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[2a] A ⼀ Step 2 OD USLME > ✅F1 (ID/RENAL/ENT/ALLERGY) > Flashcards

✅F1 (ID/RENAL/ENT/ALLERGY) Flashcards

1
Q

Acute Cervicitis Tx? -2

________________

Acute Cervicitis dx?

A
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2
Q

Describe the FeNa in

PreRenal AKI
_________________

Intrinsic Renal AKI

A

FeNa

preRenal < 1%
_________________

Intrinsic > 2%

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3
Q

Women who have sex with Women are INC risk of what 2 things?
_________________
Describe why for each

A

Cervical CA (2/2 lower HPV vaccination rates than hetero)

and

Bacterial Vaginosis (2/2 greater exchange of vaginal secretions than hetero)

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4
Q

Describe Serology for Hepatitis B -7

A

S - SEC - SCEb - Core - CEbSAb - CSAb - SAb

  • unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
  • CSAB = RESOLVED HEP B INFECTION*
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5
Q

Patient p/w isolated elevation of [total anti-HBc (Core Ab)]

What does this indicate? -3

A
  1. [window of acute HBV] = subclinical hepatitis (⇪ IgMCore and ⇪ LFT)
  2. Years after recovery from acute HBV once SAb has waned. (no IgMCore)
  3. Years after chronic HBV once (S antigen) has waned (no IgMCore)

____________________

S - SEC - SCEb - Core - CEbSAb - CSAb - SAb

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6
Q

Patient p/w isolated elevation of [total anti-HBc (Core Ab)]

How should you manage this?

A

[repeat HBV serologies] –> obtain [[IgMCore] and LFT] to determine acuity of [window acute HBV]
_________________

S - SEC - SCEb - Core - CEbSAb - CSAb - SAb

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7
Q

What 2 laboratory values are the best diagnostic test for Hepatitis B?

A

S - SEC - SCEb - Core - CEbSAb - CSAB - SAb

[SAg and CoreIgM]

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8
Q

The Hepatitis A vaccine is recommended for which groups - 3

A
  1. Travelers going to countries where HepA is present
  2. Gay Men
  3. Chronic Liver Disease

Hepatitis A can cause SIGNIFICANT but benign TRANSAMINITIS so do not be alarmed by this

self limited to 1 month

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9
Q

What is the best diagnostic test for [osteomyelitis of the foot]?
_________________
Name the test used at bedside for [osteomyelitis of the foot], and why it is not the best test?

A

contrast MRI
_________________
[probe-to-bone testing] (usually done first and not sensitive…so if negative, still must use contrast MRI to r/o infxn)

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10
Q

Diabetic foot infections with osteomyelitis require ⬜ to determine microbial involvement

A

BONE BIOPSY WITH CULTURE

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11
Q

tx Conjunctivitis -8

A
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12
Q

⬜ is a rare complication of bacterial conjunctivitis and is managed with ⬜
_________________
How does this complication typically present? -3

A

Keratitis (inflammation of cornea) ; URGENT OPHTHALMOLOGY CONSULT FOR TX
_________________
[foreign body sensation] / photophobia / vision impairment

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13
Q

What is a [Hordeolum Stye]

A

bacterial infection of [eyelid sebaceous gland]

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14
Q

Why do pts with suspected Keratitis must receive URGENT OPHTHALMOLOGY CONSULT?
_________________
How is Keratitis diagnosed?

A

Keratitis can cause corneal scarring which ➜ blindness if untreated by optho
_________________
slit-lamp

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15
Q

Health Care Personnel was recently exposed to Varicella Zoster Virus

management for special HCP (pregnant/immunocompro) who did NOT have VZV immunity prior to working?

A

[VZV IG (or antiviral tx if IG not available)]

________________

IG = ImmunoGlobulin

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16
Q

Health Care Personnel was recently exposed to Varicella Zoster Virus

________________

management for HCP who did NOT have VZV immunity prior to working?

________________

A

[Varicella Vaccine within 5d of exposure]

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17
Q

Health Care Personnel was recently exposed to Varicella Zoster Virus

List management for HCP immune to VZV prior to working?

________________

How do you prove their immunity? -2

A

NOTHING

________________

([hx of Varicella infection] or [hx of 2-dose Varicella Vaccine])

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18
Q

describe [postherpetic neuralgia]

________________

tx -4

A

persistent allodynia and pain > 4 months after resolution of acute [herpes Zoster shingles] rash

________________

[Gabapentin vs Pregablin vs TCA] –(if fail)–> Opioids

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19
Q

how is VZV transmitted? -2

_________________
Name hospital isolation rules for pts with [acute Zoster Shingles] -2

A

DIRECT CONTACT >> [active lesion aerosolization]
_________________
[localized single Zoster = [lesion coverage + standard precautions]

[DISSEMINATED ZOSTER > 1 DERMATOME = CONTACT AND AIRBORNE + standard precautions]
_________________
apply this until lesions are crusted over

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20
Q

How long are pts with acute [herpes Zoster Shingles] contagious?

________________

how is VZV transmitted? -2

A

from the onset of lesions UNTIL LESIONS HAVE COMPLETELY CRUSTED OVER

________________

DIRECT CONTACT >> [active lesion aerosolization]

In Hospital: Contact and Airborne precautions. Home: keep lesions covered until completely crusted over!

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21
Q

How is Viral Conjunctivitis spread? -2

A

EYE DISCHARGE directly

Contaminated Surfaces

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22
Q

SIADH can range from mild, SEVERE or Euvolemia

What are the s/s of SEVERE SIADH?-2

Tx?

A

SEVERE SIADH = SEIZURES / COMA

________________

SEVERE SIADH (TX): [3% Hypertonic Saline]

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23
Q

SIADH can range from mild, SEVERE or Euvolemia

What are the s/s of mild SIADH?-2

Tx?

A

mild SIADH = nausea / forgetful

________________
mild SIADH: [Fluid restriction +/- salt tablets]

SEVERE SIADH: [3% Hypertonic Saline]

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24
Q

SIADH can range from mild, SEVERE or Euvolemia

What are the causes of SIADH -5

A
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25
Q

What are the causes of Acute Cervicitis? -5

A
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26
Q

4 major signs of Acute Cervicitis?

A
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27
Q

[T or F]

Crusted over eyes in the morning indicates patient is contagious with viral conjunctivitis

A

FALSE

(only EYE DISCHARGE and contaminated surfaces transmit viral conjunctivitis)

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28
Q

Describe Desmoid tumors

________________

how do you differentiate it from lipoma?

A

Desmoid tumor= slow but locally aggressive benign neoplasm with high recurrence rate (tx = radiation if asx // surgery if sx)

________________

Lipoma will NOT reoccur

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29
Q

What are the 3 Pillars for reducing [Catheter Line Associated Bloodstream Infections]? -3

A
  1. Clean insertion site with Chlorhexidine before insertion
  2. Use Maximum barrier precautious (large sterile drape, mask) during insertion
  3. Remove Catheter once no longer needed after insertion
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30
Q

features of Multiple Myeloma -4

A

CUBP

  1. [CRAB - end organ damage]
    * hyperCalcemia*

Renal failure

Anemia normocytic

[Back pain 2/2 vertebral dark lytic lesions]

________________

  1. [Urine IgG or Urine IgA]

________________

  1. [Bone marrow with ≥10% clonal plasmacytosis/plasmacytoma]

________________

  1. [Protein (M Protein) in serum]
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31
Q

[CRYOGLOBULINEMIA TYPE 2] MOD

A

[Chronic Viremia/Autoimmune disease] ➜ [B cell hyperactivation] ➜ forms IgM which bind to IgG = ⇪ mixed circulating immune complexes

these [circulating immune complexes] desposit in small vessels ➜ INFLAMMATORY vasculitis (glomerulonephritis)

________________

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32
Q

[Cryoglobulinemia Type 1] MOD

A

[B Cell CA (Multiple Myeloma)] ➜ Monoclonal immunoglobulins that aggregate at low temp < 37C = Cryoglobulins.

Cryoglobulin precipitation ➜ noninflammatory microvascular occlusion and hyperviscosity sx when CG are high

________________

hyperviscosity sx = blurred vision, vertigo, ataxia

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33
Q

[T or F]

Varenicline has many serious adverse effects when combined with Nicotine Replacement Therapy

A

FALSE

________________

Varenicline + NRT = ✔︎

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34
Q

How does Cyclosporine affect Gout?

A

Cyclosporine [⬇︎ uric acid excretion] ➜ INC GOUT

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35
Q

What is the 5 step approach to treating Acne Vulgaris

A

“Losers Treating Bad Acne Is vulgar”

pre: [Lifestyle 3∆ = no vigorous scrubs / use water-based products / use pH neutral detergents]
1st: [Topical Retinoids with salicylic acid] = [Noninflammatory Comedonal Acne]
2nd: add Benzoyl peroxide = Inflammatory Acne
3rd: add Antibiotics (Topical before Oral) - erythromycin, clindamycin = Inflammatory Acne
4th: add [Isotretinoin PO] = Nodulocystic Acne

________________

36
Q

How does Cyclosporine affect Gout?

A

Cyclosporine [⬇︎ uric acid excretion] ➜ INC GOUT

37
Q

What is Spondylolysis?

________________

Dx?

________________

Tx? -2

A

[FATIGUE FRACTURE of pars interarticularis] 2/2 overuse injury ➜ [dull/achy lower back pain with radiation to butt and thigh, ⇪ with activity, ⬇︎ with rest.]

________________

Dx = Lumbar Spine XR

________________

tx = [activity modification x 90 d] + [symptom control x 90 d]

38
Q

Potassium Iodide Indication - 2

A
  1. PreOp tx for Thyroidectomy in Graves
  2. Thyroid Storm
39
Q

In the context of thyroid disease, what is the indication for CTS - 3

A
  1. Thyroid Storm
  2. Type 2 amiodarone-induced thyrotoxicosis
  3. SEVERE DeQuervain Subactue Thyroiditis
40
Q

How does looking at Thyroglobulin levels help determine etiology of thyroid disease?

A

Thyroglobulin is the base needed to make thyroid hormone.

If thyroid hormone is elevated…and Thyroglobulin is also elevated then Thyroid is naturally producing a lot of thyroid hormone

________________

If thyroid hormone is elevated …but Thyroglobulin is low then that means thyroid hormone must had been exogenousouly given

41
Q

tx for Thyroid Storm - 3

A

HHH** needs **PPP

Propranolol –> PTU —(1 hr later)–> [Potassium Iodine and CTS]

42
Q

cp for Thyroid Storm - 3

A

HHH** needs **PPP

Hot, Head and Heart

  1. Hot = Fever
  2. Head = CNS dysfunction with tremor
  3. Heart = Tachycardia, palpitations, HTN, HF

________________

tx = Propranolol –> PTU —(1 hr later)–> [Potassium Iodine and CTS]

43
Q

Pregnancy requires 50% greater thyroid hormone requirements

________________

How does the body achieve this? -2

A
  1. 1st trimester, fetal βhCG stimulate maternal TSH receptors ➜ [⇪ maternal T3/T4 production] (but remember, this INC T3/T4 feed back on ANT Pit ➜ low TSH 1st trimester)

and

  1. elevated maternal estrogen ➜ [⇪ thyroxine binding globulin] ➜ [⇪ binding sites for T4 to travel on] ➜ [⇪ TOTAL (not free) maternal T4 available]

________________

(hypOthyroid patients wont be able to INC maternal T3/T4 production ➜ requires INC exogenous dose/Levothyroxine )

44
Q

Potassium Iodide Indication - 2

A
  1. PreOp tx for Thyroidectomy in Graves
  2. Thyroid Storm
45
Q

Acne Treatment for females with [premenstrual acne flares] is different

What is it?

________________

MOA

A

[Combined OCP]

________________

[combined OCP] ⬇︎ sebum production and are antiandrogenic

46
Q

What 3 physical exam findings indicate widespread microvascular occlusion?

A
  1. Livedo reticularis
  2. digital ischemia
  3. retiform purpura (net like reflect of vasculature - image)
47
Q

What are the two definitive treatments for thyroid disease

A
  1. Radioactive Iodine
  2. Thyroidectomy
48
Q

how do you manage DKA -5

A

FIPAR control

  1. Fluid control: (NS) < [Blood Sodium 135] < (1/2 NS)
  2. Insulin control: [Continuous infusion but maintain BG > 200] ➜ [BG < 200 = ⬇︎ infusion and add dextrose] ➜ [on DKA Resolution = subQ insulin ➜ DC insulin infusion 2h later]
  3. Potassium control: [maintain between 3.3-5.3]
  4. ANION GAP CONTROL: [correct to 10-14] - (give HCO3 for pH<6.9)
  5. RESOLUTION = ([ANION GAP CORRECTION] + [PO TOLERANCE])
49
Q

Why is maternal thyroid hormone so important during pregnancy?

A

the fetus completely depends on maternal thyroid hormone for brain development up until 12WG when fetal thyroid gland forms

50
Q

how do you manage a Newly pregnant patient who has preexisting hypOthyroidism? -2

A

[⇪ baseline Levothyroxine dose] at time of pregnancy detection

then

[get TSH q4 wks ➜ Levothyroxine dose adjusted per trimester]

51
Q

[Febrile Nonhemolytic transfusion] rxn occurs ⬜ after transfusion starts. and Pts have what sx -3?
_________________

How is this related to Leukoreduction? -3

A

1-6 hours ; [Fever / Chills / Malaise] (NO HEMOLYSIS)
_________________
Leukoreduction =

prevents Febrile nonhemolytic transfusion rxn

⬇︎HLA alloimmunization

[⬇︎CMV transmission (resides in leukocytes)]

52
Q

List Reversible causes of Urinary Incontinence in the elderly-8

A
53
Q

Name the 12 Absolute Contraindications to Organ Donation

A
  1. DONATOR NOT [OFFICIALLY DEAD WITH APNEA]

2-12 in pic
_________________

DEATH = APNEA ([No cardiac activity] OR [No Brain and Brainstem activity] = )

54
Q

Explain how a Physician should approach the discussion of [Brain Death Diagnosis] and [Organ Donation]

A

1st: [Brain Death Dx] = Physician

________________

Later: [Organ Donation] = [OPO (Organ Procurement Organization)]

55
Q

Postoperative pulmonary complications occur most in pts undergoing ⬜ or ⬜ surgery.

What factors make this Risk Greatest? How do you mitigate these?

A

thoracic; upper abd
_________________
COPD / smoker / CHF / sleep apnea

SURGERY IS DELAYED until these pulm/cardiac conditions are treated and optimized

56
Q

BPPV p/w ⬜ and is treated with ⬜
_________________

How do you diagnose BPPV?

_________________

BPPV= Benign Paroxysmal Positional Vertigo

A

[brief < 1 min] episodes of dizziness triggered by head positional ∆ ; [canalith repositioning procedures (i.e. Epley)]
_________________
dx: Dix-Hallpike maneuver

57
Q

[Glucose-6-Phosphate Dehydrogenase] deficiency

cp -3

A

JAUNDICE / FATIGUE / unconjugated hyperbilirubinemia

________________

X-linked RBC enzymatic defect in African/Middle Eastern/Southeast asian ➜ ⇪ RBC hemolysis from oxidative stress

58
Q

[Glucose-6-Phosphate Dehydrogenase] deficiency

etx

________________

dx -3

A

[X-linked RBC (G6PD) enzyme defect] in African/Middle E/SE asian ➜ [RBC hemolysis from oxidative stress (infection/sulfa/fava beans)] =

JAUNDICE / FATIGUE / unconjugated hyperbilirubinemia

________________

measure G6PD activity | [peripheral smear: bite cells] | [p\smear: heinz bodies (accumulated denatured hgb)]

59
Q

dx?

A

[Heinz bodies (accumulated denatured hgb)] in G6PD

GLUCOSE 6 PHOSPHATE DEFICIENCY

60
Q

Diagnosis? | What’s the best diagnostic test for this condition?

A

Spherocytes in Hereditary Spherocytosis
_________________
Osmotic Fragility test

61
Q

Pts are recommended to employ ⬜ during the prodromal phase of VANS to abort the syncopal episode

What are they?

A

[physical counterpressure maneuvers]

_________________

[crossing legs while tensing body muscles] or [clenching fist while tensing arm muscles]

these improve venous return and cardiac output

62
Q

Concussion is defined as ⬜

Management? (2)

A

neuro disturbances a/w mild TBI without intracranial structural injury
_________________
[REST ≥24H] ➜ [gradual return to activity with progression titrated to tolerance]

note: it is nml for concussion sx to wax/wane as pt returns to activity

63
Q

Both Meniere disease and [Middle ear effusion 2/2 nasopharyngeal mass] have aural fullness and hearing loss

How do you differentiate them?

A

Meniere disease = 1. Vertigo + aural fullness + hearing loss

  1. effusion is in the labrinyth and not observed on physical exam
    _________________
    MEE = persistent uL middle ear effusion may be 2/2 nasopharyngeal carcinoma mass obstructing eustachian tube orifice and fiberoptic nasal endoscopy
64
Q

ADPKD - [Autosomal Dominant Polycystic Kidney Dz]

Describe the Disease - 7

A

ADPKD

Aneurysm (Berry)

Doomed [HTN and MVP]

[PrOteinuria AND Hematuria]

Kidney Failure (Early vs. Late onset) - Hepatomegaly occurs if cystic involvement

Differentation problem = Etx

Image: Renal Ultrasound which = Dx

65
Q

Basilar Artery occlusion CP

A

Locked In Syndrome!!! (preserved consciousness but with quadriplegia)

66
Q

Basilar Artery occlusion CP

A

Locked In Syndrome!!! (preserved consciousness but with quadriplegia)

67
Q

Explain how Chronic Kidney Disease is related to the 3 indicators for Parathyroidectomy

A

CKD

[⬇︎ conversion of 25-hydroxyvitD to 1-25DihydroxyVitD] ➜ [⇪ Phosphate retention] ➜ [bind free Ca+ (also ⬇︎Ca+ absorption)] ➜ [⬇︎free Ca+] ➜ [compensatory 2º hyperparathyroidism ( ⇪ PTH)]
_________________

EVENTUALLY…. [2º HPTH] may progress to [3° HyperParathyroidism AUTONOMOUS PTH SECRETION]➜ [HIGH PTH AND ULTIMATELY HIGH CA+] ➜ [high bone turnover = ⇪ BONE ALP] ➜

PTH sx = parathyroidectomy

  • Persistently elevated [Ca+> 10.5] , [(P )because of CKD] and [PTH>800]
  • Tissue calcification /[calciphylaxis (vascular calcification)]
  • Heavy intractable bone pain
68
Q

cp for Thalassemia trait
_________________

How do you differentiate α from β Thalassemia?

A
  1. anemia that is
  2. ⼀microcytic (low mean corpuscular volume)
  3. ⼀hypOchromic (low mean corpuscular hgb)
  4. [⇪ ferriTin (INC RBC turnover ➜ more iron to Tuck into storage)]
  5. [normal RDW (all RBC uniformly made microcytic)]

_________________

Hgb electrophoresis: [βT minor = ⇪ HgbA2]

69
Q

[Gp2B/3a R blockers] are anti-⬜

________________

Name all 3

A

anti-platelet

________________

“I ATE [Gp2B/3a] for breakfast”

[Abciximab / Tirofiban / EpTiFibatide]

70
Q

Between assigning team roles with redundancy vs specific team roles, which is preferred and why?
_________________

A

SPECIFIC;

task overlap between team members may ➜ duplication errors! [Ideal = clear specific roles with continuous refinement of clinical processes via quality improvement and by tracking outcomes]

71
Q

diagnostic crtieria for Cannabis Withdrawal

A

[≥1 physical sx (abd pain, sweating, shakiness, fever, chills, HA)]

+

[≥2 post cessation sx (Irritability,anxiety,insomnia, ⬇︎appetite, restlessness, depression)]

72
Q

What is this a complication of?

A

Acute Sinusitis

________________

dx: Orbital Cellulitis

73
Q

Which 2 organisms cause Cellulitis?

poorly demarcated confluent erythema and/or induration involving deep dermis, SQ fat +/- fever

A

GASP > MssA
_________________
cellulitis: poorly demarcated confluent erythema and/or induration involving deep dermis, SQ fat +/- fever

74
Q

Which abx are HIGH risk for causing C.Diff infection (6)

A

C diff tx = Fidaxomicin PO

Reinfections are from persistent spores of the intiial strain

75
Q

Name 2 indications for a [Contrast Head CT]

A

abscess intracranial

mass intracranial

76
Q

Describe Management for Tetanus Prophylaxis

A
77
Q

What is the greatest risk factor for PID?

A

Multiple Sexual Partners
_________________
other RF = [age 15-25], previous PID, inconsistent condom, partner with STI

78
Q

Pt presents with signs of Sarcoidosis but rapidly deteriorates after being given steroids

Dx?

A

Histoplasmosis

Mississippi and Ohio River basins

79
Q

Septic Arthritis may lack classic signs in infants

What clinical presentation should you expect? (4)

A

[infant Pseudoparalysis (won’t move affected joint)]

[infant ⇪ inflammatory markers]

joint effusion

[aversion to being held]
_________________
tx = debridement + IVA

(IVA = IV antibiotics)

80
Q

Management for ischemic CVA/TIA (4)
_________________

When are thrombolytics not allowed in CVA/TIA? (2)
_________________

How long are ischemic Stroke patients eligible for Mechanical Thrombectomy?

A

[> 4.5h since onset] or contraindication

_________________
24h

thrombolytics = alteplase tPA

81
Q

cp for Congenital Rubella Syndrome (6)

A

[BL cataracts]

[sensorineural hearing loss]

[patent ductus arteriosus]

[Bluberry muffin rash (purpuric lesions)]

low birth weight

microcephaly

82
Q

At what point, should you consider Antibiotic prophylaxis (continuous vs postcoital) for young female patients with recurrent UTI? (2)

A

[≥ 2 UTI in 6 mo]

OR

[≥3 UTI in 1 year]

obtain further diagnostics if c/f nephrolithiasis or obstruction

83
Q

clinical presentation of [Complex Regional Pain Syndrome] (5)

A

patient S/P RECENT JOINT INJURY now p/w joint POOP / burning / edema / skin ∆ / ⬇︎ROM

etx: INC sensitivity of sympathetic nerves

84
Q

⬜ are flagellated motile protozoan that cause ⬜
_________________
How is this a/w HIV?

A

Trichomonas vaginalis ; Trichomoniasis
_________________

Trichomonads ⇪ rates of HIV transmission

85
Q

Describe [candida Balanitis]
_________________
tx?

A

[infection / inflammation of glans penis (common in uncircumcised infants)] ➜ THICK WHITE DISCHARGE

+ [concurrent Candida Diaper Dermatitis]

_________________
topical antifungal

Balanoposthitis = inflammation of glans penis AND foreskin

[2a] A ⼀ Step 2 OD USLME (21 decks)

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