UWORLD 30-45
Alcoholic w/d sz occur when?
12-48 hours after last drink
Alcoholic hallucinoses presents
12-48 hours after last drink and is associated with visual, auditory, or tactile hallucinations
Workup for bilious emesis in the neonate...
1: stop feeds, NG decompression, IV fluids 2: abdominal XR 3a: double bubble - Duodenal Atresia 3b: NG in misplaced duodenum - UGI series - ligament of trietz malpositioned and corckscrew patter --> Midguc volvulus/malrotation 3c: dilated loops of bowel--> microcolon or hirschpung dz
Factorial design
2 or more experimental interventions, each with 2 or more variables that are studied independently
When do you administer rhogam during pregnancy?
28 weeks
Delirium tremens presents....
48-96 hours after last drink
Developmental milestones
4823
Metabolic alkalosis
4866
First Trimester combined test: cffDNA: CVS sampling: Second trimester quad screen: Amniocentesis: Second trimester ultrasound:
9-13 weeks; not diagnostic >10 weeks; high S/S for aneuploidy; not diagnostic - if abnormal follow up with CVS 10-13 weeks: definitive karyotype diagnosis 15-22 weeks: NTD, aneuploidy but not diagnostic 15-20 weeks: definitive karyotype; 18-20 weeks: fetal growth, anatomy, placenta position
In the setting of suspected congenital diaphragmatic hernia with associated respiratory distress, what should be the first steps of actions?
ABCs - secure the airway with *endotracheal intubation* and NOT BVM or blow-by (risk of GI distension and further problems with lung function) Place NG or OG tube to decompress the GI tract CXR to look for proper placement of tubes
Quad Screen components
AFP, estriol, Bhcg, inihibin In down syndrome, estriol, afp are DOWN
You suspect a patient has SLE (DOPAMINERASH). What laboratory tests do you want to order?
ANA is the first order test. It is CHEAP and has a much higher SENSITIVITY than Anti-dsDNA or Anti-smith which are somtimes even negative in the setting os systemic disease
Milk-alkali syndrome
Abdominal pain, constpation, polydipsia 2/2 high calcium levels Renal vasocontriction leads to low glomeular filtreation but also inhibition of NaKCL channel and IMPAIRED ADH secretion leading to loss of sodium and free water leading to hypovolemia and increased reabsorption of bicarbonate
What are the main substrates for gluconeogenesis?
Alanine (muscle) -->pyruvate Lactate --> pyruvate (anaerobic metabolism) Glycerol-3-phosphate --> glucose (adipose tissue)
What is the most common adolescent/adult-onset muscular dystrophy?
Autosomal dominant - Myotonic Muscular Dystrophy Type 1 Myotonia (delayed muscle relaxation) is noticable in the inability to release a handshake Weakness of facial muscles, forearms, hands, ankle dorsiflexors, *dysphagia*, testicular atrophy, frontal baldness
Hookworm infection
Barefoot on beach. Causes cutaneous larva migrans The worm will travel within the epidermis becasue it has teouble breaking through the dermis Rx: ivermectin
Farmer in upper midwest down to Mississippi river valley with cough and violacious skin nodules, some with central abscesses.
Blastomycosis; most commonly caused PULMONARY disease but can spread HEMATOGENOUSLY to the skin, bone, prostate. Rx: ITRAconazole
Fluid in the pericardium can cause tamponade and resultant pericardial tamponade. What other conditions can result in pulsus paradoxus?
COPD/Asthma because these conditions can result in large drops in intrathoracic pressure on inspiration leading to pulmonary vasculature pooling and reduced LV filling and therefore low LVEDV.
What imaging technique should be implemented urgently in the setting of possible ischmeic colitis?
CT with IV contrast
Chikungunya fever
Caribbean Fever, malaise, LAD, *Polyarthralgias*, *lyphopenia, thrombocytopenia* POssibility that person will have persistent arthralgias requiring MTX
In what circumstance is an odds ratio a good approximation for the relative risk of a study?
Case-control studies cannot measure RR because they do not follow patient over time or measure disease incidence. Instead, they use odds ratios, a measure of association that compares the odds of exposure among individuals with the disease and those without the disease. In the situation where the disease is rare (low prevalence), diseasr incidence is typically low and the OR geneerally approximates the RR *Rare disease assumption*
What is the inheritance pattern of the muscular dystrophies?
Duchenne: X-recessive Becker: X-recessive *Myotonic*: autosomal dominant
MCC bloody diarrhea in the ABSCENCE of fever...
EHEC
MCC bloody diarrhea...
EHEC, shigella, campylobacter
Social Anxiety disorder
Fear of negative evaluation in social and performance situations. There is a performace-only subtype which can be confused with specific phobia but it is better characterised by SAD due the the reliance on the negative evaluation of others opinions which causes the anxiety
What is CP and What is the greatest risk factor for CP? What is a risk factor you used to think was important but actually isnt?
Group of clinical syndromes characterized by non-progerssive motor dysfunction. premature birth <32 weeks acute intrapartum hypoxia Spastic diplegia is the most common seen in premature infants
what is the diagnostic tet of choice for acromegaly?
IGF-1 followed by oral gtt
Pemphigus Vulgaris
IgG + C3 depositis to desmoglein (intraepidermal) Flaccid Bullae w/ (+) Nikolsky Rx: High-potency steroids + immunomodualtors (azathioprine, mycophenalate, rituximab)
Bullous pemphigoid
IgG + C3 deposits along BM against hemi-desmosomes Tense bullae w/ (-) Nikolsky Rx: *TOPICAL* high-potency steroids
How does PML differ from HIV dementia?
In PML there is usually altered mental status, motor deficits, ataxia, and vision abnormalities. Imaging will show *focal, asymmetric* lesions. In HIV-dementia there are changes in multiple COGNITIVE domains such as memory, attention, calculation, executive function, as well as changes in personality. Imaging will show *diffuse* increase in intensity of white matter. CD4<200.
What is one thing to remember with ABO incompatability of the newborn regarding severity?
It usually causes a mild hemolytic anemia; must monitor for severe anemia and hyperbilirubinemia
When do you need to further investigate a lung nodule?
Lung nodules<0.6 cm are unlikely to be malignant. >0.8 cm w/ concerning features such as irregular borders, history of smoking or family history of lung cancer, age, sex need to be biopsied or have surgical excision If biopsy is inconclusive, a PET scan can be done in order to look for increased metabolic activy
Erythematous papules or plaques coalescing to form large, painful, inflammatory bkister and crusting with central clearing
Necrolytic migratory erythma
What is the drug and who recieves RSV prophylaxis?
Palivizumab; <2 years of age Preterm <29 weeks gestation Chronic lung disease of prematurity Hemodynamically significant congenital heart diease
Which treatment option for Grave's disease can cause worsening of the opthalmopathy
RAI; afterwards you can see a large bump in the number of thyrotropin-receptor antibodies
Review PAI
Review primary adrenal insufficiency
Dizzy and ataxic patient with upper extremity pain and weakness during exercise.
Subclavian steal syndrome; stenosis or narrowing of the subclavian artery just proximal to the vertebral artery leading to upper extremity claudication and vertebrobasilar insufficiency in patients with concurrent atherosclerosis of the circle of willis.
Which patients with concern for UTI shoul dhave culture beforehand?
Those considered to be complicated: diabetes, pregancy, CKD, indwelling catheter, hospital acquired, urinary tract obstruction, immunocompromised
In a pregnant mother with hyperthyroidism what side effect do you need to watch out for?
Trick question - the baby will be find; mom will experiecne bone loss if untreated 2/2 increased activity of osteoclasts and LOW PTH leading to calcium wasting
What is unique about prepatellar bursiitis?
Unlike other forms of bursitis which are usually non-infectious, prepatellar bursitis usually is secondary to local extension from cellulitis, repetative friction, or trauma. Organism is usually S. Aureus Because of this it usually needs to be aspirated for cell count and gram stain. Clindamycin or dicloxacillin is a good choice for mild cases. If worries about MRSA start with clinda, bactrim, or doxy.
In what type of urine are uric acid stones found? How can you prevent/treat?
acidic urine; Potassium citrate to alkalize the urine
What causes the hemorrhagic cystitis with cyclophosphamide use and how can you prevent it?
acrolein; plenty of water and MESNA
What are the contraindications for pertussis-containing vaccination (DTAP/TDAP)?
anaphylaxis progressive neurological disorders (uncontrolled epilepsy, infantile spasms) encephalopathy within a week of administration GBS, sz w.i 3 days, temp >105, hypotonic-hyporesponsive episodes, inconsolable crying are all precautions, not contraindications
What is the antibody test most used for the diagnosis of rhematoid arthritis?
anti-cyclic citrullinated peptide antibodies
What is the prophylatic antibiotic of choice in the setting of febrile neutropenia?
anti-pseudomonal beta-lactam
Triad of mixed cryoglobinemia
arthralgias palpable purpura glomerulonephritis
What is the treatment regimen for babesiosis?
atovaquone + azythromycin quinine + clinda
What is the arrhythmia most specific for digitalis toxicity?
atrial tachycardia with AV block; digitalis can lead to increased ectopy in the atria or ventricles leading to atrial tachycardia digitalis also increased VAGAL TONE, resulting in decrased conduction through the AV node potentially causing AV block
Clinical indications of botulinium toxin in the newborn? Treatment?
bilateral ptosis drooling *DESCENDING PARALYSIS* weak suck and gag reflexes Botulinum immunoglobilun
What is the major toxicity of mycophenalate?
bone marrow suppression
vaccinations for *medically stable* preterm infants should be administered...
by chronological age and NOT gestational age *Must be 2kg to get the HepB vaccine, though.*
How can cyanide toxicity present?
cherry-red skin, AMS, arrhythmias, tachypnea followed by respiratory depression, metabolic acidosis (HAGMA from lactic acidosis)
What is the appropriate treatemtn for post-partum ebndometritis?
clinda + gentamycin
What is the name of the wart caused by HPV, syphillis?
condyloma acuminata conydloma lata
Acyclovir effect on kidney
crystal-induced nephropahty resulting in obstruction
What is the major toxicity of azathioprine?
diarrhea, leukopenia, hepatoxicity
Bicuspid aortic valce commonly leads to aortic regurgitation. What does this murmur sound like?
early decrescendo diastolic murmur
What finding on blood work should make you think of AIN
eosinophilia
Low TSH + HIgh T4 + low thyroglobulin
exogenous thryoid homormone administration
Cross-over study
group of participants is randomized to one treatment for a period of time and the other group is given an alternate treatment for the same period of itme. At the end of the time period the two groups then switch treatmetns for another set period of time
What are the most common early side effects of carvidopa/levodopa?
hallucinations, confusion, agitation, dizziness
What effects does gentamicin have on the ear? How can it be tested?
hearing loss by damaging the cochlear cells vestibulopathy by damaging the motion-sensitive hair cells in the inner ear - test with the head thrust test
AEIOU
hemodyalysis Acidosis Electrolyte abnormality (K) Ingestion (alcohols, salicylate, lithium, valproate) Overload (volume) Uremia (encephalopathy, pericarditis, bleedinga0
What is the most common cause of abnormal uterine bleeding in an adolescent>
immaturity of the hypothalamic-pituitary-ovarian axis resulting in anovulation and persistent endometrial proliferation resulting in heavy menses. Treatment is with high dose E/P OCP to stabilize the denuded endometrial lining and stop the bleeding process
What are the sources of foodborne botulism? How do you know if you have it? Treatment?
improperly canned foods Ages seafood (cured fish) Onse tof symptoms is within 36 hours (blurred vision, diplopia) As seen in babies, it is a *descening muscle weakness symmetrically* Equine antitoxin therapy
What is is the different in LAP score between CML and leukemoid reactino? Metamyelycyts vs myeloctyes?
in CML the LAP activity is LOW In CML, metamyelocytes <<<myelocytes In CML there will also be a WBC >100K w/ absolute basophilia In Leukomooid reaction the LAP activity is elevated IN leukomoid reaction, Metamyelocytes>>>myelocytes
What is different on the ECG findings with tricuspid atresia and ebstein anomaly?
in the latter (ebstein), there will be RA enlargement 2/2 the regurgitation through a floppy tricuspid valve. there will also be cardiomegaly. In the former (tricuspid atresia) there will be evidence of LAE and LV hypertrophy because there is not as much increased back-flow into the RA.
Patients with endometriosis are at greatest risk for developing what?
infertility
What are the late (5-10 yrs) side effects of carvidopa/levodopa?
involuntary movements (dyskonesia, dystonia)
How can you differentiate BZD from opioid overdose?
lack of severe respiratory depression, lack of pupillary contriction ( normal to be >3mm)
Lytic bone lesion + rash + signs of DI
langerhans cell histiocytosis bone lesions look punched out
What change does acromegaly have on the heart?
leads to concentric myocardial hypertrophy which results in diastolic dysfunction and heart failure
What is the cold standard for diagnosis of sphincter of Oddi dysfunction?
manometrey
Renal vein thrombosis is most commonly seen in patients with which types of kidney disease?
membranous nephropathy
Fetal hydantoin syndrome
midface hypoplasia microcephaly cleft lip/palate digital hypoplasia hirsutism, developmental delay can be caused by exposure to anticonvulsants
What are the first line agent for reducing craving in alcohol use disorder?
naltrexone (Mu-opiod antagonist) Acamprostae (gutamate modulator)
What is the major toxicity of Cyclosporine?
nephrotoxicity; also look for gingival hypertrophy
Brain metastasis is commonly seen in what type of lung cancer?
non-small cell lunc cancer
investigators decision is adversely affected by knowledge of the exposure status of the su
observer bias
What is the gold standard test for diagnosing type 2 diabestes in patient swith PCOS?
oral GTT; more sensitive in detecting glucose intlerance than standard screening tests
What is the treatment for morton neuroma?
padded shoe to take pressure off the metatarsal head
HSP findings
palpable purupura arthralgias abdominal pain renal disease (hematuria > nephrotic proteinuria)
in setting of MS flare, what is the treatment of choice when glucocorticoid are not working? what is the maintenance therapy?
plasmapharesis IFN B + copolymer-1 (glatiramer)
What are the treatments for HPV warts?
podophyllin resin or trichloroacetic acid
Causes of nephrotic/nephritic syndrome with LOW C3
post-streptococcal membranoproliferative mixed cryoglobinemia lupus nephritis
What is the pathophys behind NPH
reduced CSF absorption
Vitamin B2 deficiency
riboflavin angular cheilitis (fissures at corner of lips) glossitis stomatitis (hyperemic/edematous oropharyngeal mucous membrane) normocytic, normochromic anemia seborrheic dermatitis
New onset RBBB
sign of right heart strain, consider PE in correct setting
Most important modifible risk factors for osteoporosis
smoking excessive alcohol intake sedentary lifestyle
When do you do GBS screening?
~36 weeks
In patients with *symptomatic* pelvic organ prolapse, what are the treatment options?
Surgery or non surgical; decision is based on the patient preference and *surgical risk assessement*
What condition do you need to look out for in the setting of prolonged tachycardia? how do you treat it?
tachycardia-mediated cardiomypoathy which can result in global cardiac dysfunction Treat with aggressive rhythm or rate control. Resuming normally should increased the left ventricular function
A patient comes in with bad abdominal pain for weeks. Now had bloody diarrhea and painful bowel movements. Additionally he has a fever and leukocytosis. NO recent travel or illness.
think undiagnosed IBD with toxic megacolon Rx: steroids + (ampicillin - gentamicin - flagyl)
When treating ADHD, what patient populaiton would benefit from atomoxetine use?
those with a history of illicit substance use or a strong family preference against a stimulant
Who is required to get an EGD in the setting of presumed GERD?
those with alarm symptoms (odynophagia, dysphagia, hematemasis) or those >50 with 5 years of symtpoms OR firsk factors (smoking)
What effect does thyrotoxicosis have on cardiac output? Why?
thyrotoxicosis results in increased cardiac ionotropy and chronotropy, directly. It also increased the sensitivity of tissues to catecholamines
What is the use of demeclocycline?
treating SIADH (inhibits ADH-mediated insertion of aquaporins)
Besides penicillamine, what else can we do to lower copper levels in setting of wilson disease?
trientine as another chealator zine (intereferes with copper absorption)
Treatment regimen for septic thrombophlebitis?
vancomycin for MRSA ceftriaxone for enterobacteracea
What is one of the most common causes of recurrent UTI in children?
vesicoureteral reflux; diagnosed with IV pyelography; renal ultrasound will show blunting of the calyces