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Dedicated - Step 2 > 5 > Flashcards

5 Flashcards

1
Q

What metabolic abnormalities can be caused by hypothyroidism?

A
  1. Hyperlipidemia
  2. Hyponatremia (decreased free water clearance)
  3. Elevated CK
  4. Elevated serum transaminase
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2
Q

How does hypothyroidism lead to hypercholesteremia?

A

Decreased surface LDL receptors (type 2a HLD) and/or decreased LDL receptor activity

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3
Q

What 2 things must be ruled out before diagnosing SIADH?

A

Hypothyroidism

Adrenal insufficiency

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4
Q

First-line treatment of MDD with psychotic features?

A

Antidepressant + antipsychotic or ECT

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5
Q

Presentation - acute depression with suicidal ideation, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, intense craving

A

Cocaine withdrawal

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6
Q

When is RhoGAM (anti-D immune globulin) indicated?

A

Rh(D)-negative women:

  • 28-32 weeks
  • <72 hours after delivery of Rh(D)-positive infant
  • <72 hours after spontaneous abortion
  • Ectopic pregnancy, threatened abortion
  • Hydatidiform mole
  • CV sampling, amniocentesis
  • Abdominal trauma
  • T2/T3 bleeding
  • External cephalic version
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7
Q

When is antepartum prophylaxis with RhoGAM not indicated?

A

If the father is Rh(D) negative

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8
Q

Presentation - bilious emesis, bloody stools, abdominal distention in a preterm neonate

A

Necrotizing enterocolitis

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9
Q

X-ray findings of necrotizing enterocolitis?

A

Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum

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10
Q

Rx of necrotizing enterocolitis?

A

Bowel rest, parenteral nutrition (D/C enteral feeds)
Broad-spectrum IV ABX
+/- surgery

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11
Q

X-ray: dilated stomach and duodenum (double bubble sign), no distal air

A

Duodenal atresia

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12
Q

What is the most common late manifestation of Lyme disease and how does it present?

A

Lyme arthritis; inflammatory monoarticular or asymmetric oligoarticular arthritis, most commonly in the knee

Synovial fluid - inflammatory profile, negative Gram stain and culture

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13
Q

Features of early localized Lyme disease (days-1 month)?

A

1Erythema migrans

Fatigue, HA, myalgias, arthrlagias

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14
Q

Features of early disseminated Lyme disease (weeks-months)?

A 
Multiple erythema migrans
Unilateral/bilateral CN palsy
Meningitis
Carditis (eg, AV block)
Migratory arthralgias
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15
Q

Features of late Lyme disease (months-years)?

A

Arthritis
Encephalitis
Peripheral neuropathy

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16
Q

Confirm Dx of Lyme arthritis?

A

Serum ELISA and Western blot testing

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17
Q

Rx Lyme arthritis?

A

Oral doxycycline or amoxicillin (if no neuro manifestations)

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18
Q

Reactive arthritis (formerly Reiter syndrome) presents 1-4 weeks after ___ or ___ infection.

A

Enteric; chlamydial

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19
Q

Features of rheumatic fever?

A

Rare complication of S. pharyngitis -> fever, migratory arthralgias, subcutaneous nodules, carditis, neuropsychiatric signs

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20
Q

Sudden-onset respiratory distress and radiographic signs of air trapping (unilateral hyperinflation, mediastinal shift, etc.) are concerning for ___.

A

Foreign body aspiration

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21
Q

Nebulized albuterol is used for asthma. Nebulized racemic epinephrine treats ___.

A

Croup

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22
Q

In pregnant women with prior HSV infection, what should be done?

A

Antiviral suppression beginning at 36 weeks

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23
Q

In pregnant women with lesions/prodromal symptoms of HSV during labor, what should be done?

A

C-section

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24
Q

The evaluation of adrenal insufficiency should include what tests?

A
  • 8am serum cortisol
  • Plasma ACTH
  • ACTH stimulation test (aka cosyntropin test)
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25
Q

Interpret:

  • Basal cortisol LOW
  • ACTH HIGH
  • Minimal cortisol response to cosyntropin
A

Primary adrenal insufficiency

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26
Q

Interpret:

  • Basal cortisol LOW
  • ACTH LOW
  • Minimal or suboptimal cortisol response to cosyntropin
A

Secondary or tertiary adrenal insufficiency

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27
Q

What is the dexamethasone suppression test used for?

A

Evaluation of hypercortisolism (suppresses release of ACTH from the pituitary, subsequently reduces adrenal cortisol production)

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28
Q

___ is a dimorphic fungus found in decaying plant matter and soil and primarily infects gardeners and landscapers via direct cutaneous inoculation.

A

Sporothrix schenckii

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29
Q

Appearance of skin manifestation of sporotrichosis?

A

Skin papule -> ulceration with non-purulent, odorless drainage

Proximal lesions along lymphatic chain

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30
Q

Rx sporotrhicosis?

A

3-6 months of oral itraconazole

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31
Q

Presentation - cutaneous lesion (vesicular, erythematous, or papular) with prominent, tender, regional LAD and possible systemic spread?

A

Cat scratch fever

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32
Q

Presentation - systemic symptoms (fever), painful LAD, lymphangitis

A

Lymphatic filariasis (nematode endemic to Africa, Asia, Latin America, some parts of Caribbean)

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33
Q

Presentation - papular lesion at the site of entry (usually lower extremity) and proximal, intensely pruritic, reddish-brown tracks

A

Hookworm larvae

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34
Q

What is Ogilvie syndrome?

A

Acute colonic pseudoobstruction

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35
Q

Clinical findings of Ogilvie syndrome?

A

Abdominal distension, pain, obstipation, vomiting

Tympanic to percussion, decreased bowel sounds

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36
Q

Etiologies of Ogilvie syndrome?

A

Major surgery, traumatic injury, severe infection
Electrolyte derangement (hypoK, hypoMg, hypoCa)
Medications (opiates, anticholinergics, etc.)
Neurologic disorders (eg, dementia, stroke)

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37
Q

X-ray findings of Ogilvie syndrome?

A

Colonic dilation, normal haustra, non-dilated small bowel

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38
Q

CT findings of Ogilvie syndrome?

A

Colonic dilation without anatomic obstruction

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39
Q

Rx Ogilvie syndrome?

A

NPO, NG/retal tube decompression

Neostigmine if no improvement within 48 hours

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40
Q

Presentation - hematochezia, liver abscesses

A

E. histolytica

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41
Q

Red flags for developmental dysplasia of the hip?

A
  1. Positive Ortolani test
  2. Dislocated hip
  3. Limited hip abduction
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42
Q

Supportive findings for developmental dysplasia of the hip?

A
  1. Limb length discrepancy

2. Asymmetric gluteal/inguinal/thigh creases

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43
Q

Management of developmental dysplasia of the hips?

A

If red flags -> refer to ortho

If supportive findings or only risk factors -> hip U/S (<4 months), hip radiograph (>4 months)

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44
Q

Undiagnosed pleural effusion is best evaluated with ___, except in patients with clear-cut evidence of ___.

A

Thoracentesis; CHF

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45
Q

What 3 tumors cause ~75% of all malignant pleural effusions?

A
  1. Lung carcinoma
  2. Breast carcinoma
  3. Lymphoma
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46
Q

In the setting of pleural effusion, what is the next step if thoracentesis is non-diagnostic and the patient has a lung mass?

A

Bronchoscopy

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47
Q

Presentation - nocturnal perianal pruritis

A

Enterobius vermicularis (aka pinworm) infection

48
Q

Rx pinworm infection?

A

Pyrantel pamoate or albendazole for patient and all household contacts

49
Q

Presentation - urticaria, abdominal pain, respiratory problems

A

Strongyloidiasis

50
Q

Rx strongyloidiasis and onchocerciasis?

A

Ivermectin

51
Q

Uses of metronidazole?

A

Protozoan infections
Trichomonoiasis
Intra-abdominal anaerobic infections

52
Q

Rx scabies

A

Permethrin

53
Q

Rx schistosomiasis

A

Praziquantel

54
Q

Presentation - microthrombocytopenia, eczema, recurrent infections

A

Wiskott-Aldrich syndrome

55
Q

Inheritance pattern, mutation, and pathophysiology of Wiskott-Aldrich syndrome?

A

X-linked recessive
Defect in WAS protein gene
Impaired cytoskeleton changes in leukocytes, platelets

56
Q

Rx Wiskott-Aldrich syndrome

A

Stem cell transplant

57
Q

Most common cause of urinary tract obstruction in newborn boys?

A

Posterior urethral valves

58
Q

Dx intraamniotic infection?

A

Maternal fever PLUS 1+ of the following:

  • Fetal tachycardia (>160)
  • Maternal luekocytosis
  • Purulent amniotic fluid
59
Q

Define preterm premature rupture of membranes (PPROM).

A

Rupture of membranes prior to 37 weeks in the ABSENCE of contractions

60
Q

Management of PPROM?

A

Expectant until 34 weeks -> delivery

Prior to 34 weeks -> corticosteroids for fetal lung maturity, course of prophylactic broad-spectrum ABX

61
Q

Management of PPROM + intraamniotic infection?

A

Delivery, regardless of gestational age

62
Q

Define uterine size-dates discrepancy.

A

> 2 cm difference in fundal heigh measurement from gestational age

63
Q

Who receives anti-viral therapy (eg, oseltamivir) in the setting of influenza?

A

Risk factors for influenza complications (eg, age 65+, chronic medical problems, pregnancy)

Those without risk factors who come to the office within 48 hours of system onset (may reduce symptom duration)

Do not give vaccine until symptoms abate if moderate or severe illness

64
Q

Patients with typical GERD symptoms require an upper GI endoscopy in what situations?

A

If they have alarm symptoms (dysphagia, odynophagia, weight loss, anemia, GI bleeding, recurrent vomiting)

Men >50 with chronic (>5 years) symptoms and cancer risk factors

65
Q

If a patient has symptoms consistent with GERD and no reason to get an endoscopy, what should be done?

A

Once daily PPI for 2 months

66
Q

If GERD is refractory to PPI?

A

Switch PPIs or increase to 2x daily

67
Q

If GERD symptoms persist?

A

Consider endoscopy or esophageal pH monitoring

68
Q

___ presents with anorexia, N/V, early satiety, postprandial fullness, and impaired glycemic control. What medication can relieve these symptoms?

A

Diabetic gastroparesis; metoclopramide (prokinetic and antiemetic properties)

Alternative -> erythromycin

69
Q

___ are useful in the palliation of anorexia and in promoting weight gain in patients with cancer-related anorexia/cachexia syndrome.

A

Progesterone analogs (eg, megestrol acetate, medroxyprogesterone acetate)

70
Q

What are the Light criteria for exudative pleural effusions?

A

Pleural fluid protein/serum protein ratio >0.5

Pleural fluid LDH/ serum LDH ratio >0.6

Pleural fluid LDH> 2/3 upper limit of normal of serum LDH

71
Q

Features of rheumatoid effusions?

A

Exudative effusion with:

  • Very LOW glucose (<50)
  • Very HIGH LDH (>700)
  • Possible low pH
72
Q

Presentation - diarrhea acquired during international travel, abdominal cramps, foul-smelling stools, bloating, and benign abdominal findings

A

Giardiasis

73
Q

Dx Giardiasis?

A

Stool antigen assay

May also use stool microscopy to identify oocysts and trophozoites

74
Q

Rx giardiasis?

A

Metronidazole

75
Q

Empiric treatment for traveler’s diarrhea (most commonly due to E. coli)?

A

Short course of ciprofloxacin

76
Q

Presentation - pruritic, purple/pink, polygonal papules and plaques on flexor surfaces of wrists and ankles, may have lacy, white network of lines (Wickham striae)

A

Lichen planus

77
Q

What disease is lichen planus associated with?

A

Hepatitis C

78
Q

What medications is lichen planus associated with?

A

ACEIs

Thiazides

79
Q

Rx lichen planus

A

Topical high-potency glucocorticoids (eg, betamethasone)

If widespread, systemic glucocorticoids, phototherapy

80
Q

Presentation - pruritic rash affecting the flexor surfaces, presenting in childhood

A

Atopic dermatitis

81
Q

Presentation - intensely pruritic, erythematous papules and vesicles on the elbows, back, knees, and buttocks; associated with?

A

Dermatitis herpetiformis; celiac disease

82
Q

Presentation - targetlike plaques with central clearing that begin on the extensor surfaces of the distal extremities and spread centripitally; common to have oral lesions and a febrile prodrome

A

Erythema multiforme

83
Q

Presentation - sharply demarcated erythematous plaques with a thick, silvery scale, involves the scalp, knees, and extensor surfaces

A

Psoriasis

84
Q

Presentation - round/ovoid annular plaques with a scaly border and central clearing

A

Tinea corporis

85
Q

DDx - normal AG metabolic acidosis

A 
Diarrhea
Fistulas
Carbonic anhydrase inhibitors
Renal tubular acidosis
Ureteral diversion
Iatrogenic
86
Q

Anion gap = ?

A

Na - Cl - HCO3

87
Q

Presentation - non-anion gap metabolic acidosis + hyperkalemia out of proportion to the renal dysfunction

A

Rental tubular disorder

88
Q

Define rental tubular acidosis.

A

Group of disorders characterized by non-anion gap metabolic acidosis in the presence of preserved kidney function

89
Q

Loop diuretics cause what 2 electrolyte abnormalities?

A

Hypokalemia

Metabolic alkalosis

90
Q

Role of aldosterone?

A

Saves sodium

Pushes potassium out

91
Q

What is incidence?

A

Measure of new cases

92
Q

What is prevalence?

A

Measure of total number of cases at a point in time

93
Q

How do prevalence and incidence of diseases change with improved treatments?

A

Prevalence increases

Incidence is not affected

94
Q

What is the most effective lifestyle intervention for reducing blood pressure in obese patients?

A

Weight loss > DASH diet > Exercise > reduced dietary sodium > reduced alcohol intake

95
Q

Define hypertension.

A

Systolic >130 and/or diastolic >90

96
Q

___ is painless dilation of the cervix that may cause T2 delivery and presents with vaginal spotting, pelvic pressure, and increased vaginal discharge in the absence of preterm labor.

A

Cervical insufficiency

97
Q

DDx - metabolic acidosis with both an AG and an osmolar gap?

A

Intoxication with:

  • Ethylene glycol
  • Methanol
  • Ethanol
98
Q

Specific finding in ethylene glycol poisoning?

A

Calcium oxalate crystals (rectangular, envelope-shaped)

99
Q

DDx - high anion gap metabolic acidosis

A
  1. Drug ingestion (salicylates, isoniazid, iron)
  2. Lactic acidosis 2/2 hypoperfusion
  3. Uremia (increased BUN from renal failure)
  4. DKA (increased urine and serum ketones)
  5. Osmolar gap (ethylene glycol, methanol, propylene glycol)
100
Q

Methanol poisoning can lead to ___.

A

Blindness

101
Q

Calculate osmolar gap?

A

Measured serum Osm - calculated serum Osm

102
Q

Calculated serum osm?

A

2Na + glucose/18 + BUN/2.8

103
Q

Major complication of ethylene glycol poiosoning?

A

Acute renal failure

104
Q

Why does uremia cause an AG metabolic acidosis?

A

Because acid excretion (through formation of ammonium) is impaired

105
Q

What should be considered in patients typical risk factors for COPD (eg, age 45 or less), those with atypical features (eg, basilar-predominant disease), or unexplained liver disease?

A

A1AT deficiency

106
Q

How does the emphysema of smoking-induced COPD and COPD 2/2 A1AT deficiency differ anatomically?

A

Smoking-indued: centrilobular, affects upper lobes

A1AT: panacinar, affects lower lobes

107
Q

A1AT deficiency is frequenctly associated with ___ disease.

A

Liver

108
Q

Describe the mechanism of type 2 heparin-induced thrombocytopenia.

A

Heparin + PF4 + IgG + platelet -> immune complex -> BOTH

  1. Thrombocytopenia via splenic macrophages removing the complex + thrombus formation leading to consumption
  2. Arterial and venous thrombosis via platelet activation/release/aggregation
109
Q

What is the Jarisch-Herxheimer reaction?

A

Acute febrile reaction that commonly occurs <12 hours (within 6-48 hours) after initial treatment of early syphilis

110
Q

What is immune reconstitution inflammatory syndrome?

A

Paradoxical worsening of infectious symptoms in patients with HIV initiated on HAART (due to immune system improvement)

111
Q

Presentation - unilateral orbitofrontal headache associated with N/V, severe unilateral eye pain (+/- halos around lights) with conjunctival injection, and a dilated pupil with poor light response

A

Acute angle-closure glaucoma

112
Q

Features of sideroblastic anemia?

A

Microcytic/hypochromic anemia, dimorphic RBC population on smear, elevated serum iron, decreased TIBC

113
Q

In patients with an identifiable cause of vitamin B6 deficiency leading to sideroblastic anemia, administration of ___ can easily correct the problem.

A

Pyridoxine

114
Q

Cause of sideroblastic anemia?

A

Defective heme synthesis

115
Q

Presentation - ptosis, down-and-out gaze, diplopia, normal pupillary response

A

Ischemic CN III palsy (damage to inner somatic fibers, spares more peripheral parasympathetics

Dedicated - Step 2 (22 decks)

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