Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Random > Random UWorld 8/8/17 > Flashcards

Random UWorld 8/8/17 Flashcards

1
Q

65yo lady with 6 mos worsening dry cough and dyspnea. dry late inspiratory crackles and digital clubbing on exam. diffuse reticular or nodular opacities on cxr, fibrosis honeycombing traction bronchiectasis on high resolution ct, no identifiable environmental infectious or autoimmune cause

daignosis
pft pattern

A

pulmonary fibrosis due to ILD interstitial lung disease … call it IPF idiopathic pulmonary fibrosis when no identifiable environmental infectious or autoimmune cause found

restrictive pft pattern!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

trial of labor ok or contraindicated with history of the following

  • low transverse csection
  • classical vertical csection
  • abdominal myomectomy without uterine cavity entry
  • abdominal myomectomy With uterine cavity entry
A

low transverse CS - trial of labor ok

Classic Vertical CS - No trial of labor, contraindicated

myomectomy without entry - trial of labor ok

myomectomy With Entry - No trial of labor, Contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Terbutaline is a ___ adminstered to relax the ___

A

Terbutaline is a Tocolytic to relax the Uterus when contractile abnormalities occur (tachysystole, tetany)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Amnioinfusion involves what to treat what

A

Aminoinfusion - catheter insertion for intrauterine infusion - to relieve umbilical cord compression and resolve variable decels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

young guy with unprovoked DVT/PE and family history with normal pt ptt but high DDimer

suspect
why
pathophys

A

Factor V Leiden

Most Common inherited hypercoagulable disorder in Whites

Activated Protein C Resistance - factor V mut (autosomal dominant but homo worse off than hetero) resists protein c and activates thrombin… thus clotting without pt or ptt changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

endometrial biopsy indications

over 45yo

under 45yo

A

over 45 if abnormal uterine bleeding or postmenopausal bleeding

under 45 if abnormal uterine bleeding AND unopposed estrogen or lynch syndrome hnpcc or failed medical management of uterine bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TF
ocp or cyclic progestin or continuous progestin are appropriate tx for premenopausal abnormal uterine bleeding after uterine cancer ruled out

A

T

all works to differentiate endometrium prevent unopposed estrogen uterine proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

solitary painless firm mobile breast mass 2cm in size noted on breast exam and mammography

diagnosis

A

fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

placenta accreta typically only occurs in patients with history of __ __ or __

A

placenta accreta usually only if history of CSection Myomectomy or DandC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

in treating inverted uterus, placental removal and uterotonics should be given After __

A

after reduction of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

immunocompromised patient with fever pleuritic chest pain hemoptysis, CT with nodules with surrounding ground glass opacities

diagnosis
name for ct finding
treat

A

pulmonary aspegillosis

“halo sign” - nodules with surrounding ground glass opacities

voriconazole and caspofungin (an echinocandin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CMV pneumonitis
3 symptoms
ct finding

hemoptysis? chest pain? productive cough? nodules with halo sign (surrounding ground glass opacities)?

A

CMV PNA
low fever, dry cough, sob
patchy or diffuse ground-glass opacities on ct

NO hemoptysis cp sputum halo signs… think more aspergillus there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

immunocompromised patient, dyspnea, nonproductive cough, fever, bilateral diffuse interstitial infiltrates on imaging

think what opportunistic bug?

A

PCP pneumocystis pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

immunosuppressed patient, fever hemoptysis dyspnea upper lobe disease… thick sputum and nodules with surrounding ground glass opacities (halo sign)

what makes you think reactivation of TB and what doesn’t?

A

fever hemoptysis dyspnea upper lobe disease immunocompromise…. TB or aspergillus

thick sputum, nodules with surrounding ground glass opacities (halo sign) …. more aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

guy on PPI with burning chest pain for 15 minutes per episode when lifting things at work… work him up for ulcers or angina?

A

Atypical Angina
get an Exercise EKG

only after ruling out angina can you go after gerd and ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tf

absent achilles reflexes can be normal in elderly

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ear pain worse with chewing, history of teeth grinding while sleeping, no ear tenderness on exam or otoscopic abnorms

diagnosis
treatment

A

temperomandibular joint dysfunction

nighttime bite guard, surgery if refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Herpes Zoster infection that causes Bell’s Palsy with vesicles on the outer ear, aka

A

Ramsay Hunt syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pathophys of flushing and pruritus side effect of niacin

treat

A

Prostaglandin-induced peripheral vasoDilation

treat with low dose Aspirin 30 min before taking Niacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

10-20 days after throat or skin infection - periorbital swelling, hematuria, oliguria, hypertension - hematuria with rbc casts and poteinuria on ua - low serum C3 complement

diagnosis
IgA nephropathy?
Membranoproliferative glomerulonephritis?

A

PSGN post strep glomerulonephritis

not iga nephropathy – that v5 days after urti and normal serum complement levels

not mpgn - similar symptoms and low complement but no temporal relationship with infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

severe infection eg cdiff, super high wbc like 50s, predominance of late neutrophil precursors (bands and metamyelocytes), high leukocyte alk phos score

diagnosis

how different from CML?

A

Leukemoid Reaction
-bad infection mobilizing the young troops

vs cml will have Low leukocyte alk phos score (becaues the neutrophils suck), and Earlier neutrophil precursors on peripheral smear (more myelocytes than metamyelocytes) and “absolute basophilia”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

myelodysplastic syndrome often presents with infection in the setting of ___

A

myelodysplastic syndrome - PANcytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

old guy states wavy appearance of lines when looking at a grid and issues reading and driving

diagnosis
prevalence
expect what on physical exam

A

Macular Degeneration
-Wavy lines is one of the earliest signs (visualizing straight lines takes fine visual acuity so macula function)

Most Common cause of blindness in industrialized countries (risks are age and smoking)

Drusen deposits on macula on exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

guy already on digoxin is put on amio for afib, week later has gi sx anorexia nausea vomiting abdominal pain and fatigue

your recommendation, why

A

decrease digoxin dose

amio increases digoxin levels and this is acute digoxin toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

acute vs chronic digoxin toxicity symptoms

A

Acute digoxin tox - GI symptoms mostly, maybe weakness and confusion

Chronic digoxin tox - more Neuro and Visual (lethargy, confusion… color changes scotomas blindness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

TF

HIT can cause acute limb ischemia with low platelets and high PTT

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

does warfarin affect PT or PTT

A

PT

INR is PT/referencePT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pt with history of depression overdosed no fever hypotension dilated pupils and seizure and QRS prolongation on ekg

what drug od’d
mechanism of symptoms
biggest concern
how to treat, why

A

TCA - depression, anticholinergic side-effects - fever, hypotension, dilated pupils, seizure, decreased conduction velocity

biggest concern is hypotension and long qrs (arrhythmia)

treat with Sodium Bicarbonate - improves blood pressure, narrows qrs, avoids arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

give the following for what ekg changes

calcium gluconate
magnesium sulfate
sodium bicarbonate

A

calcium gluconate - hyperkalemia… stabilizes cardiac membrane in hyperkalemia

magnesium sulfate - torsades from long qt

sodium bicarb - hypotension and qrs widening eg from anticholinergic side effects of tca overdose… also give after other emergent meds in hyperkalemia with widened qrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

treat a thoracic esophageal perf vs a cervical esophageal perf

A

thoracic esophageal perf - surgery

cervical esophageal perf - abx, conservative mgmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

big purple/black periumbilical patches surrounded by erythema in several days postop patient

think
pathophys
diagnose
treat

A

HIT (necrotic skin lesions at heparin injection sites)

heparin induces a confomational change in platelet surface protein Platelet Factor 4 that exposes a neoantigen tat the body can develop antibodies to (HIT antibodies) and cause platelet aggregation thrombosis and thrombocytopenia

Serotonin Release Assay (gold standard)
HIT ab immunoassay (if high titers)

stop heparin (before diagnosis even confirmed, switch anticoagulation to argatroban, fondaparinux or the like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what anticoagulant can cause an acquired deficiency of protein C

A

Warfarin - can cause acquired protein C deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

necrotic skin lesions at abdominal heparin injection sites

think
pathophys
diagnose
treat

A

HIT (necrotic skin lesions at heparin injection sites… big purple/black periumbilical patches surrounded by erythema in several days postop patient)

heparin induces a confomational change in platelet surface protein Platelet Factor 4 that exposes a neoantigen tat the body can develop antibodies to (HIT antibodies) and cause platelet aggregation thrombosis and thrombocytopenia

Serotonin Release Assay (gold standard)
HIT ab immunoassay (if high titers)

stop heparin (before diagnosis even confirmed, switch anticoagulation to argatroban, fondaparinux or the like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

expect elevated levels of ___ in megaloblastic anemia

A

elevated HomoCysteine in megaloblastic anemia

-folate and b12 involved in homocysteine metabolism to methionine… no folate b12 - homocysteine buildup, methionine drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

why does Cobalamin B12 Deficiency cause ELEVATED Methylmalonic Acid levels but not folate

A

Cobalamin B12 involved in methylmalonyl coa to succinyl coa… no cobalamin b12 - methylmalonate buildup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

why is Haptoglobin Decreased in hemolytic anemias

A

because haptoglobin binds free hemoglobin and levels drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Burr cells

Spur cells

when do you see them

A

both Burr and Spur in Liver Disease

also Burr in ESRD

(burr is serrated, spurr has fewer larger projections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

scleroderma renal crisis with low hb and plts

what on smear

A

shistocytes

MAHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q 
what kind of colon polyp is most concerning, hyperplastic polyp
tubular adenoma
villous adenoma
hamartomatous polyp
inflammatory pseudopolyp
submucosal polyp
A

villous adenoma is most concerning

others have low malignant potential… hyperplasia not concerning (dysplasia is) submucosal polyp = lipoma or lymphoid aggregate… hamartomatous polyp = juvenile polyp or peutz jeghers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what age is risk for hydatiform molar pregnancy?

A

either extreme of maternal age, young or old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

15yo girl, lmp 4 mos ago, sounds like hyperemesis gravidarum maybe getting into preeclampsia and uterus is too big for 4 months

diagnosis
pathophys of preeclampsia here
treatment

A

hydatiform mole

abnormal placental spiral artery development, placental hypoperfusion and ischemia, maternal htn

suction curettage
follow downtrend bhcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

histologically describe glomerular damage from diabetes

A

glomerular basement membrane changes
diffuse glomerular sclerosis
nodular glomerular sclerosis (kimmelstiel wilson nodules pathognomonic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

middle age guy, periodic difficulty breathing and wheezing, history of asthma chronic rhinosinusitis with nasal polyps, maybe urticaria, takes aspirin

  • diagnosis
  • pathophys
  • how to tell from asthma/allergy exacerbation
  • treatment
A

Aspirin Exacerbated Respiratory Disease

NON-IgE mediated PSEUDOAllergic drug reaction… from increased conversion of arachidonic acid to proinflammatory leukotrienes and decreased antiinflammatory prostaglandins by blocking cox1 cox2 and shunting arachidonic acid to 5lipoxygenase pathway

looks a lot like asthma/allergy exacerbation, just tie to within 3 hours of aspirin use which the patient might not naturally do

avoid aspirin/nsaids vs desensitize
use leukotriene receptor antagonist instead (Montelukast)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

young dude with multiple sexual partners has mild systemic symptoms fever/malaise and painful vesicular rash on erythematous base on palm of his hand

diagnosis
bug
how contracted typically
treat/course

A

herpetic whitlow
herpes simplex virus

hand contact with genital herpes or health care worker touching infected oral secretions

spontaneous resolution in weeks but recurrence common…. treatment with acyclovir if immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Erythema multiforme associated with what virus

A

Herpes simplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Erythematous papules and plaques that evolve into target lesions associated with herpes simplex

A

Eryhema multiforme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Initial large lesion followed by numerous small oval scaly plaques that follow cleavage lines of the trunk

A

Pityriasis rosea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Diffuse maculopapular rash involving palms and soles and oral mucosa think

A

Secondary syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Who gets HAV vaccine

A

Liver disease hbc hcv
Msm
Ivdu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pneumococcus vaccine recs for hiv patient

A

Pcv13 once

Ppsv23 8 wks later 5 years later and age 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Vaccines contraindicated in hiv if cd4 count v200

A

Varicella mmr zoster (live vaccines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what kind of beta blocker for esophageal varices

A

NONSELECTIVE propanolol nadolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

nasopharyngeal carcinoma
associated with what virus
what demographics

A

nasopharyngeal carcinoma
EBV reactivation associated
Chinese Africa Mid East (diet, genetics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Aflatoxin B1 is a __toxin that contaminates __ products and increases risk of __

A

Aflatoxin B1
mycotoxin
contaminates agricultural products
increases risk of HCC hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

TF

recurrent sinusitis increases risk of nasopharyngeal carcinoma

A

F
sinusitis - risk of nasal polyposis but not cancer

EBV reactivation and Chinese African Mid East risk NasoPharyngeal Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

seems like malaria but midwestern usa not africa

A

babesiosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

4-7 weeks after mosquito bite fever headache myalgias arthralgias retroorbital painrash LeukoPenia
think

A

Dengue Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

african trypanosomiasis aka

pathogen

A

african sleeping sickness

tsetse fly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

african travel, acute febrile illness with skin lesion, myocarditis, progression to CNS involvement
think
pathogen

A

african trypanosomiasis aka sleeping sickness

tsetse fly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

normal postvoid residual in postpartum mamma

A

150ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

how to evaluate risk of preterm labor in preggy with prior cervical conization

what to do if at risk

A

transvaginal ultrasound in 2nd trimester for measurement of cervical length and changes during valsalva

(not digital cervical exam… going to be abnormal…. won’t get length…not as reproducible and accurate)

vaginal progesterone to maintain uterine quiescence if at risk…. intramuscular progesterone and cerclage if prior preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

treat bacterial vaginosis with

A

metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

history of rheumatoid arthritis, now anemic, low iron low tibc high feritin

dx
tx

A

anemia of chronic disease

meithotrexate - treat ra to treat anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

kid, fever sore throat odynophagia, vesicles on tonsils and soft palate

diagnosis
bug

A

herpangina

coxsackie A virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

why treat asymptomatic bacteruria in pregnancy

A

higher risk of pyelo because high progesterone relaxes urinary smooth muscle tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q 
HIV patient with low CD4 count in Missouri has systemic, lung findings, liver findings, oral ulcers, pancytopenia
think
why
workup
treat
A

disseminated histoplamsosis

opportunistic infection, endemic to midwest/central, starts in lungs and disseminates to liver, spleen, bones, mucosa/skin

urine or serum histoplasma antigen (faster than blood cultures, lymph node biopsy not required)

Amphotericin B.. later -azole for mantainence and antiretroviral for hiv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

how does rotor’s syndrome cause dark urine with urinary bili but not urobilinogen in urine

A

rotors is conjugated hyperbilirubinemia by impaired hepatic secretion of bilirubin. Conjugated bili is water Soluble so can be eliminated in Urine e.g. in rotors… but normally secreted into bile and feces then deconjugated for resorption with 5% loss as urobilinogen in feces and 1% loss as such in urine…. so will only see urobilinogen in urine if bili is getting into intestines and resorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

TF

fever and chest pain with chylothorax (thoracic duct disruption) eg in the setting of trauma or cancer

A

F

chyle is does not provoke inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

when metronidazole for vaginitis

A

for bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

pna symptoms with foul smelling sputum refractory to azythro course… this all after upper endoscopy, what else to prescribe, why

A

clindamycin - covers anaerobes
or
amoxicillin-clavalunate, carbapenem, (metronidazole if only anti-anaerobe choice but high rate of failure

aspiration pna in setting of post egd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

kid, fever sore throat odynophagia, vesicles on tonsils and soft palate

diagnosis
bug

A

herpangina

coxsackie A virus

72
Q

old smoker hard non-tender 3cm submandibular mass think

workup

A

head/neck cancer - Majority SCC, especially in adult smoker
-any hard unilateral non-tender lymph nodes always suspicous for cancer

prompt biopsy

73
Q

HIV patient with low CD4 count in Missouri has systemic, lung, and liver findings, pancytopenia
think
why
workup

A

disseminated histoplamsosis

opportunistic infection, endemic to midwest/central, starts in lungs and disseminates to liver, spleen, bones, mucosa/skin

urine or serum histoplasma antigen

74
Q

guy with ascites and right sided lung dullness and decreased breath sounds think
how

A

plerual effusion from hepatic hydrothorax

- ascites gets thru small diaphragmatic defects on R usually because less muscular there

75
Q

major organ complication of heredetery hemochromatosis (bronze diabetes with elevated transaminases)

nephrotic syndrome?

A

cirrhosis and Hepatocellular Carcinoma

not nephrotic syndrome

… maybe cardiomyopathy next organ dysfunction…. joints, certain infections… hypogonadism, hypothyroidism

76
Q

homeless guy confused abdominal pain vomiting blurred vision, metabolic gap acidosis and optic disc hyperemia
think
how
big complications
how different from something Very similar, what about something Very common

A

methanol poisoning

usuing methanol as sub for alcohol

blindness, coma

ethanol poisoning similar but Kidney damage instead of Eyes

Aspirin overdose similar but tinnitus, fever, and hyperventilation

77
Q

woman postmenopausal flushing, pounding pulse, chronic diarrhea, R sided valvular insufficiency (tricuspid insufficiency)

diagnosis, endocarditis?
diagnose
treat

A

carcinoid syndrome (carcinoid tumor in gut Mets to Liver causing effects via hormonal secretion … histamine serotonin vip etc

  • no flushing or diarrhea with endocarditis… and look for fever malaise arthralgias and ivdu history)

24 hr urinary 5-HIAA
(5-hydroxyindoleacetic acid)

octreotide for symptoms, surgery for mets

78
Q

vibrio vuilnificus from shellfish OR __

skin findings with the second
feared complications
who is high risk

A

vibrio from shellfish or ocean WOUND infection eg cut on dock

bullae, fascitis, erythematous streaking up from site
liver disease, septic shock

prior liver disease at high risk

79
Q

ciprofloxacin covers

A

gnr’s

80
Q

person clearing bushes gets bad rash on fingers and hands with coag neg staph on cultures – impetigo? cellulitis?

A

contact dermatitis (e.g. poison ivy/oak)

coag neg staph (saphro, epidermidis) is skin flora

impetigo and cellulitis - staph a coag positive… and ipetigo i kids

81
Q

guy with ascites and right sided lung dullness and decreased breath sounds think
how

A

plerual effusion from hepatic hydrothorax

- ascites gets thru small diaphragmatic defects on R usually because less muscular there

82
Q

major organ complication of heredetery hemochromatosis (bronze diabetes with elevated transaminases)

nephrotic syndrome?

A

cirrhosis and Hepatocellular Carcinoma

not nephrotic syndrome

… maybe cardiomyopathy next organ dysfunction…. joints, certain infections… hypogonadism, hypothyroidism

83
Q

homeless guy confused abdominal pain vomiting blurred vision, metabolic gap acidosis and optic disc hyperemia
think
how
big complications
how different from something Very similar

A

methanol poisoning

usuing methanol as sub for alcohol

blindness, coma

ethanol poisoning similar but Kidney damage instead of Eyes

84
Q

f/u painless rectal bleeding

^50 or malignancy risk
40-50
v40 no red flags

A

^50 colonoscopy
40-50 colonoscopy or sigmoidoscopy
v40 no flags - anoscopy

85
Q

vibrio vuilnificus from shellfish OR __

skin findings with the second
feared complications
who is high risk

A

vibrio from shellfish or ocean WOUND infection eg cut on dock

bullae, fascitis, erythematous streaking up from site
liver disease, septic shock

prior liver disease at high risk

86
Q

travel in the states, fever cough diarrhea confusion, hyponatremia, mild hepatitis, interstitial infiltrates on cxr, neutrophils no organisms
you think
rapid test

A

leigonella

Urine legionella Antigen (more rapid than buffered charcoal yeast extract cultures etc)

87
Q

when is ranolazine ever used

A

not often, low yield

occasioally if chronic stable angina refractory to bb, nitrates, ccbs

88
Q

seems like CAP plus arthralgias and erythema nodosum (painful erythematous papules on shins), or erythema multiforme, from desert southwest

think
diagnose
treat

A

coccidioides - endemic mycosis of desert southwest

serologic testing (often cultures too..)

usually self resolve no treatment
if immunocompromised or high risk… azole… ketaconazole fluconazole

89
Q

2 mycoses endemic to central and midwest usa

A

histoplasma

blastomyces

90
Q

3 top causes of aortic stenosis

which is:
overall?
v70yo?
^70yo?
number 3?
A

bicuspid aortic valve most common, v70yo

senile calcific aortic stenosis ^70

rheumatic heart disease much less frequent

91
Q

f/u painless rectal bleeding

^50 or malignancy risk
40-50
v40 no red flags

A

^50 colonoscopy

92
Q

treat HOCM

A

avoid dehydration
BB first then nondipine CCB verap dilt if not responding (both decrease contractility, prolong diastole, more preload, opening up, prevent outflow obstruction

93
Q

why is PID extremely rare after the first trimester

A

cervical mucus and decidua sealing off an protecting the uterus/pregnancy

94
Q

chorioamnionitis in 39weeker in active stage 1 labor, fetal hr 165…. give antibiotics and.. oxytocin or csection?

A

oxytocin
-deliver… vaginal is ok… fetal hr likely related to fever rather than fetal distress… can give antipyretics to help

csection if decels (fetal distress)

with IV antibiotics - amp gent clinda

95
Q

give steroids to women with chorioamnionitis currently delivering at 33 weeks?

A

yes

steroids for any preggy delivering v34 weeks – lung development for fetus

96
Q

TF

chorioamnionitis is an indication for csection

A

F
oxytocin
-deliver… vaginal is ok… fetal hr likely related to fever rather than fetal distress… can give antipyretics to help

csection if decels (fetal distress)

with IV antibiotics - amp gent clinda

97
Q

g6pd more male or female?

A

male, usually x-linked

98
Q

adequate montevido units

A

^200 MVUs in 10 minutes are Adequate Contractions

99
Q

what vaccines to get in pregnancy

if high risk

which contraindicated

A

tdap
flu

if high risk:
hbv
hav
pneumococcus
meningococcus
hflu
vzv IMMUNOGLOBULIN

contraindicated:
hpv mmr liveattenuated flu vzv

100
Q

why is PID extremely rare after the first trimester

A

cervical mucus and decidua sealing off an protecting the uterus/pregnancy

101
Q

chorioamnionitis in 39weeker in active stage 1 labor, fetal hr 165…. give antibiotics and.. oxytocin or csection?

A

oxytocin
-deliver… vaginal is ok… fetal hr likely related to fever rather than fetal distress… can give antipyretics to help

csection if decels (fetal distress)

with IV antibiotics - amp gent clinda

102
Q

give steroids to women with chorioamnionitis currently delivering at 33 weeks?

A

yes

steroids for any preggy delivering v34 weeks – lung development for fetus

103
Q

ppd for pregnant lady?

A

No

only if immunocompromised or actively tb sick contacts

asymptomatic immigrants can be screened postpartum

104
Q

“powder-burn” lesions in posterior culdesac on female pelvic laparotomy signify

A

endometriosis

-powder-burns, adhesions, scar tissue, fleshy nodules, chocolate fluid… all endometriosis

105
Q

adequate montevido units

A

^200 MVUs in 10 minutes are Adequate Contractions

106
Q

what vaccines to get in pregnancy

if high risk

which contraindicated

A

tdap
flu

if high risk:
hbv
hav
pneumococcus
meningococcus
hflu
vzv IMMUNOGLOBULIN

contraindicated:
hpv mmr liveattenuated flu vzv

107
Q

TB patient on isoniazid symptomatically improved but now with mild ast alt elevation what to make of it?

A

isoniazid hepatitis/hepatotoxicity
-common, mild, just observe…. discontinue if gets symptomatic or severe and switch to second line drugs (eg not RIPE)

-same strategy for most RIPE drugs… some hepatotox expected

108
Q

biopsy asymptomatic elevation of liver enzymes?

A

if etiology unknown

if you know it, no need to biopsy

109
Q

when to give RhD immunoglobulin to mismatched mom

A

28 weeks for ppx

after delivery if infant is RhD positive

110
Q

blood typing and antibody screening happens when in pregnancy

when is RhD Ig given

A

blood typing and antibody screening at first prenatal visit

RhD given 28 wks (half life lasts till birth) and postpartum

111
Q

“powder-burn” lesions in posterior culdesac on female pelvic laparotomy signify

A

endometriosis

112
Q

incidental endometriosis found on lap in asymptomatic patient (asymptomatic for endometriosis) with copper iud

start nsaids and ocps or change to progesterone iud?

A

observe
don’t do anything!

can consider nsaids ocps progesterone iud if symptoms arise… surgical resection hysterectomy oopherectomy if symptoms bad and persistent

113
Q

gonadotropin-independent precocious puberty, cafe au lat spots, endocrine hyperfunction… think…

A

McCune Albright syndrome

114
Q

diarrhea in AIDS, what bug and cd4 count if:

severe diarrhea cd4v180
no fever cd4v100
high fever cd4v50
bloody diarrhea cd4v50

A

severe watery - cryptosporidium v180

no fever - microsporidium/isosporidium v100

high fever - MAC v50

bloody diarrhea - CMV v50

(all usually watery diarrhea except bloody cmv)

115
Q

biopsy asymptomatic elevation of liver enzymes?

A

if etiology unknown

if you know it, no need to biopsy

116
Q 
gastrointestinal (colitis) CMV in AIDS
cd4
distinguishing diarrhea feature
diagnose
treat
A 
gi cmv in hiv
cd4v50
bloody diarrhea
colonoscopy with bopsy
gancyclovir for treatment
also OCULAR EXAM to rule out concurrent RETINITIS
117
Q

blood typing and antibody screening happens when in pregnancy

when is RhD Ig given

A

blood typing and antibody screening at first prenatal visit

RhD given 28 wks (half life lasts till birth) and postpartum

118
Q

normal internal genitalia, external virilization, undetectable estrogen levels
think

A

aromatase deficiency

can’t convert androgens to estrogens

119
Q

ambiguous external genitalia, normal uterus and ovaries, electrolyte abnorms

think

A

CAH congenital adrenal hyperplasia

17alphahydroxylase deficiency

120
Q

gonadotropin-independent precocious puberty, cafe au lat spots, endocrine hyperfunction… think…

A

McCune Albright syndrome

121
Q

spep vs flow cytometry use in heme

A

spep for multiple myeloma mspike

flow cytometry for CLL demonstrating clonality of mature B cells)

122
Q

ekg shows QRS widening when pt heartrate is increased, what 2 drugs could be responsible?

A

flecainide
propafenone

both class IC antiarrhythmics sodium channel blockers
-less time to to dissociate from receptors when heart reat up, cause QRS Widening... called USE DEPENDENCE... why they are used to treat Supraventricular Arrthymias... eg paroxysmal afib

class IV ccb’s also use dependence but not qrs widening

123
Q

breath sounds, tactile fremitus, precussion, and mediastinal shift

consolidation (pna) vs atelectasis (mucus plug)

A

consolidation - INC BEATH SOUNDS, inc fremitus, dull percussion, no shift

atelectasis - DEC BREATH SOUNDS, DEC FREMIUTS, dull percussion, SHIFT

124
Q

60yo guy with fever productive cough and lobe infiltrate suggesting pna bnut also dramatic leukocytosis to 40s (Lymphocytes) and hepatosplenomegaly, cervical lymphadenopathy, anemia and thrombocytopenia

think
diagnose

A

CLL

flow cytometry (clonality of mature B cells)

125
Q

encapsulated organisms to fear post splenectomy

A

strep pneumo
h flu
neisseria meningitidis

encapsulated, antibody-mediated phagocytosis in spleen to remove

so get vaccinated for above and early antibiotics if infected

126
Q

impaired b cell isotype switiching in what disease and what infections increased risk

A

cvid - low IgG because can’t switch isotype

recurrent sinopulmonary and gi infections and autoimmune disease

127
Q

wbc in multiple myeloma

A

low wbc

pancytopenia… infiltrative…

128
Q

cgd recurrently infected by what organisms

A

catalase positive bacterial or fungal

eg staph aureus or aspergillus

129
Q

TF
smoking cessation reduces blood pressure

rank top 5 factors that can reduce blood pressure

A

FALSE
reduces cv risk factors, yes, but NOT BLOOD PRESSURE

weight loss to bmi v25
DASH diet high in fruits and veggies low fat
exercise
decrease dietary sodium
decrease alcohol
130
Q

DASH diet stands for

consists of

A

Dietary Approaches to Stop Hypertension diet

rich fruits veggies, low fat

131
Q

best method of blood pressure reduction in non-obese patient

rank top 5 factors that can reduce blood pressure

A

DASH diet high in fruits and veggies low fat

weight loss to bmi v25
DASH diet high in fruits and veggies low fat
exercise
decrease dietary sodium
decrease alcohol
132
Q

encapsulated organisms to fear post splenectomy

A

strep pneumo
h flu
neisseria meningitidis

133
Q

impaired b cell isotype switiching in what disease and what infections increased risk

A

cvid - low IgG because can’t switch isotype

recurrent sinopulmonary and gi infections and autoimmune disease

134
Q

recurrent bacterial skin and mucosa infections… think more leukocyte adhesion deficiency or IgA deficiency?

A

think leukocyte adhesion deficiency with recurrent skin and mucosa bacterial infections

IgA deficiency typically asymptomatic

135
Q

what are vascular rings

how do they present

any association with gerd?

A

congenital anomalies where aortic arch vessels encircle the trachea or esophagus

present infancy with airway obstruction
adulthood with dysphagia

no association with GERD (that would be peptic stricture or adenocarcinoma)

136
Q 
young woman, large painful hepatic mass, long term oral contraception use, elevated  alk phos and gtt but liver labs otherwise normal
think
why alk phos and gtt
diagnose
risks
treat
A

hepatic adenoma (benign)

alk phos and gtt biliary labs from compression… otherwise all lft’s often normal

ulstrasound hyperechoic lesions
con CT early peripheral enhancement

risks growth, rupture, malignant transformation

surgical excision (no needle bx - bleed risk)

137
Q

DASH diet stands for

consists of

A

Dietary Approaches to Stop Hypertension diet

rich fruits veggies, low fat

138
Q

young woman large painful hepatic mass, liver labs pretty normal, imaging with mass with increased arterial flow and maybe central scar
think
pathophys

A

Focal Nodular Hyperplasia

Liver Mass / Lesion in young women caused by Hyperperfusion from Anomalous Arteries

139
Q

Hydatid liver cysts are caused by ___

Most cases in US are seen in ___ or ___ exposed to ___ or ___

A

Hydatid liver cysts are caused by ECHINOCOCCUS TAPEWORM infection
Most cases in US are seen in IMMIGRANTS or SOUTHWESTERN Americans exposed to SHEEP or DOGS

140
Q

nodular regeneration most commonly occurs in the setting of…

A

cirrhosis

141
Q

___ is a benign liver tumor most often seen in young and middle-aged women who take ___

A

HEPATIC ADENOMA

benign liver tumor in young/middle aged women who take ORAL CONTRACEPTIVES

142
Q

treat acute angioedema from ACEI causing airway compromise and vasomotor instability

if that treatment fails

A

subq epinephrine

tracheostomy if epi fails

(stop ACEI obviously)

143
Q

other than angioedema, 3 next ACEI complications to watch for

A

angioedema

cough
hyperkalema
acute renal failure if already bilateral renal artery stenosis

144
Q

rapidly enlarging liver mass with satellite lesions usually in cirrhotic or chronic hepatitis (B especially)… likely systemic symptoms, elevated AFP

think

A

hepatocellular carcinoma

145
Q

young woman large painful hepatic mass, liver labs pretty normal, imaging with mass with increased arterial flow and maybe central scar
think
pathophys

A

focal nodular hyperplasia

Liver Mass / Lesion in young women caused by Hyperperfusion from Anomalous Arteries

146
Q

young female school teacher / daycare worker with 10 days joint pain stiffness for 10 minutes in am in wrists MCPs PIPs knees ankles with tenderness but no swelling or redness and maybe non-specific rash, maybe fever fatigue diarrhea

think
diagnose - ANA? dsDNA? Rheumatoid factor?
treatment

A

viral arthritis
-probably Parvovirus B19 contracted working with kids (adults often don’t get slapped cheek rash)… otherwise could be hep b c hiv rubella

B19 IgM if immunocompetent
NAAT for B19 DNA if immunocompromised or reactivated

–ANA dsDNA are for SLE.. symptoms more chronic and varied…. and RA (different from lupus arthritis…) has longer morning stiffness ^1 hour, joint Swelling, and less acute with symptom onset over 6 mos not 10 days

no treatment usually self-resolves

147
Q

antibodies in rheumatoid arthritis

A

anti-CCT anti cyclic citrullinated peptide

rheumatoid factor

148
Q

___ is a benign liver tumor most often seen in young and middle-aged women who take ___

A

HEPATIC ADENOMA

benign liver tumor in young/middle aged women who take ORAL CONTRACEPTIVES

149
Q

___ is usuallly associated with chronic hep C and cause arthralgias, chronic vasculitic syndrome with palpable purpura lymphadenopathy nephropathy neuropathy

A

Mixed Cryoglobulinemia

150
Q

preconception hemoglobinopathy screening in Mediterranean vs African patient

A

CBC for Mediterranean couple, only workup further if abnormalities

Hb Electrophoresis and CBC in African couple

SO CBC is first screen for hemoglobinopathies!

151
Q

TF

prophylactic colectomy for UC patient recommended 8 years into disease

A

F
colectomy if dysplasia identified

offer annual/biannual colonoscopies at 8 years of disease (12-15 years if disease limited to left colon and rectum)

152
Q

acid base disturbance in acute asthma exacerbation

what to make of the opposite

A

repiratory alkalosis - hyperventilation

extremely concerning if pH and PaCO2 normalize or start trending acidic because failing to ventilate / IMPENDING RESPIRATORY COLLAPSE

153
Q

young female school teacher / daycare worker with 10 days joint pain stiffness for 10 minutes in am in wrists MCPs PIPs knees ankles with tenderness but no swelling or redness and maybe non-specific rash, maybe fever fatigue diarrhea

think
diagnose - ANA? dsDNA? Rheumatoid factor?

A

viral arthritis
-probably Parvovirus B19 contracted working with kids (adults often don’t get slapped cheek rash)… otherwise could be hep b c hiv rubella

B19 IgM if immunocompetent
NAAT for B19 DNA if immunocompromised or reactivated

–ANA dsDNA are for SLE.. symptoms more chronic and varied…. and RA (different from lupus arthritis…) has longer morning stiffness ^1 hour, joint Swelling, and less acute with symptom onset over 6 mos not 10 days

154
Q

antibodies in rheumatoid arthritis

A

anti-CCT anti cyclic citrullinated peptide

rheumatoid factor

155
Q

why does TB infect teh apices

A

high O2 tensions slow lymphatic elimination

156
Q

Cryptococcal infection in HIV pt occurs at CD4 count v___ and causes ___ or ___

A

Cryptococcal meningitis or pneumonia in HIV with CD4v100

157
Q

preconception hemoglobinopathy screening in Mediterranean vs African patient

A

CBC for Mediterranean couple, only workup further if abnormalities

Hb Electrophoresis and CBC in African couple

SO CBC is first screen for hemoglobinopathies!

158
Q

TF

appendicitis in pregancy is a thing

A

T

159
Q

infective endocarditis started on vanc now found to be penicillin sensitive strep should be switched to

what if patient allergic to penicillin

A

iv Ceftriaxone
or iv Penicillin GGGG.. not another penicillin

if pt allergic to penicillin then just keep on vanc

160
Q

reversible causes of asystole / pulseless electrical activity to try to treat while you do 2 minute chest compressions, epinephrine q3-5, and assess for shockable rhythm q2min (PEA/asystole is not shockable… only vtach vfib…)

A

5 H’s and T’s for reversible asystole / pulseless electrical activity

hypovolemia hypoxia H (acidosis) hypo/erkalemia hypothermia

tension tamponade toxins thrombosis trauma

161
Q

hiv
subacute cough
cavitary inflammatory upper lung lesion
alcoholic

think
social and behavioral risk factors

A

Reactivation TB

risk factors for exposure

  • social - incarcaeration group living international travel
  • behavioral - substance abuse
162
Q

defibrillation ideal for

cardioversion ideal for

A

defib ideal for VFib and pulseless VTach

cardioversion for symptomatic or sustained monomorphic VTach unresponsive to antiarrhythmics, and hemodynamically unstable AFib Before pulseless electrical activity or asystole develops (cardioversion is synchronized with qrs…)

163
Q

lung cancer screening guidelines

A

age55-80
and ^30pack year smoking
and currently smoking within past 15 years

annual low dose chest CT

164
Q

pneumocystis pneumonia cxr findings

A

often normal

or diffuse alveolar infiltrates

165
Q

hiv pt severe acute retinal necrosis with pain keratitis uveitis and fundoscopic perippheral pale lesions with central retinal necrosis
vs
hiv pt painless retinitis without keratitis or conjunctivitis, and funduscopic hemorrhages and fluffy or granular lesions around retinal vessels

what bugs
pathophys

A

HSV and VZV retitnitis severe painful with anterior symptoms

CMV retinitis painless without anterior eye symptoms

reactivation of previous infection in immunocompromized AIDS patient

166
Q

infective endocarditis started on vanc now found to be penicillin sensitive strep should be switched to

A

iv Ceftriaxone

or Penicillin GGGG.. not another penicillin

167
Q

how are cardioversion and defibrillation different

A

cardioversion shocks with a qrs complex

defibrillation shocks on command

168
Q

mechanism of anticholinergic urinary retention

A

detrusor hypoactivity

169
Q

most common serious ocular complication of HIV patients, painless, fluffy/granular retinal lesions near vessels with hemorrhages

think

A

CMV retinitis

170
Q

hepatitis panel in recovery from HBV infection

which is marker of vaccine or virus exposure, which specific to exposure

A

HBsAb, HBcAb, HBeAb might wane

HBsAb vaccine or virus exposure

HBcAb and HBeAb virus specific

171
Q

elderly guy with new urinary retention after starting diphenhydramine for a cough, why?

A

Diphenhydramine is an H1-antihistamine with Anticholinergic effects (dryness of mucosa and eyes, urinary retention) – old guys with BPH at particular risk for urinary retention

172
Q

name 3 first gen H1 antihistamines and their major side effect

A

diphenhydramine
chlorpheniramine
hydroxyzine

anticholinergic side effects (dryness of eyes mouth etc, urinary retention)

173
Q

mechanism of anticholinergic urinary retention

A

detrusor hypoactivity

174
Q

systolic anterior motion of the mitral valve think

A

HOCM

175
Q

hepatitis panel in recovery from HBV infection

which is marker of vaccine or virus exposure, which specific to exposure

A

HBsAb, HBcAb, HBeAb might wane

HBsAb vaccine or virus exposure

HBcAb and HBeAb virus specific

176
Q

who has higher rate of chronic HBV vs spontaneous clearance, kids or adults

A

infants get chronic HBV
kids have high chance of chronic
adults usually get over it, self-limited

Random (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions