3 Flashcards
(129 cards)
1
Q
Cardiac involvement of amyloidosis typically presents with what type of cardiomyopathy?
A
Restrictive; may progress to dilated
2
Q
Features of restrictive cardiomyopathy on echocardiogram?
A
Thickened ventricular walls and diastolic dysfunction
3
Q
Dx amyloidosis?
A
Tissue biopsy
4
Q
Alcohol-related heart disease typically presents with what type of cardiomyopathy?
A
Dilated
5
Q
Restrictive cardiomyopathy typically presents with what type of heart failure?
A
Right-sided
6
Q
Constrictive pericarditis typically presents with what type of heart failure?
A
Right-sided
7
Q
In addition to amyloidosis, list two other infiltrative diseases that initially present with restrictive, then dilated, cardiomyopathy.
A
Hemochromatosis
Sarcoidosis
8
Q
Other possible presenting symptoms/signs of amyloidosis?
A
Asymptomatic proteinuria or nephrotic syndrome Hepatomegaly Macroglossia Peripheral/autonomic neuropathy Waxy skin thickening, easy bruising
9
Q
Symptoms of catatonia?
A
Immobility (or excessive purposeless activity)
Mutism, stupor (decreased alertness and response to stimuli)
Negativism (resistance to instructions and movement)
Posturing (assuming positions against gravity)
Waxy flexibility
Echophenomena
10
Q
Catatonia most often presents in the context of what two psychiatric illnesses?
A
Bipolar disorder
MDD
(It may occur in schizophrenia, ASD, general medical illnesses, etc.)
11
Q
Symptoms of akinetic mutism?
A
Similar to catatonia, but NO echophenomena
12
Q
Cause of locked-in syndrome?
A
Pontine stroke
13
Q
Symptoms of locked-in syndrome?
A
Paralysis, mutism, preservation of cognitive abilities
14
Q
The numerous causes of anemia may be divided into what three categories?
A
- Decreased RBC production
- Increased RBC destruction
- Blood loss
15
Q
Pathophysiology of anemia in lymphoproliferative disorders?
A
Bone marrow infiltration with cancerous cells
16
Q
Which contraceptive has weight gain as a common side effect?
A
Medroxyprogesterone injections
17
Q
Features of HELLP syndrome?
A
Preeclampsia N/V RUQ or epigastric pain microangiopathic Hemolytic anemia Elevated liver enzymes Low platelet count
18
Q
Rx HELLP syndrome?
A
Delivery
Magnesium for seizure prophylaxis
Antihypertensives
19
Q
Acute fatty liver of pregnancy overlaps with HELLP syndrome, but patients with AFLP are more likely to have additional extrahepatic complications such as…?
A
Leukocytosis
Hypoglycemia
Acute kidney injury
20
Q
Sudden-onset dyspnea, hypoxia, and crackles in the setting of severe preeclampsia is most likely due to what?
A
Acute pulmonary edema
21
Q
Pathophysiologic mechanism of acute pulmonary edema in severe pre-eclampsia?
A
Generalized arterial vasospasm (systemic HTN) -> increased afterload -> increased pulmonary capillary pressure -> pulmonary edema
Decreased albumin
Decreased renal function
Increased vascular permeability due to endothelial damage
22
Q
Symptoms of magnesium sulfate toxicity?
A
Neuromuscular depression
Decreased respiratory effort/apnea, muscle paralysis, somnolence, visual disturbances, decreased/absent DTRs
23
Q
Strenuous activity during hot and humid weather, dehydration, poor acclimatization, lack of physical fitness, and obesity are risk factors for exertional heat stroke. Several medications also increase risk - list them (4).
A
Anticholinergics
Antihistamines
Phenithiazines
Tricyclics
24
Q
Clinical manifestations of exertional heat stroke?
A
Core temperature >40 (104 F) immediately after collapse AND CNS dysfunction (AMS, confusion, irritability, seizure), additional organ/tissue damage (renal/hepatic failure, DIC, ARDS)
25
Management of exertional heat stroke?
Rapid cooling - ice water immersion preferred; can consider high-flow cool water dousing, ice/wet towel rotation, evaporative cooling
Fluid resuscitation
Electrolyte correction
Management of end-organ complications
No role for antipyretic therapy
26
Features of non-exertional (or classic) heat stroke?
Similar clinical features and potential complications
Occurs in the absence of strenuous activity, typically effects elderly patients with many comorbidities that limit their ability to escape/cope with excessive heat
27
Management for non-exertional heat stroke?
Evaporative cooling (rather than ice-water immersion)
28
AE of aminoglycosides (eg, gentamicin)?
Ototoxicity to both the cochlea (sensorineural hearing loss) and vestibular system (imbalance)
29
Features of AG ototoxicity?
1. Bilateral, but not necessarily symmetric, hearing loss (whisper test)
2. Imbalance and oscillopsia (bilateral vestibular systems affected)
3. Positive head thrust test (inability to maintain visual fixation during forced, rapid head movement, evaluates vestibulo-ocular reflex, which is affected by peripheral but not central vestibulopathies)
30
Distinguish BPPV from AG ototoxicity.
BPPV: brief (<1 minute) episodic vertigo stimulated by specific head movements, no hearing loss, confirmed by Dix-Hallpike (not head thrust)
31
Features of Meniere disease?
Discrete episodes of spinning vertigo accompanied by hearing loss and tinnitus or aural fullness
32
Features of tinea capitis?
Most common in AA children and immunocompromised
Causes a scaly erythematous patch that can progress to alopecia with inflammation, LAD, and scarring +/- black dots in affected area
33
Rx tinea capitis?
Oral griseofulvin or terbinafine
34
Characteristic lab findings of HUS?
Microangiopathic hemolytic anemia
Thrombocytopenia
AKI
35
Lab findings indicating RBC destruction?
```
Increased LDH
Low haptoglobin (binds free Hgb normally; if free Hgb increases, haptoglobin decreases)
Increased unconjugated bilirubin
Hemoglobinemia
Hemoglobinuria
```
36
Decreased ferritin?
Iron deficiency anemia
37
Compare clinical presentation of transient synovitis and septic arthritis in children.
TS: well-appearing, afebrile or low-grade fever, able to bear weight
SA: ill-appearing, febrile, non-weight bearing
38
Compare diagnostic work-up of TS vs. SA in children.
TS: normal or mildly elevated WBC, ESR/CRP, unilateral or bilateral U/S effusion, Dx of exclusion (key)
SA: moderately elevated WBC, ESR, CRP, +/- positive blood culture, unilateral U/S effusion, synovial fluid WBC >50,000
39
In patients with overlapping clinical features of TS and SA (for example, low grade fever, mildly elevated ESR, severe pain, inability to ambulate, leukocytosis), what should be done?
Bilateral hip U/S - if unilateral, arthrocentesis performed
40
Characteristic finding aplastic anemia?
Decreased reticulocyte count in the presence of anemia
41
Expected acid-base disturbance in acute asthma exacerbation?
Respiratory alkalosis with a low PaCO2 due to hyperventilation
42
What is an alarming finding suggesting impending respiratory failure in patients with an acute asthma exacerbation?
Normal or elevated PaCO2
43
Most common pediatric bony malignancy?
Osteosarcoma
44
Second most common pediatric bony malignancy?
Ewing sarcoma
45
Clinical features of Ewing sarcoma?
Chronic, localized pain and swelling
Long-bone diaphyses and axial skeleton (eg, pelvis)
+/- systemic findings
Early mets
46
X-ray findings of Ewing sarcoma?
Central lytic lesion
Onion skinning (lamelleted periosteal reaction)
Moth-eaten appearance
Periosteal elevation (Codman triangle -> non-specific finding)
47
2 bone tumors located in the epiphysis?
1. Giant cell tumor
| 2. Chondroblastoma
48
2 bone tumors located in the metaphysis?
1. Chondrosarcoma
| 2. Osteosarcoma
49
6 bone tumors located in the diaphysis?
Round cell lesions: Ewing tumor, malignant lymphoma, myeloma
Fibrosarcoma
Non-ossifying fibroma
Bone cyst
50
Bone tumor presenting with a painful mass in patients age >30, X-ray shows osteolytic lesion with well-defined or ragged moth-eaten margins
Fibrosarcoma
51
Bone tumor presenting in young adults with pain and swelling, X-ray shows lytic area with a "soap bubble" appearance
Giant cell tumor
52
Bone tumor presenting in adolescent boys, commonly located in the proximal femur, causes pain at night that responds to NSAIDs, small round lucency on X-ray
Osteoid osteoma
53
Presents in children and young adults, typically located at the proximal femur or humerus, pathologic fracture is the common presentation, cystic lesion with well-defined margins
Unicameral bone cysts
54
Presentation of hereditary spherocytosis in an infant?
Prolonged neonatal jaundice
Findings of hemolysis
Elevated MCHC
(Low to normal MCV, negative direct Coombs, spherocytes on peripheral smear)
55
Rx hereditary spherocytosis?
Supportive
RBC or exchange transfusion if hemolysis is severe
56
Blood group A - antigens on RBC and antibodies in serum?
A-Ag
| Anti-B
57
Blood group B - antigens on RBC and antibodies in serum?
B-Ag
| Anti-A
58
Blood group AB - antigens on RBC and antibodies in serum?
A-Ag + B-Ag
| None
59
Blood group O - antigens on RBC and antibodies in serum?
None
| Anti-B + Anti-A
60
Timing of presentation of beta thalassemia?
After 6 months (after fetal Hgb decreases)
61
Ab found in Hashimoto thyroiditis?
Anti-TPO (antithyroid peroxidase)
Anti-thyroglobulin may also be present
62
High titers of anti-TPO are associated with increased risk of ___ in both euthyroid and hypothyroid women.
Miscarriage
63
Compare thyroid size in hypothyroidism with anti-TPO vs. anti-TSH receptor Ab.
Anti-TPO: enlarged
Anti-TSH receptor: atrophy
64
Features of primary syphilis?
Painless genital ulcer (chancre)
65
Features of secondary syphilis?
Diffuse maculopapular rash beginning on the trunk and extending to the extremities (also involves palms and soles), LAD (epitrochlear -> pathognomnoic), condyloma lata (raised gray genital papules), oral lesions, hepatitis
66
Features of latent syphilis?
Asymptomatic
67
Features of tertiary syphilis?
CNS (tabes dorsalis, dementia)
CV (aortic aneurysm/insfufficnecy)
Cutaneous (gummas)
68
Dx syphilis?
Combination of non-treponemal (RPR) and treponemal-specific (T. pallidum immunoassay) tests
69
Rx primary and secondary syphilis?
One dose IM penicillin G benzathine
Confirm adequate treatment by a 4-fold decrease in titers at 6-12 months
70
Presentation - painless vaginal bleeding after 20 weeks gestation?
Placenta previa
71
3 risk factors for placenta previa?
Prior placenta previa
Prior C-section
Multiple gestation
Smoking
72
Dx placenta previa?
Transabdominal, then TVUS
73
Management of placenta previa?
No intercourse
No digital cervical exam
Inpatient admission for bleeding episodes
Most resolve by T3
If persistent previa, deliver via C-section at 36-37 weeks
74
Define pre-term labor.
Cervical dilation of 3+ cm or effacement with regular painful uterine contractions at <37 weeks
75
Both transfusion-associated circulatory overload and transfusion-associated acute lung injury may present with acute dyspnea and diffuse bilateral infiltrates on CXR. How can they be distinguished?
TRALI: absent JVD, crackles/rales on auscultation, normal EF, normal BNP
TACO: present JVD, crackles/rales +/- S3, decreased EF, high BNP
76
General causes of thrombocytopenia?
1. Decreased platelet production
2. Increased platelet destruction
3. Dilutional
4. Splenic sequestration
77
DDx - thrombocytopenia due to decreased production
1. Viral infections (EBV, hepatitis C, HIV, etc.)
2. Chemo
3. Myelodysplasia (especially if >60 years old)
4. Alcohol use
5. Congenital (eg, Fanconi syndrome)
6. Vitamin B12 or folate deficiency
78
DDx - thrombocytopenia due to increased destruction
1. SLE
2. Medications (eg, heparin)
3. ITP, DIC, TTP, HUS
4. Antiphospholipid syndrome
79
Schilling test?
Determine whether a patient had vitamin B12 deficiency due to pernicious anemia or a malabsorption syndrome
80
ITP is a diagnosis of exclusion.
Don't forget it.
81
Mainstay of therapy in patients with alcoholic cardiomyopathy (can lead to normalization of LVF over time)?
Complete cessation of alcohol consumption
82
AFib is most commonly caused by ectopic foci in what location?
Within the pulmonary veins
83
Atrial flutter commonly involves a re-entrant circuit around what structure?
Tricuspid annulus
84
AV nodal re-entry tachycardia results from a re-entrant circuit formed by what structure?
2 separate conducting pathways within the AV node
85
EKG findings of AFib?
Absent P waves (replaced by tiny chaotic fibrillatory waves)
Irregularly irregular R-R intervals
Narrow QRS
86
Characteristic EKG finding of WPW?
Slurred upsloping R waves (aka delta waves)
87
EKG findings of AV nodal re-entry tachycardia?
Sudden onset and termination
Rapid (140-250/min) regular rhythm
Narrow QRS
Absence of definite P waves
88
EKG findings of sinus tachycardia?
Rate 100-180/min
Regular R-R intervals
Normal P waves and QRS complexes
89
EKG findings of atrial flutter?
Sawtooth waves
90
What is the major cause of morbidity and mortality in patients with PAD?
CV disease
91
Patients with PAD and intermittent claudication have an estimated 20% 5-year risk of ___ and ___, and a 15-30% risk of death due to CV causes. Only 1-2% of patients progress to develop ___.
Non-fatal MI; stroke
Critical limb ischemia with risk of limb amputation
92
Initial treatment of chronic venous insufficiency?
Conservative measures (leg elevation, exercise, compression therapy)
If no response -> venous duplex U/S to confirm diagnosis by identifying venous reflux
93
Estimate CVP = ?
JVP + depth to R atrium (5 cm)
94
Normal CVP?
6-8 cm H2O (elevated >8)
95
Splenic infarction usually occurs in what settings?
Splenic artery (or sub-branch) occlusion due to hypercoagulable states, embolic disease, or hemoglobinopathy
96
Although patients with sickle cell trait are generally aymptomatic, they occasionally develop splenic infarct and intravascular hemolysis in what settings?
Flying at high altitude
| Dehydration due to alcohol consumption
97
Treatment with vitamin ___ reduces morbidity and mortality rates in children with severe measles.
A
98
How is measles transmitted?
Airborne
99
Clinical presentation of measles?
Prodrome (eg, cough , coryza, conunctivitis, fever, Koplik spots)
Maculopapular exanthem (cephalocaudal and centrifugal spread, spares palms and soles)
100
Features of hereditary hemorrhagic telangiectasia (aka Osler-Weber-Rendu syndrome)?
Diffuse telangiectasis
Recurrent epistaxis
Widespread AV malformations (tend to occur in mucus membranes, skin, GI tract; may be present in liver, brain, lung)
101
AV malformations in the lungs cause what findings?
Chronic hypoxemia
Digital clubbing
Reactive polycythemia
Can present as massive, sometimes fatal, hemoptysis
102
Findings of polycythemia vera?
Increased production of all 3 blood cell lines, splenomegaly, >60 y/o
103
Renal transplant dysfunction in the early post-operative period manifests as oliguria, HTN, and increased creatinine/BUN. It can be explained by many causes, including what?
```
Ureteral obstruction (renal U/S)
Acute rejection (biopsy -> lymphocyte infiltrate)
Cyclosporine toxicity
Vascular obstruction
ATN
And more
```
104
Rx acute rejection?
High-dose IV steroids
105
Characteristic features of child abuse in the form of deliberate scald injuries?
- Burns with sharp lines of demarcation
- Uniform depth
- Lack of splash marks
- Spared flexural creases (due to ankle, knee, and hip flexion at the time of forced immersion)
106
In DKA, measured serum K levels are often initially high - why?
Extracellular shift of K driven by increased plasma tonicity
| Loss of insulin-dependent potassium uptake across cell membranes
107
Rx acute exacerbations of MS?
Glucocorticoids
Consider plasmapheresis if refractory
108
Maintenance therapy in patients with relapsing-remitting or secondary, progressive forms of MS?
Interferon beta
| Glatiramer acetate
109
Why may baclofen be used in MS?
Treatment of muscle spasticity
110
___ is a myeloproliferative disorder marked by erythrocytosis. It is almost always caused by a mutation of ___ in a myeloid precursor cell.
Polycythemia vera; JAK2
111
Symptoms of polycythemia vera?
Increased blood viscosity -> HTN, erythromelalgia (burning cyanosis in hands/feet), transient visual disturbances
Increased RBC turnover -> gouty arthritis
Aquagenic pruritus (itching after bathing)
Bleeding
112
Exam findings in polycythemia vera?
```
Facial plethora (ruddy cyanosis)
Splenomegaly
```
113
Lab findings in polycythemia vera?
Elevated Hgb
Leukocytosis and thrombocytosis
Low EPO level**
JAK2 mutation positive
114
Complications of polycythemia vera?
Thrombosis
| Myelofibrosis and acute leukemia
115
Treatment of polycythemia vera?
Phlebotomy
| Hydroxyurea (if increased risk of thrombus)
116
BCR-ABL fusion protein?
CML
117
Severe nodulocystic acne may be the initial sign of hyperandrogenism in patients with ___.
PCOS
118
DDx of hyperandrogenism?
PCOS
Androgen-secreting tumor
Cushing syndrome
Non-classic CAH
119
What statistical method is used to compare the means of two groups of subjects?
Two-sample t test
120
The t statistic is obtained to calculate what value?
P value
121
How does a two-sample z test differ from the t test?
Used to compare two means, but uses population variances, not sample variances
122
What statistical test is used to compare 3+ means?
ANOVA
123
What statistical test is appropriate for categorical data and proportions?
Chi-square test
124
Pediatric chronic rhinosinusitis with nasal polyposis + exocrine pancreatic dysfunction = ?
Cystic fibrosis
125
Features of CF?
```
Sinusitis
Barrel chest
Pneumonia/bronchiectasis
Cachexia
Biliary cirrhosis
Pancreatic exocrine insufficiency
Diabetes
Digital clubbing
Inspissated stool
Absent vas deferens
```
126
How does primary ciliary dyskinesia differ from CF in its presentation?
No GI symptoms
127
In patients with upper GI bleeding, ongoing hematemesis, and depressed level of consciousness, what key step must be done?
Intubation to protect the airway prior to endoscopic treatment
128
What is the most common cardiac manifestation of SLE?
Pericarditis
129
EKG findings of pericarditis?
Diffuse ST elevation and PR depression, eventual diffuse T wave inversion
