UWorld Self Assessment 4/4

P - Kernig sign

meningeal irritation

P - roseola infantum**

HHV6 > 7 s/s - *febrile seizures*; fevers last 3-5d; skin eruption as fever subsides; rose colored macules and papules begin on neck and trunk and spread to face and extremities ---- vs - measles - paramyxovirus - erythematous macules/papules on face that spread down to rest of body; cough, coryza, conjunctivitis; koplick spots

O - Bartholin gland abscess

I&D

P - HSP

-bx of lesions > leukocytoclastic vasculitis (postcapillary venules w/ extensive IgA deposition) recent URI; nonblanching skin rash on b/l LEs (purpura) and Buttocks; --- vs - polyarteritis nodosa bx > necrotizing vasculitis

M - Beta-blockers in CHF

-digoxin, loop diuretics help w/ symptom conrol in pts w/ CHF; -ACE inhibitors, aldo antags, and Bblockers > decrease mortality ---- vs -clonidine = alpha blocker for tx of HTN not chf -amiodarone =ventricular arrythmas in pt w/ chf -chlorthalidone = thiazide help if loop is not enough in chf -nifedipine - CI in CHF'; will make it worse

M - Amenorrhea**

1st step check TSH, T4 - hypothyroid can present with ___; and even galactorrhea; wt gain --- CT head not helpful in assessing pituitary ---- ovarian failure > high FSH/LH ratio + hot flashes PCOS - hirsutism, acne, obesity

Ps - Efavirenz**

AE - "weird, colorful dreams" NNRTI ----- lamivudine ae = hepatotoxicity abacavir ae = lactic acidosis; hepatitis; hypersensitivity rxn didanosine ae = pancreatitis TMP-SMX ae = gi upset, steven johnson syndrome; neutropenia, allergic rxns

M - Torsades**

Clue = QT prolongation tx = magnesium sulfate; if that doesnt work > temporary pacemaker and/or IV isoproterenol ---- vs - procainamide > will prolong QT, avoid vs - lidocaine > tx of ventricular arrhythmias other than torsades vs - adenosine - tx of SVT vs - digoxin - tx of afib or heart failure vs - verapamil - tx of SVT vs - propafenone - will prolong QT, avoid

M - Monocular vision loss

MS - demyelinating dz of CNS > transient neuro changes YOUNG ADULTS; > demyelination, inflammation of optic nerve > OPTIC NEURITIS; heat exacerbates symptoms ---- vs -vascular spasm - prolonged uncontrolled HTN > transiet blindness due to retinal ischemia

S - Splenectomy**

Most likely cause of thrombocytosis is prior surgery....particularly ___ bc the spleens role is to remove old platelets from the circulation =scenario - blunt trauma > MC injury is spleen -howell jolly bodies = nuclear fragments that can't be removed since spleen is gone

M - Headaches

SAH -severe headache, sudden onset; worst HA of my life; abrupt, sudden; r/o SAH > dx = noncontrast CT head > if negative and still think SAH > do lumbar puncture ----- vs - triptan tx for migraine carbamazepine tx for trigeminal neuralgia

Ps - Alcoholic liver disease**

alcohol withdrawal - evidenced by SNS overactivity = tachy, HTN, dilated pupils, tremor; all after 1 day of being in hospital w/o access to alcohol; AMS> tx = benzos ----- vs cirrhosis > hepatic encephalopathy > clues: low albumin, elevated INR & Bili

O - Mgmt of preterm labor**

all women btw 24-34wks > give corticosteroids *betamethasone injection* > to enhance fetal lung maturity; effect peaks at 48h after administration ----- vs - cervical cerclage - if advanced cervical dilation in absence of labor and abrubtion; CI if in labor vs - pelvic rest, bed rest, hydration - don't do anything

M - Monocular vision loss

amaurosis fugaz = retinal artery emboli =sudden transient monocular blindness; last minutes; retinal ischemia from Carotid artery emboli = MCC; exam w/ carotid bruit supports dx ---- vs -postictal vision loss - s/p occipital lobe szs; preceding visual aura w/ flashes of light and color -acute angle closure glaucoma - red painful eye, blurred vision, nausea -choroidal inflammation (posterior uveitis) - retinal detachment > permanent vision loss > s/s red eye; photophobia, pain -temporal arteritis - monocular vision loss can be permanent STEROID ASAP; other giant cell s/s

Ps - Cocaine abuse**

best tx = psychotherapy w/ individual and group (NA) therapies -clue that psychotic pt is not shizo pt; nice clothes; SNS s/s ex dilated pupils; HTN; tachycardia

S - Widened mediastinum

blunt chest trauma > widened mediastinum > next step = TEE (ER in unstable pt) or CT scan (in stable pt); -exploratory thoractomoy in acutely unstable pt w/ shock

P - Cystic fibrosis**

child; multiple episodes of pneumonia; chronic diarrhea tx w/ PANCRELIPASE > dz of pancreas and respiratory tract -thick viscous secretions > obstruct pancreas > insuff > malabsorption > steatorrhea >impaired clearance in resp tract > inc bacterial infections; obstructive airway dz; bronchiectasis; recurrent pneumonia > wheezing; prolonged expiration *-MC org = pseudomonas aeruginosa* ---- vs - asthma MC org - viral, allergens

M - Triptans**

coadministration of triptan and ergotamines may result in prolonged vasospasm due to overactivation of 5HT receptors; thus triptans should not be given for at least 24h after ergotamine is given ---- vs these can be safely combined w/ triptans: -metoclopramide; promethazine; meperidine; diclofenac

O - endometriosis

common cause of infertility and cyclic pelvic pain s/s - pain or nodularity of rectovaginal septum ; fixation of uterus in a retroverted position dx -laparoscopy; pelvic US can help -who - young pt ----- vs - leiomyoma - pain does not follow menstrual cycle; no rectovaginal nodule vs - old pt > ovarian cancer w/ same description

M - Central cyanosis

cyanosis in lips/ mucous membranes; warm extremities + tachypnea & diaphoresis while breastfeeding = congenital heart dz! -MCC - low arterial oxygen saturation ---- vs - periphral cyanosis - in distal extremities only; MCC increased 02 extraction 2/2 sluggish bld flow; cool clammy extremities vs - sickle cell dz - s/s dont start until later in life (not while breastfeeding) due to protective effects of fetal hemoglobin (HbF)

O - oral contraceptives

decreased risk of ovarian and endometrial cancer increased risk of breast and cervical cancer; HTN, venous thombosis

M - Rhadomyolysis

dipstick + blood ; no RBCs; common after seizures

O - Placenta previa

dx - transabdominal US > blood near cervical os s/s painless bleeding **neither bimanual nor speculum vaginal exam until PP is excluded --- vs - placental abruption - painful bleeding > retroplacental clot

M - PE chest pain**

dyspnea; tachypnea, hypoxemia; CP -substernal or *pleuritic*; cough and HEMOPTYSIS; s/s of dvt -common scenario - bus/truck driver ----- focal pleuritic CP w/ hemoptysis is consistent w/ peripheral emboli that cause pulm infarction > release of mediators cause by hypoxia & infarction > bronchoconstriction > wheezing ---- vs - acute pericarditis > no hypoxia; + friction rub on Physical exam

M - Cubital tunnel syndrome

elbow; ulnar nerve distribution; lateral ring finger and pinky; weakened grip; medial forearm; weak hand -------- -compression location: epicondylar groove, cubital tunnel, guyons canal at the wrist -risk inc w/ repeat bend on elbow (frequent lifting > cubital tunnel); repeated leaning on elbow (epicondylar groove) tx- avoid activities that provoke s/s; steroid injections; surgical decompression

M - HIT**

elevated PTT - sign heparin was recently used; collaborated by h/o recent surgery; and signs of PE txed with heparin -stop heparin > start argatroban

M - Urge incontinence

frequent voluntary voiding; voiding schedule (aka overactive bladder) ; 2nd step > anti-musc (antiPS > dont pee) -pelvic floor exercises -alpha antagonists useful in men w/ BPH w/urge incontinence not in women

M - Carpal tunnel syndrome**

in pregancy - volume overload > accumulation of fluid in CT in hypOthyroid- accumulation of matrix substances in CT in amyloidosis - amyloid fibril depoits in CT; MC in setting of ESRD or chronic hemodialysis due to B2microglobulin deposits in RA - tenosynovial inflammation in acromegaly - synovial tendon hyperplasia

S - Postop infxn**

indurated central venous catheter insertion site + gram positive bactermia = catheter assoc blood stream infection; MCC = coag negative staphylococci ---- vs -post op pneumonia - new or worsening hypoxia, cough, sputum production, new infiltrate on CXR vs - atelectasis - seen in post op fever; but not the cause of the fever

O - Chlamydia infxn

infertility if untreated 2/2 PID -friable cervix w/ yellow discharge; intracellular > not seen by microscopy w/ gram stain; but will see many neutrophils tx - azithromycin or doxycycline

S - Cataract

lens opacification > worse driving at night > avoid bright lights > "glare" -inc risk in DM; and excessive sunlight exposure tx - surgery to replace the lens

S - AAA**

only s/s given: hypotensive; tachycardic; dizzy; weak; back pain; bruit over carotid a.; h/o coronary bypass -pain from ruptured ___ > referred to the back -affected pts have atherosclerosis of other vessels such as coronary and carotids -most are asymptomatic

M - Hypertriglyceridemia**

palmar xanthomas = primary hypertriglyceridemia - tx = fenofibrate; gemfibrozil; and fibric acid derivative

O - Preterm labor**

preterm = 20-37wks gestation; labor = regular painful uterine contractions, bloody vaginal d/c, effaced/dilated cervix -B-agonists like terbutaline, ritodrine > dec myometral contraction and delay labor AE of B1 agonists > tachycardia, inc stroke volume AE of B2 agonists > vasodilation, bronchodilation > palpitations, chest discomfort; tremor; SOB >>>severe= *tachypnea, hypoxia, crackles = pulmonary edema* (tachycardia > dec diastolic filling time + excess volume of pregnancy > pulmonary venous congestion >> pulmonary edema)

Ps - Opiod overdose

respiratory acidosis due to respiratory depression -pinpoint pupils;

M - Hyperthyroidism

sclera seen above iris on downward gaze = proptosis s/s same as pheo but not episodic = wt loss; HTN, palpitations; diaphoresis ---- extra-adrenal pheos > adjacent to aorta > in organ of zuckerlandl

M - Diabetic nephropathy

slow progression to diabetic nephropathy by BLOOD PRESSURE CONTROL!!! < 130/80; -particularly w/ ACEi or ARBs

M - CLL

smudge cells; LAD; lymphocytosis 90%; elderly; ---- vs -hypersegemnted neutorphils > B12 def / folate def - aur rods > AML - heinz bodies > G6PD def -teardrop - Myelofibrosis; bone marrow; metastatic cancer

M - Hereditary spherocystosis

spherocytes > inc risk of gallstones tx - blood transfusions, folic acid supplementation ---- vs -burr cells - echinocytes - renal dz

M - Torsades**

sudden onset syncome *w/o a prodrome* = ARRHYTHMIA MCC - torsades de pointes; polymorphic vtach -h/o sotalol use; CAD; electrolyte disturbances from diarrhea all predispose to torsades; hypokalemia, hypomagnesemia from diarrhea > "tip the point" > torsades ---- vs - vertebrobasilar insufficiency > assoc w/ neuro manifestations

P - Kawasaki

tx - IVIG and ASA to dec risk of coronary artery aneurysms ---- vs -Rocky mountin spotted fever tx = doxycycline

M - Raynaud phenomenon**

tx - calcium channel blocker = nifedipine -will block the cold induced vasospasm of the fingers

M - OA

tx - wt loss, exercise; NSAIDs or acetaminophen 2nd line - intraarticular injections; antimalarials

M - Hypercalcemia

~> 14 = malignancy MCC squamous lung cancer; PTHrP; s/s - volume depletion 2/2 natriuresis > 1st step IV NS bolus