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Random :-) Flashcards

1
Q

Name the bulk forming laxatives.

A
  • Methylcellulose
  • Psyllium
  • Polycarbophil
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2
Q

What is the MOA of bulk forming laxatives?

A

Retain fluid in the stool to increase weight and consistency

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3
Q

Name the osmotic laxatives.

A
  • Lactulose
  • Saline cathartics
  • Sorbitol
  • Polyethylene glycol
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4
Q

What is the MOA of osmotic laxatives?

A

Increase water in the colon

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5
Q

Name the stool softeners.

A
  • Docusate
  • Glycerin
  • Mineral oil
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6
Q

What is the MOA of stool softeners?

A

Decrease surface tension which facilitates penetration of fat and water into the stool

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7
Q

Name the stimulant laxatives.

A
  • Bisacodyl
  • Senna
  • Cascara Sagrada
  • Castor oil
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8
Q

What is the MOA of stimulate laxatives?

A

Irritants that stimulate muscle walls of the intestines to produce movement

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9
Q

List the B vitamins and their names.

A
  • B1 = thiamine
  • B2 = riboflavin
  • B3 = niacin
  • B6 = pyridoxine
  • B7 = biotin
  • B9 = folate
  • B12 = cobalamin
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10
Q

What diseases can be caused by vitamin B1 deficiency?

A
  • Beriberi - tingling, poor coordination, edema, cardiac dysfunction
  • Wernicke’s encephalopathy - ataxia, confusion
  • Korsakoff syndrome - confabulation, retrograde and anterograde amnesia

*Vitamin B1 = thiamine

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11
Q

What disease can be caused by vitamin B3 deficiency?

A
  • Pellagra (4 D’s) - dermatitis, dementia, diarrhea, death

*Vitamin B3 = niacin

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12
Q

How do you treat anthrax?

A

Ciprofloxacin

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13
Q

What is the other name for Cat-Scratch disease? How does it present? How is it treated?

A
  • Bartonellosis
  • Gradual regional lymph node enlargmeent (axilla, groin, neck) which may last 2-3 months or longer
  • Azithromycin (1st line). If patient has optic neuritis or neurologic disease, Doxycycline is preferred
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14
Q

Which drug is commonly used for pre-op antibiotic prophylaxis?

A

Cefazolin

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15
Q

Which stain is used in the diagnosis of cryptococcosis and what does it show?

A

India ink stain → shows encapsulated, budding round yeast

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16
Q

What drug is given as prophylaxis for close contacts of a patient diagnosed with diphtheria?

A

Erythromycin for 7-10 days

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17
Q

Describe the symptoms of dengue hemorrhagic fever.

A
  • Biphasic fever - high fever that breaks in 2 days followed by joint pain (“break bone”), HA
  • Biphasic rash - flushed skin → defervescence with onset of maculopapular rash → petechiae on extensor surface of limbs
  • Hemorrhagic fever - ecchymosis, GI bleeding, epistaxis
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18
Q

What is dengue hemorrhagic fever caused by? How is it treated?

A
  • Aedes mosquito
  • Permethrin on clothes, DEET on body
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19
Q

How is AIDS defined?

A

CD4 count < 200 or the development of an AIDS-defining illness with or without HIV testing

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20
Q

At what CD4 count can you see CMV retinitis? CMV colitis?

A
  • Retinitis = CD4 < 50
  • Colitis = CD4 < 100
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21
Q

What are the symptoms of shigella infection? Treatment?

A
  • Lower abdominal pain, high fever, tenesmus, explosive watery diarrhea (mucoid, bloody)
  • Treat with bactrim or a fluoroquinolone
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22
Q

How is a liver abscess caused by entamoeba histolytica treated?

A

Metronidazole

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23
Q

How long must a tick be attached to have the highest likelihood of transmission?

A

72 hours

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24
Q

How do you diagnose Lyme disease?

A

Serologic testing → ELISA followed by Western blot to confirm. ELISA can be falsely positive in patients with syphilis

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25
Q

How do you treat Lyme disease?

A
  • Early disease
    • Doxycycline BID for 10-21 days; if allergic, azithromycin or erythromycin
    • Kids < 8 YO or pregnant women - Amoxicillin
  • Late/Severe disease
    • IV ceftriaxone
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26
Q

What is malaria caused by? How is it transmitted?

A
  • Plasmodium falciparum
  • Transmitted by the female Anopheles mosquito
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27
Q

How is malaria diagnosed? Treated?

A
  • Gemsa stain peripheral smear (thin and thick)
  • Treatment:
    • Uncomplicated - chloroquine phosphate
    • Uncomplicated, chloroquine resistant - quinine (PO) + doxy
    • Complicated or P. falciparum - quinidine (IV) + doxy (IV)
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28
Q

At what CD4 count is mycobacterium avium complex (MAC) seen? What is given for treatment? HIV prophylaxis?

A
  • CD4 < 50
  • Treatment - clarithromycin + ethambutol
  • Prophylaxis - clarithromycin, azithromycin
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29
Q

What is the rabies post-exposure prophylaxis for someone who is not previously vaccinated?

A
  • Rabies immune globulin - 20 units/kg; give 1/2 within the wound and 1/2 IM
  • Human diploid cell vaccine - 1 mL IM injection on days 0, 3, 7, and 14 (+/- day 28)
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30
Q

What is the triad for Ramsay Hunt syndrome?

A
  • Ipsilateral facial paralysis (Bell’s palsy, CN 7)
  • Ear pain
  • Vesicles of the auditory canal/auricle
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31
Q

What causes schistosomiasis? How is it treated?

A
  • Parasitic flatworm. Most human infections are caused by Schistosoma mansoni, S. haematobium, or S. japonicum.
  • Praziquantel
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32
Q

How does toxic shock syndrome present?

A

Sudden onset high fever, tachycardia, hypotension, N/V/D, rash (diffuse erythematous macular rash that includes the palms and soles)

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33
Q

At what CD4 count do you see toxoplasmosis? What might you see on head CT or MRI?

A
  • CD4 < 100
  • Ring-enhancing lesions
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34
Q

What is given prophylactically to prevent toxoplasmosis?

A

Bactrim

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35
Q

True or False?

Rabies post-exposure prophylaxis for a patient who is previously vaccinated consists of the vaccine only.

A

True. The vaccine is given 1 mL IM on days 0 and 3

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36
Q

What is the most common intestinal helminth worlwide? Where is it found?

A
  • Ascaris lumbricoides
  • Soil contaminated by human feces or uncooked food contaminated by soil that contains roundworm eggs
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37
Q

What is the vaccine schedule for Hepatitis B?

A
  • Birth
  • 1-2 months
  • 6-18 months
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38
Q

What is the vaccine schedule for MMR?

A
  • 12-15 months
  • 4-6 years
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39
Q

What is the vaccine schedule for DTaP?

A
  • 2 months
  • 4 months
  • 6 months
  • 15-18 months
  • 4-6 years
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40
Q

What is the vaccine schedule for rotavirus? This vaccine increases the risk of which disease?

A
  • Schedule:
    • 2 months
    • 4 months
    • 6 months (3-dose series only)
  • Intussusception
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41
Q

What is the vaccine schedule for the pneumococcal conjugate vaccine (PCV13)?

A
  • 2 months
  • 4 months
  • 6 months
  • 12-15 months
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42
Q

What is the vaccine schedule for inactivated poliovirus?

A
  • 2 months
  • 4 months
  • 6-18 months
  • 4-6 years
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43
Q

What is the vaccine schedule for varicella?

A
  • 12-15 months
  • 4-6 years
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44
Q

In coronary arteriography, what drug is used to induce coronary vasospasm?

A

Ergonovine

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45
Q

What are the drugs of choice for MI due to cocaine use?

A

Nitrates and CCBs

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46
Q

Why are beta blockers avoided in patients with a cocaine-induced MI?

A

Concerns for coronary artery vasoconstriction and systemic hypertension which can result from unopposed alpha-adrenergic stimulation

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47
Q

What is the initial test of choice for a dissecting aortic aneurysm? Gold standard test?

A
  • CT with contrast
  • MRI angiography
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48
Q

What is the treatment for Dressler syndrome?

A

Aspirin or colchicine

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49
Q

Describe the changes in mitral stenosis with position changes and respiration.

A
  • Decreases with valsalva, standing, and inspiration
  • Increases with laying supine, squatting, and expiration
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50
Q

What is the MOA for cilostazol and what disease is it used to treat?

A
  • MOA - decreases platelet aggregation and is a direct arterial vasodilator
  • Peripheral arterial disease
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51
Q

What is the most common cause of acute bronchitis? What is the hallmark symptom?

A
  • MCC = Adenovirus
  • Cough that lasts 1-3 weeks
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52
Q

In acute bronchitis, who might antibiotics be appropriate for if refractory to conservative treatment?

A
  • Patients with a cough for > 7-10 days
  • The elderly
  • Patients with COPD
  • Immunocompromised patients
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53
Q

What are the lab findings for acute respiratory distress syndrome?

A
  • ABG - PaO2/FiO2 ratio < 200 mm Hg that is not responsive to 100% O2
  • CXR - diffuse bilateral pulmonary infiltrates (“white out”)
  • Cardiac cath of pulmonary artery (Swan-Ganz) - PCWP < 18 mm Hg
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54
Q

What are the chest x-ray findings of asbestosis?

A

Pleural calcifications/plaques. Lower lobes are primarily affected.

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55
Q

What areas of the body does aspergillosis most commonly affect? What type of toxin does it produce?

A
  • Lungs, sinuses, CNS
  • Aflatoxin B1 → associated with an increased risk of hepatocellular carcinoma
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56
Q

How is aspergillosis diagnosed?

A
  • CXR - may show an aspergilloma (fungal ball)
  • Biopsy - dusky necrotic tissue; septate hyphae with regular branching at wide angles (>45 degrees)
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57
Q

How is aspergillosis treated?

A
  • If allergic - tapered corticosteroids
  • Severe or sinusitis - voriconazole
  • Aspergilloma - surgical resection of symptomatic
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58
Q

What is the term for a pulmonary artery coupled with a dilated bronchus?

A

Signet ring sign

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59
Q

What is the study of choice in bronchiectasis?

A

High-resolution CT scan

60
Q

What pulmonary disease is haemophilus influenza pneumonia associated with?

A

COPD

61
Q

How is legionella pneumonia treated?

A

Levofloxacin or azithromycin

62
Q

How is pertussis treated?

A
  • Supportive - O2, nebulizers, ventilation if needed
  • Macrolides - azithromycin, erythromycin
  • If allergic to macrolides - bactrim
63
Q

Name the industries specific to each of the pneumoconioses: silicosis, coal worker’s pneumoconiosis, berylliosis, byssinosis, and asbestosis

A
  • Silicosis - mining, quarry work, pottery, sandblasting
  • Coal worker’s pneumoconiosis - coal or carbon mines
  • Berylliosis - electronics, aerospace, ceramics
  • Byssinosis - cotton
  • Asbestosis - destruction or renovation of old buildings, insulation, ship building, pipe fitters
64
Q

What are the physical exam findings for pneumonia?

A
  • Dullness to percussion
  • Increased tactile fremitus
  • Positive egophony
  • Bronchial breath sounds
65
Q

What are the physical exam findings of pneumothorax?

A
  • Hyperresonance to percussion
  • Decreased tactile fremitus
  • Decreased breath sounds over affected area
66
Q

What do the following HBV markers indicate?

(+) HBsAg, Anti-Hbs IgM, (+) HBeAg

A

Acute hepatitis B infection

67
Q

What do the following HBV markers indicate?

(+) HBsAg, Anti-HBc IgG, (+) HBeAg

A

Chronic hepatitis B with active viral replication

68
Q

What do the following HBV markers indicate?

(+) Anti-HBs, Anti-HBc IgG, +/- Anti-HBe

A

Recovery from hepatitis B (immunity)

69
Q

What does the following HBV marker indicate?

(+) Anti-HBs

A

Immunity from previous vaccination

70
Q

Discuss what each of the HBV antigens or antibodies indicates.

A
  • Surface antigen (HBsAg) - earliest routine indicator of acute HBV
  • Surface antibody (Anti-Hbs) - detects previous exposure; can develop from vaccination
  • Core antibody (Anti-HBc) IgM - first antibody produced after infection; used to detect acute infections
  • Core antibody (Anti-HBc) IgG - produced in response to core antigen
  • E antigen - marker of infectivity; used to monitor the effectiveness of treatment
71
Q

What is Budd-Chiari syndrome? How does it manifest?

A
  • Hepatic venous outflow tract obstruction
    • Primary - caused by an obstruction due to a venous process (thrombosis or phlebitis)
    • Secondary - due to compression or invasion of the hepatic veins and/or IVC by a lesion that originates outside of the vein (malignancy)
  • Abdominal pain, distension due to ascites, hepatomegaly, GI bleeding, acute liver failure (5%)
72
Q

In acute compartmental syndrome, what compartmental pressure would you likely see?

A

Pressure > 30-45 mm Hg

73
Q

Which test for an ACL injury is most sensitive? What injury is pathognomonic for an ACL tear?

A
  • Lachman’s test
  • Segond fracture
74
Q

Wht is the name for a vertical compression fracture of the atlas? What is the mechanism of injury for a Hangman’s fracture and what bone is involved?

A
  • Jefferson (Burst) fracture
  • Hyperextension then flexion of the axis pedicle
75
Q

What is the most common malignant bone tumor in children? What are the common x-ray findings? What is the most common site of metastasis?

A
  • Osteosarcoma
  • Sun ray/burst or “hair on end” appearance
  • Lungs
76
Q

What is the term for chronic degenerative changes of the spine? Describe spondylolysis. What is the term for a stress fracture and sliding of the vertebra?

A
  • Spondylosis
  • Stress fracture in the Pars interarticularis
  • Spondylolisthesis
77
Q

What are the lab findings you would expect to see in a patient with dermatomyositis? What antibody is specific for this disease?

A
  • Elevated CPK and ESR
  • Anti-Mi-2
78
Q

Describe a Bennett fracture. Describe a Rolando fracture.

A
  • Benentt = intraarticular fracture through the base of the 1st metacarpal (thumb)
  • Rolando = comminuted intraarticular fracture of the base of the 1st metacarpal
79
Q

Describe a Galeazzi fracture. Describe a Monteggia fracture.

A
  • Galeazzi - mid-distal radial shaft fracture with dislocation of the distal radial ulnar joint
  • Monteggia - proximal ulnar shaft fracture with an anterior radial head dislocation
80
Q

What is the best initial treatment for osteoarthritis in an elderly patient with a bleeding risk and mild to moderate disease?

A

Acetaminophen

81
Q

What population is most commonly affected in acute osteomyelitis? What is the most common cause of both acute and chronic osteomyelitis?

A
  • Children
  • Staph aureus
82
Q

Describe pes anserinus pain syndrome (aka, pes anserine bursitis).

A

Inflammation of the bursa located between the tibia and the 3 tendons of the hamstring muscles (sartorius, gracilis, semitendinosus) at the medial knee

83
Q

Describe polymyalgia rheumatica. What condition is it associated with?

A
  • Symmetrical aching and stiffness about the shoulders, hip girdle, neck and torso. Patient will complain of difficulty combing their hair, putting on a coat, or getting out of a chair.
  • Giant cell (Temporal) arteritis
84
Q

What antibody is most specific for polymyositis?

A

Anti-Jo 1

85
Q

What joints are most commonly affected in rheumatoid arthritis? Describe Boutonniere deformity. Describe swan neck deformity.

A
  • MCP, wrist, PIP, knee, MTP (metatarsophalangeal joint), shoulder, ankle
  • Boutonniere = PIP in flexion, DIP in hyperextension
  • Swan neck = PIP in hyperextension, DIP in flexion
86
Q

What antibodies would be positive in rheumatoid arthritis? Which one is most specific?

A
  • Rheumatoid factor (RF), anti-citrullinated peptide/protein antibody (ACPA), anti-cyclic citrullinated peptide antibody (anti-CCP)
  • anti-CCP
87
Q

Describe the two types of scleroderma. What the the antibodies specific to each type?

A
  • Types:
    • Limited (aka, CREST syndrome) - calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility disorder, sclerodactyly, telangiectasia
    • Diffuse - trunk and proximal extremities
  • Anti-centromere is specific for limited.Anti-SCL 70is specific fordiffuse.
88
Q

Describe a Smith fracture. What nerve is most commonly injured? How is the fracture immobilized?

A
  • A distal radius fracture with volar angulation and displacement
  • Median nerve injury
  • Sugar tong splint or cast
89
Q

Describe a Colles fracture. What nerves are commonly injured?

A
  • Distal radius fracture with dorsal angulation and displacement
  • Median and ulnar nerves
90
Q

What antibodies are found in systemic lupus erythematosus?

A

anti-Smith, anti-dsDNA

91
Q

What are the organisms most associated with acute otitis media? Which organism is most common?

A
  • S. pneumo (MC)
  • H. flu
  • M. catarrhalis
  • Strep pyogenes
92
Q

What is the treatment of choice for acute otitis media?

A

Amoxicillin 80-90 mg/kg/day for 10-14 days

93
Q

What is the most common cause of acute sinusitis? Which sinuses are most commonly involved? How is it treated?

A
  • S. pneumo, H. flu, Moraxella catarrhalis
  • Maxillary sinuses
  • Amoxicillin for 10-14 days
94
Q

What is the most common cause of vision loss in people over 65 YO?

A

Macular degeneration

95
Q

Describe the types of macular degeneration. What are the symptoms of this disease?

A
  • Types:
    • Exudative - due to leakage of serous fluid and blood due to neovascularization under the retina
    • Nonexudative - characterized by atrophy and degeneration of the central retina. Drusen (yellowish-white deposits) form under the pigment epithelium
  • Loss of central vision, metamorphopsia (straight lines appear bent); peripheral vision is preserved
96
Q

How is macular degeneration diagnosed? Treated?

A
  • Dx: Amsler grid testing, Fluorescein angiography
  • Treatments:
    • Exudative - anti-VEGF inhibitors
    • Nonexudative - OTC vitamins (zinc; vitamins A, C, E); Amsler grid to monitor stability
97
Q

What is the most common cause of bacterial conjunctivitis? Viral conjunctivitis?

A
  • Staph aureus
  • Adenovirus
98
Q

How is bacterial conjunctivitis treated? Under what circumstances would you use a fluoroquinolone for treatment?

A
  • Erythromycin ophthalmic ointment
  • The patient is a contact lens wearer
99
Q

What type of blepharitis is caused by inflammation of the Mebomian glands? What conditions is this type of blepharitis associated with?

A
  • Posterior (most common type)
  • Rosacea, allergic dermatitis
100
Q

What are the symptoms of cholesteatoma? What type of hearing loss can result from this condition?

A
  • Painless otorrhea, brown/yellow discharge with a strong odor, may have dizziness or vertigo
  • Conductive hearing loss
101
Q

What is the most common cause of vision loss or blindness in people between 25-74 YO?

A

Diabetic retinopathy

102
Q

Describe the types of diabetic retinopathy.

A
  • Nonproliferative - early stage; retinal blood vessels are weakened
  • Proliferative - advanced disease; circulation issues deprive the retina of oxygen resulting in new, fragile, blood vessel growth. New vessels may leak blood into the vitreous humor clouding vision
103
Q

Describe the fundoscopy findings of diabetic retinopathy.

A
  • Nonproliferative - microaneurysms, hard exudates, cotton wool spots, blot and dot hemorrhages, venous dilation
  • Proliferative - neovascularization
104
Q

What structures are inflammed in anterior uveitis? Posterior uveitis?

A
  • Iris or ciliary body
  • Choroid
105
Q

How is uveitis diagnosed? How is it treated?

A
  • Slit lamp - inflammatory “cells (WBCs) and flare (proteins in the vitreous humor)”
  • Treatment:
    • Anterior - topical glucocorticoids
    • Posterior - systemic glucocorticoids
106
Q

What is the anatomical location of Wharton’s duct? Stenson’s duct? Which duct is most commonly affected in sialolithiasis?

A
  • Whartons’ duct - submandibular
  • Stenson’s duct - in the rear of the mouth near the 2nd upper molar
  • Wharton’s duct is most commonly affected
107
Q

How is sialolithiasis treated?

A
  • Conservative (1st line) - sialogogues, increase fluids, gland massage, moist heat to affected area; avoid anticholinergic drugs
  • If refractory to conservative tx, extracorporeal lithotripsy
108
Q

What is the most common cause of sialadenitis? How is it treated?

A
  • Staph aureus
  • Dicloxacillin or nafcillin +/- metronidazole for anaerobic coverage; Clindamycin if severe
109
Q

Describe the types of retinal detachment. Which type is most common?

A
  • Rhegmatogenous (MC) - full-thickness retinal tear causes the retinal inner sensory later to detach from the choroid plexus
  • Tractional - adhesions separate the retina from its base
  • Exudative (serous) - fluid accumulates beneath the retina causing detachment
110
Q

How is retinal detachment managed?

A

Ophthalmologic emergency → keep the patient supine with their head turned toward the side of detachment until opthalmology arrives

111
Q

What is the most common cause of a peritonsilar abscess?

A

Strep pyogenes

112
Q

What electrolyte abnormalities might you see in bulimia nervosa?

A

Hypokalemia, hypomagnesemia

113
Q

List 5 physical abnormalities that can manifest in a patient with anorexia nervosa. List 5 lab abnormalities.

A
  • Amenorrhea, bradycardia, arrhythmia, constipation, lanugo hair
    • Can also have hypotension, acute coronary syndrome, MVP, alopecia, peripheral neuropathy, seizures, hypothyroidism, osteopenia, osteoporosis
  • Hyponatremia, hypochloremic hypokalemic alkalosis, QT prolongation, hypercholesterolemia, transaminitis
    • Can also have leukopenia, anemia, elevated BUN, increased GH, increased cortisol, decreased LH and FSH, hypoglycemia
114
Q

When is it appropriate to hospitalize a patient with anorexia? What is the treatment?

A
  • If the patient is < 75% of their expected body weight
  • CBT, supervised weight-gain programs
115
Q

What labs must be monitored in a patient taking lithium? What are the adverse effects of lithium?

A
  • Lithium levels, BUN/Cr, TSH
  • Nephrogenic DI, thyroid enlargement, hypothyroidism, QT prolongation, Ebstein’s anomaly
116
Q

What is the name for calluses on the dorsum of the hand in a patient with bulimia nervosa? Treatment?

A
  • Russell’s sign
  • CBT and fluoxetine
117
Q

When does maternal (postpartum) blues typically manifest? When do the symptoms resolve? What is the treatment?

A
  • Onset of symptoms 2-3 days after delivery
  • Symptoms typically resolve within 10 days
  • Treatment is supportive
118
Q

Define MDD with peripartum onset (aka, postpartum depression). What is the treatment?

A
  • Depressed affect, anxiety, and poor concentraiton for ≥ 2 weeks
  • Treatment is CBT and SSRIs (1st line)
119
Q

Define postpartum psychosis. What is the treatment?

A
  • A condition characterized by mood-congruent delusions, hallucinations, and thoughts of harming the baby or self
  • Treatment is hospitalization and initiation of atypical antipsychotics. If refractory, ECT may be used
120
Q

What is the MOA of 1st-gen antipsychotics? What is the MOA of 2nd-gen antipsychotics?

A
  • 1st gen - block dopamine (D2) receptors
  • 2nd gen - block dopamine (D2) and serotonin (2A) receptors
121
Q

Which generation of antipsychotics is better for positive symptoms? Negative symptoms?

A
  • Both typical and atypical antipsychotics have similar efficacies in treating positive symptoms
  • Atypical antipsychotics are more effective at treating negative symptoms
122
Q

How does treatment with antipsychotics result in extrapyramidal symptoms? What hormone level increases due to the use of antipsychotics?

A
  • Extrapyramidal symptoms occur through blockage of the dopamine pathways in the nigrostriatum
  • Prolactin levels increase due to dopamine blockade in the tuberoinfundibular area
123
Q

List the antidopaminergic effects of antipsychotics.

A
  • Parkinsonism - bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor
  • Akathisia - anxiety and restlessness
  • Dystonia - sustained painful contractions of the neck, tongue, and eye muscles
  • Hyperprolactinemia - decreased libido, galactorrhea, gynecomastia, impotence, amenorrhea
124
Q

List the anti-histaminic, adrenergic, and muscarinic effects of antipsychotics.

A
  • Antihistaminic - sedation, weight gain
  • Anti-alpha-1 adrenergic - orthostatic hypotension, cardiac abnormalities, sexual dysfunction
  • Antimuscarinic - dry mouth, tachycardia, urinary retention, blurry vision, constipation
125
Q

What is the most common histological type of vulvar cancer? What is the most common presenting symptom?

A
  • Squamous
  • Pruritus
126
Q

Define gestational hypertension.

A

Hypertension that develops after 20 weeks gestation without proteinuria or other signs/symptoms of preeclampsia

127
Q

What is the term for hypertension in pregnancy that develops before 20 weeks gestation?

A

Chronic or pre-existing hypertension

128
Q

What is the MOA for ethinyl estradiol (estrogen)? MOA for progestin?

A
  • Ethinyl estradiol - decreases FSH, prevents maturation of the follical, potentiates progestin effects
  • Progestin - decreases LH, inhibits ovulation, thickens cervical mucus, alters peristalsis of the fallopian tube
129
Q

Name 5 absolute contraindications to the use of OCPs.

A
  • History of thromboembolic disease (DVT, pulmonary embolism)
  • Undiagnosed abnormal vaginal bleeding
  • Cerebral vascular disease
  • Known or suspected breast cancer
  • Smokers > 35 YO
130
Q

List the types of intrauterine devices and their respective lifespans. List 3 contraindications to the use of IUDs. What medical conditions are progestin-only contraceptives indicated for?

A
  • Copper T380A (10 years), Mirena (5 years), Skyla (3 years)
  • CI’s - pregnancy, acute pelvic infection (PID, cervicitis), unexplained vaginal bleeding
  • Indicated for women with DM, thromboembolism, menorrhagia, dysmenorrhea, or women who are breastfeeding
131
Q

List the options for emergency contraception. Which drug blocks the LH surge if taken in the pre-ovulatory period? Which drug delays ovulation in both the pre-ovulatory period and after the LH surge?

A
  • Levonorgestrel, estrogen + progesterone, mifepristone, copper IUD, ulipristal
  • Levonorgestrel
  • Ulipristal
132
Q

What is the strongest risk factor for endometritis? How is it treated?

A
  • C-section
  • Treatment:
    • Post C-section - clindamycin + gentamicin
    • Post vaginal delivery or chorioamnionitis - ampicillin + gentamicin
133
Q

What is the most common inherited cause of intellectual disability? Describe the physical manifestations of this disease.

A
  • Fragile X syndrome
  • Long protruding ears, long face, prominent jaw, hyperextensible joints, micropenis, macroorchidism
134
Q

When is the screening for gestational diabetes done? Briefly describe the screening tests and the values that indicate the patient has gestational diabetes.

A
  • 24-28 weeks gestation
  • Testing:
    • 50-g 1 hour glucose test → positve if glucose > 140 mg/dL
    • 100-g 3 hr glucose test → positive if:
      • Fasting > 95 mg/dL
      • 1 hr > 180 mg/dL
      • 2 hr > 155 mg/dL
      • 3 hr > 140 mg/dL
135
Q

What drugs can be used to treat gestational hypertension?

A
  • Methyldopa (1st line)
  • Labetalol
  • Hydralazine
  • Nifedipine
136
Q

What is a complete hydatidiform mole?

A

It is when an egg with no maternal DNA is fertilized by 2 sperm resulting in two paternal sets of DNA. The genotype is 46, XX. This has associated with a higher risk of malignancy (choriocarcinoma).

137
Q

What is an incomplete hydatidiform mole?

A

It is when an egg is fertilized by 2 sperm. The karyotype is 69, XXY.

138
Q

What are the hormone levels you would expect on labs in hypothalamic amenorrhea?

A

Normal to decreased FSH and LH, decreased estradiol, normal prolactin

139
Q

What are the hormone levels you would expect on labs in polycystic ovarian syndrome?

A

Decreased FSH, increased LH, increased testosterone, and increased estrogen

140
Q

Define preeclampsia.

A

Hypertension + proteinuria +/- edema after 20 weeks gestation

141
Q

When is it unsafe to have a vaginal birth after C-section?

A
  • Placenta previa
  • Inverted T-incision with prior pregnancy
  • Heart disease
  • Shortness of breath
142
Q

Define premature labor. How can you diagnose premature labor?

A
  • Cervical dilation > 3 cm and/or > 80% effacement before 37 weeks
  • Dx:
    • Nitrazine pH paper test turns blue if pH > 6.5 indicating amniotic fluid
    • The presence of fetal fibronectin → a protein produced by cells at the border of the amniotic sac and the mother’s uterus, attaching the amniotic sac to the uterine lining
143
Q

What causes acromegaly? How is it diagnosed?

A
  • Pituitary adenoma
  • Dx:
    • Screening - insulin-like growth factor 1 (IGF-1)
    • Confirmatory - oral glucose suppression test
144
Q

What causes Charcot’s foot? What is the most commonly affected part of the foot?

A
  • aka, Diabetic foot → Caused by joint damage and destruction as a result of peripheral neuropathy from DM
  • Most commonly affects the midfoot
145
Q

What is the cause of cushing’s disease? Cushing’s syndrome? How is it diagnosed?

A
  • Disease - ACTH-secreting pituitary adenoma
  • Syndrome - excessive levels of glucocorticoids due to any cause
  • Dx:
    • Low-dose dexamethasone suppression test
    • 24-hour urinary free cortisol
    • Salivary cortisol levels
    • High-dose dexamethasone suppression test
      • Elevated ACTH + suppression = Cushing’s disease
      • Elevated ACTH + no suppression = likely an ectopic ACTH-producing tumor
    • ACTH level
      • If low, cause is likely an adrenal tumor or hyperplasia
      • If high, likely an ACTH-secreting pituitary adenoma
    • Corticotropin-releasing hormone (CRH) stimulation test
      • Increased ACTH/cortisol = Cushing’s
      • No response = ectopic ACTH secretion or an adrenal tumor

PANCE Prep (4 decks)

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