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Uworld Gaby > UW 24 > Flashcards

UW 24 Flashcards

1
Q

Wells criteria for pulmonary embolism (7)

A

3 points:
DVT
Other diagnosis less likely

1.5 points:
Tachycardia
Recent surgery/bed ridden
Hx of DVT

1 point
Malignancy (hypercoagulability)
Hemoptisis

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2
Q

Pancreatitis due to biliary stone surgical management

A

If sings of obstruction: ERCP

If medical management was succesfull: elective cholecistectomy

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3
Q

HIDA indication (hepatobiliary iminodiacetic acid)

A

Tracer for biliary secretion

Used when diagnosis is not clear with ultrasound.

If gallbladder can not be visualized it meas obstruction.

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4
Q

What causes butulism infants vs. adults

A

Infants: bacteria colonization that produces the toxin (spores)
Adults: preformed toxin

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5
Q

Clinical presentation of infant botulism

A

<12 months

First: Poor feeding, constipation, hypotonia

Oculobulbar palsy: midirasis, ptosis, absence of gag reflex,

Symmetric descending paralysis

Autonomic dysfunction: decreased salivation, fluctuating HR

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6
Q

Empiric ATB treatment for patients with splenectomy

A

Amoxicilin-clavulanic

or

Levofloxacin for penicillin allergic patients

TMP-SMX also have similar spectrum but its not used due to delay batericidal effect and resistance

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7
Q

Pinealoma

A

Parinaud sd:
Limited upwasrd gaze
Lid retraction
Pupil react to accomodation but not to light

Obstructive hydrocephalus
Papilledema, vomiting ataxia

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8
Q

Brain tumor in children

A

Craneopharingioma: most common supracellar. Optic chiasm compresion (bitemporal hemianopsia). Craneo, Cystic, Calcifications

Astrocytoma: Posterior fossa/infratentorial. Symptoms of intracraneal pressure

Medulloblastoma: arises from the cerebellar vermis or fourth ventricle. Presents with ataxia. Highly malignant but responds to radiation. Drop metastasis to central cord

Pinealoma: Parinaud sd and obstructive hydrocephalus

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9
Q

Pertusis presentation

A

Common in infants but DO NOT exclude adults with paroxysm of cough

Catharral: URI symptoms for 1-2 weeks
Paroxysmal: cough can last for 2-3 months
Convalescent: symptoms wane

Labs: leukocytosis with lymphocytosis

Treat with macrolides and close contacts too

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10
Q

Side effect of calcineurin inhibitors

A

Cyclosporin and tracolimus (via IL-2 inhibition)

Vasoconstriction (renal), hypertension

Prerenal acute kidney injury

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11
Q

Otitis media common organisms in children <2 yoa

A

S. pneumonia
S. pyogenes
S. aureus

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12
Q

Otocholestoma presentation

A

Recurrent painless otorrhea

Perly white mass or retraction pocket in the superior portion of the timpanic membrane

Associated with recurrent Otitis media

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13
Q

Post partum urinary incontinance

A

Stress incontinance

Due to weakness of the pelvic floor and streching of the pudendal nerve

Normal up to 6 weeks after birth

Reassurance +/- kegel exercise

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14
Q

Lead poisoning antidote

A

Oral succiner
EDTA
Dimecarpol

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15
Q

Specific contraindications of pregestin and copper IUD

A

Copper: Wilson

Progestin: breast cancer, active liver disease

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16
Q

Suprascapular nerve entrapment

A 
Shoulder pain
Weak abduction (supraspenitatus)
Weak external rotation (Infraspinatus)

Crossing of the arm may produce scapular pain

Common due to backpack compression

17
Q

Erlichiosis

A

Rocky mountain spoted fever without the spots

Tick vector (lone star), south east and south central USA

Flu like symptoms (fever, myalgias, chills)
Neurologic symptoms
Rash uncommon (,30%)

Leukopenia and thrombocytopenia
LFTs and LDH elevated
Intracytoplasmatic morula in monocytes (MEGA berry: monocytes erlichia, graulocytes anaplasma)
PCR for erlichia

Treatment:
Empiric doxy

18
Q

What other screen do you do in a patient with Irritable bowel sd

A

If its IBS - D, then screen for celiac

If it is constipation predominate, just clinical diagnosis

19
Q

Calprotectin use

A

To diagnose inflamatory diarrhea (infectious , inflamatory bowel disease)

20
Q

Mononucleosis EBV vs. CMV

A

CMV is usually milder (pharyngitis, lyphadenopaties) Hepatosplenomegaly may or may not be preset
Presence of atypical lymphocyte
Negative monopost test

Positive CMV PCR

21
Q

Defect in Duchene and Beker muscular dystrophy

A

Distrophin

Presents at age 2-3

Axial and proximal muscle weakness

EMG: polyphasic potentials and increased recruitment

22
Q

Defect in Marfan sd

A

Fibrilin

23
Q

Defect in achondroplasia

A

Fibroblast growth factor receptor 3

24
Q

Defect in osteogenesis imperfecta

A

Colagen I

25
Q

Causes of Galactorrhea

A

Pregnancy
Hyperprolactinemia
Hypothyroidsm
Chest wall, nipple estimulation (trauma, shingles, surgery)
Medication (antipsychotics, antidepresants)

26
Q

Hyperthrophic pulmonary osteoarthropathy

A

Digital clubbing is accompanied by arthropathy (pain,) that is a attributable to a pulmonary condition like cancer, tb or emphysema

27
Q

Trauma patients evaluation

A

ABC

FAST, Chest Xray and pelvic xrays, and cervical spine i

28
Q

When is a cervical spine imaging study indicated in a trauma patient

A

High energy impact (car crash or fall > 3mts (10ft)

or
Altered mental status
Spinal tenderness
Neurologic deficit 
Intoxication
Distracting injury

(basically the same is true for any other segment of the spine)

29
Q

Patient with a cervical fracture on imaging: next step

A

Complete spine imaging

One vertebra fracture in a patient with blunt trauma is indication for the entire spine

30
Q

Management of TCAs overdose

A

Supportive ABCs

Activated charcoal if <2hr of ingestion
NaHCO3 for QRS widening or arrhythmia (TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension)

31
Q

Effect of TCAs on heart (patophysiology)

A

TCAs bind to Na channels in Purkinje system and myocardioum causing >100 QRS and hypotension)

Sodium bicarbonate increases pH and inhibits TCAs from binding to Na channels

32
Q

Aspirin intoxication management

A

Sodium bicarbonate alkalinizes urine and helps with excretion

33
Q

Tumor associated with molar pregnancy

A

Teca lutein cyst

34
Q

Erythema nodoso

Etiology
Pathologic findings
Evolution

A

Sarcoidosis
Inflamatory bowel disease
Medication (antibiotics, OCPs)
S. pyogenes infection

Septal paniculitis without vasculitis

Natural regresion
Residual hyperpigmentation

35
Q

Salmonella no typhi vs. typhoideal

A

Non typhoideal;
Vomit, diarrhea +/- blood, fever
Poultry or non refrigerated food

36
Q

Rash of dermatomyocytis

A

Violaceous periorbital rash

Shawal rash: rash involving the shoulder, upper chest and back

Gottron papules: papular rash with scales on the dorsa of the hands, over bony prominences

37
Q

Urine low specific gravity cut off

A

<1.006

38
Q

Suspected polyuria

A

Complete 24hr urine colection:

<3 L: not true polyuria

> 3 L:
…Diluted: Diabetes insipidus, polydipsia
… Concentrated: osmotic diuresis (DM, urea, saline)

DI can present with normal or elevated Na

39
Q

Anysocytosis and RBW

A

Anysocytosis is the presence of RBC with multiple size and RBW is the quantification of that

Uworld Gaby (77 decks)

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