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UWorld IV Flashcards

1
Q

Immune deficiency that has low Ig levels and causes frequent sinopulmonary infections?

A

Common variable immunodeficiency

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2
Q

Complications of cryptorchidism?

A

Inguinal hernia
Testicular torsion
Sub fertility
Testicular cancer

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3
Q

Risk factors for cryptorchidism?

A 
Prematurity
Small for gestational age
Low birth weight
Genetic disorder
neural tube defect
Inutero exposure to diethylstilbestrol
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4
Q

Girl with precocious puberty, cafe-au-lait spots, and bone defects/fractures - Dx? Associated condition?

A

McCune-Albright syndrome (Three P’s)

Cushing’s syndrome

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5
Q

Treatment for Croup?

A

Mild (no stridor at rest): corticosteroids

Moderate/Severe (stridor at rest): corticosteroids and nebulized epinephrine

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6
Q

Description of colon in meconium ileus?

A

Narrow, underdeveloped colon, “microcolon”, or diffusely narrow colon.

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7
Q

Infection in atopic dermatitis - Impetigo Pathogen and presentation?

A

Staph aureus, Strep pyogenes

Painful, non-puritic pustules with honey crusted coating

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8
Q

Infection in atopic dermatitis - Eczema herpeticum Pathogen and presentation?

A

Herpes Simplex 1

Painful vesicular rash with “punched-out” erosions and hemorrhagic crusting

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9
Q

Infection in atopic dermatitis - Tinea corporis pathogen and presentation?

A

Trichphyton rubrum

Pruritic circular patch with central clearing and raised, scaly border

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10
Q

Infection in atopic dermatitis - Molluscum contagiosum pathogen and presentation?

A

Poxvirus

Flesh colored papules with central umbilication

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11
Q

Features of neurofibromatosis type 1?

A 
Café-Au-Lait spots
macrocephaly
feeding problems
short stature
learning disabilities
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12
Q

Ddx of melanic stools in toddlerhood?

A 
hemorrhoids
infectious colitis
intussusception
Meckel's diverticulum
inflammatory bowel disease
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13
Q

Laboratory findings in juvenile idiopathic arthritis

A 
Elevated ESR and CRP
Hyperferritinemia
Hypergammaglobulinemia
Thrombocytosis
Anemia
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14
Q

What do antibodies to streptolycin O indicate?

A

Prior infection with group A streptococcus
Predisposes to acute rheumatic fever
Pharyngitis, carditis, chorea, subcutaneous nodules, erythema marginatum

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15
Q

Emergency contraception options by time after intercourse and efficacy?

A

Copper IUD - 0-120 hours, 99% efficacious (Inflammatory reaction toxic to sperm, ova, and implantation)
Ulipristol pill - 0-120 hours, 85% efficacious (Antiprogestin delays ovulation)
Levonorgestrel pill - 0-72 hours, 85% efficacious (Progestin delay ovulation)
OCPs - 0-72 hours, 75% efficacious (Progestin delays ovulation)

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16
Q

What signs in PE or presentation signify the need to investigate physical or sexual abuse?

A

Malnutrition
Sudden behavioral or scholastic changes
- Mood changes, bedwetting, academic difficulties
Also unexplained or implausible injuries or those in various stages of healing.

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17
Q

Child with pertussis: Who gets prophylaxis and with what?

A

All close contacts regardless of immunization status
Age: less than 1 month = Azithromycin x 5 days
Age over one months = Azithromycin x 5 days, OR Clarithromycin x 7 days OR Erythromycin x 14 days

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18
Q

A child with bilateral leg pains occurring at night but with no change in daily activity or physical exam findings?

A

Normal growing pains
Treatment is parental education and reassurance
Massage, stretching, heat and OTC analgesics also helpful

19
Q

Who should receive chlamydia and gonnorhea testing?

A

All sexually active women age 24 or under
New partner within 2 months
Multiple partners
History of STI
Illicit drug use
Incarceration
Contact with sex workers
Infected women may be asymptomatic, NAAT test is the preferred method
Positive test = immediate abx treatment, abstention from sex during treatment, and testing of all partners within last 2 months

20
Q

Workup for primary amenorrhea?

A

1st: Pelvic exam/US to find uterus

If Uterus is present: Test serum FSH - increased = karyotyping (not pituitary), FSH - low = Cranial MRI (pituitary/hypothalamus abnl)

If Uterus is absent: Karyotype and serum testosterone: 46XX w/ Female testoerone levels = abnormal Mullerian development
46XY w/Male testosterone levels = Androgen insensitivity syndrome

21
Q

What is a GnRH stimulation test used to evaluate?

A

Precocious puberty

22
Q

Which renal complications are seen in sickle cell trait?

A

Renal papillary necrosis
Hematuria
Urinary tract infections
Renal medullary carcinoma

23
Q

Clinical features of selective IgA deficiency?

A

Usually asymptomatic
Recurrent sinopulmonary and GI infections
Associated with autoimmune disease (celiac) and atopy (asthma, eczema)
Anaphylaxis during transfusions

24
Q

Presentation of diamond-blackfan anemia?

A

Macrocytic anemia (without hyperhsegmented neutrophils, thus not a megaloblastic anemia)
Low reticulocyte count
50% with congenital anomalies (not necessarily syndromic anomalies, though)

25
Benefits of breastfeeding to the infant?
Improved immunity Improved GI function Prevention of infectious disease: Otitis media, gastroenteritis, Respiratory illnesses, Urinary tract infections Decreased risk of childhood cancer, DM type 1, and necrotizing enterocolitis
26
Benefits of breastfeeding to the mother?
More rapid uterine involution and decreased post part bleeding Faster weight return to prepartum weight Improved child spacing Improved maternal-infant bonding Reduced risk of ovarian and breast cancer
27
Most common comorbid conditions with Tourettes?
Obsessive-compulsive disorder | ADHD
28
Child with anal puritis and eggs visible on tape test: Dx and Tx?
Dx: Pinworm, Enterobius vermicularis Tx: Albendazole or pyrantel pamoate for patient and ALL HOUSEHOLD CONTACTS. Pyrantel is preferred by pregnant patients.
29
What does a loud S2 signify?
Pulmonary hypertension
30
Long term management of sickle cell anemia?
Vaccination (auto-splenectomy) Penicillin prophylaxis to age 5 Folic acid supplementation Hydroxyurea for pts with recurrent vaso-occlusive crises. Increases the level of Hb-F but causes myelosuppression
31
Treatment for acute pain crisis in SS anemia?
Hydration Analgesia +/- transfusions
32
Causes of meningitis in children under 3 months? 3 months to 10 years? 11 or older? With rash?
Under 3 month: Group B Strep, E. coli and gram neg, listeria, herpes simplex 3m - 10y: Strep pneumo, N meningitidis 11 and older: N meningitidis With rash: N meningitidis
33
PE maneuver that can differentiate benign from pathologic murmurs?
Positions or actions that decrease blood return to the heart will decrease the volume of benign murmurs. Standing, or valsalva will both do this.
34
Management/treatment of laryngomalacia?
Most will feed, grow, and ventilate normally with spontaneous resolution by 18 months. May have symptoms of GERD - vomiting, arching of the back with feeds, poor weight gain, and may be treated with upright positioning after feeds and acid reducers
35
What lab findings differentiate iron deficiency anemia fro thalassemias? Alpha from beta thal?
Iron def shows increased RDW and decreased # of RBCs, both are normal in thalassemia. Smear shows microcytosis and hypochromia in iron def, but target cells in thalassemia Iron def responds to iron supplements, Thal doesn't a-Thalassemia is normal on gel electrophoresis, B-Thal shows increased HbA2
36
Treatment for OCD?
#1 Cognitive behavioral therapy and/or SSRI #2 Clomipramine or antipsychotic augmentation for treatment non-response #3 Deep brain stimulation for severe or refractory cases
37
What is the presentation of cat-scratch disease? Organism?
Localized papule with local, ipsilateral lymph node involvement/lymphadenopathy with cat exposure. May also cause fever. Does not need to have noticed a cat scratch or bite. Bartonella henselae
38
Diagnosis and treatment of cat-scratch disease?
Dx: usually clinical, may use serology Tx: azythromycin
39
What does Pasteurella multocida infection present with?
Cellulitis and other soft tissue infection 1-2 days after a dog or cat bite.
40
What bacteria is associated with turtle/reptile contact?
Salmonella enteriditis Severe mesenteric adenitis - inflammation of the mesenteric lymph nodes in the RLQ that closely mimics appendicitis (Kids with turtles presenting with appendicitis) Also causes enteritis/bloody diarrhea
41
Mechanisms of infertility in cystic fibrosis patients?
Inspissated mucus in genital tract prevents the development of the vas deferens bilaterally. If the testes descend, sperm will be made, but cannot be ejaculated. Female reproductive tracts develop normally, but CF causes malnutrition disrupting ovulation/fertility. Also, mucus is thickened preventing sperm motility.
42
What is the workup for lead poisoning in a child with lead exposure risk factors? Treatment?
#1: Draw venous lead level Undetectable: no further testing Mild (5-44mcg/dL): No medication and repeat test in 1 month Moderate (45-69): DMSA Dimercaptosuccinic acid Severe (above 70mcg/dL): Dimercaprol AND calcium disodium edetate EDTA D before E = DMSA lower levels, EDTA higher levels
43
Presentation and underlying disorder of Wiskot-Aldrich syndrome?
Eczema, microthrombocytopenia, and frequent infections X-linked, WAS protein defect causes cytoskeleton dysfunction and decreased immune cell migration. May show purpura, petechiae, or intracranial or GI bleeds
44
Appearance of craniopharyngioma on imaging and presentation?
Result from remnants of the Rathke pouch, may cause visual field defects and endocrine disorders like DI. Calcifications may result and appear white/bone like on imaging

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