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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
risk factors cervical cancer (2)
HPV | TOBACCO SMOKING
26
elevated pulm artery pressure, elevated RA pressure, nml pulmonary capillary wedge pressure
PE elevated pulm artery + elevated RA pressure = pulm htn nml pulmonary cap pressure = nml left ventricular function so intrinsic pulm process
27
elevated pulm artery pressure, elevated RA pressure, elevated PCWP
left hsided heart failure leading to right sided heart failure
28
patient receiving treatment for asthma develops arm weakness, tremors, palpitations
hypokalemia 2/2 beta 2 agonists albuterol drives K into cells!!! watch out for htese side fx and get electrolyte panel
29
When can gestational HTN be diagnosed?
AFTER 20 WEEKS any HTN dx before 20 weeks is chronic HTN (primary/secondary)
30
end organ features of pre-eclampsia
``` proteinuria transaminitis thrombocytopenia headache/visual changes pulmonary edema ELEVATED CR ```
31
HTN during pregnancy increases risk of what to mother and fetus
mother - abruptio placentae, pre-eclampsia, postpartum hemorrhage fetal - PRE TERM LABOR, growth restriction, still birth
32
thrombocytopenia without anemia or leukopenia | dx and what to work up
ITP | test for hep C and HIV (may be initial presentation in small subset of patients)
33
Dx criteria for intermittent asthma
less than or EQUAL to 2 day time/night time symptoms rx with rescue SABA prn
34
patient being treated for severe COPD develops headache, insomnia, vomiting, palpitations. EKG shows atrial tachy and PVC
theophylline toxicity
35
what drugs worsen theophylline toxicity
cytochrome oxidase inhibitors | ciprofloxacin, erythro/clarithromycin, verapamil, cimetidine
36
40 year old patient, hemolytic anemia, cytopenias, hypercoagulable states (i.e. hepatic vein thrombosis) dx, work up, rx
PNH flow cytometry (absence of CD55/CD59) rx with eculizumab (inhibits complement activation)
37
most accurate assessment of getstational age
first trimester US with crown rump length later ultrasounds become inaccurate as pregnancy progresses
38
dysmenorrhea, dyspareunia, dyschezia | dx and rx
endometriosis | OCPs and or NSAIDS
39
how to evaluate an ovarian mass in post menopausal woman
pelvic U/S and CA-125!!!! CA-125 helps to evaluate risk and track progress of treatment if elevated then proceed to surgical laparoscopy
40
rx breast abscess during breastfeeding
needle aspiration, abx, CONTINUE BREASTFEEDING
41
significant leukocytosis (often greater than 100,00), lymphoblasts, SMUDGE CELLS on peripheral smear
CLL
42
pneumonia, splenomegaly, anemia, thromboycytopenia, mild leukocytosis, no B symptoms
hairy cell leukemia look for this on peripheral smear
43
thrombocytopenia, fever, young patient, neurologic manifestations, renal failure, increased LDH, decreased haptoglobin dx rx work up, rx
TTP (platelet consumption, blood shearing due to hyaline clot, microangiopathic hemolytic anemia autoantibody to ADAMTS13 (decreased ADAMTS13) rx with plasma exchange EMERGENTLY
44
dysuria, pyuria, urinary frequency, urethral discharge, no rowth on gram stain/culture
chlamydial urethritis rx with azithromycin, doxy dx with nucleic amplificaiton testing
45
antibiotic prphylaxis for CD4<50
PCP CD4<200 : tmp/sulfa toxo CD4<100: tmp/fula MAC < 50: azithromycin histso <150: itraconazole if in endemic area
46
step on nail, when is the only time you give tetanus immunoglobulin
only when DIRTY/SEVERE wound with unimmunized, uncertain, or <3 tetanus toxoid doses previously
47
when to give tetanus vaccine in childhood and then boosters
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
patient with hx of asthma or chronic rhinosinusitis on aspirin develops asthmatic symptoms, congestion, facial flushing
aspirin exacerbated respiratory disease | non IgE, pseudoallergic reaction) due to prostaglandin/leukotriene misbalance
49
radiation therapy after initial chemo/radiation fails (recurrence)
salvage
50
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
induction -> consolidation
51
fever, flank pain, DIC within 1 hour blood transfusion | positive COOMBS
acute hemolytic transufsion reaction (ABO incompatibility)
52
fever and chills within 1-6 hours of tranfusion (MCC cause of tranfusion reaction)
febrile non hemolytic (cytokine accumulation) during blood storage
53
respiratory distress, pulmonary edema within 6 hours transfusion
transufsion related acute lung injyr (donor anti luekocyte antibodies)
54
mild fever and hemolytic anemia within 2 days after transfusion, positive direct coombs test,
delayed hemolytic (anamnestic antibody response)
55
anaphylactic vs urticarial/allergic transfusion reaction?
anaphl - recipient anti IgA | allergic - recipient IgE/mast cell activation
56
pink plasma after transfusion
acute hemolytic tranfusion reaction
57
Iga deficient patients are at risk for developing WHAT after
ANPHYLAXIS AFTER BLOOD TRANSFUSION
58
how to prevent febrile non hemolytic transufsion reaction
leukoreduced blood products
59
sickle cell patient presents with progressive hip pain reduced range of motion, normal intial x rays
avascular necrosis
60
tumor with elevated b hcg, normal AFP
seminoma
61
pneumococcus vaccine in normal adults vs. chronic liver disaese/DM/smokers
normal >65 = 13 then 23 | risk = 23 alone then 13, 23
62
order of tests for working up lady with amenorrhea/galactorrhea
meds, TSH, prolactin, MRI
63
how does thyroid affect prolactin level
TRH causes prolactin elevation... | so hypothyroidism leads to more TRH
64
most common etiology acromegaly
benign GH secreting tumor
65
acromegaly kid vs adult
kid - before closure growth plates = gigantism | adult - growth plates already fused = hands, feet, face visceral organs, DIABETES (stimulate glucose production)
66
what do acromegaly patients die from
diastolic heart failure (big heart)
67
how to dx acromegaly
IGF-1 level -> glucose suppression test (fails to suppress GH) -> MRI
68
pharm rx acromegaly
octreotide (somatostatin)
69
elevated T4 elevated TSH
central hyperthyroidism (rare)
70
how does insulin effect epi, cortisol, GH
increases insulin = decrease epi, cortisol, GH
71
rx when no pituitary on MRI
if patient is asymptomatic, nothing...EMPTY SELLA SYNDROME they're fine
72
urine osm and urine Na, serum osm in SIADH
Uosm and UNaincreased!!!!! serum osm decreased reabsorbing water patient will also be hyponatremic
73
pharm rx SIADH
induce something like diabetes insipidus demeclocycline (get water back into urine)
74
pathophys diabetes insipidus (central and nephrogenic)
central - No ADH production nephrogenic - no ADH receptor (cannot reabsorb water)
75
test to dx diabetes insipidus
water deprivation test (will fail)
76
water deprivation test how to differentiate central nephrogenic
central - give ADH and uosm will increase | nephrogenic - give ADH Uosm will not increase
77
rx nephrogenic dm insipidu
GENTLE diuresis (HCTZ and/or amilioride)
78
rx central dibaetes insipidus
DDAVP (give ADH)
79
third degree burn patient develops eschar formation with tissue tension, tense
acute compartment due to venous compromise
80
rx child with rfrequent sinus, bacterial, Giardia infections,
ivig | common variable immune deficiency
81
renal side effect lithium
nephrogenic DM insipidus
82
first sign of lymphoma
NONTENDER/fixedlymphadenopathy reactive/mobile lymph nodes are usually infection
83
non tender LAD, what to do next
exicisional bx
84
Reed Sternberg cells
owl eyes Hodgkin lymphoma (better prognosis)
85
how to stage lymphoma (order)
CXR /CT chest/abd/pelvis THEN BONE MARROW BX
86
starry sky pattern on biopsy
Burkitt lymphoma (non hodgkin) (a/w EBV) Hodgkin as well as narophayrngeal carcinoma
87
cyclical fevers, lymph nodes hurt with alcohol drinking
hodgkin "Mr. Hodgkin likes to REED 15-30 books everyday"
88
CD 15 and CD 30
Hodgkin
89
side effects vincristine/vinblastine
peripheral neuropathy
90
side effects doxi/donorubicin
cardiac toxicity (dose dependent heart failure)
91
side effect cisplatin
ototoxicity | nephrotoxicity
92
bleomycin side effect
pulmonary fibrosis
93
cyclophosphamide sid effect
hemhorragic cystitis
94
side effect any chemo for hodgkin
you get another malignancy
95
elevated T4, low TSH...what to do next
radio iodine uptake scan
96
diffuse uptake on radio scan (all hot)
Grave's disease (exophtalmos, pretibilar myxedema)
97
waxy, discolored induration of skin (anterior aspect lower legs) exophtalmos
pretibial myxedema + buggy eyes = grave's
98
thyroid stimulating antibodies
Thyroid stimulating I | TSI
99
two pharm rx grave's
``` Polythiuriacil PTU (safe in pregancy) thionamides (methimazole) ```

CK_Gyn (4 decks)

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