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CK_Gyn > UWORLD > Flashcards

UWORLD Flashcards

1
Q

symmetrically full breasts, tenderness, and warmth 3-5 days post partum
dx and rx?

A

breast engorgement

proceed with breast feeding, NSAIDS, cool compresses

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2
Q

unilateral breast pain, isolated firm tender erythematous area accompanied by fever
dx and potential complication?

A

mastitis

can lead to FLUCTUANT mass

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3
Q

focal tenderness, and firmness/erythema; no fever; unilateral

A

plugged ducts

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4
Q

soft, mobile, well circumscribed mass at base of labia majoria (4 o clock or 8 o clock position)…dx and rx

A

bartholin duct cyst

OBSERVE!!! usually resolve on its own

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5
Q

dysmenorrhea, dyspareunia, pain pakes before menses

A

endometriosis

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6
Q

dysmenorrhea, pelvic pain, menorrhagia, bulky globular tender uterus

A

adenomyosis

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7
Q

dull and ill defined pelvic ache WORSENS with standing

A

pelvic congestion

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8
Q

dysmenorrhea, enlarged uterus, heavy menses, constipation, urinary frequency, pelvic pain/heaviness

A

fibroids

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9
Q

rx lichen sclerosis

A

topical corticosteroids

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10
Q

When to do EMB of AUB <45

A

unopposed estrogen exposure (obesity, chronic estrogen exposure, anovulation)
failed medical management

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11
Q

rx spinal cord compression

A

iv steroids (then MRI and surgery if confirmed)

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12
Q

side effects of EPO therapy (4)

A
  1. WORSENING OF HTN!!!!!
  2. headache
  3. flu like illness

side effects worse with IV than with subq

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13
Q

how to prophylax against esophageal varices bleeding?

A

non selective beta blocker (i.e. naldolol)

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14
Q

two ways to improve poor oxygenation on ventilator (PaO2 < 60)

A
  1. increase PEEP

2. increase FiO2 (but NOT MORE THAN 60%)

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15
Q

When can you do cell free fetal DNA testing and who should it be offered to?

A

can do it greater than 10 weeks

offer to mothers greater than age 35

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16
Q

When to do quad screen?

A

2nd trimester! papp a, estriol , b hcg, inhibin

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17
Q

c/i breast feeding (3)

A 
INFECTION (HIV, active TB, herpetic breast lesions, varicella)
SUBSTANCE USE (ANY)
CHEMO/RADIATION therapy

HEP B and C ok if baby got vaccine and immunoglobulin, AND nipple isn’t cracked

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18
Q

bad effects of mom marijuana use on baby

A

decreased muscle tone
delayed motor development
sedation

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19
Q

meningococcal vaccine schedule

A

primary at 11-12, but can receive until 18
then booster 16-21

if you’re going to college, traveling to endemic area, or have complement def/asplenia or some shit, give vaccine even if older than 18

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20
Q

indications and contraindications for yellow fever vaccine

A

give before going to africa

BUT THIS IS A LIVE VACCINE…(do not give to AIDS pts or immunosuppresed patients on therapy)

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21
Q

alternative to syphilis treatment in non pregnant patient

A

oral doxy

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22
Q

34 year old woman, multiple pink/skin colored papules that are exophytic/cauliflower like growths on labia
dx and rx

A

condyloma acuminata (genital warts HPV 6 and 11)

rx trichloroacetic acid/podophylin resin, imiquimod, cryotherapy/laswer therapy

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23
Q

flat velvety vulvar lesions, broader base and flat surface, lobulated, RPR positive

A

condyloma lata (secondary syphilis)

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24
Q

manuever to convert baby in breech past 37 weeks assuming no contraindications (olighydramnios, placental abnormalities like previa, multiple gestations)

A

external cephalic version

internal podalic version is used on twins to convert 2nd twin to breech

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25
Q

risk factors cervical cancer (2)

A

HPV

TOBACCO SMOKING

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26
Q

elevated pulm artery pressure, elevated RA pressure, nml pulmonary capillary wedge pressure

A

PE

elevated pulm artery + elevated RA pressure = pulm htn

nml pulmonary cap pressure = nml left ventricular function so intrinsic pulm process

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27
Q

elevated pulm artery pressure, elevated RA pressure, elevated PCWP

A

left hsided heart failure leading to right sided heart failure

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28
Q

patient receiving treatment for asthma develops arm weakness, tremors, palpitations

A

hypokalemia 2/2 beta 2 agonists

albuterol drives K into cells!!! watch out for htese side fx and get electrolyte panel

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29
Q

When can gestational HTN be diagnosed?

A

AFTER 20 WEEKS

any HTN dx before 20 weeks is chronic HTN (primary/secondary)

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30
Q

end organ features of pre-eclampsia

A 
proteinuria
transaminitis
thrombocytopenia
headache/visual changes
pulmonary edema
ELEVATED CR
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31
Q

HTN during pregnancy increases risk of what to mother and fetus

A

mother - abruptio placentae, pre-eclampsia, postpartum hemorrhage
fetal - PRE TERM LABOR, growth restriction, still birth

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32
Q

thrombocytopenia without anemia or leukopenia

dx and what to work up

A

ITP

test for hep C and HIV (may be initial presentation in small subset of patients)

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33
Q

Dx criteria for intermittent asthma

A

less than or EQUAL to 2 day time/night time symptoms

rx with rescue SABA prn

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34
Q

patient being treated for severe COPD develops headache, insomnia, vomiting, palpitations. EKG shows atrial tachy and PVC

A

theophylline toxicity

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35
Q

what drugs worsen theophylline toxicity

A

cytochrome oxidase inhibitors

ciprofloxacin, erythro/clarithromycin, verapamil, cimetidine

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36
Q

40 year old patient, hemolytic anemia, cytopenias, hypercoagulable states (i.e. hepatic vein thrombosis)
dx, work up, rx

A

PNH
flow cytometry (absence of CD55/CD59)
rx with eculizumab (inhibits complement activation)

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37
Q

most accurate assessment of getstational age

A

first trimester US with crown rump length

later ultrasounds become inaccurate as pregnancy progresses

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38
Q

dysmenorrhea, dyspareunia, dyschezia

dx and rx

A

endometriosis

OCPs and or NSAIDS

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39
Q

how to evaluate an ovarian mass in post menopausal woman

A

pelvic U/S and CA-125!!!!

CA-125 helps to evaluate risk and track progress of treatment

if elevated then proceed to surgical laparoscopy

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40
Q

rx breast abscess during breastfeeding

A

needle aspiration, abx, CONTINUE BREASTFEEDING

41
Q

significant leukocytosis (often greater than 100,00), lymphoblasts, SMUDGE CELLS on peripheral smear

A

CLL

42
Q

pneumonia, splenomegaly, anemia, thromboycytopenia, mild leukocytosis, no B symptoms

A

hairy cell leukemia

look for this on peripheral smear

43
Q

thrombocytopenia, fever, young patient, neurologic manifestations, renal failure, increased LDH, decreased haptoglobin

dx rx work up, rx

A

TTP (platelet consumption, blood shearing due to hyaline clot, microangiopathic hemolytic anemia

autoantibody to ADAMTS13 (decreased ADAMTS13)

rx with plasma exchange EMERGENTLY

44
Q

dysuria, pyuria, urinary frequency, urethral discharge, no rowth on gram stain/culture

A

chlamydial urethritis
rx with azithromycin, doxy

dx with nucleic amplificaiton testing

45
Q

antibiotic prphylaxis for CD4<50

A

PCP CD4<200 : tmp/sulfa
toxo CD4<100: tmp/fula
MAC < 50: azithromycin
histso <150: itraconazole if in endemic area

46
Q

step on nail, when is the only time you give tetanus immunoglobulin

A

only when DIRTY/SEVERE wound with unimmunized, uncertain, or <3 tetanus toxoid doses previously

47
Q

when to give tetanus vaccine in childhood and then boosters

A

3 vaccine series 2,4,6 months, 2 boosters then TdAp after age 7, then booster every 10 years

single dose of Tdap after injuries

48
Q

patient with hx of asthma or chronic rhinosinusitis on aspirin develops asthmatic symptoms, congestion, facial flushing

A

aspirin exacerbated respiratory disease

non IgE, pseudoallergic reaction) due to prostaglandin/leukotriene misbalance

49
Q

radiation therapy after initial chemo/radiation fails (recurrence)

A

salvage

50
Q

intiial dose of chemo treatment to rapidly kill tumor cells and send into remission….then therapy given after this initial therapy to further reduce tumor burden

A

induction -> consolidation

51
Q

fever, flank pain, DIC within 1 hour blood transfusion

positive COOMBS

A

acute hemolytic transufsion reaction (ABO incompatibility)

52
Q

fever and chills within 1-6 hours of tranfusion (MCC cause of tranfusion reaction)

A

febrile non hemolytic (cytokine accumulation) during blood storage

53
Q

respiratory distress, pulmonary edema within 6 hours transfusion

A

transufsion related acute lung injyr (donor anti luekocyte antibodies)

54
Q

mild fever and hemolytic anemia within 2 days after transfusion, positive direct coombs test,

A

delayed hemolytic (anamnestic antibody response)

55
Q

anaphylactic vs urticarial/allergic transfusion reaction?

A

anaphl - recipient anti IgA

allergic - recipient IgE/mast cell activation

56
Q

pink plasma after transfusion

A

acute hemolytic tranfusion reaction

57
Q

Iga deficient patients are at risk for developing WHAT after

A

ANPHYLAXIS AFTER BLOOD TRANSFUSION

58
Q

how to prevent febrile non hemolytic transufsion reaction

A

leukoreduced blood products

59
Q

sickle cell patient presents with progressive hip pain reduced range of motion, normal intial x rays

A

avascular necrosis

60
Q

tumor with elevated b hcg, normal AFP

A

seminoma

61
Q

pneumococcus vaccine in normal adults vs. chronic liver disaese/DM/smokers

A

normal >65 = 13 then 23

risk = 23 alone then 13, 23

62
Q

order of tests for working up lady with amenorrhea/galactorrhea

A

meds, TSH, prolactin, MRI

63
Q

how does thyroid affect prolactin level

A

TRH causes prolactin elevation…

so hypothyroidism leads to more TRH

64
Q

most common etiology acromegaly

A

benign GH secreting tumor

65
Q

acromegaly kid vs adult

A

kid - before closure growth plates = gigantism

adult - growth plates already fused = hands, feet, face visceral organs, DIABETES (stimulate glucose production)

66
Q

what do acromegaly patients die from

A

diastolic heart failure (big heart)

67
Q

how to dx acromegaly

A

IGF-1 level -> glucose suppression test (fails to suppress GH) -> MRI

68
Q

pharm rx acromegaly

A

octreotide (somatostatin)

69
Q

elevated T4 elevated TSH

A

central hyperthyroidism (rare)

70
Q

how does insulin effect epi, cortisol, GH

A

increases insulin = decrease epi, cortisol, GH

71
Q

rx when no pituitary on MRI

A

if patient is asymptomatic, nothing…EMPTY SELLA SYNDROME they’re fine

72
Q

urine osm and urine Na, serum osm in SIADH

A

Uosm and UNaincreased!!!!!
serum osm decreased

reabsorbing water

patient will also be hyponatremic

73
Q

pharm rx SIADH

A

induce something like diabetes insipidus

demeclocycline (get water back into urine)

74
Q

pathophys diabetes insipidus (central and nephrogenic)

A

central - No ADH production
nephrogenic - no ADH receptor

(cannot reabsorb water)

75
Q

test to dx diabetes insipidus

A

water deprivation test (will fail)

76
Q

water deprivation test how to differentiate central nephrogenic

A

central - give ADH and uosm will increase

nephrogenic - give ADH Uosm will not increase

77
Q

rx nephrogenic dm insipidu

A

GENTLE diuresis (HCTZ and/or amilioride)

78
Q

rx central dibaetes insipidus

A

DDAVP (give ADH)

79
Q

third degree burn patient develops eschar formation with tissue tension, tense

A

acute compartment due to venous compromise

80
Q

rx child with rfrequent sinus, bacterial, Giardia infections,

A

ivig

common variable immune deficiency

81
Q

renal side effect lithium

A

nephrogenic DM insipidus

82
Q

first sign of lymphoma

A

NONTENDER/fixedlymphadenopathy

reactive/mobile lymph nodes are usually infection

83
Q

non tender LAD, what to do next

A

exicisional bx

84
Q

Reed Sternberg cells

A

owl eyes

Hodgkin lymphoma (better prognosis)

85
Q

how to stage lymphoma (order)

A

CXR /CT chest/abd/pelvis THEN BONE MARROW BX

86
Q

starry sky pattern on biopsy

A

Burkitt lymphoma
(non hodgkin) (a/w EBV)
Hodgkin

as well as narophayrngeal carcinoma

87
Q

cyclical fevers, lymph nodes hurt with alcohol drinking

A

hodgkin

“Mr. Hodgkin likes to REED 15-30 books everyday”

88
Q

CD 15 and CD 30

A

Hodgkin

89
Q

side effects vincristine/vinblastine

A

peripheral neuropathy

90
Q

side effects doxi/donorubicin

A

cardiac toxicity (dose dependent heart failure)

91
Q

side effect cisplatin

A

ototoxicity

nephrotoxicity

92
Q

bleomycin side effect

A

pulmonary fibrosis

93
Q

cyclophosphamide sid effect

A

hemhorragic cystitis

94
Q

side effect any chemo for hodgkin

A

you get another malignancy

95
Q

elevated T4, low TSH…what to do next

A

radio iodine uptake scan

96
Q

diffuse uptake on radio scan (all hot)

A

Grave’s disease (exophtalmos, pretibilar myxedema)

97
Q

waxy, discolored induration of skin (anterior aspect lower legs)
exophtalmos

A

pretibial myxedema + buggy eyes = grave’s

98
Q

thyroid stimulating antibodies

A

Thyroid stimulating I

TSI

99
Q

two pharm rx grave’s

A 
Polythiuriacil PTU (safe in pregancy)
thionamides (methimazole)

CK_Gyn (4 decks)

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