Uworld 7/4/13

Front 1

When is the triple or quad screen done in pregnancy?
What do the results mean?

Back 1

15-20wga (bHCG, maternal serum AFP/MSAFP, estriol, inhibin A)
-elevated MSAFP=dating error, neural tube defect, abd wall defect
-Downs=ABEI (down, up, down up)
-Edwards=ABEI (down down down normal)
-Patau=ABEI (all normal)

Front 2

What murmurs need to be worked up?
What don't?
Next workup step?

Back 2

diastolic, continuous, and loud systolic
-don't workup midsystolic murmur in asymptomatic pt (benign)
-TTE

Front 3

Things to consider in women complaining of hirsuitism (6)? and what to check?

Back 3

1.Meds (phenytoin, diazoxide, cyclosporine)-idiopathic
2.Family hx, ambiguous genitalis-CAH (check 17-hydroxyprogesterone)
3.Hirsuit since menarche-PCOS (check LH: FSH 2:1)
4.Rapid onset-Adrenal vs. sertoli-leydig (ovarian) tumor (check DHEA-S for adrenal and testosterone for ovarian. specifically DHEAS since DHEA only is produced in both)
5.glucose intolerance-Cushings dz (dexamethasone suppress test followed by ACTH level)

Front 4

Pt w/ penetrating injury to L eye lost vision, now 3wks later w/ burred vision in R eye.
ML Dx?
Pathophys?

Back 4

Sympathetic opthalmia (spared eye injury)
-dead eye uncovers "hidden antigens" to body that cause immune resoponse agains other eye

Front 5

TMT for hepatic encephalopathy?
2nd line?

Back 5

Lactulose (broken down by gut flora causes conversion ammonia to ammonium that can not be absorbed)
-Rifaximin, po sodium benzoate, neomycin (short term since can cause aminoglyc side effects->oto and nephro tox)

Front 6

Pt w/ charcot's triad->what is it?
ML Dx?
Initial TMT?
If still persists, next step?
What about Reynold's Pentad?

Back 6

fever, jaundice, RUQ pain
-Acute Cholangitis
-broad spec abx and fluid
-need urgent biliary decompression->ERCP w/ sphincterotomy and stent placement (NOT SURGERY)
-add AMS and HypOtn->supparative cholangitis

Front 7

TMT for bacillus cereus?

Back 7

nothing (it's a preformed heat-stable toxin), sx usually w/in 6hrs of consuming re-heated rice

Front 8

Most common organisms in celllutlitis?

Back 8

1. Staph
2. Strep pyo (GAS)

Front 9

PCOS puts women at risk for what?

Back 9

endometrial ca (from unaposed estrogen)

Front 10

What is the pathophys of mallory-weiss synd?

Back 10

Ruptured submucosal ARTERIES of distal esophagus and prox stomach from increased intragastric pressure during vomiting->tear in mucosa

Front 11

Pain on palp of vertebra on exam=? (2 possible)

Back 11

spinal infxn (abscess) or lytic lesion

Front 12

Initial test for pt w/ concern for compression fracture or lytic lesion vertebra?

Back 12

x-ray spine, then MRI if still concerned

Front 13

Pt postpartum 2mos ago, now w/ lethargy, weight gain, fatigue, preg was compolicated by vag bleeding needing transfucsion, no mestrual periods since, has dry skin, delayed dtrs.
ML Dx?
Pathophys?
Presentation?

Back 13

Sheehan's syndrome
-ischemic necrosis of pituitary
-in postpartum pts w/ hx of peri-partum bleeding, lactation failure (prolactin deficiency, baby gets formula feed), secondary amenorrhea, sx of hypopituitarism (amenorrhea, down libido, down body hair, central obesity, increased LDL, less lean muscle since decreased GH)

Front 14

Trendelenburg sign=?

Back 14

gluteus minimus/medeus weakness on contralateral side (the side of the standing leg, not the lifted leg that is drooping), since these muscles innervated by superior gluteal nerve and usually abduct the thigh

Front 15

electrolyte and acid-base disturbance of loop diuretic?

Back 15

hypokalemia and hyponatremia (since inhibits Na-K-2Cl transport in loop henle) and metabolic alkalosis (since increases aldo level leading to loss of H+)

Front 16

Pt needs to be catheterized for micturition due to thoracic vertebral fracture. Best way to do so to prevent UTI?

Back 16

Intermittent catheterizaiton

Front 17

Breastfeeding mom wants contraceptive but with option to get pregnant in 1yr.
best tmt?

Back 17

Progestin-only contraceptive (not combined OCPs since estrogen will inhibit lactation/affect volume/composition of milk), barrier, IUD, sterilization (not here since wants to get pregnant again)

Front 18

Premature infant needs vaccines. What timeline (age) do you follow to give them?
What vaccine should be given at birth?

Back 18

Baby's chronological age (not gestational age, does not depend on type of vaccine)
-HepB (all babies)

Front 19

What vaccines given at 2mo age?

Back 19

Hep B, rotavirus, Tdap, Hib, pneumococcal, inactive polio

Front 20

How to Dx TTP?

Back 20

Clinically, but can do peripheral blood smear for confirmation

Front 21

What are the most common 2ndary malignancy after Hodgkin's dz?

Back 21

lung and breast

Front 22

How long after radiation therapy can you get radiation-induced fibrosis?

Back 22

4-24mos after, will be diffuse on CXR

Front 23

What is ichthyosis vulgaris?

Back 23

LIZARD SKIN, usually on extensor surfaces, will be increased dryness esp in winter w/ rough/dry/horny plates (spares face and diaper area)

Front 24

Where does psoriasis usually occur?

Back 24

elbows, knees, scalp trunk

Front 25

Where does atopic dermatitis usually occur? When? Sx?

Back 25

cheek, forehad, limbs, INFANTS, ITCHY

Front 26

What kind of pathophys causes drop of O2sat in consolidation (may change w/ pt positioning)?

Back 26

increased A-V shunting (since blood perfusing consolidated areas isn't ventilated, so O2Sat will be worse when pt lies on side of consolidation since more bloodflow thru the shunt)

Front 27

What is pathophys causing drop of O2sat in PE?

Back 27

increased dead space (ie. increased volume of inhaled air that cannot be used for gas exchange since no perfusion in that area)

Front 28

Compare/contrast motor deficits of anterior vs. middle cerebral artery stroke?

Back 28

Anterior=contralat lower extrem weakness w/ sensory stuff and urinary incontinencs, primitive reflexes (grasp/suckle), paratonic rigidity
Middle=more contralat UPPER extrem and homonymous hemianopia (may have aphasia if L or neglect if R)

Front 29

Differentiate intracerebral hemorrhage from subarachnoid hemorrhage

Back 29

intracereb: hx of HTN, coagulopathy, IV drug use, sx progress over min to hour starting w/ focal sx followed by sx of increased intracranial pressure (somnolence, naus/vom/hA/bradycardia)
subarach: rupture arterial saccular berry aneurysm, sever HA onset, neck stiff (meningeal irritation), no focal deficits

Front 30

Pt on dig and verapimil for afib, now w/ anorexia.
ML Dx?
What other sx?
What other causes?
Dx Test?
If was toxic, TMT?

Back 30

Dig-side effect from elevated level due to decreased renal clearance (due to verapimil)
-GI #1 (naus/vom/anorexia), hyperkalemia (from inhibited Na/K ATPase), confusion, visual disturbed (blurry, yellow halo), rythm (vtach, junctional arrythm, brady)
-hypokalemia (since competes w/ K for binding to ATPase), any decrease renal
-K level and EKG w/ downsloping ST in all leads
-STOP DIG and KLAM (normalize K, lidocaine, anti-dig-Fab/dig-specific ab, Mg+)

Front 31

Describe calculation of PPV?

Back 31

ability to identify those w/ disease (true pos) from those w/ pos results (total pos)

Front 32

Describe calc of sensitivity?

Back 32

SNOUT->ability to rule out (TP/(TP + FN)) = 1 perfect sensitive->ie you catch all the people w/ the dz

Front 33

Describe calc specifity?

Back 33

SPIN->ability to rule in (TN/TN+FP)) =1 perfect specific->ie you catch all the people w/out the dz

Front 34

S3=?
What does it sound like?
TMT in these pts if symptomatic?

Back 34

enlarged ventricle w/ blood->turbulentc sound, means LV failure if sx of SOB, low O2sat
-ken-tuc-KY
-diuretics

Front 35

Pt w/ signs of atherosclerosis and resistant HTN.
THink what?
look for what on physical?

Back 35

Renal artery stenosis
-bruit in periumbilical area

Front 36

Differentiate subclavian art atherosclerosis/stenosis from coarctation of aorta on BP?

Back 36

subclav: BP in L greater than BP in R ARM
coarc: BP in upper extrem greater than BP in lower extrem (if coarc hi enough prox to L subclav->BP in R greater than BP in L->RARE condition)

Front 37

What is normal JVD?

Back 37

<3cm

Front 38

If pt w/ scattered wheezes, JVD of 2cm, lower extrem bilat pitting edema, HTN, dilated totruous superficial leg veins.
ML Dx?
Cause?
TMT?

Back 38

Chronic Venous Insufficiency (not edema from CHF since JVD<3, no crackles, no ascites)
-incompetent venous valves->leg pain, edema, stasis dermatitis, skin fibrosis, ulcers (risk factors: age, female, obeses, hx lower extrem surgery, hx DVT)
-leg elevation, compressing stockings, compression pneumatic devices

Front 39

TMT of wolf-parkinson-white syndrome w/ afib?

Back 39

convert back to sinus via cardiovert or antiarrythmics like procainamide

Front 40

What type of immune response is done by pnemococcal vaccine?
What type by most others?
What type by polio?

Back 40

-T-cell independent B cell response (polysaccharide w/out any attached ptn to active t cell, so no t cell)
-T-cell dependent (ie. tetanus, n meningitis, HiB, diphtheria)
-IgA response (increase anti-polio IgA ab in GI tract)

Front 41

Define central cord syndrome?

Back 41

usually hyperextension injury in elderly from degenerative change in cervical spin->weakness moreso in upper than lower extrem w/ possibel pain/temp deficit

Front 42

What makes something a confounder?

Back 42

it should be related to the exposure being looked at in a case-control study (therefore unsure which one is really causing the effect)

Front 43

What is seen on CXR in sarcoid?
Other findings?
Dx Tests?
TMT?

Back 43

bilateral hilar lymphadenopathy and diffuse interstitial infiltrates (but if it just says one part->still think sarcoid)
-fine rales
-parotid enlargement
-e nodosum
-facial palsy
-heart block/restrictive cardiomyopathy
-CNS involved
-IRITIS/UVEITIS
-arthritis
-TEST: CXR initial, best is lymph node bx w/ noncaseating granulomas, also up ACE, hypercalciuria/cemia, restrictive lung dz on PFTs
-TMT w/ prednisone

Front 44

Velcro-like inspiratory crackles on lung exam=?

Back 44

idiopathic pulm fibrosis

Front 45

What is the presenting sx in ankylosing spondylitis?

Back 45

back pain (don't choose w/out this)

Front 46

Pt w/ likely cirrhosis.
Managment step?

Back 46

PPx esophageal endoscopy to screen for varices->if present ppx w/ propranolol

Front 47

Metformin side effects?
Contraindications?

Back 47

none (no hypoglycemia)
-discontinue w/ renal dysfunction (also not in sepsis or liver failure)->risk of lactic acidosis

Front 48

What drug class is glipizide?
Side effects?

Back 48

sulfonylurea (trigger insulin release from pancrease via closure of K channel in Beta cells)
-HYPOGLYCEMIA, eliminated in liver (so contraind in liver failure)

Front 49

What drug class is pioglitazone?
side effects?

Back 49

Thiazoladinedione (increase insulin sensitivity tissues)
-HEPATOTOXIC since excreted via liver, increased fluid overload/edema (contraind in CHF)

Front 50

What class of drug is miglitol? other drug in class?
side effects?

Back 50

alpha glucosidase inhibitor (block glucose absorption in bowel), other is acarbose
-GI disturb (flatus, diarrhea, abd pain), safe in renal failure

Front 51

What drug class is exenatide? Other drugs?
Side effects?

Back 51

Incretin (glucose insulinotropic peptides)->all injections, sitagliptin, saxagliptin, linagliptin (decrease gastric motility, help weight loss and raise insulin
-exenatide = PANCREATITIS

Front 52

What is pramlintide?
side effects?

Back 52

amylin analog (mimetic) increases insulin absorption
-decreased appetite, hypoglycemia, naus/diarrhea

Front 53

Side effects of erythropoeitin therapy?

Back 53

Worsening HTN (treat w/ dialysis for fluid removal and anti-hypertensive->most common side effect
HEADACHE
FLU-LIKE synd (give anti-inflammatory)
Red cell aplasia (rare)

Front 54

intra-arterial cath in radial artery showing significant variation in systolic bp related to resp cycle=?

Back 54

pulsus paradoxus->think cardiac tamponade

Front 55

DES puts you at risk for?

Back 55

clear cell adenocarcinoma of vagina and cervix
-uterine anomaly (T-shape, small)
-vaginal septae

In men: cryptorchidism, testicular hypoplasia, hypospadius, microphallus

Front 56

Risk factors ovarian ca?

Back 56

family hx, nulliparity, lack of prior OCPs

Front 57

Risk factors endometrial adenoca?

Back 57

obesity, nulliparity, late menopause, HTN, DM, chronic unopposed estrogen stim, chronic tamoxifen

Front 58

TMT of nocardia?
FIrst place of manifestation dz?

Back 58

bactrim
-lungs

Front 59

Name the drugs that have mortality benefit as secondary prevention post MI?

Back 59

1.aspirin
2. beta blockers
3. acei
4. statin (lipid lowering)

Front 60

When should clopidogrel be used?

Back 60

pts w/ unstable MI/NSTEMI (at least 1yr)
post perc coronary invervention (at least one month to prevent stent thrombosis)

Front 61

What are the common organisms in viral meningitis?

Back 61

Enteroviruses: echovirus and coxsackievirus

Front 62

Triphasic sharp spikes on EEG=?
Presentation?
Cause?
Dx test
prognosis?

Back 62

Creutfeldt-Jakob Dz (prion)
-progressive rapid dementia, myoclonus, behavior change
-prion (misfolded ptn that convert normal ptn to be like them) cause sspongiform encephalopathy
-Dx w/ EEG showing triphasic spikes
-death w/in 1yr

Front 63

What are risk factors osteoporosis?
One that is most significant

Back 63

modifiable: low estrogen hormone, malnutrition, lo ca, lo vit D, use of steroids/anticonvulsants, immobility, cigs, ETOH use
nonmodifiable: female, aging, small body, early menopause/late menarche (estrogen is protective), caucasion/asian, fam hx
-ETOH IS MOST SIGNIFICANT (dose-dependent increase osteo), obesity is protective since more estrogen, but increases risk arthritis

Front 64

Drugs that cause macrocytic anemia?

Back 64

HYDROXYUREA (sickle cell pts need folate), PHENYTOIN (epilepsy pts), METHOREXATE (chemo pt or autoimmune pt), TRIMETHOPRIM (abx pt), ZIDOVUDINE (AIDS pt)

Front 65

Fetus in distress (late decels) + preterm labor.
TMT?

Back 65

regardless of gestational age->EMERGENT C-SECTION (anytime fetus is in distress)

Front 66

What factors is vit K needed for?

Back 66

II, VII, IX, X, ptn C, Ptn S (so any dz causing malabsorption of fat soluble vitamins: celiac, chronic pancreatitis, CF->deficiency)

Front 67

What are the first things that should be given to the disoriented pt walking into the ED?

Back 67

Thiamine-prevent Wernickes
Dextrose-prevent hypoglycemia
Supplemental O2-prevent hypoxia
Naloxone-prevent opiate overdose

Front 68

Differentiate gonnococcal arthritis from reactive arthritis

Back 68

Reactive: triad of arthritis (knee, sacroiliac (apophyseal joint)->usually asymmetric), urethritis, conjunctivits, EXTRAS: mouth ulcers, enthesitis (achilles tendon pain)
Gonn: triad of dermatitis, tenosynovitis (usually wrist/hand), migratory polyarthritis assymetric->single septic arthritis

Front 69

TMT of gout attack?
Chronic TMT?

Back 69

-NSAIDS (indomethacin)->steroid injection (oral if mult joint)->Colchicine (if the other two contraindicated, renal insufficiency contrai for nsaid)
-Chronic
1. diet (low ETOH, lose weight, low meat/purines)
2. stop thiazides, aspirin, niacin (use losartan for HTN)
3.Colchicine (SE of diarrhea/naus, agranulocytosis)
4. Allopurinol (safe w/ renal, but can cause SJS/TEN)
5. Febuxostat (same as allopurinol but no SJS)
-All these can cause hypersensitivity rxn (rash, hemolysis, allergic intersitial nephriits)

Front 70

Oddities of lupus anticoagulant/anti-phospholipid ab?

Back 70

1. slightly prolonged PTT (Immunoglobs prolong PTT by binding phospholipids in the assay->seen in Russell viper test to specifically test for lupus anticoag)
2. normal vWF, bleeding time, plt count, PT/INR
3. D-dimer hi to normal (from blood clots)

Front 71

What is the most significant risk factor cancer?
Others?

Back 71

SMOKING
-male, >50yo, black, chronic pancreatitis, diabetes, obese, familial

Front 72

Clubbing in COPD=?

Back 72

MALIGNANCY (not hypoxemia)->check for lung cancer!!!

Front 73

What is conn's syndrome?
What are the metabolic acid-base and electrolyte changes?

Back 73

Primary hyperaldo (likely from adrenal adenoma)
-hypokalemia, hypernatremia, HTN, metabolic alkalosis (w/ hi serum bicarb)

Front 74

TMT for claudication?

Back 74

aspirin, smoking cessation, Cilostazol (antispasmodic antiplt w/ best efficacy)

Front 75

Pt w/ claudication sx w/ ABI 1
Next step?

Back 75

ABI after excercise

Front 76

TPN can cause what as a complication (why)?

Back 76

gall bladder stasis from lack of CCK release in GI (needed for stimulating gallbladder contraction and is secreted in dudoenum when ptn and fats present, not in TPN)->leads to gallstones and bile sludge->cholecystitis

Front 77

Elderly gets orthostatic hypotension.
What age-related change causes this?
Other age related changes?

Back 77

decreased baroreceptoor sensitivity (from arterial stiffness decreases norep content nerves causes reduced sensitivity myocard to sympathetic stim)
-decreased max cardiac output/HR, increaxed contraction and relaxiation time, decreased myocytes, increased myocardial stiffness in diastole, pigmentation of myocardium, decreased GFR promoting Na retention

Front 78

When lidocaine is used to treat anything outside of vfib/vtach, what happens?

Back 78

increased risk asystole

Front 79

When to get mammogram screening?

Back 79

50 to 75 every 2 yrs

Front 80

What is contraindication for succhinylcholine?
What to give instead?

Back 80

Hyperkalemia (since drug causes signif K release, and can lead to arrhythmia in those predisposed): crush/burn injury >8hrs old (rhabdo risk), demylinating syndromes (GBS), tumor lysis syndrome
-Give vecuronium or rocuronium (nondepolarizing agent)

Front 81

What is the tmt for central retinal artery occlusion?

Back 81

Emergency: immediate ocular massage (to dislodge the emoblus), hyperbaric O2 (hi flow oxygen) or Carbogen therapy (5%CO2 w/ 95% O2) early on

Front 82

Name and differentiate 3 common bone tumors in kids and age?

Back 82

Osteosarcoma (malignant, most common): 13-16yo BOYS, sunburst and codman triangle at metaphysis long bones w/ soft tissue mass, up Alk phosph and LDH (higher =worse prog)->tmt surgery and chemo
Ewing Sarcomea (rare but 2nd common bone): adolescent BOYS, XR w/ osteolytic lesion and onion skin periosteal rxn, at diaphysis long bone, small blue cell on bx->CHEMO
Osteochondroma (exostosis-benign): under 25 MEN, bature bony outgrowth

Front 83

What's another name for IV NS?
For IV albumin?

Back 83

Intravenous crystalloid!
colloid=thick stuff

Front 84

Pt took cocaine, found on floor passed out brought to ED.
CPK elevated=?
risk factors
this puts him at risk for?

Back 84

rhabdomyolysis
-immobillization, cocaine (vasoconstrictor)
-acute renal failure

Front 85

When pt gets pRBCs and starts to wheeze immediately in min, then resp distress and LOC
What caused this?
TMT?

Back 85

Anaphylactic rxn (think IgA deficiency)
-stop infusion, give epi, IV fluids, possibly vasopressors

Front 86

What is tmt for person comes in agitated, dilated eyes, L side chest pain, EKG w/ ST depression and T wave inversion in V4-6, negative cardiac enzymes?
ML Dx?

Back 86

Cocaine intox
-IV diazepam and supplemental O2 (relieves anxiety/agitation, reduces BP and HR)
-Then aspirin (prevent thrombus), CCB and nitrates (vasodilatory for cocaine-induced vasoconstriciton)
NEVER BETA BLOCKERS

Front 87

What are lab indications to check thyroid levels?

Back 87

hyperlipidemia (esp LDL), hypOnatremia (hypothyroid->inappropriate hi ADH), hi serum muscle enzymes (myopathy), anemia (pernicious anemia from chronic autoimmune thyroiditis)

Front 88

What seen in cervical spondylosis?

Back 88

Pt >50yo, has chronic neck pain w/ limited neck rotation/lateral bending (from osteoarthritis), getting sensory deficit (osteophyte induced radiculopathy), will see bone spurs and sclerotic facet joints

Front 89

What is best diagnostic test if suspect chronic pancreatitis?
TMT?

Back 89

CT scan abdomen showing calcifications pancreas (Amylase/lipase may be low to normal)
-pain management, stop smoking and ETOH, small frequent meals, pancreatic enzyme supplement

Front 90

Pt w/ blunt abdominal trauma initial FAST negative now hypotensive w/ L shoulder pain, epigastric discomfort, nausea
ML Dx?
Dx test?

Back 90

Splenic rupture (kehr sign is pain from splenic hemorrhage irritatign diaphragm going to shoulder)
-do CT w/ VI contrast (since U/S already done)

Front 91

Pig=?
Tell me the rest

Back 91

Cysticercosis (pork tapework Taenia solium), larvae ingested in undercooked pork->taenesis or carrying of larvae->ppop->people eat infected human feces->infect human GI wall->disseminate hematogenously to BRAIN (neurocysticercosis/NCC), MUSCLE (myositis and atrophy), EYE, subcu tissue (firm painful nodules) (now cysticercosis)
NCC=multiple small fluid filled cysts in brain parenchyma, neuro sx or 80% asymptomatic till found on brain bx)

Front 92

Pt w/ neck and facial pain, fever, chills, inxn on neck now draining w/ erythema and induration, gram stain shows gram+ branching bacteria.
ML dx?
Pathophys
TMT?

Back 92

Acinomyces-anaerobic gram + branching w/ sulfur granules (the drainage will appear yellow)
-causes infxn cervicofacial thoracic or abd region w/ drainage-slow growing nontdender w/ sinus tracks causing drainage
-hi dose IV penicillin 6-12wks

Front 93

Pt s/p coronary art bypass w/ 10U pRBCs, now POD 2, develops jaundice, normal AST/ALT, alk phosph 335, tbili 9.2
ML Dx?

Back 93

POstoperative cholestasis: benign condition after surgery w/ hypotension and lots of blood loss (jaundice 2/2 increased pigment load in transuion, decreased liver function from hypotension, and decreased renal bili excretion from tubular necrosis)

Front 94

Pt w/ scaling in toe webs in foor w/ KOH prep showing hyphae, now w/ pain in calf w/ swelling warm tender not well demarcated w/ linear streaks of erythema, temp 103.1, chills, rigos
ML Dx?
TMT?

Back 94

Cellulitis (staph vs. strep) caused by tinea pedia is toes (can give terbinafine or itraconazole to resolve that)
-TMT w/ IV nafcillin or cefazolin (inpatient since systemic toxic findings: rigors, chills, confusion, hi fever), if outpt give po dicloxacillin

Front 95

Pt w/ vitamin B12 deficiency.
Concern for what long term complication?

Back 95

gastric ca, since pernicious anemia is most common cause B12 deficiency (causes by anti-IF ab and chronic atrophic gastritis decreasing IF production in gastric parietal cells->increased risk gastric cancer x3)->monitor w/ periodic stool tests for blood

Front 96

Boy w/ fever, sore throat, posterior cervcial lymph nodes, treated w/ penicillin therapy, improved, now 10days later has fever, skin rash, joint pain, scattered urticaria, and lymphadenopathy.
ML Dx?

Back 96

Serum sickness-like immune-complex mediated hypersensitivity rxn to abx (common when kids w/ viral illness treated w/ abx, esp penicillin, amoxicillin, bactrim, and cefaclor)
-NOT a true drug allergy

Front 97

pregnant mom 18wga, has quad screen shows up MSAFP.
Next step?

Back 97

ultrasound to confirm the test, gestational age accuracy, r/o nonviable pregnancy or multiple gestations
-follow this w/ amniocentessis to confirm

Front 98

What are risk factors for placental abruption?

Back 98

cocaine use, HTN (of any kind, gestational, chronic, pree), ETOH, smoking, diabetes, SLE

Front 99

Cutoff for symptomatic carotid stenosis and asymptomatic for surgery?

Back 99

asymptomatic >60 (men >80 best)
symtpomatic >50

Front 100

What is typical presentation of coarctation of aorta?

Back 100

Pt w/ unremitting HTN, epistaxis, HA, blurred vision, EKG findings of LVH (increase voltage QRS complex and ST and Twave changes in L precordial leads)
-In young pts, always do simultaneous palp of brachial and femoral pulses for brachial-femoral delay and do BP in upper and lower extrem

Front 101

Can you give nifedipine post STEMI?

Back 101

NO: contraindicated since causes vasodilation and reflex tachy

Front 102

What meds to all pts w/ acute MI?

Back 102

Heparin, ACEi, B blocker, Aspirin

Front 103

Pt w/ hx of megacolon, now w/ prominent cardiomegaly.
ML Dx?

Back 103

Chaga dz (PROTOZOAL dz from trypanosoma cruzi)->can cause megacolon/megaesophagus/dilated dardiomegaly