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Mixed 4 Flashcards

1
Q

What is the cause of primary dysmenorrhea?

A

Excessive prostaglandin production -> uterine hypercontractility, hypertonicity, ischemia

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2
Q

Risk factors for primary dysmenorrhea?

A 
Age <30
BMI <20
Tobacco use
Menarche at age <12
Heavy/long menstrual periods
Sexual abuse
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3
Q

Presentation of primary dysmenorrhea?

A

Pain first 2-3 days of menses (lower abdominal pain, may radiate to back/thighs)
N/V, diarrhea, malaise, dizziness, GI symptoms
Normal pelvic exam

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4
Q

First-line treatment of primary dysmenorrhea?

A

Non-sexually active patients - NSAIDs (inhibit prostaglandin synthesis)

Sexually active - combined OCs (suppress ovulation)

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5
Q

Routine monitoring for the development of what side effects is recommended in patients taking second-generation antipsychotics. Which 2 are associated with the greatest risk?

A

Weight gain, hyperglycemia, dyslipidemia

Olanzapine and clazpine

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6
Q

Which labs should be ordered to monitor patients taking second-generation antipsychotics? Schedule?

A

BMI
Fasting glucose and lipids
Blood pressure
Waist circumference

Baseline, 3 months, annually (earlier and more frequent monitoring is recommended for patients with DM and those who have gained >5% of initial weight)

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7
Q

What maneuvers cause decreased preload?

A

Valsalva (strain)
Abrupt standing
Nitroglycerin administration

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8
Q

What maneuvers cause increased afterload?

A

Sustained hand grip

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9
Q

What maneuvers caused increased preload?

A

Passive leg raise

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10
Q

What maneuvers cause increased afterload and preload?

A

Squatting

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11
Q

Hypertrophic cardiomyopathy is defined as left ventricular hypertrophy and normal chamber size without a clear etiology. What causes it?

A

Asymmetrical left ventricular hypertrophy -> left ventricular outflow tract obstruction

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12
Q

Inheritance pattern of HCM?

A

Autosomal dominant

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13
Q

Physical exam findings of HCM?

A

Carotid pulse with dual upstroke (due to midsystolic obstruction during cardiac contraction)

Systolic ejection murmur along the left sternal border with a strong apical impulse

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14
Q

Discuss the physiology that causes the changes in murmur intensity in HCM with various physical maneuvers.

A

Increased preload or afterload -> increased LV cavity size -> decreased outflow obstruction -> decreased murmur

Decreased preload -> decreased cavity size -> increased intensity

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15
Q

Handgrip maneuver decreases murmur intensity in HCM. It also decreases murmur intensity in ___ and increases murmur intensity of ___.

A

AS; MR

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16
Q

Leg raise/squatting/supine positioning decrease murmur intensity in HCM. It will increase murmurs in what 3 situations?

A

AR
MR
VSD

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17
Q

Hemoglobin electrophoresis pattern in a normal patient?

A

A: 95-98%
A2: ~2.5%
F: <1%
S: Absent

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18
Q

Hemoglobin electrophoresis pattern in a patient with beta-thalassemia minor?

A

A: decreased
A2: increased
F: near normal
S: absent

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19
Q

Hemoglobin electrophoresis pattern in a patient with beta-thalassemia major?

A

A: absent
A2: increased (++)
F: increased (++)
S: absent

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20
Q

Hemoglobin electrophoresis pattern in a patient with sickle cell trait?

A

A: decreased (–)
A2: near normal
F: near normal
S: increased

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21
Q

Hemoglobin electrophoresis pattern in a patient with sickle cell disease?

A

A: absent
A2: near normal
F: increased (++)
S: increased (++)

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22
Q

What is Hgb F?

A

2 alpha and 2 gamma chains

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23
Q

What is Hgb A2?

A

2 alpha and 2 delta chains

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24
Q

What is Hgb A?

A

2 alpha and 2 beta chains

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25
Q

Rx beta-thalassemia major?

A 
Transfusions
Chelation therapy (required to avoid damage from additional iron from transfusions)
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26
Q

Why is hydroxyurea used to treat sickle cell disease?

A

Increases Hgb F by inducing a change in gene expression at the beta globin locus -> reduces the relative concentration of Hgb S and minimizes complications caused by sickling

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27
Q

What is unique about isoniazid-induced hepatic cell injury?

A

Extrahepatic hypersensitivity manifestations (rash, arthralgias, fever, leukocytosis, eosinophilia) are common in patients with drug-induced liver injury, but are characteristically absent when caused by isoniazid.

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28
Q

What is an idiosyncratic reaction?

A

Unlike direct toxic effects, which are dose-dependent and have short latent periods, these reactions are NOT dose-dependent and have variable latent periods.

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29
Q

Drug-induced liver disease be broadly categorized according to morphology - what are some examples?

A 
Cholestasis (eg, anabolic steroids)
Fatty liver (eg, valproate)
Hepatitis (eg, isoniazid)
Toxic or fulminant liver (eg, acetaminophen)
Granulomatous (eg, allopurinol)
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30
Q

What is the most commonly ingested foreign body?

A

Coins

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31
Q

First step in evaluation of any foreign body ingestion?

A

PA and lateral X-Rays

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32
Q

What determines the next step in management of foreign body ingestion after X-rays?

A

If high-risk features (patient symptomatic, object is a button battery, magnet, or sharp item) -> endoscopic removal

If no high-risk features -> serial X-rays

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33
Q

If a foreign body ingestion is managed with serial X-rays, what determines the next step?

A

If no transit (24 hours) -> endoscopic removal

If object moving distally -> no intervention

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34
Q

When a radiolucent, low-risk foreign body is suspected but not visualized on x-ray, what should be done next?

A

CT scan

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35
Q

Intervention of choice for foreign body aspiration?

A

Rigid bronchoscopy (vs. flexible)

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36
Q

Presentation - theca lutein cysts (multilocular, bilaterally enlarged (10-15cm) ovaries), enlarged uterus, hyperemesis gravidarum?

A

Complete hydatidiform mole

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37
Q

Pathogenesis of complete hydatidiform mole?

A

Abnormal fertilization of an empty ovum by either 2 sperm or by 1 that subsequently duplicates its genome -> proliferative trophoblastic tissue that secretes high levels of beta-hCG

38
Q

Management of unilateral cryptorchidism noted at birth?

A

Monitor until age 6 months for spontaneous descent; after 6 months, this becomes unlikely. Orchiopexy is then indicated before age 1

39
Q

Risk factors for cryptorchidism?

A

Prematurity
Small for gestational age
Low birth weight (<2.5 kg, 5.5 lb)
Genetic disorders

40
Q

Clinical features of cryptorchidism?

A

Empty, hypoplastic, poorly rugated scrotum or hemiscrotum

+/- inguinal fullness

41
Q

Complications of cryptorchidism?

A

Inguinal hernia
Testicular torsion
Subfertility
Testicular cancer

42
Q

3 most common causes of acute bacterial rhinosinusitis?

A

Non-typeable H. influenzae
S. pneumoniae
M. catarrhalis

43
Q

Clinical features of acute bacterial rhinosinusitis?

A

Cough, nasal discharge
Fever
Face pain/headache

44
Q

Diagnostic criteria for acute bacterial rhinosinusitis?

A

1 of 3:

  • Persistent symptoms 10+ days without improvement
  • Severe onset (fever 102.2+ with drainage) for 3+ days
  • Worsening symptoms following initial improvement
45
Q

Rx acute bacterial rhinosinusitis?

A

Amoxicillin +/- clavulanate if symptoms are severe or worsening

If persistent but not worsening, observe or treat with oral ABX

46
Q

Although the ___ sinuses are not fully developed in children, what sinuses are present at birth?

A

Paranasal; ethmoid and maxillary

47
Q

In any patient, what two lab values provide the best picture of acid-base status?

A

pH and PaCO2

48
Q

What is the major extracellular buffer in human blood?

A

Carbon dioxide-bicarbonate buffer pair

49
Q

Timing of HPV vaccination?

A

Females: 11-26
Males: 9-21 (9-26 for men who have sex with men, individuals with HIV)

50
Q

List 6 diseases associated with HPV.

A
  1. Cervical cancer
  2. Vulvar and vaginal cancers
  3. Anal cancer
  4. Penile cancer
  5. Oropharyngeal cancer
  6. Genital warts (condyloma acuminata)
51
Q

Lab findings (FSH, LH, Prl, TSH) in ovarian failure?

A

FSH: increase
LH: increase
Prl: normal
TSH: normal

52
Q

Lab findings (FSH, LH, Prl, TSH) in functional hypothalamic amenorrhea?

A

FSH: decrease
LH: decrease
Prl: normal
TSH: normal

53
Q

Lab findings (FSH, LH, Prl, TSH) in Asherman syndrome?

A

All normal

54
Q

Lab findings (FSH, LH, Prl, TSH) in prolactinoma?

A

FSH: decrease
LH: decrease
Prl: increase
TSH: normal

55
Q

Lab findings (FSH, LH, Prl, TSH) in hypothyroidism?

A

FSH: decrease
LH: decrease
Prl: increase
TSH: increase

56
Q

Presentation - history of cancer, amenorrhea, signs of estrogen deficiency

A

Ovarian failure 2/2 chemotherapy

57
Q

How can chemotherapy lead to ovarian failure?

A

Chemo and radiation target rapidly dividing cancer cells but also affect the proliferating granulosa and theca cells of the ovary. Patients undergoing cancer treatment often have transient amenorrhea but have an overall shortened reproductive capacity even if menses return. Ovarian failure results in decreased estrogen -> decreased negative feedback with hypothalamus and pituitary -> increased FSH and LH

58
Q

How can hypothyroidism lead to amenorrhea?

A

Low T3/T4 increase TRH secretion from the hypothalamus; increased TRH stimulates Prl secretion, which has inhibitory effects on GnRH, thereby decreasing FSH and LH

59
Q

List 4 common causes of diarrhea in patients with AIDS and the expected CD4 count at which one becomes susceptible.

A
  1. Cryptosporidium (<180)
  2. Microsporidium/isosporidium (<100)
  3. Mycobacterium avium complex (<50)
  4. CMV (<50)
60
Q

Presentation of diarrhea 2/2 cryptosporidium?

A

Severe watery diarrhea*
Low-grade fever
Weight loss

61
Q

Presentation of diarrhea 2/2 microsporidium/isosporidium?

A

Watery diarrhea
Crampy abdominal pain
Weight loss
Fever is rare*

62
Q

Presentation of diarrhea 2/2 MAC?

A

Watery diarrhea
High fever (>39 C)*
Weight loss

63
Q

Presentation of diarrhea 2/2 CMV?

A 
Frequent, small volume diarrhea*
Hematochezia*
Abdominal pain*
Low-grade fever
Weight loss
64
Q

Dx CMV colitis?

A

Colonoscopy with biopsy (eosinophilic intranuclear and basophilic intracytoplasmic inclusions)

Serology and PCR may be positive but do no conclusively prove end-organ disease

65
Q

Rx active CMV infection?

A

Ganciclovir

Also, ocular exam required to rule out concurrent retinitis

66
Q

Constipation is a common problem in toddlers due to transition to solid food and cow’s milk, toilet training, and school entry. In addition to dietary modification, ___ should be initiated.

A

Laxative therapy to soften stools

67
Q

Presentation - premature, low-birth-weight infant who initially developed respiratory distress syndrome requiring surfactant therapy and mechanical ventilation now presents with rhonchi, persistent oxygen requirement with tachypnea, and radiographi findings of haziness and decreased lung volumes

A

Bronchopulmonary dysplasia (chronic lung disease of the neonate)

68
Q

Bronchiectasis is a result of airway remodeling and thickening due to chronic inflammation. In children, it is generally associated with ___.

A

CF (due to viscous secretions causing recurrent infection)

69
Q

Because colonic malignancy can mimic the presentation and CT findings seen in diverticulitis, what is recommended in follow-up?

A

Colonoscopy, typically 4-8 weeks later

70
Q

Mainstays of treatment of COPD?

A

Life prolonging: smoking cessation, supplemental O2, lung reduction

Decreased symptoms, improved quality of life, decreased hospitalizations: inhaled bronchodilators (anticholinergics like ipratropium and tiotropium, short-acting beta agonists); inhaled steroids and LABAs if more severe

71
Q

Alpha-adrenergic blockers are used to treat ___ and ___.

A

BPH; HTN

72
Q

Dopamine agonists are used to treat ___, __, and ___.

A

Parkinson’s disease; prolactinomas; restless leg syndrome

73
Q

List 3 alpha 2-adrenergic agonists and what they are used to treat.

A

Clonidine and methyldopa - HTN

Dexmedetomidine - sedation in the ICU

74
Q

Presentation - 5+ days of fever and 4+ of the following: non-exudative bilateral limbic-sparing conjunctivitis, erythematous, fissured lips and mucositis (strawberry tongue), polymorphous rash, extremity changes (swelling, erythema, and/or desquamation of palms and soles), cervical lymphadenopathy (>1.5 cm); irritability is common?

A

Kawasaki disease (aka mucocutaneous lymph node syndrome)

75
Q

What complication are patients with Kawasaki disease at risk for and how should they be screened?

A

CV sequelae, particularly coronary artery aneurysms; echocardiogram for all patients with suspected KD, repeat 6-8 weeks later

76
Q

Rx Kawasaki disease

A

IV Ig within 10 days of fever onset

Aspirin (anti-inflammatory and anti-platelet effects), avoided in pediatric patients due to risk fo Reye syndrome

77
Q

What increases risk of aneurysms in Kawasaki disease?

A

Delayed treatment, infants, prolonged fevers (>14 days)

78
Q

Presentation - fever, cough, coryza, conjunctivitis, rash that spreads cephalocaudally?

A

Measles

79
Q

Although strawberry tongue and LAD can occur in both Kawasaki and GAS pharyngitis, what symptoms of KD are inconsistent with scarlet fever?

A

Conjunctivitis, extremity edema, maculopapular rash

80
Q

Presentation - prolonged fever, malaise, exudative pharyngitis/tonsillitis, splenomegaly, generalized LAD; may have onset of autoimmune hemolytic anemia and thrombocytopenia up to 2-3 weeks after onset of initial symptoms

A

Infectious mononucleosis

81
Q

Infectious mono may present with the development of a rash after giving what medication?

A

Amoxicillin

82
Q

Lab findings in infectious mono?

A

Reactive leukocytosis
Positive serum heterophile antibodies (monospot test)
Atypical lymphocytes on blood smear
Elevated transaminases in many patients due to mild transient hepatitis

83
Q

Indications for preventing malaria in most travelers who visit malaria endemic countries?

A

Malaria chemoprophylaxis

  • Chloroquine in areas without resistance (parts of Central America, Caribbean)
  • Atovaquone-proguanil, doxycycline, or mefloquine in areas with high rates of resistance (Africa, Asia, Oceania)
  • Mefloquine treatment should begin 2+ weeks prior to travel, continue during the stay, and discontinue 4 weeks after returning
  • Primaquine chemoprophylaxis in areas that have >90% P. vivax
  • Measures for avoiding mosquito bites are also recommended
84
Q

Side effects to watch for with mefloquine?

A

Neuropsychiatric side effects (anxiety, depression, restlessness)

85
Q

Rx patients with P. vivax malaria to eliminate dormant hepatic hypnozoites?

A

Primaquine

86
Q

MS is frequently associated with what psychiatric illness?

A

Depression

87
Q

Common presentation symptoms of MS?

A

Sensory disturbances, motor weakness, bowel/bladder dysfunction

  • Ocular manifestations
  • Lhermitte sign
  • Uhthoff phenomenon
88
Q

Ocular manifestations of MS?

A 
Optic neuritis (painful eye movement)
Internuclear ophthalmoplegia (impaired adduction on lateral gaze)
89
Q

What is the Lhermitte sign?

A

Electrical sensation in limb or back

90
Q

What is the Uthoff phenomenon?

A

Symptom worsening with increased body temperature

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