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Mixed > UW 3 > Flashcards

UW 3 Flashcards

1
Q

Elderly pt w/dehydration tx?

A

IV sodium fluids:
0.9% NS or
Crystalloid

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2
Q

Complication with rehydration of elderly pt?

A

Sodium loading can unmask subclinical heart failure

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3
Q

Heavy proteinuria, rapidly progressive development of renal failure in HIV + pt?

A

Focal Segmental Glomerulosclerosis (Collapsing type)

  • Azotemia
  • Normal sized kidneys
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4
Q

Air under the diaphragm? Tx?

A

Perforated viscus

Immediate surgery -> emergent exploratory laparotomy

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5
Q

Pt presents w/severe epigastric pain, N/V after eating?

A

Perforated peptic ulcer.

Look for pneumoperitoneum

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6
Q

When do we check for Gestational DM in pregnancy (GDM)?

A

24-28 wks

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7
Q

What is tx for GDM?

A
  1. Dietary modifications/Exercise

2. Insulin - does not cross placenta

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8
Q

What is goal glucose during pregnancy?

A

Fasting blood sugars < 95 mg/dL
1 hour postprandial level of < 140 mg/dL
2 hour level < 120 mg/DL

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9
Q

Complications of maternal hyperglycemia seen in 2nd and 3rd trimester?

A

Persistent -> fetal hyperglycemia -> fetal hyperinsulinemia -> Fetal hypoxemia -> polycythemia
Hypoglycemia
Organomegaly
Macrosomia - shoulder dystocia

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10
Q

Complications of maternal hyperglycemia in 1st trimester?

A
  1. Congenital anomalies
    - small colon syndrome
    - NTDs
    - Congenital heart dz
  2. Spontaneous Abortions
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11
Q

Most likely cause of neonate with thyrotoxicosis with mother w/Graves treated with surgery and meds?

A

Persistence of thyroid stimulating immunoglobulin in mother

Maternal - post thyroidectomy, TSI levels remain high for months; TSI Autoabs can cross placenta

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12
Q

Etiology of Lambert eaton?

A

AutoAbs to voltage-gated Calcium channel

Presynaptic motor nerve terminal

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13
Q

Receptors involved in myasthenia graves?

DTRs in MG?

A

Postsynaptic Ach receptors

DTRs usually preserved

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14
Q

Multicentric CNS inflammation and demyelination?

A

Multiple Sclerosis

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15
Q

Rash seen in pellagra?

A

Resembles sun burn
Bilateral and symmetric
Progresses to become hyperpigmented and thickened

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16
Q

Diaphragmatic hernia presentation?

A

MC on left side - left side displaces/impairs left lung growth ->absent left side breath sounds
- Deviation of heart into Right thorax -> impairs right lung growth - right lung aeration and right sided heart sounds
Pulmonary hypoplasia and pulmonary HTN
Polyhydramnios b/c of esophageal compression
Concave abdomen and barrel shaped chest on PE

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17
Q

Scaphoid abdomen and respiratory distress?

A

Diaphragmatic hernia

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18
Q

Dx testing for diaphragmatic hernia

A

CXR to look for loops of bowel in chest

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19
Q

Tx for diaphragmatic hernia

A

Immediate intubation
Naso or orogastric tube for suction
Place umbilical arterial line for ABG and BP
Place umbilical venous catheter for IVF and meds
Surgical correction

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20
Q

VSD seen in which groups?

A

Trisomy 13, 18, 21

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21
Q

Heart defect common in Trisomy 21?

A

Endocardial cushion defect

ASD

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22
Q

Heart defects seen in CATCH-22, DiGeorge, and velocardiofacial syndromes?

A

Conotruncal - Truncus arteriosus, tet of fallot, interrupted aortic arch

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23
Q

Cryptochidism is ass’d with what complications despite orchiopexy?

A

Subfertility

Testicular cancer

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24
Q

Risk of testicular torsion with cryptochidsm post orchiopexy?

A

NO, b/c testis is surgically affixed to scrotal wall

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25
Q

Dose-limiting side effect of hydroxyurea?

A

Myelosuppression - neutropenia, thrombocytopenia

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26
Q

Indomethacin CI in who?

A

Renal Failure

Hx of GI bleeds

27
Q

Are gallstones radiolucent or opaque?

A

80% radiolucent

28
Q

Best initial test for Cholelithiasis?

A

Abdominal US

29
Q

Tx for symptomatic GB Dz?

A

Laparoscopic cholecystectomy

30
Q

When do we do ERCP?

A

Cholangitis

Biliary obstruction with a stone

31
Q

When do we do HIDA scan?

A

Confirmation for acute cholecystitis

- esp acalculous type

32
Q

Most frequently injured organs in BAT?

A

Liver

Spleen

33
Q

Free intraperitoneal fluid after BAT?

A

Splenic Laceration

34
Q

HypoTN after BAT is suggestive of?

A

Solid organ or vascular injury

35
Q

Next step in hemodynamically unstable pt w/evidence of free intraperitoneal fluid on US?

A

Emergency surgical exploration

36
Q

When do we see bladder rupture?

A

Lower abdominal trauma w/pelvic fx where bony fragments damage and rupture bladder

37
Q

Signs of pelvic trauma?

A

Pelvic pain, tenderness

38
Q

When do we see rupture/tear of descending aorta?

A

Chest trauma from deceleration injuries

39
Q

When do we see small bowel injury in trauma?

A

GSW

Stab wound

40
Q

Tx for bacterial vaginosis in pregnancy?

A

Oral Metronidazole

  • same for non-pregnant
  • Vaginal metronidazole and clindamycin - alternatives
41
Q

Tx for HSV in pregnancy?

A

Acyclovir = Risk to fetus greater than risk of tx

42
Q

Tx for Candidiasis in pregnancy?

A

Fluconazole

43
Q

Are macrolides safe in pregnancy?

A

Azithromycin - Yes

Erythromycin estolate - NO. CI b/c causes acute cholestatic hepatitis

44
Q

Presentation of psoas abscess

A

Fever

Lower abdominal or back pain

45
Q

Dx for Intraabdominal abscess?

A

Psoas abscess - Deep abdominal palpation elicits tenderness = psoas muscle deep on posterior abd wall
CT scan

46
Q

High clinical suspicion of psoas abscess with negative CT?

A

Exploratory Laparatomy

47
Q

Dense intramembranous deposits that stain for C3?

A

Membranoproliferative glomerulonephritis

- caused by IgG abs

48
Q

C3 nephritic factor?

A

IgG abs directed against C3 convertase of alternative complement pathway
- Abs react w/C3 convertase and lead to persistent complement activation and kidney damage

49
Q

Cell mediated injury seen in what glomerular dz?

A

Idiopathic crescenteric glomerulonephritis

50
Q

Hypertensive intracranial hemorrhage occurs most commonly in what part of brain?

A

Basal ganglia
Pons
Thalamus
Cerebellum

51
Q

Presentation of hypertensive intracranial hemorrhage

A

Initial - Mc in BG/Cerebellum/thalamus/pons
Progress - focal sx’s (hemiplegia, hemiparesis)
ICP -vomiting, HA

52
Q

Strongest influence on long term prognosis after STEMI?

A

Restoration of coronary blood flow

53
Q

What factors determine myocardial oxygen demand?

A

Heart rate
Preload
Afterload
Contractility

54
Q

Pt presents with HTN and Hypokalemia - next best step?

A

Plasma Aldosterone/Renin Ratio:

  1. Elevated - Adrenal suppression tets
  2. Positive - Adrenal imagining
55
Q

Sticking sensation in throat, dysphagia w/heartburn, Manometry - absence of peristaltic waves in lower 2/3 esophagus, significant decrease in LES tone?

A

Scleroderma - esp absence of peristaltic waves = not seen in GERD

56
Q

What can severe coughing paroxysms result in?

A

Subcutaneous emphysema - air leaking from chest wall to subcutaneous tissues, can lead to pneumothorax

57
Q

Subcutaneous emphysema secondary to cough, what test must be done?

A

CXR to r/o pneumothorax

58
Q

Which marker is indicative of infectivity in Hep B?

A

HBsAg

59
Q

Hepatitis B marker for successful vaccination or clearance?

A

Anti-HBs

60
Q

Hep B marker indicative for noninfectivity?

A

Anti-HBs

61
Q

Marker that indicates active viral replication?

A

HBeAg

62
Q

Marker suggests cessation of active viral replication and low infectivity?

A

Anti-HBe

63
Q

Best screening for acute hepatitis?

A

HBsAg

anti-HBc

64
Q

What is glucose testing in pregnancy?

A

Glucose load test -non fasting: 50 g then test 1 hr later = 140, then do glucose tolerance test. if any high, then DM confirmed.

Mixed (19 decks)

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