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1
Q

AE of what rheum drug - macrocytic anemia +/- pancytopenia

A

MTX

Other AE: nausea, stomatitis, rash, hepatotoxicity, ILD, alopecia, fever

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2
Q

AE of what rheum drug - GI distress, visual disturbances, hemolysis if G6PD deficiency

A

Hydroxychloroquine

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3
Q

AE of what rheum drug - pancreatitis, liver toxicity, dose dependent bone marrow suppression

A

Azathioprine

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4
Q

Presentation - transient vision loss lasting a few seconds with changes in head position, blind spot enlargement on visual field testing

A

Papilledema 2/2 increased ICP

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5
Q

Work-up of suspected papilledema?

A

Urgent diagnostic evaluation (ophthalmologic exam, neuroimaging, and/or LP) to prevent vision loss

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6
Q

Cause of amaurosis fugax?

A

Usually vascular (eg, embolus to ophthalmic artery)

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7
Q

Presentation - peripheral visual field deficits, extensive cupping of the optic disc on fundoscopy

A

Glaucoma

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8
Q

Cause of glaucoma?

A

Increased intraocular pressure

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9
Q

Fundoscopic exam finding of optic neuritis?

A

Optic disc edema

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10
Q

Compare the presentations of anterior vs. posterior uveitis.

A

Anterior: eye pain and redness

Posterior: painless, floaters/reduced visual acuity

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11
Q

Vaccines for adults with HIV?

A

HAV: chronic liver disease, MSM, IV drug use, travel to countries where HepA is prevalent

HBV: all patients without documented immunity

HPV: all patients age 11-26

Influenza (inactivated): everyone annually

MCV (A, C, W, Y): all

PCV13 1x
PPSV23: 8 weeks later, 5 years later, age 65

Tdap: 1x, Td Q10 years

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12
Q

When are live vaccines (MMR, VZV, etc.) contraindicated in patients with HIV?

A

CD4 <200

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13
Q

Dx and Rx PMS/PMDD

A

Symptom/menstrual diary over 2 cycles

SSRIs; combined OCs are an option

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14
Q

Define preterm prelabor rupture of membranes (pPROM).

A

ROM <37 weeks gestation

Before the onset of labor

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15
Q

4 major risks associated with pPROM?

A
  1. Placental abruption
  2. Intraamniotic infection
  3. Umbilical cord prolapse
  4. Preterm labor
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16
Q

Patients with familial adenomatous polyposis have a significantly increased risk of colorectal cancer. What is the standard of care by way of prevention?

A

Frequent colonoscopic screening starting in childhood and elective proctocolectomy

  • Annual screening sigmoidoscopies starting at age 10-12
  • Annual colonoscopies once colorectal adenomas are detected or if age 50+
  • Regular screening for upper GI tract tumors
  • Proctocolectomy if presentation with CRC or adenomas with high-grade dysplasia
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17
Q

Presentation - palpable tender mass on the anterior vaginal wall with associated purulent discharge; may present as dyspareunia, dysuria, post-void dribbling

A

Urethral diverticulum

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18
Q

Dx and Rx urethral diverticulum

A

MRI to confirm

Rx - surgical excision

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19
Q

___ is commonly characterized by an acute illness involving the skin/mucosa and either respiratory or CV compromise.

A

Anaphylaxis

Other manifestations include GI, neuro, and ocular symptoms

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20
Q

What labs can be drawn if the diagnosis of anaphylaxis is unclear?

A

Serum tryptase

Plasma histamine

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21
Q

Why can medications such as NSAIDs or beta-adrenergic blockers exacerbate anaphylaxis?

A

Cause non-immunologic mast cell activation or unopposed alpha-adrenergic effects respectively

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22
Q

Features of neonatal abstinence syndrome due to infant withdrawal to opiates?

A

Presents in the first few days of life
Irritability, high-pitched cry, poor sleep, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, diarrhea

Note - prenatal exposure can lead to increased risk of IUGR and SIDS

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23
Q

Lab findings suggesting primary hyperaldosteronism (aldosterone-producing tumor or bilateral adrenal hyperplasia)?

A

HTN
Hypokalemia
Decreased renin
Increased aldosterone

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24
Q

Lab findings suggesting secondary hyperaldosteronism (renovascular or malignant HTN, renin-secreting tumor, diuretic use)?

A

HTN
Hypokalemia
Increased renin
Decreased aldosterone

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25
4 possible causes of HTN + hypokalemia + decreased renin + decreased aldosterone
1. CAH 2. Deoxycorticosterone-producing adrenal tumor 3. Cushing syndrome 4. Exogenous mineralocorticoids
26
Although aldosterone causes increased renal reabsorption of sodium, most patients with PH do not have edema or clinically significant hypernatremia - explain.
Aldosterone escape - increased Na leads to HTN and increased blood volume -> increased renal blood flow, GFR, and atrial natriuretic peptide -> Na+ excretion
27
Triad - congenital heart disease, T-cell deficiency, hypocalcemia
DiGeroge syndrome
28
List the 3 types of thyroiditis.
1. Chronic autoimmune (Hashimoto) 2. Painless (silent) 3. Subacute (de Quervain)
29
Compare the clinical features of the 3 types of thyroiditis.
1. Hashimoto: HYPOTHYROID, diffuse goiter 2. Painless: mild brief hyperthyroid phase, small NONTENDER goiter, spontaneous recovery 3. Subacute: post-viral, prominent fever, HYPERTHYROID, PAINFUL goiter
30
Compare the Dx testing results of the 3 types of thyroiditis.
1. Hashimoto: TPO Ab, variable radioiodine uptake 2. Painless: TPO Ab, low uptake 3. Subacute: elevated ESR, CRP, low radioiodine uptake
31
Rx thyrotoxicosis in subacute thyroiditis
Beta blockers to control thyrotoxic symptoms | NSAIDs for pain relief; steroids if pain does not respond
32
Findings of suppurative thyroiditis?
Rare condition High-grade fever, pain, palpable enlargement due to abscess formation EUTHYROID
33
Oral emergency contraceptive options that prevent pregnancy by delaying ovulation?
Levonorgestrel (progestin) Ulipristal (anti-progestin) Progestin OCPs
34
Distinguish between breastfeeding jaundice and breast milk jaundice.
FEEDING: first week of life, insufficient quantity (decreased bili elimination, increased enterohepatic circulation) + SUBOPTIMAL breastfeeding, signs of DEHYDRATION MILK: peaks at 2 weeks, deconjugation of intestinal bili due to high levels of beta-glucuronidase in milk + ADEQUATE breastfeeding, NORMAL exam
35
Normal frequency of breastfeeding?
At least 10-20 minutes per breast Q2-3 hours
36
Normal # of wet diapers in the first week of life?
At least the infant's age in days
37
ABO hemolytic disease almost exclusively affects infants with blood types ___ who are born to mothers with type ___.
A or B; O
38
Management of breastfeeding jaundice?
1. Increase frequency and duration of feeds, maintain adequate hydration, promote bilirubin excretion 2. If bilirubin continues to rise despite such efforts -> formula supplementation (do not discontinue breastfeeding) (If bilirubin levels are below the phototherapy threshold)
39
What causes vasospastic angina and how is it treated?
Hyperreactivity of intimal smooth muscle -> intermittent coronary artery vasopspasm CCBs (diltiazem, amlodipine, etc.) - preventive Sublingual nitroglycerin - abortive Smoking cessation
40
Presentation of vasospastic angina?
Young patients (<50) Smoking + minimal other CAD risk factors Recurrent chest discomfort at rest or during sleep, resolves spontaneously within 15 minutes ECG: STEMI Coronary angio: no CAD
41
What is cilostazol?
PDE III inhibitor that causes arterial vasodilation and inhibits platelet aggregation; used for patients with intermittent lower extremity claudication
42
What is ranolazine?
Antianginal drug that decreases myocardial Ca2+ level by inhibiting late-phase sodium influx into ischemic cardiomyocytes; effective in treating stable angina due to atherosclerotic CAD
43
List the 7 initial interventions involved in stabilization of acute STEMI.
1. Supplemental O2 (if <90% or dyspnea) 2. Aspirin 325 mg 3. P2Y12 inhibitor (eg, clopidogrel) 4. Nitrates (sublingual) 5. Beta blocker (unless hypotension, bradycardia, chronic heart failure, heart block) 6. High-dose statin (eg, atorvastatin 80 mg) 7. Anticoagulation (depends on planned revascularization)
44
After initial stabilization of acute STEMI - if there is persistent pain, HTN, or heart failure, what is done?
IV nitroglycerin (except if hypotension, RV infarct, or severe aortic stenosis) Vasodilators
45
After initial stabilization of acute STEMI - if there is persistent severe pain, what is done?
IV morphine Anxiolytic + preload reducing
46
After initial stabilization of acute STEMI - if there is unstable sinus bradycardia, what is done?
IV atropine
47
After initial stabilization of acute STEMI - if there is pulmonary edema, what is done?
IV furosemide (not if patient is hypotensive or hypovolemic) Decreases preload -> decreases pulmonary capillary pressure Venodilates -> further decreases preload
48
Reperfusion options for acute STEMI?
Percutaneous transluminal coronary angioplasty within 90 minutes (preferred) Thrombolysis (if PCTA no available within 120 mintues)
49
2 major uses of digoxin?
Rate control in patients with rapid AF | Improve symptoms in CHF
50
Presentation - delirium, elevated vitals (hypertermia, HTN, tachycardia), diaphoresis in the setting of multiple SUDs
DT
51
Where does atopic dermatitis present in infants vs. children/adults?
Infants: extensor surfaces, cheeks Children/adults: flexor surfaces (neck, antecubital fossae, volar wrists, popliteal fossae, dorsal ankles)
52
Presentation - total or segmental non-obstructive colonic dilation, severe bloody diarrhea, systemic findings
Toxic megacolon
53
Dx toxic megacolon
Plain abdominal XR (dilated R or transverse colon, thick haustral markings that do not extend across the entire lumen) + 3 or more of the following: fever >38 C, pulse >120, WBCs >10500, and anemia
54
Rx toxic megacolon
Medical emergency | IVF, broad-specrum ABX, NPO, IV steroids if IBD-induced
55
R-sided colon cancer tends to present with ___; L-sided colon cancer tends to present with ___.
Anemia; bowel obstruction
56
Symptoms of SIBO?
Bloating, flatulence, water diarrhea, abdominal pain +/- malabsorption and nutritional deficiencies
57
Causes of SIBO?
``` Anatomic abnormalities (eg, strictures, surgery) Motility disorders (eg, DM, scleroderma) Alterations in gastric/pancreatic secretions (eg, atorphic gastritis, chronic pancreatitis) ```
58
Dx SIBO
Jejunal aspirate and culture showing >10E5 organisms/mL Carbohydrate breath test
59
Organisms involved in SIBO?
Streptococci Bacteroides Escherichia Lactobacillus
60
Rx SIBO?
``` ABX (eg, refaximin, amox-clav) Avoid antimotility agents (eg, narcotics) Dietary changes (high-fat, low barb) Promotility agents (eg, metoclopramide) ```
61
What is dumping syndrome?
Complication of gastric bypass, occurs when high-carb foods are rapidly emptied into the small bowel, leading to osmotically driven fluid shifts from the plasma to the intestines Abdominal pain, diarrhea shortly after meals + sympathetic activation (tachycardia, diaphoresis, flushing, hypoglycemia)
62
What is androgen insensitivity syndrome?
Complete defect in androgen receptor function Phenotypically female Primary amenorrhea due to absent uterus No pubic or axillary hair
63
Features of 5-alpha-reductase deficiency?
Impaired conversion of testosterone to dihydrotestosterone Initially have female external genitalia and male internal genitalia until puberty -> virilization due to increased levels of T
64
Emergent management of central retinal artery occlusion?
Ocular massage and high-flow O2 administration
65
Management of acute angle closure glaucoma?
Topical pilocarpine and beta-blockers
66
Infants who receive oral macrolide should be monitored for what AE?
Pyloric stenosis
67
Describe the administration of PPSV23 and PCV13 in adults.
Age 65+: 1 dose PCV13, then PPSV23 6-12 months later Age 19-64: -PPSV23 alone: chronic heart, lung, or liver disease, DM, current smokers/alcoholics -PCV13 + PPSV23: CSF leaks, cochlear implants, SCD/asplenia, immunocompromise, CKD
68
Reverse hypochloremic hypokalemic metabolic alkalosis 2/2 gastric loss?
Isotonic NaCl and K
69
Features of ankylosing spondylitis
Insidious onset of inflammatory back pain at age <40 Symptoms >30 months RELIEVED WITH EXERCISE, but not rest Nocturnal pain Associated exam findings: - Arthritis (sacroiliitis) - Reduced chest expansion and spinal mobility - Enthesitis - Dactylitis - Uveitis
70
3 complications of ankylosing spondylitis?
Osteoporosis/vertebral fractures Aortic regurgitation Cauda equina
71
Describe the T3, T4, TSH, and reverse T3 findings in early/mild + prolonged/severe euthyroid sick syndrome.
T3: decreased T4: normal -> decreased TSH: normal -> decreased RT3 -> elevated
72
Characteristic thyroid lab findings in euthyroid sick syndrome caused by?
Low T3 with normal TSH and T4 in patients with acute illness due primarily to decreased peripheral conversion of T4 to T3
73
What is the major cause of delayed morbidity and mortality in subarachnoid hemorrhage and what can it cause? How can it be prevented?
Vasospasm; cerebral infarction; nimodipine
74
What is the major cause of death within the first 24 hours of presentation of SAH?
Rebleeding
75
Dx post-SAH vasospasm?
CTA
76
In patients with ARDS, how does mechanical ventilation improve oxygenation?
By providing an increased fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) to prevent alveolar collapse
77
Goal PaO2 in MV?
PaO2 at 55-80 mmHg; corresponds roughly to O2 saturation of 88-95
78
What vent settings primarily influence PaO2?
FiO2 | PEEP
79
What vent settings primarily influence PaCO2?
RR | TV
80
Prolonged high FiO2 can cause ___. It should be reduced as soon as possible below levels that predispose to this problem, approximately ___%.
Oxygen toxicity; 60
81
Management of stable vs. unstable ectopic pregnancy
Stable - MTX | Unstable - surgery
82
What physical exam finding is highly specific for epileptic seizure?
Tongue biting (especially the lateral tongue)
83
What is the most specific symptom of giant cell arteritis?
Jaw claudication
84
Rx open angle glaucoma?
Acetazolamide
85
What is calciphylaxis (aka calcific uremic arteriolopathy)?
Systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis; presents with painful nodules and ulcers, soft tissue calcification on imaging
86
Risk factors for calciphylaxis?
``` ESRD on hemodialysis Hypercalcemia, hyperphosphatemia Hyperparathyroidism Obesity, DM Oral anticoagulants ```

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