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uworld gaby > UW 12 > Flashcards

UW 12 Flashcards

1
Q

Treament for septic arthritis
Gram +
Gram -
No bacteria but elevated WBC

A

Gram +: vanco
Gram -: cephalosporin3rd
Negative mycroscopy: vanco + cephalosporin if immunocompromised

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2
Q

Nephrotic sd. associations:

Focal segmental

A 
African american, 
hispanic, 
obesity, 
HIV, 
heroin
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3
Q

Nephrotic sd. associations:

Membranous nephropathy

A

Heb B, Hep C
SLE,
NSAIDs,
Adenocarcinoma (lung, breast)

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4
Q

Nephrotic sd. associations:

Mebranousproliferative glomerulonephritis

A

Hep B and C

Lipodistrophy

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5
Q

Nephrotic sd. associations:

Minimal Change

A

NSAIDs
Lymphoma

More common in children

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6
Q

IgA nephropathy hx

A

Hematuria that follows URT infection

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7
Q

Pathognomonic finding in Focal segmental glomerulosclerosis

A

Partial sclerosis limited to a segment of the glomerulus

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8
Q

Painless hematochezia in infants (5

A

Meckel diverticulum (most common)

Intestinal hemangioma (if >5 cutaneous hemagiomas)
Intestinal polip: children 2-10
Lymphonudular hyperplasia (inflamed tissue): milk-indiced colitis
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9
Q

Juvenile Myoclonic epilepsy

A

Clinical features:
Absence seizure
Morning myoclonus
Generalized tonic-clonic seizure

Diagnosis:
EEG: bilateral polyspike and slow-wave activity

Treatment:
Valproic acid
Avoid triggers (alcohol, sleep depravation)

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10
Q

Lenox-Gastaux sd

A

Severe seizure type accompanied by intellectual disability

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11
Q

Psycogenic non epiletic seizure

A

Seizure-like event
Usually witness
Return to baseline is immediate (no post ictal state)

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12
Q

Presystolic accentuation of MS murmur

A

Due to atrial contration in patients with sinus rhythm
Can not be heard in patients with FA

FA clue: tachycardia with irregular rhythm

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13
Q

How does severity of Mitral regurge affect its murmur

A

It gets earlier as it gets more severe

Moderate: late diastolic murmur
Severe: early or mid diastolic murmur

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14
Q

Etiology of bacterial meningitis in eldery and treatment

A

S. pneumonia
S. meningitidis
Listeria

Vanco+cephalosporin+ampicillin

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15
Q

Etiology of bacterial meningitis in general

A

S. pnumonia
S. meningitidis
H. influenzae
GBS

<1 m: GBS, E. coli, listeria: ampicilin + cefotaxime or genta

1-3: S. pneumonia, S. meningitidis, H. influenza: vanco + cefotaxime

Adults: S. meningitidis, S. pneumonia: vanco + ceftiraxone or cefotazime

Old people: vanco+ampicilin+ 3rd cephalosporin

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16
Q

Factitious disorder vs. malingering

A

Factitious: primary gain. Want medical procedures

Mallingering: secondary gain
miss work, make money
Against medical procedures

17
Q

Herpangina

A

Oral vesicles in uvula, soft palate and tonsilar pillars usually associated with Cosackie A virus

Herpes gigivostomatis presents with oral ulcers in the anterior mouth (bocal mucosal, hard palate, gingival, tonge)

18
Q

Neutrophils in B12 deficiency

A

Hypersegmented

19
Q

Myelodisplastic Sd

A

Epidemiology:
Hematopoietic stem cell neoplasia
Increased risk with age and chemo/radio hx
May transform to leukimia

Manifestetions
Cytopenias: anemia, leukopenia, thrombocytopenia
Hepatosplenomegaly, lymphadenopaties (RARE)

Diagnosis:
Ovalomacrocytosis
Neutrophil hyposegmentation, hypogranulation

Treatment
Tranfusion for symptomatic cytopenias
Chemo
Stem cell transplant

20
Q

Common manifestations of pancoast tumor

A 
Shoulder pain
Horner sd (ptosis, miosis, enophtalmos and anhidrosis)

Symptoms of C8 - T2 invation
Intrinsic hand muscle weakness
Paresthesias of 4th and 5h digits, mideal arm and forearm

Supraclavicular lymphadenopathy

Weight loss

21
Q

Clues for malabsorption

A

Bulky, foul smelling, floating stools

Weight loss (loss os muscle, subcutaneous fat, fatigue)

Pallor, fatigue (iron)
Bone pain, fracture (vit D)
Easy brusing: vit K
Hyperkeratosis: vit A

Painless diarrhea: celiac disease

Abdominal pain: think pancreatic origin

Bloody diarrhea: UC

Other: cystic fibrosis

22
Q

Epidural abscess

A

TRIAD OF: Localized back pain, fever, level of neurologic deficits

Starts with fever and pain and then may present with shooting pain (radicular pain) to progress to paresthesias and paralysis

23
Q

Management of spinal metastasis

A

Corticosteroids to reduce edema

24
Q

Cutaneous manifestations of Granulomatosis with Polyangytis

A

Pyoderma gangrenoso: inmune system dysregulation or vascular occlusion causing necrosis

Leukocytoclastic angiitis: purpura on the lower extremities with ulceration

Granulomatosis with polyangitis is a necrotizing vasculitis

25
Q

Interventions that improve survival in COPD patients

A

O2

Smocking cesation

26
Q

Managment of COPD excacerbation (7)

A

Oxygen (goal is 88-92)
Bronchodilators (B2 agonist and Anticholinergics=ipratropium)
Corticosteroids
ATB if >cardinal symptoms (dysnea, cough, increased baseline sputum production)
NPPV (non invasive positive pressure ventilation)
Intubation if NPPV fails
Oseltamivir if influenza

27
Q

Indicationf for oxygen therapy in COPD

A

O2Sat: <88% CO2: <55mmHg

O2Sat: <89% CO2: <59mmHg:
cor pulmonale, right heart failure, polycithemia

O2 can worsen hypercapnia. O2Sat is: 90%-93%

28
Q

Things to remember about boderline personality disorder

A

Very brief periods of paranoia also called transiet psychotic effect

29
Q

Screaning for breast cancer

A

Mamogram for women every 2 years for patients 50-74
Genetic counseling and testing for women with high risk family history

High risk family history:
>2 1st degree relative with breast cancer, 1 <50yoa
3 or more 1st and 2nd degree relative with breast cancer
1st and 2nd with breast and ovarian cancer
1st and 2nd with bilateral breast cancer
Male relative with breath cancer
Askenazi jew with 1st and 2nd with breast or ovarian cancer

30
Q

Painful vs painless myopathy

A

Proximal muscle weakness

Paiful: thyroid and statin

Painless: cushing

31
Q

Chrons vs. UC dxx of diarrhea characteristics

A

UC: bloody, lower abdominal pain, tenesmus. Toxic mega colon

Chrons: watery, low grade fever, weight loss,

32
Q

Etiology of Impetigo

A

S. aureus (most common)

S. pyogenes

33
Q

Management of DKA

A

Fluids: 0.9%, switch to Dextrose 5% when glucose <200

Insulin: IV infusion until…
Patient able to eat. Glucose <200. Anion gap <12. Bicarb >15.

Potasium: IV if K <5.5

Others
Bicarb if pH <6.9
Phospaphate if <1 and there is cardiac dysfunction or respiratory depresion

34
Q

CML vs Leukemoid reaction

A

Leukocyte cout
LR: >50000 CML: often >100000

Cause:
LR: Severe infection CML: BCR-ABL fusion

LAP score
LR: High CML: low

Netrophil precursor:
LR: More mature (Matamyelocites>myelocytes) CML: opposite

Absolute basophilia:
LR: not present CML: present

CML: thrombocytosis and anemia are common

35
Q

Recomendations to prevent gout attacks (7)

A 
Weight loss to BMI <25 
Low fat diet
Decreased seafood and meat intake
Protein intake from vegetable and low fat dairy products
Avoidance of alcoholic bevarages
Avoidance of diuretics
36
Q

Indications for lowering serum urate in Gout (5)

A 
Repeated and disabling attacks
Tophi suggesting chronic disease
Xray evidence of chronic gouty disease
Uric acid kidney stone
Renal insuficiency
37
Q

Medications for gout

A

Xantine oxidase inhibitors
Allopurinol (prefered)
Febuxostat (for patients that can not tolarate hallopurinol)

Niacin and thiazide dirutics can lead to hyperuricemia

38
Q

Changes of location on auscultation of aortic regurge

A

Valvular AR: best heard on ULSB

Due to aortic root dilatation: heard on the right side too.

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