uworld13

Question 1

someone who has acute illness and midly low T3 think…

Answer 1

euthyroid sick syndrome (due to cytokines and decreased deiodination)

Question 2

is T3 or T4 decreased with hypothyroidism primarily?

Answer 2

T4

T3 only decreases at late stage

Question 3

reidel’s thyroiditis

Answer 3

inflammatory disorder- fibrosclerosis of thyroid and surround

hard goiter

Question 4

pneumo 13 vs pneumo23 vaccines

Answer 4

13: over 65
23: >65 or under >65+DM, liver dz, or lung dz

Question 5

what should you think with this: jaundice, dark urine, pale stool, weight loss

Answer 5

pancreatic cancer (head)

Question 6

courvoiser sign

Answer 6

distended gallbladder

seen in pancreatic cancer of head

Question 7

how does acid base shifts affect calcium levels?

Answer 7

acidic–> H+ leaves albumin, leaving room to bind Calcium –> decreased ionized Ca –> signs of hypocalcemia

Question 8

how does hypersplenism affect platelet levels?

Answer 8

platelet sequestreation, but no clinical bleeding (overall platelet function and mass nl)

Question 9

should you give abx before blood clx taken?

Answer 9

no

Question 10

ARDS treatment

Answer 10

PEEP

Question 11

fever, pustular rash, polyarthralgia with sex work. think

Answer 11

disseminated gonococcal infection

Question 12

pulmonary contusion on CXR

Answer 12

patchy irregular alveolar infilrates

Question 13

timeline of fat embolism vs pulm contusion after trauma

Answer 13

fat: 12-72 hours
pulm: <24

Question 14

treatment for pulm contusion

Answer 14

pain meds
nebs, chest PT
supp O2 and vent

Question 15

other causes of pancreatitis besides gallstones and etoh

Answer 15

hypertriglyceridemia

meds (valproic acid, azathioprine, thiazides)

infection

recent ERCP, trauma

Question 16

if someone has HIT, what anticoagulant should they have

Answer 16

non-heparin product (factor X inh, fondoparinaux)

once platelets have increased and they are on the other anticoagulant, could they then transition to warfarin

Question 17

pleural fluid with low glucose think…

Answer 17

empyema- WBC consume glucose

Question 18

amylase in pleural fluid, think

Answer 18

pancreatitis

esophageal rupture

Question 19

PNH pathophys

Answer 19

genetic defect of anchor for CD55,59 –> overactive MAC

Question 20

low haptoglobin and high LDH, think intravascular or extravascular hemolysis

Answer 20

intravascular

Question 21

PNH sxs

Answer 21

hemolysis- -> dark urine

cytopenias

hypercoagulable state– thromboses

Question 22

dx and tx of PNH

Answer 22

dx: flow cytometry
tx: eculizumab, iron folate supp

Question 23

what factors should you admit patient for pneumonia

Answer 23

age >65
confusion
hypotension
RR>30
urea>20