UWSA2 Flashcards

1
Q

woman gets soft subareolar mass from to weeks to months after cessation of breast feeding

A

galactocele

  • benign milk retention cyst
  • can get as large as 5cm
  • dx made with ultrasound and needle aspiration
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2
Q

explain the difference b/w primary and secondary adrenal insufficiency

A

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

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3
Q

erythrasma

A

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
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4
Q

signs of congenital CMV

A
jaundice 
petechiae
hepatosplenomegaly 
periventricular calcifications 
microcephaly
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5
Q

how to treat a gout flare in pts on anticoagulants

A

colchicine

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6
Q

triad of acute liver failure

-there may be more symptoms but these three are the most specific

A
  • elevated aminotransferases
  • hepatic encephalopathy
  • prolonged prothrombin time

*all of these in a pt without underlying liver disease

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7
Q

patient with extensor vs flexor posturing when lying supine, what do you think of

A

flexor means problem is above red nucleus

extensor means problem is below red nucleus

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8
Q

infarctions of this area impair motor functioning causing…

  • hemiparesis
  • dysarthria-clumsy hand syndrome
A

basis pontis (basilar pons)

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9
Q

recurrent lapses into sleep or naps 3 or more times/week for 3 months
… what is this and what are the other criteria

A

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
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10
Q

patient randomly has ischemic ulcers and gangrene but also smokes

A
thromboangiitis obliterans (buerger disease) 
-inflammatory vaso-occlusive disorder to small and medium sized vessels 

-tx: stop smoking

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11
Q

patient has asthma or cystic fibrosis that gets worse and leads to recurrent pulmonary infiltrates and bronchiectasis

A

allergic bronchopulmonary aspergillosis

-tx: long-term oral steroids and itraconazole

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12
Q

treatment of hypercalcemia

A

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
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13
Q

what is the strongest risk factor for prosthetic valve thrombosis of a mechanical heart valve

A

inadequate warfarin anticoagulation

  • goal INR for mitral valve: 2.5-3.5
  • goal INR for aortic valve: 2-3
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14
Q

bipolar I vs bipolar II

A

bipolar I
-manic episodes

bipolar II
-hypomanic episodes + 1 major depressive episode

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15
Q

cyclothymic disorder

A

2+ years of fluctuating, mild hypomanic & depressive symptoms

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16
Q

most common etiology of persistent nasal obstruction during childhood

A

adenoid hypertrophy

  • presents with recurrent sinus and ear infections, mouth breathing, sleep disturbances/snoring due to apnea
  • not seen on exam
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17
Q

what disease are nasal polyps associated with

A

cystic fibrosis

-able to be visualized on exam

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18
Q

positive fetal fibronectin test, next step?

A

give IM betamethasone if they are less than 34 weeks

-+ FFN is associated with delivery within the next week

19
Q

if someone has lambert-eaton, what is your next step

A

get a chest CT cause its associated with small cell lung cancer

20
Q

colonic pseudo-obstruction

A

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
21
Q

what is one thing required in most states regardless of consent?

A

neonatal prophylaxis against gonococcal conjunctivitis

-topical erythromycin

22
Q

what is the most common dermal manifestation of antiphospholipid syndrome

A

livedo reticularis

  • transient latticelike rash caused by impaired blood flow in superficial venules
  • prolonged aPTT due to lupus anticoagulant
23
Q

what does doxorubicin do to the heart

A

cardiac myocyte necrosis and death

  • cardiomyocyte replacement by fibrous tissue
  • not reversible
24
Q

trastuzumab cardiotoxicity

A

myocardial stunning/hibernation without myocyte destruction

-reversible

25
delusional disorder
persistent delusions lasting 1+ months with no other psych symptoms
26
behcet syndrome
genital aphthous ulcers - recurrent and painful - heal w/i 1-3 weeks
27
liver mass with central stellate scar
focal nodular hyperplasia
28
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
29
loss of peripheral vision in a pt with normal visual acuity | -usually elderly pt
open-angle glaucoma | -enlarged cup/disc ratio > 0.6
30
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
31
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
32
what are the three vaccinations a mother should get during the third trimester
Tdap inactivated influenza Rho(D) immunoglobulin- if indicated
33
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
34
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
35
which medications can cause akathisia
-inner restlessness meds - antipsychotics - antiemetics (prochlorperazine, promethazine, metoclopramide) *these can cause all the different types of extrapyramidal symptoms
36
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
37
what to give pts with recurrent hepatic encephalopathy if they are already compliant with their meds
nonabsorbable abx | -give rifaximin on top of lactulose
38
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
39
what is the aortic valve area in severe aortic stenosis
less than 1cm and if they have symptoms | -refer them for valve replacement
40
whatre uterine fibroids made of
aka leiomyomata uteri | -abnormal proliferation of the myometrium
41
how to dx uterine fibroids
sonohysterography | -saline infusion u/s which improves sensitivity of the dx
42
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
43
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