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Dedicated - Step 2 > 18 > Flashcards

18 Flashcards

1
Q

Distinguish between causes of acute limb ischemia?

A
  1. Arterial emboli -> sudden symptoms, sources include L atrial thrombus (AFib), L ventricular thrombus (anterior MI), infective endocarditis, thrombus from valves
  2. Arterial thrombosis - PVD, less severe presentation, pulses diminished in both extremities
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2
Q

___ can cause recurrent respiratory papillomatosis, which results in hoarseness due to wartlike growths on the true vocal cords.

A

HPV (6 and 11)

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3
Q

Mainstay of treatment of recurrent respiratory papillomatosis?

A

Surgical debridement

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4
Q

MOA - calcineurin inhibitor (eg, tacrolimus, cyclosporine) renal toxicity?

A

Vasoconstriction

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5
Q

Presentation - N/V, RUQ/epigastric pain, fulminant liver failure in pregnancy

A

Acute fatty liver of pregnancy

May see profound hypoglycemia, increased AST/ALT, bilir, thrombocytopenia, DIC

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6
Q

Management of acute fatty liver of pregnancy?

A

Immediate delivery regardless of gestational age

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7
Q

In the US, what are the most common source of rabies transmission?

A

Bats (other causes in the US include raccoons, skunks, foxes; dogs in the developing world)

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8
Q

Acute unilateral cervical lymphadenitis in children is usually caused by ___.

A

Bacterial infection, most commonly S. aureus, followed by GAS

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9
Q

Cause of acute unilateral lymphadenitis in older children with a history of periodontal disease?

A

Peptostreptococcus

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10
Q

Cause of unilateral subacute-chronic LAD, usually <5 y/o, firm, non-tender, usually <4 cm

A

Non-TB mycobacteria

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11
Q

What does an S4 indicate?

A

Stiff L ventricle -> restrictive cardiomoypathy or LVH from prolonged HTN

Believed to result from blood striking a stiffened left ventricle during atrial contraction

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12
Q

Rx primary Raynaud phenomenon?

A

CCBs (eg, nifedipine, amlodipine), avoid aggravating factors

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13
Q

What is the primary MV abnormality in patients with HCM?

A

Systolic anterior motion of the MV -> anterior motion of MV leaflets toward the septum aka abnormal leaflet motion

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14
Q

How does HCM murmur change with preload?

A

Increased preload/increase afterload -> decreased murmur

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15
Q

Rx RTA?

A

Oral bicarbonate replacement

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16
Q

3 types of RTA?

A

1 (Distal) - poor hydrogen secretion into urine (urine pH above 5.5)

2 (Proximal) - poor bicarbonate resorption

4 - aldosterone resistance (high K)

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17
Q

Lab findings in all types of RTA?

A

Low serum bicarbonate
Hyperchloremia
Normal AG metabolic acidosis

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18
Q

Distinguish between types of RTA?

A

Urine pH and urine electrolytes

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19
Q

Fundoscopy findings of central retinal artery occlusion?

A 
Whitened retina (edema)
Cherry red spot (central fovea appears red from underlying choroid)
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20
Q

Fundoscopy findings of hypertensive retinopathy?

A

Hard exudates
AV nicking
Flame hemorrhages
Silver wiring

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21
Q

Fundoscopy findings of central retinal vein occlusion

A

Venous dilation/tortuosity
Scattered and diffuse hemorrhages (blood and thunder)
Cotton wool spots
Disc swelling

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22
Q

3 major side effects of MTX?

A

Oral ulcers
Macrocytic anemia
Hepatotoxicity

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23
Q

Vaginitis with NORMAL pH (3.8-4.5)

A

Candida vaginitis

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24
Q

How do endometrial polyps typically present?

A

Regular monthly menses with intermenstrual bleeding

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25
Q

Cafe-au-lait macules, skinfold freckling, Lisch nodules, neurofibromas, optic pathway gliomas

A

NF1

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26
Q

When should anticoagulation be given to a patient with suspected PE prior to diagnostic work-up?

A

Moderate to severe distress
High likelihood of PE
No absolute or relative contraindications

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27
Q

Modified Wells criteria for pre-test probability of PE?

A

+3: clinical signs of DVT, alternate diagnosis less likely than PE
+1.5: Hx of PE or DVT, HR>100, recent surgery/immobilization
+1: Hemoptysis, cancer

> 4 PE likely

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28
Q

Steps in managing patients with suspected PE

A
  1. Supportive care (O2, IVF for hypotension, etc.)
  2. Assess for absolute contraindication
    2a. If contraindications -> Dx testing + IVC filter if positive
    2b. If no contraindications -> Wells criteria
    3a. If Wells criteria indicates PE is likely -> anticoagulate, then Dx
    3b. If unlikely -> Dx then Rx if positive
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29
Q

Cause of phototoxic drug eruptions (exaggerated sunburn reactions with erythema, edema, and vesicles in sun-exposed areas)

A

ABX (tetracyclines)
Antipsychotics (chlorpromazine, prochlorperazine)
Diuretics (furosemide, HCTZ)
Amio, promethazine, piroxicam

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30
Q

Presentation - sensorineural hearing loss, cardiac defects (eg, PDA), cataracts

A

Congenital rubella syndrome

Other findings can include fetal growth restriction, HSM, purpueric blueberry muffin rash

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31
Q

Presentation - chorioretinitis, hydrocephalus, diffuse intracranial calcifications

A

Congenital toxoplasmosis

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32
Q

Presentation - chorioretinitis, periventricular calcificiations

A

Congenital CMV

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33
Q

Presentation - fever, disseminated abscesses in multiple organs, skin lesions in newborns

A

L. monocytogenes

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34
Q

Presentation - hepatomegaly, snuffles (nasal discharge), OA destruction, maculopapular rash

A

Congenital syphilis

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35
Q

Elevated BNP and S3 are signs of ___ and are noted in patients with CHF due to LV systolic dysfunction.

A

Increased cardiac filling pressures

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36
Q

Where is S3 best heard?

A

Over the apex in the LLD position

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37
Q

Rapidly progressive hirsutism with virilization suggests very high androgen levels due to ___. Elevated DHEAS is seen in ___.

A

An androgen-producing neoplasm; androgen-producing adrenal tumors

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38
Q

Vitamin C deficiency causes microvascular bleeding due to impaired synthesis of ___.

A

Collagen

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39
Q

For younger patients with minimal rectal bleeding (<40) and no risk factors, what is suspected and what can be done?

A

Hemorrhoids; office-based anoscopy

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40
Q

Mature cystic teratomas are common in premenopausal women - they may cause intermittent colicky pelvic pain, often triggered by physical activity - what is happening?

A

Partial adnexal rotation/intermittent torsion

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41
Q

Localized papule with ipsilateral regional LAD in the setting of cat exposure

A

Cat-scratch disease caused by Bartonella henselae; majority of patients do not recall a specific scratch or bite

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42
Q

Rx cat-scratch disease?

A

Azithromycin

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43
Q

Posterior urethral valves present in newborn boys with bladder distention, decreased urine output, and respiratory distress. Initial evaluation and management?

A

Renal and bladder U/S (dilated bladder with bilateral hydroureters/hydronephrosis) -> voiding cystourethrogram

If posterior urethral valves are confirmed -> bladder drainage and electrolyte correction, then cystoscopy to confirm the diagnosis and ablate

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44
Q

Medications for bipolar disorder that are safe in pregnancy?

A

Lamotrigine

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45
Q

Pathophysiology of androgen insensitivity syndrome?

A

X-linked mutation in the androgen receptor

During development, the testes produce AMH and testosterone. AMH causes regression of uterus, upper 1/3 of vagina, etc. Testosterone has no effect on peripheral tissues and male external genitalia do not develop.

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46
Q

Key clinical features of androgen insensitivity syndrome?

A

Genotypically male (46, XY)
Phenotypically female
+Breast development, female external genitalia
Absent/minimal axillary and pubic hair, absent uterus, cervix, upper 1/3 vagina
+Cryptorchid testes

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47
Q

Distinguish Mullerian agenesis from androgen insensitivity syndrome.

A

Mullerian - ovaries are present, normal axillary and pubic hair development

AIS - no ovaries (testes instead), minimal/no axillary/pubic hair development

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48
Q 
Cause of BPP:
Nonstress test (0)
Amniotic fluid volume (0)
Fetal movements (2)
Fetal tone (2)
Fetal breathing movements (0)

at 41 weeks gestation?

A

Uteroplacental insufficiency -> deliver

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49
Q

Distinguish RMSF from measles.

A

Both can have fever and conjunctival injection

RMSF: rash on distal extremities (includes palms/soles) and spreads centripetally

Measles: spreads cepahlocaudally

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50
Q

Features of roseola?

A

Fever first that completely resolves -> rash appears

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51
Q

Define acute liver failure.

A

Acute onset of severe liver injury (very elevated aminotransferases) with encephalopathy and impaired synthetic function (INR 1.5+) in a patient without cirrhosis or underlying liver disease.

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52
Q

The presence of ___ differentiates acute liver failure from acute hepatitis, which has a much better prognosis than ALF.

A

Hepatic encephalopathy

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53
Q

List the normal features of lymph nodes.

A

Soft, mobile, <2 cm, no systemic symptoms

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54
Q

List the abnormal features of lymph nodes.

A

Firm or hard, immobile, >2 cm, systemic symptoms

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55
Q

Empiric therapy for cervical lymphadenitis?

A

Clindamycin

56
Q

Dx of vestibular schwannoma?

A

Audiogram

MRI with contrast of internal auditory canal

57
Q

Eustachian tube dysfunction vs. vestibular schwannoma?

A

ET - conductive hearing loss, pain, popping sounds, middle ear effusion

VS - sensorineural hearing loss

58
Q

Most common form of paroxysmal SV tachycardia + what causes it?

A

AV nodal reentrant tachycardia; reentry mechanism due to the presence of a dual electrical pathway (slow and fast) in the AV node

59
Q

How can a patient terminate AVNRT themselves?

A

Vagal maneuvers (carotid sinus massage, cold-water immersion or diving reflex, Valsalva, eyeball pressure) that increase parasympathetic tone and temporarily slow conduction in the AV node/increase refractory period

60
Q

Acute myeloid leukemia typically presents with fatigue + symptoms from 1+ cytopenias. How can APML present?

A

DIC

61
Q

Effect of renin?

A

Converts angiotensinogen (liver) to angiotensin I

62
Q

Effect of ACE?

A

Converts angiotensin I to angiotensin II

63
Q

Effects of angiotensin II?

A
  1. Release of aldosterone from adrenal cortex

2. Vasoconstriction (receptors on blood vessels) -> HTN

64
Q

Effects of aldosterone?

A

Sodium reabsorption -> HTN

65
Q

Effect of alpha-adrenergic blockers?

A

Direct vasodilators used to treat HTN

66
Q

Cause of hemolytic anemia in patients with G6PD deficiency?

A

Oxidative injury (medications like dapsone, TMP-SMX, primaquine, infections, foods like fava beans)

67
Q

Although most patients are asymptomatic, how does symptomatic Paget disease of bone present?

A

Skeletal deformities (femoral bowing, etc.)
Bone pain
Fractures
If cranial bones are involved (enlarging cranial bones) -> headaches and hearing loss

68
Q

Mechanism of injury in Paget disease of bone?

A

Osteoclast dysfunction with a focal increase in bone turnover, progresses to osteoblast dysfunction later in the disease

69
Q

Major etiologies of constrictive pericarditis?

A
  1. Idiopathic or viral pericarditis
  2. Cardiac surgery or radiation therapy
  3. Tuberculous pericarditis (endemic areas)
70
Q

Clinical presentation of constrictive pericarditis?

A 
Fatigue and DOE
Peripheral edema and ascites
Increased JVP
Pericardial knock
Pulsus paradoxus
Kussmaul's sign
71
Q

EKG findings of constrictive pericarditis?

A

Non-specific, AFIb, or low-voltage QRS complex

72
Q

Imaging findings of constrictive pericarditis?

A

Pericardial thickening and calcification

73
Q

Jugular venous pulse tracing findings of constrictive pericarditis?

A

Prominent x and y descents

74
Q

Rx options for bacterial conjunctivitis?

A

Erythromycin ointment
Polymyxin-trimethoprim drops
Azithromycin drops
Preferred agents in contact lens wearers -> FQ drops

75
Q

Rx options for viral conjunctivitis?

A

Warm or cold compresses

+/- antihistamine/decongestant drops

76
Q

CXR findings of coarctation of the aorta?

A

Inferior notching of the 3rd to 8th ribs

“3” sign due to aortic indentation

77
Q

Prominent R atrial contour on CXR?

A

Ebstein congenital anomaly

78
Q

Upturning of the cardiac apex (“boot-shaped heart”)?

A

Tetralogy of Fallot

79
Q

Conditions associated with gastroschisis?

A

Psych - there are none.

80
Q

Pharm management of symptomatic patients with HCM?

A

Negative inotropes (beta, blockers, non-di CCBs - verapamil, disopyramide) -> start with beta-blockers

Prolong diastole, decrease contractility, decreases LVOT obstruction, improves angina symptoms

NOTHING that reduces LV preload

81
Q

When evaluating secondary sexual development, what is the first step in the work-up?

A

Bone age

82
Q

If there is early secondary sexual development and normal bone age, what is the DDx?

A

Premature thelarche (isolated breast development)

Premature adrenarche (isolated pubic hair development)

83
Q

If there is early secondary sexual development and advanced bone age, what is the next step?

A

Check basal LH

If high -> central precocious puberty
If low -> GnRH stimulation test
If high -> central precocious puberty
If low after stim test -> peripheral precocious puberty

84
Q

Cause of central precocious puberty?

A

Early activation of the HPG axis (check MRI to look for tumor, otherwise idiopathic)

85
Q

Cause of peripheral precocious puberty?

A

Gonadal or adrenal release of excess sex hormones

86
Q

Rx central precocious puberty?

A

GnRH therapy

87
Q

Severe aortic stenosis indicated by valve area ___ cm^2?

A

<1 cm ^2

88
Q

In patients with mild to moderate AS, what is the cause of anginal symptoms?

A

Another cause - most commonly obstructive CAD

Angina due to AS only occurs if severe (<1 cm^2)

89
Q

Severe aortic stenosis leads to low pulse pressure (<25 mm Hg) - how is this calculated?

A

Systolic - diastolic BP

90
Q

Nephrotic syndrome is frequently complicated by ___.

A

Hypercoagulation (most commonly manifested by renal vein thrombosis)

Other complications include protein malnurition, iron-resistant microcytic hypochromic anemia, increased infection susceptibility, vitamin D deficiency

91
Q

List features that help differentiate UC from CD.

A

CD: multiple portions of GI tract involved, rectal sparing, presence of non-caseating granulomas, fistula formation, cobblestoning, creeping fat, transmural inflammation

UC: bloody diarrhea, continuous involvement of the rectum and colon, toxic megacolon

92
Q

Presbyopia is a common age-related decrease in ___ that leads to difficulty with near vision.

A

Lens elasticity (prevents accommodation)

93
Q

Hydatidiform mole can present with ___ at <20 weeks gestation.

A

Preeclampsia with severe features

94
Q

What causes early preeclampsia in hydatidiform mole?

A

Abnormal placental spiral artery development

95
Q

Presentation - abdominal mass, elevated beta-hCG, ascites in an adolescent

A

Embryonal carcinoma

96
Q

Dx Retinoblastoma

A

MRI of the brain and orbits

97
Q

___ is used as a measure of association in cohort studies.

A

Relative risk (ratio of the risk in the exposed group to that in the unexposed group)

98
Q

Interpret RR <1 and >1.

A

> 1 means there is a positive association between the risk factor and the outcome

<1 means that there is a negative association

Farther from one, stronger association

99
Q

Most common cause of GN in adults?

A

IgA nephropathy

100
Q

Distinguish IgA nephropathy from post-infectious GN

A

Earlier onset of URI-related GN (within 5 days)
Normal serum complement levels
Kidney biopsy

101
Q

Endemic mycosis of the desert SW that causes community-acquired pneumonia (fever, chest pain, cough, lobar infiltrate) often accompanied by arthrlagias, erythema nodosum, and erythema multiforme

A

Coccidioides

102
Q

Rx Coccidioides?

A

Healthy patients usually do not require antifungal therapy

High risk for dissemination - ketoconazole or fluconazole

103
Q

Milk-protein-induced allergic proctocolitis can cause painless rectal bleeding that resolves with elimination of dietary cow’s milk. It is virtually exclusive to what age group?

A

Infants (resolves by age 1)

104
Q

Presentation - painless hematochezia without abdominal pain, diarrhea, or vomiting in young toddlers

A

Meckel diverticulum

105
Q

Abnormal ABI?

A

0.90 or less

106
Q

ABI 1.30+?

A

Suggests calcified and uncompressible vessels -> TBI

107
Q

Acute digoxin toxicity?

A

GI, weakness, confusion

108
Q

Chronic digoxin toxicity?

A

Less GI, more neuro symptoms, visual changes

109
Q

___ increases the serum levels of digoxin.

A

Amiodarone

110
Q

Define active phase protraction of labor.

A

<1 cm cervical dilation in 2 hours during the active phase of labor (6-10 cervical dilation)

111
Q

Common cause of labor protraction?

A

Cephalopelvic disproportion

112
Q

Risk factors for cephalopelvic disproportion?

A

Late-term pregnancies
Fetal anomaly or malposition (occiput anterior)
Maternal obesity, excessive weight gain, nulliparity, advanced maternal age, inadequate contractions

113
Q

Adequate contraction strength?

A

200+ MVUs

114
Q

Neuraxial anesthsia can length which stage of labor?

A

2nd stage (10cm until fetal delivery)

115
Q

Symptoms of GU syndrome of menopause?

A 
Vulvovaginal dryness, irritation, pruritus
Dyspareunia
Vaginal bleeding
Urinary incontinence, recurrent UTI
Pelvic pressure
116
Q

Physical exam findings of GU syndrome of menopause?

A

Narrowed introitus
Pale mucosa, decreased elasticity, decreased rugae
Petechiae, fissures, loss of labial volume

117
Q

Rx GU syndrome of menupause?

A

Vaginal moisturizer and lubricant

Topical vaginal estrogen

118
Q

Presentation - symptoms within 1-2 weeks of ovulation induction for infertility treatment, including abdominal pain, ascites, bilateral enlarged cystic ovaries, third spacing -> intravascular volume depletion, can result in thromboembolism, multiorgan failure, death

A

Ovarian hyperstimulation syndrome

119
Q

Cause of ovarian hyperstimulation syndrome?

A

Increased hCG enhances ovarian vascular permeability -> acute fluid shift into extravascular space

120
Q

Manage ovarian hyperstimulation syndrome?

A

Correct lytes
Paracentesis and/or thoracentesis
Thromboembolism PPx

121
Q

Most common extraskeletal complication of ankylosing spondylitis?

A

Anterior uveitis

122
Q

Episcleritis is inflammation seen at the white of the eye, without involvement of the uveal tract. It is most strongly associated with what 2 AI conditions?

A

RA; IBD

123
Q

Over 15% of adult patients with dermatomyositis will have or develop ___.

A

An internal malignancy (regular age-appropriate cancer screening is essential)

124
Q

3 possible extramuscular findings of dermatomyositis?

A

ILD
Dysphagia
Myocarditis

125
Q

Ab findings of dermatomyositis?

A

Anti-RNP
Anti-Jo-1 (anti-synthetase)
Anti-Mi2 (anti-helicase)

126
Q

Pathognomonic exam finding of dermatomyositis?

A

Gottron’s papules

127
Q

Acute erosive gastropathy is characterized by the development of hemorrhagic lesions after ___ or exposure of the gastric mucosa to various injurious agents (eg, alcohol, aspirin, cocaine).

A

Ischemia

128
Q

Most common pathogen isolated in infants and young children with CF?

A

S. aureus

129
Q

Most common cause of CF-related pneumonia in adults?

A

P. aeruginosa

130
Q

Patients with hyperthyroidism and a suppressed TSH should undergo thyroid radioiodine scintigraphy to distinguish ___ from ___.

A

Painless thyroiditis; Graves disease

Decreased uptake in painless due to release of preformed thyroid hormone

Increased uptake in Graves due to increased synthesis

131
Q

Key distinguishing feature of subacute thyroiditis (aka De Quervain)

A

Hyperthyroidism, decreased uptake, PAINFUL AND TENDER

132
Q

What causes the low glucose concentration in exudative effusions of empyemas?

A

High metabolic activity of leukocytes and bacteria within the pleural fluid

133
Q

2 causes of elevated pleural amylase concentrations found in pleural effusions?

A

Esophageal rupture or pancreatitis

134
Q

List 2 important dopamine antagonists that are not antipsychotics.

A

Antiemetics metoclopramide and prochlorperazine

135
Q

Immediate and long-term management of severe (>14 or symptomatic) hypercalcemia?

A

NS hydration + calcitonin
Avoid loop diuretics unless heart failure exists
Bisphosphonate (long-term)

Dedicated - Step 2 (22 decks)

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