Level 3 Flashcards
T score between -1.0 and -2.5
Osteopenia
Idiopathic avascular necrosis of the femoral head in a child; mild pain, limp, and Trendelenburg gait
Legg-Calve-Perthes disease
Most common cause of osteomalacia
Vitamin D deficiency
Osteoporosis is diagnosed with a DEXA T score below
-2.5
Subarachnoid hemorrhage is treated with which medication?
Nimodipine (calcium channel blocker)
Drug of choice for patients with subarachnoid hemorrhage and severely elevated BP
Labetalol
The blue-dot sign is pathognomonic for this condition
Torsion of the appendix testis (remnant of the paramesonephric duct)
Adult polycystic kidney disease is associated with
berry aneurysms, hepatic cysts, and thoracic aortic aneurysms
Goals of tx of hyperkalemia
1) Membrane stabilization (calcium chloride or gluconate)
2) Shift of K into cells (beta-agonist, IV sodium bicarb, or insulin + glucose)
3) Excretion (furosemide, sodium polystyrene sulfonate)
Charcot’s triad
Fever, Jaundice, RUQ pain
Reynold’s pentad
Fever, Jaundice, RUQ pain, AMS, hypotension
Patient presents with jaundice and pruritis, and is associated with Ulcerative Colitis
Primary Sclerosing Cholangitis
Inactivation of neutrophil elastase is associated with
alpha-1 antitrypsin deficiency
Primary ciliary dyskinesia and situs inversus
Kartagener syndrome
Most important and accurate test to make the diagnosis of acute pancreatitis
CT scan
Most common cause of acute pancreatitis
Gallstones
Presents as red, itchy, macerated plaques and erosions within the skin folds; a border of fine scale as well as satellitle papules and pustules
Candidal intertrigo
Most commonly presents with abdominal pain, neuropathy, and non-specific psych symptoms; no rash; Urine porphobilinogen and aminolevulinic acid will be elevated
Acute intermittent porphyria
Neuroendocrine tumor that typically arises in the midgut (appendix) and releases serotonin; flushing, abdominal pain, and diarrhea; urine levels of 5-hydroxyindoleacetic acid (5-HIAA) will be increased
Carcinoid tumor
Most common cause of postpartum hemorrhage
Uterine atony
Treatment of uterine atony starts with
uterine massage
Uterotonic drugs: oxytocin, carboprost, misopristol, and methylergonovine
Patients with pellagra commonly display
Dermatitis, Diarrhea, and Dementia (niacin deficiency)
The majority of renal calculi are
calcium stones
Used to treat ethylene glycol and methanol intoxication
Fomepizole (competitive inhibitor of alcohol dehydrogenase)
CHA2DS2-VASc
Congestive heat failure Hypertension Her (female sex) Age Diabetes Stroke (hx) Vascular disease (hx)
Blowing holosystolic murmur heard best at the left lower sternal border that increases with inspiration
Tricuspid regurgitation
Most common benign tumor in women
Leiomyomas
A process in which a left to right cardiac shunt reverses to a right to left shunt due to pulmonary HTN
Eisenmenger syndrome (most commonly due to a large, VSD or ASD)
Most common infection causing aplastic crisis in patients with sickle cell disease
Parvovirus B19
Renal biopsy shows IgG and C3 deposits as the basement membrane, with a “spike-and-dome” appearance
Membranous Glomerulonephritis
Erb-Duchenne’s palsy is caused by injury to which nerve roots?
C5-C6 (most common)
Klumpke’s palsy is caused by injury to which nerve roots?
C8-T1
Treatment of choice for central diabetes insipidus
Desmopressin
Best initial test for acromegaly
Insulin-like growth factor (IGF)
First lab to be increased after the induction of warfarin
PT/INR
Treatment of choice for H pylori
Amoxicillin, clarithromycin, and a PPI
Medications commonly implicated in drug-induced Lupus
Hydralazine, isoniazid, procainamide, penicilliamine
Caused by injury to C8-T1 nerve root causing Horner’s syndrome, ulnar nerve distribution numbness, and paralysis of the intrinsic muscles of the hand
Klumpke’s Paralysis
Most sensitive test for ruling out drug-induced lupus erythematosus
Anti-histone antibodies
Anti-thyroid-stimulating hormone (TSH) receptor antibodies are diagnostic of this condition
Graves disease
Anti-thyroid peroxidase (TPO) antibodies or anti-thyroglobulin antibodies are diagnostic of this condition
Hashimoto thyroiditis
Patient wants treatment for depression but low risk of sexual side effects
Bupropion
Atypical antidepressant that is contraindicated in patients with eating disorders
Bupropion
The Five W’s of post-op fever
Wind (atelectasis) Water (UTI) Wound (Infection) Walking (DVT) Wonder drugs (Med reaction)
Pinworm; can cause symptoms of appendicitis; associated with nocturnal pruritus ani (anal itching)
Enterobius vermicularis
Muscle shortens
Concentric
Muscle lengthens
Eccentric
The most specific tests for SLE
anti-Smith Ab and anti-dsDNA
Most sensitive test for ruling out SLE
antinuclear antibody (ANA)
First-line tx for Alzheimer’s
Donepezil, rivastigmine, or galantamine
Primitive neuroectodermal tumor most often arising in the diaphysis of extremity long bones in male patients; small round blue cells with hyperchromatic nuclei and minimal clear cytoplasm
Ewing sarcoma
Lymph nodes that drain the ovaries and testes
Para-aortic lymph nodes
Port wine stain of the face and seizures
Sturge-Weber (look for homonymous hemianopia)
Autosomal dominant disorder that is characterized by the combination of medullary thyroid carcinoma, primary hyperparathyroidism, and pheochromocytoma
MEN 2A Sipple Syndrome
Treatment of thyroid storm is with
PTU or methimazole
Patients should be evaluated __________ weeks after initiating treatment with levothyroxine
4-6 weeks
What is the diagnostic method of choice for lesions suspicious for malignant melanoma?
Excisional biopsy
The prognosis for malignant melanoma is related to
the depth of invasion (Breslow thickness)
Sinusoidal heart rate pattern on fetal tracing indicates
severe fetal anemia, usually due to Rh isoimmunization or severe hypoxia
Late decelerations are caused by
uteroplacental insufficiency
Umbilical cord compression causes
variable decelerations
Pressure of the fetal head causes
early decelerations
Most specific tests for RA
anti-CCP antibodies and radiographic findings
Infectious epididymitis in patients under 35 is most often caused by
Chlamydia trachomatis and Neisseria gonorrhoeae
Most common cause of infectious epididymitis in patients of 35 y/o
E. coli
Most likely breast cancer to be missed on mammography, even with a palpable lesion
Invasive lobular carcinoma
Most common type of breast cancer
Invasive ductal carcinoma
Most common cause of bloody nipple discharge
Intraductal papilloma
Most common type of testicular germ cell tumors and malignancy in patients between 15-35 y/o
Seminoma (“fried-egg appearance”)
Most common testicular cancer in prepubescent males; always presents with significantly elevated AFP levels
Yolk sac (endodermal sinus) tumor; may reveals Schiller-Duvall bodies
Which types of HPV causes the majority of genital warts?
6&11
Which types of HPV causes the majority of cervical cancers?
16&18
First-line pharmacological treatment for OCD
SSRI
Drug of choice for essential tremor
Propranolol
Fat embolism is associated with a(n)
petechial rash
The therapy of choice for TTP is
plasma exchange (FAT RN) Fever, Anemia, Thrombocytopenia, Renal disease, Neuro dysfunction
ADAMTS13 deficiency
Most common fungal cause of otitis externa
Aspergillus niger
Most common risk factor for dementia
Age
Most common cause of meningitis in adults?
S. pneumonia
Very common cause of meningitis in neonates
Group B Strep
Meningitis associated with recent brain surgery or indwelling cath
Staph
Immunocompromised or elderly patient with meningitis
Listeria
Lymphocytes are more specific to which type of meningitis?
Viral
Bacterial meningitis should be treated with
vancomycin, ceftriaxone and steroids
Chemoprophylaxis with rifampin or cipro is also recommended for close contacts
A disorder of the breast in which the mammary duct becomes clogged. Classically, patients present with unilateral greenish nipple discharge. The discharge can also be bloody. Mostly seen in menopausal women and can mimic the presentation of breast cancer.
Ductal ectasia
Renal biopsy in a patient with Henock-Schonlein Purpura reveals
IgA deposits
MRSA is a S. aureus species with an oxacillin MIC greater than
4 mcg/mL
What is the abx of choice in invasive MRSA infections, particularly in immunocompromised patients with comorbidities?
IV vancomycin
Coarctation of the aorta most commonly occurs
just distal to the left subclavian artery
Treating delirium tremens (three B’s)
Benzo, Beta blocker, Banana bag (thiamine/folate)
Urine 5-hydroxyindoleacetic acid level (5-HIAA)
Used when carcinoid tumor is suspected
Urinary metanephrine level
Used to diagnose pheochromocytoma
Most common etiology of spontaneous bacterial peritonitis (diagnosed when PMN count > 250
E. coli (Klebsiella is the second most common cause)
Occurs when IgA and the gliadin protein combine, forming an immune complex that is deposited along the papillary dermis; transglutaminase antibodies
Dermatitis herpetiformis
Anti-hemidesmosome antibodies are seen in
bullous pemphigoid
What is the tx of choice for dermatitis herpetiformis
Dapsone
What CHF med causes transient excess brightness of vision?
Ivabradine (SA nodal inhibitor)
Muscle weakness associated with carpal tunnel syndrome can be noted in the LOAF muscles
Lumbricals one and two, Oppens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
Homozygous C282Y HFE gene mutation
Hereditary Hemochromatosis
Dystrophic bone disorder in which elevated levels of phosphate and lowered levels of calcium combine to incrase serum PTH levels; seen in patients with kidney failure
Renal ostedystrophy
Patients with a family hx of FAP without genetic proof of disease should undergo annual flexible sigmoidoscopy or colonoscopy starting at
puberty
Infants with confirmed sickle cell disease should receive
twice-daily penicillin V until at least 5 years of age
Monosodium urate crystals which have strong negative birefringence and are needle-shaped
Gout
First-line therapy for mild to moderate rosacea
Combo of topical metronidazole and topical azelaic acid
Lead toxicity is best treated with
Succimer, EDTA and dimercaprol
Reccurent, spontaneous abortions should raise suspicion for
antiphospholipid syndrome
Decreased hemoglobin, decreased MCV, decreased iron, decreased TIBC, decreased transferring and high-normal or increased ferritin
Anemia of Chronic Disease
Increased reticulocyte count, increased RDW, decreased haptoglobin, elevated LDH, and indirect hyperbilirubinemia
Hemolytic anemia
Most common inherited hyperbilirubinemia; Mutation in the promoter region of UGT1A1 gene → ↓ activity of UDP-glucuronosyltransferase→ decreased conjugation of bilirubin → ↑ indirect bilirubin
Gilbert syndrome
UDP-glucuronosyltransferase activity is (almost) absent; ↑↑ Indirect bilirubin (20–50 mg/dL)
Crigler-Najjar Syndrome
Defective MRP2 transporter; → impaired movement of conjugated (direct) bilirubin from the hepatocyte to the bile canaliculi; Liver biopsy: darker granular pigmentation
Dubin-Johnson syndrome
Defective organic anion transport proteins (OATP) 1B1 and 1B3 in hepatocytes → impaired transport and reduced storage capacity of conjugated (direct) bilirubin; ; ↑ Urinary coproporphyrins I and III (fraction of isomer I < 70% of total)
Rotor syndrome
First line treatment for ascites
Spironolactone and/or furosemide
What tests should be ordered when breast cancer is confirmed?
- HER2 overexpression
- ER expression
- PR expression
- CBC
- Alanine aminotransferase
- Aspartate aminotransferase
- Alkaline phosphatase
- Sentinel lymph node biopsy
What is the best therapy for dermatitis herpetiformis?
Dapsone and a gluten-free diet
Post-resptococcal glomerulonephritis is caused by
Skin infections (impetigo) or pharyngitis
Rheumatic fever generally only comes after
Strep pharyngitis
Imbalance of the normal vaginal bacterial; presents with increased vaginal discharge that is thin and gray-white with a fish odor; vaginal pH increases to greater than 4.5; clue cells
Bacterial vaginosis
Presents with a green and frothy vaginal discharge, vaginal itching or burning, and pain with intercourse; actively motile protozoa
Trichomonas
Postcoital contraception should be used within how many hours of coitus?
72 hours
Anti-transglutaminase IgA and anti-endomysium IgA are useful screening tests for
Celiac disease
A patient whom overdoses on acetaminophen and presents after 8 hours should be given
N-acetylcysteine
Pharmacologic treatment for SIADH
Tolvaptan, conivaptan
Hand, foot and mouth disease is most commonly caused by
Coxsackie A virus
High fever which then resolves and then a maculopapular rash develops on the trunk, spreads to the neck
HHV-6; roseola infantum
Abdominal distension, failure of passage of meconium within the first 48 hours of life, and bilious vomiting
Hirschsprung disease (rectal biopsy will reveal absence of ganglionic cells)
This procedure is indicated for patients with significant left main coronary artery disease (more than 70% stenosis) or triple-vessel disease that cannot be treated with PCI
Coronary bypass
May cause DM, necrolytic migratory erythema, weight loss and diarrhea
Glucagonoma
First-line treatment for tinea capitis
Oral griseofulvin or oral terbinafine
Feigning of an illness in order to achieve a secondary gain, which may include getting sick leave from work, applying for disability, acquiring drugs, or looking for accommodation in the hospital
Malingering
Characterized by the conscious production of signs and symptoms in order to assume the “sick role”
Factitious disorder (Munchausen)
Autosomal dominant disease characterized by multiple vascular malformations, including AVM’s that can occur anywhere; telangiectasias on the tongue
Osler-Weber-Rendu
Pheochromocytoma should first be treated with
phenoxybenzamine (alpha blocker) before beta blocker
Treatment of choice for small cell lung cancer
Chemotherapy +/- radiation
Chest x-ray reveals an “egg-on-string appearance”; large, void-shaped heart and a narrow mediastinum
Transposition of the great vessels
Classic boot-shaped heart on X-ray
Tetralogy of Fallot
Chest x-ray will reveal a “snowman” appearance
Total anomalous pulmonary venous return
Tumor of the pancreas that causes watery diarrhea, hypochlorhydria, and hyperglycemia
VIPoma (vasoactive intestinal polypeptide); treat with octreotide
Which deficiency results in decreased calcium and phosphate absorption?
Vitamin D deficiency
Caused by target organ resistance to PTH; pt’s will have hypocalcemia, elevated phosphate, and elevated PTH
Pseudohypoparathyroidism
A rare inherited disorder characterized by the combination of primary brain tumors and colorectal cancer or polyposis. Associated with familial adenomatous polyposis (mostly medulloblastomas) and Lynch syndrome (mostly gliomas)
Turcot’s syndrome
Atypical antipsychotic typically avoided due to its side effect of agranulocytosis
Clozapine
Which medication can be used to augment therapy when MDD is resistant to monotherapy with antidepressants?
Lithium
Hepatic vein obstruction that leads to hepatomegaly, ascites, and abdominal discomfort. It is most commonly due to a thrombotic occlusion secondary to a chronic myeloproliferative neoplasm (e.g., polycythemia vera), but may be caused by other conditions associated with hypercoagulable states. The obstruction of blood flow causes congestion of the liver with subsequent liver cell damage resulting in progressive liver failure.
Budd-Chiari syndrome
What type of hyperbilirubinemia results in elevated levels of urine urobilinogen?
Conjugated
Only curative treatment of carcinoid syndrome
Surgery (look for episodic cutaneous flushing, wheezing, intestinal cramping, diarrhea and liver lesions)
Positive antimitochondrial antibodies
Primary biliary cirrhosis
First-line treatment for hemochromatosis
Chronic phlebotomy
The constellation of Convulsions, Confusion/Coma, and Cardiac Conduction irregularities
TCA overdose
When to begin prophylaxis for P jiroveci (PCP) pneumonia
CD4 < 200 (TMP-SMX)
When to begin prophylaxis for toxoplasmosis
CD4 < 100 (TMP-SMX)
When to begin prophylaxis for mycobacteria avium-intracelullare
CD4 <50 (azithromycin)
Ulcerative colotis should be treated with
5-ASA (mesalamine) or sulfasalazine
Initial step in the evaluation of primary hyperaldosteronism (Conn syndrome)
Plasma aldosterone-to-renin ratio
All Bacterial Meningitis gets empiric:
+Ceftriaxone, +Vanc, +Steroids, +/- Ampicillin
CRAFFT screen for peds
Car, Relax, Alone, Forget, Friends, Trouble
Allergic rhinitis, asthma, blood eosinophilia and positive p-ANCA
Churg-Strauss syndrome
Most specific test for CREST syndrome
Anti-centromere antibodies
Male adolescent with absent puberty, poor sense of smell, and undectable LH/FSH levels
Kallman syndrome
Occurs after extensive postpartum hemorrhage; anterior pituitary hormones will be decreased
Sheehan’s syndrome
Caused by antibodies against nicotinic acetylcholine receptors, leading to muscle weakness, particularly after continued use
Myasthenia gravis
A congenital disorder caused by microdeletion on the long arm of chromosome 22. The clinical presentation is variable and includes features such as congenital heart defects, craniofacial abnormalities, and/or defective development of the third and fourth pharyngeal pouches, resulting in hypoplastic thymus and parathyroids
DiGeorge Syndrome
A genetic condition in which a male inherits one (~ 80%) or more additional X chromosomes (47 XXY, 48 XXXY, etc), causing decreased serum testosterone. Typical presentations include a tall/slender frame, sparse pubic hair, decreased muscle bulk, infertility, and gynecomastia.
Klinefelter syndrome
Osteomyelitis in a patient with sickle cell disease is most likely due to
Salmonella
Due to an adrenal adenoma or adrenal hyperplasia that increases the secretion of aldoserone; hypernatremia, hypokalemia, and mild metabolic alkalosis
Conn syndrome
Respiratory and craniosacral motion
Superior transverse axis
Postural motion
Middle transverse axis
Innominate rotation
Inferior transverse axis
Seborrheic dermatitis is caused by
Malassezia overgrowth
Chelation therapy is recommended for children with serum lead levels greater than
45 ug/dL; succimer is the chelating agent of choice
Hospital admission for IV chelation therapy is recommended for children with serum lead levels greater than
70 ug/dL
Gastrinomas are most commonly found
in the duodenum (increase in fasting serum gastrin)
Ratio of the risks of exposure to non-exposure in the development of a disease and is used in cohort studiets
Relative risk
Most classical additional lab finding in leukemoid reaction is
increased leukocute alkaline phosphatase
Smudge cells; lymphocytes express CD5
Chronic lymphoblastic leukemia (CLL)
9;22 translocation; Philadelphia chromosome; results from formation of a bcr-abl fusion gene
Chronic myelogenous lekuemia (CML)
Helpful tumor marker to support the diagnosis of pancreatic cancer
CA 19-9
Migratory superficial thrombophlebitis
Trousseau’s syndrome
Pancreatic cancer is most often located
in the pancreatic head
Heliotrope rash and Gottron papules
Dermatomyositis
OCD is treated with
CBT plus clomipramine (TCA) or an SSRI
Risk factors for colorectal cancer
Alcohol use, insulin resistance, obesity, red meat consumption, tobacco use
Tympanostomy tube otorrhea is treated with
topical abx drops: ofloxacin or cipro-dexamethasone
Congenital infection that causes sensorineural hearing loss and periventricular calcifications
Congenital cytomegalovirus
Early presents with maculopapular lesions on the palms and soles, rhinitis (snuffles), heaptosplenomegaly and jaundice. Late manifests with frontal bossing of the head, saddle-nose deformity, keratitis, sensorineural hearing loss and Hutchinson teeth
Congenital syphilis
Which deficiency results in demyelination of the dorsal columns and lateral corticospinal tracts of the spinal cord?
Vitamin B12 deficiency
Bilateral loss of pain and temperature on the back; “cape-like”
Syringomyelia
Most important treatable risk factor for stroke
Hypertension
Vasculitis that primarily affects the upper and lower respiratory tracts and kidneys resulting in nephritic syndrome; rhinitis; hemoptysis and a positive c-ANCA finding; anti-glomerular basement membrane antibodies
Granulomatosis with polyangiitis
Esophageal web formation, glossitis, koilonychia and anemia
Plummer-Vinson syndrome
RhoGAM is administered to all Rh-negative women at how many weeks’ gestation?
28 weeks
Most appropriate treatment for GI volvulus
Sigmoidoscopy
Acquired by eating contaminated raw or undercooked fish; preferentially uses vitamin B12 as a source of nutrition, causing deficiency in thehost
Diphyllobothrium latum
Croup (laryngotracheitis) is most commonly caused by
Parainfluenza virus type 1
A fall on outstretched hands results in what type of radial head dysfunction?
Posterior radial head
First-line for prevention of seizures in children with juvenile myoclonic epilepsy or absence epilepsy
Valproate
First-line pharmacologic therapy for narcolepsy
Modafinil
Most specific test for pancreatic cancer
ERCP
Ribs 1-5 rotate around a
transverse axis
Ribs 6-10 rotate around a
AP axis
