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Dedicated - Step 2 > 8 > Flashcards

8 Flashcards

1
Q

Distinguish aplastic anemia from ALL.

A

ALL: hypercellular bone marrow, painful

Aplastic anemia: hypocellular bone marrow, painLESS

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2
Q

Presentation - soft, mobile, non-tender masses at the base of the labia majora at the 4 and 8 o’clock positions.

A

Bartholin duct cysts

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3
Q

Presentation - cysts that appear along the lateral aspects of the upper anterior vagina, do not involve the vulva

A

Gartner duct cyst

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4
Q

Presentation - cysts located lateral to the urethral meatus in the anterior vaginal vestibule

A

Skene gland cysts

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5
Q

Management of asymptomatic Bartholin cyst?

A

Observation and expectant management (most resolve spontaneously)

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6
Q

Rx symptomatic Bartholin cyst?

A

I&D + placement of Word catheter to reduce risk of recurrence

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7
Q

Rx condylomata acuminata

A

Cryotherapy and topical podophyllotoxin

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8
Q

Best next step in management of a patient with DM and suspected osteomyelitis?

A

Bone biopsy and culture (positive superficial wound cultures do not reliably predict the culprit organisms)

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9
Q

Presentation - chest pain, neck pain, syncope, history of HTN, mediastinal widening on CXR, pericardial effusion

A

Acute aortic dissection

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10
Q

Why are Type A (ascending aorta) dissections a surgical emergency?

A

Can lead to aortic rupture into the pericardial space and hemopericardium, which rapidly progresses to tamponade and shock

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11
Q

Next step in suspected Type A dissection?

A

CTA if hemodynamically stable and no renal dysfunction

TEE if hemodynamically unstable or renal insufficiency

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12
Q

Single most important prognostic consideration in the treatment of patients with breast cancer?

A

Tumor burden based on TNM staging

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13
Q

What is Osgood-Schlatter disease?

A

Osteochondritis of the tibial tubercle that causes chronic knee pain worse with running and jumping in active adolescents

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14
Q

List the 3 types of acne vulgaris and distinguish between them.

A
  1. Comedonal (closed/open comedones on forehead, nose, chin)
  2. Inflammatory (inflamed papules <5 mm and pustules, erythema)
  3. Nodular (cystic) (large >5 mm nodules, can appear cystic, can merge to form sinus tracts with scarring)
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15
Q

Rx comedonal acne?

A

Topical retinoids; salicylic, azelaic, or glycolic acid

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16
Q

Rx inflammatory acne (mild, moderate, severe)?

A

Mild: topical retinoids + benzoyl peroxide
Moderate: add topical ABX (erythro/clinda)
Severe: add oral ABX (tetracyclines)

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17
Q

Rx nodular acne

A

Moderate: topical retinoid + benzoyl peroxide + topical ABX
Severe: + oral ABX
Unresponsive severe: + oral isotretinoin

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18
Q

What causes mixed cryoglobulinemia syndrome (MCS)?

A

Immune complex deposition in small- to medium-sized blood vessels, leading to endothelial injury and end-organ damage

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19
Q

Presentation of MCS?

A 
Systemic: fatigue, arthralgias
Skin: non-blanching palpable purpura, LCV 
Renal: most commonly HTN; also GN
Pulmonary: dyspnea, pleurisy
Liver: elevated transaminases
Neuro: peripheral neuropathies
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20
Q

MCV is most commonly associated with chronic inflammatory conditions such as ___ and ___. What testing should be done?

A

HCV; SLE

HCV, HBV, HIV

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21
Q

Dx MCS?

A

Serologically - serum cryoglobulins, low complement levels positive RF, elevated transaminases, kidney injury

OR

Skin/renal biopsy

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22
Q

Rx MCS

A

Rx underlying disease + plasmapohresis/immunosuppression if rapidly progressive or life-threatening course

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23
Q

Decreased ADAMTS13 activity causes what illness?

A

TTP

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24
Q

Features of type 1 cryoglobulinemia?

A

Asympatomatic
Hyperviscosity (blurry vision, etc.), thrombosis (eg, Raynaud)
Skin: livedo reticularis, purpura

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25
Q

Compare complement levels in type 1 and mixed cryoglobulinemia syndromes

A

Type 1: normal

Mixed: low C4

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26
Q

Features of TTP?

A

Fever, microangiopathic hemolytic anemia, thrombocytopenia with NONpalpable purpura, kidney injury, neuro findings

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27
Q

Cause of type 1 cryoglobulinemia?

A

Lymphoproliferative or hematologic disorders like multiple myeloma

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28
Q

Presentation - very light menses or secondary amenorrhea that does not respond to a progesterone challenge

A

Asherman syndrome

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29
Q

Dx and Rx Asherman syndrome?

A

Hysteroscopy (can lyse adhesions)

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30
Q

What type of neoplasm is a hairy cell leukemia, what age population does it affect, and what mutation causes it?

A

Clonal B-cell neoplasm
Middle-age/older adults
BRAF mutation

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31
Q

Features of hairy cell leukemia?

A

Pancytopenia (bone marrow fibrosis)
Splenomegaly (early satiety)
Uncommon to have hepatomegaly, LAD, or B symptoms

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32
Q

Dx hairy cell leuemima

A

Smear: hairy leukocytes

BM Bx with flow cytometry

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33
Q

Peripheral smear with “smudge cells”

A

Chronic lymphocytic leukemia

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34
Q

Peripheral smear with Reed-Sternberg cells

A

Hodgkin lymphoma

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35
Q

What can cause an immobile uterus, cervical motion tenderness, and pelvic anatomy distortion?

A

Endometriosis

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36
Q

Urethral meatus located at the coronal margin

A

Hypospadias (ventrally displaced urethral opening)

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37
Q

Management of hypospadias?

A

Urologic evaluation

Circumcision is deferred until after eval because foreskin may be used in repair

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38
Q

Which patients with hypospadius need renal U/S?

A

If they have other congenital abnormalities

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39
Q

In the setting of spontaneous abortion, treatment options include expectant management, medical induction with misoprostol, and suction curettage - when is curettage indicated?

A

Infection

Hemodynamic instability

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40
Q

When is oxytocin indicated in the setting of a spontaneous abortion?

A

It’s not during the first or second trimesters, as there are few oxytocin receptors in the uterus during early pregnancy

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41
Q

Most cases of intussusception occur at age 2 or younger following a viral illness - what serves as a nidus for telescoping in this setting?

A

Hypertrophied Peyer patches in the lymphoid-rich terminal ileum

42
Q

List 6 pathological lead points that may lead to intussusception.

A
  1. Congenital malformation of the intestines (eg, Meckel diverticulum)
  2. HSP (small-bowel hematoma)
  3. Celiac disease
  4. Intestinal tumor
  5. Polyps
  6. Inspissated stool in CF
43
Q

Presentation of intussusception?

A 
Sudden, intermittent abdominal pain
Children may draw up their legs
Currant jelly stools
Sausage-shaped abdominal mass
Lethargy or AMS
44
Q

Dx intussusception?

A

Target sign on U/S

45
Q

Rx intussusception?

A

Air or saline enema

Surgery for removal of lead point

46
Q

Pathologic mechanism of croup?

A

Viral infection in which edema and narrowing of the proximal trachea result in a barky cough and inspiratory stridor

47
Q

Age of patients affected by croup?

A

6 months to 3 years

48
Q

Rx croup?

A

Mild (no stridor at rest): humidified air +/- steroids

Moderate/severe (stridor at rest): steroids + neb epi

49
Q

Vitamin K-deficient bleeding results from deficiency of what factors?

A

2, 7, 9, 10

50
Q

Confirm Dx of Vitamin K-deficient bleeding?

A

Reversal of symptoms with vitamin K administration

51
Q

Presentation - mucocutaneous bleeding and petechiae in the setting of normal PT, aPTT, platelet count

A

Impaired platelet function

52
Q

Most common causes of acute unilateral lymphadenitis in children (presents with pronounced erythema and tenderness)?

A

S. aureus

S. pyogenes

53
Q

Expected cause of unilateral acute cervical adenitis in children associated with dental caries and periodontal disease?

A

Anaerobic bacteria (eg, Prevotella buccae)

54
Q

Expected cause of bilateral acute cervical adenitis in children associated with paryngoconjunctivitis?

A

Adenovirus

55
Q

Rx acute unilateral lymphadenitis empirically?

A

Clindamycin (MRSA, S. pyogenes activity)

56
Q

Most common cause of subacute unilateral LAD in young children (slow onset, non-tender node)

A

Non-tuberculous mycobacteria (eg, Mycobacterium avium)

57
Q

Presentation - environmental exposure, painful sensorimotor polyneuropathy, skin lesions (hypo/hyperpigmented, hyperkeratotic), pancytopenia, mild transaminase elevation, Mees lines (horizontal fingernail striatino)

A

Chronic arsenic toxicity

58
Q

Dx arsenic toxicity?

A

Elevated urine arsenic levels

59
Q

Mechanism of arsenic poisoning?

A

Binds to sulfhydryl groups and disrupts cellular respiration and gluconeogenesis

60
Q

Rx arsenic poisoning?

A

Chelation with dimercaprol or DMSA

61
Q

Presentation - patchy sensorimotor neuropathy and autonomic dysfunction

A

Acute intermittent porphyria

62
Q

Distinguish chronic lead poisoning from chronic arsenic poisoning.

A

Lead - sensorimotor neuropathy in stocking-glove distribution along with microcytic anemia; GI complains are typical, NO skin changes

63
Q

Distinguish focal seizures from absence seizures.

A

Both can have staring spells; however, focal seizures are associated with a post-ictal phase and are NOT provoked by hyperventilation, whereas absence are NOT associated with a post-ictal phase and ARE prooked by hyperventilation

64
Q

Characteristic features of duodenal ulcer?

A

Epigastric pain that improves with eating

65
Q

What causes the majority of duodenal ulcers?

A

H. pylori or NSAIDs

66
Q

___ is inflammation of the lung parenchyma caused by antigen exposure. Acute episodes present with cough, breathlessness, fever, and malaise that occur within 4-6 hours of antigenic exposure. Chronic exposure may cause weight loss, clubbing, and honeycombing of the lung.

A

Hypersensitivity pneumonitis

67
Q

Classic radiographic findings of hypersensitivity pneumonitis?

A

Ground glass opacity or “haziness” in the lower lung fields

68
Q

Best treatment for hypersensitivity pneumonitis?

A

Avoidance of antigenic exposure

May speed acute recovery/manage severe episodes with systemic corticosteroids

69
Q

GERD predisposes patients to what 3 conditions?

A
  1. Barrett’s esophagus
  2. Erosive esophagitis
  3. Esophageal (peptic) stricture formation
70
Q

Symmetric and circumferential narrowing of the involved esophagus with dysphagia for solids but typically no weight loss?

A

Peptic strictures

Note - may cause an improvement in heartburn symptoms by blocking reflux

71
Q

3 additional causes of peptic strictures aside from GERD?

A

Radiation
Systemic sclerosis
Caustic ingestions

72
Q

Next step in management of a stricture in the setting of Barrett’s?

A

Biopsy to r/o adenocarcinoma via endoscopy (dilation performed if no malignancy detected)

73
Q

Foundation of management of fibromyalgia?

A

Exercise

74
Q

Age of presentation of Hodgkin lymphoma?

A

Bimodal: 15-35, >60

75
Q

Features of Hodgkin lymphoma?

A

PainLESS cervical and supraclavicular LAD
Mediastinal mass (may cause cough, SOB, chest pain)
B symptoms (subacute fever, sweats, weight loss, fatigue, etc.)
Pruritis (paraneoplastic process)

76
Q

Dx Hodgkin lymphoma?

A

Lymph node biopsy (Reed-Sternberg cells on histology)

77
Q

By age 12 months, an infant’s weight ___ and height increases by ___.

A

Triples; 50%

78
Q

When are platelet transfusions given?

A

Platelet count <10000 or <50000 with active bleeding

79
Q

When is whole blood transfusion (PRBCs + plasma) indicated?

A

Severe hemorrhage requiring massive blood transfusions to assist in volume expansion

80
Q

Single photon emission CT scan is a useful tool to evaluate what?

A

CAD

81
Q

Decreased tracer uptake at rest and with exercise during single photon emission CT scan indicates?

A

Likely scar tissue with decreased perfusion and CAD (fixed defect)

82
Q

Decreased tracer uptake with stress but normal uptake at rest during single photon emission CT scan indicates?

A

Inducible ischemia and likely CAD

83
Q

Presentation - multisystem involvement with acute or subacute renal failure, skin manifestations including livedo reticularis or blue toe syndrome, cerebral or intestinal ischemia, and Hollenhorst plaques after recent catheterization

A

Choelsterol embolization

84
Q

Lab findings of cholesterol embolization?

A

Elevated serum Cr, eosinophilia, hypocomplementemia

UA - benign with few cells or casts, may have eosinophiluria

85
Q

Skin or renal biopsy finings of cholesterol embolization?

A

Biconvex, needle-shaped clefts with occluded vessels

Perivascular inflammation with eosinophils

86
Q

Typical cause of non-purulent vs. purulent cellulitis?

A

Non-purulent: beta-hemolytic Streptococcus, MSSA

Purulent: S. aureus (MSSA and MRSA)

87
Q

Cause of erysipelas?

A

S. pyogenes

88
Q

Compare the skin findings of erysipelas and cellulitis

A

Erysipelas:

  • Superficial dermis and lymphatics
  • Raised, sharply demarcated edges
  • Rapid spread and onset
  • Fever early in course
Cellulitis:
-Deep dermis and subcutaneous fat
-Flat edges with poor demarcation
-Indolent
-Localized (fever later in course)
\+/- purulent drainage
89
Q

Approximately only half of patients with acute liver failure will survive without ___.

A

Liver transplantation

90
Q

Most common cause of death in acute liver failure?

A

Cerebral edema -> coma and brain stem herniation

91
Q

Metabolic alkalosis can be classified as saline-responsive and saline-unresponsive based on what two factors?

A
  1. Urinary chloride levels

2. Extracellular fluid volume status

92
Q

How is saline-responsive metabolic alkalosis defined?

A

Low urinary chloride excretion
Volume contraction
Corrects with saline infusion alone

93
Q

How is saline-unresponsive metabolic alkalosis defined?

A

Urinary chloride >20 mEq/L
Variable volume status
Saline unresponsive

94
Q

Why is sertraline the first line Rx for MDD post-MI?

A

Very low risk of adverse drug interactions, especially with cardiac medications

95
Q

Which SSRI is avoided in patients with recent MI and wy?

A

Citalopram; potential for dose-dependent QT prolongation

96
Q

XR findings suggestive of thoracic aortic aneurysm?

A

Widened mediastinum
Enlarged aortic knob
Tracheal deviation
Widened aorta

97
Q

Cause of TAA?

A

Age-related degenerative changes that lead to disruption of the aortic wall medial layer with loss of elasticity and consequent aortic dilation

98
Q

Presentation of thoracic aortic aneurysm?

A

Asymptomatic until discovery is made incidentally on CXR, CT, or EKG

Some develop chest pain or abdominal discomfort as it grows to compress surroudning structures

99
Q

Why is a chest CT with contrast usually needed to confirm the diagnosis of TAA?

A

CXR cannot always distinguish TAA from tortuous aorta

100
Q

Compare the major manifestations of Waldenstrom macroglobulinemia to multiple myeloma.

A

Waldenstrom: hyperviscosity syndrome, HSM, neuropathy, bleeding, LAD

Multiple myeloma: osteolytic lesions/fractures, hypcalcemia, anemia, renal insufficiency

101
Q

Compare the monoclonal antibody, peripheral smear findings, and BM biopsy findings of Waldenstrom vs. multiple myeloma.

A

Waldenstrom, IgM, Rouleaux, >10% clonal B cells

MM: IgG, IgA, light chains; Rouleaux, >10% clonal plasma cells

102
Q

Screening test for Waldenstrom macoglobulinemia?

A

SPEP (monoclonal IgM spike)

If positive -> BM biopsy
Also - serum viscosity testing

Dedicated - Step 2 (22 decks)

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