UWorld 8/10 Flashcards
Acute lead exposure ssx?
- GI = abdominal pain, constipation
- Neurologic = headache, cognitive deficits, peripheral neuropathy
- Musculoskeletal = joint pains, muscle aches
- Hematologic = microcytic anemia w/ basophilic stippiling
- Anorexia
Which antipsychotic has the least risk of TD?
-clozapine
Chronic lead exposure ssx?
- *ssx of acute exposure (neurologic, GI, anemia, musculoskeletal, and anemia) plus:
1. Nonspecific ssx = fatigue, insomnia
2. HTN
3. Neuropsych ssx
4. Nephropathy (^^creatinine)
5. Reproductive effects = miscarriages, stillbirths
Most likely cause of microcytic anemia in kids?
-Pb poisoning
Tx of lead poisoning?
-chelation
What are 2 main things to look out for when tx with clozaril?
- Agranulocytosis
2. Seizures, it lowers the threshold
How is Parkinson’s dz dx?
- via PE
- 2/3 cardinal ssx must be present:
1. Resting tremor
2. Rigidity
3. Bradykinesia
How is appendicitis dx?
- via physical ssx + labs
- only if clinical picture is not typical is imaging required (either CT or ultrasound)
Imaging in dx of appedicitis?
- ONLY used when presentation is atypical and unclear
- normally this is a clinical dx!
Ssx of digoxin tox?
- Cardiac = life-threatening arrhythmias
- GI = anorexia, nausea, vomiting, abdominal pain
- Neurologic = fatigue, confusion, wkness, visual disturbances (yellow halos)
* *think vangough starry night
The addition of which medication can increase digoxin levels ?
-amioderone –> so decrease digoxin dose by 25-50% and then. He k the dig level weekly
Dx procedure of choice when suspecting renal colic in pregnancy?
-abdominal US
6 types of drugs that can cause acute pancreatitis?
- Diuretics = furosemide, thiazides
- Drugs for inflammatory bowel dz = sulfasalazine, 5-ASA
- Immunosuppressive agents = azathioprine
- HIV-related meds = didanosine, pentamidine
- Antibiotics = metronidazole, tetracycline
- Anti-seizure medications = valproic acid
Low grade fever during first 24 hrs post-partum?
-common and normal
Leukocytosis during the first 24 hrs postpartum?
-common and normal
Intrapartum chills?
-common and normal
Postpartum chills?
-common and normal
Lochia? Changes?
- discharge postpartum
- lochia rubia (red) for first few days –> lochia serosa (pale) after 3/4 days –> lochia alba (yellow/white)
- if foul smelling –> suspect endometritis!
Best way to dx primary syphillis?
- with dark field microscopy
- serum tests have high false neg results in primary stage!
Tx for epidural hematomas?
-emergency craniotomy!
What type II DM meds can cause wt gain?
- sulfonylureas!
2. Thiazolidinediones
What DM II meds can induce CHF in pts with heart dz?
-thiazolidinediones
What DM II medication can help with weight loss?
-GLP-1 receptor agonists!
Most common cause of acute liver failure in the US?
-acetaminophen toxicity
What are the three most common causes of severe acute hepatic injury? What is seen on labs?
- transaminase levels > 1000 U/L
1. Acute viral hepatitis
2. Ischemic hepatopathy (“shock liver”)
3. Toxic liver injury (esp with acetaminophen)
Tx of acetaminophen intox?
-acetylcysteine to tx liver injury
What are the 3 most common cardiac abnormalities seen in turner’s syndrome?
- Bicuspid aortic valve
- Coarctation of aorta
- Aortic root dilation –> increased risk of aortic dissection
Triad for normal pressure hydrocephalus?
- Gait disturbance
- Dementia
- Urinary incontinence
What is postcardiotomy syndrome?
- pericardial effusion that can occur days or months after cardiac surgery
- ssx:
1. Distant heart sounds
2. Hypotension
3. Distended jugular veins
Most common parasitic infection of the brain?
- neurocysticercosis caused by taenia solium (pork parasite)
- more common in a rural area with poorer sanitary conditions where pigs are raised
How is cystercosis contracted?
- by eating pork
- but also can get even if dont eat pork!
Most common manifestations of cystercosis?
- multiple, small fluid-filled cysts in brain parenchyma (and can be found elsewhere in body, spread hematogenously)
- most commonly causes neurologic sx (seizures, etc)
What commonly causes an abrupt onset of nausea and vomiting?
-ingestion of preformed toxin or chemical irritants
What are the 2 most common causes of preformed toxin acutely induced vomiting in the US?
- Staph aureus –> poultry and egg products (esp mayo), meat and meat products, milk and dairy products (cream filled paistries)
- Bacillus cerus (heat stable exotoxin) –> starchy foods (classically, reheated fried rice)
Penile fracture?
- surgical emergency!
- needs urgent urethral imaging (retrograde urethralgram) + surgical repair
Absent peristaltic waves in lower 2/3 of esophagus + decreased LES tone?
-Dismotility caused by scleroderma
What do you need to worry about after re-profusion?
-COMPARTMENT SYNDROME!
Embolic occlusion in a limb v compartment syndrome?
- BOTH cause: severe pain and paresthesias
- embolic occlusion causes: pulselessness, palor, an no local swelling
- compartment syndrome causes swelling and redness!!
Paralysis seen in botulism v tick borne dz?
- botulism = descending
- tick = ascending
Rapidly ascending paralysis with one limb that is worse?
-think tick-borne paralysis!
Most common cause of unilateral cervical lymphadenitis in children? Best tx?
- Strep
- Staph
Tx: I&D + clindamycin (has good node penetration)
Cyclical vomiting: ssx? Cause? Tx?
- ssx: recurrent, self limiting episodes of nausea and vomiting, with no apparent cause
- cause: unknown, common in kids who have parents with migraines
- tx: anti-emetics + reassurance
How to dx PID as the cause of infertility?
-hysterosalpingogram
Abdominal pain that radiates to arms?
-highly suspicious for MI –> must rule this out first before doing a GI workup!
What condition is associated with bilateral trigeminal neuralgia?
-MS!
What drug is most commonly the cause of nephrogenic DI?
-lithium
Urine osmolality in DI?
-decreased = diluted
Urine [sodium] in DI?
-decreased = diluted
Serum osmolality in DI?
- increased
- mainly consists of Na!
What can be seen on CXR with boerhaave syndrome?
- Pneumomediastinum
- Pleural effusions (usually left)
- +/- pneumothorax
Pleural effusion fluid analysis in boreehave syndrome?
- Exudative
- low pH
- very HIGH amylase –> due to saliva in esophageal contents
Tests for pts with suspected BPH?
- Urinalysis –> look for hematuria (stones or bladder ca) or infection
- Creatinine –> to look for obstruction
- if either are abnormal, do an abdominal US
* *after rectal exam confirms suspicion!
Sudden vasomotor collapse + skin rash?
- waterhouse-friderichsen syndrome
- adrenal hemorrhage
- due to fulminant meningococcemia infection
- has almost 100% mortality!
Specific mutation in marfans?
-fibrillin-1 gene
ESR in temporal arteritis?
- > 50
Hydatid disease: due to? How contracted? Ssx?
- Due to ecchinococcus granulosus infection
- humans get it from close intimate contact with dogs (dogs are definitive hosts)
- causes unilocular cystic lesions in any organ (liver, lungs, muscle, & bones) –> usually asymptomatic and found incidentally, but can cause sx from compression of local tissue
What is highly suggestive of a hydatid cyst?
-eggshell calcification of a hepatic cyst on CT scan!
Tx of hydatid cyst?
- DONT aspirate, bc spilling of content can cause anaphylaxis!
- tx = surgical resection + albendazole
Hip problem in infant?
-congenital hip dysplasia
Hip problem in ages 2-8 yrs old?
- Legg-Calve-Perthes disease
- avscular necrosis of femoral head
Hip problem in adolescents?
-SCIFE
Skin cancer that arises from chronically wounded, scarred or inflamed skin?
- Marjolin ulcer = squamous cell carcinoma
- commonly occurs over site of osteomyelitis, radiotx scars, or venous ulcers
- tend to be more aggressive –> early dx is important to prevent maets
First line tx for peripheral artery dz (4)?
- AKA claudication
1. Smoking cesation
2. Aspirin
3. Statin
4. Supervised exercise program
3 most common causes of chronic cough in non-smokers?
- Post nasal drip
- GERD
- Asthma
When is prenatal antibody screening done? What does it test for? What to do for a negative result?
- done at initial prenatal visit
- tests to see if the mother has anti-Rh antibodies
- if negative: give anti-D Rh immunoglobulins at 28wks-35 wks gestation bc the mother does not yet have antibodies, want to keep it that way! (The immunoglobulins have a half-life of about 6 wks, thats why you give them then)
- also give the immunoglobulins again w/in 72 hrs of the delivery if the baby is found to be Rh positive!!
What is the most common inherited cause if hypercoagulability? What does it predispose the pt to?
- factor V leiden
- predisposes to thromboses, esp DVT of lower extremities
Neonate w/ absent lung sounds on left, loud heart sounds on right, and decreased breath sounds on right? First step in management?
- congenital diaphragmatic hernia on the left (most common side)
- first: intubation
Opthalmoplegia, proptosis, severe eye pain, decreased visual acuity?
- orbital cellulitis!
- opthalmologic emergency!!
What are 3 possible complications of orbital cellulitis?
- Meningitis
- Venous thromboses
- Blindness
Most common congenital heart disease in Edward’s syndrome?
-VSD
Micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases?
-Edward’s syndrome
Most common cause of urologic problem in kids? What does it increase the risk for?
- vesicoureteral reflux (VUR)
- risk factor for UTIs and pylenophritis
- recurrent UTIs can cause renal scarring
Best method for dx of VUR?
- voiding cystourethrogram (VCUG)
- should be done in any child with recurrent febrile UTIs
OCPs and bp?
- can cause HTN
- d/c the OCP to correct the problem
Cause of symmetric and circumferential narrowing of esophagus?
-peptic stricture –> commonly seen in GERD
Ssx of peptic stricture?
- dysphagia to solids, but no weight loss
- in pts with hx of GERD
Leukemoid rxn: what is it? Dx?
- marked increase in WBCs in response to an infection or inflammation
- can look like CML on peripheral blood smear, BUT leukemoid rxn will have an increased leukocyte alkaline phosphatase (LAP) score
- LAP is usually low in CML
How does the kidney compensate for resp alkalosis?
- by preferentially excreting biocarb in the urine
- so urine will have HIGH pH (basic)
What can happen during the first few days of outpt tx with warfarin? Why?
- can have protein C deficiency bc it has a shorter half life than the clotting factors inhibited
- so the pt is actually in a hypercoagulable state and at risk for thrombus formation and skin necrosis (esp if pt has underlying congenital protein C def)
Raloxifene: MOA? Use? Increased risk of?
- MOA: antagonizes estrogen in breast and vaginal tissue & agonist of estrogen in bones
- use: first-line agent for prevention of osteoporosis (can also decrease breast CA risk)
- risk: thromboembolism
Management for flail chest?
- pain control
- supplemental oxygen
Arthritis in SLE?
- considered to be non-deforming
- most commonly affects the hands
What nerve gives sensation to cornea?
-trigeminal nerve (V1)
What is chagas dz caused by? What 3 conditions can it cause?
- cause: trypanosoma cruzi (protazoan)
- causes:
1. Megaesophagus w/ achalasia
2. Megacolon
3. Cardiac dysfunction - *seen in Latin America
Dark urine after taking TMP/SMX?
- G6PD deficiency
- due to oxidative stress
Heinz bodies?
- seen in a hemolytic event in G6PD!
- see bite cells too
Bite cells?
- seen in G6PD in a hemolytic event
- see heinz bodies too
What is the normal compensation response for metabolic acidosis?
-tachypnea = increased CO2 loss
Most common cause of hypercalcemia in ambulatory setting?
- hyperparathyroidism!
- so test PTH first!
Lots of puss filled skin infections and abscesses?
-think chronic granulomatous disease!
Tx for hemodynamically stable supraventricular tachy?
-vagal maneuvers + adenosine and AV nodal blockers
Tx for hemodynamically unstable pts with supraventricular tachycardia?
-DC cardioversion
What to test for with new onset a-fib?
- occult hyperTH
- get TSH and free T4
Most common organism that causes osteomyelitis?
-staph aureus
Best tx of pain in a pt with past opioid addiction?
- IV morphine –> faster onset of action than oral meds
- make sure to tx pain regardless of past addictioncs!
What is the idea behind the effect of standing on murmurs?
- they decrease venous return to the heart
- usually decrease the intensity of the murmur
What is the idea behind the effect of the valsalva manuver on murmurs?
- it decreases venous return to the heart
- usually decreases the intensity of the murmur
What is a common site of osteomyelitis in Iv drug users?
-the spine
2 Groups at highest risk for osteomyelitis?
- Sickle cell anemia pts
2. IV drug users
What is the most reliable ssx of vertebral osteomyelitis?
-tenderness with gentle percussion over the spinous process
