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Uworld Gaby > UW 15 > Flashcards

UW 15 Flashcards

1
Q

Severe cancer related pain with no adequate dosing during the night

A

Add a long-acting opioid or extended release medication like a fentanyl patch or sustained released morphine

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2
Q

Elevated lactate meaning

A

Poor organ perfusion

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3
Q

New Left bundle branch block is suggestive of

A

Acute MI

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4
Q

Exercise and Cocaine hemodynamic monitoring profile

Preload, CO, Afterload

A

Exercise: low preload, high CO and afterload

Cocaine: normal preload and CO, elevated afterload. Normal CO is possible due to increased in contractility and HR.

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5
Q

How is the preload in:

Cardiogenic, Hypovolemic and septic shock

A

Cardiogenic: increased

Hypovolemic: decreased
Septic: decreased

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6
Q

Candiasis vs. Tinea on KOH

A

Candidiasi: Pseudohyphae with blastoconidia

Tinea: Septate hyphae

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7
Q

What to look for in acute gout when it comes to treatment

A

Look for clues of NSAIDs contraindications: anticoagulation (aspirin, clopidogrel, apixaban)

Indomethacin (fisrt line), naproxen

Colchicine: if the patient is taking anticoagulants. Do not use in eldery or renal failure

Corticosteroids: also good to use in patients with NSAIDs contraindication. Careful with diabetic patients

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8
Q

Z score corresponding to 95% and 99% confidence interval

A

95% = 1.96

99% = 2.58

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9
Q

How do you calculate confidence interval

A

mean +/- Zscore x standard error of the mean

Standard error of the mean = standard deviation/square root of the sample

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10
Q

Interpretation of confidence intervals

A

Wider confidence interval means higher variation in results

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11
Q

Overlapping or not in confidence intervals

A

If the CI of two groups do not overlap.. it means there is statistical significance

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12
Q

Rosacea presentations

A

Erythematotelangiectasic: erythema, flushing, burning, scaling

Pustular: small papules, pustules, looks like acne

Phymatous: rinophyma

Ocular: affects conjuntiva, cornea, sensation of foreing body. Common with skin manifestations not necesarily at the same time

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13
Q

Uveitis image

A

Look for irritation as close as possible to the iris.

Common with severe pain and photophobia

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14
Q

Diagnostic requirement for liver failure

A

ALT/AST >1000
INR > 1.5 (normalized value of PT)
Sings of encephalopathy (confusion, asterixys)

May also present with: anemia, thrombocytopenia, hypoglycemia, electrolyte imbalance

Renal failure can be present but it is not specific to liver failure

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15
Q

Specifics of liver failure due to Wilson or Acetaminophen toxicity

A

Acetaminophen: low bilirubin

Wilson: very low ALP

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16
Q

Serotonin sd. AAA

A

neurological Activity: clonus, tremors, hyperreflexia, hypertonia, seizure

Autonomic stimulation: fever, diaphoresis, flushing, diarrhea, midirasis

Agitation

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17
Q

Sings and symptoms of early diseminated Lyme

A 
erythema migrans
malaise, fatigue, arthralgias
CN palsy, bells palsy, radiculopathy, lymphocytic meningitis
Cardio: av block
Regional lymphadenopathies
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18
Q

Treatment of lyme and criteria for prophylaxis

A

Mild/ skin : oral doxycycline or amoxicilin in <8 yoa or pregnant

Neurologic/Cardio: IV ceftriaxone

Ixodes tick
Attached for >36hr
Treatment initiated before 72hrs of tick removal
Rate of infection is >20%

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19
Q

Fever + painful uterine fundus (postpartum)

A

Decidua infection

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20
Q

Empiric treatment for endometritis

A

clynda + genta

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21
Q

Empiric treatment for endometritis

A

clynda + genta

If no improvement after 48hrs, think abscess

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22
Q

Fever <24 hrs post partum

A

Normal

23
Q

Empiric treatment for Community acquired pneumonia

A

Outpatient:
Macrolide, oral quinilone or betalatam + macrolide

Inpatient (not MICU)
Levofloxacin IV or betalactam + macrolide

MICU
betalactam + macrolide
belactam + fluoroquinolone

24
Q

Common mycoplasma pneumonia presentation and treatment

A

Young patient in college, prison, military

Malaise, dry cough, faringeal erythema (not exudative)
Macular/vesicular rash

Normal leukocytes, subclinical hemolytic anemia (cold agglutins)

Diffuse reticonudular opacities on xray

Treat with macrolide or resp. quinolone

25
Q

Why are penicillins are cephalosporins inefective against mycoplasma

A

They inhibit cell wall synthesis and mycoplasma doesnt have one

26
Q

Diagnosis criteria for narcolepsy

A

> 3 episodes of lapses into sleep/naps >3month + >1 of the following

  1. Catalepsy: brief loss of muscle tone precipitated by emotion (eg. laughing, exitment)
  2. Low hypocretin level on CFS
  3. Decreased REM latency

Others:
Hallucinations when falling asleep or waking up and/or sleep paralysis

Specifics: decreased sleep latency, increased REM density

27
Q

3hz spike wave activity on EEG

A

Absence seizure

28
Q

Absence seizure EEG

A

3hz spike wave activity on EEG

29
Q

Thromboangitis obliterans

A

Age <45, smoker, non occlusive limb ischemia, gangrene, ulceration, thrombosis

Pulses and ankle/brachial index usually normal

Treatment: smocking sesation

30
Q

Aspergillosis 4 different presentations

A

Allergic bronchopulmonary aspergillosis: common in asthma and cystic fibrosis. Eosinophilia, bronchiectasis. Steroids + itraconazol

Aspergilloma: usually asymptomatic. Common in patients with TB, sarcoidosis. Can cause fever, hemoptysis and cough. Solid mass in preexisting lung cavity. Itraconazol

Chronic necrotizing pulmonary aspergillosis: common in alcoholics or steroid dependent COPD patients. fever, cough, sweating. Pneumonia that does not respond to antibiotics. Vorizonazole

Invasive aspergillosis: fever, chest pain, hemoptysis. Exclusively in immunocompromised. CXR: nodules with sourounding ground glass opacities (halo sing). Voriconazol or caspofungin

31
Q

Allergic bronchopulmonary aspergillosis:

A

Common in asthma and cystic fibrosis.
Eosinophilia, bronchiectasis.
Diagnose with skin test and specific IgG
Steroids + itraconazol

32
Q

Pharmacologic treatment for bulimia vs anorexia

A

Anorexia: olanzapine

Bulimia: SSRI

Binge eating disorder: SSRI or lisdexanfetamine

33
Q

Major differences between bulimia and anorexia

A

Anorexia: BMI <18.5. Distorted views over weight and shape

Bulimia: Binge eating with compensatory behaviors. Worry about weight and body shape.

34
Q

Management of hypercalcemia

A

> 14:
Short term: IV Fluids + calcitonin, avoid diruretics unless fluid overload (patients are ussually volume depleted due to hypercalcemia induced neprhogenic diabetes insipidus)

Long term: biphosphonate

12 -14
Short term: non if asymptomatic, same as above if symptomatic

<12 or asymptomatic
No treatment needed. Avoid diuretics, lithium, volume restriction or bed rest

35
Q

Mechanic valve thrombosis

A

Mitral or Aortic
Looks like a stenosis ==> CHF ==> Cardiogenic shock

Due to inadequate anticoagulation: INR mitral 2.5-3.5. aortic 2-3

Diagnose with eco
Anticoagulate (eg. heparine)
Thrombolitics, avoid to the max
Surgery for severe CHF

36
Q

Patient with chronic cough with sputum production and +/- streacks of blood after an inciting event….

A

Bronchiectasis

37
Q

Permanent destruction and dilation of airways

A

Bronchiectasis

38
Q

Infantile hemangioma

A

May begin as a patch of telangiectasia

Progreses to a red, raised nodule at age 0-1

Regresses at 1-9 yoa (gets darker and smaller)

No treatment needed

39
Q

Infantile hemangioma

A

May begin as a patch of telangiectasia

Progresses to a red, raised nodule at age 0-1

Regresses at 1-9 yoa (gets darker and smaller)

No treatment needed

40
Q

Rett syndrom

A

Lost of motor and communicative skills (from 6-18months), gait disturbances, autism

Deceleration of head growth

Stereotypical hand movements

Ataxia

41
Q

Phenylketunuria

A 
Mosty odor
Eczema
Microcephaly
Albinism
Impaired cognition

Screen at birth

42
Q

Tay Sachs

A

Hexoaminidase A deficiency. Accumulation of ganglioside

Neurodevelomental regretion staring at age 6 months

Cherry red spot on macula, no heptosplenomegaly (vs. gaucher)

43
Q

Congenital syphilis

A

Rinorrhea
Desquamating rash in hans and soles
Bone deformities (sadle nose/ teeth later in life)

44
Q

Congenital CMV

A

Microcephaly
Periventricular calcification
Hepatosplenomegaly
Jaundice

45
Q

Rubella congenita

A

Catracts
PDA (heart defects)
Sensorineural deafness
Bluberry muphin rash

46
Q

Management of mild sunburn

A

Lotions

NSAIDs

47
Q

Management of threatened abortion

A

Vaginal bleeding with closed cervix

If fetal hr is normal and everything looks ok…
Reassurance and follow up

48
Q

Need to increased folic acid dosing in pregnancy

A

Previous neural tube defect pregnancy

Patient taking anticonvulsants

49
Q

Epstein anomaly presentation and association

A

Atrialization of the right ventricle
Atrial septal defect
Tricuspid valve defect

Lithium

50
Q

SSRI and pregnancy

A

Good to go except for paroxetine wich has been associated with cardiac defects

51
Q

Most common location of hypertensive hemorrahages and potential complication

A

Basal ganglia

Complication: Uncal herniation

52
Q

Uncal herniation

A

IPSILATERAL CN III paralysis: dilated pupil with no response to light. Down and out

Ipsilateral hemiparesis: compresion of contralat cruz cerebri

Contralat homonimus hemianopia: compresion of ipsilateral posterior cerebral artery

53
Q

Measures to prevent pulmonary complications after cardiac surgery

A

Stop smoking 8 weeks prior

Physical therapy prior to surgery

54
Q

Wiskott-Aldrich

A

Xlinked recesive (male patients)

WIPE

Wiskott-Aldrich
Infections
Purpura
Eczema

Elevated IgE/IgA, low IgM Increased risk for encapsulated bacteria)

Clasic presentation: bleeding, eczema and recurrent otitis media

Uworld Gaby (77 decks)

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