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UWorld Flashcards

1
Q

Bone lesion in child w/ pain worse at night and better /w NSAIDs

A

Also will be unrelated to activity = Osteoid osteoma

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2
Q

What are porphyrias?

A

Porphyrias = acquired or congenital disorders in heme synthesis

Enzyme deficiency early in porphyrin synthesis => acute intermittent porphyria

Enzyme deficiency late in porphyrin synthesis => porphyria cutanea tarda

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3
Q

Membranous vs. membranoproliferative glomerulonephritis

(a) Renal biopsy findings
(b) Clinical presentation

A

Membranous GN

(a) basement membrane thickening
(b) Nephrotic in adult

Membranoproliferative GN

(a) Mesangial hypercellularity
(b) Nephritic in adult

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4
Q

Three diagnostic requirements for acute liver failure

A
  1. severe acute liver injury, ALT and AST over 1000
  2. synthetic dysfunction INR > 1.5
  3. hepatic encephalopathy (confusion, asterixis)
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5
Q

Differentiate typical presentating features of Patau vs Edwards syndrome

A

Patau (trisomy 13) = midline deficits: cutis aplasia (no epidermis over skull), micropthalmia, holoprosencephaly, omphalocele

Edwards (trisomy 18): closed fists w/ overlapping fingers, rocker bottom feet, micrognathia (undersized jaw

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6
Q

Inhibin A

(a) Produced where?
(b) Level in Turners pts
(c) Relevance in the quadruple screen

A

Inhibin A

(a) Released by ovaries
(b) Low in Turners pts (ovarian dysgenesis/streak ovaries)
(c) Elevated inhibin A on quadruple screen associated w/ increased risk of Down syndrome

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7
Q

Ecthyma gangrenosum vs. pyoderma gangrenosum

A

Ecthyma gangrenosum = hemorrhagic pustules that => necrtoci ulcers, 2/2 pseuomonas in pts w/ neutropenia and pseudomonal bacteremia
-tx w/ abx

Pyoderma gangrenosum- usually systemic disease like IBD, RA
-tx w/ steroids

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8
Q

CXR finding of pulmonary contusion

A

= Parenchymal bruising in the lung causing intra-alveolar hemorrahge and edema => patchy, irregular (nonlobular) alveolar infiltrate not restricted by anatomical borders

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9
Q

Age to introduce

(a) Cow’s milk
(b) Puree food

A

(a) Cow’s milk at one year age
- too early associated w/ increased risk of iron deficiency

(b) Puree food at 6 months
- too early associated w/ increased risk of GI infection

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10
Q

Drugs that decrease warfarin effect

A

Decreased warfarin effect (reduce its activity) = Cyp 450 inducers

“chronic alcoholics steal phen-phen and never refuse greasy carbs”

  • chronic EtOH
  • St. John’s wart
  • phenytoin
  • phenobarbitol
  • nevirapine (NNRTI)
  • rifampin
  • griseofulvin (antifungal)
  • carbamazepine
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11
Q

Clinical manifestations of acute intermittent porphyria

A

Usually after exacerbating factor (usual meds, fasting) get GI symptoms (N/V/D) and neuropsych (weakness, pain, psychosis)

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12
Q

Malignant otitis externa

(a) What is it?
(b) At risk populations
(c) Tx

A

Malignant otitis externa = necrotizing infxn of external auditory canal and base of skull

(a) Caused by pseuodomonas
(b) Elderly often w/ poorly controlled diabetes or otherwise immunocompromised
(c) IV cipro

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13
Q

HIV ppx based on CD4 count

A
  • CD4 under 200: trim-sulfa for PCP
  • CD4 under 150: itraconazole for Histo
  • CD4 under 100 W/ IgG positive for toxo: trim-sulfa for toxo
  • CD4 under 50: azithromycin for MAC

Note: no fluconazole for candidiasis ppx b/c don’t want drug resistance and it’s relatively easy to treat

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14
Q

What derm abnormality do the following treat

(a) Oral dapsone
(b) Topical clobetasol

A

(a) Oral dapsone (type of abx) used for dermatitis herpetiform in addition to gluten-free diet
(a) Clobetasol = high potency glucocorticoid used to tx bullous pemphigoid

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15
Q

MC cause of

(a) AL amyloidosis
(b) AA amyloidosis

A

(a) AL amyloid = light chains, MC cause is multiple myeloma

(b) AA amyloid = abnormal proteins, MC cause is rheumatoid arthritis

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16
Q

How to determine dose of anti-D immune globulin required

A

Give standard dose at 28 weeks of gestation, then repeat w/in 72 hrs of delivery

-about 50% of Rh- F will need a higher dose after delivery, placental abruption, or procedures, so use the Kleihauer-Betke test to determine dose to give to mother

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17
Q

Reversal agent for

(a) Heparin
(b) Warfarin

A

(a) Heparin reversal w/ protamine sulfate

b) Warfarin reversal w/ prothrombin complex concentrate to quickly decrease INR (by replacing vit-K dependent factors

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18
Q

Tx of torsades

A

If stable- IV Mg

If unstable- immediate defibrillation

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19
Q

What is Duputren’s contracture?

A

Fibroblast proliferation and collagen deposition => fourth and fifth digits contracted, deforming the hand

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20
Q

D/o associated w/

(a) FSGS
(b) Membranous nephropathy
(c) MPGN
(d) Minimal change disease

A

(a) FSGS associated w/ HIV, obesity, AA/Hispanic, heroin use
(b) Membranous- adenocarcinoma (breast, lung)
(c) MPGN: hep B and C
(d) Minimal change seen in lymphoma (liquid tumors, solid associated w/ membranous) and NSAID use

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21
Q

Conditions associated w/ pulsus paradoxus

A

Pulsus paradoxus = drop in systolic BP by 10 mmHg w/ inspiration

  • cardiac tamponade/pericardial effusion classically
  • BUT ALSO: severe asthma and COPD
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22
Q

9 yo F p/w unstead gait and weakness in lower limbs

  • decreased vib/position sense in LE
  • absent ankle jerks b/l
  • deformed high plantar arches
  • T wave inversions on ECG
  • MRI: atrophy of spinal cord

Dx

A

Dx = Freidreich ataxia

  • aut recessive
  • frataxin gene = mitochondrial protein, so needed in super active muscle tissue specifically heart and skeletal muscle

Gait/limb ataxia
Loss of vib/position sense, areflexia
T wave inversions from cardiomyopathy

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23
Q

Describe classic presentation of laryngomalacia

A

Laryngomalacia (floppy supraglottic structures that collapse during inspiration) presents at age 4-8 months w/ inspiratory stridor (‘noisy breathing’) worse when supine/better when prone

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24
Q

Clinically distinguish methanol and ethylene glycol poisoning

A

Both present w/ anion gap metabolic acidosis

Main difference: methanol damages the eyes (vision loss, see optic disc hyperemia), where ethylene glycol damages the kidneys

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25
Q

Relation btwn cholinergic agents and gluacoma

A

Anticholinergic agents (ex: trihexyphenidyl, benztropine, tropicamide, scopolamine) can precipitate acute angle-closure glaucoma

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26
Q

38 yo M w/ sarcoidosis on extended course prednisone p/w 6 wk h/o progressive R hip pain

(a) Dx
(b) Diagnostic test

A

(a) Dx = avascular necrosis of the hip
- Osteonecrosis (AVN) = not uncommon complication of chronic steroid use

(b) Xrays will be normal, need MRI

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27
Q

Changes in fetal heart tracing caused by

(d) Umbilical cord compression
(e) Chorioamnionitis

A

(d) Umbilical cord compression => variable decels = abrupt drops in fetal HR of varying depth and duration
(e) Maternal infection => fetal tachycardia (baseline over 160)

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28
Q

Significance of red reflex

A

If red reflex is absent (aka eye will look white) think

(1) Opacity of lens = congenital cataracts
(2) Tumor = retinoblastoma

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29
Q

Rules for meningococcal vaccine

A

Meningococcal vaccine: primary vaccine at 11-12, then booster at 16-21 (if got primary vaccination before 16)

High-risk pts (asplenia, military recruits, college students in residential housing)

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30
Q

Nitrate vs. esterase on UA

A
  • Esterase = pyuria (presence of bacteria in urine)
  • Nitrates = presence of Enterobacteriaecae (aka E. Coli which obv is the MC), b/c they convert urinary nitrates to nitrites
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31
Q

4 antihypertensives that are safe during pregnancy

A

“Hypertensive moms love nifedipine”

Hydralazine
Methyldopa
Labetalol
Nifedipine

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32
Q

Even asymptomatic pregnant F should be screened for what during first prenatal visit

A

Increased risk of pyelo in pregnancy => screen for asymptomatic bacteriuria and tx if UA has over 100k CFUs of a single organism

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33
Q

Differentiate clinical picture of clostridial myonecrosis vs. vascular compromise s/p full thickness burn

A

Clostridial myonecrosis (gas gangrene) p/w crepitus, fever

While vascular compromise (compartment syndrome) can result from eschar that constricts venous and lymphatic drainage

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34
Q

Age of presentation of

(a) Fanconi anemia
(b) Diamond-Blackfan anemia

A

(a) Fanconi- around 8 yoa w/ progressive pancytopenia

(b) Diamond-Blackfan = presents w/ pallor in neonatal period
- congenital hypoplastic anemia, only low RBC
- associated w/ short stature, webbed neck, cleft lip, shielded chest, triphalangeal thumbs

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35
Q

Compare the facial features of Fetal alcohol syndrome, Downs, and Fragie X

A

Fragile X: macrocephaly, long narrow face

Downs: flat facies w/ slanted palpebral fissues, small low set ears

FAS: smooth philtrum (space btwn nose and mouth), thin vermillion border (gap btwn lips and skin), small palpebral fissures, microcephaly

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36
Q

Distinguish clinical features of niacin and selenium deficiency

A

Selenium deficiency = cardiomyopathy (JVD, LE edema), thyroid dysfunction, immune dysfunction

Niacin (B3) deficiency = pellagra = dermatitis, dementia, diarrhea

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37
Q

Distinguish clinical features of zinc and copper deficiency

A

Zinc deficiency = alopecia, impaired taste, pustular skin lesion, hypogonadism, immune dysfunction

Copper deficiency = brittle hair, skin depigmentation, neurologic signs, sideroblastic anemia

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38
Q

Pt who presents w/ mono-like picture but negative heterophile antibody test

A

CMV mononucleosis: get the same fever, malaise, and fatigue w/ lymphocytosis and atypical lymphocytes on peripheral smear

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39
Q

Discharge and Lab findings seen in

(a) BV
(b) Trichomoniasis
(c) Candida vaginitis

A

(a) BV = gardnerella
- thin white discharge w/ fishy odor
- clue cells
- positive whiff test

(b) Trich = thin, yellow-green malodorous discharge
- motile trichomonads

(c) Candida- thick ‘cottage cheese’ discharge
- pseudohyphae w/ normal pH

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40
Q

First line tx for IIH

A

Pseudotumor cerebri first line = acetazolamide (carbonic anhydrase inhibitor) to reduce CSF production

+/- furosemide

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41
Q

Which primary care issue can OCPS increase risk of?

A

OCPs increase risk of worsening HTN
-not of diabetes, endometrial/ovarian cancer etc

Key: link btwn OCPs and HTN (mechanism unclear)

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42
Q

Contrast use of bethanechol and oxybutynin in bladder d/o

A

Bethanechol = cholinergic agent (enhances vagal tone) used for urinary retention or atonic bladder

Oxybutynin = anticholinergic agent used to block parasymp tone of bladder during filling => used to tx overactive bladder by improving bladder filling capacity

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43
Q

(a) 3 main features of B12 deficiency

(b) Cancer screening for ppl w/ B12 deficiency

A

(a) Macrocytic anemia, glossitis, neurologic symptoms (peripheral neuropathy

(b) Periodic stool testing for blood b/c of 2-3x increased risk of gastric cancer in ppl w/ pernicious anemia as cause of their B12 deficiency
- b/c pernicious anemia => atrophic gastritis => intestinal type gastric cancer or gastric carcinoid tumor

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44
Q

Which psych drugs are known to cause

(a) Wt gain
(b) agranulocytosis
(c) Nephrogenic diabetes insipidus
(d) Amenorrhea from hyperprolactinemia

A

(a) Wt gain: olanzapine and clozapine
(b) Agranulocytosis from Clozapine
(c) Nephrogenic DI from Lithium therapy
(d) Amenorrhea from risperidone

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45
Q

First line tx for DVT in pt on dialysis

A

Renal impairment contraindicates enoxaparin (LMWH) and DOACs (ex: rivaroxaban) b/c they’re metabolized by the kidney => high bleeding risk in CKD

Use unfractionated heparin to bridge to warfarin (need bridge b/c of transient hypercoagulable state of warfarin and takes time to therapeutic dose)

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46
Q

Hereditary spherocytosis

(a) Mode of inheritance
(b) Clinical presentation
(c) Abnormality on CBC
(d) Gold standard diagnostic test

A

(a) Aut dominant
(b) Hemolytic anemia w/ jaundice and splenomegaly
(c) Elevated MCHC 2/2 cellular dehydration and membrane loss
(d) Increased osmotic fragility on acidified glycerol lysis test, abnormal eosin-5-maleimide binding test

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47
Q

Differentiate trichinellosis from strongyloidiasis

A

Both are parasitic infxn from nematodes, both have GI symptoms (abd pain, N/V/D) w/ eosinophilia

But trichinellosis has muscle phase => significant myositis: muscle pain, weakness, tenderness, swelling
(not seen in strongyloidiasis)

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48
Q

Nematode you get from undercooked pork

A

Trichinellosis

Clinically: GI symptoms (abd pain/N/V/dio) first w/ eosinophilia, then comes muscle phase when larvae infect skeletal muscle = myositis, tenderness, weakness

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49
Q

46 yo in DKA p/w foul smelling nasal discharge and necrotic nasal turbinate
-KOH stain from nasal turbinates w/ hyphae

(a) Dx
(b) Tx

A

(a) Tx = mucormycosis
- invasive fungal infxn by Rhizopus or mucor in immunocompromised (esp poorly controlled DM2)
- necortic spread (due to infarction of infected tissues) to palate, orbit, and brain is common

(b) Tx = surgical debridement w/ amphotericin B

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50
Q

What is mixed cryoglobulinemia?

(a) Clinical features
(b) Lab findings

A

Mixed cryoglobulinemia = small to medium vessel vasculitis due to deposition of of cryoglobulin-containing immune complexes
-cryoglobulin = mixture of immunoglobulins and complement

(a) Palpable purpura, myalgia, arthralgia
- also hematuria and proteinuria
(b) Anti-HCV positive (strong association w/ HepC), low serum complement, elevated Cr 2/2 kidney involvement

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51
Q

Differentiate clinical presentations of Ehrlichiosis and Lyme disease

A

Ehrlichiosis = tick bite w/ NO rash, associated leukopenia and/or thrombocytopenia, elevated LFTs and LDH

Lyme: erythema migrans rash (targetoid), heart block b/l facial palsy, encephalopathy

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52
Q

Clinical features of amniotic fluid embolism

a

A

Rapid onset respiratory failure in F during labor or immediate postpartum period
-severe hypotension and DIC

(a) Tx: correct hypxemia (intubation) and hypotension (pressors)

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53
Q

Epigastric pain promptly relieved by a glass of water and a piece of bread, also w/ intermittent melena

(a) Dx
(b) Mgmt

A

(a) Duodenal ulcer = epigastric pain improved w/ food
(b) Both abx and PPI
- abx for H. pylori eradication

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54
Q

Define preeclampsia

A

New HTN after 20 weeks plus either proteinuria or end organ damage

Then eclampsia = preeclampsia + seizure, often have proteinuria

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55
Q

Rubella vs. Measles

(a) Where does the rash start
(b) Location of lymphadenopathy

A

Both have similar prodrome and rash

Rubella (German measles)- rash starts on face and quickly spreads to body, posterior auricular LN

Measles- rash starts on face and spreads to body over a few days, cervical LN

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56
Q

Maltese cross

A

Peripheral blood smear finding of Babesiosis = tick borne protozoal illness p/w flu symptoms and anemia/intravascular hemolysis and thrombocytopenia

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57
Q

Which conjunctivitis comes first in neonates?

A

Gonorrhea first in first 3-5 days, then later (5-14) days think chlamydial

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58
Q

Dietary recommendations for pts w/ renal calculi

A
  • High fluid intake
  • Decreased sodium intake (increased Na intake enhances calcium excretion => hypercalciuria, reduced Na stimulates Ca and Na reabsorption)
  • Normal calcium intake (don’t want a lot of Ca in urine)
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59
Q

Lab abnormalities of primary hyperaldo

A

Pt w/ HTN (maybe young pt w/ FHx) w/ metabolic alkalosis (peeing out H+), mild hypernatremia, either baseline hypokalemia or very prone to diuretic induced hypokalemia

So 35 yo pt comes in w/ HTN, starts low dose diuretic and becomes symptomatic from hypokalemia

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60
Q

Choice of tx for breast abscess 2/2 mastitis

A

So first line is needle aspiration w/ abx (dicloxacillin, cephalexin b/c usually S. aureus that enters thru the nipple during breast feeding)

Then second line, if abscess is not responsive to needle aspiration and abx, suspected presence of necrotic material, and large (over 5cm) pus collection = I & D (surgical draining)

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61
Q

NF 1 vs. NF2

(a) Clinically
(b) Mode of inheritance

A

(a) NF 1 = cafe au lait spots, axillary freckling, cutaneous neurofibromas, optic glioma

NF 2 = b/l vestibular schwannomas

(a) Both aut dom inheritance

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62
Q

Major cause of morbidity in Behcet syndrome

A

Recurrent oral and genital ulcers (Behcets)- major cause of morbidity is thrombosis

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63
Q

Ascitic fluid features c/w SBP

A

Diagnostic is ascitic fluid w/ > 250 PMNs

  • then gram stain usually shows G- bacteria (E. Coli, Klebsiella)
  • SAAG over 1, protein under 1g
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64
Q

First line tx for plt dysfunciton in uremia

A

DDAVP which stimulates release of vWF and factor VIII from endothelial storage sites

(don’t transfuse plts b/c they’ll just quickly be inactivated)

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65
Q

26 yo w/ chronic diarrhea x2 wks, colonoscopy w/ dark brown mucosal pigmentation in proximal colon

A

Laxative abuse causing melanosis coli = dark brown discoloration of colon seen either on gross pathology or histologically (pigment in macrophages of lamina propria)

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66
Q

Clinical features of Hairy cell leukemia vs. CLL (chronic lymphocytic leukemia)

A

Both in adults >50 w/ leukocytosis

Hairy cell: WBCs w/ ‘hairy’ like projections on peripheral smear, oftne pancytopenia (anemia and low plts 2/2 bone marrow infiltration), splenomegaly, no B symptoms
-BRAF mutation

CLL: prominent B symptoms w/ significant leukocytosis (>100k), smudge cells on peripheral smear

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67
Q

Clinical features of Waldenstrom macroglobulinemia vs. Multiple Myeloma

A

Both: Ig spike, plasma cell malignancy (MM) vs. B cell malignancy (WM)

Waldenstrom (B cell malignancy): hyperviscosity syndrome, neuropathy, bleeding, hepatosplenomegaly (from infiltration into tissue), lymphadenopathy

MM: CRAB

vs. MGUS: lower IgM spike and no end organ damage (no HSM)

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68
Q

Cushing’s reflex

A

Indicates elevated ICP

Triad:

  1. Hypertension
  2. Bradycardia
  3. Respiratory depression
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69
Q

42 yo F w/ 4 children is nervous b/c her mom got dx w/ breast cancer at 67, best recommendation for her?

A

Decrease alcohol intake

  • EtOH is a dose-dependent risk factor for breast cancer
  • genetic testing not indicated unless mother was under age 50
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70
Q

The number of trinucleotide repeats in Friedreich’s ataxia correlates w/ what?

A

Friedreich’s ataxia: aut recessive loss of frataxin (mitochondrial enzyme) gene used in highly active muscle (so skeletal muscle and heart)

  • age of onset of limb/gait ataxia
  • shorter time to loss of ambulation (median age 25 yo)
  • increased risk of cardiomyopathy (what causes death in 30/40s)
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71
Q

Breastfeeding failure jaundice vs. breast milk jaundice

A

Breastfeeding jaundice: see signs of dehydration on exam (fewer wet diapers- should be a wet diaper for every day of age during the first week), get jaundice b/c reduced bowel movements = reduced bilirubin excretion so more in recycled, within first week of life

Breast milk jaundice: no signs of dehydration, starts 3-5 days peaks at 2 weeks, due to high beta-glucoronidase in breast milk

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72
Q

Key clinical features of fibromyalgia

(a) 1st line tx

A

FIbromyalgia = noninflammatory (so normal ESR/CRP- hence why NSAIDs/steroids aren’t helpful) pain syndrome in young to middle aged F adults
-fatigue, widespread pain, cognitive/mood disturbance

(a) TCAs (amitriptyline) w/ exercise and good sleep hygiene

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73
Q

PPSV23 vs. PCV13 vaccines

(a) Immunologic response
(b) Who gets each?

A

PPSV23 = polysaccharide vaccine

(a) T-cell independent B cell response b/c polysacc alone (no proteins) can’t be presented to T cells
(b) Immunocompromised, adults under 65 w/ diabetes cirrhosis, all > 65

PCV13 = pneumococcal conjugate vaccine

(a) T-cell dependent B cell response b/c capsular polysac are covalently attached to inactivated diptheria toxin
(b) To infants and young children

74
Q

Differentiate SCFE and Legg-Calve-Perthes

A

SCFE = adolescent obese boy p/w altered gait w/o trauma

  • Xray w/ ice cream separated from or falling off cone (displacement of capital femoral epiphysis from femoral neck)
  • tx w/ immediate screw fixation to prevent AVN

Legg-Calve-Perthe = idiopathic AVN in boys 5-7 yoa

75
Q

21 yo w/ point tenderness over second metatarsal

(a) Dx
(b) Tx

A

(a) Stress fracture

(b) RICE

76
Q

Contraindications for yellow fever vaccine

A

Can’t give to immunocompromised (HIV w/ CD4 under 200) or on immunosuppressants (high dose corticosteroids, anti-TNF)
**Key here is to know you can’t give live attenuated virus to pts on anti-TNF agents (ex: adalimumab)

77
Q

Deficiency in the following cause

(a) Aldolase B
(b) Galactosidase-1-phosphate uridyl transferase

A

(a) Aldolase B deficiency = hereditary fructose intolerance
- presents later as breast milk doesn’t contain fructose

(b) = Galactosemia
- p/w jaundice, hepatomegaly, failure to thrive after breast milk or regular formula

78
Q

What is the Hawthorne effect?

A

Ppl change their behavior when they’re aware they’re being studied

79
Q

Define fetal tachycardia

A

Fetal tachy = baseline over 160 bpm

80
Q

22 yo F w/ vaginitis- microscopic exam shows flagellated motile organisms

Dx

A

Dx = trichomoniasis
-motile trichomonads

DIFFERENT from the clue cells seen from BV (gardnerella)

81
Q

Sequelae of hyperestrinism in cirrhosis

A

Spider angiomata, palmar erythema (both are from high estrogen), testicular atrophy, decreased body hair, gynecomastia

82
Q

Naltrexone vs disulfiram for EtOH cessation

A

Disulfiram- pt must be abstinent and very highly motivated

Naltrexone- first line to decrease craving and heavy drinking, can be initiated in pts who are still drinking (as long as they’re opioid free)

83
Q

Vitamin A used in the tx of what severe viral illness?

A

Severe cases of measles (conjunctivitis, coryza, cough, Koplik spots)

84
Q

Pt w/ diagnosed RA takes indomethacin- provides good relief but symptoms recur if dose is skipped

Next step in mgmt?

A

MTX!!! (need a DMARD)

-NSAIDs and COX2 inhibitors (celecoxib) are only for symptomatic relief, they do nothing to reduce disease progression

85
Q

Drugs that can cause idiopathic intracerebral HTN

A
  1. growth hormone
  2. tetracyclines (minocycline, doxycycline)
  3. excessive vitamin A and its derivatives (isotretinoin, all-trans-retinoic acid)
86
Q

Clinically distinguish leiomyomas and adenomyosis

A

Both cause heavy menses

Fibroids usually don’t come w/ pain, uterus nontender and non-uniformly enlarged

Adenomyosis (benign endometrial glands w/in uterine muscle) cause uniformly bulky, globular, TENDER uterus. Dysmenorrhea and pelvic pain

87
Q

Eosin-5-maleimide binding and acidified glycerol lysis test

A

Used to identify hereditary spherocytosis = aut. dominant hemolytic anemia

88
Q

Ophthalmic d/o associated w/

(a) Loss of peripheral vision
(b) Loss of central vision

A

(a) Loss of peripheral vision w/ eventual tunnel vision = open angle glaucoma
(b) Loss of central vision = macular degeneration

89
Q

Typical MRI findings of brain mets

A

Brain mets: multiple, well-circumscribed lesions w/ vasogenic edema at the grey-white matter jxn

90
Q

Lab value to differentiate iron deficiency anemia from thalassemia

A

Both microcytic anemia

  • iron deficiency anemia will have elevated RDW (>20%): nutrient availability fluctuates => RBC fluctuates
  • RDW normal in thalssemia (minors), also see target cells on peripheral smear of thalassemias
91
Q

Symmetric arthritis in child associated w/ what hematologic abnormality?

A

Jeuvenile idiopathic arthritis = chronic autoimmune d/o of childhood w/ symmetric arthritis
-associated w/ anemia (of chronic disease b/c elevated hepcidin)

92
Q

Explain swollen hands and feet in Turners pts

A

Lymphedema (nonpitting edema) in Turners pts due to dysgenesis of the lymphatic network

-can cause cystic hygroma of neck and fetal hydrops

93
Q

Mgmt of variceal hemorrhage

A

Nonselective beta blocker (propranolol or nadolol) to reduce portal venous pressure
-blocks adrenergic vasodilatory response of mesnseteric arterioles => reduced portal flow

Endoscopic variceal ligation if varice is huge

94
Q

Cyp p450 substrates

A

Drugs broken down by cytp450- so especially interact w/ oter cyt p450 inducers or inhibitors

“War on anti-terrorism”

Warfarin
OCPs
Anti-epileptics
Theophylline (PDE inhibitor for COPD)

95
Q

Distinguish laryngomalacia from vascular ring

A

Both can present w/ chronic stridor

Laryngomalacia: improves w/ prone positioning

Vascular ring: stridor improves w/ neck extension

96
Q

What is reactive arthritis?

(a) Classic triad
(b) Tx

A

Reactive arthritis = seronegative spondyloarthropathy usually from an enteric or GU infxn

(a) Triad: urethritis (UTI), conjunctivitis, asymmetric oligoarthritis
- also common to have mucocutaneous lesions and enthesitis
(b) First line tx = NSAIDs

Ex: 31 yo M w/ joint pain of R knee, R heel, lower back, recent trim-sulfa for urethral discharge, mouth ulcers, sterile synovial fluid

97
Q

When does sinusitis need abx vs. CT scan of sinuses?

A

Uncomplicated- give augmentin (amox clavulanate), then if becomes complicated (periorbital edema, vision abnormality, AMS) get CT

98
Q

Drugs that cause anemia 2/2 deficiency in

(a) Vit B6
(b) Folate

A

(a) Vit B6 (pyridoxime) and isoniazid
(b) Folate deficiency associated w/ trim-sulfa, MTX, AEDs (phenytoin)

So pt w/ h/o seizures who p/w megaloblastic anemia = B12 deficiency anemia

99
Q

Otherwise healthy 44 yo M w/ single episode of Afib w/ RVR and echo showing mildly dilated LA

A

No additional therapy- CHADSVASC of basically 0

CHF, HTN, Age over 75 2 pts, DM, Stroke/TIA, Vascular disease (prior MI), age 65-74 1 pt, Sex (F)

100
Q

15 yo girl p/w short stature, no breast development, no menarche

Expected hormone abnormality

A

= Turners syndrome (45 X,O) = ovarian dysgenesis (streak ovaries)
-no estrogen/progesterone = no feedback on anterior pituitary => elevated FSH and LH

So see elevated FSH/LH and absent menarche and thelarche (breast development)

101
Q

Prostaglandins administer for which congenital heart defect?

A

Transposition of the great arteries (arterial switch): give prostaglandins to keep open ductus arteriosus to optimize inter-circulatory mixing

102
Q

Skin condition associated w/ underlying hepC

A

Porphyria cutanea tarda = painless blisters that heal as scars and super sensitive skin w/ hyperpigmentation

103
Q

MC inherited hypercoagulable d/o in Caucasians

A

Factor V Leiden = aut dom point mutation in factor V that makes it unable to respond to activated protein C

= activated protein C resistance

104
Q

Clinical features of NAFLD

(a) RF

A

P/w abnormal LFTs and hepatomegaly in obese pt w/ other features of metabolic syndrome (diabetes, HTN) who doesn’t drink EtOH excessively, has normal iron studies, negative autoimmune and hepatitis markers

(a) Obesity
(b) Tx geared towards wt loss: diet, exercise, bariatric surgery

105
Q

Ovarian mass in 7 yo girl w/ s/s premature puberty

(a) Dx
(b) Tx

A

(a) Dx = granulosa cell tumor of the ovary
- secrete estrogen (get high serum estrogen) => precocious puberty

(b) Tx = surgical removal (they’re malignant)

106
Q

43 yo F G6P5 at 39 weeks gestation has GTC seizure in delivery room

  • BP 80/40, satting 75% on facebmask
  • unconscious, purpuric rash and bleeding from IV line site

(a) Dx
(b) Next step

A

(a) Dx = amniotic fluid embolism
- presents as acute respiratory failure w/ hypotension during delivery or immediate postpartum period

(b) Tx to correct hypoxemia (intubation) and hypotension (pressors)

107
Q

Changes in fetal heart tracings caused by

(a) Contractions
(b) Inactive fetal sleep
(c) Placental insufficiency

A

(a) Contractions can cause benign early decels = shallow decreases in HR 2/2 change in ICP
(b) INactive fetal sleep and hypoglycemia => nonreactive nonstress test (no accelerations seen on tracing)
(c) Placental insufficiency => late decels = smooth drops in HR after contractions from transient fetal hypoxia from placental hypoperfusion during contraction

108
Q

Graft vs. host disease

(a) Mechanism of disease
(b) 3 MC target organs

A

(a) Recognition of host HLA by donor T cells causing activation of donor T cells => cell-mediated immune response
(b) Skin (macpap rash), intestines (+FOBT diarrhea), liver (abnormal LFTs, jaundice)

109
Q

When to consider multiple system atrophy

A

MSA = Parkinsons + autonomic dysfunction

So when pt w/ Parkinsonism (cogwheel rigidity, shuffling gait, bradykinesia) also has orthostatic hypotension, impotence, incontinence, abnormal salivation/lacramation, gastroparesis etc

110
Q

MC cause of urinary tract obstruction in newborn M

A

Posterior urethral valves => Potter sequence

Potter sequence = olioghydramnios causing facial and limb abnormalities

111
Q

When is C-sxn indicated for arrest of active labor

A

Active labor is once already 10cm dilated, then arrest of active labor is either

  • no cervical change for 4 hrs w/ adequate contractions (over 200 MVU)
  • no cervical change for 6 hrs w/o adequate contractions

For arrest of active labor- C sxn is indicated
-oxytocin won’t help if contractions are adequate!

112
Q

Differentiate infiltrating ductal carcinoma from intraductal papilloma

A

Both p/w unilateral bloody nipple discharge

Intraductal papilloma (more common), is benign: no associated mass of lymphadenopathy
-imaging w/ normal breast tissue or single dilated breast duct

Infiltrating ductal carcinoma: has corresponding breast mass and lymphadenopathy, breast imaging shows lesions w/ microcalcifications

113
Q

2 MC prodromes to reactive arthritis

A

Reactive arthritis usually causes

  • acute GI infxn (ex: salmonella, yersinia)
  • acute GU infxn (urethritis- E. coli or chlamydia)
114
Q

Dose limiting side effect of hydroxyurea in sickle cell pts

A

Myelosuppression (neutropenia, anemia, thrombocytopenia)

115
Q

When can’t tell by look- helpful hints for SCC vs. basal cell carcinoma

A

SCC: more common in immunocompromised (s/p transplant) or over a scar, more common on extremities, can display early perineural invasion causing regional neurologic symptoms (numbness, paresthesias)

BCC: MC overall, usually head or neck, upper lip

116
Q

Management/tx of lichen sclerosis vs atrophic vaginitis

A

Tx atrophic vaginitis w/ low-dose topical estrogen

While lichen sclerosis can be premalignant (increased risk of vulvar SCC) so do punch biopsy to confirm dx and r/o malignancy. Once dx confirmed tx w/ high dose topical corticosteroids (it’s a chronic inflammatory condition, not estrogen deficiency)

117
Q

Cyp450 inhibitors

A

CRACK AMIGOS

Cimetidine (H2 blocker like Ranitidine)
Ritonavir (protease inhibitor)
Amiodarone
Ciprofloxacin 
Ketoconazole (and other azoles)
Acute EtOH use
Macrolides (except Azithromycin)
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides (Bactrim)
118
Q

How to prevent recurrence of uric acid kidney stones

A

Potassium citrate to alkalinize urine and low-purine diet

  • uric acid stones are highly soluble in alkaline urine
  • citrate = stone inhibitor, reduces crystallization
119
Q

UA and serum findings findings of

(a) Post strep GN
(b) Drug induced AIN
(c) IgA nephropathy

A

(a) Hematuria, RBC casts, proteinuria on UA. Low serum C3 complement levels
(b) Hematuria, sterile pyuria, WBC cases (no RBC casts)
(c) Hematuria, normal serum complement

120
Q

Deficiency in the following cause

(a) Aldolase B
(b) Galactosidase-1-phosphate uridyl transferase

A

(a) Aldolase B deficiency = hereditary fructose intolerance
- presents later as breast milk doesn’t contain fructose

(b) = Galactosemia
- p/w jaundice, hepatomegaly, failure to thrive after breast milk or regular formula

121
Q

Tx for acute vs. chronic prostatitis

A

Acute prostatitis: Trim-sulfa or fluoroquinolone

Chronic pancreatitis: fluoroquinolone

Both for 4-6 weeks

122
Q

Alzheimers vs. NPH

A

Can have overlapping features, but differ on what comes first and what is most prominent

AD: first and most prominent is the memory, other stuff comes later

NPH: gait impairment is most prominent, cognitive disturbance come much later

123
Q

Impact of intensive glycemic control in DM2

A

No change in mortality or microvascular complications (acute MI/stroke)

Bt decreased risk of microvascular complications (retinopathy, nephropathy)

124
Q

Mechanism of cyanoide toxicity

A

Cyanide binds to cytochrome oxidase => inhibits mitochondrial oxidative phosphorylation

=> lactic acidosis (metabolic acidosis) from shift to anaerobic metabolism

125
Q

Differentiate CN III palsy that results from nerve compression vs. ischemic damage

A

Nerve compression (external) => loss of parasympathetics (mydriasis) in addition to ischemic findings

Ischemic nerve damage damages from the center, associated w/ poorly controlled diabetes, ptosis, down and out gaze, diplopia, but normal pupillary response (b/c parasympathetics intact)

126
Q

25 yo F w/ amenorrhea x2 months w/ constant vomiting, wt loss

A

Hyperemesis gravidarum = persistent N/V during pregnancy that can cause weight loss from prepregancy weight

Differentiate from typical N/V by ketones in the urine (2/2 prolonged hypoglycemia)

127
Q

Clinically differentiate lichen sclerosis from atrophic vaginitis

A

Lichen sclerosis = vulvar premalignant lesion of “cigarette” paper thinning of skin of vulvar and perianal region, spares vagina and cervix
-chronic inflammatory condition in women of all ages, associated w/ other AI d/o

While atrophic vaginitis involves vagina cervix and some vulva, no perianal region, less severe, less itchy, thinning of vagina not figure 8 w/ perianal region
-tx w/ topical estrogens

128
Q

Differentiate factitious d/o from somatic symptom d/o

A

Factitious d/o = intentional falsification w/ goal to assume sick role (secondary gain)

Somatic symptom d/o = excessive anxiety and preoccupation w/ one or more unexplained symptom

129
Q

Describe CT finding of invasive pulmonary aspergillosis

A

In immunocompromised pt: see “halo sign” = nodules w/ surrounding ground glass opacities

130
Q

Locate the stroke:

65 yo M w/ sudden onset weakness of R arm/leg and R facial paresis

  • otherwise normal exam
  • no findings on CT
A

Pure motor stroke = lacunar stroke of contralateral internal capsule

Stroke = L internal capsule posterior limb

131
Q

53 yo F s/p chemo for breast CA w/ R abd pain, lightly brushing skin on abd elicits intense pain

Dx

A

Dx = varicella zoster reactivation

Hyperesthesia/allodynia- pain can precede onset of vesciular rash by several days

132
Q

What to do when a pt w/ chronic hep C (untreated) gets pregnant

A

Don’t treat (ribavirin is teratogenic), no need for C-section (not protective), and breastfeeding should be encouraged UNLESS maternal blood present (nipple injury)

One recommendation = Hep A and B vaccination

133
Q

Anterior, middle, vs posterior mediastinal massese

A

Anterior mediastinal mass = thymoma

Middle mediastinal mass = bronchiogenic cyst

Posterior mediastinal mass = neurogenic tumors (ex: neuroblastoma)

134
Q

Protocol for pts s/p splenectomy

A
  1. ppx penicilin for 3-5 years

2. vaccines: pneumococcal, haemophilus, meningococcal

135
Q

Mode of inheritance

(a) Friedreich’s ataxia
(b) HOCM

A

(a) Aut recessive (trinucleotide repeats)

(b) Aut dom

136
Q

3 cyanotic heart disease in newborns that present w/ single S2

(a) Accompanying murmur

A
  1. TGA
  2. Tricuspid atresia
    (a) VSD murmur
  3. Truncus arteriosus
    (a) systolic ejection murmur (increased flow thru the truncal valve)

TGA is the only one that won’t have a murmur

137
Q

2 common presentations of fibromuscular dysplasia

A
  1. HTN 2/2 renal artery stenosis

2. Headaches 2/2 carotid artery stenosis

138
Q

What is Asherman syndrome?

A

Intrauterine adhesions from infection (severe endometriosis) or surgical intervention (D&C, endometrial ablation) that can cause infertility

139
Q

Eczema + imunodeficiency

A

Eczema + immunodeficiency + thrombocytopenia = Wiskott Aldrich

  • X-linked
  • immunodeficiency is 2/2 hypogammaglobulins
140
Q

67 yo w/ progressive vision loss where “vertical lines appear bent and wavy”

A

Grid test = early sign of macular degeneration- leading cause of blindness in developed countries
RF: age, smoking
Also Drusen spots

141
Q

Danger of Graves pt s/p thyroidectomy during pregnancy

A

After delivery baby may have transient thyrotoxicosis 2/2 transplacental passage of anti-TSH antiobodies during the third semester

-highest risk if mother has anti-TSH receptor antibodies above 5 times ULN

142
Q

50 yo w/ ESRD on dialysis x4 yrs w/ R carotid bruit on exam, most likely to die from what in the next 5 years?

A

Cardiovascular disease

-not stroke (despite bruit), CVD is the MC cause of death in dialysis pts, also MC cause of death in renal transplant pts

143
Q

Risk of giving pt w/ megaloblastic anemia folic acid instead of B12

A

If they’re B12 deficient, giving folic acid may correct the anemia (no longer see megaloblasts on peripheral smear), but => rapid progression of neurologic complications

  • loss of proprioception and vibration sense
  • memory deficits, irritability, dementia
144
Q

2 RF from hyperemesis gravidarum

A
  • hytadiform mole

- multiple gestations (twins)

145
Q

Tx for neonatal conjunctivitis: 3 days old vs. 10 days old

A

3 days old w/ purulent discharge = gonococcal => tx w/ single IM dose of ceftriaxone

10 day old w/ mucuopurulent d/c = chlamydia => tx w/ oral erythromycin (PO macrolide)

146
Q

23 yo s/p MVA w/ pain and SOB, progressive drowsiness
-BP 160/90, HR 50, R. sided weakness

(a) Dx?
(b) Expect dysfunction of what cranial nerve?

A

(a) Transtentorial (uncal) herniation
- Cushing’s reflex indicating elevated ICP (HTN, bradycardia, resp depression)
- compression of contralateral cerebellar peduncle => ipsilateral hemiparesis

(b) CN III compression => mydriasis from loss of parasympathetics and eye down and out

147
Q

Main clinical distinction btwn serotonin syndrome and NMS

A

Both w/ AMS and autonomic instability

NMS: rigidity and hyperthermia

SS: hyperreflexia and myoclonus**

148
Q

Palpable breast mass in F, first step?

A

Depends on age!

Under 30: get ultrasound
30 or over: mammogram

149
Q

Indication for negative-pressure wound therapy

A

= Vacuum assisted wound closure- applies sub-atmospheric pressure to accelerate healing
-ONLY in healthy, granulating wounds
NOT for infected or necrotic wounds

150
Q

Newborn w/ CF w/ nonbilious vomiting

(a) Dx
(b) Next step

A

(a) Dx = meconium ileus

(b) Next step = contrast enema in stable pts to determine level of obstruction

151
Q

Differentiate clinical presentation of Babesiosis and Ehrlichia

A

Both are tick borne p/w no rash and thrombocytopenia (and can have elevated LFTs)

Ehrlichae- leukopenia

But Babesiosis will have signs of intravascular hemolysis (jaundice, dark urine, high LDH) and leukocytosis

152
Q

When is BRCA, HER2 testing indicated?

A

Genetic testing indicated when

  • breast cancer in F under 50 yoa
  • ovarian cancer at any age
153
Q

When do use the following when assessing pt w/ possible PE

(a) D dimer
(b) Ultrasound of lower extremities
(c) TTE
(d) CTA

A

(a) D dimer if suspicion is low to rule it out, not helpful if high suspicion
(b) US of LE only if they have clinical manifestations in LE, also not that helpful b/c negative doesn’t r/o
(c) TTE in decompensating pts (too unstable for CTA) to see RV dilation/dysfunction if massive PE
(d) Gold standard = CT angiogram

154
Q

Clinical presentation of cardiac myxoma

(a) Location
(b) Complications

A

Cardiac myxoma = MC intracardiac tumor
Clinically: constitutional symptoms (fever, wt loss), can cause acute HF 2/2 obstruction

(a) 80% in the left atrium
(b) CV complications (acute HF, arrhythmia, valvular disease, heart block)
- Embolization (stroke)
- Lung invasion => respiratory symptoms

155
Q

Tx for actinic keratosis vs. BCC

A

Actinic keratoses can be tx topically w/ fluorouracil or liquid nitrogen cryotherapy

While basal cell carcinioma indicates excisional biopsy

156
Q

First line tx for croup?

(a) When to intubate

A

Croup = laryngotracheitis- seal like barky cough, inspiratory stidor

Start w/ corticosteroids (single dose dexamthasone) to reduce airway inflammation

  1. If stridor present at rest or still respiratory compromised give nebulized racemic epinpehrine
    - vasoconstricts mucosal arteries to decrease airway edema and reduce secretions

(a) Only intubate if corticosteroids and nebulized racemic epi fails

157
Q

Pt w/ painless genital ulcerated lesion but negative RPR- what to do next

A

RPR and VDRL (nontreponemal tests) can be negative early in infection => empirically treat anyway w/ penicillin

158
Q

Activity of protein C and protein S

A

They inactivate factors V and VIII

159
Q

58 yo w/ h/o chronic hepC p/w hepatic encephalopathy and SBP has gradual increase in serum Cr throughout stay

  • renal US: normal size kidneys w/o hydronephrosis
  • no improvement w/ IV saline or albumin

(a) Dx
(b) Mechanism
(c) Tx

A

(a) Hepatorenal syndrome = gradual reduction in renal perfusion induced by increasing severity of severe hepatic injury
- represents end stage of step wise process
(b) Due to splanhcnic arterial dilation induced by portal HTN
(c) Tx by splanchnic vasoconstrictors (midodrine, octreotide, norepi) or liver tranpslant

160
Q

PKU

(a) 2 hallmark clinical findings
(b) Diagnostic study

A

PKU = phenylanine hydroxylase deficiency => can’t metabolize phenylalanine to tyrosine so phenylalanine accumulates as neurotoxic byproducts

(a) Musty body odor, fair complexion (hypopigmentation)
(b) Quantitative amino acid analysis

161
Q

42 yo F w/ 4 children is nervous b/c her mom got dx w/ breast cancer at 67, best recommendation for her?

A

Decrease alcohol intake

  • EtOH is a dose-dependent risk factor for breast cancer
  • genetic testing not indicated unless mother was under age 50
162
Q

Differentiate typical pt that benefits from CBT vs dialectical behavioral therapy vs biofeedback

A

CBT: changes maladaptive behavior (I’m fat, I’m worthless)

Dialectical behavior therapy for boderline personality d/o: helps regulate emotion and manage self harm

Biofeedback for pts w/ prominent physical symptoms (pain d/o)

163
Q

Differentiate the symptoms and first line tx for

(a) Open angle glaucoma
(b) Cataracts
(c) Macular degeneration

A

(a) Open angle glaucoma = loss of peripheral vision w/ eventual tunnel vision
- tx w/ beta-blocker eye drops = Timolol

(b) Cataracts = gradual blurring of vision and decreased night vision from progressive thickening of the lens
- definitive tx w/ lens extraction

(c) Macular degeneration = loss of central vision
- not much for tx

164
Q

Urinary 5-HIAA elevated indicates what dx?

(a) Clinical features

A

Elevated 5-HIAA = Carcinoid syndrome, becomes sympatomatic when liver mets (so bypass portal circulation where histamine, serotonin, and VIP get metabolized)

(a) Episodic flushing/episodic pounding sensation, secretory diarrhea, wheezing tricuspid regurg 2/2 plaque-like deposits on R heart

165
Q

Clinical presentation of abruptio placentae vs placenta previa

A

Abruptio placentae (placenta separating from uterine wall before delivery) = vaginal bleeding, abdominal/back pain, frequent contractions

While placenta previa is painless vaginal bleeding

166
Q

Pt w/ N/V, pneumobilia, hyperactive BS, dilated loops of bowel on Xray

Dx

A

Dx = gallstone ileus = when gallstone passes thru biliary-enteric fistula into the small bowel, eventually stone to ileum (narrowest portion)

(pneumobilia is air in the biliary tree)

167
Q

MC cause of congenital hypothyroidism

(a) Clinical presentation
(b) Mgmt

A

MC cause of congenital hypothyroidism = thyroid dysgenesis (not iodine deficiency which is super uncommon nowadays)

(a) P/w poor feeding, hoarse cry, jaundice
(b) Want to recognize early and give levothyroxine to prevent permanent neurodevelopmental injury

168
Q

3 main manifestations of Friedreich’s ataxia

A

Autosomal recessive d/o, life expectancy 20 yoa

  1. Neurologic (degeneration of spinal tracts): gait ataxia, frequent falls, dysarthria (speech difficulty)
  2. skeletal deformities: scoliosis, hammer toes
  3. concentric hypertrophic cardiomyopathy
169
Q

Name the 3 ddx for vaginitis

A
  1. Bacterial vaginosis = gardnerella
  2. Trichomoniasis
  3. Candida
170
Q

MC brain tumor in children

A

Pilocytic astrocytoma = low grade astrocytoma (vs. high grade astrocytic tumor = glioblastoma which was much less common)

171
Q

Amikacin

(a) Class of abx
(b) Mechanism
(c) Side effect

A

Amikacin

(a) aminoglycoside abx (like gentamicin, tobramycin, streptomycin
(b) Inhibits protein synthesis by inhibiting 30S ribosomal subunit
(c) Renal toxicity => carefully monitor renal fxn during therapy

172
Q

Low maternal BMI/poor wt gain increases fetal risk for what?

A

Growth restriction and preterm delivery

-NOT anemia or cystic hygroma (Turner’s, lymphatic dysfunction)

173
Q

4 parts of uncal herniation syndrome

A
  1. compression of ipsilateral PCA => ischemia to visual cortex => contralateral homonymous hemianopsia
  2. compression of ipsilateral oculomotor nerve (CN III) => mydriasis, eye down and out
  3. compression of contralateral cerebellar peduncle => ipsilateral hemiparesis
  4. compression of reticular formation => altered mental status, coma
174
Q

Clinical presentation

(a) Suppurative thyroiditis
(b) Subacute thyroiditis
(c) Subacute lymphocytic thyroiditis

A

(a) Suppurative = uncommon, euthyroid, inflammatory condition so have high fever

(b) Subacute (de Quervain) = painful/tender goiter, post viral inflammatory process w/ prominent hyperthyroid symptoms
- elevated ESR/CRP

(c) Subacute lymphocytic = painless/nontender goiter, brief hyperthyroid phase
- variant of Hashimotos => TPO Ab +

175
Q

Define hypertensive emergency and malignant hypertension

A

Hypertensive emergency = severe HTN (over 180/120) w/ presence of either malignant HTN or hypertensive encephalopathy

Malignant HTN = retinal hemorrhage, exudates, and/or papilledema
-renal findings (ARF) usually present but not required for dx)

176
Q

Why is cyclophosphamide reserved for really bad SLE cases

(a) How to avoid complication

A

Cyclophosphamide (alkylating agent) reserved for SLE cases w/ significant renal or CNS involvement b/c of side effects: hemorrhagic cystitis/bladder cancer

(a) Lots of fluids and taking MESNA to clear it’s active meabolite (acrolein) from the bladder

177
Q

Dermatomyositis

(a) Antibodies
(b) Key complication

A

Demrmatomyositis

(a) Anti-Jo1 (anti-synthetase) Abs
(b) Over 15% of these pts will have malignancy => age-appropriate cancer screening is key

178
Q

72 yo presents in hypertensive emergency, started on O2 furosemide and nitroprusside drip

Complication?

A

Complication of prolonged nitroprusside (potent vasodilator) ggt = cyanide poisoning

P/w AMS (confusion, disorientation), flushing then cyanosis, arrhythmia, tachypnea, metabolic acidosis (from lactic acidosis), renal failure

179
Q

HIV+ pt w/ neck stiffness and cervical lymphadenopathy, LP w/ low glucose high protein high whites
CSF fungal stain w/ encapsulated yeast

(a) Dx
(b) Tx

A

(a) Cryptococcal meningitis from cryptococcus neoformans

(b) Tx = amphotericin plus flucytosine

180
Q

Differentiate osteosarcoma, Ewing sarcoma, osteoid osteoma

A

Osteosarcoma = spiculated sunburts on long bone, Codman’s triangle of periosteal elevation
-MC in children and young adults

Ewing Sarcoma = less common, osteolytic lesion w/ perisoteal rxn producing layers = onion skin appearance

Osteoid osteoma (benign) = sclerotic cortical lesion w/ central lucency, pain worse at night unrelated to activity and improves w/ NSAIDs

181
Q

Popliteal cyst

(a) Chronic presentation
(b) Acute presentation

A

Popliteal (Baker) cyst
(a) Usually asymptomatic, chronic painless bulge behind the knee

(b) Can rupture (trauma like strenuous exercise) pushing fluid into connecting bursa of nearby muscles
- presents like DVT: posterior knee and calf pain, venous swelling (so usually do US to r/o DVT)
- give away is the crescent sign = arc of ecchymosis distal to medial malleolus

182
Q

Tx of multiple system atrophy

A

MSA = Parkinsons + autonomic dysfunction, doesn’t usually respond to anti-Parkinson agents

Treatment aimed at increased intravascular volume w/ salt supplementation, fludrocortisone (mineralocorticoid), alpha agonist

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