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Med > Mix3 > Flashcards

Mix3 Flashcards

1
Q

Preferred therapies for HBV

A

Entecavir and tenofovir

Due to low resistance and the ability to be used in decompensated cirrhosis

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2
Q

Trichinosis

A

Intestinal stage(within 1wk): asymptomatic or abdominal pain, N/V, diarrhea

Muscle stage (within 3wk): fever, subungual hemorrhage, muscle pain/tenderness/swelling/weakness, periorbital edema, chemosis
, conjunctival/retinal hemorrhage

Lab: eosinophilia >20%, increased CPK, increased WBC

Triad: periorbital edema, myositis, eosinophilia

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3
Q

INH induced peripheral neuropathy

A

Due to excretion of B6 with INH from kidneys

Higher risk if: DM, pregnant, malnourished, uremia, alcoholism, HIV, epilepsy

Numbness and tingling in a stocking-glove distribution

PEx: deficit in vibration and proprioception

Over time: affects touch, pain, temprature sensation

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4
Q

The most common behavioral RF for TB

A

Substance abuse

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5
Q

INH hepatitis management

A

Immediate discontinuation

More frequent if: alcoholic, liver disease, >50 yo

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6
Q

If subclinical hepatic injury by INH

A

No signs/symptoms of hepatitis

Liver enzymes < 100

In10-20% of pts

continue INH with close F/U

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7
Q

Next step after positive PPD?

A

CXR

Symptom review

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8
Q

Positive PPD in immigrant < 5y

A

10 mm

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9
Q

Positive PPD in IDU

A

10 mm

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10
Q

Positive PPD in DM

A

10 mm

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11
Q

Positive PPD in prolonged CS therapy

A

10 mm

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12
Q

Positive PPD in ESRD

A

10 mm

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13
Q

Positive PPD in leukemia

A

10 mm

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14
Q

Positive TB in children <4y

A

10 mm

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15
Q

Positive PPD in malabsorption syndromes

A

10 mm

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16
Q

5mm PPD is positive if:

A 
HIV
Organ transplant
ImSup
Changes consistent with previous TB on CXR
Recent contact of known TB
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17
Q

Canadian vs US cutoff value for positive PPD

A

10 vs 15 (US)

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18
Q

Latent TB treatment

A

INH+ Rif weekly x 3mo under direct observation (not for HIV)

INH 6-9mo

Rifampin 4mo

INH + rif 4mo

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19
Q

Urine culture and gram smear in gonorrhea vs chlamydia

A

Negative smear and culture in chlamydia

Gram stain shows 95% of gonorrhea infection

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20
Q

UTI with urease producing bacterium

A

Urinary alkalization (pH>8)

Proteus mirabilis, klebsiella pneumoniae.

High pH reduces solubility of phosphate, raising the risk of struvite stones (Mg ammonia P)

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21
Q

Recommendation to pt with vaginal trichononiasis

A 
Oral Metro or tinidazole
Refrain from alcohol
Treatment of partner (testing of partner
 is unnecessary) 
Abstain from sexual activity until both partners treated
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22
Q

Tx of choice for bacterial vaginosis

A

Oral metro.

Alternative: clinda

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23
Q

Autonomic control of erectile function

A

Sympathetic: T11-T12
Parasympathetic: S2-S4

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24
Q

Acute AUB in adolescents. Reasons

A

The most common: immature HPO axis resulting unovulatory cycles
Also: hemostasis disorders, pregnancy

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25
Q

Tx of acute AUB

A

If pt is hemodynamically stable:
IV/PO estrogen
High-dose OCP
High-dose progesterone pills (if estrogen contraindicated)
Tranexamic acid (if est and prog contraindicated)
If no response to medical management after 24-36 h: emergency dilation and curettage

Packed cell: if unstable

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26
Q

Prepubertal vaginal bleeding etiology

A

Estrogen withdrawal:
In neonatal period (first 2 wk)
<1 wk duration
Normal PEx (sometimes temporary breast buds, external genitalia engorgement)

Trauma:
Fall, sexual abuse

Malignancy:
e.g. rhabdomyosarcoma
<3 y
Protruding vaginal nodules

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27
Q

Dysmenorrhea+ heavy menstrual bleeding in a multiparus woman > 40

A

Adenomyosis

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28
Q

Small ovarian cyst in post menopausal women

A

Check CA-125

If no suspicion for malignancy (small size, no solid component, no septation) and negative CA-125: observe

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29
Q

Mechanism of amenorrhea caused by marijuana

A

Functional hypothalamic

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30
Q

FSH and LH levels in pituitary dysfunction

A

Very low (<5)

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31
Q

Mechanism of anenorrhea caused by obesity

A

Anovulation

FSH and LH: nl

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32
Q

Time of testis removal in AIS

A

After completion of puberty

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33
Q

The reason for irregular menses at the beginning of menarch

A

Inadequate FSH and LH, therefore lack of ovulation and lack of progesterone

Menses due to estrogen breakthrough bleeding

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34
Q

Tx of bartholin cyst

A

If asymptomatic: non

If symptomatic: I&D + word catheter

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35
Q

Breast abscess Tx

A

Needle aspiration under US guide

+ AB for surrounding mastitis

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36
Q

Trastuzumab (Herceptin)

A

For HER2 positive breast cancer

Cardiotoxic with other chemo agents

Requires echo before administration

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37
Q

The most common side effect of tamoxifen

A

Hot flashes

Other side effects: VTE, endometrial cancer

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38
Q

RFs of breast cancer

A 
Alcohol consumption
HRT
Nulliparity
Increased age at first live birth
Genetic mutation
White race
Increasing age
Early menarche, late menopause
Obesity
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39
Q

Breast engorgement

A 
Milk production > release
No fever
No erythema
Usually bilateral
If lactation cessation desired:
Wearing a comfortable, supportive bra.
Avoidance of nipple stimulation and manipulation.
Ice pack
NSAIDs
Breast binding not recommended.
Use of medication not supported.
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40
Q

Acoustic enhancement is indicative of

A

Fluid

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41
Q

A mass suspicious for fibroadenoma in a young woman (adolescent)

A

Re-examine over one menstrual cycle. If decreased in size/tenderness after the mense, reassurance.

If older than adolescent or if persistent mass, U/S. If results consistent with fibroadenoma no further W/U for adolescents.

Excisional Bx considered if adult or if very large mass

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42
Q

Tx of CIN3

A

Cervical conization with cold knife or LEEP

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43
Q

Mechanism of HTN by OCP

A

Increased angiotensin synthesis by estrogen during hepatic first-pass metabolism

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44
Q

OCP and risk of cervical cancer

A

Increases the risk

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45
Q

OCP and wt gain

A

No wt gain

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46
Q

Contraindicated contraception method in breast cancer

A

All hormonal methods: pills, rings, patches, IUDs…

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47
Q

Adverse effects if DES

A

Daughters:
Clear cell carcinoma of the vagina/cervix
Cervical/uterine malformations
Difficulty conceiving and maintaining pregnancy

Sons:
Cryptorchidism
Microphalus
Hypospadiasis
Testicular hypoplasia
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48
Q

Ovarian endometrioma on U/S

A

Homogenous cystic ovarian mass

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49
Q

Laparoscopy in endometriosis is necessary if:

A

Failure of medical Tx
Infertility
Adnexal mass

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50
Q

Breast fat necrosis

A 
Post-trauma/surgery
e.g. seatbelt injury
Firm
Fixed
Skin/nipple retraction
Calcification on mamo, hyperechoic
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51
Q

Which ovarian cysts may rupture?

A

Simple ovarian cysts

Corpus luteum cysts

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52
Q

Typical manifestations of ovarian torsion

A 
Lower abdominal pain (often sudden)
Sharp, colicky, intermittent
Sometimes precipitating factors like exercise
N/V
Low-grade fever
Unilateral abdominal/pelvic tenderness
Voluntary guarding
\+/-palpable mass
Peritoneal signs (rebound, involuntary guarding) if necrosis
53
Q

Manifestations of ruptured ovarian cyst

A

Sudden onset of unilateral lower abdominal pain
Usually following sex or strenuous activity
Symptoms of hemoperitoneum (rigidity, rebound)
Lower quadrant tenderness
Involuntary gaurding
Pleuritic chest pain
Shoulder pain
+/- Decreased hematocrit
Free fluid

54
Q

Inadequate colposcopy. Next step?

A 
Endocervical curretage
(Deferred innpregnancy due to the risk of miscarriage or PTL)
55
Q

HSIL on pap testing during pregnancy

A

Colposcopy

Bx if high-grade features

56
Q

Screening of chlamydia and gonorrhea in women <25

A

Annually (sexually active)

57
Q

Fitz-Hugh-Curtis

A

Perihepatitis as a complication of PID
slightly elevated transaminases
RUQ pleuretic pain
Tx: hospitalization, IV AB

58
Q

Gonococcal pharyngitis symptoms

A

Asymptomatic
Or
Pharyngeal edema and non-tender cervical LAP

59
Q

If cervical swab for NAAT positive for chlamydia and negative for gonorrhea, Tx?

A

Azithromycin or doxy

With smear/culture, treat both chlamydia and gonorrhea

60
Q

Maternal estrogen effect in newborn

A

Breast hypertrophy
Swollen labia
Physiologic vaginal leukorrhea
Uterine withdrawal bleeding

61
Q

Severe features of preeclampsia

A 
SBP 160 or higher or DBP 110 or higher
Thrombocytopenia
Increased creatinine
Increased transaminases
Pulmonary edema
Visual/cerebral symptoms
62
Q

If urine dipstick positive for protein during pregnancy, next step?

A

24h urine protein (gold std)
Or
ACR

Preeclampsia in setting of increased BP confirmed 
If:
24h protein > 300 mg
Or
Protein/creatinine ratio 0.3 or higher
63
Q

Definition of preeclampsia

A

SBP 140 or higher OR DBP 90 or higher
And
Proteinuria and/or end-organ damage

64
Q

GnRH, FSH, Estrogen in PCOS

A

GnRH: increased
FSH: Nl
Estrogen: increased

65
Q

GnRH, FSH, estrogen during ovulation

A

All normal

66
Q

FSH/LH ratio in ovarian failure

A

> 2

Due to slower clearance of FSH

67
Q

Adverse effects if SERMs

A

Hot flashes: both raloxifene and tamoxifen

VTE: both

Endometrial hyperplasia/carcinoma: tamoxifen

All medicines with estrogen agonist activity increase risk of DVT

68
Q

The most common cause of rectovesical fistula

A

Obstetric injury

69
Q

If strong clinical suspicion but negative RPR/VDRL

A

Treat empirically with penicillin G

Repeat non-treponemals in 2-4 weeks for baseline titer. Repeat in 6-12 mo

70
Q

Urethral hypermobility test

A

Place pt in lithotomy position
Insert a Q-tip in urethral orifice
Angle of 30 degrees or higher from horizontal plane on increased intraabdominal pressure signifies urethral hyper-mobility (stress incontinence)

71
Q

Tx of stress incontinence

A

LSM
Kegel

If due to urethral hypermobility: urethral sling surgery

If due to internal urethral sphincter deficiency: injection of bulking agents

72
Q

Normal post-void residue

A

Women < 150 mL

Men < 50 mL

73
Q

Menopausal GU syndrome

A

Urgency
Frequency
UTI
stress/urge incontinence

Inv: U/A, U/C

Tx: 1st step: moisturizer, lubricant
If mod-sev: low-dose vaginal estrogen

74
Q

Removal of vaginal foreign body in children

A

Ca alginate swab or irrigation with warm fluids

If unsuccessful or large, examination under anesthesia

75
Q

Abortion method in unstable pt

A

Suction curettage

76
Q

Septic abortion Tx

A

Broad AB
Fluid
Suction curettage

77
Q

The most common RF for abruptio placenta

A

HTN

78
Q

The reason for hypotension after epidural

A

Blockage of sympathetic nerve fibers, therefore pooling of blood in veins
Prevention: fluid before anesthesia

Tx: left lateral decubitus, IV fluid, vasopressor

79
Q

Fetal anemia on NST

A

Sinusoidal

80
Q

Chorioamnionitis on NST

A

Fetal tachycardia

81
Q

Oxytocin adverse effects

A

Hyponatremia
Hypotension
Tachysystole (>5 uterine contractions in 10 minutes over a 30 minutes period)
Tetanic contractions

82
Q

Klumpke palsy

A

Claw hand
Horner
Intact moro and biceps reflexes

83
Q

Erb-Duchenne palsy

A 
C5 (deltoid, infraspinatus)
C6 (biceps)
\+/- C7 (wrist/finger extensors)
Waiter’s tip
Intact grasp
Decreased moro and biceps reflexes

Tx: gentle massage, PT
80% spontaneous recovery by 3 mo
If no improvement by 3-6 mo, surgery considered

84
Q

Breastfeeding contraindications

A

Active untreated TB (up to 2 wks after starting therapy)
Maternal HIV infection (in developed countries)
Herpetic breast lesions
Varicella (<5days before to 2 days after delivery)
Chemo
Ongoing RT
Active abuse of alcohol/drugs
Infant galactosemia

85
Q

Alcohol consumption and breastfeeding

A

Occasional use is not absolute contraindication

Do not breastfeed for at least 2-3 h after intake

86
Q

Inborn errors of metabolism and breastfeeding

A

The only absolute contraindication: galactosemia

Phenylketonuria: may breastfeed intermittently, but close monitoring of phenylalanine and other metabolites

87
Q

HCV and breastfeeding

A

Not a contraindication

Abstain if cracked/bleeding nipples

88
Q

H1N1 and breastfeeding

A

Mother should be separated from the infant while febrile, but should be encouraged to pump

89
Q

Protraction of active phase of labor definition and Tx

A

Cervical change that is slower than expected +/- inadequate contractions

Tx: oxytocin

90
Q

Arrest of active phase of labordefinition and Tx

A

No cervical change for:
4 hour or more with adequate contraction
Or
No cervical change for 6 hours or more with inadequate contractions

Tx: cesarian

91
Q

Definition of adequate uterine contractions

A

Contractions generating 200 MVUs or more in a 10 minute interval are considered adequate

MVU= No. of contractions in 10 min x contraction strength

92
Q

Chorioamnionitis treatment

A

Broad AB + delivery (oxytocin if vaginal) + antipyretics

93
Q

Exercise in pregnancy

A

20-30 min, moderate intensity (able to engage in normal conversation), on most/all days
Avoidance of dehydration
Avoidance of prolonged periods of lying supine
Stop if symptoms such as vaginal bleeding, leakage of fluid, contractions or chest pain develop

94
Q

Contraindications of exercise during pregnancy

A 
Absolute:
Amniotic fluid leak
Cervical incompetence
Multiple gestation
Placenta abruption or previa
Premature labour
Preeclampsia/gestational hypertension
Severe heart or lung disease
95
Q

Unsafe activities during pregnancy

A

Contact sports
High fall risk
Scuba diving
Hot yoga

96
Q

Excessive wt gain complications during pregnancy

A

GDM
Macrosomia
C/S

97
Q

Inadequate wt gain complications during pregnancy

A

IUGR

PTB

98
Q

Approach to BPP

A

0-4/10: urgent delivery
6/10: repeat in 24 h
8-10/10: Nl:continue weekly BPP

99
Q

Antepartum fetal surveillance for gestational HTN

A

Starting at 32w GA

Weekly BPP

100
Q

Gradual deceleration definition

A

30 seconds or more from onset to nadir

In early and late decelerations
Deceleration is abrupt “<30 sec” in variable deceleration

101
Q

FHR patterns DDx

A

Early deceleration: fetal head compression

Late deceleration: uteroplacental insufficiency

Variable deceleration: cord compression, cord prolapse, oligohidramnios

102
Q

The first intervention with recurrent variable decelerations

A

Maternal repositioning
If failed, aminoinfusion

Intermittent variable decelerations (<50% of contractions) are well tolerated by the fetuso

103
Q

The exception to universal GBS screening

A

Hx of GBS bacteriuria/UTI at any point during the current pregnancy
Or
Invasive early-onset GBS disease in a prior child

Intrapartum AB prophylaxis

104
Q

GDM targets

A

FPG: <95 (5.3)
1 hpp: <140 (7.8)
2 hpp: <120 (6.7)

105
Q

GDM screen

A

If high risk: at 1st prenatal visit and at 24-28w if negative

If normal risk: at 24-28

High risk pts: previous GDM, obese, previous macrosomic neonate

106
Q

GDM Tx

A

1st line: LSM (dietary modification)

2nd line: insulin, metformine, glyburide

107
Q

Dietary modification for GDM

A

Evenly distributed carbohydrates, fat, protein intake over 3 meals and 2 to 4 snacks daily

108
Q

Forceps in management of shoulder dystochia

A

Not indicated

Forceps is used for delivery of the head not shoulder

109
Q

DDx of theca-lutein cysts

A

GTN
Multiple gestation
Infertility treatment

110
Q

ALP in pregnancy

A

Normally elevated

111
Q

Conditions associated with wernicke encephalopathy

A

Chronic alcoholism
Malnutrition (Anorexia nervosa)
Hyperemesis gravidarum

112
Q

Ocular manifestations of Wernicke

A

Horizontal nystagmus
Bilateral abducent palsy

+ encephalopathy, postural and gait ataxia

113
Q

Metabolic abnormalities of hyperemesis gravidarum

A

Hypochloremic metabolic alkallosis
Hypokalemia
Elevated serum transaminases

114
Q

Tx of Wernicke in context of hyperemesis gravidarum

A

Antiemetics
Fluids
Thiamine
Glucose (after thiamine)

115
Q

Vitamin B12 deficiency symptoms

A

Dementia
Subacute combined degeneration due to demyelination of:
Spinocerebellar tract (gait ataxia)
Lateral corticospinal tract (spastic paresis)
Dorsal column (loss of position/vibration sense)
Indolent clinical course
Macrocytic anemia

116
Q

Neurosyphilis manifestations

A 
Tabes dorsalis (sensory ataxia, lancinating pain)
Argyll Robertson pupils
117
Q

Na and oxytocin

A

Oxytocin can cause hyponatremia due to similarity to ADH

118
Q

Mg therapeutic range for preeclampsia

A

5-8 mg/dL

Toxic: > 8

119
Q

Resumption of menses in non-lactating women

A

In 10 weeks

120
Q

Intrauterine fetal demise mode of delivery

A

20-23 wk: dilation and evacuation or vaginal delivery

24 wk or more: vaginal delivery

121
Q

Prolonged second stage of delivery

A

> 3 h in nulliparous

>2 h in multiparus

122
Q

The most common cause of prolongation of the second stage of delivery

A

Fetal malposition

123
Q

The optimal fetal position in delivery

A

Occiput anterior

124
Q

The main cause of low back pain in pregnancy

A

Increased lordosis
Also
Relaxation of the ligaments supporting sacroiliac and other joints

125
Q

Mx of clavicular fx in newborn

A

Reassurance
Gentle handling
Analgesics
Place affected arm in a long-sleeve and pin sleeve to chest with elbow flexed at 90 degrees

126
Q

The next step after decreased fetal movement

A

NST

127
Q

The next step after abnormal NST

A

BPP
Or
Contraction stress test

128
Q

PPV and NPP of NST

A

Low PPV

High NNP

Med (25 decks)

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