Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AV_Step 3 UWORLD > VENI VIDI VICI 3 > Flashcards

VENI VIDI VICI 3 Flashcards

1
Q

SE of lithium

A

hypothyroidism
nephrogenic DI

Toxicity: N/V, ataxia, slurred speech, hyperreflexia, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of lithium toxicity

A

stop lithium, hydrate aggressively with isotonic NaCL and consider hemodyalisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SE of second generation antipsychotics ( Olanzapine, Clozapine)

A

Weight gain
Dyslipidemia
HYPERGLYCEMIA- Can cause new onset DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SE SSRIs

A 
ED
Insomnia
Jitteriness
 GI ss
weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SE TCAs

A

Dry mouth
Blurry vision
urinary retention/constipation
confusion

toxicity ; 3 Cs: Coma, Convulsions, Cardiotoxicity ( long QT, arrhythmia due to na channel inhibition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

TTo of TCA toxicity

A

monitor ECG, sodium bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SE valoproate

A 
weight gain
hepatotoxicity
thrombocytopenia
GI distress
pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PDA dependent congenital heart disease

A

CHDTT

Coarctation of aorta
hypoplastic left heart syndrome
D-transposition 
TAPVR
Tricuspid atresia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neonate who develops severe cyanosis and respiratory distress at day 1. At birth had mild cyanosis. no murmurs, cardiogenic shock. Dx?

A

left hypoplastic heart syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Glucosuria in healthy kid, next step?

A

assess for DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S. aureus can cause necrotizing pneumonia- which would present with rapid decompensation of respiratory symptoms and chest X ray with infiltrate and cavitation

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Before starting TNF inhibitors ( i.e etanercept) always do…

A

Tb screen

Give pneumococcal and varicella vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Riskd of TNF inhibitors

A 
injection site reaction
serious infection 
neutropenia
malignancy
HF
demyelinating disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rh- pregnant mom with anti RhD titer rising trough pregnancy, next step?

A

means she is already alloimmunized ( probably for. prior prengnacy ) and there is no benefit in giving RhoGam. Baby should be studied immediately for hemolytic disease for anemia and hydrops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do you give RhoGam

A

28 weeks and < 72 from delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

< 60 years, progressive dyspnea on exertion, fatigue, clear sounds, but signs of right heart failure

A

pulmonary HTN- do an echo
dx confirmation: right heart cath

they can have ENLARGED HILA - ENLARGED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Trichomonas vaginalis test is indicated in the first prenatal visit if HIV positive

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In men neck circumference ( > 43.2 cm/17 in) correlates better with OSA
In women is obesity that correlates better with OSA

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

STOP Bang survey for OSA

A 
Snoring
Tiredness during the day 
Observed choking or apnea episodes
P- High blood pressure 
BMI> 35
Age > 50
Neck circumference M> 17, F> 16
Gender male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of umbilical hernia

A

it tends to close spontaenouly in the first years of life, but can take longer if > 1. 5cm or if African American

If reducible, asymptomatic and size stable surgery can be deferred until 5 years old.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Syndromes associated with umbilical hernia

A 
hypothyroidism ( lethargy, poor feeding, FTT)
 Beckman Wideman ( hypoglycemia, macrosomia, macroglossia, hemihyperplasia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GLYCOGEN STORAGES AND LYSOSOMAL STORAGES

A

Say it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

obese with heavy bleedings, exam is normal. next step

A

pelvic US

Labs would show high testosterone, high estrogen, LH/FSH imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

FSH and LH in PCOS

A

NORMAL!Although there is a LH/FSH imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In patients with PCOS additional tests

A

test for metabolic syndrome ( DM, Hypertension)
OSA
Non alcoholic hepatitis
Endometrial hyperplasia, endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

surgical indications of severe chronic mitral regurgitation

A

primary MR ( ie. structural defect, MVP)
- Asymptomatic with LEFV 30-60%
- Symptomatic if LEVF< 30
Asymptomatic and LEVF > 60%

seconday MR ( MIR, dilated cardiomyopathy) - medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

treatmento for SICCA

A

methylcellulose eye drops

if resistent to that: topical cyclosporin or corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Joint aspiration findings

A

leukocyte< 2,000 - non inflammatory- osteoarthritis
luekocyste 2,000-75,000- RA or gout
leukos > 100,000- infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

why early treatment of varicella zoster is important?

A

within 72 hours: To prevent risk of complications: post herpetic neuralgia and more rapid healing of vesicular lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

anatomy of femoral hernia

A

pass below the inguinal ligament and medial to the femoral vein, nerve, and artery.

Femoral hernias are at higher risk for incarceration and strangulation than the inguinal hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

female < 35 years that has been trying to be pregnant for 6 months and cant. next step?

A

nothing! still not called infertility ( 12 months in < 35, and 6 months in >=35).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

hemorrhagic pustule, teosynovitis, polyarthritis asymmetric

A

disseminated gonoccocal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

RF disseminated gonoccocal infection

A

Recent menses, pregnancy or postpartum
SLE
complement deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Percutaenous endoscopic gastrostomy does not improe survival in dementia patients, and it does not prevent aspiration pneumonia it still can happen.

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

presentation of guillain barre

A

immune-mediated demyelination

-paresthesias
-neuropathic pain
-symmetric, ascending paresthesias
hypo-arreflexia
respiratory compromise

high protein, normal leukos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

tto guillain barre

A

IVIG , plasmapheresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

sick sinus syndrome presentation

A

alternating tachycardia and bradycardia
tachycardia can be afib and bradycardia can be sinus brady, arrest.

when symptomatic often have dizziness, pre syncope, angina.

often in elderly, multiple comorbidities
chronic sinus node dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Patient who underwent catheterization, and on third day has worsening of renal function and a blue toe

A

has atheroembolism from catheterization - has elevated urine and serum eosinophils.

renal failure can be from atheroembolism or contrast induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

hyponatremia algorithm

A

say it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

flank mass that moves with respiration, is not tender

associated with anemia, hematuria and flank pain

A

renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Overall survival of renal cell carcinoma at 5 years

A

> 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Dx of renal cell carcinoma

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When can patients with pancreatitis initiate oral feedings?

A

as soon as they have appetite
in those with severe- parenteral or NG tube should be started ithin 72 hours of hospitalization
low fat, soft, low resideu diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why is it important that patients with pancreatitis initiate oral feedings?

A

reduces mortality, organ failure, need for surgery, infection rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

chronic management of gout

A

urate lowering drugs + low dose colchicine

urate lowering drugs: allopurinol, febuxstat
are recommended when:
1. multiple episodes, chronic gouty arthropathy, renal failure, tophi, recurrent kidney stones.

When initiating therapy there is risk of flare, so give colchicine. if CI, can give NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

the most significant factor of developing stroke is

A

a prior stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Human bites antibiotic

A

amoxi clavulanate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Patient with swelling of arm, and tortous engorged veins , splenomegaly+ high hemoglobin , high platelets, high leukos, Dx, next step

A

Polycythemia vera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

presentation of polycythemia vera

A
  • increased blood viscosity:
    • HTN
    • Erythromelalgia ( burning cyanosis)
    • visual disturbances
    • thrombosis
  • increased RBC turnover- gouty arthritis
  • aquagenic pruritus
  • bleeding/thrombosis
  • facial plethora
  • splenomegaly
  • increased in all three lines, rbc, thrombocytosis and leukocytosis
  • epo is low
50
Q

complications of polycythemia vera

A

thrombosis

myelofibrosis and acute leukemia

51
Q

Dx and tto of polycythemia vera

A

Genetic analysis- JAK 2 Mutation

tto: phlebotomy, and hydroxyurea if high risk of thrombosis

52
Q

long term prognosis of postpartum thyroiditis

A

there is an increased risk of persistent goiter and chronic thyroid dysfunction

53
Q

complications subclinical hypothyroidism

A 
recurrent miscarriages
severe pre-eclampsia
-preterm birth
- low birth weight
-placental abruption
54
Q

Indications for Implantable cardioverter defibrillator in HF

A
  • Prior MI and LVEF =< 30%
  • NYHA II or III and LVEF =< 35%
  • Prior VF or unstable VT without reversible cause
  • Prior sustained VT with underlying cardiomyopathy

DIFFERENT FROM BIVENTRICULAR PACEMAKER FOR CARDIAC RESYNCHRONIZATION : LVEF =< 35 PLUS sinus rhythm and PROLONGED QRS

55
Q

hyperprolactinemia– decreases testosterone– decreased libido, muscle mass, body hair and testicular size.

Who meets criteria for tto, and prognosis?

A

Criteria for tto:

  • neuro ss secondary to mass
  • hypogonadism secondary to hyperprolactinoma

TTO: Bromocriptine or cabergoline. REGARDLESS OF THE PRL LEVEL OR TUMOR SIZE In 90% of the cases medical therapy alone is helpful and shrinks the tumor.
surgery is left for refractory cases.

56
Q

Prognosis of prolactinoma

A

Bromocriptine or cabergoline. REGARDLESS OF THE PRL LEVEL OR TUMOR SIZE

In 90% of the cases medical therapy alone is helpful and shrinks the tumor.
surgery is left for refractory cases.

57
Q

Iniital labs for obesity

A

Glucose
TSH
Lipids
Hepatic enzymes

58
Q

When do you consider drugs vs bariatric surgery in obesity

A

Drugs ( phenteramine/topiramate, Orlistat, bupropion, naltrexone, liraglutide): Failure to lose weight plus BMI>=30 ( OR BMI 27-29 with comorbidity)

Bariatric surgery : failure to lose weight and BMO>=40
Or BMI>=35 plus comorbidity

59
Q

patient who believes he has parasites, has been to doctors and nothing has been shown, he is anxious and affect is flat. dx?

A

delusional disorder

60
Q

5 yo with bloody stools. How to differentiate if is EHEC or Shigella?

A

EHEC: bloody stools, abdominal pain NO FEVER
Exposure to farms, petting zoos, undercooked meat
Dx: sorbitol McConkey agar and production of shiga toxin
tto: supportive, no antibiotics risk of HUS

Shigella: bloody stools, abdominal cramps FEVER.

61
Q

Dx of thalassemias

A

electrophoresis and target cells on smear

b thalasemia increased HbA.

62
Q

RF for neural tube defects

A

prior pregnancy with enural tube defect
low folic acid intake
methrotexate, antiepileptics
Diabetes mellitus

63
Q

Pregnant patient with high AFP, next step

A

US to visualize fetal vertebral or intracranial structures.

If it fails can go with amniocentesis

64
Q

When do you do cell free fetal DNA?

A

for chromosomal abnormalities

65
Q

Medicaid and Medicare

A

Medicaid :Disabled, limited income /resources. 50% are children and only 15% have expenditure because they are healthy.

Medicare: elderly >=65, those with < 65 with certain disabilitites, and those with EDRD

66
Q

Fetal macrosomia >=4.5 kg is an indication for cesarea

A

true

67
Q

patients with hypothyroidism can have carpal tunnel syndrome ( sensation of pins and needles at night), hyperlipidemia, anemia, mild hyponatremia.

A

true

68
Q

5 types of myopathy and which of those have elevated CK

A
  1. Glucocorticoid induced myopathy: proximal m. weakness and atrophy. NO PAIN, lower extremities more involved.
  2. Polymyalgia rheumatica: pain and stiffness of proximal shoulders , pelvic girdle. tendrness with decreased range of motion
  3. Inflammatory myopathies: tenderness and weakness of proximal muscles. skin and rash. HIGH CK
  4. Statin induced myopathy: prominent muscle pain/tenderness with or without weakness. HIGH CK

5, Hpothyroid myopathy. Muscle pain and cramps, wealness involving proximal . delayed tendon reflexes, features of hypothyroidism. HIGH CK.

69
Q

CK in lambert eaton and myasthenia gravis

A

normal

70
Q

When do you recommend migraine prophylaxis

A

> 2 migraine headaches in a month

Meds: b blockers. ( propanolol), TCA ( Amytriptiline), Valproate, topiramate

71
Q

Patient who was admitted by pancreatitis and at the third day has hypoxemia, respiratory distress and bilateral infiltrates on Xray

A

ARDS

72
Q

What is the ventilator setting that is associated with improved mortality in ARDS

A

Low tidal volume- to avoid alveoli overdistension and barotrauma

73
Q

strongest risk factor for abdominal aortic aneurysm

A

smoking

74
Q

strongest risk factors for expansion of abdominal aortic aneurism

A

large size
rapid rate
smoking

75
Q

tto of abdominal aortic aneurism

A 
stop smoking
aspirin and statin
indications for surgery: 
- >=5.5
-rate of 0.5 cm in 6 months, or 1 cm in 12 months 
- ss regardless of the size
76
Q

how can posititve pressure ventilation cause hypotension

A

increases intrathoracic pressure,

give bolus of saline and if possible decrease ppv

77
Q

THERE IS NOT ENOUGH EVIDENCE TO GIVE ANTICOAGULANTS TO NEPHROTIC SYNDROME!

A

TRUE

most common places are renal vein and lower extremities

78
Q

Which patients with nephrotic syndrome are at higher risk for thrombotic events

A

albumin < 2, membranous nephropathy, and massive proteinuria

79
Q

pregnant woman who has active parvovirus infection, next step

A

baby has to be monitored with serial US.
risk of fetal anemia, hydrops fetalis and fetal demise

  • test mom IgM
  • test baby PCR ANALYSIS IN amniotic fluid

anemia is diagnosed with middle cerebral artery doppler
hydrops: with accumulation of fluid in 2 body compartments.

anemia is often transit , but in severe cases may need inutero transfusions.

80
Q

patient with fatigue, decreased sexual drive, elevated ferritin, transferrin, and mildly elevated transaminases. Dx?

A

Hemochromatosis - Do genetic studies. It is AR.

81
Q

Which medications can cause esophagitis, and how to treat them

A

tetracyclines, NSAIDs, Potassium chloride, Biphosphonates

TTO: discontinue offending agent. Often resolves in a week. If persistent may pursue upper endoscopy

82
Q

COPD who is in respiratory failure, next step

A

trial NIPPV- reduces mortality, decreased intubation rate, and reduces hospital lenght.

83
Q

Steroids can induce mood symptoms, anxiety and psychosis

A

true - so if a patient is started on steroids and then comes with symptoms think of medication induced depressive disorder.

84
Q

tto of eating disorders

A

cognitive behavior therapy and then workin on food.

SSRIs are also part of the tto

85
Q

treatment of vaginal candidiasis in pregnant

A

TOPICAL Clotrimazole, miconazole, nystatin

NOt oral fluconazole ( which is the 1st line in non-pregnant) as it can cause spontanous abortion and congenitla defects ( cleft palate, femur bowing, congenital heart disease)

86
Q

Depression in patients with stroke can manifest as restlessness, anxiety, behavioral agitation. tto?

A

SSRIs

87
Q

patient with catheter that is febrile, and has back pain. Spine imaging shows vertebral bony destruction with space disc narrowing. Blood cultures positive for S.aureus . Dx? Next step?

A

Vertebral osteomyelitis
- in these cases there is risk for infective endocarditis with a TTE, and particularly in those who have a history of valve dysfunction

  • then just pursue antibiotic treatment
88
Q

What is the most common life threatening condition of granulomatosis with polyangitis

A

diffuse alveolar hemorrhage

89
Q

patient with hx of ulcerative colitis, high bilirubin, high ALP, mildly elevated transaminases. Dx?

A

Primary sclerosing cholangitis – endoscopic cholangiography

multifocal areas of stricture and dilation intra and extrahepatic

90
Q

fetal demise, next step?

A

offer parents to hold baby, that contact decreases risk of depression, PTSD, and anxiety

91
Q

anti smith antibodies are associated with..

A

SLE

92
Q

antimitochondrial antibodies are associated with

A

primary biliary cirrhosis

93
Q

tto of inflammatory breast cancer

A

chemo, mastectomy and radiation

conservative therapy is not an option.

94
Q

Patient with nodulocystic acne tto?

A

oral tetracycline, doxycycline, minocycline, ,

erythromycin
TMP/SMX

  • Last resource is isotretinoin
95
Q

Uterine fibroids can be treated with medication ( OCPs) or surgery

A

true

96
Q

unstable patient in who you suspect retroperitoneal hemorrhage, next step

A

CT abdomen despite them being unstable as it is more sensitive and is able to localize the hemorrhage.

97
Q

management of hypercalcemia causing confusion due to malignancy

A

agressive hydration

98
Q

Gold standard for treatment and diagnosis of intussusseption

A

air or saline contrast enema

99
Q

Patients with intussusspetion

A

stabilize them first, before doing the enema

100
Q

The diagnostic test for C. difficile

A

PCR to asses for bacteerial toxin A and B ,very rapid PCR within an hour

101
Q

White coat hypertension, next step

A

24 hour BP monitoring

it is not always totally benign as it can have cardiovascular risk

102
Q

electrical alternans is associated with

A

cardiac tamponade

103
Q

tto of bph

A

alpha 1 adrenergic antagonists ( tamsulosin)

5 alpha reductase inhibitors ( Finasteride)

104
Q

tto of polymyalgia rheumatica

A

is low dose glucocorticoids- almost 100% respond well to this.

  • mortality of patients with PMR is same as general populatio
105
Q

patients with history of otitis media are at higher risk of ?

A

recurrence! particularly if previous episodes, attend to daycare and are exposed to second hand smoking

If recurrence occurs within 2 weeks its likely that it is caused by the same organism. If after 2 weeks, different organism

Mastoiditis is very rare!

106
Q

testicular mass that appears with valsalva and standing up, disappears when supine

A

Varicocele

107
Q

US findings in varicocele

A

retrograde blood flow
tortuous anechoic tubules adjacent to testis
dilation of pampiniform plexus

108
Q

tto of varicocele

A

asymptomatic patients do not need treatment

if ss ligation of gonadal vein

109
Q

complications of varicocele

A

at risk of testicular atrophy and infertility

110
Q

elderely who was started on levofloxacin and had a syncopal event

A

consider ventricular arrhythmia- long QT syndrome

hypomagnesemia, hypokalemia, lefloxocain antipsychotics.

111
Q

how to monitor prostate cancer after surgical resection

A

serail PSA measurements

iF IT GOES UP then additional imaging can be done such as US

112
Q

Dx of PCP ( fungus)

A

sputum production with hypertonic saline

113
Q

Patients in the ICU who have Foley Cath can have Candiduria, unless they are symptomatic there is no treatment, and Foley should be removed.

A

true

114
Q

MC causes of Small bowel obstruction

A

pop adhesions, hernias( incarcerations) , tumor

115
Q

Indications of parathyroidectomy

A 
age < 50 
symptomatic hypercalcemia
complications:
- osteoporisis
- nephrolithiasis/calcinosis
-CKD ( GFR< 60)

at risk of complications

  • calcium > 1 above normal
  • urinary ca excretion > 400

Those who do not meet criteria for surgery then follow up serum Ca, creatinine and dexa

116
Q

Causes of erythema multiforme

A

HSV Mycoplasma pneumoniae, hepatitis C virus, Coxsackie virus, and Epstein Barr virus

allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described.

117
Q

Patient with back pain and X ray consistent with degenerative disease- has decreased ankle reflexes but nothing else on exam. Next step

A

NSAIDs and follow-up in 4-12 weeks

Indications for MRI: Progressive neuro ss, suspicion of infection/tumor, no improvement of pain despite NSAIDs after 12 weeks.

118
Q

first line treatment of bordetella pertussi

A

Azithromyicin

  • give also to close contacts
  • contacts that are not immunized should also receie vaccine
119
Q

treatment of inguinal hernias

A

elective surgery in 1-2 weeks

120
Q

hydrocele typically resolve by age 1 year

A

true

121
Q

Oral advanced directive is only acceptable if it was given in the presence of 2 witnesses and if the patient is diagnosed with a irreversible or a terminal condition

A

true

AV_Step 3 UWORLD (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions