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Dedicated - Step 2 > 4 > Flashcards

4 Flashcards

1
Q

Harsh, holosystolic murmur best heard the LLSB?

A

VSD

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2
Q

Next step in the setting of a suspected VSD murmur?

A

Echocardiogram to determine location and size, and to r/o other defects

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3
Q

Next steps if VSD is identified?

A

Large/symptomatic -> repair

Small -> close spontaneously in 75% of children by age 2 with no sequelae

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4
Q

Characteristics of large VSD murmur compared to small?

A

Softer (less turbulence across a larger defect)

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5
Q

Sequelae of large VSD?

A

Pulmonary overcirculation, pulmonary HTN, growth failure, CHF, Eisenmenger syndrome

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6
Q

Typical characteristics of innocent flow murmur of childhood?

A

Grade I or II midsystolic ejection murmur, decreases with standing/Valsalva
Low-pitched, musical, pure, or squeeky tone at LLSB (Still’s) or high-pitched at LUSB (pulmonary flow)

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7
Q

Differentiate thalassemia minor from iron deficiency anemia.

A

Both are microcytic

Iron deficiency: elevated RDW, decreased RBCs, decreased reticulocyte count

Thalassemia: normal RDW, normal RBC count, elevated reticulocyte count

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8
Q

Vitamin B12 deficiency is common after total or partial gastrectomy due to loss of intrinsic factor, and ultimately leads to megaloblastic anemia. What is the pathogenesis?

A

B12 is a necessary cofactor in purine synthesis and its deficiency causes defective DNA synthesis. This results in ineffective erythropoiesis and high numbers of immature megaloblasts in the bone marrow.

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9
Q

3 first-line treatments for smoking cessation?

A
  1. Nicotine replacement therapy
  2. Varenicline
  3. Bupropion

All in conjunction with counseling and supportive therapy

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10
Q

Next step in management of a second-degree perineal laceration with localized pain particularly with voiding and perineal edema in the immediate postpartum period?

A

Normal -> supportive care with NSAIDs and sitz baths

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11
Q

Cell-free fetal DNA testing is non-invasive and highly sensitive/specific as a screening test for fetal aneuploidy. It can be ordered at ___ weeks gestation; what should be done if it is abnormal?

A

10+ weeks

Confirm results by chorionic villus sampling at 10-12 weeks or amniocentesis at 15-20 weeks

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12
Q

Earliest available screening for aneuploidy?

A

First-trimester combined test (nuchal translucency, beta-hCG, pregnancy-associated plasma protein) -> 9-13 weeks

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13
Q

Which prenatal testing methods provide definitive karyotpic diagnosis?

A

Chorionic villus sampling

Amniocentesis

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14
Q

What is electrical alternans?

A

Varying amplitude of the QRS complexes

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15
Q

Electical alternans with sinus tachycardia is a highly specific sign for ___.

A

Large pericardial effusion

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16
Q

Rx supraventricular and ventricular tachycardias, particularly in WPW?

A

Procainamide

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17
Q

The majority of patients with mammary Paget disease (painful, itchy, eczematous, and/or ulcerating rash on the nipple that spreads to the areola) have an underlying breast ___.

A

Adenocarcinoma

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18
Q

Presentation - palpable, mobile, rubbery, firm breast mass without nipple changes

A

Fibroadenoma

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19
Q

Most common cause of acute back pain?

A

Lumbosacral strain

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20
Q

List the 6 major findings of Kawasaki disease.

A
  1. Fever for 5+ days
  2. Cervical lymph node >1.5 cm
  3. Rash
  4. Swelling and/or erythema of palms/soles
  5. Bilateral non-exudative conjunctivitis
  6. Mucositis

(need 4/5 in addition to fever)

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21
Q

Rx Kawasaki disease

A

IVIg within 10 days of fever onset to decrease risk of coronary artery aneurysm

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22
Q

Koplik spots?

A

Pathognomonic for measles

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23
Q

In severe, chronic aortic regurgitation, the left ventricle responds to volume overload in what manner and why?

A

Eccentric hypertrophy to increase LV compliance and contractility, allow for an increase in SV to maintain CO -> temporary asymptomatic period

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24
Q

What causes concentric LVH and how are sarcomeres added?

A

Pressure overload (chronic HTN, aortic stenosis)

Sarcomeres added in parallel

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25
Q

What causes eccentric LVH and how are sarcomeres added?

A

Volume overload (AR/MR, ischemic heart disease, dilated cardiomyopathy)

Sarcomeres added in series

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26
Q

Sensorimotor polyneuropathy in diabetes is characterized by length-dependent axonopathy. Small fiber involvement causes ___, whereas large fiber involvement causes ___.

A

Small: pain and paresthesias

Large: numbness, loss of proprioception and vibration sense, diminished ankle reflexes

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27
Q

Why do patients with CF sometimes present with bleeding diathesis?

A

Fat-soluble (ADEK) vitamin deficiency due to poor absorption from pancreatic insufficiency -> vitamin K is an important cofactor in activation of factors 2, 7, 9, 10, protein C and protein S

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28
Q

Typical lab findings in Vitamin K deficiency?

A 
Increased PT and INR
Normal aPTT (unless severe)
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29
Q

Typical lab findings of factor VIII deficiency (such as Hemophilia A)?

A

Increased aPTT, normal PT/INR

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30
Q

Pathogenesis of PSGN?

A

IC deposition in the glomerular mesangium and basement membrane -> complement system activation -> C3 accumulation in deposits

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31
Q

Lab findings in acute PSGN?

A

UA: +protein, +blood, +/- RBC casts
Serum: decreased C3, possible decreased C4, increased serum Cr, increased anti-DNase B and AHase, increased ASO and anti-NAD

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32
Q

Presentation - microscopic or gross hematuria in childhood, sensorineural hearing loss, ocular defects

A

Alport syndrome (X-linked defect of type IV collagen)

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33
Q

Presentation - hematuria, proteinuria, respiratory symptoms

A

Goodpasture disease (IgG autoAb against glomerular and alveolar BM)

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34
Q

Two general presentations of vascular rings?

A

If encircling the trachea -> biphasic stridor that increases with increased work of breathing

If encircling the esophagus -> solid-food dysphagia, vomiting, recurrent food impactions

35
Q

Work-up/diagnosis of vascular rings?

A

Fluoroscopic esophagography -> compression
CT scan -> delineate anatomy, evaluate associated abnormalities
Direct laryngoscopy, bronchoscopy, echo -> possible concurrent cardiac/airway abnormalities

36
Q

Most common cause of parathyroid hormone-independent hypercalcemia?

A

Humoral hypercalcemia of malignancy

37
Q

Steps in diagnosing hypercalcemia?

A
  1. Confirm (repeat testing, correct for albumin or measure ionized Ca2+)
  2. Measure PTH
    3a. If high-normal or elevated, PTH dependent
    3b. If suppressed, PTH-independent -> 4. Measure PTHrP, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D
38
Q

Most common cause of amaurosis fugax (painless, rapid, transient monocular vision loss)?

A

Retinal ischemia due to atherosclerotic emboli originating from the ipsilateral carotid artery

39
Q

What is ocular tonometry used for?

A

Measuring intraocular pressure in patients with acute angle-closure glaucoma

40
Q

Cause of laryngomalacia?

A

Collapse of supraglottic tissues on inspiration

41
Q

Presentation of laryngomalacia?

A

Chronic inspiratory stridor that worsens when supine, improved when prone
Peak at age 4-8 months

42
Q

Dx laryngomalacia?

A

Visualization of the larynx with flexible fiberoptic laryngoscopy -> omega-shaped epiglottis, collapse of supraglottic structures during inspiration

43
Q

What Rx often improves symptoms of laryngomalacia?

A

Rx of GER

44
Q

Outcome of laryngomalacia?

A

Most will feed, grow, and ventilate normally with spontaneous resolution by 18 months

45
Q

Common cause of chronic cough?

A

ACEIs

46
Q

What is erythema nodosum?

A

Painful, subcutaneous nodules most common on the anterior legs

47
Q

If erythema nodosum is identified in a patient, what is the next step and why?

A

Labs (CBC, LFTs, renal function)
Antistreptolysin-O antibodies
TB skin testing
CXR - assess for sarcoidosis and TB

Can be an early sign of more serious disease (streptococcal infection, sarcoid, TB, endemic fungal disease, IBD, Behcet) and identification of the cause may prevent morbidity

48
Q

What is the key historical question to ask when beginning an evaluation for dysphagia?

A

Is there a history of difficulty initiating swallowing with cough, choking, or nasal regurgitation?

If yes -> likely oropharyngeal dysphagia

If no -> likely esophageal dysphagia

49
Q

If oropharyngeal dysphagia is suspected, what is the next step?

A

Videofuoroscopic modified barium swallow

50
Q

If esophageal dysphagia is suspected, what is the next question to ask?

A

Dysphagia with solids AND liquids at onset -> motility disorder

Dysphagia with solids progressing to liquids -> mechanical obstruction

51
Q

If a motility disorder is suspected, what is the next step?

A

Barium swallow followed by possible manometry

52
Q

If a mechanical obstruction is suspected, what is the next step?

A

If history of prior radiation, caustic injury, complex stricture, or surgery from esophageal/laryngeal cancer -> barium swallow followed by possible endoscopy

If no -> upper endoscopy

53
Q

Renal artery stenosis typically presents with uncontrolled hypertension. What is a highly specific exam finding? What is seen on imaging?

A

Lateralizing abdominal bruit

Atrophy of the affected kidney

54
Q

Describe the effects of renal artery stenosis on the RAAS system.

A

Decreased renal perfusion of the affected kidney (post-stenotic, atrophy) -> increased renin secretion -> RAAS system -> secondary hyperaldosteronism -> HTN -> unaffected kidney experiences high systemic pressures -> suppresses local renin secretion

55
Q

Initial treatment of choice in asymptomatic or mildly symptomatic patients with hyponatremia due to SIADH?

A

Fluid restriction

56
Q

DDx - hypervolemic hyponatremia?

A

Heart failure
Renal failure
Liver cirrhosis

57
Q

DDx - hypovolemic hyponatremia?

A

Dehydration

58
Q

DDx - euvolemic hyponatremia?

A

SIADH

59
Q

MOA - demeclocycline?

A

Decreases responsiveness to ADH at the level of the renal collecting tubule (treat SIADH if conservative measures fail to treat)

60
Q

In a normal distribution, how are the mean, median, and mode related?

A

They are all equal.

61
Q

In a positively skewed distribution (tail on the right), how are the mean, median, and mode related?

A

Mean > median > mode

62
Q

In a negatively skewed distribution (tail on the left), how are the mean, median, and mode related?

A

Mean < median < mode

63
Q

Horner syndrome + cervical paravertebral mass?

A

Neuroblastoma

64
Q

Neuroblastoma arises from neural crest cells, which are precursors to what structures?

A

Sympathetic ganglia

Adrenal medulla

65
Q

Possible clinical features of neuroblastoma?

A 
<2 y/o
Abdominal mass
periorbital ecchymoses (orbital mets)
Spinal cord compression from epidural invasion (dumbbell tumor)
Opsoclonus-myoclonus syndrome
Horner syndrome
66
Q

Diagnostic findings of neuroblastoma?

A

Elevated catecholamine metabolites
Small, round blue cells on histology
N-myc gene amplification

67
Q

Cause of acute contralateral hemiparesis?

A

Lacunar stroke leading to internal capsule infarct

68
Q

Findings of early septic shock?

A

Hyperdynamic CV state in response to peripheral vasodilation with capillary leak and intravascular hypovolemia -> increased SV, HR, pulse pressure -> bounding peripheral pulses

69
Q

Define pulsus paradoxu?

A

20+ mm Hg drop in systolic blood pressure with inspiration

70
Q

Pulsus paradoxus is most commonly seen in patients with ___.

A

Cardiac tamponade

71
Q

Cause of Meniere disease?

A

Increased volume and/or pressure of endolymph

72
Q

While Meniere is a clinical diagnosis, what should be done as part of the work-up?

A

Audiometry to fully characterize/follow hearing loss

MRI to r/o CNS lesions

73
Q

Lab findings of Addison’s disease (primary adrenal insufficiency)?

A 
Aldosterone deficiency
Non-anion gap metabolic acidosis
Hyperkalemia
Hyponatremia
Hypercalcemia
Eosinophilia
74
Q

4 general etiologies of primary adrenal insufficiency?

A

AI
Infection (TB, HIV, fungal, etc.)
Hemorrhagic infarction (meningococcemia, anticoagulants, etc.)
Metastatic cancer (eg, lung)

75
Q

Dx primary adrenal insufficiency?

A

Measure ACTH and serum cortisol with high-dose (250 micrograms) ACTH stimulation test

Primary: low cortisol, high ACTH
Secondary/tertiary: low cortisol, low ACTH

76
Q

Characteristics of a pathologic murmur?

A

Harsh, holosystolic, diastolic
Grade III+
Increases with standing/Valsalva
Loud, fixed split, or single S2

77
Q

EKG findings of hypertrophic cardiomyopathy?

A

LVH: tall R wave in aVL + deep S wave in V3

Repolarization changes in anterolateral leads (I, aVL, V4, V5, V6)

78
Q

If an initial pen light exam does not reveal any conjunctival and corneal abrasions or foreign bodies in the setting of a high-velocity ocular injury, what should be done next?

A

Fluorescein examination; if not demonstrated, but high suspicion remains, CT or U/S; NEVER MRI (magnetic)

79
Q

Possible exam findings of HSV encephalitis?

A

Hemiparesis, CN palsies, hyperreflexia

80
Q

Possible CSF findings of hSV encephalitis?

A

Increased WBCs (lymphocytic predominance)
Normal glucose
Increased protein
Often increased RBC

81
Q

Rx HSV encephalitis

A

IV acyclovir immediately after obtaining CSF

82
Q

Rx cryptococcal meningoencephalitis?

A

IV amphotericin + flucytosine

83
Q

Compare the symptoms of neurogenic vs. vascular claudication.

A

Neurogenic:

  • Posture-dependent pain
  • Lumbar extension worsens, flexion relieves
  • Lower-extremity numbness/tingling/weakness
  • LBP

Vascular:

  • Exertionally-dependent
  • Rest relieves
  • Lower-extremity cramping/tightness, NO weakness
  • Possible buttock, thigh, calf, or foot pain

Dedicated - Step 2 (22 decks)

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