Uworld Mix 10/9-9 Flashcards
35 IVDU has right sided wekaness that started 2 hours ago. Has had night sweats and malaise for the last 7 days. 102F, HTN., Tachy. Neuro exam shows 3/5 strength on right side. Theres small mobile vegetation of the aortic valve and mild aortic regurgitation. BCx done, IV antibiotics given. WHICH IS THE NEXT STEP?
- Aortic valve surgery
- Continue Current care with observation
- Antiplatelet therapy
- Start IV heparin
- Start Oral Warfarin
Continue care with observation
patient has a cerebral infarct from bacterial endocarditis with an acute stroke==TIA.
All you can do is give Antibiotics
ASA should have been used early and for atherosclerosis.
Heparin IS CONTRAINDICATED -would cause intracranial hemorrhage.
Would use warfarin b/c this is far cardiembolix stroke due to AFIB. Not in this patient.
30 year old school teacher - 3 day hisotry of fever, chills, and sore throat. He denish cough, chest pain, or difficulty breathing. He has enlarged tender cervical lymph nodes on the left, and uvula is deviated to the right. What is the most appropriate tx?
Needle peritonsillar aspiration, THEN do antibiotics.
Because the abscess is obviously there, its more complicated than a throat swab and just abx is not enough.
What two modalities of diagnosis are used to diagnose a stone in the urerters, and which is most appropriate to do first.
CT and Ultrasound. But US is done first.
Patient has back pain that is releived with leaning forward, but hurts when leaning back. Pain radiates to the buttocks with no urinary issues. There is no pain when he lays down at night. His back pain is more related to posture. What is it
Lumbar Spinal stenosis, aka Osteoarthiritis of the spine. - Neurogenic Claudication
Lumnbar extension would narrow the spinal canal.
Young person with back pain that worses with rest and improve with activity.
Ankylosing Sponyliitis (seronegative)
Patient has back pain that is relieved with leaning forward, hurts with leaning back, depends on if he’s exerting himself. There is decreased pulses, cool extremties, and diagnosed with ankle brachial index
Vascular claudiaction - aorteliac atherosclerosis
What are the wells criteria to deduce the clinical probability of PE
+3 - signs of DVT or alternate diagnosis less likely than PE
+1.5 - Previous PE or DVT, HR >100, Recent immobilization.
+1 - Hemoptysis, Cancer
Need >4.
31 female has SOB and anxiety. She was on a recent plane ride. Non smoker. Uses condoms with sex. Has only a hx of anxiety and sleep probelms, and FH of colon cancer. No edema, no skin rashes.
Ph 7.43, CO2 35, PaO2 90.
D Dimer Normal as is Xray.
What is her likelyhood of PE, and what do you do next?
Not likely.
Reassurance
What do you do when PE is unlikely
PE unlikely–> D-dimer.
If >500 Do Ct Angio.
Patient has Giant Cell artirits that is treated. 6 months later, she has difficulter climbing up stairs and getting up from a chair. she has decreased strenght in the proximal lower extremities.
Normal ESR and CK
Drug induced myopathy due to steroids.
Muslce pain and stiffness in the shoulder and pelvic girdle.
Tenderness with decerased range of motion at shoulder, neck and hp
RESPONDS to steroids
ESR increased
Polymyalgia Rheumatica
1 hour old premature girl is born, had preterm premature rupture of membranes. Born via csection. Thers severe respiratory distress. CXR shows increased lung volumes and fluid in the interlobar fissures. What is the etiology?
Delayed resorption and clearance of alveolar fluid - This is Transient Tachypnea of the Newborn
Findings of Transient Tachypnea of the newborn
Tachypnea, Increased work of breathing, CLEAR breath sounds, Chest X ray shows hyperinflation, fluid in fissures.
Management f Transient Tachypnea of the Newborn
Supportive care, resolves in 1-3 days.
What are risk factors of TTN
C-section, preamture
Patient has a 20 pack smoking history, and a plamber for the past 30. CXR shows atelectasis, bilateral pleural plaques over diaphragm. Theres a round 6 cm cavitary mass in the right lower lung field. What is most likely found on biopsy?
Bronchogenic cancer or Mesothelioma?
Bronchogenic Cancer
Remember that cancer is MORE common result of asbestos in smokers than mesothelioma.
What are three PULMONARY and 2 systemic causes of hemopthysis
Bronchitis, Bronchiectasis, and Lung Cancer, Granulomatosis with Polyangiitis, Goodpasture syndrome
Describe Bronchiectasis
IRREVERSIBLE dilation and destruction of bronchi, resulting in chronic cough and inadequate mucus clearance. Have a hx of recurrent respiratory tract infections
72 year old man passes out while getting out of bed. He had recent watery diarrhea for the past 2-3 days. BP studies show orthostatic hypotension. Asucultation shows clear lung fields. ECG normal. What is the MOST SENSITIVE indicator of the condition
Decreased Urine NA.
Hypovolumia from diarrhea –> increased aldosterone production –>causing Na resorption and K wasting.
PFts of Interstitial lung disease
normal to inc Fev1/FvC ratio, DECREASED DLCO, dec TLC, dec RV
Etiologies of exudative thoracentesis
Empyema - see neutrophils in fluid. This is bacterial infection.
Chylothorax - Milky white fluid, increased triglycerides. from DISRUPTION OF THORACIC DUCT
Malignancy
TB
What is are the PFTs for COPD or chronic bronchitis
FEV1/FVc <70% predicted, and a NORMAL DLCO.
What would have an obstructive pattern and LOW DLCo
Emphysema.
What would have an Obstructive pattern and INCEASED DLCO
Asthma
What would have restrictive pattern and LOW DLCO
Interstitial lung disease, sarcoidosis, asbestosis, heart failure
what are the features of COMPLICATED effusion from pneumonia
Bacterial invasion - ph<7.2, Glucose <60, WBC >50k
What would you change on a ventilator in a patient who has respiratory failure, bilateral opacities, and ABG of pH 7.45 PaO2 54 PaCO2 30 HCO3 - 21
INcrease in PEEP.
This both oxygenates AND stops respiratory collapse in ARDS
