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Uworld Gaby > UW 10 > Flashcards

UW 10 Flashcards

1
Q

Common complications of parenteral nutrition

A

Blood stream infection: Staph aureus and epidermidis, Klebsiella, Pseudomona, Candida

Cholelthiasis if >2 weeks: due to cholestasis

Hyperglycemia

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2
Q

Methanol and Ethynele glycol intoxication presentation

A

Methanol:
Visual blurring, central scotomata
Afferent pupillary deffect
Altered mentation

Ethyline glycol:
Flank pain
Hematuria, oliguria (direct renal damage and crystal accumulation)
Cranial nerve palsy, tetany
Calcium oxalate crystals in urine
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3
Q

Xray clue for constrictive pericarditis

A

Pericardial calcification

Chronic fibrosis and pericardial calcification

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4
Q

Clinical presentation of pulsus paradoxus

A

Weak pulse that disappears with deep inspiration

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5
Q

Chest pain with hx of viral symptoms 1-2 weeks before

A

Pericarditis

Can radiate to left shoulder

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6
Q

Physiologic explanation of pulsus paradoxus in cardiac tamponade

A

Pericardial fluid pressure on heart does not allow for filling ===> decreasing cardiac output

Inspiration creates a pressure gradient that allows for increased in venous return to the right heart ==> drop in systemic pressure

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7
Q

Normal fetal heart rate evaluation

A

2 acceleration >15 bmp, that last >15sec in a 20 min interval is considered normal

Normal rate: 110-160bmp

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8
Q

Biphysical profile

A

2 points each: 8-10 reassuring, 6 equivocal, 0-2: Extremely worrisom (may consider delivery)

Test the Baby, MAN

Tone
Breathing
Movement
Amniotic (index)
Non stress test
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9
Q

Example of a polypeptide hormone

A

ACTH

Comes from cleavage of propiomelanocortin and also produces MSH (melanocyte stimulating hormone) causing hyperpigmatation in Cushing sd that could be limited to sun exposed areas, scars, palmar creases and oral mucosa

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10
Q

Hypercortisolism clinical manifestations

A

BAM CUNSHINGOID

Buffalo hump, Brusing
Amenorrhea
Moon facies
Crazy (mood, sleep alterations)
Ulcers
Sking changes. (Hyperpigmentation only in C. disease)
Hypertension
Infection
Necrosis
Glaucoma
Obesity/osteoporosis
Immunosupresion
Diabetes
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11
Q

Dxx Cushing disease and syndrome

A

If ACTH is elevated = cushing disease
bilateral adrenal hyperplasia
Pitutary tumor vs. paraneoplastic sd (lung small cell carcinoma most common)

Cortisol only = cushing sd. (no skin pigmantation)
Adrenal tumor (unilateral), bening or malignant

Although obesity is a feature, the hypermetabolism state associated with malignacy can cause weight loss

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12
Q

Example of amminoacid derived hormones

A

Neuroendocrine

Epineprhine, norepi (pheochromocytoma)
serotonin (carcinoid tumors)

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13
Q

Arachidonic acid derivated

A

Leukotrienes, prostoglandins

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14
Q

Ecthyma gangrenosum

A

Skin lesion that rapidly evolve from papule to pustule to ulcer.
Associated with Pseudomona infection in inmunocomprimised patients

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15
Q

Labor stages

A

First
Latent: 0-6cm dilatation
Active: 6-10 cm (>1cm every 2hrs)

Second
10cm to delivery (30min - 3hrs 1st baby) (<30min multiparus)

Third:
Delivery to Placental expulsion

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16
Q

Delivery protraction vs. arrest

A

Active phase prolongation:

Protraction:
Cervical change slower than expected
Oxytocin

Arrest:
No change in 4hrs with adequate contractions or no change i 6 hrs with inadequate contraction
Csectio

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17
Q

Examples of alpha-bloquers

A

Non selective:
Phenoxybenzamine (for pheochromocytoma surgery)
Phentolamine

Selective:
tansulosin, prazosin, terasosin (for BPH)

A2 selective:
Mirtapzapine: antidepresive

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18
Q

Anticoagulation in patients with Afib

A

CHA(2)DS(2)VAS >2points (for non valvular AF)

Warfarin

Novel oral anticoagulant (direct inhibition of Xa)
apixaban, rivaroxaban. (Do not use in renal failure)

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19
Q

Imaging findings of Herpes encephalitis

A

Frontoteporal abnormalities

20
Q

CSF analysis

A

pg 223

21
Q

Characteristics of TB efussion

A

High proteins (ussually >4mg/dl)
Very high LDH
Low glucose
Low pH
Mild leukocytosis with lymphocyte predominance (not neutrophil)
Systemic symptoms may not be present or not as severe as with empyema

Empyema have a very high leukocyte concentration >50000 and neutrophile predominance

22
Q

Etiology of restrictive lung disease

A

The lungs AIN’T compliant

Alveolar (edema, hemorrhage, pus)

Interstitial lung disease (idiopatic interstitial) pneumonias, idiopatic pulmonary fibrosis, inflamatory

Neuromuscular (myastenia, prhenic n palsy, myopathy)

Thoracic (kyphoscoliosis, obesity, ascitis, pregnancy, ankylosing spondilitis)

23
Q

Spontaneous bacterial peritonitis

A

Common complication of patients with cirrhosis due to bacterial translocation

Suspect if patient with cirrhosis +
Fever, chills, hypothermia, hypotension
Diffuse abdominal pain
Ascitis

Diagnosed if >250 PMN in ascitic fluid

Treatment: IV antibiotics (3rd gen. cephalosporin) + albumin, fluroquinolones for prophylaxis

Associated with poor 1 year prognosis

24
Q

Physiological effect of tube decompresion in tension pneumothorax

A

Allows for an increase in venous return

25
Q

Live attenuated vaccine

A

Flu and polio nasal
Varicella
MMR
Yellow fever

26
Q

ALS

A

Anterior horn degeneration

Asymetric limp weaknes

UMN and LMN sings

May present with mild CK elevation <1000

27
Q

CK elevation dxx

A

ALS: very mild,

28
Q

Korsacov syndrom

A

Confabulation and amnesia in the setting of heavy alcohol consumption

29
Q

Temporal lobe epilepsy

A

Looks like an absent seizure (<20sec, no postictal state) but…

Usually in adults + post ictal state (confusion, disorientation, amnesia)

Classified as focal seizure with impaired awareness

30
Q

Lupus mnemonic

A

DOPAMINE RASH

Discoid rash
Oral ulcers
Photosentivity
Arthritis (not deformant)
Malar rash
Inmunologic criteria (anti dsDNA, anti Sm proteins)
Neurologic symptoms
ESR (elevated)
Renal involment
ANA
Serositis (pleuritic pain, muffle heart sounds (pericarditis))
Hematologic abnormalities (cytopenias)
31
Q

Skin findings on peripheral artery disease

A

Cold, thin, shiny with no hair

32
Q

Complications of gastric bypass

A

Early:
Leak
Bowel ischemia

Late
Anastomotic stricture
Cholecystitis
Dumping sd.
Marginal ulcer
33
Q

Urinary incontinance treatment

A

Urge type: antimuscarinic
Oxybutin, tolterodine, darfenecin, trospium

Overflow type: cholinergic agonist
Bethanecol
and beta agonist

34
Q

Polymysitis/dermatomiositis

A

Proximal muscle weakness (dificulty climbing stairs, combing hair)

CK elevation

Positive: ANA, anti Jo

malar rash similar to SLE

35
Q

Complications of hyperglycemia in pregnancy

A

First trimester:
Congenital heart disease, spontaneous abortion, small left colon sd, neural tube

>2nd trimester
Macrosomia
Organomegaly
Neonatal hypoglycemia
Polyctemia

All: RDS (insulin does not allow pneumocyte maturation), macrosomia, preterm delivery

36
Q

Esophageal perforation management

A

NPO, saline, broad spectrum antibiotics, PPI

Contained perforation: trial of medical management
Not contained: surgical repair

37
Q

Etiology of chronic pancreatitis

A

Alcoholism
Cystic fibrosis
Autoinmune
Ductal obstruction

38
Q

Sings and symptoms of chronic pancreatitis

A

Chronic epigastric abdominal pain (comes and goes)
Malabsorption
Diabetes

Lipase may be normal

39
Q

Weakness and leg cramps after intitation of thiazide diuretic

A

Severe hypokalemia. Think primary hyperaldosteronism

40
Q

Best intial test for primary hyperaldosteronism. Treatment

A

Morning plasma aldosterone/ plasma renin

Aldosterone level >15 and a PAC/PRA ratio >20 is diagnostic

If tumor: resection
If hyperplasia: aldosterone antagonist
spironolactone, eplerenone

41
Q

Metyrapone

A

Cortisol synthesis inhibitor used in patients with cushing sd awaiting for definite treatment

42
Q

Glomerular vs no glomerular hematuria

A

Glomerular:
Usually mycroscopic
RBC cast, Dysmorphic RBC, positive blood + Proteins
From no specific symptoms to neprhotic sd
Post strep, IgA or Alport

Non glomerular
Usually mycroscopic,
No cast, positive blood. No proteins
Sings of obstruction or dysuria
Lithiasis, cancer, PKD, papillary necrosis
43
Q

Renal ostedystrophy patophysiology

A

Renal failure===> low vitamin D production causes hypocalcemia and decreased PO4 secretion

Elevated PO4 binds to Ca forming CaPO lowering Ca even more

PTH stimulation

Increases Ca resortion ===> bone pain

44
Q

Serum albumin ascitis gradient

A

> 1.1: portal hypertension

<1: Cancer, nephrotic sd, tb, pancreatitis

45
Q

Causes of hepatic encephalopathy

A

Increased NH3 production/absorption:
Increased protein in diet, GI bleeding, constipation, infection

Decreased NH3 excretion/metabolism
Renal failure, diuretics, bypass hepatic blood flow post TIPS

46
Q

Hepatic encephalopathy management

A

Lactulose: Increase NH4 formation (from NH3)

Rifaximin or neomycin (Decreased NH4 producing bacteria)

Uworld Gaby (77 decks)

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