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UW 4 Flashcards

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1
Q

Method to control confounding

A

Matching

  • Neighbors
  • Age
  • Race
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2
Q

Presentation of Amniotic Fluid Embolism

A

During or shortly after delivery
Cardiogenic shock
DIC
Hypoxemic Resp failure

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3
Q

LLQ pain unresponsive to Abx and elevated WBC count - what is next best step

A

Abdominal CT scan for diverticulitis with possible complication, such as abscess

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4
Q

AIHA in CLL patients - intra or extravascular?

A

Extravascular

- Spleen and RES and extravascular

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5
Q

Hyperactive/tinkling bowel sounds?

A

Mechanical bowel obstruction

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6
Q

Treatment to remove K+ from body

A

Dialysis
Cation exchange resins (Kayexalate)
Diuretics

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7
Q

CMV v HSV retinitis

A

CMV = painless
Fundoscopy - fluffy granular retinal lesions near retinal vessels, hemorrhages
HSV = keratitis, conjunctivitis, eye pain, rapid visual loss
Fudoscopy - widespread, pale, peripheral lesions, central necrosis of retina

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8
Q

Who gets a tetatnus-diphtheria toxoid

A

Individuals w severe or dirty wounds who received booster > 5 years ago
Individuals w minor clean wounds who received booster > 10 years ago

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9
Q

Who gets Tetanus Immune globulin

A

Individual w severe/dirty wound
AND
Unclear/incomplete immunization Hx

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10
Q

Pt w clean or minor wound + unimmunized, uncertain or < 3 tetanus toxoid doses

A

Tetanus toxoid-containing vaccine only

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11
Q

Clubfoot Presentation

A

Equinus and varus of calcaneum and talus
Varus of midfoot
Adduction of forefoot

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12
Q

TX for clubfoot

A 
Immediate
Stretching
Manipulation
Serial plaster casts, malleable splints, taping
Surgery if poor results b/t 3-6 months
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13
Q

Presentation of medial meniscus injury

A

Forceful torsion of knee w foot planted
Popping sound + severe pain at time of injury
McMurray sign +
Bucket handle tear leads to locking of knee joint during terminal extension

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14
Q

Presentation of ACL injury

A

Hx of forceful hyperextension injury to knee or noncontact knee injury during deceleration
Effusion Rapidly after injury
Lachman’s test, anterior drawer test, pivot shift test

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15
Q

Presentation of PCL injury

A

Dashboard injury

Foreceful posterior -directed force on tiba w knee flexed at 90 degrees

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16
Q

Tension Pneumothorax TX

A

Immediate needle decompression in 2nd or 3rd IC space in MCL
or
5th IC space in MAL

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17
Q

Suspected Tension pneumothorax - do needle decompression and continue to remain unstable - next step ?

A

FAST to look for pericardial tamponade

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18
Q

Next step in tension pneumothorax after needle decompression

A

Chest tube placement in 5th IC space in MAL to maintain lung expansion

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19
Q

Cerebral Palsy Presentation

A

A group of syndromes characterized by non-progressive motor dysfunction
Most commonly spastic diplegia = hypertonia and hyperreflexia, equinovarus presentation (feet pointing down and in)
Intellectual disability

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20
Q

Leading risk factor in cerebral palsy

A

Prematurity before 32 weeks

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21
Q

Management of Cerebral Palsy

A

Physical, occupational, speech therapy

Baclofen, botulinum toxin

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22
Q

Intraventricular hemorrhage in newborn
What is it?
Risk factors

A

Bleeding into the germinal matrix
Premature
LBW infants

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23
Q

Presentation of Intraventricular hemorrhage

A 
Pallor
Cyanosis
HypoTN
Seizures
Focal neuro signs
Bulging or tense fontanel
Apnea and bradycardia
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24
Q

Management of hyponatremia with moderate sx’s - confusion, lethargy

A

Hypertonic saline in first 3-4 hours to raise Na to > 120

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25
Management of hyponatremia with severe sx's - seizures, coma
Bolus of hypertonic saline until sx's resolve | Conivaptan - Vasopressin antag
26
Management of hyponatremia in asymptomatic or mild sx's - forgetfulness, unstable gait
Fluid restriction Oral salt tablets Loops if Uosm > 2x Serum osmolality
27
Best indicator of severity of TCA intoxication
Duration of QRS complex | - predicts chances of seizures and vent arrhythmias
28
TCA overdose Presentation
``` CNS depression HypoTN Hyperthermia Anticholinergic effects - Dilated pupils - Dry flushed skin - Intestinal ileus QRS Prolongation = vent arrythmias ```
29
TX for TCA toxicity
Sodium bicarb shortens QRS | Decreases likelihood of arrhthmia
30
Diabetic mononeuropathy of CN III | Type of nerve damage
Ischemic, so only somatic nerve fibers are affected | Parasympathetics not affected so light and accommodation reflexes are normal
31
Presentation of Secondary Raynauds
``` Older, > 40 Male Asymmetric attacks Tissue ischmeia features - numbness, ulcers ANA and RF ```
32
Causes of primary adrenal insufficiency (Addison's)
``` TB AI Infxn Hemorrhagic infarction Mets cancer ```
33
Acid base of Addison's
Aldosterone deficiency | - Non AG hyperkalemic, hyponatremic Metabolic Acidosis
34
Presentation for Androgen Insensitivity
XY Karyotype External genitalia = female MIF secreted by testis - prevents female internal organ development
35
Presentation for 5 alpha reductase deficiency
XY Karyotype No conversion of Testosterone to DHT Female external genitalia Virilzation @ puberty
36
Presentation of Mullerian Agenesis
XX karyotype Primary Amenorrhea Blind ended vaginal pouch Little/no uterine tissue
37
Tea and toast diet
Folic Acid Deficiency
38
Strict vegetarians + Anemia
B12 deficiency
39
Most common finding on cervical radiography in cervical spondylosis
Osteophytes
40
Presentation of cervical spondylosis
Chronic neck pain | Limited neck rotation and lateral bending
41
Glucose 6 phosphatase deficiency
``` Von Gierke's - type I glycogen storage dz 3-4 months old Hypoglycemia Lactic Acidosis Hyperuricemia Hyperlipidemia Doll-like face, fat cheeks Thin extremities, short stature, protuberatn abdomen Normal spleen and heart ```
42
Acid maltase deficiency
Type II glyocgen storage - Pompe's Floppy baby first few weeks of life Macroglossia, difficulty feeding, heart failure
43
Presentation of acute massive PE
Syncope | Hemodynamic collapse
44
Pt with malignancy presents acutely w dyspnea, chest pain, tachycardia, hypoxia, clear lungs -DX?
PE
45
What cardiac changes do we see w acute massive PE
Acute RV dilation and failure b/c of RV outflow obstruction and increased pulmonary vascular resistance Hypokinesis of RV free wall and sparing of apex
46
What 2 signs indicate increased risk of death in PE
1. RV Dysfunction | 2. Elevated BNP and troponin
47
What does recurrent pneumonia in same anatomic region suggest? Causes?
Bronchial obstruction - Bronchogenic carcinoma - Carcinoid dtumor - Foreign body - Bronchial stenosis
48
When do we do bronchoscopy
1. Masses documented by CT 2. Negative CT +high suspicion for endotracheal obstruction 3. Central mass on CT
49
Workup for CT scan with peripheral lesion
CT-guided BX
50
Cortisol and ACTH in Primary adrenal insufficiency
Low Cortisol | High ACTH
51
Cortisol and ACTH in 2/3 adrenal insufficiency
Low Cortisol | Low ACTH
52
Calculation for NNT
1/ARR
53
MCC nontraumatic Subarachnoid hemorrhage
Ruptured saccular or berry aneurysm | Non-contrast CT shows acute bleeding in cisterns
54
Systemic blastomyosis findings | skin and bones
Ulcerated skin lesions | Lytic bone lesions
55
Presentation of Type III glycogen storage | Deficiency?
Deficient in glycogen debranching enzyme Hepatomegaly, hypoglycemia, hyperlipidemia, growth retardation High LFTs Fasting ketosis
56
Prussian blue stain means what
Presence of hemosiderin | Found in urine during hemolytic episodes
57
Pathophys of oxidative stress in G6PD
Hemoglobin oxidized to make methemoglobin, denatured globin, sulfhemoglobin - These form insoluable masses = Heniz bodies that attach to RBC membrane, decrease pliability, and promote RBC removal in spleen
58
Colorectal cancer surveillance in pts with UC
Begin colonoscopy 8 years after Dx, maybe longer if Left colon Repeat every 1-2 years
59
Presentation for spinal cord compression
Motor and sensory loss Absent rectal tone Urinary retention
60
What tracts are affected in spinal cord compression
1. Descending CS = LE weakness/loss of rectal tone 2. Ascending sensory ST -sensory 2 segments below level of lesion 3. Descending autonomics in reticulospinal tract = urinary retention/bladder flaccidity/bladder shock
61
Management of spinal cord compression
1. Immediate neurosurgical evaluation 2. Neuroimaging while awaiting - MRI 3. High dose glucocorticoids
62
Criteria for Insomnia
At least 3 nights/week for 3 months
63
Adjustment disorder w depressed mood
Marked distress out of proportion to stressor | Sx's within 3 months of onset of stressor
64
Myasthenia crisis Presentation TX
Life threatening, caused by Infnx Diaphram weakness causes respiratory distress TX: Intubate if declining respiratory status. Steroids and IVIG or Plasmapharesis
65
Presentation of unilateral cervical lymphadenitis | TX
Rapidly enlarging, fluctuant cervical LNs Children - MCC = strep or staph TX: I&D + Clindamycin

Mixed 2 (9 decks)

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