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Dedicated - Step 2 > 17 > Flashcards

17 Flashcards

1
Q

Persistent tachycardia and new arrhythmia (eg, PVCs) after blunt chest trauma are concerning for ___. Patients with these findings are admitted for what management?

A

Blunt cardiac trauma; continuous cardiac monitoring and echocardiography

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2
Q

Swimming in brackish water may expose people to what organism? It may cause cellulitis and, if ingested, sepsis, with hypotension and bullous skin lesions.

A

Vibrio vulnificus

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3
Q

What are the 2 general essential elements in defining brain death?

A
  1. Evaluating cortical and brain stem functions

2. Proving the irreversibility of brain activity loss

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4
Q

Symmetric fetal growth restriction begins in the ___ trimester and is due to what typical causes?

A

First; fetal conditions such as aneuploidy, congenital anomalies, and intrauterine infection

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5
Q

Asymmetric fetal growth restriction occurs in the second and third trimesters and is due to what typical causes?

A

Maternal conditions that cause placental insufficiency, maternal malnutrition

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6
Q

Define fetal growth restriction.

A

U/S estimated fetal weight <10th % for gestational age

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7
Q

What is asymmetric fetal growth restriction?

A

“Head-sparing” growth lag

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8
Q

3 steps in management of fetal growth restriction?

A

Weekly BPPs
Serial umbilical artery Doppler sonography
Serial growth U/S

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9
Q

Presentation - severe abdominal pain, uterine contractions, uterine tenderness, palpable, firm, tender mass, signs of inflammation (eg, leukocytosis) in pregnancy

A

Infarcted degenerating uterine fibroid

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10
Q

Dx and Rx uterine fibroid degeneration in pregnancy?

A

Dx - U/S

Rx - conservative management (acute pain control)

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11
Q

Primary responsibility of human chorionic gonadotropin (secreted by the syncytiotrophoblast)?

A

Preservation of the corpus luteum in early pregnancy

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12
Q

Presentation - medial deviation of the forefoot with a normal neutral position of the hindfoot, usually bilateral, most frequently in first-born infants

A

Metatarsus adductus

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13
Q

Distinguish congenital clubfoot from metatarsus adductus.

A

Clubfoot: rigid medial and upward deviation of both the forefoot and hindfoot, rigid positioning

Metatarsus adductus: flexible positioning, medial deviation of forefoot, neutral position of hindfoot

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14
Q

Management of MA vs. congenital clubfoot.

A

MA - reassurance

Clubfoot - serial manipulation and casting, surgery if refractory; consider karyotyping (increased risk of chromosomal abnormalities)

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15
Q

Presentation - erythematous, tender nodule at the lid margin

A

External hordeolum (acute inflammatory disorder of the eyelash follicle or tear gland)

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16
Q

Management of external hordeolum?

A

Warm compresses

If persistent or development of a large chalazion - possible incision and curettage

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17
Q

Features of blasts?

A

Fine nuclear chromatin
Small nucleoli
Scan agranular cytoplasm

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18
Q

Burkitt lymphoma is a neoplasm of mature B cells associated with ___ infection. Patients typically have a mass involving the mandible or abdominal viscera. Histologic exam shows a characteristic ___ appearance.

A

EBV; Starry sky

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19
Q

Hereditary spherocytosis inheritance pattern/associated ethnicity?

A

AD

Northern European

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20
Q

Clinical presentation of hereditary spherocytosis?

A

Hemolytic anemia (may present with RUQ pain from pigment gallstones)
Jaundice
Splenomegaly

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21
Q

Lab findings of hereditary spherocytosis?

A 
Increased MCHC
Negative Coombs
Spherocytes on peripheral smear
Increased osmotic fragility on acidified glycerol lysis test
Abnormal esoin-5-maleimide binding test
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22
Q

Rx hereditary spherocytosis

A

Folic acid supplementation
Blood transfusion
Splenectomy if severe

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23
Q

H. ducreyi is a GN rod that causes STIs (chancroid) primarily in developing countries - when should it be suspected in the US?

A

People who trade sex for drugs or money

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24
Q

What is Gaucher disease?

A

Lysosomal storage disease with the accumulation of glucocerebroside in macrophages of the bone, liver, and spleen; accumulation results in cytopenias, bone pain, FTT, HSM, and delayed puberty

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25
Q

Inheritance pattern and ethnicity - Gaucher disease

A

AR

Ashkenazi Jews

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26
Q

Manage Gaucher disease?

A

Enzyme replacement

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27
Q

Acute symptomatic hyponatremia is a medical emergency that requires a prompt increase in the serum sodium concentration with ___ at a rate of no more than ___ to avoid causing CNS osmotic demyelination syndrome.

A

3% or hypertonic saline; 0.5 mEq/L/hr

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28
Q

Always consider ___ when a patient with parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic symptoms.

A

Multiple system atrophy (Shy-Drager syndrome)

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29
Q

Distinguish benzo and opioid OD.

A

Benzo - lack of severe respiratory depression, lack of pupillary constriction

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30
Q

Normal pupillary size in bright light?

A

2-4 mm

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31
Q

Hypovolemia is a common cause of orthostatic hypotension and syncope, especially in elderly patients. What is the most sensitive indicator of this condition?

A

Decreased urine sodium (due to decreased renal perfusion -> RAAS activation -> aggressive sodium reabsorption)

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32
Q

Renal disease caused by rhabdo?

A

ATN

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33
Q

What is the mechanism of the change observed during the stress portion of a pharmacologic vasodilator stress test (when disease is present)?

A

Marked increase in blood flow in normal coronary arteries and a relatively small increase in blood flow in stenotic coronary arteries

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34
Q

3 types of stress tests?

A

Exercise EKG
Pharmacologic (adenosine or dipyridamole)
Dobutamine stress echo

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35
Q

Mechanism, indications, and contraindications to exercise EKG test?

A

Increased HR and BP

Best for patients able to reach target HR (85% of 220-age)

Not for LBBB, pacemaker, patients unable to reach tHR

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36
Q

Mechanism, indications, and contraindications to pharm stress test?

A

Non-selective adenosine agonist that dilates coronary arteries without increasing HR or BP

Best for LBBB, pacemarker, patients unable to reach tHR

Not for reactive airway disease, patients on dipyridamole or theophylline

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37
Q

Mechanism, indications, and contraindications to dobutamine stress echo?

A

Beta-1 agonist, increase HR +/- BP

Best for RAD, patients unable to reach tHR

Not for tachyarrhythmias

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38
Q

PPH typically occurs within hours of delivery and uterine atony is the most common cause. In post-C/S patients with hemorrhagic shock and no signs of uterine atony, what should be done?

A

Suspect intra-abdominal bleeding from uterine artery injury (possible retroperitoneal hematoma) -> emergency laparotomy

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39
Q

Erythematous papules that evolve into target lesions with a dusky central area, a red inflammatory zone surrounded by a pale ring, and an erythematous halo at the periphery; primarily located on the extremities

A

Erythema multiforme

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40
Q

What causes erythema multiforme?

A

Cell-mediated immune process that is typically associated with certain infections (HSV, mycoplasma, etc.) and may be an immune response against antigens deposited in skin. Can also be associated with certain medications (eg, sulfonamides), malignancies, and vascular diseases

41
Q

Typical pH of transudative pleural fluid?

A

7.4-7.55

42
Q

Typical pH of exudative pleural fluid?

A

7.30-7.45

43
Q

Decreased glucose in pleural fluid is usually seen in what settings?

A

Complicated parapneumonic effusion, malignancy, TB, or RA

44
Q

Distinguish between lumbar spinal stenosis and lumbar disk herniation?

A

Spinal stenosis: chronic, worse with extension

Herniation: acute, unialtearl radiation, inciting event, worse with flexion

45
Q

Potential clinical features of mitral stenosis?

A

Dyspnea, orthopnea, PND, hemoptysis

AFib, systemic thromboembolism

Voice horasness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)

46
Q

Physical exam findings of mitral stenosis?

A

Mitral facies (pinkish-purple patches on cheeks)
LOUD S1, loud P2 if pulmonary HTN
Opening snap (early diastolic sound)
Mid-diastolic rumble (apex)

47
Q

CXR findings of mitral stenosis?

A

Pulmonary blood flow redistribution to upper lobes, dilated pulmonary vessels, LAE, flattened L heart border

48
Q

EKG findings of mitral stenosis?

A

“P mitrale” (broad and notched P waves), atrial tachyarrhythmias, RVH (tall R waves in V1 and V2)

49
Q

Why are patients with asplenia at risk for fulminant infection with encapsulated bacteria?

A

Deficits in antibody response and Ab-mediated phagocytosis/complement activation

50
Q

Features of bacillary angiomatosis?

A

Vascular cutaneous lesions (papular, nodular, peduncular)

Systemic symptoms (fever, night sweats, fatigue)

Organ involvement rarely (liver, bone, CNS)

51
Q

Cause of bacillary angiomatosis?

A 
B. henselae/quintana
Cat exposure or homelessness (lice)
Severe immunocomprmoise (HIV, CD4 <100)
52
Q

Dx bacillary angiomatosis?

A

Lesional biopsy with microscopy/histopathology

53
Q

Rx bacillary angiomatosis?

A

Doxycycline or erythromycin

HAART

54
Q

The single most important cause of pulmonary hypertension in COPD is?

A

The narrowing (constriction) of the pulmonary arteries that occurs as a result of low blood oxygen levels

55
Q

Organophosphate poisoning involves what receptors?

A

Peripheral muscarinic and nicotinic receptors

56
Q

General mechanism of thyroiditis?

A

Release of preformed thyroid hormone

57
Q

Family history of early onset dementia, Alzheimer type, is a strong predisposing factor for developing dementia, Alzheimer type.

A

Know this.

58
Q

Unique symptoms of LEMS?

A

Weakness of proximal muscles along with depressed or absent DTRs*
Extraocular, respiratory, and bulbar muscles are typically spared*
Weakness will IMPROVE with increased activity***

59
Q

Dx LEMS?

A

Repetitive nerve stimulation (characteristic incremental response)
Autoantibodies to presynaptic Ca channels
CT indicative of a lung neoplasm

60
Q

RMSF vs. Lyme Disease

A

RMSF: characteristic rash that is initially macular (beginning on wrist and ankles) -> petechial/purpuric as it spreads centrally; may develop into AMS, DIC

Lyme: erythema migrans begins as a small erythematous macule or papule at the site, expands slowly over days to weeks

61
Q

When there is concern for a pelvic fracture, what should always be done?

A

R/o injuries to other pelvic structures - rectal exam and/or proctoscopy, retrograde cystogram (bladder), pelvic exam, retrograde urethrogram (urethra in men)

62
Q

Superficial thrombophlebitis vs. cellulitis vs. lymphangitis?

A

ST: erythema and induration of the involved vein

Cellulitis: rarely streaky

Lymphangitis: linear, streaky, erythematous lesion, often an initiating lesion or skin infection is present

63
Q

Suspected basal cell carcinoma? Most appropriate next step?

A

Excisional biopsy with narrow margin

64
Q

3 types of juvenile idiopathic arthritis?

A
  1. Pauciarticular (oligoarthritis)
  2. Polyarthritis
  3. Systemic onset (aka Still disease)
65
Q

Compare the presentation of the 3 types of juvenile idiopathic arthritis.

A
  1. Pauciarticular (oligoarthritis) - 4 or fewer joints, weight-bearing, no systemic symptoms (most common)
  2. Polyarthritis - 5+ joints, generally symmetric, systemic symptoms rare
  3. Systemic onset (aka Still disease) - recurrent high fever, HSM, salmon-colored macular rash
66
Q

Compare the ANA/RF status of the 3 types of JIA.

A
  1. Pauciarticular (oligoarthritis) - ANA+, RF-
  2. Polyarthritis - RF rarely positive, ANA+ in young children with mild disease
  3. Systemic onset (aka Still disease) - both negative
67
Q

Common additional finding in pauciarticular JIA?

A

Uveitis (slit-lamp for diagnosis)

68
Q

Abortive vs. PPx medications for migraines?

A

Abortive - triptans (+/- analgesics like naproxen)

PPx - anticonvulsants (valproate, gabapentin, topiramate), TCAs (eg, amitriptyline), beta-blockers (propranolol), and CCbs

69
Q

Most appropriate pharmacotherapy to prevent chronic pain in a patient with herpes zoster?

A

PO acyclovir

70
Q

Rx acute symptomatic ischemia of the limbs?

A

Heparin and prompt revascularization

71
Q

Strongest predisposing factor for asthma in general?

A

Family history

72
Q

Surprise, household bleach ingestion is not that big of a deal.

A

Wut.

73
Q

In a 12 year old boy with chronic renal failure 2/2 glomerulonephritis who has HTN controlled with ACEI, what is one way to minimize complications of renal failure

A

Restrict phosphorus intake

74
Q

Where is folic acid and B12 absorbed?

A

Folic acid - duodenum and jejunum

B12 - ileum

75
Q

What is the absolute risk? What is the absolute risk reduction?

A

Incidence of disease; absolute difference in outcome rates between control and treatment groups (not confounded)

76
Q

What is the relative risk? What is the relative risk reduction?

A

How much more likely an exposed person is to get the disease in comparison to an unexposed person

1 - RR

77
Q

Specificity = ?

A

d/b+d

78
Q

Sensitivity = ?

A

a/a+c

79
Q

PPV = ?

A

a/a+b

80
Q

NPV = ?

A

d/c+d

81
Q

True or false - circumcision can be done without the consent of parents.

A

False

82
Q

Management of PCP intoxication?

A

Benzos

Haloperidol -> 2nd line
(Propofol -> 3rd line)

83
Q

When are breath-holding spells common in children?

A

6 months to 2 years

84
Q

What is thyroglobulin?

A

Precursor to active T3 and T4

85
Q

Rising thyroglobulin in patients s/p total thyroidectomy and RAI treatment indicates?

A

Recurrent differentiated thyroid cancer

86
Q

Patient with untreated HIV - headaches, N/V, confusion, abducens nerve palsy, scattered, umbilicated skin papules?

A

Cryptococcus neoformans infection

87
Q

When is Cryptococcus neoformans see in patients with AIDS (CD4 count)?

A

<100

88
Q

Mechanism of C. neoformans in AIDS?

A

Replicates in the CNS, clogs the arachnoid villi with yeast components and capsular polysacchardies -> CSF outflow obstruction and increased ICP

89
Q

Dx C. neoformans?

A

LP with CSF pressure, analysis, and capsular polsaccharide Ag testing or INDIA INK STAIN

90
Q

Rx toxoplasmic encephalitis?

A

Sulfadiazine + pyrimethamine

TMP-SMX is 2nd line and PPx

91
Q

Patient with advanced AIDS - subacute confusion, diplopia

A

PML

92
Q

Dx PML?

A

Gadolinium-enhanced MRI of the brain - multifocal white matter demyelination, no mass effect

93
Q

Patients with advanced AIDS - retina, colon, lung manifestations (neuro disease is rare)

A

CMV

94
Q

Symptoms suggesting unstable AAA?

A

Abdominal/flank/groin/back pain
Pulsatile mass
Flank ecchymosis
Limb ischemia

95
Q

In a patient with suspected unstable AAA and hemodynamic instability, what is the next step?

A

If known AAA -> emergency repair

If unknown -> focused abdominal U/S -> repair if identified

96
Q

In a patient with suspected unstable AAA and hemodynamic stability, what is the first test?

A

CT Abdomen

97
Q

Rx acute dystonia?

A

Anticholinergics like benztropine or antihistamines like diphenhydramine

98
Q

What is valbenazine?

A

Vesicular monoamine transporter 2 inhibitor - treats TD

99
Q

Management of cat bites?

A

Copious irrigation and cleaning
PPx Amox/clav (covers P. multocida and oral anaerobes)
Tetanus booster as indicated
Avoid closure

Dedicated - Step 2 (22 decks)

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