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UW Notes 3 Flashcards

1
Q

preeclampsia with severe features is >140/90 with end organ damage OR above what BP?

A

160/110

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2
Q

in pregnant person with severe HTN… given the choice between hydralazine and labetalol…what should you look at to decide which one is better?

A

they’re both effective in HTN emergencies… labetalol you should look at things that beta blockers could negatively affect…such as bradycardia

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3
Q

when is methyldopa best used in pregnant HTNsive?

A

chronic HTN. not for crisis

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4
Q

pleural plaques is a buzzword for what?

A

asbestosis. NOT mesothelioma

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5
Q

what is the best management for a hemodynamically stable pt with incomplete abortion? what if they’re hemodynamically unstable

A

stable: expectant management and followup OR you can give prostaglandins
unstable: do D&C

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6
Q

torticollis. med induced or congenital or whatever… is a type of what kind of disorder?

A

dystonia

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7
Q

where does morton neuroma occur?

A

between third and fourth metatarsals. often in runners with plantar pain and crepitus when palpating

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8
Q

upper respiratory infections/ulcers
lower repsiratory infections/ulcers
glomerulonephritis

A

wegener’s

granulomatosis with polyangitis.

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9
Q

ectopy resulting in afib usually originates where?

A

pulmonary veins

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10
Q

attributable risk percent?

A

(risk of exposed-risk of unexposed)/risk of exposed

(RR-1)/RR

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11
Q

how do you reduce chance of cerebrovascular spasm s/p SAH?

A

nimodipine

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12
Q

slapped cheek is called…?

A

erythema infectiosum

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13
Q

Legg-calve-perth. how do you treat?

A

bracing and observation.

if it’s very displaced–>then surgery

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14
Q

eclampsia seizures are usually what?

A

it’s usually short, generalized, and tonic clonic

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15
Q

what are predisposing factors preeclampsia?

A

previous preeclampsia
increased maternal age
maternal hx of HTN

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16
Q

what is buproprion good for?

A

its not associated with weight gain,
it has mild stimulant effect
it helps with smoking cessation
it does not have sexual SE.

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17
Q

narcolepsy tx?

A

modafinil

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18
Q

dysgerminoma can secrete what hormones?

A

LDH and beta hcg

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19
Q

what are the two key features of obesity hypoventilation syndrome?

A
  1. day time hypercapnea

2. obesity

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20
Q

acute bacterial prostatitis. how is the presentation different from cystitis? how do you diagnose? should you do urethral catheterization if there’s retention?

A
  1. more systemic sx and regional pain with prostatitis
  2. diagnose with mid stream catch and culture
  3. DO NOT catheterize through urethra. consider suprapubic cath if needed to avoid worse inflammation
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21
Q

presence of anti HBs, anti HBc, and anti HBe?

presence of antiHBs and anti HBc WITHOUT antiHBe?

A

all three=recovering

antiHBs and HBc=resolved.

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22
Q 
normal aging patterns on sleep. 
Total sleep time
nocturnal wakings
waking in general becomes...
latency?
REM? slow wave?
A 
total sleep time--> decrease
nocturnal waking-->incrase
waking in general -->increase and earlier
latency-->increase
REM-->decrease
slow wave-->decrease
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23
Q

what class of med is fluphenazine? what is an important SE?

A

it’s a typical antipsychotic; an important SE is hypothermia

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24
Q

carboxyhemoglobinemia…what’s bound to the Hb?

A

carbon MONoxide

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25
Q

chronic macular lesion with loss of sensation…what should you be thinking of?

A

leprosy

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26
Q

You should do imaging with Type A aortic dissection. what’s preferred in renal insufficient pt? what about a normal renal function patient?

A

normal renal function: CTA

renal insufficient pt: transesophageal echocardiogram

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27
Q

what are risk factor for iron deficiency in an infant.

A
  1. prematurity
  2. low maternal iron store
  3. early introduction to cow’s milk
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28
Q

morbid obesity can result in anovulation due to excess estrogen. what are the FSH/LH levels?

A

normal

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29
Q

leukocytosis can be seen in Kawasaki disease. what is the predominant leukocyte?

A

neutrophil

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30
Q

Kawasaki disease treatment?

A

ASA and IVIG

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31
Q

what class of abx is most associated with renal failure?

A

aminoglycosides

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32
Q

Which type of amyloidosis is AL and AA?

A

AL is primary amyloidosis

AA is secondary amyloidosis 2/2 chronic inflammation

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33
Q

what’s a normal biophysical profile score for infants?

A

8 to 10 is normal

6 equivocal

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34
Q

fetal sleep cycle asts about 20 minutes; it can be disrupted via what test?

A

vibroacoustic stimulation

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35
Q

What is salvage therapy?

A

a second form of therapy when the initial treatment fails and disease recurs

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36
Q

when there’s maternal or fetal concerns weekly biophysical profile are done. If the BPP results in 8 how often should you f/u? if BPP shows 6 how often should you follow up?

A

if 8, then i’ts normal and conresume weekly f/u
if it’s 6 you need to repeat in 24 hours
if it’s 4 or lower, you need to deliver baby

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37
Q

infectious endocarditis with viridans strep…what is the tx?

A

penicillin G or ceftriaxone

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38
Q

firstline (2) medical therapies for BPH?

A

Tamsulosin and finasteride

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39
Q

three conditions where you can see asterixis

A

hepatic encephalopathy, uremic encephalopathy, CO2 retention

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40
Q

what is the AEIOU of urgent hemodialysis?

A

A=acidosis
E=electrolytes
I=ingestion (methanol/ethylene glycol, ASA, lithium, valproate
O=overload refractory to diuretics
U=uremia (sx of encephalopathy, asterixis, pericarditis, bleeding

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41
Q

Uric acid kidney stones…treatment?

A

aggressive hydration, urine akalinization via Kcitrate, low purine diet and can add allopurinol

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42
Q

syringomyelia is associated with trauma/tumor/infections..but it can also be associated with what congenital malformation?

A

Arnold chiari I

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43
Q

tension pneumo in a hemodynamically unstable pt…what should you do?

A

needle thorocostomy followed by tube thorocostomy. NO imaging unless the pt is stable.

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44
Q

freaking out about flying 2/2 fear of dying… is a what dx?

A

specific phobia

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45
Q

DM patient with neuropathy sx and new upper motor neuron sx…what should you think of?

A

spinal abscess…ask about recent illness

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46
Q

mediastinal mass in a young male that produces betahCG and AFP?

A

nonseminomatous germ cell tumor. can be locally invasive.

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47
Q

thymomas are associated with myasthenia gravis and what other disease?

A

pemphigus

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48
Q

common causes of osteomalacia?

A
  1. GI causes: by pass surgery, celiac sprue
  2. chronic liver/kidney disease (renal tubular acidosis 2)
  3. low vitamin D/calcium intake
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49
Q

pt s/p trauma with blood at urethra meatus, inability to void…what should you do?

A

retrograde urethrogram

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50
Q

malrotation-mediated obstruction and necrotizing enterocolitis both happen in very young infants and has similar sx…that’s the difference on imaging?

A

malrotation will show a gasless abd

NEC will show pneumatosis intestinalis.

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51
Q

risk factors for necrotizing enterocolitis?

A

prematurity, low birthweight, reduced mesenteric perfusion (congenital heart disease/hypotension)

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52
Q

SCID is associated with failure of T cell development…that also leads to failure of B cells to mature. What is the treatment for SCID?

A

stem cell transplant

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53
Q

Niacin causes flushing, generalized pruritis through what mechanism?

A

increase prostaglandin and peripheral dilation

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54
Q

what is the Uhthoff phenomenon?

A

sx of MS worsen in higher temperatures

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55
Q

pleural effusion that COULD be suspicious for cancer….what do you do first?

A

you do thoracentesis first bc it’s the easiest and allows you to figure out if it’s transudate or exudate.

bronchoscopy is good too, but will require sedation and is more invasive

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56
Q

Pinzmetal’s angina is usually in what kind of population…and what’s the presentation?

A

young female smokers, who get CP at night that spontaneously resolves. Transient ST elevation can be seen on ECG

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57
Q

what are the 3 hereditary germline mutations associated with pancreatic ca?

A

BRCA1 and 2; Peutz jeghers syndrome

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58
Q

besides smoking. what are two other nonhereditary factors associated with pancreatic cancer?

A

obesity

chronic pancreatitis

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59
Q

lichen sclerosis. what does the vagina look like?

A

normal. it doesn’t affect the vagina. only the vulva.

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60
Q

what does the hazard ratio signify?

A

ratio of event rate of treatment group/ nontretment group.

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61
Q

what is the mechanism of disease for membranoproliferative glomerulonephritis?

A

igG against C3 convertase leads to persistent complement activation –>C3 dense deposition in glomerulus. (NO igG deposition)

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62
Q

pts with hx of colon cancer in a first degree relative should start colonoscopy when?

A

10 years prior to dx time of the relative OR at 40 years of age

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63
Q

rheumatic fever can happen after skin or throat strep infection?

A

only pharyngitis

64
Q

post strep glomeruloneph occurs after skin or throat strep infections? how long after does it show up?

A

BOTH pharyngitis and skin infections;

2 weeks after

65
Q

charcot’s triad for cholangitis?

A

fever, RUQ pain, jaundice

66
Q

how to manage pancreatic pseudocyst if asymptomatic. if symptomatic?

A

if asymptomatic: conservative expectant management

if symptomatic: endoscopic drainage

67
Q

in patients who are pregnant/at extremes of ages/immunocompromised can get severe measles, and can benefit from vitamin A…what are the consequences of severe measles? 3

A
  1. encephalitis
  2. pneumonia
  3. blindness
68
Q

what do you expect the iron store to be in thalassemia?

A

normal or high

69
Q

which drugs are associated with decreased mortality in heart failure pts? what if the patient is African American?

A

ACE/ARB/aldo R blockers and beta blockers

in AAs: also nitrates+hydralazine

70
Q

Mono–> should avoid contact sports for how long?

A

3 weeks

71
Q

what is the mechanism of buproprion. what are its benefits. who is contraindicated in taking it

A

it’s a norepi-dopamine receptor blocker.
it does not have any weight gain/sexual SE
don’t use in seizure/eating disorder people

72
Q

what are the 6 classes of antidepressants (for unipolar depression)

A

SSRI, SNRI, NDRI, MAOI, TCA, atypicals (mirtazapine, trazodone)

73
Q

genetic abnl in Beckwith-Wiedemann syndrome. what does this genetic area code for?

A

mutation of the 11q15 area that codes for IGF2

74
Q

beckwith Wiedemann syndrome is at an increased risk for what? so you should do what to manage these pts?

A

they’re at increased risk for tumors (wilm’s and hepatoblastoma), you should do serial US and alpha fetal proteins to monitor for years

75
Q

what’s the mechanism of disease of TTP?
dx?
Treatment?

A

acquired abs to ADAMTS13 which leads to uncleaved chain of von willebrand factor–> clumps of platelets.
dx with blood smear: schistocytes
Treat plasmaphoresis and glucocorticoids

76
Q

vonGierke’s deficiency? syndromic features? presentation?

A

glucose 6 phosphatase deficiency.
“doll like face”, thin extremities, short, protuberant abd
hypoglycemia, lactic acidosis, hyperurecemia, hyperlipidemia

77
Q

enzyme deficiency in pompes’ disease?

A

acid maltase

78
Q

manifestation of theophylline toxicity

A

CNS and cardiac toxicity

HA, N/V, arrythmias

79
Q

what is a dangerous condition that can occur in someone with systemic scleroderma?

A

scleroderma renal crisis–>activation of coag cascade and renin secretion–>severe HTN; hemolysis; thrombosis

80
Q

what are Burr cells associated with? what are they also called?

A

liver/renal disease; echinocytes

81
Q

what are spur cells associated with? what are they also called?

A

liver disease; acanthocytes

82
Q

erysipelas is caused by what bacteria?

A

Group A strep

83
Q

kidney stone management 4 cardinal things you should address

A
  1. imaging confirmation via CT scan after KUB
  2. pain control NSAIDS are better than narcotics
  3. assessment of size: if
84
Q

people often can get pneumonia after influenza illnesses; what are the most common organisms associated with this?

A

strep pyogenes and staph aureus

85
Q

how to manage Mallory Weiss tears?

A

90% will spontaneously heal. if not then you have to do electrocoagulation or epiniphrine

86
Q

heat stroke pt… other than giving IV hydration what should you do to cool them?

A

put in ice bath

87
Q

you can hear a S4 in “stiff hearts” and what acute condition?

A

acute coronary syndrome/MI

“atrial gallop”

88
Q

patient who develops infectious endocarditis with a recent history of pyelonephritis. what organism should you think of?

A

enterococcus

“ U Heart Tree”

89
Q

whats’ the most common bacteria overall for infectious endocarditis?

A

staph aureus

90
Q

pernicious anemia; mechanism of disease; symptoms of disease?

A

antibodies against intrinsic factor–>leads to macrocytic anemia 2/2 B12 deificiency.
sx of peripheral neuropathy, glossitis, neurological changes, anemia

91
Q

pernicious anemia is associated with what two conditions?

A

intestinal type gastric cancer

carcinoid tumors

92
Q

Waldenstrom macroglobulinemia is associated with monoclonal IgM expansion. what are the major manifestations?

A 
hyperviscosity syndrome
neuropathy
bleeding
hepatosplenomegaly
lymphadenopathy
93
Q

what other drug can be used to treat syph if they’re allergic to penicillin? who should be desensitized and NOT be be given penicillin anyway?

A

Oral doxycycline.

pregnant, neuro/ocular syphilis

94
Q

calcium channel blockers preferentially dilate what vessels thus causing edema as one of the SE?

A

arterioles

95
Q

what drug combined with calcium channel blockers can reduce the incidence of edema? (which is a SE of CCB)

A

ACE I/ARB causes post capillary dilation to balance out the precapillary dilation of the CCB

96
Q

primary mechanism of olanzapine?

A

serotonin and dopamine receptor blocker

97
Q

angina pectoris; first line long term therapy? contraindications?

A

beta blockers; don’t give to hypotensive/bradycardic pts

98
Q

what is the immediate symptomatic treatment for thyrotoxicosis?

A

propranolol. then definitive treatment once pt is stabilized

99
Q

cyclic vomiting syndrome is associated with what condition?

A

migraines

100
Q

in a patient with aortic dissection. YOU MUST IMAGE the patient first to confirm/rule out the diagnosis… what is the preferred method of imaging in a stable patient? unstable?

A

stable do CTA

unstable do TEE

101
Q

what is the treatment for polycythemia vera?

A

phlembotomy +/- hydroxyurea

102
Q

growing pain is lower extremity bilateral pain that is only at night in a kid with otherwise no sx and nl activity. what is the tx?

A

reassurance

103
Q

serious malignant otitis externa can cause what kind of symptoms? what organism causes malignant otitis externa

A

pseudomonas. can cause skull abse osteomyelitis/facial nerve destruction

104
Q

treatment for MALToma without any metastasis

A

triple H pylori treatment:
Clarithromycin
Amoxicillin
PPI

105
Q

nasopharyngeal carcinoma is caused by what virus?

A

EBV

106
Q

HIV diarrhea

A

cryptosporidium (acid fast!)

107
Q

ECG changes associated with acute pericarditis?

A
  1. ST elevation diffusely

2. PR depression

108
Q

non ketotic hyperosmolar syndrome is associated with what? and what happens?

A

associated with recent URIs; hyperglycemia occurs with increased cortisol and catecholamine levels.

109
Q

intubated patient starts getting severe respiratory infection >48 hours after intubation. what are the likely organisms?
how should you manage?

A

G- bacilli (pseudomonas, E. coli, klebsiella)
G+ cocci: MRSA, strep
GET pulmonary sample THEN start empiric abx

110
Q

what is first stage of labor? what are the two phases of stage 1

A

start of contraction to 10 cm dilated. latent phase (up to 6) and active phase (rapid dilation)

111
Q

If labor is arrested but there is adequate contraction (200 Montevideo in 10 mins)…what should you do?

A

c section

112
Q

Asperin exacerbated respiratory disease. what are the associated sx?

A

asthma, rhinosinusitis, nasal polyps, bronchospasms, nasal congestion with NSAID/asprin use

113
Q

young man with sudden onset SOB. what do you think this is? how do you treat?

A

spontaneous pneumothorax.

treat with O2 supplementation if it’s small. Otherwise consider needle thorocostomy/tube thorocostomy

114
Q

how to treat mild hypothermia

A

IVF; passive warming at rate of 1-2 C/hr

115
Q

Hodgkin lymphoma is associated with what renal disease?

A

minimal change nephropathy

116
Q

penile fracture. what do you need to do to manage it?

A

do retrograde urethrogram THEn surgery

117
Q

what’s so good about epinephrine’s mechanism of action that makes it good for anaphylaxis?

A

alpha 1 stim: vasoconstriction

beta 2 stimulation: bronchodilation

118
Q

risk of encapsulated organism sepsis is high for how long after splenectomy? how do you mitigate infection risk?

A

up to 30 years;

you should give vaccination prior to splenectomy and do daily prophylactic oral penicillin for 5 years

119
Q

how do you treat betablocker toxicity?

A

after ABCs

do Glucagon it increases cAMP

120
Q

what are the signs of betablocker toxicity?

A

hypotension, bradycardia, wheezing, AV block.

121
Q

what kind of heart damage is most associated with infectious endocarditis?

A

mitral regurg/prolapse

122
Q

How do you treat botulism?

A

IVIG

123
Q

a child with first time proteinuria. what should you do?

A

repeat the test at least 2x; could be intermittent/transient: due to exercise, stress, orthostatic…etc

124
Q

why could a hep C patient get glomerulonephritis?

A

cryoglobulinemia. the large IgMs can get lodged everywhere (hep Sea!)

125
Q

4 common causes of priapism

A

sickle cell
medications-trazodone, prazosin
spinal cord lesions
perineal trauma

126
Q

what is contraindicated with R heart failure?

A

anything that reduces preload…such as nitrates

127
Q

alkalosis has what effect on calcium? how?

A

alkalosis causes hydrogens to dissociate from albumin…. therefore the albumin will bind more dissolved calcium causing hypocalcemia

128
Q

depo provera has to be administered every how often?

A

3 months

129
Q

thiamine deficiency is very common in alcoholics. what other B vitamin are alcoholics prone to be deficient of?

A

folate B9!

130
Q

What is the formula to assess for CO2 compensation with metabolic alkalosis?

A

pCO2=(0.9 x bicarb) +16 +/2

131
Q

what medication slows diabetic neuropathy progression?

A

ACE I

132
Q

restless leg syndrome is treated with dopamine Agonists (pramipexole, rolpinerol). If the patient also has comorbid chronic pain/insomnia what else could you use?

A

Gabapentin.

133
Q

what is the mechanism of gabapentin?

A

binds to calcium channels

134
Q

nocturnal coughing can be caused by postnasal drip and GERD. but it also can be caused by what other condition?

A

asthma

135
Q

Neonatal polycythemia causes?

A

poor perfusion, maternal hypoxia, early clamping of cord/twin twin transfusion

136
Q

neonatal polycythemia symptoms?

A 
facial plethora
ruddy skin/cyanosis
respiratory distress
hypoglycemia, hypocalcemia 
abdominal distension
137
Q

how to diagnose hirschsprung disease?

A

full thickness rectal suction biopsy

138
Q

delayed upstroke. pulsus tardus is due to what?

A

aortic stenosis

139
Q

Fanconi’s anemia symptoms?

A

short stature, eye abnl, renal abnl, café au lait spots

pancytopenia

140
Q

Diamond Blackfan anemia symptoms?

A

pure RBC aplsia with low reticulocyte. early onset with poor feeding

141
Q

Transient erythroblastopenia of childhood sx?

A

young child 2-8 years with slow development of anemia sx with normocytic anemia that is very low in Hb and reticulocyte

142
Q

what is a common cause of bloody diarrhea in HIV pts with CD4

A

CMV

143
Q

pt s/p septic shock requiring pressors. develops dusky finger tips…what’s the cause?

A

alpha 1 agonistic properties of norepi

144
Q

what is dumping syndrome? how do you diagnose and treat?

A

dumping syndrome occurs s/p gastrectomy/bowel surgery leading to rapid movement of foods through the upper GI system… with it draws fluids in to the bowels leading to pain, diarrhea, and electrolyte abnl.

This is a clinical diagnosis and should be treated with dietary modification

145
Q

pyruvate kinase deficiency causes what?

A

chronic hemolysis, skin ulcers, pigmented gall stones

146
Q

why can’t you test for G6PD deficicency after an acute attack

A

because all the severely G6PD deficient cells will have hemolyzed

147
Q

Giant cell arteritis affects what sized vessels?

A

medium and large

148
Q

what is the ocular exam finding of giant cell arteritis?

A

anterior ischemic optic neuropathy; pale swollen nerve with blurred margins

149
Q

what reduces cardiovascular morbidity in patients >40 with DM?

A

statins!

150
Q

which are the high intensity statins

A

atorvastatin and rosuvastatin

151
Q

which are the medium intensity statins?

A

atorvastatin and simvastatin

152
Q

Fish oil can do what? does it affect mortality outcomes?

A

it can reduce triglycerides; and no

153
Q

DM patient. when should you do high intensity versus moderate intensity statin?

A

high: ASCVD risk >7.5% in 10 years
medium: ASCVD risk

154
Q

what is leukomoid reaction?

A

intense leukocytosis with infections.
It has >50,000 and most will be late precursors of neutrophils (bands and metamyelocytes);
the leukocyte alkaline phosphatase score will be HIGH, so you know it’s NOT cancer

155
Q

what is the first line therapy for rheumatoid arthritis? second line?

A

DMARD such as methotrexate (anti metabolites); then if they don’t work move on to the anti cytokines like TNFalpha inhibitors

Step 2 CK (5 decks)

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