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Mixed 2 > UW 4 > Flashcards

UW 4 Flashcards

1
Q

Method to control confounding

A

Matching

  • Neighbors
  • Age
  • Race
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2
Q

Presentation of Amniotic Fluid Embolism

A

During or shortly after delivery
Cardiogenic shock
DIC
Hypoxemic Resp failure

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3
Q

LLQ pain unresponsive to Abx and elevated WBC count - what is next best step

A

Abdominal CT scan for diverticulitis with possible complication, such as abscess

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4
Q

AIHA in CLL patients - intra or extravascular?

A

Extravascular

- Spleen and RES and extravascular

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5
Q

Hyperactive/tinkling bowel sounds?

A

Mechanical bowel obstruction

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6
Q

Treatment to remove K+ from body

A

Dialysis
Cation exchange resins (Kayexalate)
Diuretics

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7
Q

CMV v HSV retinitis

A

CMV = painless
Fundoscopy - fluffy granular retinal lesions near retinal vessels, hemorrhages
HSV = keratitis, conjunctivitis, eye pain, rapid visual loss
Fudoscopy - widespread, pale, peripheral lesions, central necrosis of retina

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8
Q

Who gets a tetatnus-diphtheria toxoid

A

Individuals w severe or dirty wounds who received booster > 5 years ago
Individuals w minor clean wounds who received booster > 10 years ago

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9
Q

Who gets Tetanus Immune globulin

A

Individual w severe/dirty wound
AND
Unclear/incomplete immunization Hx

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10
Q

Pt w clean or minor wound + unimmunized, uncertain or < 3 tetanus toxoid doses

A

Tetanus toxoid-containing vaccine only

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11
Q

Clubfoot Presentation

A

Equinus and varus of calcaneum and talus
Varus of midfoot
Adduction of forefoot

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12
Q

TX for clubfoot

A 
Immediate
Stretching
Manipulation
Serial plaster casts, malleable splints, taping
Surgery if poor results b/t 3-6 months
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13
Q

Presentation of medial meniscus injury

A

Forceful torsion of knee w foot planted
Popping sound + severe pain at time of injury
McMurray sign +
Bucket handle tear leads to locking of knee joint during terminal extension

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14
Q

Presentation of ACL injury

A

Hx of forceful hyperextension injury to knee or noncontact knee injury during deceleration
Effusion Rapidly after injury
Lachman’s test, anterior drawer test, pivot shift test

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15
Q

Presentation of PCL injury

A

Dashboard injury

Foreceful posterior -directed force on tiba w knee flexed at 90 degrees

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16
Q

Tension Pneumothorax TX

A

Immediate needle decompression in 2nd or 3rd IC space in MCL
or
5th IC space in MAL

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17
Q

Suspected Tension pneumothorax - do needle decompression and continue to remain unstable - next step ?

A

FAST to look for pericardial tamponade

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18
Q

Next step in tension pneumothorax after needle decompression

A

Chest tube placement in 5th IC space in MAL to maintain lung expansion

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19
Q

Cerebral Palsy Presentation

A

A group of syndromes characterized by non-progressive motor dysfunction
Most commonly spastic diplegia = hypertonia and hyperreflexia, equinovarus presentation (feet pointing down and in)
Intellectual disability

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20
Q

Leading risk factor in cerebral palsy

A

Prematurity before 32 weeks

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21
Q

Management of Cerebral Palsy

A

Physical, occupational, speech therapy

Baclofen, botulinum toxin

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22
Q

Intraventricular hemorrhage in newborn
What is it?
Risk factors

A

Bleeding into the germinal matrix
Premature
LBW infants

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23
Q

Presentation of Intraventricular hemorrhage

A 
Pallor
Cyanosis
HypoTN
Seizures
Focal neuro signs
Bulging or tense fontanel
Apnea and bradycardia
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24
Q

Management of hyponatremia with moderate sx’s - confusion, lethargy

A

Hypertonic saline in first 3-4 hours to raise Na to > 120

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25
Q

Management of hyponatremia with severe sx’s - seizures, coma

A

Bolus of hypertonic saline until sx’s resolve

Conivaptan - Vasopressin antag

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26
Q

Management of hyponatremia in asymptomatic or mild sx’s - forgetfulness, unstable gait

A

Fluid restriction
Oral salt tablets
Loops if Uosm > 2x Serum osmolality

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27
Q

Best indicator of severity of TCA intoxication

A

Duration of QRS complex

- predicts chances of seizures and vent arrhythmias

28
Q

TCA overdose Presentation

A 
CNS depression
HypoTN
Hyperthermia
Anticholinergic effects
- Dilated pupils
- Dry flushed skin
- Intestinal ileus
QRS Prolongation = vent arrythmias
29
Q

TX for TCA toxicity

A

Sodium bicarb shortens QRS

Decreases likelihood of arrhthmia

30
Q

Diabetic mononeuropathy of CN III

Type of nerve damage

A

Ischemic, so only somatic nerve fibers are affected

Parasympathetics not affected so light and accommodation reflexes are normal

31
Q

Presentation of Secondary Raynauds

A 
Older, > 40
Male
Asymmetric attacks
Tissue ischmeia features - numbness, ulcers
ANA and RF
32
Q

Causes of primary adrenal insufficiency (Addison’s)

A 
TB
AI
Infxn
Hemorrhagic infarction
Mets cancer
33
Q

Acid base of Addison’s

A

Aldosterone deficiency

- Non AG hyperkalemic, hyponatremic Metabolic Acidosis

34
Q

Presentation for Androgen Insensitivity

A

XY Karyotype
External genitalia = female
MIF secreted by testis - prevents female internal organ development

35
Q

Presentation for 5 alpha reductase deficiency

A

XY Karyotype
No conversion of Testosterone to DHT
Female external genitalia
Virilzation @ puberty

36
Q

Presentation of Mullerian Agenesis

A

XX karyotype
Primary Amenorrhea
Blind ended vaginal pouch
Little/no uterine tissue

37
Q

Tea and toast diet

A

Folic Acid Deficiency

38
Q

Strict vegetarians + Anemia

A

B12 deficiency

39
Q

Most common finding on cervical radiography in cervical spondylosis

A

Osteophytes

40
Q

Presentation of cervical spondylosis

A

Chronic neck pain

Limited neck rotation and lateral bending

41
Q

Glucose 6 phosphatase deficiency

A 
Von Gierke's - type I glycogen storage dz
3-4 months old
Hypoglycemia
Lactic Acidosis 
Hyperuricemia
Hyperlipidemia
Doll-like face, fat cheeks
Thin extremities, short stature, protuberatn abdomen
Normal spleen and heart
42
Q

Acid maltase deficiency

A

Type II glyocgen storage - Pompe’s
Floppy baby first few weeks of life
Macroglossia, difficulty feeding, heart failure

43
Q

Presentation of acute massive PE

A

Syncope

Hemodynamic collapse

44
Q

Pt with malignancy presents acutely w dyspnea, chest pain, tachycardia, hypoxia, clear lungs -DX?

A

PE

45
Q

What cardiac changes do we see w acute massive PE

A

Acute RV dilation and failure b/c of RV outflow obstruction and increased pulmonary vascular resistance
Hypokinesis of RV free wall and sparing of apex

46
Q

What 2 signs indicate increased risk of death in PE

A
  1. RV Dysfunction

2. Elevated BNP and troponin

47
Q

What does recurrent pneumonia in same anatomic region suggest?
Causes?

A

Bronchial obstruction

  • Bronchogenic carcinoma
  • Carcinoid dtumor
  • Foreign body
  • Bronchial stenosis
48
Q

When do we do bronchoscopy

A
  1. Masses documented by CT
  2. Negative CT +high suspicion for endotracheal obstruction
  3. Central mass on CT
49
Q

Workup for CT scan with peripheral lesion

A

CT-guided BX

50
Q

Cortisol and ACTH in Primary adrenal insufficiency

A

Low Cortisol

High ACTH

51
Q

Cortisol and ACTH in 2/3 adrenal insufficiency

A

Low Cortisol

Low ACTH

52
Q

Calculation for NNT

A

1/ARR

53
Q

MCC nontraumatic Subarachnoid hemorrhage

A

Ruptured saccular or berry aneurysm

Non-contrast CT shows acute bleeding in cisterns

54
Q

Systemic blastomyosis findings

skin and bones

A

Ulcerated skin lesions

Lytic bone lesions

55
Q

Presentation of Type III glycogen storage

Deficiency?

A

Deficient in glycogen debranching enzyme
Hepatomegaly, hypoglycemia, hyperlipidemia, growth retardation
High LFTs
Fasting ketosis

56
Q

Prussian blue stain means what

A

Presence of hemosiderin

Found in urine during hemolytic episodes

57
Q

Pathophys of oxidative stress in G6PD

A

Hemoglobin oxidized to make methemoglobin, denatured globin, sulfhemoglobin
- These form insoluable masses = Heniz bodies that attach to RBC membrane, decrease pliability, and promote RBC removal in spleen

58
Q

Colorectal cancer surveillance in pts with UC

A

Begin colonoscopy 8 years after Dx, maybe longer if Left colon
Repeat every 1-2 years

59
Q

Presentation for spinal cord compression

A

Motor and sensory loss
Absent rectal tone
Urinary retention

60
Q

What tracts are affected in spinal cord compression

A
  1. Descending CS = LE weakness/loss of rectal tone
  2. Ascending sensory ST -sensory 2 segments below level of lesion
  3. Descending autonomics in reticulospinal tract = urinary retention/bladder flaccidity/bladder shock
61
Q

Management of spinal cord compression

A
  1. Immediate neurosurgical evaluation
  2. Neuroimaging while awaiting - MRI
  3. High dose glucocorticoids
62
Q

Criteria for Insomnia

A

At least 3 nights/week for 3 months

63
Q

Adjustment disorder w depressed mood

A

Marked distress out of proportion to stressor

Sx’s within 3 months of onset of stressor

64
Q

Myasthenia crisis
Presentation
TX

A

Life threatening, caused by Infnx
Diaphram weakness causes respiratory distress
TX: Intubate if declining respiratory status. Steroids and IVIG or Plasmapharesis

65
Q

Presentation of unilateral cervical lymphadenitis

TX

A

Rapidly enlarging, fluctuant cervical LNs
Children - MCC = strep or staph
TX: I&D + Clindamycin

Mixed 2 (9 decks)

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