UWSIM2 Flashcards
What is the preload, cardiac output, and after load seen in cardiogenic shock?
Cardiac output is reduced due to impaired contractility.
Preload is increased due to the heart’s inability to effectively pump out blood.
After load is increased due to an increase in peripheral vascular resistance in an effort to maintain blood pressure.
What is the most common congenital infection? What are symptoms of this infection?
CMV.
Petechiae, jaundice, hepatosplenomegaly, microcephaly, periventricular calcifications.
What is the triad of acute liver failure?
Elevated aminotransferases, hepatic encephalopathy, and prolonged prothrombin time in a patient without underlying liver disease.
Where do hypertensive hemorrhages most often occur? What are symptoms?
Basal ganglia: dilated, non-reactive ipsi pupil, contra extentensor posturing, coma, and respiratory compromise.
What is an important initial first treatment for pancreatitis?
Fluid resuscitation: pancreatitis causes systemic inflammation and aggressive fluid resuscitation within the first 48 hours is important to minimize and prevent end-organ damage, ATN, and necrotizing pancreatitis.
Patients also need pain management.
(Antibiotics are NOT typically given unless there’s evidence of infection)
What is the purpose of the fetal fibronectin test? What does a positive test result mean?
To determine if a patient <34 weeks with regular contractions and no cervical change is in preterm labor.
A positive test result is a strong indicator of delivery within the next week and therefore patients should get corticosteroids (betamethasone).
What are symptoms of Dementia with Lewy Bodies?
Fluctuating cognition/attention, well-formed visual hallucinations, and motor manifestations of parkinsonism: rigidity, bradykinesia, and postural instability).
What is the management of a patient <37 weeks with unknown GBS status who presents in labor? Why?
Penicillin.
Because women are normally swabbed at 35-37 weeks and given antibiotics if they test positive. If they present before they were swabbed we give them abx to be safe.
What diseases are associated with livedo reticularis?
SLE, polyarteritis nodosa, cholesterol embolism, antiphospholipid antibody syndrome, and cryoglobulinemia.
What lab abnormality is seen in antiphospholipid antibody syndrome?
PTT prolongation
What does focal nodular hyperplasia look like on imaging and what is the treatment?
Most common benign liver lesion that is usually <5cm, solitary lesion, due to hyperplastic response to hyperperfusion. MRI may show a lesion with arterial enhancement and a central stellate scar.
Treatment is usually to leave it alone. OCPs may increase their size because they are estrogen sensitive lesions, so women may need to stop taking them.
What symptoms are seen with an incisional hematoma?
Dark red sanguineous drainage and incisional pain.
This is an abnormal collection of blood t the incision site, often due to inadequate surgical hemostasis.
What is an ascertainment bias?
A bias that occurs when the results from a study of an atypical population are extrapolated to an entire population.
What is a selection bias?
When a treatment plan is selected based on the patients severity of their condition. Their worse outcome therefore may be a result of the selection bias rather than the treatment itself.
What is chronic open angle glaucoma? How does it present?
A type of optic neuropathy caused by an intraocular pressure and atrophy of the optic nerve head. It presents with progressive loss of peripheral vision and exam shows enlargement of the optic cup with increased cup/disk ratio.
What are the consequences of maternal hyperglycemia in the first trimester?
Congenital heart disease
NT defects
Small left colon syndrome
Spontaneous abortion
What are the consequences of maternal hyperglycemia in the second and third trimester?
Polycythemia (increased metabolic demand causes hypoxemia and those increased erythropoietin) Organomegaly Neonatal hypoglycemia Brachial plexopathy Clavicle fracture Perinatal asphyxia
What is colonic pseudo-obstruction (Ogilvie) syndrome?
Post-op complication with abdominal pain, distension, and colonic dilation without radiographic evidence of an anatomic obstruction.
How can you differentiate Ogilvie syndrome from post-op ileus?
Post-op ileus would not cause severe colonic dilatation and also occurs before return of bowel function after surgery.
What geographical location is plasmodium falciparum found? Does it have a dormant phase? What is the treatment?
Africa primarily.
NO dormant phase.
Treat with chloroquine.
What is the geographical location of plasmodium vivax? Does it have a dormant phase? What is the treatment?
Non-african countries.
YES there is a dormant phase with hepatic hypnozoites.
Treatment with chloroquine + primaquin (for hypnozoites)
What is the most effective way to prevent acquisition of genital herpes?
Consistent condom use.
This is because there can be subclinical viral shedding occurring in the absence of a recognized outbreak.
What symptoms are associated with Legionella?
Recently returned frmo a trip, GI symptoms, high fever with relative bradycardia, and signs of pulmonary infiltrate (decreased BS, crackles)
When should patients with aortic stenosis be referred for valve replacement?
When it’s severe (area <1cm^2) and symptomatic (exertional dyspnea, angina, presyncope/syncope)
What are uterine fibroids (leiomyomata uteri) made of? What symptoms do they cause?
Abnormal proliferation of the uterine myometrium. They cause heavy menstrual bleeding and an irregularly enlarged uterus.
What is active phase labor protraction? What is the most common cause?
When you’re 6 or more centimeters and cervical progression <1cm every 2 hours
Most common cause is inadequate contractions therefore give oxytocin
What is active phase labor arrest? What is the treatment?
6 or more centimeters with no cervical change for 4-6 hours.
Treatment is C-section.
When is an operative vaginal delivery (forceps) used?
When the patient is 10 cm dilated and there’s category 3 tracing or maternal exhaustion.
What are the characteristics of a tuberculosis pleural effusion?
Very high protein levels (>4) Lymphocyte leukocytosis Low glucose (<60) Increased LDH Low pH
How can you tell an empyema from TB effusion?
Empyema has frank pus or bacteria via gram stain.
Usually fever and pleuritic chest pain.
Fluid has PMN predom with >50,000 PMNs
What is the clinical presentation of spontaneous bacterial peritonitis?
Temp >100
Abdominal pain/tenderness
AMS
Hypotension, hypothermia, paralytic ileus (With severe infection)
What does a diagnostic para show in SBP?
> 250 PMNs
Positive culture (often Gram neg)
Protein <1
SAAG >1.1
What type of seizure can look like an absans seizure but in an adult?
Temporal lobe epilepsy: focal seizures with impaired consciousness (blank stare)
SLE is a multisystem inflammatory condition that commonly causes _____ and _____.
Serositis (pericardial effusion) and symmetric polyarthritis.
What is the treatment for a stable patient with monomorphic VTACH?
Amiodarone.
Calcifications on CT of the pancreas are most likely due to?
Chronic alcoholism.
Hypercalcemia >12 likely indicates what etiology?
Malignancy.
Patients who undergo Roux-en-Y bypass have a 30-40% chance of developing gallstones due to what?
Rapid weight loss, which promotes gallstone formation.
What are non-pharm and pharm treatments for overflow incontinence?
Suprapuc pressure, timed voids, double voiding.
Cholinergic agonists (bethanechol)
What is the cause of metabolic acidosis in patients with septic shock?
Insufficient oxygen to tissues causes anareobic metabolism, generating increased amounts of lactic acid.
What are the predominant presenting symptoms in pancreatic cancer?
Jaundice
Weight loss
Vague abdominal discomfort
What are the examples of immunocompromised states that increase the risk of TB?
CKD DB HIV Hematologic malignancies Immunosuppresive meds
How can you differentiate SBO from paralytic ileus?
SBO is colicky pain with hyperactive bowel sounds
Paralytic ileus is constant with decreased bowel sounds
What is the first line management for infertility in patients with PCOS?
Weight loss in order to decrease peripheral conversion of estrogen and restore ovulation.
How do you treat afib?
Anticoagulation + beta blocker or Non-dihydro CCB
A patient with renal failure + hypercalcemia + anemia should be evaluated for what?
Multiple myeloma.
What are features of fragile X syndrome?
Delayed milestones, features of autism, intellectual disability, elongated face, small testes.
The anemia seen in DIC is often due to ______.
Microangiopathic hemolytic anemia.
What are clinical associations with focal segmental glomerulosclerosis?
African american, hispanic, obesity, HIV and heroin use.
What are clinical associations with membranous nephorpthy?
Adenocarcinoma of the breast and lung
NSAIDs
HepB
SLE
What are clinical associated with membranoproliferativee glomerulonephritis?
HepB and C
What is the classic finding on imaging in patients with malrotation with midgut volvulus?
Corkscrew-shaped duodenum that is abnormally located in the right abdomen
should be suspected in neonate with bilious vomiting)
Why is there an elevated mixed venous oxygen saturation in septic shock?
Due to hyperdynamic circulation with an inability of tissues to adequately extract oxygen
What causes the acidosis in DKA?
Without insulin, fatty acids are broken down in the liver to ketones.
CLL is characterized by ____ cells.
smudge
Alpha adrenergic antagonists (-zosin) treat what type of urinary problem?
Bladder outlet obstruction from BPH
What are the first and second ling therapies for urge incontinence?
1st: bladder training
2nd: anti-muscarinic agents (oxybutynin)
What three things can cause reactive thrombocytosis?
Surgery, infection, malignancy.
splenectomy can cause dramatic thrombocytosis because the spleen normally removes platelets
Patients with amennorrhea, galactorrhea, and metabolic slowing (fatigue, weight gain, bradycardia) should be tested for what?
Hypo freaking thyroidism
How should carpal tunnel be treated when splinting fails?
Corticosteroid injections and surgical decompression
What are side effects of nifedipine?
Flushing, headache, tachycardia, palpitations
The most effective way to slow the progression of of diabetic nephropathy is by doing what?
Controlling BP
Regular use of OCPs decreases the risk of what cancers?
Endometrial and ovarian
Regular use of OCPs increases the risk of what?
Breast and cervical cancer
And hepatic adenoma
Treatment of torsades de pointes in hemodynamically stable patients is what?
Magnesium sulfate (even if they have a normal magnesium level).
