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STEP 2 CK > Medicine UWorld > Flashcards

Medicine UWorld Flashcards

1
Q

Paget Disease of the bone

A

Most patients are asymptomatic.
Bone pain and deformity - headache and hearing loss, spinal stenosis, radiculopathy, bowing, fractures, arthritis.
Giant cell tumor, osteosarcoma.

Results as an osteoclast dysfunction and increased bone turnover.

Labs - Elevated alkaline phosphatase and bone turnover markers (PINP, urine hydroxyproline).
Calcium and phosphorus are normal.

Treat with bisphosphonates.

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2
Q

What are the typical imaging findings of Paget Disease of the Bone?

A

XR: Cortical thickening with osteolytic or mixed lytic/sclerotic lesions

Bone scan: increase uptake

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3
Q

Bacillary Angiomatosis

A

Immunocompromised patients - HIV with CD4 <100
Bartonella henselae/quintana (Gram negative) from cat exposure or homelessness (lice)

Vascular cutaneous lesions, systemic symptoms, organ involvement

Diagnose with lesional biopsy and microscopy/histopathology

Treat with doxycycline or erythromycin plus antiretroviral therapy

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4
Q

What are the common drugs associated with pancreatitis?

A 
Anti-epileptics - Valproic acid
Diuretics - furosemide, thiazides
IBD - sulfasalazine, 5-ASA
Asothioprine
HIV - didanosine, pentamidine
Antibiotics - metronidazole, tetracycline
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5
Q

What is the MOA of Methotrexate? What are its side effects? How can side effects be prevented?

A

Inhibits Dihydrofolate Reductase - DMARD

SE: macrocytic anemia, pancytopenia, nausea, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia, fever

Prevent SE with folic acid supplementation

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6
Q

Chronic Pancreatitis

A

Alcohol, cystic fibrosis, ductal obstruction (stones, malignancy), autoimmune

Chronic epigastric pain, malabsorption, steatorrhea, weight loss, diabetes mellitus

Amylase and lipase may not be helpful, CT scan for diagnosis (pancreatic calcifications)

Treat with pain management, alcohol and smoking cessation, frequent and small meals, pancreatic enzyme supplements

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7
Q

What is the presentation of botulism toxicity? What is the treatment? What is the pathogenesis?

A

Acute onset within 36 hours of ingestion.
Bilateral cranial neuropathies: blurred vision, diplopia, facial weakness, dysarthria, dysphagia.
Symmetric descending muscle weakness.
Diaphragmatic muscle weakness with respiratory failure.

Treatment requires equine serum heptavalent botulinum antitoxin.

Preformed toxin that inhibits presynaptic acetylcholine release at the neuromuscular junction.

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8
Q

Polymyalgia Rheumatica

A

Age >50
Bilateral pain and morning stiffness (proximal)
Constitutional symptoms
Decreased active ROM in the shoulders, neck, hips
ESR >40
Elevated CRP
Normocytic Anemia

Treat with oral glucocorticoids

Associated with temporal arteritis

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9
Q

What is the treatment for sporotrichosis?

A

Dimorphic fungus

3-6 months of itraconazole

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10
Q

What electrolyte abnormalities are seen in Addison’s disease?

A

Hyponatremia
Hyperkalemia
+/- hyperchloremic acidosis

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11
Q

What is the management of ARDS?

A

Mechanical ventilation with low TV, high PEEP, and permissive hypercapnia.

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12
Q

Renal vein thrombosis is a complication of what?

A

Nephrotic syndrome - most commonly membranous glomerulopathy

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13
Q

Corrected serum calcium

A

Carried by albumin in the blood
decreased 0.8 for every 1 decrease in albumin

= (measured total calcium) + 0.8 (4.0 - serum albumin)

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14
Q

Pathophysiology of Bullous Pemphigoid

A

IgG autoantibodies against the hemidesmosome and basement membrane

Linear IgG and C3 deposits at the dermal-epidermal junction on DIF

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15
Q

What is the first line treatment of Bullous Pemphigoid?

A

High-potency topical steroids like clobetasol

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16
Q

What part of the esophagus does adenocarcinoma usually affect?

A

Distal, near the G-E junction, secondary to Barrett esophagus and chronic GERD

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17
Q

What part of the esophagus is affected by squamous cell carcinoma? What are the risk factors?

A

Anywhere in the esophagus

Heavy alcohol and smoking

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18
Q

Effects of glucocorticoids on the HPA axis?

A

Suppress secretion of corticotropin-releasing hormone from the hypothalamus and ACTH from the pituitary.

Sudden discontinuation of glucocorticoids can lead to central adrenal insufficiency.

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19
Q

Oligoclonal bands in a CSF sample:

A

Multiple Sclerosis

20
Q

14-3-3 protein on CSF sample:

A

Creutzfeldt Jakob Disease

21
Q

CSF findings in Guillan-Barre:

A

Albuminocytologic Dissociation (elevated CSF protein with a normal cell count)

22
Q

Monoclonal M-Spike

A

Waldenstrom Macroglobulinemia

Confirmation with bone marrow biopsy showing >10% clonal B cells

23
Q

What are the symptoms of Waldenstrom Macroglobulinemia?

A

Hyperviscosity syndrome (diplopia, headache, dilated/segmented fundoscopic findings)
Neuropathy (electric sensations)
Evidence of infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia)

24
Q

What are P2y12 receptor blockers?

A

Anti-platelets - Clopidogrel, Prasugrel, Ticagrelor

Dual antiplatelet therapy is recommended for 12 months after drug-eluding stent placement.

25
Q

What is endophthalmitis?

A

Bacterial or fungal infection of the eye, particularly the vitreous part.
Present with pain and decreased visual acuity.
Exam: swollen eyelids and conjunctiva, hypopyon (collection of pus in the anterior chamber)

26
Q

Tabes Dorsalis

A

Damage of the dorsal sensory roots and secondary degeneration of the dorsal columns.

Presents with sensory ataxia, lancinating pains, neurogenic urinary incontinence, Argyll Robertson pupils (normal constriction with accommodation but not with light)

27
Q

What are common extrapulmonary sites for TB?

A

liver, spleen, kidney, bone, adrenal gland

28
Q

Common infectious cause of primary adrenal insufficiency in endemic areas?

A

TB

Other granulomatous diseases as well

29
Q

What are the electrolyte abnormalities in chronic adrenal insufficiency?

A

Hyponatremia
Hyperkalemia
Hypercalcemia

Normal anion gap hyperkalemic, hyponatremic, metabolic acidosis

30
Q

Cough, fever, dyspnea, pulmonary infiltrates while on amiodarone:

A

Amiodarone toxicity

Causes chronic interstitial pneumonitis

31
Q

Epidural hematoma

A

Meningeal artery

Biconvex hemorrhage, does not cross suture lines

32
Q

Subarachnoid Hemorrhage

A

Ruptured saccular aneurysm

33
Q

Subdural Hematoma

A

Rupture of bridging veins

Concave hemorrhage, crosses suture lines

34
Q

Lacunar Stroke

A

Microatheroma formation and lipohyalinosis in the lenticulostriate vessels of the internal capsule

35
Q

Bath Salt Intoxication

A

Agitation, combativenss, psychosis, delirium, myoclonus, seizures
Prolonged duration of intoxication - lasts days after ingestion
Not on routine tox testing

36
Q

Phencyclidine (PCP) Intoxication

A

Psychomotor agitation, combativeness, diminished pain perception, hallucinations, hypertension, tachyardia, multidirectional nystagmus
Shorter duration than bath salts
Included in standard tox screens

37
Q

Marjolin Ulcer

A

SCC that develops at the site of a wound or burn, increased risk of metastasis

38
Q

Expansile and eccentric lytic area (soap bubble) at the bone epiphysis in a young patient:

A

Giant Cell Tumor of the Bone

39
Q

Osteitis Fibrosa Cystica

A

Commonly due to hyperparathyroidism from parathyroid carcinoma

Bone is replaced by fibrous tissue (brown tumors) and there is bone pain

Subperiosteal bone resorption on the radial aspects of the middle phalanges, clavicular tapering, salt and pepper skull, bone cysts, and brown tumors of the long bones

40
Q

Osteoid Osteoma

A

Sclerotic, cortical lesion on imaging with a central nidus of lucency
Pain that is worse at night and unrelated to activity, relieved by NSAIDs

41
Q

Most common cause of secondary bacterial pneumonia (post-influenza) in young adults:

A

Staph aureus - likely community associated MRSA

Severe, necrotizing pneumonia that is rapidly progressive and may be fatal

42
Q

What are the side effects of radioactive iodine ablation for hyperthyroidism?

A

Permanent hypothyroidism
Worsening occular problems - titers of TRAB (thyrotropin receptor antibodies) increase after RI ablation leading to worsening of ophthalmopathy
Radiation side effects

43
Q

What is the cause of Grave’s Ophthalmopathy?

A

Effects of activated T cells and thryotropin receptor antibodies (TRAB) on TSH receptors on retro-orbital fibroblasts and adipocytes

44
Q

How do you decrease worsening of Grave’s Ophthalmopathy with RI ablation?

A

Administer glucocorticoids

Thyroidectomy if moderate to severe Grave’s

45
Q

Crypt abscesses on colonoscopy:

A

ulcerative colitis

46
Q

Intestinal villous atrophy on colonscopy:

A

Celiac disease

47
Q

Perianal fistula:

A

Crohn’s disease

STEP 2 CK (5 decks)

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