big Uworld set Flashcards
72 woman with MPH of HTN, T2DM, and CAD suddenly drops her fork at dinner, speech becomes slurred, then episode of vomiting. BP is 185/107/ pulse 55. What is the ultimate cause?
Intracranial Bleeding. – the patients characteristic of a left cerebral hemisphere. This must be hypertensive in origin
29 year old man goes to ED for progressive bilateral lower extremity weakness. He had a respiratory illness 2 weeks ago. And trigeminal neuralgia that was resolved some time ago. PE shows increased resistance to passive flexion and extension of the lower extremities. DTR are +3 and plantar reflexes are upgoing bilaterally. Decreased vibratory and positional sense in the LEFT UPPER extremity. LP s done, what is found?
Oligoclonal Bands – patients has MS
Uhtoff Phenomenon
heat sensitivity - patient is exposed to hot weather, and MS symptoms oar exasperated.
24 year old girl has severe orthostatic hypotension, dry mucus membrains, dry skin. Labs show hyponatremia, hypokalemia, hyochloride, and UA shows INCREASED Na and K. Her boyfriend fat
DIURETIC abuse – with a dehydrated patients, and evidence of elevated URINE Na means salt wasting. – Either diuretic use, cerebral salt wasting, and adrenal insufficiency
When would a patient’s hypokalemia not respond to correction?
Diuretic use, hyperaldosteronism, and RTA.
20 year old kid has been on IV acyclovir, and two days later he improves, but then complains and nausea and abdominal discomfort. Labs sow Cr 2.8 and BUN of 38. What is the cause of the acute kidney injury and how?
The acyclovir is rapidly excreted into the urine, and precipitates in the renal tubules, causes obstruction. the ratio is 13.571, pointing to interstitial and NOT obstruction, but the function is indeed obstruction.
23 year old lady has progressive back pain and stiffness, present for a few years, and is relieved with physical activity. Has morning stiffness that gets better. There’s reduced forward flexion on the lumbar spine. What is it, and what would establish DIAGNOSIS
They have Ankylosing Spondylitis, and to diagnosis would be to xray the sacroiliac joints. DO NOT choose HLA B27. This is only a lab results to support diagnosis. Not establish.
What strategy improves mortality in an intubated patient after ARDS?
Preventing Alveolar overdistention by keeping low tidal volume. Providing adequate oxygenation. – prevent SpO2 <88%
32 year old woman comes to the doc because of fatigue, SOB swelling of the feet over the last several days. Had a recent cold 2 weeks ago. Vitals WNL. Has bilateral basal crackles, elevated JVP, and 2+ edema. CBC is WNL. What is seen on ECHO?
Dilated ventricles with hypokinesia
Patient has CHF, and ther recent viral infection is a clue for coxackie B induced viral myocarditis, a dilated cardiomyopathy.
How does sublingual Nitroglycerin cause pain relief from chronic stable angina?
SYSTEMIC vasodilation (not just coronary) causing decreased cardiac preload, thus decreasing left ventricular wall stress. – Thus decreasing myocardial O2 demand
Patient is a 55 yo f with a one week history of pain in multiple joints, affecting metacarpophalangeal and PIPS. They partially improve over 15 minutes of activity. Mild swelling. Normal CBC and chem. ESR is 12. She works in a day care center. Why dis?
Viral arthritis from ParvoB19
- 4 year old boy has a rash, small red bumps on his left arm that became filled with yellow fluid. 5-7 pustules on the left antecubital fossa. Some lesions are covered with a thick golen yellow crust. What is the most appropriate step?
Topical mupirocin. - Impetigo
Cause of Bullous Impetigo
S. Aureus
Cause of Nonbullous impetigo
GAS or S Aureus - this is the classic honey crust
