UWorld Review 3 Flashcards
Describe the presentation and treatment of hypersensitivity pneumonitis.
- presents with cough, breathlessness, fever, and malaise 4-6 hours after exposure to an irritating antigen such as mold or bird droppings
- CXR will show haziness in the lower lung fields
- treat with avoidance of the antigen
How are uterine leiomyomas treated?
- asymptomatic ones can be observed
- symptomatic ones can be treated medically with cOCPs or surgically with resection
Describe the pathophysiology, presentation, and treatment of postpartum urinary retention.
- due to pudendal nerve injury in the case of perineal lacerations and prolonged labor or due to bladder atony in the case of anesthesia
- presents with an inability to void by 6 hours post-delivery and may progress to overflow incontinence with dribbling of urine
- treat with intermittent catheterization until it self-resolves
What endocrine disorder may be the manifestation of a teratoma?
hyperthyroidism (aka strums ovarii)
What is subclinical hypothyroidism?
an elevated TSH in the setting of normal free T4
Describe the appropriate management of STEMI.
- supplemental oxygen
- nitrates
- dual anti-platelet therapy
- anticoagulation
- beta-blockers
- prompt repercussion with PCI or thrombolytics
- start a statin as soon as possible
Describe the genetics and presentation of Friedreich ataxia.
- due to a GAA repeat in the frataxin gene
- presents with neurologic symptoms including ataxia, dysarthria, loss of dorsal columns, and absent reflexes
- other manifestations include scoliosis, diabetes, and hypertrophic cardiomyopathy
Describe the management of lead poisoning.
- screen with finger stick lead
- confirm with a venous sample
- notify the public health department, perform nutritional counseling, and do an environmental survey
- treat with succimer only if lead levels are >45, treat with dimercaprol and EDTA if > 70
How can autoimmune hemolytic anemia be differentiated from hereditary spherocytosis?
both produce an extravascular hemolysis with spherocytes; however, AIHA is likely to have a positive Coombs test while spherocytosis has a strong family history
What happens to the erythrocyte count and MCV in those with thalassemia?
the erythrocyte count increases as the body attempts to compensate for anemia but the MCV is low as little hemoglobin is produced to fill the cells
How is androgen insensitivity differentiated from 5a-reductase deficiency?
- both produce an individual with male gonads and female external genitalia
- the difference is that those with androgen insensitivity will still undergo breast development during puberty because estrogen production is unaffected
Laryngeal papillomas are caused by what?
HPV
What does “use dependence” refer to when discussing anti arrhythmic drugs?
it is a phenomenon experienced by many class IC drugs and refers to the idea that at faster heart rates, the drugs have less time to dissociate from sodium channels, leading to progressive widening of the QRS
Describe the presentation and management of blunt cardiac injury.
- follows a rapid deceleration injury or direct blow to the precordium
- presents with arrhythmia, ACS, myocardial dysfunction, and/or cardiac tamponade
- management includes evaluation with ECG and TTE
What is leukoplakia?
a reactive precancerous lesion manifesting as a white lesion within the oropharynx which represents hyperplasia
What are the features of DiGeorge syndrome?
Conotruncal cardiac defects Abnormal facies Thymic hypoplasia Cleft palate Hypoparathyroidism
What are the features of trisomy 18?
- IUGR, microcephaly, micrognathia, and prominent occiput
- overlapping fingers with closed fist and rocker-bottom feet
- VSD
What are the features of trisomy 13?
- microcephaly/holoprosencephaly, microphthalmia, cleft lip
- cutis aplasia, umbilical hernia/omphalocele
- renal and cardiac defects
- polydactyly
What is the mechanism of pulmonary hypertension in those with scleroderma?
arterial intimal hyperplasia
How is cocaine-induced chest pain managed?
- benzodiazepines for blood pressure and anxiety
- aspirin, nitroglycerin, and CCBs
- avoid beta-blockers which will generate an a1 imbalance
Describe the presentation of a neuroblastoma.
- often present in children less than 2 with an abdominal mass
- periorbital ecchymoses representing orbital metastases, spinal cord compression, and opsoclonus-myoclonus syndrome are additional features
- labs find elevated catecholamine metabolites and an N-myc oncogene amplification on histology
Describe the maintenance phase of hypokalemic, hypochloremic, metabolic alkalosis secondary to vomiting and its treatment.
- the kidneys filter excess bicarb in response to the alkalosis; however, volume depletion simultaneously stimulates the renin-aldosterone system and water is reabsorbed at the expense of potassium and acid
- thus, treatment is with normal saline and potassium relacement
What is the MASFP, B-hCG, estriol, and inhibin A profile for each of the following:
- trisomy 18
- trisomy 21
- neural tube defect
- trisomy 18: down, down, down, normal
- trisomy 21: down, up, down, up
- neural tube defect: up, normal, normal, normal
How do we define the following types of asthma:
- intermittent
- mild persistent
- moderate persistent
- severe persistent
- intermittent: less than 2 uses of albuterol per week and less than 2 night time awakenings a month
- mild: albuterol needed 2-7 days a week, 3-4 night time awakenings monthly
- moderate: daily albuterol use and 1-3 night time awakening per week
- severe: albuterol needed multiples per day or at least 4 night time awakenings were week
In patients with AIDS, what suggests candidal esophagitis and what suggests viral esophagitis?
- candidal: likely have thrush and dysphagia in addition to odynophagia
- viral: severe odynophagia without dysphagia and without thrush
Which intervention for Grave’s disease is most likely to exacerbate ophthalmopathy and why?
radioactive iodine ablation because this increases titers of thyrotropin receptor antibodies; this is why it is generally accompanied by a steroids
What is the only current indication for hormone replacement therapy?
vasomotor symptoms in women under 60 who began menopause less than 10 years ago
What is tachycardia-mediate cardiomyopathy?
- a form of heart failure seen in those with chronic rapid ventricular rates as seen with Afib, Aflutter, Vtach, etc.
- it represents an often times reversible cause of reduced ejection fraction and can be treated with aggressive rate or rhythm control
What are the following causes of nephrotic syndrome associated with:
- minimal change disease
- FSGS
- membranous nephropathy
- membranoproliferative glomerulonephritis
- MCD: NSAIDs and lymphoma
- FSGS: African American ethnicity, obesity, HIV, and heroin use
- membranous: adenocarcinoma, NSAIDs, hepatitis B, and SLE
- membranoproliferative glomerulonephritis: Hep B and C
What is new-onset right bundle branch block indicative of?
acute right heart strain as might be seen with a massive PE
How do we define a massive PE?
one complicated by acute right heart strain and or hypotension
What is thyroglobulin?
the precursor to T3 and T3, which is produced by normal thyroid tissue or differentiated thyroid cancer
What two tumors are known for secreting AFP?
hepatocellular carcinoma and nonseminomatous germ cell tumors
Describe the presentation, diagnosis, and treatment of laryngomalacia.
- presents as inspiratory stridor that worsens when supine, peaking around age 4-8 months
- diagnosis is with laryngoscopy
- managed with reassurance and close follow up
Which viral exanthem can be treated with a vitamin? What is that vitamin?
measles is treated with vitamin A
In children with early secondary sexual development what is the first step in evaluation? What does this tell us?
the first step is to determine a bone age because if advanced it suggests precocious puberty and if normal, it suggests isolated premature thelarche or adrenarche
What are the differences between Waldenstrom macroglobulinemia and multiple myeloma.
> they differ in symptoms:
- waldenstrom causes hyperviscosity syndrome, hepatosplenomegaly, neuropathy, bleeding, and lymphadenopathy
- multiple myeloma causes osteolytic lesions, anemia, hypercalcemia, and renal insufficiency
they also differ in the antibodies produced
- waldenstrom tends to be an IgM monoclonal antibody
- MM tends to be composed of IgG, IgA, and light chains
How should shoulder dystocia be managed?
use the mnemonic BE CALM
- breath, do not push
- elevate legs, flex hips
- call for help
- apply suprapubic pressure
- enLarge vaginal opening with episiotomy
- maneuvers
What is hereditary hemorrhagic telangiectasia?
an autosomal dominant condition characterized by diffuse telangiectasia, recurrent epistaxis, and AVMs, which induces a reactive polycythemia
What are the diagnostic criteria for systemic juvenile arthritis?
arthritis present for greater than 6 weeks with associated fever and rash
What are the criteria for acute rheumatic fever?
JONES
- joints (migratory arthritis)
- heart (carditis)
- nodules (subcutaneous)
- erythema marginatum
- syndenham chorea
How does steatorrhea impact the PTH-vitamin D-Ca/P axis?
as a fat soluble vitamin, vitamin D absorption declines and so does calcium and phosphate with a subsequent rise in PTH which further depletes phosphate
What is the recommended initial therapy for those with febrile neutropenia?
an anti-pseudomonas regimen like piperacillin-tazobactam
How is primary hyperparathyroidism differentiated form hypocalciuric hypercalcemia?
- in those with hyperparthyroidism, calcium excretion in the urine is increased due to excess resorption of calcium from bones despite a simultaneously increase in calcium reabsorption from the renal tubules
- in those with hypocalciuric hypercalcemia, there is a lower level of calcium excretion in the urine
