Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 > UWorld pt2 > Flashcards

UWorld pt2 Flashcards

1
Q

Most common neuroimaging finding of schizophrenia

A

Most consistently replicated neuroimaging finding in schizophrenia = enlargement of lateral cerebral ventricles

Enlargement of cerebral ventricles in schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical feature to distinguish middle vs. anterior cerebral artery occlusion

A

Middle cerebral artery occlusion => contralateral somatoatosensory and motor deficit in face/arm/leg

vs.

Anterior cerebral artery occlusion => contralateral somatosensory and motor deficit predominantly in LE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First line pharmacologic agent for cancer-related anorexia/cachectic

A

Progesterone analogus

-lolz not weed (much better for HIV-associated cachexia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lab values to differentiate CML from leukemoid reaction

A

CML: more immature (myelocytes > metamyelocytes), absolute basophilia, low LAP (leukocyte alkaline phosphatase)

Leukemoid rxn to severe infxn: lower (like around 50k), more mature (metamyelocytes > myelocytes), high (normal) LAP, no basophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lab tests to differentiate iron deficiency anemia from thalassemia trait

A

Both will be microcytic anemias, but iron deficiency will have high RDW and low #RBCs

While thalassemia will have normal RDW and normal number of RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Besides sedation, risk of giving benadryl to elderly M

A

Benadryl has both antihistamine and anticholinergic properties

Anticholinergic properties => detrusor hypocontractility which may cause acute urinary retentnion in elderly M w/ enlarged prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 mo old girl w/ failure to thrive and a renal tubular acidosis- which type of RTA does she likely have?

A 
Type 1 (distal): not excreting enough protons
-most likely to be congenitals

Others: type 2 (proximal): not reabsorbing bicarb (ex: Fanconi syndrome) vs. type 4 (aldo resistance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Choriocarcinoma

(a) How to make dx
(b) Tx

A

Chiocarcinoma = gestational trophoblastic tumor

(a) Diagnose w/ elevated beta-hCG way after delivery
(b) Tx w/ chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

First line tx for VT on ECG

A

VT:

  • stable: IV amiodarone
  • unstable: cardiovert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Main organ systems involved in disseminated histoplasmosis

A

Disseminated histo (usually in immunocompromised) when it spreads from lungs thru lymph into systemic

  1. systemic symptoms
  2. pulm
  3. mucocutaneous (papules, nodules)
  4. reticuloendothelial (HSM, lymphadenopathy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the febrile nonhemolytic rxn to transfusion (MC transfusion rxn)

(a) Etiology

A

MC transfusion reaction is 2/2 (a) Cytokines that build up during storage of the blood

Clinically: w/in 1 hour of transfusion pt w/ fever and chills, but no DIC Or lab abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Two abx classes to treat legionella pneumonia

A

Legionella pneumonia = PNA w/ hyponatremia

Tx: macrolides (azithromycin) or quinolones (levofloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give the typical presentation of Reye syndrome

A

Reye syndrome = acute liver failure (transaminitis, coagulopathy, hyperammonemia) and encephalopathy in child after influenza or varicella infection w/ aspirin use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MC location of medulloblastoma

(a) Clinical symptoms

A

MC location of medulloblastoma = cerebellar vemis (and almost always in the posterior fossa)

(a) => presents w/ cerebellar symptoms, like truncal ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

23 yo F w/ progressive lower back pain and stiffness x3 yrs

  • relief w/ exercise
  • morning stiffness x1 hr
  • tenderness over lumbosacral area

(a) Dx
(b) Diagnostic test

A

(a) Dx = ankylosing spondylitis
(b) Diagnose w/ Xray of sacroiliac joints w/ characteristic bamboo spine
- can’t diagnost w/ HLA-B27: present but not specific enough for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Key clinical features of Chikungunya fever

A

Chikungunya fever = mosquito-borne illness in central/S America and tropical regions

High fever + severe symmetric polyarthritis (arthritis is the key here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Classic CXR findings of contained aortic rupture

(a) vs. CXR findings of bronchial rupture

A
  • widened mediastinum
  • L sided hemothorax

(a) Bronchial rupture => pneumothorax that doesn’t resolve w/ chest tube, pneumomediastinum, subcutaneous emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ddx for exudative pleural effusion

A
  1. Empyema- from baceterial infxn of the pleural space (So bacterial PNA)
  2. Tb (AFB stain)
  3. Malignancy (get cytology)
  4. Chylothorax from thoracic duct damage (see high TG in pleural fluid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Workup for unexplained erythema nodosum

A

Erythema nodosum = painful lesions on shins associated w/ strep, Tb, sarcoidosis, coccidiomycosis, IBD, Behcets

  • CBC, LFTS, BUN/Cr
  • Anti-ASO titers
  • PPD
  • CXR to screen for sarcoidosis (b/l hilar lymphadenopathy, reticular opacities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MS

(a) LP findings
(b) Classic MRI findings

A

MS

(a) Oligoclonal bands
(b) MRI findings: pericentricular and juxtacortical lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Glomerulopathy MC associated w/ renal vein thrombosis

(a) Clinical presentation

A

Membranous glomerulonephrophaty

(a) Presents as progressive gradual worsening of renal fxn and proteinuria in asymptomatic pt
ex: 6 wks of periorbital edema and abdominal distention, sudden development of R sided abdominal pain fever and gross hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is euthyroid sick syndrome

A

Euthyroid sick syndrome aka “low T3” is when T3 is low but T4/TSH normal during an acute illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is MSAFP measured to screen for fetal anomalies?

(a) When is it high
(b) When is it low

A

Maternal serum alpha-fetoprotein screen measured btwn 15-20 weeks to screen for fetal anomalies

(a) High in open neural tube defects (anencephaly, open spina bifida), ventral wall defects (omphalocele, gastrocschisis), multiple gestations
- if high get ultrasound

(b) Low AFP associated w/ aneuploidies (trisomy 18, 21)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Auer rods

A

AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

25 yo African American p/w nocturia x5 months
-normal UA and CBC

Explain his nocturia

A

Hyposthenuria = inability to concentrate urine found in SCD or sickle cell trait 2/2 RBC sickling in the vasa rectae of the inner medulla => impairs countercurrent exchange and free water reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Differentiate clinical features of patellofemoral syndrome and patellar tendonitis

A

Patellofemoral syndrome- typically young adult F athletes w/ pain on knee extension while patella is compressed (patellofemoral compression test), pain reproduced w/ squatting or stairs

Patellar tendonitis- primarily athelets, episodic pain and tenderness at the inferior patella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ECG changes expected from severe hyperkalemia

(a) Immediate tx when pt w/ hyperkalemia has ECG changes

A

ECG changes: peaked T waves, bradycardia from sinus node dysfunciton, AV block, arrhythmias (VT or VFib)

(a) IV calcium (chloride or gluconate) to stabilize cardiac myocyte
- not an anti-arrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

15 day old boy w/ bilious emesis, breastfed, KXR w/ gasless abdomen

(a) Most likely dx
(b) First step in management
(c) Diagnostic test

A

(a) Midgut volvulus 2/2 malrotation: classically presents in neonate under 1mo w/ bilious vomiting
(b) NG tube decompression, IV fluids
(c) Upper GI series (Xray w/ contrast) to visualize and r/o free air in abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Prognosis of Hodgkin lymphoma

A

HL is very responsive to tx: >90% 5-year survival for stage I-II disease
-recurrence uncommon

However- pts treated before 30 yoa have 18.5x increased risk of secondary malignancy from chemo/radiation

So 43 yo w/ pulmonary nodule, treated at 20 for HL w/ chemo/radiation, not recurrence on HL but a secondary malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

14-3-3 protein in CSF

A

Neurodegenerative prion disease (CJD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Bamboo spine

A

Bamboo spine = fusion of vertebral bodies w/ ossification of intervertebral discs that suggests ankylosing spondylitis in young adult (under 40) w/ back pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Screening guidelines for HepB vs. HepC

A

HIV and HepB screening in pts w/ high-risk sexual intercourse = unprotected or MSM

HepC: IVDU, high-risk needle exposure, or blood transfusion before 1992

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hallmark opthalmoscopy findings of

(a) Open angle glaucoma
(b) Retinal detachment
(c) Central retinal vein occlusion
(d) Simple diabetic retinopathy

A

(a) Pathologic cupping of the optic disc
(b) Retina hanging in the vitreous
(c) Disc swelling, venous dilation and tortuosity, retinal hemorrhages and cotton woll spots
(d) Microaneurysms, hemorrhages, exudates, retinal edema, then cotton wool spots next

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Use of progesterone supplementation in pregnant F

A

Can be used in F w/ h/o preterm labor to prevent recurrence of preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Expected changes in the following seen in pregnancy

(a) CBC
(b) BMP
(c) UA

A

Pregnancy changes

(a) Mild anemia due to dilation from volume shifts
(b) BMP: reduced BUN/Cr due to increased GFR/renal blood flow
- so in nonpregnant F Cr of 1.2 may be considered ULN, while this is acute insufficiency in pregnant F
(c) Normal to have 1+ proteinuria due to expected increase in glomerular basement membrane permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

34 yo HIV+ M w/ severe watery diarrhea x14 days, CD4 of 94, negative FOBT

(a) Dx
(b) Tx

A

(a) Cryptosporidium diarrhea: CD4 under 180 (not under 50 like when you’d see MAC or CMV diarrhea)
- severe watery diarrhea w/ low-grade fever and weight loss

(b) Treat the HIV, usually diarrhea persists until CD4 improves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Keywords for distinguishing the 3 systemic fungi in the US

A

All 3 w/ pulm and skin findings

Histo- hepatosplenomegaly (b/c intracellular in macrophages)

Blasto- ulcerated skin lesions and bony lesions (osteomyelitis, lytic lesions)

Coccidio- skin, lungs, meninges (SW US)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

UA sediment indicative of

(a) Glomerulonephritis
(b) Pyelonephritis
(c) Chronic renal failure
(d) ATN
(e) Interstitial nephritis
(f) Nephrotic syndrome

A

(a) GN (causing nephrotic syndrome) = RBC casts
(b) Pyelo = WBC casts
(c) CRF => broad casts and waxy casts
(d) ATN = muddy brown, granular, casts
(e) Interstitial nephritis (AIN) = WBC casts (same as pyelo)
(f) Nephrotic syndrome (indicating glomerular injury) = fatty casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

MC complication of giant cell arteritis

A

Aortic aneurysm
-vasculitis that can involve branches of the aorta

=> pts require follow up w/ serial CXRs

40
Q

Initial maneuvers to manage shoulder dystocia

A

Don’t go straight to C-sxn!!!

  1. McRobert’s: shart hip flexion w/ mother supine
  2. Suprapubic pressure to release anterior shoulder
  3. Episiotomy
  4. Maneuvers: mother on all 4s
41
Q

Pregnant pt w/ hyperemesis gravidarum p/w confusion and incoherence, wt loss, nystagmus

Dx

A

Dx = Wernicke encephalopathy 2/2 thiamine deficiency

Not just in alcoholics!! Remember the triad: encephalopathy, oculomotor dysfunciton, ataxi

42
Q

PSC vs. PBC buzzwords

A

PSC = ulcerative colitis

PBC = middle aged F w/ positive antimitochondrial antibodies

43
Q

20 yo M w/ jaundice and dark urine

-urine dipstick positive for bilirubin, negative for urobilinogen

A

Bilirubin is water soluble (can be excreted in urine), while unconjugated hyperbili is not, so urine dipstick w/ bilirubin means there is hyperbilirubinemia of CONJUGATED bilirubin

Probably Rotor’s syndrome = genetic defect in hepatic secretion of bilirubin

44
Q

37 yoM presenting in withdrawal of ?

  • severe diffuse muscle aches
  • abdominal cramps, 4 loose stools
  • persistent nausea, no vomiting
  • diaphoretic, pupils dilated
A 
Opiate withdrawal (heroin): arthralgia/myalgias, GI (N/V/abd cramping)
-dilated pupils, yawning, lacrimation
45
Q

Consequence of

(a) Ruptured berry aneurysm
(b) Intracerebral hypertensive vasculopathy

A

(a) Ruptured berry aneurysm => subarachnoid hemorrhage

b) HTN of the small penetrating branches => deep intracerebral hemorrhage (basal ganglia

46
Q

Differentiate the 3 uterotonic drug options to treat uterine atony

A

Uterotonic drugs

1st line = oxytocin
2nd line:
-methergine (methylergonovine): causes vasoconstriction, so contraindicated in pts w/ h/o HTN
-carbaprost: synthetic prostaglandin that can cause vasoconstriction => contraindicated in asthmatics

47
Q

Gas toxicity 2/2

(a) Anesthetic/dapsone
(b) House fire

A

(a) Anesthetic/dapsone c/f methemoglobinemia

(b) House fires: think cyanide or CO poisoning

48
Q

MC comorbidity of absence seizures

A

Psych comorbidities- MC ADHD (inattentive subtype) and anxiety

49
Q

Weber hearing test- explain it

Result in

(a) Sensorineural hearing loss
(b) Conductive hearing loss

A

Weber = vibrating tuning fork on middle of head/forehead equidistant btwn ears
-normal is hearing the same in both ears

(a) Sensorineural hearing loss: lateralize (hear sound louder) in unaffected ear (b/c affected ear can’t sense the vibration
(b) Conductive hearing loss: lateralize to affected ear (b/c not distracted by ambient nose that that ear can’t hear)

50
Q

II/VI holosystolic murmur over LLSB w/ diastolic rumble over the cardiac apex

A

Dx = Large VSD (NOT ToF)

  • diastolic rumble 2/2 increased flow across mitral valve
  • II/VI b/c larger the VSD = less turbulence = softer murmur

ToF murmur = harsh systolic ejection murmur over LUSB from pulmonary stenosis

51
Q

Differentiate etiologies of symmetric vs. asymmetric fetal growth restriction

A

Symmetric (both head and body small): from insult in the 1st trimester

  • chromosomal abnormality
  • congenital infxn

Asymmetric (head spared, only body small): from later insult

  • uteroplacental insufficiency (MC 2/2 maternal HTN)
  • maternal malnutrition
52
Q

3 main features of Fanconi anemia

A

Fanconi anemia = autosomal recessive mutation in DNA repair enzyme (so can’t repair DNA crosslinks)

  1. Congenital bone marrow => asplastic anemia, pancytopenia
  2. Morphologic abnormalities: short stature, microcephaly, hypo/hyperpigmented cutaneous lesions, stabismus
  3. Increased risk of malignancy
53
Q

First line tx for allergic rhinitis

A

Intranasal glucocorticoids

not monteleukast or non-sedating antihistamines: those will be second line

54
Q

Would you rather a son or daughter have Lynch syndrome?

A

Son!!

Lynch (mismatch repair) = increased risk of CRC, endometrial and ovarian carcinoma

Stupid question but more just getting at Lynch increases risk of other cancers besides CRC

55
Q

Prognosis of Hodgkin lymphoma

A

HL is very responsive to tx: >90% 5-year survival for stage I-II disease
-recurrence uncommon

However- pts treated before 30 yoa have 18.5x increased risk of secondary malignancy from chemo/radiation

So 43 yo w/ pulmonary nodule, treated at 20 for HL w/ chemo/radiation, not recurrence on HL but a secondary malignancy

56
Q

Effect of thiazides on calcium homeostasis

A

Thiazides increase calcium reabsorption
Bad: can contribute to hypercalcemia
Good: can decrease calcium urine excretion in ppl w/ recurrent radio-opaque kidney stones (calcium oxalate stones)

57
Q

Thiazide diuretics

(a) Metabolic effects
(b) Electrolyte abnormalities

A

(a) Associated w/ hyperglycemia (b/c thiazides impair insulin release) and increased LDL/TGs
(b) Hyponatremia, hypokalemia, hypomag, hyPERcalcemia

58
Q

Which dimorphic fungi most closely mimics sarcoidosis

(a) Danger of treating for sarcoid before ruling it out

A

Histoplasmosis (Mississippi and Ohio River basins)

(a) Don’t want to start pt w/ disseminated fungal infection on an immunosuppressant (aka steroids that would be first line for sarcoid)

59
Q

20 yo F- what type of murmur would be benign vs malignant

A

Benign = midsystolic murmur in otherwise healthy young, asymptomatic adults

While either diastolic or continuous murmurs = pathologic and automatically indicate TTE

60
Q

Strawberry hemangioma vs. cherry angioma

A

Strawberry (capillary) hemangioma present in first week of life, can initially grow rapidly but then regress spontaneously around 5-8 yoa

Cherry angioma = senile hemangiomas- benign vascular tumor in adults present in 30/40s and can get more w/ age
-dont regress spontaneously but are benign so only remove if wanted for cosmesis

61
Q

B/l perihilar linear streaking

A

CXR finding of transient tachypnea of the newborn- starts at birth resolves day 2 of life

-is 2/2 inadequate alveolar clearance at birth => mild residual pulmonary edema

62
Q

Hereditary cancer syndrome w/ increased risk of

(a) Clear cell renal carcinoma
(b) Pheochromocytoma
(c) Endometrial carcinoma
(d) Ovarian cancer

A

Hereditary cancer syndromes w/ increased risk of

(a) Clear cell renal carcinoma = von-Hippel Lindau (MC is hemangioblastoma)
(b) Pheo in von-Hippel Lindau, also MEN2A/B
(c) Endometrial cancer in Lynch syndrome
(d) Ovarian cancer in Lynch syndrome, BRCA 1/2

63
Q

Mechanism of acyclovir-induced AKI

A

Acyclovir causes crystaline-induced AKI (NOT AIN!!!- AIN 2/2 sulfa drugs and PPI)

Acyclovir readily excreted in urine, but then is not soluble in urine so precipitates in tubules- forming obstructive crystals

64
Q

Mechanism of refractory hypokalemia in alcoholics

A

Hypomagnesemia (2/2 poor nutritional intake, EtOH-induced renal loss, diarrhea)

Low Mg => excessive K secretion by ROMK channels in collecting duct
-so hypokalemia refracotyr to IV/oral K repletion

65
Q

47 yo on risperidone that controls refractory psychosis, develops repetitive foot tapping, tongue protrusion, lip smaking

(a) Dx
(b) Mgmt

A

(a) Tardive dyskinesia = abnormal involuntary mov’ts 2/2 prolonged antipsychotic use (or metoclopramide)
(b) Switch to clozapine- need to stop offending agent but if still need antipsychotic on board us the one w/ lowest risk of TD/EPS (clozapine)

66
Q

ODD vs. conduct d/o

A

ODD less severe: kids are angry/irritable and argumentative/defiant towards authority, but no stealing or aggression towards other

CD: violation of major social norms and rights of others: bullying, weapons, torturing animals, destroying property, stealing
-under 18, over 18 = ASPD

67
Q

Tetrology of Fallot murmur

A

ToF murmur classically = harsh, systolic ejection murmur over LUSB from pulmonary stenosis

68
Q

Maternal HTN puts fetus at increased risk of what type of growth restriction

A

Maternal HTN => underdevelopment of spiral arteries in placenta => uteroplacental insufficiency that causes asymmetric fetal growth restriction (head size normal, body small)

69
Q

3 main clinical features of lead poisoning in adults

A
  1. Heme- anemia
  2. GI- abd pain, constipation, anorexia
  3. Neuro- cognitive/memory defects, peripheral neuropathy
70
Q

Clinical features of overdose/toxicity

(a) Phenytoin
(b) Lithium
(c) Benzos

A

(a) Phenytoin toxicity: horizontal nystagmus, cerebellar ataxia, confusion
(b) Li toxicity: tremor, hyperreflexia, ataxia, seizures
(c) Benzos: slurred speech, unstead gait, drowsiness, normal pupils and RR (no nystagmus like EtOH and phenytoin)

71
Q

Protocol for malaria ppx

A

Chemoprophylaxis- typically mefloquine beginning 2 weeks prior to travel, d/c 4 weeks after retruning

Chloroquine not used b/c most strains by now are resistant

72
Q

Tx for isolated enuresis in child

A

1st line = desmopression (ADH analog) to suppress overnight urine production

Then if that doesn’t work can use TCAs (kept second line due to side effect profile)

73
Q

Explain the mechanism of infertility in PCOS

A

Mechanism = anovulation from failure of follicles to mature

So peripheral adipose converts androgens –> estrone, excess estrone inhibits GnRH release => dysregulated FH/LSH so ovulation and follicle maturation sucks

74
Q

29 yo F w/ CP and dyspnea x10days, 3 mo s/p NSVD followed by frequent dark bloody vaginal discharge

  • enlarged uterus on exam
  • CXR: multiple b/l infiltrates of various shapes

Dx

A

Dx = choriocarcinoma = gestational trophoblastic tumor (so from placenta tissue that becomes malignant)
-by nature the tumor is very invasive => very invasive cancer, commonly mets to lungs => SOB/CP

Clinical features: enlarged uterus, abd pain, irregular vaginal bleeding

75
Q

Electrolyte abnormality seen 2/2 Addisons

A

Addisons = primary adrenal insufficiency

MC is hyponatremia (b/c no Aldo to make you reabsorb all that Na in the collecting duct), also hypernatremia b/c aldo stimulates K+ secretion

76
Q

Clinical manifestation of ABO incompatibility transfusion reaction

A

ABO incompatibility transfusion occurs w/in 1-6 hrs of transfusion w/ flank pain, renal failure, and DIC (oozing from IV sites)

77
Q

S/p solid organ transplant pts should be put on what two prophylactic meds for ppx

A

Solid organ transplant require high-dose immunsuppressives to prevent organ rejection => at risk for opportunistic infxns especially PCP and CMV

So put them on Trim-Sulfa and Valganciclovir

78
Q

Define fetal growth restriction

(a) Differentiate symmetric vs asymmetric

A

FGR = ultrasound w/ fetal weight under the 10th percentile for gestational age

(a) Symmetric- both head and body (insult in the first trimester) vs. asymmetric (head sparing) from insulin in 2nd/3rd trimester

79
Q

57 yoM p/w 2 episodes hematuria, fatigue/fever x4 weeks

  • 50 pack year history
  • L sided varicocele that fails to empty when pt is recumbent
  • Hb 18, Plks 580k

(a) Next step
(b) Dx

A

(a) Abdominal CT
(b) Renal cell carcinoma- left scrotal varicocele 2/2 blockage of L renal vein
- hematuria 2/2 invasion of tumor into collecting system

80
Q

62 yo M started on a new PO med for asthma and started acting strangely

A

Steroid-induced psychosissssss

81
Q

When is amnioinfusion given

A

Amnioinfusion = put saline into uterine cavity, used to tx recurrent variable decels due to umbilical cord compression during labor

82
Q

First line tx of Prinzmetal angina

A

CCB (Diltiazem) for prevention + sublingual nitro for abortive measures

NOT beta blockers!!! Nonselective beta-blockers (propranolol) CONTRAindicated…can make it worse

83
Q

CVID vs. SCID

(a) Age of onset
(b) Tx

A

Common variable immunodeficiency = no Igs b/c of abnormal B cell maturation

  • adequate cellular (T) immunity => dont need antifungals or antivirals
    (a) Later, infxns in childhood
    (b) Tx w/ IVIG to prevent infxns

SCID = no B or T cell activity

(a) Earlier, infancy infxns and infxn after vaccines
(b) Tx w/ ppx antivirals/antifungals or trapnsplant

84
Q

22 yoM w/ fever, sore throat, malaise x2 wks

  • s/p trip to Honduras
  • tonsils enlarged and covered in white exudate
  • lympahdenopathy, hepatosplenomegaly
  • I/VI systolic murmur
  • HB 9.4, Retic 6%, Plt 120, WBC 3.8

Dx

A

Mono and autoimmune hemolytic anemia and thrombocytopenia 2/2 IgM cold-agglutinin

EBV-induced antibodies form that are against RBCs and plts => anemia and thrombocytopenia

85
Q

Define preterm premature rupture of membranes

A

Premature rupture of membranes = rupture of amniotic sac membrane more than an hour before onset of labor

Then preterm when PROM happens before 37 weeks

Give abx (penicillin) for either unknown or positive GBS status

86
Q

7 yo boy p/w bleeding gums x3 mo

  • WBC 3k, Hb 7.8, RBC count low, MCV 112, Plts 40k
  • 5th percentile for height, thumbs slightly bent, areas of hypopigmentation on skin

(a) Dx
(b) Diagnostic test

A

(a) Fanconi anemia = congenital bone marrow failure => aplastic anemia, morphologic abnormalities, and increased risk of future malignancy
(b) Diagnose by chromosomal breaks on genetic analysis

87
Q

Indication for terbutaline

A

Terbutaline = tocolytic to relax uterus when tachysystole (>5 contractions in 10 mins) or tetanic contractions (last >2 mins) that are causing fetal heart rate abnormalities

88
Q

3 MC causes of acute bacterial rhinosinusitis in children

A

30% Strep pneumo
30% Haemophilus influenza
10% Moraxella catarhallis

89
Q

40 yo w/ 4+ proteinuria, immunofluorescence shows C3 with no immunoglobulins

(a) Dx
(b) Mechanism

A

(a) Membranoproliferative glomerulonephritis => C3 deposits (w/o Igs) w/in glomerular basement membrane
(b) MPGN = IgG specifically against C3 convertase => constitutive activation of alternative complement pathway

90
Q

45 yo HIV+ M (CD 4 22) p/w fevers, nights sweats, diarrhea/cough, 10 lb wt loss x3 wks

  • clear lungs, no rashes, negative PPD, negative CMV IgG, unremarkable CXR
  • splenomegaly
  • serum alk phos 412

(a) Dx
(b) Diagnostic test
(c) Tx

A

(a) Dx = disseminated MAC
- nonspecific symptoms w/ splenomegaly and elevated alk phos (2/2 MAC hepatosplenic involvement) in pt w/ CD4 under 50 = MAC

(b) Diagnose w/ blood cultures
(c) Tx = macrolide (azithromycin or clarithromycin)

91
Q

Elevated serum homocystine vs. methionine

A

Elevated methionine in only B12 deficiency

While homocystine is elevated in both b12 and folate deficiency

92
Q

36 yo G1P0 at 38 weeks p/w sudden vaginal bleeding and severe lower abdominal pain

  • uterine tenderness w/ moderate vaginal bleeding
  • good fetal heart traving
  • contractions q2 mins for 20 seconds

(a) Dx
(b) Risk for what maternal complications

A

(a) Placental abruption = premature separation of placenta from decidua
(b) Hypovolemic shock and DIC

93
Q

10 yo boy w/ rash on LE 7-days s/p viral illness

  • rash nonblanching palpable purplish lesions
  • Plts 120k
  • UA: moderate hematuria

(a) Dx
(b) Mgmt

A

(a) Henoch-Scholein Purpura = IgA mediated vasculitis characterized by palpable purpura, arthralgias, abdominal pain, hematuria, and normal platelets
(b) Mgmt- usually just supportive w/ hydration and NSAIDs, if super severe can admit and give glucocorticoids

94
Q

Differentiate clinical manifestation of constitutional growth delay and hypothyroidism causing stunted growth

A

Constitutional growth delay: small drop off early (6 mo to 3 years), then maintain constant growth rate on 5th-10th percentile
-will eventually have growth spurt, just reassure

Hypothyroidism: kid moving along at normal pace then sudden drop off, also w/ fatigue, constipation, cold intolerance, dry hair/skin

95
Q

Indication for hormone replacement therapy

A

For vasomotor symptoms (ex: hotflashes) in pts under 60 who have undergone menopause w/in the last 10 years

96
Q

Features of diarrhea caused by the following in HIV pts

(a) CMV
(b) MAC

A

Diarrhea in HIV pts

(a) CMV diarrhea: frequent small volume bouts of diarrhea in pts w/ CD4 under 50, can have hematochezia
(b) MAC diarrhea: watery stool, febrile (very febrile, like over 102.2), only once CD4 under 50

97
Q

What is

(a) Diclofenac
(b) Febuxostat
(c) Riluzole

A

(a) Diclofenac = NSAID
(b) Febuxostat = uric acid reducer
(c) Riluzole = glutamate inhibitor to prolong survival in ALS

Step 2 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions