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Uworld1 > 7/30 > Flashcards

7/30 Flashcards

1
Q

major depressive episode w/ hx manic episode. txt?

A

2nd gen antipsychtic (quetiapine, luraside_
anticonvulsant - lamotrigine
lithium, valproate

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2
Q

65 yo with tremor during rest and improves with activity, muscle rigidity - dx and txt?

A

early Parkinson’s disease

- trihexyphenidyl (anticholinergic)

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3
Q

> 60 yo, painless GI bleeding, pt w/ renal disease and vW disease, aortic stenosis. dx and test, txt?

A

Angiodysplasia

  • usually R colon
  • can be missed on colonoscopy
  • test: endoscope
  • txt: cautery
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4
Q

65 yo M in ER for sudden, painles loss of vision in R eye; transient vision loss before, exam: 20/60, subtle retinal whitening, R carotid bruit. dx and txt?

A

Central retinal artery occlusion

- txt: ocular massage and high flow O2

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5
Q

67 yo woman with sudden-onset R side numbness 4 wks ago, followed by transient burning pain in R UE and LE induced by light touch. Dx and where?

A 
Lacunar stroke in thalamus
- branches of PCA
- contralateral sensory loss
- thalamic pain syndrome (Dejerine-Roussy syndrome)
w/ allodynia (light touch = pain)
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6
Q

23 yo at 39 wks gestation with 1day abdominal pain and persistent wetness. hx bladder infection, treated chlamydia. PE: F, diffuse uterine tenderness, nitrazine + clear fluid. Fetal HR - 165, moderate variability. Dx and txt?

A

Chorioamnionitis

  • PROM >18 hrs
  • polymicrobial
    txt:
  • broad-spectrum Abx (amp/gent, clinda), antipyretic
  • oxytocin to speed delivery
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7
Q

65 yo with chronic Foley and multiple UTI. UA - pH 8.5 +glucose and leuk esterase. dx? cause?

A

Proteus mirabilis UTI

- urease hydrolyzes urea to ammonia –> urinary alkalinization –> struvite stones that are sourve of bacteria

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8
Q

57 yo with 2 episodes of hematuria, fatigue, F, 50 yr smoking hx,, PE: L-sided varicocele that failes to empty when recumbent, UA >10 RBC. dx and test?

A

Renal cell CA

  • L sided scrotal varicocele
  • paraneoplastic (anemia, thrombocytosis, F, hyperCa
  • test: CT abdomen
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9
Q

54 yo w/ hx hand tremors treated with medication. then w/ colicky abdominal pain, confusion, HA, hallucinations and dizziness. dx and cause?

A

Acute intermittent porphyria

  • abdominal pain, neuro and psych
  • caused by primidone (anticonvulsant)
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10
Q

14 yo with odd behavior, sore knees, headache, proteinuria. Dx and test?

A

SLE

  • antinuclear Abs
  • if + then anti-ds DNA, anti-Smith, anti-U1 ribonucloprotein
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11
Q

65 yo with 4 month of periodic pack pain radiating to buttocks and thighs, worse with walking or standing. biking is okay. tingling and numbness in bother LE. Dx, test and txt?

A

Lumbar spinal stenosis

  • MRI
  • PT and exercise
  • surgery if severe
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12
Q

28 yo HIV w/ 7 days fatigue, headache, V, F, thrush. Bilateral papilledema. MRI normal. dx? test? txt?

A

Cryptococcal Ag testing of CSF

  • CSF - high opening P, low glucose, high protein
  • amphotericin B w/ flucytosine
  • maintenance: fluconazole
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13
Q

AA girl with scaly erythematous patch on scalp, hair loss with residual black dot. dx, test, txt?

A

Tinea capitis

  • KOH exam of hair shaft for spores
  • txt: oral griseofulvin
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14
Q

54 yo with HIV p/w F, exertional dyspnea, nonproductive cough. F, satting 80% on RA. PaOw 54, PaCO2 44
CXR: diffuse bilateral interstitial infiltrates. LDH 400. dx and txt?

A

Pneumocystis pneumonia

  • txt: TMP-SMX
  • add steroids if PaO2 35 on RA
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15
Q

45 yo w/ months of watery diarrhea, leg cramps, tea colored stools, face flusihing. CT - 3cm mass in pancreatic tail. Dx? test? txt?

A

VIPoma

  • watery diarrhea, hypoK, achlorhydria, - DX: VIP >75 w/ watery diarrhea, CT or MRI tumor in pancreatic tail
  • txt: IVF, octreotide (dec diarrhea), resect hepatic mets
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16
Q

role of hCG in pregnancy?

A

maintenance of corpus luteum

  • begins 8 days after fertilization
  • levels double every 48 hrs until peak at 6-8 wks
17
Q

20 yo with intermittent chest pain, PE: systolic murmur at apex that shortens with squatting. dx? test?

A

Mitral valve prolapse

  • ECHO
  • inc preload –> in L ventriculare size and volume –> delay valve prolapse (shorter murmur)
18
Q

acute lifei threatening rxns associated with HIV therapy

A
  • didanosine induced pancreatitis
  • abacavir-related hypersensitivity syndrome
  • lactic acidosis 2 to use of NRTIs
  • stevens johnson 2 to use of NNRTIs
  • nevirapine associated liver failure
19
Q

27 yo with dyspnea and CP inc with inspiration, swollen R leg, rash on face, recent painful swelling in knees, 2 previous miscarriages.CT shows PE. Dx and lab change?

A

Lupus Antiphospholipid Syndrome

  • 1 clinical (thrombosis, unexplained fetal loss, premature birth)+ 1 lab criteria (lupus anticoagulant, anticardiolipin, anti-b2GP1)
  • prolonged PTT and PT due to lupus anticoagulant
20
Q

30 yo with post-strep glomerulonephirits renal failure now with CP relieved by leaning forward. ECHO - small pericardial effusion. UA - hematuria, RBC casts, mild proteinuria. BUN 62. creatinine 3.8. next step?

A

DIALYSIS
indications:
Refractory
- acidosis 6.5)
- Infestion (toxic alcohol, salicylate, lithium, valproate, carbamazepine)
- overload
- Uremia (symptomatic - encephalopathy, pericarditis, bleeding)

21
Q

64 yo w/ recent uRI develops malaise and productive cough. yellow sputum w/ blood. F, CXR - infiltrates on lung midfields and multiple thin-walled cavities. Dx?

A

Staph aureus secondary pneumonia

- acute necrotizing pneumo with 2 pneumatoceles

22
Q

67 yo with progressive visual loss in R eye. vertical lines being bent and wavy. dx?

A

macular degeneration

  • drusen deposits
  • low fine visual acuity
23
Q

14 day old Mw/ spasms and poor suckling in last couple of days. home birth w/ untrained attendant. PE: swollen and erythematous umbilical cord. dx?

A 
Neonatal Tetanus
- generalized and fatal if not treated
- umbilical stump infection
- poor suckling/fatigue --> rigidity, spasms, opisthotonus
- mortality:
1st wk - apnea
2nd wk - septicemia
24
Q

prinzmetal’s angina patho?
associated w/?
txt?

A
  • temporary coronary artery spasms
  • Raynauds
  • migrains
  • txt: CCB, nitrates
25
Q

36 yo woman with severe epigastric and R shoulder pain for 2 hours after eating cheeseburger. similar episode before. resolves after 4 hrs. dx? test?

A

biliary colic secondary to gallstones

  • eat fatty meal –> gallbladder contraction –> pain
  • RUQ/epigastric constant w/ referred pain
  • resolves w/in 4-6 hrs
  • no abdominal tenderness, F, leukocytosis
26
Q

45 yo w/ hx recent renal transplant p/w 3 days of F, malaise, SOB

A 
CMV 
- pulm, GI, hepatits
- dx: blood PCR
- txt: d/c immunosupression
mild - PO valgancyclovir
moderate - IV gancyclovir
27
Q

43 yo M with acute R knee pain, recent dx with DMII, Xray with chondrocalcinosis and mod effusion. PE with mild hepatomegaly. dx, test, txt?

A

Hereditary hemochromatosis

  • bronze DM
  • arthralgia
  • chondrocalcinosis
  • DMII
  • inc risk Listeria, Vibrio, Yersinia
  • test: Fe study
  • txt: serial phlebotomy

Uworld1 (6 decks)

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