Uworld Mix 9/29 Flashcards
56m has progressive asthma symptoms. Patient has nighttime cough and wheezing. She sometimes needs her albuterol inhaler after meals. She is already on fluticason, albuterol, lisinopril, and aspirin with no change in her meds for YEARS. She fat. Not wheezing now. What is the next step in management?
PPI like esomeprazole - She has asthma exasperations from GERD. notice its post meals these happen.
65 m, COPD, Afib, HTN and T2DM - had SOB for 3 days, as well as runny nose, itchy eyes and sore throat. She is treated later with bronchodilatory, steroids, high flow facial mask, and lorazepam. 30 min later, has a tonic clonic seizure. Why do dis happenz
Carbon Dioxide retention - this is actually O2 induced. After sudden O2 administration cause vasodilation (cant vasoconstriction), decreased CO2 uptake, and decreased RR–> CO2 retention
What does hypercapnia cause cerebrovasculature to do
VASODILATION
LIst the timeline of complications after MI - Hours, Days, Weeks, Months
Reinfarction - hours to 2 days Vent Septal Rutpure - hours to 1 wk Free Wall Rupture - Hours - 2wks Papillary Muscle Rupture - 2 days to 1wk Pericarditis - 1 day to 3 months Left Ventricular Aneurysm - 5d to 3 months
How would a ventricular aneurysm present, and how would you confirm
Progressive decompensated HF from 5 days to 3 months after an MI, confirmed with Echocardiographay, showing thinned, dyskinetic wall.
How would a Ventricular Wall Rupture present?
A large pericardial effusion, causing tamponade, hypotension, elevated JVP, and then pulseless electrical activity
What would be the sign of ACUTE Liver Failure? theres 3 specific qualifiers
Signs for hepatic Encephalopathy, Elevated LFTs in the thousands, and INR >1.5
What differentiates acute liver failure from acute hepatitis?
Hepatic Encephalopathy. Acute Hepatitis has a much better prognosis. ACH could LEAD to ALF.
Would you see hyperbilirubinemia in Acute Liver Failure?
Yes, but it is NOT a requirement.
48 Year old Caucasion Male is SOB, out of breath. HE has a harsh Systolic mumur best heard at R2nd ICS radiating up the carotids. S4 is heard. What is the cause?
a Bicuspid aortic valve - he has CHF from aortic stenosis. a bicuspid aortic valve is the most common cause of aortic stenosis in patients under 70.
66m has SOB. started a week ago. recent hx is of stending for Coronary Artery Disease. He has smoked for 35 years, had a hx fo neumonia 6 mo ago, and is in mild respiratory distress. He has decreased breath sounds at the base. ph 7.46, pO2 73, pCO2 31 - whats dx is doing dis shit
CHF. the key here is the hix of coronary artery disease, the wheezing and the bibasilar crackles. Dont let the APPEARANCE of ABG fool you into COPD exasperation. THey have respiratory alkalosis. COPD has acidosis.
How would aspirine, alcohol, and cocaine cause bloody emesis?
ASA decreases the protective prostoglandin production, and cocaine results in vasoconstriction, the alcohol will cause mucosal erosion. This all causes a hemorrhage
What would you see in bronchoscopic biopsy for Histoplasmosis?
Granulomas with yeast forms
Patient had a bowel resection from crohns disease has been under parentereal nutrition for 2 years. Now they have gallstones causein RUQ pain. How did their hc cause this?
Gallbladder stasis - because of the resection, and parenteral nutrition, there isnt proper stimulation for CCK, which would have triggered gallbladder contraction.
When would you see estrogen induced increased cholesterol secretion is the cause of gallstones?
Pregnancy. Estrogen causes more cholesterol secretion, and progesterone causes reduction in bile acid secretion.
Would INCREASED enterohepatic recycling of bile acids cause gallstones?
NO
How would Crohns disease or ileal resection predispose to cholesterol gallstones
causing DECREASED recycling of bile acids.
34 m sexually active complaining of palpitations and dizziness. He travels frequently for works. LIver span is 8 cm and spleen isnt palpable. No Cervical lymph or skin rash. Only lab adnormality is 80k platelets. Platelet clumping has been ruled out. What does he have, and what would be next tests?
ITP - this is isolated thrombocytopenia. Could be either from decreased production, or increased destruction. Preliminary tests would be HIV, Hep C and EBV testing. However, since there is no LAN, EBV is less likely.
Sexualy active male has fever, sorethrough HA, skin rash. Rash is “spread to his entire body.” Has not been outdoors. There are several raised, grey mucosal patches. Has diffuse LAN.. HIV negative. What is the cause?
Syphilis. yes, you DO see oral lesions when secondary.
How would a patient with 2o Syphilis with EBV?
The rash in EBV is more UNLIKELY.
What is the range for normal calcium?
8.4-10.2
Patient has alcoholic cirrhosis and leg swelling. He was given furosemide to help. What would this trigger?
Hepatic Encephalopathy
What would precipitate hepatic encephalopathy in a patient with an already bad or failing liver?
Narcotics, Hypovolemia (diuretics or diarrhea), Electrolyte Change, Infection, protosystemic shunting, increased nitrogen load form a GI bleed.
What would you PHYSICALLY see in Hepatic Encephalopathy
asterixis, ataxia, AMS, and change in sleep.
What would you give to decrease ammonia in HE?
lactulose and rifamixin
So a patient has HE, and they are hypovolemic, and their labs show Na 134, K 3.0, and possible metabolic alkalosis (increased HCO3). what do you do FIRST
give K, then give fluids.
Patient has a lymph node on the cervical neck that is found to have metastatic squamous cell carcinoma. Do you treat now, or find the primary tumor first?
Find the primary tumor first
Patient has a LN on cervical neck showing metastatic squamous cell carcinoma. She smokes, drinks, been in jail, had a hysterectomy, and CT of the chest is normal. What do you do
Panendoscopy -SqCC is common in the mucosa, and need a EGD, Bronchoscopy, and Laryngoscopy.
What lab abnormality would be seen in a patient with a urinary obstruction, and intermittently has high volum
hypokalemia
60F has to always use the bathroom. Has dysuria, urgency, recurrent UTIs, Past history includes hysterectomy for endometrial cancer, and the vulvar skin shows reduced elasticity with labia minora retraction. No loss of pee with vlasalva, UA and postvoid normal. What they pee?
Estrogen Deficiency. Why this cause all the UTIs? decreased collagen–> decreased glycogen content–> loss of vaginal lactobacilli and elevated vag pH.
Guy after a motor vehicle collision, obviously hit the chest. has hypotension, tachycardia, and unresponsive, even after 2L bore infusion of saline. Neck veins are flat, trachea is midline, and extremities are cold. What would e seen in the cardiovasculature?
Small left ventricular cavity with EF well over normal. They have HYPOVOLEMIC SHOCK–> decreased preload –> decrease CO. HOWEVER, the left ventricle gets smaller due to the lack of filling, increasing EF to preserve CO as much as possible.
WHen would you see a dilated left ventricl with apical hypokinesis and engorgment of the inferior vena cava?
Cardiogenic Shock.
What is the MAIN difference between Cardiogenic and Hypovolemic Shock
JVP. Distended in Cardiogenic Shock. Flat in Hypovolemic.
When would you see diastolic collapse WITH elevated right ventricular pressure?
Cardiac Tamponade.
When would you see distolic collapse WITHOUT elevated RV pressure?
Hypovolemic Shock
Boy has Guillain-Barre Syndrome. What nervous structure is impaired and how?
Peripheral Nerve Fibers, which are DEMYELINATED.
What diseases affect the ANTERIOR HORN CELLS
Spinal Muscular Atrophy, Polio, ALS
What diseases affect the Dorsal and Lateral Spinal Column?
Vegans with B12 deficiency.
18 m old has a fever and rash, and has a history of atopic dermatitis. has clear vessicles over erythematous skin on both cheeks as well as a few scattered lesions with overylying dark red crusting. Has Submandibular LAN. Rest of the skin is dry. What is the etiology.
HSV infection superinmposed onto Atopic Dermatitis, called Eczema Herpeticum
Features of Blastomycosis
Skin - Wartlike lesions, violaceous nodules, skin ulcers.
Bone: osteomyelitis
GU - Prostatitis, Epididymo-orchitis
CNS - meningitis or brain abscess.
What areas is Balstomycosis endemic?
The midwest, mississippi river valley, great lakes, canadian provinces
Actinomyces - what do you see.
remember, actinimyces ISRAELII - granular yellow pus - sulfur granules.
Aspergillosis - what you gotta know
from molds, in the immunocompromised, usually a pulmonary infection. You DONT see cutaneous infections.
How does a polysacharide vaccine induce immunity
Relatively T cell independent B Cell response.
POlysach cannot be presented to t cells by themselves
What kind of vaccine induces a T-Cell DEPENDENT B-Cell response with memory B-Cell Production
Pneumococcal CONJUGATE vaccine
What vaccine inudeces a mostly igA response?
Polio
What vaccines produce a CD8 T cell response
Live attenuated like MMR and Intranasal infuena vaccines.
What is Legg-Calve-Perthes Disease
indiopathic avascular necrosis of the femur. See insidious hip pain, limb. Positive trendelenburg sign. X ray is NORMAL in EARLY stages, later stages show femoral head flattening fragmentation, sclerosis. MRI shows the avascular/necrotic femoral head.
What would make you suspected LCG disease vs Transient Synovitis?
LCG would last much longer. Transient synovitis resolves within a few weeks.
What would be the inpatient regimen for PID
IV Cefotetan with doxycycline
What is the Outpatient regimin for PID
IM Ceftraxone and doxycycline.
Is it safe to do a colposcopy in pregnancy?
Yes
When do you use JUST antibiotics in a pleural effusion
if its small and theres NO respiratory distress or hypoxia
What is the treatment of Restless Leg Syndrome and where does it act
Pramipexole, Ropinrole -dopamine agonists.
