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Dedicated - Step 2 > 19 > Flashcards

19 Flashcards

1
Q

___ is strongly associated with increased severity and progression of Crohn disease and should be avoided.

A

Smoking

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2
Q

Next step for patients with decreased fetal movement?

A

Antenatal fetal testing with a non-stress test followed by a BPP (if labor is contraindicated) or a contraction stress test if the NST is non-reactive

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3
Q

A non-stress test is an external monitor of fetal heart rate for 24-40 minutes. Define an abnormal result.

A

Reactive (normal): 2+ accelerations in 20 minutes, each peaking 15+/min above baseline and lasting 15+ seconds, baseline 110-160/min, moderate variability (6-25/min)

Non-reactive (abnormal): <2 accelerations
Recurrent variable or late decelerations (abnormal)

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4
Q

Abnormal BPP?

A

0, 2, or 4 points
Any result with oligohydramnios
Equivocal = 6 points

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5
Q

A contraction stress test is an external fetal heart rate monitor during spontaneous or induced uterine contractions. Define an abnormal result.

A

Late decelerations with >50% of contractions (abnormal)

No late or recurrent variable decelerations is normal

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6
Q

Umbilical artery flow velocimetry is beneficial in monitoring ___ fetuses.

A

Growth-restricted

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7
Q

An abnormal BPP score is consistent with ___. Next step?

A

Fetal hypoxia due to placental dysfunction (insufficiency); prompt delivery is indicated due to the high probability of fetal demise

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8
Q

Define oligohydramnios.

A

Single deepest pocket <2 cm or AFI 5 or fewer

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9
Q

Presentation - episodic flushing, secretory diarrhea, wheezing, murmur of tricuspid regurgitation

A

Carcinoid syndrome

Other symptoms may include telangiectasias, cyanosis, cramping, niacin deficiency

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10
Q

Dx carcinoid syndrome?

A

Elevated 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA)

CT/MRI A/P to localize
OctreoScan to detect mets
Echo if symptoms of carcinoid heart disease are present

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11
Q

Rx carcinoid syndrome?

A

Octreotide for symptomatic patients and prior to surgery/anesthesia

Surgery for liver mets

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12
Q

Preferred HIV screening test?

A

4th generation assay of HIV p24 Ag and HIV Ab

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13
Q

Define normal fetal activity?

A

10+ movements in 2 hours

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14
Q

Steps in work-up of suspected acromegaly?

A
  1. IGF-I level (if elevated -> #2)
  2. Oral glucose suppression test (if inadequate GH suppression -> #3)
  3. MRI of the brain (pituitary mass or normal -> evaluate for extrapituitary causes)
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15
Q

Features of Behcet disease?

A 
Recurrent painful oral aphthous ulcers
Genital lesions
Eye lesions (eg, uveitis)
Skin lesions (eg, erythema nodosum, acneiform lesions0
Thrombosis
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16
Q

Evaluation of Behcet disease?

A

Pathergy -> exaggerated skin ulceration with minor trauma (eg, needlestick)

Biopsy -> non-specific vasculitis of different-sized vessels

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17
Q

Reactive arthritis can share a number of features with Behcet syndrome, including arthritis, uveitis, and oral ulcerations. However, it can be distinguished with what 2 general features?

A
  • Usually follows an acute GI or GU infection

- Subaacute to chronic symptoms (rather than episodic)

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18
Q

What is the most common source of symptomatic pulmonary emoblism?

A

Proximal deep leg veins (femoral)

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19
Q

Most common cause of sepsis in patients with sickle cell disease?

A

Pneumococcus

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20
Q

Most effective method of preventing the spread of measles once a person is infected?

A

Airborne precautions

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21
Q

Next step in management of suspected brain abscess?

A

Contrast-enhanced CT or MRI (ring-enhancing lesion)

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22
Q

Common physical exam finding of AR?

A

Bounding pulse

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23
Q

What is pulsus paradoxus and when is it seen?

A

Fall in the systemic arterial pressure by >10 mmHg during inspiration

Cardiac tamponade

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24
Q

What is pulsus parvus et tardus and when is it seen?

A

Decreased pulse amplitude and delayed upstroke; AS

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25
Q

Contraindications to PDE-5 inhibitors?

A

Nitrates or alpha blockers

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26
Q

Which patients with CAD should refrain from sexual activity until they have been appropriately evaluated and stabilized?

A

Ongoing stable or unstable angina, incomplete revascularization, L ventricular dysfunction or symptomatic heart failure, high-risk arrhythmias, very recent (<2 weeks0 MI

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27
Q

Painless vaginal bleeding >20 weeks gestation

A

Placenta previa

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28
Q

Why is a reactive fetal heart tracing usually seen in early placenta previa?

A

Bleeding is primarily maternal in origin

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29
Q

What condition is due to bleeding primarily of fetal origin?

A

Vasa previa

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30
Q

Drugs of choice for treating/preventing chemo-induced N/V?

A

5-HT3 antagonists (eg, ondansetron)

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31
Q

What is the primary anticholinergic agent used to treat vomiting and when is it indicated?

A

Scopolamine; reduce motion sickness

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32
Q

Define neutropenia.

A

ANC <1500

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33
Q

Rx bell palsy

A

GLUCOCORTICOIDS (+/- acyclovir or valacyclovir)

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34
Q

Major cause of chronic diarrhea in patients with HIV who have CD4 counts <180?

A

Cryptosporidium parvum

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35
Q

List 3 other causes of diarrhea in patients with AIDS and how to distinguish them from Crypto.

A
  1. Microsporidium/isosporidium:
    - CD4 <100
    - Fever is RARE
  2. MAC
    - CD4<50
    - HIGH fever
  3. CMV
    - CD4 <50
    - Hematochezia
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36
Q

Preferred initial treatment for uncomplicated BPH?

A

Alpha-1 blockers (terazosin, tamsulosin)

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37
Q

Alternative or additional treatment for BPH?

A

5-alpha-reductase inhibitors (eg, finasteride, dulasteride)

Effectiveness may take 6-12 months

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38
Q

What is masked HTN?

A

Isolated ambulatory HTN; normal BP readings during clinic visits, but average BP throughout the day and night are elevated. These patients often present with evidence of hypertensive end-organ damage (retinopathy, LVH, etc.)

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39
Q

Patients with clinical signs of HTN but normal BP readings should be tested for masked HTN with ___.

A

Ambulatory BP monitoring

Average 24-hour BP 135/85+ is diagnostic

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40
Q

___ closely mimics the presentation of sarcoidosis and should be considered when a patient with suspected sarcoidosis deteriorates after immunosuppressive therapy.

A

Histoplasmosis

Exclude dimorphic fungi infections before starting immunosuppression in endemic regions

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41
Q

Steps in working up suspected hyperaldosteronism (HTN + hypokalemia)?

A
  1. Plasma aldosterone/renin ratio (if elevated -> #2)
  2. Adrenal suppression tests (if positive -> #3)
  3. Adrenal imaging (if normal or age>40 with abnormal CT ->#4)
    - If discrete unilateral adenoma and age <40 -> surgery
  4. Adrenal venous sampling -> unilateral adenoma/hyperplasia (consider surgery) or bilateral adrenal hyperplasia (medical therapy)
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42
Q

New-onset hearing loss or chronic ear drainage despite ABX +/- granulation tissue and skin debris within retraction pockets in children

A

Cholesteatomas

43
Q

Presentation of ACA stroke?

A

Contralateral motor and/or sensory deficits (Lower>Upper)

+/- urinary incontinence, abulia (lack of will or initiative), dyspraxia, emotional disturbances

44
Q

Presentation of MCA stroke?

A

Contralateral somatosensory and motor deficit (face, arm, and leg)

+/- conjugate eye deviation toward side of infarct, homonymous hemianopia, aphasia (dominant), hemineglect (non-dominant)

45
Q

Presentation of posterior limb of internal capsule infarct (aka lacunar)

A

Unilateral motor impariments

No sensory, cortical, visual field deficits

46
Q

Presentation of vertebrobasilar system lesion?

A

Alternate syndromes with contralateral hemiplegia and ipsilateral CN involvement

+/- ataxia

47
Q

Presentation of lesion occluding the internal carotid?

A

ACA and MCA lesions -> dense, contralateral hemiplegia (face, arm, and leg equally) with contralateral sensory, visual, language, or spatial impairments

48
Q

PCA stroke?

A

Homonymous hemianopia
Alexia without agraphia (dominant)
Visual hallucinations (calcarine cortrex)
Sensory symptoms (thalamus)
CN3 palsy with paresis of vertical and horizontal eye movements
Contralateral motor deficits

49
Q

Ear drainage, severe ear pain, granulation tissue on the floor of the external auditory canal, usually elderly patient with DM

A

Necrotizing (malignant) otitis externa

50
Q

___ is a supraventricular tachyarrhythmia characterized by distinct P waves with 3+ different morphologies, atrial rate >100/min, and an irregular rhythm. What are 3 common etiologies and how is it managed?

A

Multifocal atrial tachycardia

Exacerbation of pulmonary disease (eg, COPD)
Electrolyte disturbance (eg, hypokalemia)
Catecholamine surge (eg, sepsis)

Correct underlying disturbance
AV nodal blockade (eg, verapamil) if persistent

51
Q

Lab findings of Paget disease of bone (Ca, Ph, alk phos, urine hydroxyproline)

A

Elevated alkaline phosphatase and bone turnover markers (PINP, urine hydroxyproline)

Calcium and phosphorus are usually normal

52
Q

Rx Paget disease of bone?

A

Bisphosphonates

53
Q

Most common complication after ERCP?

A

Acute pancreatitis

54
Q

Presentation - neonatal hypoglycemia, macrosomia/macroglossia, hemihyperplasia, umbilical hernia/omphalocele

A

Beckwith-Widemann syndrome

55
Q

Next step in management of an infant with suspected Beckwith-Widemann syndrome?

A

Abdominal U/S and AFP level due to increased risk of Wilms tumor and hepatoblastoma

56
Q

Rx ITP?

A

Plts >30,000 + no bleeding - observation
Pls <30,000 - steroids
Hemorrhage - IVIG and platelet transfusion

57
Q

First step in diagnosing suspected gallstone-induced pancreatitis?

A

Abdominal U/S

ERCP if U/S is non-diagnostic and suspicion is high

58
Q

To prevent cardiorespiratory arrest and permanent neurologic disability, victims of smoke inhalation injury should be treated empirically for ___. How is this done?

A

Cyanide toxicity; antidote such as hydroxocobalamin* or sodium thiosulfate or nitrites to induce methemglobinemia

59
Q

Cyanide causes what acid-base disturbance? MOA?

A

Metabolic acidosis; cyanide binds ferric iron in cytochrome oxidase a3 in the mitochondrial electron transport chain; this blocks oxidative phosphorylation and promotes anaerobic metabolism -> lactic acidosis

60
Q

Effects of shunting a large amount of blood through an AV fistula?

A

Decreases SVR
Increases preload
Increased CO

61
Q

Clinical signs of AV fistula?

A 
Widened pulse pressure
Strong peripheral arterial pulsation (eg, brisk carotid upstroke)
Systolic flow murmur
Tachycardia
Flushed extremities
LVH
62
Q

In patients with AVF and significant AV shunting, there is a compensatory increase in ___ and ___ to mee the O2 requirements of the peripheral tissues.

A

HR; SV

63
Q

Dx AVF in the extremity?

A

Doppler U/S

64
Q

The primary anti-ischemic and anti-anginal effects of nitrates are due to what effects?

A

Systemic vasodilation and venodilation

Lowers preload and LV EDV -> reduces wall stress and myocardial O2 demand

65
Q

Medications that can trigger acute angle closure glaucoma?

A

Decongestants, antiemetics, anticholinergics (trihexphenidyl, etc.)

66
Q

MOA/indication of entacapone?

A

Increases dopamine stimulation, potentiate effects of carbidopa/levidopa in Parkinson disease

67
Q

MOA/indication of pramipexole?

A

Dopamine agonist; symptomatic Parkinson disease

68
Q

2 types of fibroids associated with recurrent pregnancy loss?

A

Submucosal and intracavitary

69
Q

Infection of the lacrimal sac, often presents with sudden onset pain and redness in the medial canthal region?

A

Dacryocystitis

70
Q

Abscess located over the upper or lower eyelid?

A

Hordeolum

71
Q

All patients with acute exacerbation of COPD should receive what treatments?

A

Inhaled bronchodilators (beta agonists and anticholinergics) and systemic glucocorticoids

+/- supplemental O2, ABX, and vent support when indicated

72
Q

___ is a mucolytic agent useful in patients with abnormal/thick mucous secretions.

A

Acetylcysteine

73
Q

Rx SCID

A

Stem cell transplant (long-term)

74
Q

Prevent febrile non-hemolytic reaction to blood transfusions?

A

Leukoreduction

75
Q

3 electrolyte causes of QT prolongation?

A

Hypocalcemia
Hypokalemia
Hypomagnesemia

76
Q

Features of congenital long QT syndrome?

A

Sudden death, congenital sensorineural deafness, QT interval of ~600 ms

77
Q

Rx long QT syndrome?

A

Maintain normal levels of Ca, K, Mg
Beta-blockers (blunts exertional HR, shortens the QT interval)
Symptomatic patients or those with a history of syncope also require long-term pacemaker placement

78
Q

Which beta blocker should be avoided in long QT syndrome?

A

Sotalol (class III anti-arrhythmic, can prolong QT by blocking K channels)

79
Q

For anticoagulation, unfractionated heparin is preferred over LMWH, fondaparinux, and rivaroxaban in patients with ___. Why

A

Severe renal insufficiency (GFR <30) -> reduced renal clearance increases anti-Xa activity levels and bleeding risk

80
Q

What are Howell-Jolly bodies and what does their presence suggest?

A

Nuclear remnants within RBCs typically removed by the spleen; asplenia or functional hyposplenism

81
Q

Precipitation of ribosomal ribonucleic acid is seen in patients with ___ and appears as ___ on smear.

A

Lead poisoning; basophilic stippling

82
Q

Hypotension is a common side effect of epidural anesthesia - MOA?

A

Blood redistribution to the lower extremities and venous pooling from sympathetic blockade

83
Q

Define prolonged QT interval.

A

QTc > 450 ms in males

>470 ms in female

84
Q

Characteristic ECG findings of WPW?

A 
Short PR (<120 ms)
Slurred initial upstroke of QRS
Widening of QRS complex with St/T wave changes
85
Q

Cause of WPW?

A

Accessory pathway that bypasses the AV node and directly connects the atria to the ventricles

86
Q

First line therapy for nocturnal enuresis?

A

Desmopressin

87
Q

AA amyloidosis occurs in the setting of chronic inflammation and is most commonly seen in patients with long-standing ___. Dx?

A

RA; biopsy demonstrating amorphus hyaline material that stains with Congo red

88
Q

List the live-attenuated vaccines (6).

A 
Polio (oral)
MMR
Rotavirus
Influenza (INTRANASAL)
Yellow fever
VZV
89
Q

Most common side effect of tamoxifen?

A

Hot flashes

90
Q

All estrogen agonists increase the risk of VTE by increasing ___.

A

Protein C resistance

91
Q

In hyperthyroidism, increased radioactive iodine uptake suggests what cause vs. decreased RAIU?

A

Increased - de novo TH synthesis

Decreased - release of preformed hormone or exogenous hormone intake

92
Q

Thyrotoxicosis due to exogenous thyroid hormone is characterized by what lab finding?

A

Low serum thyroglobulin levels

93
Q

PPx for antiphospholipid antibody syndrome in pregnant patients?

A

Low dose aspirin + LMWH

94
Q

In a ___ study, risk factor and outcome are measured simultaneously at a particular point in time.

A

Cross-sectional

95
Q

TCA overdose can present with CNS, cardiac, and anticholinergic findings. How is it treated and what is the MOA?

A

Sodium bicarbonate

Increases serum pH and extracellular sodium, thereby alleviating the cardiodepressant action on sodium channels

96
Q

Rx urgency incontinence?

A

Antimuscarinics (oxybutynin) -> prevent bladder spasms/promote relaxation

Timed voiding

97
Q

Rx urinary overflow incontinence?

A

Cholinergic therapy (bethanechol)

98
Q

Rx minimal change disease?

A

Steroids

99
Q

Dx - thickened BM and subepithelial spikes?

A

Membranous glomerulonephritis

100
Q

Dx - mesangial hypercelluarity?

A

Membranoproliferative GN

101
Q

Chronic GI disease can cause vitamin D deficiency due to malabsorption - levels of Ca, Ph, and PTH?

A

Hypocalcemia
Low phosphorus
Elevated PTH

Because Vitamin D mediates intestinal Ca and Ph absorption

102
Q

Symptoms of Vitamin D deficiency?

A

Osteomalacia, bone pain/tenderness, muscel weakness or cramps, gait abnormalities, etc.

103
Q

___ are due to microatheroma formation and lipohyalinosis in the small penetrating arteries of the brain.

A

Lacunar strokes

Dedicated - Step 2 (22 decks)

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