14 Flashcards
(128 cards)
1
Q
How does SCFE occur?
A
Excessive shearing at the proximal femoral physis (growth plate)
2
Q
Rx drug resistant CMV
A
Foscarnet
3
Q
Cause of vaginal SqCC?
A
Persistent infection with HPV 16/18; chronic tobacco use increases risk
4
Q
Rx limited plaque psoriasis?
A
Topical high-potency glucocorticoids or vitamin D derivatives (eg, calcipotriene), topical retinoids, calcineurin inhibitors
If moderate to severe - phototherapy or systemic treatment (MTX, biologics, etc.)
5
Q
Is S3 or S4 an expected finding in patients with severe MR - why?
A
S3 gallop
Backflow of blood from LV during systole -> total amount of blood entering LV during diastole increases -> eccentric hypertrophy to compensate for increased volume load
Sudden cessation of blood flow into a dilated LV during the passive filling phase of diastole
6
Q
S3 is commonly heard in ___.
A
Heart failure
7
Q
Opening snap?
A
Mitral stenosis
8
Q
S4 is commonly heard in ___ - why?
A
Concentric LVH due to systemic HTN or severe AS -> blood striking stiff L ventricle during atrial systole, just before mitral valve closure (S1)
9
Q
Uvular pulsation may be appreciated with the high-amplitude systolic pulsation and rapid diastolic collapse that occurs with severe ___.
A
AR
10
Q
Palpable fetal parts on abdominal exam, loss of fetal station
A
Uterine rupture
11
Q
Clinical features of alpha-thalassemia minima (1 gene loss)
A
Asymptomatic, silent carrier
12
Q
Clinical features of alpha-thalassemia minor (2 gene loss)
A
Mild microcytic anemia
13
Q
Clinical features of Hemoglobin H disease (3 gene loss)
A
Chronic hemolytic anemia
14
Q
Clinical features of hydrops fetalis, Hgb Barts (4 gene loss)
A
High-output cardiac failure, anasarca, death in utero
15
Q
Of the 3 main causes of vaginitis, which one has normal pH (vs increased >4.5)?
A
Candida vaginitis
16
Q
Vaginitis with clue cells and + whiff test?
A
BV
17
Q
Vaginitis with motile trichomonads?
A
Trichomoniasis
18
Q
Vaginitis with pseudohyphae?
A
Candida
19
Q
Rx BV?
A
Metronidazole or clindamycin
20
Q
Rx trichomoniasis?
A
Metronidazole + treat sexual partner
21
Q
Rx candida vaginitis?
A
Fluconazole
22
Q
Anaerobe that may cause PID associated with IUDs?
A
Actinomyces (filamentous, GP bacilli, branching)
23
Q
Subluxation of the radial head is common in preschool children. The classic mechanism is swinging or pulling a child by the arm. Full recovery after ___ confirms the diagnosis.
A
Closed reduction by forearm hyperpronation or supination of forearm + flexion of the elbow
24
Q
Physical findings of radial head subluxation
A
Arm held extended and protonated
NO swelling, deformity, or focal tenderness
25
Management of sharp foreign body?
Endoscopic removal due to the risk of esophageal perforation
26
Cause of methemoglobinemia?
Uncommon complication after excessive exposure to an oxidizing agent (eg, dapsone, nitrites, local/topical anesthetics)
27
Presentation of methemoglobinemia?
Cyanosis, pulse ox ~85% always, dark chocolate colored blood, no improvement with supplemental O2
28
Lab findings in methemoglobinemia?
```
Saturation gap (>5% difference between O2 saturation on pulse oximetry and ABG)
Normal PaO2 (falsely elevated)
```
29
Rx methemobloinemia
Methylene blue or high-dose ascorbic acid
30
Presentation of premature adrenarche?
Early activation of adrenal androgens (more common in obesity)
31
Presentation of premature adrenarche?
Precocious development of pubic and axillary hair, acne, and body odor in a child with a normal bone age
32
Compare the joints involved in OA vs. RA.
OA: knees and hips, DIP, first CMC
RA: MCP, PIP, wrists
33
Compare the XR findings of OA vs. RA.
OA: narrowed joint space, osteophytes
RA: periarticular erosions
34
Case control vs. retrospective cohort studies
Case control: outcome first, then look for associated risk factors
Retrospective cohort: first ascertain risk factor exposure and then determine the outcome
35
What is supravalvular aortic stenosis?
Second most common type of AS
| Congenital left ventricular outflow tract obstruction due to discrete or diffuse narrowing of the ascending aorta
36
Presentation of supravalvular AS?
Systolic murmur best heard at the FIRST RIGHT INTERCOSTAL SPACE
Unequal carotids
Differential blood pressure in the upper extremities
Palpable thrill in the suprasternal notch
37
Sequelae of supravalvular AS?
LVH, coronary artery stenosis (associated anomaly) -> increase myocardial O2 demand during exercise
38
Stretching of the papillary muscles can lead to ___.
MR (holosystolic or mid to late systolic murmur at apex)
39
Systolic anterior motion of the MV is seen in patients with ___.
HOCM
40
Tendency of the study population to affect the outcome since they are aware they are being studied
Hawthorne effect
41
Physiologic changes to thyroid hormones seen in pregnancy?
Thyroid hormone production increases:
Total T4 - increased
Free T4 - unchanged or mildly increased
TSH - decreased
E2 increases thyroxine-binding globulin, leading to an increased total (but not free) thyroid hormone levels
hCG stimulates TSH receptors increasing production
42
Features of acute HIV infection?
Mono-like syndrome (fever, LAD, sore throat, arthralgias, etc.)
Painful mucocutaneous ulcerations are characteristic (if present)
Generalized macular rash
GI symptoms
43
In HIV, what 2 viruses can cause severe acute retinal necrosis associated with pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis?
HSV and VZV
44
What other virus can cause retinitis in HIV and how can it be distinguished?
CMV -> PAINLESS, not usually associated with keratitis or conjunctivitis, and characterized by funduscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels
45
Exertional heat stroke occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity due to ___.
Thermoregulation failure
46
What causes heat exhaustion?
Inadequate fluid and salt replacement
47
Rx primary biliary cholangitis?
Ursodeoxycholic acid (delays histologic progression, may improve symptoms/survival)
Advanced disease - liver transplantation
48
Rx autoimmune hepatitis?
Glucocorticoids
49
Autoimmune hepatitis antibodies?
+ANA
50
MOA - type 2 HI?
Heparin induces a conformational change in a platelet surface protein which exposes a neoantigen; antibodies are formed and bind to the surface of platelets -> platelet activation, thrombocytopenia, and a prothrombic state
51
Heparin MOA?
Binds antithrombin and inactivates 10a, prolongs aPTT
52
Type 1 vs. Type 2 HIT?
Type 1 - non-immune-mediated platelet aggregation, mild thrombocytopenia within 2 days, no intervention needed
Type 2 - immune-mediated, severe, D/C heparin
53
Risk = ?
Probability of getting a disease over a certain period of time -> # diseased subjects/# of subjects at risk
54
Renal injury usually causes hypocalcemia - why?
Reduced phosphorus clearance leading to calcium phosphate salt formation
55
In an older patient with an intrinsic AKI and hypercalcemia, what should be suspected?
ATN due to multiple myeloma
56
What is the most reliable and predictive sign of opioid intoxication?
Decreased RR
57
When is hormone replacement therapy indicated?
Treatment of severe vasomotor symptoms in women age <60 who have undergone menopause within the past 10 years
58
Long-term analgesic use with 1+ analgesics can cause CKD due to what?
Tubulointerstitial nephritis and hematuria due to papillary necrosis
59
Lab findings of analgesic nephropathy?
Elevated Cr
UA with hematuria, sterile pyuria, possible WBC casts, mild proteinuria
CT with small kidneys, bilateral renal papillary calcifications
60
Rx uric acid stones?
Alkalization of the urine to pH 6.0-6.5 with oral potassium citrate
61
3 possibilities when a patient has symptoms consistent with typical renal colic but no stones on conventional radiographs?
1. Radiolucent stones (uric acid, xanthine)
2. Small calcium stones (<1-3 mm in diameter)
3. Nonstone ureteral obstruction (blood clot, tumor, etc.)
62
Uric acid stones are most commonly seen in patients with what 2 lab findings?
Unusually low urine pH (defect in renal ammonia excretion)
| Hyperuricosuria
63
Which diuretics can cause stones? Which can treat stones?
Furosemide -> increases risk of calcium stone formation (hypercalciuria)
HCTZ -> management of hypercalciuric stones (decreases urinary calcium excretion)
Thiazides -> decrease uric acid excretion, but also lower urine pH and increase the risk of uric acid stones
64
LP or empiric ABX first in suspected meningitis?
LP prior to ABX UNLESS critically ill or some other barrier to getting the LP immeidately
65
Why is head imaging not required before LP in infants?
Open anterior fontanelle eliminates risk for herniation
66
What causes renal failure in HUS?
Thrombotic angiopathy (NOT glomerulonephritis)
67
Most common cause of pediatric stroke?
Sickle cell disease
68
Acute pancreatitis complicated by hypotension is thought to arise from what process?
Intravascular volume loss secondary to local and systemic vascular endothelial injury -> vasodilation, increased vascular permeability, and plasma leak into the retroperitoneum
69
Most common acid-base disturbance caused by a PE? Explain
Respiratory alkalosis - hyperventilation as a patient tries to overcome hypoxia and V/Q mismatching
70
Presentation - decreased sensation over 4th and 5th fingers, weak grip due to involvement of interosseous muscles?
Ulnar nerve entrapment
71
Most common site of ulnar nerve entrapment?
Elbow (where the nerve lies at the medial epicondylar groove)
May occur due to leaning on the elbows while working at a desk or table
72
What is Budd-Chiari syndrome?
Hepatic venous outflow obstruction
73
3 general causes of Budd-Chiari syndrome?
1. Myeloproliferative disorder (eg, polycythemia vera)
2. Malignancy (eg, HCC)
3. OC use/pregnancy
74
Acute presentation of Budd-Chiari syndrome?
Jaundice, hepatic encephalopathy, variceal bleeding
| Prolonged INR/PTT; elevated transaminases
75
Subacute/chronic presentation of Budd-Chiari syndrome?
Vague, progressive abdominal pain
HSM, ascites
Mild/moderate elevation in bilirubin/transaminases
76
Dx Budd-Chiari
Abdominal Doppler U/S -> decreased hepatic vein flow
| Investigation for underlying disorders (JAK2 testing for PV)
77
What are the 2 phases of the first stage of labor and what defines normal labor progression?
```
Latent phase (0-6 cm)
Active phase (6-10 cm)
Active phase, 1+ cm/2 hours
```
78
Define active phase labor arrest.
No cervical change for 4+ hours with adequate contractions or 6+ hours with inadequate contractions
79
When is an intrauterine pressure catheter placed?
When labor has not completely arrested but cervical change slows to <1 cm/2 hr (labor protraction)
80
Define inadequate contractions.
<200 MVU
81
When is an operative vaginal delivery performed?
Expedite delivery for category III tracings or maternal exhasution during stage 2 (10 cm dilation)
82
Define chronic or pre-existing HTN in gestation.
Systolic 140+ AND/OR diastolic 90+ BEFORE 20 weeks during 2 separate measurements taken at least 4 hours apart
83
Risks related to HTN in pregnancy?
```
Superimposed preeclampsia
Postpartum hemorrhage
GDM
Abruptio placentae
C/S
Fetal growth restriction
Perinatal mortality
Preterm labor
Oligohydramnios
```
May be linked to increased SVR and arterial stiffness -> placental dysfunction
84
Although patients with biliary pancreatitis may sometimes have a normal U/S (especially if the stone is pased), they typically have an elevated ___ level.
ALT (>150)
85
In patients with a history of splenectomy or functional asplenia, ___ would be an expected finding on peripheral smear.
Howell-Jolly bodies (small purple dots within the RBCs)
86
What are Heinz bodies?
Small inclusions within an RBC -> aggregates of denatured Hgb, common in patients with hemolysis due to G6PD deficiency and thalassemia
87
What are bite cells?
RBCs with Heinz bodies removed by phagocytes
88
Risk factors for brain abscess?
```
Mastoiditis
Otitis media
Sinusitis
Dental infection
Cyanotic heart disease (hematogenous spread of bacteria)
```
89
Rx tinea corporis?
Topical antifungal (clotrimazole, terbinafine, etc.)
90
What type of anemia is seen in sickle cell disease?
Normocytic, normochromic, hemolytic anemia with compensatory reticulocytosis
91
Why may patients with SCD develop folate deficiency?
Chronic hemolysis without adequate supplementation
92
What is Diamond-Blackfan anemia?
Congenital pure red cell aplasia characterized by macrocytic anemia and several congenital abnormalities (cleft palate, webbed neck, triphalangeal thumbs)
93
Cause of Diamond-Blackfan anemia?
Congenital erythroid aplasia
94
Lab findings of Diamond-Blackfan anemia?
Macrocytic anemia
Reticulocytopenia
Normal platelets and WBCs
95
Rx Diamond-Blackfan anemia?
Steroids
| RBC transfusions
96
Compare Fanconi and Diamond-Blackfan anemia.
Fanconi - pancytopenic BM failure
DBA - pure red cell aplasia, normal platelet and WBC counts
97
Unfavorable metabolic side effects of thiazide diuretics?
Hyperglycemia
Increased LDL and triglycerides
Hyperuricemia
98
Electrolyte abnormalities due to thiazides?
Hyponatremia
Hypokalemia
Hypomagnesemia
Hypercalcemia
99
Patients with androgen insensitivity syndrome are genotypically male but appear phenotypically female. Management?
Elective gonadectomy (increased risk of testicular cancer due to bilateral cryptorchid testes)
100
Management of Turner syndrome?
```
Estrogen replacement (development of secondary sexual characteristics, prevention of osteoporosis)
GH therapy (management of short stature)
```
101
First-line ABX in pregnant patients with asymptomatic bacteriuria?
Cephalexin
Amox-clav
Nitrofurantoin
Fosfomycin
102
Define mild UC.
<4 bowel movements/day
Intermittent hematochezia
Normal inflammatory markers
No anemia
Dx with colonoscopy - inflammation and superficial ulcerations extending from the anorectum continuously to more proximal regions of the colon
103
First-line treatment of mild UC?
5-aminosalicylic acid medications (mesalamine, sulfasalazine) -> suppositories or enemas preferred if limited to rectosigmoid
104
First-line therapy in moderate to severe UC?
Anti-tumor necrosis factor-alpha inhibitors (infliximab, adalimumab, golimumab)
105
Complications of temporal arteritis?
Permanent vision loss
| Aortic aneurysm
106
What causes increased alveolar-arterial oxygen gradient?
R->L intrapulmonary shunting
VQ mismatch
Impaired gas exchange
107
3 major complications of cocaine use?
Acute MI
Aortic dissection
Intracranial hemorrhage
108
Changes to management of chest pain 2/2 cocaine use?
Benzos for blood pressure and anxiety
NO BETA BLOCKERS
No fibrinolytics
109
What is indicated in all patients with new-onset ascites?
Paracentesis to determine the etiology
110
Most common malignancy diagnosed in patients exposed to asbestos?
Bronchgenic carcinoma
111
Clinical features of aortic dissection?
History of HTN (#1 risk factor), Marfan syndrome, cocaine use
Severe, sharp, tearing chest or back pain
+/- >20 mm Hg variation in SBP between arms
112
Distinguish acute aortic regurgitation/heart failure due to aortic dissection vs. cardiac tamponade due to aortic dissection.
Tamponade will NOT have pulmonary edema
113
Serum-to-ascites albumin gradient of 1.1+ indicates vs. <1.1?
1.1+ - portal hypertensive etiologies (cardiac ascites, cirrhosis, etc.)
<1.1 - non-portal hypertension
114
Neutrophil count of ascites indicating peritonitis?
250/mm^3 or higher
115
Total protein count in peritonitis (high vs. low)?
2.5+ g/dL (high-protein) - CHF, constrictive pericarditis, etc.
<2.5 g/dL (low-protein) - cirrhosis, nephrotic syndrome
116
Screening mammography?
Biennial for women 50-74
117
AAA screening recs?
Men age 65-75 who ever smoked (abdominal U/S 1x)
118
What is mixed connective tissue disease?
Clinical features of SLE, SS, and polymyositis (sequential)
Important manfiestations include Raynaud, swelling of the fingers and hands, inflammatory arthritis, and myositis
119
Autoantibodies for ___ have high sensitivity and specificity for MCTD.
U1 ribonucleoprotein
120
Most common cause of death in MTCD?
Pulmonary HTN
121
Most common type of kidney stone?
calcium oxalate stones
122
3 common types of kidney stones?
Calcium (oxalate, phosphate)
Magnesium ammonium phosphate (struvite)
Uric acid
123
Appearance of the 3 common types of kidney stones on radiography?
Calcium - small, radiopaque
Struvite - large, radiopaque
Uric acid - small, radiolucent
124
Crystal morphology - rectangular/prism kidney stones
Struvite
125
Crystal morphology - yellow/brown, rhomboidal kidney stones
Uric acid
126
Crystal morphology - octahedron or envelope kidney stones
Calcium oxalate
127
Crystal morphology - wedge or rosette kidney stones
Calcium phosphate
128
Most consistently replicated neuroimaging finding in schizophrenia?
Enlargement of the lateral cerebral ventricles
