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12 Flashcards

1
Q

2 best predictors of post-operative outcomes following lung resection surgery?

A
  1. FEV1

2. DLCO

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2
Q

Based on pre-operative FEV1 and DLCO measurements, the % of planned resection is used to estimate post-operative FEV1 and DLCO. Patients with an estimated post-operative FEV1 or DLCO of less than ___% are at elevated risk of post-operative morbidity.

A

40

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3
Q

2 uses for capnography (aka end-tidal CO2 measurement)?

A

Indicative of aerobic metabolism; monitor correct endotracheal tube placement, measure effectiveness of CPR

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4
Q

Maximal inspiratory pressure (or negative inspiratory force) is a measurement of inspiratory muscle strength - what is it used for?

A

Monitor patients with hypoventilation due to neuromuscular disease (MG, GBS, etc.); assess need for MV

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5
Q

Features of Marfan syndrome?

A 
AD
Tall stature, long thin extremities
Arachnodactyly
Joint hypermobility
Upward lens dislocation
Aortic root dilation
Kyphosis and/or scoliosis
Skin hyperelasticity
Pectus excavatum
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6
Q

Cause of Marfan syndrome?

A

Mutation or the fibrillin-1 gene -> systemic weakening of connective tissue

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7
Q

What is the most life-threatening finding in Marfan syndrome, how does it present, and what are complications to monitor for?

A

Aortic root dilation

Aortic regurgitation (diastolic murmur)

Echo for development of aneurysms and aortic arch dissection

May also have MV prolapse (mid-systolic click, late systolic murmur)

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8
Q

What autosomal recessive disorder caused by deficient cystathionine synthase mimics Marfan syndrome? How is it different?

A

Homocystinuria

Fair complexion, thromboembolic events, intellectual disability, DOWNWARD lens dislocation

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9
Q

What is caused by defective collagen production and how does it present?

A

Ehlers-Dnalos

Scoliosis, joint laxity, aortic dilation; do not have tall stature, lens problems, etc.

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10
Q

If you see something that looks like Marfan, but the patient has joint contractures + no ocular or CV symptoms, suspect ___.

A

Congenital contractural arachnodactyly (AD condition 2/2 mutations is fibrillin-2)

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11
Q

Presentation - within 1 year of Roux-en-Y gastric bypass, progressive nausea, postprandial vomiting, GER, dysphagia

A

Stomal (anastomotic) stenosis

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12
Q

Dx and Rx stomal stenosis?

A

EGD to diagnose + balloon dilation to treat

Surgery if this fails

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13
Q

Define preeclampsia and preeclampsia with severe features.

A

New-onset elevated BP (140/90+) + proteinuria OR signs of end-organ DYSFUNCTION at 20+ weeks

Severe if signs of end-organ damage (severe HTN, Plt <100,000, transaminitis, Cr 1.1+, headaches/visual changes)

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14
Q

Sever eHTN in pregnancy?

A

Systolic 160+ or diastolic 110+ for 15+ minutes

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15
Q

First-line drugs for maternal hypertensive crisis?

A 
IV hydralazine (vasodilator)
IV labetalol (beta blocker with alpha-blocking activity)
Oral nifedipine (CCB)
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16
Q

Rx chronic hypertension in pregnancy?

A

Methyldopa

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17
Q

True or false - it is ethical for students to perform procedures on deceased patients for training purposes with permission of the family or the patient prior to death.

A

True

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18
Q

Patients with hypoalbuminemia may have a significant deficit in total body ___.

A

Calcium

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19
Q

___ use is associated with tendinopathy and tendon rupture (Achilles most commonly).

A

Fluoroquinolone

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20
Q

Yellow-green malodorous discharge

A

Trichomoniasis

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21
Q

Malodorous thin white discharge

A

BV

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22
Q

First-line alternative to stimulants for child and adolescent ADHD?

A

Atomoxetine (SNRI)

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23
Q

Pathology of coarctation of the aorta?

A

Thickening of the tunica media of the aortic arch near the ductus arteriosus following CLOSURE of the ductus (normally)

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24
Q

Findings of coarctation of the aorta?

A

Upper extremity HTN
Lower extremity hypotension and hypoxia
Diminished/delayed femoral pulses
Systolic ejection murmur at the L interscapular area

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25
Q

Presentation - fever, pleuritic chest pain, hemoptysis in an immunocompromised patient

CT scan with pulmonary nodules + surrounding ground-glass opacities

A

Invasive aspergillosis

May also have positive cultures and positive cell wall biomarkers (galactomannan, beta-D-glucan)

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26
Q

Rx invasive aspergillosus

A

Voriconazole + an echinocandin (eg, caspofungin)

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27
Q

How does chronic pulmonary aspergillosis compare to invasive?

A

Risk factors -> lung disease/damage (cavitary TB)

Presentation: >3 months of weight loss, cough, hempotysis, fatigue
Cavitary lesion +/- fungal ball
+Aspergillus IgG serology

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28
Q

Rx chronic pulmonary aspergillosis

A

Resect if possible
Azole (voriconazole)
Embolization if severe hemoptysis

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29
Q

Next step if positive screen for critical CHD in a newborn (+ pre- and post-ductal pulse oximetry)?

A

Echo

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30
Q

What is the hyperoxia test used for?

A

Distinguishing between cyanosis due to pulmonary disease (improves with O2) and CHD (persistent cyanosis)

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31
Q

Rx SCFE?

A

Surgical screw fixation for stabilization of the physis to prevent further slippage

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32
Q

Dx SCFE?

A

Posteriorly displaced femoral head on frog-leg lateral hip radiograph

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33
Q

Mechanisms of physiologic jaundice due to indirect hyperbilirubinemia in newborns?

A
  1. High RBC turnover
  2. Hepatic bilirubin clearance is decreased
  3. Enterohepatic recycling is increased
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34
Q

Patients with an acute COPD exacerbation and continued symptoms despite medical management should be considered for what next step?

A

Non-invasive ventilatory support

  • Start with non-invasive PPV (facemask)
  • If they fail a 2-hour trial of NPPV or decomponsate, consider intubation
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35
Q

Oxygen in hypercapnic and hypoxemic patients should be titrated gradually with a goal arterial oxygen saturation of ___ or PaO2 of ___.

A

88-92%

60-70 mmHg

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36
Q

Why is NPPV in patients with acute exacerbation of COPD helpful?

A

Decreases mortality, rate of intubation, hospital length of stay, and incidence of nosocomial infections

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37
Q

Pathologic hallmark of diabetic nephropathy?

A

Nodular glomerulosclerosis (diffuse glomerulsclerosis is more common)

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38
Q

Pathologic mechanism of COPD?

A

Progressive expiratory airflow limitation (manifests as FEV1/FVC <0.7) which causes air trapping, decreased vital capacity, and increased total lung capacity (due to air trapping)

FEV1 is disproportionately decreased as compared to VC.

Note - the alveolar-capillary membrane is also destroyed in COPD

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39
Q

Rx patients with early syphilis + severe penicillin allergy

A

Oral doxycycline

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40
Q

Pathophysiology of diffuse esophageal spasm?

A

Uncoordinated contractions of the esophageal body

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41
Q

Findings of diffuse esophageal spasm on manometry?

A

Intermittent peristalsis, multiple simultaneous contractions of the middle and lower esophagus

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42
Q

Finings of diffuse esophageal spasm on esophogram?

A

Corkscrew pattern

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43
Q

Rx diffuse esophageal spasm

A

CCBs

Alternates - nitrates or TCAs

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44
Q

Management following a caustic ingestion?

A

ABCs
Decontamination: remove contaminated clothing and visible chemicals, irrigate exposed skin
CXR if respiratory symptoms
Serial CXR/KUB to identify any signs of perforation
Endoscopy within 24 hours in the absence of perforation

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45
Q

What can be done to reduce the progression of diabetic nephropathy?

A
  1. Strict BP control (ACEIs, ARBs), target <130/80

2. Tight glycemic control with target AC <7%

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46
Q

Recommended screening colonoscopy schedule for patients with UC or Crohn with colonic involvement?

A

8-10 years after initial diagnosis + repeat every 1-2 years thereafter

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47
Q

Recommended screening colonoscopy schedule for patients with HNPCC (Lynch syndrome)?

A

Start at age 20-25

Repeat every 1-2 years

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48
Q

Recommended screening colonoscopy schedule for patients with classical FAP?

A

Start at age 10-12

Repeat annually

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49
Q

Recommended screening colonoscopy schedule for patients with a FAMILY HISTORY of adenomatous polyps or CRC -> 1 first-degree relative age <60, 2+ first-degree relatives at any age

A

Age 40 or 10 years before the age diagnosis in the affected relative (whichever is earlier)
Repeat Q5 years

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50
Q

3 steps to reduce risk of long-term prescription opioid misuse?

A
  1. Review state prescription drug-monitoring program data
  2. Random UDS
  3. Regular follow-up at least every 3 months
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51
Q

Presentation - adolescent patients with cyclic lower abdominal pain in the absence of apparent vaginal bleeding, defecatory rectal pain, blue bulging vaginal mass/membrane that swells with increased pressure

A

Imperforate hymen

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52
Q

Presentation - subacute, severe, unilateral limb pain (burning or tingling, out of proportion, non-dermatomal, allodynia) presenting within 4-6 weeks following trauma or surgery

A

Complex regional pain syndrome (CRPS)

May also include edema/sudomotor changes (eg, sweating) and vasomotor changes (eg, erythema, altered skin temperature)

If advanced -> trophic changes

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53
Q

XR findings of CRPS?

A

Patchy demineralization

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54
Q

Bone scintigraphy findings of CRPS?

A

Increased uptake in the affected limb

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55
Q

Management of CPRS?

A

PT/OT, exercise

NSAIDs, antineuropathic meds

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56
Q

Type of bias - Prolongation of apparent survival in patients to whom a test is applied without changing the prognosis of the disease

A

Lead-time bias

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57
Q

Medications that can cause idiopathic intracranial HTN?

A

Growth hormone
Tetracyclines
Excessive vitamin A and its derivatives (eg, isotretinoin, all-trans-retinoic acid)

[Manage by stopping meds]

58
Q

What is vitiligo?

A

Acquired depigmentation disorder that occurs due to melanocyte destruction

59
Q

Appearance of vitiligo? Associations?

A

Flat hypopigmented macules with distinct borders that can expand and coalesce; autoimmune disease

60
Q

Rx vitiligo?

A

Corticosteroids and phototherapy

61
Q

Rx acute cluster headache (abort)?

A

100% O2 by facemask

Second line - subQ sumatriptan (so long as there are no contraindications), ergotamine

62
Q

Prophylaxis for acute cluster headaches?

A

Verapamil

Lithium

63
Q

Preferred treatment in adjustment disorders?

A

Psychotherapy

64
Q

Pathogenesis of VW disease?

A

Impaired activity/quantity of VWF -> poor platelet-endothelial binding and reduced factor 8 levels due to increased destruction

65
Q

___ therapy for RA is associated with hepatotoxicity. Serum liver studies should be checked prior to initiation and periodically thereafter. How can this and other toxicity related to this drug be mitigated?

A

MTX; concurrent folic acid

66
Q

AE of RA DMARD leflunomide?

A

Hepatotoxicity

Cytopenias

67
Q

AE of RA DMARD sulfasalazine?

A

Hepatotoxicity
Stomatosis
Hemolytic anemia IN PATIENTS WITH G6PD DEFICIENCY

68
Q

AE of RA DMARDs TNF inhibitors?

A

Infection
Demyelination
CHF
Malignancy

69
Q

Joints affected by RA?

A

Symmetric polyarthritis -> MCPs, PIPs, wrists

70
Q

Before starting a TNF-alpha inhibitor, what pre-testing should be done and why?

A

Interferon gamma release assay to assess for latent TB

71
Q

Rx patients with CAP who are hospitalized?

A

FQ (eg, moxifloxacin, levofloxacin)

or

Beta-lactam + macrolide (eg, ceftriaxone + azithromycin)

72
Q

CURB-65?

A 
Confusion
Urea >20 mg/dL
Respirations 30+/min
BP (systolic <90 or diastolic <60)
Age 65+

0 - outpatient
1-2 - likely inpatient
3-4 - urgent inpatient, possible ICU if >4

73
Q

The standard meds for CAP treat what 4 most common bacterial CAP organisms?

A

S. pneumoniae
H. influenzae
Legionella
M. pneumoniae

74
Q

Lab findings in prerenal AKI (Serum Cr, urine output, BUN/Cr ratio, FENA, urine sediment)?

A

Increased serum Cr
Decreased urine output
BUN:Cr ratio >20:1 (increased resorption of Na and H2O leads to increased passive resorption of urea)
FENA <1%
Unremarkable or bland urine sediment (unless acute tubular necrosis occurs)

75
Q

What causes incisional hernias?

A

Fascial closure breakdown

76
Q

Distinguish rectus abdominis diastasis from incisional hernia.

A

Rectus abdominis diastasis is not a true hernia, so it has no fascial defect. therefore, it is not palpable while supine, unlike an inguinal hernia.

77
Q

Abdominal U/S or CT findings of acute cholangitis?

A

Dilation of the intrahepatic and common bile duct

78
Q

Management of acute choalngitis?

A

Supportive care
Broad-spectrum ABX
Biliary drainage (preferably by ERCP with sphincterotomy)

79
Q

U/S finding of primary sclerosing cholangitis?

A

Short, annular strictures alternating with normal bile duct (beads on a string)

80
Q

What uterine surgical history = contraindicated trial of labor?

A

Classical C-section (vertical incision)

Abdominal myomectomy WITH uterine cavity entry (during removal of intramural or submucosal fibroids)

81
Q

PID typically presents with fever, lower abdominal tenderness, mucopurulent cervical discharge, and cervical motion and uterine tenderness. Describe two other presentations to watch out for.

A
  1. Intermenstrual spotting (cervicitis) and abdominal pain that worsenes with menses
  2. Fitz-Hugh-Curtis disease (perihepatitis) -> liver capsule inflammation causing pleuritic RUQ pain, vomiting, and slightly elevated transaminases +/- symptoms of acute PID
82
Q

What are the 5 main ulcerative STDs?

A
  1. Chancroid
  2. Genital herpes
  3. Granuloma inguinale (donovanosis)
  4. Syphilis
  5. Lymphogranuloma venereum
83
Q

Which of the 5 main ulcerative STDs are initially painful?

A
  1. Chancroid

2. Genital herpes

84
Q

Presentation - single, indurated, well-circumscribed non-exudative ulcer with a clean base (may start as a papule)

A

Syphilis (T. pallidum)

85
Q

Presentation - multiple deep ulcers, base may have gray to yellow exudate

A

Chancroid (Haemophilus ducreyi)

86
Q

Presentation - small, shallow ulcers with large, painful, coalesced inguinal lymph nodes

A

Lymphogranuloma venereum (C. trachomatis)

87
Q

Presentation - multiple, small, grouped ulcers that are shallow with an erythematous base

A

Genital herpes (HSV 1 and 2)

88
Q

Presentation - extensive and progressive ulcerative lesions without LAD, base may have granulation-like tissue

A

Granuloma inguinale (Klebsiella granulomatis)

89
Q

One possible cause of hammer toe and claw deformities?

A

Diabetic peripheral neuropathy

90
Q

Among patients with meningitis, a viral etiology is suggested when CSF analysis reveals what?

A

Mildly elevated WBC count and protein level

Normal glucose concentration

91
Q

Why is doxycycline contraindicated in young children and pregnant/lactating women?

A

Permanent discoloration of teeth and retardation of skeletal development

92
Q

Rx Lyme disease (pregnant women and children <8 y/o)

A

Oral amoxicillin

93
Q

3rd line treatment for Lyme?

A

Azithromycin

94
Q

All patients with smoke inhalation should be suspected to have acute CO poisoning and treated with ___.

A

100% O2 via a non-rebreather facemask

95
Q

Dx CO poisoning?

A

ABG - carboxyhemoglobin level

96
Q

Why is human milk considered to be the ideal nutritional source for full-term infants?

A

Protein is 70% whey and 30% casein, more easily digested and helps to improve gastric emptying

Contains lactoferrin, lysozyme, and secretory IgA (immunity)

Main carbohydrate is lactose

Ca2+ and Ph are better absorbed

Less reflux and colic than formula

97
Q

What happens to RA pressure (aka preload), PCWP (aka preload/LA pressure/LV EDP), cardiac index (aka pump function), SVR (afterload), and mixed venous O2 saturation in hypovolemic shock?

A

All decrease except SVR, which increases (in response to the hypovolemic state)

98
Q

What happens to RA pressure, PCWP, cardiac index, SVR, and mixed venous O2 saturation in cardiogenic shock?

A

RA pressure (fluid backup), PCWP (fluid backup), and SVR increase (in response)

Cardiac index decreases significantly (pump failure)

MVO2 decreases

99
Q

What happens to RA pressure, PCWP, cardiac index, SVR, and mixed venous O2 saturation in septic shock?

A

RA pressure and PCWP are normal or decreased

Cardiac index and MvO2 increase

SVR decreases

100
Q

Stridor that increases with exertion and improves with prone positioning?

A

Laryngomalacia

101
Q

When are breath sounds increased on pulmonary auscultation (the only major pathology that doesn’t decrease)?

A

CONSOLIDATION

102
Q

When is tactile fremitus increased?

A

Consolidation

103
Q

Which 2 pathologies cause hyperresonant lungs?

A

Pneumothorax

Emphysema

104
Q

Rx unilateral adrenal adenoma

A

Surgery (preferred)

105
Q

Rx bilateral adrenal hyperplasia?

A

Medical therapy preferred -> aldosterone antagonists (eplerenone, spironolactone)

106
Q

Condylomata acuminata vs. condylomata lata?

A

HPV 6/11 vs. secondary syphilis

107
Q

Presentation - unilateral conjunctivitis with NO symptoms or allergies

A

Subconjunctival hemorrhage - benign condition, just observe

108
Q

Presentation - cyclical fever with non-specific constitutional and GI manifestations, anemia, and thrombocytopenia

A

Malaria

109
Q

Dx malaria

A

Thin and thick peripheral blood smears

110
Q

Presentation - fever, headache, marked muscle and joint pain, retro-orbital pain, rash, and leukopenia

A

Mosquito-borne dengue fever

111
Q

Presentation - acute febrile illness, myocarditis, chancre, progresses to CNS involvement

A

Sleeping sickness transmitted by the testes flies (African trypanosomiasis - East Africa)

112
Q

Most common cause of neoanatal sepsis?

A

GBS

113
Q

Why is it possible for infants born to mothers with appropriate GBS management to get GBS meningitis?

A

These measures do not decrease the risk of late-onset (>7 days) GBS sepsis from horizontal transmission (vs. vertical)

114
Q

Presentation - chorioretinitis, hydrocephalus, intracranial calcifications

A

Congenital toxoplasmosis

115
Q

What is hyposthenuria and in what illnesses is it seen?

A

The inability of the kidneys to concentrate urine; sickle cell disease and trait

116
Q

Cause of central DI?

A

Insufficient ADH production

117
Q

A relative risk of 0.71 shows that the drug/intervention decreases the risk by ___%.

A

29%

118
Q

Phenytoin is highly protein-bound and metabolized by what system?

A

Hepatically by the CYP450 system

119
Q

Features of acute phenytoin toxicity?

A 
Horizontal nystagmus
Ataxia
N/V
Hyperreflexia may occur
Can progress to AMS, coma, death
120
Q

How do beta blockers treat stable angina?

A

Decrease exertional HR and myocardial contractility -> reduces oxygen demand

121
Q

First-line treatment of chronic stable angina?

A

Beta-blocker

122
Q

Alternative to beta-blocker for treatment of chronic stable angina? MOA?

A

Nondihydropyridine CCBs (V, D)

Same a beta-blockers

123
Q

How are dihydropyridine CCBs used in chronic stable angina? MOA?

A

Added to beta blocker if needed

Coronary artery vasodilation + decreased afterload via systemic vasodilation

124
Q

Rx persistent angina? MOA?

A

Add long-acting nitrates (isosorbide MONOnitrate)

Decrease preload by dilation of capacitance veins

125
Q

Alternative Rx for refractory chronic stable angina? MOA?

A

Ranolazine

Decreased myocardial Ca2+ influx -> reduced ventricular wall stress and myocardial O2 demand

126
Q

Most common heart defect in Down syndrome?

A

Complete AV septal defect

127
Q

Possible auscultation findings of complete AV septal defect?

A
  1. Fixed split S2 (ASD)
  2. Systolic ejection murmur (increased flow across the pulmonary valve due to L->R shunt across the ASD)
  3. Holosystolic murmur of VSD
  4. Holosystolic apical murmur (AV valve regurgitation)
128
Q

Coarctation of the aorta is associated with ___ syndrome.

A

Turner

129
Q

Symptomatic ___ presents with cyanosis and heart failure due to severe tricuspid regurgitation. Auscultation reveals a widely split S1 and S2 + a loud S3 and/or S4 and a holosystolic or early systolic murmur at the LLSB.

A

Ebstein

130
Q

PDA is strongly associated with ___ syndrome.

A

Congenital rubella

131
Q

Transposition of the great arteries is strongly associated with ___ syndrome.

A

DiGeorge

132
Q

Gout is a common complication of myeloproliferative disorders - why?

A

Excessive turnover of purines -> increased uric acid production

133
Q

4 causes of gout related to increased urate production

A
  1. Primary gout
  2. Myeloproliferative/lymphoproliferative disorders
  3. Tumor lysis syndrome
  4. HGPT deficiency (Lesch-Nyhan syndrome)
134
Q

2 causes of gout related to decreased urate clearance?

A

CKD

Thiazide/loop diuretics

135
Q

Features of vasculitis neuropathies?

A

Assc. with systemic vasculitis
Patchy, asymmetric neuropathy affecting several nerves
Severe pain
Systemic symptoms

136
Q

Features of alcoholic neuropathy?

A

Symmetric distal polyneuropathy (paraesthesia, burning pain, ataxia)
Loss of DTRs and light touch and vibratory sense

137
Q

Presentation - developomental delay, sensorineural deafness, cataracts, HSM, purpura

A

Congenital rubella syndrome

138
Q

Presentation - cutaneous findings (blue toe syndrome, livedo reticularis), cerebral/intestinal ischemia, AKI, Hollenhorst plaques

A

Cholesterol embolism

139
Q

Rx cholesterol embolism?

A

Supportive

Statin therapy for risk factor reduction and prevention of recurrent embolism

140
Q

Distinguish between chronic bronchitis vs. emphysema-predominant COPD.

A

DLCO - normal in chronic bronchitis, decreased in emphysema

Dedicated - Step 2 (22 decks)

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