UWorld D Flashcards
78 y/oF p/w acute hypoxic RF requiring intubation, PNA treated and she’s extubated but then develops stridor and increased WOB
Cause of stridor?
Laryngeal edema, presents w/ post-extubation stridor
-occurs in up to 30% of intubated pts
We give magnesium sulfate to asthmatics?
In severe asthma exacerbation (peak expiratory flow under 40% of baseline): mag sulfate can be used as a parenteral bronchodilator if pt has already failed 1 hour of SABA and glucocorticoids
So pt w/ bad asthma comes in- you give SABA and IV steroids, 1 hr later worse, w/ PEF under 40, consider mg sulfate
Lung CA associated with
(a) SIADH
(b) PTHrP
(a) SIADH- small cell carcinoma
(b) PTHrP- squamous cell carcinoma
20 month old girl p/w cough and fever
Harsh, brassy coughing followed by mild inspiratory stridor
(a) Diagnosis
(b) CXR sign
(c) Tx
(a) Croup = laryngotracheitis = parainfluenza infxn of larynx and trachea
(b) CXR- steepe sign due to subglottic narrowing
(c) Single dose of corticosteroids can treat mild croup
Radiographic findings c/w benign pulmonary nodule
Popcorn calcification (hamartoma), concentric, diffuse homogeneous, laminated, central Basically popcorn calcification = hamartoma and is benign
While eccentric, asymmetric, reticular, punctate raise suspicion for malignancy
Aside from pressors, what other support may brain-dead pt need to manage organs for donation
Maintain euvolemia- may require IV fluids and desmopressin to combat central diabetes insipidus that can increase UOP to 1L/hr and cause volume depletion
Goals for managing brain-dead organ donor: maintain euvolemia, normotensive, normothermic
Large PE
(a) Possible conduction disturbance
(b) Valvular abnormality
(a) RBBB due to RV strain
(b) Tricuspid regurg due to dilation of RV that stretches the tricuspid valve annulus
Chance that pt has lung cancer if CT chest if read as positive (noncalcified nodule over 4mm)
Chance of cancer is under 10%, super high false positive rate of 96% but study showed 20% relative mortality reduction in group that got screened
So counsel that screening is helpful but any positive finding needs to be confirmed by further workup
When to give Rhogam
Rh+ father, Rh- mother, baby has a chance of being Rh+
Prevent mother from making anti-Rh+ antibodies when maternal and fetal blood mix (through placenta and through maternal hemorrhage) for the next baby
So give
- 28 weeks
- within 72 hours post-partum
Standard dose (300 ug) given at 28 weeks, then have to do Rosette test to qualitatively test for fetomaternal hemorrhage.
negative: give standard dose anti-D immune globulin
positive: determine amount of hemorrhage by Kleihaur-Betke test and increase dose of anti-D immune globulin based on percentage of fetal RBC in maternal circulation
Gastroschisis vs. omphalocele
Gastroschisis = eviscerated bowel w/ no covering membrane
Omphalocele = sac containing multiple organs at umbilicus
3 indications for GBS prophylaxis for mothers w/ unknown GBS status
GBS ppx in mothers w/ unknown status if (not just everyone w/ unknown status)
- preterm labor (under 37 weeks)
- intrapartum fever
- rupture of membranes for 18+ hours
Neonatal jaundice- when do tbilis peak?
(b) When to stop phototherapy
(c) What is the danger to the baby?
Tbilis peak at day 5-7
(b) Continue phototherapy until bilis normalize (don’t just expect them to plateau then resolve)
(c) Kernicterus = bilirubin-induced encephalopathy
When is exchange transfusion indicated for neonatal physiologic jaundice?
When tbilis are severe, above 20-25 = toxic, too high risk of kernicterus (bili encephlopathy) => exchange transfusion
3 causes of elevated maternal serum AFP
Elevated AFP
- multiple gestation (twins)
- open neural tube = anencephaly, open spina bifida
- ventral wall defect = omphalocele, gastrochisis
Association w/ reduced plasma maternal serum AFP
Trisomy- 18 and 21
31 y/oF at 35 weeks gestation, UA with glucose and 2+ protein, amniotic fluid index of 30 cm
Diagnosis?
Maternal gestational diabetes (glucosuria, proteinuria) w/ polyhydramnios (amniotic fluid index over 24)
Maternal diabetes => fetal hyperglycemia that causes osmotic diuresis => polyhydramnios
Explain the amniotic fluid index- what determines it?
(b) What can cause high vs. low
Amniotic fluid index = measures of amniotic fluid around baby, determined by how much produced (baby swallows it, then kidneys process it) and resorption (by placenta)
(a) High- unable to swallow it (duodenal atresia, anencephale), making too much (maternal diabetes), congenital infection (placental insufficiency
Low- not making enough (kidneys stink)
Explain how the following cause oligohydramnios
(a) Preeclampsia
(b) NSAID
Oligohydramnios = low amniotic fluid index (under 5cm)
(a) Preeclampsia causes placental insufficiency => intrauterine growth restriction and vasoconstriction to kidneys
(b) NSAIDs also reduce renal blood flow
Amniotic fluid index
(a) in oligohydramnios
(b) in polyhydramnios
AFI
(a) Oligohydramnios- under 5cm
(b) Polyhydramnios- over 24cm
Explain how the following cause polyhydramnios
(a) maternal diabetes
(b) duodenal atresia
Too much amniotic fluid
(a) Maternal diabetes causes fetal hyperglycemia then fetal glycosuria => osmotic diuresis
(b) Baby can’t swallow amniotic fluid => can’t give it back to placental to resorb into maternal circulation
28 y/oF treated for asymptomatic GBS at 14 weeks
Screen again?
Does she need peripartum ppx?
Regardless of when, if treated during pregnancy assumed that rectovaginal flora concentration is high enough and still give PCN ppx peripartum
So at 14 weeks: give amox to treat, then PCN ppx during labor
28 y/oF in 2nd stage of labor noticed to have multiple hyperpigmented 1-2cm sessile lesions on labia manjora/majora
C-section? vaginal birth?
Condyloma accuminata from HPV
C-section doesn’t reduce rate of vertical transmission => vaginal delivery
38 y/oF at 27 weeks gestation in MVA presenting w/ dull abdominal pain, no vaginal bleeding
What should you be worried about?
Abruptio placenta = placental detachment from uterine wall prior to fetal delivery
Clinical features of abruptio placenta
Abruptio placenta = detachment of placenta from uterine wall before fetal delivery
Clinically can present w/ vaginal bleeding, abdominal pain, frequent low-intensity contractions, rigid uterus
