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UWorld Flashcards

1
Q

Lyme disease tx in pregnant vs not?

A

Regular-Doxy

Pregnant-Amoxicillin

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2
Q

Common skin infections, 3 types and pathogens

A

Erysipelas- strep pyogenes

Cellulitis-S. pyogenes, MSSA

Abscess- MSSA, MRSA

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3
Q

Primary CNS lymphoma is seen w/ what? And strongly related to what?
Whats a good prognostic indicator?

A

HIV infections and strongly related to EBV

Best prognostic indicator is increase in CD4 or immunity getting better

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4
Q

Emotional lability, irregular rapid jerking movements of the face, hands and feet, some murmur in 8yo.

Think?

A

Acute rheumatic fever
Sydenham chorea

From untreated Strep Pharyngitis

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5
Q

Tx of uncomplicated pneumonia in children

  • Preschool or focal lung findings, organism, tx?
  • Older, w/ bilateral lung findings, organisms, tx?
A

Preschool/focal lung

  • Strep pneumo
  • Amoxicillin

Older, w/ bilateral lung

  • Mycoplasma pneumoniae
  • Azithromycin
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6
Q

How to decrease risk of Cdiff?

A

PPI

PPI alter colonic flora

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7
Q

Rabies prophylaxis guidelines for

  1. Pre-exposure
  2. Post-exposure previously unvaccinated
  3. *Post exposure previously vaccinated
A

Pre-exposure
-Vaccine series

Post-exposure prophylaxis previously unvaccinated
-Vaccine and Immunoglobulin

Post-exposure previously vaccinated
*Rabies vaccine

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8
Q

C dif tx for:

Initial

Recurrence:

Multiple recurrences:

Fulminant

A

Initial:
PO vanc

Recurrence:
PO vanc again, but prolonged

Multiple recurrences:
Fecal transplant

Fulminant (hypotension/shock/ileus/megacolon):

-Metronidazole IV +++ Vanc PO

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9
Q

Fever, hypotension, swelling and erythema of left leg after puncture would w/ wood splinter. Leg more painful to palpation than expected after visual inspection.

Dx?
Cause?
Tx?

A

Necrotizing fasciitis

Strep pyogenes

Surgical debridement

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10
Q

Most serious complication of diphtheria?

A

Myocarditis

Erythromycin or penicillin

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11
Q

Papules with central umbilication in untreated HIV pt?

How do you diagnose?

A

Cutaneous cryptococcosis

Biopsy lesion

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12
Q

Cleaning fish tank, gets cut and rapidly progressive cellulitis w/ hemorrhagic bullous lesions, and septic shock.

Dx?

A

Vibro vulnificus

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13
Q

Epiglotittis is a life threatening infection typically caused by

A

H. influenza

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14
Q

Health care worker has +TB sin test, but -CXR, can they work?

A

They have latent TB
Latent TB is not infectious.
They can work w/o restrictions

Only tx latent TB if pt is immunocompromised, inmate or work at high risk places

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15
Q

Cat scratch disease Tx?

A

Azithromycin

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16
Q

Acute cystitis Tx first line?

How about in pregnancy?
4 options

A

TMP/SMX first line

Fofomycin
Nitrofurintoin
Cephalexin
Amoxicillin Calvulanate

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17
Q

50 yo MALE with 3 mo, hx of urinary frequency, urgency, pelvic pain w/ urine leukocytes and bacteruria.

Dx?
Tx? for how long?

A

Bacterial prostatitis

Fluroquinolone or TMP/SMX

For 6 WEEKS
-has to be long course

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18
Q

When do you give oseltamivir for influenza?

A

If symptoms started <48hrs ago

OR

Immunocompromised, or >65yo

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19
Q

Pt w/ manifestations of meningitis, fever, headache, photophobia, nuchal rigidity, and/or signs of encephalitis, such as confusion, focal neurologic findings (hyperreflexia), in Aug after summer camp.

Dx?

What other organisms?

A

West Nile Virus

Its a viral meningoencephalitis picture:
Entero-coxsakie
Herpes
Arboviruses- west nile

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20
Q

Most common cause of cellulitis

A

Strep pyogenes

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21
Q

Varicella-zoster virus precautions in the hospital?

A

Localized- standard, cover lesion

Disseminated: contact and airborne precautions

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22
Q

What is ovarian hyperstimulation syndrome?

A

Serious complication of ovulation induction therapy for infertility

pts develop enlarged ovaries, ascites, hemoconcentration, and multi organ failure

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23
Q

How to work up palpable breast mass in women?

A

Age <30: u/s then mammogram

Age>30: mammogram +/- u/s

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24
Q

What is associated with the highest risk for PID?

A

Having multiple sexual partners

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25
Q

What is associated with the highest risk for PID?

A

Having multiple sexual partners

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26
Q

Tx for primary dysmenorrhea?

A

First try NSAIDs like naproxen (especially in non-sexually active) then try OCPs

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27
Q

Lobular carcinoma in situ
What is it?
What is the risk?
What do you do if you find it on needle biopsy?

A

NONmalignant lesion that’s incidental finding on mammogram

  • Having it may increase risk of other cancers, but its not malignant on its own
  • Do excisional biopsy
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28
Q

Pelvic pain, dyschezia (pain w/ BM), rectovaginal nodularity and ovarian mass?

A

Endometriosis

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29
Q

Treatment of acute uterine bleeding?

A

OCPs w/ high dose estrogen

In D+C, the endometrium is surgically removed, only done when pt is unstable

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30
Q

Most effective contraceptive?

A

Progestin subdermal implant, then IUDs

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31
Q

Acute prostatitis vs chronic bacterial prostatitis vs chronic pelvic pain syndrome?

A

Acute: fever, dysuria, pain, warm tender prostate

Chronic bacterial prostatitis: >20 leuks in urine after prostate massage, w/ bacterial growth on culture

Chronic prostatitis/chronic pelvic pain syndrome: >20leuks, but ASEPTIC culture

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32
Q

Scrotal pain, swelling, tenderness, otherwise normal.
Dx?
Cause?
Tx?

A

Epididymitis

Gonorrhea or chlamydia

Tx w/ abx

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33
Q

Pt was hit in the balls, has quite a bit of bruising and selling, otherwise normal.
Next step?

A

Get u/s just to make sure there’s no vascular injury

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34
Q

CYP450 inducers can do what w/ OCPs?

A

Decrease their efficacy, accidental pregnancies

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35
Q

Most common viral sexually transmitted disease?

How do you tx it?

A

Conddylomata acuminata by HPV

Tx w/ trichloroacetic acid (if internal) podophyllin if external

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36
Q

Pt is drooling, afraid to drink water, fever, throat pain, went to a cave?
Dx?
Tx?

A

Rabies

Hydrophobia is pathognomonic for rabies-water triggers pharyngeal spasms

Once symptoms show, its palliative care; give Ig and vaccine prior

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37
Q

Immune reconstitution inflammatory syndrome?

Cause?
Tx?

A

Usually in pt w/ HIV and TB, being started on both meds.

The immunity comes back and pt has an overabundant inflammatory response, fever/chill etc

Symptomatic treatment only, don’t stop AART or RIPE

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38
Q

Acute HepB progression to chronic hepatitis risk?

What age range do you worry about?

A

Very low >5% in adults

20-50% in ages 1-5, so you vaccinate for Hep b

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39
Q

Acute hepatitis B management
AST/ALT >1,200, positive for HepB antigen, hemodynamically stable.

What do you do?

A

Hep B hepatitis resolves spontaneously in most people

No need to start antiviral therapy.

Follow up with serial lab testing as outpatient

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40
Q

When to give tetanus toxoid vs immunoglobulin?

A

Unimmunized, uncertain or <3 tetanus doses w/ clean or minor wounds get toxoid only

If wound is deep or dirty, give toxoid+immunoglobulin

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41
Q

Most common adverse reaction that occurs with transfusion??

How do you prevent it?

A

Febrile nonhemolytic transfusion reaction

1-6hrs after starting
Due to left over leuk derbis in donor red cell concentrate

Prevent by leukoreduction, when its washed out more

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42
Q

What do you do if pt refuses testing for HIV after nurse accidentally sticks herself w/ needle?

A

HIV prophylaxis for nurse

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43
Q

Pt w/ suspected PCP, how do you diagnose?

A

Sputum sample culture

If no growth, do BAL

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44
Q

Pts with PCP pneumonia should receive corticosteroids in addition to antimicrobials if ABG shows….

A

Alvelolar arterial O2 gradient >35

or

Arterial oxygen tension<70

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45
Q

Treatment of syphilis by stage

Primary
Secondary
Early latent <12mo

Late latent>12mo
Unknown duration

Neurosyphilis
Congenital

A

Primary, secondary: single dose IM penicillin G

Late latent/unknown: IM penicillin for 3 WEEKS

Neuro and congenital: Penicillin IV

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46
Q

Patients with syphilis who have neurologic signs or symptoms require…

A

LP to r/o neurosyphillis

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47
Q

Fever, HA, erythematous macular and/or petechial rash on wrists and ankles of child who went to NC for trip.

Dx?
Tx?

A

Rocky mountain spotted fever

Doxy

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48
Q

Untreated Chlamydia trachomatis infection during pregnancy causes what for

Mom?
Baby?

A

Preterm/preterm rupture/labor

Neonatal pneumonia and blindness

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49
Q

Lyme arthritis treatment?

Prognosis?

A

Doxycycline or amoxicillin for 1 month

Will recover fully

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50
Q

1st and second line for Otitis media?

A

Amoxicillin

if fails, do amoxicillin calvulanate

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51
Q

Most common pathogens for otitis media in order (3)?

What about otitis conjunctivitis syndrome?

A

Strep pneumo
Non typeable H. flu
Moraxella

Otitis conjunctiviits is from H. flu

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52
Q

Patients with suspected pulmonary tuberculosis who have abnormal chest imaging should get what test to confirm dx of active TB?

If that’s positive or negative?

A

Sputum acid fast bacilli smear and culture

if positive= active TB

if neg= NAAT, mycobacterial cultures need to be done to r/o active TB

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53
Q

Postexposure prophylaxis when do you start?

When is pcr test reliable?

A

Less than 74 hrs after exposure

After 1-4 wks pcr test is reliable

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54
Q

Empiric tx for CAP?

A

Ceftriaxone and azithromycin

or

just levo

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55
Q

Active TB treatment?

A

RIPE for 2 months, isoniazid+rifampin for 9-12months

if meningitis, steroid for 8 weeks

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56
Q

30yo fever, nuchal rigidity, vomiting, yellow-white nodules near optic disc on fundoscopy, exposure to immigrant from asia and cats.

Dx?

A

Tuberculous meningitis

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57
Q

Breastfeeding contraindications

For mom and baby?

A 
Mom:
Active TB
**HIV
Herpetic breast lesions
Active varicella
Chemo/radiation
Active substance use disorder

Baby:
Galactosemia

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58
Q

HIV management during pregnancy

Antepartum
Intra
Post

Breastfeeding?

A

Antepartum:
-Continue ART, 3 agents

Intra:

  • ART+Zidovudine for c-section
  • ART for vaginal

Post:
-Zidovudine or if viral load is really high, multidrug ART

DONT breastfeed during pregnancy. Not even on therapy regardless of viral load.

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59
Q

Pt is exposed to person w/ meningococcal meningitis.
What’s the next step?
What’s the exception to this?

A

Rifampin

*If pt is taking OCP’s give ciprofloxacin or ceftriaxone instead

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60
Q

When do you give ciprofloxacin for meningococcal meningitis exposure?

A

If pt is on OCPs

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61
Q

Urgency incontinence
Cause?
Tx?
-Lifestyle vs meds?

A

Sudden urge to urinate caused by detrusor muscle overactivity

  • Bladder training
  • Antimusccarinics like oxybutynin, tolterodine, solifenacin
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62
Q

Pt has positive Hep C antibody but no symptoms what do you do next?

A

Need more testing to confirm diagnosis

Get HCV RNA in blood

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63
Q

Centor criteria

A
  • Used to predict likelihood of strep pharyngitis
  • Criteria: tonsillar exudates, tender anterior cervical lymphadenopathy, fever, absence of cough
  • <3, likely have viral, tx symptomatically
  • > 3, should get rapid antigen test for strep and tx w/ oral penicillin, cephalosporin if allergic
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64
Q

How to define recurrent UTIs? How do you tx?

A

> 2 in 6 months or >3 in 1 year

-Antibiotic prophylaxis postcital

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65
Q

Emergency contraception meds?

A

Ulipristal

Levonorgestrel (planB)

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66
Q

Sexual assault victims should get what empiric abx?

A

Azithromycin, ceftriaxone, metronidazole,

HIV prophylaxis as well, up to 72 hrs after

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67
Q

HCP needle stick from HIV positive pt, but patient’s viral load is undetectable.

What do you do?

A

HIV prophylaxis w/ meds

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68
Q

Single, rubbery, mobile breast mass in adolescents?

A

Fibroadenoma

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69
Q

Pt calls on the phone w/ complains of 2 day hx burning w/ urination, cloudy urine. Hx of uncompliated cystitis a year ago No other sx.

What do you need to tell them?

A

Prescribe TMP/SMX, this history over the phone is enough.

No need for UA

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70
Q

When does pap screening start? How about chlamydia and gonorrhea testing?

A

Pap for only >21 years

Gonorrhea/Chlamydia ANY AGE thats sexually active

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71
Q

True or False:

Administering antipyretics prior to vaccination prevents high fevers.

A

False,

Dont take tylenol before shots

72
Q

When do you need to do surgical tx for cryptorchidism?

A

If not descended after 6 months

73
Q

Tx for coxsackievirus viral meningeoencephalitis?

A

If you suspect viral meningitis, give empiric acyclovir

Steroids are only for pneumococcal meningitis

74
Q

Absolute contraindications for OCPs?

A

Migrane w/ aura

> 15 cigs per day for age >35!!

Antiphospholipid-antibody

lots of other stuffs too

75
Q

First line therapy for premenstrual syndrome/premenstrual dysphoric disorder?

A

SSRIs

76
Q

Postmenopausal woman, new onset pelvic pressure/pain, uterine mass, ascites. Hx of tamoxifen use for breast cancer.

Dx?

A

Uterine sarcoma

Tamoxifien increases risk

77
Q

What do you give for any mammalian bites?

A

Amoxicillin calvulanate

-especially cat or human bites

78
Q

Months after a vaginal delivery, patient has abnormal vaginal bleeding, enlarged uterus, vascular lesion in vaginal and positive UPT.

Dx?
Pathology?

A

Gestational trophoblastic neoplasia

aka
Choriocarcinoma

-Neoplasm that results form malignant transformation of the chorionic villi or trophoblast, can follow molar or normal pregnancies

79
Q

Sarcoma botryoides

A

Vaginal sarcoma present in infants with ‘cluster of grapes’ appearance

80
Q

When do mammograms start?

A

50

then every 2 years

81
Q

What is the mid-urethral sling procedure used for vs pessary?

A

Mid-urethral sling is for stress incontinence

Pessary is for pelvic organ prolapse

82
Q

Vulvodynia

What is it?

A

Chronic raw, burning vulvar pain in the absence of a specific disorder

83
Q

Prepubertal girl has intermittent vaginal bleeding, chronic malodorous vaginal discharge.
Dx?

A

Foreign body

84
Q

Thin, white, wrinkled skin over labia majora/minora, atrophic changes, excoriations, erosions, severe puritis

Dx?
Tx?

A

Lichen sclerosus

Topical corticosteroids

85
Q

Tx for priapism?

2

A

Aspiration of corpora cavernosa

Injection of alpha agonist like phenylephrine

86
Q

Pt w/ hx IVDU, has 10 day hx fatigue, now has fever, AMS, oral petechiae, holosystolic murmur, neck stiffness.

Dx?

A

Mycotic aneurysm

Septic embolization and localized vessel destruction caused an aneurysm that burst

87
Q

Homosexual women have increased risk of?

A

BV-its passed through vaginal fluid

And increased risk of cervical cancer—due to lack of vaccine/screening

88
Q

Pt had flu like illness, treated symptomatically, then develops fever, sinus pain, purulent discharge.

Dx?
Tx?

A

Acute bacterial rhinosinusitis

Amoxicillin-calvulanate

89
Q

Rectocele are caused by?

Tx?

A

Pelvic organ prolapse

Tx w/ pessary placement

90
Q

Most common complication of prostate resction?

A

Retrograde ejaculation

91
Q

What causes erysipelas?

A

Group A strep

92
Q

DKA pt, has fever, HA, purulent nasal discharge and necrosis of nasal turbinate.

Dx?
Tx?

A

Mucormycosis

Amphotericin B

93
Q

How does tamoxifen work?

A

Estrogen receptor agonist at endometrium and can lead to hyperplasia/cancer.

But antagonist at breast

94
Q

First step in evaluating postmenopausal bleeding?

A

Endometrial biopsy

95
Q

Pearly penil papules

What do you do about them?

A

Normal variant. Reassurance

96
Q

How to dx condylomata acuminata?

A

Shave biopsy

97
Q

Pt moved to us from Ghana 2 yrs ago. Now has increased urgency, dysuria, blood in urine.
No help w/ abx

What’s the next step?
What’s the differential?

A

Urine sediment microscopy

Urinary schistosomiasis
-chronic infection causes bladder scarring and inflammation, can be anemic coz of chronic blood loss

98
Q

Postmenopausal F has bilateral clear yellow nipple discharge, only with manipulation. All labs, u/s and mammogram are negative. She takes soy and Vit E supplements.

Dx?
What do you do?

A

Benign and physiologic
Reassurance

Phytoestrogens (soy) and vit E DONT cause nipple discharge

99
Q

Serum sickness and HepB

-Mediated by?

A

Immune complex mediated hypersensitivity rxn

Circulating antibodies combine w/ antigen and overload normal clearance mechanism

Seen as prodrome in HepB

100
Q

Perinatal hepatitis B infection

-What vaccines/immunoglobulins do you give and when?

A

Everyone gets HepB vaccine at birth

If baby has it already, they still get the vaccine AND Immunoglobulin

vaccines at 0,2,6months

101
Q

Young patient has a wide range of nonspecific symptoms

  • Significant weight loss
  • Fever
  • Myalgias etc

What do you need to check first?

A

HIV

102
Q

What is herpangina?

What causes it?

A

Vesicles/ulcer on posterior soft palate, usually kids

Caused by coxsakie A

103
Q

Functional constipation in toilet training child, keeps getting UTI’s.

What do you do to tx?

A

Give laxatives

Fecal retention causes rectal distension, obstruction of bladder, stagnant urine, promotes microbial growth–>pyelo

104
Q

Cryptococcal meningoencephalitis

CD4?
LP?

Features?

Pt is treated but develops increasing nausea, headaches etc. What do you do?

How long should this pt be treated for?

A

CD4<100
Elevated opening pressure >250
Low leuks w/ lymphocytic predominance

May have papular lesions looking like molluscum contagiosum

Increasing nausea/HA due to fungus taking up too much space and increasing ICP. Do serial LPs

Pt w/ crypto has to be treated for a year on po fluconazole, while starting AART

105
Q

Staph aureus bacteremia pt being treated w/ vanc has intermittent back pain.

Think of?
How to dx?

A

Metastatic infections of spine like osteomyelitis or epidural abscess

Dx w/ spinal mri

106
Q

Pt is on cipro after UTI, now has C.diff. Tx?

A

Stop cipro

Start Vanc and TMP/SMX

107
Q

Fever, chest pain, hemoptysis in neutropenic pt on levo, tmp-smx, vanc and fluconazole.

Has cavitary nodules w/ surrounding ground glass opacities.

Dx?

A

Aspergillus

108
Q

Pt coming back from India has fever, muscle aches, petechiae, elevated liver enzymes.

Dx?
What are they at risk for?

A

Dengue hemorrhagic fever

At risk for circulatory collapse

109
Q

Empiric therapy for CF pt w/ pneumonia like sx?

A

Vanc and Cefepine+Amikacin

Staph and two to cover pseudomonas

110
Q

How to treat trichomoniasis in breastfeeding?

A

Metronidazole single dose

Express and discard milk for 24hrs after

111
Q

Pathophysiology of toxic shock syndrome vs septic shock?

A

TSS:
Wide spread activation of T cells by bacterial EOXtoxin leading to massive release of cytokines/ usually staph

Septic: Bacterial cell lysis and endotoxin circulation

112
Q

8yoM fever, tonsillar exudates, tender anterior cervical lymphadenopathy and palatal pettechiae.

Dx?
Tx?
Duration? Why is it this long?

A

Strep pharyngitis

Penicillin for 19 days to prevent acute rheumatic fever

113
Q

Infections due to human bites.

Organism?
Tx?

A

Eikenella corrodens

Amoxicillin/calvulanat
Gram neg, anerobe

114
Q

When is exercise contraindicated in pregnancy?

What exercise should be avoided in all cases

A

Placenta previa
Cerclage placement

Dont: Scuba dive, contact sports, skydiving, exercise with fall risk

115
Q

When to change antiepileptics in pregnancy?

A

Only change 6months PRIOR to conception.

Once pregnant, DO NOT change meds.

116
Q

How do you check for neural tube defects?

A

Alpha Fetoprotein and anatomy ultrasound

117
Q

What is the Kleihauer Betke test for ?

A
  • Determines the amount of fetomaternal blood mixing

- Determines the amount of Rho-Gam to be given

118
Q

What do you do for subchorionic hematomas? What are the patients at increased risk for?

A

Expectant management

Complications

  • spontaneous abortion
  • abruptio placentae
  • PPROM
  • preterm delivery
119
Q

What else can you treat BV w/ other than metronidazole?

A

Clindamycin

120
Q

What can BV increase risk of in pregnancy?

A

preterm, pprom, chorio, endometritis,

121
Q

First maneuver to do in shoulder dystocia?

A

Hyperflex maternal legs at the hip

122
Q

Scalp swelling after birth that crosses suture lines.
Dx?
Tx?

A

Caput succedaneum

Resolves spontaneously

123
Q

Pregnant pts with sickle cell disease.

What are they at increased risk for?

A

Increased risk of vaso occlusive episodes during pregnancy

-Eg acute sickle hepatic crises

124
Q

Tx for pregnant patient that’s acutely manic?

A

Haldol

125
Q

22yo comes in after elective termination of pregnancy at outside facility w/

  • Fever, tachycardia, hypotension, lower abd pain, mucopurulent cervical discharge.
  • U/s has echogenic mass in endometrial cavity

Dx?
Tx?

A

Septic abortion

IV Empiric abx

Suction and curettage

126
Q

Abx choice for postpartum endometritis?

A

Clindamycin plus gentamicin

127
Q

Common side effects of OCPs?

A

Breakthrough bleeding
Breast tenderness
Nausea

NOT weight gain.

128
Q

When do you give Rh-Gam?

What if the pt had a previous pregnancy when she got Rh-D-Gam?

A

At 28 weeks AND postpartum

Regardless

129
Q

Pt has a hx of preeclampsia, how do you prophylax and when?

A

Aspirin starting at 12 weeks

130
Q

Pt has a hx of preeclampsia, how do you prophylax and when?

A

Aspirin starting at 12 weeks

131
Q

Bariatric surgery and pregnancy?

A

Delay pregnancy for at least a year after sugery

-Surgery can cause some nutritional deficiencies

132
Q

Pregnancy pt has slightly elevated AFPs.

Next step?

A

Obstetric transabdominal ultrasound

133
Q

Normal amniotic fluid index?

Causes for polyhydramnios?

A

24

GI atresia, anencephaly, diabetes, multiple gest etc

134
Q

Diabetes mellitus can do what to amniotic fluid index?

A

Polyhydramnios >24cm

135
Q

Prognosis for Cerclage placement in pt w/ prolapsing amniotic membrane?

A

poor

136
Q

Multiparus pt has increased vaginal bleeding 20min after vacuum assisted delivery. Intact placenta delivery.

Uterine fundus is soft and palpated 3cm above the umbilicus. Fist-sized clots extruding from vagina.

Dx?
Tx (2)?

A

Uterine atony

Uterine massage and oxytocin

137
Q

What is pemphigoid getationis?

A

Pregnancy related autoimmune disease, typically abdominal pruritis, rash around umbilicus

138
Q

Pregnant pt has focal abdominal pruritis, no rash, all labs normal.
Dx?

A

Pregnancy induced pruritis

139
Q

What’s pylephlebitis? When does it occur?

A

Infective portal vein thrombosis

-Complication of untreated appendicitis or other intraabdominal/pelvic infections

140
Q

Third trimester painful vaginal bleeding, tender rigid uterus, late decelerations

Dx?

A

Abruptio placentae

141
Q

If pt got Rh-Gam, but ended up making antibodies for the next pregnancy. What happened?

A

Not enough Rh-Gam was given to begin with

142
Q

Pregnant pt has worsening headache, papiledema, right sided weakness/blurry vision..
Dx?
Tx?

A

Central venous sinus thrombosis

LMW heparin

143
Q

What is contraindicated in placenta previa? (2)

A

Digital cervical exam

Vaginal delivery

144
Q

Immediately postpartum, pt has hypoxemia, hypotension, hematuria.

Dx?

A

Amniotic fluid embolism

Full blown DIC and everything

145
Q

Pt in 1st trimester w/ family hx of breast ca has complex ovarian mass w/ septations that has grown to >13cm in size.

What do you do?

A

Surgical removal at 2nd trimester

Mass>10 is at risk for torsion, description is likely ca

146
Q

Prenatal screening basics

Initial visit
24-28wks
36-38wks

A

Initial:
-All infections, pap, baseline cbc, RhD

24-28:

  • Anemia
  • Gestational diabetes

36-38:
-GBS

147
Q

What happens in gestational thrombocytopenia?

A

Benign
Asymptomatic thrombocytopenia during pregnancy that should resolve.

Expectant management

148
Q

14wks preg pt has urine culture that grew GBS. No UTI symptoms now.

What do you do?

A

Treat w/ ampicillin now

AND

treat again intrapartum

149
Q

Pt is getting HD and IV iron. Little into it, he is hypotensive, muffeled heart sounds, wheezing, tachycardic, flushed, pitting edema.

Dx?

A

Anaphylaxis from IV iron

150
Q

What are the severe features of preeclampsia?

When does this occur?

A 
SBP>160;DBP>110
Thrombocytopenia
Increasing creatinine
Increasing LFTs
Pulmonary edema
Visual or cerebral sx

From after 20wks gestation to 12 weeks postpartum

151
Q

When do you give oxytocin to aid active labor?

A

If no cervical change or inadequate contractions in 2hrs after cervix has dilated to 6cm

152
Q

Stimulant medications for ADHD and substance use/abuse?

A

Current research says stimulant meds for ADHD does NOT increase risk for substance use or abuse

even in pts with some social use

153
Q

Single item screening for alcohol?

A

How many times in the past year have you had 5 (4 for F) or more drinks in a day?

154
Q

Anorexic pt admitted for unstable vitals, gets IV nutrition, now has dyspnea, orthopnea, crackles at bases, and pitting edema.

Dx?
What do you do?

A

Refeeding syndrome

-Replace electrolytes like Phosphorous and potassium

155
Q

When is RhoGam given postpartum?

A

Up to 72 hrs after delivery

156
Q

Reversed or absent umbilical artery end diastolic flow suggests…?

A

Placental insufficiency and impending fetal hypoxia

—Indication for Delivery!

157
Q

What do you want to look for before giving varenicline?

A

Psych history

158
Q

Next step when you suspect preeclampsia or HELLP in postpartum like days after?

A

Mag

159
Q

Pyoderma grangrenosm

  • vs ecthyma grangrenosum
  • vs clostridial myonecrosis
A

Pyoderma grangrenosm-seen in IBD, painful

Ecthyma-with pseduomonas, PAINLESS, tx w/ iv abx

Clostridial myonecrosis aka as gangrene, painful, needs SURGERY

160
Q

Empiric tx for neonate presenting with fever, unspecified lethargy etc?

What do you cover?

A

Ampicillin plus gentamicin/cefotaxime

Listeria, E coli

161
Q

Ceftriaxone and sulfonamides should be avoided in neonates.

Why?

A

They can cause hyperbilirubinemia and kernicteris

162
Q

Asymptomatic bacteriuria is common in elderly women.

What do you do?

A

Nothing.

Only tx if symptomatic

163
Q

Giardia

When do you tx?
Who has restrictions in activity?

A

Treat only symptomatic pts w/ metro, not anyone who tested +

All symptomatic pts should stay away from recreational water venues/bodies

164
Q

Pt is + for N.Gonorrheae and - for Chlamydia.

How do you treat?

A

Ceftriaxone+Azithromycin

  • Azithromycin is to limit ceftriaxone abx resistance
  • If pt only had chlamydia, you’d only give Azithromycin or doxy ONLY
165
Q

Young with history of

  • Inconsistent condom use
  • Painless pustules on distal extremities
  • Swelling and pain w/ passive extension of hands
  • Multiple joint pains

Dx?

A

Disseminated gonococcal infection

  • Dermatitis
  • Tenosynovitis
  • Polyarthralgia
166
Q

Tx of Mono?

When do you admit?

A

Supportive, some NSAIDs mostly

-If tonsils swell and pt can’t breathe, admit, give IV steroid

167
Q

CT imaging findings in congenital CMV vs toxo?

What else can they have?

A

CMV-periventricular calcifications

Toxo-Intracerebral calcifications

They both can have hearing loss, lesions, hepatosplenomegaly

168
Q

Congenital sensorineural hearing loss, PDA, cataracts, low weight, microcephaly, purpuric lesions.

Dx?

A

Congenital Rubella

169
Q

What is HIV associated lipodystrophy?

A

Metabolic issues secondary to anti-retroviral therapy

170
Q

TB exposure at work.
Next step?

TB exposure at home, positive interferon, neg CXR, exposure strain resistant to isoniazid.
Next step?

A
  1. Skin test, retest 8-10 weeks

2. Rifampin 4-6 months

171
Q

Most common cause of traveler’s diarrhea?

A

Enterotoxigenic Ecoli

172
Q

Virologic failure in HIV?

A

Viral load should be <200w/in 6 months

173
Q

HIV associated thrombocytopenia (HIV-TP).

What is it?
What do you do?

A

Low platelets seen w/ HIV+, no real symptoms. Just tx w/ ART for HIV

174
Q

Isoniazid side effects (2)

A

Hepatotoxic-asymptomatic, self resolving

Neuropathy

175
Q

Gonococcal vs non gonococcal urethritis.

Organism?
Gram stain will show?
Treatment?

A

Gonococcal: Neisseria, purulent, stain has diplococci, tx w/ ceftriaxone and azithro

Non-gonococcal: chlamydia, trich; watery, stain has neutrophils/wbs no organisms, tx w/ azithromycin

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