UW 12

Question 1

Treament for septic arthritis
Gram +
Gram -
No bacteria but elevated WBC

Answer 1

Gram +: vanco
Gram -: cephalosporin3rd
Negative mycroscopy: vanco + cephalosporin if immunocompromised

Question 2

Nephrotic sd. associations:

Focal segmental

Answer 2

African american, 
hispanic, 
obesity, 
HIV, 
heroin

Question 3

Nephrotic sd. associations:

Membranous nephropathy

Answer 3

Heb B, Hep C
SLE,
NSAIDs,
Adenocarcinoma (lung, breast)

Question 4

Nephrotic sd. associations:

Mebranousproliferative glomerulonephritis

Answer 4

Hep B and C

Lipodistrophy

Question 5

Nephrotic sd. associations:

Minimal Change

Answer 5

NSAIDs
Lymphoma

More common in children

Question 6

IgA nephropathy hx

Answer 6

Hematuria that follows URT infection

Question 7

Pathognomonic finding in Focal segmental glomerulosclerosis

Answer 7

Partial sclerosis limited to a segment of the glomerulus

Question 8

Painless hematochezia in infants (5

Answer 8

Meckel diverticulum (most common)

Intestinal hemangioma (if >5 cutaneous hemagiomas)
Intestinal polip: children 2-10
Lymphonudular hyperplasia (inflamed tissue): milk-indiced colitis

Question 9

Juvenile Myoclonic epilepsy

Answer 9

Clinical features:
Absence seizure
Morning myoclonus
Generalized tonic-clonic seizure

Diagnosis:
EEG: bilateral polyspike and slow-wave activity

Treatment:
Valproic acid
Avoid triggers (alcohol, sleep depravation)

Question 10

Lenox-Gastaux sd

Answer 10

Severe seizure type accompanied by intellectual disability

Question 11

Psycogenic non epiletic seizure

Answer 11

Seizure-like event
Usually witness
Return to baseline is immediate (no post ictal state)

Question 12

Presystolic accentuation of MS murmur

Answer 12

Due to atrial contration in patients with sinus rhythm
Can not be heard in patients with FA

FA clue: tachycardia with irregular rhythm

Question 13

How does severity of Mitral regurge affect its murmur

Answer 13

It gets earlier as it gets more severe

Moderate: late diastolic murmur
Severe: early or mid diastolic murmur

Question 14

Etiology of bacterial meningitis in eldery and treatment

Answer 14

S. pneumonia
S. meningitidis
Listeria

Vanco+cephalosporin+ampicillin

Question 15

Etiology of bacterial meningitis in general

Answer 15

S. pnumonia
S. meningitidis
H. influenzae
GBS

<1 m: GBS, E. coli, listeria: ampicilin + cefotaxime or genta

1-3: S. pneumonia, S. meningitidis, H. influenza: vanco + cefotaxime

Adults: S. meningitidis, S. pneumonia: vanco + ceftiraxone or cefotazime

Old people: vanco+ampicilin+ 3rd cephalosporin

Question 16

Factitious disorder vs. malingering

Answer 16

Factitious: primary gain. Want medical procedures

Mallingering: secondary gain
miss work, make money
Against medical procedures

Question 17

Herpangina

Answer 17

Oral vesicles in uvula, soft palate and tonsilar pillars usually associated with Cosackie A virus

Herpes gigivostomatis presents with oral ulcers in the anterior mouth (bocal mucosal, hard palate, gingival, tonge)

Question 18

Neutrophils in B12 deficiency

Answer 18

Hypersegmented

Question 19

Myelodisplastic Sd

Answer 19

Epidemiology:
Hematopoietic stem cell neoplasia
Increased risk with age and chemo/radio hx
May transform to leukimia

Manifestetions
Cytopenias: anemia, leukopenia, thrombocytopenia
Hepatosplenomegaly, lymphadenopaties (RARE)

Diagnosis:
Ovalomacrocytosis
Neutrophil hyposegmentation, hypogranulation

Treatment
Tranfusion for symptomatic cytopenias
Chemo
Stem cell transplant

Question 20

Common manifestations of pancoast tumor

Answer 20

Shoulder pain
Horner sd (ptosis, miosis, enophtalmos and anhidrosis)

Symptoms of C8 - T2 invation
Intrinsic hand muscle weakness
Paresthesias of 4th and 5h digits, mideal arm and forearm

Supraclavicular lymphadenopathy

Weight loss

Question 21

Clues for malabsorption

Answer 21

Bulky, foul smelling, floating stools

Weight loss (loss os muscle, subcutaneous fat, fatigue)

Pallor, fatigue (iron)
Bone pain, fracture (vit D)
Easy brusing: vit K
Hyperkeratosis: vit A

Painless diarrhea: celiac disease

Abdominal pain: think pancreatic origin

Bloody diarrhea: UC

Other: cystic fibrosis

Question 22

Epidural abscess

Answer 22

TRIAD OF: Localized back pain, fever, level of neurologic deficits

Starts with fever and pain and then may present with shooting pain (radicular pain) to progress to paresthesias and paralysis

Question 23

Management of spinal metastasis

Answer 23

Corticosteroids to reduce edema

Question 24

Cutaneous manifestations of Granulomatosis with Polyangytis

Answer 24

Pyoderma gangrenoso: inmune system dysregulation or vascular occlusion causing necrosis

Leukocytoclastic angiitis: purpura on the lower extremities with ulceration

Granulomatosis with polyangitis is a necrotizing vasculitis

Question 25

Interventions that improve survival in COPD patients

Answer 25

O2 | Smocking cesation

Question 26

Managment of COPD excacerbation (7)

Answer 26

Oxygen (goal is 88-92) Bronchodilators (B2 agonist and Anticholinergics=ipratropium) Corticosteroids ATB if >cardinal symptoms (dysnea, cough, increased baseline sputum production) NPPV (non invasive positive pressure ventilation) Intubation if NPPV fails Oseltamivir if influenza

Question 27

Indicationf for oxygen therapy in COPD

Answer 27

O2Sat: <88% CO2: <55mmHg O2Sat: <89% CO2: <59mmHg: cor pulmonale, right heart failure, polycithemia O2 can worsen hypercapnia. O2Sat is: 90%-93%

Question 28

Things to remember about boderline personality disorder

Answer 28

Very brief periods of paranoia also called transiet psychotic effect

Question 29

Screaning for breast cancer

Answer 29

Mamogram for women every 2 years for patients 50-74 Genetic counseling and testing for women with high risk family history High risk family history: >2 1st degree relative with breast cancer, 1 <50yoa 3 or more 1st and 2nd degree relative with breast cancer 1st and 2nd with breast and ovarian cancer 1st and 2nd with bilateral breast cancer Male relative with breath cancer Askenazi jew with 1st and 2nd with breast or ovarian cancer

Question 30

Painful vs painless myopathy

Answer 30

Proximal muscle weakness Paiful: thyroid and statin Painless: cushing

Question 31

Chrons vs. UC dxx of diarrhea characteristics

Answer 31

UC: bloody, lower abdominal pain, tenesmus. Toxic mega colon Chrons: watery, low grade fever, weight loss,

Question 32

Etiology of Impetigo

Answer 32

S. aureus (most common) | S. pyogenes

Question 33

Management of DKA

Answer 33

Fluids: 0.9%, switch to Dextrose 5% when glucose <200 Insulin: IV infusion until... Patient able to eat. Glucose <200. Anion gap <12. Bicarb >15. Potasium: IV if K <5.5 Others Bicarb if pH <6.9 Phospaphate if <1 and there is cardiac dysfunction or respiratory depresion

Question 34

CML vs Leukemoid reaction

Answer 34

Leukocyte cout LR: >50000 CML: often >100000 Cause: LR: Severe infection CML: BCR-ABL fusion LAP score LR: High CML: low Netrophil precursor: LR: More mature (Matamyelocites>myelocytes) CML: opposite Absolute basophilia: LR: not present CML: present CML: thrombocytosis and anemia are common

Question 35

Recomendations to prevent gout attacks (7)

Answer 35

``` Weight loss to BMI <25 Low fat diet Decreased seafood and meat intake Protein intake from vegetable and low fat dairy products Avoidance of alcoholic bevarages Avoidance of diuretics ```

Question 36

Indications for lowering serum urate in Gout (5)

Answer 36

``` Repeated and disabling attacks Tophi suggesting chronic disease Xray evidence of chronic gouty disease Uric acid kidney stone Renal insuficiency ```

Question 37

Medications for gout

Answer 37

Xantine oxidase inhibitors Allopurinol (prefered) Febuxostat (for patients that can not tolarate hallopurinol) Niacin and thiazide dirutics can lead to hyperuricemia

Question 38

Changes of location on auscultation of aortic regurge

Answer 38

Valvular AR: best heard on ULSB Due to aortic root dilatation: heard on the right side too.