UWORLD facts 3 Flashcards
The displacement of otoliths in the semicircular canals is known as ____________. How is it treated?
BPPV. Treated wit hteh EPley maneuver (head positioning exercises)
What kind of vertigo can antihistamiens and phenothiazines (promethazine, prochlorpremazine) treat?
acute vertigo (not chronic)
A child with intestinal obstruction and failure ot pass stool for 48 hours, with explosive expulsion of gas and stool with rectal examination, suggests _________
How do you confirm the diagnosis?
Hirschsprung’s Disease (HD). Confirmed with rectal suction biopsy
Acute onset of fever and RUQ pain after colitis think:
Entamoeba histolytica (abscesses most often found in R hepatic lobe; contain accelular proteinaceous material (anchovy paste)). Treated with flagyl or chloroquine
Symptoms of a UTI WITH perineal pain or obstructive symptoms (like weak urinary stream) =
How do you treat?
acute prostatitis.
Treat with bactrim or fluoroquinolone
How do you differentiate between a coin in the esophagus or trachea on Xray?
If in esophagus, will appear linear on LATERAL xray
If in trachea, will appear linear on PA view
When can patients with coin ingestion be observed?
if they are asymptomatic and the coin ingestion occurred wtihin 24 hours. REpeat xrays should be obtained in 12-24 hours to make sure it has passed
When is surgery indicated for AAA?
1) If diameter reaches or exceeds 5.5cm
2) if it has grown more than 0.5 cm over a 6 month period
otherwise observe every 6 months if > 5, every year if >4.0, and every 2 years if >3
What is the criteria for surgery for hyperparathyroidism?
1) serum Ca greater than 1.0 above normal; 2) reduced Cr Cl 400; 5) nephrolithiasis or nephrocalcinosis; 6) age
What should spiral femur fractures make you think of?
child abuse. Requires spica cast
How can you differentiate ulcers due to neuropathy vs due to arterial insufficiency based on placement?
neuropathy = pressure points
arterial insufficiency = distal extremities (tips of toes); LATERAL malleolus (media = venous insuffiency)
What are the high intensity statins and who should be placed on them?
High-intesntiy statins include artova 40-80 and rosuvastatin 20-40.
Those with clinically significant atherosclerotic disease AND 75 or younger; those with LDL >190; and those with ASCVD risk 7.5% or greater with diabetes at least age 40.
Clinically significant atherosclerotic disease and OLDER than 75 or 40-75 with diabetes but ASCVD risk
What is the most common cause of erythema multiforme?
HSV. Targetoid lesions!
Why is prior uterine surgery (like a C section) a risk factor for retained products of conception?
it can lead to abnormal placentation (like placental attachment to the uterus; when the placenta invaseds the uterine wall over the area of ap rior scar, it is referred to as placenta accreta
What hormone is elevated in40% of patients with HCC?
AFP
HCC arises from hepatocytes
Where do the most common benign tumors of the liver arise from?
blood vessels! Cavernous hemangiomas
T/F: radical prostatectomy results in improved survival compared to radiotherapy for prostate cancer.
FALSE. Unclear if any difference in survival or complications. Radiation therapy has a lower frequency of post-treatment urinary incontience but a higher incidence of bowel dysfunction (compared to prostatectomy)
How do you treat pertussis?
erythromycin for patient and all close contacts (regardless of immunization status)
Bilateral reticular and linear opacitices predominantly affecting the upper lungs:
granulomatous lung disease
Primarily peripheral and basal reticular opacities with honeycombing:
Usual interstitail pneumonitis (pathologic manifestion of IPF)
T/F: Inguinal hernias shoudl be corrected in all children promptly.
True! (doesn’t seem to be age limit)
Who should get the herpes zoster vaccine?
Immunocompetent individuals over age 60 (should not be given to patients with immunodeficiency, AIDS, or those receiving immunosuppressive therapy)
What is the strongest risk factor for age-related macular degeneration?
smoking
What does a malignant pleural effusion in a patient with lung cancer mean?
Very poor prognosis; median survival of only four months, stage IV. Manage with palliation = obliteration of the pleural space
Between which lead levels should children be treated with DMSA?
moderate = levels 45-69
Between which levels should children be treated with EDTA?
If 70 or over, children should be treated with parenteral dimercaprol and EDTA
When should patients with PCP be treated with O2?
If PaO2 less than 70 or AA gradient greater than 35
When syould a patient get Xrays of the ankle?
1) pain near the malleoli
2) bony tenderness at the malleoli; OR
inability to bear weight
If S3 represents rapid ventricular filling, what does S4 mean?
atrial contraction (it represents left ventricular hypertrophy as it is caused by a stiff LV)
What are the indications for ICD therapy?
Primary: prior MI and LVEF ≤ 35% class I, less than 30% class II or III; sudden VF with unexplained cause. Structural disease and VT
What is the indication for cardiac resynchronization therapy?
patients in sinus rhythm with LVEF ≤35 percent, LBBB and a QRS duration ≥150 ms, and New York Heart Association (NYHA) functional class II, III, or ambulatory class IV symptoms with optimal medical therapy
What is the most common cause of inherited thrombophilia?
Factor V Leiden (which results in a resistance to the antithrombotic effects of protein C)
What is the difference between a delusional disorder about an illness vs illness anxiety disorder (hypochondriasis)?
in hyperchondriasis, these patients do not have rigidly fixed delusions: they can acknowledge the possibility they do not have the feared illness
What is normal transferrin saturation?
20-50% (in kids >16%)
When do NTDs occur?
during the 5 and 6 weeks of gestation, when the neural tube usually closes
In an NTD, what would the results of a quad screen show?
elevated afp, but nrmal hcg, estriol, and inhibin
What are the results of a quad screen in down syndrome?
elevated hcg and inhibin, low afb and estriol
What genus of virus is the BK virus?
polyoma virus (dsDNA)
Macrosomia is birthweight over _____ g
4500
T/F: Patients with nephrotic syndrome are prone to opportunistic infectoin.
False! They are at increased risk for infection, but moreso those caused by typical organisms like pneumococcus (not opportunistic)
What meds should be started in someone with NSTEMI?
aspirin, morphine, nitro, oxygen, beta blockers, statins, ACEI
There is some evidence that the atypical antipsychotic olanzapine may be helpful in patients with which ED?
anorexia
Which psych meds are used in treatment of BN?
antidepressants (particularly fluoxetine)