UW 22

Question 1

Definition of precocious puberty

Answer 1

Development of secondary sexual characters

<8 girls

<9 boys

Hair, odor, acne: androgens
Breast: estrogen

Question 2

Vaginal hematoma

Answer 2

Risks:
>4kg baby
Nullyparity
Forceps

Injury to the uterine artery and accumulation of blood in perivaginal space until is big enough to protrude

Expectant management if stable
Surgical management if unstable

Question 3

Risk for preeclampsia

Answer 3

Systemic disease (lupus, chronic hypertension)
Hypertension
Multiple gestation
Nullyparity
Advanced maternal age

Diabetic mom needs a baseline protein level

Question 4

Lupus mnemonic

Answer 4

DOPAMINE RASH

Discoid rash
Oral urlcers
Photosensitivity
Arthritis
Malar rash
Immuno: DNA, sM antibodies
Elevated ESR
Renal impairment
ANA antibodie
Serositis
Hematologic cytopenias: (autoimmune destruction)

Question 5

Risk factor for surgical site infection

Answer 5

Malnutrition: hypoalbuminemia, obisity
Smocking
Poorly controlled DM, vascular disease, venous disease
Steoroids, immunosupresants, chemotherapy
Infection on other site of the body
Advanced age

Question 6

Risk factors for Otitis media

Answer 6

Smocking exposure
Lack of breastfeeding
Age 6-18 months (eustachian tubes being straight and narrow)
Daycare

Question 7

Treatment for otitis media

Answer 7

Amoxicillin
Amoxi-clav

Clynda or azithromycin for penicillin allergies

Question 8

Choroid plexus papilloma

Answer 8

Brain tumor
Increases production of CSF

Macrocephaly, ventriculomegaly
Symptoms of Increased intracranial pressure

Question 9

Contraindications of Dpt vaccine

Answer 9

Anaphylactic reaction

Encephalopathy, infantile spasm, uncontrolled epilepsy within a week of TDaP

Question 10

Post exposure prophylaxis to Pertusis

Answer 10

Any close contact within 21 days of exposure

Azytro, Clarythro, Erithro

Question 11

Management of Uterine invertion

Answer 11

Agressive IV fluis
Replace uterus
Remove placenta and uterotonics (after manual replacement)

Question 12

Caustic injuries management

Answer 12

At home:
Remove clothing, clean person
Do not induce vomiting

At hospital arrival:
Confirm decontamination
Chest and abdominal x-rays
+/- Intubation if severe, gastric lavage

Later:
Upper endoscopy 12-24 hrs
Upper GI series
Consider nasogastric tube placement

Question 13

Umbilicated papule skin lesion

Answer 13

Molluscum

Cryptococcus

Question 14

Treatment for Cryptococcal meningitis

Answer 14

Anphotericin B + flucytosin for 2 week

Fluconazol for 8 weeks

Question 15

Presentation of Cryptococcal meningitis

Answer 15

AIDS <100 CD4

Confusion, altered mental status

Sings and symptoms of elevated ICP (headache, nausea, vomitig, VII palsy)

May present with papular umbilicated lesions that look like Molluscum

Question 16

Management of Hypertension and Diabetes after delivery

Answer 16

Gestational diabetes:
………. Fasting glucose at 24 and 72hr
………. 2hr glucose tolerance 6-12 weeks after delivery
………. Check every 3 years due to increased risk

Preeclampsia can develop up to 12 weeks postpartum
……… Check for urine protein if hypertensive

Question 17

Target glucose level in pregnant patient

Answer 17

Fasting <90
1hr <140
2hrs <120

Question 18

Non caseating granulomas (lung)

Answer 18

Hypersensitivity pneumonitis
Sarcoidosis
Goodpasture

Question 19

Hypersensitivity pneumonitis

Acute and chronic presentation

Answer 19

Acute:
Episodes of “self limiting” pneumonia-like symptoms
Dyspnea, dry cough, malaise, fever, leukocytosis
Within 4-6 hrs of exposure
Mirconodular infiltrates

Chronic:
Progressive dyspnea, couch, weight loss

Question 20

CMV retinitis

Answer 20

Central vision loss, scotomata (blind spots), floaters and photophobia

Sub acute presentation

Yellow fluffy lesion in the retina, close to retinal vassels

Question 21

Examination of herpes simplex retinitis

Answer 21

Fluoresin dye test

Question 22

Other CN deficits with vestibular shwanoma

Answer 22

CN V and VI palsy

Question 23

Causes of Sensorineural hearing loss

Answer 23

Vestibular shwanoma
Meniere disease
Presbicusis
Aminoglycosides

Question 24

RIne y Weber test

Answer 24

Rine:
Normal and conductive: AC>BC
SN: BC>AC

Webber
Lat toward affected side: conductive
Lat away from affected side: SN

Question 25

Causes of conductive hearing loss

Answer 25

Cerumen
Otitis externa or media
Timpanic perforation
Cholestoma
Otosclerosis (worse in pregnancy, autosomal dominant)

Question 26

Varizella vaccine and PEP

Answer 26

1 and 4 yoa

If Hx of diseases or to dosis: observation

Within 10 days of exposure
Immunocompetent: vaccinate
Immunocompromised/pregnant: VZIG

Question 27

Myelocyte vs. metamyelocyte

Answer 27

Metamyelocyte is more mature

More in leukemoid reaction

Question 28

What cell line is affected in Myeloid leukemias

Answer 28

Neutrophil

Question 29

Huntintong chorea.. where is the lesion?

Answer 29

Caudate nucleus

Question 30

Breast pain evaluation

Answer 30

Cyclic:
Mass: imaging
No mass: observation

No cyclic
Mass: biopsy
No mass: imaging

Question 31

Immune reconstitution inflammatory sd

Answer 31

Patient with HIV recently initiated in antiretroviral therapy. Seem to get worse because of “reactivation of immune system”

Question 32

Dupuytren contracture

Answer 32

Lo que tiene galdos

Question 33

Imaging for ginecological pathology

Answer 33

US has higher sensitivity than CT

Question 34

Eye exam in herpes simplex infection

Answer 34

Dendritic ulcers in the cornea and eye vesicle

Question 35

CMV sequelae of intrauterine infection

Answer 35

Sensorineural hearing loss

Periventricular calcification

Question 36

Toplasmosis sequelae of intrauterine infection

Answer 36

Chorioretinitis
Obstructive hydrocephalus

Intracerebral calcification

Question 37

Eating disorder pharmacological treatment

Answer 37

Anorexia: olanzapine

Bulimia: fluoxetine

Binge eating: SSRI, topiramate, lisdexanphetamine

Question 38

Complication of high voltage electrical injury

Answer 38

Compartment sd
Rhamdomyolisis
Heme pigment induced AKI

Question 39

Management of gestational diabetes

Answer 39

First line: Dietary modifications

Second line: Insulin, metformin (equally effective)