Uworld Mix 9/30 Flashcards
44 year old womanwith 5 past pregnancys has frequent loss of urine over the last year. Persists for 3 months despite pelvic floor exercises, and needs to concentrate to hold in her urine. She has a slight bulge in the anterior vaginal wall. Post void volume is 50ml. What is the most appropriate therapy. and what it do.
Oral Oxybutynin, an antimuscarinic drug would increase bladder activity and reduce the hyperactivity.
What would differentiate urge incontinence with stress incontinence?
Stress incontence is leakage, happens with valsalva. Often they dont feel like they have to go. Urge incontence would have nocturia.
What kind of incontinence is treated with pessary placement.
Stress incontinence
What are the treatements, in order, for stress incontinence
Lifestyle, Pelvic floor exercises, surgery, pessary placement.
Patient has a lot of pregnancies, has STRONG URGE to void, had a past pelvic surgery for leakage. Do they now have stress or urge incontinence
Urge
How long is a cough to be considered Acute Bronchitis
cough >5days to 3 weeks. When it last >5 days, think acute bronchitis first.
How often do you do colonoscopies if the patient has UC or Crohns?
8 to 10 years AFTER dx, then repeat EVERY 1-3 years!
What condition would you have a colonoscopy every 5 years
a patient that had a previous polyp, or with a family history.
Patient presents with Pulsus paradoxus. What is it and what conditions do you see this in
> 10mmHG on inspiration, seen most commonly with Cardiac Tamponade. but ALSO asthma and COPD
Mechanism of Pulsus Paradoxus in Tamponade
During inspiration, venous return to the right heart causes the ventricular septum to shift to the LEFT side, reducing the left ventricular EDV. Thus, there is less systemic stroke volume.
Mechanism of Pulsus Paradoxus in Asthma or COPD exasperation
the intrathoracic pressure drop is HUGE, causing a pooling of blood to the pulm vascultur, leading to decreasing left ventricular preload. this can impinge on the OUTWARD EXPANSION OF THE HEART, thus like Tamponade.
When do you give Gemfibrozil for Tryglyceride reduction
when the levels are over 1000.
In patients with a hypertriglyceridemia level of 150-500, what does the patient need BESIDE statin therapy
Lifestyle modification - including weight loss, stop alcohol intake, and increased exercise.
What is Cor Pulmonale
right heart failure caused by pulmonary hTN that occurs due to underlying diseases of the lungs, pulm vasculature, or sleep apnea.
patient has been on empric IV Vanc. you narrow down the bug to Step Mutans, sensitive to penicillin. However, there is no IV penicillin or amoxicillin available. What can you give?
IV ceftriaxone
What vaccines must be given to HIV patients
Hep B, Pneumococcal, Td if indicated. And if the CD4 count is above 200, then they can receive MMR and Varicella
45 Female - had recently finished treatment for tuberculosis with RIPE. She drinks alcohol, on OCPs. Now, has fatigue, nausea, icteric, and her LFTs are in the hundreds. BR is 4.8. PT/PTT normal. Hep Serology all negative. Bx shows panlobular mononuclear infiltration and hepatic cell necrosis. What is the dx
Hepatitis from ISONIAZID use
What makes isoniazid induced liver injury different from other drug induced liver injury
Other drug induced liver injuries would have a rash, eosinophilia, arthralgias, fever, leukocytosis
What kind of hepatitis is characterized as granulomas on liver biopsy.
Tuberculous hepatitis, aka miliary tuberculosis.
once drug induced and viral induced hepatitis is ruled out, what do you consider
autoimmune hepatitis
What kind of liver abnormalities can be caused by OCPs
LFTs, hepatic adenoma. but NOT necrosis. or dysfunction.
54 year old male stepped on a nail, his last TD vaccine was 12 years ago. What kind of vaccine/booster does he get.
Tdap, meaning the full vaccine, not just the booster. Recommendation is a Td booster every ten years after 18, and adult patients should get the Tdap as a one time dose in place of the booster.
So - Tdap, 10 years after 18, another Tdap, then ten years.
Patient has hypotension, JVP, muffled heart sounds, with pulsus paradoxus. His complains of worsening weakness and exertional dyspnea for 2 days. WHat is the cause of his complaints?
Decreased Left ventricular preload - he has Cardiac Tamponade - which is fluid in the pericardial cavity.. This RESTRICT VENOUS RETURN to the heart, thus decreasing preload.
75 year old man has a 6 month history of chronic stable angina. He was given three meds, ASA, nitro, and something else. What is the mechanism of the something else.
firstline is BB, second line is CCB. either way, they both REDUCE MYOCARDIAL CONTRACTILITY and heart rate, thus reducing myocardial oxygen demand.
Once cholesterol levels are above 190, should you wait for statin therapy after lifestyle change?
No
Patient is an old man with repeated pneumonia and infections. He has a fever now. Theres bronchial breath sounds on the lower left lung. Theres point tenderness on the right side of the ribs. X ray shows osteolytic lesions. labs show increased leukocytes. What does he have, and why cant he fight infections.
He has multiple myeloma, and thus has decreased immunity because he cant make antibodies.
What disease would be from a immunodeficiency through complement or MAC deficiency
Neisseria Gonorrhea
What is more common a cause for MR, Myxomatous Degeneration, or Rheumatic Heart disease
Myxomatous Degeneration - this would cause MVP. More common in developed countries.
What age would UC present?
BIMODAL distribution. MOST at 15-40, but some will present at 50-80.
28 female IV drug uses has a fever, dry mucus membranes, poor dentition, and a early diastolic murmur had the LSB at full expiration. ECG shows 2:1 2nd degree AV block. Leukocytosis of 13K is there too. Is this tricuspid valve endocarditis or perivalvular abcess.
Perivalvular abcess. If this was TV endocarditis, this would be a HOLOSYSTOLIC murmur, bigger with inspiration, and conduction abnormalities are much less common.
Management of moderate hypercalcemia - 12-14
if any tx, IVF>
Management of severe or symptomatic hypercalcemia - >14
NS with calcitonin, avoid loop diuretics (unless theres volume overload.
Long term - bisphosphonates.
When would you use glucocorticoids for hypercalcemia?
Granulomatois diseases like sarcoidosos or lymphomas. These areas would have more 1,25 dihydroxyvitamin D
Why shoudl you NOT use Loop diuretics to help hypercalcemia?
could worsen the volume depletion that is caused by hypercalcemia.
When would you give a patient both Tdap vaccine AND tetanus Immunoglobulin?
When the wound is severe or dirty, and they are either unimmunized, <3 doses of toxoid, or uncertain of when.
When should an adult recieve their adult vaccination of Tdap
if they have not received one within 5 years, post their 3 tetanus toxoid doses
This lady has mood instability after a break up, hx of cutting herself, blah blah Borderline Personality Disorder. What would she most likely have a history of?
Childhood trauma, such as sexual abuse and neglect.
Treatment for Borderline Personality Disorder.
Psychotherapy - with adjunctive ppharm with 2nd gen antipsychotics
Sexually active female after a gangbang with a painless ulcer and some LAN has tested negative with RPR and HSV PCR. What is the next best step in managment
give penicillin empirically anyway. Cant hurt
2nd trimester: What does a decreased AFP, HCG, Estriol, and normal Inhibin A mean
Trisomy 18.
2nd trimester: what does an increase in bHCG & inhibin A, with a decrease in AFP and Estriol mean?
Trisomy 21. think - Downs are MORE INHIBITED but MORE HCGable
2nd trimester - what DEFECT does an increased AFP mean.
Neural Tube defect of Abdominal Wall defect.
11 year old boy has a pruritic skin rash for 2 weeks. It wakes him at night. he had a cousin over with the same symptoms. he has 2-3 erythmatous papules and vesicles with excoriation on his neck, hands, feet and waistline. not his chest or upper arms. What does he have, and what do you give., and what is the key
Scabies - so give him topical permethrin. The key here is the hands, feet, and WAISTLINE, and the fact that it avoided the chest and upper arms. it goes towards the flexors.
Patient is a 54m post laprascopic sugery for biliary pancreatitis. 4 days later, they have decreased breath sounds at both bases, and PO2 is low, with low CO2. What do they have and why
Atelectasis, due to impaired cough and shallow breathing. They postoperatively have a change in lung compliance, shallow breathing, limiting recruitment of alveoli. This is why you need incentive spirometry.
patient possibly OD’d on something for heart disease THey have profound bradycardia and an av block. atropine doesnt work. Treatment? would trancutaneous pacing work?
Glucagon. OD’s on BB. Pacing would NOT help in an OD.
24 female started noticing chest pains with exercising. She’s always had this murmur on the first right intercostal space, mid systolic, with a palpable thrill. What is causes the chest pains.
She has a SUPRAVALVULAR aortic stenosis. Which is like AS but higher. its congenitla. They would get hypertrophy over time, as well as coronary artery stenosis. thus, they would get myocardial ischemia, thus the anginal symptoms from INCREASED MYOCARDIAL OXYGEN DEMAND
How would acute lead toxicity present in adults?
Gastrointestinal (abdominal pain, constipation), Neuropsychiatric (forgetfulness and neuropathies), and MICROCYTIC ANEMIA. = basophliic stippling.
What would be the first line therapy for bullous pemphigoid
a topical steroid like CLOBETASOL
What is the treatment of spontaneous Pneumothorax?
if small, Observation and oxygen. If LARGE - needle aspiration or chest tube.
What is the difference between syphillis and granuloma inguinal
Granuloma Inguinal has no LAN and is usually seen in India, Guyana and New Guinea
What would cause benign jaundice (with increased uncongugated BR despite normal total BR)
decreased heaptic uridine diphosphogluconurate glucoronosyltransferase (UGT). These levels dont reach “adult levels” until 2 weeks post birth.
What is first tretment for physiologic jaundice if there is rapidly arising hyperbilirubinemia
phototherapy. Exchang transfusion if >20-25
Side effects of Cyclophosphamide - not just one
Hemorrhagic Cystitis, Bladder carcinoma, Sterility, and myelopsupression.
What chemo/immunosupression drug causes cochlear dysfunction
cisplatin
What drug that starts with C could cause Gout?
Cyclosporine
