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Dedicated - Step 2 > 10 > Flashcards

10 Flashcards

1
Q

AE of what rheum drug - macrocytic anemia +/- pancytopenia

A

MTX

Other AE: nausea, stomatitis, rash, hepatotoxicity, ILD, alopecia, fever

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2
Q

AE of what rheum drug - GI distress, visual disturbances, hemolysis if G6PD deficiency

A

Hydroxychloroquine

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3
Q

AE of what rheum drug - pancreatitis, liver toxicity, dose dependent bone marrow suppression

A

Azathioprine

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4
Q

Presentation - transient vision loss lasting a few seconds with changes in head position, blind spot enlargement on visual field testing

A

Papilledema 2/2 increased ICP

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5
Q

Work-up of suspected papilledema?

A

Urgent diagnostic evaluation (ophthalmologic exam, neuroimaging, and/or LP) to prevent vision loss

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6
Q

Cause of amaurosis fugax?

A

Usually vascular (eg, embolus to ophthalmic artery)

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7
Q

Presentation - peripheral visual field deficits, extensive cupping of the optic disc on fundoscopy

A

Glaucoma

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8
Q

Cause of glaucoma?

A

Increased intraocular pressure

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9
Q

Fundoscopic exam finding of optic neuritis?

A

Optic disc edema

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10
Q

Compare the presentations of anterior vs. posterior uveitis.

A

Anterior: eye pain and redness

Posterior: painless, floaters/reduced visual acuity

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11
Q

Vaccines for adults with HIV?

A

HAV: chronic liver disease, MSM, IV drug use, travel to countries where HepA is prevalent

HBV: all patients without documented immunity

HPV: all patients age 11-26

Influenza (inactivated): everyone annually

MCV (A, C, W, Y): all

PCV13 1x
PPSV23: 8 weeks later, 5 years later, age 65

Tdap: 1x, Td Q10 years

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12
Q

When are live vaccines (MMR, VZV, etc.) contraindicated in patients with HIV?

A

CD4 <200

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13
Q

Dx and Rx PMS/PMDD

A

Symptom/menstrual diary over 2 cycles

SSRIs; combined OCs are an option

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14
Q

Define preterm prelabor rupture of membranes (pPROM).

A

ROM <37 weeks gestation

Before the onset of labor

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15
Q

4 major risks associated with pPROM?

A
  1. Placental abruption
  2. Intraamniotic infection
  3. Umbilical cord prolapse
  4. Preterm labor
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16
Q

Patients with familial adenomatous polyposis have a significantly increased risk of colorectal cancer. What is the standard of care by way of prevention?

A

Frequent colonoscopic screening starting in childhood and elective proctocolectomy

  • Annual screening sigmoidoscopies starting at age 10-12
  • Annual colonoscopies once colorectal adenomas are detected or if age 50+
  • Regular screening for upper GI tract tumors
  • Proctocolectomy if presentation with CRC or adenomas with high-grade dysplasia
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17
Q

Presentation - palpable tender mass on the anterior vaginal wall with associated purulent discharge; may present as dyspareunia, dysuria, post-void dribbling

A

Urethral diverticulum

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18
Q

Dx and Rx urethral diverticulum

A

MRI to confirm

Rx - surgical excision

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19
Q

___ is commonly characterized by an acute illness involving the skin/mucosa and either respiratory or CV compromise.

A

Anaphylaxis

Other manifestations include GI, neuro, and ocular symptoms

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20
Q

What labs can be drawn if the diagnosis of anaphylaxis is unclear?

A

Serum tryptase

Plasma histamine

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21
Q

Why can medications such as NSAIDs or beta-adrenergic blockers exacerbate anaphylaxis?

A

Cause non-immunologic mast cell activation or unopposed alpha-adrenergic effects respectively

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22
Q

Features of neonatal abstinence syndrome due to infant withdrawal to opiates?

A

Presents in the first few days of life
Irritability, high-pitched cry, poor sleep, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, diarrhea

Note - prenatal exposure can lead to increased risk of IUGR and SIDS

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23
Q

Lab findings suggesting primary hyperaldosteronism (aldosterone-producing tumor or bilateral adrenal hyperplasia)?

A

HTN
Hypokalemia
Decreased renin
Increased aldosterone

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24
Q

Lab findings suggesting secondary hyperaldosteronism (renovascular or malignant HTN, renin-secreting tumor, diuretic use)?

A

HTN
Hypokalemia
Increased renin
Decreased aldosterone

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25
Q

4 possible causes of HTN + hypokalemia + decreased renin + decreased aldosterone

A
  1. CAH
  2. Deoxycorticosterone-producing adrenal tumor
  3. Cushing syndrome
  4. Exogenous mineralocorticoids
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26
Q

Although aldosterone causes increased renal reabsorption of sodium, most patients with PH do not have edema or clinically significant hypernatremia - explain.

A

Aldosterone escape - increased Na leads to HTN and increased blood volume -> increased renal blood flow, GFR, and atrial natriuretic peptide -> Na+ excretion

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27
Q

Triad - congenital heart disease, T-cell deficiency, hypocalcemia

A

DiGeroge syndrome

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28
Q

List the 3 types of thyroiditis.

A
  1. Chronic autoimmune (Hashimoto)
  2. Painless (silent)
  3. Subacute (de Quervain)
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29
Q

Compare the clinical features of the 3 types of thyroiditis.

A
  1. Hashimoto: HYPOTHYROID, diffuse goiter
  2. Painless: mild brief hyperthyroid phase, small NONTENDER goiter, spontaneous recovery
  3. Subacute: post-viral, prominent fever, HYPERTHYROID, PAINFUL goiter
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30
Q

Compare the Dx testing results of the 3 types of thyroiditis.

A
  1. Hashimoto: TPO Ab, variable radioiodine uptake
  2. Painless: TPO Ab, low uptake
  3. Subacute: elevated ESR, CRP, low radioiodine uptake
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31
Q

Rx thyrotoxicosis in subacute thyroiditis

A

Beta blockers to control thyrotoxic symptoms

NSAIDs for pain relief; steroids if pain does not respond

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32
Q

Findings of suppurative thyroiditis?

A

Rare condition
High-grade fever, pain, palpable enlargement due to abscess formation
EUTHYROID

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33
Q

Oral emergency contraceptive options that prevent pregnancy by delaying ovulation?

A

Levonorgestrel (progestin)
Ulipristal (anti-progestin)
Progestin OCPs

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34
Q

Distinguish between breastfeeding jaundice and breast milk jaundice.

A

FEEDING: first week of life, insufficient quantity (decreased bili elimination, increased enterohepatic circulation) + SUBOPTIMAL breastfeeding, signs of DEHYDRATION

MILK: peaks at 2 weeks, deconjugation of intestinal bili due to high levels of beta-glucuronidase in milk + ADEQUATE breastfeeding, NORMAL exam

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35
Q

Normal frequency of breastfeeding?

A

At least 10-20 minutes per breast Q2-3 hours

36
Q

Normal # of wet diapers in the first week of life?

A

At least the infant’s age in days

37
Q

ABO hemolytic disease almost exclusively affects infants with blood types ___ who are born to mothers with type ___.

A

A or B; O

38
Q

Management of breastfeeding jaundice?

A
  1. Increase frequency and duration of feeds, maintain adequate hydration, promote bilirubin excretion
  2. If bilirubin continues to rise despite such efforts -> formula supplementation (do not discontinue breastfeeding)

(If bilirubin levels are below the phototherapy threshold)

39
Q

What causes vasospastic angina and how is it treated?

A

Hyperreactivity of intimal smooth muscle -> intermittent coronary artery vasopspasm

CCBs (diltiazem, amlodipine, etc.) - preventive
Sublingual nitroglycerin - abortive

Smoking cessation

40
Q

Presentation of vasospastic angina?

A

Young patients (<50)
Smoking + minimal other CAD risk factors
Recurrent chest discomfort at rest or during sleep, resolves spontaneously within 15 minutes

ECG: STEMI
Coronary angio: no CAD

41
Q

What is cilostazol?

A

PDE III inhibitor that causes arterial vasodilation and inhibits platelet aggregation; used for patients with intermittent lower extremity claudication

42
Q

What is ranolazine?

A

Antianginal drug that decreases myocardial Ca2+ level by inhibiting late-phase sodium influx into ischemic cardiomyocytes; effective in treating stable angina due to atherosclerotic CAD

43
Q

List the 7 initial interventions involved in stabilization of acute STEMI.

A
  1. Supplemental O2 (if <90% or dyspnea)
  2. Aspirin 325 mg
  3. P2Y12 inhibitor (eg, clopidogrel)
  4. Nitrates (sublingual)
  5. Beta blocker (unless hypotension, bradycardia, chronic heart failure, heart block)
  6. High-dose statin (eg, atorvastatin 80 mg)
  7. Anticoagulation (depends on planned revascularization)
44
Q

After initial stabilization of acute STEMI - if there is persistent pain, HTN, or heart failure, what is done?

A

IV nitroglycerin (except if hypotension, RV infarct, or severe aortic stenosis)

Vasodilators

45
Q

After initial stabilization of acute STEMI - if there is persistent severe pain, what is done?

A

IV morphine

Anxiolytic + preload reducing

46
Q

After initial stabilization of acute STEMI - if there is unstable sinus bradycardia, what is done?

A

IV atropine

47
Q

After initial stabilization of acute STEMI - if there is pulmonary edema, what is done?

A

IV furosemide (not if patient is hypotensive or hypovolemic)

Decreases preload -> decreases pulmonary capillary pressure
Venodilates -> further decreases preload

48
Q

Reperfusion options for acute STEMI?

A

Percutaneous transluminal coronary angioplasty within 90 minutes (preferred)

Thrombolysis (if PCTA no available within 120 mintues)

49
Q

2 major uses of digoxin?

A

Rate control in patients with rapid AF

Improve symptoms in CHF

50
Q

Presentation - delirium, elevated vitals (hypertermia, HTN, tachycardia), diaphoresis in the setting of multiple SUDs

A

DT

51
Q

Where does atopic dermatitis present in infants vs. children/adults?

A

Infants: extensor surfaces, cheeks

Children/adults: flexor surfaces (neck, antecubital fossae, volar wrists, popliteal fossae, dorsal ankles)

52
Q

Presentation - total or segmental non-obstructive colonic dilation, severe bloody diarrhea, systemic findings

A

Toxic megacolon

53
Q

Dx toxic megacolon

A

Plain abdominal XR (dilated R or transverse colon, thick haustral markings that do not extend across the entire lumen) + 3 or more of the following: fever >38 C, pulse >120, WBCs >10500, and anemia

54
Q

Rx toxic megacolon

A

Medical emergency

IVF, broad-specrum ABX, NPO, IV steroids if IBD-induced

55
Q

R-sided colon cancer tends to present with ___; L-sided colon cancer tends to present with ___.

A

Anemia; bowel obstruction

56
Q

Symptoms of SIBO?

A

Bloating, flatulence, water diarrhea, abdominal pain +/- malabsorption and nutritional deficiencies

57
Q

Causes of SIBO?

A 
Anatomic abnormalities (eg, strictures, surgery)
Motility disorders (eg, DM, scleroderma)
Alterations in gastric/pancreatic secretions (eg, atorphic gastritis, chronic pancreatitis)
58
Q

Dx SIBO

A

Jejunal aspirate and culture showing >10E5 organisms/mL

Carbohydrate breath test

59
Q

Organisms involved in SIBO?

A

Streptococci
Bacteroides
Escherichia
Lactobacillus

60
Q

Rx SIBO?

A 
ABX (eg, refaximin, amox-clav)
Avoid antimotility agents (eg, narcotics)
Dietary changes (high-fat, low barb)
Promotility agents (eg, metoclopramide)
61
Q

What is dumping syndrome?

A

Complication of gastric bypass, occurs when high-carb foods are rapidly emptied into the small bowel, leading to osmotically driven fluid shifts from the plasma to the intestines

Abdominal pain, diarrhea shortly after meals + sympathetic activation (tachycardia, diaphoresis, flushing, hypoglycemia)

62
Q

What is androgen insensitivity syndrome?

A

Complete defect in androgen receptor function

Phenotypically female
Primary amenorrhea due to absent uterus
No pubic or axillary hair

63
Q

Features of 5-alpha-reductase deficiency?

A

Impaired conversion of testosterone to dihydrotestosterone

Initially have female external genitalia and male internal genitalia until puberty -> virilization due to increased levels of T

64
Q

Emergent management of central retinal artery occlusion?

A

Ocular massage and high-flow O2 administration

65
Q

Management of acute angle closure glaucoma?

A

Topical pilocarpine and beta-blockers

66
Q

Infants who receive oral macrolide should be monitored for what AE?

A

Pyloric stenosis

67
Q

Describe the administration of PPSV23 and PCV13 in adults.

A

Age 65+: 1 dose PCV13, then PPSV23 6-12 months later

Age 19-64:
-PPSV23 alone: chronic heart, lung, or liver disease, DM, current smokers/alcoholics

-PCV13 + PPSV23: CSF leaks, cochlear implants, SCD/asplenia, immunocompromise, CKD

68
Q

Reverse hypochloremic hypokalemic metabolic alkalosis 2/2 gastric loss?

A

Isotonic NaCl and K

69
Q

Features of ankylosing spondylitis

A

Insidious onset of inflammatory back pain at age <40
Symptoms >30 months
RELIEVED WITH EXERCISE, but not rest
Nocturnal pain

Associated exam findings:

  • Arthritis (sacroiliitis)
  • Reduced chest expansion and spinal mobility
  • Enthesitis
  • Dactylitis
  • Uveitis
70
Q

3 complications of ankylosing spondylitis?

A

Osteoporosis/vertebral fractures
Aortic regurgitation
Cauda equina

71
Q

Describe the T3, T4, TSH, and reverse T3 findings in early/mild + prolonged/severe euthyroid sick syndrome.

A

T3: decreased

T4: normal -> decreased

TSH: normal -> decreased

RT3 -> elevated

72
Q

Characteristic thyroid lab findings in euthyroid sick syndrome caused by?

A

Low T3 with normal TSH and T4 in patients with acute illness due primarily to decreased peripheral conversion of T4 to T3

73
Q

What is the major cause of delayed morbidity and mortality in subarachnoid hemorrhage and what can it cause? How can it be prevented?

A

Vasospasm; cerebral infarction; nimodipine

74
Q

What is the major cause of death within the first 24 hours of presentation of SAH?

A

Rebleeding

75
Q

Dx post-SAH vasospasm?

A

CTA

76
Q

In patients with ARDS, how does mechanical ventilation improve oxygenation?

A

By providing an increased fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) to prevent alveolar collapse

77
Q

Goal PaO2 in MV?

A

PaO2 at 55-80 mmHg; corresponds roughly to O2 saturation of 88-95

78
Q

What vent settings primarily influence PaO2?

A

FiO2

PEEP

79
Q

What vent settings primarily influence PaCO2?

A

RR

TV

80
Q

Prolonged high FiO2 can cause ___. It should be reduced as soon as possible below levels that predispose to this problem, approximately ___%.

A

Oxygen toxicity; 60

81
Q

Management of stable vs. unstable ectopic pregnancy

A

Stable - MTX

Unstable - surgery

82
Q

What physical exam finding is highly specific for epileptic seizure?

A

Tongue biting (especially the lateral tongue)

83
Q

What is the most specific symptom of giant cell arteritis?

A

Jaw claudication

84
Q

Rx open angle glaucoma?

A

Acetazolamide

85
Q

What is calciphylaxis (aka calcific uremic arteriolopathy)?

A

Systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis; presents with painful nodules and ulcers, soft tissue calcification on imaging

86
Q

Risk factors for calciphylaxis?

A 
ESRD on hemodialysis
Hypercalcemia, hyperphosphatemia
Hyperparathyroidism
Obesity, DM
Oral anticoagulants

Dedicated - Step 2 (22 decks)

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