13 Flashcards
(140 cards)
1
Q
DDx - obstructive pattern (FEV1/FVC <70%) + divide by low, normal, and increased DLCO
A
Low: emphysema
Normal: chronic bronchitis, asthma
Increased: asthma
2
Q
DDx - restrictive pattern (FEV1/FVC >70% predicted, FVC <80% predicted) + divided by low, normal, and increased DLCO
A
Low: ILD, sarcoidosis, asbestosis, heart failure
Normal: MSK deformity, neuromuscular disease
Increased: morbid obesity
3
Q
DDx - normal spirometry with low DLCO
A
Anemia
PE
Pulmonary HTN
4
Q
DDx - normal spirometry with increased DLCO
A
Pulmonary hemorrhage
Polycythemia
5
Q
Define chronic bronchitis.
A
Productive cough for 3+ months over 2 consecutive years
6
Q
What is bronchiectasis?
A
Disease of abnormal bronchial widening in the setting of recurrent infection and inflammation
7
Q
Drug of choice for stabilizing bony metastatic lesions to prevent hypercalcemia of malignancy and pathologic fractures?
A
Bisphosphonates
8
Q
___ injury can occur from blunt force injury but typically results in immediate coma. It is usually diagnose dwith ___.
A
Diffuse axonal; MRI
9
Q
___ presents with rapidly progressive dementia, myoclonus, mood symptoms, and hypersomnia. How is it diagnosed?
A
Creutzfeldt-Jakob disease; high levels of 14-3-3 protein in the CSF
10
Q
Other diagnostic findings in CJD?
A
Periodic sharp wave complexes on EEG
Caudate nucleus/putamen findings
Spongiform changes and neuronal loss without inflammation (path)
11
Q
High anti-Hu Ab titers are seen in ___, a syndrome associated with ___.
A
Paraneoplastic encephalomyelitis; small cell lung cancer
12
Q
Pathologic cause of nephrogenic DI?
A
Impaired renal RESPONSE to ADH
13
Q
Infants born to women with ___ are at risk for thyrotoxicosis due to passage of maternal TSH receptor Ab across the placenta. How do these infants present?
A
Graves’ disease
Warm, moist skin, tachycardia, poor feeding, irritability, poor weight gain, low birth weight or preterm birth
14
Q
Rx neonatal thyrotoxicosis?
A
Methimazole + beta-blocker to prevent AE on the developing nervous system; will self-resolve as the Ab clears from the infant’s circulation
15
Q
Management of blunt abdominal trauma leading to suspected abruptio placentae?
A
- Aggressive fluid resuscitation with crystalloids + place patient in LLD position if the spine is stable to displace the uterus off the aortocaval vessels and maximize CO
- Emergency transfusion if fluid resuscitation is unresponsive or if bleeding is persistent (CBC should be repeated after IVF)
16
Q
What is the Kleihauer-Betke test used for?
A
To determine the necessary dose of Rh(D) anti-D Ig after delivery of an Rh-positive fetus to an Rh-negative mother
17
Q
Hypomagnesemia can lead to refractory hypokalemia - why?
A
Intracellular Mg2+ is thought to inhibit potassium secretion by renal outer medullary potassium (ROMK) channels in the collecting tubules
Therefore, low intracellular Mg results in excessive renal K loss and refractory hypokalemia
18
Q
Define fetal tachycardia
A
> 160/min
19
Q
Cause of a sinusoidal fetal heart tracing?
A
Fetal anemia
20
Q
What is an early deceleration? What causes them?
A
Shallow decrease in the fetal HR that is a mirror image with the uterine contraction
Autonomic response to alterations in intracranial pressure caused by fetal head compression during contractions
21
Q
What is a late deceleration and what causes it?
A
Smooth and subtle drops in fetal heart rate that occur after contractions due to transient fetal hypoxia caused by placental hypoperfusion during contractions
22
Q
What are variable decelerations and what causes them?
A
Abrupt drops in the fetal heart rate of varying length and duration; compression of the umbilical cord causing transient fetal hypertension that triggers a parasympathetic response and slows the HR
23
Q
Clinical features of intrahepatic cholestasis of pregnancy?
A
3rd Trimester
Generalized pruritis worse on the hands and feet
No associated rash
RUQ pain
24
Q
Lab abnormalities seen in intrahepatic cholestasis of pregnancy?
A
Increased total bile acids (>10)
Increased transaminases
+/- increased total and direct bilirubin
25
Obstetric risks of intrahepatic cholestasis of pregnancy?
Intrauterine fetal demise (>100 bile acids)
Preterm delivery
Meconium-stained amniotic fluid
Neonatal RDS
26
Management of intrahepatic cholestasis of pregnancy?
Delivery at 37 weeks gestation
Frequent monitoring
Ursodeoxycholic acid
Antihistamines
27
Features of Turner syndrome?
Webbed neck
Horseshoe kidney
Nail dysplasia
Congenital lymphedema
```
Narrow high-arched palate
Low hairline
Broad chest with widely spaced nipples
Cubitus valgus
Short stature
Coarctation of the aorta
Bicuspid aortic valve
Streak ovaries, amenorrhea, infertility
```
28
How does congenital lymphedema present?
Non-pitting carpal and pedal edema
29
Severe obstruction of lymphatic vessels can result in ___ of the neck.
Cystic hygroma
30
What causes NONPITTING edema?
High protein content of interstitial fluid
31
Beta-hCG levels become undetectable ___ after delivery.
2-4 weeks
32
Presentation of rotator cuff impingement or tendinopathy
Pain with abduction and external rotation
Subacromial tenderness
Normal range of motion with positive impingement tests (eg, Neer, Hawkins)
33
Presentation of rotator cuff tear
Similar to above, but weakness with external rotation and age >40
34
Presentation of adhesive capsulitis (frozen shoulder)
Decreased PASSIVE AND ACTIVE ROM
| Stiffness +/- pain
35
Presentation of biceps tendinopathy/rupture
ANTERIOR shoulder pain
Pain with lifting, carrying, or overhead reaching
Weakness less common
36
Presentation of glenohumeral OA
Uncommon, usually caused by trauma
Gradual onset of anterior or deep shoulder pain
Decreased active and passive abduction and external rotation
37
What is the key pathogenic factor in the development of DM2 and associated abnormalities?
INSULIN RESISTANCE
38
Next step in work-up of hemarthrosis after minor trauma?
Coagulation studies (suspicious for a bleeding disorder)
39
Coag studies in hemophilia?
Prolonged PTT
Normal PT
Normal platelet count
Absent or decreased factor 8 (hemophilia A) or 9 (hemophilia B) activity
40
Rx hemophilia A and B
Factor replacement
| Desmopressin for mild A
41
The receiver operating characteristic curve of a quantitative diagnostic test demonstrates the trade-off between sensitivity and specificity of a test at various cutoff points. How does changing the cutoff point affect the sensitivity and specificity?
Increasing the true-positive rate (increases sensitivity) also increases the false-positive rate (decreases specificity)
42
Presentation of hereditary angioedema?
Recurrent episodes of edema (face, limbs, genitalia, bowel, larynx, etc.) WITHOUT associated pruritis or urticaria
Laryngeal edema
Colicky abdominal pain, vomiting, diarrhea
43
Cause of heredtiary angioedema?
Deficiency or dysfunction of C1 inhibitor -> excessive bradykinin
44
Dx hereditary angioedema
Low C4 level
| Low C1 inhibitor protein or function
45
Management of hereditary angioedema?
C1 inhibitor concentrate
46
Pathogenic mechanism of immune hemolytic anemia (for example)?
Antibody-mediated (type II) hypersensitivity
IgG/M react with cell-bound Ag -> complement activation and cell destruction
47
Pathogenic mechanism of tuberculin skin test and allergic contact dermatitis?
Cell-mediated (type IV) hypersensitivity
48
Pathogenic mechanism of anaphylaxis?
IgE-mediated (type I) hypersensitivity -> mast cell and basophil degranulation
49
Pathogenic mechanism of serum sickness?
Immune complex-mediated (type III) hypersensitivity
Ab complexes activate complement wherever IC deposit
50
What is unique about a STEMI in the inferior leads (and what are these leads)?
II, III aVF, RCA occlusion
50% chance of involving the R ventricle
51
Management of RV MI?
Leads to impaired RV filling and creates high sensitivity to intravascular volume depletion
AVOID nitrates (venous dilation -> decreased preload -> profound hypotension), diuretics (volume depletion), opiates (venous dilation)
GIVE BOLUS with IV saline to increase preload
Otherwise - standard STEMI management
-Inotropes (dopamine, dobutamine) if persistent hypotension
52
Which antibiotic can exacerbate MG and why?
FQs
| Block neuromuscular transmission
53
How does the body compensate for chronic hypercapnia?
Increasing renal bicarbonate retention; creating a compensatory metabolic alkalosis
54
Main cause of hypercapnia in COPD?
Increased dead space ventilation
55
Cause of positive Trendelenburg sign?
Weakness or paralysis of the gluteus medius and minimus muscles, which are innervated by the superior gluteal nerve
56
Features of primary sclerosing cholangitis?
Fatigue and pruritis
Majority asymptomatic at diagnosis
90% have underlying IBD (mainly UC)
57
Complications of PSC?
```
Intrahepatic or extrahepatic biliary stricture
Cholangitis and cholelithiasis
Cholangiocarcinoma
Cholestasis
Colon cancer
```
58
Distinguish PBC from PSC?
PBC - middle-age women, no association with UC, +serum antimitochondrial Ab
59
Cause of TRALI?
Donor anti-leukocyte Ab
60
What is a primary hypotension reaction to blood transfusion?
Transient hypotension often in patients taking ACEIs that occurs within minutes of transfusion and is caused by bradykinin in blood products
61
What are the HIV-associated neurocognitive disorders and how do they present?
Impaired memory and attention/concentration, personality and behavior changes, motor symptoms (eg, ataxia, slowed movement)
Asymptomatic neurocognitive impairment
Mild neurocognitive disorder
HIV-associated dementia
62
Distinguish PML from HIV dementia.
PML - AMS, motor deficits, ataxia, vision abnormalities, FOCAL ASYMMETRIC lesions on MRI
63
CHA2DS2-VASc Score?
```
CHF
HTN
Age 75+ (+2)
DM
Stroke/TIA/thromboembolism (+2)
Vascular disease
Age 65-74 (+1)
Sex category (F)
```
64
Anticoagulation in NONVALVULAR AF based on CHA2DS2-VAsc
0 -> none
1 -> none or aspirin or oral anticoagulants
2+ -> oral anticoagulants
65
Secondary amyloidosis is a complication of a chronic inflammatory condition (eg, chronic infection, IBD, RA) resulting in extracellular tissue deposition of fibrils into tissues and organs. Patients can develop multi-organ dysfunction (eg, kidneys, liver, GI tract). Treatment?
Treat the underlying inflammatory disease
Colchicine for prevention and treatmen
66
Define SGA?
<10th percentile for gestational age at birth
67
Complications of SGA infants?
```
Hypoxia
Polycythemia
Hypoglycemia
Hypothermia
Hypocalcemia
```
68
How is PEA of asystole managed?
CPR and vasopressor therapy (eg, epinephrine or vasopressin)
+assess for reversible causes
NO role for defibrillation or synchronized cardioversion
69
Reversible causes of asystole/pulseless electrical activity?
```
Hypovolemia
Hypoxemia
Hydrogen ions (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade (cardiac)
Toxins (narcotics, benzos)
Thrombosis (pulmonary or coronary)
Trauma
```
70
Indications for imaging in low back pain (X-ray)?
Osteoporosis/compression fracture
Suspected malignancy
Ankylosing spondylitis (eg, insidious onset, nocturnal pain, better with movement)
71
Indications for imaging in low back pain (MRI)?
Sensory/motor deficits
Cauda equina syndrome
Suspected epidural abscess/infection (eg, fever IVDU, concurrent infection, hemodialysis)
72
Red flag features prompting consideration for imaging in low back pain?
```
Sudden onset of pain associated with midline spine tenderness
Hx cancer or recent infection
Constitutional symptoms
Trauma
Significant/progressive neuro defects
```
73
What can increase sensitivity of XR in patients with low back pain?
ESR/CRP
74
Fever and sore throat in any patient taking antithyroid drugs suggests ___. What should be done?
Agranulocytosis
STOP the drugs and check the WBC count. If agranulocytosis has occurred, give broad-spectrum ABX +/- granulocyte colony stimulating factors
75
Long-term medical therapy in patients with an NSTEMI?
1. Dual antiplatelet therapy (aspirin and P2y12 receptor blocker aka clopidogrel etc)
2. Beta blockers
3. ACEIs or ARBs
4. Statins
5. Aldosterone agonists if LVEF of 40 or less with heart failrue symptoms or DM
76
Who else gets dual antiplatelet therapy?
Drug-eluting stent (minimum 12 months)
77
Outcome of radioiodine therapy for Graves disease?
Resolution of hyperthyroidism in 6-18 weeks
Gradually leads to permanent hypothyroidism in most patients
Can acutely worsen Graves ophthalmopathy
78
Features of digitalis toxicity?
Increased atopy + increased vagal tone (and thus decreased conduction through the AV node) -> atrial tachycardia + AV block
79
Presentation of patients with MASSIVE PE?
Low arterial perfusion (hypotension, syncope), acute dyspnea, pleuritic chest pain, tachycardia
Thrombus increases pulmonary vascular resistance and RV pressure -> RV hypokinesis and dilation and hypotension
80
Language delay without an attempt to compensate through non-verbal means?
ASD
81
Absence of joint attention (ie, spontaneous attempt to share interests with others by eye gazing and pointing at objects)
ASD
82
What is the primary predisposing factor for vulvulus in children?
Malrotation of the midgut during early fetal development
83
The evaluation of clinically stable neonates with bilious emesis begins with what?
1. Cessation of enteral feeds, NG tube decompression, IV fluids
2. XR to r/o pneumoperitoneum
84
If there is no evidence of free air and the bowel gas pattern is not suggestive of duodenal atresia (double bubble) or distal obstruction (dilated loops of bowel), then ___ should be performed.
Upper GI series
85
Dx malrotation vs. volvulus based on upper GI series (aka barium swallow)
Malrotation: Ligament of Treitz on the R side of the abdomen
Volvulus: corkscrew pattern
86
What are the 3 major types of fetal heart rate decelerations seen on tracing?
1. Early
2. Late
3. Variable
87
Describe the relationship of early decelerations to contraction.
Symmetric to contraction
Nadir of deceleration corresponds to peak of contraction
Gradual (30+ seconds from onset to nadir)
88
Etiology of early decelerations?
Fetal head compression
89
Describe the relationship of late decelerations to contraction.
Delayed compared to contraction
Nadir of deceleration occurs after peak of contraction
Gradual (30+ seconds from onset to nadir)
90
Etiology of late decelerations?
Uteroplacental insufficiency
91
Describe the relationship of variable decelerations to contractions.
Can be but not necessarily associated with contractions
Abrupt (<30 seconds from onset to nadir)
Decrease over 15+ seconds/minute, duration 15+ seconds, but <2 minutes
92
Etiology of variable decelerations?
Cord compression
Oligohydramnios
Cord prolapse
93
Normal baseline FHR?
110-160
94
Define moderate variability?
Average amplitude of 6-25/min
95
Why are variable decelerations common after ROM/decreases in amniotic fluid volume?
Umbilical cord compression
96
When do variable decelerations due to umbilical cord compression require intervention?
Intermittent (decelerations with <50% of contractions) are well-tolerated, no intervention
50+% of contractions can result in lack of fetal placental blood flow -> maternal repositioning, then amnioinfusion
97
Category I tracing?
```
ALL:
-Baseline 110-160
-Moderate variability (6-25/min)
-No late/variable decelerations
+/- early decelerations
+/- accelerations
```
98
Category III tracing?
1+ of the following:
-Absent variability + recurrent late decelerations
-Absent variability + recurrent variable decelerations
-Absent variability + bradycardia
Sinusoidal pattern
99
What is the purpose of fetal scalp stimulation?
Evaluate fetal acidosis in patients who have no accelerations on FHR monitoring
CONTRAINDICATED in patients with decelerations
100
Which opioids do not show up on standard UDS?
Standard UDS measure morphine (breakdown product of all natural non-synthetics)
Not on UDS: semi-synthetic (hydrocodone, hydromorphone, oxycodone, etc.) and synthetic: (eg, fentanyl, meperidine, methadone, tramadol)
101
What testing can be used to very false-positive and possible false-negative results obtained on initial UDS.
Gas chromatography/mass spectometry
102
Presentation - severe microcephaly, thin cerebral cortices, multiple intracranial calcifications, neuro and ocular abnormalities, ventriculomegaly
Congenital Zika syndrome
103
Presentation - generalized erythema, superficial flaccid blisters, epidermal shedding with light pressure in infants and young children
Staphylococcal scalded skin syndrome
104
Rx Staphylococcal scalded skin syndrome?
```
Antistaphylococcal antibiotic (eg, nafcillin, vancomycin)
Wound care
```
105
Presentation - well-demarcated, warm, tender area of erythema, +/- constitutional symptoms
Erysipelas (bacterial infection of the dermis)
106
Fine pink sandpaper-like rash following an episode of pharyngitis in children, prominent in flexural areas, often desquamates
Scarlet fever (GAS)
107
"Sail sign" on X-ray?
Thymus
108
Presentation - abdominal pain, jaundice, palpable mass in chidlren <10 y/o
Biliary cyst (dilation of the biliary tree)
109
Managementof biliary cyst?
Surgical resection to relieve the obstruction and reduce the risk of malignancy
110
Maternal management of HCV in pregnancy?
Avoid ribavirin (teratogen)
No indication for barrier protection in serodiscordant monogamous couples
Hepatitis A and B vaccination
111
Prevention of vertical transmission of HCV in pregnancy?
Strongly associated with maternal viral load
C/S not protective
Avoid scalp electrodes
Encourage breastfeeding unless maternal blood is present
112
___ occurs in 25% of patients with severe factor 8 deficiency. When should it be considered?
Inhibitor development (recognition of the infused factor as foreign, forming antibodies); bleeding refractory to replacement therapy or with increased bleeding frequency
113
Most common AE of inhaled corticosteroid therapy?
Oropharyngeal thrush
114
Most common cause of a non-reactive non-stress test (eg, no accelerations)?
Quiet fetal sleep cycle (up to 40 minutes)
115
Define a reactive stress test.
Baseline of 110-160/min
Moderate variability (6-25/min)
2+ accelerations in 20 minutes each peaking 15+ minutes about baseline and lasting 15+ seconds
116
Acute unilateral motor weakness WITHOUT sensory deficits or higher cortical dysfunction is suggestive of what type of stroke? Common cause?
Lacunar stroke affecting the posterior limb of the internal capsule; chronic hypertension
117
Rapidly growing volcano-like nodule with a central keratotic plug
Keratoacanthoma
118
Presentation - early adolescence to young adulthood - herald patch (erythematous annular lesion on the trunk) that may increase in size and develop scaling around the edge; within a week, clusters of smaller, erythematous oval lesions appear on the trunk, typically distributed obliquely along the lines of tension +/- pruritis +/- viral produrome
Pityriasis rosea
119
Management of pityriasis rosea?
Supportive (self-limited)
120
Clinical findings of milk-alkali syndrome?
Symptomatic hypercalcemia (N/V, constipation, polyuria, polydipsia, neuropsych symptoms)
Metabolic alkalosis
AKI
121
Rx milk-alkali syndrome?
D/C of causative agent
| Isotonic saline followed by furosemide
122
Dx Wilson disease?
Decreased ceruloplasmin
Increased urinary copper excretion
Kayser-Flesicher rings
Increased copper content on liver biopsy
123
In a patient with suspected infective endocarditis, what is the most appropriate next step?
Serial blood cultures from separate venipuncture sites over a specified period prior to initiating antibiotic therapy
Then TTE or TEE
124
Presentation of organophosphate poisoning?
Inhibition of AChEsterase -> cholinergic excess -> bradycardia, miosis, rhonchi, muscle fasciculations, salivatino, lacrimation, urination, defecation
125
Reverse organophosphate poisoning?
Atropine
126
Rx hepatic encephalopathy?
Identify the underlying precipitant and lower serum ammonia with non-absorbable disaccharides (lactulose, lactilol, etc.)
127
New-onset SOB, fevers, dry cough, bilateral mid- and lower-lung reticular opacities, possible maculopapular rash, recent UTI
Acute nitrofurantoin-induced pulmonary injury (acute hypersensitivity pneumonitis in the short-term, 3-9 days after medication initiation)
Note - long-term use can lead ot ILD
128
Most common cause of healthcare-associated infective endocarditis?
Staphoylococcal
129
Most common cause of community-acquired infective endocarditis?
Streptococcal
130
Infective endocarditis after a dental procedure
Viridans group streptococci
131
Cause of acute anterolateral STEMI?
Left anterior descending artery occlusion
132
Causes of thyrotoxicosis with normal or increased radioactive iodine uptake?
Graves disease
Toxic multinodular goiter
Toxic nodule
133
Causes of thyrotoxicosis with decreased RAIU?
```
Painless thyroiditis
Subacute thyroiditis
Amiodarone-induced thyroiditis
Excessive dose of levothyroxine
Struma ovarii
Iodine-induced
Extensive thyroid cancer mets
```
134
Presentation - unilateral head and neck pain, transient vision loss, ipsilateral partial Horner syndrome (ptosis + miosis without anhidrosis), signs of cerebral ischemia
Carotid artery dissection (suspect in the setting of trauma, can be spontaneous, HTN, smoking, connective tissue disease, OCs contribute)
135
Dx carotid artery dissection?
Neurovascular imaging (CTA, etc.)
136
Rx carotid artery dissection?
Thrombolysis (if within 4.5 hours of symptom onset)
| Antiplatelet therapy +/- anticoagulation
137
3 most common causes of aortic stenosis in the general population?
Senile calcific aortic stenosis
Bicuspid aortic valve
Rheumatic heart disease
138
Most common cause of aortic stenosis in patients under 70 y/o?
Bicuspid aortic valve
139
Distinguish HCM murmur from AS.
HCM is best appreciated in the LLSB and does not typically radiate tot he carotids
140
Rx acute bacterial prostatitis?
6 weeks TMP-SMX or FQ
