UWorld_6.6

Question 1

Afib: 1st line tx

Answer 1

• unstable pt: cardioversion

- stable pt: 1. b-blockers vs. ca-chan blockers 2. anticoag based on CHADS-VASC score

Question 2

Determination of need for anticoagulation in Afib

Answer 2

• CHA2DS2-VASc score
• CHF = +1
• Hyptertension = +1
• Age >75 = +2
• DM = +1
• Stroke (prior) = +2
• Vasc. dz = +1
• Age 65-74 = +1
• Sc (sex category) = +1 if female
• anticoagulation advised if score >= 2

Question 3

Duodenal hematoma management

Answer 3

• occurs with blunt abdominal trauma
• bowel rest + parenteral nutrition + NG suction
• surgery considered second line if conservative tx fails

Question 4

Characteristics of lateral medullary infarct

Answer 4

• ipsilateral loss of pain/temp @ face + contralateral loss of pain/temp @ body
• ipsilateral Horner’s syndrome (miosis, ptosis, anhidrosis)
• vertigo to side of lesion + nystagmus
• ipsilateral bulbar m. weakness ==> choking, hoarseness
• motor fxn is spared

Question 5

Cause of lateral medullary infarct/wallenberg syndrome

Answer 5

occlusion of posterior inferior cerebellar artery or vertebral artery

Question 6

Deficits in medial mid-pontine infarct

Answer 6

contralateral ataxia and hemiparesis

Question 7

Deficits in medial medullary infarct + cause

Answer 7

• contralateral paralysis of arm/leg + tongue deviation towards the lesion
• caused by occlusion of vertebral or anterior spinal artery

Question 8

BG goals in gestational DM

Answer 8

-Fasting

Question 9

Newborn/fetal consequences of maternal hyperglycemia

Answer 9

• congenital malformations
• macrosomia
• neonatal hypoglycemia
• hyperviscosity 2/2 polycythemia`

Question 10

Thyroid hormone production during pregnancy

Answer 10

• increased thyroid hormone production ==> increased total T4 & T3
• increased thyroxine-binding globulin
• overall: slightly elevated free T4/T3 and decreased TSH

Question 11

Adenosine deaminase deficiency ==>

Answer 11

• impaired T cells

- viral, fungal, bacterial infections

Question 12

X-linked agammaglobulinemia ==>

Answer 12

• impaired B cell development
• absent lymphoid tissue
• recurrent sinopulmonary and GI infections

Question 13

Complement deficiency ==>

Answer 13

• risk for disseminated bacterial infections

- esp. w/encapsulated bacteria: s. pneumo, n. menigitidis

Question 14

Impaired oxidative burst ==>

Answer 14

• chronic granulomatous disease

- recurrent skin & pulm infections w/catalase + organisms: s.aureus, serratia marcescens

Question 15

Niemann-Pick vs. Tay Sachs

Answer 15

• both: AR, 2-6 mo., loss of motor milestones, hypotonia, feeding difficulties, “cherry-red” macula
• NP: sphingomyelinase deficiency, HSM, arreflexia
• TS: B-hexosaminidase A deficiency, no HSM, hyperrflexia

Question 16

Characteristics of nasal polyps

Answer 16

• assoc. w/chronic sinusitis, asthma, aspirin/NSAID-induced bronchospasm in condition = aspirin-exacerbated respiratory disease
• sx = bilateral nasal obstruction, nasal discharge, anosmia

Question 17

Common toxic exposure in house fire

Answer 17

cyanide toxicity

Question 18

Cyanide toxicity tx

Answer 18

• hydroxocobalamin
• sodium thiosulfate
• IV fluids for support
• if no antidote: nitrates to induce methemoglobinemia

Question 19

Tx of legionnaires dz

Answer 19

• macrolides

- fluoroquinolones