UWSA2 Flashcards
woman gets soft subareolar mass from to weeks to months after cessation of breast feeding
galactocele
- benign milk retention cyst
- can get as large as 5cm
- dx made with ultrasound and needle aspiration
explain the difference b/w primary and secondary adrenal insufficiency
primary- destruction of adrenal cortex (bilateral)
-all three layers affected
secondary- disruption of hypothalamic-pituitary axis
- cortisol (glucocorticoid) and ACTH decrease
- aldosterone (mineralocorticoid) will be normal
*Note: neither include anything with the adrenal medulla
erythrasma
superficial skin infection affecting areas where skin touches or folds on itself
- well-demarcated, thin, red-brown plaques with wrinkling and fine scale
- coral-red appearance under woods lamp
signs of congenital CMV
jaundice petechiae hepatosplenomegaly periventricular calcifications microcephaly
how to treat a gout flare in pts on anticoagulants
colchicine
triad of acute liver failure
-there may be more symptoms but these three are the most specific
- elevated aminotransferases
- hepatic encephalopathy
- prolonged prothrombin time
*all of these in a pt without underlying liver disease
patient with extensor vs flexor posturing when lying supine, what do you think of
flexor means problem is above red nucleus
extensor means problem is below red nucleus
infarctions of this area impair motor functioning causing…
- hemiparesis
- dysarthria-clumsy hand syndrome
basis pontis (basilar pons)
recurrent lapses into sleep or naps 3 or more times/week for 3 months
… what is this and what are the other criteria
narcolepsy and they must have 1 or more of the following as well
- cataplexy: brief loss of muscle ton precipitated by strong emotion
- low CSF levels of hypocretin-1
- shortened REM sleep latency
patient randomly has ischemic ulcers and gangrene but also smokes
thromboangiitis obliterans (buerger disease) -inflammatory vaso-occlusive disorder to small and medium sized vessels
-tx: stop smoking
patient has asthma or cystic fibrosis that gets worse and leads to recurrent pulmonary infiltrates and bronchiectasis
allergic bronchopulmonary aspergillosis
-tx: long-term oral steroids and itraconazole
treatment of hypercalcemia
severe > 14
- short term- hydration + calcitonin
- avoid loop diuretics unless heart failure exists
- long term- bisphosphonates (zoledronic acid)
moderate 12-14
-no treatment unless symptomatic, look above if needed
mild < 12
- no immediate treatment
- avoid thiazides, lithium, volume depletion, and prolonged bed rest
what is the strongest risk factor for prosthetic valve thrombosis of a mechanical heart valve
inadequate warfarin anticoagulation
- goal INR for mitral valve: 2.5-3.5
- goal INR for aortic valve: 2-3
bipolar I vs bipolar II
bipolar I
-manic episodes
bipolar II
-hypomanic episodes + 1 major depressive episode
cyclothymic disorder
2+ years of fluctuating, mild hypomanic & depressive symptoms
most common etiology of persistent nasal obstruction during childhood
adenoid hypertrophy
- presents with recurrent sinus and ear infections, mouth breathing, sleep disturbances/snoring due to apnea
- not seen on exam
what disease are nasal polyps associated with
cystic fibrosis
-able to be visualized on exam
positive fetal fibronectin test, next step?
give IM betamethasone if they are less than 34 weeks
-+ FFN is associated with delivery within the next week
if someone has lambert-eaton, what is your next step
get a chest CT cause its associated with small cell lung cancer
colonic pseudo-obstruction
aka ogilvie syndrome
- acute dilation of the colon only without any actual obstruction
- massive dilation of the cecum (diameter > 10cm)
- due to surgery, trauma, infection, electrolyte derangement (all decreased), medications, neuro disorders
- treat with npo, ng/rectal tube decompression
- use neostigmine if no improvement within 48 hours
what is one thing required in most states regardless of consent?
neonatal prophylaxis against gonococcal conjunctivitis
-topical erythromycin
what is the most common dermal manifestation of antiphospholipid syndrome
livedo reticularis
- transient latticelike rash caused by impaired blood flow in superficial venules
- prolonged aPTT due to lupus anticoagulant
what does doxorubicin do to the heart
cardiac myocyte necrosis and death
- cardiomyocyte replacement by fibrous tissue
- not reversible
trastuzumab cardiotoxicity
myocardial stunning/hibernation without myocyte destruction
-reversible
delusional disorder
persistent delusions lasting 1+ months with no other psych symptoms
behcet syndrome
genital aphthous ulcers
- recurrent and painful
- heal w/i 1-3 weeks
liver mass with central stellate scar
focal nodular hyperplasia
patients with hyperemesis gravidarum are more likely to have what type of pregnancy
pts with hydatidiform mole or multifetal gestation are at increased risk for HG
-get pelvic u/s if they have it
loss of peripheral vision in a pt with normal visual acuity
-usually elderly pt
open-angle glaucoma
-enlarged cup/disc ratio > 0.6
DRESS syndrome
Drug- most commonly due to allopurinol and antiepileptics (phenytoin, carbamazepine)
Reaction (rash)- morbilliform eruption starts on face or upper trunk and becomes diffuse and confluent, with facial edema
Eosinophilia
Systemic Symptoms- fever, malaise, diffuse lymphadenopathy with some sort of organ involvement (liver, kidney, lung)
- can happen 2-8 weeks after drug initiation
- offending drug should be stopped immediately and usually pts recover completely
what should you worry about if someone gets malaria from a non-African country
its likely vivax and you need to worry about dormant hepatic infection that can reactivate if you dont use primaquine to get rid of the hepatic hypnozoites
-can cause a persistent dormant infection
what are the three vaccinations a mother should get during the third trimester
Tdap
inactivated influenza
Rho(D) immunoglobulin- if indicated
choriocarcinoma
- secretes hCG, following any type of pregnancy
- very aggressive
- uterine mass that most commonly metastasizes to the vagina and lungs (on vagina presents as red, friable lesions)
- can cause bloody purulent vaginal discharge
- pelvic pressure and enlarged uterus
patient presents with microscopic colitis
- frequent watery bms
- fecal urgency
- incontinence
- classically: nocturnal diarrhea
- workup for pretty much everything else is negative
what do you see on biopsy of the colon?
mononuclear predominant infiltrate
-risk factors: > 50, women, smoking, possibly NSAIDs
which medications can cause akathisia
-inner restlessness
meds
- antipsychotics
- antiemetics (prochlorperazine, promethazine, metoclopramide)
*these can cause all the different types of extrapyramidal symptoms
how to differentiate myelodysplastic syndrome and myelofibrosis
both have pancytopenia
- myelodysplastic syndrome has dysplastic cells- PMNS with decreased segmentation and decreased granulation/anything where the cells dont look normal. also insufficient reticulocytosis
- myelofibrosis has pretty huge splenomegaly due to extramedullary hematopoiesis
what to give pts with recurrent hepatic encephalopathy if they are already compliant with their meds
nonabsorbable abx
-give rifaximin on top of lactulose
patient comes back from a trip with gi symptoms, fever, relative bradycardia, and a pulmonary infiltrate, what do you think
legionella pneumophilia pneumonia
- dx with urine legionella antigen
- treat with respiratory fluoroquinolone or newer macrolide
what is the aortic valve area in severe aortic stenosis
less than 1cm and if they have symptoms
-refer them for valve replacement
whatre uterine fibroids made of
aka leiomyomata uteri
-abnormal proliferation of the myometrium
how to dx uterine fibroids
sonohysterography
-saline infusion u/s which improves sensitivity of the dx
patient has blurred vision, raynauds, headaches, confusion, possibly ataxia… what do you think of if they also have tons of IgM
waldenstrom macroglobulinemia
- hyperviscosity syndrome
- do serum IgM plasma exchange to reduce viscosity
how to treat codylomata acuminata (presents in clusters)
HPV induced anogenital warts
- may worsen due to pregnancy due to physiologic immunosuppression
- give topical trichloroacetic acid
