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Mock Board 2/13 (UWorld + Kaplan)

Terms in this set (48)

Organophosphate Poisoning
-Cholinergic Excess: bradycardia, miosis, bronchorrhea, muscle fasciculations, salivation, lacrimation, diarrhea, urination
Tx: 1) Remove clothing
2) Atropine!
Antipsychotic medication MOA
Dopamine D2 receptor blockade
UTI Antibiotics in Pregnancy
Diabetic neuropathy
-alterations in sensation, including loss of proprioception
-motor findings are a late manifestation
-usually lower motor neuron process
Biliary Atresia
Initially well appearing baby with development of(over 1-8wks): jaundice, acholic stools or dark urine, hepatomegaly, conjugated hyperbilirubinemia, mild elevation in LFTs
Dx: US w/ absent or abnl gallbladder, hepatobiliary scintigraphy, liver biopsy(expanding portal tracts w/ bile duct obstruction), intraoperative cholangiogram is GOLD STANDARD
Tx: Kasai procedure (hepatoportoenterostomy) or liver transplant
Precocious Puberty
-development of secondary sex characteristics <8 yo girls, <9yo boys
-accelerated bone growth and advanced bone age are commonly seen
Two catergories:
1) Central= result of early activation of the hypothalamic pituitary ovarian (HPO) axis (high FSH/LH)
2) Peripheral= gonadal or adrenal release of excess sex hormones (FSH/LH low)
Raising the cut off point of a test will do what to sensitivity? specificity?
i.e. increased CAGE question cut off from 2 to 3
Sensitivity will DECREASE!
Specificity will INCREASE!
(False and true positives will decrease; false and true negatives will increase)
Blunt Abdominal Trauma
-most frequently caused by mva
-most common solid organs injured: liver and spleen
S/Sxs: hypotension, tachycardia, chest and abdominal wall ecchymoses, tender abdomen
Intracerebral Hemorrhage Stroke
-Hx of uncontrolled HTN, coagulopathy, illicit drug usee
-Sxs progress over minutes to hours
-focal neuro sxs appear early, followed by features of increased ICP
Lacunar Stroke
-seen in HTN patients
-present with severe focal sxs depending on affected area
-small infarcts, do not cause rapidly worsening global neuro sxs like intracerebral hemorrhage stroke
DDX of Marfanoid body habitus
Most Common Cause of Megaloblastic Anemia in Chronic Alcoholics
Folate Deficiency!
*Thiamine deficiency= associated w/ Wernicke's encephalopathy
Intracranial Hypertension (ICH)
S/Sxs: HA (worse at night), N/V, mental status changes, focal neuro sxs, seizure, papilledema, Cushing reflex
*Sinusitis= frontal HA that worsens w/ leaning forward but assoc w/ nasal congestion, purulent discharge but not blurred vision and falls
Wallenburg Syndrome
Immunologic Blood Transfusion Reactions
Clozapine Treatment Guidelines
Indications:
1) Treatment resistant schizophrenia
2) Schizophrenia associated w/ suicidality
Adverse effects:
-Agranulocytosis
-Seizures
-Myocarditis
-Metabolic syndrome
Rubella
Congenital Disease:
-sensorineural hearing loss
-intellectual disability
-cardiac anomalies
-cataracts, glaucoma
*also can have conjunctivitis
Dx: PCR, acute & convalescent serology for anti rubella IgM & IgG
PPx: live attenuated Rubella vaccine
Tx: Supportive care
Fetal and Neonatal Complications from Maternal Diabetes Mellitus
Reentrant Ventricular Arrhythmias (ie V fib)
Most common cause of sudden cardiac arrest in the immediate post infarction period in patients w/ acute MI
Primary Renal Causes of Nephrotic Syndrome
Disorders of Sexual Development
Medications to Withhold Prior to Cardiac Stress Testing
Hold for 48hrs: Bblockers, CCBs, nitrates
Hold for 48hrs prior to vasodilator stress test: Dipyridamole
Hold for 12 hrs prior to vasodilator stress test: caffeine containing food or drinks
Continue: ACEI, ARBs, Digoxin, Statins, Diuretics
Transtentorial Herniation
Cryptococcal Meningoencephalitis
-subacute invasive fungal infection, Cryptococcus neoformans
-seen in IC patients, especially those with advanced HIV disease CD4<100
S/Sxs: fever, lethargy, HA, AMS
LP: elevated opening pressure, low WBC <50, low glucose, elevated protein
Tx: IV Amphotericin B and flucytosine, followed by fluconazole and maintenance therapy
Primary Humoral Deficiencies
Disseminated Gonococcal Infection
-fever, knee pain, WBC >50k= septic arthritis (mcc= Neisseria gonorrhoeae)
-asymmetric polyarthralgias (often assoc w/ tenosynovitis and skin rash)
Effect of Arterial Oxygenation & Ventilation in Various Environments
Viridans Group Streptococci in Infective Endocarditis
Tx: 1) Empiric Vancomycin- to cover staphylococci, streptococci, and enterococci after obtaining blood cx
2) Most viridans group streptococci susceptible to penicillin, so treat with IV PCN G or IV Ceftriaxone(favored since once/day injection) for 4 weeks post discharge
Cervical Actinomycosis
RF: dental caries, extractions, infected tooth, gingivitis/gingival trauma, DM, immunosuppresion, malnutrition, local tissue damage 2/2 malignancy or irradiation
-anaerobic, gram positive, filamentous branching bacteria
-slowly growing, nontender, indurated mass that can form abscesses/fistulas; yellow granular pus "sulfur granules"
Tx: high dose penicillin for approx 12wks
Treatment of Acne
Duodenal Hematoma
Most commonly occurs in children following blunt abdominal trauma
Treatment= conservatively w/ nasogastric suction and parenteral nutrition
Evaluation of Hemoptysis
Complications of Shoulder Dystocia
Klumpke palsy
-due to excessive traxtion of the 8th cervical and 1st thoracic nerves
S/Sx: "claw hand" (extended wrist, hyperextended metacarpophalangeal joints, flexed interphalangeal joints, absent grasp reflex), horner syndrome
HOCM
AUTOSOMAL DOMINANT
-mutations in sarcomere genes; most commonly in the cardiac myosin binding protein C gene and cardiac beta myosin heavy chain gene
Cephalohematoma
-Subperiosteal hemorrhage, limited to the surface of ONE cranial bone
-No discoloration of the overlying scalp
*Caput succedaneum= diffuse, ecchymotic swelling of the scalp, may extend across the MIDLINE and ACROSS suture lines
Excisional Biopsy w/ narrow margins
preferred study for the diagnosis of melanoma (excise with a 1cm margin once for therapeutic purposes or if depth of the lesion <1mm)
Placental Abruption
-most common risk factor: maternal HTN, cocaine or tobacco use, trauma, excessive uterine distention, previous abruption
S/Sxs: abdominal/uterine pain w/ or w/o vaginal bleeding, increased uterine tone=firm uterus
pH and PaCO2
Provide best picture of acid base status
Pulmonary Nocardiosis Tx
Tx with Bactrim
* when brain involved, use Carbapenems for better coverage
*Aztreonam is a monobactam abx used to treat gram negative bacterial infecctions (ie Pseudomonas aeruginosa)
Chronic Hypercapnic Respiratory Failure
Causes: chronic COPD, obesity hypoventilation syndrome, neuromuscular disease
1) Gradual increases in the pC02 that results in respiratory acidosis
2) Compensation= kidneys increase bicarb retention
Evaluation of Subacute (3-8 wks) or Chronic (>8wks) Cough
Gaucher Disease
-deficiency of the enzyme glucocerebrosidase (accumulation of glucocerebrosides within lysosomes of histiocytes)
-most common in Ashekenazi Jews
*Common adult variant type I affects bone marrow, liver, spleen
Tx: Imiglucerase (enzyme replacement therapy)
Patient presents with s/sxs of acute pulmonary edema not responding to furosemide, nitrates, and morphine?
Treat w/ Dobutamine next!
*Dobutamine= positive ionotrope, decreases afterload, and increases cardiac output
Tetanus Prophylaxis
Treatment of dysmotility in the small bowel (ie Scleroderma)?
-leads to dilation and bacterial overgrowth which in turn leads to malabsorption and diarrhea (treat with appropriate antibiotics)
Hypersensitivities
Type I= anaphylaxis, IgE mediated, mast cell degranulation (NSAIDs, contrast)
Type II= cytotoxic, complement+ab complexes (ie drug induced hemolytic anemia,thrombocytopenia)
Type III= immune Ag-Ab complex mediated (serum sickness, RA, glomerulonephritis)
Type IV= cell mediated, cytokines>macrophages (contact dermatitis)
Bullous pemphigoid
-autoimmune (autoantibodies against hemidesmosomal proteins) blistering disorder, affects elderly
- urticarial plaques and tense blisters
Dx: biopsy showing immunofluorescent antibodies at dermo epidermal junction
*Pemphigus vulgaris= IgG autoantibodies against desmogleins (desmosomes at epidermal surface), + nikolsky sign, painful NOT pruritic
Symptoms of acute brain stem infarction best evaluated with?
Angiography of cerebral vessels
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