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Step 2 > UWSA2 > Flashcards

UWSA2 Flashcards

1
Q

woman gets soft subareolar mass from to weeks to months after cessation of breast feeding

A

galactocele

  • benign milk retention cyst
  • can get as large as 5cm
  • dx made with ultrasound and needle aspiration
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2
Q

explain the difference b/w primary and secondary adrenal insufficiency

A

primary- destruction of adrenal cortex (bilateral)
-all three layers affected

secondary- disruption of hypothalamic-pituitary axis

  • cortisol (glucocorticoid) and ACTH decrease
  • aldosterone (mineralocorticoid) will be normal

*Note: neither include anything with the adrenal medulla

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3
Q

erythrasma

A

superficial skin infection affecting areas where skin touches or folds on itself

  • well-demarcated, thin, red-brown plaques with wrinkling and fine scale
  • coral-red appearance under woods lamp
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4
Q

signs of congenital CMV

A 
jaundice 
petechiae
hepatosplenomegaly 
periventricular calcifications 
microcephaly
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5
Q

how to treat a gout flare in pts on anticoagulants

A

colchicine

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6
Q

triad of acute liver failure

-there may be more symptoms but these three are the most specific

A
  • elevated aminotransferases
  • hepatic encephalopathy
  • prolonged prothrombin time

*all of these in a pt without underlying liver disease

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7
Q

patient with extensor vs flexor posturing when lying supine, what do you think of

A

flexor means problem is above red nucleus

extensor means problem is below red nucleus

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8
Q

infarctions of this area impair motor functioning causing…

  • hemiparesis
  • dysarthria-clumsy hand syndrome
A

basis pontis (basilar pons)

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9
Q

recurrent lapses into sleep or naps 3 or more times/week for 3 months
… what is this and what are the other criteria

A

narcolepsy and they must have 1 or more of the following as well

  • cataplexy: brief loss of muscle ton precipitated by strong emotion
  • low CSF levels of hypocretin-1
  • shortened REM sleep latency
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10
Q

patient randomly has ischemic ulcers and gangrene but also smokes

A 
thromboangiitis obliterans (buerger disease) 
-inflammatory vaso-occlusive disorder to small and medium sized vessels

-tx: stop smoking

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11
Q

patient has asthma or cystic fibrosis that gets worse and leads to recurrent pulmonary infiltrates and bronchiectasis

A

allergic bronchopulmonary aspergillosis

-tx: long-term oral steroids and itraconazole

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12
Q

treatment of hypercalcemia

A

severe > 14

  • short term- hydration + calcitonin
  • avoid loop diuretics unless heart failure exists
  • long term- bisphosphonates (zoledronic acid)

moderate 12-14
-no treatment unless symptomatic, look above if needed

mild < 12

  • no immediate treatment
  • avoid thiazides, lithium, volume depletion, and prolonged bed rest
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13
Q

what is the strongest risk factor for prosthetic valve thrombosis of a mechanical heart valve

A

inadequate warfarin anticoagulation

  • goal INR for mitral valve: 2.5-3.5
  • goal INR for aortic valve: 2-3
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14
Q

bipolar I vs bipolar II

A

bipolar I
-manic episodes

bipolar II
-hypomanic episodes + 1 major depressive episode

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15
Q

cyclothymic disorder

A

2+ years of fluctuating, mild hypomanic & depressive symptoms

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16
Q

most common etiology of persistent nasal obstruction during childhood

A

adenoid hypertrophy

  • presents with recurrent sinus and ear infections, mouth breathing, sleep disturbances/snoring due to apnea
  • not seen on exam
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17
Q

what disease are nasal polyps associated with

A

cystic fibrosis

-able to be visualized on exam

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18
Q

positive fetal fibronectin test, next step?

A

give IM betamethasone if they are less than 34 weeks

-+ FFN is associated with delivery within the next week

19
Q

if someone has lambert-eaton, what is your next step

A

get a chest CT cause its associated with small cell lung cancer

20
Q

colonic pseudo-obstruction

A

aka ogilvie syndrome

  • acute dilation of the colon only without any actual obstruction
  • massive dilation of the cecum (diameter > 10cm)
  • due to surgery, trauma, infection, electrolyte derangement (all decreased), medications, neuro disorders
  • treat with npo, ng/rectal tube decompression
  • use neostigmine if no improvement within 48 hours
21
Q

what is one thing required in most states regardless of consent?

A

neonatal prophylaxis against gonococcal conjunctivitis

-topical erythromycin

22
Q

what is the most common dermal manifestation of antiphospholipid syndrome

A

livedo reticularis

  • transient latticelike rash caused by impaired blood flow in superficial venules
  • prolonged aPTT due to lupus anticoagulant
23
Q

what does doxorubicin do to the heart

A

cardiac myocyte necrosis and death

  • cardiomyocyte replacement by fibrous tissue
  • not reversible
24
Q

trastuzumab cardiotoxicity

A

myocardial stunning/hibernation without myocyte destruction

-reversible

25
Q

delusional disorder

A

persistent delusions lasting 1+ months with no other psych symptoms

26
Q

behcet syndrome

A

genital aphthous ulcers

  • recurrent and painful
  • heal w/i 1-3 weeks
27
Q

liver mass with central stellate scar

A

focal nodular hyperplasia

28
Q

patients with hyperemesis gravidarum are more likely to have what type of pregnancy

A

pts with hydatidiform mole or multifetal gestation are at increased risk for HG
-get pelvic u/s if they have it

29
Q

loss of peripheral vision in a pt with normal visual acuity

-usually elderly pt

A

open-angle glaucoma

-enlarged cup/disc ratio > 0.6

30
Q

DRESS syndrome

A

Drug- most commonly due to allopurinol and antiepileptics (phenytoin, carbamazepine)
Reaction (rash)- morbilliform eruption starts on face or upper trunk and becomes diffuse and confluent, with facial edema
Eosinophilia
Systemic Symptoms- fever, malaise, diffuse lymphadenopathy with some sort of organ involvement (liver, kidney, lung)

  • can happen 2-8 weeks after drug initiation
  • offending drug should be stopped immediately and usually pts recover completely
31
Q

what should you worry about if someone gets malaria from a non-African country

A

its likely vivax and you need to worry about dormant hepatic infection that can reactivate if you dont use primaquine to get rid of the hepatic hypnozoites
-can cause a persistent dormant infection

32
Q

what are the three vaccinations a mother should get during the third trimester

A

Tdap
inactivated influenza
Rho(D) immunoglobulin- if indicated

33
Q

choriocarcinoma

A
  • secretes hCG, following any type of pregnancy
  • very aggressive
  • uterine mass that most commonly metastasizes to the vagina and lungs (on vagina presents as red, friable lesions)
  • can cause bloody purulent vaginal discharge
  • pelvic pressure and enlarged uterus
34
Q

patient presents with microscopic colitis

  • frequent watery bms
  • fecal urgency
  • incontinence
  • classically: nocturnal diarrhea
  • workup for pretty much everything else is negative

what do you see on biopsy of the colon?

A

mononuclear predominant infiltrate

-risk factors: > 50, women, smoking, possibly NSAIDs

35
Q

which medications can cause akathisia

A

-inner restlessness

meds

  • antipsychotics
  • antiemetics (prochlorperazine, promethazine, metoclopramide)

*these can cause all the different types of extrapyramidal symptoms

36
Q

how to differentiate myelodysplastic syndrome and myelofibrosis

A

both have pancytopenia

  • myelodysplastic syndrome has dysplastic cells- PMNS with decreased segmentation and decreased granulation/anything where the cells dont look normal. also insufficient reticulocytosis
  • myelofibrosis has pretty huge splenomegaly due to extramedullary hematopoiesis
37
Q

what to give pts with recurrent hepatic encephalopathy if they are already compliant with their meds

A

nonabsorbable abx

-give rifaximin on top of lactulose

38
Q

patient comes back from a trip with gi symptoms, fever, relative bradycardia, and a pulmonary infiltrate, what do you think

A

legionella pneumophilia pneumonia

  • dx with urine legionella antigen
  • treat with respiratory fluoroquinolone or newer macrolide
39
Q

what is the aortic valve area in severe aortic stenosis

A

less than 1cm and if they have symptoms

-refer them for valve replacement

40
Q

whatre uterine fibroids made of

A

aka leiomyomata uteri

-abnormal proliferation of the myometrium

41
Q

how to dx uterine fibroids

A

sonohysterography

-saline infusion u/s which improves sensitivity of the dx

42
Q

patient has blurred vision, raynauds, headaches, confusion, possibly ataxia… what do you think of if they also have tons of IgM

A

waldenstrom macroglobulinemia

  • hyperviscosity syndrome
  • do serum IgM plasma exchange to reduce viscosity
43
Q

how to treat codylomata acuminata (presents in clusters)

A

HPV induced anogenital warts

  • may worsen due to pregnancy due to physiologic immunosuppression
  • give topical trichloroacetic acid

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