UWorld form 1 Flashcards
when do you do amnioinfusion
Cord Compression –> repetitive variables
painless ulcer with black necrotic center in immunocomp patient
ecythma gangrenosum= pseudomonas
in brief, CSF in HSV meningitis
lymphocytic pleocytosis, inc protein, nl gluc
inc red cells= from hemorrheage of frontotemporal lobes
why do you get hyperpigmentation with AI and ectopic ACTH
because POMC gets cleaved to ACTH –> both have high ACTH
features of hypercortisolism
high BP, purple straie, easy bruising, easy fatiguability
**most common paraneoplastic in Small cell lung cancer!!
when do you consider a pt in labor “arrest” and move to section
no cervical change >4 hours WITH good contractions
no cervical change >6 hours with bad contractions
most common reason for “protracted” labor
inadequate contractions, give IV oxy
TB pleural effusion vs empyema
TB= very high protein (>4), Glucose <60, lymphocytic predom
Empyema= very low glucose <30, neutrophils, FEVER!!
headache worse with leaning forward, some JVD, but no peripheral edema….
SVC syndrome, most commonly due to malignancy
SBP
enteric bacteria from gut translocates and causes infection. Present with fever, abd pain, ascities,
- empirics= cephalosporin
- proph= FQ
age demographic and prodrome to bullous pempHigoid
elderly, presents with urticarial/eczematous prodrome
classic ALS
UMN + LMN (fasciulations/ atrophy are signs of denervation)
three biggest risks of ALL types of diabetic mothers
macrosomia
RDS
premature delivery
“serositis” in SLE
pleurisy
pericarditis –> effusion
peritonitis
(**migratory joint pains)
drug of choice in monomorphic Vtach (stable)
AMIODORONE
thin, shiny skin in a person with CVD is ALWAYS:
PAD –> evaluate with ABI
most common cause of primary hyperaldosteronism (2)
bilateral adrenal hyperplasa –> tx with SPIRONOLACTNE
aldo producing adenoma –> adrenalectomy
hypercalcemia in primary PTH vs malignancy
much higher in malignancy
<12 in PTH
Hyperthyroidism can also cause hypercalcemia from increased bone turnover
overflow incont classic presentation
urinary freq, NOCTURIA, frequent dribbling
high post void residual
- men >50
- women >150
how do you treat incontinence:
- stress
- urge
- overflow
stress= kegels, pessary, urethral sling procedure, pelvic floor surgery
urge= bladder training, antimuscarinics
overflow= cholinergics (bethanecol), intermittent self cath (neurogenic bladder)
BUN:Cr that suggests hepatic encephalopathy is due to GI bleed
> 20:1
differentiate galbladder mass from pancreatic
Pancreatic has jaundice and elevated alk phos/bili because it is OBSTRUCTING the gb
GB cancer is (much more rare) but also would still be able to produce bile and it wouldn’t show obstructive signs
signs of acute iron toxicity
- hemmoragic gastroenteriris (caustic to GI tract)
- dark stools, can be green
deFEroxamine!!
t/f: chronic ESRD can reactivate TB?
true
reactivation TB vs primary TB
presents with fever, COUGH, NIGHT SWEATS, HEMOPTYSIS, weight loss, fatigue and EFFECTS UPPER LOBES PRIMARILY
primary TB is usually mild, often turns latent, and is in LOWER/MIDDLE LOBE
miliary TB
systemic spread of dz –> effects bone, liver, lymphatics mostly, but can really go anwhere
three types of infx that TB can decide to do
- parimary/latent –> heal by fibrosis, mostly in kids
- miliary
- reactivation
potts deisease
when TB effects the bones
prognostic factor of astrocytoma
differentiation!! Most common brain tumor in adults
I/II lack central necrosis and increased mitosis
GBM= grade Iv
infections in sickle cell dz
ENCAPSULATED ORGS
- sepsis/meningitis/bacteremia= strep pneumo, h flu
- osteomyelitis= salmonella, (staph too)
dysgerminoma/seminoma
adolescents
-secrete bHCG and LDH
granulosa cell tumor: young girl vs postmenopausal women
sx are bsed on high estrogen expression, so precocious puberty or endometrial bleeding
c diff
don’t forget about c diff with recent antibiotic use!! don’t forget it can turn into toxic megacolon
AHIA like looking picture but add decreased fibrinogen and increased INR…
DIC
pain with relief of teste elevation suggests…
epididymitis –> treat with antibiotics
absent cremasteric reflex suggest….
testicular torsion of spermatic cord (pampiniform plexus)
JME
progression from absence –> myoclonus –> GTC (in teens)
worse with sleep deprivation
what features typlica of ACTH dependeant process are NOT typical of ACTH independant process (exogenous steroids, adrenal adenoma)
hyperpigmentation
androgen xs
best way to relieve PAIN of ACS
nitrates: venous dilation –> decreased preload/RV volume/wall stress–> decreased O2 demand
gout treatment
1st line= lifestyle
1st line acute= NSAIDs ( indomethacin)
–> next: steroids or colchicine if RENAL contraindications for NSAIDs
Chronic= allopurinol for >2 attack/ year but DO NOT start right away
celiac is what type of disorder?
AI malabsorption due to villous atrophy
***lactose intol DOES NOT cause fat malabsoprtion of fe deficiancy anemia
albuminocytologic dissociation
normal leukocyte count with ELEVATED PROTEIN seen in GBS
factitious disorder
INTENTIONAL production of sx to assume sick role
viral (cocksakie A) strep
runny nose, cough, vesicles on posterior pharynx/tonsiler pillars
wegners (granulomatosis with polyangitis)
ANCA
small-medium necrotizing vasculitis
upper airway: ENT, saddle nose deformity
lower airyway
kidney: rapidly progressive GN
skin: urticaria, pyoderma gangrenosum, NON HEALING WOUNDS,
malnutrition in elderly
common in dementia
- hypoalbuminemia –> edema
- brusing –> C/K
- gums –> C?
risk/dx of myelodysplastic syndrome
older people and peopel with previous chemo/rad
-ovalomacrocytes (messed up red blood cells) and neutrophil hyposegmentation/ hypergranulation
usually presents with cytopenias
dx= BM tgap with hypocellular marrow
EKG signs of impending hyperkalemia
flattening of P wave and wiening of QRS –> in the clinical context of something like recent seizure or rhabdo where K is on the rise
pheo
adrenal medulla (from neuro endocrine cells)
- makes you pale
- beta blockade can cause RISE in BP –> tx first with alpha block, then add beta
genetic disorders associated with peho
RET
VHL
NF1
what complication of GAS does impetigo progress into
PSGN
glucocorticoids in COPD exacerbation
decrease length of hospital stay
neutropenic fever!!!!
sepsis with abnormal immune response in someone getting chemo
mechanism of ketosis in DKA
fatty acids transfered to liver, broken down by lipolysis
how do you CONFIRM CLL?
flow –> looking for monoclonal B cells
*treat with rituximab
test for aortic rupture/ dissection
CT with contrast or tEe
not TTE
painful, unilateral, fluctuant swelling on medial aspect of labia majora that extends into the introitus
bartholin gland cyst- pain with sitting, walking, sex
*usually e. coli
sx of Graves:
- skin
- nails
- eyes
- menstrual cycle
- ltyes
Skin: pretibial myxedema
Nails: onycholysis (nail separating from bed), CLUBBING!!
Eyes: lid log, proptosis
Menstural cycle: ammenorrhea/ irregularity
Lytes: HYPERcalcemia, hyperglycemia, bone loss
headache, GI distress, petechial rash
rocky mountain spotted fever
inreasing “night blindness”
cataracts! also see loss of distance vision
- mostly happens to older people but idabetes is a risk too
- expect to see loss of red reflex due to increasing opacification
secondary thrombocytosis
think of spelnectomy
sterile pyuria
> 3 WBC with NO bacteria –> sign of chlamydia urethritis!
order of tocolytics in pregnancy
INT
Indomethacin –> cox inhibitor –> can’t use past 32 week because risk closing ductus
Nifedipine –> 32-34 weeks –> can cause tachy, flushing, nasuea, headaches
Terbutaline (beta ag) –> used short term in patient
use of Mg as “tocolytic”
neuroprotection for babe. it is a weak tocolytic
types of cyanosis in a new born
CENTRAL: highly vascular things like lips, mm –> due to decreased O2 sat
PERIPHERAL: blue extremeties–> NORMAL O2 sat but INC O2 extraction
striate palmar xanthomas
yellow streaks on palms indicative of high triglycerides like in dysbetalipoprteinemia
differentiate rash of measles and rubella
both occur with fever and spread from face down
measles= “dark brick red”
rubella= lighter
what do you see on UA in rhabdo
“blood” on dipstick but it is false positive because it thinks its hemoglobin
no casts!! unless ATN
decreased cancer risk with OCPs
endometrial
ovarian
class III antiarrythmics
can cause arrythmias –> look for precipitants like diarrhea to push someone into wide QRS –> into torsades
