Final mock SB (F) Flashcards
Final mock blocks (F2 B1-4) Deck is full
what is a galactocele?
benign milk retention cyst
when will a galactocele occur?
w/in a few mos of cessation of breast feeding
how does galactocele present on p/e?
soft, mobile, nontender mass in the subareolar area
why are fibroademonas unlikely in breastfeeding mothers?
they incr in size 2/2 high estrogen and breast feeding mothers are estrogen deficient
why do pts w/ R sided heart failure require careful diuresis?
they are preload dependent
what cortisol, ACTH and aldosterone levels are expected in 1* adrenal insufficiency?
cortisol = decr ACTH = incr aldosterone = decr
what type of steroid is aldosterone?
mineralocorticoid
what should make you suspicious for functional hypothalamic amenorrhea?
- pt has recent h/o significant wt loss
- low BMI
- progesterone challenge test fails to provoke bleeding (low estrogen state)
pts w/ 1* ovary insufficiency present w/ what s/s and what FSH level?
- amenorrhea
- vasomotor s/s
- incr FSH
pt develops F + n/v + vague abd pain 2-10 days s/p lap chole. bile ducts are nL on imaging. Dx = ?
bile leak
how do you distinguish bile leak from retained gallstone s/p lap chole on imaging?
retained gallstone will have biliary dilation
a wider CI indicates what?
wider range of possible effects
how does lyme dz present other than the bulls-eye rash?
- systemic s/s = fatigue, malaise, arthralgias
- regional lymphadenopathy
- neurologic = meningitis, CN palsy (twisted face), radicoloneuritis
- cardiac = AV block
what are infantile hemangiomas?
benign vasc tumors
how do infantile hemangiomas present?
bright red, raised nodules that grow during 1st year of life and then shrink over the next 8-9 yrs (nL gone by age 10)
what is the MC solid malignancy in young men?
germ cell tumors
young man presents w/ painless, ovoid, unilateral testicular mass that does not transilluminate. dx = ?
germ cell tumor
what is required to dx germ cell tumor in young men?
- radical orichectomy
- U/S and serum tumor markers are helpful but not diagnostic
what is hematocele?
blood accumulation in the tunica vaginalis 2/2 testicular trauma
are hematocele painful or painless?
painful
what clinicla findings do all TORCH infx present w/?
- IUGR
- hepatosplenomegally
- jaundice
- blueberry muffin spots
what does management of mild sunburn include?
cold compress + NSAIDs
when are NSAIDs not 1st line tx for acute gout attack?
if the pt is on anti-coag
coadmin NSAID + anticoag = incr bleeding risk
how does occular rosacea present?
- burning, foreign body sensation, blepharitits, keratitis, conjunctivitis, corneal ulcers and recurrent chalazia
- can involve cornea, conjunctiva and eyelids
what does viral conjunctivitis present w/ other than eye discomfort and watering?
URI s/s
what triad characterizes acute liver failure?
- incr LFTs
- hepatic encephalopathy
- prolongued prothrombin time (elevated PT)
acute liver failure 2/2 wilson’s dz will present w/ what lab in addition to the ALF triad?
decr ALP
GGT is a marker of liver damage. is it specific enough to dx acute liver failure?
no
when do you tx pregnant women for MDD?
when exhibiting mod-severe s/s
post-partum woman presents w/ 1 day high F + uterine fundal tenderness. dx = ?
post-partum endometritis
post-partum F fails to respond after 2 days of ABX. Ddx = ?
- pelvic abscess
- superficial pelvic thrombophlebitis
how does post-partum endometritis present?
- F
- purulent lochia
- uterine fundal tenderness
young pt presents w/ indolent HA + malaise + F + persistent dry cough + pharyngitis + rash. CXR shows interstitial inflitrates. dx = ?
atypical PNA 2/2 m pneumoniae
how do you tx atypical PNA 2/2 m. pneumoniae?
- azythromycin (macrolide)
- resp fluoroquinolone
what types of infx are commonly treated w/ clindamycin?
dental and skin infx (anaerobic + aerobic bugs)
will pre-op ABX reduce post-op resp compliations in pts w/o signs of active infx pre-operatively?
no
what are the effects of PO and inhaled corticosteroids on COPD pts post-operatively?
PO - some decr PNA
inhaled - incr risk PNA
what is thromboangiitis obliterans (buerger’s dz)?
nonartherosclerotic, inflam vaso-occlusive disorder of sm and med-sized vessles
how does thromboangiitis obliterans (buerger’s dz) present?
ischemic ulcers + gangrene in young smokers
young F smoker presents w/ distal ulcers and gangrene. how do you distinguish btwn PAD and brueger’s dz?
PAD will have compromised blood flow and decr pulses
pt w/ complex asthma or CF hx presents w/ severe PNA s/s + bronchiectasis on CXR + eosinophilia on labs. Dx = ?
allergic bronchopulmonary aspergillosis
how do you tx allergic bronchopulmonary aspergillosis?
long term PO corticosteroids + itraconazole
pt presents w/ mechanical heart valve + warfarin + INR = 1.5 + SOB + pulm crackles. Dx = ?
prosthetic valve thrombosis
what is bronchiectasis?
dz of bronchial damage and dilation triggered by decr host defense
what is not typically seen in emphysema?
recurrent bacterial resp. infx
what is labert eaton synd assoc w/?
small cell lung Ca
why is a chest CT usually obtained as part of the Lambert Eaton synd w/u?
close assoc w/ small cell lung Ca
how does dementia w/ lewy bodies present?
- fluctuating cognition/attention
- well-formed visual hallucinations
- motor manifestations of parkinsonism (bradykinesia, rigidity, postural instability)
when is amnioinfusion used?
to decr cord compression 2/2 ROM if baby is exhibiting recurrent variable decels
why is Mg given to pts @ risk of delivery < 32wks?
- fetal neuroprotection (ppx CP)
- mild tocolytic
pts w/ unknown GBS status and expected to deliver @ < 37wks gestation require what?
GBS ppx (penicillin)
vit C def (scurvy) causes what?
- petichial and perifollicular hemorrhages
- mucosal bleeding
- peridontal dz
- corkscrew hair
- capillary wall fragility
- poor wound healing
how does chancroid present?
- PAINFUL genital ulcers
- lymphadenitis (tender nodes)
how does anal cancer present?
- anal bleeding, pain, and fullness
- anal mass or ulcerated lesion (friable)
- painless lymphadenopathy
what are C/I for copper IUD?
- wilson’s dz
- Cu allergy
- heavy menstrual bleeding
- acute pelvic infx
is current menstruation a C/I for IUD placement?
no
pregnant female presents w/ F and tachycardia. uterus is not tender. does she have chorioamnionitis?
not likely
how does acute pyelonephritis present in pregnancy?
F + flank pain +/- ARDS +/- preterm labor
pt presents w/ ear displacement + recent h/o OTM. dx = ?
mastoiditis
do you need imaging to dx mastoiditis?
not normally
what imaging might you get to confirm uncertain dx of mastoiditis or w/u intracranial complications?
CT or MRI
how do you tx mastoiditis?
IV ABX + surgical drainage
anti-B2-glycoprotein is used to dx APL synd. when is Beta-2 microgloulin incr?
- lymphoproliferative disorders (mult myeloma)
- conditions w/ incr cell turnover
what vasculitic disorders can exhibit livedo reticularis?
- polyarteritis nodosa
- SLE
what vasoocclusive disorders can exhibit livedo reticularis?
- cholesterol embolization
- APL synd
- cryoglobulinemia
which hemolytic anemia can present w/ livedo reticularis?
cold-agglutinin dz
adv stage cervical Ca can present how?
back pain + edema + pelvic mass + hydronephrosis
how do you tx hypoparathyroidism?
vit D + Ca2+ supplementation
why must you closely monitor Ca2+ and phos levels during hypoparathyroidism tx?
high levels can lead to soft tissue calcification
what Ca/Phos levels are concerning for incr risk of soft tissue calcification?
(s. Ca x s. Phos) > 55
how might pt present if calcification of the basal ganglia has occurred?
extrapyramidal s/s (movement disorders)
is vit D toxicity assoc w/ incr or decr Ca2+?
hypercalcemia
anthracycline induced cardiotoxicity is due to what?
myocyte necrosis and destruction (fibrosis)
what are the anthracyclines?
hint: cardiotoxic chemo drugs
- doxoRUBICIN
- daunoRUBICIN
- epiRUBICIN
- idraRUBICIN
how does doxyrubicin damage the heart?
causes myocyte necrosis and destruction (fibrosis)
cardiomyocyte hypertrophy and disarray are seen in what heart condition?
hypertrophic cardiomyopathy
yound child (< 6yo) worries about her parents dying and has recently been fixated on death. she has friends at school and no diff going to school. does she have separation anxiety?
no
severe COPD is often accompanied by what?
pulmonary cachexia
what is pulmonary cachexia characterized by?
loss of mean muscle mass 2/2 energy imbalance and systemic inflammation
lung Ca advanced enough to cause cachexia (incr wt loss + muscle wasting) will present w/ what finding on CXR?
lung mass
how does viral pleuritis present?
- viral prodrome (F, cough, rhinorrhea)
- pleuritic CP
- SOB
- pleuritic friction rub
- NO pleural effusion
what is pleuritis?
inflammation of the parietal pleura
if pleuritis is 2/2 bacterial PNA, what will typically be seen on CXR?
consolidatioin
what is a hordeolum?
acute inflammatory nodule 2/2 infx of eyelash folicle (stye) or meibomian gland (internal hordeolum) w/ staph aureus
what is a chalazeon?
granulomatous rxn to a blocked meibomian tear gland
how do you distinguish hordeolum from chalazeon?
hordeolum = PAINFUL and closer to lid margin
how does chalazeon present?
solitary, PAINLESS, rubbery, nodular lesion below the eye
pulm HTN in pts w/ L heart dz is caused by what?
incr LA and pulm venous pressures
what are common causes of pulm HTN 2/2 incr LA or pulm venous HTN?
- LV systolic/diastolic dysf(x)
- mitral or aortic valve dz
- congenital cardiomyopathies
what is diastolic heart failure
HFrEF
1* pulm arterial HTN is characterized by what?
vasc proliferation w/ intimal hyperplasia
how does chronic open-angle glaucoma present?
- progressive peripheral vision loss
- incr IOP
- incr cup: disc ratio
retinal exam in diabetic retinopathy reveals what?
vascular proliferation +/- vitreos hemorrhage
retinal exam reveals cherry red fovea. pt presented w/ sudden monocular vision loss. dx = ?
central retinal artery occlusion
retinal exam reveals arteriovenous nicking, cotton wool spots (fuzzy yellow spots), ateriolar narrowing, and hard exudates (discrete yellow spots). dx = ?
hypertensive retinopathy
what are common complications of maternal hyperglycemia?
- macrosomia
- hypoglycemia
- hypocalcemia
- polycythemia (2/2 chronic hypoxia in utero)
how does cecal volvulus present?
abd pain + cramping
what is cecal volvulus?
torsion of cecum and asc colon
pt presents w/ decr Na + severely incr glucose. what type of hyponatremia is this?
hypertonic hypoNa
why does severely high blood glucose lead to hyponatremia?
glucose pulls H2O out of cells and this dilutes Na
other than UE SBP> LE SBP, how can a pt w/ coarctation of the aorta present?
- HA, epistaxis (2/2 incr upper body BP)
- LE claudication
- brachial-femoral pulse delay
pt presents w/ pulsatile mass + SYSTOLIC bruit s/p left heart cath. dx = ?
pseudoaneurysm
pr presents w/ continuous bruit s/p left heart cath. dx = ?
AV fistula
what are some of the facial abnormalities seen in DiGeorge synd?
- low set ears
- small jaw
- cleft palate
a cortisol producing adenoma can cause what?
cushing synd
what labs do you expect in cushing synd (cortisol producing adenoma)?
- cortisol = incr
- ACTH = decr
- DHEAs = decr
- dexamethasone suppression test = negative (b/c tumor does what it wants)
how does DRESS synd present?
- diffuse, confluent, morbiliform rash + eosinophilia + systemic s/s (F, malaise, lympadenopathy)
- onset = 2-8 wks s/p starting allopurinol or anti-epileptic therapy
which malaria is assoc w/ dormant liver infx?
p. vivax infx
how do you tx p. vivax malaria?
chloroquine (kill 1* infx) + primaquine (kill liver hypnozoites)
how does choriocarcinoma present?
- recent pregnancy (mole, kid, spontaneous abortion)
- abn bleeding, pelvic pressure, big uterus
- vagina mets w/ red friable lesions
what nail findings are assoc w/ psoriasis?
- onycholysis
- pitting
what is onycholysis?
distal separation of nail plate from the nail bed
what dz is caused by exocrine gland dysf(x)?
sjogrens synd
what are the dermal manifestations of sjogren’s synd?
- reynaud phenom
- cutaneous vasculitis
- chronic urticaria
what causes septic arthritis in kids?
hematogenous spread of bacteria into the joint space
how does legionella PNA present?
- HIGH fever
- preceeded by GI s/s
- typical PNA s/s
how do you tx legionella PNA?
- levofloxacin
- newer macrolide (azithromycin)
what is lochia?
nL shedding of blood and decidua after delivery
what does lochia look like?
- red/brown for several days
- pink for several weeks
in non-lactating women, when do ovulation and menses resume?
ovulation @ 6-12 wks post-partum
menses @ 8-14 wks post-partum
what predisposes to uric acid stones?
- incr s. uric acid
- acidic urine
why might a pt w. chronic diarrhea present w/ uric acid stones?
diarrhea –> HCO3- loss –> acidic urine –> uric acid stones
how can you prevent uric acid stone precipitation?
urine alkalization w/ KHCO3- and/or KCitrate
how do you alkalize the urine?
- KHCO3-
- KCitrate
what is most likely to influence adolescents adherence s/ safe sex practices?
use of condoms by their peers
presence of a cavitary lesion on CXR of a pt suspected of lung Ca is highly suggestive of what?
SCC
how is thyroid function affected by pregnancy?
- estrogen –> incr TBG –> incr bound thyroid hormone
- BHCG –> TSH receptor stimulation –> incr T3/T4 and decr TSH
**both have to happen to balance out and keep things working
what is another name for anogenital warts?
chondyloma acuminata
what is the 1st line tx of chondyloma accuminata in pregnancy?
topical trichloroacetic acid
what tx for choldyloma acuminata are avoided during pregnancy and why?
- imiquimod (teratogenic potential)
- podophyllin resin (teratogenic potential)
- excisional biopsy (risks assoc w/ anesthesia and sx)
