UWOrld wrong questions part3 (3rd 200 q's) Flashcards
(178 cards)
1
Q
a) Gold standard of treatment of hot flashes? b) Tx in woman with breast cancer hx? c) with depression? d) with HTN? e) with insomnia/seizure/pain?
A
a) estrogen b) Desvenlafaxine or SSRI; c) venlafaxine d) clonidine e) gabapentin
2
Q
what neuro problem is absolute contraindication to OCP use?
A
migraine with aura
3
Q
what meds reduce effectiveness of combo OCPs?
A
RIFAMPIN! also, Guinness, Coronas, & PBRs induce chronic alcoholism: Griseofulvin, Carbamazepine, Phenytoin, Barbs, Rifampin, St Johns Wort, Chronic alcoholism
4
Q
avoid progesterone IUD if you have what?
A
breast cancer
5
Q
OCP use decreases incidence of what types of cancer?
A
ovarian, endometrial, colon; (NOT breast)
6
Q
pulmonary cause of a) decreased PaO2 / increased PaCO2 vs b) decreased PaO2 / decreased PaCO2?
A
a) resp acidosis from alveolar hypoventilation, COPD, OSA, NM diseases like Lambert Eaton, Guillian-Barre, and Myasthenia gravis b/c all of these relate to KEEPING CO2 IN———- b) resp alkalosis from ANYTHING that would cause increased RR (thus blowing off CO2): atelectasis, PE, pleural effusion, pulm edema (all V/Q mismatch!!)
7
Q
how to tell diff btwn esophageal perforation and aortic dissection? Next step in management, Tx for esophageal perf?
A
Esoph perf: mediastinal air (pneumomediastinum), pneumothorax. Dx with water soluble Gastrografin (NOT barium) contrast esophogram. Tx: broad Abx + supportive care unless significant leak.————- Aortic dissection: decreased BP, hemothorax, Dx with TEE.
8
Q
succussion splash on epigastrium (placing stethoscope here and rocking patient back and forth at hips)indicates what?
A
gastric outlet obstruction (tumor, PUD, Crohn, strictures, caustic agents, bezoars) b/c this is sound of retained gastric material >3 hrs after meal.
9
Q
ingestion of acid can cause what anatomical problem?
A
pyloric stricture (type of gastric outlet obstruction)
10
Q
main signifier Sx of atelectasis?
A
shallow breathing (with increased RR, causing decreased CO2) 2-5 days after surgery
11
Q
COPD and pneumothorax: what tactile fremitus, breath sounds, and percussion?
A
decreased tactile fremitis, decreased breath ounds, and hyperresonant to percussion
12
Q
bronchial breath sounds/”bronchophony”/egophony, etc, think what lung issue?
A
consolidation – lobar pneumonia
13
Q
pleural effusion: what is tactile fremitus, breath sounds, and percussion in this patient?
A
decreased tactile fremitus, decreased breath sounds, and dull percussion. Also, mediastinal shift away from effusion IF large.
14
Q
bleeding varices: 1st, 2nd, and 3rd line of management?
A
1st: IVF, Abx, octreotide. —2nd: endoscopy within 12 h with sclerotherapy or band ligation —- 3rd: If no further bleeding, give BB + endoscopic band ligation 1-2 w later. If continued bleeding, temp balloon tamponade with eventual TIPS/shunt surgery.
15
Q
the 2 main atypical signs of a massive PE? Tx?
A
hypotension (causing syncope) and right heart strain (causing JVD, R BBB, bradycardia). Tx: thrombolytics
16
Q
what should be done in workup of achalasia?
A
Barium study, then manometry to confirm, plus endoscopy to r/o tumor/cancer at GE juntion
17
Q
After doing physical, measuring hCG, TSH, & all hormones for amenorrhea and they turn out normal, what do you do next in workup and what does it mean?
A
Progesterone challenge. Give 5-10 days of progesterone, withdraw, and if she bleeds this means estrogen is normal (b/c endometrial lining was built up). If no bleeding, then low estrogen. ———— Next do estrogen-progesterone challenge and if this fails there’s an anatomical defect.
18
Q
Next step if physical exam shows absence/difficulty finding uterus? 2nd step?
A
pelvis U/S. then karyotype and testosterone.
19
Q
2 possibilities of Dz if uterus is absent?
A
1) Androgen insensitivity syndrome: 46XY, normal outer female development but with testes/male internals and elevated testosterone.————–2) Abnormal mullerian development: 46XX, normal outer female development but missing female internals and normal female testosterone levels.
20
Q
Patient with amenorrhea – if uterus is present, what is next step? Step after that?
A
b-hCG and FSH. —–>Then if FSH is high do karyotype for Turner syndrome. If FSH low do cranial MRI. If FSH is normal, do prolactin and TSH.
21
Q
amenorrhea in patient who had D&C might be what? Tx?
A
Asherman syndrome (scarring of ovaries from surgery) - do progesterone withdrawal test. Tx: lysis of adhesions + estrogen
22
Q
Dix-Hallpike manuever diagnoses what? Tx?
A
Benign Paroxysmal Positional Vertigo. Tx: Epley maneuver
23
Q
dysmenorrhea: workup? Tx?
A
b-HCG, vag culture, U/A. Tx: NSAIDS, OCPs
24
Q
Dysmenorrhea, dyspareinua, and dyschezia (painful defecation during menses), tender adnexal masses=? Dx? Tx?
A
endometriosis. Dx: Bx (CA-125 too general). Tx: NSAIDS, OCPs, GnRH agonist continuous, progestin // if fertility desired, lap surgery or hysterectomy WITH B/L salpingo-oopherectomy
25
Patient with GERD Sx - what is 1st and 2nd step in management?
1st: if alarm sx (dysphagia, weight loss, blood, recurrent vom) or >55 then endoscopy, if esophagitis do H pylori test then Tx, if no esophagitis workup for other things like with manometry.------------------------ If no alarm Sx then once daily PPI for 2 months. 2nd step: if refractory switch to diff PPI or increase to 2x daily, if not working 3) do endo/pH monitoring.
26
Tx for cholecystitis for patients who do not want lap chole?
Tx: ursodeoxycholic acid + avoid fatty foods
27
aortic stenosis murmurs or ESRD + anemia + painless GI bleeding in patient >60 = what? Dx?
angiodysplasia (or AV malformations) of GI tract. Dx: colonoscopy or capsule endoscopy.
28
increased direct bilirubin in adult after illness + normal LFTs + dark granular pigment in hepatocytes on liver Bx = ?
Dubin Johnson syndrome. (if no pigment, then might be Rotor syndrome)
29
Carcinoid syndrome - what heart abnormalities? Dx? Tx?
valvular lesions (R>L). Dx: 5-HIAA, CT/MRI of abd/pelvis, octrescan, echo. Tx: octreotide for Sx; surgery for liver mets.
30
Tx for duodenal hematoma causing obstruction?
NG suction with parenteral nutrition. After 1-2weeks, Laparotomy/laparoscopy if this fails.
31
After finding gastrin level for working up ZE syndrome, what is next step? 3rd step?
If >1000, check gastric pH off PPIs for 1 week. If >4, no gastrinoma. If
32
a) Irregular,heavy periods suggest what? b) regular, heavy periods suggest what?
a) anovulation. b) anatomic (adenomyosis, fibroids, etc)
33
abnormal uterine bleeding - what workup after labs and cultures?
if >45 OR 6months, endometrial Bx. U/S pelvis; hysteroscopy.
34
abnormal uterine bleeding with depression, constipation, think = ?
hypothyroidism
35
abnormal uterine bleeding started with menarche, think = ? What are lab values?
von Willebrand Dz (increased bleeding time and PTT)
36
abnormal uterine bleeding in unstable patient, do what?
IVF, RBCs, intrauterine tamponade(balloon to decrease bleeding), uterine curettage. If persists ---> IV high dose estrogen + antiemetic
37
cirrhosis or asciites + fever or change in mental status, think = ? Dx?
spontaneous bacterial peritonitis. Dx: paracentesis (BEFORE Abx) showing PMNs >250.
38
nonbleeding esophageal varices, how to Tx?
nonselective BBs(propranolol, nadolol); endoscopic variceal ligation if BBs contrindicated
39
decreased total T3 and T4, but normal free T3 and T4, normal TSH = ?
liver disease (because liver makes thyroxine-binding proteins)
40
acute cholangitis, what is 1st, 2nd, and 3rd step of management?
1st: IVF, broad Abx. --->2nd (if not better): biliary decompression/drainage by ERCP. 3rd:(eventual) cholecystectomy
41
diangosis of diverticulitis?
abdominal CT (NOT upright film/XR; NEVER -scopy)
42
diagnose someone with Hep C, what is 1st step in management? 2nd step? 3rd step/
1st: Liver Biopsy to stage.(b/c meds will only help if not yet cirrhotic)------ 2nd:INF, ribavirin. --------3rd: U/S every 6 months for HCC surviellance
43
how to diagnose pancreatic cancer if with jaundice vs not jaundice?
Jaundice: abd U/S. ----------No jaundice: abd CT
44
(+) progestin challenge, LH:FSH >2:1, anovulation, increased T = ?
PCOS (need 2 of 3: anovulation, cysts on U/S, hyperandrogen Sx)
45
best drug for PCOS to improve fertility?
clomiphene
46
most common causes of steatorrhea?
chronic pancreatitis due to alcohol abuse>CF>other pancreatitis, Crohn's, Celiac (but NOT lactose intolerance)
47
when to admit patient for CAP?
2 or more of the following: age>65, RR>30, hypotension, uremia(BUN>20), confusion
48
a)How to treat CAP outpatient? b) CAP inpatient non-iCU? c) CAP inpatient ICU?
a) macrolide or doxy (unless they mave comorbid, then just like inpatient non-ICU)-------------b) FQ or b-lactam + macrolide --------------------c) b-lactam + macrolide(IV) or b-lactam + FQ
49
when do you put chest tube(aka tube thoracostomy) for parapneumonic effusion?
empyema: when pleural fluid pH
50
large anterior mediastinal mass with increased AFP and b-HCG in young man = ?
nonseminomatous germ cell tumor
51
what mass tends to be located in anterior mediastinum? middle mediastinum?
anterior: thymoma. Middle: bronchogenic cysts
52
what disease has transiently elevated LFTs over time, porphyria cutanea tarda, essential mixed cryoglobulinemia (circ Ig's deposit in vessels, low serum complement)
hep C
53
a) erosions on dorsum of hands = ? b) painful nodules on anterior legs = ? c) necrotizing vasculits with rash from Ag-Ab immune complexes = ?
a) porphyria cutanea tarda (with hep C) . b) erythema nodosum (with infections/sarcoid) c) polyarteritis nodosa (with hep B)
54
symmetric, circumferental narrowing of esophagus with dysphagia for solids only, no weight loss? associated/causal disease?
Esophageal (peptic) stricture. Caused by GERD (or radiation, systemic sclerosis, and caustic ingestions).
55
Diagnostic test of choice of Zenker diverticulum?
contrast esophagram
56
after getting abnormal quad screen, what is next step? step after that?
1) U/S to confirm dating, etc. 2) definitive diagnosis: CVS[10-13 wks] or amniocentesis. [15-20 weeks]
57
What does increased ACh indicated in amniocentesis?
neural tube defects
58
diff between quad screen results of Down and Edwards and Patau?
Down: decreased AFP, decreased estriol, increased b-hCG, increased inhibin. / Edwards: decreased AFP, decreased estriol, decreased b-hCG, decreased inhibin (ALL DECREASED) / Patau: only decreased AFP.
59
Best anti-nausea meds for morning sickness?
pyridoxine (vit B6) + doxylamine (anti-hist)
60
when do you do screening for gestational diabetes? How do you diagnose?
24-28 wks. 50g 1 hr oral glucose tolerance test, then if (+) do 100 g 1,2,3hr oral glucose tolerance test. If 2+ of these test results are positive, it is diagnosed,
61
what do you do for pregnant patient with bacteria/WBCs in urine and no Sx?
this is Asymptomatic bacteruria, but must prevent from causing UTI/pyelo. Tx: nitrofurantoin, amoxicillin, cephalexin, fosfomycin, or TMP-SMX. repeat urine culture 1 wk after finishing Abx.
62
how to treat pyelo in pregnant patient?
ADMIT, then IV amp + genta, ceftriaxone, meropenem, or piper-tazo. Continue oral Abx for rest of pregnancy.
63
when to get pap smears for normal patients?
start at age 21, every 3 years till 29. 30+ can continue q3 or pap + HPV testing q5. Stop at 65.
64
Treatment for squamous cell carcinoma of vagina?
Stage I & 2cm: external beam radiation-------------- Stage II, III, IV: external beam radiation + therapy
65
how to treat lichen sclerosis?
punch biopsy to r/o SCC; steroids
66
Thayer Martin media is for what?
culture for gonorrhea
67
how to treat PID as outpatient? inpatient?
Outpt: ceftriaxone, doxy, or metro. / Inpt: IV cefotetan + doxy, or IV cefoxitin + doxy.
68
how to treat granuloma inguinale? How to distinguish it from other ulcerating STDs? what microorganism?
doxycycline. no lymphadenopathy, . From Klebsiella granulomatis.
69
If you have ASCUS on pap, what is next step?/
If 21-24 yrs, repeat pap in 1 year -> if repeat is (+), do colpo. -----------If 25+, do HPV testing->if (+), do colpo.
70
If "atypical squamous cells: cannot exclude high grade SIL" on pap, what is next step?
colposcopy
71
If AGUS(atypical glandular cells of undetermined signficance) on pap, what is next step?
endocervical sampling, colposcopy, & endometrial Bx if >35 or risk factors.
72
If LSIL (low grade squamous intraepi lesions), what is next step?
If 21-24, rpeat pap 1 yr. If 25-29, colpo. If >30, HPV testing --> if (+) colpo, if (=) repeat pap & HPV in 1 yr.
73
If HSIL (high grade squamous epi lesions), what next?
If 21-24, colpo, if (+) LEEP ./. If 25+, LEEP.
74
Cervical cancer -- Tx/
If microscopic invasion, simple hysterectomy + conization. If gross invasion, radical hysterectomy + lymphadenectomy,
75
Tx of epithelial tumors of ovarian cancer?
TAH-BSO, peritoneal washings, lymph node dissection, omentectomy, chemo (this is BAD)
76
Tx of germ cell tumors of ovarian cancer?
U/L salpingo-oopherectomy
77
Breast absess Tx?
oral/IV Abx: diclox, cephalex, amox-clauv acid, TMP-SMX, or metro.
78
multiple, B/L masses in breasts that increase size and pain before menses? Tx?
fibrocystic change. Tx: reduce caffeine/fat, BC pills
79
woman
fibroadenoma. U/S, FNA (mamm not necessary). Tx: excise, cryotherapy
80
If screening mammogram is low suspicion, what is next step? high suspicision, what is next step?
low: repeat mammo in 6 months. / High: biopsy (FNA, core, or open): if nonbloody, observe closely. If bloody, better Bx. If malignant, treat.
81
If palpable mass on breast exam, what is next step? (and steps after)
mammogram. If high suspicion, biopsy./ If low suspicion, U/S-->if solid mass or complex cyst, biopsy. If simple cyst, repeat mammo 6 months.
82
How to treat LCIS?
because ALWAYS ER and PR +
83
When do you add radiation to a MASTectomy?(**you always do lumpectomy with rad for local solitary cancer)
when the breast cancer mass is >5cm
84
a)fundus at pubic symphysis is how many weeks? b) btwn umbilicus and symphysis?c) at umbilicus? d)above?
a) 12 weeks. b) 16 weeks. c) 20 weeks. d)weeks = centimeters from the pubic symphysis
85
when do you do fetal U/S? when do yo give anti-D if RhD(-)?
a) 18-20 wks. b)28 wks, and birth
86
with acute abdomen, besides exp lap why would you have to give FFP?
If patient is chronically on warfarin prior to the accident
87
what defines too much infant crying and what is this?
infantile colic: more than 3hrs a day, more than 3 days a week, more than 3 wks
88
baby with abdominal distention, X-ray showing air in bowel wall (train track/double appearance) and linear branching areas of lucency over the liver showing portal venous air = what disease?
necrotizing enterocolitis (intenstinal air = pneumatosis intestinalis)
89
painless hematochezia in a toddler, most common cause? Dx?
Meckel's diverticulum. Do Tech-99, scan
90
baby with nonbilious vomiting, what test? with bilious vomiting, what next step?
nonbilious: abd U/S to look for pyloric stenosis. ---------- bilious: stop feeds, NG, IV -->abd X-ray [if free air->ex lap. if dilated loops of bowel-> contrast enema (meconium ileus or Hirshsprung). If NG tube in misplaced duodenum, upper GI series (i.e. barium enema)->if ligament of Treitz on right side of abdomen, malrotation. If corkscrew pattern contrast, volvulus. --------if double bubble on XR, duodenal atresia.
91
how to manage DVT in pregnancy?
anticoag with heparin or LMWH (not warfarin), continue until labor or 24 hrs before scheduled delivery, restart hep post-partum and do hep-->war for 6 wks post-partum
92
why are NSAIDs teratogenic?
premature closure of ductus arteriosis
93
nasal hypoplasia, epiphyseal stippling, limb hypoplasia from what teratogenic drug?
warfarin
94
what to you treat syphillis with in penicillin-allergic pt?
desensitize, then STILL give penicillin.
95
When you don't know mother's GBS screening status, when do you give penicillin PPx?
intrapartum fever, prolonged rupture of membranes, or preterm labor
96
how to treat Toxoplasmosis?
spiramycin or pyrimethamine + sulfadiazine
97
Mother with rash of diff ages, baby with skin scarring and limb hypoplasia, think =? Tx?
varicella zoster. Acyclovir.
98
flu-like Sx in mother, baby with abscesses in internal organs, think =?
Listeriosis
99
suspected ectopic pregnancy in stable pt, next step in management? 2nd? 3rd?
1) transvaginal U/S, quantitative hCG. 2) if bHCG >1500, confirms ectopic if you see NOTHING in TVUS. If a)if falls, monitor hCG till 0 (failed preg), b)if it goes up approp aka double, repeat TVUS when bCG>1500. c)if it goes up inapprop, its abnormal pregnancy of some kind: do D&C(no chorionic villi, ectopic. (+) chorionic villi, failed uterine pregnancy).
100
Tx of ectopic pregnancy?
salpingostomy, or salpingectomy. Can use methotrexate if normal renal/LFTs, bHCG
101
what kind of abortion: bleeding, closed cervix, no passage of POC. Tx?
threatened abortion. Expectant management/observation.
102
what kind of abortion: bleeding, open cervix, no passage of POC. Tx?
inevitable abortion. D&C, misoprostol, or expectant management.
103
what kind of abortion: bleeding, open cervix, some passage of POC. Tx?
incomplete abortion. D&C, misoprostol, or expectant management.
104
what kind of abortion: bleeding, closed cervix, passage of POC. Tx?
complete abortion. None.
105
what kind of abortion: no bleeding, closed cervix, NO passage of POC. Tx?
missed abortion. Dead but stuck in there, so D&C, misoprostol, or expectant.
106
how to tell the difference between cervical insufficiency and inevitable abortion? Dx, Tx of cervical insufficiency?
cervical: painless cervical dilation. abortion: painful, cramping (it's labor!) Dx: U/S. Tx: placement of cervical cerclage (tied up to try to prevent preterm birth?
107
intrauterine fetal demise = ? Tx?
"stillbirth" = death after 20 wks (unlike abortion, which is
108
maternal diabetes, mult gestations, and fetal anemia cause poly or oligohydramnios?
polyhydramnios
109
what is needed to diagnose acute pancreatitis?
amylase or lipase (abd CT NOT needed)
110
CF can be diagnosed using what 2 methods?
quantitative pilocarpine iontophoresis or sweat Cl-.
111
nephritis, low complement, and increased LFTs, think what? What other nephritic syndromes have low complement?
mixed cryoglobulinemia associated with hep C..... lupus, post-strep glomerulo, and MPGN also have low complement.
112
how to diagnose Zenker diverticulum?
Barium esophagram. Then do manometry after.
113
besides post-strep GN, what other kidney disease comes after a resp infection, how shortly afterwards, and how else to distinguish with post-strep GN?
IgA nephropathy.
114
what STDs do you screen ALL pregnant women for, regardless of risk factors? what vaccine to always give.
syphilis (RPR), HIV, and hep B. Give flu vaccine.
115
1st and 2nd line treatment for stress incontinence?
1st: Kegels. 2nd: urethropexy (NOT oxybutynin; this is for urge incontinence)
116
what are the 2 peripartum conditions that present with painFUL vaginal bleeding?
uterine rupture(feet also palpable in this one), placental abruption
117
Dx of lichen sclerosis? Tx?
vulvar punch Bx. Topical steroid.
118
If patient is
Tocolysis (CCBs), steroids for fetal lung maturity, and MgSO4 for neuroprotection
119
1st line drug for fibromyalgia? 2nd line?
TCAs (amytriptyline). 2nd: SSRIs inc duloxetine and milnacipran
120
IE: 1st step in management? 2nd?
1st: serial(3+) blood cultures. 2nd: Abx
121
what is micro path of Actinomyces and Nocardia? What is basic presentation of the two diseases?
gram (+) rods. Nocardia = pneumonia in immunocomp; Actinomyces=head/neck abscesses?
122
most common extrapulmonary manifestation of Blastomycosis? Location (regional)?
SKIN: nodular lesions --> microabscesses. In southeast AND upper midwest
123
How to treat a) comedonal acne b)inflammatory acne c) cystic acne?
a) topical retinoids b)topical Abx (erythro, clinda) and if several oral Abx c) topical retinoid and if severe oral Abx; if really several ORAL retinoid
124
1st and 2nd line Tx of herpes zoster? how to treat the ppost-herp neuralgia?
1st: valacyclovir. 2nd: acyclovir. For neuralgia, TCAs
125
Tx of Tourette's?
anitpsychotics (esp haloperidol, pimozide)
126
when does birth weight double? triple? quadruple? / height increase by 50%? double? triple?
W: 4 months, 1 yr, 2 yrs / H: 1 yr, 4 yrs, 13yrs
127
a) what age do babies have social smile, eyes follow to midline, and lifts head 45 degrees? b) what age do they laugh, lift head to 90, eyes can go past midline? c) when does stranger anxiety start?
a) 2 months b) 4 months c) 6 months
128
a) what age do babies grasp with thumbs? b) separation anxiety? c) make 2 block tower?
a) 9 months b) 9 months c) 12 months
129
a) what age do babies dress themselves? b) make 6 block tower? c) draw a circle?
a) 2 years b) 2 yrs c) 3 years
130
a) at what age do babies attempt to feed themselves? b) crawling + pulling selves up to stand? c) play with others, hop on 1 foot?
a) 6 months b) 9 months c) 4 yrs
131
at what age do babies a) parallel play b) pick things up(pincer grasp)? c) use cup and spoon? d) skip, draw stick figure?
a) 18 months b) 12 months c) 18 months d) 6 years
132
a) when to intro solid foods and what kind? b) when cow's milk?(if not what happens?)
a) 4-6 mo, iron fortified cereal. b) 12 months, if not hemorrhage/iron def anemia
133
when do you F/U visits with babies?(first 6 visits are when)
2 days, 2 weeks, 1 month, 2 months, 4 months, 6 months (then q3months till age 2)
134
a) How many DTaP vaccines do you give a child? b) Hib c) PCV(pneumo)?
a) 5 b) 5 c)4
135
a) what vaccine do you give at birth? b) Tdap? c)Meningococcal (MCV4)? d) when do you start flu vaccines?
a) hep B b) 11-12 yrs c)11-12 yrs with booster at 16 d) 6 months
136
what do you use to Tx cerebral palsy to alleviate contracture?
dantrolene, baclofen, benzos, Botox. / Phys therapy, Sx, braces too.
137
What is first step in management of baby with single umbilical artery?
renal U/S
138
diff btwn caput succedanium and cephalohematoma?
caput: crosses suture lines, resolves in days. Cephalohematoma: blood, does not cross suture lines, resolves in weeks-months, can be caused by vacuum delivery.
139
SKIN ISSUES IN NEWBORNS(benign, no Tx needed, go away on own) - what is: a) cutus marmorata b) erythema toxicum neonatorum c) harlequin color change
a) spiderwebbing/red marbling of skin b) 2-3mm yellow pustule with red base (looks like pimples) arising in 1st 1-3 days, micro: eosinophils. c)intense redding of gravity-dep side, blanching of nondep side
140
SKIN ISSUES IN NEWBORNS: a) macular stains/Stork bities b) milia c) acne neonatorum? d) infantile acne?
a) red marks on back of neck and upper eyelids/mid forehead; benign but permanent b) sweat obstructed by keratin -- give loose clothing, cool baths c) at 3 wks, till few months. can Tx with retinoids/benzoyl per. d)at 3-4 mo, clear by age 1-3. same Tx as above.
141
a) if anterior fontanelle closes early' b) if it closes late, what are possible etiologies?
a) craniosynostosis. b) Down, achondroplasia, rickets, hypothyroidism, increased ICP
142
painless bleeding late in pregnancy, woman with prior C-section -- what is this? Dx? Tx?
Placenta previa. Dx: U/S. Tx: C-section
143
what are 4 meds for tocolysis (labor suppressants)?
MgSO4, indomethacin, nifedepine, and terbutaline
144
How to treat choriocarcinoma?
chemo (methotrexate), surgical resection, follow hCG levels till they fall again, and avoid pregnancy for at least 1 year
145
How long should latent phase last in nulliparous woman? In multiparous woman? how many cm/hr does cervix dilate in active phase for nulliparous? for multiparous? 2nd stage -- length for nulli? multip?
Latent, nulli: 20 hrs. multi: 14 hrs. Active, nulli: 1.2 cm/hr. multi: 1.5 cm/hr. 2nd stage, nulli: 4 hrs. multi: 3 hrs.
146
How to manage atonic uterus?
fundal/bimanual massage. Uterotonic agent: oxytocin, methylergonovine (except in HTN), carboprost (except in asthma).
147
Treatment for measles?
IVF, antipyretics, Vitamin A
148
fever, anorexia, and malaise for a few days then suboccipital/posterior cervical lymphadenopathy and rash = ?
rubella (German measles)
149
cervical lymphadenopathy, coarse red rash that blanches, starts in trunk then spreads everywhere but palms and soles; most prominent in axilla and groin, red tongue and pharynx - ?
scarlet fever from Strep pyogenes
150
if acute B/L cervical lymphadenopathy in a child, what is this? If acute and U/L, what is this? chronic and U/L?
B/L: prob viral i.e URIs, mono, HSV
U/L, acute: prob bacterial (S aureus, group A Strep, etc). U/L, chronic: Bartonella, Toxoplasmosis, TB, Actinomyces (sinuses drain pus)
151
What vitamin deficiency shows increased RBC fragility
vitamin E
152
diff between branchial cleft cyst vs thyroglossal duct cyst?
branchial: lateral neck, doesn't move with swallowing / thyroglossal: midline neck, moves with swallowing.
153
red lips, blue fingertips but normal pulse ox --> what is this?
CO poisoning (b/c Hgb is saturated, it's just saturated with CO)
154
what kind of anemia (micro, normo, macro) are the following? a) anemia of chronic disease b) thalassemia c) liver disease d) alcoholism e) lead poisoning f) hemolytic g) sideroblastic
a) normo OR micro b) micro c) macro d) macro e) micro f) normo g) micro
155
Coombs test - what does it do? a) direct? c) indirect?
determines if a hemolytic anemia is caused by autoimmune -- if so, they'll agglutinate. a) reagent mixed with RBCs, if agluttinates it means RBCs are coated with IgG & complement. c) type O RBCs mixed with plasma/serum, then with reagent --> shows anti-RBCs Ab's in serum (i.e for Rh- mother)
156
Disease with cold agglutinins? warm?
Cold: Mycoplasma, EBV. / Warm:
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Drug induced hemolytic anemia - what will you see on smear, Coombs? what drugs?
(+) Coombs test, Burr cells, spherocytes, schistocytes. Penicillin, methyl-dopa, quinidine/quinine, NSAIDs, cephalosporins.
158
Immune hemolytic anemia -- what you see on smear, Coombs? Tx?
anti-RBCs Ab's. (+) Coombs test, Burr cells, spherocytes, schistocytes. Tx: steroids, maybe splenectomy.
159
jaundice, gallstones, splenomegaly, anemia with increased reticulocytes, increased MCHC, poss increased K, smear: schistocytes, positive osmotic fragility test - what disease? Tx?
hereditary spherocytosis (defective RBC membrane). Tx: folic acid, RBC transfusions, splenectomy.
160
bite cells and Heinz bodies -- in what Dz? Tx?
G6PD deficiency. Tx: avoid oxidants; sometimes transfusions.
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In hemolytic anemia, what is the level of a) LDH b) haptoglobin c) MCV?
a) increased b) decreased c) normal
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How to treat a) Salmonella/Shigella? b) Camplylobacter?
a) fluoroquinolone or TMP-SMX b) erythromycin
163
what anemia will have a) low MCV, normal or increased iron, normal ferritin, normal TIBC? b) low MCV, increased iron, increased ferritin, decreased TIBC? c) decreased iron, increased ferritin, decreased TIBC?
a) lead poisoning b) sideroblastic anemia (b/c it's a problem manufacturing heme but you overproduce iron) c) anemia of chronic disease
164
basophilic stippling (denatured RNA granules on RBCs) on smear in what diseases?
lead poisoning, thalassemia, alcohol use
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lead chelators for poisoning?
EDTA, succimer. In kids if severe, add dimercaptol.
166
how to treat pertussis?
azithromycin, erythro, or clarithro (macrolide), PPx for all close contacts, hospital if seizures, resp distress, cyanosis, apnea, pneumonia with it.
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young child diagnosed with UTI -- what other workup is needed/
renal/bladder U/S; voiding cysturethrogram if >2 febrile UTIs or Hx urologic disease/HTN/poor growth
168
child who can't follow moving target with eyes well, falls over, spots on face after age 5, gets sinus/lung infections =? What lab finding for Dx?
Ataxia-Telangiectasia (IgA and T cell deficiency). Lab: increased AFP after 8 months of ago. [[[[[[acronym: ATAXIA: Ataxia, Telangiectasia, Acute leukemia/lymphoma(10% of pts), X-ray sensitivity, IgA deficiency, AFP]]]]]]]
169
boy with S aureus and Aspergillus infections, what is this? Dx? tx?
CGD. Dx: negative nitroblue tetrazolium test. Tx: PPx TMP-SMX and itraconazole; IFN-gamma
170
tricuspid regurg & widely split S2 in child born to psych patient, think what? what might be on EKG?
Ebstein's anomaly (from lithium). EKG: SVT or WPW b/c of dilated RA
171
metabolic syndrome in child with lactic acidosis, hyperlipidemia, hepatomegaly, increased glycogen, severe fasting hypoglycemia, enlarged kidneys, hyperuricemia?
Type I (Von Gierke)
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metabolic syndrome in child with hepatomegaly, hypoglycemia, hyperlipidemia, but normal kidneys, lactate, and acid, think=?
Type III (Cori)
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where do you see spur cells (acanthocytes)?
abetalipoproteinemia
174
anemia with low MCV, mental status changes, neuropathy, and constipation, think =?
lead poisoning
175
a) HbH = ? b) Hemoglobin barts =?
a) alpha thalassemia with 3 alleles defective. Bind O2 too tightly, O2 dissociation curve all the way to left. microcytosis, hemolysis. b) all 4 messed up - erythroblastosis fetalis.
176
a)beta thal minor = ? b) beta thal major = ? c) main thing you see on smear with thalassemia?
a) decreased beta-globin, increased HbA2(alpha globin + delta globin) --------b) no beta-globins, so HbA2 + HbF (alpha + gamma globin)----------c)target cells
177
in patient with microcytic anemia, what must you check before giving iron supplements?
r/o thalassemia. B/c otherwise you can cause iron overload. Confirm iron def with iron studies! if iron comes back normal, they may have thalassemia, so next step = Hgb electrophoresis
178
what PPx + vaccines do sickle cell kids need?
Pneumococcal, Hib, Meningococcal, Hep B, and annual flu. PPx penicillin till age 5.
