UWorld Review 3 Flashcards
(44 cards)
Describe the presentation and treatment of hypersensitivity pneumonitis.
- presents with cough, breathlessness, fever, and malaise 4-6 hours after exposure to an irritating antigen such as mold or bird droppings
- CXR will show haziness in the lower lung fields
- treat with avoidance of the antigen
How are uterine leiomyomas treated?
- asymptomatic ones can be observed
- symptomatic ones can be treated medically with cOCPs or surgically with resection
Describe the pathophysiology, presentation, and treatment of postpartum urinary retention.
- due to pudendal nerve injury in the case of perineal lacerations and prolonged labor or due to bladder atony in the case of anesthesia
- presents with an inability to void by 6 hours post-delivery and may progress to overflow incontinence with dribbling of urine
- treat with intermittent catheterization until it self-resolves
What endocrine disorder may be the manifestation of a teratoma?
hyperthyroidism (aka strums ovarii)
What is subclinical hypothyroidism?
an elevated TSH in the setting of normal free T4
Describe the appropriate management of STEMI.
- supplemental oxygen
- nitrates
- dual anti-platelet therapy
- anticoagulation
- beta-blockers
- prompt repercussion with PCI or thrombolytics
- start a statin as soon as possible
Describe the genetics and presentation of Friedreich ataxia.
- due to a GAA repeat in the frataxin gene
- presents with neurologic symptoms including ataxia, dysarthria, loss of dorsal columns, and absent reflexes
- other manifestations include scoliosis, diabetes, and hypertrophic cardiomyopathy
Describe the management of lead poisoning.
- screen with finger stick lead
- confirm with a venous sample
- notify the public health department, perform nutritional counseling, and do an environmental survey
- treat with succimer only if lead levels are >45, treat with dimercaprol and EDTA if > 70
How can autoimmune hemolytic anemia be differentiated from hereditary spherocytosis?
both produce an extravascular hemolysis with spherocytes; however, AIHA is likely to have a positive Coombs test while spherocytosis has a strong family history
What happens to the erythrocyte count and MCV in those with thalassemia?
the erythrocyte count increases as the body attempts to compensate for anemia but the MCV is low as little hemoglobin is produced to fill the cells
How is androgen insensitivity differentiated from 5a-reductase deficiency?
- both produce an individual with male gonads and female external genitalia
- the difference is that those with androgen insensitivity will still undergo breast development during puberty because estrogen production is unaffected
Laryngeal papillomas are caused by what?
HPV
What does “use dependence” refer to when discussing anti arrhythmic drugs?
it is a phenomenon experienced by many class IC drugs and refers to the idea that at faster heart rates, the drugs have less time to dissociate from sodium channels, leading to progressive widening of the QRS
Describe the presentation and management of blunt cardiac injury.
- follows a rapid deceleration injury or direct blow to the precordium
- presents with arrhythmia, ACS, myocardial dysfunction, and/or cardiac tamponade
- management includes evaluation with ECG and TTE
What is leukoplakia?
a reactive precancerous lesion manifesting as a white lesion within the oropharynx which represents hyperplasia
What are the features of DiGeorge syndrome?
Conotruncal cardiac defects Abnormal facies Thymic hypoplasia Cleft palate Hypoparathyroidism
What are the features of trisomy 18?
- IUGR, microcephaly, micrognathia, and prominent occiput
- overlapping fingers with closed fist and rocker-bottom feet
- VSD
What are the features of trisomy 13?
- microcephaly/holoprosencephaly, microphthalmia, cleft lip
- cutis aplasia, umbilical hernia/omphalocele
- renal and cardiac defects
- polydactyly
What is the mechanism of pulmonary hypertension in those with scleroderma?
arterial intimal hyperplasia
How is cocaine-induced chest pain managed?
- benzodiazepines for blood pressure and anxiety
- aspirin, nitroglycerin, and CCBs
- avoid beta-blockers which will generate an a1 imbalance
Describe the presentation of a neuroblastoma.
- often present in children less than 2 with an abdominal mass
- periorbital ecchymoses representing orbital metastases, spinal cord compression, and opsoclonus-myoclonus syndrome are additional features
- labs find elevated catecholamine metabolites and an N-myc oncogene amplification on histology
Describe the maintenance phase of hypokalemic, hypochloremic, metabolic alkalosis secondary to vomiting and its treatment.
- the kidneys filter excess bicarb in response to the alkalosis; however, volume depletion simultaneously stimulates the renin-aldosterone system and water is reabsorbed at the expense of potassium and acid
- thus, treatment is with normal saline and potassium relacement
What is the MASFP, B-hCG, estriol, and inhibin A profile for each of the following:
- trisomy 18
- trisomy 21
- neural tube defect
- trisomy 18: down, down, down, normal
- trisomy 21: down, up, down, up
- neural tube defect: up, normal, normal, normal
How do we define the following types of asthma:
- intermittent
- mild persistent
- moderate persistent
- severe persistent
- intermittent: less than 2 uses of albuterol per week and less than 2 night time awakenings a month
- mild: albuterol needed 2-7 days a week, 3-4 night time awakenings monthly
- moderate: daily albuterol use and 1-3 night time awakening per week
- severe: albuterol needed multiples per day or at least 4 night time awakenings were week
