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UWorld Pt 2 Flashcards

1
Q

Long-term complications of untreated hyperthyroidism

A
  • Cardiac arrhythmias (AFib) from excessive adrenergic tone
  • Cardiomyopathy
  • Osteoporosis due to thyroid hormone stimulated release of Ca and Phos from bone
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2
Q

Red flag signs to consider secondary causes of hypertension?

A

Young onset
Resistant to 2 or more meds
Sudden jump
Other atherosclerotic diseases (ex: CAD, carotid artery stenosis, PAD)

ex: 57 y/oM w/ PMH of claudication, carotid artery duplex abnormality, HTN previously controlled on HCTZ and amlodipine presenting w/ sudden sustained increase in BP over the past month.

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3
Q

Case control vs.

(a) cross sectional study design
(b) Cohort study

A

Case control- look at pts w/ and w/o disease, then look back to see if had exosure to risk factor (ex: take ppl w/ and w/o CAD, see who smoked)

(b) Cross sectional- Look at ppl w/ and w/o risk factor, then compare disease prevalence (take smokers vs. nonsmokers, see who has CAD)
(c) Cohort study- Look at exposure to risk factor, then either look back at past (restrospective) or wait till future (prospective) to compare disease incidence

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4
Q

Which study design is most similar to restrospective cohort?

A

Cross sectional: both look at risk factor exposure

  • retrospective cohort: look who in the past did or did not have exposure, then see if disease incidence (still in the past)
  • cross sectional: looking at current exposure to risk factor, then compare disease prevalence (who has the disease now w/ current exposure)
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5
Q

Give an example of a cross-sectional study

A

ex: Comparing coronary artery calcification score calculated before stress test, to prevalence of ischemia on stress test

B/c comparing current risk factor exposure (CAC score value) to current prevalence of disease

vs. incidence of disease which would get you to cohort study

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6
Q

Urethritis in male

(a) 2 MC types
(b) Urethral discharge
(c) Tx

A

(a) Urethritis categorized by gonococcal (neisseria gonorrhea) vs. nongonococcal (MC chlamydia trachomatis)

Gonococcal

(a) purulent discharge
(c) IM CTX + azithro for concurrent chlamydia

Nongonococcal

(b) Watery scant discharge
(c) Azithro

So if NAAT for gonorrohea is negative, discharge watery and scant: azithro is first line (or CTX + azithro, but not just CTX)

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7
Q

What is the kappa-statistic?

A

Quantitative measure of inter-rater reliability ranging from -1 (perfect disagreement) to +1 (perfect agreement), kappa of 0 suggests agreement due to change

Higher kappa means better reliability

ex: have 2 radiologists read the same CXR if counting diagnosis

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8
Q

Mathmatically what is the power of a test/study

A

Power = ability to detect a difference when one actually exists

power = 1 - beta
beta is the risk of type II error- failing to reject null hypothesis when it is false

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9
Q

Type I vs. type II error

A

Type I error (alpha)= reject null hypothesis when it is true (say there is a significant difference when one does not exist)

Type II error (beta) = failing to reject null hypothesis when it is false
1-beta = power

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10
Q

In SLE

(a) Antibody most likely to be positive
(b) Antibody most likely to mean SLE
(b) Antibody that correlates w/ disease activity

A

SLE

(a) Most sensitive- dsDNA
(b) Most specific- anti-smith, don’t correlate w/ disease activity, may even remain positive in pts w/ clinically silent SLE while anti-DS Ab return to normal range
(c) Correlate w/ disease acitivty = anti-dsDNA, associated w/ development of lupus nephritis

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11
Q

Dx associated w/

(a) Anti-centromere Ab
(b) Anti-Smith Ab
(c) Anti-mitochondrial Ab
(d) Anti-RO/SSA

A

(a) Anti-centromere = scleroderma
(b) Anti-smith = specific, but not very sensitive, for SLE
(c) Anti-mitochondrial = PBC
(d) Anti-RO = connective tissue disease, not very specific: Sjogrens, lupus erythematous (butterfly rash of SLE), RA

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12
Q

When to add hydroxychloroquine vs. cyclophosphamide to prednisone in lupus patients

A

Prednisone

+hydroxychloroquine (anti-malarial agent) for less severe manifestations- arthralgias, serositis (pleural effusion), cutaneous manifestations

+cyclophosphamide (alkalating agent to block cell replication) used in more severe solid end-organ involvement: lupus nephritis, CNS involvement, vasculitis

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13
Q

Clinical features of hidradenitis suppurativa

A

Chronic inflammatory d/o of occluded skin follicles- starts w/ nodules in intertriginous area (armpit, groin) that can progress to abscess, recurrent nodules w/ sinus tracts, comedones, scarring

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14
Q

Tx for hidradenitis suppurativa

A

Hidradenitis suppurativa = chronic inflammatory skin d/o of clogged hair follicles, recurrent nodules in intertriginous areas that can become abscesses and form sinus tracts

Tx = weight loss, smoking cessation
Mild- topical clinda, intralesional steroids
Moderate (sinus tracts/scaring)- oral abx, start w/ doxy (tetracyclines)
Very severe can try TNF-alpha inhibitors, retinoids, surgical excision

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15
Q

Pt has anti-hepatitis C virus antibody positive- next step in management?

A

Send hepC RNA PCR

Pos Ab can be active infection, but could also be cleared infection or false positive. So before tx must confirm w/ PCR

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16
Q

How may pregnancy mirror hyperthryoidism?

A

Hyperestrogen states can raise levels of thyroxine-bnding globulin secreted by the liver, so total T3/T4 can be elevated
But TSH should be normal or low

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17
Q

Besides avoiding abx use, how to decrease risk of CDiff

A

Avoid PPIs or gastric acid reducers.

CDiff spores are acid resistance, but PPIs may alter the colonic microbiome therefore allowing CDiff proliferation

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18
Q

Routine prenatal lab tests for pregnant mamas

A

Initial prenatal visit: all the stuff- RhD type, Ab screen, CBC, infections (HIV, VDRL/RPR, HBsAg, chlamydia PCR), Rubella and varicella immunity, pap (if screening indicated), dipstick for urine protein, urine culture

24-28 weeks: CBC (Hb/Hct), Ab screen in RhD negative, 50g 1-hr GCT

35-37 weeks: group B strep culture

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19
Q

When during pregnancy to send

(a) TSH
(b) Urine culture
(c) CBC
(d) 24 hr urine protein collection

A

(a) Not routinely sent if asymptomatic, only if symptoms of hypo/hyper or known thyroid disease b/c pregnancy can alter TBG
(b) Urine culture sent in early pregnancy to screen for asymptomatic bacteriuria (usually GBS)
(c) CBC at initial visit, then again at 24-28 weeks- for physiologic anemia due to expanding plasma volume, tx w/ iron supplementation
(d) Urine protein in evaluation for preeclampsia

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20
Q

Platelet cutoff to get epidural for labor

A

Risk of spinal epidural hematoma- contraindicated for severe thrombocytopenia (plts under 70k) or rapidly dropping platelets (ex: in preecampsia w/ severe features)

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21
Q

Abx choice for UTI in pregnancy

A

3 options: fosfomycin, keflex (cephalexin), augmentin (amox-clavulanate) for 3-7 days

Have to avoid cipro and bactrim (tx UTI in non-pregnant pts) given risk to fetus

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22
Q

Do all snorers get sleep study?

A

Noo- depends on risk factors: obesity, HTN, observed apneas, old age, neck circumference over 17cm

look for other modifiable behaviors (smoking cessation, EtOH before bed)

ex: 45 y/o non-obese M who drinks 1-2 beers prior to bed, wife complains of snoring, doesnt need sleep study

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23
Q

68 y/oF started on metop and amiodarone for AFib, INR is 2.6, what to do w/ Coumadin dose?

A

Amio inhibits Cyp2C9 (liver enzyme) that metabolizes warfarin-

Amio slows warfarin metabolism => reduce dose by 25-50%

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24
Q

Name 4 drugs that increase effect of warfarin

A

Flagyl, quinolones (cipro, levaquin)- by altering intestinal flora

Amio and azoles by inhibiting liver enzyme

Acetaminophen by reducing vitK recycling

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25
Q

Do the following increase or decrease effect of warfarin

(a) flagyl
(b) rifampin
(c) OCPs
(d) amio

A

(a,d) flagyl and amio increase effect of warfarin => increased INR

(b,c) rifampin and OCPs reduce effect of warfarin, would lower the INR

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26
Q

Pt w/ Afib developed popliteal thrombus treated w/ thrombus aspiration, what would leg pain a few hours later be concerning for?

A

Compartment syndrome due to post-traumatic edema/inflammation

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27
Q

Diagnostic pressures for compartment syndrome

A

compartment pressure over 30

OR

diastolic - compartment pressure less than 20-30

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28
Q

Clinical features of renal cell carcinoma

A

Smoker, hematuria, erythrocytosis (elevated Hb due to EPO paraneoplastic syndrome)

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29
Q

What dermatologic condition is associated w/ celiac disease?

A

Dermatitis herpetiform = intensely pruritic papules and vesicles on extensor surfaces (knees, elbows) as well as back and buttocks

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30
Q

Escalating tx for eczema

A

Atopic dermatitis:
Emollients
Oral antihistamines
Low potency topical steroids: hydrocortisone
High potency topical steroids: triamcinolone, betamethasone
UV phototherapy
Systemic immunosuppressants

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31
Q

Triamcinolone vs. hydrocort?

A

High-potency (triamcinolone) vs. low-potency (hydrocortisone) topical steroid

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32
Q

Tacrolimus vs. triamcinolone use for eczema

A

Don’t use steroid cream (triamcinolone) on the face or eyelids, instead use tacrolimus (calcineurin inhibitor)

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33
Q

Name 3 dermatologic conditions that doxy can be used to treat

A
  1. rosacea
  2. hidradenitis suppurativa
  3. acne
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34
Q

Should women w/ HIV breast feed?

A

Independent of viral load/control- in developed nations don’t breastfeed with HIV

In resource-poor nations can consider breastfeeding due to high infant mortality from water-borne (formula) illnesses

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35
Q

Define preterm labor

(a) When to give betamethasone
(b) When to give tocolytics
(c) Other drugs used

A

Preterm labor = before 37 weeks 0 days

(a) Betamethasone (intramuscular) definitely before 34 weeks, +/- for 34-37 weeks

(b) Tocolytics (nifedipine)before 34 weeks (33 weeks 6/7 days and before)
- contraindicated after 34 weeks

(c) Before 32 weeks also give mag sulfate, then PCN at all times if GBS positive or unknown

36
Q

76 y/oF w/ malaise, diffuse achy pain x6 weeks mostly in shoulders and pelvis

(a) Dx
(b) Next step in mgmt.
(c) Tx
(d) R/o what other symptoms

A

(a) Polymyalgia rheumatic
(b) Confirm w/ highly sensitive ESR
(c) Low-dose glucocorticoids (ex: pred 10-20mg PO daily)
(d) Ensure no headache, jaw claudication, vision loss, forehead TTP to r/o GCA- would be cause for much higher steroid dose (pred 40-60mg)

37
Q

How to distinguish statin-induced myopathy from polymyalgia rheumatica

A

PMR- elevated ESR is highly sensitive

Statin-induced myopathy: normal ESR, elevated CPK

38
Q

Elevated WBC in CSF- how to determine viral meningitis vs. traumatic tap

A

Correct WBC for RBC due to blood leakage into CSF- expect 1 WBC for every 750-1000 RBCs

Ex: CSF w/ 75,000 RBCs, 100 WBCs, absent xanthochromia, elevated protein, high glucose- c/w traumatic tap and not viral meningitis

39
Q

Interval f/u colonoscopy after polypectomy

(a) When f/u in 5 yrs vs 10 yrs
(b) When f/u in 3 yrs vs 10 yrs

A

Polyps- typical progression from dysplastic –> carcinoma in situ –> adenocarcinoma

(a) 5 yrs when 1-2 small (under 1 cm) tubular adenomas present
(b) 3 yrs for 3-10 adenomatous polyps, any adenoma over 1cm, any adenoma w/ high-grade dysplasia or villous features

Then for large (over 2cm) sessile polyps or polyps w/ adenocarcinoma: 2-6 mo f/u

40
Q

What features of adenomatous polyp require close (2-3/6 month) repeat colonoscopy?

A

Close f/u required: size, pathology (endoscopist can tattoo original removed lesion)

  • over 2cm (large) sessile polyp: 2-6 months f/u
  • polyp w/ adenocarcinoma (must have minimal invasion and at least 2mm margins): 2-3 month f/u

Exclude residual or recurrent disease
Also assess for any missed synchronous lesion

41
Q

Healthy 61 y/oM has 1-cm pedunculated polyp found in sigmoid colon on colonoscopy

  • path shows well-differentiated adenocarcinoma in the head of the polyp
  • stalk and polyp margins are free of cancerous tissue

When should his next colonoscopy be?

A

Colonoscopy f/u based on size (small under 1cm, large over 2cm) and pathology (adenocarcinoma or not)

Adenocarcinoma w/ good margins: f/u in 2-3 months to assess for residual or recurrent disease

42
Q

32 y/oM w/ epilepsy, starting carbamazepine

What warning signs for dangerous side effect should he be warned about?

(a) What if he was 80 y/o?

A

Carbamazepine and bone marrow suppression
Be aware of early symptoms: fever, mouth ulcers, easy bruising/petechiae as markers of neutropenia, aplastic anemia, or thrombocytopenia

(a) Elderly at risk of SIADH and mild anticholingeric effects (glaucoma, urinary retention, constipation)

43
Q

50 y/oM p/w acute gout flare- best step to confirm diagnosis

A

Not serum uric acid (can be normal in acute flare)-

Arthrocentesis!
See negatively birefringent, needle-shaped crystals

44
Q

Gout vs pseudogout arthrocentesis

A

Gout- negatively birefringent, needle-shaped crystals

Pseudogout- positively birefringent rhomboid-shaped crystals

45
Q

When to use NSAIDs vs colchicine for acute gout flare?

A

NSAIDs always first line (indomethacin)

But if NSAIDs contraindicated (CKD, peptic ulcer disease, on anticoagulation, CHF)- use colchicine (microtubule polymerization inhibitor)

46
Q

Illness script for polymyositis

A

40-50 y/o, painless proximal muscle weakness (can’t climb stairs, can’t brush hair) w/ elevated muscle enzymes (CK, AST/ALT and inflammatory markers

47
Q

Diagnostic criteria that distinguish:

(a) fibromyalgia
(b) polymyositis
(c) polymyalgia rheumatica

A

Diagnostic criteria

(a) fibromyalgia- 3+ months of widespread pain index, normal labs
(b) painless proximal muscle weakness- elevated muscle enzymes (CK, transaminases), autoantibodies (ANA, anti-Jo1)
(c) PMR- elevated inflammatory markers (ESR/CRP) and rapid improvement w/ glucocorticoids

48
Q

Typical clinical features of

(a) fibromyalgia
(b) polymyositis
(c) polymyalgia rheumatica

A

Clinical features

(a) fibromyalgia- younger (under 50s) w/ diffuse widespread pain worse at trigger points
(b) polymyositis- painless proximal muscle weakness (difficulty combing hair, getting up out of car/walking stairs)
(c) PMR- age 50, stiffness greater than pain in shoulders, hip girdle, neck, w/ systemic signs and symptoms

49
Q

Symptoms of pellagra

A

Pellagra = niacin (B3) deficiency

D’s: dementia, diarrhea, dermatitis (symmetric in sun-exposed areas, usually forms vesicles and blisters)

50
Q

4 prophylactic antimicrobials for neutropenic pts

A

Prolonged neutropenia requires infection prophylaxis

Valgancyclovir- CMV ppx
Batrim- PCP ppx
Fluconazole- against candida (no activity against aspergillus)
Levofloxacin- legionella

51
Q

Definition of delayed puberty in boys

(a) First line in mgmt

A

Delayed puberty = lack of testicular enlargement (over 4ml) by age 14

(a) Start w/ LH, FSH, testosterone levels (to distinguish primary from secondary hypogonadism) and bone radiograph

52
Q

26 y/oM w/ progressive lower back pain x6 months worse in the morning

Exam w/ reduced ROM of lumbosacral spine and markedly reduced chest expansion

(a) Dx
(b) First step in diagnosis

A

(a) Ankylosing spondylitis
1. LBP/stiffness for more than 3 months
2. limited ROM of lumbar spine
3. Limited chest expansion

(b) Play Xray of SI joint- to see early changes of sacroilitis

53
Q

3 diagnostic features of ankylosing spondylitis

A
  1. Chronic (more than 3 months) lower back pain/stiffness improves w/ exercise, not relieved w/ rest
    - due to sacroilitis
  2. limited ROM of lumbar spine
    - bamboo spine on spine xray
  3. limited chest expansion
54
Q

Extraocular manifestations of ankylosing spondylitis

(a) Ocular
(b) Pulmonary

A

(a) Ocular = anterior uveitis- can present as acute unilateral eye pain, photophobia, blurring of vision

(b) Pulmonary- restrictive lung disease due to limited motion at costovertebral joints => limited chest wall expansion,
=> development of apical pulmonary fibrosis

55
Q

Orthostatic proteinuria

(a) Clinical manifestation
(b) Lab tests
(c) Management

A

Orthostatic proteinuria-

(a) MC cause of protienuria in adolescents: normal protein excretion at night (supine) but higher during day (when upright)
(b) 24 urine collection split to day and night
(c) No mgmt/tx

56
Q

NPH vs regular insulin

(b) Reduce which to reduce occurrence of post-exercise hypoglycemia

A

Regular insulin- faster acting

NPH = intermediate acting insulin, peak w/in 4-6 hrs, lasts 16-18 hrs

(b) Reduce NPH (basal for type 1s) b/c exercise promotes non-insulin-mediated glucose uptake by exercising the muscle => reduce basal insulin on board w/ exercise

57
Q

Mechanism of

(a) escitalopram
(b) venlafaxine

A

(a) escitalopram = lexapro = SSRI

(b) venlafaxine = SNRI

58
Q

When to start tx of depression w/ meds vs therapy

A

For moderate to severe start w/ meds first (escitalopram) then better change of involvement w/ therapy

59
Q

DKA treatment

(a) When to give subQ insulin vs. drip
(b) When to give K
(c) When to consider bicarb repletion

A

DKA: IV fluids, insulin gtt

(a) Keep insulin gtt until anion gap is closed, if AG still open and serum glucose falls below 200 add D5 to IV fluids
- when pt tolerating PO, serum glucose under 200, AG closed, bicarb 15 or over: give subQ then stop insulin infusion over 1-2 hrs to prevent rebound ketoacidosis

(b) K if serum K 5.3 or below
(c) Bicarb if pH under 6.9

60
Q

Treating DKA:

Pt on IV fluids and insulin gtt: serum glucose 180 anion gap 28

Next step?

A

Serum glucose is under 200 BUT anion gap still open => keep insulin gtt just reduce the rate, add D5 to IV saline

  • add D5 when serum glucose falls under 200
  • don’t turn off IV insulin (and transition to subQ) until pt tolerating PO, serum glucose under 200, AG closed, bicarb over 15
61
Q

Features of suicide attempts/behavior in borderline personality d/o vs. MDD

A

MDD- major depressive episode lasting 2 weeks or longer
SIGECAPS

BPD: irritability, marked mood swings, unstable interpersonal relationships, impulsivity, recurrent suicidal behaviors or threats, frantic efforts to avoid abandonment

62
Q

Treatment of acute mania in pregnancy

A

First line tx = haloperidol (safe in pregnancy, works faster than maintenance lamotrigene)

Second line- lithium

63
Q

Clinical features to differentiate Mallory-Weiss tear from Boerhaave syndrome

A

Both can have hematemesis after vomiting w/ epigastric pain

Mallory-Weiss (partial thickness tear in esophagus): epigastric pain, hematemesis

Boerhaave syndrome (esophageal transmural tear): mediastinitis, fever, chest pain, left pleural effusion (due to negative pressure in chest sucking esophageal contents into pleural cavity).

So 54 y/oM w/ epigastric and retrosternal chest pain, N/V, small hematemsis, fever, HR 120, reduced breath sounds over L base = esophageal perf (not just Mallory-Weiss)

64
Q

High or low calcium or mag would cause hyperactive reflexes

A

Hyperactive reflexes associated w/ hypocalcemia
-esp after major surgery requiring extensive transfusions

Hypermagnesemia associated w/ loss of deep tendon reflexes

65
Q

26 y/oM from South America presents in VTach, TTE w/ apical aneurysm.

Most likely dx?

A

Chagas! from protozoan infection w/ Trypanosoma Cruzi- Mexico, Central and South America

chronic Chagas => cardiomyopathy and GI disease

-presence of LV apical aneurysm in absence of coronary disease is pathognomonic for Chagas

66
Q

2 body systems involved in chronic Chagas

A

Chronic infection w/ protozoan trypanosoma cruzi (S/central America, Mexico) causes

  1. Cardiac manifestations
    - dilated cardiomyopathy
    - fibrosis causing conduction abnormalities => Vtach
    - LV apical aneurysm (when in absence of coronary disease is pathognomonic for Chagas)
  2. GI involvement = progressive dilation of esophagus and colon
    - can progress to megacolon
67
Q

Skilled vs nonskilled home care

A

Skilled- medication adherence assistance, PT, OT

Nonskilled- bathing, grooming dressing

80 y/o homebound F independent of ADLs but requires walker for movement would need homebound skilled nursing

68
Q

Definition of recurrent UTIs in female

(b) Type of ppx abx

A

2 or more infections in 6 months, 3 or more in one year

(b) Antibiotic ppx (bactrim, nitrofurantoin, keflex, cipro), can give postcoitally if UTIs are temporally related to intercourse. UTIs unrelated to sexual activity can get daily low-dose abx suppression

69
Q

55 y/oM 3 days s/p MI develops sharp retrosternal chest pain, worse w/ deep inspiration, scratchy heart sound appreciated during ventricular systole

Dx?

A

Dx = acute pericarditis

Peri-MI percarditis w/in 4 days due to localized inflammation, same presentation as Dresslers just Dresslers (immune mediated) occurs several weeks after MI

70
Q

Timeline after MI to expect

(a) Dresslers
(b) Ventricular aneurysm
(c) Peri-infarction pericarditis

A

(a) Immune mediated percarditis weeks (6-8 weeks) after MI
- chest pain improved by sitting up, worse w/ deep inspiration

(b) Ventricular aneurysm is late: weeks to months after MI, w/ persistent ST elevations w/ same-lead Qwaves
(c) Peri-infarction pericarditis- 1-4 days post-MI

71
Q

Timeline after MI to expect

(a) Papillary muscle rupture
(b) Free wall rupture
(c) IV septum rupture

A

(a) Papillary muscle rupture: acute or w/in 3-5 days
- develop severe MR, severe pulmonary edema

(b) Free wall rupture 5 days-2 weeks
- p/w pericardial effusion w/ tamponade

(c) IV septum rupture: acute or w/in 3-5 days
- shock, biV failure

72
Q

Tx of peri-MI vs. viral acute pericarditis

A

Idiopathic or viral acute pericarditis: tx w/ NSAID (naproxen) and colchicine

for Peri-infarction pericarditis (w/in 4 days of MI): tx w/ high-dose ASA b/c NSAIDs and glucocorticoids can impair myocardial healing and may increase risk of ventricular septal or free wall rupture

73
Q

Valproate for seizure d/o

(a) Can use in pregnancy?
(b) Breastfeeding?

A

(a) Yes, use lowest dose possible (duh, but dont want to stop and cause seizure activity), then have mom take tons of folate and offer AFP screening
(b) Breastfeeding encouraged in women taking AEDs- benefits of breastfeeding outweigh risk of medication exposure to infant

74
Q

Abx choice for osteomyelitis in children

(a) health child w/ low likelihood of MRSA
(b) health child w/ high likelihood of MRSA
(c) children w/ sickle cell disease

A

Health child- MC organism S. aureus
(a) Nafcillin/oxacillin or cefazolin (1st generation)

(b) Clinda or vancomycin

SCD: still S. aureus most common, but need to cover for salmonella given functional asplenia
(c) As above (naf or clinda) + third-generation cephalosporin (CTX) for gram negative coverage

75
Q

Empiric antibiotics for child w/ sickle cell disease presenting w/

(a) Osteo
(b) Acute chest syndrome

A

(a) Osteo: nafcillin/keflex (MSSA) or vanc vs. clinda (MRSA) + gram negative coverage w/ CTX (3rd gen cephalosporin) to cover salmonella given increased risk of encapsulated organisms given functional asplenia
(b) Acute chest: CTX to cover CAP organisms (S. pneuo) and azithro for atypicals (mycoplasma)

76
Q

Cutoff size for +PPD

A

Positive PPD = 10mm or more induration at 48 hrs

77
Q

Most important modifiable risk factor to reduce AAA expansion

A

Smoking cessation- more important than BP control in reducing rate of aneurysm expansion

78
Q

What is akathisia?

(b) Management

A

Akathisia = inner restlessness/inability to sit still seen w/ first (less but still w/ second) generation antipsychotics

(b) Try to reduce dose, but if mood is stable can consider adding beta-blocker for symptom tx

79
Q

First line tx of chlamydia during pregnancy

A

Azithromycin

80
Q

Dermatomyositis

(a) Muscular features
(b) Dermatologic features

A

(a) Symmetric proximal muscle weakness (cant brush hair, stand from car)
(b) Gottron’s papules (purple/red papules on jMCP and ICP joints hands), heliotrope rash (purple/red rash on eyes or shawl-distribution)

81
Q

When to diagnose dermatomyositis w/ serum antibody testing vs. muscle or skin biopsy

A

If clinical features are typical- confirm w/ serologic testing: ANA, anti-RNP, anti-Jo1, anti-Mi2

If rash nonspecific, isolated (not symmetric proximal) muscle/skin involvement, or negative antibodies- then progress to tissue diagnosis

82
Q

Tx of dermatomyosis

A

Dermatomyositis (proximal symmetric muscle weakness w/ typical skin findings Gottron’s papules/heliotrope rash)

  1. high-dose glucocorticoids PLUS steroid-sparing agent
  2. Malignancy screening- high assocation w/ malignancies, especially adenocarcinomas
83
Q

Define the second stage of labor

(b) When second-stage labor arrest would indicate C-section

A

Second stage of labor = once fully dilated (over 10cm) until fetal delivery

(b) Arrested second stage of labor = no fetal descent (no change in fetal station) after nulliparous pts push for 3 or more hrs, or 4 or more hours w/ an epidural
- most likely due to cephalopelvic disproportion

C-section indicated 2/2 high risk to neonate (sepsis) and mother (postpartum hemorrhage, chorioamnionitis)

84
Q

Indication for endometrial biopsy

A

Over age 45 w/ abnormal uterine bleeding

Given high risk of endometrial hyperplasia w/ unopposed estrogen

85
Q

Describe the murmur of the most common complication of rheumatic heart disease

A

Mitral stenosis

  • loud S1
  • short apical low-pitched diastolic rumbling murmur
86
Q

Link in drugs used for prolactinoma and Parkinson’s

A

Dopamine agonists used in Parkinsons also inhibit prolactin release, so are first-line tx in prolactinomas

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