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2 Flashcards

1
Q

___ presents with chronic lateral hip pain and tenderness over the greater trochanter during flexion or when lying on the affected side.

A

Greater trochanteric pain syndrome

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2
Q

Rx greater trochanteric pain syndrome?

A

First: heat, activity modification, NSAIDs

If persistent: Local steroid injection

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3
Q

Diagnosis of greater trochanteric pain syndrome (trochanteric bursitis)?

A

Clinical (local tenderness over the greater trochanter during flexion on exam)
X-ray to rule out hip joint pathology

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4
Q

What are the two MOA of tamoxifen?

A

Estrogen antagonist on breast tissue (treat and prevent breast cancer)

Estrogen agonist in the uterus (increased risk of endometrial polyps, hyperplasia, and cancer)

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5
Q

What are the two SERMs (selective estrogen receptor modulators)?

A

Tamoxifen

Raloxifene

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6
Q

Indication for raloxifene?

A

Post-menopausal osteoporosis

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7
Q

AE of SERMs?

A

Hot flashes
VTE
Endometrial hyperplasia and carcinoma (tamoxifen only)

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8
Q

Indication for tamoxifen?

A

Adjuvant treatment for premenopausal women at low risk of breast cancer recurrence

Second-line for post-menopausal women who cannot use aromatase inhibitor therapy

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9
Q

___ are testosterone-secreting sex cord-stromal tumors that can present with rapid-onset virilization, amenorrhea, and a large pelvic mass.

A

Sertoli-Leydig cell tumors

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10
Q

What is a struma ovarii?

A

Type of teratoma (germ cell tumor) composed of mature thyroid tissue; patients present with amenorrhea, pelvic mass, and hyperthyroidism

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11
Q

Clinical features of congenital hypothyroidism?

A

Initially normal at birth
Symptoms develop after maternal T4 wanes: lethargy, enlarged fontanelle, hoarse cry, protruding tongue, umbilical hernia, poor feeding, constipation, dry skin, jaundice, poor feeding, weakness, hypotonia, apathy, sluggish movement, abdominal bloating

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12
Q

Most common cause of congenital hypothyroidism worldwide?

A

Thyroid dysgenesis (aplasia, hypoplasia, ectopic gland, etc.)

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13
Q

Prompt recognition and treatment with levothyroxine is necessary to prevent ___ in congenital hypothyroidism.

A

Neurodevelopmental injury

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14
Q

Differentiate between the 3 types of twin pregnancy.

A

Monochorionic, monoamniotic: 1 placenta, 1 amniotic sac

Mono, di: 1 placenta, 2 amniotic sacs, T-sign at intertwin membrane

Di, di: 2 placentas, 2 amniotic sacs, Lambda sign at intertwin membrane

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15
Q

4 maternal complications of twin pregnancy?

A
  1. Hyperemesis gravidarum
  2. Pre-eclampsia
  3. Gestational DM
  4. Iron-deficiency anemia
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16
Q

4 general fetal complications of twin pregnancies?

A
  1. Congenital anomalies
  2. Fetal growth restriction
  3. Pre-term delivery
  4. Malpresentation (eg, breech)
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17
Q

1 fetal complication of monochorionic twin pregnancies?

A

Twin-twin transfusion syndrome

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18
Q

2 fetal complications of monoamniotic twin pregnancies?

A
  1. Conjoined twins

2. Cord entanglement

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19
Q

Most common complication of twin pregnancies?

A

Pre-term delivery (<37 weeks)

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20
Q

Define fetal macrosomia?

A

Estimated fetal weight of 4,500+ g

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21
Q

Define intermittent asthma.

A

Symptom frequency/SABA use 2 or fewer days/week

Nighttime awakenings 2 or fewer times/month

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22
Q

Define mild persistent asthma.

A

Symptom frequency/SABA use >2 days/week, but not daily

Nighttime awakenings 3-4 times/month

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23
Q

Define moderate persistent asthma.

A

Symptom frequency/SAA use daily

Nighttime awakenings >1 time/week, but not nightly

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24
Q

Define severe persistent asthma.

A

Symptom frequency/SABAS use throughout the day

Nighttime awakenings 4-7 times/week

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25
Q

What are the steps of asthma management?

A

Step 1: SABA PRN
Step 2: Low-dose ICS
Step 3: Low-dose ICS + LABA / OR / Medium-dose ICS
Step 4: Medium-dose ICS + LABA
Step 5: High-dose ICS + LABA AND consider omalizumab for patients with allergies
Step 6: Step 5 + oral corticosteroid

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26
Q

Examples of low-dose inhaled corticosteroid?

A

Beclomethasone

Fluticasone

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27
Q

Examples of LABAs?

A

Salmeterol

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28
Q

What is theophylline and what is its role in asthma management?

A

Methylxanthine PDE inhibitor that causes bronchodilation

Use somewhat limited by AE

Alternate Step 3

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29
Q

Features of tremor in Parkinson’s disease?

A

Resting tumor
4-6 Hz
Asymmetric
Associated with rigidity

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30
Q

Management of tremor in Parkinson’s disease?

A

Trihexyphenidyl (anticholinergic)

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31
Q

Management of essential tremor?

A

Propranolol (first-line)

Second-line: clonazepam, primidone

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32
Q

In addition to thyroid dysgenesis (most common cause), what are 2 other causes of congenital hypothyroidism?

A
  1. Inborn errors of thyroxin synthesis (10%)

2. Transplacental maternal thyrotropin-receptor blocking antibodies (5%)

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33
Q

What is Werdnig-Hoffman syndrome?

A

AR disorder involving degeneration of the anterior horn cells and CN motor nuclei, one cause of “floppy baby” syndrome

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34
Q

What is myotonic congenital myopathy?

A

AD disorder characterized by muscle weakness and atrophy (most prominent in distal muscles of upper and lower extremities), myotonia, testicular atrophy, and baldness

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35
Q

List 4 infectious complications of atopic dermatitis.

A
  1. Impetigo
  2. Eczema herpeticum
  3. Molluscum contagiosum
  4. Tinea corporis
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36
Q

Pathogen and presentation of impetigo?

A

S. aureus and S. pyogenes

Painful, non-pruritic pustules with honey-crusted adherent coating

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37
Q

Pathogen and presentation of eczema herpeticum?

A

HSV 1

Painful vesicular rash with “punched-out” erosions and hemorrhagic crusting

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38
Q

Pathogen and presentation of molluscum contagiosum?

A

Poxvirus

Flesh-colored papules with central umbilication

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39
Q

Pathogen and presentation of tinea corporis?

A

Trichophyton rubrum

Pruritic circular patch with central clearing and raised, scaly border

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40
Q

Risk factors for iron deficiency anemia in young children?

A
  1. Prematurity
  2. Lead exposure
  3. Age <1: delayed introduction of solids; cow’s, soy, or goat’s milk
  4. Age >1: >24 oz/day cow’s milk, <3 servings/day iron-rich foods
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41
Q

Lab findings of iron deficiency anemia in young children?

A 
Decreased MCV
Decreased MCHC
Increased RDW (size variability)
Low erythrocyte count
Increased TIBC (upregulated transferrin production, lower serum iron)
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42
Q

Lab findings of beta thalassemia?

A 
Decreased MCV
Decreased MCHC
Low RDW
Normal/elevated erythrocyte count
Abnormal Hgb electrophoresis
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43
Q

What is TIBC?

A

Direct measure of iron bound by transferrin

Indirect measure of transferrin levels

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44
Q

Presentation - <1 week of systemic (fever, malaise, myalgias, headache) and respiratory (rhinorrhea, sore throat, non-productive cough) symptoms

A

Influenza

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45
Q

Most common complication of influenza? Other complications?

A

Pneumonia (secondary bacterial infection or direct viral attack)

Muscle (myositis, rhabdomyolysis)
Heart (myocarditis, pericarditis)
CNS (encephalitis, transverse myelitis)

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46
Q

Typical XR findings of viral pneumonia?

A

Bilateral diffuse reticular infiltrates

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47
Q

In an infant with meningococcemia, watch out for ___.

A

Waterhouse-Friderichsen syndrome (sudden vasomotor collapse and skin rash due to adrenal hemorrhage)

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48
Q

Features of Sturge-Weber syndrome?

A

Capillary malformation (port wine stain) along the trigeminal nerve (V1/V2) distribution

Leptomeningeal capillary-venous malformations affecting the brain and eye

Seizures +/- hemiparesis, intellectual disability, visual field defects, glaucoma

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49
Q

Mutation causing Sturge-Weber syndrome?

A

GNAQ gene

50
Q

Dx Sturge-Weber?

A

MRI of the brain with contrast demonstrating intracranial vascular malformation

51
Q

Manage Sturge-Weber syndrome?

A

Laser therapy
Anti-epileptic drugs
Intraocular pressure reduction

52
Q

Features of Klippel-Trenaunay syndrome?

A

Capillary, venous, and sometimes lymphatic malformations in combination with limb overgrowth

No neuro abnormalities
Port wine stain involving the lower extremity

53
Q

Features of NF1?

A 
Optic glioma
Lisch nodules
Cafe-au-lait macules
Scoliosis
Axillary and inguinal freckling
Neurofibromas
Pseudoarthrosis
54
Q

Features of Tuberous sclerosis?

A

Seizures and ID
Retinal hamartomas
Hypopigmented ash-leaf spots
Angiofibromas (malar erythematous papules)
Shagreen patches (flesh-colored plaques on the back)

55
Q

Rx carpal tunnel syndrome?

A

1st - splinting
May add - glucocorticoids
Surgery only if severe (atrophy, weakness) or refractory

56
Q

Most common childhood cancer?

A

Acute lymphoblastic leukemia

57
Q

M vs. F distribution of ALL

Peak age of ALL

A

M>F

2-5 years

58
Q

Dx ALL?

A

BM biopsy with >25% lymphoblasts

59
Q

Dx and manage epiglottitis?

A

Direct laryngoscopy during intubation to secure the airway

60
Q

Thumb sign?

A

Epiglottitis

61
Q

Steeple sign?

A

Bacterial tracheitis or croup

62
Q

Causes of Cushing syndrome (hypercortisolism)?

A

Exogenous glucocorticoids
ACTH-producing pituitary tumor
Ectopic ACTH production
Primary adrenal disease

63
Q

3 electrolyte disturbances that can cause muscle weakness?

A

Hypokalemia
Hypomagnesemia
Hypercalcemia

64
Q

1 electrolyte disturbance that can cause tetany?

A

Hypocalcemia

65
Q

Diagnose chronic pancreatitis?

A

Pancreatic calcifications on CT or plain film

Note that amylase and lipase can be normal and non-diagnostic

66
Q

What is Chagas disease and what causes it?

A

Chronic disease that can cause megaesophagus, megacolon, and/or cardiac dysfunction

Trypanosoma cruzi (protozoa), endemic to Latin America

67
Q

Lab abnormalities of bulimia nervosa?

A

Hypokalemia
Hypochloremia
Metabolic alkalosis

68
Q

What is a hazard ratio?

A

Ratio of an event rate occurring in the treatment arm vs. the non-treatment arm

69
Q

Hazard ratio <1 ?

A

Treatment arm had a lower event rate

70
Q

Hazard ratio >1?

A

Treatment arm had a higher rate of events

71
Q

What type of study design involves randomization to different interventions with additional study of 2+ variables?

A

Factorial design studies

72
Q

What type of study involves the grouping of different data points into similar categories?

A

Cluster analysis

73
Q

What type of study randomizes one treatment to one group and a different treatment to the other group?

A

Parallel study

74
Q

What type of study involves two groups of participants receiving different treatments for a period of time followed by switching treatments?

A

Cross-over study

75
Q

Features of a non-functioning pituitary adenoma?

A
  • Arise from gonadotropin-secreting cells in the pituitary
  • Dysfunctional cells secrete common alpha-subunit of LH and FSH (rather than the normal alpha and beta)
  • Production of most pituitary hormones will be decreased due to compression of neighboring normal pituitary cells
  • Prl levels are mildly to moderately elevated due to anatomic disruption of the dopaminergic pathways that normally suppress secretion
76
Q

Features of Klinefelter syndrome?

A

47, XXY

Hypogonadism, small testes, decreased virilization

HPA axis intact, LH increased

77
Q

Affect of antipsychotics on HPA axis?

A

Can cause hyperprolactinemia (due to blockade of dopamine)

TSH is usually unaffected

78
Q

Lab abnormalities caused by HCTZ?

A

Hypokalemia
Hyperglycemia
Hyperuricemia

79
Q

Common causes of sciatica (aka lumbosacral radiculopathy)?

A

Nerve root compression usually from herniated disc or lumbar spondylosis

80
Q

Management of sciatica?

A

Because most patients experience spontaneous resolution, begin with NSAIDs or acetaminophen

MRI not indicated initially, as it does not change management (so long as there are no associated symptoms concerning for cauda equina syndrome or epidural abscess)

81
Q

2 main causes of symptomatic cholelithiasis in pregnancy?

A

Increased biliary cholesterol excretion (estrogen effect)

Decreased gallbladder motility (progesterone effect)

82
Q

Management of symptomatic cholelithiasis in pregnancy?

A

Conservative (eg, pain control)

Cholecystectomy for complicated, recurrent cases

83
Q

Why can pre-eclampsia cause RUQ pain?

A

Stretching of the liver capsule

84
Q

Diagnostic test with high sensitivity and specificity for severe pancreatic exocrine insufficiency?

A

Fecal elastase (low levels indicate insufficiency)

85
Q

Increased fecal calprotectin and leukocytes occur in patients with what condiiton?

A

IBD

86
Q

Most common form of drug-induced renal failure?

A

Analgesic nephropathy

87
Q

Most common pathologies seen in drug-induced renal failure?

A

Papillary necrosis

Chronic tubulointerstitial nephritis

88
Q

Common drugs associated with pancreatitis?

A
  1. Diuretics (furosemide, thiazides)
  2. IBD drugs (sulfasalazine, 5-ASA)
  3. Immunosuppressives (azathioprine)
  4. HIV-related (didanosine, pentamidine)
  5. ABX (metronidazole, tetracycline)
  6. Anti-seizure medications (valproic acid)
89
Q

Features of Down syndrome?

A 
Epicathnic folds
Upslanting palpebral fissures
Low-set small ears
Flat facial profile
Short neck with excess skin
Furrowed tongue
Sandal-toe deformity
Hypoplastic incurved 5th finger
Single transverse palmar crease
Brushfield spots

Low birth weight
Hypotonia (may present with poor feeding due to weak suck)

90
Q

Features of Beckwith-Wiedemann syndrome?

A

Macrosomia
Hemihyperplasia (asymmetric overgrowth of one side of the body)
Omphalocele
Macroglossia

91
Q

Features of Fragile X syndrome?

A 
Neurobehavioral problems
Prominent forehead
Large ears
Long, narrow face
Prominent chin
Macroorchidism
92
Q

Filamentous, aerobic, gram-positive bacteria that is partially acid-fast?

A

Nocardia

93
Q

Typical disease caused by Nocardia?

A

Pulmonary or disseminated disease (particularly to the brain, also the skin) in immunocompromised hosts

94
Q

Rx pulmonary nocardiosis? If brain involved?

A

TMP-SMX; add carbapenems

6-12 months of treatment

95
Q

ABX type, organism targeted - aztreonam

A

Monobactam

GN, including P. aeruginosa

96
Q

Rx of choice for Actinomyces?

A

Penicillin G

97
Q

Key differences between Actinomyces and Nocardia?

A

Anaerobic
NOT acid-fast
Sulfur granules

98
Q

Well-known AE of high-dose niacin therapy? What is its MOA?

A

Cutaneous flushing and intensive generalized pruritis; prostaglandin-induced peripheral vasodilation

Rx with low-dose aspirin

99
Q

How is pulmonary hypertension classified?

A

Group 1: pulmonary arterial HTN
Group 2: due to L-sided heart disease
Group 3: due to chronic lung disease (COPD, ILD, etc.)
Group 4: due to chronic thromboembolic disease
Group 5: due to other causes

100
Q

Physical exam signs of pulmonary HTN

A 
L parasternal life
R ventricular heave
Loud P2, right-sided S3
Pansystolic murmur of TR
JVD, ascites, peripheral edema, hepatomegaly
101
Q

CREST syndrome?

A 
Calcinosis cutis
Raynoud phenomenon
Esophageal dysmotility with reflux
Sclerodactyly
Telangiectasia
102
Q

CREST syndrome is a part of what illness?

A

Systemic sclerosis (limited cutaneous)

103
Q

Compare the findings of limited vs. diffuse cutaneous systemic sclerosis.

A

Limited:

  • Scleroderma on head and distal UE
  • Prominent vascular manifestations (Raynaud, cutaneous telangiectasia, pulmonary arterial HTN)
  • CREST

Diffuse:

  • Scleroderma on trunk and UE
  • Prominent internal organ involvement (renal crisis, MI and myocardial fibrosis, ILD)
104
Q

Which type of systemic sclerosis has a better prognosis?

A

Limited cutaneous

105
Q

Ab of limited cutaneous?

A

Anticentromere

106
Q

Ab of diffuse cutaneous?

A

Anti-Scl-70 (topoisomerase-1)

Anti-RNA polymerase III

107
Q

Histologic findings of pulmonary arterial hypertension?

A

Intimal hyperplasia of the pulmonary arteries

108
Q

Cause of brachial-femoral pulse delay?

A

Aortic coarctation

109
Q

Cause of systolic ejection murmur radiating to the carotids?

A

Aortic stenosis

110
Q

Cause of systolic ejection murmur WITHOUT radiation to the carotids?

A

HCM

111
Q

S3 heard at the apex on end-expiration indicates?

A

LV failure

112
Q

S3 heard at the LL sternal border on end-inspiration

A

RV failure

113
Q

Cause of wide fixed splitting of S2?

A

ASD

114
Q

Most accurate method for measuring pulmonary arterial pressure? Least invasive?

A

Right heart catheterization; Echo

115
Q

Define pulmonary HTN.

A

Resting pulmonary arterial systolic pressure >30

116
Q

Alveolar spaces filled with fibroblasts?

A

ILD

117
Q

Initial management of plantar fasciitis?

A

Activity modification, stretching, padded heel inserts

118
Q

Cause of tarsal tunnel syndrome?

A

Compression of the tibial nerve

119
Q

Most patients with parvovirus B19 infection are asymptomatic or have flu-like symptoms. However, there are 3 unique presentations caused by this virus. What are they?

A
  1. Erythema infectiosum (fifth disease) - fever, nausea, slapped cheek rash (more common in kids)
  2. Acute symmetric arthralgia/arthritis: hands, wrists, knees, feet; may have morbilliform exanthem
  3. Transient pure red cell aplasia (aplastic crises in patients with underlying hematologic disease like sickle cell)
120
Q

What patient characteristic can be used to effectively rule out polymyalgia rheumatica?

A

Age - almost exclusively occurs in patients >50

Dedicated - Step 2 (22 decks)

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