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Bellevue Medicine > UWorld 7 > Flashcards

UWorld 7 Flashcards

1
Q

What is Pellagra?

3 D’s

A

Pellagra = due to niacin deficiency

3 D’s = dermatitis, dirarrhea, dementia
Dermatitis in sun exposed areas- rough, hyperpigmented scaly skin
Diarrhea
Dementia

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2
Q

What lab markers should be monitored in pts taking amiodarone

A

Amiodarine (dirty antiarrhythmic) is associated w/ hypo/hyper-thyroid and hepatotoxicity

=> Periodically monitor thyroid and hepatic function markers

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3
Q

68 yo M w/ LLE pain: cold and pale below the knee
PMH: HTN, DM2, Afib, MDD
-Not palpable posterior tibial or dorsalis pedal pulses

Dx?
(a) What could have prevented this acute problem?

A

Arterial emboli causing acute limb ischemia

(a) Warfarin (or RIvaroxaban)- most effective (better than ASA+Plavix) to reduce risk of systemic embolization in pts w/ AFib

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4
Q

IBS

(a) Subtypes
(b) Colonoscopy findings

A

IBS

(a) diarrhea or constipation predominant, or mixed
(b) Normal colonic mucosa on colonoscopy

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5
Q

Surveillance screening for pts w/ cirrhosis

A

Surveillance for HCC w/ ultrasound every 6 mo

-regardless of the etiology of cirrhosis

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6
Q

65 yo F presents w/ HF exacerbation, started on IV furosemide

  • already on aspirin, digoxin, furosemide…
  • day 3: tele reveals 6 beats of wide complex ventricular tachycardia

Next step in management?

A

Measure serum electrolytes- VT most likely from electrolyte imbalance (hypokalemia, hypomagnesemia) due to diuretics

Also check Dig levels- VT can be from dig toxicity

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7
Q

Most common valve involved in IE in an IVDU

(a) What murmur does this cause?

A

Tricuspid valve involvement (right-sided) more common than aortic

(a) Systolic murmur that increases w/ inspiration

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8
Q

Clinical features of hypocalcemia

A

Muscle cramps
Chvostek sign- facial twitch when tap on facial nerve
Trousseau sign- carpopedal spasm when inflate BP cuff for 3+ seconds
Paresthesias
Hyperreflexia/tetany
Seizures

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9
Q

Mechanism of low Hb in beta-thalassemia major

(a) Tx

A

Normal adult Hb has 2 alpha and 2 beta chains (a2b2) w/ a heme.
Beta-thal major = impaired production of beta-globin chain => excess of alpha-globin chains which are unstable and cause chronic hemolysis

(a) Transfusion
- beta-thal major (not minor) is transfusion dependent anemia

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10
Q

68 yo M p/w exertional fatigue

  • mild mucosal pallor, no lymphadenopathy
  • Hb: 9.4 (MCV 92)
  • Na 136, K 4.4, Ca 10.7
  • Tprot 9, Alb 3.7, Tbili .9, alk phos 100

Dx

A

Constitutional symptoms orbone pain + anemia + hypercalcemia + protein gap (total - albumin > 4) = multiple myeloma

Cloncal plasma cell proliferation

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11
Q

Central retinal vein occlusion

(a) Clinical presentation
(b) Opthalmoscope findings

A

Central retinal vein occlusion

(a) Sudden, painless, unialteral loss of vision
(b) disk swelling, retinal hemorrhages, cotton wool spots, venous dilationa nd tortuosity

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12
Q

Tx for acute MS exacerbation

A

First line = high dose IV glucocorticoids (methylprednisone)

Plasma exchange for pts who don’t respond to high-dose glucocorticoids

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13
Q

65 yo M w/ sudden vision loss in left eye that resolved after 5 minutes

  • similar episode 3 mo ago that lasted a few seconds
  • no flashes or floaters
  • funduscopy: whitened, edematous retina following destribution of retinal arterioles in the left eye

Dx and mechanism

A

Amaurosis fugax: hypertensive pt w/ temporarly vision loss

Mechanism: retinal emboli from the ipsilateral carotid artery, often due to atherosclerosis
-once the clot breaks up blood flow is restored and vision returns

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14
Q

Name 2 ototoxic drugs

A

Aminoglycosides

Loop diuretics

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15
Q

Most common vaccine-preventable disease among travelers

A

Hep A

-consider hepA vaccine for all ppl traveling to developing countries

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16
Q

When do prolactinomas require tx?

(a) Surgery vs. meds

A

If asymptomatic- can do no tx
If symptomatic or huge (> 10 mm): start w/ dopamine agonists (cabergoline, bromocriptine)

If very large (over 3 cm) or if increases in size while on tx => resection (transsphenoidal surgery)

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17
Q

34 yo Brazillian male w/ h/o megacolon 2 yrs ago presents w/ new onset HF

A

Chagas disease = chronic disease from protozoa trypanosoma cruzi (endemic to Latin America) that can cause megaesophagus, megacolon, and/or cardiac dysfunction

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18
Q

Lab value to differentiate beta-thalassemia from iron deficiency anemia

A

Both are microcytic anemias, but beta-thalassemia you have a disproportionately high RBC count

Iron deficiency anemia has low RBC count

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19
Q

Major cause of mortality in TCA overdose

A

Hypotension

=> after ABCs administer sodium bicarb to help improve BP

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20
Q

Malignant otitis externa

(a) Most common causative organism
(b) Tx

A

Malignant otitis externa = severe infection typically seen in elderly diabetic pts

(a) Pseudomonas
(b) Systemic (not topical) abx: ciprofloxacin

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21
Q

What is the most common benign primary cardiac tumor?

(a) Most common location
(b) Clinical presentation

A

Cardiac myxoma

(a) 80% in the left atrium
(b) Constitutional (fever, wt loss), CV complications (mitral disease, arrhythmias), embolization

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22
Q

Mechanism of osteomyelitis adjacent to a foot ucler

A

Contiguous spread of infection = along tissue planes

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23
Q

Bronchoscopy sample culture: branching, filmentous bacteria that is partially acid fast

A

Nocardia

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24
Q

68 yo F w/ recent right-sided facial droop.

What could help localize facial nerve palsy to lesion above or below the pons?

A

Bell’s palsy = rapid onset of unilateral upper and lower facial weakness = acute peripheral neuropathy of CN VII (lesion below the pons)

Peripheral vs. central facial palsy
Peripheral = Bell’s palsy = loss of forehead and brow movement, inability to close eyes and eyelid dropping

vs. central: preservation of forehead and brow movements
- contralateral lower facial weakness that spares the forehead

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25
Q

Syphilis tx in ppl w/ penicillin allergy

(a) Primary
(b) Secondary
(c) Tertiary
(d) During pregnancy

A

Treating syphilis in ppl w/ penicillin allergy

(a) Primary- doxy x14 days
(b) Secondary- doxy x14 days
(c) Tertiary- ceftriaxone x14 days
(d) Pregnancy- desensitize and administer penicilin

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26
Q

Name some causes of acute hypocalcemia

A
  • neck surgery (parathyroidectomy)
  • pancreatitis
  • sepsis
  • tumor lysis syndrome
  • acute alkalosis
  • chelation
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27
Q

How long after an MI would you expect the following complications

(a) papillary muscle rupture
(b) free wall rupture
(c) pericarditis
(d) left ventricular aneurysm

A

MI complications

(a) Papillary muscle rupture: 2-7 days after MI
(b) free wall rupture: hour to 2 weeks after MI
(c) pericarditis: 1 day to 3 mo after
(d) left ventricular aneurysm: 5 days to 3 mo after

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28
Q

24 yo F w/ daily crampy abdominal pain x2 years

  • not always preceded by eating
  • often accompanied by passage of small loose stools and mucus, which relieves the pain
  • mother died of colon cancer at age 65

Dx

A

IBS = Irritable bowel syndrome

-diagnose using Rome III criteria

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29
Q

When would you transfuse in a pt w Hb above 7?

A

Treshold of Hb under 9 is considered for unstable pts w/ ACS or active bleeding and hypovolemia

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30
Q

Mechanism of heparin

A

Activates antithrombin III that inactivates thrombin, factor IXa (intrinsic pathway) and Xa (common pathway)

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31
Q

Esophageal cancer associated with

(a) Heavy EtOH consumption
(b) smoking
(c) Barrets

A

Esophageal cancers

Adenocarcinoma from Barrett’s/GERD

Squamous cell from heavy EtOH or smoking

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32
Q

Diagnostic test for acute onset of acute pancreatitis

A

Amylase/lipase- don’t need imaging to confirm diagnosis

CT used if diagnosis is unclear or pts don’t improve w/ conservative management

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33
Q

UA sediment findings indicative of ATN vs. AIN

A

Acute tubulonephritis = muddy brown granular casts

Acute interstitial nephritis = WBC casts

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34
Q

Organism that causes bacillary angiomatosis in immunocompromised pt

A

Bartonella

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35
Q

Hairy cell leukemia

(a) Type of cancer
(b) Clinical presentation
(c) Peripheral smear
(d) Bone marrow aspirate

A

Hairy cell leukemia

(a) B-lymphocyte derivative of chronic leukemia (CLL subtype)
(b) Pancytopenia (10% w/ leukocytosis tho) and splenomegaly
(c) Peripheral smear: lymphocytes have fine hair-like irregular projections
(b) Often a ‘dry tap’- unsuccessful BM biopsy b/c BM is fibrotic

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36
Q

59 yo w/ h/o COPD presents w/ severe dyspnea and left-sided chest discomfort

  • trace ankle edema, markedly decreased breath sounds over left chest
  • EKG: snus tach
  • PaO2 59 mmHg

Dx and mechanism

A

Spontaneous pneumothorax- suspect it in pts w/ COPD w/ catastrophic worsening of respiratory symptoms

Chronic destruction of alveolar sacs in COPD cause formation of large alveolar blebs (dilated apical alveoli) in the upper lobes. these blebs can then rupture and leak air in to the pleural space => spontaneous pneumothorax

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37
Q

50 yo F wandering the streets w/ abnormal gait BIB police

  • incoherent mumbling, not oriented to time or place
  • T 97.3, BP 160/100, HR 100, RR 18, BMI 17
  • pupils 3mm b/l, react slowly to light
  • symmetrical DTRs

Best initial tx

A

Thiamine (B1) then give glucose

Chronic malnutrition => Wernicke’s encephlopathy: classic triad of encephalopathy, ocular dysfunction, and gait ataxia

When don’t know the cause of AMS, often start empiric tx w/ thiamine

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38
Q

ROME III criteria

A

Diagnostic criteria for IBS

Recurrent abdominal pain/discomfort for 3+days/mo for the past 3 mo + 2:

  • symptom improvement w/ BM
  • change in frequency of stool
  • change in form of stool
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39
Q

Associated BMP lab finding of upper GI bleed

A

Elevated BUN/creatinine ratio

Possibly due to increased urea production (from intestinal breakdown of Hb) and increased urea reabsorption (due to hypovolemia)

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40
Q

Which type of anemia can prednisone be effective in treating?

A

Prednisone = tx of choice for autoimmune hemolytic anemia

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41
Q

Tx of TCA overdose

A

1st- ABCs (duh always)

Then sodium bicarb to improve BP, shorten QRS interval, and prevent arrhythmia

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42
Q

What drug should be avoided in acute glaucoma?

A

Atropine (muscarinic antagonist) = mydriatic agent (dilates the pupil) and worsen glaucoma

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43
Q

28 yo F in MVA
-liver laceration and extensive hemoperitoneum, fluid resuscitaiton abd blood transufion
post-op numbness, forceful flexion of wrist while measuring BP, diffusely hyperactive reflexes

Dx

A

Hypocalcemia

Due to citrate in transfused blood that binds to ionized (active) calcium
Positive Trousseau’s sign: carpopedal spasm when BP cuff inflated for 3+ seconds

High risk when liver is injured (liver laceration) b/c citrate is rapidly metabolized by the liver

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44
Q

66 yo M w/ right elbow pain, back pain, headaches

  • Xray of right arm exhibits a radiolucent lesion
  • Labs: Normocytic Anemia

Next best step

A

Serum protein electrophoresis- looking for M-spike (monoclonal protein) of multiple myeloma

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45
Q

75 AA M w/ diabetes and HTN presents for annual physical

  • fundus: cupping of the optic disk
  • constricted peripheral vision

Dx

A

Primary open angle glaucoma- often asymptomatic early on

gradual loss of peripheral vision (vs. macular degeneration which is loss of central vision)

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46
Q

Ddx for Restrictive lung disease- differentiate by DLCO

A

Restrictive lung disease:

Normal DLCO = chest wall weakness

Reduced DLCO = interstitial lung disease

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47
Q

Vitreous hemorrhage

(a) Clinical presentation
(b) Risk factor
(c) Diagnostic clue on opthalmoscopy

A

Vitreous hemorrhage

(a) sudden loss of vision and onset of floaters
(b) Most commonly caused by diabetic retinopathy
(c) Loss of fundus details (fundus hard to visualize), floating debris

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48
Q

Most common causative organism of infective endocarditis

A

Staph aureus

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49
Q

When oseltamivir is indicated

A

To tx confirmed or suspected influenza within 48 hrs of symptom onset
-can decrease illness severity and duration by 2-3 days

Key is w/in 48 hrs of symptom onset (or later if pt is at high risk for complications), just get symptomatic treatment

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50
Q

Ludwig angina- what is it?

(a) Typical organisms
(b) Symptoms

A

Ludwig angina = cellulitis of the floor of the mouth (submandibular and subligual spaces b/l) from an infected tooth

(a) Strep species and anaerobes
(b) odynophagia, dysphagia, fever, difficulty breathing, pain, erythema

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51
Q

Clinical sign that can distinguish gastric vs. duodenal ulcer

A

Gastric ulcers often feel worse after eating due to increased acid secretion

Duodenal ulcers worse on an empty stomach and improves w/ food due to alkaline secretion into the duodenum

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52
Q

Workup for amaurosis fugax

A

Amaurosis fugax = transient monocular vision loss due to retinal emboli, most commonly from the ipsilateral carotid artery due to atherosclerosis

=> workup includes noninvasive evaluation of the carotids

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53
Q

Ddx for hypokalemia, metabolic alkalosis in a normotensive pt

A
  • Bulimia
  • Gitelmann’s syndrome (thiazide-sensitive NCC loss of fxn mutation)
  • Diabetic abuse
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54
Q

54 yo alcoholic M presents w/ dysphagia, drooling, and fever

  • unable to eat, mouth is swollen and hot
  • redness extending into floor of the mouth
  • palpable crepitus of the mandibular area
  • leukocytosis

(a) Dx?
(b) Source of infection

A

(a) Ludwig angina = rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces
(b) From infected 2nd or 3rd mandibular molar (from teeth!!)

55
Q

Mechanism of MTX

(a) Causes what kind of anemia? How to avoid this

A

MTX = DMARD by inhibiting folate metabolism (needed for cell replication)

(a) Macrocytic anemia
=> often give w/ supplemental folic acid which doesn’t decrease the efficacy of MTX

56
Q

Describe how laryngeal edema would alter one’s pulmonary flow-volume loop

A

Flatten both the top and bottom due to fixed upper airway obstruction: flattened b/c the obstruction limits airflow during inspiration and expiration

57
Q

Describe how nephrotic syndrome increases risk for

(a) atherosclerotic disease
(b) renal venous thrombosis

A

Nephrotic syndrome (proteinuria, hypoalbuminemia, peripheral edema)

(a) low plasma oncotic pressure (due to hypoalbuminemia) causes increase of liver protein and lipid synthesis => increase in cholesterol and TG synthesis => increased atherosclerotic risk
(b) Loss of antithrombin II in urine => hypercoagulable which tends to affect venous system, particularly the renal veins

58
Q

2 mo post MI- pt complains of CP
-EKG showing persistent ST seg elevation w/ deep Q waves in the same lead

Dx?

A

Ventricular aneurysm = late complication of MI

59
Q

When to give fluids to prevent contrast-induced AKI

A

Start giving IV fluids before the procedure and continue a few hours after

60
Q

Red urine is a side effect of which drug

A

Rifampin (Tb drug) causes red to orange discoloration of body fluids

61
Q

Pt on chronic prednisone decides to abruptly stop: explain what happens and why

A

Chronic glucocorticoid therapy (only seen really w/ steroids for >3 weeks) suppresses the HPA axis => decreased CRH release from hypothalamus and therefore decreased ACTH from the pituitary => low cortisol levels

Adrenal insufficiency => nausea, weakness, fatigue

62
Q

38 yo w/ 6 weeks of progressive r. hip pain

  • present at rest, worse w/ weight bearing
  • h/o sarcoidosis tx w/ extended courses of oral glucocorticoids
  • forced abduction and internal rotation of the femur aggravates the pain
  • normal reflexes and sensation
  • Plain film of hip wnl

Dx?

A

Avascular necrosis 2/2 steroid use

Typical to see groin pain on weight bearing

  • pain on hip abduction and internal rotation
  • no erythema, swelling, or point tenderness

Normal WBC count, ESR, and CR

63
Q

Knee joint aspiration:

calcium pyrophosphate dihydrate deposition vs. monosodium urate crystal deposition

A

Pseudogout (calcium pyrophosphate) vs. actual gout (monosodium urate crystals)

64
Q

Most common secondary cause of hypertension

(a) Physical exam finding

A

Renovascular HTN is the most common and correctable cause of secondary HTN
ex: renal artery stenosis

(a) Abdominal bruit

65
Q

43 yo M w/ periodic involuntary head turning and head fixation to the r. side
-hypertrophied left SCM

(a) Dx?
(b) Common etiology

A

(a) Dystonia, specifically torticollis = focal dystonia of the SCM
Dystonia = sustained muscle contraction resulting in twisting, repetitive mov’ts, or abnormal postures

(b) Drug induced by antipsychotics

66
Q

Name the triad for nephrotic syndrome

A
  1. proteinuria (technically more than 3.5 g/day in the urine)
  2. hypoalbuminemia (under 4 g)
  3. peripheral edema
67
Q

Which anticoagulant is most likely to decreaselevels of protein S

A

Warfarin- inhibits vitamin-K dependent clotting factors and anticoagulating proteins (C and S)

68
Q

Lab value to differentiate autoimmune adrenal insufficiency vs. secondary adrenal insufficiency 2/2 chronic glucocorticoid therapy

A

Difference is mineralocorticoid and ACTH
Both have low cortisol

Autoimmune (primary): ACTH is elevated and aldo is low
Secondary (2/2 chronic steroid use): ACTH is low and aldo is normal

69
Q

Tx for normal pressure hydrocephalus

A

Tx w/ large volume LPs, and if successful- VP (ventriculoperitoneal) shunt

70
Q

How to diagnose cancer in the head vs. tail of the pancreas

A

Cancers in the head of the pancreas (more common) will likely cause jaundice => if suspecting pancreatic adenocarcinoma in a pt w/ jaundice do abdominal ultrasound

Cancers in the tail of the pancreas: dx w/ CT w/ contrast

Wouldn’t diagnose wither w/ ERCP- more invasive and more to clean out obstructed bile duct

71
Q

Sensorineural or conductive hearing loss?

(a) Presbycusis
(b) Acoustic neuroma
(c) Colesteatoma
(d) Menieres disease
(e) Otitis media

A

Sensorineural hearing loss = disorder of the inner ear, cochlea, or auditory nerve

  • presbycusis
  • Menieres
  • acoutsic neuroma

Conductive = something that limits sound from getting to the inner ear

  • otitis media or externa
  • cholestatoma (keratinizing expansion of middle ear)
  • trauma
  • cerumen impaction
  • TM perforaction
72
Q

Differentiate imaging findings of aspergillosis and histoplasmosis

A

Histo: calcified nodes, calcification of CXR or solitary nodule

Aspergilloma = cavitary lesions

73
Q

P-ANCA (+) associations

A

Vasculitis, but p-ANCA can also be positive in IBD and ankylosing spondylitis (both of which are associated w/ HLA-B27) w/o vasculitis

74
Q

Which Graves’ tx is most likely to worsen eye disease initially?

A

Radioiodine ablation can cause worsening of opthlamopathy

75
Q

Give example of when you don’t need permission from pt’s next of kin to remove pt from a vent

A

Brain death

Brain death is a legally acceptable definition of death

76
Q

Myelofibrotic disorders findings on bone marrow biopsy

A

Myelofibrotic disorders = proliferation of abnormal hematopoeitic cells

BM biopsy hypocellular, fibrotic bone marrow => fatigue, anemia

77
Q

Describe clinical presentation of presbycusis

A

Progressive b/l symmetric sensorineural hearing loss w/ subjective tinnitus (ringing in the ears), advanced age, and absence of other neurologic signs

ex: 75 yo M w/ prgoressive hearing loss and ringing in the ears, subjective continuous high-pitched ringing in both ears

78
Q

Most common form of drug-induced chronic renal failure

A

Analgesic nephropathy

-causes a tubulointerstitial nephritis

79
Q

Risk of Graves’ treatments

(a) Methimazole
(b) Propylthiouracil
(c) Radioiodine ablation
(d) Surgery

A

Adverse effects of Graves’ disease treatments

(a) Methimazole => agranulocytosis, cholestasis
(b) Propylthiouracil => hepatic failure, ANCA-associated vasculities
(c) Radioiodine ablation => permanent hypothyroidism, worsening of opthalmopathy
(d) Surgery => permanent hypothyroidism, recurrent laryngeal nerve damage

80
Q

Clinical presentation of TCA overdose

A

TCA overdose => CNS depression, hypotension (major cause of mortality)
-anticholinergic effects => dilated pupils, hyperthermia, intestinal ileus, QRS prolongation

81
Q

Differentiate epidemiology: alpha vs. beta thalassemia

A

Alpha- more common in pts from SE descent

Beta- Mediterranean descent

82
Q

Gold standard diagnostic test for malaria

A

Blood smear

showing Plasmodium falciparum parasites infecting RBCs

83
Q

FIrst line tx for central diabetes insipidus

A

Intranasal desmopressin (basically synthetic ADH)

84
Q

Central features of Cushing syndrome

A

Cushing syndrome = cortisol excess
Progressive central obesity, skin atrophy and wide purplish striae, proximal muscle weakness**, HTN, glucose intolerance, skin hyperpigmentation

85
Q

Mechanism of warfarin

A

Inhibiting synthesis of vitamin-K dependent clotting factors (IX, X, VII, and II) AND vitamin-K dependent anticoagulant protein C and S

86
Q

How to distinguish bulimia from Gitelmann’s syndrome

A

Both present w/ hypokalemia metabolic alkalosis

Recall: Gitelmann’s = autosomal recessive mutation in thiazide-sensitive NCC symporter

Differentiate by the urine chloride concentration

  • high urine chloride in Gitelmann’s
  • low urine Cl in bulimia (b/c losing Cl- by voming up gastric juices)
87
Q

34 yo M presents w/ difficulty walking x3 days

  • lower back pain last week while lifting
  • URI 1 mo ago in Connecticut
  • smoker, normotensive
  • LE sensation decreased
  • mild hyperreflexia, +Babinski

(a) Dx
(b) Diagnostic test

A

(a) Spinal cord compression (possibly from disk herniation)
- UMN signs (hyperreflexia, Babinski) indicates CNS involvement
- LE and b/l => localizes to the spinal cord

(b) Diagnose w/ spinal MRI

88
Q

Tx for

(a) Hairy cell leukemia
(b) non-Hodgkin’s lymphoma
(c) CLL

A

Tx

(a) Hairy cell = cladribine (purine analog)
(b) NHL = CHOP regimen
(c) CLL = chlorambucil, rituximab etc (basically chemotherapy) and prednisone

89
Q

Differentiate leukmoid reaction from CML

A

Both present w/ neutrophilia and dramatic leukocytosis

Leukmoid rxn: rxn to severe infection- Leukocyte count 50-100k

  • high leukocyte alkaline phos
  • more mature neutrophil precusors (more metamyelocytes aka bands than myelocytes)

AML: caused by BCR-ABL fushion gene, Leukocyte over 100k

  • low leukocyte alk phos
  • more immature neutrophil precursors (more myelocytes than bands)
90
Q

Ppd induration cuttoff points for treatment

A

Ppd over 5 mm- treat in HIV positive or otherwise immunosuppressed (organ transplant)

Ppd over 10mm: recent immigrants from Tb-endemic areas, IVDU, children under 4

Ppd over 15mm: treat healthy individuals

So in an otherwise completely healthy pt- would need induration over 15 mm to indicate tx

91
Q

2 indications for placing a chest tube to drain a parapneumonic effusion

A
  1. pleural fluid pH under 7.2 (low pH indicates empyema)
    * *important one
  2. Glucose less than 60
92
Q

Differentiate NPH and Alzheimer’s

A

NPH- gait is predominant and early finding

Alzheimer’s- gait disturbance is a late finding, starts w/ memory loss

93
Q

Syphilis tx

(a) primary syphilis
(b) tertiary syphilis
(c) During pregnancy

A

Syphilis tx

(a) Primary and secondary- 1 dose PenG IM
(b) Tertiary- 14 days of PenG IV
(c) Pregnancy- the same depending on stage

94
Q

Aplastic anemia

(a) Bone marrow biopsy findings
(b) CBC findings

A

Aplastic anemia = damaged BM and habitating hematopoetic cells causing decrease in all 3 cell lines

(a) Hypoplastic fat-filled marrow
(b) Pancytopenia (not just anemia)

95
Q

32 yo Italian-American M presents for routine checkup

  • Found to have Hb 10.8, high RBC count, MCV 61, normal leukocytes and platetes
  • peripheral smear shows target cells

(a) Dx
(b) Tx

A

(a) beta-thalassemia minor (trait)
- one normal and one abnormal beta-globin gene
- beta most common in Mediterranean, alpha more common in SE asian descent

(b) Tx = no specific tx needed for beta-thalassemia minor (pts are asymptomatic and Hb is above 10)

96
Q

Presbycusis vs. otosclerosis

A

Presbycusis = sensorineural hearing loss of aging, 60s yoa
-high frequency sound loss

Otosclerosis = chronic conductive hearing loss due to bony overgrowth of the stapes

  • middle-aged individuals
  • starts w/ low frequency hearing loss
97
Q

Contrast induced AKI

(a) Time line- how long after contrast?
(b) Duration

A

(a) Spike in creatinine w/in 24 hrs of contrast administration
(b) Return to normal renal fxn w/in 5 days

98
Q

Hairy cell leukemia

(a) Cytochemical feature
(b) Drug of choice

A

Hairy cell leukemia = B-lymphocyte derived chronic leukemia

(a) TRAP: tartrate-resistant acid phosphatase stain
(b) Drug of choice = Cladribine = purine analog
- but very indolent course, don’t always need to treat

99
Q

When to add corticosteroids to PCP tx?

A

Tx w/ bactrim + steroids if PaO2 is under 70 mmHg (on ABG)

If PaO2 over 70- can treat w/ just bactrim

100
Q

63 yo F w/ recent onset left-sided weakness

  • fatigue, low fever, occasional palpitations over last 3 mo
  • mid-diastolic rumble at the apex
  • TTE shows mass in the LA

Dx

A

Intracardiac tumor = cardiac myxoma = most common benign primary cardiac tumor
-over 80% are in the left atrium
Often presents w/ chronic systemic symptoms and embolic phenomenon (left sided weakness)

Mass = not a vegetation! aka not infective endocarditis

101
Q

1 day after being treated for a severe acute-asthma attak w/ albuterol nebs and IV methylprednisone- 25 yo F compalins of muscle weakness: difficulty lifting arms and mild hand tremors

Next step

A

Check serum electrolyte panel: beta-2 agonists (albuterol) pushes K+ into cells (hence why albuterol can sometimes be used during hyperkalemia)

Resulting hypokalemia => muscle weakness, EKG changes, tremor, HA

102
Q

Mechanism by which splenectomized pts are at increased risk of encapsulated organisms

A

Due to impaired phagocytosis

Antigens enter thru splenic artery- get phagocytosed by dendritic cells which present antigens to helper-T cells that go to the primary follicles to find and activate B cells

103
Q

How to confirm dx of multiple myeloma

A

Bone marrow biopsy w/ >10% clonal plasma cells

104
Q

52 yo F w/ pounding sensation in neck and LE edema

  • wt loss
  • migraine, chronic diarrhea, severe post-menopausal flushes
  • poor oral hygiene
  • 2/6 systolic murmur that increases w/ inspiration
  • severe tricuspid insufficiency

Dx

A

Carcinoid syndrome

  • Skin: flushing
  • GI: diarrhea
  • Cardiac: right valvular lesions

Episodic flushing present in 85% of pts

Confirm w/ elevated urinary 5HIA

105
Q

Riluzole

(a) Indication
(b) Mechanism

A

Riluzole = glutamate inhibitor approved for ALS (amyotrophic lateral sclerosis)

Doesn’t stop or reverse the underlying neurodegenerative disease, but may prolong survival and time to tracheostomy

106
Q

Complications of acute pancreatitis

A

Pleural effusion, ileus (failure of peristalsis), pancreatic pseudocyst/abscess/necrosis, ARDS

107
Q

Define resistant hypertension

A

HTN that persists despite using at least 3 antihypertensive agents of different classes w/ one being a diuretic

Next step is to evaluate for secondary causes

108
Q

First line tx for acute episode of glaucoma

A

IV mannitol = osmotic diuretic w/ immediate onset of action

109
Q

In a pt w/ GI distress, what signs suggest etiology besides IBS

A
  • rectal bleeding
  • nocturnal awakening from abdominal pain
  • wt loss
  • anemia or electrolyte d/o (lab abnormalities)
110
Q

Dressler syndrome

A

Dressler syndrome = post MI injury syndrome
Immune-mediated pericarditis weeks to months after an acute MI

Pleuritic CP, fever, leukocytosis, pericardial friction rub, diffuse ST seg elevation

111
Q

How to make a diagnosis of asperilloma

A

Aspergillus IgG serology + radiographic findings (cavitary lesions on chest CT)

112
Q

Most common cause of death from Ludwig angina

A

Asphyxiation

Ludwig angina = progressive b/l cellulitis of submandibular and sublingual spaces from an infected tooth
-swelling can obstruct the airway => asphyxiation

113
Q

Preferred tx for Graves’ disease and its contraindications

A

Radioactive iodine therapy is preferred
-less expensive and fewer complications than surgery (subtotal thyroidectomy)

Contraindications = pregnancy and very severe opthalmopathy

114
Q

Describe microbiology of nocardioia

(a) Tx

A

Gram-positive rod
PARTIALLY ACID-FAST

(a) Bactrim

115
Q

What does it mean when a murmur’s intensity increases w/ inspiration

A

100% sensitive and 88% specific for a right sided murmur (tricuspid or aortic)

116
Q

Which cause of hyperthyroidism is most likely to develop hypothyroidism following radioactive therapy?

A

Graves’ disease b/c the entire thyroid gland is hyperfunction => radioiodine (radioactive that causes thyroid ablation via beta-emissions) is taken up by the entire gland

While toxic adenoma and multinodular goiter pts usually remain euthyroid b/c spotty extra uptake

117
Q

Epigastric pain + intermittent melenia that improves after meals

(a) Dx
(b) Tx

A

(a) Duodenal ulcer
- improves after food due to alkaline secretion into duodenum (opposite of gastric ulcers which are worse after eating)

(b) Tx = PPI + abx eradication of H. Pylori

118
Q

Signs/symptoms of neuroleptic malignant syndrome

A

Fever
muscle rigidity
autonomic instability: tachycardia, labile BP, tachypnea, diaphoresis

119
Q

Main mechanism of nitroglycerin in MI pain relief

A

Dilation of capacitance vessels (veins)

=> decrease in ventricular preload and decreases heart size => decreasing oxygen requirement of the heart

120
Q

Most common causes of duodenal uclers

(a) Tx of duodenal ulcers

A

Majority of duodenal ulcers are caused by H. pylori or NSAID use

(a) Tx = PPI + abx eradication of H. pylori (amoxicillin + clarithryomycin)

121
Q

Primary vs. central adrenal insufficiency

(a) Cause
(b) Salt wasting
(c) Symptoms

A

(a) Primary (autoimmune) vs. Central (HPA axis inhibition ex: 2/2 chronic steroid therapy)

(b) Mineralocorticoid deficiency much more pronounced in primary
(c) Primary has much more severe symptoms w/ hyperkalemia, hyponatremia, and hypotension
- less severe symptoms in central

122
Q

When can live vaccines be given to HIV+ patients

A

Most live vaccines are containdicated, EXCEPT MMR and varicella zoster vaccines- and only in pts w/ CD4 over 200 and no h/o AIDS-defining illness

123
Q

What is Larmbert Eaton syndrome?

(a) Clinical presentation
(b) Etiology

A

Rare autoimmune syndrome where autoantibodies are produced against presynaptic voltage-gated Ca2+ channels at the nmj

(a) Muscle weakness (similar to MG)
(b) Etiology- 60% have underlying malignancy, most commonly small cell lung cancer

124
Q

Differentiate obstructive vs. restrictive disease on spirometry

A

Obstructive disease (asthma, COPD) = low FEV1/FVC

Normal or high FEV1/FVC (low VC)

125
Q

43 yo M w/ h/o Hodgkin lymphoma tx 20 years ago w/ chemo and radiation tx presents w/ left-sided CP
-CXR reveals mass in left chest

Dx

A

Secondary malignancy

Hodgkin lymphoma have very good response to treatment, recurrence after 20 yrs is very uncommon- but due to the chemo and radiation there’s a 20x increase in developing a second cancer in HL pts

126
Q

Which type of anemia is an indication for splenectomy?

A

Moderate, symptomatic, hereditary spherocytosis

127
Q

32 yo F w/ fatigue, SOB, and swelling of feet x3 days

  • recent cold 2 weeks ago
  • JVP, b/l basilar crackles, 2+ b/l pitting edema to ankles

Dx
(a) Echo findings

A

Dilated cardiomyopathy 2/2 acute viral myocarditis (most commonly coxsackievirus B)

(a) Dilated ventricles w/ diffuse hypokinesia

128
Q

Bullous pemphigoid vs. pemphigus vulgaris

A

Bullous pemphigoid = benign pruritic disease of tense blisters
-IgG and C3 deposits in dermal epidermal jxn

Pemphigus vulgaris = flaccid (not tense) blisters
-IgG intracellular deposits in the epidermis

129
Q

67 yo M w/ HTN and HA

  • BP 190/120 on lisinopril-HCTZ, amlodipine, metoprolol, ASA
  • periumbilical systolic-diastolic bruit

Dx

A

Renal artery stenosis- think of secondary causes of HTN when still so high on multiple meds

Systolic-diastolic bruits seen in about 40% of pts w/ renal artery stenosis, but less than 1% of pts w/o renal artery stenosis.

130
Q

Differentiate Trousseau’s and Chvostek’s sign

A

Both signs of hypocalcemia

Trousseaus = carpopedal spasm (spasm of wrist/thumb) when BP cuff inflated for 3+ seconds

Chvostek’s = twitching of facial muscles when tap on the facial nerve

131
Q

Name some common associated etiologies of avascular necrosis

A 
Steroid use
EtOH use
SLE
Antiphospholipid syndrome
SCD
Osteomyelitis
HIV
132
Q

Epidermal cyst vs. lipoma

A

Both free-moving benign lesions

Epidermal cysts recur and have central punctum (pore-like opening), while lipomas don’t recur and don’t have opening

133
Q

34 yo M presents w/ HA, fever, fatigue who returned from Kenya 2 weeks ago

  • intense chills w/ shivering
  • few hrs later: high grade fever w/ profuse sweating
  • similar symptoms a few days ago
A

Malaria- cyclical fevers (periodic febrile paroxysms)

Nonspecific malaise, HA, nausea, vom, abdominal pain

Bellevue Medicine (6 decks)

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