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Uworld SA 1 Flashcards

1
Q

Pts on TPN are at greatest risk of developing?

A

Blood stream infections (Central line associated infection)

Staph epi, staph a, klebsiella, pseudomonas, candida

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2
Q

Pt drank antifreeze. What would you suspect on ABG?

A

AG metabloic acidosis
LOW PCO2, HCO3 b/c they are being absorbed by free H+
Calcium oxalate crystals in the urine

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3
Q

Nonstress test is reactive if

A

> 2 accelerations (+15bpm over baseline) lasting over 15 seconds in a 20 min period
reactive NST = adequate fetal oxygenation

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4
Q

Pt on chemo
develops bulla surrounded by erytema on foot. Bulla ruptured leaving apainless black ulcer
Dx and Tx?

A 
Ecthyma gangrenosum (psuedomonas)
Piptazo, fluroquinolones
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5
Q

Pt was started on a med for BPH and had syncope in the middle of the night. Why?

A

Orthostatic hypotension

He was probably started on alpha blocker

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6
Q

37 M
severe weakness and dizziness, syncope 2 x in 24 hour
Vague mid chest discomfort and L sided neck pain
recent URI
Thready pulses in both radial a. that disappear with deep inspiration

A

Cardiac tamponade
chest pain, decreased cardiac output, pulsus paradoxus following a viral infection -> tamponade d/t pericarditis
Lungs will stay clear

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7
Q 
36 F
confusion agitation x 2 days
twitching of R arm this morning
T - 10.7
Neck supple
EEG - high amplitude slow waves over the L temporal and frontal lobes
Dx and CSF findings?
A

HSV encephalitis
fever, HA, seizure, confusion, stupor x days
CT/MRI/EEG - abn frontotemporal region
CSF - lymphocytosis, RBCs, NL glucose

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8
Q

Smoker has progressive dyspnea but FEV1/FVC 85%

A

Fibrosis

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9
Q 
Older man
Pain in legs
Worse walking downhill
absent ankle reflexes
Next step?
A

MRI

Lumbar spinal stenosis

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10
Q 
Older male
fatigue, HA, easy bruising
180/120
Increased pigmentation in plamar creases
lower extremity ecchymosis
hypokalemia
hypernatremia
3cm mediastinal mass
Dx?
A

Paraneoplastic cushing syndrome
ectopic ACTH (polypeptide) from small cell lung carcinoma
Hypertension, hyperpigmentation

NL cushings no hyperpigmentation

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11
Q 
40 wk gest
in labor
presents 5cm, 90%, -4
2hrs - 6 cm, 90%, -4
5 hrs - unchanged
Inadequate contractions
Next step?
A

IV oxytocin
6 cm >3hrs = protracted labor

C-section if NO change >4 hrs w/ adequate, OR NO change > 6 hours with inadequate

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12
Q

Latent vs active phase of preganancy?

A

Latent 0-6cm

Active 6-10 cm (rapid changes)

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13
Q

Older man
R hand weakness, slurred speech 15-20 min
hx of afib
What can prevent future episodes?

A

Anticoagulation (rivaroxaban)

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14
Q 
Pleural effustion with:
yellow
Protein > 4
WBC w/ Lymphocyte predominance
low glucose (<60)
A

Exudative effusion

Causes: infection, malignancy, PE

chylothorax has similar findings but fluid will look milky

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15
Q

Once pt is dx’d with HIV what vaccine should they receive quickly?

A

pneumococcal 23

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16
Q

Smoker presents with HA that gets worse when he leans forward
recent dx of small cell lung cancer
PE - crazy JVD, no peripheral edema
Dx and next step?

A 
superior vena cava syndrome
Needs radiation (palliative)
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17
Q

Hospitalized pt s/p surgery develops RUL PNA

Dx?

A

Aspiration PNA, raising head of bed can prevent this

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18
Q

Pt with cirrhosis has a mild fever

Dx and how did this happen?

A

Spontaneous bacterial peritonitis
Peritoneal fluid becomes infected when an enteric organism translocates across the intestinal wall
Paracentesis w/ PMH >250 = diagnostic

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19
Q

Bullus pemphigoid Ab’s target the?

A

Hemidesmosomes

Histo - subepidermal cleavage, linear IgG at BM

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20
Q

Pemphigus vulgaris histo

A

Acantholysis, intraepidermal cleavage
NO oral cavity involvment
Intact bullus are rare - skin is very fragile!

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21
Q

adult w/ neuro syx has a solitary enhancing brain lesion in the temporal lobe. Most likely cause?

A

Metastases, most common intracranial tumor in adults

Melanoma, lung, breast, renal

Peripheral, circumscribed enhancing lesion surrounded by vasgenic edema on MRI

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22
Q

Woman had a voluntary abortion during last pregnancy d/t fetal anencephaly. What is recommended to decrease her risk for her next pregnancy?

A

Begin folic acid

Decreases risk of neural tube defects

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23
Q 
Older man
weakness x 6 wks
Difficults with chairs and stairs
AST - 250
ALT - 140
Lactate - 665
CK - 3700
A

Polymyositis

symmetric proximal m. weakness
Painless (usually), elevated CK
NO skin findings
bx - patchy necrosis, CD8 infiltration of the endomysium

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24
Q

Older adult
symmetric stiffness of shoulders, hip girlde
Elevated ESR, C reactive protein

A

Polymyalgia rheumatica

Association with temporal arterits

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25
Q

In PTX, chest tubes improve vitals by increasing?

A

Venous return

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26
Q

Sudden SOB after UCD placement
No lung markings on CXR with a vertical pleural line
Dx?

A

Tension PTX

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27
Q

Older man
feeling weak x 3 months, instability
PE - atrophy of the hand muscles b/l, upgoing babinsky and hyperactive knee jerk

A

ALS

Mixed UMN and LMN
UMN - hyperreflexia, Babinski
LMN - fasiculations, atrophy

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28
Q

If it sounds like ALS but has Parkinson features (ie tremor) suspect?

A

Multiple system atrophy

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29
Q

Adult with periods of unresponsiveness “blank staring” x 1 min
followed by 20 min of confusion, dragging 1 leg

A

Temporal lobe epilepsy

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30
Q

Gestational DM in 3rd trimester is associated with which PE finding in the neonate?

A

Respiratory distress (fetal lung immaturity), preterm delivery, macrosomia

GDM in 1st trimester - increases risk of cardiac and CNS dz

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31
Q

Female
Serositis (pleural/pericardia effusion)
symmetric arthritis
Pancytopenia

A

SLE

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32
Q

Tx for vtach?

A

Amiodarone

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33
Q

Two hours after a pneumatic dilation of esophageal stricture pt develops nausea, retching, SOB, chest pain
Emesis w/ clotted blood
Dx?

A

Esophageal perforation

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34
Q

Most common cause of pancreatic calcifications?

A

Chronic pancreatitis most commonly d/t alcoholism

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35
Q

Man with all the PMH possible has foot pain
foot is thin, shiny, devoid of hair, shallow ulcer
Next step?

A

ABI

Hairless = vascular, not neuro

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36
Q

Pt is started on chlorthalidone for HTN but develops severe leg cramps and loss of reflexes. How should he be managed long term?

A

Spironolactone

likely developed severe hypokalemia while on thiazide suggesting his HTN is d/t primary hyperaldosteronism

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37
Q

best screening for primary hyperaldosteronism?

A

early morning Plasma aldosterone to plasma renin ratio

If ratio > 20 - PH. Need CT to determine if unilateral vs bilateral

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38
Q

Older man with unspecific syx
Ca - 14
Dx?

A

Malignancy

Hypercalcemia of malignancy d/t parathyroid hormone related protein (very common in nonsmall cell lung cancer). Sr Ca is usually much higher than what would be expected in primary hyperparathyroidism (14 vs 10)

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39
Q

Gastric bypass pt develops cholelithiasis Why is she at increased risk?

A

Rapid weight loss

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40
Q

Older man w/ reddish brown urine x 2 days
strep syx 1 month ago
Long smoking hx
dipstic k + blood, protein
Microscopic exam numerous RBCs many of which are DYSMORPHIC
Dx?

A

Primary glomerular pathology

glomerulo = proteinuria, dysmorphic erythrocytes, red cell casts
PSGN and IgA nephropathy look similar but can be differentiated based on hx

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41
Q

Pt has CKD
Low Ca
High phos
dx?

A

Secondart hyperparathyroidism

the elevation in PTH -> renal osteodystrophy w/ associated bone pain

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42
Q

T 1 DM has frequent urinary dribbling/leakage worse at night.
Post void volume 300 mL
Tx?

A

Cholinergic agonist (bethanechol)

Overflow incontinence d/t neurogenic bladder. Tx with augemented voidtechniques, cholinergics. Severe cases -> cath

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43
Q

Diagnositc criteria for SBP

A

> 250 PMN’s on paracentesis

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44
Q

Guy in septic shock has metabolic acidosis. Why?

A

Increased tissue metabolic acid production (LDH)

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45
Q

Young adult
fatigue, orthopnea following URI
PMI 6th intercostal space
Dx?

A

Dilated cardiomyopathy (viral)

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46
Q

Plaques on the knees

A

Psoriasis

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47
Q 
Jaundice x 3 months
Abd discomfort
Fullness RUQ
T bili - 12.5
Alk Phos - 350
Where is the lesion?
A

Pancreas

Jaundice + weight loss + vague abd pain -> pancreatic cancer

elevated T bili, alk phos suggest cholestasis d/t tumor obstruction of CBD

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48
Q

Kid abd pain, dizziness x 2 hours
vomiting brig red blood, diarrhea w/ dark green stools
Which of moms pills did he take?

A

Iron

GI hemorrhage - bloody diarrhea and hematemsis. Can progress to met acidosis, hepatotoxicity, SBO, death

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49
Q 
Older woman w/ back pain, fever, nighsweats, weight loss
On peritoneal dialysis, former smoker
TTP L3/L4
CXR - cavitory infiltrate in LUL
Collapse of L3/L4 vertebral bodies
Dx?
A

TB

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50
Q

Pt has new irregulaly irregular heart rhthm. What is the best initial test?

A

TSH and T4

Hyperthyroidism needs to be identified in new a fib

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51
Q

R knee pain from twisting injury
Medial knee pain w/ weight bearing, squatting
Unable to fully extend knee and feels the knee will give way while walking
Dx and PE finding?

A

Meniscal tear

Painful click during flexion/extension

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52
Q

What is the key prognositc factor in in astrocytomas?

A

Degree of anaplasia (atypia, mitoses, neovascularity, necrosis are worrisome)

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53
Q 
LN
splenomegaly
Mild cytopenias
Leukocytosis with significant lymphocyte predominancy
Dx?
A

CLL

Tx - Rituximab, Ab directed against CD20 Ag

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54
Q

IBDU has add neuro syx and holosystolic murmur

Dx?

A

Brain abscess
IE can cause hematogenous seeding to the brain -> FND, elevated intracranial pressure, fever
Dx - gadolinium enhanced MRI

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55
Q

Pt with CAP is dry and has hyponatremia. Why hypoNa?

A

Intravascular volume depletion

Low volume -> ADH secretion -> retain free water

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56
Q

SCD pt with bacteremia/sepsis

Etiology?

A

Strep pneumo or H. flu

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57
Q

SCD pt with PNA

A

Strep pneumo

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58
Q

SCD pt with osteomyelitis or septric arthritis

A

Staph aureus

Salmonella

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59
Q

SCD pt with meningitis

A

Strep pneumo

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60
Q

When are prophylactic abx given prior to dental work

A

Prosthetic heart valves
Previous IE

Not required in pts with MVP, Rhemmatic fever, CHD (ASD, bicuspid)

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61
Q

How would increasing the cutoff TSH for hyperthyroidism affect Sens and Spec?

A

Sensitivity would decrease (TP/TP+FN, FN would be increased so Sens would decrease)
Specificity would increase

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62
Q

AFter receiving haloperidol pt develops muscle stiffness and difficulty turning his neck. Tx?

A

Diphenhydramine ( or benztropine, trihexyphenidyl; anticholinergics)

torticollis d/t EPS

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63
Q

Tx for neuroleptic malignant syndrome?

A

Dantrolene

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64
Q

Post menopausal female with bloating, R adnexal fullness, nodularity along rectovaginal septum
Dx?

A

Epithelial ovarian carcinoma

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65
Q 
Severe epigastric pain w/ vomiting x 23 hours
BMI 31 
42 female
Alk phos - 90
ALT - 79
Dx?
A

Acute cholecystitis

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66
Q

Best way to improve fertility in a PCOS pt?

A

Weight loss

OCP’s recommended to stabilize the endometrium in those not seeking pregnancy

67
Q

Pt with vertigo elicited by positional changes. Most likely to benefit from?

A

Epley maneuver

Dx BPPV, confirm dx with Dix-Hallpike maneuver

68
Q

Displaced humerous fx increases risk of?

A

Radial n. injury

Weakness of wrist/finger extension

69
Q

Pt w/ pancreatic cancer has bad pruritis. Best palliative syx option?

A

Endoscopic stent placement - relieve cholestasis in the CBD

Ursodeoxycholic acid is a reasonable option in those with INTRAhepatic cholestasis

70
Q

Pt 3 yrs s/p L mastectomy has DOE x 3 months
CXR - L pleural effusion
Dx?

A

Malignant pleural effusion

71
Q 
Black toddler
low back, leg pain x 3 hours
viral URI last week
Hgb - 8.5
LDH - 700
Dx?
A

Microvascular occlusion

Most likely the initial presentation of SCD

72
Q

absent P waves with irregularly irregular QRS complexes on EKG

A

a fib

73
Q

NL P wave and PR interval that gradually increases until P wave fails to conduct ventricles

A

Mobitz type I, second degree AV block (Wenckebach)

74
Q

Teen has fatigue while playing basketball
Mid systolic murmur best heard at LUSB w/ wide fixed splitting of S2
Dx?

A

ASD
L to R cardiac shunting

Fatigued, not cyantoic

75
Q

5 y/o has watery diarrhea 2 wks aft taking abx

pathophys?

A

Disruption of colonic microflora

C. diff

76
Q 
71 M
Impaired cognition, memory over a year
More unsteady on his feet
Urinary frequency/urgency
Dx?
A

Cerebrovascular dz

FND, gait disturbance, urologic, personality changes
stepwise decline

77
Q

Pt is septic, pancytopenic following a round of chemo
Hyponatremic, hypokalemic
Next step?

A

IV NS

78
Q

16 M immigrant from Thailand
intermittent nausea, watery diarrhea, bloating
episodic periumbilical pain, lost 5lb
Hgb 10.4, MCV 72
Eos - 800
dry cough, SOB when he first arrived to the US
Dx?

A

Parasitic infection
Get stool analysis for ova and parasites

Hookworm suspicious d/t respiratory findings but unclear (Ancylostoma, Necator)

79
Q

Patient presenting with renal failure, hypercalcemia, anemia

Concerning for?

A

MM

RF d/t light chain casts causing renal tubular injury

80
Q

Fragile X is strongly associated with which psych pathology?

A

Autism

CGG repeat on FMR1 on X chromosome

delayed milestones, sutism, ID, elongated face, large testes

81
Q

What do you do with a little old lady with dementia that is wandering around the hospital and being hostile

A

Haloperidol

You snow her.. in reality it’s probably delerium

82
Q

Young guy with schizophreniform syx decides to leave during your assessment and the guards catch him. Now what?

A

Soft restraints, IM haloperidol, lorazepam

83
Q

What workup is needed for pts with new onset psychosis?

A 
Need to r/o metabolic causes
CMP
CBC
TSH
Utox - most likely to be useful
84
Q 
3 days s/p anterior MI
80/40, 120
holosystolic murmur at LSB
Cardiogenic shock
Increased Oxygen saturation in RV vs RA
Dx?
A

VSD

Ventricular septum rupture 3-5 days s/p MI, L to R shunt in ventricles

85
Q

Pt has acute SOB and R sided heart pressures are elevated compared to L heart pressures
Dx?

A

PE

86
Q

RA pt
T - 100.8
Swelling of 2nd MCp joing, exquisite TTP x 2 days
Dx?

A

Gramp + bacterial infection (septic arthritis)
acute monoarthritis w/ fever
Staph aureus most common

87
Q

2 y/o with painless bloody BM
Tc-pertechnetate scan reveals dense area of uptake
This is caused by?

A

Gastric mucosa

Meckel diverticulum

88
Q 
s/p breast ducal cancer but new dx of lytic bone lesions
presenting with fatigue x 3 days
Hgb - 6.3
WBC - 18k
Plt - 42K
Alk phos - 160
LDH - 1200
INR - 3.2
Fibrinogen - 125 (L)
Dx?
A

DIC, most common coagulopathy in malignancy
DIC = thrombocytopenia, increased INR, decreased fibrinogen
Anemia, LDH d/t microangiopathic hemolytic anemia -> non immune hemolysis from RBC fragmentation

89
Q

Childhood murmur
irregularly irregular
Echo - thickening of mitral valve leaflets w/ commissural fusion and restricted mitral valve opening
Cardiac exam finding?

A

Mid diastolic murmur at cardiac apex

Dx rheumatic mitral stenosis

90
Q

Young guy with syncopal episode during exercise
2/6 murmur at LSB while standing
T wave inversion V4-6
Dx?

A

Hypertrophic cardiomyopathy
AD; disorder of cardiac sarcomere
systolic murmur that increases with standing

91
Q

Nursing home residenct is bed bound and has non-blanching erythema on both heels. Next step?

A

Pillows under her legs
Early sign of pressure ulcer

Once a true ulcer forms -> dressing that maintains a moist wound environment is needed

92
Q

2 hrs s/p thoracentesis (2L) pt is dizzy, diaphoretic
70/palp, 130, 91% on 40% O2
dullness to percussion and absent breath sounds
Dx?

A

Hemothorax
suspect in pts with difficulty breathing, hemodynamic instability shortly after thoracentesis
Causes decreased LV preload

93
Q

Guy presents with acute scrotal pain

What PE finding suggest a need for urgent surgical intervention?

A

Absence of cremasteric reflex (testicular torsion; reduced venous outflow)

94
Q

Pt on chemo for non small cell lung cancer develops tinnitus, decreased hearing
Why?

A

Chemo side effect

cisplatin - nephrotoxicity, tinnitus, hearing loss, electrolytie abn, n/v, neurotoxicity

95
Q 
Nephrotic syndrome with:
Black/Hispanic guy OR
obese OR
HIV OR
IVDU
A

Focal segmental glomerulosclerosis

96
Q 
Nephrotic syndrome associated with:
adenocarcinoma
NSAIDs
HBV
SLE
A

Membranous nephropathy

97
Q

Nephritis syndrome associated with:
HBV, HCV
Lipodystrophy

A

Membranoproliferative GN

98
Q

Nephrotic dz associated with:
NSAIDs
Lymphoma

A

Minimal change dz

99
Q

Nephrotic syndrome associated with:

URI

A

IgA nephropathy

100
Q

hrs after a trauma pt develops SOB
CXR - nonlobar airspace opacity
Dx?

A

Pulmonary contusion
generally develops <24 hrs after injury
Tx - supportive

101
Q

14 yr old
episodes of limb jerking followed by confusion
Also some urinary incontinence
Dx?

A

Juvenile myocloic epilepsy
Teen w/ progression from absence to myoclonic to tonic clonic seizure
seizure typically occurs upon awakening
worsened by sleep deprivation

102
Q 
woman with hx of:
Progressive proximal muscle weakness
Weight gain
irregular menses
oily skin
Dx?
A

Cushing syndrome

d/t adrenal tumor OR ectopic ACTH production

103
Q

How does nitrostat reduce chest pain?

A

Venous dilation

The reduced preload reduces myocardial oxygen demand

104
Q 
3wk old infant
bilious vomiting
no recent stool
Upper GI series - corkscrew shap, Rward displaced duodenum
dx?
A

Midgut volvulus

needs surgery quickly

105
Q

Older pt on glucocorticioids develops meningitis. Needs additional microbial coverage against?

A

Listeria
RFs >50, immunocompromised
Tx - ampicillin

106
Q

Best way to prevent gout after initial attack?

A

EtOh cessation

Weight loss

107
Q

Pathophys of Parkinson’s

A

Decreased DA activity in the substantia nigra

108
Q

R sided neck and arm pain
Ulnar parathesia
CXR - RUL dense mass, hemidiaphragm
Dx?

A

Superior sulcus tumor (pancoast tumor)
Associated with smoking
phrenic n. damage

109
Q 
Young adult
frequent diarrhea
microcytic anemia
Fractures out of proportion to injury
Dx?
A

Celiac dz

Malabsorption of Iron, Vit D

110
Q

Older guy
soft murmur after second heart sound, declines in intensity disappearing suddenly before the first heart sound
Accentuated when he stis up, leans forward, and puts his hands behind his head
Dx?

A

Aortic regurgitation

In developed countries it is caused by aortic root dilation or congenital bicuspid valve

111
Q

Pt has had frequent hospitalizations d/t odd skin infections
hospitalized for cellulitis
Next day develops sepsis, nurse finds used syringe in his belongings
Utox -
Dx?

A

Factitious disorder
pt intentionally makes himself sick for attention

Malingering - fake syx for a specific reward (ie workmans comp)

112
Q

IVDU w/ b/l lower extremity paralysis

Dx and Tx?

A

Spinal epidural abscess
Tx - broad spectrum abx
Staph aureus most common

113
Q

4 M
pain on swalling
PE - erythema of pharynx, vesicles,
Next step?

A

Obs

Herpangina d/t Coxsackie A

114
Q 
In septic shock what is
PCWP
CI
SVR
Mixed venous O2
A

PCWP - NL/low (capillary leakage = decreased preload)
CI - high
SVR - low (vasodilation)
MvO2 - high (tissues unable to extract O2)

115
Q

frequent URI’s
rapidly progressive GN
Nonhealing ulcer
Dx?

A

Granulomatosis w/ polyangiitis (GPA; Wegner)
necrotizing vasculitis
ANCA +

116
Q

Older guy wandering around in traffic with b/l ecchymoses and pedal edema, gums inflamed

A

Malnutrition

common in elderly especially those w/ dementia

117
Q 
DOE x 6 months
pancytopenic
Blood smear - ovalomacrocytosis, PMN w/ reduced segmentation
B12 NL
Next step?
A

Bone marrow bx
Suspicious for myelodysplastic syndrome, a neoplastic stem cell disorder in older pts with previous chemo or radiation
Presents with cytopenias and dysplastic RBC, WBC’s
Tx - Chemo, hematopoietic stem cells

118
Q

6hrs s/p seizure pt has
K+ - 5.9
EKG - flattening of P wave, PR intervale prolongation, widening of the WRS
Next?

A

Calcium gluconate

Hyperkalemia causing EKG changes responds to Ca gluconate through stabalization of the cardiac membranes

119
Q 
40ish F
HA, sweating x months
weight loss
240/140 
TSH, electrolytes WNL
UA 1+ protein
Dx?
A

Adrenal meduallary dz (pheo)

adrenal cortex produces gluccocorticoids, mineralcorticoids (aldosterone, cortisol)

120
Q 
29 F
abd pain, diarrhea, fever x 2 months
multiple nonbloody BM's WD
passing gas and malodorous d/c from her vagina
weight loss
Dx?
A

Crohn’s
fevers, chronic diarrhea, abd pain, weight loss
FISTULAs

121
Q

Kiddo has honey crusted lesions around his mouth. Increases risk for?

A

PSGN
Impetigo, Staph aureus, GAS
NOT rheumatic fever

122
Q 
Pt presenting with SOB
Smoker
Meds - albuterol, iprtropium
Clear lung sounds
CXR - hyperinflation
Tx?
A

Glucocorticoids

COPD exacerbation

123
Q 
Pt on chemo
presenting w/ fever, tachy, AMS
Hgb - 9.1
WBC - 600
PLT - 90k
What is causing her AMS?
A

Bacterial infection

Chemo -> neutropenia -> infection/sepsis
Cannot build an adequate immune response so their signs of sepsis are milder than the immunocompentent

124
Q

26 F
Impulsive
Mood instability
Unstable sense of self (description of detachment)
Fear of abandonment with transient paranoia/psychosis
Dx?

A

Borderline personality disorder

125
Q 
69 M
Concerns for depression
Cold all the time, still muscles, constipation
Also some hallucinations
Dx?
A

hypothyroidism

New onset of psychosis w/ physical syx needs a work up
hypothyroidism is often dx’d as depression and can present with psychotic syx

126
Q

Pathophys of ketone production in DKA

A

Fatty acid breakdown in the liver (lipolysis) -> makes ketones

127
Q

management of DKA?

A

IV NS
Insulin drip
K+ containing fluids

128
Q 
Older adult
LN, hepatosplenomegaly
Mild thrombocyotpenia, anemia
Lymphocytosis
more susceptible to infection
Dx and finding on Blood smear?
A

CLL

smudge cells

129
Q

ICU pt develops Gram + cocci in clusters bacteremia

How?

A

Central line associated infection

130
Q 
28 wk gestation
syx suspicious for PE
CXR WNL
V/Q scan shows low probability for PE
Next step?
A

CT angio of the chest

Need a NL V/Q scan to r/o PE

131
Q

Hereditary spherocytosis increases risk for which GI pathology?

A

Cholelithiasis d/t chronic hemolysis

bilirubin gallstones

132
Q

HAART drug that produces colorful vivid dreams

A

Efavirenz

non-necleuoside RT inhibitor that causes neuropsych side effects (insomnia, dreams, depression, anxiety)

133
Q

Woman with urinary incontinence that feels the sens to urinate but cannot make it to the bathroom quickly enough
Dx, tx?

A

Urge incontinence
1st line - bladder training
2nd line - anti muscarinic (oxybutynin)

134
Q 
6 F
palpable purpura
arthalgia
abd pain
hematuria
A

Henoch-schonlein purpura
IgA-mediated vasculitis
Tx - supportive

135
Q

Pt has new onset back pain while bowling
hypotensive
Dx?

A

AAA

back pain d/t referred pain

136
Q

B/l knee pain, worse at end of day

Tx?

A

NSAIDs

137
Q

32 wk gestation w/ painless vag bleeding
FHR reassuring
Next step?

A

transabdominal U/S

suspicious for placenta previa

138
Q

MVA pt
CXR - wide mediastinum
hemodynamically stable
Next step?

A

CT angio OR transesophageal echo

139
Q

Tx for F with 3 cm swelling in medial aspect of R labium majus?

A

Incision and Drainage

Dx - Bartholin cyst
4 or 8 o’clock position

140
Q

Young guy being irrate and yelling at traffic
dilated pupils
Totally fine the next morning
Long term tx?

A

12 step program + individual therapy

suspicious for caccaine use disorder

141
Q 
45 F
fatigue, weight loss (20lb) x 6 mo
palpitation, diaphoresis, dyspnea, amenorrhea
PMH - vitiligo
Smoker
PE - sclera are seen about the iris on downward gase
digital clubbing
Ca - 10.3
Dx?
A

Hyperthyroidism

lid lag, amenorrhea, PMH sig for autoimmune dz

142
Q

6mo M
irritable, febril
When the hip is flexed the knee cannot be extended more than 135 degrees on both sides
Why?

A

Meningitis

Kernig sign = inability to exted knee; indication of meningeal irritation

143
Q

Pt took her sister’s migraine medication w/o relief. Gets sumatriptan in the ER which helps. Hours later 220/110, 120
What did her sister have?

A

Dihydrerotamine
co admin with triptan -> prolonged vasospasm d/t overactivation of serotonin R
HTN, MI, CVA

144
Q

Kiddo with high fever > 5 days
nonexudative conjunctivitis, mucositis, cervical lymphadenopathy, rash, extremity changes
Dx, Tx?

A

Kawasaki dz

Tx - IVIG to decrease the risk of coronary a. aneurysm

145
Q

Older woman difficult driving at night d/t halos around the cars
dx and PE finding?

A

Cataract
RF - age, smoking, sunlight, DM, steroids
PE - loss of red reflex

146
Q

What change may be seen on CBC in a pt with splenectomy?

A

Thrombocytosis

147
Q

23 F has burning urination despite abx tx
Pyuria
No organisms on urine culture
Dx and risk of?

A

Chlamydia urethritis
suspect in young pt with dysuria, sterile pyuria, and risky sex behaviors
Risk of infertility d/t scarring of Fallopian tubes

148
Q 
Pt presenting with decompensated HFrEF
No meds
P - 75
Diuresed in the hospital
What should he be given for outpt management for the best long term outcomes
A

B blocker (but apparently atenolol)

149
Q 
31 F
amenorrhea x 6 months
weight gain
expressable galactorrhea b/l
Next step?
A

Measure TSH

should always be included in work up for amenorrhea

Can also cause hyperprolactinemia w/ galactorrhea

150
Q

33wk gestation
bloody vaginal discharge
50% effaced, 2 cm dilated and given a tocolytic
hours later - HA, nausea, flushing, 96/62
What tocolytic was she given?

A

CCB (used at 32-34 wks)

Tocolytics - Indomethacin (COX inhibitor), nifedipine, terbutaline (beta agonist)

151
Q

Newborn hass cyanosis of the lips, nail beds, and tongue. What is causing this?

A

Low arterial oxygen saturation

Central cyanosis vs. peripheral cyanosis (ie SCD)

152
Q

23 M
blood sample is milky and opalexcent
PE - yellow streaks on his palms
Dx, Tx?

A

Familial dysbetalipoproteinemia
Tx - Fenofibrate
yellow streak on palms = striate palmar xanthomas

153
Q

30 wk gestation
3cm dilated, 80%, -3
Next step?

A

IM betamethasone (<37 wks)
Tocolytics
Magnesium sulfate
penicillin if GBS unk

154
Q

What are the best ways to prevent progression of nephropathy in the setting of T2DM?

A

1st - blood pressure control (ACEI)

2nd - glycemic control

155
Q

Pt has intermittent tingling over 4th and 5th fingers and medial forearm
Where is the compression?

A

Elbow

Ulnar n. compression in the epicondylar groove

156
Q 
13mo M w/ rash
fever x 3 days
PE - blanching, pink macules on his neck, back, abdomen, chest
No vesicles
Dx?
A

Roseola (HHV6)

<2 y/o
3-5 days of high fever followed by maculopapular rash
Tx - supportive

157
Q

Scleroderma pt has Raynaud’s. Tx?

A

Nifdeipine

158
Q

Pt has big seizure. Dark urine in the foley. What would be found on UA?

A

+ blood on dipstick (NO RBC casts)

rhabdomyolysis -> myoglobin

159
Q

16 y/o w/ hemoptysis
frequent PNA’s
Pancreatic enzymes for chronic diarrhea
Why does he have hemoptysis?

A

Bronchial airway dilation and erosion

CF = PNA + diarrhea
develops bronchiectasis after chronic airway inflammation and ifection leading to scarring and dilation of airways

160
Q

Regular OCP use can reduce the risk of which cancer?

A

Ovarian, endometrial cancers

161
Q

Older pt is having syncope that he describes as sudden black outs lasting 1-2 minutes without confusion afterwards.
What is causing his syncope?

A

Ventricular arrhythmias
suspect in syncope w/ rapid onset of LOC w/o a preceding prodrome
Torsades de pointes is most common
Etiologies = antiarrhythmic drugs, structural heart dz, hypokalemia, hypomagnesmia predispose to Torsades

162
Q

How do you tx a pt with QT interval prolongation in a pt that is hemodynamically stable?

A

Magnesium sulfate

Even if the Mag level is NL

163
Q

67 F
episode of unilateral vision loss x 10min
Carotid bruit
What is causing her vision loss?

A

Retinal embolism

Amaurosis fugax - painless, sudden, transient monocular vision loss d/t retinal a. emboli from the ipsilateral carotid a. atherosclerotic plaque

164
Q

32 F
progressive vision impairment in her R eye
Vision became blurry during a shower this morning, discomfort of the eye last night
episodes of dizziness, clumsiness x 6 months
Reduced R visual acuity, NL fundoscopy
What is causing her syx?

A

Demyelinating disorder
d/t MS presenting with optic neuritis
Exposure to heat can exacerbate syx (Uhthoff phenomenon)

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