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Flashcards in UWORLD Deck (99):
1

symmetrically full breasts, tenderness, and warmth 3-5 days post partum
dx and rx?

breast engorgement

proceed with breast feeding, NSAIDS, cool compresses

2

unilateral breast pain, isolated firm tender erythematous area accompanied by fever
dx and potential complication?

mastitis

can lead to FLUCTUANT mass

3

focal tenderness, and firmness/erythema; no fever; unilateral

plugged ducts

4

soft, mobile, well circumscribed mass at base of labia majoria (4 o clock or 8 o clock position)...dx and rx

bartholin duct cyst

OBSERVE!!! usually resolve on its own

5

dysmenorrhea, dyspareunia, pain pakes before menses

endometriosis

6

dysmenorrhea, pelvic pain, menorrhagia, bulky globular tender uterus

adenomyosis

7

dull and ill defined pelvic ache WORSENS with standing

pelvic congestion

8

dysmenorrhea, enlarged uterus, heavy menses, constipation, urinary frequency, pelvic pain/heaviness

fibroids

9

rx lichen sclerosis

topical corticosteroids

10

When to do EMB of AUB <45

unopposed estrogen exposure (obesity, chronic estrogen exposure, anovulation)
failed medical management

11

rx spinal cord compression

iv steroids (then MRI and surgery if confirmed)

12

side effects of EPO therapy (4)

1. WORSENING OF HTN!!!!!
2. headache
3. flu like illness

side effects worse with IV than with subq

13

how to prophylax against esophageal varices bleeding?

non selective beta blocker (i.e. naldolol)

14

two ways to improve poor oxygenation on ventilator (PaO2 < 60)

1. increase PEEP
2. increase FiO2 (but NOT MORE THAN 60%)

15

When can you do cell free fetal DNA testing and who should it be offered to?

can do it greater than 10 weeks

offer to mothers greater than age 35

16

When to do quad screen?

2nd trimester! papp a, estriol , b hcg, inhibin

17

c/i breast feeding (3)

INFECTION (HIV, active TB, herpetic breast lesions, varicella)
SUBSTANCE USE (ANY)
CHEMO/RADIATION therapy

HEP B and C ok if baby got vaccine and immunoglobulin, AND nipple isn't cracked

18

bad effects of mom marijuana use on baby

decreased muscle tone
delayed motor development
sedation

19

meningococcal vaccine schedule

primary at 11-12, but can receive until 18
then booster 16-21

if you're going to college, traveling to endemic area, or have complement def/asplenia or some shit, give vaccine even if older than 18

20

indications and contraindications for yellow fever vaccine

give before going to africa

BUT THIS IS A LIVE VACCINE...(do not give to AIDS pts or immunosuppresed patients on therapy)

21

alternative to syphilis treatment in non pregnant patient

oral doxy

22

34 year old woman, multiple pink/skin colored papules that are exophytic/cauliflower like growths on labia
dx and rx

condyloma acuminata (genital warts HPV 6 and 11)

rx trichloroacetic acid/podophylin resin, imiquimod, cryotherapy/laswer therapy

23

flat velvety vulvar lesions, broader base and flat surface, lobulated, RPR positive

condyloma lata (secondary syphilis)

24

manuever to convert baby in breech past 37 weeks assuming no contraindications (olighydramnios, placental abnormalities like previa, multiple gestations)

external cephalic version

internal podalic version is used on twins to convert 2nd twin to breech

25

risk factors cervical cancer (2)

HPV
TOBACCO SMOKING

26

elevated pulm artery pressure, elevated RA pressure, nml pulmonary capillary wedge pressure

PE

elevated pulm artery + elevated RA pressure = pulm htn

nml pulmonary cap pressure = nml left ventricular function so intrinsic pulm process

27

elevated pulm artery pressure, elevated RA pressure, elevated PCWP

left hsided heart failure leading to right sided heart failure

28

patient receiving treatment for asthma develops arm weakness, tremors, palpitations

hypokalemia 2/2 beta 2 agonists

albuterol drives K into cells!!! watch out for htese side fx and get electrolyte panel

29

When can gestational HTN be diagnosed?

AFTER 20 WEEKS

any HTN dx before 20 weeks is chronic HTN (primary/secondary)

30

end organ features of pre-eclampsia

proteinuria
transaminitis
thrombocytopenia
headache/visual changes
pulmonary edema
ELEVATED CR

31

HTN during pregnancy increases risk of what to mother and fetus

mother - abruptio placentae, pre-eclampsia, postpartum hemorrhage
fetal - PRE TERM LABOR, growth restriction, still birth

32

thrombocytopenia without anemia or leukopenia
dx and what to work up

ITP
test for hep C and HIV (may be initial presentation in small subset of patients)

33

Dx criteria for intermittent asthma

less than or EQUAL to 2 day time/night time symptoms

rx with rescue SABA prn

34

patient being treated for severe COPD develops headache, insomnia, vomiting, palpitations. EKG shows atrial tachy and PVC

theophylline toxicity

35

what drugs worsen theophylline toxicity

cytochrome oxidase inhibitors
(ciprofloxacin, erythro/clarithromycin, verapamil, cimetidine)

36

40 year old patient, hemolytic anemia, cytopenias, hypercoagulable states (i.e. hepatic vein thrombosis)
dx, work up, rx

PNH
flow cytometry (absence of CD55/CD59)
rx with eculizumab (inhibits complement activation)

37

most accurate assessment of getstational age

first trimester US with crown rump length

later ultrasounds become inaccurate as pregnancy progresses

38

dysmenorrhea, dyspareunia, dyschezia
dx and rx

endometriosis
OCPs and or NSAIDS

39

how to evaluate an ovarian mass in post menopausal woman

pelvic U/S and CA-125!!!!

CA-125 helps to evaluate risk and track progress of treatment

if elevated then proceed to surgical laparoscopy

40

rx breast abscess during breastfeeding

needle aspiration, abx, CONTINUE BREASTFEEDING

41

significant leukocytosis (often greater than 100,00), lymphoblasts, SMUDGE CELLS on peripheral smear

CLL

42

pneumonia, splenomegaly, anemia, thromboycytopenia, mild leukocytosis, no B symptoms

hairy cell leukemia

look for this on peripheral smear

43

thrombocytopenia, fever, young patient, neurologic manifestations, renal failure, increased LDH, decreased haptoglobin

dx rx work up, rx

TTP (platelet consumption, blood shearing due to hyaline clot, microangiopathic hemolytic anemia

autoantibody to ADAMTS13 (decreased ADAMTS13)

rx with plasma exchange EMERGENTLY

44

dysuria, pyuria, urinary frequency, urethral discharge, no rowth on gram stain/culture

chlamydial urethritis
rx with azithromycin, doxy

dx with nucleic amplificaiton testing

45

antibiotic prphylaxis for CD4<50

PCP CD4<200 : tmp/sulfa
toxo CD4<100: tmp/fula
MAC < 50: azithromycin
histso <150: itraconazole if in endemic area

46

step on nail, when is the only time you give tetanus immunoglobulin

only when DIRTY/SEVERE wound with unimmunized, uncertain, or <3 tetanus toxoid doses previously

47

when to give tetanus vaccine in childhood and then boosters

3 vaccine series 2,4,6 months, 2 boosters then TdAp after age 7, then booster every 10 years

single dose of Tdap after injuries

48

patient with hx of asthma or chronic rhinosinusitis on aspirin develops asthmatic symptoms, congestion, facial flushing

aspirin exacerbated respiratory disease
(non IgE, pseudoallergic reaction) due to prostaglandin/leukotriene misbalance)

49

radiation therapy after initial chemo/radiation fails (recurrence)

salvage

50

intiial dose of chemo treatment to rapidly kill tumor cells and send into remission....then therapy given after this initial therapy to further reduce tumor burden

induction -> consolidation

51

fever, flank pain, DIC within 1 hour blood transfusion
positive COOMBS

acute hemolytic transufsion reaction (ABO incompatibility)

52

fever and chills within 1-6 hours of tranfusion (MCC cause of tranfusion reaction)

febrile non hemolytic (cytokine accumulation) during blood storage

53

respiratory distress, pulmonary edema within 6 hours transfusion

transufsion related acute lung injyr (donor anti luekocyte antibodies)

54

mild fever and hemolytic anemia within 2 days after transfusion, positive direct coombs test,

delayed hemolytic (anamnestic antibody response)

55

anaphylactic vs urticarial/allergic transfusion reaction?

anaphl - recipient anti IgA
allergic - recipient IgE/mast cell activation

56

pink plasma after transfusion

acute hemolytic tranfusion reaction

57

Iga deficient patients are at risk for developing WHAT after

ANPHYLAXIS AFTER BLOOD TRANSFUSION

58

how to prevent febrile non hemolytic transufsion reaction

leukoreduced blood products

59

sickle cell patient presents with progressive hip pain reduced range of motion, normal intial x rays

avascular necrosis

60

tumor with elevated b hcg, normal AFP

seminoma

61

pneumococcus vaccine in normal adults vs. chronic liver disaese/DM/smokers

normal >65 = 13 then 23
risk = 23 alone then 13, 23

62

order of tests for working up lady with amenorrhea/galactorrhea

meds, TSH, prolactin, MRI

63

how does thyroid affect prolactin level

TRH causes prolactin elevation...
so hypothyroidism leads to more TRH

64

most common etiology acromegaly

benign GH secreting tumor

65

acromegaly kid vs adult

kid - before closure growth plates = gigantism
adult - growth plates already fused = hands, feet, face visceral organs, DIABETES (stimulate glucose production)

66

what do acromegaly patients die from

diastolic heart failure (big heart)

67

how to dx acromegaly

IGF-1 level -> glucose suppression test (fails to suppress GH) -> MRI

68

pharm rx acromegaly

octreotide (somatostatin)

69

elevated T4 elevated TSH

central hyperthyroidism (rare)

70

how does insulin effect epi, cortisol, GH

increases insulin = decrease epi, cortisol, GH

71

rx when no pituitary on MRI

if patient is asymptomatic, nothing...EMPTY SELLA SYNDROME they're fine

72

urine osm and urine Na, serum osm in SIADH

Uosm and UNaincreased!!!!!
serum osm decreased

reabsorbing water

patient will also be hyponatremic

73

pharm rx SIADH

induce something like diabetes insipidus

demeclocycline (get water back into urine)

74

pathophys diabetes insipidus (central and nephrogenic)

central - No ADH production
nephrogenic - no ADH receptor

(cannot reabsorb water)

75

test to dx diabetes insipidus

water deprivation test (will fail)

76

water deprivation test how to differentiate central nephrogenic

central - give ADH and uosm will increase
nephrogenic - give ADH Uosm will not increase

77

rx nephrogenic dm insipidu

GENTLE diuresis (HCTZ and/or amilioride)

78

rx central dibaetes insipidus

DDAVP (give ADH)

79

third degree burn patient develops eschar formation with tissue tension, tense

acute compartment due to venous compromise

80

rx child with rfrequent sinus, bacterial, Giardia infections,

ivig
(common variable immune deficiency)

81

renal side effect lithium

nephrogenic DM insipidus

82

first sign of lymphoma

NONTENDER/fixedlymphadenopathy

reactive/mobile lymph nodes are usually infection

83

non tender LAD, what to do next

exicisional bx

84

Reed Sternberg cells

owl eyes

Hodgkin lymphoma (better prognosis)

85

how to stage lymphoma (order)

CXR /CT chest/abd/pelvis THEN BONE MARROW BX

86

starry sky pattern on biopsy

Burkitt lymphoma
(non hodgkin) (a/w EBV)
Hodgkin

as well as narophayrngeal carcinoma

87

cyclical fevers, lymph nodes hurt with alcohol drinking

hodgkin

"Mr. Hodgkin likes to REED 15-30 books everyday"

88

CD 15 and CD 30

Hodgkin

89

side effects vincristine/vinblastine

peripheral neuropathy

90

side effects doxi/donorubicin

cardiac toxicity (dose dependent heart failure)

91

side effect cisplatin

ototoxicity
nephrotoxicity

92

bleomycin side effect

pulmonary fibrosis

93

cyclophosphamide sid effect

hemhorragic cystitis

94

side effect any chemo for hodgkin

you get another malignancy

95

elevated T4, low TSH...what to do next

radio iodine uptake scan

96

diffuse uptake on radio scan (all hot)

Grave's disease (exophtalmos, pretibilar myxedema)

97

waxy, discolored induration of skin (anterior aspect lower legs)
exophtalmos

pretibial myxedema + buggy eyes = grave's

98

thyroid stimulating antibodies

Thyroid stimulating I
(TSI)

99

two pharm rx grave's

Polythiuriacil PTU (safe in pregancy)
thionamides (methimazole)