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STEP 2 > UW1 > Flashcards

UW1 Flashcards

1
Q

How do you treat X-linked agammaglobulinemia? What is this called when it presents later in life?

A

IVIG ; Common variable immunodeficiency

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1
Q

Where do melanocytes come from? What neonatal marks around the sacrum involve melanocytes?

A

Neural crest (S100); Mongolian spots

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1
Q

What are 2 interventions in extreme leukocytosis to prevent leukostasis?

A

Plasmapheresis and hydroxyurea

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1
Q

What is a major AE of didanosine?

A

pancreatitis

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2
Q

What is the solid form of Waldenstroms macroglobulinemia called?

A

Lymphoplasmacytic lymphoma

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2
Q

Where do the following ulcers classically occur: Venous stasis? PAD? DM neuropathy?

A

Medial malleolus; MTP (dorsal); Sole of foot

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2
Q

What is the best way to dx chronic pancreatitis and why?

A

CT of abdomen usually shows calcifications; lipase and amylase may be normal/low because so much parenchyma has been destroyed

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2
Q

Which cause of microcytic anemia often has a normochromic and hypochromic population of cells?

A

Sideroblastic anemia

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2
Q

What is the tumor marker for dysgerminoma?

A

LDH

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2
Q

Why may post-op pts be hypocalcemic?

A

Secondary to hemodilution from fluids or chelation with EDTA from tranfusions

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3
Q

Differentiate type I and type II hepatorenal syndrome

A

Type I = a two fold increase in creatinine > 2.5 in less than 2 weeks; Type II is a less severe form and is due to diuretic resistant ascites

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3
Q

At what BUN level do you typically see pericarditis as a result of uremia?

A

60

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3
Q

What is the first line medication for DM neuropathy?

A

TCA’s followed by gabapentin

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3
Q

If a person overdosed on their diabetic neuropathy medications how would you treat them?

A

NaHCO3 since it is a TCA overdose

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3
Q

What is the MC cause of acute hemolytic transfusion rxn?

A

Clerical error (i.e. ABO incompatibility)

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4
Q

What is the MC cause of lacunar strokes?

A

HTN causing lipohyalinosis of small vessels (i.e. lenticulostriate)

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4
Q

Pt with Paroxysmal Nocturnal Hemoglobinuria gets spontaneous ascites

A

Budd-Chiari Syndrome due to venous thrombosis

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5
Q

Which cells harbor CMV?

A

Monocytes (use leukoreduced PRBC)

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6
Q

What should be calculated to determine type of aki in a pt on diuretics?

A

Feurea because FENA will be elevated due to natriuresis from the diuretic

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6
Q

What are 3 possible causes of asterixis?

A

Uremia, CO2 retention (COPD), and liver failure (hyperammonemia)

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6
Q

What is the tx for restrictive pericarditis?

A

Definitive tx with pericardiectomy

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6
Q

What symptoms do MOST ppl with histoplasmosis have?

A

Asymptomatic

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7
Q

What are 3 opiods you cannot give SSRI’s with?

A

Meperidine, tramodol, DXM

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8
Q

What is an absolute contraindication to epidural anesthesia for labor?

A

Refractory maternal hypotension

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9
Q

What information does a positive low dose dexamethasone suppression test give you?

A

Tells you that there is hypercortisolism does not necessarily tell why

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10
Q

What tumor marker would you look for to detect the ovarian tumor responsible for precocious puberty in girls?

A

Inhibin (granulosa cell tumor)

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11
Q

What is a major AE of AZT?

A

Anemia (Zidovudine)

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12
Q

How do you typically deal with ring-enhancing tumors in AIDS pts?

A

First give sulfadiazine-pyrimethamine assuming it is toxo; if not get better then consider bx for CNS lymphoma (DLBCL assoc EBV, enters via CD21)

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12
Q

What drugs are CI in hepatic encephalopathy for agitiation?

A

Benzodiazepines since potentiate GABA and the hyperammonemia is causing potentiation of GABA

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13
Q

What is oscillopsia?

A

The sensation of things moving around in the peripheral vision secondary to vestibular issue

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14
Q

Tubulointerstitial nephritis can be induced by chronic use of what type of meds?

A

Analgesics

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14
Q

What are the sx of acute digoxin toxicity? Chronic?

A

Acute = Anorexia, NV, abd pain; Less likely GI more likely neuro i.e. yellow vision or scotomas

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15
Q

What should ya think for a pig farmer with seizures? Pig farmer with bloody diarrhea?

A

Neuricysticercosis (T. solium); Balantidium coli (ciliated protozoan)

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15
Q

What are some provocative meds for pseudotumor cerebri?

A

Doxy and retinoids

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15
Q

Atypical causes of PNA are best tx with what drug class?

A

Macrolides

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17
Q

What is the first line therapy for Goodpasture’s dz? Why not the same as Wegener’s

A

Cyclophosphamide and Cortiosteroids with plasmapheresis; not the same as for Wegener’s because there are anti-GBM Abs to clear out with plasma exchange not present in Wegener’s

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18
Q

How can you abort a cluster headache? What alternative dx may be the case if this doesnt work and pt is a female?

A

100% O2 and triptan; paroxysmal hemicrania

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19
Q

What defense mechanism is common in alcoholics and substance abusers?

A

Denial

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20
Q

How do you treat suspected CO toxicity? What if carboxyhemoglobin levels come back > 20 and person is severely sx?

A

100% O2 via nonrebreather; hyperbaric O2 (i.e. HBO)

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21
Q

What do you do for ascites that is refractory to max doses of spironolactone and furosemide?

A

Large volume paracentesis

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22
Q

What is the major difference between a leukemoid rxn and CML?

A

LAP score is low in CML and high in leukemoid rxn

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23
Q

Which is worse Mobitz I or II?

A

II? I is a progressively prolonged PR with dropped QRS; II is randomly dropped P waves and can spontaneously degenerate into 3rd degree AV block and often needs pacing

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25
Q

What effect does pulmonary edema have on lung compliance? A-a gradient?

A

Increased; Increased

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26
Q

What is type I RTA assoc with?

A

Autoimmune dz (it is distal, due to decreased H secretion) often complicated by nephrolithiasis with calcim PHOSPHATE stones and nephrocalcinosis

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28
Q

What is the most important risk factor for developing breast CA? What is the most important prognosticator?

A

Age; Tumor burden (i.e. stage)

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29
Q

What effect does hypocalcemia have on QRS? Hypercalcemia?

A

Prolongs; shortens

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31
Q

In whom is succinylcholine C/I and why? (4) What drugs are better in these pts?

A

Hyperkalemia (any cause), Demyelinating dz (d/t hyperK), Crush/Burn victims (d/t hyperK), and Tumor Lysis Syndrome (hyperK); Vecuronium or rocuronium

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33
Q

What should you do for a person with hearing problems and caf? au lait spots?

A

MRI with gadolinium for acoustic neuromas

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35
Q

What are leukoreduced PRBC used for?

A

Hx of febrile nonhemolytic transfusion rxn or seronegativity for CMV

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36
Q

What is the gest diagnostic test for posterior urethral valves?

A

Voding cystourethrogram

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37
Q

What is the benzo of choice for status epilepticus? What do use for rapid sequence intubation in these pts?

A

Lorazepam, propofol

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39
Q

What joints are affected in ankylosing spondylitis?

A

Facet joints leading to bamboo spine; sacroiliac joint

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40
Q

What is the solid form of ALL L3?

A

Burkitt Lymphoma

41
Q

What is multifocal atrial tachycardia assoc with? What are the dx criteria?

A

COPD and pulm dz; > 3 P wave morphologies with rate > 100 if not then it is wandering atrial pacemaker

42
Q

What are your 2 options for initial screening test for Cushing’s dz

A

24 hour urinary free cortisol or low dose (1mg) dexamethasone suppression test

43
Q

What is the immeidate mgmt of Kawasaki dz?

A

ASA and IVIG

44
Q

What causes splanchnic vessel blood pooling in hepatorenal syndrome?

A

increased nitric oxide production in splanchnic vessels

45
Q

What is the first line tx for essential tremor? In whom would the second line agent be contraindicated and why?

A

Propanolol; Porphyria since primidone is metabolized to phenobarbital and can precipitate acute intermittent porphyria

47
Q

What supplement is often provided in hereditary spherocytosis?

A

Folate; in times of extreme anemia may need tranfusion

48
Q

What disease has degeneration of the lenticular nucleus? Who needs screened?

A

Wilson’s dz (Hepatolenticular degeneration); relatives of 1st degree relatives

50
Q

Name 3 paraneoplastic syndromes of small cell ca

A

ACTH secretion, LEMS, and SIADH

51
Q

In the outpatient setting what do you do if a person has cellulitis and fever?

A

i.e. if pt is toxic that is indication for admission with IV abx (IV vanc or maybe clinda)

52
Q

What bug is the #1 cause of brain abscess resulting from sinusitis?

A

Viridans group strep

53
Q

How do you Tx Wenckebach?

A

Nothing to do unless symptomatic on AV nodal blocking drugs then you can hold em

54
Q

How should you treat a perimenopausal woman with complex hyperplasia without atypia?

A

Progestins (to oppose the estrogen) with repeat bx in 3-6 months; if there was atypia then hysterectomy

55
Q

What are 3 first line tx for acute mania?

A

Valproate, lithium, or atypical antipsychotics

56
Q

What are the coagulation studies like for Hemophilias A and B?

A

increased aPTT with normal PT

58
Q

What is the most specific arrhythmia for digoxin toxicity? What other commonly used heart med predisposes? What electrolyte abnormality?

A

2 degree AV block with atrial tachycardia; very unusual to have ectopy and AV block at same time!; Amiodarone, Hypokalemia

59
Q

What is the first line therapy for Wegeners granulomatosis? Why no plasmapheresis?

A

Corticosteroids and cyclophosphamide; there is nothing to clear out

60
Q

What test is best to check if vesicoureteral reflux is progressing to calyceal clubbing and scarring?

A

Renal scintigraphy with dimercaptosuccinic acid

62
Q

What is typically the first line medication for pre-eclampsia and gestational HTN? Contraindications?

A

Labetolol; asthmatics (can give alpha-methyldopa or nifedipine)

64
Q

MOA of bupropion? C/I in who (2)

A

inhibits DA and NE reuptake by unknown mechanism; epileptics and bulimics

65
Q

How do you treat otitis externa? Malignant otitis externa?

A

Ciprofloxacin and dexamethosone topically; IV ciprofloxacin

66
Q

How do you ppx against toxo/pcp in AIDS if there is a sulfa allergy? What if also G6PD?

A

Dapsone, atovaquone

68
Q

What can be done if there is no access to a mediastinal lymph node via bronchoscopy (i.e. EBUS)?

A

Mediastinoscopy

69
Q

Who should be screened for Wilson’s dz? Inheritance?

A

1st degree relatives of affected pts; AR

70
Q

What is the first step to do if you suspect normal pressure hydrocephalus?

A

Do a large volume CSF removal and observe; if the sx improve then you can do a ventriculoperitoneal shunt

71
Q

In the outpatient setting with high suspicion of MRSA but non-toxic what would outpatient tx for cellulitis be?

A

TMP-SMX, clindamycin, or doxycycline

72
Q

T/F Polycythemia vera only has increased RBC’s?

A

ABSOLUTELY FALSE it is a clonal myeloproliferative disorder that also has an element of thrombocytosis and mild granulocytosis

74
Q

What concentration of epinephrine is given in anaphylaxis?

A

IM 1:1000

75
Q

What abx can cause serotonin syndrome when combined with SSRI’s?

A

Linezolid because has weak serotoninergic activity

77
Q

What is the Hawthorne effect?

A

People modify behaviors after learning the purpose of a study

77
Q

What condition precludes the existence of S4?

A

Afib; cant get atrial kick

78
Q

Name some causes of spurious hyperkalemia

A

Fist clenching, leukocytosis (got pimped on heme onc), and thrombocytosis as well as delays in analyzing the sample

80
Q

Henoch Schonlein purpura is due to deposition of what in the tissues?

A

IgA and C3

81
Q

What medication can improve healing in venous stasis ulcers?

A

ASA

82
Q

What is the greatest predictor of development of a coronary artery aneurysm in Kawasaki dz?

A

Fever length, if fever went on for 8 days that is high risk

83
Q

How do you treat 3rd degree heart block?

A

Immediate trancutaneous pacer while awaiting transvenous pacer; ability to degenerate to asystole is a major concern;

83
Q

How do you treat nonclassical CAH?

A

OCP’s to decrease CRH and ACTH

83
Q

Which pulmonary infection is assoc. with antibodies against RBC’s?

A

M. pneumoniae

84
Q

Methanol and ethylene glycol have similar presentations but methanol notably affects the ____ while ethylene glcyol notably affects the ______

A

Eyes (optic disk hyperemia); kidneys and can lead to ESRD if the kidneys don?t recover from the AKI

85
Q

Which cells are not filtered out in leukoreduced blood products?

A

Lymphocytes (same size as RBC)

86
Q

How do you dx DM gastroparesis? How do you manage it?

A

Gastric scintigraphy scan; increase fiber with smaller and more frequent meals and prokinetic agent (metoclopromide chronically assuming not Parkinsons; erythromycin acutely)

87
Q

Which electrolyte abnormality is notorious for causng refractory hypokalemia?

A

Hypomagnesemia; Mg is important for K reuptake (MC in alcholics)

88
Q

What other class of antidepressatn can you not give SSRI’s with?

A

MAOI’s

89
Q

Why are CCB overdoses weird?

A

They cause profound hypotension, bradycardia, with PRESERVED MENTATION

91
Q

Eggshell calcifications in the upper lobes usually from what? Predisposes to what?

A

Silicosis; predisposes to TB (cant form a phagolysosome)

92
Q

The presence of palatal ulcers may tip you off to infxn with which dimorphic fungus?

A

Hisoplasma capsulatum

93
Q

What kind of stones form in type I RTA?

A

Calcium phosphate

94
Q

What cell is affected in LEMS?

A

Presynaptic calcium channels

95
Q

What is required for definitive dx of pseudotumor cerebri after normal neuroimaging is shown?

A

Normal CSF analysis with elevated opening pressure ( > 200)

96
Q

In the outpatient setting how would you treat cellulitis if there was low suspicion for MRSA?

A

Cephalexin

98
Q

What is unique about Todd paralysis?

A

MOTOR ONLY

100
Q

What is the next best step in asymptomatic hyperkalemia?

A

Draw another sample

102
Q

What is an important complication of meningitis in peds? What is the ppx in exposed children? Adults?

A

Deafness; Rifampin; Cipro or rifampin bc cant give cipro to kid

103
Q

What is Berkson’s bias?

A

Bias introduced when experiments are done on hospitalized pts

104
Q

What part of the brain is MC affected by medulloblastomas?

A

Cerebellar vermis

105
Q

What is the Pygmalian effect?

A

ppl more likely to perform better with greater expectations placed on them

106
Q

What is the tetrad of CADASIL?

A

Psychiatric disturbance, dementia, multiple white matter strokes, and migraine with aura

107
Q

What is the cause of nonclassical CAH?

A

MILD deficiency of 21-hydroxylase

109
Q

Why is obesity a risk factor for endometrial hyperplasia?

A

The aromatase in adipose leads to increased estrogen levels

111
Q

How can the LAP score be misleading when differentiating CML from leukemoid rxn?

A

In CML with secondary infection it will be elevated so when in doubt do a flow cytometry (i.e. looking for that BCR ABL)

112
Q

What is the most important aspect of therapy in fat embolus syndrome?

A

Respiratory support

113
Q

What disease can predispose to septic arthritis, AA amyloidosis, and anemia of chronic dz?

A

RA

114
Q

Why is there hypochloremia in obesity hypoventilation syndrome and OSA?

A

Because the chronic acidosis leads to increased HCO3 absorption by kidneys with exchange for Cl to maintain electrical neutrality

115
Q

What is the arthritis in hemophilia pts referred to as?

A

Hemophilic arthritis secondary to recurrent hemarthroses with hemosiderin deposition

116
Q

What is photopsia?

A

Flashing lights seen in retinal detachment

118
Q

Why does histoplasma sometimes cause LAD, pancytopenia, and hepatosplenomegaly?

A

Targets MO in the reticuloendothelial system

119
Q

How do you tx Philadelphia positive ALL

A

Imatinib, dasatinib (non receptor tyrosine kinase inhibitors)

120
Q

Irradiated blood products are used in who and for what?

A

BMT pts to prevent transfusion-related GVHD

121
Q

What should you always do next whenever confronted with metabolic acidosis on labs?

A

CALCULATE A FUCKING ANION GAP

122
Q

What are scintillating scotomas suggestive of?

A

Aura of migraine with aura

123
Q

What can be seen on the physical exam of a pt with 3rd degree heart block and why?

A

Canon A waves due to atrioventricular dissociation

124
Q

How is the presentation of reactivated TB different from CAP?

A

TB often has pretty nonspecific sx not the picture of fulminant CAP

125
Q

How does Huntington’s chorea typically show up on neuroimaging? How do you treat the associated psychosis? The chorea?

A

Enlarged lateral ventricles (because caudate makes up the wall of the lateral ventricles); haloperidol; tetrabenazine

126
Q

When do you use milrinone in CHF?

A

For refractory CHF to the typical meds this is inotropic support (recall that in EF

127
Q

What is the likely cause of basophilic stippling with low MCV? Basophilic stippling with high MCV?

A

Sideroblastic anemia (lead poisoning); Alcoholism

128
Q

What ist he most common sex cord stromal tumor

A

Leydig

129
Q

Dull achy headaches, refractory to OTC pain meds raise suspicion for what?

A

Brain tumor

130
Q

Presence of a fever for more than 5 days is an important consideration for what pediatric illness?

A

Kawasaki dz

131
Q

What kind of metabolic disturbance does diarrhea cause?

A

Non-Gap metabolic acidosis

132
Q

When may angioedema occur when being treated with ACE-I

A

ANYTIME IN THE COURSE OF THERAPY

STEP 2 (13 decks)

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