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Dedicated - Step 2 > 3 > Flashcards

3 Flashcards

1
Q

Cardiac involvement of amyloidosis typically presents with what type of cardiomyopathy?

A

Restrictive; may progress to dilated

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2
Q

Features of restrictive cardiomyopathy on echocardiogram?

A

Thickened ventricular walls and diastolic dysfunction

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3
Q

Dx amyloidosis?

A

Tissue biopsy

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4
Q

Alcohol-related heart disease typically presents with what type of cardiomyopathy?

A

Dilated

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5
Q

Restrictive cardiomyopathy typically presents with what type of heart failure?

A

Right-sided

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6
Q

Constrictive pericarditis typically presents with what type of heart failure?

A

Right-sided

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7
Q

In addition to amyloidosis, list two other infiltrative diseases that initially present with restrictive, then dilated, cardiomyopathy.

A

Hemochromatosis

Sarcoidosis

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8
Q

Other possible presenting symptoms/signs of amyloidosis?

A 
Asymptomatic proteinuria or nephrotic syndrome
Hepatomegaly
Macroglossia
Peripheral/autonomic neuropathy
Waxy skin thickening, easy bruising
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9
Q

Symptoms of catatonia?

A

Immobility (or excessive purposeless activity)
Mutism, stupor (decreased alertness and response to stimuli)
Negativism (resistance to instructions and movement)
Posturing (assuming positions against gravity)
Waxy flexibility
Echophenomena

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10
Q

Catatonia most often presents in the context of what two psychiatric illnesses?

A

Bipolar disorder
MDD

(It may occur in schizophrenia, ASD, general medical illnesses, etc.)

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11
Q

Symptoms of akinetic mutism?

A

Similar to catatonia, but NO echophenomena

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12
Q

Cause of locked-in syndrome?

A

Pontine stroke

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13
Q

Symptoms of locked-in syndrome?

A

Paralysis, mutism, preservation of cognitive abilities

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14
Q

The numerous causes of anemia may be divided into what three categories?

A
  1. Decreased RBC production
  2. Increased RBC destruction
  3. Blood loss
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15
Q

Pathophysiology of anemia in lymphoproliferative disorders?

A

Bone marrow infiltration with cancerous cells

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16
Q

Which contraceptive has weight gain as a common side effect?

A

Medroxyprogesterone injections

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17
Q

Features of HELLP syndrome?

A 
Preeclampsia
N/V
RUQ or epigastric pain
microangiopathic Hemolytic anemia
Elevated liver enzymes
Low platelet count
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18
Q

Rx HELLP syndrome?

A

Delivery
Magnesium for seizure prophylaxis
Antihypertensives

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19
Q

Acute fatty liver of pregnancy overlaps with HELLP syndrome, but patients with AFLP are more likely to have additional extrahepatic complications such as…?

A

Leukocytosis
Hypoglycemia
Acute kidney injury

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20
Q

Sudden-onset dyspnea, hypoxia, and crackles in the setting of severe preeclampsia is most likely due to what?

A

Acute pulmonary edema

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21
Q

Pathophysiologic mechanism of acute pulmonary edema in severe pre-eclampsia?

A

Generalized arterial vasospasm (systemic HTN) -> increased afterload -> increased pulmonary capillary pressure -> pulmonary edema

Decreased albumin
Decreased renal function
Increased vascular permeability due to endothelial damage

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22
Q

Symptoms of magnesium sulfate toxicity?

A

Neuromuscular depression

Decreased respiratory effort/apnea, muscle paralysis, somnolence, visual disturbances, decreased/absent DTRs

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23
Q

Strenuous activity during hot and humid weather, dehydration, poor acclimatization, lack of physical fitness, and obesity are risk factors for exertional heat stroke. Several medications also increase risk - list them (4).

A

Anticholinergics
Antihistamines
Phenithiazines
Tricyclics

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24
Q

Clinical manifestations of exertional heat stroke?

A

Core temperature >40 (104 F) immediately after collapse AND CNS dysfunction (AMS, confusion, irritability, seizure), additional organ/tissue damage (renal/hepatic failure, DIC, ARDS)

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25
Q

Management of exertional heat stroke?

A

Rapid cooling - ice water immersion preferred; can consider high-flow cool water dousing, ice/wet towel rotation, evaporative cooling

Fluid resuscitation
Electrolyte correction
Management of end-organ complications
No role for antipyretic therapy

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26
Q

Features of non-exertional (or classic) heat stroke?

A

Similar clinical features and potential complications
Occurs in the absence of strenuous activity, typically effects elderly patients with many comorbidities that limit their ability to escape/cope with excessive heat

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27
Q

Management for non-exertional heat stroke?

A

Evaporative cooling (rather than ice-water immersion)

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28
Q

AE of aminoglycosides (eg, gentamicin)?

A

Ototoxicity to both the cochlea (sensorineural hearing loss) and vestibular system (imbalance)

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29
Q

Features of AG ototoxicity?

A
  1. Bilateral, but not necessarily symmetric, hearing loss (whisper test)
  2. Imbalance and oscillopsia (bilateral vestibular systems affected)
  3. Positive head thrust test (inability to maintain visual fixation during forced, rapid head movement, evaluates vestibulo-ocular reflex, which is affected by peripheral but not central vestibulopathies)
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30
Q

Distinguish BPPV from AG ototoxicity.

A

BPPV: brief (<1 minute) episodic vertigo stimulated by specific head movements, no hearing loss, confirmed by Dix-Hallpike (not head thrust)

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31
Q

Features of Meniere disease?

A

Discrete episodes of spinning vertigo accompanied by hearing loss and tinnitus or aural fullness

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32
Q

Features of tinea capitis?

A

Most common in AA children and immunocompromised

Causes a scaly erythematous patch that can progress to alopecia with inflammation, LAD, and scarring +/- black dots in affected area

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33
Q

Rx tinea capitis?

A

Oral griseofulvin or terbinafine

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34
Q

Characteristic lab findings of HUS?

A

Microangiopathic hemolytic anemia
Thrombocytopenia
AKI

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35
Q

Lab findings indicating RBC destruction?

A 
Increased LDH
Low haptoglobin (binds free Hgb normally; if free Hgb increases, haptoglobin decreases)
Increased unconjugated bilirubin
Hemoglobinemia
Hemoglobinuria
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36
Q

Decreased ferritin?

A

Iron deficiency anemia

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37
Q

Compare clinical presentation of transient synovitis and septic arthritis in children.

A

TS: well-appearing, afebrile or low-grade fever, able to bear weight

SA: ill-appearing, febrile, non-weight bearing

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38
Q

Compare diagnostic work-up of TS vs. SA in children.

A

TS: normal or mildly elevated WBC, ESR/CRP, unilateral or bilateral U/S effusion, Dx of exclusion (key)

SA: moderately elevated WBC, ESR, CRP, +/- positive blood culture, unilateral U/S effusion, synovial fluid WBC >50,000

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39
Q

In patients with overlapping clinical features of TS and SA (for example, low grade fever, mildly elevated ESR, severe pain, inability to ambulate, leukocytosis), what should be done?

A

Bilateral hip U/S - if unilateral, arthrocentesis performed

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40
Q

Characteristic finding aplastic anemia?

A

Decreased reticulocyte count in the presence of anemia

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41
Q

Expected acid-base disturbance in acute asthma exacerbation?

A

Respiratory alkalosis with a low PaCO2 due to hyperventilation

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42
Q

What is an alarming finding suggesting impending respiratory failure in patients with an acute asthma exacerbation?

A

Normal or elevated PaCO2

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43
Q

Most common pediatric bony malignancy?

A

Osteosarcoma

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44
Q

Second most common pediatric bony malignancy?

A

Ewing sarcoma

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45
Q

Clinical features of Ewing sarcoma?

A

Chronic, localized pain and swelling
Long-bone diaphyses and axial skeleton (eg, pelvis)
+/- systemic findings
Early mets

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46
Q

X-ray findings of Ewing sarcoma?

A

Central lytic lesion
Onion skinning (lamelleted periosteal reaction)
Moth-eaten appearance
Periosteal elevation (Codman triangle -> non-specific finding)

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47
Q

2 bone tumors located in the epiphysis?

A
  1. Giant cell tumor

2. Chondroblastoma

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48
Q

2 bone tumors located in the metaphysis?

A
  1. Chondrosarcoma

2. Osteosarcoma

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49
Q

6 bone tumors located in the diaphysis?

A

Round cell lesions: Ewing tumor, malignant lymphoma, myeloma

Fibrosarcoma
Non-ossifying fibroma
Bone cyst

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50
Q

Bone tumor presenting with a painful mass in patients age >30, X-ray shows osteolytic lesion with well-defined or ragged moth-eaten margins

A

Fibrosarcoma

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51
Q

Bone tumor presenting in young adults with pain and swelling, X-ray shows lytic area with a “soap bubble” appearance

A

Giant cell tumor

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52
Q

Bone tumor presenting in adolescent boys, commonly located in the proximal femur, causes pain at night that responds to NSAIDs, small round lucency on X-ray

A

Osteoid osteoma

53
Q

Presents in children and young adults, typically located at the proximal femur or humerus, pathologic fracture is the common presentation, cystic lesion with well-defined margins

A

Unicameral bone cysts

54
Q

Presentation of hereditary spherocytosis in an infant?

A

Prolonged neonatal jaundice
Findings of hemolysis
Elevated MCHC
(Low to normal MCV, negative direct Coombs, spherocytes on peripheral smear)

55
Q

Rx hereditary spherocytosis?

A

Supportive

RBC or exchange transfusion if hemolysis is severe

56
Q

Blood group A - antigens on RBC and antibodies in serum?

A

A-Ag

Anti-B

57
Q

Blood group B - antigens on RBC and antibodies in serum?

A

B-Ag

Anti-A

58
Q

Blood group AB - antigens on RBC and antibodies in serum?

A

A-Ag + B-Ag

None

59
Q

Blood group O - antigens on RBC and antibodies in serum?

A

None

Anti-B + Anti-A

60
Q

Timing of presentation of beta thalassemia?

A

After 6 months (after fetal Hgb decreases)

61
Q

Ab found in Hashimoto thyroiditis?

A

Anti-TPO (antithyroid peroxidase)

Anti-thyroglobulin may also be present

62
Q

High titers of anti-TPO are associated with increased risk of ___ in both euthyroid and hypothyroid women.

A

Miscarriage

63
Q

Compare thyroid size in hypothyroidism with anti-TPO vs. anti-TSH receptor Ab.

A

Anti-TPO: enlarged

Anti-TSH receptor: atrophy

64
Q

Features of primary syphilis?

A

Painless genital ulcer (chancre)

65
Q

Features of secondary syphilis?

A

Diffuse maculopapular rash beginning on the trunk and extending to the extremities (also involves palms and soles), LAD (epitrochlear -> pathognomnoic), condyloma lata (raised gray genital papules), oral lesions, hepatitis

66
Q

Features of latent syphilis?

A

Asymptomatic

67
Q

Features of tertiary syphilis?

A

CNS (tabes dorsalis, dementia)
CV (aortic aneurysm/insfufficnecy)
Cutaneous (gummas)

68
Q

Dx syphilis?

A

Combination of non-treponemal (RPR) and treponemal-specific (T. pallidum immunoassay) tests

69
Q

Rx primary and secondary syphilis?

A

One dose IM penicillin G benzathine

Confirm adequate treatment by a 4-fold decrease in titers at 6-12 months

70
Q

Presentation - painless vaginal bleeding after 20 weeks gestation?

A

Placenta previa

71
Q

3 risk factors for placenta previa?

A

Prior placenta previa
Prior C-section
Multiple gestation
Smoking

72
Q

Dx placenta previa?

A

Transabdominal, then TVUS

73
Q

Management of placenta previa?

A

No intercourse
No digital cervical exam
Inpatient admission for bleeding episodes

Most resolve by T3

If persistent previa, deliver via C-section at 36-37 weeks

74
Q

Define pre-term labor.

A

Cervical dilation of 3+ cm or effacement with regular painful uterine contractions at <37 weeks

75
Q

Both transfusion-associated circulatory overload and transfusion-associated acute lung injury may present with acute dyspnea and diffuse bilateral infiltrates on CXR. How can they be distinguished?

A

TRALI: absent JVD, crackles/rales on auscultation, normal EF, normal BNP

TACO: present JVD, crackles/rales +/- S3, decreased EF, high BNP

76
Q

General causes of thrombocytopenia?

A
  1. Decreased platelet production
  2. Increased platelet destruction
  3. Dilutional
  4. Splenic sequestration
77
Q

DDx - thrombocytopenia due to decreased production

A
  1. Viral infections (EBV, hepatitis C, HIV, etc.)
  2. Chemo
  3. Myelodysplasia (especially if >60 years old)
  4. Alcohol use
  5. Congenital (eg, Fanconi syndrome)
  6. Vitamin B12 or folate deficiency
78
Q

DDx - thrombocytopenia due to increased destruction

A
  1. SLE
  2. Medications (eg, heparin)
  3. ITP, DIC, TTP, HUS
  4. Antiphospholipid syndrome
79
Q

Schilling test?

A

Determine whether a patient had vitamin B12 deficiency due to pernicious anemia or a malabsorption syndrome

80
Q

ITP is a diagnosis of exclusion.

A

Don’t forget it.

81
Q

Mainstay of therapy in patients with alcoholic cardiomyopathy (can lead to normalization of LVF over time)?

A

Complete cessation of alcohol consumption

82
Q

AFib is most commonly caused by ectopic foci in what location?

A

Within the pulmonary veins

83
Q

Atrial flutter commonly involves a re-entrant circuit around what structure?

A

Tricuspid annulus

84
Q

AV nodal re-entry tachycardia results from a re-entrant circuit formed by what structure?

A

2 separate conducting pathways within the AV node

85
Q

EKG findings of AFib?

A

Absent P waves (replaced by tiny chaotic fibrillatory waves)
Irregularly irregular R-R intervals
Narrow QRS

86
Q

Characteristic EKG finding of WPW?

A

Slurred upsloping R waves (aka delta waves)

87
Q

EKG findings of AV nodal re-entry tachycardia?

A

Sudden onset and termination
Rapid (140-250/min) regular rhythm
Narrow QRS
Absence of definite P waves

88
Q

EKG findings of sinus tachycardia?

A

Rate 100-180/min
Regular R-R intervals
Normal P waves and QRS complexes

89
Q

EKG findings of atrial flutter?

A

Sawtooth waves

90
Q

What is the major cause of morbidity and mortality in patients with PAD?

A

CV disease

91
Q

Patients with PAD and intermittent claudication have an estimated 20% 5-year risk of ___ and ___, and a 15-30% risk of death due to CV causes. Only 1-2% of patients progress to develop ___.

A

Non-fatal MI; stroke

Critical limb ischemia with risk of limb amputation

92
Q

Initial treatment of chronic venous insufficiency?

A

Conservative measures (leg elevation, exercise, compression therapy)

If no response -> venous duplex U/S to confirm diagnosis by identifying venous reflux

93
Q

Estimate CVP = ?

A

JVP + depth to R atrium (5 cm)

94
Q

Normal CVP?

A

6-8 cm H2O (elevated >8)

95
Q

Splenic infarction usually occurs in what settings?

A

Splenic artery (or sub-branch) occlusion due to hypercoagulable states, embolic disease, or hemoglobinopathy

96
Q

Although patients with sickle cell trait are generally aymptomatic, they occasionally develop splenic infarct and intravascular hemolysis in what settings?

A

Flying at high altitude

Dehydration due to alcohol consumption

97
Q

Treatment with vitamin ___ reduces morbidity and mortality rates in children with severe measles.

A

A

98
Q

How is measles transmitted?

A

Airborne

99
Q

Clinical presentation of measles?

A

Prodrome (eg, cough , coryza, conunctivitis, fever, Koplik spots)

Maculopapular exanthem (cephalocaudal and centrifugal spread, spares palms and soles)

100
Q

Features of hereditary hemorrhagic telangiectasia (aka Osler-Weber-Rendu syndrome)?

A

Diffuse telangiectasis
Recurrent epistaxis
Widespread AV malformations (tend to occur in mucus membranes, skin, GI tract; may be present in liver, brain, lung)

101
Q

AV malformations in the lungs cause what findings?

A

Chronic hypoxemia
Digital clubbing
Reactive polycythemia
Can present as massive, sometimes fatal, hemoptysis

102
Q

Findings of polycythemia vera?

A

Increased production of all 3 blood cell lines, splenomegaly, >60 y/o

103
Q

Renal transplant dysfunction in the early post-operative period manifests as oliguria, HTN, and increased creatinine/BUN. It can be explained by many causes, including what?

A 
Ureteral obstruction (renal U/S)
Acute rejection (biopsy -> lymphocyte infiltrate)
Cyclosporine toxicity
Vascular obstruction
ATN
And more
104
Q

Rx acute rejection?

A

High-dose IV steroids

105
Q

Characteristic features of child abuse in the form of deliberate scald injuries?

A
  • Burns with sharp lines of demarcation
  • Uniform depth
  • Lack of splash marks
  • Spared flexural creases (due to ankle, knee, and hip flexion at the time of forced immersion)
106
Q

In DKA, measured serum K levels are often initially high - why?

A

Extracellular shift of K driven by increased plasma tonicity

Loss of insulin-dependent potassium uptake across cell membranes

107
Q

Rx acute exacerbations of MS?

A

Glucocorticoids

Consider plasmapheresis if refractory

108
Q

Maintenance therapy in patients with relapsing-remitting or secondary, progressive forms of MS?

A

Interferon beta

Glatiramer acetate

109
Q

Why may baclofen be used in MS?

A

Treatment of muscle spasticity

110
Q

___ is a myeloproliferative disorder marked by erythrocytosis. It is almost always caused by a mutation of ___ in a myeloid precursor cell.

A

Polycythemia vera; JAK2

111
Q

Symptoms of polycythemia vera?

A

Increased blood viscosity -> HTN, erythromelalgia (burning cyanosis in hands/feet), transient visual disturbances

Increased RBC turnover -> gouty arthritis

Aquagenic pruritus (itching after bathing)

Bleeding

112
Q

Exam findings in polycythemia vera?

A 
Facial plethora (ruddy cyanosis)
Splenomegaly
113
Q

Lab findings in polycythemia vera?

A

Elevated Hgb
Leukocytosis and thrombocytosis
Low EPO level**
JAK2 mutation positive

114
Q

Complications of polycythemia vera?

A

Thrombosis

Myelofibrosis and acute leukemia

115
Q

Treatment of polycythemia vera?

A

Phlebotomy

Hydroxyurea (if increased risk of thrombus)

116
Q

BCR-ABL fusion protein?

A

CML

117
Q

Severe nodulocystic acne may be the initial sign of hyperandrogenism in patients with ___.

A

PCOS

118
Q

DDx of hyperandrogenism?

A

PCOS
Androgen-secreting tumor
Cushing syndrome
Non-classic CAH

119
Q

What statistical method is used to compare the means of two groups of subjects?

A

Two-sample t test

120
Q

The t statistic is obtained to calculate what value?

A

P value

121
Q

How does a two-sample z test differ from the t test?

A

Used to compare two means, but uses population variances, not sample variances

122
Q

What statistical test is used to compare 3+ means?

A

ANOVA

123
Q

What statistical test is appropriate for categorical data and proportions?

A

Chi-square test

124
Q

Pediatric chronic rhinosinusitis with nasal polyposis + exocrine pancreatic dysfunction = ?

A

Cystic fibrosis

125
Q

Features of CF?

A 
Sinusitis
Barrel chest
Pneumonia/bronchiectasis
Cachexia
Biliary cirrhosis
Pancreatic exocrine insufficiency
Diabetes
Digital clubbing
Inspissated stool
Absent vas deferens
126
Q

How does primary ciliary dyskinesia differ from CF in its presentation?

A

No GI symptoms

127
Q

In patients with upper GI bleeding, ongoing hematemesis, and depressed level of consciousness, what key step must be done?

A

Intubation to protect the airway prior to endoscopic treatment

128
Q

What is the most common cardiac manifestation of SLE?

A

Pericarditis

129
Q

EKG findings of pericarditis?

A

Diffuse ST elevation and PR depression, eventual diffuse T wave inversion

Dedicated - Step 2 (22 decks)

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