Uworld 6/27/13

Front 1

Pt s/p CABG POD 12, now febrile, puss from drainage site in sternum, chest pain. CXR shows widened mediastinum.
ML Dx?
TMT?

Back 1

Acute Mediastinitis (in cardiac surg w/ sternotomy, usually 2wks post op occurs)
-Drainage, surgical debridement and reclosure, prolonged abs therapy

Front 2

Pt s/p CABG POD 6 now w/ Afib w/ RVR on EKG for 12hrs.
Next Step?
Goes on for 36hr.
Next Step?

Back 2

-rate control w/ beta blocker or amiodarone (normal after CABG 40% pts, self resolves w/in 24hrs)
-Cardioversion and anticoagulation

Front 3

Light's Criteria?
What for?

Back 3

On tap, if ONE of following = exudative effusion:
pleural ptn: serum >0.5
pleural LDH: serum >0.6
pleural LDH > 2/3 normal serum LDH range

Front 4

noncomplicated vs. complicated vs. empyema pleural effusion?

Back 4

All exudative:
complicated if pleural glucose <60 (used by bacteria), LDH elevated (from neutrophil lysis), pH <7.2 cx are usually negative
Empyema if FRANK PUS (progresses from complicated)

Front 5

Type of pleural effusion seen in heart failure?

Back 5

bilateral transudative effusion

Front 6

Type of pleural effusion in hypoalbuminemia?
Causes of hypoalbuminema?

Back 6

bilateral transudative effusion
-Cirrhosis or proteinuria

Front 7

Other non pna causes exudative effusion?

Back 7

-Drug-induced lupus (procainamide, INH, hydralazine)
-rheumatoid pleurisy
-TB
-Malignancy

Front 8

G3P2 via c/s, F at 38wk gestation w/ sudden intense lower abd pain, vaginal bleeding, variable decels on fetal HR, fetus shifts from 0 to -2 station.
ML Dx?
Risk factors?
Red flags?
TMT?

Back 8

Uterine Rupture
-prior c sections, abd trauma (has scar that ruptures), less than 1% risk, but 9% if old vertical technique c/s
-presenting part retracts back (O to -2 station, no longer able to palpate head occiput)
-Delivery w/ emergent C-section

Front 9

Risk factors for placental abruption?
Signs?

Back 9

cocain use, HTN (greatest), smoking, prior abruption
-sudden abd pain 3rd trimester (80% have vag bleeding but could be retroplacental)

Front 10

Indicator of Vasa Previa?

Back 10

sinusoidal fetal heart rate pattern

Front 11

Postpartum F, fever, tender uterus, foul-smelling lochia.
ML Dx?

Back 11

Endometritis

Front 12

40yo w/ new onset diabetes, hepatomegaly, hurting joints (arthropathy)
Think what?
Dx Test?
Confirmatory Test?
TMT?

Back 12

Hemochromatosis (abnromal fe depo in liver, pancreas, heart, pituitary ->hyperpigment skin, hepatomegaly/risk HCC, "bronze" diabetes, arthropathy, restrictive heart failure, hypogonadism)
-Iron Studies
-Liver bx
-Defuroxamine, phlebotomy

Front 13

Pt w/ forehead w/ fine loose yellow greasy looking rash
ML Dx?
Pathophys?
Associated conditions?
TMT?

Back 13

Seborrheic Dermatitis
-inflammed sebaceous glands (scalp, face/eyebrows/nasolabial fold/external ear, chest, umbilicus, body folds)
-Parkinsons, HIV
-topical antifungals (may be related to pityrosporum ovale)

Front 14

cheeks and nose w/ red hue and telangiectasia worse when working out
ML Dx?

Back 14

Rosacea (rosy hue, telangiectasia on cheek, nose, chin worse w/ heat, workout, emotion, hot drink)

Front 15

Pt w/ 4 circular patches w/ central clearing and scaly borders on trunk, constant itchy)
ML Dx?
Cause?
Dx Test?
TMT?

Back 15

Tinea Corporis infxn (ring shaped scale patch w/ distinct borders that are itchy)
-dermatophyte Trichophyton rubrum
-microscopic exam w/ KOH shows hyphae
-Terbinafine (2% antifungal lotion/cream), or Griseofulvin (systemic tmt)

Front 16

Pt w/ oval scaly plaques numerous following cleavage lines of trunk crinkled like cigarrette paper, had larger patch earlier.
ML Dx?

Back 16

Pityriasis Rosea (large patch was herald patch)

Front 17

Pt found unresponsive brought to ED w/ low BP, HR 120, RR 33, febrile, O2sat 79%, CXR w/ RUL infiltrate, BUN/Cr 51/2.1, AST/ALT 2500/2300, Alk phosph 162, tBili 1.2
What's going on?
Liver?
Kidney?

Back 17

Pt w/ pneumonia in septic shock
-Shock Liver (ischemic hepatic injury since huge jump in AST/ALT->only time they get this hi)
-prerenal kidney failure

Front 18

G2P1 hispanic F 30wks gestation w/ intense pruritis , no abnormalities on exam, no jaundice, skin excoriations seen, AST/ALT 500/500, Alk phosph 800, GGT 60, tBili/dBili 2.4/1.1.
ML Dx?
What needs to ruled out?
TMT?
Complications of Dz?
Recommendations?

Back 18

Intrahepatic cholestasis of pregnancy (jaundice in 20% pts only, pruritis usually in palms/soles), resolves w/ good prognosis
-rule out viral hepatitis w/ hep panel
-ursodeoxycholic acid or cholestyramine
-gallstones in future, baby w/ meconium-stained amniotic fluid and prematurity
-Early delivery when fetal lung mature

Front 19

Pt w/ hyperkalemia, ekg w/ wide complex rhythm at 32/min w/out P waves.
Next Step?
What it does?
Later Steps?

Back 19

Calcium Gluconate
-antagonizes effect K on heart cell membrane (but short lived)
-Insulin & glucose, sodium polystyrene sulfonate (kayexalate), beta 2 agonist (albuterol)

Front 20

Pt w/ severe noncardiac chest pain. Esophageal manometry showing multiple contractions in middle and lower esophagus.
ML dx?

Back 20

Diffuse esophageal spasm

Front 21

32yo female w/ bloody nipple discharge. no mass.
ML Dx?
Test?

Back 21

Intraductal papilloma
-U/S (usually will show nothing since only picks up masses >1cm dm and these are usuallly less than 2mm)

Front 22

firm mobile breast mass in 25yo F painless.
ML Dx?

Back 22

Fibroadenoma (15-25yo F, benign, no change w/ menstrual cycle)

Front 23

70yo male w/ back pain for 3mos, hx HTN on HCTZ, recent hearing loss w/ hearing aid, exam w/ anterolateral femoral bowing.
ML Dx?
Pathophys?
Findings on labs?

Back 23

Paget's Dz
-occurs in 3% adults >40, increased bone turnover from osteoclast hyperfunction ->mosaic pattern of lamellar bone. Sx = enlarging hat size, CN 8 entrapment cause hearing loss, bone/joing pain, fractures, skeletal deforms)
-normal Ca, PO4, elevated Alk phosph

Front 24

Most common thyroid gland malignancy?
Risk factors?
Worst prognosis thyroid ca?
When to suspect thyroid lymphoma?

Back 24

Papillary Carcinoma of thyroid
-neck irradiation, family hx
-Anaplastic thyroid ca
-Pt w/ Hashimoto's thyroiditis

Front 25

What is relative risk used for?
-what is significant value RR?

Back 25

association in cohort studies
-RR>1 positive association risk factor to outcome (farther from 1= greater association
-RR<1 no associatio

Front 26

3rd trimester pregnant F w/ painless vaginal bleeding?
Concern?

Back 26

placenta previa

Front 27

Triad of preeclampsia?

Back 27

HTN, proteinuria, edema

Front 28

Pt playing in sandbox, now w/ pruritic serpiginous reddish brown lesions on skin moving arm slowly every day.
mL Dx?
Cause?

Back 28

Cutaneous Larva Migrans (creeping eruption)
-from ancylostoma braziliense (dog or cat hookwarm), helminthic dz, infx from soiled cat/dog feces, especially in sand/sandbox in tropical regions/south USA

Front 29

Pt w/ clenched fist human bite wound "fight bite"
TMT?

Back 29

Amoxicillin-clavulanate (since polymocrobial and need gram+ and - and anaerobe coverage)

Front 30

Pt w/ lung abscess
abx tmt?

Back 30

clindamycin

Front 31

63yo Pt fatigued, HTN treated w/ lisinopril, osteoarthritis treated w/ naproxen, Hgb 8.6, ESR 15, MCV 17.
ML Dx?
Likely Cause?
What is expected on Fe studies?
Significance of ESR?

Back 31

Fe deficiency anemia
-Naproxen induced bleeding ulcer/gastritis
-normal ESR = not chronic (anemia of chronic dz)
-lo serum Fe, lo serum ferritin (since body stores low), hi TIBC (since usually inverse relationship w/ body stores Fe), lo transferrin sat (= Fe/TIBC = lo/hi = lo)

Front 32

Fe studies in anemia chronic dz?

Back 32

lo serum Fe, hi ferritin, lo TIBC, lo to normal transferritin sat
-Elevated ESR (inflammatory condition which causes elevated ferritin as acute phase reactant)

Front 33

30yo school teacher w/ 3days fever, chills, sore throat, now w/ muffled voice, enlarged tender lymph nodes on L, uvula deviated R
ML Dx?
Pathophys?
Next Steps?
Complications?

Back 33

Peritonsillar Abscess
-initially tonsillitis, but develops to abscess (suggested by "hot potato voice" and large unilateral lymphadenopathy)
-Needle peritonsillar aspiration and IV abx (if can't remove all pus->surgery)
-parapharyngeal space spread and involve carotid sheath

Front 34

Pt w/ pulselessness and pallor in arm 2days after treatment for DVT
ML Dx?

Back 34

HIT from unfractionated heparin causing abnormal intravascular thrombosis (look for thrombocytopenia w/ hypercoagulation)

Front 35

Greatest risk factor for TB?
others?

Back 35

Immigrant!
Nursing home, healthcare, prison workers

Front 36

What changes in thyroid function during pregnancy?

Back 36

increased TOTAL T4 & T3, normal FREE T4 & T3, normal TSH (may have mild decrease TSH but in normal range)
-due to elevated thyroid binding globulin (TBG) and stimulation of TSH receptors by chorionic gonadotropin

Front 37

Differentiate ligamentous tear from meniscal tear?

Back 37

meniscal = pop w/ joint swelling slowly over days
ligament = maybe pop w/ immediate joint swelling w/ blood (since highly vascular)

Front 38

sudden eye pain, vomiting, Eye hard as rock =
When does it usually occur?
Cause?
TMT?

Back 38

acute angle closure glaucoma (55-70yo pts)
-in dark movie theater, stress time, drugs (anything causing pupillary dilation)
-closure of pre-existing narrow anterior chamber angle
-IV acetazolamide (w/ po admin also) to lower intraoc pressure followed by laser peripheral iridotomy (permanent tmt)

Front 39

Trauma to eye w/ severe pain and photophobia
ML Dx?
Exam test?

Back 39

Corneal abrasion
-Slit lamp w/ fluorescein shows corneal abrasion

Front 40

gradual peripheral vision loss w/ tunnel vision and cupping of optic disc =

Back 40

open angle glaucoma (insidious onset)

Front 41

Differentiate partial vs. complex seizures?
Differentiate simple partial vs. complex partial vs. partial w/ 2ndary generalization?

Back 41

Partial starts w/ discrete focus, complex involves all brain from beginning.
-simple partial is no LOC, pt remembers events
-complex partial has LOC, aura (which is simple partial seizure basically), automatisms, and post-ictal state
-partial w/ generalization starts like complex partial or simple partial but goes to tonic clonic activity (evident by blood-tinged sputum = bitten tongue), has post-ictal (may have loss bladder/bowel)

Front 42

physical findings lumbosacral strain?
TMT?

Back 42

straight leg raise negative, no neuro deficit, local tenderness
-NSAIDS and EARLY mobilization

Front 43

Main cause of death in subarrachnoid heamorrahge?
TMT to prevent?

Back 43

vasospasm of brain base arteries cause ischemia and infraction
-calcium channel blockers (nimodipine)

Front 44

22yo pt w/ fever, sore throat, fatigue preventing going to class, posterior/anterior cervical lymphadenopathy, splenomegaly, exudatve tonsillitis.
ML Dx?
Triad
Cause?
Dx Test?

Back 44

Infectious Mono (glandular fever/kissing dz)
-hi fever, lymphadenopathy (usually posterior), pharyngitis
-EBV
-Monospot test (heterophile antibody test), if negative does not rule out mono so then do EBV-specific ab test

Front 45

Most common complication peptic ulcer dz?

Back 45

Hemorrhage

Front 46

15yo w/ amenhorrhea, normal breast/pubes/axillary hair development, blind vaginal pouch, no uterus or adnexa, U/S shows 2 ovaries
ML Dx?
Karyotype?

Back 46

Mullerian Agenesis (uterus and fallopian tube and proximal vag)
-46 xx

Front 47

BNP in pt SOB tells you what?

Back 47

elevated = heart failure (expect to hear 3rd heart sound from dilated L ventricle)
not elevated = non cardiac

Front 48

Infxn where in neck most likely to involve mediastinum?

Back 48

Retropharyngeal space -> acute necrotizing mediastinitis (tmt w/ debridement of mediastinum)

Front 49

boy wakes up w/ red eye asymptomatic.
ML Dx?
what do?
causes?

Back 49

Subconjunctival hemorrhage
nothing, observe, check bp
HTN, excess rubbing, violent coughin spells

Front 50

Empiric tmt for IV-drug abuse related endocarditis?

Back 50

Vancomycin

Front 51

Measurment of association in case control study?
-what is case control

Back 51

Exposure Odds Ratio
-When select pop w/ disease and compare to pop w/out dz are asked about exposures

Front 52

Measurement used in cross-sectional studies?

Back 52

Prevalence odds ratio

Front 53

Pt w/ altered mental status to ED, hx of viral gastroenteritis 4days prior, has been drinking a lot, some weight loss over past 2 mos, really thirsty, respirations 28/min deep and rapid.
ML Dx?
Dx Test?
Cause?

Back 53

DKA
fingerstick glucose
-stuporous pt w/ rapid breathing (kusmauls) w/ hx weight loss, polydypsia, polyuria = DKA (brought on by GI infxn)

Front 54

What drugs cause interstitial nephritis?
Classic findings?
TMT?

Back 54

Sick Drugs Ravage Poor Nephrons = sulfas, diuretics, rifampin, penicillins (including cephalosporins), NSAIDS
-fever, rash, arthralgias, hematuria, CVA tenderness
-stop the offending drug

Front 55

F to OBGYN for 1st prenatal visit 10wks pregnant.
Screening recommendations?
Diet recommendation?

Back 55

RPR or VRDL for syphilis (all pregnant women on 1st prenatal screening. if positive->confirm w/ FTA-ABS & tmt w/ penicillin)
-eat diet rich in folic acid or supplement (no need to check folic acid though)

Front 56

What is breastfeeding failure jaundice?
Timecourse?
What feeding is normal?
Signs?
TMT?

Back 56

exaggeration of physiologic jaundice since baby is not getting enough nutrition, the enterohepatic circulation increases causing increased resorption of unconjucated bili.
-occurs first week life
-15-20min each breast 8x/day for >4 wet diapers mixed w/ 8-12 stools/day loosing <10% birth weight in 1st wek
-dehydrated infant (less wet diapers and >10% weight loss)
-improve breastfeeding techniques

Front 57

What is breast milk jaundice?
Timecourse?
TMT?

Back 57

-factor in human milk increases bilirubin enerohepatic circulation
-starts 3-5days life but goes for more than 3rd wk life or further out
-stop breastfeeding if bili elevated temporarily

Front 58

3wks after birth, baby w/ clay-colored stool, dark urine, enlarged liver.
What lab to expect?
ML Dx?

Back 58

elevated conjugated hyperbilirubin
-Biliary Atresia

Front 59

When do you see ABO incompatibility mom and baby?
what types?

Back 59

in first 24hrs life
-mom is O and baby is anything

Front 60

Any baby w/ elevated bilirubin is treated.
Followup?
Concern?

Back 60

re-evaluate bili in 12-24hrs
-Kernicterus (devastating neuro consequence)

Front 61

TMT of uncomplicated cystitis?
2nd line

Back 61

-Bactrim or Nitrofurantoin
-cipro or levofloxacin

Front 62

Cause of normal pressure hydrocephalus?

Back 62

decreased CSF absorption at the arachnoid villi or obstructive hydrocephalus->backup pressure->dilation ventricles

Front 63

22yo w/ resting tremor, muscular rigidity, clumsy gait for several months, now w/ slurred speech drooling, hepatomegaly, AST/aLT 250/250, liver bx w/ portal fibrosis and hepatocyte necrosis.
ML Dx?
Cause?
Dx Test?

Back 63

Wilson's Dz
-aut recessive dz in younger, copper deposition in liver, basal ganglia, cornea (liver dz presentation in kids, brain dz presentation in young adult)
-low serum ceruloplasmin, increased urinary copper, slit lamp exam eyes w/ kayser-flescher rings

Front 64

Pt w/ thickened and swollen hands and feet, coarse facial features, prominent frontal bone and jaw.
ML Dx?
Pathophys?
Risk of what?

Back 64

Acromegaly
-pituitary adenoma producing excess GH. Hi GH cause hi IGF-1 that leads to excess growth bone and soft tissue
-Congestive heart failure (#1 cause death), others=cardiomyopathy, HTN

Front 65

Asian pt w/ insensate hypopigmented patch of skin?
ML Dx?
Cause?
Dx Test?

Back 65

Leprosy!
mycobacterium leprae->chronic granulomatous dz affecting peripheral nerves and skin, after insensate hypopigmented plaque prosgresses to muscle atrophy w/ crippling deformity hand (seen in face, ears, wrist, but, knees, eyebrows)
-acid fast bacilli on SKIN BIOPSY

Front 66

What causes anion gap met acidosis?

Back 66

Methanol-buildup of formaldehyde/formic acid->eye
Uremia-ESRD unable to get rid of H+ as NH4+
DKA-DM1, alcoholic, starvation
Paraldyhyde or Phenformin
INH or Iron tablets
Lactic acidosis-hypoxia, mitochondria dysfunction
Ethylene Glycol-buildup oxalate and glycolic acid
Salicylate poisoning-see primary resp alkalosis

Front 67

HIV pt w/ tuberculin skin test 6mm after 48hrs.
Next step?
if negative next step?
What to check b4 starting?

Back 67

-CXR
-INH and pyridoxine for 9 mos (pyridoxine is ppx to neuropathy of INH)
-Liver fxn (pyridoxine doesn't protect from INH hepatotox)

Front 68

3 major complications of anterior wall MI and differentiate?

Back 68

-Pericardial Tamponade (LV wall rupture): hypotension, JVD, distant heart sound, pericardial rub, pulsus parodoxus
-Papillary muscle tear: Mitral regurg (pansystolic loudest at apex radiate to axilla), SOB, bibasilar crackles of pulm edema
-Intraseptal rupture: pansystolic murmur heard best at LEFT STERNAL BORDER w/ THRILL

Front 69

Differentiate restrictive vs obstructive lung dz on PFTs
-Differentiate pulm fibrosis from ankylosing spondylitis

Back 69

-Both have decreased FEV1 and FVC, but FEV1/FVC >80% in restrictive, <80% in obstructive
-ankylosing spondylitis has >FRC from fusion of CVA joints causing restriction of chest wall motion. All other restrictive has <FRC

Front 70

2yo child w/ MCV 70, Hgb 9.5
How tell btwn Fe deficiency or Thalassemia?
What is retic count in Fe def?

Back 70

Red Cell distribution width (RDW) is <20% in thalassemia or ACD and >20% in iron deficiency
-retic count is low

Front 71

Cause of GVHD
Sx?

Back 71

activation of donor T lymphocytes
-targets skin (rash), intestines (bloody diarrhea), liver (jaundice w/ up LFTs)

Front 72

Pt w/ hepatic vein thrombosis found to have blood disorder.
ML Dx?
Confirmatory Testing?
Pathophys?

Back 72

Paroxysmal Nocturnal Hemoglobinuria (PNH)
-flow cytometry for CD55 and CD59
-initial CBC shows lo Hgb, lo haptoglobin, hi LDH, elevated bilirubin = intravascular hemolysis
-From abnormal GP1 anchor ptn on rbcs preventing binding CD55 and CD59 that normally prevent rbc destruction

Front 73

What pt population gets G6PD deficiency?

Back 73

African American males

Front 74

Most important path marker in tmt of invasive breast ca pt?
test?
tmt if present?

Back 74

HER2 oncogene
-oncogene amplification by FISH of immunohistochemical stain
-Herceptin (trastuzumab-targets the oncogene)

Front 75

rupturing bullae over body and in mouth.
ML Dx?
Dx test?
TMT?

Back 75

pemphigus vulgaris (IgG intercellulary in epidermis against desmogleins)
-Immunofluorescent micrscopy to IgG
-Steroids and immunosupressives (azathioprine, prednisone, methotrexate)

Front 76

23yo Mississippi guy for pre-employment visit found to have 1cm nodule in R lung field. asymptomatic
ML Dx?
Cancer?

Back 76

Histoplasmisis (ohio and missipppir river valleys) dimorphic fungus 5% pts symptomic, guano droppings (if sx leads to chronic cavitary pulm histoplasmosis which is progressive fatal dz affecting old COPDers or immunocomprised)
-Not cancer since nonsmoke and under 35yo

Front 77

Pt playing golf in hot weather, w/ sudden dizziness unable to stand, vomiting, occipital headache, temp 100F, BP 210/100
ML Dx?
TMT?

Back 77

Cerebellar Hemorrhage (acute onset HA occipital, vomiting, ataxia) w/ fever from hemorrhage
-evacuate hematoma immediately

Front 78

F pt w/ low abd pain, nocturia, urgency, frequency, relieved by urinating, dyspareunia, extreme pain on bimaunal exam. no cervical motion tenderness.
ML Dx?
Dx Test and finding?
What must be ruled out?

Back 78

Interstitial Cystitis (painful bladder syndrome): chronic pelvic pain worse w/ bladder filling, spicy food, excercise, intercourse w/ urgency/frequency/nocturia relieved w/ urination
-Cystoscopy w/ submucosal petechia or ulcers
-UTI via U/A and Ucx (both negative)

Front 79

pregnant F dxed w/ high glucose at 12wks gestation.
ML Dx?
1st recommendation?
At followup still hi glucose
2nd recommendation
goal?

Back 79

-Gestational diabetes (increase risk miscarriage, preterm birth, stillbirth, pree)
-dietary mod
-Insulin
-goal fasting glucose 75-90

Front 80

Baby risk in Gest diabetes mom?

Back 80

-macrosomia
-hypocalcemia-due to PTH suprresion by DM mom
-hypoglycemia-hi baseline insulin produciton
-hyperviscosity (from polycythemia->due to fetal hypoxia from increased metabolic rate of hyperglycemia0

Front 81

Pt returned from foreign country w/ chest pain worse on inspiration in L side and one x hemoptysis, HR 120, RR 29
ML Dx?

Back 81

THink PE w/ pulmonary infarction (causing hemoptyis)

Front 82

fat boy w/ severe knee pain, limping started acutely.
ML Dx?
What is seen in physical exam?
Dx Test and finding?
TMT?

Back 82

SCFE (from obese load on forming growth plate of femoral head that is weak cartilage w/out bone strength yet)-most common presentation at knee referred from hip
-loss of abduction and internal rotation hip as well as external rotation thigh whil hip is flexed
-Lateral frog let xray of hip
-surgical pinning of slipped epiphysis where it lies

Front 83

Pt w/ recurrent nasal discharge, congestion, constant sensation dripping down back of throat, food tastes bland, has sickle cell trait, hx of wheezing after taking naproxen.
ML Dx?
Pathophys?

Back 83

Aspirin Exacerbated Respiratory Disease (AERD)
-asthma, chronic rinosinusitis w/ nasal polyposis, bronchospasm or nasal congestion after taking NSAIDs/Aspirin, bland tast from congestion

Front 84

Pt comes to ED w/ sudden loss of vision in L eye, hx HTN, fundoscopic exam w/ swollen optic disc, retinal hemorrhage, dilated veins, cotton wool spots
ML Dx?

Back 84

Central Retinal Vein Occlusion (CRVO)
-associated w/ coagulopathy, hyperviscosity, chronic glaucoma, or atherosclerosis risk factors
-see "blood and thunder" on fund exam w/ description

Front 85

differentiate central retinal vein vs. artery occlusion

Back 85

vein: sudden vision loss, "blood and thunber" w/ swollen optic disk, retinal hemorrhage, dilated veins, cotton wool spots
Artery: painless vision loss, pale optic disc, cherry red fovea, boxcar segmentation blood in retinal veins

Front 86

5mo old w/ rash face hands chest, scratching areas, erythematous, erosions, scaling, excoriated papule and plaques, symmetrical, diaper area spared
ML Dx?
TMT?

Back 86

Atopic Dermatitis (affects face, scalp, extensors, but skips diaper)
-bland emollients, topical anti-inflammatory ointment

Front 87

Steps in evaluating hyponatremia?

Back 87

Serum osmolality: normal vs. Hi (>295) vs. low (<280)
-Normal = hyperptnemia vs. hyperlipidemia
-Hi >295 = hyperglycemia vs. exogenous solutes (mannitol, radiocontrast)
-For low serum osmol->EC volume: hypovolemic vs euvolemic vs. hypervolemic
=hypovolemic: UNa <10->nonrenal salt loss (dehydrated, vomit, diarrhea)
=hypovolemic: UNa >20->renal loss (diuretic, ACEi, mineralocorticoid deficiency)
=Euvolemic: UNa>20, Uosm<300->psychogenic polydipsia vs. beer potomania
=Euvolemic: UNa>20, Uosm >3000->SIADH
=Hypervolemic: CHF, hepatic failure, nephrotic syndrome

Front 88

Pt w/ bloody diarrhea, afebrile, w/ abd pain.
ML Dx?
Cuase?
Complications?

Back 88

Enerohemorrhagic E.Coli
ingest uncooked beef
-HUS and TTP

Front 89

Pt that is an IV drug user, now w/ low back pain that is tender to gentle percussion, no neuro deficit, good leg raise.
ML Dx?
Dx Test?
TMT

Back 89

Vertebral Osteomylitis (iv drug user, sickle cell, immunosuppresed pts)
-MRI
-long term IV abx

Front 90

Pt w/ ED, no nocturnal erections, poorly controlled diabetes, on doxazosin for HTN
TMT?
4 rules of TMT?

Back 90

Sildenafil (PDE5i)
1.contraindicated w/ nitrates (cause hypotension)
2.can cause priapis
3.drugs that interfere w/ metabolism are erythromycin and cimetidine
4. if w/ alpha blocker (doxazosin) give at least 4 hrs apart to reduce chance hypotension

Front 91

Most common cause pna in HIV?

Back 91

still strep pneumo!

Front 92

Pt w/ headaches or chronic pain now w/ confusion x2 days, drinks 2-3shots whiskey past mo since dxed w/ prostate ca. exam w/ hepatomegaly. AST/ALT 6000/7000 bilii t/d 5/4
ML Dx?

Back 92

Drug induced liver damage (think acetaminophen for pain)

Front 93

Pt w/ recent DVT found to have elevated homocystein level.
TMT?
Pathophys?

Back 93

Pyridoxine (B6), folate, B12->all needed for conversion homocystein to cystein to methionine, homocystein can cause clotting, thrombosis

Front 94

Findings of biopsy of paget's dz breast?
Related dz?

Back 94

large cells w/ clear halos.
-adenocarcinoma