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Uworld SA 1 Flashcards

1
Q

Pts on TPN are at greatest risk of developing?

A

Blood stream infections (Central line associated infection)

Staph epi, staph a, klebsiella, pseudomonas, candida

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2
Q

Pt drank antifreeze. What would you suspect on ABG?

A

AG metabloic acidosis
LOW PCO2, HCO3 b/c they are being absorbed by free H+
Calcium oxalate crystals in the urine

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3
Q

Nonstress test is reactive if

A

> 2 accelerations (+15bpm over baseline) lasting over 15 seconds in a 20 min period
reactive NST = adequate fetal oxygenation

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4
Q

Pt on chemo
develops bulla surrounded by erytema on foot. Bulla ruptured leaving apainless black ulcer
Dx and Tx?

A 
Ecthyma gangrenosum (psuedomonas)
Piptazo, fluroquinolones
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5
Q

Pt was started on a med for BPH and had syncope in the middle of the night. Why?

A

Orthostatic hypotension

He was probably started on alpha blocker

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6
Q

37 M
severe weakness and dizziness, syncope 2 x in 24 hour
Vague mid chest discomfort and L sided neck pain
recent URI
Thready pulses in both radial a. that disappear with deep inspiration

A

Cardiac tamponade
chest pain, decreased cardiac output, pulsus paradoxus following a viral infection -> tamponade d/t pericarditis
Lungs will stay clear

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7
Q 
36 F
confusion agitation x 2 days
twitching of R arm this morning
T - 10.7
Neck supple
EEG - high amplitude slow waves over the L temporal and frontal lobes
Dx and CSF findings?
A

HSV encephalitis
fever, HA, seizure, confusion, stupor x days
CT/MRI/EEG - abn frontotemporal region
CSF - lymphocytosis, RBCs, NL glucose

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8
Q

Smoker has progressive dyspnea but FEV1/FVC 85%

A

Fibrosis

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9
Q 
Older man
Pain in legs
Worse walking downhill
absent ankle reflexes
Next step?
A

MRI

Lumbar spinal stenosis

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10
Q 
Older male
fatigue, HA, easy bruising
180/120
Increased pigmentation in plamar creases
lower extremity ecchymosis
hypokalemia
hypernatremia
3cm mediastinal mass
Dx?
A

Paraneoplastic cushing syndrome
ectopic ACTH (polypeptide) from small cell lung carcinoma
Hypertension, hyperpigmentation

NL cushings no hyperpigmentation

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11
Q 
40 wk gest
in labor
presents 5cm, 90%, -4
2hrs - 6 cm, 90%, -4
5 hrs - unchanged
Inadequate contractions
Next step?
A

IV oxytocin
6 cm >3hrs = protracted labor

C-section if NO change >4 hrs w/ adequate, OR NO change > 6 hours with inadequate

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12
Q

Latent vs active phase of preganancy?

A

Latent 0-6cm

Active 6-10 cm (rapid changes)

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13
Q

Older man
R hand weakness, slurred speech 15-20 min
hx of afib
What can prevent future episodes?

A

Anticoagulation (rivaroxaban)

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14
Q 
Pleural effustion with:
yellow
Protein > 4
WBC w/ Lymphocyte predominance
low glucose (<60)
A

Exudative effusion

Causes: infection, malignancy, PE

chylothorax has similar findings but fluid will look milky

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15
Q

Once pt is dx’d with HIV what vaccine should they receive quickly?

A

pneumococcal 23

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16
Q

Smoker presents with HA that gets worse when he leans forward
recent dx of small cell lung cancer
PE - crazy JVD, no peripheral edema
Dx and next step?

A 
superior vena cava syndrome
Needs radiation (palliative)
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17
Q

Hospitalized pt s/p surgery develops RUL PNA

Dx?

A

Aspiration PNA, raising head of bed can prevent this

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18
Q

Pt with cirrhosis has a mild fever

Dx and how did this happen?

A

Spontaneous bacterial peritonitis
Peritoneal fluid becomes infected when an enteric organism translocates across the intestinal wall
Paracentesis w/ PMH >250 = diagnostic

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19
Q

Bullus pemphigoid Ab’s target the?

A

Hemidesmosomes

Histo - subepidermal cleavage, linear IgG at BM

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20
Q

Pemphigus vulgaris histo

A

Acantholysis, intraepidermal cleavage
NO oral cavity involvment
Intact bullus are rare - skin is very fragile!

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21
Q

adult w/ neuro syx has a solitary enhancing brain lesion in the temporal lobe. Most likely cause?

A

Metastases, most common intracranial tumor in adults

Melanoma, lung, breast, renal

Peripheral, circumscribed enhancing lesion surrounded by vasgenic edema on MRI

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22
Q

Woman had a voluntary abortion during last pregnancy d/t fetal anencephaly. What is recommended to decrease her risk for her next pregnancy?

A

Begin folic acid

Decreases risk of neural tube defects

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23
Q 
Older man
weakness x 6 wks
Difficults with chairs and stairs
AST - 250
ALT - 140
Lactate - 665
CK - 3700
A

Polymyositis

symmetric proximal m. weakness
Painless (usually), elevated CK
NO skin findings
bx - patchy necrosis, CD8 infiltration of the endomysium

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24
Q

Older adult
symmetric stiffness of shoulders, hip girlde
Elevated ESR, C reactive protein

A

Polymyalgia rheumatica

Association with temporal arterits

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25
In PTX, chest tubes improve vitals by increasing?
Venous return
26
Sudden SOB after UCD placement No lung markings on CXR with a vertical pleural line Dx?
Tension PTX
27
Older man feeling weak x 3 months, instability PE - atrophy of the hand muscles b/l, upgoing babinsky and hyperactive knee jerk
ALS Mixed UMN and LMN UMN - hyperreflexia, Babinski LMN - fasiculations, atrophy
28
If it sounds like ALS but has Parkinson features (ie tremor) suspect?
Multiple system atrophy
29
Adult with periods of unresponsiveness "blank staring" x 1 min followed by 20 min of confusion, dragging 1 leg
Temporal lobe epilepsy
30
Gestational DM in 3rd trimester is associated with which PE finding in the neonate?
Respiratory distress (fetal lung immaturity), preterm delivery, macrosomia GDM in 1st trimester - increases risk of cardiac and CNS dz
31
Female Serositis (pleural/pericardia effusion) symmetric arthritis Pancytopenia
SLE
32
Tx for vtach?
Amiodarone
33
Two hours after a pneumatic dilation of esophageal stricture pt develops nausea, retching, SOB, chest pain Emesis w/ clotted blood Dx?
Esophageal perforation
34
Most common cause of pancreatic calcifications?
Chronic pancreatitis most commonly d/t alcoholism
35
Man with all the PMH possible has foot pain foot is thin, shiny, devoid of hair, shallow ulcer Next step?
ABI Hairless = vascular, not neuro
36
Pt is started on chlorthalidone for HTN but develops severe leg cramps and loss of reflexes. How should he be managed long term?
Spironolactone likely developed severe hypokalemia while on thiazide suggesting his HTN is d/t primary hyperaldosteronism
37
best screening for primary hyperaldosteronism?
early morning Plasma aldosterone to plasma renin ratio | If ratio > 20 - PH. Need CT to determine if unilateral vs bilateral
38
Older man with unspecific syx Ca - 14 Dx?
Malignancy Hypercalcemia of malignancy d/t parathyroid hormone related protein (very common in nonsmall cell lung cancer). Sr Ca is usually much higher than what would be expected in primary hyperparathyroidism (14 vs 10)
39
Gastric bypass pt develops cholelithiasis Why is she at increased risk?
Rapid weight loss
40
Older man w/ reddish brown urine x 2 days strep syx 1 month ago Long smoking hx dipstic k + blood, protein Microscopic exam numerous RBCs many of which are DYSMORPHIC Dx?
Primary glomerular pathology glomerulo = proteinuria, dysmorphic erythrocytes, red cell casts PSGN and IgA nephropathy look similar but can be differentiated based on hx
41
Pt has CKD Low Ca High phos dx?
Secondart hyperparathyroidism the elevation in PTH -> renal osteodystrophy w/ associated bone pain
42
T 1 DM has frequent urinary dribbling/leakage worse at night. Post void volume 300 mL Tx?
Cholinergic agonist (bethanechol) Overflow incontinence d/t neurogenic bladder. Tx with augemented voidtechniques, cholinergics. Severe cases -> cath
43
Diagnositc criteria for SBP
>250 PMN's on paracentesis
44
Guy in septic shock has metabolic acidosis. Why?
Increased tissue metabolic acid production (LDH)
45
Young adult fatigue, orthopnea following URI PMI 6th intercostal space Dx?
Dilated cardiomyopathy (viral)
46
Plaques on the knees
Psoriasis
47
``` Jaundice x 3 months Abd discomfort Fullness RUQ T bili - 12.5 Alk Phos - 350 Where is the lesion? ```
Pancreas Jaundice + weight loss + vague abd pain -> pancreatic cancer elevated T bili, alk phos suggest cholestasis d/t tumor obstruction of CBD
48
Kid abd pain, dizziness x 2 hours vomiting brig red blood, diarrhea w/ dark green stools Which of moms pills did he take?
Iron GI hemorrhage - bloody diarrhea and hematemsis. Can progress to met acidosis, hepatotoxicity, SBO, death
49
``` Older woman w/ back pain, fever, nighsweats, weight loss On peritoneal dialysis, former smoker TTP L3/L4 CXR - cavitory infiltrate in LUL Collapse of L3/L4 vertebral bodies Dx? ```
TB
50
Pt has new irregulaly irregular heart rhthm. What is the best initial test?
TSH and T4 Hyperthyroidism needs to be identified in new a fib
51
R knee pain from twisting injury Medial knee pain w/ weight bearing, squatting Unable to fully extend knee and feels the knee will give way while walking Dx and PE finding?
Meniscal tear | Painful click during flexion/extension
52
What is the key prognositc factor in in astrocytomas?
Degree of anaplasia (atypia, mitoses, neovascularity, necrosis are worrisome)
53
``` LN splenomegaly Mild cytopenias Leukocytosis with significant lymphocyte predominancy Dx? ```
CLL | Tx - Rituximab, Ab directed against CD20 Ag
54
IBDU has add neuro syx and holosystolic murmur | Dx?
Brain abscess IE can cause hematogenous seeding to the brain -> FND, elevated intracranial pressure, fever Dx - gadolinium enhanced MRI
55
Pt with CAP is dry and has hyponatremia. Why hypoNa?
Intravascular volume depletion Low volume -> ADH secretion -> retain free water
56
SCD pt with bacteremia/sepsis | Etiology?
Strep pneumo or H. flu
57
SCD pt with PNA
Strep pneumo
58
SCD pt with osteomyelitis or septric arthritis
Staph aureus | Salmonella
59
SCD pt with meningitis
Strep pneumo
60
When are prophylactic abx given prior to dental work
Prosthetic heart valves Previous IE Not required in pts with MVP, Rhemmatic fever, CHD (ASD, bicuspid)
61
How would increasing the cutoff TSH for hyperthyroidism affect Sens and Spec?
Sensitivity would decrease (TP/TP+FN, FN would be increased so Sens would decrease) Specificity would increase
62
AFter receiving haloperidol pt develops muscle stiffness and difficulty turning his neck. Tx?
Diphenhydramine ( or benztropine, trihexyphenidyl; anticholinergics) torticollis d/t EPS
63
Tx for neuroleptic malignant syndrome?
Dantrolene
64
Post menopausal female with bloating, R adnexal fullness, nodularity along rectovaginal septum Dx?
Epithelial ovarian carcinoma
65
``` Severe epigastric pain w/ vomiting x 23 hours BMI 31 42 female Alk phos - 90 ALT - 79 Dx? ```
Acute cholecystitis
66
Best way to improve fertility in a PCOS pt?
Weight loss OCP's recommended to stabilize the endometrium in those not seeking pregnancy
67
Pt with vertigo elicited by positional changes. Most likely to benefit from?
Epley maneuver | Dx BPPV, confirm dx with Dix-Hallpike maneuver
68
Displaced humerous fx increases risk of?
Radial n. injury | Weakness of wrist/finger extension
69
Pt w/ pancreatic cancer has bad pruritis. Best palliative syx option?
Endoscopic stent placement - relieve cholestasis in the CBD Ursodeoxycholic acid is a reasonable option in those with INTRAhepatic cholestasis
70
Pt 3 yrs s/p L mastectomy has DOE x 3 months CXR - L pleural effusion Dx?
Malignant pleural effusion
71
``` Black toddler low back, leg pain x 3 hours viral URI last week Hgb - 8.5 LDH - 700 Dx? ```
Microvascular occlusion Most likely the initial presentation of SCD
72
absent P waves with irregularly irregular QRS complexes on EKG
a fib
73
NL P wave and PR interval that gradually increases until P wave fails to conduct ventricles
Mobitz type I, second degree AV block (Wenckebach)
74
Teen has fatigue while playing basketball Mid systolic murmur best heard at LUSB w/ wide fixed splitting of S2 Dx?
ASD L to R cardiac shunting Fatigued, not cyantoic
75
5 y/o has watery diarrhea 2 wks aft taking abx | pathophys?
Disruption of colonic microflora C. diff
76
``` 71 M Impaired cognition, memory over a year More unsteady on his feet Urinary frequency/urgency Dx? ```
Cerebrovascular dz FND, gait disturbance, urologic, personality changes stepwise decline
77
Pt is septic, pancytopenic following a round of chemo Hyponatremic, hypokalemic Next step?
IV NS
78
16 M immigrant from Thailand intermittent nausea, watery diarrhea, bloating episodic periumbilical pain, lost 5lb Hgb 10.4, MCV 72 Eos - 800 dry cough, SOB when he first arrived to the US Dx?
Parasitic infection Get stool analysis for ova and parasites Hookworm suspicious d/t respiratory findings but unclear (Ancylostoma, Necator)
79
Patient presenting with renal failure, hypercalcemia, anemia | Concerning for?
MM RF d/t light chain casts causing renal tubular injury
80
Fragile X is strongly associated with which psych pathology?
Autism CGG repeat on FMR1 on X chromosome delayed milestones, sutism, ID, elongated face, large testes
81
What do you do with a little old lady with dementia that is wandering around the hospital and being hostile
Haloperidol You snow her.. in reality it's probably delerium
82
Young guy with schizophreniform syx decides to leave during your assessment and the guards catch him. Now what?
Soft restraints, IM haloperidol, lorazepam
83
What workup is needed for pts with new onset psychosis?
``` Need to r/o metabolic causes CMP CBC TSH Utox - most likely to be useful ```
84
``` 3 days s/p anterior MI 80/40, 120 holosystolic murmur at LSB Cardiogenic shock Increased Oxygen saturation in RV vs RA Dx? ```
VSD Ventricular septum rupture 3-5 days s/p MI, L to R shunt in ventricles
85
Pt has acute SOB and R sided heart pressures are elevated compared to L heart pressures Dx?
PE
86
RA pt T - 100.8 Swelling of 2nd MCp joing, exquisite TTP x 2 days Dx?
Gramp + bacterial infection (septic arthritis) acute monoarthritis w/ fever Staph aureus most common
87
2 y/o with painless bloody BM Tc-pertechnetate scan reveals dense area of uptake This is caused by?
Gastric mucosa | Meckel diverticulum
88
``` s/p breast ducal cancer but new dx of lytic bone lesions presenting with fatigue x 3 days Hgb - 6.3 WBC - 18k Plt - 42K Alk phos - 160 LDH - 1200 INR - 3.2 Fibrinogen - 125 (L) Dx? ```
DIC, most common coagulopathy in malignancy DIC = thrombocytopenia, increased INR, decreased fibrinogen Anemia, LDH d/t microangiopathic hemolytic anemia -> non immune hemolysis from RBC fragmentation
89
Childhood murmur irregularly irregular Echo - thickening of mitral valve leaflets w/ commissural fusion and restricted mitral valve opening Cardiac exam finding?
Mid diastolic murmur at cardiac apex | Dx rheumatic mitral stenosis
90
Young guy with syncopal episode during exercise 2/6 murmur at LSB while standing T wave inversion V4-6 Dx?
Hypertrophic cardiomyopathy AD; disorder of cardiac sarcomere systolic murmur that increases with standing
91
Nursing home residenct is bed bound and has non-blanching erythema on both heels. Next step?
Pillows under her legs Early sign of pressure ulcer Once a true ulcer forms -> dressing that maintains a moist wound environment is needed
92
2 hrs s/p thoracentesis (2L) pt is dizzy, diaphoretic 70/palp, 130, 91% on 40% O2 dullness to percussion and absent breath sounds Dx?
Hemothorax suspect in pts with difficulty breathing, hemodynamic instability shortly after thoracentesis Causes decreased LV preload
93
Guy presents with acute scrotal pain | What PE finding suggest a need for urgent surgical intervention?
Absence of cremasteric reflex (testicular torsion; reduced venous outflow)
94
Pt on chemo for non small cell lung cancer develops tinnitus, decreased hearing Why?
Chemo side effect | cisplatin - nephrotoxicity, tinnitus, hearing loss, electrolytie abn, n/v, neurotoxicity
95
``` Nephrotic syndrome with: Black/Hispanic guy OR obese OR HIV OR IVDU ```
Focal segmental glomerulosclerosis
96
``` Nephrotic syndrome associated with: adenocarcinoma NSAIDs HBV SLE ```
Membranous nephropathy
97
Nephritis syndrome associated with: HBV, HCV Lipodystrophy
Membranoproliferative GN
98
Nephrotic dz associated with: NSAIDs Lymphoma
Minimal change dz
99
Nephrotic syndrome associated with: | URI
IgA nephropathy
100
hrs after a trauma pt develops SOB CXR - nonlobar airspace opacity Dx?
Pulmonary contusion generally develops <24 hrs after injury Tx - supportive
101
14 yr old episodes of limb jerking followed by confusion Also some urinary incontinence Dx?
Juvenile myocloic epilepsy Teen w/ progression from absence to myoclonic to tonic clonic seizure seizure typically occurs upon awakening worsened by sleep deprivation
102
``` woman with hx of: Progressive proximal muscle weakness Weight gain irregular menses oily skin Dx? ```
Cushing syndrome | d/t adrenal tumor OR ectopic ACTH production
103
How does nitrostat reduce chest pain?
Venous dilation | The reduced preload reduces myocardial oxygen demand
104
``` 3wk old infant bilious vomiting no recent stool Upper GI series - corkscrew shap, Rward displaced duodenum dx? ```
Midgut volvulus | needs surgery quickly
105
Older pt on glucocorticioids develops meningitis. Needs additional microbial coverage against?
Listeria RFs >50, immunocompromised Tx - ampicillin
106
Best way to prevent gout after initial attack?
EtOh cessation | Weight loss
107
Pathophys of Parkinson's
Decreased DA activity in the substantia nigra
108
R sided neck and arm pain Ulnar parathesia CXR - RUL dense mass, hemidiaphragm Dx?
Superior sulcus tumor (pancoast tumor) Associated with smoking phrenic n. damage
109
``` Young adult frequent diarrhea microcytic anemia Fractures out of proportion to injury Dx? ```
Celiac dz | Malabsorption of Iron, Vit D
110
Older guy soft murmur after second heart sound, declines in intensity disappearing suddenly before the first heart sound Accentuated when he stis up, leans forward, and puts his hands behind his head Dx?
Aortic regurgitation | In developed countries it is caused by aortic root dilation or congenital bicuspid valve
111
Pt has had frequent hospitalizations d/t odd skin infections hospitalized for cellulitis Next day develops sepsis, nurse finds used syringe in his belongings Utox - Dx?
Factitious disorder pt intentionally makes himself sick for attention Malingering - fake syx for a specific reward (ie workmans comp)
112
IVDU w/ b/l lower extremity paralysis | Dx and Tx?
Spinal epidural abscess Tx - broad spectrum abx Staph aureus most common
113
4 M pain on swalling PE - erythema of pharynx, vesicles, Next step?
Obs | Herpangina d/t Coxsackie A
114
``` In septic shock what is PCWP CI SVR Mixed venous O2 ```
PCWP - NL/low (capillary leakage = decreased preload) CI - high SVR - low (vasodilation) MvO2 - high (tissues unable to extract O2)
115
frequent URI's rapidly progressive GN Nonhealing ulcer Dx?
Granulomatosis w/ polyangiitis (GPA; Wegner) necrotizing vasculitis ANCA +
116
Older guy wandering around in traffic with b/l ecchymoses and pedal edema, gums inflamed
Malnutrition | common in elderly especially those w/ dementia
117
``` DOE x 6 months pancytopenic Blood smear - ovalomacrocytosis, PMN w/ reduced segmentation B12 NL Next step? ```
Bone marrow bx Suspicious for myelodysplastic syndrome, a neoplastic stem cell disorder in older pts with previous chemo or radiation Presents with cytopenias and dysplastic RBC, WBC's Tx - Chemo, hematopoietic stem cells
118
6hrs s/p seizure pt has K+ - 5.9 EKG - flattening of P wave, PR intervale prolongation, widening of the WRS Next?
Calcium gluconate | Hyperkalemia causing EKG changes responds to Ca gluconate through stabalization of the cardiac membranes
119
``` 40ish F HA, sweating x months weight loss 240/140 TSH, electrolytes WNL UA 1+ protein Dx? ```
Adrenal meduallary dz (pheo) adrenal cortex produces gluccocorticoids, mineralcorticoids (aldosterone, cortisol)
120
``` 29 F abd pain, diarrhea, fever x 2 months multiple nonbloody BM's WD passing gas and malodorous d/c from her vagina weight loss Dx? ```
Crohn's fevers, chronic diarrhea, abd pain, weight loss FISTULAs
121
Kiddo has honey crusted lesions around his mouth. Increases risk for?
PSGN Impetigo, Staph aureus, GAS NOT rheumatic fever
122
``` Pt presenting with SOB Smoker Meds - albuterol, iprtropium Clear lung sounds CXR - hyperinflation Tx? ```
Glucocorticoids | COPD exacerbation
123
``` Pt on chemo presenting w/ fever, tachy, AMS Hgb - 9.1 WBC - 600 PLT - 90k What is causing her AMS? ```
Bacterial infection Chemo -> neutropenia -> infection/sepsis Cannot build an adequate immune response so their signs of sepsis are milder than the immunocompentent
124
26 F Impulsive Mood instability Unstable sense of self (description of detachment) Fear of abandonment with transient paranoia/psychosis Dx?
Borderline personality disorder
125
``` 69 M Concerns for depression Cold all the time, still muscles, constipation Also some hallucinations Dx? ```
hypothyroidism New onset of psychosis w/ physical syx needs a work up hypothyroidism is often dx'd as depression and can present with psychotic syx
126
Pathophys of ketone production in DKA
Fatty acid breakdown in the liver (lipolysis) -> makes ketones
127
management of DKA?
IV NS Insulin drip K+ containing fluids
128
``` Older adult LN, hepatosplenomegaly Mild thrombocyotpenia, anemia Lymphocytosis more susceptible to infection Dx and finding on Blood smear? ```
CLL | smudge cells
129
ICU pt develops Gram + cocci in clusters bacteremia | How?
Central line associated infection
130
``` 28 wk gestation syx suspicious for PE CXR WNL V/Q scan shows low probability for PE Next step? ```
CT angio of the chest | Need a NL V/Q scan to r/o PE
131
Hereditary spherocytosis increases risk for which GI pathology?
Cholelithiasis d/t chronic hemolysis | bilirubin gallstones
132
HAART drug that produces colorful vivid dreams
Efavirenz | non-necleuoside RT inhibitor that causes neuropsych side effects (insomnia, dreams, depression, anxiety)
133
Woman with urinary incontinence that feels the sens to urinate but cannot make it to the bathroom quickly enough Dx, tx?
Urge incontinence 1st line - bladder training 2nd line - anti muscarinic (oxybutynin)
134
``` 6 F palpable purpura arthalgia abd pain hematuria ```
Henoch-schonlein purpura IgA-mediated vasculitis Tx - supportive
135
Pt has new onset back pain while bowling hypotensive Dx?
AAA | back pain d/t referred pain
136
B/l knee pain, worse at end of day | Tx?
NSAIDs
137
32 wk gestation w/ painless vag bleeding FHR reassuring Next step?
transabdominal U/S | suspicious for placenta previa
138
MVA pt CXR - wide mediastinum hemodynamically stable Next step?
CT angio OR transesophageal echo
139
Tx for F with 3 cm swelling in medial aspect of R labium majus?
Incision and Drainage Dx - Bartholin cyst 4 or 8 o'clock position
140
Young guy being irrate and yelling at traffic dilated pupils Totally fine the next morning Long term tx?
12 step program + individual therapy suspicious for caccaine use disorder
141
``` 45 F fatigue, weight loss (20lb) x 6 mo palpitation, diaphoresis, dyspnea, amenorrhea PMH - vitiligo Smoker PE - sclera are seen about the iris on downward gase digital clubbing Ca - 10.3 Dx? ```
Hyperthyroidism lid lag, amenorrhea, PMH sig for autoimmune dz
142
6mo M irritable, febril When the hip is flexed the knee cannot be extended more than 135 degrees on both sides Why?
Meningitis | Kernig sign = inability to exted knee; indication of meningeal irritation
143
Pt took her sister's migraine medication w/o relief. Gets sumatriptan in the ER which helps. Hours later 220/110, 120 What did her sister have?
Dihydrerotamine co admin with triptan -> prolonged vasospasm d/t overactivation of serotonin R HTN, MI, CVA
144
Kiddo with high fever > 5 days nonexudative conjunctivitis, mucositis, cervical lymphadenopathy, rash, extremity changes Dx, Tx?
Kawasaki dz | Tx - IVIG to decrease the risk of coronary a. aneurysm
145
Older woman difficult driving at night d/t halos around the cars dx and PE finding?
Cataract RF - age, smoking, sunlight, DM, steroids PE - loss of red reflex
146
What change may be seen on CBC in a pt with splenectomy?
Thrombocytosis
147
23 F has burning urination despite abx tx Pyuria No organisms on urine culture Dx and risk of?
Chlamydia urethritis suspect in young pt with dysuria, sterile pyuria, and risky sex behaviors Risk of infertility d/t scarring of Fallopian tubes
148
``` Pt presenting with decompensated HFrEF No meds P - 75 Diuresed in the hospital What should he be given for outpt management for the best long term outcomes ```
B blocker (but apparently atenolol)
149
``` 31 F amenorrhea x 6 months weight gain expressable galactorrhea b/l Next step? ```
Measure TSH should always be included in work up for amenorrhea Can also cause hyperprolactinemia w/ galactorrhea
150
33wk gestation bloody vaginal discharge 50% effaced, 2 cm dilated and given a tocolytic hours later - HA, nausea, flushing, 96/62 What tocolytic was she given?
CCB (used at 32-34 wks) Tocolytics - Indomethacin (COX inhibitor), nifedipine, terbutaline (beta agonist)
151
Newborn hass cyanosis of the lips, nail beds, and tongue. What is causing this?
Low arterial oxygen saturation | Central cyanosis vs. peripheral cyanosis (ie SCD)
152
23 M blood sample is milky and opalexcent PE - yellow streaks on his palms Dx, Tx?
Familial dysbetalipoproteinemia Tx - Fenofibrate yellow streak on palms = striate palmar xanthomas
153
30 wk gestation 3cm dilated, 80%, -3 Next step?
IM betamethasone (<37 wks) Tocolytics Magnesium sulfate penicillin if GBS unk
154
What are the best ways to prevent progression of nephropathy in the setting of T2DM?
1st - blood pressure control (ACEI) | 2nd - glycemic control
155
Pt has intermittent tingling over 4th and 5th fingers and medial forearm Where is the compression?
Elbow | Ulnar n. compression in the epicondylar groove
156
``` 13mo M w/ rash fever x 3 days PE - blanching, pink macules on his neck, back, abdomen, chest No vesicles Dx? ```
Roseola (HHV6) <2 y/o 3-5 days of high fever followed by maculopapular rash Tx - supportive
157
Scleroderma pt has Raynaud's. Tx?
Nifdeipine
158
Pt has big seizure. Dark urine in the foley. What would be found on UA?
+ blood on dipstick (NO RBC casts) | rhabdomyolysis -> myoglobin
159
16 y/o w/ hemoptysis frequent PNA's Pancreatic enzymes for chronic diarrhea Why does he have hemoptysis?
Bronchial airway dilation and erosion CF = PNA + diarrhea develops bronchiectasis after chronic airway inflammation and ifection leading to scarring and dilation of airways
160
Regular OCP use can reduce the risk of which cancer?
Ovarian, endometrial cancers
161
Older pt is having syncope that he describes as sudden black outs lasting 1-2 minutes without confusion afterwards. What is causing his syncope?
Ventricular arrhythmias suspect in syncope w/ rapid onset of LOC w/o a preceding prodrome Torsades de pointes is most common Etiologies = antiarrhythmic drugs, structural heart dz, hypokalemia, hypomagnesmia predispose to Torsades
162
How do you tx a pt with QT interval prolongation in a pt that is hemodynamically stable?
Magnesium sulfate | Even if the Mag level is NL
163
67 F episode of unilateral vision loss x 10min Carotid bruit What is causing her vision loss?
Retinal embolism Amaurosis fugax - painless, sudden, transient monocular vision loss d/t retinal a. emboli from the ipsilateral carotid a. atherosclerotic plaque
164
32 F progressive vision impairment in her R eye Vision became blurry during a shower this morning, discomfort of the eye last night episodes of dizziness, clumsiness x 6 months Reduced R visual acuity, NL fundoscopy What is causing her syx?
Demyelinating disorder d/t MS presenting with optic neuritis Exposure to heat can exacerbate syx (Uhthoff phenomenon)

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