uworld Flashcards
main cause of zenker diverticulum
motor dysfunction
mucosal tear at the Gastroesophageal junction
mallory-Weiss tear
nonunion (bone dont grow back together) of fracture. pt had acute osteomyelitis 6 months ago and treated. pt has sinus tract with a persistently draining wound strongly suggests?
chornic osteomyelitis: xray shows fragmentation of the bone and ragged, irregular fracture lines. Question: Next best step: Immediate surgical debridement + ABX
tinea versicolor is the same as
malassezia globosa
what drug can you give >65 yo with acute delirium?
haloperidol
wrong answer: BENZO, memantine (used for alzh chronic dementia)
acute lymphoblastic leukemia is diagnosed via:
Pt can have: bone pain and lymphadenopathy
bone marrow biopsy:
> 25% lymphoblast
pt with BLUNT ABD TRAUMA, hypotension, right chest/abdominal wall injury and free intraperitoneal fluid. DX
HEPATIC LACERATION. one the most common solid organ injuries (along with splenic lacerations due to BAT).
young child with episodic inconsolable crying (lying with legs drawn to abdomen) thinking possible intussussception. Best next step
ultrasound-guided air contrast enema.
= procedure of choice for dx and tx.
pt complain of gait disturbance and constant sensation of objects moving around him. an abnormal HEAD THRUST test can help detect vestibular dysf due to?
gentamicin
what can cause BILATERAL trigeminal neuralgia (its usually unilat) and whats the cause?
MS
causes ** demyelination of the nucleus of the trig nerve or nerve roots.
most common cause of lobar hemorrhage in adults usually > 60
amyloid angiopathy.
pt on pallative care for cancer. has lumbar spine metastases = worsening low back pain. significant pain. ibuprofen isnt working anymore. next step for pain?
short-acting opioid
not: transdermal fentanyl patch.
intention tremor
cerebellar dysfunction
ct scan shows *numerous punctate hemorrhages with blurring of the gray-white interface.. pt was in MVA. diagnosis?
diffuse axonal injury
pt in status epilepticus. pt is given iv benzo to terminate sz. best next step?
start nonbenzo antiepileptic med to prevent sz recurrence (fosphenytoin, phenytoin, levetiracetam, valproate).
not monitor w/ continuous EEG
if you suspect MS. orderr?
MRI of brain and head
idiopathic pseudotumor cerebri. if untreated which complication is likely to develop?
blindness
trihexyphenidyl (anticholinergic) can be used to treat?
parkinsonism
cisplatin, taxanes (paclitaxel) and vinca alkaloids (vincristine) can cause chemo induced pripheraly neuropathy that presents as?
symmetric, distal sensory neuropathy that spreads in a stocking-glove pattern.
pt has myasthenia gravis. after ACH receptor AB confirmation. what should you get.
CT scan of chest
look for thymoma
pt with involuntary head turning and head fixation to one side. hypertrophied left SCM
dystonia
pt with lead toxicity. give?
calcium disodium EDTA
diabetic pt with CN3 palsy. ptosis down and out gaze, diplopia. but NORMAL pupillary response. cause?
nerve ISCHEMIC.
if it was blown (dilated) ( no pupillary response) = nerve compression.
kid with Henoch schonlein purpura is at increased risk of developing?
intussception
emergent tx of central retinal artery occlusion is done with
an ocular massage and high flow oxygen administration.
1 month old with VSD. most appropriate course of action
echocardiography
not reassurance, no further workup.
acute rheumatic fever. tx
penicillin.
prior to prescribing SSRI. you tell pt about what early side effects
HA, Nausea, insomnia/sedation, anxiety, dizziness.
initial management of uncomplicated hemorrhoids?
high fiber diet and follow up.
inc intake of fluid and fiber, reduction of fat and alcohol, exercise
anal fissure (“posterior mucosal tear of the anus and a skin tag”). in addition to stool softeners and sitz baths, BNS?
topical lidocaine and nifedipine
abd US reveals gallstones, thickened gallbladder wall w/ edema and normal common bile duct. BNS management? A. HIDA scan. B. Cholecystectomy w/in 72 hours?
laparoscopic cholecystectomy within 72 hours.
pt with HIT. stop heparin and start?
argatroban.
(safe in HIT) not LMWH
mammary paget disease is associated with?
adenocarcinoma (carcinoma that starts in glandular tissue, generally mc type of breast cancer).
components of Glasgow coma scale assessment?
answer: EYE OPENING
also VERBAL RESPONSE, MOTOR RESPONSE
hypothyroidism.
hyperlipidemia
16 yo w/ ITP. platelet count 10,000. IVIG and steriods arent helping. BNS?
splenectomy.
if actively bleeding can try anti-D immunoglobulin if bleeding and pt is RH+.
Turner syndrome pt has inc risk for?
osteoporotic fracture.
TS pt has dec Estrogen thus no inhibition of osteoclast bone reabsorption
empirical tx for epiglottis?
Ceftriaxone (H. Influ, and streptococcus species) vancomycin (staph a)
variocele. pt should consider surgery bc what complication?
inferitlity
scleroderma renal crisis typically presents w/ acute renal failure (w/out previous kidney disease_ and malignant htn (blurry vision, ha, nausea. what will be seen on blood smear?
schistocytes.
from microangiopathic hemolytic anemia, and thrombocytopenia.
preterm infant with anemia dx and cause?
anemia of prematurity
due to diminshed erythropoietin levels, shortened RBC life span and blood loss. will see loss H and H and low RC.
HIV pt with CD <90. pain on swallowing and substernal burning for wk. white plaques on buccal mucosa and palate. tx
oral fluconazole.
PCP (p jirovecii) dx will be made with
bronchoalveolar lavage.
dx of endometriosis is done by?
laparscopy
meniscal tear.
xray looks normal of knee. bns
*MRI of the knee = DX.
also chart says arthroscopy.
most effective nonpharmacologic measure to dec BP
wt loss (10% wt loss)
chronic granulomatous disease. cause of inc susceptibility to fungal and catalase + bacteria?
decreased superoxide production (no respiratory burst)
reyes syndrome
MICROvesicular fatty infiltration
not macro
Henoch-schonlein purpur is an IgA mediated vasculitis. what lab finding is most likely seen in this pt
hematuria***
not in creatinine.
stress urinary incontinence is caused by weak pelvic floor muscles that cause
urethral hypermobility.
aplastic crisis in sickle cell
hemoglobin (4.5) and reticulocytes (0.1)are low only
downs syndrome pt can have atlantoaxial instability leading to
spinal cord compression (not ischemia)
untreated shoulder dislocation can lead to
*shoulder abduction weakness. bc axillary nerve damage.
edwards syndrome trisomy 18
micrognathia**
closed fists w/ OVERLAPPING fingers.
prominent occiputk,, rocker bottom feet
osteogenesis imperfecta (blue sclera, freq fx, conductive hearing loss, dentinogenesis imperfecta, joint hypermobility)
type 1 collagen gene (COL1A1) defect
5yo kid exposed to Varicella zoster virus (chickenpox). he hasnt received vaccines after 1 yr. BNS
administer varicella vaccine.
topiramate can be used for
migraine prophylaxis
upslanting palpebral fissures, mouth is open w/ a protruding tongue, palate narrow, but intact. no hepatosplenomegaly
downs syndrome.
postmenopausal bleeding. 1st step
TVUS or endometrial bx.
TVUS shows <= 4mm –> stop
> 4 –> get bx.
RIGHT sided varicocele. BNS
get abd US to look for secondary cause (renal or retroperitoneal tumor).
LEFT sided varicocele BNS
observation
gastric cancer (wt loss, chronic mid epigastric pain worsens with eating). initial test of choice
EGD
not ct scan of abdomen
what two infections can worsen psoriasis symp
HIV***
also strept pharyngitis (Guttate psoriasis)
36 week pregnant women. w/ hx of HSV. what to do.
begin antiviral (acyclovir**) supp at 36 wks until delivery. if lesion/prodromal symptoms during labor –> C section
dash diet or smoking cessation lower BP more?
DASH
prinzmetal angina tx
CCB (*DILTIAZEM, amlodipine)
first line pharmacotherapy for nocturnal enuresis
DESMOPRESSIN
Hypotension
JVD
New onset RBBB
Acute MASSIVE Pulm Embolism
