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Dedicated - Step 2 > 14 > Flashcards

14 Flashcards

1
Q

How does SCFE occur?

A

Excessive shearing at the proximal femoral physis (growth plate)

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2
Q

Rx drug resistant CMV

A

Foscarnet

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3
Q

Cause of vaginal SqCC?

A

Persistent infection with HPV 16/18; chronic tobacco use increases risk

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4
Q

Rx limited plaque psoriasis?

A

Topical high-potency glucocorticoids or vitamin D derivatives (eg, calcipotriene), topical retinoids, calcineurin inhibitors

If moderate to severe - phototherapy or systemic treatment (MTX, biologics, etc.)

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5
Q

Is S3 or S4 an expected finding in patients with severe MR - why?

A

S3 gallop

Backflow of blood from LV during systole -> total amount of blood entering LV during diastole increases -> eccentric hypertrophy to compensate for increased volume load

Sudden cessation of blood flow into a dilated LV during the passive filling phase of diastole

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6
Q

S3 is commonly heard in ___.

A

Heart failure

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7
Q

Opening snap?

A

Mitral stenosis

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8
Q

S4 is commonly heard in ___ - why?

A

Concentric LVH due to systemic HTN or severe AS -> blood striking stiff L ventricle during atrial systole, just before mitral valve closure (S1)

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9
Q

Uvular pulsation may be appreciated with the high-amplitude systolic pulsation and rapid diastolic collapse that occurs with severe ___.

A

AR

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10
Q

Palpable fetal parts on abdominal exam, loss of fetal station

A

Uterine rupture

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11
Q

Clinical features of alpha-thalassemia minima (1 gene loss)

A

Asymptomatic, silent carrier

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12
Q

Clinical features of alpha-thalassemia minor (2 gene loss)

A

Mild microcytic anemia

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13
Q

Clinical features of Hemoglobin H disease (3 gene loss)

A

Chronic hemolytic anemia

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14
Q

Clinical features of hydrops fetalis, Hgb Barts (4 gene loss)

A

High-output cardiac failure, anasarca, death in utero

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15
Q

Of the 3 main causes of vaginitis, which one has normal pH (vs increased >4.5)?

A

Candida vaginitis

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16
Q

Vaginitis with clue cells and + whiff test?

A

BV

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17
Q

Vaginitis with motile trichomonads?

A

Trichomoniasis

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18
Q

Vaginitis with pseudohyphae?

A

Candida

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19
Q

Rx BV?

A

Metronidazole or clindamycin

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20
Q

Rx trichomoniasis?

A

Metronidazole + treat sexual partner

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21
Q

Rx candida vaginitis?

A

Fluconazole

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22
Q

Anaerobe that may cause PID associated with IUDs?

A

Actinomyces (filamentous, GP bacilli, branching)

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23
Q

Subluxation of the radial head is common in preschool children. The classic mechanism is swinging or pulling a child by the arm. Full recovery after ___ confirms the diagnosis.

A

Closed reduction by forearm hyperpronation or supination of forearm + flexion of the elbow

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24
Q

Physical findings of radial head subluxation

A

Arm held extended and protonated

NO swelling, deformity, or focal tenderness

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25
Q

Management of sharp foreign body?

A

Endoscopic removal due to the risk of esophageal perforation

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26
Q

Cause of methemoglobinemia?

A

Uncommon complication after excessive exposure to an oxidizing agent (eg, dapsone, nitrites, local/topical anesthetics)

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27
Q

Presentation of methemoglobinemia?

A

Cyanosis, pulse ox ~85% always, dark chocolate colored blood, no improvement with supplemental O2

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28
Q

Lab findings in methemoglobinemia?

A 
Saturation gap (>5% difference between O2 saturation on pulse oximetry and ABG)
Normal PaO2 (falsely elevated)
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29
Q

Rx methemobloinemia

A

Methylene blue or high-dose ascorbic acid

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30
Q

Presentation of premature adrenarche?

A

Early activation of adrenal androgens (more common in obesity)

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31
Q

Presentation of premature adrenarche?

A

Precocious development of pubic and axillary hair, acne, and body odor in a child with a normal bone age

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32
Q

Compare the joints involved in OA vs. RA.

A

OA: knees and hips, DIP, first CMC

RA: MCP, PIP, wrists

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33
Q

Compare the XR findings of OA vs. RA.

A

OA: narrowed joint space, osteophytes

RA: periarticular erosions

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34
Q

Case control vs. retrospective cohort studies

A

Case control: outcome first, then look for associated risk factors

Retrospective cohort: first ascertain risk factor exposure and then determine the outcome

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35
Q

What is supravalvular aortic stenosis?

A

Second most common type of AS

Congenital left ventricular outflow tract obstruction due to discrete or diffuse narrowing of the ascending aorta

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36
Q

Presentation of supravalvular AS?

A

Systolic murmur best heard at the FIRST RIGHT INTERCOSTAL SPACE
Unequal carotids
Differential blood pressure in the upper extremities
Palpable thrill in the suprasternal notch

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37
Q

Sequelae of supravalvular AS?

A

LVH, coronary artery stenosis (associated anomaly) -> increase myocardial O2 demand during exercise

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38
Q

Stretching of the papillary muscles can lead to ___.

A

MR (holosystolic or mid to late systolic murmur at apex)

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39
Q

Systolic anterior motion of the MV is seen in patients with ___.

A

HOCM

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40
Q

Tendency of the study population to affect the outcome since they are aware they are being studied

A

Hawthorne effect

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41
Q

Physiologic changes to thyroid hormones seen in pregnancy?

A

Thyroid hormone production increases:
Total T4 - increased
Free T4 - unchanged or mildly increased
TSH - decreased

E2 increases thyroxine-binding globulin, leading to an increased total (but not free) thyroid hormone levels

hCG stimulates TSH receptors increasing production

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42
Q

Features of acute HIV infection?

A

Mono-like syndrome (fever, LAD, sore throat, arthralgias, etc.)
Painful mucocutaneous ulcerations are characteristic (if present)
Generalized macular rash
GI symptoms

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43
Q

In HIV, what 2 viruses can cause severe acute retinal necrosis associated with pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis?

A

HSV and VZV

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44
Q

What other virus can cause retinitis in HIV and how can it be distinguished?

A

CMV -> PAINLESS, not usually associated with keratitis or conjunctivitis, and characterized by funduscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels

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45
Q

Exertional heat stroke occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity due to ___.

A

Thermoregulation failure

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46
Q

What causes heat exhaustion?

A

Inadequate fluid and salt replacement

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47
Q

Rx primary biliary cholangitis?

A

Ursodeoxycholic acid (delays histologic progression, may improve symptoms/survival)

Advanced disease - liver transplantation

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48
Q

Rx autoimmune hepatitis?

A

Glucocorticoids

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49
Q

Autoimmune hepatitis antibodies?

A

+ANA

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50
Q

MOA - type 2 HI?

A

Heparin induces a conformational change in a platelet surface protein which exposes a neoantigen; antibodies are formed and bind to the surface of platelets -> platelet activation, thrombocytopenia, and a prothrombic state

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51
Q

Heparin MOA?

A

Binds antithrombin and inactivates 10a, prolongs aPTT

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52
Q

Type 1 vs. Type 2 HIT?

A

Type 1 - non-immune-mediated platelet aggregation, mild thrombocytopenia within 2 days, no intervention needed

Type 2 - immune-mediated, severe, D/C heparin

53
Q

Risk = ?

A

Probability of getting a disease over a certain period of time -> # diseased subjects/# of subjects at risk

54
Q

Renal injury usually causes hypocalcemia - why?

A

Reduced phosphorus clearance leading to calcium phosphate salt formation

55
Q

In an older patient with an intrinsic AKI and hypercalcemia, what should be suspected?

A

ATN due to multiple myeloma

56
Q

What is the most reliable and predictive sign of opioid intoxication?

A

Decreased RR

57
Q

When is hormone replacement therapy indicated?

A

Treatment of severe vasomotor symptoms in women age <60 who have undergone menopause within the past 10 years

58
Q

Long-term analgesic use with 1+ analgesics can cause CKD due to what?

A

Tubulointerstitial nephritis and hematuria due to papillary necrosis

59
Q

Lab findings of analgesic nephropathy?

A

Elevated Cr
UA with hematuria, sterile pyuria, possible WBC casts, mild proteinuria
CT with small kidneys, bilateral renal papillary calcifications

60
Q

Rx uric acid stones?

A

Alkalization of the urine to pH 6.0-6.5 with oral potassium citrate

61
Q

3 possibilities when a patient has symptoms consistent with typical renal colic but no stones on conventional radiographs?

A
  1. Radiolucent stones (uric acid, xanthine)
  2. Small calcium stones (<1-3 mm in diameter)
  3. Nonstone ureteral obstruction (blood clot, tumor, etc.)
62
Q

Uric acid stones are most commonly seen in patients with what 2 lab findings?

A

Unusually low urine pH (defect in renal ammonia excretion)

Hyperuricosuria

63
Q

Which diuretics can cause stones? Which can treat stones?

A

Furosemide -> increases risk of calcium stone formation (hypercalciuria)
HCTZ -> management of hypercalciuric stones (decreases urinary calcium excretion)
Thiazides -> decrease uric acid excretion, but also lower urine pH and increase the risk of uric acid stones

64
Q

LP or empiric ABX first in suspected meningitis?

A

LP prior to ABX UNLESS critically ill or some other barrier to getting the LP immeidately

65
Q

Why is head imaging not required before LP in infants?

A

Open anterior fontanelle eliminates risk for herniation

66
Q

What causes renal failure in HUS?

A

Thrombotic angiopathy (NOT glomerulonephritis)

67
Q

Most common cause of pediatric stroke?

A

Sickle cell disease

68
Q

Acute pancreatitis complicated by hypotension is thought to arise from what process?

A

Intravascular volume loss secondary to local and systemic vascular endothelial injury -> vasodilation, increased vascular permeability, and plasma leak into the retroperitoneum

69
Q

Most common acid-base disturbance caused by a PE? Explain

A

Respiratory alkalosis - hyperventilation as a patient tries to overcome hypoxia and V/Q mismatching

70
Q

Presentation - decreased sensation over 4th and 5th fingers, weak grip due to involvement of interosseous muscles?

A

Ulnar nerve entrapment

71
Q

Most common site of ulnar nerve entrapment?

A

Elbow (where the nerve lies at the medial epicondylar groove)

May occur due to leaning on the elbows while working at a desk or table

72
Q

What is Budd-Chiari syndrome?

A

Hepatic venous outflow obstruction

73
Q

3 general causes of Budd-Chiari syndrome?

A
  1. Myeloproliferative disorder (eg, polycythemia vera)
  2. Malignancy (eg, HCC)
  3. OC use/pregnancy
74
Q

Acute presentation of Budd-Chiari syndrome?

A

Jaundice, hepatic encephalopathy, variceal bleeding

Prolonged INR/PTT; elevated transaminases

75
Q

Subacute/chronic presentation of Budd-Chiari syndrome?

A

Vague, progressive abdominal pain
HSM, ascites
Mild/moderate elevation in bilirubin/transaminases

76
Q

Dx Budd-Chiari

A

Abdominal Doppler U/S -> decreased hepatic vein flow

Investigation for underlying disorders (JAK2 testing for PV)

77
Q

What are the 2 phases of the first stage of labor and what defines normal labor progression?

A 
Latent phase (0-6 cm)
Active phase (6-10 cm)
Active phase, 1+ cm/2 hours
78
Q

Define active phase labor arrest.

A

No cervical change for 4+ hours with adequate contractions or 6+ hours with inadequate contractions

79
Q

When is an intrauterine pressure catheter placed?

A

When labor has not completely arrested but cervical change slows to <1 cm/2 hr (labor protraction)

80
Q

Define inadequate contractions.

A

<200 MVU

81
Q

When is an operative vaginal delivery performed?

A

Expedite delivery for category III tracings or maternal exhasution during stage 2 (10 cm dilation)

82
Q

Define chronic or pre-existing HTN in gestation.

A

Systolic 140+ AND/OR diastolic 90+ BEFORE 20 weeks during 2 separate measurements taken at least 4 hours apart

83
Q

Risks related to HTN in pregnancy?

A 
Superimposed preeclampsia
Postpartum hemorrhage
GDM
Abruptio placentae
C/S
Fetal growth restriction
Perinatal mortality
Preterm labor
Oligohydramnios

May be linked to increased SVR and arterial stiffness -> placental dysfunction

84
Q

Although patients with biliary pancreatitis may sometimes have a normal U/S (especially if the stone is pased), they typically have an elevated ___ level.

A

ALT (>150)

85
Q

In patients with a history of splenectomy or functional asplenia, ___ would be an expected finding on peripheral smear.

A

Howell-Jolly bodies (small purple dots within the RBCs)

86
Q

What are Heinz bodies?

A

Small inclusions within an RBC -> aggregates of denatured Hgb, common in patients with hemolysis due to G6PD deficiency and thalassemia

87
Q

What are bite cells?

A

RBCs with Heinz bodies removed by phagocytes

88
Q

Risk factors for brain abscess?

A 
Mastoiditis
Otitis media
Sinusitis
Dental infection
Cyanotic heart disease (hematogenous spread of bacteria)
89
Q

Rx tinea corporis?

A

Topical antifungal (clotrimazole, terbinafine, etc.)

90
Q

What type of anemia is seen in sickle cell disease?

A

Normocytic, normochromic, hemolytic anemia with compensatory reticulocytosis

91
Q

Why may patients with SCD develop folate deficiency?

A

Chronic hemolysis without adequate supplementation

92
Q

What is Diamond-Blackfan anemia?

A

Congenital pure red cell aplasia characterized by macrocytic anemia and several congenital abnormalities (cleft palate, webbed neck, triphalangeal thumbs)

93
Q

Cause of Diamond-Blackfan anemia?

A

Congenital erythroid aplasia

94
Q

Lab findings of Diamond-Blackfan anemia?

A

Macrocytic anemia
Reticulocytopenia
Normal platelets and WBCs

95
Q

Rx Diamond-Blackfan anemia?

A

Steroids

RBC transfusions

96
Q

Compare Fanconi and Diamond-Blackfan anemia.

A

Fanconi - pancytopenic BM failure

DBA - pure red cell aplasia, normal platelet and WBC counts

97
Q

Unfavorable metabolic side effects of thiazide diuretics?

A

Hyperglycemia
Increased LDL and triglycerides
Hyperuricemia

98
Q

Electrolyte abnormalities due to thiazides?

A

Hyponatremia
Hypokalemia
Hypomagnesemia
Hypercalcemia

99
Q

Patients with androgen insensitivity syndrome are genotypically male but appear phenotypically female. Management?

A

Elective gonadectomy (increased risk of testicular cancer due to bilateral cryptorchid testes)

100
Q

Management of Turner syndrome?

A 
Estrogen replacement (development of secondary sexual characteristics, prevention of osteoporosis)
GH therapy (management of short stature)
101
Q

First-line ABX in pregnant patients with asymptomatic bacteriuria?

A

Cephalexin
Amox-clav
Nitrofurantoin
Fosfomycin

102
Q

Define mild UC.

A

<4 bowel movements/day
Intermittent hematochezia
Normal inflammatory markers
No anemia

Dx with colonoscopy - inflammation and superficial ulcerations extending from the anorectum continuously to more proximal regions of the colon

103
Q

First-line treatment of mild UC?

A

5-aminosalicylic acid medications (mesalamine, sulfasalazine) -> suppositories or enemas preferred if limited to rectosigmoid

104
Q

First-line therapy in moderate to severe UC?

A

Anti-tumor necrosis factor-alpha inhibitors (infliximab, adalimumab, golimumab)

105
Q

Complications of temporal arteritis?

A

Permanent vision loss

Aortic aneurysm

106
Q

What causes increased alveolar-arterial oxygen gradient?

A

R->L intrapulmonary shunting
VQ mismatch
Impaired gas exchange

107
Q

3 major complications of cocaine use?

A

Acute MI
Aortic dissection
Intracranial hemorrhage

108
Q

Changes to management of chest pain 2/2 cocaine use?

A

Benzos for blood pressure and anxiety
NO BETA BLOCKERS
No fibrinolytics

109
Q

What is indicated in all patients with new-onset ascites?

A

Paracentesis to determine the etiology

110
Q

Most common malignancy diagnosed in patients exposed to asbestos?

A

Bronchgenic carcinoma

111
Q

Clinical features of aortic dissection?

A

History of HTN (#1 risk factor), Marfan syndrome, cocaine use
Severe, sharp, tearing chest or back pain
+/- >20 mm Hg variation in SBP between arms

112
Q

Distinguish acute aortic regurgitation/heart failure due to aortic dissection vs. cardiac tamponade due to aortic dissection.

A

Tamponade will NOT have pulmonary edema

113
Q

Serum-to-ascites albumin gradient of 1.1+ indicates vs. <1.1?

A

1.1+ - portal hypertensive etiologies (cardiac ascites, cirrhosis, etc.)

<1.1 - non-portal hypertension

114
Q

Neutrophil count of ascites indicating peritonitis?

A

250/mm^3 or higher

115
Q

Total protein count in peritonitis (high vs. low)?

A

2.5+ g/dL (high-protein) - CHF, constrictive pericarditis, etc.

<2.5 g/dL (low-protein) - cirrhosis, nephrotic syndrome

116
Q

Screening mammography?

A

Biennial for women 50-74

117
Q

AAA screening recs?

A

Men age 65-75 who ever smoked (abdominal U/S 1x)

118
Q

What is mixed connective tissue disease?

A

Clinical features of SLE, SS, and polymyositis (sequential)

Important manfiestations include Raynaud, swelling of the fingers and hands, inflammatory arthritis, and myositis

119
Q

Autoantibodies for ___ have high sensitivity and specificity for MCTD.

A

U1 ribonucleoprotein

120
Q

Most common cause of death in MTCD?

A

Pulmonary HTN

121
Q

Most common type of kidney stone?

A

calcium oxalate stones

122
Q

3 common types of kidney stones?

A

Calcium (oxalate, phosphate)
Magnesium ammonium phosphate (struvite)
Uric acid

123
Q

Appearance of the 3 common types of kidney stones on radiography?

A

Calcium - small, radiopaque
Struvite - large, radiopaque
Uric acid - small, radiolucent

124
Q

Crystal morphology - rectangular/prism kidney stones

A

Struvite

125
Q

Crystal morphology - yellow/brown, rhomboidal kidney stones

A

Uric acid

126
Q

Crystal morphology - octahedron or envelope kidney stones

A

Calcium oxalate

127
Q

Crystal morphology - wedge or rosette kidney stones

A

Calcium phosphate

128
Q

Most consistently replicated neuroimaging finding in schizophrenia?

A

Enlargement of the lateral cerebral ventricles

Dedicated - Step 2 (22 decks)

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