Uworld SA 1 Flashcards
Pts on TPN are at greatest risk of developing?
Blood stream infections (Central line associated infection)
Staph epi, staph a, klebsiella, pseudomonas, candida
Pt drank antifreeze. What would you suspect on ABG?
AG metabloic acidosis
LOW PCO2, HCO3 b/c they are being absorbed by free H+
Calcium oxalate crystals in the urine
Nonstress test is reactive if
> 2 accelerations (+15bpm over baseline) lasting over 15 seconds in a 20 min period
reactive NST = adequate fetal oxygenation
Pt on chemo
develops bulla surrounded by erytema on foot. Bulla ruptured leaving apainless black ulcer
Dx and Tx?
Ecthyma gangrenosum (psuedomonas) Piptazo, fluroquinolones
Pt was started on a med for BPH and had syncope in the middle of the night. Why?
Orthostatic hypotension
He was probably started on alpha blocker
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
Cardiac tamponade
chest pain, decreased cardiac output, pulsus paradoxus following a viral infection -> tamponade d/t pericarditis
Lungs will stay clear
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?
HSV encephalitis
fever, HA, seizure, confusion, stupor x days
CT/MRI/EEG - abn frontotemporal region
CSF - lymphocytosis, RBCs, NL glucose
Smoker has progressive dyspnea but FEV1/FVC 85%
Fibrosis
Older man Pain in legs Worse walking downhill absent ankle reflexes Next step?
MRI
Lumbar spinal stenosis
Older male fatigue, HA, easy bruising 180/120 Increased pigmentation in plamar creases lower extremity ecchymosis hypokalemia hypernatremia 3cm mediastinal mass Dx?
Paraneoplastic cushing syndrome
ectopic ACTH (polypeptide) from small cell lung carcinoma
Hypertension, hyperpigmentation
NL cushings no hyperpigmentation
40 wk gest in labor presents 5cm, 90%, -4 2hrs - 6 cm, 90%, -4 5 hrs - unchanged Inadequate contractions Next step?
IV oxytocin
6 cm >3hrs = protracted labor
C-section if NO change >4 hrs w/ adequate, OR NO change > 6 hours with inadequate
Latent vs active phase of preganancy?
Latent 0-6cm
Active 6-10 cm (rapid changes)
Older man
R hand weakness, slurred speech 15-20 min
hx of afib
What can prevent future episodes?
Anticoagulation (rivaroxaban)
Pleural effustion with: yellow Protein > 4 WBC w/ Lymphocyte predominance low glucose (<60)
Exudative effusion
Causes: infection, malignancy, PE
chylothorax has similar findings but fluid will look milky
Once pt is dx’d with HIV what vaccine should they receive quickly?
pneumococcal 23
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?
superior vena cava syndrome Needs radiation (palliative)
Hospitalized pt s/p surgery develops RUL PNA
Dx?
Aspiration PNA, raising head of bed can prevent this
Pt with cirrhosis has a mild fever
Dx and how did this happen?
Spontaneous bacterial peritonitis
Peritoneal fluid becomes infected when an enteric organism translocates across the intestinal wall
Paracentesis w/ PMH >250 = diagnostic
Bullus pemphigoid Ab’s target the?
Hemidesmosomes
Histo - subepidermal cleavage, linear IgG at BM
Pemphigus vulgaris histo
Acantholysis, intraepidermal cleavage
NO oral cavity involvment
Intact bullus are rare - skin is very fragile!
adult w/ neuro syx has a solitary enhancing brain lesion in the temporal lobe. Most likely cause?
Metastases, most common intracranial tumor in adults
Melanoma, lung, breast, renal
Peripheral, circumscribed enhancing lesion surrounded by vasgenic edema on MRI
Woman had a voluntary abortion during last pregnancy d/t fetal anencephaly. What is recommended to decrease her risk for her next pregnancy?
Begin folic acid
Decreases risk of neural tube defects
Older man weakness x 6 wks Difficults with chairs and stairs AST - 250 ALT - 140 Lactate - 665 CK - 3700
Polymyositis
symmetric proximal m. weakness
Painless (usually), elevated CK
NO skin findings
bx - patchy necrosis, CD8 infiltration of the endomysium
Older adult
symmetric stiffness of shoulders, hip girlde
Elevated ESR, C reactive protein
Polymyalgia rheumatica
Association with temporal arterits
In PTX, chest tubes improve vitals by increasing?
Venous return
Sudden SOB after UCD placement
No lung markings on CXR with a vertical pleural line
Dx?
Tension PTX
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
If it sounds like ALS but has Parkinson features (ie tremor) suspect?
Multiple system atrophy
Adult with periods of unresponsiveness “blank staring” x 1 min
followed by 20 min of confusion, dragging 1 leg
Temporal lobe epilepsy
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
Female
Serositis (pleural/pericardia effusion)
symmetric arthritis
Pancytopenia
SLE
Tx for vtach?
Amiodarone
Two hours after a pneumatic dilation of esophageal stricture pt develops nausea, retching, SOB, chest pain
Emesis w/ clotted blood
Dx?
Esophageal perforation
Most common cause of pancreatic calcifications?
Chronic pancreatitis most commonly d/t alcoholism
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
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
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
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)
Gastric bypass pt develops cholelithiasis Why is she at increased risk?
Rapid weight loss
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
Pt has CKD
Low Ca
High phos
dx?
Secondart hyperparathyroidism
the elevation in PTH -> renal osteodystrophy w/ associated bone pain
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
Diagnositc criteria for SBP
> 250 PMN’s on paracentesis
Guy in septic shock has metabolic acidosis. Why?
Increased tissue metabolic acid production (LDH)
Young adult
fatigue, orthopnea following URI
PMI 6th intercostal space
Dx?
Dilated cardiomyopathy (viral)
Plaques on the knees
Psoriasis
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
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
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
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
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
What is the key prognositc factor in in astrocytomas?
Degree of anaplasia (atypia, mitoses, neovascularity, necrosis are worrisome)
LN splenomegaly Mild cytopenias Leukocytosis with significant lymphocyte predominancy Dx?
CLL
Tx - Rituximab, Ab directed against CD20 Ag
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
Pt with CAP is dry and has hyponatremia. Why hypoNa?
Intravascular volume depletion
Low volume -> ADH secretion -> retain free water
SCD pt with bacteremia/sepsis
Etiology?
Strep pneumo or H. flu
SCD pt with PNA
Strep pneumo
SCD pt with osteomyelitis or septric arthritis
Staph aureus
Salmonella
SCD pt with meningitis
Strep pneumo
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)
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
AFter receiving haloperidol pt develops muscle stiffness and difficulty turning his neck. Tx?
Diphenhydramine ( or benztropine, trihexyphenidyl; anticholinergics)
torticollis d/t EPS
Tx for neuroleptic malignant syndrome?
Dantrolene
Post menopausal female with bloating, R adnexal fullness, nodularity along rectovaginal septum
Dx?
Epithelial ovarian carcinoma
Severe epigastric pain w/ vomiting x 23 hours BMI 31 42 female Alk phos - 90 ALT - 79 Dx?
Acute cholecystitis
Best way to improve fertility in a PCOS pt?
Weight loss
OCP’s recommended to stabilize the endometrium in those not seeking pregnancy
Pt with vertigo elicited by positional changes. Most likely to benefit from?
Epley maneuver
Dx BPPV, confirm dx with Dix-Hallpike maneuver
Displaced humerous fx increases risk of?
Radial n. injury
Weakness of wrist/finger extension
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
Pt 3 yrs s/p L mastectomy has DOE x 3 months
CXR - L pleural effusion
Dx?
Malignant pleural effusion
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
absent P waves with irregularly irregular QRS complexes on EKG
a fib
NL P wave and PR interval that gradually increases until P wave fails to conduct ventricles
Mobitz type I, second degree AV block (Wenckebach)
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
5 y/o has watery diarrhea 2 wks aft taking abx
pathophys?
Disruption of colonic microflora
C. diff
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
Pt is septic, pancytopenic following a round of chemo
Hyponatremic, hypokalemic
Next step?
IV NS
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)
Patient presenting with renal failure, hypercalcemia, anemia
Concerning for?
MM
RF d/t light chain casts causing renal tubular injury
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
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
Young guy with schizophreniform syx decides to leave during your assessment and the guards catch him. Now what?
Soft restraints, IM haloperidol, lorazepam
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
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
Pt has acute SOB and R sided heart pressures are elevated compared to L heart pressures
Dx?
PE
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
2 y/o with painless bloody BM
Tc-pertechnetate scan reveals dense area of uptake
This is caused by?
Gastric mucosa
Meckel diverticulum
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
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
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
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
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
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)
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
Nephrotic syndrome with: Black/Hispanic guy OR obese OR HIV OR IVDU
Focal segmental glomerulosclerosis
Nephrotic syndrome associated with: adenocarcinoma NSAIDs HBV SLE
Membranous nephropathy
Nephritis syndrome associated with:
HBV, HCV
Lipodystrophy
Membranoproliferative GN
Nephrotic dz associated with:
NSAIDs
Lymphoma
Minimal change dz
Nephrotic syndrome associated with:
URI
IgA nephropathy
hrs after a trauma pt develops SOB
CXR - nonlobar airspace opacity
Dx?
Pulmonary contusion
generally develops <24 hrs after injury
Tx - supportive
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
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
How does nitrostat reduce chest pain?
Venous dilation
The reduced preload reduces myocardial oxygen demand
3wk old infant bilious vomiting no recent stool Upper GI series - corkscrew shap, Rward displaced duodenum dx?
Midgut volvulus
needs surgery quickly
Older pt on glucocorticioids develops meningitis. Needs additional microbial coverage against?
Listeria
RFs >50, immunocompromised
Tx - ampicillin
Best way to prevent gout after initial attack?
EtOh cessation
Weight loss
Pathophys of Parkinson’s
Decreased DA activity in the substantia nigra
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
Young adult frequent diarrhea microcytic anemia Fractures out of proportion to injury Dx?
Celiac dz
Malabsorption of Iron, Vit D
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
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)
IVDU w/ b/l lower extremity paralysis
Dx and Tx?
Spinal epidural abscess
Tx - broad spectrum abx
Staph aureus most common
4 M
pain on swalling
PE - erythema of pharynx, vesicles,
Next step?
Obs
Herpangina d/t Coxsackie A
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)
frequent URI’s
rapidly progressive GN
Nonhealing ulcer
Dx?
Granulomatosis w/ polyangiitis (GPA; Wegner)
necrotizing vasculitis
ANCA +
Older guy wandering around in traffic with b/l ecchymoses and pedal edema, gums inflamed
Malnutrition
common in elderly especially those w/ dementia
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
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
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)
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
Kiddo has honey crusted lesions around his mouth. Increases risk for?
PSGN
Impetigo, Staph aureus, GAS
NOT rheumatic fever
Pt presenting with SOB Smoker Meds - albuterol, iprtropium Clear lung sounds CXR - hyperinflation Tx?
Glucocorticoids
COPD exacerbation
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
26 F
Impulsive
Mood instability
Unstable sense of self (description of detachment)
Fear of abandonment with transient paranoia/psychosis
Dx?
Borderline personality disorder
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
Pathophys of ketone production in DKA
Fatty acid breakdown in the liver (lipolysis) -> makes ketones
management of DKA?
IV NS
Insulin drip
K+ containing fluids
Older adult LN, hepatosplenomegaly Mild thrombocyotpenia, anemia Lymphocytosis more susceptible to infection Dx and finding on Blood smear?
CLL
smudge cells
ICU pt develops Gram + cocci in clusters bacteremia
How?
Central line associated infection
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
Hereditary spherocytosis increases risk for which GI pathology?
Cholelithiasis d/t chronic hemolysis
bilirubin gallstones
HAART drug that produces colorful vivid dreams
Efavirenz
non-necleuoside RT inhibitor that causes neuropsych side effects (insomnia, dreams, depression, anxiety)
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)
6 F palpable purpura arthalgia abd pain hematuria
Henoch-schonlein purpura
IgA-mediated vasculitis
Tx - supportive
Pt has new onset back pain while bowling
hypotensive
Dx?
AAA
back pain d/t referred pain
B/l knee pain, worse at end of day
Tx?
NSAIDs
32 wk gestation w/ painless vag bleeding
FHR reassuring
Next step?
transabdominal U/S
suspicious for placenta previa
MVA pt
CXR - wide mediastinum
hemodynamically stable
Next step?
CT angio OR transesophageal echo
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
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
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
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
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
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
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
What change may be seen on CBC in a pt with splenectomy?
Thrombocytosis
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
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)
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
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)
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)
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
30 wk gestation
3cm dilated, 80%, -3
Next step?
IM betamethasone (<37 wks)
Tocolytics
Magnesium sulfate
penicillin if GBS unk
What are the best ways to prevent progression of nephropathy in the setting of T2DM?
1st - blood pressure control (ACEI)
2nd - glycemic control
Pt has intermittent tingling over 4th and 5th fingers and medial forearm
Where is the compression?
Elbow
Ulnar n. compression in the epicondylar groove
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
Scleroderma pt has Raynaud’s. Tx?
Nifdeipine
Pt has big seizure. Dark urine in the foley. What would be found on UA?
+ blood on dipstick (NO RBC casts)
rhabdomyolysis -> myoglobin
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
Regular OCP use can reduce the risk of which cancer?
Ovarian, endometrial cancers
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
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
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
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)
