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UWorld > Incorrects > Flashcards

Incorrects Flashcards

1
Q

Extraperitoneal vs intraperitoneal pain differences?

A

Intraperitoneal involves the peritoneum (rigidity/rebound tenderness). Extraperitoneal may leak into the pelvis causing lower abd pain but no peritoneal signs.

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2
Q

Virus assoc with focal segmental glomerulosclerosis?

A

HIV

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3
Q

Virus assoc with membranous glomerulonephritis?

A

HIV with HepB coinfxn

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4
Q

Preferred HIV test?

A

One that includes the HIV p24 antigen and HIV antibodies. This will Dx acute or early infxn vs antibodies alone.

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5
Q

When is HIV RNA testing to be used over HIV p24 and antibody testing?

A

It is recommended in pts with negative serologic tests and high clinical suspicion of acute HIV.

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6
Q

Pseudoallergic rxns are often 2° to what?

A

Often due to NSAIDs (ASA, ibuprofen, etc.) in asthmatics, chronic rhinosinusitis with nasal polyposis, or pts with chronic urticaria.

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7
Q

Aspirin-exacerbated respiratory disease path?

A

Pseudoallergic rxn due to ASA in asthmatics (atopic individuals) that causes allergic-rxn-like response due to inhibition of COX1 and 2 and shunting toward LOX pathway. This overproduces Leukotrienes which are proinflammatory.

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8
Q

Due to increased RFs what are pregnant women all screened for via urine?

A

Asymptomatic bacteriuria. RFs increase possibility of pyelonephritis, preterm delivery, and low birthweight all due to infxn.

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9
Q

What is Rx for acute asymptomatic bacteriuria in pregnant females?

A

Amox-clav
Cephalexin
Nitrofurantoin
Fosfomycin

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10
Q

Allergic conjunctivits presentation?

A

Always bilateral
Watery discharge
Pruritis

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11
Q

Bacterial conjunctivitis presentation?

A

Unilateral or bilateral
Purulent discharge
Unremitting discharge

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12
Q

Viral conjunctivitis presentation?

A

Uni/bilateral
Watery/mucoid
Viral prodrome associated with Sx

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13
Q

Leukocyte adhesion deficiency presentation?

A

Delayed umbilical cord separation
Recurrent skin/mucosal bacterial infxn (w/o purulence)
Severe periodontal disease
Marked leukocytosis with neutrophil predominance common

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14
Q

Best contraception method in female with breast cancer Hx?

A

Copper IUD. All hormone containing contraception is absolutely contraindicated in females with breast cancer. Hx of thromboembolis, stroke, liver disease, smoking, CV disease, and HTN ≥160/100 are also contrad.

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15
Q

How effective are condoms at preventing pregnancy?

A

Only 80% in typical condom use.

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16
Q

What emergency (postcoital) contraceptive is the most efficacious?

A

Copper IUD. Can be used in nulliparous women and adolescents.

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17
Q

Hypopituitarism characterized by?

A

Glucocorticoid deficiency
Hypogonadism
Hypothyroid
Aldosterone unaffected (Renin controlled)

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18
Q

Next step in female with positive pregnancy test, free fluid in posterior cul-de-sac, and tachycardia with BP of 90/55?

A

Surgical exploration. Hemodynamic instability due to ruptured ectopic pregnancy requires emergency surgery.

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19
Q

What is a cornual ectopic pregnancy?

A

Implantation of the gestational sac in the outer quadrant (cornual) areas of the uterus. This is abnormal. This does not mean the pt has a bicornuate uterus. The corners where the tubes enter the uterus is called the cornuate (horns).

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20
Q

1 y/o presenting with recurrent, severe viral, fungal, or opportunistic infxns (PCP, etc.) and failure to thrive (height/weight below 5%) with chronic diarrhea likely has?

A

SCID. Failure of T cell development leads to B cell dysfxn. Absent T cells (CD 3+) and low B cells (CD 19+) leads to globally low Ig.

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21
Q

SCID treatment?

A

Stem cell transplant.

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22
Q

What is methemoglobinemia?

A

Oxidation of one of the iron groups on Hgb to the ferric (Fe3+) state. This has a decreased affinity for O2 than the other ferrous heme groups and leads to poor O2 delivery to tissues.

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23
Q

Methemoglobinemia Sx?

A 
Low SpO2 (~85% - actually an overestimation of O2 bound Hgb)
Fatigue
Lethargy
Cyanosis
Dark blue/red blood
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24
Q

What causes methemoglobinemia?

A

Oxidizing agent exposure (Dapsone, nitrites, local/topical anesthetics like lidocaine, benzocaine)

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25
Q

Methemoglobinemia Rx?

A

Methylene blue and discontinuation of drug

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26
Q

Dimercaprol use?

A

Lead poisoning as chelating agent

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27
Q

Fomepizole use?

A

Ethylene glycol or methanol (inhibits EtOH dehy)

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28
Q

Glucagon antidote use?

A

ß-blocker or Ca++ channel blocker OD

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29
Q

3 treatments in CN poisoning?

A

Hydroxycobalamin preferred. Sodium thiosulfate is alternative. Nitrites that induce methemoglobinemia only if others not available. Cyanide binds avidly to Fe3+.

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30
Q

Cyanide toxicity pathophys?

A

Inhibits cytochrome oxidase a3 in ETC by binding ferric iron (Fe3+) inhibiting its reduction to ferrous iron (Fe2+). This forces cells to anaerobic metabolism, lactic acid formation, and acidosis.

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31
Q

Senile purpura pathophys?

A

Loss of elastic fibers in perivascular CT leads to skin fragility that leads to small ecchymosis, despite normal lab studies. Normal daily trauma leads to small bruises under the skin that would normally not result in bleeding in the young person.

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32
Q

Gold standard for Dx of Duchenne MD?

A

Genetic testing for Xp21 dystrophin gene. Hence, X-linked recessive.

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33
Q

Active TB treatment

A

Rifampin, INH, pyrazinamide, ethambutol

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34
Q

Latent TB treatment

A

9 months of INH and pyridoxine

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35
Q

A postmenopausal woman with symptoms of bleeding with wiping after urination and a normal pap smear. Her vaginal pH is 6 and she has sparse pubic hair and normal UA. She likely has symptoms due to?

A

Menopause. Loss of vaginal epithelial elasticity leads to these symptoms. Bleeding is almost solely due to menopause and rarely arises in BV, lichen sclerosis, or vulvar intraepithelial neoplasia (VIN) even.

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36
Q

Classic Sx of systemic juvenile idiopathic arthritis?

A

Rash
High fever
Large joint involvement

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37
Q

Hypertrophic osteoarthropathy is a clinical syndrome involving what?

A

Digital clubbing and bony swellings of the toes/fingers due to CF or malignancy

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38
Q

Is Hib vax safe in pregnancy?

A

Yes. It is inactivated, but it is indicated only in unvaccinated or high-risk patients (HIV, Sickle cell, splenectomy Hx)

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39
Q

What vaccines are OK in pregnancy?

A

Injectable influenza
Tdap
Rho (D) immunoglobulin

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40
Q

What is the most prognostic sign in malignant melanoma?

A

Breslow depth. This is the distance from the epidermal granular cell layer to the deepest visible melanoma cells.

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41
Q

When is antepartum fetal surveillance performed and why?

A

When fetal demise is a high risk and to evaluate for fetal hypoxia.

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42
Q

What is the typical surveillance modality in antepartum fetal surveillance?

A

Biophysical profile (BPP). Usually composed of:
NST (fetal tone, movement, and breathing movements.)
US (assess amniotic fluid)
***Each individual assessment worth 2 points for total of 10.

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43
Q

What is a normal non-stress test (NST) in antepartum fetal surveillance?

A

≥2 HR accelerations (≥15BPM over baseline and ≥15 seconds long) within a 20 minute period

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44
Q

The Biophysical profile scores mean what?

A

0-4: fetal hypoxia indicating urgent delivery
6: Equivocal (repeat in 24hrs)
8-10: No fetal hypoxia

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45
Q

A mother with gestational HTN requires weekly BPPs starting when?

A

32 weeks gestation until birth.

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46
Q

When is mag sulfate administered for fetal neuroprotection?

A

24-32 weeks gestation when preterm birth anticipated within 24 hrs.

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47
Q

When would doppler US be used of the umbilical artery?

A

If fetoplacental vascular pathology is suspected in a growth-restricted fetus (<10th percentile weight for gestational age).

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48
Q

Define growth-restriction in the fetus

A

<10th percentile weight for gestational age.

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49
Q

When is vibroacoustic stimulation used during NST?

A

To differentiate from lack of accelerations or a sleep cycle in the fetus.

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50
Q

Indications for renal/bladder US in a child?

A

Infants <24 months with a first febrile UTI

Recurrent febrile UTIs in any aged child

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51
Q

Indications for daily prophylactic antibiotics in children with UTI Hx?

A

Recurrence or evidence of high-grade vesicoureteral reflux

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52
Q

Voding cysturethrogram is considered when in a child?

A

If hydronephrosis or scarring is seen on US. Or in a child<2 with recurrent UTIs or a first UTI from an organism other than E coli

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53
Q

What type of cardiomyopathy occurs from viral myocarditis?

A

Dilated cardiomyopathy. Dilated ventricles and diffuse hypokinesia results in systolic dysfxn (i.e. low ejection fraction).

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54
Q

Concentric hypertrophy develops in response to what most commonly?

A

Chronic pressure overload. Aortic stenosis or HTN often lead to concentric hypertrophy. Concentric hypertrophy develops only in chronic conditions and never acutely, unlike dilated heart failure (viral myocarditis).

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55
Q

Eccentric hypertrophy develops in response to what change?

A

Chronic volume overload (e.g. valvular regurgitation). This does not present acutely, only over time in response to overloading of volume.

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56
Q

Dilated cardiomyopathy most commonly results from what virus?

A

Coxsackievirus B. Echo is diagnostic.

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57
Q

Nitrous oxide abuse is associated with what vitamin deficiency?

A

B12 deficiency and can lead to polyneuropathy.

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58
Q

MR murmur?

A

Holosystolic heard at apex that radiates to axilla.

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59
Q

Bupropion major SE?

A

Sz

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60
Q

Clozapine major SE?

A

Neutropenia

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61
Q

Lamotrigine major SE?

A

Rashes (Stevens-Johnson syndrome)

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62
Q

Lithium major SE?

A

DI and thyroid issues

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63
Q

Trazodone major SE?

A

Priapism - “trazabone”

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64
Q

Management of thyroid storm?

A

Propanolol
PTU followed by iodine (SSKI) to reduce hormone synth/release
Glucocorticoids (to reduce T4-T3 conversion

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65
Q

Cystercercosis cause and location?

A

Taenia solium (pork). Cysts in brain or muscle.

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66
Q

Hydatid cyst cause and location?

A

Echinococcus granulosis (dogs). Eggshell calcified lesion in liver commonly.

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67
Q

Amebic liver abscess Sx?

A

Fever, RUQ pain after weeks of intestinal amebiasis. Eggshell calcification would not be present as in hydatid cyst.

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68
Q

Define primary ovarian insufficiency.

A

Cessation of ovarian fxn at an age <40. It is a form of hypergonadotropic hypogonadism (high GnRH and FSH, low estrogen).

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69
Q

Hypothalamic hypogonadism is characterized by?

A

Low GnRH causing low FSH and estrogen. MCC by low caloric intake or strenuous exercise.

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70
Q

PCO characterized by what hormone levels?

A

Elevated GnRH, normal FSH, elevated estrogen. Increased peripheral androgen to estrone conversion occurs, leading to elevated, nonpulsatile GnRH levels and favoring LH prodxn over FSH prodxn. (LH high, FSH low)

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71
Q

Dx test for Type 2 HIT?

A

Serotonin release assay. This is the gold std confirmatory test.

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72
Q

Management of HIT?

A

Stop heparin. Start direct thrombin inhibitor (argatroban) or fondaparinux.

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73
Q

First step in suspected toxic megacolon (fever, abd. distention, luekocytosis, hypotension)?

A

Abdominal Xray. Barium is contra’d.

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74
Q

What heparin is used in renal failure for DVT Rx?

A

Unfractionated heparin. This is heparin that is unchanged from its normal form as is LMWH. LMWH has less SE than heparin due to lower affinity for other receptors.

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75
Q

Wells score >4 indicates what next step?

A

CTA. Emperic anticoagulation is appropriate in these patients also, but CTA is the next diagnostic step.

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76
Q

Wells score ≤4 indicates what next step?

A

D-dimer.

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77
Q

When is IVC filter considered in DVT and PE?

A

When bleeding risks (ulcer, diverticulosis, etc.) are present and anticoagulation is contraindicated.

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78
Q

Six drugs needed after acute STEMI?

A

Dual antiplatelet (ASA and P2Y12 receptor blocker)
Statins
Anticoagulation
PCI
ß blocker (only if no bradycardia or cardiogenic shock)

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79
Q

Broca’s aphasia is often associated with what deficits?

A

Right hemiparesis due to damage to the motor cortex nearby.

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80
Q

Wernicke’s aphasia associated deficits?

A

Right superior visual field defect due to damage to the visual areas nearby.

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81
Q

Conduction aphasia is due to damage to?

A

Arcuate fasciculus connecting the two together. Poor repetition of spoken language.

82
Q

What side of the brain is dominant in a right handed person?

A

The left hemisphere. This is usually the case with lefties also (70%) and is the area of the brain where verbal/written language fxn is harbored.

83
Q

MCC if PTH independent hypercalcemia?

A

Humoral hypercalcemia of malignancy (due to PTHrP). Often presents with very high levels (>14) of Ca++ snd symptomatic (polyuria, constipation, nausea), but Vit D conversion is not as effective as PTH so PTH is often low-normal.

84
Q

Reticulocytes and platelets in splenic crisis in sickle cell?

A

Reticulocytes: elevated
Platelets: decreased (trapped in spleen also)

85
Q

Reticulocytes and platelets in aplastic anemia in SS disease?

A

R: low (reduced due to ineffective erythropoiesis)
P: normal (typically unaffected)

86
Q

FFP is given when?

A

Known or suspected coagulopathy (eg INR>1.5) with bleeding

87
Q

Cerebral angiography is useful for Dx of what?

A

Cerebral aneurysms and AV malformation

88
Q

Conduct disorder is on the same spectrum of disorder of what when a patient turns 18?

A

Antisocial personality disorder. Violating rights of others, social norms and laws, these people are impulsive, irritable, and aggressive often fighting and showing no remorse. Evidence of conduct disorder must be present before turning 15 for Dx.

89
Q

Vaccinations that are critical to reducing death in HepC positive patients are?

A

HepA and Hep B vaccines. An Acute viral hepatitis could be life threatening. Both are inactivated vaccines and can be given during pregnancy also.

90
Q

Does breastfeeding increase risk of HCV infxn in the newborn?

A

No. Only if the nipples are actively bleeding is there a risk of Tx.

91
Q

MOA of flutamide?

A

Anti-androgen provides androgen blockade by binding dihydrotestosterone receptors. Can be used in combo with other drugs to prolong survival in prostate cancers with limited disease.

92
Q

What cystic ovarian changes are associated with hydatidiform moles?

A

Theca lutein cysts. These cysts are bilateral and multiloculated that respond to high ß-hCG from the mole.

93
Q

Theca lutein cysts are associated with what abnormality?

A

Hydatidiform mole. Moles produce high hCG that result in theca lutein cell proliferation.

94
Q

Complete hydatidiform moles are produced in what two ways?

A

One sperm fertilizes an egg with inactive/nonfxnal maternal chromosomes and divides and fertilizes or two sperm fertilize an egg at the same time.

95
Q

Partial hydatidiform moles are produced in what way?

A

Two sperm fertilize one egg and the 3 sets of genes produce a cell with 69, XXX or XXY or XYY.

96
Q

MCC of congenital hypothyroidism worldwide?

A

Thyroid dysgenesis (aplasia, hypoplasia, ectopic gland).

97
Q

A newborn screen comes back with high TSH and low T4. Most likely Dx?

A

Thyroid dysgenesis. These newborns appear normal at birth, but with waning T4 from mother after birth they develop lethargy, an enlarging fontanelle, protruding tongue, poor feeding, dry skin, constipation, and jaundice. Rx: levothyroxine

98
Q

Newborn presents with jitteriness, tachycardia, and poor feeding. Suspicion leads to a maternal drug test, which is negative. What is good to check next?

A

TSH-receptor antibodies. Grave’s disease can lead to transplacental movement of Ig that can affect the baby.

99
Q

Therapy for Legionnaires disease?

A

Macrolide or fluoroquinolone

100
Q

Elderly patients with evidence of cognitive impairment require what testing first?

A

Neurocognitive testing. (Mini-mental state examination or MMSE). This is prior to TSH and B12, drug screen, thiamine, etc.

101
Q

Wernicke syndrome cause and Sx?

A

Thiamine deficiency leads to encephalopathy, occulomotor dysfxn (horizontal nystagmus), and gait ataxia.

102
Q

PPROM <34 weeks with signs of infxn or fetal compromise requires what Rx?

A

Antibiotics
Corticosteroids (betamethasone)
Mag (if <32 wks)
Delivery

103
Q

PPROM <34 weeks, but no signs of infxn or fetal compromise requires what Rx?

A

Antibiotics
Steroids
Fetal surveillance

104
Q

PPROM (34-37 wks) requires what Rx?

A

Antibiotics
+/- Steroids
Delivery

105
Q

PPROM complications include?

A

Infxn (chorioamnionitis, endometritis)
Cord prolapse
Abruptio placentae

106
Q

When is external cephalic version be performed to correct malpresentation birth?

A

≥37wks delivery

107
Q

Combined hormonal contraceptives are contraindicated in what cases?

A 
Breast cancer
Migraines w/ aura
Smokers>35
HTN
CV disease, DVT/stroke
DM w/ end organ dmg
Antiphospholipid antibody syndrome
Cirrhosis
Recent major surgery
<3wks postpartum
108
Q

Typical Sx of Lyme disease?

A

Early: Erythema migrans
Fatigue
Flu-like Sx
Migratory arthritis (aspirate ~25K WBCs, negative gram stain)
Worsening rash, CN palsy, and carditis (AV block) indicate progression
Late: Arthritis, encephalitis, neuropathy

109
Q

Lyme Rx in the absence of neurologic Sx?

A

Doxy or amoxicillin are first line. Ceftriaxone is used with neuro Sx due to penetration into CNS.

110
Q

What is the biggest difference between grief and MDD?

A

Functional decline is far less noticeable. MDD is severe and suicidality is related to hopelessness rather than “joining the deceased”. MDD must be treated with SSRI.

111
Q

Mirtazapine MOA

A

Tetracyclic antidepressant causes alpha 2 antagonism resulting in NE/serotonin release. Mixed alpha1, and histamine agonism with antimuscarinic effects also.

112
Q

Sustained hand grip causes?

A

Increased afterload

113
Q

Squatting from standing causes?

A

Increased afterload and preload

114
Q

Passive leg raise causes

A

Increased preload

115
Q

Valsalva (straining phase) causes?

A

Reduced preload

116
Q

Abrupt standing causes?

A

Reduced preload

117
Q

NItroglycerin causes what effect on preload/afterload?

A

Reduced preload

118
Q

What effects increase HOCM murmur?

A

Decreased afterload and/or decreased preload (both result in decreased LV size, thus, increasing obstrxn and murmur)

119
Q

What effects increase MVP murmur?

A

Increased afterload and increased preload

120
Q

AR, MR, VSD are all increased by?

A

Squatting and handgrip

121
Q

All right sided murmurs are increased by?

A

Increased venous return (aka preload increase)

122
Q

First-line Rx for acute angle closure glaucoma?

A

Acetazolamide.

123
Q

MC kidney stone formed by?

A

Calcium oxalate. Envelope-shaped on microscopic exam. Fat malabsorption leads to increased oxalate absorption leading to Ca++ chelation.

124
Q

CaPO4 stones are common in?

A

Hyperparathyroidism

Renal tubular acidosis (Type 1)

125
Q

Uric acid stones are formed commonly in?

A

Increased cell turnover leads to hyperuricemia and hyperuricosuria.

126
Q

Cysteine stones form when?

A

Usually familial AA reabsorption issues. Cysteinuria is a classic example.

127
Q

Struvite stones form when urine is?

A

Alkaline from urease producing bacteria (proteus)

128
Q

Adverse clinical events are most commonly associated with what problem in the hospital environment?

A

Communication failures.

129
Q

What is the best way to reduce communication errors in the hospital environment?

A

Checklists prevent undesired medical outcomes from communication failures during the handoff process.

130
Q

Renal transplant dysfxn typically presents as?

A

Oliguria
HTN
Increased Cr/BUN

131
Q

First line Rx in acute organ transplant rejection?

A

High dose steroids

132
Q

Renal transplant rejection in early postop period is most commonly due to?

A 
Ureteral obstrxn
Vascular obstrxn
Cyclosporine toxicity
Acute rejxn
Cyclosporine toxicity
Acute tubular necrosis
***US, MRI, biopsy, and radioisotope scanning helps differentiate.
133
Q

Minimal change disease assoc. with what disease?

A

Lymphoma

134
Q

Membranoprolif. glomerulonephritis commonly assoc. with what disease?

A

Hep B and C

135
Q

Focal segmental glomerulosclerosis commonly assoc. with what disease?

A

HIV

Heroin use

136
Q

IgA nephropathy commonly assoc. with what disease?

A

URI

137
Q

Gold std for testing in suspected ovarian torsion?

A

US showing mass with absent doppler flow.

138
Q

Appropriate compensation in acute respiratory acidosis?

A

Serum HCO3 increases by 1 for each 10 PaCO2 rise

139
Q

Appropriate compensation in acute respiratory alkalosis?

A

Serum HCO3 reduced by 2 for each 10 PaCO2 decreased

140
Q

Appropriate compensation in metabolic acidosis?

A

Winter’s formula: PaCO2 will equal 1.5xHCO3 +8 +/- 2

141
Q

Appropriate compensation in metabolic alkalosis?

A

Increased PaCO2 by 0.7 for each 1 mEq HCO3 elevation

142
Q

Rx for radial head subluxation?

A

Hyperpronation of forearm OR supination of forearm with flexion of elbow.

143
Q

Steppage gait (prominent lifting of leg when walking due to foot drop) is commonly due to?

A

L5 radiculopathy OR neuropathy of common peroneal nerve

144
Q

Difficulty initiating forward movement of the feet (magnetic gait) is due to damage where?

A

White matter fibers of the frontal lobe (cortico-cortical fibers). Often due to normal pressure hydrocephalus.

145
Q

Cerebellar hemisphere pathology leads to?

A

Limb ataxia

146
Q

Cerebellar vermis pathology leads to?

A

Truncal ataxia.

147
Q

Precipitous drops in sodium levels can result in what pathology?

A

Cerebral edema.

148
Q

Management of severe hypovolemic hypernatremia?

A

Normal saline. Anything else (hypotonic solutions) could lead to cerebral edema.

149
Q

Drugs to reduce vasospasm after subarachnoid bleed?

A

Nimendipine or other Ca++ channel blockers

150
Q

AV malformation is the MCC of intracerebral hemorrhage in what population?

A

Children

151
Q

Wallenberg syndrome cause?

A

Posterior inferior cerebellar artery (PICA) injury. Leads to lateral medullary syndrome (vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temp in ipsilateral face and contralateral body, bulbar weakness, ipsilateral Horners).

152
Q

Donepezil (Aricept) use?

A

Alzheimer’s disease. Improves cognitive fxn.

153
Q

Widespread or recalcitrant seborrheic dermatitis management?

A

Low dose steroids creams or topical ketoconazole

154
Q

Young female athlete with amenorrhea for several months denies visual changes, heat intolerance, hot flashes, or night sweats usually has her period q 28 days for 4 days. Her vitals are stable. BMI is 20. Habitus is muscular. She has mild acne, no thyromegaly or facial hair. She is Tanner stage V. Pregnancy test negative. TSH/prolactin are normal. Dx?

A

Hypothalamic amenorrhea. Due to low GnRH resulting in low LH/FSH and estrogen. She has athlete’s triad (amenorrhea, osteoporosis, and an eating disorder.

155
Q

Athlete’s triad?

A

Amenorrhea (low GnRH secretion –> low LH/FSH –> low estrogen)
Osteoporosis (low estrogen)
Eating disorder (caloric deficiency relative to expenditure)

156
Q

Two-sample “T” test and “Z” test are used for what?

A

Both are used for comparing the means of two groups. T test is used for samples and Z tests for population, rather than a subset (sample).

157
Q

ANOVA is used for what?

A

Comparing 3 or more means

158
Q

Chi-squared test is used for what?

A

Categorical data/proportions

159
Q

4 C’s of measles (rubeola)?

A

Cough
Coryza
Conjunctivitis
Koplik spots

160
Q

B6 deficiency leads to?

A

Neurologic impairment and skin/mucus breakdown (stomatitis, cheilosis)

161
Q

Vitamin E deficiency leads to?

A

Hemolytic anemia and ataxia (and other neuro sx)

162
Q

First line Rx in exercise induced asthma?

A

Short acting ß agonist 10-20 mins before workout. Steroid inhalers or montelukast are appropriate in athletes who exercise daily in addition to the SABA.

163
Q

Can fibroids lead to problems during pregnancy?

A

Obstetrical complications like miscarriage, malpresentaiton, abruption, and preterm birth can occur all due to fibroids.

164
Q

Classic signs of molar pregnancy are?

A

Vaginal bleeding
Hyperemesis gravidarum
Diffusely enlarged uterus with regular contour

165
Q

PE signs in a patient with Leiomyomata?

A

Irregularly enlarged uterus
Size-date discrepancy
Pressure on colon/bladder resulting in sensations of incomplete boiding

166
Q

RFs for uterine inversion?

A

Nulliparity
Fetal macrosomia
Placenta accreta
Rapid labor/delicery

167
Q

Placenta accreta RFs?

A

Uterine surgery (Csxn, myomectomy, D&C)

168
Q

In uterine prolapse after childbirth where placenta is still attached to the uterus, when should the placenta be removed?

A

After replacement of the uterus. Otherwise massive hemorrhage may ensure. Uterotonics (oxytocin and misoprostol) should be given afterwards to prevent hemorrhage.

169
Q

Classic aspergillosis Sx?

A

Pulm. disease (fever, pleuritic pain, hemoptysis)

Nodular/focal infiltrates on CXR

170
Q

Cryptosporidium classic Sx?

A

Diarrheal disease in immunosuppressed

171
Q

Delayed and diminished carotid pulse, soft second heart sound, and a mid or late systolic murmur with maximal intensity at the 2nd right IS, most likely?

A

Aortic stenosis. The soft heart sound is due to thick/calcified leaflets with severely reduced mobility.

172
Q

First line Rx for trigeminal neuralgia?

A

Carbamazepine or oxcarbazepine. 2nd line: nerve decompression/ablation

173
Q

Pathophys behind trigeminal neuralgia?

A

Compression if CNV (trigeminal). Usually leads to V2-3 nerve pain, but V1 can occur rarely and lead to lacrimation or rhinorrhea.

174
Q

Evidence of a small VSD over a large VSD include?

A

Harsh and loud murmur at LLSB
Normal ECG
Absence of concerning Sx (tachycardia, tachypnea, failure to thrive, heave)

175
Q

Management of suspected VSD?

A

Echo for Dx
Most close spontaneously by 2 years
Large or symptomatic VSDs can lead to Eisenmenger syndrome and may need surgery

176
Q

Innocent “flow” murmur of childhood sound?

A

Low grade (1 or 2) midsystolic ejection murmur

177
Q

Rx for at risk children with RSV?

A

Palivizumab. Premies, lung disease of prematurity, congenital heart disease are indivations for use.

178
Q

Prophylactic Rx for cluster HA?

A

Verapamil
Lithium
***Should be started after onset of acute attacks.

179
Q

Cluster HA paroxysms?

A

Attacks begind during sleep, peak rapidly, last 90 minutes or so and occur up to 8x daily for 6-8 weeks followed by a remission period. Verapamil and lithium can be used prophylactically to reduce episodes after the first attacks begin.

180
Q

Sx associated with small fiber injury from long-term DM?

A

“Positive” symptoms: pain, paresthesias, allodynia (painful response and sensitization to non-painful stimuli)

181
Q

Sx associated with large fiber injury from long-term DM?

A

“Negative” symptoms: numbness, loss of proprioception/vibration sense, diminished ankle reflexes

182
Q

RFs for preterm labor?

A 
Prior PTL
Multiple gestation
Short cervix
Cervical surgery
Cigarettes
183
Q

Screening for preterm labor?

A

TVUS for short cervix. If ID’ed then cerclage is Rx.

184
Q

Leading cause of neonatal M&M?

A

Preterm birth (<37wks GA).

185
Q

Basal ganglia dysfxn usually leads to what signs?

A

Extrapyramidal signs. Resting tremor, rigidity, bradykinesia, choreiform movements.

186
Q

Cerebellar dysfxn usually causes what?

A

Ataxia
Intention tremor
Dysdiadochokinesia

187
Q

What local changes may be expected in area surrounding PE?

A

Pleural effusion due to hemorrhage/inflammation.

188
Q

A child with an IgA nephropathy and palpable purpura, arthritis, and abdominal pain and/or intussusception likely has?

A

Henoch-Schönlein purpura. Results in a glomerular disease due to IgA-mediated leukocytoclastic vasculitis.

189
Q

Nodular lesion on the skin with hyperpigmented appearance and firm to the touch. It dimples in the middle when pinched. Dx?

A

Dermatofibroma. Fibroblastic proliferation causes lesions. May result from trauma. BCC does not dimple as does dermatofibroma.

190
Q

What arrhythmia is common after CABG?

A

Atrial fibrillation. Usually self-limited and resolves in <24hrs.

191
Q

Pt presents with fever, CP, leukocytosis, and mediastinal widening on chest Xray. He recently had CABG. Dx?

A

Acute mediastinitis. Rx: Drainage, debridement, ABx

192
Q

Easy ulcer staging method?

A

Each stage is another layer of the skin. For example, stage 1 is the outer epidermis irritation, 2 is down into dermis, 3 is into SubQ fat, 4 is full thickness into muscle, bone, tendon.

193
Q

Allergic contact dermatitis appearance?

A

Well demarcated
Erythema
Papules/vesicles
Chronic lichenification

194
Q

Irritant contact dermatitis apperance?

A

Often on hands
Erythema
Fissures

195
Q

Metformin is contra’d in acute renal failure, liver failure, and sepsis due to risk of ?

A

Lactic acidosis. Short stent of insulin can replace it for DM Rx.

196
Q

Classic signs of iron overdose?

A

Hours: Hematemesis, melena, hypotensive shock (iron is a potent vasodilator), anion-gap metabolic acidosis
Days: Liver necrosis
Weeks: Gastric scarring and pyloric stenosis

197
Q

Iron chelator?

A

Deferoxamine

198
Q

Vitamin A OD?

A

N, V, blurry vision

Chronic can lead to increased intracranial pressure (pseudotumor cerebri.

199
Q

Underlying pathology in lacunar stroke?

A

HTN, DM, high LDL, and smoking all lead to microatheroma and lipohyalinosis formation in small vessels of brain (BG, Pons, subcortical white matter).

200
Q

Drugs used for ovulation induction if pregnancy unsuccessful in PCOS?

A

Clomiphene.

201
Q

Sx in failure of müllerian duct fusion?

A

Müllerian agenesis leads to primary amenorrhea, foreshortened vagina with no palpable uterus, and normal hormone levels.

UWorld (18 decks)

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