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Dedicated - Step 2 > 7 > Flashcards

7 Flashcards

1
Q

Most common cause of community-acquired bacterial meningitis?

A

S. pneumoniae

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2
Q

Typical pathologic cause of community-acquired bacterial meningitis?

A

Hematogenous dissemination; may occur +/- concurrent pneumococcal pneumonia

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3
Q

Rx community-acquired bacterial meningitis?

A

3rd generation cephalosporin (eg, ceftriaxone), vancomycin, and dexamethasone (decrease inflammatory morbidity) +/- ampicillin if >50 or immunocompromised

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4
Q

Presentation - AMS, fever, generalized muscle rigidity, autonomic instability (abnormal vitals, sweating)

A

Neuroleptic malignant syndrome

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5
Q

Rx NMS?

A

1 - Stop the causative medication (antipsychotics) or restart dopamine agents

Supportive care, ICU
Dantrolene or bromocriptine if refractory

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6
Q

Rx severe serotonin syndrome?

A

Cyproheptadine

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7
Q

Features of atypical depression?

A

Hypersomnia, hyperphagia, heavy feeling in limbs, hypersensitivity to rejection, mood reactivity (ability to respond to positive events)

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8
Q

Features of melancholic depression?

A

Weight loss
Insomnia
Pervasive anhedonia
Inability to respond to positive events

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9
Q

What 2 interventions together reduce perinatal HIV transmission to <1%?

A

Maternal combination antiretroviral therapy during pregnancy (initiate ASAP regardless of CD4 count or viral load) + neonatal zidovudine therapy

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10
Q

Antepartum HIV management?

A
  1. HIV RNA viral load at initial visit, every 2-4 weeks after change in therapy, monthly until undetectable, then every 3 months
  2. CD4 cell count Q3-6 months
  3. Resistance testing if not previously performed
  4. ART ASAP
  5. Avoid amniocentesis unless viral load if 1000 copies or less
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11
Q

Intrapartum HIV management?

A
  1. Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery
  2. If load is 1000 or less: ART + vaginal delivery
  3. If load is >1000: ART + zidovudine + C/S
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12
Q

Postpartum HIV management?

A

Mother: continue ART
Infant + load 1000 or less: zidovudine for 6+ weks
Infant + load >1000: multi-drug ART

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13
Q

3 drug ART regiment during pregnancy?

A

2 NRTIs (zidovudine, tenofovir, etc.) + 1 NNRTI or 1 PI

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14
Q

DDx - dyspepsia

A 
NSAIDs
Gastric or esophageal cancer
Functional dyspepsia
GERD
Symptomatic infection with H. pylori
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15
Q

Who should get an endoscopy in the setting of dyspepsia?

A

> 55 or alarm symptoms (weight loss, bleeding, anemia, dysphagia, persistent vomiting, etc.)

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16
Q

How does hypomagnesemia cause hypocalcemia?

A

Induces resistance to PTH and decreases PTH secretion

Note that phosphorus levels are normal or low in Mg deficiency despite PTH deficiency, possibly due to intracellular phosphorus depletion

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17
Q

Serum calcium concentration falls by ___ mg/dL for every ___ gm/L decrease in albumin.

A

0.8; 1.0

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18
Q

How does hypophosphatemia cause hypocalcemia?

A

Trick question, it doesn’t.

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19
Q

3 common drug categories causing interstitial nephritis?

A

ABX (PCN, TMP-SMX, cephalosporins, rifampin, etc.)
NSAIDs
Diuretics

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20
Q

Manage acute interstitial nephritis?

A

D/C offending drug

+/- systemic glucocorticoids

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21
Q

Type of rash seen in disseminated gonococcemia?

A

Vesicopustular rash

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22
Q

Distinguish between Meniere disease, BPPV, and vestibular neuritis.

A

BPPV: BRIEF EPISODIC (<1 minute), caused by head movement, +Dix Hallpike

Meniere: RECURRENT EPISODIC (20 min-several hours) + hearing loss/tinnitus/ear fullness

Vestibular neuritis: ACUTE SINGLE EPISODE (days), after a viral syndrome, +head thrust test

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23
Q

Rx acute cholangitis?

A

ABX coverage of enteric bacteria (broad-spectrum)

Biliary drainage by ERCP within 24-48 hours

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24
Q

Findings of acute fatty liver of pregnancy?

A

3T -> RUQ pain, jaundice, elevated transaminases, thrombocytopenia (<100,000), profound hypoglycemia

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25
Q

Presentation - acute chest pain, SOB, cough, subcutaneous emphysema, crunching sound over the heart (Hamman sign)

A

Spontaneous pneumomediastinum

Risk factors - asthma or respiratory infection, tall thin, adolescent boys

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26
Q

Dx spontaneous pneumomediastinum?

A

CXR - confirm presence of mediastinal gas and r/o pneumothorax

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27
Q

___ classically occurs in exclusively breastfed infants without vitamin D supplementation.

A

Nutritional rickets

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28
Q

Findings of nutritional rickets in infants?

A

Craniotabes (skull bones that depress with pressure)
Widened wrists (growth plate enlargement)
Radial/ulnar bowing
Delayed fontanel closure
Lower extremity bowing only with weight-bearing

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29
Q

Autosomal recessive lysosomal storage disorder that presents with dysostosis multiplex, a range of skeletal findings including shortened and thickened long bones, coarse facial features, developmental delay, and frequent infections

A

Hurler syndrome

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30
Q

Rx epiglottitis

A

Endotracheal intubation

ABX: ceftriaxone (Hib and Strep) + vancomycin (S. aureus)

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31
Q

Empiric therapy for neonatal sepsis?

A

Ampicillin and Gentamin (covers GBS, E. coli)

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32
Q

Antimicrobial prophylaxis given to patients with CGD?

A

TMP-SMX

Itraconazole

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33
Q

Most common cause of otitis externa?

A

P. aeruginosa

Other - S. aureus

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34
Q

Rx otitis externa?

A

Topical ABX (eg, FQ) +/- topical glucocorticoid

Consider wick placement to facilitate medication delivery

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35
Q

Secondhand smoke is associated with increased rates of what 3 diseases in chidlren?

A

Childhood middle ear disease
Dental caries
Lower respiratory tract infections

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36
Q

Maternal hyperglycemia increases the risk of what 4 fetal complications in the first trimester?

A

Congenital heart disease
Neural tube defects
Small L colon syndrome
Sponatneous abortion

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37
Q

Maternal hyperglycemia increases the risk of fetal hyperglycemia and hyperinsulinemia, which increases risk of what complications in the second and third trimesters?

A
  1. Polycythemia (increased metabolic demand, fetal hypoxemia, erythropoiesis)
  2. Organomegaly
  3. Neonatal hypoglycemia
  4. Macrosomia -> shoulder dystocia -> brachial plexopathy, clavicle fracture, perinatal asphyxia
38
Q

What causes Lyme disease and what part o the US is it endemic to?

A

Spirochete Borrelia burgorferi, transmitted via Ixodes scapularis tick

Northeastern US

39
Q

Rx Lyme disease if there are neuro/cardiac manifestations?

A

IV ABX (ceftriaxone, etc.)

40
Q

Autoimmune disorder that may cause AV block, systemic symptoms, skin lesions (eg, Gottron papules, heliotrope eruption), and mylagias with significant symmetric proximal muscle weakness

A

Dermatomyositis

41
Q

Most common cause of osteomyelitis?

A

Hematogenous spread of S. aureus

42
Q

Initial evaluation of suspected osteomyelitis?

A 
Labs (CBC, ESR, CRP)
Blood Cx
X-Rays
MRI if X-ray normal
Start empiric treatment based on these findings
43
Q

Gold standard of definitive diagnosis of osteomyelitis?

A

Bone biopsy and/or culture

44
Q

Common causes of neonatal osteomyelitis?

A

E. coli

GBS

45
Q

Cause of osteomyelitis of the foot after a puncture wound of the plantar surface?

A

P. aeruginosa (also cause in IV drug use)

46
Q

Initial management of large, progressively expansive, or symptomatic pleural effusions?

A

Diagnostic thoracentesis and fluid analysis

47
Q

Presentation - erythema involving the central face, facial flushing, telangiectasis, burning discomfort, symptoms precipitated by hot drinks, alcohol, heat, emotion, etc.

A

Erythemato-telangiectatic rosacea

48
Q

Two other presentations of rosacea?

A

Papulopustular: papules and pustules on central face

Ocular: conjunctival hyperemia, lid margin telangiectasias

49
Q

In addition to avoidance of triggers, sun protection, and gentle cleansers/emollients, what medications can be used for papulopustular and erythematotelangiectatic type rosacea, respectively?

A

Topical metronidazole

Laser or topical brimonidine (vasoconstrictive alpha-2 agonist)

50
Q

Distinguish rosacea from carcinoid syndrome.

A

Rosacea - flushing lasts must longer

Carcinoid - 20-30 seconds of flushing (+diarrhea, +hypotension and cyanosis if severe)

51
Q

Define second stage arrest of labor.

A

Lack of fetal descent after 4+ hours of pushing in a primagravida with an epidural (3+ without), or 3+ hours in a multigravida with an epidural (2+ without)

52
Q

Management of second-stage arrest?

A

Operative vaginal delivery (vacuum-assisted)

53
Q

Ideal fetal head position for delivery?

A

Occiput anterior (flexed head presents a small diameter, facilitates cardinal movements of labor)

54
Q

Because hepatitis C virus may spontaneously clear in up to half of affected patients, the diagnosis of chronic infection is a 2-step process requiring what tests?

A

Positive serologic Ab test

Confirmatory molecular test (HCV RNA)

55
Q

Pathopysiologic mechanisms of NAFLD?

A
  1. Increased transport of free fatty acids rom adipose tissue to the liver
  2. Decreased oxidation of FFA in the liver
  3. Decreased clearance of FFA from the liver
  4. Peripheral insulin resistance -> increased peripheral lipolysis, triglyceride synthesis, hepatic uptake of fatty acids
  5. FFA increase oxidative stress and production of pro-inflammatory cytokines
56
Q

What two immunosuppressive medications have the same mechanism of action (calcineurin-inhibitors -> inhibits transcription of IL-2 and several other cytokines)?

A

Cyclosporine

Tacrolimus

57
Q

AE of cyclosporine?

A 
Nephrotoxicity* (most common)
HTN (Rx with CCBs)
Hyperkalemia
Gum hypertrophy
Hirsutism
Tremor and other neurotoxicity
Glucose intolerance
Infection
Increased risk of SqCC of skin, lymphoproliferative diseases
GI manifestations
58
Q

Tacrolimus has similar AE to cyclosporine - how does it differ?

A

Does not usually cause hirsutism or gum hypertrophy

Higher incidence of neurotoxicity, diarrhea, glucose intolerance

59
Q

MOA - azathioprine?

A

Purine analog that is enzymatically converted to 6-mercaptopurine and inhibits purine synthesis

60
Q

AE azathioprine?

A

Dose-related diarrhea
Leukopenia
Hepatotoxicity

61
Q

MOA - MMF

A

Reversible inhibitor of inosine monophophate dehydrogenase (RLS in de novo purine synthesis)

62
Q

Major toxicity of mycophenolate?

A

Bone MARROW suppression

63
Q

What is mupirocin?

A

Topical ABX used to treat superficial skin infections like impetigo, eradicate MRSA from nares

64
Q

What is topical 5-fluorouracil used for?

A

Treatment of skin conditions caused by rapid cell division such as actinic keratoses and superficial basal cell carcinomas

65
Q

List the 2 non-treponemal syphilis tests and the important features.

A

RPR
VDRL

  • Quantitative (titers -> decreased titers confirms treatment)
  • May be negative if early (higher false-negative rates)
66
Q

List the 2 treponemal syphilis tests and the important features.

A

FTA-ABS
TP-EIA

  • Qualitative (reactive/non-reacive)
  • Greater sensitivity in early infection
  • Remain positive after treatment
67
Q

What is a pathergy test useful for?

A

Diagnosing Behcet syndrome

68
Q

What are the most appropriate diagnostic tests for acute Hepatitis B infection and why?

A

HBsAg (elevated first) and anti-HBc IgM

Both elevated during initial infection, anti-HBc will remain elevated during the window period (lag between disappearance of HBsAg and appearance of anti-HBs)

69
Q

Which hepatitis B serologic marker is a good indicator of infectivity?

A

HBeAg (but a poor test for acute infection)

70
Q

What are the 3 goals of treating hyperkalemia?

A
  1. Stabilize the cardiac membrane with calcium
  2. Shift potassium intracellularly
  3. Decrease the total body potassium contet
71
Q

What is the fastest way to lower serum potassium concentration? Other options?

A

Insulin/glucose administration

Beta-adrenergic agonists, sodium bicarbonate

72
Q

ECG changes of hyperkalemia?

A

Tall peaked T waves* with shortened QT interval
PR prolongation and QRS widening
Disappearance of P wave
Conduction blocks ectopy or sine wave pattern

73
Q

How is cardiac membrane stabilized in hyperkalemia?

A

Calcium infusion (calcium chloride or gluconate, NOT calcium carbonate -> oral)

74
Q

How is potassium removed from the body in hyperkalemia?

A

Diuretics (furosemide)
Cation exchange resins (sodium polystyrene sulfonate)
Hemodialysis

75
Q

Presentation - bone pain and fractures, constitutional symptoms, recurrent infections

A

Multiple myeloma

76
Q

Lab and radiologic findings in multiple myeloma?

A 
Normocytic anemia
Renal insufficiency
Hypercalcemia (may lead to fatigue, constipation, depression)
Monoclonal paraproteinemia (M-soke)
Osteolytic lesions/osteopenia
77
Q

Dx multiple myeloma

A

Serum/urine protein electrophoresis (M-spike)
Peripheral blood smear (rouleaux)
Serum free light chain analysis
Confirm with BM biopsy

78
Q

DDx for liver abscess?

A 
Amebic abscess (E. histolytica, an intestinal protozoan)
Pyogenic (bacterial abscess)
Hydatid cyst (Echinococcus)
79
Q

Expected findings in Echinococcus cysts?

A

NO fever
Frequently asymptomatic
Require contact with animals (dogs, sheep)
+/- eosinophilia

80
Q

Expected findings in bacterial liver abscess?

A

Fever, RUQ pain
Older patients with underlying medical conditions (DM, hepatobiliary disease, etc.)
Following peritonitis

81
Q

Rx amebic liver abscess?

A

Metronidazole (>90% cure with oral therapy)
Luminal agent (paromomycin, also required to eradicate colonization)
DO NOT DRAIN unless mass effect, imminent rupture, dx uncertain

82
Q

Rx Echinococcus liver cyst?

A

Aspiration of cyst + albendazole

83
Q

Clostridium septicum bacteremia is strongly associated with underlying ___. What other cause of bacteremia has a similar link?

A

Colon cancer; Group D streptococci (S. bovis)

84
Q

S. aureus and S. bovis bacteremia should prompt evaluation with ___.

A

TTE; organism often seeds native and damaged valves

85
Q

Candidemia should prompt ___ evaluation.

A

Ophthalmologic

86
Q

Common cause of heel pain in children who play running/jumping sport, presents with tenderness at the base of the heel?

A

Calcaneal apophysitis (aka Sever disease)

87
Q

Histopathology - cells in rosette pattern (aka Call-Exner bodies)

A

Granulosa cell tumor

88
Q

Lab findings in alcoholic hepatitis (AST, ALT, GGT, elevated ferritin)

A

Elevated AST>ALT (2:1) - total almost always <500
Elevated GGT
Elevated ferritin

89
Q

Presentation - chronic, crampy abdominal pain, bloating, and watery diarrhea after meals

A

Lactose intolerance

90
Q

Insufficient bile salt absorption by the ___ can result in diarrhea in the immediate post-op period after cholecystectomy.

A

Terminal ileum

91
Q

Use of PPIs has been associated with ___ infections.

A

C. difficile

92
Q

What causes SIBO?

A

Bacteria from the colon inappropriately being present in the small intestine (usually associated with underlying motility disorders or anatomical abnormalities)

Dedicated - Step 2 (22 decks)

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