Uworld Mix 1 9/28 Flashcards
Define Fetal Hydantoin Syndrome
From fetal exposures to Phenytoin or carbamezapine. . See midfacial hypoplasia, microcephaly, cleft lip and palate, DIGITAL HYPOPLASIA, HIRSUTISM, DELAY
How dos Fetal Alcohol SYndrome differ from FEtal Hydantoin Syndrome?
HAS does not have sleft palate or excess hair.
Squamous Cell vs Basal Cell carcinoma
SCC - enlarging nodul, keratinized, ulceratev crusting, bleeding. Seen often with the immunosupressed. Basal Cell - pearly, flesh colored, flesh colored, Most common.
Blood pressure pattern in Coarctation of the Aorta
HYPERtension in the UPPER ext, and HYPO tension in the lower extremitis.
Baby vomits after having milk, and has eczema and bloody stools. What does it have and what do you do?
Milk Protein Allergy, Avoid milk and soy protein, switch to HYDROLYZED formula.
14 yera old girl, progressive lower limb weakness. Has high plantar arches. Wide based gait, , and decreased strenght in the lower extremities. Decreased vibratoyr and postion ense. MRI SHOWS CERVICAL SPINAL ATROPHY
Freidrich’s Ataxia.
What is Dawn Phenomena
a HYPERglycemic surge, in the early morning, due to increase in growth hormone and cortisol in the morning. THis is Fasting Hyperglacyemia.
What is the target range of glucose for a diabetic
80-130
What would be a sign that there is inadequate basal insulin control?
If they are never in their glucose
What would give 24 hour peakless coverage of for insulin?
Glargine.
ARDS - what is the pathophysiology?
Lung injury –>fluid cytookin leakage into alveoli. See impaired gas exchange, decreased lung compliance, PHTN
ARDS - How is the lung compliance
Lung compliance is DECREASED - due to stiff lungs and loss of surfactant, and increased recoil.
Lab findings of SIADH
Hyponatremia, LOW S-Osmo, HIGH urine Osmo, high URINE sodium
To reduce proetinuria in Diabetic Nephropathy, do you need aggressive BP or control Glucose, and why?
BP control. Intense glucose control if done too aggressively could cause hypoglycemia.
What would be the TX of choice for LEGIONELLA, and which is preferred
FLuroquinolone>Macrolide
What is the backbone for EMPERIC Endocarditis therapy
Vanc + Genta
Native valve prophylaxis
Vanc. Once cultured, switch to Oxacillin, Nafcillin, Penicillin G.
Prosthetic Valve PPX
Vanc, Genta, Cefipime/Ceftraxone
SBE PPX
Gentamicin + Ceftiaxone
Homeless man with HIV and a CD4 count of 30 has a positive Toxo Serology, and the CT scan shows ASYMMETRIC, HYPODENCE, NONENHANCING WHITE MATTER LESION. What the DX
PML
DIagnosis for PML in an aids patient?
LP PCR for JC virus. Brain BX is rarely needed. CT shows lesions with NO ENHANCMENTS.
DX CT for: Toxo Primary CNS Lumphoma HSV Encephatlitis PML
Toxo - MULTIPLE, Ring ENHANCING, with EDEMA
Prim. CNS Lymphoma - ONE, well Defined ENHANCING lesion.
HSV Encephalitis - Unilateral Lobe-enhancing lesions with Mass Effect
PML- MULTIPLE, NONEnhancing, White matter lesions, ASYMMETRIC
Young patient has been going under chemo for cancer. Has had fever and chills for the last 24 hours. Leukocytes are LOW - only 690, with 20% neutrophils. What does he have, what do you give. and why.
Febrile Neutropenia = when the absolute Neut count is <1500, and MORE severe when <500. THey are especially vilnerable to Pseudomonas Aeroginosa. PIPERCILLAN-TAZOBACTAM, Cefepime, or peropenem
GUy with urethral discharge and burning when peeing has no other medical problems, He tests positive for N. Gonorrhoeae. What other test is indicated?
Syphillis, Chlamydia, HIV and Hepatitis B
55m has a recent renal tranplant 5 days ago, and is on immunosupression therapy. What needs to be added to prevent opportunistic infection?
- TMP just laid AIDS for Toxo and PCP
63 m has scrotal pain, and he has a hx of dysuria and frequency. He has a fever. There is a TENDER MASS in the left scrotum that is erythmatous. there is no DC> What is the organism? and the dx
E. Coli is MOST likeyl- Acute Epididymitis
When can Staph aureus cause Epididymitis?
Whent there was surgery or overlying skin infection. NOT Uti
What are causes of Acute Epididymitis?
<35 = Sexually Transmitted >35 = Baldder Outlet Obstruction
In a person with a past Hep B infection of a couple years, what would be the POSITIVE serology
HBsAB, and HBcAB
What is the ONE marker for Acute HBV and the others
hb SURFACE Ag, HBeAG, and IgM anti-HBc
CHronic HBV Carrier surology?
HBsAg, IgG Anti-HBc.
What is the ONE marker for Vaccination of HBV, its the one.
Anti-HBs
Two makers that show they are immune due to a PAST infection
HBcAB, HbsAB
Hypopigmented lesion, then causing nearby loss of sensation and tingling, exposure in South America. Theres no sensation. There is lack of sensation with whatever is involved to the nerve. What is DX and what would confirm?
Leprosy, and skin BX from the edge of the lesion.
What is treatment for Mycobacterium Leprai, aka Leprosy?
Dapsone and Rifampin
Describe the organism Mycobacterium Leprai
acid fast bacillus that causes a chronic granulomatous disease of the skin.
What is the most common cause of Osteomyelitis in a nail wound to the foot in a regular HEALTHY patient?
Pseudomonas
What is the cause of osteomyelitis in a foot if a patient has a condition like diabetes?
Strep and Staph, E.Coli, Klebsiella
in an immunocompromised patient, with respiratory symptoms, what differentiates Legionella from PCP?
Legionella would have a high fever and GI symptoms.
What is the mechanism of statins (not just HMG Coa inhibition
inhibitis INTRAcellular synthesis pathway, stopping the converstion of HMG-CoA to mevalonate. Side effects include myalgias. Statin decrease CoQ10 syntheissi, which involves muscle cell energy production.
Patient has an acute arterial occlusion in the LLE, in bad pain. they have a history of atrial fibrillation. They have HTN, DM, AND he has a right carotid bruit. What medication could have PREVENTED this problem?
Aspirin plus MORE anticoagulation. Warfaran or apixaban
What are causes of SENSORINEURAL hearing loss?
Ototoxicity from antibiotics,Menieres disease, acoustic neuroma
Is otosclerosis conductive or sensori loss
Conductive.
Patient has asterixis 6 days post op, drowsy on exam, with high blood pressure. Labs show BUN of 78, elevated LFTs, but normal Albumin and Bilirubin and a CK or 32000. What is the next step?
Hemodialysis They have uremic encephalopathy.
If they have asterixis, when would you use Lactulose?
When the cause is HEPATIC encephalopathy, when showing liver dysfunction.
What is the AEIOU mnemonic for Urgent Dialysis.
Acidosis
Electrolyte Abnormality - HyperK, Arrythmias.
Ingestion 0 Toxins, Salicylates, Lithium, NaValproate, Carbamezapine
Overload
Uremia - symptomatic - encephalopathy, Pericarditis, Bleeding
Will a Cerebellar disease show a positive babinski?
No. Bainski is indicative of Upper Motor Neuron Lesion
Time course for Papillary Muscle Rupture and details
3-5 days after. New Holo murmur. from RCA
Interventricular Septum Rupture
3-5 days, LAD, new holo murmur, Biventricular Failur, SHOCK, see increased O2 in RA to RV
Free Wall Rupture
within 5 days to 2 weeks, LAD, distant heart sounds - Pericardial effusion with tamponade
Left ventricular aneurysm
up to SEVERAL MONTHS AFTER - LAD, see subacture heart failure, stable angina.
Patient’s eye has a “down and out” presentation. How would two causes, Nerve Ischemia and Nervie compression, be different?
Nerve Compression would have mydriasis
Patient has maroon colored GI bleed thats painless for the past 2 weeks. She has HTN, DM, hypercholestrol. Carotid pulses delayed. BUN is 34, Cr is 1.6. MCV is normal He last colonoscopy at 6 months ago was unremarkable, but only reached ascending colon. What is the cause and why?
Angiodysplasia - this is mostly in the right colon. seen with advanced RENAL DISEASE and vWD and Aortic Stenosis.
Meningococcal Infection vs Pneumococcal Meningitis?
Meningococcal Infection - this is Neiseeira Meningitis, see shock symptoms and skin petechia and rash
Pneumococcal - Most common cause
Ptient has bad nose bleeds, petechia, Labs have elevated Pt/PTT, increased bleeding time, decreased fibrinogen. He has LOW platelets and LOW leukocytes. What do he got
Acute Myeloid/Promyeloid Leukemia
What would a bone marrow biopsy show in APML?
Atypical Promyelocytes
What is the difference between a Papillary Muscle Rupture and Rupture of the interventricular septum on presentation
IVentricular Rupture has a very harsh mumru. The papillary muscle rupture has a softer systolic murmur of mitral regurge.
Parameters for mammogram in a woman with no RF
age 50-75, every 2 years.
