Uworld 7/13/13

Front 1

Signs of c. botulinum infxn?
Cause?

Back 1

constipated, poor feed, hypotonia, loss DTRs, impaired gag reflex, resp difficulty, hypotn, neurogen bladder
-ingestion of c. botulinim (honey) in GI tract that then produces toxin that blocks ACh release

Front 2

Klumpke paralysis=?

Back 2

From excessive traction of arm on delivery
Paralyzed hand (claw hand w/ lack of grasp reflex) w/ Horner syndrome (ptosis, miosis, anhydrosis)
-C7-81 +/-T1 (confirm on MRI w/ nerve root avulsion/rupture)
-Immobilize the arm

Front 3

What predisposes baby to facial nerve palsy?
signs?

Back 3

pressure over facial nerve in utero/labor, forceps delivery
-Facial paralysis more noticable on baby crying (usually improves w/ time)

Front 4

Differentiate swelling in newborn scalp

Back 4

cross suture lines=caput succedaneum (swollen soft tissue)
Does not cross=cephalohematoma (subperiosteal hemorrhage)

Front 5

absent moro reflex w/ intact grasp reflex in newborn=?
What is the arm's position?

Back 5

Erb-Duchene paralysis (C5-C6) "waiter tip"
internally rotated adducted w/ pronated forearm

Front 6

Differentiate chronic hep B and C

Back 6

chronic hep C has waxing and waining LFTs w/ arthralgias on occasion (cryoglobulinemia, porphyria cut tarda, ITP, glomerulonephritis, etc.)
Chronic hep B does not wax/wane

Front 7

Hundred of adenomatous polyps in colon=?
Managment?

Back 7

Familial adenom polyposis (FAP): aut dom from mut APC gene
-elective proctocolectomy at time of dx (100% risk ca)

Front 8

What is the most common cause of amblyopia in childhood.
Dx Test/
TMT?

Back 8

Strabismus (medial deviation of eye or esodeviation)
-Do cover test (the normal eye keeps position, but the abnormal one must change to refixate on object)
-TMT w/ covering the normal eye (so prob eye can mature properly rather than go blind)

Front 9

Type of renal problem in HSP?
Dx Test?
TMT?

Back 9

IgA mediated vasculitis (mesangial IgA depot)
-usually clinical but bx w/ IgA depot on immunof in skin or renal (this is a leukocytoclastic vasculitis)
-Resolves by self, steroids if abd pain/renal prob progressive

Front 10

rupture of berry aneurysm=?

Back 10

subarrachnoid hemorrhage (they'll have a HA b4 any neuro findings) So if neuro findings + HTN=basal ganglia/putamen hemorrhage

Front 11

Name physiologic feet/leg problems in newborn that are seen commonly?

Back 11

metatarsus adductus: if overcorrects to abduction when passively or actively moved->reassurance, if only corrects to neutral->orthosis/corrective shoes, if do not correct/rigid->serial castings
internal tibial torsion: reassurance (corrects in 95% cases)

Front 12

In what conditions can you breastfeed and when can't you?

Back 12

Can: mastitis, rubella, breast milk jaundice (only switch to formual for 2ddays and resume), hemolytic dz newborne (erythroblastosis fetalis->ab in milk are inactivated in baby GI tract), Hep B/C, malaria, toxoplasmosis,
Can't: HIV, on HAART/CHEMO/RADIATION, active TB,

Front 13

How to tell it's not marfan's but homocystinuria?
How to tell homocystinuria from phenylketonuria?
TMT of homoc

Back 13

Marfan's + Thromboembolic events/stroke=homocystinuria (also downard lens dislocation), marfans does not have retardation!
-It's cystathionine synthase deficiency
-Phenylk and homo have fair skin, blue eyes, but only phenyl has musty odor & eczema
-TMT w/ hi dose vit D

Front 14

Differentiate papillary muscle rupture vs. free wall rupture post MI

Back 14

Pap muscle: requires RCA infart, 3-5days post MI, have acute pulm edema (SOB) + new holosystolic murmur
Free wall: requires LAD infarct: 5-2wk postMI, have JVD, distant heart sounds, shock from pericardial effusion/tamponade (no new murmur or lung sounds)

Front 15

What is the arrythmia of dig toxicity?

Back 15

atrial tachy w/ AV block
EKG may show downsloping of ST seg in all leads

Front 16

What are common drug-induced causes of pancreatitis and why are pts taking them?

Back 16

diuretics-lasix, thiazides
Seizure/bipolar: valproate
IBD: sulfasalazine, 5-ASA
AIDS: didanosine, pentamidine
abx: metronidazole, tetracyclines
Immunosuprresives: azathioprine, L-aspariginase

Front 17

What are findings/complications of meningococcemia?

Back 17

meningitis, skin petechia/purpura, joint arthralgias, septic appearing
Complication: ADRENAL FAILURE (Waterhouse-friderichsen) and HEMORRHAGE=sudden hypotn and death

Front 18

alternate name of croup?
Cause?
TMT?

Back 18

Laryngotracheobronchitis (LTB)
-parainfluenza
-racemic epi to prevent asphyxiation

Front 19

TMT of croup vs epiglottitis vs whooping cough?

Back 19

Croup: racemic epi (young 0-5yo)
epiglottitis: intubate + ceftiaxone + rifampin to contacts (older children)
Whoop: erythro/azithro if catarrhal stage, isolate, macrolide sto close contacts

Front 20

What is bacillary angiomatosis? TMT
Differentiate from molluscum contagiosum and kaposi sarcoma

Back 20

bartonella (GNR) infxn->bright red fiable exophytic PRURITIC nodules in HIV pt: give po erythromycin
-Kaposi skin lesions are papules (light brown-violet) that become plaques or nodules on trunk/face/extrem
-molluscum contagiosum (HPV): dome papules w/ central umbilication by poxvirus, NONPRURITIC

Front 21

Management of minimal change dz?

Back 21

In kids and hodgkins: empiric steroid therapy (has benign course but frequently relapses after steroids stopped)

Front 22

wide fixed splitting of S2=>

Back 22

ASD (will see no sx) also ejection systolic murmur

Front 23

Types of chronic vs acute prostatitis?

Back 23

acute: irritative voiding, exquisitely tender, bacturia and pyuria on u/a
chronic bacterial: irritative voiding, afebrile, u/a normal, ucx w/ >10wbcs, and +cx
inflammatory chronic: irritative, u/a normal, ucx w/ >10wbc, -cx
non-inflammatory chronic: irritative, u/a normal, ucx w/ <10wbc, -cx

Front 24

fever, chills, L lung base sounds less, LUQ tender, CT w/ fluid colleciton in spleen, wbc count 23500, 65% pmn, 11% band, elevated LFTs
ML Dx?

Back 24

Infective endocarditis! L sided causing septic emboli to spleen (can also go to liver, kidney, brain), possibly Hep C too (suggests IV drug use) Key things=hi WBC, fever chills, and random findings in distant organs from septic emboli in Hi Risk pt=IE

Front 25

Common findings associated w/ types of pna?

Back 25

HiB=COPD
Staph=recent viral/flu
Kleb=alcohol, DM=currant jelly, hemop (necrotizing pna)
Anaerobes=poor dent, demented, aspir=foul rot egg
Myco=young military dorm=dry cough=PCR, cold agglutin, pmn on sputum gram stain
Chlamydi=hoarseness=serologic titers
Legionella=water source/ac=GI diarrhea, HA, confuse=urine antigen/cx charcoal-yeast agar

Front 26

Hemi-neglect = lesion where?

Back 26

R parietal lobe (non-dom parietal lobe)

Front 27

Pt in MVA w/ internal bleeding u/s shows fluid at spleno-renal angle, but is hemodynamically responsive to fluids.
Next Step?

Back 27

Abd CT to document splenic injury in case of need for later surgery

Front 28

What is seen in CXR on staph aureus pna. When do you get it?
Differentiate from bronchiectasis

Back 28

multiple cavitary lesions (acute necrotizing pna w/ 2ndary pneumatocels), it's a super infection w/ bloody yellow sputum, hi fever, the worst stuff.
pna after recent viral URI/influenza
-Bronchiectasis has same sputum production and is also necrotizing, but is chronic w/ dilated bronchi (not cavities)

Front 29

What is pimozide?

Back 29

typical antipsychotic (that or haldol treat tourrettes_

Front 30

When to suspect chorioamniotnitis

Back 30

PPROM or prolonged ROM (no it by amniotic fluid pH 7-7.5 wheras vag fluid is 4-4.5) w/ fever and 1 of: mom HR>100, baby HR>160, mom WBCC >15000, uterine tenderness, foul-smelling amniotic fluid
-Deliver immediately (can be vaginal)

Front 31

Pt when arm abducted past 90 degrees and asked lower arm slowley, suddenly drops when near the 90 degree=?

Back 31

Complete rotator cuff tear (drop arm test)->supraspinatus most likely

Front 32

"popeye sign" =

Back 32

rupture of long head tendon biceps (muscle belly pops up in mid arm w/ weakness on supination but can still flex foream)

Front 33

Differentiate findings nocardia vs. TB vs. actinomyces

Back 33

Nocardia: PARTIALLY acid-fast, gram+ beading rod (filamentous), aerobe in soil: like TB w/ weight loss, fever, night sweats, purulent cough, CXR w/ alveolar infiltrate/nodules and cavitation (even chest wall invasion), disseminates to anywhere but esp subq and brain abscess (look for immunocompromised or steroid user)->BACTRIM
TB: acid fast non branching rods do NOT gram stain (same sx nocardia) w/ cavitary lesion->RIPE
Actinomyces: filamentous gram positive SULFUR granules ANAEROBIC so usually cervicofacial skin and sinus tract dz->PENICILLIN G

Front 34

Management of child swallowing battery?

Back 34

CXR to determine location immediately
if in esophagus->immediate endoscopic removal (prevent esophageal ulceration)
if passed esophagus: observe to confirm excretion in stool

Front 35

Cri du chat=

Back 35

cry of the cat: 5p deletion: cat-like cry, hypotonia, short stature, mental retard, facial abnromalities

Front 36

Steps of tmt for pseudotumor cerebri?

Back 36

1. fundoscopy to routine monitor visual fields
2. weight loss
3. acetazolamide (inhibits chooid plexus carb anhydrase CSF prod)
4. Steroids (if waiting for surgery w/ deteriorating vision)
5. surgery w/ lumboperitoneal shunt (rpted lumbar puncture no longer the norm)

Front 37

1st line tmt otitis media?
for sinusitis?
for pharyngitis?

Back 37

-amoxicillin 10day course (strep pneumo 1, HiB 2)
-amoxicillin-clavulonate (or doxy or bactrim) w/ decongestant
-amoxicillin or penicillin (cephalexin if penicillin rash, clinda or macroolide if pen anaphylaxis)

Front 38

When to worry about neonatal jaundice (5 rules)

Back 38

1. appears 1st 24hrs life (phys jaundice happens day 2 or 3, if day 5 think neonatal sepsis, if b4 1day think erythroblastosis fatalis)
2. rate increase tbili >5mg/hr
3. bili level >12 or 10 in premie
4. jaundice after 10days old
5. conj bili every >2

Front 39

Differentiate hyaline membrane dz vs. transient tachypnea newborn vs. persistent pulm htn newborn vs meconium asp syndrome

Back 39

HMD: PREMATURE, immediate tachyp, grunt, use intercostal/sub muscles, nasal flare, cyanaosis, harsh tubular sound, CXR fine reticular granular esp over bases->mech vent and surfactant administer
TTN: TERM, cyanosis corrects w/ O2, flat diaphragm, fluid lines in fissures, prom vasc marking, pleural fluid
PPHN: TERM, cyanosis, hypoxia not correcting w/ O2, XR normal or opacification
MAS: TERM, resp distress in 1hr after deliver, ptx or pneumomediastinum, increased AP diameter/flat diaphragm (think emphysema findings)

Front 40

2yo w/ otitis media has seizure-like episode for 3 min.
ML Dx?
Criteria
TMT?

Back 40

Simple febrile seizure (common in kids <6yo w/ viral/bacterial infxn, Dtap, MMR)
1. seizure w/ temp >38 (100.4)
2. age <6
3. no CNS infxn
4. no acute systemic metabolic cause
5. no hx of afebrile seizure
-if <15min=simple->treat otitis media and send home,
-if >15min=complex: at risk for future seizures (epilepsy)

Front 41

Rules for chickenpox?

Back 41

usually get it b4 16yo. If exposed, has 10-14day incubation period b4 vesicles, are contagious 48hr b4 vesicles to when all are crusted over and should be isolated throughout. Get vacc w/in 5 days of exposure or not effective, only in immunocompitent. If don't get rash in 2wks, can give vaccine for future. If immunocompromised/pregnant, get VZIG w/in 96hr (does not always prevent infxn but can delay it).

Front 42

What is the cause of grave's opthalmopathy?

Back 42

autoimmune lymphocytic infiltrate of EOM causing fibroblast prolif and hyaluronic acid depot->edema and fibrosis

Front 43

Differentiate roseola from chickenpox.

Back 43

Roseola (Herpes virus 6): fever->5days later maculopap rash trunk spreads periph
Chickenpox (VZV): prodrome (fever/malaise/anorexia)->rash on trunk w/ vesicles that break and scab in crops

Front 44

wedge shaped lesion on CT=?

Back 44

Pulm Embolism

Front 45

1st step in management of a suspected congenital diaphragmatic hernia?

Back 45

place OG tube and put to suction to prevent bowel distention and further lung compression
then CXR

Front 46

Differentiate precocious adrenarche, thelarche, and pubarche

Back 46

adrenarche: activation adrenal glands b4 6yo, have dark axillary hair, benign->no workup
Pubarche: pubic hair growth b4 8yo, alarm->50% time CNS disorder
Thelarche: breast development b4 8yo, benign, no prob

Front 47

Managmenet of possible renal colic?

Back 47

Do pelvic u/s 1st (IVP, CT and shockwave lith are contraI in preg)

Front 48

What is seen in chlamydia conjunctivitis?

Back 48

purulent discharge, later goes to pna 3-19wks after bith (no wheezing or fever->otherwise thing RSV bronchiolitis)
TMT: po erythromycin

Front 49

loud P2=?
Who gets this?

Back 49

endocardial cushion defect (AV canal) causing pulm HTN
Down's syndrome (most common defect in Down's)

Front 50

Large kidneys bilat=(5)?

Back 50

Amyloidosis (look for GI/IBD, psoriasis, RA, chronic infxns, multiple myeloma)
HIV nephropathy
Polycystic kidneys
Diabetes
Renal Cell Ca

Front 51

Differentiate physical exam findings of vaginosis and pH

Back 51

Trichomonas: PRURITIC, INFLAMMED, MALODOROUS, frothy, pH up >4.5
Bacterial vaginosis: nonpruritic, noninflammed, stinky, up pH >4.5
Candida: thick clusters, down pH <4.5

Front 52

How do you treat PEA?

Back 52

start CPR, give O2, attache monitor/defibrillator->if asystole/PEA->CPRx2min, IV access, give epi q3min->shock->CPRx2min, epi q3->shock->CPRx2min, amiodarone push->treat reversible causes->rpt starting at shock

Front 53

5Hs & Ts of PEA

Back 53

Hypovol, hypoxia, H-acidosis, Hypo/perkalemia, hypothermia

Tension pneumo, tamponade, toxin (narcotic/benzo), thrombus, trauma

Front 54

Differentiate milia and erythema toxicum and sebaceous hyperplasia

Back 54

milia: small pearly white cysts on baby usually around nose
sebaceous hyperpalsia: little yellowish flat papules on face/nose
Erythema toxicum neon: erythematous papules and vesicles w/ surrounding erythema/halo (pustules have eosinophils)
ALL BENIGN

Front 55

asbestosis = what risk?

Back 55

BRONCHOGENIC CA >>>mesothelioma

Front 56

Todd's Paralysis=?

Back 56

LOC w/ disorientation, slow gain consciousness and postictal paralysis (todd paralysis) usually resolving w/in 24hr

Front 57

What is mech ondansetron?

Back 57

serotonin agonist (5HT3 receptor) use for chemo-induced vomiting ppx

Front 58

1mo old infant starts crying spontaneously at night and cannot be comorted, been going on for days.
ML Dx?
TMT

Back 58

Infantile colic (benign crying of unknown etiology)
-from 1mo-4mo age (will spontaneously resolve)

Front 59

MRI findings of friedreich ataxia:

Back 59

atrophy cervical spinal cord and cerebellar atrophy
-Get myocarditis w/ T-wave inversion (ddx MI, myocarditis, old pericarditis, dig tox, contusion)

Front 60

What are the symptoms of Fragile X?
What is the cause?

Back 60

large head, long face, prominent forehead, chin, protruiding ears, large testes, hypereactivy autistic
-FMR1 methylation gene mut w/ CGG repeats

Front 61

Galaktokinase def vs galactosemia vs fructosuria vs fructose intol

Back 61

-Galaktokinase def: cataracts, social smile, asx, aut rec
-Galactosemia: def galac-1-phosph-uridyl-transf, aut rec, bilat cataract, fail to thrive, hypoglycemia, jaundice (vomiting), hepatomegaly, retard (convulsions)->Galactitol buidliup in these 2 dz
-Frucosuria (fructokinase def): aut rec, benign, fructose in urine/blood
-Fruc intol: aldolase b def, aut rec, fructose-1-phosph builds up, hypoglyc, jaundice, cirrhosis, vomit w/in 20-30min of fructose meal or sucrose

Front 62

When is bedwetting normal?

Back 62

up to 5yo (don't order a single test till then!)