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Fall Finals > Fall + Summer Comp > Flashcards

Fall + Summer Comp Flashcards

1
Q

Storage form of iron

A

ferritin, in liver (Fe2+)

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2
Q

what type of iron is absorbed best?*

A

heme-iron (animal sources)

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3
Q

nutrients required for proper iron absorption*

A

B12, Folic Acid, Copper, Vit C

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4
Q

EPO is produced by

A

kidneys

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5
Q

Thrombopoietin is produced by

A

liver and kidneys

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6
Q

where are platelets stored?

A

20-40% in spleen

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7
Q

Pelger-Huet anomaly - cell in peripheral blood smear

A

inherited blood condition where WBC have dumb-bell shaped nucleus

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8
Q

poikilocytosis

A

variation in RBC shape

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9
Q

Schistocyte

A

RBC fragment, characteristic of mechanical trauma

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10
Q

anisocytosis

A

variation in RBC size

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11
Q

Burr cells

A

aka echinocytes
associated with uremia, chronic renal disease
irregular short projections

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12
Q

basophilic staining of rbc*

A

aggregates of ribosomes

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13
Q

Inclusions in RBC*

A

basophilic staining: aggregates of ribosomes, many small dots
Howell-Jolly bodies: nuclear fragm after splenectomy, one dot*

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14
Q

Peyer’s patches*

A

B cells in ileum (sm. intestines)

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15
Q

NK cells

A

recognize non-self proteins, non-specific immunity

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16
Q

Left shift/”Bandemia” *

A

higher number of immature WBC
serious infection
CBC: inc segments and bands

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17
Q

aplastic anemia

A

bone marrow suppressed, no production

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18
Q

segmented neutrophils, common in…?

A

bacterial infection

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19
Q

most common anemia cause

A

iron deficiency

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20
Q

haptoglobin

A

binds free HGB (after RBC taken apart) and recycles heme

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21
Q

signs of anemia (later Sx, asymp initially)

A

fatigue, SOB, weakness
pallor: conjunctiva, mucosa, palmar creases
tachycardia

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22
Q

Sickle Cell*

A

DNA point mutation in HGB Beta chain

smear: target + sickled cell

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23
Q

what can uremic metabolite from renal failure cause?

A

decrease lifespan of RBC

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24
Q

G6PD function

A

protects RBC from oxidative stress, genetic deficiency can cause anemia (episodic from triggers)

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25
Q

G6PD deficiency on smear

A 
Heinz bodies: see early in acute phase, denatured Hgb
Bite cells (pac man): macrophage removing Heinz bodies
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26
Q

megaloblastic anemia

A

impaired DNA synthesis, cell grow w/o division

folace, B12 deficiency

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27
Q

Schilling test

A

evaluates B12 deficiency (in meat/dairy)

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28
Q

B12 deficiency

A

permanent neuro damage if left untreated! (dementia Sx, numbness, glossitis)
affects posterior column first (vibra/propriocep)
can be immune problem

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29
Q

Folic acid deficiency

A

Sx rapid bc low body stores
leafy greens, animal products
NO NEURO SX

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30
Q

acute chest syndrome

A

LEADING CAUSE OF DEATH IN SC
new infiltrate w/pulm Sx
vaso-occlusion of sickle cell crisis, painful, episodic, from triggers

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31
Q

How does aspirin interfere w/clotting

A

irreversibly inhibits COX (cyclooxygenase I)

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32
Q

How does NSAIDs interfere w/clotting

A

reversibly inhibits COX (cyclooxygenase I)

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33
Q

clotting common pathway converts…

A

fibrinogen to fibrin

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34
Q

Where are clotting factors produced from?

A

all from liver

EXCEPT VWF produced by megakaryocytes/endothelial cells - binds F8

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35
Q

Vitamin K dependent pro-coagulants*

A

Factors 2, 7, 9, 10 (production blocked by warfarin)

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36
Q

Vitamin K dependent anti-coagulant*

A

Warfarin

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37
Q

Factor V Leiden

A

overactive FVa, resistant to protein C

Spontaneous DVT!

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38
Q

Number 1 cause of inherited thrombophilia***

A

Factor V Leiden mutation

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39
Q

most common hereditary bleeding disorder***

A

von willebrand’s disease

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40
Q

Most significant effect of polycythemia vera

A

75% splenomegaly

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41
Q

intense itching after bathing

A

polycythemia vera, increased histamine release

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42
Q

Tx for polycythemia and hemochromatosis

A

phlebotomy

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43
Q

hemochromatosis

A

excessive iron destroys pancreatic islet cells–> insulin dependent diabetes
most serious effect: cirrhosis of liver
Sx occurs when Fe >10g
Dx w/serum transferrin

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44
Q

HEMOCHROMATOSIS TRIAD

A

Cirrhosis, DM, skin pigmentation

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45
Q

which immunoglobulin crosses placenta?

A

IgG (anti-AB, anti-D)

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46
Q

erythroblastosis fetalis

A

mom’s AB attacks infant’s RBC

hemolytic dz of infants

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47
Q

hypersegmented neutrophils on smear*

A

megaloblastic anemia (B12 Pernicious)

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48
Q

idiopathic thrombocytopenia (ITP)

A

Almost immediate thrombolysis

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49
Q

what do basophils release?

A

heparin

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50
Q

hematologic cause of post-surgery numbness/tingling

A

normocytic anemia

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51
Q

presence of holly jowell bodies on smear

A

splenectomy

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52
Q

lead poisoning on smear

A

basophilic stippling

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53
Q

examples of type III hypersensitivity rxn

A

SLE, Arthus Rxn, farmer’s lung, serum sickness

cardinal finding: 90% rash

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54
Q

transfusion reaction is what type of hypersensitivity rxn

A

type II, hemolytic

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55
Q

How to prevent the spread of impetigo

A

wash hands

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56
Q

Dowling Degos Dz

A

reticulated macules, brownish black on flexures (axilla, groin, neck)

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57
Q

presentation of acute cutaneous rheumatoid arthritis

A

DIP spared

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58
Q

erysipelas

A

sharply demarcated red, superficial fiery red infection

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59
Q

scabies is characterized by

A

nocturnal pruritus

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60
Q

“spaghetti and meatballs” on KOH

A

tinea versicolor

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61
Q

“Blueberry muffin” lesion

A

Rubella: triad of cardiac, hearing, ocular

from cutaneous hematopoiesis

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62
Q

Wart subtypes associated w/malignancy

A

6, 11, 16, 18, 31, 35

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63
Q

Most common subtypes assoc w/common warts

A

2, 4

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64
Q

rare CON of cryotherapy treatment of warts

A

“doughnut wart”: recurrence around treated spot annually

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65
Q

most common subtypes of genital warts (condylomata acuminata)

A

> 90% 6, 11

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66
Q

Molluscum Contagiosum on adult face

A

think HIV

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67
Q

Herpes Gladuatorum

A

on face, arm, neck, and upper trunk

spread from contact sports

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68
Q

Gold standard for Dx of HSV

A

Tissue culture

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69
Q

tzanck smear

A

fast Dx of HSV but can’t distinguish HSV1 or 2

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70
Q

Herpes Zoster

A

Shingles

reactivation of varicella virus

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71
Q

“dew drops on roses”

A

varicella: vesicles, papules, ulcers, blisters

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72
Q

herpes zoster ophthalmicus affects which nerve

A

trigeminal

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73
Q

herpes zoster oticus (Ramsay Hunt) affects which nerve

A

facial nerve

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74
Q

Hand foot mouth disease

A

Coxsackievirus A16
Enterovirus 71
fecal oral

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75
Q

pitting of nails (looks like sandpaper scratched on nail)

A

Psoriasis

could also be alopecia areata

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76
Q

Nail atrophy, “angle wings”

A

lichen planus

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77
Q

“Boggey”, well-circumcised plaque on scalp

A

Kerion, caused by trichophyton tonsurans most common

Tx: PO anti-fungal: griseofulvin

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78
Q

looks like ringworm on head

A

tinea capitis
Tx w/griseofulvin
children, living in crowded conditions

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79
Q

Actinic Keratosis

A 
"Solar Keratosis"
precancerous, confined to epidermis
can become squamous cell carcinoma if extend to dermis
REMOVAL OF SCALE CAUSES BLEEDING!
tx: cryo, surgery, Tretinoin, 5FU
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80
Q

Basal cell carcinoma

A

80% of skin cancers
don’t usually metastasize, locally destructive
most commonly NODULAR: sun-exposed area, umbilicated center, SHINY (Pearly), telangiectasis

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81
Q

Squamous Cell Carcinoma

A 
strong risk of metastasis
precursor = AK (60%)
20% of skin cancers
hyperkeratotic lesion w/crusting and ulceration, necrotic center
Tx: <4mm deep ED&amp;C, >4mm Mohs
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82
Q

Bowen’s disease

A

squamous cell carcinoma in situ***
slow growing, red scaly plaques, grows horizontally
Tx: electrodessication and curettage, cryo, excision, 5FU

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83
Q

erythroplasia of queyrat*

A

almost exclusively in uncircumcised men**

SCC in situ

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84
Q

Melanoma

A

rare but highest risk of metastasis and mortality
always obtain full thickness biopsy
Tx: wide excision to confirm margins and ree-excision to get full depth

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85
Q

Mucocutaneous rash of Lupus Erythematous

A

Malar rash: butterfly rash
discoid rash: “coin shaped”
subacute cutaneous
Acute cutaneous spares knuckles!

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86
Q

Dermatomyositis

A 
rare but severe, affects muscle and skin
INVOLVES KNUCKLES
heliotrope erythema of eyelids
gottron's papules: on knuckles, joints, side of fingers
20-70% coincide w/internal malignancy!
Definitive Dx: muscle biopsy
Tx: 1st line high dose steroid taper
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87
Q

Scleroderma

A

CREST syndrome: calcinosis, raynaud’s, esophageal dysfunction, sclerodactyly, telangiectasias; limited type, TIGHT skin
Systemic type can be fatal

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88
Q

Bullous Pemphigoid

A

thicker bulla, on flexor surfaces

Tx: oral prednisone

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89
Q

Dermatitis Herpetiformis

A

Extensor surface

ALMOST ALL W/GLUTEN SENSITIVITY ENTEROPATHY

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90
Q

Psoriasis

A

Extensor surface
immune mediated rapidly growing skin cells
Stress induced
Auspitz’s sign: bleed when pick silver-white dry scales
Koebner’s phenomenon: psoriasis at/shape of trauma
can get psoriatic arthritis: “pencil in a cup” collapsed joint space

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91
Q

Acute drug induced photoallergy can cause

A

stevens johnson syndrome

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92
Q

Melasma

A

area of dark pigmentation on women’s face, darker skin types

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93
Q

Seborrheic Keratosis

A

looks like “stuck on mud”
benign, superficial
sudden increase can suggest malignancy
“stucco keratosis”: small white-gray SK, pepper on dorsal foot of older fair skins

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94
Q

What are skin tags (acrochordons) a marker for?

A

insulin resistance and atherosclerosis

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95
Q

Tx of keloid

A

refer or intralesional steroid (topicals dont work), don’t remove bc worst scarring

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96
Q

Wood’s lamp

A

blue/green: fungus

bright coral: bacterial

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97
Q

“one hand, two feet” syndrome

A

Tinea Pedis! (fine scaling w/creases)

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98
Q

Satellite lesions

A

yeast infection (Candida) - opportunistic

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99
Q

Koplik spots

A

Measles

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100
Q

Scarlet fever

A

Sandpaper quality on arms
Pastia’s lines
desquamation

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101
Q

Fifth’s Dz

A

erythema infectiosum, Parvovirus B19

Slapped cheeks, reticular rash

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102
Q

Roseola Infantum

A

very high fever** (102, 104F) then rash (fine almond shaped)

Febrile seizures common

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103
Q

Kawasaki Dz

A

Febrile >5days
cardiovascular main cause of mortality
Tx: ASA high dose

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104
Q

Eccrine (merocrine) gland

A

sweat, not w/hair follicle

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105
Q

Apocrine gland

A

thick milky fluid, w/hair

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106
Q

Lanugo hair

A

only on fetus

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107
Q

Macula Densa cells

A

sense low Na+, Cl-
signal to Juxtaglomerular cells
in distant convoluted tubules
NOT stimulated by high GFR***

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108
Q

Juxtaglomerular cells

A

IN WALL OF AFFERENT ARTERIOLE
SENSE LOW BP
Secrete Renin to inc Na+ absorption to inc BP

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109
Q

Angiotensin II

A

Vasoconstrict arterioles

dec GFR. inc BP

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110
Q

ADH

A

Inc H2O reabsorption in DCT, inc BP

during dehydration to decrease urine

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111
Q

Aldosterone

A

inc Na reabsorption, inc K secretion; inc BP

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112
Q

RAA System

A

dec BP/dec Na/sympathetic –> JG –> Renin splits angiotensinogen (liver) –> Angiotensin I –> Angiotensin II by ACE from lungs –> aldosterone

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113
Q

hemolytic uremic syndrome

A

hemolysis
thrombocytopenia
acute renal failure

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114
Q

gold standard test in DM/HTN to assess early glomerular dz

A

microalbumin test

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115
Q

red blood cell cast

A

glomerulonephritis

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116
Q

WBC cast

A

pyelonephritis

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117
Q

WBC in urine microscopy

A

bladder in fection

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118
Q

RBC in urine microscopy

A

bleed from ureter and down

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119
Q

Muddy brown cast

A

Acute tubular necrosis

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120
Q

LHU graduate GPA to be good standing

A

3.0

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121
Q

90% cause renal artery stenosis

A

atherosclerosis

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122
Q

“beads” on renal angiography

A

aneurysms of fibromuscular dysplasia, more prevalent in women

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123
Q

Hypertensive emergency

A

BP >180/120

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124
Q

Anasara

A

MASSIVE and generalized edema

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125
Q

nephrotic syndrome

A

extreme proteinuria (>3.5g/day) from glomerular damage that causes EDEMA

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126
Q

edema worst in the morning

A

Renal cause/hypoalbumin

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127
Q

Myxedema

A

thyroid

causes facial edema

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128
Q

Edema that increases at end of day and better throughout night

A

Cardiac/dependent/cyclic causes

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129
Q

Signs of nephrotic syndrome*

A

Proteinuria: >3.5g.day
Hyperlipidemia: see fatty casts, inc hepatic synthesis
edema of legs/feet/ankle
Hypoalbuminemia

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130
Q

Gold standard test to Dx nephrotic syndrome

A

24hr Urine

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131
Q

Primary causes of nephrotic syndrome

A

Minimal changes Dz: 80% of childhood NS; good prognosis
Focal Segmental Glomerulosclerosis: poor prognosis
Membranous Glomerulopathy: 80% of NS in ADULTS

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132
Q

2nd causes of nephrotic syndrome

A 
DM!!!
SLEO
Cancer
Amyloidosis
Malaria
Infections
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133
Q

Most common systemic Dz causing nephrotic syndrome

A

Diabetic glomerulosclerosis (DM I OR II)

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134
Q

Fatty casts and Oval fat bodies

A

Nephrotic Syndrome

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135
Q

Consequences of proteinuria*

A 
immunocompromised
Hypercoagulable
Anemic
Hypothyroid
Dec Ca+/Vi D
HTN, Atherosclerosis
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136
Q

Features of Nephritic Syndrome*

A 
Inflammation of glomeruli
HTN
Oliguria
Coca-Cola urine (hematuria)
Berger's disease (IgA nephropathy) --> most common cause of primary glomerulonephritis
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137
Q

1 cause of acute kidney injury

A

chronic kidney dz

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138
Q

Dx for Acute kidney injury

A

inc creatinine, Dec urine output

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139
Q

Berger’s Dz

A

IgA nephropathy –> IgA deposits in glomeruli

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140
Q

What Tx do you avoid in Acute Kidney Injury?

A

IV/PO K+ bc already hyperkalemia –> arrhythmias

Tx w/IV Ca++ bc cardiac protective

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141
Q

Calcitriol

A

increases Ca absorption in small intestines

secreted by kidneys

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142
Q

Primary causes of chronic kidney failure

A

Diabetes

HTN

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143
Q

Sx of chronic kidney failure

A

fatigue, nausea, anorexia

late: confusion, pruritus (from hyperphosphatemia), dry skin

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144
Q

Urinary calculi can cause

A

flank pain, infection, hematuria, N/V

CVA tenderness

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145
Q

Presentation of stone within ureter

A

severe colicky pain, radiates to groin

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146
Q

Choice imaging study for renal stones*

A

Non-contrast CT abdomen/pelvis

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147
Q

Struvite stones are more common in…

A

women
see Staghorn Calculi*
UNDERLYING UTI

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148
Q

1st stone after 50yo

A

RARE, consider other causes

consider abdominal aortic aneurysm if pt >60yo

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149
Q

Most common calculi

A

calcium oxalate

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150
Q

Crohn’s Dz

A

Inflammatory Bowel Disease

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151
Q

Tx of stones

A

<5mm: pass on its own; Hydration, pain, alpha blocker in expulsive therapy
>5mm: urology consult OR struvite! (underlying UTI)
eswl (shockwave therapy): <2cm

152
Q

Post-Strep glomerulonephritis

A

self-limiting
Sx: hematuria, upper body EDEMA, HTN, Hypo C3
Dx w/ C3/C4 test*

153
Q

Most common glomerular hematuria

A

IgA nephropathy (Berger’s dz):
HEMATURIA ATTACKS after non specific viral illness, exercise, or immunization
RECURRENT*
benight; supportive Tx

154
Q

What diseases are most commonly associated w/glomerular dz?

A

DM, SLE

155
Q

most common polycystic kidney disease

A 
Autosomal dominant
in both kidneys and other organs
PKD1 mutation
Pain, HTN, hematuria
assoc risks: cerebral aneurysm, CAD, Cardiac hypertrophy
156
Q

Most common infectious agent in pyelonephritis

A

E coli

157
Q

Acute pyelonephritis in men

A

ALL CONSIDERED COMPLICATED bc high probability of tract anomalies, enlarged prostate
ALL NEED IMAGING

158
Q

Tests for UTI

A

Leukocyte esterase test

nitrite test

159
Q

Painless, Gross hematuria is what until proven otherwise

A

CANCER

also worry about cancer if pt >40yo

160
Q

microscopic hematuria criteria

A

> /= 3 RBC

161
Q

Highest risk factors for renal cancer

A

tobacco use

occupational exposure

162
Q

Imaging study for renal cancer

A

CT urography ub adults

U/S in kids

163
Q

Most common renal malignancy

A

90% renal cell carcinoma –> clear cell carcinoma most common type

164
Q

Gold standard type of access for hemodialysis

A

AV fistula

165
Q

complication of replacing sodium too fast

A

central pontine myelinolysis

166
Q

Normal BUN:CREAT

A

20:1 or less

167
Q

BUN 60’s: Creat 1.8

A

prerenal azotemia

168
Q

pseudo/isotonic hyponatremia

A

displaced by protein and lipids, inc osmotic force

erroneous low sodium

169
Q

Na <120

A

seizures and comas

170
Q

ARPKD

A

liver fibrosis

171
Q

lesion in lyme disease

A

Erythema chronicum migrans

172
Q

BIG 5 TO RULE OUT W/CHEST PAIN**

A 
acute coronary syndrome
aortic dissection
PE
Tension pneumothorax
Esophageal rupture
173
Q

Chest Pain DDx*

A 
Acute coronary syndrome
acute aortic dissection
mediastinitis
pericardial tamponade
pulmonary embolism
tension pneumothorax
174
Q

Quick Estimate for rate in EKG

A

300, 150, 100, 75, 60, 50, 43, 38

175
Q

Wolf-Parkinson-White Syndrome*

A

LAD, right-sided accessory pathway
SEE DELTA WAVE*
Shrt PR, Wide QRS

176
Q

aortic ejection kick*

A

early systolic, just after S1

aortic stenosis

177
Q

opening snap*

A 
early diastolic sound, just after S2
mitral stenosis (or tricuspid)
178
Q

Anterior leads on EKG

A

V3,4

179
Q

QRS UP in 1 and DOWN in AVF*

A

LAD

180
Q

QRS down in 1 and DOWN in AVF*

A

Extreme RAD

181
Q

“Party streamer” on EKG

A

Torsades de Pointes

182
Q

“bag of worms” on EKG

A

V Fib; high freq, disorganized

need immediate defibrillation, fatal 3-5min; ischemic heart disease

183
Q

“coved” T wave on EKG

A

Brugada Syndrome type I

Types II, III is “saddleback “

184
Q

Commotio cordis

A 
blunt blow ("precordial thump") to T wave cause V Fib and sudden death
avg age 15yo
185
Q

LDL >190*

A

REQUIRE HIGH INTENSITY STATIN THERAPY

186
Q

TRIGLYCERIDE LEVEL >1000MG/L*

A

RISK FOR PANCREATITIS

187
Q

Paradoxical splitting

A

opposite of physiological splitting

A2 FOLLOWS P2 during expiration

188
Q

S4 Gallop

A

atrial contraction hitting a stiff noncompliant wall
“tennessee”
Hypertrophic Cardiomyopathy (HCM), LVH

189
Q

Aortic ejection click

A

Early SYSTOLIC sound – Heard just after S1
abnormally shaped or stenotic aortic valve*
aortic stenosis

190
Q

Opening Snap*

A

Opening of abnormal tricuspid or mitral valve
Early DIASTOLIC*** sound — Heard just after S2
mitral stenosis

191
Q

what keeps HR lower than true intrinsic SA rate?

A

vagal tone dominant at rest

192
Q

What grade of murmurs do thrills start?

A

Grade IV

193
Q

Prinzmetal’s Variant Angina*

A

occurs at rest, morning
coronary artery spasm WITHOUT plaques
can cause ventricular arrhythmias

194
Q

Friction rub*

A

pericardial inflammation

195
Q

Leaning forward and inspiration*

A

increase pericardial friction rub

196
Q

Posterior wall leads EKG*

A

V1-2

197
Q

Beck’s triad for acute cardiac tamponade

A

JVD
low Arterial pressure
Muffled heart sounds

198
Q

5 P’s of acute limb ischemia*

A 
Pain
Pulseless
Pallor
Paresthesias
Paralysis
199
Q

What do you grow on Sabouraud’s agar

A

Fungus

200
Q

NEGATIVE Beta lactamase testing on culture plate

A

GOOD –> means not resistant

201
Q

What fungal infection shows hilar adenopathy on CXR?

A

Histoplasmosis

202
Q

What organism causes rheumatic fever, tonsil abscess?

A

S. pyogenes

203
Q

Most virulent form of Hepatitis?

A

Hep B

204
Q

What can high altitudes cause?

A

HAPE: pulmonary edema
HACE: cerebral edema

205
Q

Absent cremaster reflex

A

testicular torsion

206
Q

Follistatin mechanism

A

binds to activin to inhibit FSH

207
Q

What is not a risk factor for testicular cancer?

A

Varicocele (reversible)

208
Q

“Saxophone penis”

A

LGV

209
Q

G6PD Triggers

A

Fava beans, Sulfa drugs

210
Q

Trichinella can be found in…

A

Pork

211
Q

itchy anus, scotch tape test

A

Enterobius vermicularis

212
Q

What is present with 1/3 of patients w/Paget’s disease of vulva?***

A

second neoplasm (cervical or vaginal)

213
Q

What is cervical cancer strongly associated with?***

A

HPV***

214
Q

Most common gynecologic malignancy***

A

endometrial cancer***

215
Q

Endometrial cancer TRIAD***

A

Obesity
HTN
DM

216
Q

What increases risk of endometrial cancer

A

increased estrogen

nulliparity

217
Q

Endometrial cancer Sx***

A

> 60% abnormal uterine bleeding***

uterus can be enlarged, hard, fixed

218
Q

Ovarian cancer presentation***

A

ASYMPTOMATIC UNTIL WELL ADVANCED***

symptoms don’t become apparent until tumor compress/invade adjacent structures, ascites develop, or evident metastasis

219
Q

What lab result is elevated in ovarian cancer?***

A

Ca-125 (postmenopausal women, advanced stage)

^serum tumor marker

220
Q

Activin and Inhibin

A

produced by gonads
growth factor beta family
Inhibin: decreases FSH, +conversion: progesterone
Activin: increases FSH, + conversion: estradiol

221
Q

Follistatin

A

inhibit FSH synth and release
inhibit FSH response to GnRH
binds to activin to inhibit

222
Q

Metabolic Syndrome

A

cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels

223
Q

Mesonephric duct

A

Wolffian, Male

224
Q

Paramesonephric duct

A

Mullerian, Female

225
Q

What are three developmental defects?*** (identify them)

A

agenesis: MRKH Syndrome
ex: mullerian duct doesnt develop –> no cervix, uterus, vagina, tubes
lateral fusion defects
vertical fusion defects: vagina and cervix abnormalities

226
Q

Lateral fusion defects***

A

Mullerian ducts dont fuse –> various effects

227
Q

unicornuate uterus***

A

destruction of one mullerian duct
almost aways MISSING KIDNEY AND URETER ON SAME SIDE***
pregnancy loss

228
Q

Most common type of developmental defect***

A

septate uterus***
indented fundus
failure of reabsorption of septum

229
Q

What should you check w/mullerian abnormalities?***

A

50% renal anomalies

12% skeletal

230
Q

CAH

A

ambiguous genitalia
too little cortisol so ACTH increased –> too much androgens
also little aldosterone

231
Q

What is PCOS at increased risk for?***

A

Endometrial cancer (3x)

232
Q

What is NOT typical of PCOs?***

A

true virilization!

233
Q

acanthosis nigricans*

A

discoloration of skin folds from hyperinsulinemia

areas of dark, velvety discoloration in body folds and creases.

234
Q

Detrusor instability/urge incontinence

A

losing all urine

overstimulation of detrusor

235
Q

Overflow incontinence

A

reduced sensation of full bladder, leaking

cant stimulate detrusor

236
Q

Genuine stress incontinence

A

leak urine

trauma, pelvic prolapse, drugs relax sphincter

237
Q

Triad of ectopic pregnancy***

A

amenorrhea
irregular vaginal bleeding
pelvic pain

238
Q

Endometriosis

A

endometrial tissue outside of uterus
estrogen dependent, benign
in reproductive popu.
Ex: pelvis endometriosis, ovarian endometrioma, deeply infiltrating endometriosis
Sx: dysmenorrhea, dyspareunia, chronic pelvic pain

239
Q

Adenomyosis

A

ectopic endometrial tissue grow down into myometrium

perimenopausal women

240
Q

Tx for both endometriosis and adenomyosis

A

hysterectomy 1st line

241
Q

What age group is affected by vulvar cancer?

A

postmenopausal

242
Q

Leukoplakia

A

white lesions
hyperkeratosis
avascularity

243
Q

Vaginal pH of bacterial vaginosis or Trich?

A

> 5.0

fungal/physiological discharge <4.5

244
Q

Do postmenopausal women get yeast infections?

A

No but can get atrophic vaginitis (vaginal inflammation from thinning of tissue, decreased lubrication
from low estrogen)

245
Q

Lichen planus (psoriasis)*

A

inflammatory, autoimmune

mucous mem.

246
Q

Candida vaginitis

A

thick, curd-like vaginal discharge

itching

247
Q

Organism that common causes BV

A

Gardnerella vaginalis

248
Q

“strawberry cervix”

A

trichomonas (women more symptomatic)

5%

249
Q

Trichomonas SSx

A

copious discharge, can be frothy

50% irritation, dysuria

250
Q

Leiomyoma v. adnexal masses

A

Leiomyoma: central/uterine
Adnexal: more lateral

251
Q

Leiomyoma are dependent on what hormone?

A

estrogen

252
Q

Rash of palms/feet: what do you think of?

A

Mono (EBV), rocky mountain spotted fever, Lyme, syphilis

253
Q

puerpera

A

just gave birth

254
Q

Climacteric

A

perimenopause

255
Q

gravidity

A

pregnancy

256
Q

What to rule out w/Chancroid by Haemophilus ducreyi

A

must rule out Syphilis and HSV
NOT chancre
chancroid: purulent base, bleeds easily

257
Q

HSV SSx

A

painful blisters on genitals (butts, thighs)
more likely recurrent than zoster
Raw burning “cut”

258
Q

LGV = lymphogranuloma venereum

A

elephantiasis, enlarged inguinal lymph nodes

259
Q

Congenital syphilis presents with?

A 
hutchinson teeth
saddle nose
frontal bossing
(eat away bones)
chancre
260
Q

disseminated gonococcal infection has pain where?

A

joints and tendon

261
Q

condyloma lata v condyloma accuminata

A

lata: flat, syphilis
accuminata: HPV

262
Q

Reiter’s disease

A

reactive arthritis

263
Q

Gold standard Tx for BPH

A

trans urethral resection of prostate (TURP)

264
Q

Low testosterone with low or low normal LH/FSH =***

A

secondary hypogonadism

265
Q

withdrawal from what can be fatal?***

A

alcohol and benzodiazepines

NOT opioids

266
Q

what is the risk of too rapid rehydration and refeeding in eating disorders?*

A

risk of CHF* and edema

significant risk of hypophophatemia (life threatening arrythmias)

267
Q

stages of grief by Elisabeth Kubler Ross**

A 
Denial
Anger
Bargaining
Depression
Acceptance
268
Q

Takotsubo Cardiomyopathy*

A

stressed induced non-ischemic cardiomyopathy
usu. normal cardiac function within 2 months
“broken heart syndrome”

269
Q

best values spirometry measures

A

Forced expiratory volume in one second (FEV1)
Forced vital capacity (FVC)
FEV1/FVC%

270
Q

Obstructive pattern on PFT

A

DECREASED FEV1,
DECREASED FEF 25-75
Decreased FEV1/FVC - <70% predicted

271
Q

DDx for obstructive lung dz

A

asthma

COPD (chronic bronchitis, emphysema)

272
Q

Restrictive pattern on PFT

A

Decreased TLC, FVC

Normal or increased: FEV1/FVC ratio

273
Q

significant bronchodilator response value

A

FEV1 increase by 12% AND >200ml

asthma: >20%

274
Q

what does spirogram measure

A

forced inspiratory and expiratory flow rate
gold standard
evaluate upper respiratory obstruction

275
Q

lung volume patterns in obstructive dz*

A

TLC >120% PREDICTED

RV >120% PREDICTED

276
Q

lung volume patterns in restrictive dz*

A

TLC <80% PREDICTED

RV <80% PREDICTED

277
Q

What value is used to follow disease severity in COPD patients?*

A

FEV1

marker for obstructive lung dz

278
Q

Causes of COPD

A

Asthma; 10-30 fold increase risk
childhood respiratory infection
alpha 1-trypsin deficiency

279
Q

Biggest risk for COPD

A

80-90% TOBACCO SMOKE

VERY HIGH RISK if >40ppy

280
Q

Pathophysiology of COPD

A 
chronic irritation
airflow limitation/air trapping
gas exchange abnormalities
mucus hypersecretion
pulm vascular scarring from chronic inflammation --> pulm HTN --> R HF
PERMANENT
281
Q

2 types of COPD

A

emphysema
chronic bronchitis
(often coexist)

282
Q

Biggest symptoms of Chronic Bronchitis

A

excessive mucus –> cough

283
Q

Acute Bronchitis

A

affects LARGE bronchi

from virus/bacteria

284
Q

Chronic Bronchitis

A

increase mucus and inflammation from hyperplasia/hypertrophy of goblet cells/mucus glands
affecting terminal bronchioles

285
Q

Emphysema

A

permanent destruction of alveolar sac –> enlarged air spaces

286
Q

Classic COPD Symptoms

A

chronic cough
sputum (purulent w/exacerbation)
breathlessness + fatigue, DOE
(and wheezing, chest tightness)

287
Q

Late dz presentation of COPD

A 
muscle wasting, weakness
pursed lip breathing**
R HF Sx: JVC, Peripheral edema, hepatomegaly
depression, anxiety
osteoporosis
polycythemia (inc epo from hypoxia)
288
Q

Spirometry findings for COPD

A

FEV1/FVC <0.7 –> Dx
(reduced expiratory flow)
FEV1: stages/determines tx for COPD

289
Q

how to distinguish asthma from COPD?

A

Do Pre/Post bronchodilator spirometry

asthma will have post bronchodilator change, but NOT COPD

290
Q

What do ALL COPD patients need?

A

flu and pneumococcal vaccine!

291
Q

Characteristics of Asthma*

A

airflow obstruction
bronchial hyper-responsiveness
underlying inflammation
(attacks of impaired breathing)

292
Q

Asthma cough characteristics

A

non-productive (dry)
episodic
worst at night*

293
Q

Hyperkalemia*

A

increased amplitude and peaking in T wave

hypokalemia: T flattening or inversion

294
Q

How to objectively diagnose asthma?*

A

FEV1 increase 12% from baseline after SABA (reversibility)

atleast 20% decrease in FEV1 after methacholine (bronchoprovocation test)

295
Q

Transudative pleural effusion*

A

due to increased hydrostatic pressure or low plasma oncotic pressure
***causes: 90% CHF, cirrhosis, nephrotic syndrome, PE

296
Q

Exudative pleural effusion*

A

due to inflammation and increased capillary permeability

***causes: pneumonia, cancer, TB, viral infection, PE

297
Q

Lab differences between transudative and exudative fluid*

A

Transudative fluid: low in protein and LDH

Exudative: high in protein and LDH

298
Q

Causes of exudative pleural effusion***

A

malignancy: lung, breast, ovarian
infection: TB, bacterial pneumonia
PE
Chylothorax: lymph fluid accumulation
Hemothorax
GI dz
Collagen dz

299
Q

Light’s Criteria for exudative pleural effusion

A
  1. pleural fluid protein/serum protein >0.5
  2. or pleural fluid LDH/serum LDH >0.6
  3. or pleural fluid LDH >2/3 normal upper limit of serum LDH
300
Q

Biggest PE finding in Pleural Effusion*

A

dullness w/percussion

301
Q

Lab results of pleural effusion w/malignancy*

A

pos cytology, need 3 diff samples
glu <60mg/dl
frank red fluid

302
Q

Lab results of pleural effusion w/chylothorax*

A

milky fluid

triglyceride >110 mg/dl*

303
Q

Low glucose levels of pleural fluid

A

infections
autoimmune
malignancy

304
Q

What is low pH of pleural fluid and malignancy associated with?

A

poorer prognosis

305
Q

What can you get if you remove too much pleural fluid at once?

A

pulmonary edema

306
Q

Interstitial lung disease

A

damage to alveolar walls and lung parenchyma from inflammation and resulting fibrosis

307
Q

Hallmarks of interstitial lung disease

A

restrictive pattern on PFT

decrease diffusing capacity for carbon monoxide

308
Q

Most common type of interstitial lung dz*

A

idiopathic interstitial fibrosis - DLCO (diffusing capacity) reduced

309
Q

“ground glass” on CXR

A

amiodarone

Inflammation –> potentially reversible

310
Q

“honey comb” on CXR

A

Fibrosis

VERY POOR PROGNOSIS - IRREVERSIBLE

311
Q

Pathology of idiopathic pulm fibrosis

A

triggering event –> inflammation –> damage alveolar-cap basement membrane –> inc perm –> FIBROSIS

312
Q

characteristic of sarcoidosis

A

multiple uniform non-caseating granulomas (lungs and lymph nodes) - north american blacks*
large, “fluffy” nodules on CXR
most don’t req treatment

313
Q

What can you get with sarcoidosis*

A

iritis and uveitis*

314
Q

Sarcoidosis staging*

A

Stage 0: normal
Stage I: Hilar adenopathy only
Stage II: Hilar adenopathy and parenchymal involvement
Stage III: parenchymal involvement alone

315
Q

pneumoconiosis

A

hypersensitivity pneumonitis from inhaled dusts/chemicals (occupational)

316
Q

what cancer can you get with asbestos

A

mesothelioma

317
Q

Cotton pneumoconiosis**

A

Byssinosis***

318
Q

mineral/stone pneumoconiosis**

A

silica - most toxic

319
Q

shiparyward/contractors pneumoconiosis**

A

asbestos

320
Q

Where do you relieve tension pneumothorax?***

A

2nd intercostal space

321
Q

What is ineffective in ARDs?***

A

FiO2 ineffective

322
Q

What is a cause of spontaneous pneumothorax?***

A

emphysema

323
Q

Tracheal deviation of tension pneumothorax*

A

AWAY from side w/decreased breath sounds

324
Q

most common risk factor of lung abscess?

A

alcoholism

lung abscess 75% right side*

325
Q

which side is more common in bronchiectasis?*

A

left*

326
Q

what’s the mean arterial pressure in pulmonary HTN*

A

> 20mmHg at rest

327
Q

Group 1 pulmonary HTN

A

pulmonary arterial HTN - RIGHT heart dz

328
Q

Group 2 pulmonary HTN

A

pulmonary venous HTN - LEFT heart dz

329
Q

What should you think w/dyspnea at rest AND pleuritic chest pain

A

PE

330
Q

Which PE is more likely to cause pulmonary infarct and pleuritis*

A

segmental and subsegmental (branches)*

331
Q

Clot in transit PE*

A

TRAVELS THROUGH HEART

HIGH MORTALITY!!

332
Q

RV thrombus has**

A

double mortality!!

333
Q

cor pulmonale

A

right sided heart failure from pulmonary HTN (from chronic lung disease like COPD, OSA)

334
Q

Massive PEs sign

A

systolic BP <90mmHg or drop in atleast 40mmHg from baseline
JVD
only 4% of PEs byt 20-60% mortality

335
Q

Pathophysiology of cystic fibrosis

A

defect in CFTR gene –> abnormal Cl transport –> mucus more viscous/sticky to bacteria –> promote infection/inflammation

336
Q

Dx of CF*

A

Dz in one or more organs

>/= 60mmol/L sweat chloride**

337
Q

Presentations of CF

A

Respiratory tract involvement
sinus dz: chronic nasal congestion
pancreatic dz: pancreatic insufficiency - fat malabsorption
meconium ileus: meconium obstruction, distal intest obstrunction syndrom (DIOS)
hepatobiliary dz: focal biliary cirrhosis
musculoskeletal dz: dec bone mineral desnity
reduced/infertility: >95% males infertile bc defect in sperm transport*** (absent vas deferens most common)

338
Q

What do most patients eventually get w/CF*

A

Pseudomonas respiratory infection

339
Q

How to differentiate between asthma and emphysema w/DLCO?

A

asthma: inc DLCO
emphysema: dec DLCO
(DLCO unaffected in Chronic bronchitis)

340
Q

Ghon lesion

A

fibrotic, calcified lesion
contain: T cell, macrophage, central necrosis
Latent TB

341
Q

Where do you first see calcifications in TB?

A

Apices

342
Q

Mesial Temporal Sclerosis*

A

complex partial seizure pattern

most common adult epilepsy

343
Q

Lennox-Gastaut Syndrome*

A

Juvenile atonic seizures associated with severe developmental delay

344
Q

Best imaging study for ischemia localization*

A

MRI

345
Q

Cauda equina Sx*

A

urinary retention

346
Q

What vascular system supports spinal cord?*

A

anterior and posterior vertebral artery

347
Q

MoA of phenytoin*

A

decrease sodium in neurons by blocking na channels

348
Q

What does kyphoplasty treat?*

A

vertebral compression

349
Q

Tx for cluster HA*

A

O2, subQ sumatriptan

prevention with: verapamil* (CCB)

350
Q

idiopathic intracranial HTN (pseudotumor cerebri)

A

young obese women in childbearing years get

351
Q

Polymyalgia rheumatica*

A

50% of those w/temporal arteritis

pain/stiffness in neck that radiates to hip; steroid tx years; self resolves

352
Q

Cluster HA characteristics

A

severe orbital, supraorbital/temporal pain
UNILATERAL
***Autonomic Sx: ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion
15-180 MINUTES
occur in clusters then remission

353
Q

Cluster HA characteristics

A

severe orbital, supraorbital/temporal pain
UNILATERAL
***Autonomic Sx: ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion; horner’s syndrome
15-180 MINUTES
occur in clusters then remission

354
Q

Most common aneurysm*

A

Saccular aneurysm (“Berry”)

355
Q

How is Parkinson’s Dz characterized clinically from other parkinsonisms

A

Asymmetric parkinsonism

Clear/Dramatic benefit from dopaminergic therapy

356
Q

essential tremor

A

worst w/action

not parkinson’s

357
Q

how to confirm normal pressure hydrocephalus

A

beneficial response to Large volume CSF tap
improves gait, not cognition
“feet glued to floor”

358
Q

tremor in Parkinson’s

A

“pill rolling”
improves w/intention
presents unilaterally, can progress to bilateral

359
Q

Cardinal symptom of PD*

A

Bradykinesia or Akinesia
progresses distal to proximal
classic shuffling gait w/unsteadiness
festination: quick short steps, “unwilling running pace”

360
Q

primary neurochemical change in AD

A

Reduced amount of acetylcholine

cholinesterase inhibitor used in treatment - Donepezil, galantamine and rivastigmine

361
Q

cauda equina syndrome

A

compromised canal below L1
most commonly from herniated nucleus pulposus
urinary retention, dec sphincter tone, Perineal/Saddle paresthesia
EMERGENCY

362
Q

radiculopathy

A

dysfunction of nerve root
Pain, sensory impairment, weakness, decreased DTR in a nerve root distribution
non-emergent, eg sciatica

363
Q

how does pain decreased in spinal stenosis*

A

sitting or spinal flexion*

(increase w/spine extension)*

364
Q

ankylosing spondylitis

A

Inflammatory arthritis of the spine (Seronegative spondyloarthropathy)
squaring of vertebral bodies and syndesmophytes
can have fusion

365
Q

what is ankylosing spondylitis characterized by?*

A

Morning stiffness, improved with exercises/activity**
pain wakes you up at night
can have extraskeletal manifestation: uveitis. psoriasis, IBD

366
Q

steroid effect on lower back pain

A

NO EFFECT

367
Q

Spondylosis

A 
Osteoarthritis of the spine
“wear and tear” of the spine
Bone spurs
Disc space narrowing
morning stiffness
368
Q

Spondylolysis

A

Defect or stress fracture in pars interarticularis
Most common at L5-S1
worry w/young HS athletes
“Scotty dog” on XRAY**

369
Q

Spondylolisthesis

A

Defect or fractures of bilateral pars interarticularis resulting in slippage

370
Q

Which posturing is commonly seen in pontine strokes*

A

decerebrate posturing

371
Q

What is present w/true vertigo?*

A

nystagmus

372
Q

Vestibular Neuritis*

A

Inflammation of vestibulocochlear nerve
usu. VIRAL AND SELF LIMITING
Occurs in healthy young people
PE: vestibular imbalance (veer toward affected side), horizontal nystagmus, positive head thrust test (eye moves)

373
Q

labyrinthitis*

A

vestibular neuritis AND unilateral hearing loss

374
Q

Paraphimosis*

A

Inability to return the retracted foreskin to its natural position covering the glans. –> EDEMA AND CONGESTION OF GLANS* –> PENILE NECROSIS
urologic emergency!!!

375
Q

What severe pathology can Enterohemorrhagic E. coli cause?

A

hemorrhagic colitis and hemolytic uremia syndrome

Fall Finals (2 decks)

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