U world Q 3 Flashcards by Meghan May

A chronic TIIDM comes to urgent care for unilateral painful facial swelling. The swelling is well demarcated. Pt’s temp is 100.
Most likely dx and causitive agent?

Erysipelas; specific type of cellulitis seen in diabetics with prominent swelling and sharply demarcated
Group A Beta hemolytic or GAS (usually Strep pyogenes)

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A 35yoF comes to clinic with symptoms suggestive for premature ovarian failure. What would you expect to see with her FSH, LH and FSH/LH ratio?

FSH and LH are both increased

>1 FSH/LH ratio seen bc FSH is cleared from circulation slower

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A 20 wk gravida 1 para 0 comes to urgent care with signs suggestive for pyelonephtritis… what test do you order ot confirm diagnosis?

US of kidneys and abdomen

CT is standard but contraindicated in preggers

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Pt presents with cp and a.fib—> proceeds to lose consiousness and you cannot find pulse on exam. Still see a.fib on monitor. What do you do?

Pt has pulseless electrical activity; organized rhythm but not measurable pulse–> you need to start chest compressions! Get IV access and give Epi every 3-5 mins

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When is defibrillation the therapy of choice?

In patients with ventricular fibrillation and pulseless VT

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When do we provide immediate synchronized cardioversion?

Symptomatic or sustained monomorphic Ventricular tachycardia or hemodynically unstable pts with A.fib with RVR (as soon as pt devos PEA you start compressions)

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Pt comes in with abnormal uterine bleeding, pain with sex, heavy menses. You suspect either adenomyosis or Leiomyomata (fibroids). How do you tell the difference?

Adenomyosis = endometrial glands in uterus causing smooth symmetrical enlargement
Fibriods are proliferation of smooth muscle cells causing IRREGULAR/BULKY enlargment

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Why would you give someone Tamsulosin to help with kidney stone passage

its’ an alpha1 blocker; prevents spasms (therers alpha 1 receptors on the kidney ureters)

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Which drugs are the best to treat Tourettes?

2nd gen antipyschotics–> risperidone or use alpha adrenergic receptor agonist (clonidine, guanfacine)

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Dx that shows follicular conjuctivitis and pannus (neovascularization) formation in the cornea with concurrent infection in nasopharnx.

Trachoma; from chlamydia trachomatis

tx w/ oral azithormycin or tetracycline

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Pt comes in with pain, photophobia and decreased vision in her eye. You see dendritic ulcers on exam.

Herpes simplex keratitis

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3 days after birth baby comes into hospital with mucoid secreations. Mom has no prenatal care.

Gonococcal conjuctivitis– tx w/ ceftriaxone

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pt with contrast induce ATN has FUCKED UP LABS!!! While we expect >1%FeNa and Urine Na >20mEq/L you actually see low urine sodium and high specific gravity— why?

bc contrast causes spasm of afferent arterial causing reabsorption of water and sodium.

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Woman presents with hirsitism, balding and acne. PE shows clitoral enlargment. What’s the next best test?

Get serum testosterone and DHEAS levels; find site of excess androgen production
Elevated DHEAS with normal testosterone=Adrenal source

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Pt comes in with renal colic. you see a 5mm stone in the right ureter and several smaller stones in both pelvices. His urine pH is 4.5 (normal 5-6) and the stone is 100% uric acid when he passes it. What do you do for treatment?

Hydration and alkalinze the urine! Give pt Potassium citrate if there is acidic urine with uric acid stones

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best imaging to diagnos Acoustic Neuromas? (MEN2 syndromes)

MRI with gandolinium

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What happens to serum haptoglobin, LDH and Bilirubin in intravascular hemolytic anemia like mechanical destruction or microangiopathic hemolytic anemia (DIC, HUS, TTP)

LDH and indirect Bilirubin will INCREASE

destruction results in increased free hemoglobin which Haptoglolbin BINDS TO thus DECREASED HAPTOGLOBIN

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What happens to these values during PREGANCY
TSH
Free T4
Total T4

TSH unchanged
Free T4 unchanged
Total T4 INCREASED

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What standard deviations do you use for 68%, 95% and 99%

68% lie within +/- 1 standard deviation
95% lie within +/- 2 standards
99% w/in +/-3 standards

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MCC of PNA in community
MCC of PNA in child with CF
MCC of PNA in adult with CF

Strep. pneumo
Staph.Aureus in CF kiddos
Pseudomonas in CF adults

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Criteria for SIRS

Temp >101.3 OR 90
RR > 20
WBC >12,000 or

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Why do we see hypocalcemia in alcoholics?

Due to hypomagnesia which decrease PTH levels and increases PTH resistance

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What type of study looks for disease prevalence?

Cross sectional; taken at a point in time

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What type of study looks at disease Incidence by looking at past records?

Cohort study (retrospective)

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What type of study looks at the risk factor associated with disease?

Case control

?Pt has right upper lobe infiltrate and foul smelling sputum. You suspect aspiration PNA. What do you use to tx

Clindamycin to cover for anerobes | also to metronidazole with amoxicillin or amox-clavulonate

What is the most appropriate therapy for pt with CAP that you will tx outpatient

Erythromycin or if suspect resistance use Doxy

If a pt comes in with swelling/effusion of a joint and you see chronic calcium around the cartilage- likely dx

Psuedogout or acute calcium phyrophostpate crystal arthritis

Pt presents with syncope, fatigue, wt loss and vague GI tenderness occuring for three months. Her BP is 90/65 and You notice hyperpigmentation on the palmar creases and suspect adrenal insufficiency. What do you expect to see with potassium and sodium levels?

HYPERkalemia from mineralcorticoid deficiency | HYPOnatremia from increased ADH release

Pt presents with weakness in his left hand and decreased sensation on the 4th an 5th fingers. Not a smoker, doesn't do drugs. PE shows weak grip. What's the location of pathlogical process?

Ulnar nerve entrapment. | Elbow at medial epicondylar groove!

How long are you at risk of sepsis from encapsulated bacteria after a splenectomy?

up to 30 years!!! even though you get the vaccine 2 weeks after or before the procedure you have big risk rest thus take oral penicillin for 3-5 yrs after treatment

What murmur is associated with AS? What different heart sound do we end up hearing down the line as it progresses?

Has mid-systolic murmur in RUSB with delayed carotid pulses | Second heart sound becomes softer as it gets more severe.

What happens to the serum calcium, serum phosphorus, alk phos and urine hydroxproline in Pagets?

Serum Calcium and Serum Phosphorous = Normal | Alk.Phos and Urine Hydroxyproline= Elevated

Pt comes in with COPD exacerbation.. what do you do for management? (there are 4 things!)

Supplement )2 with goal of 88-92% Inhaled bronchodialators Systemic glucocorticoids (methpred) Antibiotics

What special test should women >35 have done in their newborn screening?

Should have cell free fetal DNA testing at 10 wks of gestation. Great for detective Downs, Edwards or Patau

What screening is done 1st trimester for pregnant women?

DO pregnancy associated plasma protein, B-hCG and US with nuchal translucency.

What screening is done in the 2nd trimester?

Quad screen: maternal serum alpha fetoprotein, B-hCG, unconjugated estriol and inhibin A levels

Quad screen shows | Low AFP, Low B-hCG, low Estriol, normal inhibin A

Trisomy 18

Quad screen shows | Low AFP, High B-hcG, Low Estriol, High inhibin A

Downs

What is a complication to be aware of for central subclavian venous cath placement?

Tension pneumothorax-- | rapid onset distension of neck, hypotension, tachycardia tachypnea

Pt comes in with SOB and wts loss. CXR shows large pleural effusion. She has extensive smoking history. Whats the next most apporpriate step in management?

Get a thoracentesis unless it's for sure CHF! | Any pt with undx pleural effusion needs to be tapped

What is first line tx of ADHD

Atomoxetine methylphenidate or dextroamphetamine Alpha2 agonist--clonidine and guanfacine

Tx for Tourettes

Haloperidol, Pimozide, Risperidone or meds such as clonidine adn Alpha 2 Agonists.

Best medication for Depression + Neuropathic pain

Duloxetine (SNRIs)

Patient with depression, fearful of wt gain and sexual side effects

Buprorion (lowers seizure threshold)

Patients with depression, decreased sleep and decreased appetite.

Mirtazapine

Atypical anti that causes diabetes, wt gain, avoid in diabetics

Olanzapine

Greater incidence of movement disorders from atyipcal antipsychotics

Risperidone

Lower incidence of movement disorders thus best in patients with existing movement disorders

Quetiapine

Atypical that causes Increase risk of prolongation of QT interval; avoid in patients with conduction defects

Ziprasidone

Atypical that has high risk of agranulocytosis and need to monitor CBC--never use as first line

Clozapine

Atypical that is a parital dopamine agonist and approved as adjuvant tx in major depression

Aripirazole

The only antipyschotic that is Pregancy B category

Lurasidone

First line treatment for panic disorder? | First line treatment for panic attack?

Disorder use SSRIs | Attach use Benzos

Treatment of choice for OCD is either SSRI or this specific TCA

Clomipramine

Tx of choice for hoarding OR Body Dysmorphic

SSRI or CBT

What agent do you avoid in acute angle glaucoma

Atropine is BAD! Safe is timolol (B-blocker decreases aqueos humor), Pilocarpine reduces pressure via opening canals of Schlemm. Acetazolamide is carbonic anhydrase inhibotor reduce prdocution

What SE is seen with Nevirapine

Nevirapine associated liver failure

What HIV drug can lead to lactic acidosis

any of the NRTIs

Crystal induced nephropathy (bloody RBCs and crystals seen in urinalysis) caused by which HIV drug

Indinavir

HIV drug that induces pancreatitis

Didanisone

Ingestion: pt is homeless presents with flank pain, blood in urine, tetany (hypocalcemia). HIGH anion gap metabolic acidosis with calcium oxalate crystals in urine. OD and Tx

OD is Ethylene glycol | Tx: Fomepizole or ethanol to block alcohol dehydrogenase and may need hemodialysis

Ingestion: likely alcoholic. Have AMS, blurred vision with scotomata, anion gap metabolic acidosis

Tx same as ethylene glyclol with fomepizole or ethanol | Methanol affects Ma eyes

Pt brought in by EMS from a house fire. Labs show elevated Lactate >10mEq/L. What's going on and how do you treat it

Cyanide poisoning | Tx Sodium thiosulfate

PT comes in with terrible headache, nausea and vomitting. Hx HTN and hyperlipidemia. CT shows subarachnoid hemorrhage. Coil intervention is done. What complications happen 24 hrs after surgery 3 days or more after surgery

w/in 24 hrs subarachnoid worry about REbleed >3 days worry about Vasospasm causing stroke like sx --tx with Nimodipine to reduce spasms

HIV pt comes in with AMS, you see a solitary weakly ring enhancing periventricular mass on MRI. His CSF shows EBV DNA. What is the likely dx?

CNS lymphoma!!!!

HIV pt comes in with AMS. Imaging shows cortical and subcortical atrophy and secondary ventricular enlargement. Dx

AIDS dementia complex

Pt with AIDS comes to clinic with multiple ring-enhancing spherical lesions throughout the basal ganglia. What is the likely dx adn what medicine could have prevented this?

Toxoplasmosis | Should have been on TMP-SMX

Pt has complaints of progressive DOE, fatigue and exertional syncope--suggestive of outflow obstruction. Pt comes in with delayed and diminished carotid pulses, a single soft second heart sound and a mid-late peaking systolic murmur heard at second right intercostal space radiating to carotids. Dx?

Severe Aortic Stenosis

What are secondary causes of digital clubbing? (clubbing in adult)

Lung malignancy, CF or Right to left shunts, NEVER from COPD