UWorld 2 Flashcards
1
Q
increased peak pressure a/w unchanged plateau pressure suggests…
A
some pathology causing increased airway resistance (bronchospasm, mucus plug, ETT obstruction)
2
Q
increased peak pressure and plateau pressure suggests…
A
some pathology causing decreased pulmonary compliance (pulm edema, atelectasis, pneumonia, R mainstem intubation)
3
Q
what is the plateau pressure
A
elastic pressure (compliance) + PEEP (since you set the PEEP, it's pretty much showing you compliance)
4
Q
what is peak airway pressure
A
resistive P (flow x resistance) + plateau P (compliance + PEEP)
5
Q
explain the hormones in primary ovarian insufficiency
A
(a type of hypogonadotropic hypogonadism)
ovaries stop functioning –> estrogen down
amps up feedback @ hypothalamus –> increased GnRH and FSH
6
Q
explain the hormones in hypothalamic hypogonadism
A
usually they’re too skinny –> shuts down hypothalamus
less GnRH –> less FSH –> less estrogen
7
Q
explain the hormones in PCOS
A
(i think)
the ovaries are crap and not really ovulating –> estrogen down
hypothalamus goes nuts trying to help –> GnRH up (but not pulsatile)
this makes LH go up more than FSH (which is low/normal)
then also you’re making a bunch of androgens and they get converted to estrone which is an estrogen but doesn’t help so you get high (unhelpful) estrogen
Total: GnRH up, LH up, FSH low/norm, E up
8
Q
when do you get benzo withdrawal seizures
A
short acting benzos are more likely
24 hrs+ after abrupt stop
9
Q
when can you turn a breech baby
A
37 weeks to onset of labor
10
Q
what do leuk esterases and nitrates tell you
A
+ leuks = pyuria
+ nitrates = enterobacteriaceae (like E. coli)
11
Q
AE of succinylcholine (who to avoid)
A
hyperkalemia –> cardiac arrhythmias
rhabdo, burns, guillain-barre
12
Q
AE etomidate
A
adrenal insufficiency
13
Q
AE nitrous oxide (who to avoid)
A
inactivates B12 –> neurotox (B12 def people)
14
Q
AE propofol (who to avoid)
A
myocardial depression –> severe hTN
ventricular systolic dysfunction
15
Q
who can’t breastfeed
A
active TB HIV HSV breast lesions varicella meds/chemo/drugs
16
Q
walk through the hypertension/hypokalemia workup
A
look at the renin-aldosterone ratio
both up –> secondary hyperaldosteronism (somethings making you make renin/is making renin)
aldo up, not renin –> primary hyperaldosteronism (you’re making too much aldo in adrenals)
both down –> something else is making trouble
17
Q
tx: acute CHF exacerbation
A
LMNOP lasix/loops morphine NG O2 position
18
Q
evidence of cholecystitis vs choledocolithiasis
A
both can have similar sx, elevated LFTs or bilirubin
choledocolithiasis will have increased alk-phos + possibly very high bilirubin (> 4)
19
Q
polymyositis vs polymyalgia rheumatica (sx)
A
polymyositis: proximal muscle weakness but mild pain
polymyalgia rheumatica: stiffness in same places + neck
20
Q
polymyositis vs polymyalgia rheumatica (labs)
A
polymyositis: up CK, aldolase, AST, anti-Jo, ANA, up ESR?
polymyalgia rheumatica: up ESR, CRP
21
Q
indication for HRT
A
hot flashes (nothing else!) women < 60 who meno'd in past 10 yrs
22
Q
preterm labor definition
A
contractions (making cervical change!) before 37 wks
23
Q
newborn CXR: egg on a string
A
transposition of great vessels
24
Q
newborn CXR: snowman sign
A
total anomalous pulm venous return w/ obstruction
25
cyanotic newborn: single S2
transposition of great vessels
tricuspid atresia
truncus arteriosus
26
well circumscribed, round, dural-based mass on MRI
meningioma
27
tx: meningioma
resection
28
MSK effects of CF
osteopenia
| kyphoscoliosis
29
tx: DM ileus
metoclopramide
| erythromycin
30
drugs causing folate def
phenytoin
trimethoprim (TMP)
methotrexate
hydroxyurea? (--> macrocytosis)
31
why do you not CT infant meningitis first?
herniation is rare (fontanelles are open)
32
knee injury: people who kneel a lot
prepatellar bursitis
33
knee injury: people who jump/forcefully extend a lot
patellar tendinitis
34
knee injury: pain w/ active motion, normal passive ROM
think bursitis
35
tx: prostatitis
TMP-SMX or FQs (acute)
| FQs (chronic)
36
MC orgs of bacterial rhinosinusitis
strep pneumo
H flu
moraxella catarrhalis (way less)
37
neck xray: widened prevertebral space
think retropharyngeal abscess
38
tylenol overdose, what ot expect
n/v
RUQ pain
LFTs up
--> liver failure
39
mgmt: PAD
1. lifestyle (stop smoking), supervised exercise program, ASA, statins
2. (if persists) Cilostazol or surgical stenting
40
emergency: can't get an IV
IO
41
MCC pneumonia in CF pts
kids: staph aureus
| > 20: pseudomonas
42
tx: pneumonia in CF pts
cefepime (staph + pseudomonas)
| vanco (MRSA)
43
why is there increased CSF in NPH
decreased absorption (or obstruction)
44
tx: chronic LBP
exercise regimen
| NSAIDs/tylenol intermittently
45
RFs for focal sclerosing GN
```
MC nephrotic syndrome in adults
AA/Hispanic
HIV
heroin
obesity
```
46
lyme/RMSF vs ehrlichiosis
ehrlichiosis has no rash
| ehrlichiosis has leukopenia +/- thrombocytopenia and increased LFTs and LDH
47
FeNA values
> 2% = acute tubular necrosis
| < 1% = acute interstitial nephritis
48
mgmt: variceal hemorrhage
1. IVF, octreotide, Abx
2. EGD
3a (stopped bleeding): start prophylaxis (BB, band 1-2 wks later)
3b (bleeding/rebleed): balloon tamponade, eventual TIPS/shunt surg
49
multiple myeloma: sx
weight loss
fatigue
bone pain
50
multiple myeloma: labs
hypercalcemia
normocytic anemia
renal insufficiency
protein gap (TP 4+ > alb)
51
what do you do if you see a protein gap
get serum protein electrophoresis
polyclonal = infxn, CT d/os
monoclonal = MM, Waldenstrom's
52
pneumococcal vs meningococcal meningitis
pneumococcal doesn't have rapid onset shock or skin stuff
53
Ca forms in the body
ionized (45%) -- only physiologically active form
alb-bound (40%)
bound to other crap (15%)
54
Ca changes w/ acid-base stuff
acidosis --> alb holds more H+ (and less Ca) --> up ionized Ca
alkalosis --> alb releases more H+ (and holds more Ca) --> down ionized Ca
55
HIV pt: painless retinitis
CMV
56
HIV pt: rapid b/l necrotizing retinitis
HSV
57
signs of cyanide toxicity
AMS, lactic acidosis, seizures, coma
58
chorioamnionitis aka
intraamniotic infection
59
criteria for chorioamnionitis
maternal fever plus 1:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous amniotic fluid
- purulent vaginal discharge
60
tx: chorioamnionitis
broad spectrum Abx
deliver (accelerate w/ oxytocin)
antipyretics
61
tx: disseminated GC
IV ceftriaxone, switch to oral cefixime when clinically improved
62
mgmt: pap --> atypical glandular cells
could be cervical or endometrial adenocarcinoma
who: > 35 or < 35 w/ RFs (obese, anovulation)
mgmt: colp, endocervical curettage and EMB
63
signs of acute arsenic poisoning
garlic breath
vomiting
watery diarrhea
QTc prolongation
64
signs of chronic arsenic poisoning
hypo/hyperpigmentation
hyperkeratosis
stocking-glove neuropathy
65
eyes: acute onset discomfort, photophobia, watery discharge, bulbar conjunctival injection
episcleritis
66
eyes: localized red, tender swelling over eyelid
hordeolum (stye) - usually staph aureus
67
eyes: fever, proptosis, restricted EOM, red, swollen eyelids
orbital cellulitis
68
eyes: sudden onset pain and redness in medial canthal region
dacryocystitis
69
whats that benign red thing on the baby butt called
strawberry (or superficial) hemangioma
| also, they aren't always on the butt
70
whats the adult hemangioma called
cherry hemangioma
71
mgmt: minimal BRBPR
< 40, no red flags: anoscopy (then sigmoid/colonoscopy if don't find anything)
40 - 49, no red flags: sigmoid/colonoscopy
50+ or red flags: colonoscopy
72
breast: peau d'orange
inflammatory breast carcinoma
73
breast: firm, mobile spherical, palpable mass (young woman)
fibroadenoma (benign)
74
breast: unilateral nipple discharge w/o skin changes or other sx
```
intraductal papilloma (benign)
even if discharge is bloody
```
75
breast: fever, diffuse warmth, erythema
mastitis
76
breast: dimpling/contour changes
infiltrating ductal carcinoma or lobular breast carcinoma
77
breast: diffuse erythema, edema and dimpling
inflammatory breast carcinoma
78
breastfeeding failure jaundice
first week of life
baby or mom fail
signs of dehydration
79
breast milk jaundice
peak @ 2 weeks (start at day 3-5)
adequate feeding
normal exam (besides jaundice)
80
how does lung infxn --> pleural effusion
cytokines released
| increase capillary permeability
81
HIV pt: fever, headache and signs of increased ICP
think cryptococcus meningitis
82
tx: frostbite
rapid rewarming in a water bath (98.6 - 102.2) with tons of pain meds
83
newborn: cutis aplasia
trisomy 13 (Patau)
84
newborn: cat like cry
5p deletion
85
newborn: clenched fists
trisomy 18 (Edwards)
86
newborn: microphthalmia
trisomy 13 (Patau)
87
newborn: rocker bottom feet
trisomy 18 (Edwards)
88
newborn: polydactyly
trisomy 13 (Patau)
89
nephropathy a/w hep B
membranous, membranoproliferative
90
nephropathy a/w hep C
membranoproliferative
91
nephropathy a/w lipodystrophy
membranoproliferative
92
nephropathy a/w lymphoma
minimal change dz
93
nephropathy a/w URI
IgA nephropathy
94
things for NF-1
```
cafe-au-lait spots
freckles in axilla/inguinal
lisch nodules (iris hamartomas)
neurofibromas (peripheral nerve sheath tumors)
optic gliomas
```
95
daddy, where do PEs come from?
```
usually from proximal deep veins of LEs (iliac, femoral, popliteal)
renal veins (in nephropathy)
R atrium (with pacemakers)
```
96
hematuria: glomerular vs non
glomerular: blood (RBC casts, dysmorphic RBCs) and protein
| non glomerular: blood (normal RBCs), no protein
97
lactation suppression
avoid nipple stimulation
ice packs
NSAIDs
no binding (mastitis) no bromocriptine
98
MCC a sudden heart attack outside the hospital
sustained v tach or vfib
99
most important prognosis indicator for out of hospital heart attack
time to resuscitation (CPR, defibrillator)
100
what not to give people with AV block
adenosine
BB
digoxin
101
prenatal care: when do you type and screen
initial visit
102
prenatal care: when do you do HIV/HBsAg/RPR/Chlamydia
initial visit
103
prenatal care: when do you do the 1 hr GTTT
24 - 28 wks
104
prenatal care: when do you get the GBS culture
35 - 37 wks
105
prenatal care: when do you get the Ab screen if shes Rh negative
24 - 28 wks
106
prenatal care: when do you check her rubella/varicella immunity
initial visit
107
prenatal care: when do you do a UA
initial
108
ataxia, dysarthria, scoliosis, foot deformities, CM
Friedreich ataxia
109
MCC death in Friedreich ataxia
CM/respiratory complications
110
hereditary thrombophilias
factor V leiden
prothrombin mutation
antithrombin def
protein C/S def
111
talk through protein C/S
protein C and S stop you from making clots (by inhibiting factor V)
protein C/S def --> more clots
Warfarin stops production of C and S (not on purpose!) which is why you have to bridge therapy
112
lung exam: when do you get increased tactile fremitus
consolidation
113
lung exam: when do you get dullness to percussion
consolidation
pleural effusion
atelectasis
114
lung exam: when do you get a mediastinal shift (away)
pneumothorax
| large pleural effusion
115
lung exam: when do you get hyperresonant percussion
pneumothorax
| emphysema
116
lung exam: when do you get decreased tactile fremitus
pleural effusion
pneumothorax
emphysema
atelectasis
117
lung exam: when do you get a mediastinal shift (toward)
large atelectasis
118
ABI: PAD
< 0.90
119
ABI > 1.3
calcified or non compressible vessels -- do more tests
120
GI sx/complications of HSP
```
abdominal pain (nbd)
intussusceptions (bd)
```
121
bradycardia, AV block, hypotension, wheezing
```
BB overdose
(consider CCB, digoxin or cholinergic agents w/o wheezing)
```
122
mgmt: BB overdoes
IVF
IV atropine
IV glucagon (if still hTN)
or try calcium, pressors, insulin/glucose
123
tx: anemia of prematurity
stop taking all their blood
iron supplement
transfusions if bad, but it doesn't help long term
124
things that up warfarin (inhibit CYP450)
```
tylenol/NSAIDs
abx/metronidazole
amiodarone
cimetidine/omeprazole
SSRIs
```
125
things that down warfarin (induce CYP450)
carbamazepine/phenytoin
OCPs
phenobarbital
rifampin
126
CHF w/ LV hypertrophy but not HTN
think about amyloidosis
127
waxy skin
amyloidosis
128
niemann pick def
sphingomyelinase
129
tay sachs def
beta hexosaminidase
130
what to do when you suspect blunt aortic injury
CXR
131
tx: mucormycosis
debridement and amphotericin B
132
loud P2
think pulm HTN
133
wedge shaped opacity on chest CT
think PE
134
EKG: broad, notched P waves
mitral stenosis
135
risk of cocaine in pregnancy
placental abruption
136
fetal hydantoin syndrome
mom on anti-seizures (phenytoin, carbamazepine)
| midfacial hypoplasia, microcephaly, cleft lip/palate, little fingers, hirsutism, developmental delay
137
aplastic anemia vs aplastic crisis
aplastic anemia = pancytopenia
| aplastic crisis is just RBCs, but super low (< 6)
138
aplastic crisis vs splenic sequestration crisis
aplastic has low reticulocytes (< 1%)
| splenic has higher + splenomegaly
139
RFs for c. diff
abx, hospitalization, PPI
140
MC meningitis in kids by age
< 3 mo: GBS, E. coli, listeria, HSV
3 mo - 10: strep pneumo, neisseria
> 11: neisseria
141
PTU risks
liver injury/failure
142
methimazole risks
teratogen (1st TM), agranulocytosis
143
HIV screening test
assay for HIV p24 antigen and HIV Abs
| confirmation w/ HIV-1/HIV-2 ab differentiation immunoassay
144
ascending paralysis in hours/days w/o autonomic dysfunction
tick-borne paralysis (find that sucker)
145
kidney stone: primary hyperPTH
calcium phosphate
146
kidney stone: small bowel dz/resection
calcium oxalate
147
kidney stone: recurrent UTIs
struvite
148
kidney stone: RTA
calcium phosphate
149
target cells
thalassemias
150
alpha vs beta thalassemia minor
Hgb electrophoresis:
alpha = normal
beta = increased Hgb A2
151
tx: inducible ischemia on nuclear stress test
BB and anti-platelet
152
measles vs rubella
rubella doesn't have Kopliks spots and rash doesn't darken and its milder/shorter
153
fundoscopy: pallor of optic disc, cherry red fovea
central retinal artery occlusion
154
fundoscopy: grey, elevated retina
retinal detachment
155
"curtain coming down over my eyes"
retinal detachment
| central retinal artery occlusion
156
CSF: herpes encephalitis
lymphocytes
RBCs
elevated protein
157
where do you get colonic ischemia
```
splenic flexure (SMA/IMA watershed)
rectosigmoid jxn (sigmoid/superior rectal watershed)
```
158
when do you use unfractionated vs LMWH
ESRD
159
ages for HPV vaccine
female: 11 - 26
males: 9 - 21 (9 - 26 for MSM or HIV)
160
tx: PCP pneumonia
TMP-SMX
| if PaO2 < 70 or A-a gradient > 35: add corticosteroid
161
12 month old: how much should they weigh/be tall
weight x 3
| height x 1.5
162
MC location for HTN hemorrhagic strokes
BG (putamen)
cerebellar nuclei
thalamus
pons
163
BG stroke -->
contra hemiparesis
contra sensory loss
conjugate gaze to side of lesion
164
CF infections by age
< 20: staph
| > 20: pseudomonas
165
pneumo vaccine, who gets what + immune responses
polysaccharide (23) (< 65 w/ predisposing problems): T cell independent
conjugate (13) (kids): T-cell dependent
people > 65 and all immunocompromised get both
166
psych med --> infertility
dopa blockers
167
what else do you check when you have hypocalcemia
alb and Mg
| low-> hypocalcemia
168
hepatojugular reflux
failing right ventricle (can't deal with the increase in venous return)
169
Kussmaul's sign
increase in jugular venous pressure on inspiration
| a/w constrictive pericarditis
170
pregnancy liver d/os
intrahepatic cholestasis of pregnancy
HELLP
acute fatty liver of pregnancy
171
3rd TM: itchy papular rash around umbilicus
pruritic urticarial papules and plaques of pregnancy
172
pregnancy: general pruritus, worse at night, worse on palms/soles
intrahepatic cholestasis of pregnancy
173
acute otitis media vs otitis media w/ effusion
OMWE: middle ear effusion w/o inflammation
| turns out acute otitis media has an effusion anyway
174
drugs a/w photosensitivity
```
tetracyclines
chlorpromazine
furosemide
HCTZ
amiodarone
promethazine
```
175
anti-endomysial abs
celiacs
176
anti-cardiolipin abs
antiphospholipid syndrome
177
DM med that helps lose weight
GLP-1 receptor agonists (-atides)
178
tx: OCD
SSRI
| CBT (exposure and response prevention)
179
definition of preeclampsia
new onset HTN (>140/+/- >90) @ > 20wks
| proteinuria +/- end organ damage
180
RFs for pubic symphysis diastasis
macrosomia
multiparity
precipitous labor
operative delivery
181
McRoberts maneuver complication
mom femoral nerve damage
182
tx: postpartum endometritis
clindamycin + gentamicin
183
tx: impetigo
limited: topical mupirocin
| extensive or bullous: oral cephalexin or clinda
184
HCM murmur
systolic
| improved w/ more blood
185
murmur with dual upstroke of carotid pulse
HCM
186
CN responsible for corneal reflex
CN V (trigeminal)
187
indications for carotid endarterectomy
males: > 60% (asx); > 50% sx
females: > 70 %
188
dx: hemorrhagic stroke
CT w/o contrast
189
tx: TCA overdose
supportive: O2/IVF
1st 2 hrs: activated charcoal
wide QRS: IV bicarb (alleviate depression of Na channels)
190
dx: lactose intolerance
hydrogen breath test
| stool: increased stool osmotic gap, low stool pH
191
talk about K levels in DKA/HHS
insulin deficiency and hyperosmolarity take K out of the cells (up K)
but you're peeing out a million everything (down K)
so even though levels look normal, the total is low
192
tx: central retinal artery occlusion
ocular massage and high flow O2
193
when do you bx a mole (even if it's good by ABCDE)
- person has lots, but one is diff from the others (ugly duckling)
- nodularity
- itch or bleed
194
contraindications to rota vaccine
past intussusception
| hx of Meckel's (or other GI malformation)
195
newborn CXR: diffuse reticulogranular pattern
respiratory distress syndrome
196
when do strawberry hemangiomas go away by
5 - 8 yo
197
digoxin causes what arrhythmia
atrial tachycardia w/ AV block
198
pain along tendon sheaths
tenosynovitis
199
polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions
disseminated GC
200
workup: precocious puberty
central or peripheral?
central: high FSH/LH from high GnRH
peripheral: low FSH/LH w/ gonads or adrenals going wild
201
sausage digits
dactylitis
| psoriatic arthritis
202
arthritis + nail stuff
think psoriatic arthritis
203
rash in fat embolism
petechiae
204
fat embolism time frame
12 - 24 hrs after injury
205
complications of SAH
rebleed (first 24 hr)
vasospasm (3 days +)
seizures
SIADH/hNa
206
when will you see xanthochromia
6 hr after onset
207
mammography: microcalcifications
ductal carcinoma in situ
208
breast: diffuse nodularity with b/l mastalgia
fibrocystic changes
209
breast: fixed, palpable mass with irregular borders
lobular breast carcinoma
210
corkscrew esophagram
diffuse esophageal spasm
211
which do you use for number needed to treat: RRR or ARR
ARR
212
recurrent, predictable vomiting w/ no sx between episodes
cyclic vomiting syndrome
213
CD4 count for HIV associated dementia
< 200
214
where is 0 station
midway btwn ischial spines
215
quick loss of fetal station
think uterine rupture
216
painless vaginal bleeding upon rupture of membranes
think vasa previa
217
tx: post nasal drip
antihistamine or antihistamine + decongestant
218
categories of DM retinopathy
simple
pre-proliferative
proliferative/malignant
219
fundoscopy for DM retinopathy (categories)
simple: microaneurysms, hemorrhages, exudates, edema
pre-proliferative: cotton wool spots
proliferative/malignant: newly formed vessels
220
workup: primary amenorrhea
uterus?
yes --> FSH (increased --> karyotyping; decreased --> MRI)
no --> karyotype, serum T (XX, normal --> abnormal mullerian; XY, normal --> androgen insensitivity syndrome)
221
tx: ringworm
local: topical clotrimazole
| extensive/refractory: oral griseofulvin
222
infant: webbed neck, cleft lip, thumb things, macrocytic anemia
Diamond-Blackfan syndrome
223
infant: cafe-au-lait, microcephaly, no thumbs, pancytopenia, macrocytosis
Fanconi anemia
224
big, tender lymph node in kids (+ MC org)
lymphadenitis
staph aureus
GAS
225
lymphadenitis in older kid w/ periodontal dz
think peptostreptococcuss
226
skin things in cushing syndrome
striae
dermal atrophy
easy bruisability
(apparently all because CT breaks down)
227
what does the D-xylose test show you
shows if intestines are absorbing properly (if they are, most of it is absorbed and peed out)
only for small intestine mucosal dz (not enzymatic activity since you don't need any enzymes to absorb D-xylose)
228
HMB +/- dysmenorrhea: get the uterus stuff straight
adenomyosis: HMB and dysmen
fibroids: more HMB, less dysmen
PID: no HMB yes dysmen
endometriosis: no HMB, yes dysmen
229
acanthosis nigricans
```
insulin resistance (young, fat)
GI malignancy (older)
```
230
indications for parathyroidectomy
sx hypercalcemia
| asx hypercalcemia w/ complications (osteoporosis, stones) or young < 50
231
mid diastolic sound
think pericardial knock
232
enzyme def: ambiguous genitalia in girls and HTN/fluid/salt retention
11 beta-hydroxylase
(low cortisol and aldo, but increased 11 stuff (which acts like a mineralocorticoid))
high T
233
enzyme def: ambiguous genitalia in girls and hTN/salt wasting
21-hydroxylase
low cortisol and aldo
high T
234
enzyme def: low cortisol, high mineralocorticoids, high T
17 alpha hydroxylase
235
conjunctival edema
allergic conjunctivitis
236
gritty feeling in eye
viral conjunctivitis
237
dementia w/ hallucinations
lewy body dementia
238
fluids (+ insulin) in DKA/HHS
```
initially NS (+ IV insulin)
add dextrose 5% when glucose < 200 (+switch to SQ insulin)
```
239
healthy people w/o RF PPD
> 15 mm
240
blunt trauma: when do you FAST vs serial abd exams/CT
FAST it they're awake/alert
241
contraindications for exercise in preg
```
amniotic fluid leak
cervical incompetence
multis
placenta abruption/previa
preeclampsia/gest HTN
severe heart/lung dz
also no hot yoga
```
242
MC orgs sickle cell sepsis (apparently this just like, happens)
strep pneumo
H flu
neisseria meningitidis
243
prevention: sickle cell sepsis
vaccinations
PCN till age 5
folic acid supplementation
244
tx: lichen sclerosus
topical clobetasol
245
MC childhood cancer
ALL
246
preseptal cellulitis vs orbital cellulitis
orbital has ophthalmoplegia and pain with EOM
| orbital can have proptosis or vision impairment
247
tet spells
ToF
248
cohort vs case control
cohort = start with RFs, compare dz incidence
| case control = start w/ dz, look at past RFs
249
tx: celiacs
dapsone and gluten free
250
epigastric pain + vomiting 24-36 hrs post abdominal trauma
think duodenal hematoma
251
tx: minimal change dz
corticosteroids
252
tx: uric acid stones
hydration
alkalinization of urine (K citrate)
low purine diet
recurrent --> add allopurinol
253
posterior MI: LCX or RCA
both have ST depression in V1 - V3
LCX: ST elevation in I and aVL
RCA: ST depression in I and aVL
254
ST elevations in some/all V1 - V6: MI (+ vessel)
anterior MI (LAD)
255
ST elevation in I, aVL, V5, V6: MI (+ vessel)
lateral MI (LCX, diagonal)
256
ST depression in II, III, aVF
lateral MI (LCX, diagonal)
257
water hammer pulse
AR
258
mass in anterior mediastinum
thymoma
259
mass in middle mediastinum
```
bronchogenic cyst
tracheal tumors
pericardial cysts
lymphoma
LN enlargement
arch aortic aneurysms
```
260
mass in posterior mediastinum
```
all neurogenic tumors:
meningocele
enteric cysts
lymphomas
diaphragmatic hernias
esophageal tumors
aortic aneurysms
```
261
muddy brown casts
ATN
262
waxy casts
chronic renal failure
263
RBC casts
glomerular dz or vasculitis
264
fatty casts
nephrotic syndrome
265
broad casts
chronic renal failure
266
WBC casts
interstitial nephritis
| pyelonephritis
267
hyaline casts
nephrotic syndrome
268
increased breath sounds
consolidation
269
tx: pagets
bisphosphonates
270
dx: amyloidosis
fat pad bx
271
tests before starting Li
UA
BUN, Cr
thyroid fxn
272
transplant a tylenol overdose?
apparently yes
273
head MRI: numerous minute punctate hemorrhages
think diffuse axonal injury
274
CT: crescentic collection
subdural
275
CT: biconvex collection
epidural
276
post MVA: pt loses consciousness instantly then --> vegetative state
think diffuse axonal injury
277
definition abnormal uterine bleeding
```
heavy
> 7 days
more often than every 21 days
less often than every 35
any post meno bleeding
```
278
when do you do an EMB: > 45 yo
any abnormal uterine bleeding
279
when do you do an EMB: < 45 yo
abnormal uterine bleeding + (any of following)
- unopposed estrogen exposure
- failed medical mgmt
- lynch syndrome (HNPCC)
280
MCC megaloblastic anemia in alcoholics
folate def
281
mgmt: eclampsia
mg sulfate
anti-HTN (hydralazine, labetalol...)
deliver
282
when do you treat moms for GBS
+ test: during labor
| unknown and < 37 wks: during labor
283
nephrotic syndrome complications
edema (hypoalbuminemia)
hypercoagulability (--> renal vein thrombosis, PE)
hyperlipidemia
microcytic hypochromic anemia (iron resistant)
decreased thyroxin
vit D def
infection
284
white reflex (aka + dz)
leukocoria
| retinoblastoma
285
premie: lethargy, hypotonia, rapidly increasing head circumference, bulging fontanelle
intraventricular hemorrhage
286
why do serial head U/S in premies
screening for intraventricular hemorrhage (up to half are asx)
287
complications of temporal arteritis
aortic aneurysm (get serial CXRs)
288
vaccines for chronic liver dz
Tdap/Td
flu
pneumo (23, then 13+23 @ 65)
hep A/B
289
workup: low TSH, high T3/T4
1. RAIU (unless clearly graves)
2a. high uptake --> graves (diffuse pattern) or toxic adenoma/multinodular (nodular)
2b. low uptake --> 3
3. measure thyroglobulin
4a. high --> thyroiditis (spills pre-formed)
4b. low --> exogenous hormone, struma ovarii?
290
ALL cell levels
+/- leukocytosis
| anemia and or thrombocytopenia
291
skin rash worsened by hot drinks, EtOH, sun or emotion
rosacea
292
what do you transfuse with for severe hemorrhage (trauma)
whole blood
293
what do you transfuse with for acute GI bleed
PRBCs
294
early onset HTN and bilateral abdominal masses
ADPKD
295
bilateral flaccid paralysis, loss of pain/temp, vibration/proprio in tact
anterior spinal cord syndrome (disruption of anterior spinal artery)
296
prophylaxis post organ transplant
TMP-SMX (PCP)
| -cyclovir (CMV)
297
paraneoplastic lung cancers
squamous cell: PTHrP
| small cell: SIADH, ACTH
298
MC orgs brain abscess
viridans strep
staph aureus
gram negs
299
CT: hypodense lesions in temporal lobe
think HSV
300
CT: single ring enhancing lesion w/ central necrosis
think brain abscess
301
signs it was prob just a febrile seizure
return to mental baseline (after post-ictal)
| normal neuro exam
302
why do you get tardive dyskinesia
dopa receptor supersensitivity
303
mgmt: inevitable abortion
hemo stable: misoprostol, nothing or D&C
| hemo unstable: D&C
304
why can't you use oxytocin for 1 TM/2 TM abortions
there aren't many oxytocin receptors on uterus yet
305
baby with retinal hemorrhages and bulging fontanelle
abusive head trauma --> subdural bleeding
306
sx of hypercalcemia
abdominal pain
constipation
polydipsia
307
tx: pinworm (+aka)
```
enterobius vermicularis (butthole guy)
albendazole or pyrantel pamoate (esp preggers)
```
308
tx: strongyloides
ivermectin
309
tx: amebiasis
metronidazole
310
tx: chagas
benznidazole
311
tx: river blindness (+aka)
onchocerciasis
| ivermectin
312
urticaria, abdominal pain, resp problems
think strongyloidiasis
313
thyroid and bones
hyperthyroid --> up osteoclast activity --> bone loss, osteoporosis, hypercalcemia
