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Dedicated - Step 2 > 6 > Flashcards

6 Flashcards

1
Q

Presentation - tonsil ulcer in a smoker

A

Oropharyngeal squamous cell carcinoma

Other manifestations include referred otalgia or an isolated neck mass

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2
Q

In a patient with a tonsil lesion concerning for cancer, what diagnostic steps should be done next?

A

Biopsy, HPV status, neck imaging (CT scan)

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3
Q

Why is an aphthous ulcer the wrong answer in a smoker with sore throat and tonsillar ulcer for 3+ months?

A

Typically resolves in 1-2 weeks, usually seen in oral cavity rather than the oropharynx

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4
Q

PCP intoxication?

A

Psychotic symptoms
Violence
NYSTAGMUS

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5
Q

Cocaine intoxication?

A

Psychotic symptoms (paranoia, hallucination)
Anxiety, irritability
Mood swings, grandiosity
PHYSICAL SIGNS OF SYMPATHETIC ACTIVATION (tachycardia, pupil dilation, diaphoresis, tremors)

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6
Q

Most common complication of sickle cell trait?

A

Painless hematuria

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7
Q

Distinguish between atrophic vaginitis and lichen sclerosus.

A

Lichen sclerosus does NOT affect the vagina.

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8
Q

Primary ovarian insufficiency is associated with what 2 conditions?

A

Autoimmune disorders

Turner syndrome

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9
Q

Pathologic mechanism of sequelae of severe vitamin D deficiency (osteomalacia)?

A

Decreased intestinal calcium and phosphorus absorption -> secondary hyperparathyroidism

Defective mineralization of the organic bone matrix

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10
Q

X-ray findings of osteomalacia?

A

Decreased bone density
Thinning of cortex
Codfish vertebral bodies (concave shape)
Pseudofracures (Looser zones)

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11
Q

DDx - hypokalemia?

A

Increased K entry into cells (beta-adrenergic agonists, insulin, hematopoiesis)
Renal K wasting
GI fluid loss

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12
Q

Amphetamine abuse during pregnancy is associated with what 5 risks?

A 
Spontaneous abortion
Preterm delivery
Preeclampsia
Abruptio placentae
Fetal growth restriction
Intrauterine fetal demise
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13
Q

Gastroschisis is associated with first-trimester use of ___.

A

NSAIDs

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14
Q

2 mechanisms of AKI in rhabdomyolysis?

A

Decreased renal perfusion (intravascular volume depletion from shifting of fluid into damaged muscle tissue)

Direct renal tubular toxicity of heme pigments

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15
Q

Lab abnormalities seen in rhabdomyolysis?

A

Hyperkalemia
Hyperphosphatemia
Hypocalcemia (calcium deposits in damaged muscle tissue)
Increased AST>ALT

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16
Q

A brain that has seized for >5 minutes (status epilepticus) is at increased risk of developing permanent injury due to ___. What pathologic finding is the hallmark?

A

Excitatory cytotoxicity; cortical laminar necrosis

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17
Q

Patients with HIV are at increased risk of CAP. When should you suspect PCP

A 
CD4<200
Indolent symptoms (dyspnea, nonproductive cough)
Usually bilateral diffuse interstitial infiltrates
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18
Q

Presentation - bilateral lower-extremity pains that occur at night in children age 2-12 years, no systemic symptoms, normal activity, normal exam

A

Growing pains

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19
Q

Presentation - palpable purpura on the lower extremities, arthralgia/arthritis, abdominal pain, possible intussusception, renal disease (hematuria +/- proteinuria)

A

HSP (IgA-mediated small vessel vasculitis)

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20
Q

Renal biopsy finding in HSP?

A

IgA deposition in the mesangium

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21
Q

Lab findings in HSP?

A

Normal platelet count and coag studies
Normal to increased creatinine
Hematuria +/- RBC casts +/- proteinuria (non-nephrotic range)

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22
Q

Renal biopsy findings in membranous nephropathy?

A

Thickening of the glomerular basement membrane

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23
Q

Renal biopsy findings in Alport syndrome?

A

Thinning and splitting of the glomerular basement membrane

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24
Q

Renal biopsy findings in Goodpasture syndrome?

A

Linear IgG deposits on the basement membrane

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25
Q

Renal biopsy findings in FSGS?

A

Localized regions of mesangial sclerosis and basement membrane collapse

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26
Q

Renal biopsy findings in minimal change disease?

A

Fusion or flattening of the podocytes

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27
Q

Most common glomerular cause of ESRD in adults in the US?

A

FSGS

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28
Q

What is Legg-Calve-Perthes disease?

A

Idiophatic avascular osteonecrosis of the femoral head

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29
Q

Presentation of Legg-Calve-Perthes disease?

A

Boys age 3-12
Insidious-onset hip or referred knee pain
Antalgic gait
Restricted hip abduction, internal rotation
Positive Trendelenberg sign

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30
Q

XR findings of Legg-Calve-Perthes disease?

A

Early stage: may be normal

Later stages: femoral head flattening, fragmentation, sclerosis

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31
Q

MRI findings of Legg-Calve-Perthes disease?

A

Avascular/necrotic femoral head

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32
Q

Rx Legg-Calve-Perthes disease?

A

Non-weight bearing

Splinting, possible surgical repair

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33
Q

Pancreatic cancer should be suspected in patients with a history of chronic pancreatitis who develop abdominal pain and weight loss. Patients with jaundice should undergo ___ to rule out cancer in the head of the pancreas. Patients without jaundice should undergo ___ to rule out cancer in the body and tail.

A

U/S; abdominal CT scan

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34
Q

What is the secretin test and what is it used for?

A

Measure the ability of pancreatic ductal cells to produce bicarbonate; diagnose chronic pancreatitis

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35
Q

What is the most common cause of congenital bone marrow failure?

A

Fanconi anemia (type of aplastic anemia)

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36
Q

Pathophysiology of Fanconi anemia?

A

Inherited DNA repair defect -> bone marrow failure

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37
Q

Clinical findings in Fanconi anemia?

A 
Short stature
Hypo/hyperpigmented macules
Abnormal thumbs
GU malformations
Pancytopenia, including a macrocytic anemia
Positive chromosomal breakage test
38
Q

Rx Fanconi anemia?

A

Stem cell transplant

39
Q

Gold standard for diagnosing acute angle-closure glaucoma? If unavailable?

A

Gonioscopy (visualizes the iridocorneal angle); ocular tonometry (measures intraocular pressure)

40
Q

What is fluorescein staining of the eye used for?

A

Detect corneal abrasions or herpes keratitis

41
Q

Presentation - Cough for >5 days to 3 weeks (+/- purulent sputum) + absent systemic findings (fever, chills, etc.), wheezing or rhonchi, chest wall tenderness, preceding respiratory illness

A

Acute bronchitis

42
Q

Diagnose and treat acute bronchitis?

A

Clinical diagnosis, CXR only when pneumonia is suspected
Symptomatic (NSAIDs and/or bronchodilators)
ABX not recommended

43
Q

___ testing should be considered for patients with molluscum contagiosum, especially if lesions are widespread or involve the face.

A

HIV

44
Q

Presentation - neonate with sensorineural hearing loss, cataracts (cloudy lenses, asymmetric or absent red reflexes, nystagmus) PDA

A

Congenital rubella

45
Q

First step in diagnosing patients with hypertriglyceridemia?

A

Evaluate for secondary causes (inherited disorder like familial hypertriglycermidemia, DM, obesity, hypothyroidism, nephrotic syndrome, alcohol abuse, medication AE like tamoxifen, beta blockers, steroids, anti-retrovirals)

46
Q

Elevated triglyceride levels (>150 mg/dL) are associated with increased risk of ___ and extremely elevated levels (>1000 mg/dL) can cause ___.

A

CV events; pancreatitis

47
Q

In patients with mild-moderate hypertriglyceridemia (150-500) who have known or are at high risk for CAD, what is the first-line therapy? What lifestyle modifications should be implemented?

A

High-intensity statin (rosuvastatin, atorvastatin); reduce alcohol intake, increase exercise, weight loss

48
Q

Why is niacin + statin not indicated for hypertriglyceridemia?

A

Combo is associated with increased AE without improved CV outcomes

49
Q

Most effective pharmacologic strategy for lowering triglyceride levels?

A

Fibrates

50
Q

When should statins be chosen over fibrates in patients with hypertriglyceridemia?

A

If mid-moderate

If CAD or risk for CAD

51
Q

Presentation - persistent otorrhea and conductive hearing loss, possible pearly white mass behind an intact tympanic membrane on exam

A

Cholesteatomas (accumulation of keratin debris and squamous epithelial cells within a tympanic membrane retraction pocket)

52
Q

In a patient who recently received packed RBCs and developed hypocalcemia, what is the most likely cause?

A

Patients who have received the equivalence of more than one blood volume of blood transfusions or pRBCs of 24 hours may develop elevated levels of citrate, which chelates calcium and magnesium, reducing their plasma levels

53
Q

Explain acid-base shifts and calcium homeostasis in acidosis and alkalosis.

A

Increased extracellular pH (decreased H+) -> dissociation of hydrogen ions from albumin molecules -> increased albumin available to bind calcium

54
Q

Plasma calcium exists in what 3 forms? Which is the only physiologically active form?

A
  1. Ionized calcium (45%) - only physiologically active form
  2. Albumin-bound calcium (40%)
  3. Calcium bond to inorganic and organic anions (15%)
55
Q

What intervention improves CV and overall long-term mortality in patients with STEMI?

A

Prompt recognition and restoration of coronary blood flow with primary percutaneous intervention or fibrinolysis

  • Lower rates of recurrent MI and ICH
  • Improved survival
56
Q

Current guidelines for primary PCI in patients with acute STEMI?

A

Within 90 minutes of first medical contact in a PCI-capable hospital or within 120 minutes for patients who require transport to a PCI-capable hospital from another

57
Q

List the 7 most common complications after acute MI.

A
  1. Reinfarction (hours - 2 days)
  2. Ventricular septal rupture (hours - 1 week)
  3. Free wall rupture (hours - 2 weeks)
  4. Post-infarction angina (hours - 1 month)
  5. Papillary muscle rupture (2 days - 1 week)
  6. Pericarditis (1 day - 3 months)
  7. Left ventricular aneurysm (5 days - 3 months)
58
Q

EKG findings of ventricular aneurysm?

A

Persistent STEMI after recent MI

Deep Q waves in the same leads

59
Q

What two types of pericarditis can present after an MI? How do they differ?

A

Acute: first several days, diffuse ST segment elevation

Weeks to months later: Dressler syndrome (immune-mediated pericarditis)

60
Q

Presentation - non-gonoccocal urethritis, asymmetric oligoarthritis (knee, SI spine), conjunctivitis, possible mucocutaneous lesions and enthesitis

A

Reactive arthritis

61
Q

Rx acute reactive arthritis

A

NSAIDs

62
Q

Presentation - intermittent headaches, dizziness, nausea, polycythemia, possible environmental exposure

A

Chronic CO poisoning

63
Q

Dx CO poisoning

A

ABG with co-oximetry

64
Q

Characteristic XR finding of pericardial effusion?

A

Enlarged cardiac silhouette

65
Q

Purpose of VW factor?

A

Assists in platelet adhesion and aggregation

Carries factor 8

66
Q

How does VWF deficiency lead to impaired coagulation pathway?

A

Unbound factor 8 is more rapidly degraded

67
Q

Hematologic lab findings in VWF deficiency?

A 
Prolonged bleeding time
Normal PT (extrinsic pathway)
Normal or prolonged aPTT (intrinsic pathway)
Normal platelet count
68
Q

Dx VWF deficiency

A

VWF antigen level
VWF activity (ristocetin cofactor activity)
Factor 8 levels

69
Q

Rx acute bleeding/prophylaxis in VWF deficiency

A

Desmopressin (DDAVP) -> potentiates release of VWF from endothelial cells

70
Q

2 causes of enlarged boggy uterus?

A

Uterine atony

Retained products of conception

71
Q

Initial management of GERD?

A

Fewer than 2 episodes/week: lifestyle changes and H2 blockers PRN

More frequency or severe symptoms, evidence of erosive esophagitis, or laryngopharyngeal involvement: 8-week course of PPI

72
Q

Rx Prinzmetal angina?

A

CCBs (eg, nifedipine)

73
Q

NNT = ?

A

1/ARR (absolute risk reduction)

74
Q

ARR (absolute risk reduction) = ?

A

Experimental event rate (EER) = a/a+b

Control event rate (CER) = c/c+d

ARR = CER - EER

75
Q

Presentation - asymptomatic, AKI within 7 days of starting a new drug, UA with hematuria, pyuria, and crystals

A

Crystal-induced AKI

76
Q

Causes of crystal-induced AKI?

A 
Acyclovir
Sulfonamides
MTX
Ethylene glycol
Protease inhibitors
Uric acid (tumor lysis syndrome)
77
Q

Mechanism of the AKI in crystal-induced?

A

Typically renal tubular obstruction

78
Q

Fracture of ribs 1-3 is associated with what injuries?

A

Subclavian vessels
Brachial plexus
Mediastinal vessels

79
Q

Fracture of ribs 3-6 is associated with what injuries?

A

CV

80
Q

Fractures of ribs 9-12 is associated with what injuries?

A

Intraabdominal:
Liver (right)
Spleen (left)
Kidney (posterior ribs 11 and 12)

81
Q

DDx - anterior mediastinal mass?

A

Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma

82
Q

Distinguish between seminomas and nonseminomatous germ cell tumors

A

Seminomas: elevated beta-HCG, AFP ALWAYS NORMAL

Non-seminomatous germ cell tumors: elevated AFP, often elevated beta-hCG

83
Q

When is stranger anxiety normal?

A

Peaks at 8-9 months, resolves by age 2

84
Q

When is separation anxiety normal?

A

Until about 18-24 months (once child develops object permanence)

85
Q

When is not responding to your name considered abnormal in development?

A

By 12 months

86
Q

Hexagonal crystals on UA?

A

Cystine stones

87
Q

Pathogenesis of cystinuria?

A

Group of inherited disorders characterized by impaired transport of cystine and the dibasic amino acids (ornthine, lysine, and arginine) by the brush borders of renal tubular and intestinal epithelial cells -> decreased reabsorption of cystine, increased urine concentration

88
Q

Dx cystinuria?

A

Urinary cyanide-nitroprusside test

89
Q

Rx acute hypocalcemia?

A

IV calcium gluconate/chloride

90
Q

How does TPN lead to gallstone formation and bile sludging?

A

Causes gallbladder stasis

91
Q

Women age <45 with abnormal uterine bleeding who have ___ require evaluation for endometrial hyperplasia/cancer with an endometrial biopsy.

A

Failed medical management

Dedicated - Step 2 (22 decks)

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