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Step 2 > HY Review #4 > Flashcards

HY Review #4 Flashcards

1
Q

Distributive shock = any shock with

A

low SVR
(Septic, Anaphylactic, Neurogenic)

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2
Q

Septic Shock: origin is massive vasodilation s/t inflammatory response resulting in ____ BUT that causes a _____

A

↓ SVR
↑CO (reflex tachycardia)

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3
Q

Cardiogenic shock: The Heart doesn’t work so start with ___

A

↓ CO

(↑ SVR)

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4
Q

Hypovolemic shock: the problem is ↓ Preload s/t to ↓ Total blood volume so start with ____ & ____

A

↓ CVP (low preload)
↓ CO (low total blood volume)

↑ SVR (b/c body tries to increase preload)

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5
Q

Neurogenic shock: The SNS doesn’t work so No Tachycardia and no Vasoconstriction so start with ___ & ____

A

↓ CO (pt Bradycardic b/c PSNS dominates)
↓ SVR (no vascular tone from SNS)

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6
Q

Anaphylactic shock: origin is mass vasodilation s/t histamine and Bradykinin release resulting in ____ BUT that causes a _____

A

↓SVR
↑CO (reflex tachycardia)

Tx: Epinephrine

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7
Q

Cardiac Tamponade (Obstructive shock):
origin is Extrinsic compression of heart by fluid in pericardium
Resulting in ___ & ___

A

↑ CVP
↑ PCWP (opposite of TPX/PE)
──
↑ SVR ↓ CO

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8
Q

TPX/PE (Obstructive shock):
origin is Extrinsic compression of heart by air in thoracic cavity
Resulting in ___ , but a ___

A

↑ CVP
↓ PCWP (opposite of cardiac tamponade)
──
↑ SVR ↓ CO

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9
Q

Septic Shock tx

A

IVFs + Antibiotics
→ If necessary add Pressors (Norepinephrine)

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10
Q

Cardiogenic shock tx (3)
What to avoid giving?

A

Give either:
1. Dobutamine (Beta 1 agonist ionotrope)
2. Milrinone (PDE-1 inhibitor)
3. Digoxin (↑ Ca for muscles)

Avoid IVFs

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11
Q

Hypovolemic shock tx:

A

Normal saline

(if Hemorrhagic, consider transfusion)

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12
Q

Neurogenic shock tx:

A

IVFs (NS) & Pressors (Norepinephrine)

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13
Q

TIP: In all forms of shock except Neurogenic (where ALL values go down) SVR and CO are always ____.

A

opposite direction to each other.

(↓ CO in cardiogenic, Hypovolemic, & Neurogenic shocks)

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14
Q

HBV algorithm
1st always look at ____
2nd look at ____
3rd look at vaccination or infection hx via ____

A

Always look at HepB-sAg first
─
If HepB-sAg (+) = Active Infection
Next look at HepB-c Ab
- Acute Infection → (+) IgM
- Chronic Infection → (+) IgG
─
If HepB-sAg (–) = No infection
Next look at HepB-c Ab
- Core Ab (+) → cleared old infection
- Core Ab (–) → vaccinated (vaccine does not have core antigen)

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15
Q

In the window period of HBV infection a pt has
symptomatic HBV infection (↑ LFTs ± Jaundice)
HBV serologies with show ____.

A

All Negative,
Except Core Ab IgM (+)

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16
Q

Pemphigus Vulgaris vs Bullous Pemphigoid
Blisters

A

Pemphigus Vulgaris (flaccid, Rupture +Nikolsky)
─
Bullous Pemphigoid (tense, Bullae, no rupture)

Both present in 40+ yo)

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17
Q

Pemphigus Vulgaris vs Bullous Pemphigoid
Antibodies & Prognosis

A

Pemphigus Vulgaris (anti-Desmosome/Desmoglein Abs) → between intraepithelial cells → fishnet → bad prognosis higher mortality
─
Bullous Pemphigoid (anti-Hemidesmosome Abs) → between subepidermal cells below the epithelium→ linear pattern → better prognosis

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18
Q

Pemphigus Vulgaris vs Bullous Pemphigoid
Treatment

A

Pemphigus Vulgaris → ± High-dose systemic steroids; prednisone)
(supportive care + Burn Center referral)

Bullous Pemphigoid → ± High-dose topical steroids; clobetasol, betamethasone
(supportive care + Burn Center referral)

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19
Q

22M was found unconscious (± Headache) by his family.
His neighbor saw him grilling indoors yesterday as temperatures were sub-zero at the time.
Dx/Dxt/Tx/Imaging findings?

A

Carbon Monoxide (CO) Poisoning
Check Carboxy-Hemoglobin levels
100% O2 or Hyperbaric O2 (to displace CO)
Neuroimaging: Globus Pallidus abnormalities

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20
Q

A 19 yo with a history of Diffuse Large Cell Lymphoma on chemotherapy is brought to the ED with a 3 day history of high fevers and flu like sxs.
Exam → Febrile and Nutropenic
Dx/Dxt/Tx?
ppx?

A

Neutropenic fever
NBSID: → blood cultures
Tx: Anti-pseudomonal ABs (Ceftazidine 3º, Cefepime 4º, Gentamicin, Carbapenem, Or Pip-Tazo)

Ppx → G-CSF/ GM-CSF analog
(Filgrastim, Saragranostin)

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21
Q

Diagnosis:
Neutropenic fever + Diarrhea + RLQ tenderness + abdominal distention

A

Necrotizing Enterocolitis (Typhlitis)

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22
Q
  1. Tx of HTN in an CKD patient with proteinuria:
  2. BP target for HTN in CKD:
  3. CKD pt w/severe Normocytic anemia of ch dz:
A
  1. ACE-i/ARB
  2. <130/80
  3. EPO def (kidneys make this)
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23
Q

Renal transplant pts
Hirsutism and dental/gingival anomalies on immunosuppression
= ______ Toxicity

Most likely malignant complication s/t immunosuppression
= _______ cancer

A

Cyclosporin Toxicity

Squamous Cell Skin Cancer

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24
Q

Down syndrome (40F)
Early onset Alzheimer’s dementia
Intra-cerebral hemorrhage on CT
Diagnosis?

A

amyloid angiopathy (Aneurysm rupture)

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25
Q

39F
h/o RA + Enlarged tongue
Progressive increases in Cr
Dx/MCCOD?

A

Amyloidosis A

Amyloidosis can cause:
•Restrictive Cardiomyopathy (mccod)
• Nephrotic Syndrome

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26
Q

Elderly pt w/ Tingling of lateral 3 fingers
hypercalcemia, anemia, High Cr
Dx?

A

Carpal Tunnel
s/t Amyloidosis triggered by Multiple Myeloma

(Classic MSK problem in amyloidosis)

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27
Q

54M who has been on dialysis for 2 years and has amyloidosis
Patho?

A

Dialysis cant filter
Beta 2 Microglobulin
so it increases in blood

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28
Q

Old person >70 w/restrictive heart dz. Dx?

A

Senile Amyloidosis (Transthyretin accumulates)

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29
Q

25M Asian
Chronic diarrhea, skin hyperpigmentation and nail atrophy
multiple flesh polyp in stomach and large intestines
no malignancy detected on biopsy
dx?

A

Cronkhile Canada Syndrome

Stool studies → lots of protein
Heritable → no, sporadic mutation

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30
Q

25M
Chronic diarrhea, skin hyperpigmentation and nail atrophy
multiple flesh polyp in Colon and Rectum ONLY
no malignancy detected on biopsy
dx?

A

Familial adenomatous polyposis (FAP)

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31
Q

Gene mutation associated with FAP

A

APC gene mutation (tumor suppressor)

APC → KRAS → p53 (adenoma to tumor mutation)

mnemonic: AK-53

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32
Q

Colon cancer screening guidelines for pts with FAP?

A

Colonoscopies every 1-2 years
starting at age 10 or when diagnosed

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33
Q

Pt has Familial adenomatous polyposis (FAP)
& Bony and/or soft tissue tumors
Dx?

A

Gardner syndrome
(Osteomas of mandible or skull/ Fibromas on skin)

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34
Q

Syndrome causes Malignant brain tumors
Medulloblastomas in Familial adenomatous polyposis (FAP)

A

Turcot syndrome

FYI: causes Gliomas in Lynch syndrome

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35
Q

Hyperpigmented macules on the lips w/multiple colonic polyps
Dx:

A

Puetz Jeghers (AD)

NBME Peds presentstion→ Intusseception (polyp lead point)

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36
Q

7 yo boy & Tanner 5 body
Tx/Cx?

A

Continuous Leuprolide (GnRH analog and shuts down HPG axis)

↓ bone mineral density

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37
Q

82F w/pruritus and a thin labia (thin paper-like skin).
Dx/Dxt/Tx?

A

Lichen Sclerosis (can happen to teens)
Punch Biopsy of vulva (bc in 20% it is CANCER so need to r/o)
High potency Topical Steroids
(Clobetasol, Halobetasol)

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38
Q

HPV 6/11 → causes
HPV 16/18/30s → causes & is the BRF for

Most important prognostic predictor in vulvar cancer?

A

HPV 6/11 → Genital warts (condyloma accuminata)
HPV 16/18/30s → Cervical Cancer

Prognostic vulvar predictor → LN involvement

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39
Q

Pap smear guidelines: (HY)
21-65 → pap-smear every __ years
or
30-65 → Pap smear + HPV testing together every __ years

HIV pts → pap-smear ___

A

21-65 → every 3 years
30-65 → co-test every 5 years
HIV pts → Yearly

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40
Q

Atypical squamous cells of undetermined significance (ASCUS) on Pap-Smear NBSIM?

> 30 yo ____

< 30 yo have 2 options
1. ______
2. _____

A

30+ → Colposcopy + Biopsy

<30
Colposcopy + Biopsy
or
<30 High-Risk HPV testing

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41
Q

27F High-Risk HPV testing
NBSIM for Negative Results?
NBSIM for Positive Results?

A

Negative → go back to regular pap-smear screening

Positive → Colposcopy + Biopsy

42
Q

Low/High Grade Squamous Intraepithelial lesions on pap-smear. NBSIM?

A

LSIL/HSIL → Colposcopy + Biopsy

At any age

43
Q

Atypical glandular cells on pap-smear.
NBSIM?

Prognosis?

A

Colposcopy w/ Biopsy
+
Endocervical Curettage
+
Endometrial Biopsy (Sampling)

(WORST finding on pap-smear; cancer everywhere)

44
Q

Ovarian tumor markers
Endodermal sinus/Yolk Sac:
Granulosa cell:
Sertoli-Leydig:
Choriocarcinoma:

A

Endodermal sinus/Yolk Sac → AFP
Granulosa cell → Estrogen
Sertoli-Leydig → Testosterone
Choriocarcinoma → Beta HCG

45
Q

22F Sudden onset R sided lower abdominal pain, N/V
pt has h/o ovarian cysts.
Dx?

A

Ovarian torsion
(Bc cysts can make ovary bulky)

(Transvaginal U/S + Doppler)

46
Q

22F Sudden onset R sided lower abdominal pain, N/V
pt has h/o ovarian cysts.
Free fluid is seen in the cul-de-sac
Dx/Dxt?

A

Rupture of Ovarian Cyst
Transvaginal U/S
(abdominal if option not there)

Supportive care (if blood flow is okay)

47
Q

An ovarian cyst on NBMEs should be interrogated with __ & __

NBSIM for:
•benign, asymptomatic cysts
• cysts with malignant featurs

A

Transvaginal U/S
CA-125 levels

NBSIM:
•monitor for a few cycles (2-3) then resect

•Laparoscopy/Laparotomy

48
Q

MCC of Ovarian cyst during pregnancy (especially 1st trimester).

A

Corpus Luteal Cyst (self resolves)

49
Q

12F w/ Calcified, smooth walled ovarian mass
Dx?

A

Teratoma (Dermoid Cysts)
(Mets to → Anterior Mediastinum)

(neurogenic tumors → posterior mediastinum)

50
Q

20s Female presents with severe nausea/vomiting & found to have an ovarian mass.
Dx?

A

Choriocarcinoma

(mass must be making B-HCG → hyperemesis)

51
Q

7F with Precocious puberty found to have an adnexal mass.
Dx?

A

Granulosa cell tumor
(mass must be making estrogen that makes girl go into puberty)

52
Q

Psammoma bodies in the ovaries
mcc of ovarian cancer

A

Serious Cystuadenocarcinoma

53
Q

20F with hirsutism & voice deepening found to have an adnexal mass.
Dx?

A

Sertoli Ley-dig cell tumor
(mass must be making Testosterone)

54
Q

20F with hirsutism & voice deepening
Pt has no adnexal masses and normal Testosterone levels
Dx?

A

Adrenal mass making DHEAS

55
Q

Signet ring cells pathognomonic for what cancer?

A

Krukenberg Tumor

(GI malignancy mets to ovary)

56
Q

Most likely presenting complaint in endometrial cancer?
Dx testing→
Tx→

A

Abnormal vaginal bleeding
Endometrial biopsy
Hysterectomy

57
Q

Endometrial cancer screening guidelines for pts with Lynch Syndrome (HNPCC)?

A

Annual endometrial biopsy
(ouch)

58
Q

BRF for uterine sarcoma?

A

h/o pelvic radiotherapy

59
Q
  1. Most important health hazard associated with menopause.
  2. MCC of Death in a postmenopausal female:
A
  1. Osteoporosis
  2. Cardiovascular Disease (HY)
60
Q

30F with Ehlers Danlos (Type 3/5 collagen problems) has chronic vaginal “heaviness”.
Dx/Tx?

A

Pessary
Pelvic organ prolapse

61
Q

Tx of common postmenopausal complications
Hot flashes:
Vaginal atrophy:
Osteoporosis:

A

Hot flashes→ HRT or Venlafaxine (if HRT c/i)

Vaginal atrophy → Estrogen creams/ Lubricants

Osteoporosis → Bisphosphonates (Risedronate Alendronate Zoledronic acid)

62
Q

17F is Depressed and irritable starting few days before her period has Pre-Menstrual Syndrome (PMS)
NBSIM?
1st Line Tx?

A

Start Symptom Diary
SSRIs (1st Line)
OCPs (2nd Line)

63
Q

In Adrenal Cortex Hemorrhage (Waterhouse Friederichsen syndrome) what is true of the following lab markers?
Cortisol:
ACTH:
Aldosterone:
Renin:
Angiotensin I & II:
Potassium:
Sodium:

A

Cortisol: ↓
ACTH: ↑ (no neg feedback)
Aldosterone: ↓
Renin: ↑
Ang 1/ 2: ↑
Potassium: ↑ (bc low aldosterone)
Sodium: ↓

64
Q

Per the NBMEs, when should colonoscopies be started?

A

45yo every 10 years

1º relative (+) FMH: start at 40 yo or 10 years earlier than when family was dx

65
Q

Per the NBMEs, when should breast cancer screening (mammogram) be started?

A

40yo

Every 1-2 years

(up until 74 then re-evaluate need)

66
Q

Per the NBMEs, how is osteoarthritis managed?
First line:
Second line:
3rd line:

A

First line: Weight loss and Exercise
Second line: Acetaminophen
3rd line: NSAIDs

If all these measures don’t work
First line: Injecting Steroid into Joint
2nd line: Joint Replacement

67
Q

Per the NBMEs, how is carpal tunnel syndrome managed?
1st line:
2nd line:

Dx test:
3rd line:

A

Wrist splint/straightening devices/ergonomic positioning

Inject steroids

Dx test: Nerve conduction study (before 3rd line tx)

Carpal tunnel release sx (cut Flexor Retinaculum)

68
Q

36M with 3 day history of fevers and arthralgias.
Has a red, itchy, non-tender rash on trunk and thighs
Recently, started rituximab 2 weeks ago for gastric maltoma.
Dx/Tx?
T__HSR

A

Serum sickness
T3HSR)
Tx: Stop offending agent or (if cant) steroid tx

Other Serum sickness causes: Antivenoms Anti-toxins
Drugs containing proteins/ABs

69
Q

Pt presents with RUQ pain + Fever & No Jaundice
Pt recently lost a lot of weight
Dx/Dxt (2)/Tx?

A

Acute cholecystitis
RUQ U/S (pericholecystic fluid, Bladder wall thickening)
If unclear → HIDA Scan (Hepatobiliary Scintigraphy)

Tx : Cholecystectomy + Ceftriaxone
(Cefotaxime or Ampicillin-Sulfabactam)
─────
Patho: Rapid weight loss produces high cholesterol → stone forms & occludes cystic duct

70
Q

Pt presents 2w post cholecystectomy w/ Abd pain
Elevated GGT/ALT
Dilated CBD on ultrasound
Dx?

A

High Yield
Retained Stone

(obstructive pattern ↑ GGT/ALP & ↑ D.Bili → dilates CBD)

71
Q

Pt presents 2w post cholecystectomy w/ Abd pain
Elevated GGT/ALP &
↑ Direct Bilirubin
Normal CBD on ultrasound
Dx?

A

Bile Peritonitis

(failed anastomosis → bile anastomotic leak)

72
Q

Dx test is the right answer when choledocolithiasis is highly suspected but U/S is negative for CDB dilation.

A

MRCP

73
Q

Increased indirect bilirubin causes (3)

A

Hemolysis

Gilbert Syndrome (mild def of UDP-GP; illness get juandiced. No tx)

Crigler Najar (Def of UDP-GP)

74
Q

Increased direct bilirubin causes (3)

A

Obstructive liver disease

(PBC, PSC, Choledocolithiasis)

75
Q

Elevated hematocrit (2)

A

P. Vera (EPO low)
EPO tumor (RCC, HCC, Hemangioblastoma)

76
Q

CSF Xanthochromia (>900) causes

A

HSV encephalitis/meningitis
Subarachnoid Hemorrhage

77
Q

Increased alkaline phosphatase
(some causes- not all)

A

•Obstructive liver disease

•Cholangiocarcinoma,

•Pancreatic Cancer

78
Q

Increased Gamma glutamyl transferase
causes
(list 2, not an exhaustive list)

A

•Alcoholic liver dz

• Obstructive liver dz

79
Q

CSF opening pressures > 200 Crazy High
Fat + Female
dx/dxt/tx?

A

Pseudotumor Cerebri (Idiopathic intracranial HTN)
Dx via LP
Tx: Serial LP
Acetazolamide (bc Carbonic Anhydrase is needed for CSF production)

80
Q

↑ 200 wbc’s in CSF
90% lymphocytes
slightly ↑ opening pressures
dx?

A

Viral aseptic meningitis

81
Q

↑↑↑ 800 wbc’s in CSF
90% Neutrophils
markedly ↑↑↑ opening pressures
↓ Glucose
dx?

A

Bacterial meningitis

82
Q

↑↑ 700 wbc’s in CSF
90% lymphocytes
markedly ↑↑↑ opening pressures
Dx?

A

Fungal or TB meningitis

83
Q

Elevated homocysteine levels in a 12 yo F with a h/o sickle cell dz

A

Folate Deficiency

84
Q

Antibody against the constant region of the IgG antibody

A

RF Factor
IgM against constant IgG part = rheumatoid factor

85
Q

Why Elevated BUN in a patient with hemoptysis

A

bc GI bleed causes increased BUN (bc bacteria broken down to urea)

86
Q

Elevated Calcium in an old guy with bone pain and pathologic fractures

A

Prostate cancer

87
Q

Decreased calcium in a 25 yo F with a history of foul smelling diarrhea and pernicious anemia .

A

Malabsorption s/t Celiac disease (young pt)

88
Q

Elevated creatine kinase after surgery of any sort .
Dx/Tx?

A

Malignant Hyperthermia s/t Anesthesia
Dantrolene (Ryanodine Ca channel blocker)

89
Q

Decreased bicarbonate 3 days after admission to the hospital in a diabetic. All his home medications were continued on admission .

A

Metformin toxicity (lactic acidosis)

90
Q

Elevated FSH in a 38 yo F .

A

Pre-mature ovarian failure

Under age 40 FSH should not be high.

91
Q

Markedly elevated serum ferritin in a patient with new onset diabetes and restrictive cardiomyopathy.
Dx/Tx/Mutation?

A

Hereditary Hemochromatosis → Bronze Diabetes
(have ↑ Ferritin & Iron)
HFE gene mutation C282y mutation
Tx: Phlebotomy regularly

92
Q

_____ can cause hand arthritis that looks exactly like OA
(joint narrowing, osteophytes, calcifications),
but presents at <40 yo.
Tx: Phlebotomy.

A

Hemochromatosis

93
Q

Elevated PT/INR → (3)

A

Warfarin, Heparin, DIC

94
Q

Elevated PTT → (6)

A

Warfarin, Heparin, DIC
vWB dz
Hemophilia A & B

95
Q

Flank pain radiating to the groin in a Crohn’s disease patient?

A

Crohn’s always messes up terminal ileum → so you reabsorb more Oxalate → Calcium Oxalate stones

(Anti-freeze causes these stones too)

96
Q

Fever, abdominal pain, and leukocytosis
after colectomy with ileoanal anastomosis for Ulcerative Colitis
Dx/NBSIM?

A

Anastomotic Leak → Ex-Lap

97
Q

Initial treatment of hypercalcemia is

A

normal saline

(after that you can start calcitonin)

98
Q

Osteopenia can hide the detection of small fractures on x-ray, if they are suspected after a fall/trauma NBSIM is:

A

MRI or CT scan

99
Q

Wernicke’s encephalopathy
Confusion, Ataxia, Nystagmus (CAN of beer)
↑ MCV
± abnormal B12 (cobalamin) & B9 (folate) levels

tx/cx

A

Tx: Thiamine supplementation
Cx: Korsakoff Dementia (irreversible)
confabulation, amnesia, psychosis

100
Q

Chronic osteomyelitis
soft tissue infection ± purulent draining sinus tract to skin
indolent infection with gradually increasing pain + weight loss
confirmatory test →

A

bone biopsy

101
Q

Most common Long-term pediatric complication of bacterial meningitis

A

Hearing loss
(rarely, seizures)

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