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UWSA1 Flashcards

1
Q

what to think of if someone drinks antifreeze

A

ethylene glycol poisoning

  • causing a metabolic acidosis with increased anion gap
  • compensatory drop in paCO2
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2
Q

pt taking medication for BPH and nocturnal urinary symptoms, what should you be concerned about

A

they could be taking an alpha-blocker in which case lookout for orthostatic symptoms which occur du e to peripheral vasodilation

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3
Q

what heart problem can occur after a viral illness

A

acute pericarditis which can cause cardiac tamponade

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4
Q

why is there RBC elevation in CSF of someone with herpes encephalitis

A

result of hemorrhagic destruction of frontotemporal lobes

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5
Q

how does interstitial lung disease present

  • progressive dyspnea and nonproductive cough
  • fine bibasilar velcro-like crackles
A

pulmonary fibrosis that leads to stiffening of lungs and decreased lung compliance
-FEV1 and FVC decrease proportionally so the ratio is roughly the same or may even be increased

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6
Q

what is the most common cause of spinal stenosis and what is the classic symptom

dx definitively with MRI of spine even tho x-ray can suggest it

A

cause: degernative osteoarthritis (spondylosis)
symptom: neurogenic claudication, lower extremity pain with extension of spine and flexion relieves the pain

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7
Q

if pt has increased pigmentation in palmar creases what do you immediately think of

A

increased levels of ACTH (polypeptide) b/c when POMC gets cleaved into ACTH it also stimulates melanogenesis

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8
Q

when to use vaginal misoprostol

A

used for cervical ripening (softening and thinning of the cervix) in pts undergoing labor induction
-not used for pts in spontaneous active labor

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9
Q

most common etiology of active phase protraction of labor when cervical dilation is slower than expected (< 1cm ever 2 hours)

A

contraction inadequacy is most common

-give oxytocin

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10
Q

how to help prevent thrombotic events in pts with a.fib

A

give warfarin or NOAC (rivaroxaban, dabigatran, apixaban, edoxaban)

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11
Q

explain pleural fluid in pt with tb

A

very elevated protein (always >4), lymphocytic leukocytosis, low glucose < 60

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12
Q

what color is the fluid in a chylothorax

A

turbid or milky white

-due to leakage of chyle into thoracic space from obstruction of thoracic duct

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13
Q

when to give what vaccinations for HIV pts with CD4 count above 200

A
  • all pts with HIV require pneumococcal and INACTIVATED influenza
  • Zoster vaccination indicated for those with no hx of disease and no evidence of immunity
  • once CD4count is below 200 then treat prophylactically for opportunistic infections
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14
Q

most common cause of superior vena cava syndrome

A

malignancy

-do radiation therapy

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15
Q

how does spontaneous bacterial peritonitis occur

A

peritoneal fluid becomes infected by enteric organism that translocates across intestinal wall
- >250 PMNs on paracentesis is diagnostic

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16
Q

how to treat bullous pemphigoid

A

high-potency topical glucocorticoids

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17
Q

which cancers most commonly go to the brain

A

melanoma, lung, breast, renal

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18
Q

why does tension pneumothorax lead to hypotension

A

essentially causes superior vena cava syndrome

  • high intrathoracic pressure impedes venous return by compressing the vena cava
  • needle decompression causes an increase in venous return
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19
Q

what is the most common manifestation of temporal lobe epilepsy

A

focal seizures with impaired awareness

-you know its from the temporal lobe because of the associated automatisms like hand or mouth movements

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20
Q

all forms of poorly controlled diabetes (pre and gestational) in pregnancy have increased risk of what

A

fetal lung immaturity
preterm delivery
macrosomia

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21
Q

when you see a pt with v.tach what is the next thing to do

A

determine if the pt is stable or unstable

-if stable then give IV amiodarone

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22
Q

how to treat supraventricular tachycardia/tachyarrhythmia

A

-adenosine
-digoxin
(verapamil or metoprolol if adenosine doesnt work)

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23
Q

what to think of if a pt has weakness and leg cramps after initiation of thiazide diuretic

A

significant hypokalemia

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24
Q

what to think of if pt has persistent hypertension OR hypertension and hypokalemia (muscle weakness)

A

hyperaldosteronism

  • primary = tumor
  • secondary = mimickers
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25
Q

what to lookout for after a pt has gastric bypass surgery

A

these pts have 30-40% chance of developing symptomatic gallstones due to rapid weight loss which promotes their formation (due to increased bile concentrations of mucin and calcium)

  • usually pts get ursodeoxycholic acid 6 months postop to reduce risk of gallstone development
  • if pt has gallstones before the surgery some surgeons might even just take out the gallbladder at that time too
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26
Q

pt with CKD has low calcium and high phosphate, what do you think of if they also have bone pain

A

secondary hyperparathyroidism
-kidney isnt helping increase the calcium so the bone works extra hard and becomes thinner cause its giving up so much calcium causing renal osteodystrophy and associated bone pain

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27
Q

how to treat overflow incontinence

A

cholinergic agonists

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28
Q

how does a pt with hepatic encephalopathy present and what do you look for after

A

altered mentation and asterixis with EtOH abuse hx

  • look for cause in hx, look for infection, electrolyte abnormalities, and evaluate for high-nitrogen states like GI bleeding and dietary changes
  • give lactulose
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29
Q

what presentation should make you think of septic shock

A

fever, tachycardia, hypotension, bronchial breath sounds (or something else that could be the site of initial infection)

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30
Q

what to be concerned about in septic shock

A

its a hypermetabolic state so pts might have insufficient o2 delivery to meet metabolic demands of peripheral tissues resulting in creased anaerobic metabolism from cells leading to buildup of lactic acid –> metabolic acidosis

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31
Q

lichen simplex chronicus

A

aka neurodermatitis

  • thickened excoriated plaques due to persistent scratching and rubbing
  • associated with anxiety disorder
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32
Q

jaundice + weight loss and abdominal discomfort with fullness in RUQ

A

pancreatic cancer

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33
Q

how does acute iron poisoning present

A

direct injury of GI tract –> lots of abdominal pain hematemesis and green/black stool (diarrhea) from disintegrating iron tablets

  • followed by shock and anion gap metabolic acidosis
  • hepatic necrosis and bowel scarring/obstruction may also occur
  • treat with deferoxamine and whole bowel irrigation
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34
Q
  • acute twisting injury of the knee
  • joint line tenderness
  • slow-onset effusion
  • sensation of instability
  • locking or catching when the joint is rotated or extended while under load
A

meniscal tears

-can also occur from minimal trauma in older pts with chronic degeneration of the cartilage

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35
Q

prognosis of astrocytomas are affected by what

A 
*these can all make prognosis worse
tumor grade 
increased atypica
mitoses
neovascularity
necrosis
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36
Q

how to treat CLL

A

median survival is 10 years and treatment is not necessary until advanced symptoms occur
-monoclonal antibodies against CD20 antigen are often part of the first-line treatment

37
Q

serum sodium < 135
decreased intake and output of water, orthostatic lightheadedness, dry mucous membranes, poor skin turgor, tachycardia, orthostatic hypotension

A

hypovolemic hyponatremia

extrarenal losses have urine sodium < 20

renal losses have urine sodium > 20

decreased effective circulating volume in CHF and cirrhosis

38
Q

abx prophylaxis for infective endocarditis is recommended for who

A

only in pts with high risk of adverse events from IE like prosthetic heart valves or previous IE

39
Q

pt presents with large adnexal mass and symptoms of hyperestrogenism (precocious puberty, endometrial hyperplasia, postmenopausal bleeding)

A

granulosa cell tumor

40
Q

right-sided adnexal fullness and firm nodularity along the rectovaginal septum with small chest pleural effusion

A

epithelial ovarian carcinoma

  • high CA-125
  • increased urinary frequency/urgency, pain, bloating, and abdominal distention
41
Q

most common cancers that cause malignant pleural effusion

A

breast and lung cancer

-malignancy should be suspected in pts with large unilateral pleural effusions without evidence of infection

42
Q

goal in management of septic shock

A

restoring adequate tissue perfusion through IV saline and identifying/treating underlying infection

-then start vasopressors (dopaimine, norepi) only if pt fails to respond with IV fluids

43
Q

pt presents with chronic gi discomfort, malabsorption (diarrhea, weight loss), and eosinophilia

A

hookworm or some parasitic infection

44
Q

CRAB findings in multiple myeloma

A

Calcium increased
Renal insufficiency (tubular damage)
Anemia (normocytic)
Bone lytic lesions and osteopenia

45
Q

fragile X syndrome

CGG repeat

A

hypermethylation of gene and impaired transcription of protein FMRP which is important to brain development

  • features of autism
  • delayed milestones, seizures, macrocephaly, and hypotonia
  • more typical features: elongated face, large ears, enlarged testes
  • CGG repeat = Chin Giant Gonads
46
Q

in a pt with psychosis what do you want to do

A

urine drug screen to rule anything else out

47
Q

positive technetium-99m pertechnetate scan

A

meckel diverticulum

  • ectopic gastric mucosa within 2ft of ileocecal valve
  • rule of 2s
  • persistent vitelline duct
48
Q

what is a common cause of DIC

A

microangiopathic hemolysis

49
Q

pt gets thoracentesis then develops quick reaccumulation of pleural effusion, has difficulty breathing, and hemodynamic instability

A

hemothorax

-causes decreased LV preload

50
Q

nephrotic syndrome and hypoalbuminemia

A

FSGS

51
Q

does a pulmonary contusion show on x-ray?

A

yes as a nonlobular opacity

-alveolar hemorrhage and edema resulta nd impair oxygen diffusion

52
Q

how does a pt with parkinson disease present

A

small steps and festinating gait with slow speech and resting hand tremor with cogwheel rigidity on passive range of motion

  • frequent falls are typical
  • histology: frontal lobe atrophy with dopaminergic neuron degeneration in substantia nigra pars compacta
53
Q

when is xanthochromia seen in CSF of pts

A

subarachnoid hemorrhage

54
Q

what will the lumbar puncture findings be in someone with guillain-barre syndrome

A

elevated protein with normal leukocyte count

-albuminocytologic dissociation

55
Q

pt presents with sudden paralysis and has a hx of injection drug use or spinal procedure

A

spinal epidural abscess

  • most commonly with concurrent distant infection (skin or soft tissue)
  • classic triad: fever, back pain, neurologic manifestations
  • treatment: broad-spectrum abx (vanc + ceftriaxone) and aspiration or surgical decompression
56
Q

oral vesicles on uvula, soft palate, and tonsillar pillars in child

A

herpangina caused by coxsackie A virus

-dx is clinical and treatment is reassurance and supportive care

57
Q

granulomatosis with polyangiitis

A

necrotizing vasculitis

  • affects upper and lower respiratory tracts and kidneys
  • cutaneous manifestations are also common as the vasculitic inflammation may lead to localized ischemia and impaired wound healing
58
Q

stem cell disorder primarily in older adults and those who have had previous chemo or radiation

A

myelodysplastic syndrome

  • macrocytic anemia, leukopenia, and thrombocytopenia
  • peripheral blood smear shows signs of dysplasia including oval macrocytes and hyposegmented/hypogranulated neutrophils
  • bone marrow biopsy required for dx
59
Q

increased symptomatic calcium… how do you treat this

A

calcium gluconate

60
Q

how to treat COPD exacerbation

A 
O2 with target at 88-92
bronchodilators 
glucocorticoids 
abx if needed 
oseltamivir if influenza 
NPPV if vent failure 
Trach intubation if NPPV failed or contraindicated
61
Q

after a pt gets chemotherapy what are you concerned about

A

chemo can cause neutropenia putting pts at risk for systemic infections and sepsis

62
Q

myxedema madness

A

if a pt has hypothyroidism (fatigue, weight gain, cold intolerance, myalgia, and constipation)
-also possible depressed mood
PLUS psychosis then its still hypothyroidism cause myxedema madness can be found in these pts

63
Q

what is the basis of diabetic ketoacidosis in children

A

fatty acid breakdown in the liver causing increased ketones and acidosis

64
Q

when to add K vs glucose to pt who you are treating diabetic ketoacidosis

A

add IV serum K if <5.3
hold if 5.3 or above

add glucose if serum glucose < 200

65
Q

whatre bad prognostic factors in pts with CLL

A

multiple chain lymphadenopathy
hepatosplenomegaly
anemia and thrombocytopenia

66
Q

what is the richter transformation

A

CLL/SLL transforms into aggressive lymphoma most commonly diffuse large B-cell lymphoma

67
Q

if you think a pregnant pt has a PE but the V/Q scan shows a low probability then what do you do

A

get a CT-Angiography or LE ultrasound for further testing
-D-Dimers are NOT helpful in pregnant pts cause it changes during pregnancy anyways

*Note: in any situation where the pretest probability is low then a low D-Dimer cant actually rule out a PE

68
Q

what HIV med should be used cautiously in pts with hx of psych illness (its an NNRT)

A

Efavirenz

they could develop anxiety, insomnia, dizziness, impaired concentration, and VIVID DREAMS
-even in previously nonanxious pts

69
Q

describe the difference b/w stress, urgency, and overflow urinary incontinence

A

STRESS

  • leaking with valsalva, cough, sneeze, laugh
  • lifestyle modification, pelvic floor exercises, pessary, pelvic floor surgery

URGENCY

  • sudden, overwhelming, or frequent need to void
  • lifestyle mod, bladder training, antimuscarinic

OVERFLOW

  • constant involuntary dribble and incomplete emptying
  • identify and correct underlying cause, cholinergic agonists, intermittent self-cath
70
Q

what is the next step in pts with vaginal bleeding at > 20 weeks gestation

A

transabdominal ultrasound to evaluate placental location

71
Q

if pt has blunt thoracic aortic injury how do you treat them if they are hemodynamically unstable vs stable

A

unstable (hypotension, active hemorrhage): thoracotomy +/- transesophageal echo in OR

stable: CT angiography to determine vascular surgery vs open thoracic surgery repair

72
Q

what is an aortography

A

looking at the aorta via femoral artery catheterization

73
Q

migraine treatment

A

pt who already got a triptan or ergot derivative in the past 24hrs sholudnt get another one cause that can cause prolonged vasocontriction due to overactivation of serotonin receptors (can lead to htn, mi, stroke)

74
Q

flame hemorrhages in the eye

A

hypertensive retinopathy

  • acute monocular loss of visual acuity and visual field defects
  • headaches and other neuro problems also present
75
Q

increased optic cup/dic ratio

A

optic nerve atrophy due to open-angle glaucoma

-gradual loss of peripheral vision

76
Q

glare, halos around bright light, difficulty with night driving (loss of visual acuity), myopic shift

A

cataracts

  • progressive opacifications of lens caused by oxidative damage from smoking or sunlight exposure
  • pts with DM also at high risk
77
Q

after a splenectomy what can you expect to see on pts CBC

A

thrombocytosis

-typically platelet count normalizes after several weeks but some may have it for months or years after surgery

78
Q

most common cause of sterile pyuria with associated urethritis

A

chlamydia

79
Q

which beta blockers have been shown to improve symptoms and overall long-term survival in pts with heart failure and LV systolic dysfunction with ejection fraction < 40%

A

metoprolol succinate
carvedilol
bisoprolol

80
Q

patient has galactorrhea but also signs of hypothyroidism, what do you think

A

hypothyroidism is a common cause of hyperprolactinemia, abnormal uterine bleeding can also occur
-evaluate further with TSH level

81
Q

how to treat carpal tunnel syndrome

A
  • wrist splinting
  • glucocorticoid injection
  • surgery for severe or refractory symptoms
82
Q

first-line tocolytics depending on weeks

A

<32 weeks: indomethacin
maternal se- gastritis, platelet dysfunction
fetal se- oligohydramnios, closure of ductus arteriosus

32-34 weeks: nifedipine
maternal se- tachycardia, palpitations, nausea, flushing, headache

Short-term tocolytic for inpatient use: terbutaline (beta agonist)
maternal se- tachycardia/arrhythmias, hypotension, hyperglycemia, pulmonary edema

83
Q

palmar xanthomas

A

dysbetalipoproteinemias

  • defective ApoE
  • palmar xanthomas show severe hypertriglyceridemia
  • can also cause premature atherosclerosis
84
Q

what does cholestyramine do

A

bile acid binding resin that helps reduce LDL levels

-might actually increase TGs

85
Q

what does ezetimibe do

A

prevents absorption of dietary cholesterol from gut

-reduces LDL best when used with statin

86
Q

how to treat raynauds

A

calcium channel blockers

87
Q

pt has rhabdomyolysis, what do you expect to see with kidney stuff

A

some blood and pigmented casts due to skeletal muscle necrosis causes heme-containing myoglobin into the bloodstream

  • heme pigment is responsible for renal manifestations of rhabdo
  • dark red urine
  • positive blood but no red blood cells
88
Q

sudden onset syncope without a prodrome

A

arrhythmia

possibly due to TdP

89
Q

what medication used to maintain sinus rhythm can predispose to Tdp

A

sotalol

  • side effect of QT prolongation
  • hypokalemia and hypomagnesemia can both lead to cardiac problems
  • GIVING MAGNESIUM can prevent episodes of Tdp

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