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STEP2 > UWorld Review 2 > Flashcards

UWorld Review 2 Flashcards

1
Q

Describe the etiology, presentation, diagnosis, lab findings, and management of infectious mononucleosis.

A
  • most commonly caused by EBV
  • presents with prolonged course of fever, fatigue, pharyngitis with or without exudates, tender cervical or diffuse lymphadenopathy, and hepatosplenomegaly
  • a rash may appear if given amoxicillin
  • diagnosis is typically with a mono spot test positive for heterophiles antibodies; perform anti-EBV antibody testing instead for children under 4
  • blood smear will show atypical lymphocytes and labs show a transient hepatitis
  • manage with avoidance of contact sports for at least four weeks due to the risk of splenic rupture
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2
Q

What are the Centor criteria?

A

a set of criteria used to evaluate for GAS pharyngitis
- age 14 or less
- cervical adenopathy
- pharyngeal exudates
- fever
- absence of a cough
for those with 2-3 points, perform GAS testing; for those with 4-5 points consider empiric treatment with amoxicillin

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3
Q

Describe the presentation, diagnosis, and treatment of GAS pharyngitis.

A
  • presents with sore throat, cervical adenopathy, pharyngeal exudates, fever, and no cough
  • rapid strep test is the best first test; can follow with a throat culture if rapid is negative
  • will typically resolve on it’s own within one week without treatment, but amoxicillin is used to prevent rheumatic fever
  • use cephalexin for those with penicillin allergy causing rash; use clindamycin or a macrolide for penicillin allergy causing anaphylaxis
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4
Q

What is the standard recommendation for colorectal cancer screening?

A

every 10 years starting at age 50

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5
Q

What is the recommendation for colorectal cancer screening in those with risk factors (family history of CRC, personal history of CRC, personal history of IBD)?

A
  • single family member: begin at 40 or 10 years younger than age of the family member; repeat every 5 years if the family member was less than 60
  • 3 family members across 2 generations with 1 before age 50 (HNPCC): start at age 25 and repeat every 1-2 years
  • familial adenomatous polyposis (FAP): sigmoidoscopy at age 12 and repeat every year
  • previous adenomatous polyp: colonoscopy every 3-5 years
  • previous CRC: colonoscopy 1 year post-resection, 3 years post-resection, then every 5 years
  • history of IBD: 8-10 years post-diagnosis, then repeat every 1-2 years
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6
Q

Describe the diagnosis and treatment of ADHD.

A
  • diagnosis requires 6 months of symptoms (inattention, hyperactivity, etc.) that interfere with daily functioning in two areas with symptoms present since at least age 12
  • first-line treatment are stimulants
  • atomoxetine is a second-line agent with fewer side effects and less abuse potential
  • alpha-2 agonists (clonidine and guanfacine) are second-line agents helpful for comorbid tic disorders, but have no benefit in adult populations
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7
Q

How does acute mediastinitis presents and how is it treated?

A
  • presents with fever, chest pain, leukocytosis, and mediastinal widening on CXR
  • it requires surgical drainage and prolonged antibiotics
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8
Q

How should afib be treated in the post-CABG patient?

A
  • in this case it is a common and usually self-limited
  • rate control with beta-blockers or amiodarone is best in these cases lasting less than 24 hours
  • antigoculation and/or cardioversion should only be used for cases that persist for longer than 24 hours
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9
Q

What is the difference between atrial flutter and atrial fibrillation?

A

fluter is a regular rhythm that tends to return to sinus or deteriorate into fibrillation which is an irregularly irregular rhythm

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10
Q

Describe the management of atrial fibrillation.

A
  • for hemodynamically unstable patients, the first step is synchronized electroconversion
  • for acute but stable patients with an exogenous cause (post-CABG, cocaine, alcohol, etc.), rate control is all that is necessary; most cases with spontaneously revert
  • chronic cases (lasting >48 hours) should be managed with rate control first (beta-blockers, CCBs, or digoxin) and then started on anticoagulation (NOACs preferred in most cases, warfarin for mitral stenosis or metal valves, aspirin for CHADS-VASC less than 2)
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11
Q

What is the most significant complication of succinylcholine use? How does its mechanism of action contribute? How can it be avoided?

A
  • it is a depolarizing neuromuscular blocker that binds postsynaptic acetylcholine receptors, triggering an influx of sodium ions and efflux of potassium
  • this may contribute to hyperkalemia and cardiac arrhythmias, especially in patients already at risk for hyperkalemia (crush injury, burn injury, etc.)
  • in such patients, use a non-depolarizing agent like vecuronium or rocuronium
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12
Q

What is the most significant complication for each of the following anesthetics:

  • succinylcholine
  • halothane
  • etomidate
  • nitrous oxide
  • propofol
A
  • succinylcholine: hyperkalemia and cardiac arrhythmia
  • halothane: acute liver failure
  • etomidate: inhibition of 11B-hydroxylase and adrenal insufficiency
  • nitrous oxide: vitamin B12 inactivation and deficiency
  • propofol: myocardial depression and severe hypotension
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13
Q

Describe the spectrum of rashes that are attributable to drug hypersensitivities and which drugs are common offending agents.

A
  • caused by the same agents that cause hemolysis, drug-induced thrombocytopenia, and interstitial nephritis
  • these include penicillins, sulfa drugs, allopurinol, phenytoin, lamotrigine, and NSAIDs
  • the mildest is a morbilliform rash: there is no mucous membrane involvement and the skin stays intact
  • erythema multiform is a defined by widespread, small target lesions that spare the mucous membranes
  • SJS involves the mucous membranes and sloughing; sloughing of the respiratory epithelium can lead to respiratory failure
  • TEN is SJS which involves a greater portion of the skin and has a positive Nikolsky sign
  • treat SJS and TEN with IVIG
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14
Q

Describe the etiology, presentation, and treatment of erythema multiforme.

A
  • most commonly a drug hypersensitivity reaction or a manifestation of herpes simplex virus
  • presents as small, erythematous, round papules that evolve into target lesions
  • treat symptomatically with antihistamines and topical glucocorticoids
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15
Q

Describe the presentation, diagnosis, and management of fibrocystic changes of the breast.

A
  • presents with nodular tissue bilaterally, often accompanied by diffuse, cyclical, premenstrual tenderness
  • it is a clinical diagnosis based on exam findings
  • management involves observation; NSAIDs and cOCPs can be offered for pain management
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16
Q

Describe the pathophysiology and management of symptomatic cholelithiasis in pregnancy.

A
  • estrogen causes increased biliary cholesterol excretion while progesterone reduces gallbladder motility
  • patients are managed conservatively with pain control
    since most cases resolve
  • cholecystectomy is reserved for complicated or recurrent cases
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17
Q

Describe the five options and timing of genetic testing available in the prenatal period.

A
  • in the first trimester, between 9-13 weeks, a combined test of maternal B-hCG, maternal PAPP-A, and nuchal translucency can be performed as a screening tool
  • in the first trimester, after 10 weeks, cell-free fetal DNA testing can be performed as a screening tool
  • in the second trimester, between 15-20 weeks, a triple or quad screen can be performed with MSAFP, B-hCG, estriol, and (for the quad) inhibin A
  • CVS is a confirmatory test performed at 10-13 weeks
  • amniocentesis is a confirmatory test performed at 15-17 weeks
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18
Q

What routine prenatal testing is performed in each of the trimesters?

A
  • in the first trimester, a dating ultrasound, pap smear, and G/C are performed along with routine blood tests
  • in the second trimester, a routine ultrasound for anatomy is performed at 18-20 weeks
  • in the third trimester a 1-hr GTT is performed at 24-28 weeks; a CBC for anemia at 27 weeks; and G/C, STD, and GBS testing at 36 weeks
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19
Q

Describe the geographical distribution, presentation, and diagnosis of histoplasmosis.

A
  • it is most prevalent in the Ohio and Mississippi river valleys, associated with caves and bird droppings
  • it presents with respiratory symptoms, hilar adenopathy, non-caveating granulomas, erythema nodosum, and hepatosplenomegaly
  • culture is the most accurate test but most often diagnosis is with urine antigen testing
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20
Q

Describe the geographical distribution, presentation, and diagnosis of blastomyces.

A
  • it is most prevalent in the great lakes region and Ohio river valley, associated with soil
  • it presents with respiratory symptoms, hazy patchy alveolar infiltrates on CXR, and skin, bone, and prostate lesions
  • diagnosis is made with culture
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21
Q

Describe the geographical distribution, presentation, and diagnosis of coccidioidomycosis.

A
  • most prevalent in the southwest US, associated with dust exposure
  • it presents with respiratory symptoms, arthritis, erythema nodosum, and occasionally meningitis
  • diagnosis is made by culture
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22
Q

Which two organisms that cause UTIs have urease activity? How does this affect the pH of an infected individual’s urine?

A
  • both Proteus mirabilis and Klebsiella pneumoniae have urease activity
  • this causes urinary alkalization
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23
Q

The first test of choice when evaluating for bladder cancer is what?

A

after other causes have been ruled out with UA, cystoscopy and abdominal CT are the next best steps

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24
Q

Under what circumstances should a patient with nephrolithiasis undergo evaluation by urology?

A
  • if they initially present with urosepsis, AKI, anuria, or complete obstruction
  • if the stone is found to be greater than 1cm
  • if pain is uncontrollable or the stone fails to pass after 4-6 weeks of medical management
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25
Q

Describe the flow-volume loops for obstructive and restrictive lung disease and for fixed upper airway obstruction

A
  • obstructive: shifted toward higher lung volumes with a scooped-out appearance during exhalation as airflow decreases during the effort-independent phase of exhalation
  • restrictive: shift toward lower lung volumes with a normal pattern of air flow velocity
  • fixed upper airway obstruction: limited airflow during inspiration and expiration causes a flattening fo the top and bottom of the curve with little change in overall volumes
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26
Q

Newborns should undergo what routine preventative measures and what routine screenings?

A
  • prevention: vitamin K, hepatitis B vaccine, silver nitrate and erythromycin eye ointment
  • screening: newborn screening, hyperbilirubinemia, hearing, pre- and post-ductal pulse oximetry, hypoglycemia
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27
Q

How do we screen for congenital heart disease in newborns? How should this be followed up?

A
  • screen with pre- and post-ductal pulse oximetry

- follow up with echocardiogram

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28
Q

What is the best way to differentiate primary from central cases of adrenal insufficiency?

A

aldosterone levels will be normal for cases of central insufficiency because renin rather than ACTH controls release of aldosterone

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29
Q

What are the three key features of vascular dementia?

A
  • significant executive dysfunction
  • focal neurologic findings (asymmetric reflexes, urinary frequency, gait abnormalities)
  • step-wise decline
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30
Q

What differentiates non-allergic rhinitis from allergic rhinitis? How are the two treated?

A
  • NAR: prominent nasal congestion, postnasal drainage, onset after 20, and erythematous nasal mucosa without any specific triggers
  • allergic: more eye symptoms, itching, sneezing, and a pale bluish nasal mucosa with identifiable triggers
  • both are treated with intranasal glucocorticoids and antihistamines
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31
Q

GvHD targets what organs?

A
  • skin: maculopapular rash that may generalize
  • intestine: bloody diarrhea
  • liver: jaundice and abnormal LFTs
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32
Q

How is severe hypercalcemia defined and managed?

A
  • it is defined as serum calcium greater than 14
  • short-term management includes normal saline to increase excretion and clacitonin to inhibit osteoclasts
  • bisphosphonates are then given for long-term maintenance therapy but won’t be effective for several days
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33
Q

What is exercise-associated hyponatremia?

A

a phenomenon that affects athletes who ingest large amounts of hypotonic fluid during and immediately following prolonged exercise, which is then complicated by the nonosmotic stimulation (by exertion, pain, hypoglycemia, etc.) of ADH release

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34
Q

What is the only proven effective way to reduce the incidence of catheter-associated UTI?

A

avoiding unnecessary catheter use, minimizing the duration of catheterization, and replacing catheters often

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35
Q

What role does CT play in the management of pancreatitis?

A

it is used only when the diagnosis is uncertain or patients fail to improve with standard treatment

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36
Q

How is massive hemoptysis defined and controlled?

A
  • it is defined as more than 600mL in a 24 hour period or rate greater than 100mL/hr
  • begin by securing the patients airway
  • if bleeding, continues begin with bronchoscopy, then embolization, and finally resection
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37
Q

How should ingestion of a foreign body be managed?

A
  • begin with PA and lateral x-rays to locate the object
  • for patients who are symptomatic or have swallowed objects that are sharp, magnetic, or batteries, perform endoscopic removal
  • for patients without these high-risk features, serial x-rays can be performed with endoscopic removal only if the object fails to progress
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38
Q

Empiric antibiotic treatment for treatment of a pneumonia in a CF patient must cover what?

A

use cefepime and vancomycin to cover Pseudomonas and MRSA

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39
Q

What is the pathophysiology for referring syndrome?

A
  • the surge of insulin is ultimately responsible
  • it triggers a decrease in serum phos, potassium, and magnesium as well as a rise in sodium and water retention
  • manifesting as seizures, wernicke encephalopathy, congestive heart failure, and arrhythmia
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40
Q

Describe the presentation of sick sinus syndrome?

A
  • it is the inability of the SA node to generate an adequate heart rate secondary to age-related fibrosis of the node
  • presents with bradycardia, sinus pauses (delayed P waves), and SA exit block (dropped P waves)
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41
Q

What is the hydrogen breath test?

A

a test for lactose intolerance which is positive if there is bacterial carbohydrate metabolism

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42
Q

When being mechanically ventilated, PaO2 is controlled by what two settings?

A

FiO2 and PEEP

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43
Q

The two preferred modalities for diagnosing a ureteral stone are what?

A

non contrast CT or ultrasound

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44
Q

What is the hallmark of hepatorenal syndrome? How is it treated?

A
  • the hallmark are signs of pre-renal AKI that don’t respond to fluids
  • treatment is with splanchnic vasoconstrictors midodrine, octreotide, and norepinephrine
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45
Q

Describe the proper evaluation of thyroid nodules.

A
  1. begin with a TSH level and thyroid ultrasound
    - if the TSH is normal or elevated, consider an FNA
  2. for low TS, perform a radioactive iodine scintigraphy
    - a cold nodule should be referred for FNA
  3. a hyper functional nodule should be treated for hyperthyroidism
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46
Q

Describe the presentation of vaginal cancer.

A
  • vaginal bleeding
  • malodorous vaginal discharge
  • irregular vaginal lesion, typically in the upper third of the posterior vagina
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47
Q

What is chonedrocalcinosis?

A

calcified articular cartilage on radiographies diagnostic of calcium pyrophosphate dihydrate crystal deposition disease (pseudogout)

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48
Q

What are the features of hereditary hemochromatosis?

A
  • bronze diabetes, hypogonadism, and hypothyroidism
  • arthropathy and chondrocalcinosis
  • hepatic dysfunction
  • cardiomyopathy
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49
Q

Nocturnal watery bowel movements and abdominal cramps are a symptom of what kind of diarrhea?

A

osmotic diarrhea

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50
Q

What is the most common cause of abnormal uterine bleeding in adolescence?

A

HPO axis immaturity

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51
Q

Define the following types of chemotherapy:

  • adjuvant
  • neoadjuvant
  • consolidation
  • induction
  • maintenance
  • salvage
A
  • adjuvant: given alongside standard standard therapy
  • neoadjuvant: given before induction therapy
  • consolidation: follows induction therapy to further reduce tumor burden
  • induction: an initial dose of treatment to rapidly kill tumor cells and send the patient into remission
  • maintenance: given after induction and consolidation to kill residual tumor cells and maintain remission
  • salvage: used for recurrence of cancer
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52
Q

What are exudates and how are they differentiated from transudates?

A
  • exudates are due to an increase in vascular permeability rather than an imbalance of hydrostatic and oncotic pressure
  • they are defined by meeting at least one of Light’s criteria: pleural/serum protein ratio > 0.5, pleural/serum LDH ratio > 0.6, or pleural fluid LDH >⅔ upper limit of normal serum LDH
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53
Q

What is the best next step in a patient with acute arterial occlusion leading to a threatened limb?

A

anticoagulation with IV heparin

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54
Q

What is a short inter pregnancy interval and why is it avoided?

A
  • defined as a period less than 18 months between pregnancies
  • complications include maternal anemia and low birth weight as the woman are nutritionally depleted by prior pregnancy
  • and preterm delivery or PPROM due to persistent genital tract inflammation caused by previous pregnancy
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55
Q

What is the strongest risk factor for preterm labor? What is the best first step in evaluating the risk of preterm labor?

A
  • a prior preterm labor is the greatest risk factor

- and a transvaginal ultrasound measurement of cervical length in the second trimester is the best assessment

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56
Q

What is fetal fibronectin useful for?

A

it is an indicator for the risk of preterm labor after 20 weeks gestation (prior to that it is physiologically elevated and not a good indicator)

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57
Q

What is used for preterm birth prophylaxis?

A
  • for women who have either a short cervix or a history of preterm birth, use vaginal or IM progesterone to maintain uterine quiescence
  • for those with both, cerclage may be indicated
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58
Q

Describe the etiology, presentation, complications, treatment, and prevention of bronchiolitis.

A
  • most often caused by RSV
  • typically presents in children less than 2 with nasal congestion, cough, respiratory distress, and wheezing and crackles on lung auscultation
  • may be complicated by apnea in infants less than 2 months old or by respiratory failure
  • treatment is supportive
  • palivizumab is used for prophylaxis for children less than 2 at high risk: congenital heart disease, chronic lung disease of prematurity, preterm birth before 29 weeks
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59
Q

How can seborrheic dermatitis be distinguished from tinea capitus?

A

SD is more oily and involves the eyelids, nasolabial folds, and post auricular area; tinea is made up of pruritic, fine, white scales and does not involve these additional structures

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60
Q

Which form of bilirubin is readily excreted in urine?

A

conjugated, which is the more water soluble

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61
Q

What are three metabolic changes that may exacerbate hepatic encephalopathy?

A
  • hypovolemia
  • hypokalemia: intracellular potassium shifts out and hydrogen ions replace them in the intracellular space, leading to an intracellular acidosis which increases ammonia production
  • metabolic alkalosis: promotes conversion of ammonium to ammonia, which can enter the CNS
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62
Q

Which anticoagulation alternatives are acceptable for those with HIT?

A

argatroban and fondaparinux

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63
Q

What is unique about each of the following lung carcinomas:

  • adenocarcinoma
  • squamous cell
  • small cell
  • large cell
A
  • adenocarcinoma: most common overall and in nonsmokers, typically a peripheral lesion
  • squamous cell: central, necrotic, cavitary lesions associated with hypercalcemia
  • small cell: central lesions associated with Cushing syndrome, SIADH, and LEMS
  • large cell: peripheral lesions associated with gynecomastia and glaactorrhea
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64
Q

What is situational syncope?

A

a form of neurally mediated syncope associated with specific triggers like micturition, defecation, or coughing, which alter the autonomic response and can precipitate syncope

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65
Q

What are direct and indirect Coombs tests?

A
  • direct looks for antibodies that have bound or do bind in vivo to RBCs
  • indirect looks for antibodies in serum that would bind to RBCs in vitro (think Rh antibody screening)
66
Q

Which are more often benign, systolic or diastolic murmurs?

A

systolic

67
Q

How can hematomas, pseudoaneurysms, and AV fistulas at the site of femoral catheterizations be distinguished?

A
  • hematomas have a mass but no bruit
  • pseudoaneurysms have a pulsatile mass and systolic bruit
  • AVFs have a continuous bruit but no mass
68
Q

SERMs have what side effects?

A
  • both tamoxifen and raloxifene cause hot flashes and venous thromboembolism
  • only tamoxifen increases the risk for endometrial cancer
69
Q

What is the best contraceptive method for a woman with recently diagnosed breast cancer?

A

a copper IUD; avoid any hormones because even IUDs may lead to some systemic absorption

70
Q

How should a maternal history of HSV affect delivery?

A
  • begin antiviral suppression at 36 weeks

- if lesions are present during labor, this is an indication for cesarean; otherwise, vaginal delivery can proceed

71
Q

Describe the natural history, presentation, potential complications, and management of strawberry hemangiomas.

A
  • present as a patch of telangiectasia which often grow during the first year of life before turning a deeper red and involuting
  • complications include ulceration and scarring, vision impairment, or airway obstruction depending on location
  • use topical beta blockers for ulcerated or cosmetically sensitive areas
72
Q

Which is seen in children, cherry angiomas or strawberry hemangiomas?

A

strawberry hemangiomas

73
Q

Pink stains in neonatal diapers are suggestive of what?

A

it is physiologic and these are representative of uric acid crystals

74
Q

What is considered normal neonatal weight loss?

A

loss of 7% in the first five days with return to birth weight by 10-14 days

75
Q

What is pellagra?

A
  • it is a name for the syndrome caused by niacin deficiency
  • presents with the four D’s: diarrhea, dermatitis (photosensitive), depression/dementia/distraction, and death
  • abdominal complains, a photosensitive rash similar to sunburn which later becomes hyperpigmented and thickened, and neurologic manifestations
76
Q

Pediatric seizures in the setting of an acute bacterial gastroenteritis is most strongly associated with what pathogen?

A

shigella

77
Q

Describe the etiology, presentation, and treatment of multifocal atrial tachycardia.

A
  • it is a supra ventricular tachycardia seen in the context of COPD exacerbation, catecholamine surge secondary to sepsis, or electrolyte imbalance
  • presents with palpitations if and is defined by a rapid, irregular puls, an ECG demonstrating three or more P-wave forms, and a heart rate greater than 100bpm
  • the best treatment is appropriate management of the underlying disease; verapamil is only used if persistent
78
Q

What is the difference between cafe-au-lait spots, congenital dermal melanocytosis, and congenital melanocytic nevus?

A
  • cafe au last spots are usually multiple, flat hyperpigemented macules without hair
  • congenital melanocytic nevus is typically a singular hyperpigmented macule with dense overlying hair
  • congenital dermal melanocytosis is a flat, gray-blue patch that is poorly circumscribed and classically located on the lower back of Asians and African Americans
79
Q

What are nevus simplex and nevus flammeus?

A
  • nevus simplex is a blanchable pink patch typically on the head which fades over time after birth
  • nevus flammeus is another name for a port-wine stain which is blanchable but unilateral and doesn’t fade
80
Q

What kind of anemia is seen in those with sickle cell disease if left unmanageD?

A
  • they begin with a normocytic, hemolytic anemia with compensatory reticulocytosis
  • overtime, they are susceptible to folate deficiency and a microcytic anemia with inappropriately low reticulocyte count
81
Q

What are the gross motor landmarks expected at 2, 4, 6, 9, and 12 months of age?

A
  • 2: lifts head
  • 4: rolls over, sits with trunk support
  • 6: sits propped on hands
  • 9: pulls to stand and cruises
  • 12: stands well, walks first steps independently
82
Q

What are the fine motor landmarks expected at 2, 4, 6, 9, and 12 months of age?

A
  • 2: eyes track past midline
  • 4: reaches midline
  • 6: transfers objects and has raking grasp
  • 9: 3-finger pincer, holds cup
  • 12: 2-finger pincer
83
Q

What are the language landmarks expected at 2, 4, 6, 9, and 12 months of age?

A
  • 2: alerts to voice
  • 4: laughs and turns to voice
  • 6: responds to name, babbles
  • 9: mama and dada
  • 12: says first words other than dada and mama
84
Q

What are the cognitive landmarks expected at 2, 4, 6, 9, and 12 months of age?

A
  • 2: social smile
  • 4: enjoys looking around
  • 6: stranger anxiety
  • 9: waves bye and plays pat-a-cake
  • 12: separation anxiety and comes when called
85
Q

By one year of age, height and weight should increase by how much?

A
  • weight times 3

- height up 50%

86
Q

How does acute pancreatitis lead to shock?

A

activated pancreatic enzymes enter the vascular system and increase vascular permeability, triggering a cascade of inflammation with vasodilation and increase vascular permeability

87
Q

Describe the difference between vulvodynia and genitopelvic pain disorder.

A
  • vulvodynia is characterized by pain with touch of the vestibule and external examination
  • genitopelvic pain disorder is pain with penetration causing anxiety
88
Q

What is most likely to cause obstructive urination in men over and under 40?

A
  • over 40 is BPH

- under 40 is urethral stricture

89
Q

What is the difference between an uncomplicated and a complicated parapneumonic effusion?

A
  • complicated are those with bacterial invasion or empyemas
  • these tend to have low pH, low glucose, and an elevated WBC
  • both receive antibiotics but complicated typically require drainage as well
90
Q

What murmur is associated with tetralogy of Fallot?

A

a harsh, crescendo-decrescendo systolic murmur at the pulmonic space secondary to right outflow tract stenosis

91
Q

What are the features of metabolic syndrome and what causes this?

A

patients must meet 3 of the following five criteria:
- abdominal obesity (waist >40 in men, >35 in women)
- fasting glucose 100-110
- blood pressure > 130/80
- triglycerides > 150
- HDL < 40 for men, <50 for women
these changes are mediated by insulin resistance

92
Q

Describe the fundoscopic findings consistent with diabetic retinopathy.

A
  • initial changes include microaneurysms, hemorrhages, exudates, and retinal edema
  • eventually cotton wool spots and then new vessels form
93
Q

Describe the presentation of Riedel thyroiditis.

A

it is a slowly progressive fibrosis of the thyroid gland and surrounding tissues leading to hypothyroidism

94
Q

Describe the presentation of thyroid lymphoma.

A
  • presents in patients with a history fo Hashimoto thyroiditis
  • presents with rapidly progressive thyroid enlargement, thyroid tenderness, compression of surrounding structures, and B symptoms
95
Q

At what point is aortic stenosis considered severe?

A

when valve area is less than 1 sq cm

96
Q

When can pap testing be stopped?

A

at age 65 or the time of hysterectomy

  • if there is no history of CIN2 or higher
  • and either 3 consecutive negative paps or 2 consecutive negative co-testing results
97
Q

What is believed to be the pathogenesis of HELLP syndrome?

A

abnormal placentation triggering systemic inflammation and activation of the coagulation and complement cascades, which consumes platelets and forms micro thrombi that are particularly damaging to the liver

98
Q

What features are typical of HIV-associated dementia?

A
  • long history of HIV infection and CD4 count less than 200
  • most significant cognitive changes are apathy and impaired attention
  • subcortical deficits include slowed movement and difficulty with smooth limb movement
99
Q

What drugs are known for causing a false positive amphetamine test?

A

all have sympathetic activity

  • atenolol, propanolol
  • bupropion
  • nasal decongestants
100
Q

What drugs are known for causing a false positive PCP test?

A
  • dextromethorphan
  • diphenhydramine and doxylamine
  • ketamine
  • tramadol
  • venlafaxine
101
Q

What is the first-line treatment for torsades?

A
  • defibrillation for unstable patients

- magnesium for stable patinets

102
Q

Describe the presentation of cyanide poisoning.

A
  • acute toxicity causes neurologic and cardiorespiratory stimulation manifesting as hyperventilation, tachycardia, headache, vertigo, dizziness, nausea, and vomiting
  • later these systems are depressed, manifesting as seizures, bradycardia, hypotension, cardiopulmonary arrest, and coma
103
Q

What are risk factors for iron deficiency in young children?

A
  • prematurity
  • lead exposure
  • in those less than 1: delayed introduction of solid foods or intake of cow, soy, or goat milk
  • in those older than 1: intake of more than 24 ounces of cow’s milk in a day
104
Q

Those who are resuscitated following drowning are at highest risk for what complication?

A

acute respiratory distress syndrome since the fluid frequently washes out the patient’s surfactant

105
Q

What is the treatment for Lyme disease?

A
  • for early, localized Lyme, use doxycycline in the general population and amoxicillin in children less than 8 years old
  • in all populations, use ceftriaxone for late disease
106
Q

What murmur is characteristic of an ASD?

A

split S2 and systolic ejection murmur at the left upper sternal border produced by increased flow across the pulmonic valve

107
Q

What are the features of trisomy 18?

A

What are the features of all the three key trisomies?

108
Q

What is an aortoenteric fistula?

A

a rare and late complication of AAA repair in which the duodenum erodes into the proximal part of the aortic graft

109
Q

Describe the pathogenesis and presentation for bowel ischemia following AAA repair.

A
  • it is the result of inadequate colonic collateral arterial perfusion to the left and sigmoid colon due to loss of the IMA during graft placement
  • presents with abdominal pain, bloody diarrhea, fever, and leukocytosis shortly after surgery
110
Q

How should Bartholin duct cysts be managed?

A
  • expectant management is suitable for asymptomatic cysts as they are likely to resolve
  • I&D is only required for symptomatic cysts and abscesses
111
Q

How is intrauterine fetal demise confirmed?

A

by the absence of fetal cardiac activity on ultrasound

112
Q

Describe the risk factors, presentation, diagnosis, treatment, and proper prophylaxis for C. diff.

A
  • risk factors include hospitalization, PPI use, and recent antibiotics, particularly clindamycin
  • presents with profuse watery diarrhea, potentially complicated by fulminant colitis or toxic megacolon
  • diagnosis is by stool PCR for exotoxin genes
  • treat with oral vancomycin
  • prevent with soap and water for hand hygiene and contact isolation
113
Q

What is empiric therapy for septic arthritis? What should be added if this fails to improve the patient’s condition?

A
  • start with vancomycin

- add ceftriaxone to cover for Kingella and other gram-negatives if patients fail to improve

114
Q

At what point is bedwetting considered abnormal?

A

children five and older

115
Q

What is the first-line treatment for enuresis?

A
  • for primary (failure to train by age five) use enuresis alarms and desmopressin as first line agents
  • for secondary (return of enuresis after 6 months of continence) refer to therapy as most cases are psychological
116
Q

What are the two first line agents for acute agitation?

A
  • second generation antipsychotics are preferred

- benzodiazepines can be used for delirium secondary only to alcohol or benzodiazepine withdrawal

117
Q

If a patient undergoes a nuclear stress test, what is indicated by a tracer uptake defect that is present at both rest and with activity?

A

this is suggestive of scar tissue

118
Q

Describe the presentation of gallstone ileus?

A
  • presents as a “tumbling” obstruction with episodes of nausea, vomiting, and abdominal pain until it becomes lodge at the terminal ileum
  • then it causes a mechanical bowel obstruction which manifests with pneumobilia, hyperactive bowel sounds, and dilated loops of bowel
119
Q

What three measures can be taken to reduce the risk of aspiration pneumonia in those with dysphagia?

A
  • diet modification
  • oral hygiene
  • elevation of the head of the bed
120
Q

Describe the pathogenesis, presentation, diagnostic criteria, and treatment of SBP.

A
  • it is thought to be from enteric bacteria translocating across the intestinal wall to seed ascitic fluid
  • presents with fever, abdominal pain, altered mental status, hypotension, and paralytic ileus
  • diagnosis requires more than 250 PMNs, ascites total protein less than 1, and serum-ascites albumin gradient of 1.1 or greater
  • treat with ceftriaxone and then a fluoroquinolone for prophylaxis
121
Q

What is the key difference between polymyositis and polymyalgia rheumatica?

A

polymyositis involves more weakness and less pain compared to PMR which tends to be the reverse

122
Q

Through what mechanism does a tension pneumothorax affect the heart?

A

it increase intrapleural pressure, compressing mediastinal structures and impeding venous return

123
Q

How can absence seizures be differentiated from temporal lobe epilepsy with complex partial seizures?

A

both may have staring with automatisms depending on how the temporal lobe seizure manifests; however:

  • absence seizures are more common in children
  • absence seizures have no post-ictal state
  • absence seizures last less than 30 seconds
124
Q

What complications can be seen in infants of diabetic mothers who are overtly diabetic versus develop gestational diabetes in the second or third trimester?

A
  • overt diabetics with hyperglycemia in the first trimester can expect cardiac, limb, and neural tube defects
  • all women, regardless of onset, have an increased risk for preterm delivery, fetal macrosomia, respiratory distress, and neonatal hypoglycemia
125
Q

Thin, shiny, hairless skin on the lower extremities is suggestive of what underlying disease?

A

peripheral vascular disease

126
Q

How can primary hyperparathyroidism be distinguished from PTHrP and hypercalcemia of malignancy based on history alone?

A
  • those with primary hyperparathyroidism rarely have symptomatic hypercalcemia as levels don’t rise high enough unlike with PTHrP
  • furthermore, those with PTHrP are more likely to have a history suggestive of lung cancer
127
Q

Describe the pathogenesis of renal osteodystrophy.

A
  • chronic kidney disease lowers GFR, producing hyperphosphatemia, and reduces activation of vitamin D, producing hypocalcemia
  • extra phosphate binds and precipitates calcium, further exacerbating the hypocalcemia
  • these changes stimulate PTH synthesis, a secondary hyperparathyroidism
  • extra PTH increases bone resorption and induces PTH resistance leading to adynamic bond disease
  • this is renal osteodystrophy, manifesting as plain and increased risk of fracture
128
Q

What is hyperpigmentation along with adrenal dysfunction indicative of?

A

primary insufficiency

129
Q

Describe a tuberculous pleural effusion.

A
  • they are exudative, meeting Light criteria
  • they tend to have very high protein levels (>4) and lymphocytic infiltrate, and low glucose levels
  • they also tend to have markedly elevated LDH, low pH, and a yellow discoloration
130
Q

What are IVIG and aspirin given to those with Kawasaki disease?

A
  • IVIG to prevent coronary aneurysm formation

- aspirin to prevent coronary artery thrombosis

131
Q

What are the symptoms of cataracts?

A

painless blurring of vision, glare, halos around light, and worsening distance vision

132
Q

What is the most common cause of sterile pyuria?

A

Chlamydia trachomatis urethritis

133
Q

What medication improve long-term survival in patients with HFrEF?

A
  • ACEi/ARB
  • beta-blockers (specifically, metoprolol, carvedilol, and bisoprolol)
  • aldosterone antagonists
  • combination of hydralazine and nitrates
134
Q

Describe the pathogenesis for how hypothyroidism contributes to amenorrhea?

A
  • low thyroxine stimulates TRH release
  • TRH acts at the anterior pituitary to release TSH as well as prolactin
  • prolactin then inhibits the HPO to induce amenorrhea
135
Q

TRH stimulates the release of what hormones from the anterior pituitary?

A

TSH and prolactin

136
Q

What are the three tocolytics and what are their specific indications?

A
  • indomethacin: first line for women less than 32 weeks
  • nifedipine: first line for women 32-34 weeks gestation
  • terbutaline: short-term, inpatient use
137
Q

Why is indomethacin not the preferred tocolytic later in pregnancy?

A

because it can stimulate oligohydramnios and premature closure of the ductus arteriosus

138
Q

What is familial dysbetalipoproteinemia? How does it manifest and how is it treated?

A
  • it is a genetic cause of severe hypertriglyceridemia
  • often presents with grossly lipemia serum, palmar xanthomas, and repeated pancreatitis post-alcohol consumption
  • teat with fenofibrate
139
Q

How is preterm labor managed between:

  • less than 32 weeks
  • 32-34 weeks
  • 34-37 weeks
A

as long as there are no other indications for delivery:

  • less than 32 weeks: betamethasone, magnesium, and tocolytics
  • 32-34 weeks: betamethasone and tocolytics
  • 34-37 weeks: betamethasone
140
Q

What are the JNC8 blood pressure recommendations?

A
  • for those less than 60, who have CKD, or who have diabetes, the goal of treatment is 140/90
  • for those over 60 without CKD or diabetes, the goal of treatment is 150/90
141
Q

What is the most common cause of hemoptysis in pediatrics? Describe the pathogenesis.

A
  • the most common cause is CF-associated bronchiectasis
  • chronic airway inflammation causes bronchiectasis through enlargement and scarring of the airways, this is accompanied by fragile bronchial arteries beneath the surface which are predisposed to bleeding
142
Q

OCPs reduce the risk of what cancers?

A

ovarian and endometrial

143
Q

What is the most common cause of rapid-onset loss of consciousness without a preceding prodrome?

A

arrhythmia

144
Q

Describe a mitral stenosis murmur.

A
  • will hear a loud first heart sound, an early diastolic opening snap, and a low-pitched diastolic murmur best heard at the apex
  • early on in the disease, the murmur is primarily late diastolic but as the disease progresses, it becomes mid-diastolic and then immediately follows the opening snap
145
Q

Describe the progression of juvenile myoclonic epilepsy.

A

patients progress from absence seizures to myoclonic seizures and then tonic-clonic seizures

146
Q

Why does distributive shock lead to an elevated mixed venous oxygen saturation?

A

because reduced SVR increases the cardiac index and there is an inability of tissues to adequately extract oxygen, rising PvO2

147
Q

Describe the presentation of acute iron poisoning.

A
  • patients present with abdominal pain, hematemesis, and melon secondary to free radical production and lipid per oxidation destroying the GI mucosa
  • stools are also often green-black due to the iron tablets themselves
  • accompanying symptoms are shock, liver necrosis, and an anion gap metabolic acidosis
148
Q

Patients with sickle cell disease are most likely to experience bacteremia from what organism?

A

streptococcus pneumoniae because they are asplenic and susceptible to encapsulated organisms

149
Q

Antibiotic prophylaxis for dental work is only indicated for whom?

A

those with a prosthetic heart valve, history of infective endocarditis, or congenital heart disease should be treated with amoxicillin; acquired heart disease is not an indication

150
Q

GU cancers not covered in MTB.

A

Epithelial ovarian carcinoma, granulosa, seminoma, etc.

151
Q

Ursodeoxycholic acid is only indicated for pruritus due to what?

A

intrahepatic cholestasis; extrahepatic cholestasis (e.g. pancreatic cancer) requires endoscopic stent placement to improve excretion

152
Q

What trinucleotide repeat manifests with autism-type features in early childhood?

A

the FMR1 repeat of fragile X syndrome

153
Q

Describe the presentation, diagnosis, and treatment of Entamoeba histolytica.

A
  • the initial infection is often asymptomatic but may produce a bloody dysentery; it later manifests as fever and RUQ pain with an abscess present in the right lobe of the liver
  • diagnosis with stool microscopy can be used early but is too insensitive late, so serology must be used
  • treat with metronidazole for liver abscesses and paromomycin to clear the intestinal infection
154
Q

What will pulmonary artery catheterization show in those with cardiac tamponade?

A

intracardiac diastolic pressures

155
Q

Under what circumstances can menopause be diagnosed clinically?

A

in women over age 45 with a 12 month history of amenorrhea who are without symptoms concerning for another disease process such as hyperthyroidism

156
Q

Describe the presentation of hypo plastic left heart syndrome.

A

this is rarely a cyanotic heart disease and instead manifests as shock due to impaired systemic perfusion along with pale or mottled skin

157
Q

What is unique about the exam and radiograph findings for the following:

  • transposition of the great vessels
  • ToF
  • tricuspid atresia
  • truncus arteriosus
  • TAPVR
A
  • transposition: single S2, CXR showing egg-on-a-string heart
  • ToF: pulmonic stenosis murmur, VSD murmur, CXR showing boot shaped heart
  • TA: single S2, CXR showing minimal pulmonary blood flow
  • truncus: single S2, systolic ejection murmur, and CXR showing pulmonary edema from increased flow
  • TAPVR: severe cyanosis, respiratory distress, and pulmonary edema plus snowman sign from dilated SVC on CXR
158
Q

Describe the pathogenesis, presentation, diagnosis, and treatment of a psoas abscess.

A
  • usually due to hematologic seeding or direct extension of an intraabdominal infection
  • presents with subacute fever, abdominal or flank pain radiating to the groin, anorexia, and a positive psoas sign (pain with hip extension)
  • diagnosis is with CT
  • treat with drainage and antibiotics
159
Q

Describe the pathogenesis, presentation, and treatment of ABO hemolytic disease of the newborn.

A
  • seen in infants with blood types A or B born to mothers who are blood type O because these mothers develop IgG antibodies early in life through environmental exposures to similar antigens
  • presents with mild symptoms including jaundice, anemia, hyperbilirubinemia, and a positive coombs test
  • manage with supportive care and treatment of hyperbilirubinemia as you normally would
160
Q

Describe the pathophysiology, presentation, diagnosis, and treatment of phenylketonuria.

A
  • due to an autosomal recessive defect in phenylalanine hydroxylase which prevents conversion of phenylalanine into tyrosine
  • presents with intellectual disability, seizures, hypo pigmentation, and musty body odor
  • diagnosis is with a newborn screening and quantitative amino acid analysis
  • treat with dietary modification
161
Q

Describe the pathogenesis, presentation, and management of anemia of prematurity.

A
  • due to impaired EPO production, a shorter RBC life span, and repeated blood sampling in preterm infants
  • usually asymptomatic but it may manifest as tachycardia, apnea, and poor weight gain
  • labs demonstrate an aplastic anemia
  • manage with iron supplementation, PRN transfusions, and minimization of blood draws
162
Q

Through what mechanism are ACEIs and ARBs nephroprotective?

A

they lead to dilation of the glomerular efferent, reducing intraglomerular pressures while also inhibiting the renin-angiotensin-aldosterone system

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