nerve palsies
- and/or radiculoneuritis
- Facial Nerve palsy is particularly common (about 8%)
Describe the facial nerve balsy that can occur in early Lyme disease?
Rapid onset facial weakness that is often bilateral
gene mutation in Rett syndrome
MECP2
Preload in cardiogenic shock?
increased
This is an inflammatory condition involving occluded skin surfaces such as the axillae, groin, inframammary folds, or abdominal folds. It is most commonly due to Candida species.
Intertrigo
The diagnosis of Intertrigo is mainly based on clinical features, but potassium hydroxide prep or fungal culture of skin scraping can confirm the diagnosis if need . . . how will it appear?
-pseudohyphae with budding yeast forms (blastoconidia)
This is a superficial skin infection that also affects intertriginal areas. It is caused by Corynebacterium minutissimum and presents with well-demarcated, thin, red-brown plaques with wrinkling and a fine scale
Erythrasma
Diagnostic “imaging” of Erythrasma
coral-red appearance under wood’s lamp
Tinea cruris presents as annular lesions with partial central clearing and a scaly-raised border. It can be caused by a number of dermatophytes, which appear on KOH prep as what?
septate hyphae
All congenital infections can present in neonatal period with IUGR, Hepatosplenomegaly, jaundice, and blueberry muffin spots . . what is the most common congenital infection?
CMV
Treatment of mild-moderate sunburn
- Topical: cool compresses, calamine lotion, aloe vera
- Oral: NSAIDS
Gout can be triggered by thiazide and loop diuretics due to decreased clearance of urate. What are acute treatment options
- NSAIDS
- Colchicine
- glucocorticoids
What is the preferred treatment for acute gout in patients taking anticoagulants?
Colchicine and glucocorticoids due to the risk of bleeding with NSAIDs
Patient presents with first trimester vaginal bleeding, closed cervix, and a fetus with a normal heart rate on US is consistent with threatened abortion. US can also reveal a subchorionic hematoma, an abnormal collection of blood between the placenta and the uterus. Risk factors for spontaneous abortion include advanced maternal age and a previous spontaneous abortion. Describe the management?
Patients with a threatened abortion frequently have uncomplicated pregnancies with normal outcomes. Therefore, management of a threatened abortion is expectant with outpatient observation
-Serial US can be performed until either the symptoms resolve or there is progression to a complete abortion
Acute liver failure is characterized by what triad?
- Elevated aminotransferases
- Hepatic encephalopathy
- Prolonged prothrombin time with INR > 1.5
- in a patient without underlying liver disease
Uncontrolled HTN is at risk for Hypertensive vasculopathy, the most common cause of spontaneous intracranial hemorrhage. Hypertensive cerebral vascular damage typically occurs near the branch points off of major intracerebral vessels; the basal ganglia is the most common (50%) site of hemorrhage. One potential consequence of basal ganglia hemorrhage is uncal herniation . . describe this and the PE findings?
- Mass effect pushes pare of the temporal lobe (uncus) laterally and downward against the tentorium cerebelli
- this compresses the 3rd cranial nerve and results in a dilated, nonreactive IPSILATERAL pupil
- Further displacement causes midbrain compression with CONTRALATERAL extensor posturing, coma, and respiratory compromise
Hypertensive hemorrhage can occur in the cerebellum and may push the cerebellum through the foramen magnum, resulting in cerebellar tonsillar herniation. Manifestations typically include what?
- neck tilt
- flaccid paralysis
- coma
- blood pressure instability
- respiratory arress
What analgesic has some serotonin activity and can potentially cause serotonin syndrome if used with another serotonergic med
Tramadol
Describe what Hypnagogic and hypnopompic hallucinations and cataplexy associated with narcolepsy are?
- Hypnagogic and hypnopompic hallucinations: Hallucinations that occur as the patient is going to sleep and waking up
- Cataplexy: Considered pathognomonic. sudden muscle weakness in response to intense emotion
pathology of narcolepsy
-decreased REM latency, with patients entering REM sleep within 15 minutes of sleep onset (normal is 90 minutes)
- Poorly controlled asthma with recurrent exacerbations
- severe: recurrent infiltrates, fever, cough productive of brownish sputum and hemoptysis
- Central BRONCHIECTASIS commonly results from a recurrent cycle of inflammation
- peripheral eosinophilia is typically present
Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis is typically diagnosed how?
skin testing and Aspergillus-specific IgE levels
The most frequent symptom of bronchiectasis is what?
a persistent cough with mucopurulent sputum that may be streaked with blood
-Dyspnea, fatigue, and weight loss are common
pathophysiology of Paget disease of bone
osteoclast dysfunction with disordered bone remodeling
Patients with pancreatitis often have hypocalcemia, possibly due to what?
calcium binding to free fatty acid complexes, calcium saponification, or cellular shifts
Management of Preeclampsia after 37 weeks gestation
- Labor induction for a vaginal delivery is preferred
- C section is indicated for obstetrical indications (eg, failed induction) or for a nonreassuring fetal status
Management of preeclampsia with severe features at < 34 weeks
conservative management with hospital admission and observation
Management for patients with preeclampsia without severe features at < 37 weeks
Outpatient management
This is the most common etiolog of persistent nasal obstruction during childhood. Affected patients have nasal congestion refractory to medical management. Hx may suggest chronic upper airway obstruction (eg, recurrent sinus and ear infections, mouth breathing, sleep disturbances/snoring due to apnea). Mucopurulent nasal discharge, postnasal drip, and elongated/flattened facial features (due to changes in the structure of the palate, jaw, and teeth) may suggest the diagnosis
Adenoid hypertrophy
The tunica albuginea is the fibrous tissue that immediately overlies the testicles and the corpora cavernosa of the penis. In this dz, excess collagen formation within the tunica albuginea can cause painful erections with curvature of the penis
Peyronie disease
Primitive reflexes (eg, rooting, sucking, glabellar) are frontal release signs that are generally more prevalent in what type of dementias?
frontally based like frontotemporal dementia
Vitamin C deficiency (Scurvy) causes impaired collagen synthesis with decreased connective tissue strength. Symptoms include what
- Petechial and perifollicular hemorrhages
- mucosal bleeding
- periodontal disease
Mechanism of Levonorgestrel IUD
- Thickens cervical mucus
- Impairs implantation
Mechanism of Copper IUD
- Cytotoxic endometrial inflammation
- Impairs sperm function
- Impairs implantation
Duration of Levonorgestrel IUD
3-5 years
Duration of Copper IUD
10 years
Benefits of Levonorgestrel IUD
Decreases menstrual flow
Benefits of Copper IUD
- Nonhormonal
- Can be used as emergency contraception
Contraindications to Levonorgestrel IUD
- Active liver disease
- Breast Cancer
- Acute pelvic infection
Contraindications to Copper IUD
- Wilson Disease
- Copper allergy
- Heavy menstrual bleeding
- Acute pelvic infection
Risk factors for pyelonephritis is pregnancy
- Asymptomatic bacteriuria
- DM
- Age < 20
- Tobacco use
Complication of pyelonephritis in pregnancy
- Preterm labor
- Low birth weight
- Acute respiratory distress syndrome
During the second and third trimesters of pregnancy, what predisposes patients to the development of pyelonephritis
elevations in progesterone cause urinary stasis and hydronephrosis
presenting symptoms of chorioamnionitis
- fever
- maternal and/or fetal tachycardia
- uterine tenderness
child has fever, otalgia, inflammation of the mastoid, and ear displacement, suggesting what
Acute mastoiditis, a severe complication of acute otitis media
Acute mastoiditis can be diagnosed clinically in most cases, if uncertain or intracranial complications are expected when what imaging?
CT scan or MRI with contrast
Treatment of acute mastoiditis
IV antibiotics and surgical drainage
Patient has lower back pain, lower extremity edema, and a lower uterine segment mass with associated hydronephrosis concerning for what?
advanced stage cervical cancer
Describe the relationship between cervical cancer and immunosuppression
- Cervical cancer is an AIDS-defining illness
- more frequent Pap test screening recommended
During thyroid surgery, the parathyroid glands can be inadvertently removed or injured by direct trauma or devascularization. This can lead to transient or permanent postoperative hypoparathyroidism with hypocalcemia and HYPERphosphatemia. Describe how this needs to be monitored and what the possible ramifications are?
- With permanent postop hypoparathyroidism, lifelone therapy and close monitoring are required to maintain normal serum calcium and phosphorus levels
- A calcium-phosphorus product (serum calcium x serum phosphorus) >55 increases the risk of SOFT TISSUE CALCIFICATION
- Deposition of calcium (possibly induced by hyperphosphatemia) in the basal ganglia, a complication associated with chronic hypoparathyroidism, leads to extrapyramidal manifestations (eg, movement disorders)
- Other potential complications include nephrocalcinosis and cataracts
What are favorable prognostic factors in schizophrenia
- Acute onset (lack of prodrome)
- Identifiable precipitant
- Older age at onset
- Presence of positive psychotic symptoms
- Female gender
Negative prognostic factors in schizophrenia
- Family Hx
- early onset
- No clear precipitant
- Prodromal phase (ie, idiosyncratic thinking and perceptrual disturbances, deterioration in academic or occupational functioning, increasing social isolation)
- Gradual onset of psychosis
- Negative symptoms
- Male gender
Microscopic hematuria might be present in acute appendicitis why?
due to the proximity of the right ureter to appendiceal inflammation
Lack of placental delivery 30 minutes after fetal delivery and excessive vaginal bleeding are hallmarks of postpartum hemorrhage due to what?
a retained placenta
What are risk factors for retained placenta
- gestational age 24-27 weeks
- Stillbirth
Cardiomyocyte hypertrophy and disarray are seen in patients with what
hypertrophic cardiomyopathy
Anthracycline (eg, doxorubicin, daunorubicin, epirubicin, idarubicin) are chemotherapy agents that are commonly implicated in chemo-induced cardiotoxicity by what mechanism?
-oxidative damage of cellular membranes and to cardiac myocyte necrosis and death with eventual replacement by fibrous tissue
Trastuxumab-related cardiotoxicity is due to what
loss of myocardial contractility (myocardial stunning)
Painless penile ulcer for SEVERAL MONTHS likely has what
Penile cancer . . SCC
Describe the difference in time frame between Penile cancer and primary syphilis
- Primary syphilis manifests with a painless papule that ulcerates over time (chancre)
- resolves spontaneously within 3-6 weeks
Risk factors for penile cancer
- HPV
- Phimosis: a congenital narrowing of the opening of the foreskin so that it cannot be retracted
- cigarette smoking
What liver mass?
- Associated with anomalous arteries
- Arterial flow and central stellate scar on imaging
Focal nodular hyperplasia
Management of Focal Nodular hyperplasia
- May be estrogen sensitive and patients on OCPs tend to have larger and more vascular lesions
- It is generally stable and does not normally results in complications
- Management is conservative; some providers advise women to discontinue use of OCPs and offer serial examinations for patients with larger masses (> 8 cm)
Gram-positive bacillus that causes adult meningitis
Listeria
This is loss of lean muscle mass associated with chronic pulmonary disease, namely COPD. BMI <20 or weight loss >5% is often used to suggest this disorder
Pulmonary cachexia
What are the local vascular complications of cardiac catheterization?
- Hematoma
- Pseudoaneurysm
- AV fistula
Which local vascular complications of cardiac catheterization?
- +/- mass
- no bruit
Hematoma
Which local vascular complications of cardiac catheterization?
- Bulging, pulsatile mass
- Systolic bruit
Pseudoaneurysm
Which local vascular complications of cardiac catheterization?
- No mass
- Contineous bruit
AV fistula
Unlike dermal melanomas, which typically appear as asymmetric shapes with irregular borders, nail melanomas form what?
longitudinal bands in the nail plate (longitudinal melanoychia) due to the presence of pigment in the nail as it grows outward
Patients with experimentation with maijuana and alcohol, sexual curiosity, increasing need for privacy, and transient oppositional behavior are characteristic of what?
normal adolescence
Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting and a loss of > 5% of prepregnancy weight. Patients with what are at increased risk?
what should be performed on all patients with this to evaluate?
- Multifetal gestation and hydatidiform mole
- Pelvic US
What is the gold standard for investigating a new palpable breast mass in a postmenopausal patient
Diagnostic mammography even if a recent screening mammogram was negative
A common sexual disorder in women charactrized by lack of, or significantly reduced sexual interest/arousal that is not better explained by another medical disorder
Female sexual interest/arousal disorder
Removal of urinary catheters within how many hours postop has been shown to reduce the risk of UTI, allow for earlier discharge from the hospital, and reduce mortality compared to catheter continuation
24-48 hours
Uncontrolled maternal hyperglycemia leads to fetal hyperinsulinemia and may result in a large for gestational age infant which can have what complications
- Hypoglycemia
- hypocalcemia
- polycythemia
What is the treatment of choice for DVT in pregnant patients
either unfractionated heparin or low molecular weight heparin
DRESS syndrome is a rare, potentially life-threatening drug reaction characterized by what?
- Drug: most commonly allopurinol and antiepileptics
- Reaction (rash): morbilliform eruption that starts on the face or upper trunk and becomes diffuse (often > 50% body surface area) and confluent; facial edema is common
- Eosinophilia
- Systemic Symptoms: fever, malaise, and diffuse lymphadenopathy; approximately 90% of patients have involvement of 1 or more organ system (eg, liver transaminitis, kidney, lung)
Describe the latency period of DRESS syndrome
unlike other drug reactions, it has an unusually long latency (2-8 weeks) between drug initiation and the manifestations of symptoms
Treatment of DRESS syndrome
immediate cessation of the inciting drug
CT scan reveals colonic dilation with oral contrast visualized throughout the colon, suggesting no anatomic obstruction but there is “obstruction” cuz no BM
Acute colonic pseudo-obstruction (Ogilvie syndrome)
Post op Olgilvie syndrome tends to present how many days after surgery
3-7 days
P vivax is a dominant specis of malaria outside of africa and, unlike P falciparum has a dormant hepatic phase that may cause recurrent parasitemia weeks or months after initial infections Treatment require a combination of antimalarial drugs that target both the erythrocyte phase (eg, chloroquine) and the dormant hepatic phase with what?
- Primaquine
- without this most patients will relapse
Tdap vaccine in pregnancy?
All pregnant patients should receive this during each pregnancy
A patient with abnormal uterine bleeding, pelvic pressure, an enlarged uterus, and a friable (vascular) vaginal lesion is concerning for what
choriocarcinoma
Microscopic colitis is characterized by watery and nocturnal diarrhea, fecal urgency, and incontinence. Risk factors include age > 50, female sex, smoking, and possibly NSAIDs. Colonoscopy reveals what?
inflammatory infiltrates with a monocytic predominance
what does peripheral blood smear show in myelodysplastic syndrome
Dysplastic erythrocytes (eg, ovalomacrocytosis) and granulocytes (eg, reduced segmentation)
What increases risk for myelodysplastic syndrome
- older age
- previous chemo/radiation
Patients with Aortic stenosis are asymptomatic for a prolonged period, and classic symptoms (eg, exertional dyspnea, angina, presyncope/syncope) usually develop in those with severe Aortic stenosis (ie, aortic valve area < 1 cm). Mortality increases dramatically after development of symptoms; therefore, patients with severe symptomatic Aortic stenosis should have what mangement
referral for Aortic valve replacement
Isotretinoin is used to treat severe, recalcitrant nodulocystic acne associated with significant scarring that has not responded to other therapies, including systemic antibiotics. It is teratogenic; therefore, female patients should have what management
pregnancy testing prior to and periodically during therapy, and use 2 forms of highly effective contraception
Testicular torsion is caused by what
twisting of the spermatic cord due to inadequate fixation of the lower pole of the testis to the tunica vaginalis
Heavy menstrual bleeding in the setting of an irregularly shaped, enlarged uterus is most likely due to a submucous and/or intramural fibroid. When a fibroid uterus is suspected, transvaginal US is the first step in evaluation as it is widely available, cost-effective and has high sensitivity for detecting fibroids. What improves the sensitivity of diagnosing submucous fibroids and how?
Sonohysterography (Saline infusion US) by enhancing endometrial visualization with intrauterine saline infusion and is the best study to confirm the diagnosis
Ovarian malignancy can manifest with acute small bowel obstruction and signs of bowel necrosis (eg, fever, leukocytosis). CT scan may show omental caking along with dilated loops of bowel and air fluid levels. What is required for treatment?
Exploratory Laparotomy
Describe how chronic diarrhea can predispose to uric acid kidney stone formation
can cause urine to be hyper-concentrated and abnormally acidic due to ongoing GI bicarb and water losses
-Urine alkalinization helps prevent precipitation of uric acid stones
ECG in a PE commonly shows sinus tachycardia and may show evidence of right heart strain such as what
T wave inversion in leads V1-V3
This refers to the retraction and entrapment of the prepuce in an uncircumcised male patient?
What is the management?
- Paraphimosis
- Urgent manual or surgical reduction of the prepuce
Elderly institutionalized patients are at risk for this. They may have insidious onset of abdominal pain and distention, obstipation, and N/V. Abdominal radiograph demonstrates near-total colonic dilation but no air in the rectum
Torsion of the sigmoid colon
Describe the difference in appearance on x-ray b/t SCC of the lung and adenocarcinoma
- SCC: Cavitary lesion
- Adenocarcinoma typically causes a peripheral nodules
What is the most common etiology of ataxia in children and often follows a viral illness. . . it is a diagnosis of exclusion
Acute postinfectious cerebellar ataxia
Thyroid hormone production increases during pregnancy to cope with metabolic demands. Estrogen causes on increase in thyroxine-binding globulin, leading to increased total (but not free) thyroid hormone levels. How does hCG related to thyroid
It directly stimulates TSH receptors, causing increased production of thyroid hormones
