7.13.17 Flashcards
FEV1 65% of predicted
FVC 58% of predicted
FEV1/FVC 85%
what condition?
interstitial lung dz
normal FEV1/FVC
80%
what is arrest of active phase of labor?
no cervical change –> contractions:
- adeq –> >4hr
- inadeq –> >6hr
at what cervical dilation does active phase of labor start?
6cm
protracted active phase of labor –> MCC
inadeq contractions
protracted active phase of labor –> tx
oxytocin
what are adeq uterine contractions?
forceful and occur q2-3min
pleural effusion –> Lights criteria –> exudate
protein (pleural:serum): >0.5
LDH: >0.6
pleural effusion –> exudate –> common cause (3)
- infect
- malig
- PE
pleural effusion –> exudate –> what 3 charact of exudate point to TB vs other etiology?
- high protein (always >4)
- lymphocytic leukocytosis
- low glucose (<60)
43F –> 2 day confuse, lethargy –> h/o hepC, alcohol, IVDA –> T100.8, BP 120/70, HR 110, RR 20 –> scleral icterus, scattered spider angioma, abd distended w shifting dullness, diffuse tender –> what condition?
cirrhosis –> spont bact peritonitis
tense bullae –> what condition?
bullous pemphigoid
bullous pemphigoid –> bx finding
subepidermal cleavage –> IgG deposit at BM
preg –> high risk pts should take how much folic acid? avg risk pts?
4mg vs 0.4
preg –> who is at high risk for neural tube defects (4)
- methotrexate
- antiepileptic
- DM
- prior preg w NTD
34F –> MVA –> CP, SOB –> BP 90/50, HR 118, O2 88% –> neck veins distended, trachea deviated R, L breath sounds absent –> what condition?
tension pneumo –> superior vena cava compression –> impede venous return
tension pneumo –> tx? MOA?
needle decompress –> allow lung re-expand –> increase venous return
DM during preg –> increased risk for what conditions in neonate (3)
- fetal lung immaturity
- preterm
- macrosomia
DM during preg –> why increased risk of RDS?
maternal hypergly –> fetal hyperinsulin –> delay cell maturation –> immature pneumocytes –> can’t produce surfactant
how can differentiate 1ary hyperPTH vs hyperCa of malig?
hyperCa of malig: rapid rise in Ca –> severe neuro ssx
1ary hyperPTH: modest hyperCa –> usu asx or mild, nonspecific ssx
1ary hyperPTH –> Ca usu at what level?
<12 (modest)
45F –> severe RUQ abd pain radiate to R shoulder, N/V –> h/o roux en Y gastric bypass –> what condition?
gastric bypass –> rapid wt loss –> promote gallstone formation –> symptomatic gallstones
UA –> blood & protein vs blood & no protein –> glomerular hematuria or nonglomerular etiology?
glomerular: blood & protein
nonglomerular: blood, no protein
hematuria –> gross vs microscopic blood –> glomerular or nonglom etiology?
glomerular: microscopic
nonglomerular: gross
hematuria –> dysmorphic vs normal RBC –> glomerular or nonglom etiology?
glom: dysmorphic
non: normal
35F –> several week severe ache in low back, hip, knees –> h/o end stage renal dz, DM1, sarcoid –> Cr 3.1, Ca 7.9, phosphorus 6.1 –> what condition?
chronic kidney dz –> decrease GFR –> decreased Ca, elevated phosphorus –> increase PTH (PTH hyperplasia & 2ary hyperPTH) –> renal osteodystrophy –> bone pain
chronic kidney dz –> what lab values indicate 2ary hyperPTH
elevated phosphate + low Ca
spont bact peritonitis –> ascitic fluid –> PMN count
> 250
spont bact peritonitis –> tx
empiric broad spectrum abx –> 3rd gen ceph
62M –> 2day confuse, lethargy –> h/o cirrhosis, black stool for past few days –> moderate ascites, stool occult +, pitting edema, asterixis –> what condition?
GI bleed –> blood absorbed in small intestine –> high N loaded state –> hepatic encephalopathy
70F –> lethargy, decreased oral intake, SOB –> last night vomit –> h/o Parkinson w cog impair –> T 102, BP 70/60, HR 120, bronchial breath sounds in R lung base –> what condition?
aspiration pneumonia –> septic shock
bronchial breath sounds –> normal over trachea –> if heard elsewhere, indicates what?
no ventilation (ie consolidation) –> sound originates from bronchi and transmits to chest wall
septic shock –> how lead to acidosis?
septic shock –> hypotension & hypermetab state –> insuff O2 delivery to meet metab demands –> increased anaerobic metab –> lactic acid –> metab acidosis
38M –> 1wk fatigue, DOE, choking sensation when fall asleep supine –> h/o URI 2wk ago –> bibasilar crackles, pitting edema, PMI 6th intercostal space ant axillary line –> what condition?
coxsackie B –> myocarditis –> dilated cardiomyopathy –> heart fail
when (what presentation) should suspect myocarditis?
young –> recent viral ill:
- HF
- CP
- arrhythmia
T/F: pt w murmur needs dental prophylaxis
F
normal T4 5-12 –> if increase upper limit to 13 –> what happens to:
- sens
- spec
sens –> decrease
spec –> increase
humeral midshaft fracture –> freq comp?
radial N injury
radial N injury –> presentation (2)
- weak wrist/finger extend
- loss of sens dorsal hand
16M –> several month nausea, watery diarrhea, bloat, wt loss –> h/o dry cough, SOB, wheeze that resolved; emigrate from Thailand –> Hb 10.4, MCV 72 –> what condition?
Thailand –> hookworm infect –> enter lung –> then intestines –> ingest blood:
- diarrhea
- malabsorption
- IDA
3rd trim screens (3)
- gestational DM
- alloimmunization
- maternal anemia
at what gestational age are 3rd trim screens done
20-28wk
gestational DM –> screening test? positive test?
1hr gtt >140
positive screen for gestation DM –> definitive test? positive test?
3hr gtt (any two):
- fasting >90
- 1hr >130
- 2hr >155
- 3hr >140
maternal anemia screen –> positive test?
Hb <10
positive screen for maternal anemia –> cause of anemia?
iron def
normal duration of stage 2 labor in nulliparous mother
3hr
what kind of mult gestation is at risk for twin twin transfusion?
monoZygotic
monoChorionic
diAmniotic
twin twin transfusion –> who does worse little twin or big twin?
big twin bc got too much blood
postpartum hemorrhage –> uterus absent –> what condition
uterine inversion
postpartum hemorrhage –> uterus boggy –> what condition
uterine atony
postpartum hemorrhage –> uterus firm –> what condition
retained placenta
postpartum hemorrhage –> uterus normal –> what condition
vag laceration
HIV preg –> tx –> preferred NRTI
tenofavir + emtircitabine
HIV preg –> when can vag delivery?
viral load <1000 + HAART
63M –> 6mo progressive fatigue, wt loss –> h/o 7mo ago pneumonia –> Hb 9.2, MCV 86, plt 150,000, WBC 9200, Ca 11.8, BUN 30, Cr 2.2 –> UA no proteinuria or hematuria –> what condition
MM
what presentation points to mult myeloma?
anemia + renal insuff + hyperCa
how does MM lead to renal insuff
monoclonal light chain –> clog renal tubule
fragile X –> presentation (5)
- delayed milestone
- autistic beh
- intell disability
- elongated face
- large testes
VSD –> how many days after MI?
3-5day
CP, SOB, hypotension, tachycardia, hypoxia –> what condition?
PE
FEV1/FVC: obstructive pattern? restrictive?
obstructive: <70%
restrictive: >70% (FVC <80%)
obstructive pattern –> what condition?
- low DLCO
- normal DLCO
- high DLCO
low: emphysema
normal: chronic bronchitis, asthma
low: asthma
33F –> sensation of severe spinning & intense nausea for 1-2hr, has lie to down w eyes closed for relief, hear mechanical humming –> tuning fork on forehead, sound more prominent in L ear –> what condition?
Meniere dz
Meniere dz –> pathophys
inner ear disorder –> defective resorb endolymph –> increased vol & pressure of endolymph –> damage vestibular & cochlea
Meniere dz –> classic triad
- tinnitis
- episodic vertigo
- sensorineural hearing loss
molar preg –> tx
suction curettage
molar preg –> f/u?
- monitor B-hCG
- contraceptive (1yr)
choriocarcinoma –> initial eval
TVUS
choriocarcinoma –> best for dx?
bx curettage
63F –> 1day swelling of R 2nd MCP w guarding, tender –> h/o RA, joint deformities of b/l wrists, MCP, PIP –> R 100.8, BP 140/90, HR 90 –> what condition?
septic arthritis
septic arthritis –> presentation (2)
- acute monoarthritis: hot swollen, decreased ROM
- fever