Uworld 9/3/15

Front 1

Findings in Different microcytic anemias?

Back 1

All have low MCV

Iron: hi RDW, lo RBCs, microcytosis/hypochromia, low iron, low ferritin, hi TIBC, hgb increases w/ fe tabs, normal hgb electrophoresis

alpha-thal: normal RDW, normal RBCs, target cells, normal to HIGH ferritin and iron, normal hgb electrophoresis

beta-thal: same as alpha except hi hgb A2 and HgF on electrophoresis

anemia chronic dz: from RA, ESRD, etc. hi ferritin, low TIBC, low FE, normal fe sat, correct underlying dz

Sideroblastic anemia: ETOH, lead, isoniazid, hi Fe (in mitochondria), prussian blue stain, if major: remove toxin, if minor: pyridoxine replacement

Front 2

Heinz body=?

Back 2

G6PD deficiency

-sudden hemolysis->hemolytic anemia

-X-linked in AA

-get sx from oxidant stress: infxn, oxidizing drugs (sulfas, dapsone, primaquine), FAVA beans

-blood smear: heinz body, BITE cells

-can test for G6PD levels (but only 2 months after)

-TMT: none, avoid stressor

Front 3

24yo M bartender fatigue, fever, sweats, myalgias, sore throat, smoker, sex active, flushed, maculopap rash on face, trunk, palms, soles, well-healed puncture wounds inside forearms, general lymphadenop, neg HIV ELISA, neg heterophile, NGTD bcx=?

Back 3

Acute retroviral syndrome (HIV) will occur 2-3wks after getting infected and 2-3wks before seroconversion (acts like mono w/ maculopap rash)

-test w/ HIV RNA or p24 antigen

Front 4

Contraindications to using bupropion for quiting smoking?

Back 4

reduces seizure threshold-seizure disorders

eating disorders

Front 5

Colonoscopy screening guidelines

Back 5

General pop or single 1st degree relative age >60 w/ colon ca: start age 10 colonoscopy q10yrs or sigmoidoscopy q5yrs (w/ FOBT q3yrs) or FOBT or fecal immunochemical test YEARLY

Increased risk (1st deg relative age <60 colon ca /adenomatous polyps or 2 first degree relatives any age): colonoscopy age 40 OR 10 yrs b4 age of ca dx (whichever first), rpt q3-5yrs

Front 6

TMT of constipation in kids?

Back 6

1. diet mod (hi fiber fruits/veggies)

2. mag hydroxide (aka Milk of mag)

Front 7

56yo F w/ met breast ca w/ tumor estrogen and prog receptor negative, started on chemo w/o response, after workup, add monoclonal ab tmt w/ good response

What was it?

Back 7

HER-2/neu over expression (oncogene that has BAD prognosis), but very treatable with Trastuzumab or Herceptin, and these increase sensitivity to chemo

Front 8

Most sig risk factor for Colon Ca?

Protective factors?

Back 8

ETOH intake (more than smoking) (other than FAP, IBD, AA, fam hx

-high fiber diet, regular NSAIDS, hormone replacement, exercise

Front 9

Rules of RhD ppx in pregnancy?

Back 9

-give to ALL Rh (D) neg women at 28wks gest RhoGAM if no anti-D isoimmunizaiton detected during ab screening at 20 wks

-Also, give RhoGAM after any procedure (amniocentesis) and after delivery for Rh negative moms

Front 10

Increased AFP in 2nd trimester=?

Workup?

Back 10

concern for neural tube defects

-do u/s to confirm dating (if error->rpt AFP at correct date)

-if correct and no detection on u/s->do amnio for amniotic fluid AFP and acetylcholinesterase levels

Front 11

Rules of diphenhydramine with hobbies?

Back 11

Don't use before driving, operating machinery, flying planes, or DIVING

Front 12

Mgmt of inguinal hernia in kids?

Back 12

elective repair as soon as possible

Front 13

13yo boy was camping, came back w/ pruritic lesions R arm 2 days ago, this AM had similar on L hand, linear, erythematous, irregular=>

Back 13

poison IVY dermatitis (can occur 2-3 days later)

Front 14

Risks with PPI long term?

Back 14

increased osteoporosis, decreased absorption of B12 and iron, hypomagnesemia, interstitial nephritis, c.diff

Front 15

Most common causes of acute otitis media?

Signs/sx

TMT?

Complications?

Back 15

strep pna, nontypable HiB, moraxella (pseudomonas is for EXTERNA)

middle ear effusion PLUS bulging tymp membranes

-Amoxicillin x10days (if rpt in same month: do amoxicillin-clavulanate)

-conductive hearing loss, mastoiditis, meningitis

Front 16

TMT for cherry angioma?

Strawberry Angioma?

Spider Angioma

Back 16

-in elderly: reassurance, benign vasc tmor

-in childhood, conservative, can consider propranolol if ulcerated

-LFTs

Front 17

55yo w/ 1mo mild achy stiff hand joints worse in morning for 1 hour, HTN on amlodipine, multiple sharp demarcated erythematous scaly plaques on extensors both elbos, hand w/ yellow nails, erythema on distal fingers, xray w/ bony erosions and new bone formation DIP=?

Dx Test?

common findings?

TMT?

Back 17

Psoriatic Arthritis

-none

-dactilytitis, psoriasis extensor surfaces, onychomycosis looking nails, DIP infolvement (RA would only be PIP and MCP!), enthesitis tendon insertion sites, nail pitting, HLA-B27

-NSAIDs first, but if extensive->methotrexate, can use topical steroids if mild or facial psoriasis)

Front 18

39yo F w/ pscyh dz on haldol/valproate controlled, now complains of "can't sit still or relax" and gen discomfort=?

TMT?

Back 18

Akathisia

-beta blocker-propranolol

Front 19

TMT for GBS?

Back 19

Plasmapheresis and/or IVIG x2wks

-plasmapheresis is better <7days onset

Front 20

Tmt of oral thrush?

What if patient uses inhaled steroids for asthma?

Back 20

nystatin suspension

-then also wasthc to ensure proper technique using inhaler

Front 21

Rules for HSV in pregnancy?

Back 21

Treat HSV if patient having an active lesion

-any patient with h/o HSV: give antiviral agent acyclovir at 36wks gestation to delivery

-if active genital lesions or prodrome=c-section

Front 22

Pediatric community-acquired pna

-most common cause?

TMT?

Back 22

if preschool age OR focal lung findings: strep pna->give hi dose po amoxicillin

if older OR well appearing w/ bilat lung findings: mycoplasma->give azithromycin

Front 23

patient that received lots of blood now with seizures=think what?

Back 23

HYPOCALCEMIA (citrate from blood binds to calcium)->give calcium gluconate for every 500ml pRBCs given

(hypokalemia happens more often with hypothermia)

Front 24

polymyalgia rheumatica is associated with what?

First dx test?

Back 24

Giant cell (temporal) arteritis (if have HA or jaw pain)

-do ESR (if >50 w/ HA, very specific for GCA)->to temporal artery bx

-give hi dose steroids if GCA suspected

Front 25

In patients with some kind of chronic pain/back pain, what is the most significant predictor of likelihood to return to work?

Back 25

Patient's recovery of expectation

Front 26

Patient on chronic steroids for lupus

Next step for maintenance?

Back 26

start Calcium and vit D to decrease rate of bone loss

Front 27

Patient with incidental finding of pituitary mass after MVA, with normal labs and tests

Next step?

Back 27

rpt pituitary MRI in 6-12mos (don't need to resect unless enlarging or clinical sx)

Front 28

Howell-Jolly bodies=?

Back 28

sickle cell anemia

Front 29

Maintenance therapy for sickle cell?

Back 29

pneumococcal vaccination

Penicillin till age 5

folate

hydroxyurea if crisis >4/yr

Front 30

What is the goal INR for mechanical heart valves?

Back 30

2-3 if aortic and no risk factors (afib, severe LV dysfunction w/ EF <30, prior DVT/PE, hypercoag state)

2.5-3.5 if mitral or aortic w/ risk factors

Front 31

6mo old baby for well baby exam, in <5 percentile lenght and 25th percentile head circ

Next step?

Back 31

Provide dietary recommendations (failure to thrive)

Front 32

tmt of scabies?

Back 32

topical permethrin

Front 33

tmt of chronic tinea pedis (pruritis erythema scaling between toes that may be linear and have sharp borders and acompany onychomycosis)?

Back 33

topical terbinafine, but if more extensive->po terbinafine (if also onychomycosis)

Front 34

Patient w/ h/o HTN w/ increased Cr 2 from 1.6 a year ago

Dx test?

TMT?

Back 34

likely hypertensive renal failure

-urine protein (if 500-1000 indicates CKD from HTN)

-ACEi or ARB most effective in slowing

Front 35

42yo F to ED w/ AMS, h/o hypoTH, depression, back pain, on levothyroxin, amytriptyline, daily oxycodone, confused, agitated, febrile, hypotensive, flushed, mydriasis, hyperreflexive, wide QRS=?

TMT?

Back 35

TCA (amitriptyline overdose)-drowsy/coma/seizure/resp depression/tachy/hypotn/prolonged everything on EKG/arrythmias/dry mouth/blurred vision/midriasis/u retention (antichol stuff)

-activated charcoal if w/in 2hrs of ingestion

-IV sodium bicarb if QRS wide to prevent arrythmia

-supplemental O2, intubate, IVF as needed

Front 36

differentiate legionella from atypical pnas vs. strep pna?

Back 36

strep pna is most likely CAP: typical acute onset, purulent sputum, XR w/ single lobe infiltrate

Atypical PCP, mycoplasma, chlamydia: gradual onset, nonproductive cough, INTERSTITIAL infiltrates on XR

Legionella: CAP + diarrhea/n/v/HA/confusion (sputum w/ no organisms but many neutrophils)

Front 37

Pregnant woman w/ acute TB

TMT

Back 37

isoniazid, rifampin, ethambutol (only add pyrazinamide if it is multi-drug resistant TB since teratogenic)

Front 38

Patient w/ HA, myalgias, lo grade fever, no CT findings

CSF shows no xanthochromia, 75000rbcs, 100wbc, normal ptn, mild hi glucose=>

Back 38

traumatic LP (since no xanthochromia to indicate SAH)