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Dedicated - Step 2 > 15 > Flashcards

15 Flashcards

1
Q

Classic triad - respiratory distress, neurologic dysfunction (eg, confusion), petechial rash

A

Fat embolism syndrome; however, rash is only present 50% of the time

Presents 24-72 hours following inciting event (fracture, orthopedic surgery, pancreatitis)

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2
Q

Explain the pulmonary findings in patients with fat embolism syndrome.

A

Patients typically develop pulmonary edema (mimicking ARDS) after 24-48 hours (bilateral ground-glass opacities on chest CT)

No pulmonary arterial filing defects, because emboli obstruct the pulmonary capillaries and are too small to be detected

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3
Q

Patients with persistent tachyarrhythmia (narrow- or wide-complex) causing hemodynamic instability should be managed with ___. How does the management differ in patients who do not have hemodynamic instability?

A

Immediate synchronized cardioversion; adenosine or vagal maneuvers can be considered, followed by IV beta blockers or CCBs if these fail

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4
Q

IV antiarrhythmics like amiodarone and procainamide can be used in patients with stable recurrent or refractory ___.

A

Wide-complex tachycardia

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5
Q

When is defibrillation (unsynchronized cardioversion) indicated?

A

Pulseless cardiac arrest with a shockable rhythm (VFib, pulseless VTach)

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6
Q

Risks of intrahepatic cholestasis of pregnancy?

A

Intrauterine fetal demise
Preterm delivery
Meconium-stained amniotic fluid
Neonatal respiratory distress syndrome

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7
Q

What is polymorphic eruption of pregnancy?

A

Aka pruritic urticarial papules and plaques of pregnancy -> cause pruritis within the abdominal striae that spreads centrifugally but spares the palms and soles

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8
Q

Manage polymorphic eruption of pregnancy?

A

Topical steroids

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9
Q

Most appropriate initial imaging study for fecal impaction when necessary?

A

Plain XR

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10
Q

Post-menopausal women with endometrial cells on Pap test require what next step?

A

Endometrial biopsy

Note - if pre-menopausal, only if abnormal uterine bleeding or risk for endometrial hyperplasia

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11
Q

Who gets endometrial evaluation when atypical glandular cells are found on Pap?

A

Women age 35+ OR at risk for endometrial hyperplasia

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12
Q

Risk factors for pPROM?

A

Prior pPROM
GU infection (including ASB, BV)
Antepartum bleeding

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13
Q

Dx and Rx postpartum urinary retention (inability to void 6+ hours after vaginal delivery)?

A

Urethral catheterization

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14
Q

Up to 70% of patients with mitral stenosis will develop AFib - why?

A

Significant L atrial dilation

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15
Q

All non-immune asymptomatic healthy patients age >1 year with varicella exposure should receive post-exposure prophylaxis with ___.

A

Varicella vaccine

At-risk patients who CANNOT receive the varicella vaccine should receive VZIg instead

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16
Q

Lobes impacted by aspiration while upright and aspiration while recumbent?

A

Upright -> lower lobes or R middle lobe

Recumbent -> posterior segment of the upper lobes

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17
Q

What determines blood flow across the large unrestrictive VSD in Tetralogy of Fallot?

A

Relative resistance between the systemic pulmonary circulations

If SVR > pulmonary vascular resistance, blood will shunt from ventricles to the pulmonary artery

If PVR > SVR, blood will shunt from ventricles into the aorta, resulting in cyanosis

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18
Q

Treatment of a tet spell?

A
  1. Immeidate knee-chest positioning (kinks the femoral arteries and increases SVR, reducing R to L shunting)
  2. Inhaled O2 (stimulates pulmonary vasodilation and decreases SVR)
  3. IV fluids (improve RV filling and pulmonary flow)
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19
Q

What is HSP?

A

IgA-mediated vasculitis that presents with palpable purpura on the lower extremities, arthralgia/arthritis, abdominal pain (+/- intussusception), and renal disease (similar to IgA nephropathy, usually presents with hematuria, +/- mild proteinuria)

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20
Q

Management of HSP?

A

Supportive (hydration and NSAIDs) for most patients

Hospitalization and systemic glucocorticoids (severe symptoms)

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21
Q

Timing of renal manifestations of HSP?

A

Can develop at symptom onset or months after the initial presentation

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22
Q

Features of Turner syndrome (external)?

A 
Narrow, high-arched palate
Low hairline
Webbed neck
Broad chest with widely spaced nipples
Cubitus valgus
Short stature
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23
Q

Features of Turner syndrome (internal)?

A

Coarcatation of the aorta
Bicuspid aortic valve
Horseshoe kidney
Streak ovaries, amenorrhea, infertility

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24
Q

Complications of Turner syndrome?

A

Primary ovarian insufficiency/estrogen deficiency -> increased bone resorption, decreased bone mineral density, increased risk of osteoporotic fracture

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25
Q

Serologies - acute HBV (early phase, window phase, and recovery phase)

A

Early: +HBsAg, HBeAg, anti-HBc IgM

Window: +ONLY anti-HBc IgM

Recovery: +anti-HBc IgG, anti-HBs, anti-HBe

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26
Q

Serologies - chronic HBV carrier

A

+HBsAg

+anti-HBc IgG

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27
Q

Serologies - acute flare of chronic HBV

A

+HBsAg, (likely) +HBeAg, anti-HBc IgM, anti-HBc IgG

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28
Q

Serologies - HBV vaccination

A

ONLY +anti-HBs

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29
Q

Serologies - immunity due to natural HBV infection

A

+anti-HBs, anti-HBc IgG

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30
Q

This antigen indicates HBV infectivity/active viral replication

A

HBeAg

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31
Q

Presentation - small (<4 cm), firm, unilateral or bilateral subareolar mass, no pathologic features (eg, nipple discharge, axillary LAD, systemic illness)

A

Pubertal gynecomastia (due to imbalance of estrogens and androgens during mid-puberty)

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32
Q

Management of pubertal gynecomastia?

A

Reassurance and observation, should resolve within 1 year

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33
Q

Presentation - small, firm testes and bilateral gynecomastia

A

Klinefelter syndrome (47, XXY)

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34
Q

Which symptom of Kawasaki is typically the last to manifest, and which is the least common?

A

Last - extremity changes

Least common - LAD

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35
Q

Rx Kawasaki disease?

A

Aspirin and IVIg

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36
Q

Presentation of scarlet fever?

A

Pharyngitis, fever, sandpaper-like rash (usually desquamates)

+/- strawberry tongue and cervical LAD

Rash prominent over skin folds

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37
Q

___ can cause an acute symmetric arthritis of the hands (MCP, PIP, wrist), knees, and ankle joints. How is the diagnosis confirmed and treated?

A

Parvovirus B19; anti-parvovirus B19 IgM (if immunocompenet) or NAAT for B19 DNA (if immunocompromised); self-limited, no treatment needed

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38
Q

Presentation - chronic vasculitic syndrome characterized by palpable purpura, LAD, nephropathy, neuropathy, and arthralgias

A

Mixed cryoglobulinemia (associated with chronic HCV)

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39
Q

Aminoglycosides are used to treat serious ___ infections.

A

Gram Negative

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40
Q

Major AE of AGs?

A

Nephrotoxic

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41
Q

What is pellagra and what causes it?

A

Dermatitis (sun-exposed areas, rough, hyperpigmented, scaly skin), diarrhea, and dementia
Niacin (B3) deficiency

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42
Q

In developing countries, niacin deficiency is seen in populations that subsist primarily on ___ products.

A

Corn

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43
Q

In developed countries, niacin deficiency is primarily seen in patients with impaired ___. Name 3 other instances.

A

Nutritional intake;

  1. Carcinoid syndrome (depletion of tryptophan)
  2. Hartnup disease (congenital tryptophan absorption disorder)
  3. Prolonged INH therapy (interferes with tryptophan metabolism)
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44
Q

Features of acute intermittent porphyria?

A

Abdominal pain, vomiting, diarrhea, neuro symptoms (agitation, paresthesias, confusion, etc.)

Episodic symptoms
Chronic transaminase elevation is common
F>M

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45
Q

What is erythema toxicum neonatorum and what should be done about it?

A

Benign neonatal rash characterized by blanching erythematous papules and pustules (spares palms and soles)

Reassurance, resolves spontaneously within 2 weeks of birth

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46
Q

3 complications associated with ankylosing spondylitis?

A

Osteoporosis/vertebral fractures
Aortic regurgitation
Cauda equina

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47
Q

What medications can cause a false-positive phencyclidine result?

A

Dextromethorphan, diphenhydramine, doxylamine, ketamine, tramadol, venlafaxine

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48
Q

Rx septic arthritis (GP cocci on Gram stain)?

A

Vancomycin

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49
Q

Rx septic arthritis (GN rods on Gram Stain)?

A

Third-generation cephalosporin

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50
Q

Rx septic arthritis (negative Gram Stain)?

A

Vancomycin (+ 3rd generation cephalosporin if immunocompromised)

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51
Q

Features of aspirin-exacerbated respiratory disease?

A

Patients with asthma and chronic rhinosinusitis

Sudden worsening of asthma and nasal congestion 30 minutes to 3 hours after ingestion of NSAIDs

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52
Q

Management of upper airway cough syndrome (postnasal drip syndrome)?

A

Diphenhydramine (anticholinergic effect)

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53
Q

When evaluating a patient with hypertension, one should look for secondary causes, including ___ in younger women.

A

OCPs

54
Q

In a patient with Hepatitis A, what should be done to decrease risk of disease transmission?

A

Post-exposure prophylaxis with either Hepatitis A vaccine or Hepatitis A Ig in those with close personal contacts (sexual, household), child care center contacts, and food preparation co-workers

In general, younger patients (40 and younger) -> vaccine; older patients (41+) -> IG

55
Q

Persistence of HBsAg indicates?

A

Chronic infection (>6 months)

56
Q

Most effective single agent for allergic rhinitis?

A

Glucocorticoid nasal sprays (eg, fluticasone, mometasone)

Other options - oral antihistamines, antihistamine or cromolyn nasal sprays, leukotriene modifiers

57
Q

Hypovolemic hyponatremia occurs due to a multiple-pathway mechanism that illustrates the body’s priority to restore ___ at the risk of developing ___. Explain the mechanism.

A

Euvolemia; hypotonicity

Solute and water loss:

  1. Decreased renal perfusion -> RAS -> angiotensin II -> increased thirst -> increased water intake -> decreased serum Na
    * Angiotensin also increases ADH
    * Angiotensin also increased aldosterone -> increases Na reabsorption
  2. Hypotension -> baroreceptor activation -> increased ADH (non-osmotic stimulation) -> increased water reabsorption -> decreased serum Na
  3. Hypovolemia -> L atrial stretch receptor stimulation -> increased ADH (#2)
58
Q

Rx hypovolemic hyponatremia

A

Infusion of NS (replenishes the body’s depleted salt stores, restores euvolemia, and shuts off non-osmotic stimuli for ADH release)

59
Q

Who gets screened for HIV and HepB?

A

History of high-risk sexual intercourse (unprotected or MSM)

60
Q

Who gets screened for HepC?

A

IVDU, high-risk needlestick exposure, blood transfusions before 1992

61
Q

Initial criteria for extubation readiness and first step?

A

pH >7.25
Adequate oxygenation on minimal ventilator settings (FiO2 40% or less, PEEP 5 cm H2O or less)
Sufficient mental alertness to protect the airway and intact inspiratory effort

Spontaneous breathing trial

62
Q

Patients with a ___ (high or low) rapid shallow breathing index (RR per minute/TV in L) are unlikely to do well without continued vent support.

A

High (breathing fast and shallow)

63
Q

Who can be extubated without an SBT?

A

May be appropriate for patients who were intubated for an elective surgical procedure

64
Q

Appropriate compensation in a primary metabolic acidosis?

A

PaCO2 = 1.5HCO3 + 8 +/-2

65
Q

Appropriate compensation in a primary metabolic alkalosis?

A

Increase PaCO2 by 0.7 mmHg for every 1 mEq/L rise in HCO3

66
Q

Most common glomerulopathy associated with HIV?

A

Collapsing FSGS

Presents with heavy proteinuria with rapid development of renal failure

67
Q

4 modifiable breast cancer risk factors

A

HRT
Nulliparity
Increased age at first live birth
Alcohol consumption

68
Q

Hydroxyurea is a relatively safe therapy with a dose-limiting side effect of ___.

A

Myelosuppression

69
Q

Maintenance management of sickle cell anemia?

A

Vaccination
PCN until age 5
Folic acid supplementation
Hydroxyurea (if re3current vaso-occlusive crises)

70
Q

Rx polycythemia vera?

A

Serial phlebotomy

+/- bone marrow suppressive drugs (eg, hydroxyurea) if high risk of thrombosis

71
Q

Mild reaction sometimes seen with MMR vaccination?

A

Fever and maculopapular rash 1-3 weeks after immunization

AVOID CONTACT WITH IMMUNOCOMPROMISED INDIVIDUALS

72
Q

Causes of increased maternal serum AFP (3)?

A
  1. Open neural tube defects (eg, anencephaly, open spina bifida)
  2. Ventral wall defects (eg, omphalocele, gastroschisis)
  3. Multiple gestation
73
Q

Causes of decreased maternal serum AFP (1)?

A

Aneuploidies (trisomy 18 and 21)

74
Q

Next step if MSAFP is elevated?

A

U/S evaluation of the fetal anatomy

Clarify the number of fetuses

Confirm gestation age

75
Q

Rx gonococcal urethritis

A

Azithro (or doxy) PLUS ceftriaxone (unless gonorrhea is ruled out)

Never ceftriaxone alone (increasing resistance)

Azithro or doxy alone can be used if gonorrhea is confidently ruled out

76
Q

Normally, elevated plasma Ca2+ suppresses PTH secretion - if this is not the case, what should be suspected?

A

Primary hyperparathyroidism

77
Q

Secondary hyperparathyroidism is characterized by increased secretion of ___ in response to ___. It is a common finding in what disease and why?

A

PTH; hypocalcemia; CKD due to inadequate phosphate excretion and low 1,25-hydroxyvitamin D levels

High phosphorus
Low/low-normal calcium

78
Q

Expected levels of calcium and pTH in primary osteoporosis?

A

Normal

79
Q

When should you suspect aortic dissection?

A
  1. Risk factors (Marfan syndrome, CTD, HTN, etc.)
  2. Tearing chest/abdominal pain radiating to the back
  3. Perfusion deficits (eg, pulse deficit, >20 mm Hg BP difference between R and L arm, AR murmur)
80
Q

Work-up if aortic dissection is suspected?

A

CXR and EKG; if these suggest other diagnoses -> evaluate and treatment appropriately

If no, check serum creatinine/constrast allergy

If normal/no allergy -> TEE, chest CT with contrast, MRI if non-emergency and patient can lie still

If not normal or allergy or unstable -> TEE preferred

81
Q

Target screening for elevated blood lead levels should be performed in children with risk factors. What should be done if a capillary test is elevated?

A

Repeat testing by venous blood draw to verify a high blood lead level from capillary screening (5+)

82
Q

When is chelation therapy given for lead poisoning in children?

A

Dimercaptosuccinic acid (succimer) - lead levels 45-69

Dimercaprol (British anti-Lewisite) PLUS calcium disodium edetate (EDTA) for lead levels 70+ or acute encephalopathy

83
Q

What else should be checked when suspecting lead poisoning in children?

A

Iron deficiency (Rx with oral ferrou sulfate if deficient), as comorbid iron deficiency can increase GI absorption of lead

84
Q

First step (and subsequent steps in management of a newborn with respiratory compromise and suspected congenital diaphragmatic hernia?

A

Endotracheal intubation

(Bag-and-mask ventilation can exacerbate respiratory decline)

Then place a G-tube to decompress the stomach and bowel (continuous suction)

Then place an umbilical A-line (blood gases and BP) and an umbilical venous catheter (fluids and meds)

When stable, CXR

85
Q

Features of congenital diaphragmatic hernia on exam?

A

Concave abdomen
Barrel-shaped chest
If left-sided -> absent L breath sounds
Deviation of heart into R thorax impairs R lung development –> R-sided heart sounds, fair right lung aeration

86
Q

Unlike in adults, GAS pharyngitis in children should always be confirmed by ___ or ___ prior to initiating ABX.

A

Rapid streptococcal Ag testing; throat culture

87
Q

Discuss the use of Centor criteria in adults vs. children.

A

Adults with a 4 can receive empiric ABX without testing

The criteria are NOT reliable in pre-adolescents. Clinical features do not reliably distinguish bacterial from viral pharyngitis in children except when obvious viral manifestations (eg, conjunctivitis, rhinorrhea, cough, exanthem, oral ulcers) are present

88
Q

Patients with long-standing ankylosing spondylitis are at increased risk for ___.

A

Vertebral fracture, often resulting from minimal trauma

89
Q

Bedwetting is normal before what age?

A

Age 5

90
Q

First-line therapies in patients seeking treatment for nocturnal enuresis (urinary incontinence in children age 5+)

A

Enuresis alarm therapy

Desmopressin

91
Q

2 conditions associated with acanthosis nigricans

A 
Insulin resistance (DM, PCOS, etc.) - younger patients
GI malignancy - older patients
92
Q

3 conditions associated with multiple skin tags?

A

Insulin resistance
Pregnancy
Crohn disease (perianal skin tags)

93
Q

1 condition associated with porphyria cutanea tarda and cutaneous leukcytoclastic vasculitis (palpable purpura) 2/2 cryoglobulinemia?

A

Hepatitis C

94
Q

1 condition associated with dermatitis herpetiformis?

A

Celiac disease

95
Q

1 condition associated with sudden-onset severe psoriasis, recurrent herpes zoster, or disseminated molluscum contagiosum

A

HIV

96
Q

2 conditions associated with severe seborrheic dermatitis

A

HIV

Parkinson disease

97
Q

1 condition associated with explosive onset of multiple itchy, seborrheic keratoses

A

GI malignancy

98
Q

1 condition associated with pyoderma gangrenosum

A

IBD

99
Q

Inability to life the skin of the dorsum of the second toe (positive Stemmer sign) is higly specific for ___.

A

Lymphedema

100
Q

D-xylose is a monosaccharide that is absorbed in the proximal SI without degradation by pancreatic or brush border enzymes. Compare the findings of the D-xylose test in patients with SI mucosal disease vs. enzyme deficiencies.

A

Impaired absorption if small intestinal mucosal disease vs. normal absorption if malabsorption is due to enzyme deficiencies

Normal test: high urine levels (minimal fecal excretion)

Abnormal test: low urine levels (high fecal excretion), low venous levels - patient cannot absorb into the intestines

101
Q

What can cause a false-positive D-xylose test (low urinary level despite normal mucosal absorption)?

A
  1. Delayed gastric emptying
  2. Impaired glomerular filtration
  3. SIBO
102
Q

Rx SIBO?

A

Rifaximin

103
Q

Imaging findings of NPH?

A

Enlargement of the ventricles out of proportion to the sulci

104
Q

Dx NPH?

A

Improvement after high volume LP or lumbar drain placement, normal opening pressure

105
Q

Definitive Rx of NPH?

A

Ventricular shunt

106
Q

What is Felty syndrome?

A

Formation of autoantibodies against neutrophil components and granulocyte colony-stimulating factor

Complication of seropositive RA (severe erosive joint disease/deformity, rheumatoid nodules, vasculitis) characterized by neutropenia (ANC <2000) and splenomegaly

107
Q

Dx Felty syndrome

A

Anti-CCP and RF + in 90%
Markedly elevated ESR, often >85
Peripheral smear and BM biopsy to r/o other causes of neutropenia
[Most patients are HLA-DR4 positive]

108
Q

Features of Mobitz type I second degree (Wenckebach) AV block?

A

Progressive prolongation of PR interval leading to a non-conducted P wave and a “dropped” QRS complex

Constant P-P interval
Increasing PR interval
Decreasing R-R interval
Group beating (repeating clusters of beats followed by a dropped QRS)
109
Q

Cause of Wenckebach AV block?

A

Impaired AV node conduction

110
Q

Features of PACs?

A

Normal rate
Irregular rhythm
P wave of PAC often has a different shape from the one originating in the SA node
Normal QRS

111
Q

Cause of PACs?

A

Depolarization of the atria originating in a focus outside the SA node

112
Q

Cause of sick sinus syndrome?

A

Impaired SA node automaticity (often due to degeneration and/or fibrosis of the SA node and surrouding atrial myocardium)

113
Q

Drug-induced acne is a common side effect of __ and is characterized by monomorphic papules without associated comedones, cysts, or nodules.

A

Systemic glucocorticoids

114
Q

Management of drug-induced acne?

A

D/C offending medication

Standard acne therapy unlikely to be effective

115
Q

Endoscopic and biopsy findings of UC?

A 
Erythema, friable mucosa
Pseudopolyps
Involvement of rectosigmoid
Continuous colonic involvement
Mucosal and submucosal inflammation
Crypt abscesses
116
Q

Complications of UC?

A 
Toxic megacolon
Primary sclerosing cholangitis
Colorectal cancer
Erythema nodosum/pyoderma gangrenosum
Spondyloarthritis
117
Q

___ results when an external variable positively or negatively impacts the effect of a risk factor on a disease of interest. Stratified analysis helps determine whether a variable is ___ or ___.

A

Effect modification; confounder or effect modifier

118
Q

Secondary bacterial pneumonia is the most common complication of influenza, but is rare in young individuals. What is the one major exception?

A

Community-assoicated MRSA -> preferentially attacks young patients with influenza

119
Q

Manifestations of community-associated MRSA pneumonia?

A

High fever, productive cough with hemoptysis, leukopenia, multilobar cavitary infiltrates

120
Q

4 risk factors for placental abruption?

A

Maternal HTN or preeclampsia/eclampsia
Abdominal trauma
Prior placental abruption
Cocaine and tobacco use

121
Q

Clinical presentation of placental abruption?

A

Sudden-onset vaginal bleeding
Abdominal or back pain
High-frequency, low-intensity contractions
Hypertonic, tender uterus

122
Q

Management of asymptomatic microprolactinoma (<10 mm)

A

No treatment

123
Q

Management of macroprolactinoma (>10 mm) or symptomatic micro?

A

Dopamine agonists (Cabergoline or bromocriptine) –> resect if very large (3+ cm) or increase in size while on treatment

124
Q

Key blood smear finding in AML?

A

Auer rods

Also numerous atypical promyelocytes (large myeloid cells with intracytoplasmic violet granules)

125
Q

Confirm diagnosis of APL?

A

Cyotgenetic analysis for the characteristic mutation (t[15;17])

126
Q

Why is APL considered a medical emegency?

A

High risk of pulmonary/CV hemorrhage from tumor-induced consumptive coagulopathy

127
Q

Rx APL?

A

All-trans retinoic acid

128
Q

___ is an idiopathic chronic condition characterized by pain that is exacerbated by bladder filling and relieved by voiding. Additional features may include dyspareunia, frequency, and urgency.

A

Interstitial cystitis (painful bladder syndrome)

129
Q

Dx idiopathic cystitis?

A

Clinical, diagnosis of exclusion - UA, post-void residual, STI screening

130
Q

Rx uremic pericarditis.

A

Dialysis

131
Q

Which anti-depressant can cause dose-dependent HTN?

A

Venlafaxine (SNRI - via norepinephrine reuptake inhibition)

Dedicated - Step 2 (22 decks)

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