High-Risk OB

Question 1

presentation of choriocarcinoma (rare complication of hyatidaform mole)

Answer 1

abnormal uterine bleeding
dyspnea
hemoptysi

(Hematogenous spread to lungs causes “cannonball”metastases B.)

Question 2

5 risk factors for preeclampsia

Answer 2

1. nulliparity
2. obesity
3. age > 35
4. chronic HTN
5. CKD

Question 3

Cause of death in eclampsia

Answer 3

1. stroke
2. intracranial hemorrhage
3. ARDS

Question 4

Preeclampsia with thrombotic microangiopathy of the liver.

Answer 4

HELLP syndrome

(Hemolysis, Elevated Liver enzymes, Low Platelets. May occur in the absence of hypertension and proteinuria.)

Question 5

complication of receiving factor VIII as therapy for hemophilia A?

Answer 5

inhibitor development (Ab form against infused factor VII)

(presents w/decreased pTT, but not PT)

Question 6

sickle cell disease or trait will protect against malaria ….(morbidity/mortality/infection)

Answer 6

morbidity/mortality, NOT infection

they still get infected at equal rates

Question 7

Symmetrical vs. asymmetrical growth restriction

(particularly important in growth-restricted infants)

Answer 7

• symmetrical (weight, length, and occipitofrontal circumference [OFC] all ≤ 10%)
• asymmetrical (only weight ≤ 10%)

(asymmetrical = problem in late pregnancy; symmetrical = problem in early pregnancy)

Question 8

TORCH infection presentation (6)

Answer 8

1. Growth restriction
2. Hepatosplenomegaly
3. Rash or petechiae
4. Jaundice
5. Microcephaly or hydrocephalus
6. Seizure

(W/U: liver enzyms, fundoscopy & stool Ag)

Question 9

How do you evaluate for serious bacterial infection in newborns?

Answer 9

1. CBC
2. CRP/procalcitonin (gives idea of how severe)
3. CXR
4. UA
5. CSF

Question 10

HIV infection presentation in young, sexually active patient (3)?

(1-4 weeks post infection)

Answer 10

1. aspectic meningitis
2. maculopapular rash
3. diffuse lymphadenopathy

Question 11

Infantile/Strawberry Hemangioma complications (2)?

Answer 11

1. ulceration/disfiguration
2. vision impairement if near the eye and untreated

(If unresponsive to medications (propranolol): cryotherapy, laser therapy or resection)

Question 12

Eclampsia = preeclampsia + …

Answer 12

seizures

(preeclampsia = proteinuria + HTN past 20 weeks)

Question 13

which pre-natal infection can lead to cataracts in the infant?

Answer 13

rubella

(deaf, cardiac malformation, “blueberry muffin” skin d/t extramedullary hematopoesis)

Question 14

keratoconjunctivitis can be caused by

infection of cornea and conjunctiva

Answer 14

HSV-1

recurrent infection

Question 15

arthritis, conjunctivitis, urethritis preceeded by GI infection

Answer 15

reactive arthritis (autoimmune reaction)

usually triggered by GI infection of chlamydia

Question 16

What do these lab findings indicate?
* ↑ Parathyroid hormone (PTH)
* ↓ Phosphate
* ↑ Bone alkaline phosphatase

Answer 16

Rickets or Osteomalacia

Question 17

complications of Paget’s disease

rare, but highly tested

Answer 17

1. high output HF: increased vascularity can cause AV fistula in bone. Blood bipasses the resistance vessels (arterioles)
2. osteosarcoma”osteo-suck-oma on a starburst”

Question 18

what are the 3 lab findings of osteitis fibrosa cystica?

d/t Parathyroid adenoma/hyperPTH

Answer 18

1. ↑ PTH
2. Hypercalcemia
3. ↓ Phosphate

Question 19

Hyperthyroidism can cause osteoporosis d/t increased activity of bone turnover. How can hypothyroidism lead to secondary osteoporosis?

Answer 19

T4 dose too high → iatrogenic hyperthyroidism

(must check TSH, if it is low/suppressed, dose is too high)

especially problematic in post-menopausal women on T4

Question 20

difference between reactive arthritis & septic arthritis (related to STI infection)

Answer 20

-septic arthritis: fever, pain, one joint
-reactive arthritis: conjunctivitis, urethritis, multiple joint

(septic arthritis is from untreated gonorrhea; reactive is an immune reaction to previous infection; may have been treated)

Question 21

3 complications seen in patients with Ehlers-Danlos

Answer 21

1. organ rupture (i.e. uterus)
2. AA
3. retinal detachment

(lens dislocations: upward/out is Marfans; downward/in is d/t homocysteinuria)

Question 22

2 parasitic infections that may cause hemolytic anemia

Answer 22

1. malaria
2. babesia

Question 23

Fatigue, weakness, pallor
Bleeding (especially gums)
Infections

Answer 23

AML (acute myelogenous leukemia)

(sx d/t bone marrow suppression: few red cells and platelets, blasts present)

Question 24

3 complications of polycythemia vera

(sx: aquagenic pruritis, erythromelalgia : severe, burning pain and red-blue coloration and DVT)

Answer 24

1. myelofibrosis: spent phase; burned out bone marrow
2. leukemia (CML or MC AML)
3. Gout: excess DNA turnorver Increased purine metabolism → ↑ uric acid (also seen in CML and myelofibrosis)

Question 25

Ifosfamide may cause which complications?

Answer 25

1. hemorrhagic cystitis 1. fanconi syndrome (loss of reabsorption in PCT) 2. encephalopathy

Question 26

which chemo Rx increases the risk of PML & can reactivate Hep B infection?

Answer 26

rituximab (tx: NHL, CLL, ITP, RA)

Question 27

which type of hyperthyroidism presents with a painful nodule?

Answer 27

DeQuervain's Thyroiditis (subacute granulomatous thyroiditis)

Question 28

Infection post-abdominal surgery that presents with yellow granules

Answer 28

abdominal actinomycetes

Question 29

Noncardiac asteroides causes what type of infection in immune-compromised patients?

Answer 29

Pneumonia (Tx: TMP/SMX)

Question 30

4 endemic fungal infections

Answer 30

1. blasto (eastern & central US) 1. cocciodes (valley fever) 1. histoplasmosis (Ohio & mississippi) 1. para-cocciodes (latin america)

Question 31

medullary thyroid carcinoma is derived from ... cells

Answer 31

c-cells (calcitonin can deposit in the tumor, "tumor cells in an amyloid background”)

Question 32

medullary thyroid cancer increases... (hormone).

Answer 32

calcitonin (opposes PTH action; no affect on normal Ca2+ homeostasis) (a/wMEN 2A & 2B, "Calci2nin")

Question 33

Of the B-cell and T-cell deficiencies (Wiskott Aldrich, Hyper-IgM, Ataxia Telangiectasia, SCID), which 2 present with recurrent pyogenic infections?

Answer 33

1. Wiskott Aldrich (defective Ag-presentation) 1. Hyper-IgM (no class-switching --> non-specific immune defense)

Question 34

What are the 2 entry inhibitors used to tx HIV infection

Answer 34

1. Maravi**roc** inhibits **doc**king. 1. En**fu**virtide inhibits **fu**sion

Question 35

**Situs inversus**, chronic ear infections, sinusitis, bronchiectasis, infertility

Answer 35

Primary ciliary dyskinesia (Kartagener syndrome) (Dynein arm defect--> impaired migration & orientation of cells. pts are infertile)

Question 36

whipple disease is d/t *T. whipplei* infection. Which diagnostic study is used?

Answer 36

PAS ⊕ foamy macrophages in intestinal lamina propria (sx: **c**ardiac sx, **a**rthralgia, **n**euro) **PAS**s the **foamy Whipp**ed cream in a **CAN**.