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1
Q

What causes GVHD?

A

Recognition of host major and minor HLA-antigens by donor T-cells and consequent cell-mediated immune response

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2
Q

Organs typically affected in GVHD + symptoms?

A

Skin (maculopapular rash involving palms, soles, and face), intestine (blood + diarrhea), liver (abnormal LFTs, jaundice)

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3
Q

What mediates graft rejection?

A

Activation of host T-cells

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4
Q

GnRH, FSH, and estrogen findings in hypothalamic hypogonadism?

A

All decreased

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5
Q

GnRH, FSH, and estrogen findings in primary ovarian insufficiency?

A

GnRH and FSH increased

Estrogen decreased

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6
Q

GnRH, FSH, and estrogen findings in PCOS?

A

GnRH: increased
FSH: normal
Estrogen: increased

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7
Q

GnRH, FSH, and estrogen findings in exogenous estrogen use?

A

GnRH and FSH decreased

Estrogen increased

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8
Q

Management of preterm prelabor rupture of membranes?

A

If <34 weeks -> expectant management with prophlyactic latency ABX, steroids, and inpatient monitoring

If <34 weeks + complications develop -> deliver + IAI Rx, steroids, Mg if <32 weeks

If 34 to <37 weeks: deliver, GBS PPx, +/- steroids

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9
Q

What is amnioinfusion used for?

A

Variable fetal HR decelerations in labor

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10
Q

When are tocolytics indicated in PPROM?

A

Never - they are contrindicated because contractions often indicate a complication requiring delivery or intervention

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11
Q

Management of dyspareunia due to hypoestrogenism in the setting of postpartum breastfeeding?

A

Non-hormonal lubricants and moisturizers

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12
Q

Presentation - hematuria, renovascular congestion (enlarged kidney on imaging), flank pain, possible elevated ADH and/or AKI

A

Renal vein thrombosis

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13
Q

Common causes/risk factors of renal vein thrombosis?

A

Hypercoagulability: nephrotic syndrome, malignancy, OCPs
Volume depletion (infants)
Trauma

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14
Q

Dx renal vein thrombosis

A

CTA or MRA

Renal venography

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15
Q

Rx renal vein thrombosis

A

Anticoagulation

Thrombolysis/ectomy if AKI present

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16
Q

There is significant overlap between presentation of renal infarction and acute RVT - distinguish between them.

A

Infarct - cardioembolic disease -> incomplete infarction -> wedge-shaped area of ischemia, often report abdominal pain + flank pain

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17
Q

Nearly all patients with CF develop ___. Most male patients develop ___. ~20% develop sensorineural hearing loss - why?

A

Sinopulmonary disease; infertility (only 20% of females have fertility problems)

Frequent treatment with aminoglycosides for GN infections

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18
Q

When comparing iron studies in the 3 main microcytic anemias (iron deficiency, thalassemia, and anemia of chronic disease), what are the key distinguishing findings?

A

[MCV: decreased in all three; may be normal in chronic disease or very decreased in thalassemia]

Iron: INCREASED in thalassemia; decreased in the other 2

TIBC: INCREASED in iron deficiency; decreased in the other two

Ferritin: DECREASED in iron deficiency; increased (both) or normal (chronic) in the other two

Transferrin saturation: VERY INCREASED in thalassemia, decreased (both) or normal (chronic) in the other two

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19
Q

Transferrin saturation = ?

A

Iron/TIBC

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20
Q

Key findings in iron studies suggesting iron deficiency anemia?

A

Decreased ferritin

Increased TIBC

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21
Q

Key findings in iron studies suggesting thalassemia?

A

Increased iron

Very increased transferrin

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22
Q

Key findings in iron studies suggesting anemia of chronic disease?

A

Decreased iron + decreased TIBC

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23
Q

Rx hereditary spherocytosis?

A

Splenectomy

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24
Q

Rx anemia of chronic disease?

A

Rx underlying condition (Fe supplementation is not helpful, because the problem involves USING iron rather than a deficiency of iron)

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25
Presentation - micrognathia, microcephaly, prominent occiput, low-set ears, rocker-bottom feet, overlapping fingers, absent palmar creases, heart and renal defects
Trisomy 18 (Edward syndrome)
26
Holosystolic murmur best heard at the LLSB
VSD
27
What causes the fixed split S2 heard in ASD?
Delayed closure of the pulmonic valve
28
Truncus arteriosus is associated with what syndrome?
DiGeroge
29
Acute rheumatic fever is a complication of untreated S. pyogenes pharyngitis. List 5 major clinical features.
1. Carditis 2. Chorea 3. Erythema marginatum 4. Subcutaneous nodules 5. Migratory arthritis Minor - fever, arthralgias, elevated ESR/CRP, prolonged PR interval
30
Late cardiac sequelae of acute rheumatic fever?
Mitral regurgitation/stenosis
31
Diagnostic criteria for acute rheumatic fever?
2 major 1 major + 2 minor Anything with chorea or carditis present
32
Why do we give patients penicillin when they have GAS pharyngitis?
TO PREVENT ARF
33
Follow-up management of patients with ARF?
Prophylactic long-acting IM benzathine PNC G for several years
34
Most common virus causing peri/myocarditis
Coxsackievirus
35
List 6 ECG findings suggesting an arrhythmias as the cause of syncope.
1. Inappropriate sinus bradycardia 2. SA block 3. Sinus pauses 4. AV block 5. Non-sustained ventricular arrhythmias 6. Short or prolonged QTc interval NOT isolated premature ventricular beats
36
___ is due to polymorphic ventricular tachycardia in the setting of a prolonged QT interval.
Torsades de pointes
37
What crystals cause gout and how are they identified?
Monosodium urate crystals: needle shaped, negatively birefringent (YELLOW when PARALLEL, BLUE when PERPENDICULAR)
38
True or false - the presence of synovial crystals rules out septic arthritis.
False - they can be present between flares - look for other signs of septic arthritis
39
What crystals cause pseudogout and how do they appear?
Calcium pyrophosphate crystals - smaller, rhomboid, weakly positive birefringent (opposite gout)
40
Synovial fluid findings in gout?
Leukocytosis (2000-100,000 with >50% neutrophils)
41
Presentation - normal internal genitalia, external virilization, undetectable serum estrogen, polycystic ovaries in an adolescent female patient
Aromatase deficiency
42
How does aromatase deficiency first manifest?
In utero -> placenta cannot convert androgens into estrogens -> transient masculinization of Mom that resolves after delivery
43
Presentation - females with ambiguous external genitalia, normal internal female reproductive organs, electrolyte abnormalities
Classic congenital adrenal hyperplasia
44
Presentation - females with primary amenorrhea and virilization at puberty, normal genitalia at birth
Non-classic late-onset CAH
45
Features of Kallman syndrome?
X-linked Hypogonadotropic hypogonadism + anosmia Delayed puberty, LH and FSH low or absent
46
What is McCune-Albright syndrome?
Cafe au lait spots Polyostotic fibrous dysplasia Autonomous endocrine hyperfunction -> gonandotropin-independent precocious puberty
47
Rx ethylene glycol poisoning?
Fomepizole (competitive inhibitor of alcohol dehydrogenase) Sodium bicarbonate Hemodialysis
48
What is methylene blue used for?
Rx methemoglobinemia (ingestion of dapsone or anesthetics)
49
Antidote for cyanide poisoning?
Sodium thiosulfate
50
Calcium oxalate deposition in the kidneys + hypocalcemia?
Ethylene glycol ingestion
51
Lifestyle changes to decrease risk for gout?
``` Dairy product intake Vitamin C (>1500 mg/day) Coffee intake (6+ cups/day) ```
52
Etiology of allergic conjunctivitis?
IgE-mediated acute hypersensitivity to environmental allergens
53
Exercise recommendations for healthy women with uncomplicated pregnancies?
Moderate-intensity exercise for 20-30 minutes on most or all days of the week + avoid contact sports and activities with high fall risks. Also don't scuba dive or do hot yoga.
54
Contraindications to exercise in pregnancy?
Risk of preterm delivery Preeclampsia Severe caridopulmonary disease
55
Pathophysiology of ARDS?
Lung injury -> fluid and cytokine leakage into alveoli -> impaired gas exchange, decreased lung compliance, and pulmonary HTN
56
Management of ARDS?
MV (eg, low TV, high PEEP, permissive hypercapnia)
57
Dx ARDS?
New/worsening respiratory distress within 1 week of insult Bilateral lung opacities (pulmonary edema) NOT due to CHF/fluid overload Hypoxemia with PaO2/FiO2 ratio of 300 mm Hg or less
58
Patients with upper GI bleeding often have an elevated BUN and BUN/Cr ratio - why?
1. Increased urea production from intestinal breakdown of Hgb 2. Increased urea reabsorption from hypovolemia
59
The aldosterone/renin ratio is elevated in ___.
Primary hyperaldosteronism
60
___ toxicity is a severe adverse effect of long-term amiodarone use and can occur months to several years after the initiation of therapy.
Pulmonary
61
Presentation of interstitial pneumonitis due to amiodarone toxicity?
Progressive dyspnea, non-productive cough, new reticular or ground-glass opacities on chest XR
62
What is amiodarone used for?
(Class III antiarrhythmic) Management of ventricular arrhythmias in patients with CAD and ischemic cardiomyopathy
63
Loop diuretics cause what 2 electrolyte abnormalities, which can cause what EKG abnormality?
Hypokalemia; hypomagnesemia Ventricular tachycardia
64
___ is a potassium sparing diuretic with proven mortality benefit in patients with severe CHF.
Spironolactone
65
Both Crohn disease and UC have multiple extraintestinal manifestations - list 4.
1. Arthritis - axial or peripheral 2. Eye (uveitis, episcleritis, etc.) 3. Skin (pyoderma gangreonsum, etc.) 4. Hepatobiliary (PSC, etc.)
66
4 major causes of HF with preserved LVEF.
1. LV diastolic dysfunction (HTN w/concentric LVH, restrictive, hypertrophic) 2. Valvular heart disease (AS/AR/MS/MR) 3. Pericardial disease (constrictive pericarditis, tamponade) 4. Systemic disorders -> high-output failure (thyrotoxicosis, severe anemia, large AV fistula)
67
Manage HFpEF?
Control BP and HR Address concurrent conditions (AF, MI) Rx volume overload with diuretics Exercise training/cardiac rehab
68
2 general causes of diastolic dysfunction?
Impaired myocardial relaxation Increased LV wall stiffness (decreased compliance) Both of these cause LV end-diastolic pressure -> back-up
69
Type of selection bias - study population differs from target population due to non-random selection methods
Ascertainment (sampling) bias
70
Type of selection bias - disease studied using only hospital-based patients may lead to results not applicable to target population
Berkson bias
71
Type of selection bias - exposures that happen long before disease assessment can cause study to miss diseased participants that die early or recover
Prevalence (Neyman) bias
72
Type of observational bias - subjects with negative outcomes are more likely to report certain exposures than controls, common in retrospective studies
Recall bias
73
Type of observational bias - subjects over- or under-report exposure history due to perceived social stigma
Reporting bias
74
Type of observational bias - risk factor itself causes increased monitoring in exposed group relative to unexposed group, which increases probability of identifying a disease
Surveillance (detection) bias
75
3 strongest predictors of AAA expansion and rupture?
1. Large aneurysm diameter 2. Rapid rate of expansion 3. Current cigarette smoking
76
Current indications for operative or endovascular repair of AAA?
Size >5.5 cm Rapid rate of expansion (>0.5 cm in 6 months or >1 cm/year) Symptoms regardless of size
77
Presentation - 46XY, phenotypically female at birth with female external and male internal genitalia + virilization at puberty
5-alpha-reductase deficiency
78
Pathogenesis of 5-alpha-reductase deficiency?
Testes produce T -> male internal genitalia T converted to DHT via 5-alpha-reductase; DHT -> male external genitalia and prostate Without 5-alpha-reductase, no external genitalia
79
Dx 5-alpha-reductase deficiency?
Elevated T/DHT ratio
80
Pathogenesis of androgen insensitivity syndrome?
Defect androgen receptor -> prevents virilization during embroygenesis Testosterone resistance -> absent male external genitalia
81
Distinguish between 5-alpha-reductase deficiency and androgen insensitivity syndrome
5-alpha-reductase: NO breast development (T binds receptor and inhibits proliferation) AIS: ++Breast development (defective androgen receptor unable to inhibit breast tissue proliferation)
82
Bilateral labial masses
Undescended testes
83
Features of Takayasu arteritis?
Female, Asian, age 10-40 Constitutional symptoms ARTERIO-OCCLUSIVE (claudication, ulcers, etc.) in upper extremities Arthralgias/myalgias BP discrepancies Pulse deficits Arterial bruits
84
Dx and Rx Takayasu arteritis
Elevated ESR/CRP CXR with aortic dilation and widened mediastinum CT/MRI: wall thickening and narrowing of lumen of large arteries Rx - systemic glucocorticoids
85
Fundoscopy - blood and thunder appearance, cotton wool spots, disc swelling, hemorrhages, venous dilation
Central retinal vein occlusion
86
Unlike sensitivity and specificity, PPV and NPV depend on the ___ of the disease in the population being tested.
Prevalence
87
A change in a test cutoff point that causes an increase in the number of false positives and true positives will have what effect on PPV?
Decrease
88
PPV = ?
TP/(TP + FP) = (a/a+b) | High PPV -> positive test more likely to be true

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