Uworld 7/5/13

Front 1

Pt w/ hazy cornea w/ central ulcer, stromal abscess. Hypopyon present.
ML Dx?
What is hypopyon?
Story preceding this usually?

Back 1

Bacterial keratitis
-pus collection in anterior chamber eye
-contact wearers following corneal trauma or foreign body entering

Front 2

Opthalmic nerve is what branch of what?

Back 2

1st branch of trigeminal (V1)

Front 3

Test for corneal abrasion?

Back 3

slit lamp shows it

Front 4

Who gets fungal keratitis?
What does it look like?

Back 4

agricultural worker or immunocompromised
-multiple stromal abscesses (stroma is area within corneal layers)

Front 5

20yo M w/ up Ca, normal or increased PTH= what 2 possible things?
How to tell them apart?

Back 5

Familial Hypocaciuric Hypercalcemia (aut dom condition) vs. Primary hyperparathyroidism

Do24hr urine calcium (will be elvated in hyperPTH, but not in FHH) TMT of hyperPTH is parathyroidectomy, but no tmt for FHH (benign asymtpomatic)

Front 6

Pt w/ stroke.
Dx test?
TMT based on time and test result?
Followup?

Back 6

noncon CT
-if <3-4.5hr: thrombolytic tPA
-if >4.5hr: aspirin (already on it->add dipyridamole or switch to clopidogrel
-if hemorrhagic nothing
Followup w/ echo (if damaged valve->repair, if thrombus->heparin followed by warfarin INR 2-3, patent FO, ASD)
EKG (if afib->warf 2-3INR, if not ->holter 24hr for arrythmia)
Carotid duplex (if >70%->repair w/ CEA, under 50% meds)
Control DM w/ A1C <7%, HTN, LDL under 100 w/ statin, smoking cess

Front 7

pleural plaques on CXR=?
who gets it?
Risk of?
findings on dx test?

Back 7

asbestosis
-shipyard, mining, construction, insulation, pipe work (can take >20yrs to start)
-lung ca, malignant mesothelioma
-Restrictive w/ lo FVC, lung volume, diffusion cap, pulm compliance, up FEV1/FVC ratio >80%

Front 8

What is normal jugular venous pressure?

Back 8

<10cmH20 (JVD is normal at <3cm)

Front 9

Describe typical findings of coccidiomycosis?

Back 9

pulmonary mostly w/ fever fatigue weight loss dry cough pleuritic chest pain
Cutaneous: erythema multiforme, e. nodosum, arthralgias common
-Look for pt in southwest US or central/south america

Front 10

What is seen in histoplasmosis?

Back 10

in ohio and missiissipi riv valleys, Acute PNA in 10%)

Front 11

What is seen in blastomycosis?

Back 11

Chicago plasmosis or blasto-dermatitis are alternative names
-PROSTATITIS, pna findings, bones and joint, skin ulcers
-IMMUNOCOMPROMISED only

Front 12

What is seen in aspergillosis?

Back 12

immunocompromised w/ caviatry lung lesions on CXR, pulm nodules w/ 'halo sign' or 'air crescent', invasive pulm dz w/ hemoptysis, cough, SOB, hi fever

Front 13

cryptococcus usually causes what?
who gets it?

Back 13

meningoencephalitis after atypical pulm phase w/ cough and maybe chest pain in HIV <200

Front 14

72 Pt w/ urinary retention and absent bilat achilles reflex.
ML Dx?

Back 14

Enlarged prostate (cord compression causes incontinence not retention)
-old people lose their reflexes typically (don't be shocked by this)

Front 15

Who typically gets myocarditis?
When?
Cause usually?
Presentation?
Dx test?
TMT

Back 15

infants and young children
spring and summer
-viral (enterovirus #1), toxin, autoimmune
-flulike syndrome->resp distress-acute heart faiure (may have cardiomegaly on CXR, holosystoic murmur of mitral regurg suddenly, hepatomegaly from congestion, decreased O2 perfusion w/ pulm edema)
-echo for initial, myocardial bx is gold standard
-Put kid in ICU for acute decomp and arrythmia

Front 16

Strawberry tongue=think what dzs?

Back 16

Scarlet fever vs. kawasaki vs Toxic Shock (staph scalded skin has no strawberry tongue->no mucus membrane involved, immediate rash only)
-kawasaki has unremitting fever>5 days despite aspirin and desquamating rash later (scarlet fever does not)
-TSS has shock type sx (w/signs organ failure), hx of condom or nasal packing, desquamates >1-2wks
-

Front 17

What is contraindication of ACEi in pregnancy?

Back 17

fetal renal agenesis and feal death

Front 18

Best initial tmt of mild pree?

Back 18

bed rest at home w/ close followup (methyldopa if HTN does not improve or exceeds 160/110)

Front 19

Where is pes anserine bursa?
Signs of bursitis?
TMT?

Back 19

Medial tibia just below the knee
point tenderness (may be agravated at night by sleeping on side w/ knees making contact)->no tests will cause it pain, XR normal
-rest ice maneuvers to reduce (steroid inject if bad)

Front 20

Pt w/ swelling directly over patella, point tenderness on it and pain.

Back 20

Prepatellar bursitis (will see swelling) usually from trauma, tmt w/ rest ice, steroid inj if bad

Front 21

What worsens patellofemoral pain syndrome?

Back 21

Runners Knee: activity, and prolonged sitting (sustained flexion)
may have crepitus on patellar motion

Front 22

What drugs cause drug-induced esophagitis?

Back 22

Tetracyclines
NSAIDS, aspirin
Alendronate
Potassium Chloride, quinidine, iron

Front 23

What are signs of cortisol deficiency?

Back 23

weakness, fatigue, loss of appetite, EOSINOPHILIA, decreased libido (not seen in hypothyroid)

Front 24

Differentiate central (secondary) adrenal insufficiency from primary adrenal insufficiency?

Back 24

Primary ahs hi ACTH and melanocyte stim hormone->hyperpigmentation, salt wasting, hyperk

2ndary does not have salt wasting or hyperk since aldo is ACTH independent (uses renin-aa system) and no hyperpigment since no MSH

Front 25

elevated alpha subunit TSH=?

Back 25

rare TSH-secreting pituitary adenoma

Front 26

Signs of a SEVERE asthma attack?

Back 26

normal pco2 (pt giving up), silent lungs, cyanosis, speech difficulty, AMS

Front 27

Define fulminant hepatic failure
TMT?
Contraindications?

Back 27

hepatic encephalopathy w/in 8wks of acute liver failure (marked increase ALT, up PT, coagulopathy)->usually caused by ETOH, acetaminophen and hepB or D
-Emergent Liver transplant
-irreversible cardioplm dz, incurable malignancy (or <5yr onset), ACTIVE ETOH or substance use

Front 28

Differential of abnormal uterine bleeding?
Dx tests?
When to do uterine bx?

Back 28

PALM COEIN (polyp, adenomyosis, leiomyomata, malignancy/hyperplasia endometrium, coagulopathy (von-willebrand), ovulatory dz (PCOS, hypothyroid, cyst), endometritis/ashermans/atrophy, iatrogenic, not yet classified (pregnant/ectopic/miscarriage->unlikely if intermenstrual)
Test: pap, TSH/prolactin/FSH, PT/PTT/INR, plts, factor VIII, endo bx, pelvic u/s, bHCG, LH:FSH
Bx if: >35yo, obese, chronic HTN, diabetic

Front 29

TMT of abnormal uterine bleeding if uterine bx negative and all organic dz ruled out?

Back 29

cyclic progestins
-if failed: endometrial ablation or hysterectomy

Front 30

Chronic smoker developing sudden bilat clubbing and joint-arthropathy in wrists, w/ decreased breath sounds and prolonged exp phase
ML Dx?
Dx Test?

Back 30

Hypertrophic Pulmonary Osteoarthropathy (HPOA, HOA can occur in smokers w/out lung dz as just arthropathy but clubbing indicates likely underlying lung cancer)
CXR

Front 31

What are characteristic lab and bx findings in goodpasture's?
Clinically?
TMT

Back 31

Anti-GBM ab
linear depositis on glomeruli
-hemoptysis (may cause anemia), hematuria
-plasmapheresis and steroids

Front 32

What is pathophys of Berger's dz?
Classic story?
TMT?

Back 32

IgA immune complexes to glomeruli (dx w/ bx)
-asian pt w/ gross hematuria 1-2days after URI (may even be strep infxn, whereas poststrep glomer. is 1-2WKS after)
-no TMT (usually resolves), give ACEi and steroids for severe ptnuria

Front 33

What is the pathophys of poststrep glomerulonephritis?
Presentation
TMT?

Back 33

circulating immune-complex mediated
1-3wks after strep throat OR SKIN infxn, dark urine, periorbital edema, HTN, U/A w/ ptnuria, rbcs, rbc casts, lo complement level
confirm w/ ASO titer and anti-DNAse ab
-Abx and diuretics (for fluid overload

Front 34

Pt w/ nephrotic syndrome w/ bx showing C3 and intramembranous deposits=?
What is the pathophys?

Back 34

Type II membranoproliferative glomerulonephritis
-persistent activation of alternative complement pathway by IgG antibodies (called C3 nephritic factor)->lead to kidney damage

Front 35

patient recently dxed w/ polyarteritis nodosa.
TMT?
Check for what?

Back 35

Prednisone and cyclophosphamide
-screen for HepB

Front 36

TMT of nephrotic syndrom?

Back 36

Steroids (if not working after several wks->cyclophoshamide)
-ACEi/ARB for proteinuria
-salt restriction/diuretic for edema
-Statin for hyperlipidemia

Front 37

What is the hematologic findings in SLE?

Back 37

warm IgG autoimmune hemolytic anemia (see spherocytosis, coombs +, extravasc hemolysis), ITP-type thrombocytopenia, neutropenia from ab-mediated destruction (less common but can occur)

Front 38

What is good intensity for working out in pregnancy?

Back 38

up to 30min, intensity of 12-14 out of 20 or such that you are able to carry on conversation

Front 39

TMT of disk herniation or any 'mechanical back pain'?

Back 39

early mobilization and NSAIDs

Front 40

Type I vs Type II mobitz block?

Back 40

Type I (wenckebach): PR increases gradually until QRS dropped (in dig tox, increased vagal tone, inferior wall MI, athlets, old adults)

Type II has same PR intervalw/ sudden QRS drop

Front 41

What is posttransplant ppx?

Back 41

Bactrim (not azithromycin) to prevent PCP
-vaccinate agains infuenza, pneumococcus, hepB

Front 42

Pt w/ subacute bacterial endocarditis senstivite to penicillin.
TMT?

Back 42

IV!!!! penicllin or ceftriaxone (not oral since doesn't work)

Front 43

What causes secondary amenorrhea in elite female athletes?

Back 43

estrogen deficiency (from inadequate nutrtion->low LH and GnRH)

Front 44

Hordeolum vs stye vs chalazion vs dacrocystitis?

Back 44

Hordeolum is Stye: infxn sebaceous cyst, tender, upper or lower eyelid, staph aureus, abx and warm compress
Chalazion: obstructed meibomian gland w/ ganulomatous inflammation, hard, NONtender, warm compress and drain
Dacrocystitis: of medial canthus, tender, infxn lacrimal sack (infants and adults>40), staph or strep, po abx

Front 45

When to get DEXA scan?

Back 45

All women >65yo

Front 46

Pt had colonoscopy w/ hi risk polyp removed.
Followup?

Back 46

rpt colonoscopy every 3-5yrs

Front 47

What precipitates Rosoacea?
TMT?

Back 47

hot drinks, heat, emotion, rapid temp chang->flushing of cheeks, nose, chin w/ papules/pustules + telangiectasia
-topical metronidazole

Front 48

Describe 2ndary syphilis?

Back 48

diffuse maculopapular rash starting in trunk spreading to involve face, palms, soles w/ general lymphadenopathy and constitutional sx

Front 49

Pt treated w/ penicillin for syphilis yesterday now w/ hi fever, HA, and muscle pain.
ML Dx?

Back 49

Jarisch-Herxheimer rxn (w/in 24hrs of treating syphilis) from brreakdown and release of trepenomal contents

Front 50

infant who has had wheezing and SOB since birth, treated w/ bronchodilators and steroids that did not help, wheezing improved on neck extension.
ML Dx?

Back 50

Vascular ring (from double aortic arch, R side aorta, pulm sling, anomalous innominate artery. Improves on neck extension, worse while supine. Surgery if sever leading to strido

Front 51

What heme disorder is seen in ESRD?
TMT?

Back 51

Anemia from no epo (normocytic normochromic hypoproliferative)
-Give supplemental Epo AND IRON (since epo surge will deplete stores fast)

Front 52

3 things in differential for polyuria?

Back 52

Osmotic diuresis (glucose, mannitol)
Primary polydypsia
DI (nephrogenic vs. central)
Dx w/ Uosm->water deprivation->DDAVP tests

Front 53

Name the 6 things of anorexia?

Back 53

1. osteoporosis
2. hyperlipidemia and hyper carotene
3. euthyroid sick syndrom
4. prolonged QT
5. amenorrhea, low estrogen, anovulation
6. hyponatremia from excess water drinking

In pregnancy: premature, small for gest age (IUGR), postpartum depression, hyperemesis gravidum

Front 54

Levels in pseudohypoparathyroidism?
Levels in x-linked hypophosphatemic rickets?
Levels in renal failure 2ndary hyperparathyroidism?
Levels in osteomalacia or rickets?

Back 54

1.lo Ca, hi PO4, hi PTH, normal alk phosph, normal vit D
2.norm Ca, lo PO4 (from renal PO4 wasting), norm PTH, norm alk phosph, norm vit D
3,lo Ca, hi PO4, hi PTH, lo vit D, norm alk phosph
4.lo Ca, very lo PO4, hi PTH, lo vit D, HI alk phosph

Front 55

When does papillary muscle/free wall/interventricular wall rupture usually occur after MI?
What about Dressler's syndrom?
What about acute pericarditis?
What can occur months after presenting w/ new mitral regurg?

Back 55

3-7days after
wk-mos after (immune mediated pericarditis)
1-3days
Ventricular aneurysm (will be identical to wall rupture in presentation)

Front 56

What are the dietary recommendations for pts w/ renal calculi?

Back 56

1. decrease ptn and oxalate intake
2. decrease sodium intake (Na enhances Ca excretion)
3. increase fluids
4. increase dietary ca (or at least include it)

Front 57

What presents identical to malaria but you can get it in New York?!
Presentation?
Transmission?
Kind of patient?
Dx Test?
TMT?

Back 57

Babesiosis-parasite (in northeast USA)
-flu-like, jaundice (from hemolytic anemia), hemoglobinuria, drenching sweats, RENAL FAILURE
-Ixodes tick (look for hx tick bite)
-over 40 w/ hx of SPLENECTOMY, immunocompromised
-Giemsa stain
-Quinine-clindamycin or Atovaquone-azithromycin

Front 58

What is the nickname for ehrilichiosis?

Back 58

spottless Rocky Mountain Spotted Fever

Front 59

What is Q fever?

Back 59

Coxiella burnetii from cattle, goat, sheep (meat processing workers and vets get it)->flu-like synd, hepatitis, pna

Front 60

TMT for chronic hepB w/ up ALT?
for chronic HepC w/ up ALT?
For normal LFTs in hepB?
for normal LFTs in hepC?

Back 60

-interferon alpha and ribavirin
-interferon alpha and lamivudine
-none
-none

Front 61

After labs have detected a conjugated hyperbilirubinemia in a pt w/ asymptomatic icterus, next workup step?

Back 61

U/S abdomen or CT
-if these show nothing, then ERCP or perc trans cholangiogram

Front 62

Philadelphia chromosome is what?

Back 62

abnormal chromosome 22 (translocation of 9 & 22)->BCR-ABL genee
in CML
Treat w/ imatinib (gleevec) tyrosine kinase inhibitor

Front 63

Wehn do you use all-trans retinoic acid tmt?

Back 63

APML

Front 64

Eye motor and sensory innervations and eyelid?

Back 64

Opthalmic V1: sensory scalp, forehad, upper eyelid, conjunctiva, cornea, nose, frontal sinus->damage makes you prone to corneal injury
Optic II: vision
Oculomotor III: eye movement (most), eyelid opening, pupillary constriction->damage cause ptosis, anisocoria, impaired eye adduction

Front 65

What is seen in CSF of MS pts?

Back 65

oligoclonal bands (immunoglobulins IgG mostly, some IgM and IgA)

Front 66

albumino-cytologic dissociation=?

Back 66

guillain barre-syndrome (elevated ptn and normal cell count)

Front 67

Name the 3 invasive fetal monitoring tests, when they can be done, and what for?

Back 67

-chorionic villus sampling: 10-13wga, for advanced maternal age >35yo, to obtain fetal karyotype early after abnormal u/s, more risky than amnio
-amniocentesis: >14wga, for same indications, safer
-fetal blood sampling (perc umbilical blood sample): done for pts w/ Rh isoimmunization or fetal anemia suspected

Front 68

Name 5 factors of infertility
Algorithm for testing?

Back 68

ovulatory (PCOS, primary ovulatory failure, hypothyroid), uterine (fibroids, septate uterus), tubal (hx G or C, PID), peritoneal (endometriosis), male (mumps, hernia, varicocele)
-1yr unable conceive->semen analysis (+ is male)->irregular menses?
yes->check basal body temp, midluteal serum progest, LH: FSH, TSH (ovulatory->give clomiphene citrate, if POF check antimullerian hormone)
no->hysterosalpingogram->normal (endometriosis->dx w/ lap and ablation)
nonpatent tubes+hx g&C->tubal->laparoscopic tmt w/ intraU fertilization
->fibroids->treat

Front 69

unrestrained driver in car accident w/ CXR show alveolar opacities=?

Back 69

Pulm contusion from steering wheel (can be bilateral here), don't give large volume IV fluid since makes it worse

Front 70

Down syndrome is related to what?
When does this occur?
Presenting signs/sx?
Dx Test?
TMT?

Back 70

Hirschsprungs dz
-don't pass meconium 1st 48hrs, rectal w/ tight anus & explosion of stool/gas, extreme constipation/distension
-XR w/ distended bowel loops, barium enema to determine level obstruction, rectal full thick bx is gold standard to dx (aganglionic cells in submucosa)
-Surgery

Front 71

What is gestational trophoblastic dz?
When to suspect?
Types and presentation?
Dx test?

Back 71

abnormal tissue neoplasia in younger women
-women after normal pregnancy/abortion/molar, w/ irregular bleeding/enlarged uterus/pelvic pain 8wks postpartum
-invasive gest troph neoplasia (GTN)->local invasion
-choriocarcinoma->metastatic to lungs (will see on CXR)
-Check bHCG

Front 72

When to evaluate primary amenorhea?
First test

Back 72

if normal secondary sex characteristics->16
if no normal->14
FSH level (if there is no 2ndary sex characteristics and normal pelvic exam)->if up do karyotype, if down do pituitary MRI

Front 73

Dx test to evaluate precocious puberty?

Back 73

GnRH stim test

Front 74

What's the technical term for osgood schlatter dz?
Who gets it?
Dx Tests?
TMT?

Back 74

traction apophysitis
-adolescent MALE athletes w/ running/jumping sports
-pain on extending knee against resistance, XR w/ anterior soft tissue swelling or irrgularitiy in shaft/tubercle
-activity restriction, stretching, NSAIDs

Front 75

Pt dxed w/ HIV has low CD4 count.
Should he get vaccines?

Back 75

he should not get live vaccines including BCG, anthrax, po typhoid, intranasal flu, po polio, yellow fever.

One EXCEPTION: Can get MMR as long as CD4 >200 (since at hi risk for getting measles)

Front 76

What is the acid-base irregularity seen in seizures?
TMT?

Back 76

anion gap metabolic acidosis from lactic acidosis of muscles->transient
-TMT is observe and rpt labs in 2hrs (usually resolves w/in 90min)

Front 77

How to tell if gastroenteritis (stomach flu) is from what organism?

Back 77

-if febrile=infectious (shigella, salmonella, yersinia, campylobacter, e coli-travel hx, giardia-camping/hiking/smelly, c. dif-hospital/abx/sick)
-if afebrile w/ ACUTE presentation=pre-formed toxin (s. aureus vs. bacillus cereus)
--if s. aureus: look for hx salad (mayo product), cream filled pasty, milk, dairy, meats, eggs
--if b. cereus: look for re-heating of starchy food

Front 78

What are 3 methods to control confounders?

Back 78

matching, restriction, randomization

Front 79

How do you control observer's bias?

Back 79

blinding the study

Front 80

How do you control selection bias?

Back 80

choosing representive sample of the population and having hi rates of followup

Front 81

How do you control ascertainment bias?

Back 81

having strict protocol for case ascertainment

Front 82

What is acanthosis nigricans associated w/?

Back 82

insulin resistance (PCOS, obese, DM)
GI and GU malignancy (will see weight loss in these pts in contrast to insulin resistance)

Front 83

What are perianal skin tags associated w/?

Back 83

Crohns dz

Front 84

What are multiple skin tags associated w/?

Back 84

insulin resistance (PCOS, obesity, DM)
Pregnancy

Front 85

What dz porphyria cutanea tarda associated w/?

Back 85

HepC

Front 86

What dz is severe seborrheic dermatitis associated w/?

Back 86

HIV infxn

Front 87

What dz is sudden-onset severe psoriasis associated w/?

Back 87

HIV infxn

Front 88

What is the exlposive onset of multiple itchy seborrheic keratoses associated w/?

Back 88

GI malignancy

Front 89

Herpetic whitlow is associated w/ what career?
Dx Test?
TMT

Back 89

healthcare workers/dentist (NOT sex workers)
-Tzanck smear w/ multinucleated cells
-po acyclovir and topical bacitracin (to prevent 2ndary infxn

Front 90

What is a felon?
Who gets it?
TMT?

Back 90

bacterial infxn distal volar space feels like tense abscess w/ throbbing pain
-Tailors, from needle injury
-I& D and cephalosporin

Front 91

Diagnostic criteria for spont bacterial peritonitis?
-Who is at hi risk from getting this

Back 91

From paracentesis: PMN count>250 and positive ascites culture (confirm is ascites by SAAG>1.1)
-cirrhotic pts

Front 92

Pt gets fatty liver (steatosis) after alcohol ingestion and promises to quit drinking.
Will it resolve?

Back 92

Yes, as long as pt is abstinent

Front 93

What is tmt of vaginismus?
What is it?

Back 93

Kegel excercise and gradual dilation to bring desensitization, also relaxation
-involuntary contraction perineal muscles

Front 94

Pt w/ hematuria and scrotal varicocele that does not resolve when recumbant=?
What other dzs can be associated with this one?

Back 94

most likely RCC->do CT scan
-lo epo->anemia, thrombocytopenia
-or ectopic production epo->polycythemia
-hypercalcemia

Front 95

Pt w/ recurrent sinopulmonary infxns and pseudomembranous colitis infxn.
Dx test?

Back 95

quantatative measure of serum Ig levels (recurrent bacterial infxns indicate possible humoral immune deficiecny w/ loss of IgG, IgA->most common in women, etc.)

Front 96

Side effects cyclophosphamide?
preventative tmt?

Back 96

bladder ca!, hemorrhagic cystitis, sterility, myelosuppression
-drink fluids, void lots, take MESNA

Front 97

Pt gets cochlear dysfunction and on lots of meds.
Which ones may have done this/

Back 97

cisplatin, carboplatin, aminoglycosides

Front 98

Pt w/ optic neuritis on lots of meths.
Which ones may have done this?

Back 98

ethambutol (used in TB for RIPE), hydroxychloroquine (for SLE and malaria)

Front 99

Pt w/ digital vasospasm (raynauds) on lots of drugs.
Which ones may have done this?

Back 99

beta-blockers, ergotamine (used to treat migraines)

Front 100

Differentiate Tropical sprue vs. whipple's vs. celiac dz

Back 100

Tropical:

Front 101

What is seen in xray in pulm htn

Back 101

enlarged pulmonary arteries w/ rapid tapering of distal vessels (pruning) and enlarged R ventricle

Defined as mean pulm art pressure >25 at rest or >30 during excercise

Front 102

Where do most subarrachnoid hemorrhages occur?

Back 102

ruptured saccular aneurysm in anterior circle of willis

Front 103

Pt w/ hx of SLE on steroids, postop immediately found to have naus/vom/acute abd pain, bp 70/40, HR 110, glucose 50
ML Dx?

Back 103

Acute adrenal insufficiency (think about it in any pt who is exogenous steroid-dependent put thru stress like surgery)

Front 104

What is a howell-jowell body look like?
When do you get it?

Back 104

on peripheral smear: rbc w/ single, round, blue inclusion on Wright stain
-splenectomy, splenic infarcion

Front 105

What are the mostlikely organisms in septic arthritis and indicated tmts?

Back 105

birth to 3mo: GBS, gram neg rods (e.coli), staph->tmt w/ antistaphylococcal (nafcillin vs vanco) PLUS gentamicin or cefotaxime

Older 3mos: Staph, group A strep, strep pneumo->tmt w/ nafcillin, clinda, cefazolin, or vanco

Front 106

Describe the rash in disseminated gonococcal infxn?

Back 106

2-10 discrete purpuric or pustular lesions w/ hemorrhagic component and central necrosis occasionaly (blood cx are often negative)

Front 107

What are common side effects of niacin therapy?
Pathophys?

Back 107

cutaneous flushing and puritis
-prostaglandin induced peripheral vasodilation

Front 108

What is the complication of pseudotumor cerebri?
TMT of intracranial hypoertension?

Back 108

Blindness
-weight loss, if fails->acetazolamide->if fails shunt

Front 109

What are the only things that decrease mortality of COPD?

Back 109

1 smoking cessation
2 at home oxygen

Front 110

Amsterdam criteria is for what?
Define it?
What are these pts at hi risk of?

Back 110

Lynch syndrome (HNPCC):
1. at least 3 relatives w/ colorectal ca, 1 is 1st degree of other 2
2.involvement of 2 or more generations
3.at least 1 pt dxed b4 50yo
4familial adenomatous polyposis is excluded
-risk of extracolonic tumors->number one is endometrial ca

Front 111

What is the most common cause of polycythemia (hi RBCs) in a term neonate?
Sx of polycythemia neonate?
TMT?

Back 111

delayed clamping of umbilical cord->increased blood transfer
-respiratory distress, lethargy, irritability, seizures from hyperviscosity
-hydration and partial exchange transfusion (if symptomatic)