5 Flashcards
(115 cards)
1
Q
What metabolic abnormalities can be caused by hypothyroidism?
A
- Hyperlipidemia
- Hyponatremia (decreased free water clearance)
- Elevated CK
- Elevated serum transaminase
2
Q
How does hypothyroidism lead to hypercholesteremia?
A
Decreased surface LDL receptors (type 2a HLD) and/or decreased LDL receptor activity
3
Q
What 2 things must be ruled out before diagnosing SIADH?
A
Hypothyroidism
Adrenal insufficiency
4
Q
First-line treatment of MDD with psychotic features?
A
Antidepressant + antipsychotic or ECT
5
Q
Presentation - acute depression with suicidal ideation, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, intense craving
A
Cocaine withdrawal
6
Q
When is RhoGAM (anti-D immune globulin) indicated?
A
Rh(D)-negative women:
- 28-32 weeks
- <72 hours after delivery of Rh(D)-positive infant
- <72 hours after spontaneous abortion
- Ectopic pregnancy, threatened abortion
- Hydatidiform mole
- CV sampling, amniocentesis
- Abdominal trauma
- T2/T3 bleeding
- External cephalic version
7
Q
When is antepartum prophylaxis with RhoGAM not indicated?
A
If the father is Rh(D) negative
8
Q
Presentation - bilious emesis, bloody stools, abdominal distention in a preterm neonate
A
Necrotizing enterocolitis
9
Q
X-ray findings of necrotizing enterocolitis?
A
Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum
10
Q
Rx of necrotizing enterocolitis?
A
Bowel rest, parenteral nutrition (D/C enteral feeds)
Broad-spectrum IV ABX
+/- surgery
11
Q
X-ray: dilated stomach and duodenum (double bubble sign), no distal air
A
Duodenal atresia
12
Q
What is the most common late manifestation of Lyme disease and how does it present?
A
Lyme arthritis; inflammatory monoarticular or asymmetric oligoarticular arthritis, most commonly in the knee
Synovial fluid - inflammatory profile, negative Gram stain and culture
13
Q
Features of early localized Lyme disease (days-1 month)?
A
1Erythema migrans
Fatigue, HA, myalgias, arthrlagias
14
Q
Features of early disseminated Lyme disease (weeks-months)?
A
Multiple erythema migrans Unilateral/bilateral CN palsy Meningitis Carditis (eg, AV block) Migratory arthralgias
15
Q
Features of late Lyme disease (months-years)?
A
Arthritis
Encephalitis
Peripheral neuropathy
16
Q
Confirm Dx of Lyme arthritis?
A
Serum ELISA and Western blot testing
17
Q
Rx Lyme arthritis?
A
Oral doxycycline or amoxicillin (if no neuro manifestations)
18
Q
Reactive arthritis (formerly Reiter syndrome) presents 1-4 weeks after ___ or ___ infection.
A
Enteric; chlamydial
19
Q
Features of rheumatic fever?
A
Rare complication of S. pharyngitis -> fever, migratory arthralgias, subcutaneous nodules, carditis, neuropsychiatric signs
20
Q
Sudden-onset respiratory distress and radiographic signs of air trapping (unilateral hyperinflation, mediastinal shift, etc.) are concerning for ___.
A
Foreign body aspiration
21
Q
Nebulized albuterol is used for asthma. Nebulized racemic epinephrine treats ___.
A
Croup
22
Q
In pregnant women with prior HSV infection, what should be done?
A
Antiviral suppression beginning at 36 weeks
23
Q
In pregnant women with lesions/prodromal symptoms of HSV during labor, what should be done?
A
C-section
24
Q
The evaluation of adrenal insufficiency should include what tests?
A
- 8am serum cortisol
- Plasma ACTH
- ACTH stimulation test (aka cosyntropin test)
25
Interpret:
- Basal cortisol LOW
- ACTH HIGH
- Minimal cortisol response to cosyntropin
Primary adrenal insufficiency
26
Interpret:
- Basal cortisol LOW
- ACTH LOW
- Minimal or suboptimal cortisol response to cosyntropin
Secondary or tertiary adrenal insufficiency
27
What is the dexamethasone suppression test used for?
Evaluation of hypercortisolism (suppresses release of ACTH from the pituitary, subsequently reduces adrenal cortisol production)
28
___ is a dimorphic fungus found in decaying plant matter and soil and primarily infects gardeners and landscapers via direct cutaneous inoculation.
Sporothrix schenckii
29
Appearance of skin manifestation of sporotrichosis?
Skin papule -> ulceration with non-purulent, odorless drainage
Proximal lesions along lymphatic chain
30
Rx sporotrhicosis?
3-6 months of oral itraconazole
31
Presentation - cutaneous lesion (vesicular, erythematous, or papular) with prominent, tender, regional LAD and possible systemic spread?
Cat scratch fever
32
Presentation - systemic symptoms (fever), painful LAD, lymphangitis
Lymphatic filariasis (nematode endemic to Africa, Asia, Latin America, some parts of Caribbean)
33
Presentation - papular lesion at the site of entry (usually lower extremity) and proximal, intensely pruritic, reddish-brown tracks
Hookworm larvae
34
What is Ogilvie syndrome?
Acute colonic pseudoobstruction
35
Clinical findings of Ogilvie syndrome?
Abdominal distension, pain, obstipation, vomiting
| Tympanic to percussion, decreased bowel sounds
36
Etiologies of Ogilvie syndrome?
Major surgery, traumatic injury, severe infection
Electrolyte derangement (hypoK, hypoMg, hypoCa)
Medications (opiates, anticholinergics, etc.)
Neurologic disorders (eg, dementia, stroke)
37
X-ray findings of Ogilvie syndrome?
Colonic dilation, normal haustra, non-dilated small bowel
38
CT findings of Ogilvie syndrome?
Colonic dilation without anatomic obstruction
39
Rx Ogilvie syndrome?
NPO, NG/retal tube decompression
| Neostigmine if no improvement within 48 hours
40
Presentation - hematochezia, liver abscesses
E. histolytica
41
Red flags for developmental dysplasia of the hip?
1. Positive Ortolani test
2. Dislocated hip
3. Limited hip abduction
42
Supportive findings for developmental dysplasia of the hip?
1. Limb length discrepancy
| 2. Asymmetric gluteal/inguinal/thigh creases
43
Management of developmental dysplasia of the hips?
If red flags -> refer to ortho
| If supportive findings or only risk factors -> hip U/S (<4 months), hip radiograph (>4 months)
44
Undiagnosed pleural effusion is best evaluated with ___, except in patients with clear-cut evidence of ___.
Thoracentesis; CHF
45
What 3 tumors cause ~75% of all malignant pleural effusions?
1. Lung carcinoma
2. Breast carcinoma
3. Lymphoma
46
In the setting of pleural effusion, what is the next step if thoracentesis is non-diagnostic and the patient has a lung mass?
Bronchoscopy
47
Presentation - nocturnal perianal pruritis
Enterobius vermicularis (aka pinworm) infection
48
Rx pinworm infection?
Pyrantel pamoate or albendazole for patient and all household contacts
49
Presentation - urticaria, abdominal pain, respiratory problems
Strongyloidiasis
50
Rx strongyloidiasis and onchocerciasis?
Ivermectin
51
Uses of metronidazole?
Protozoan infections
Trichomonoiasis
Intra-abdominal anaerobic infections
52
Rx scabies
Permethrin
53
Rx schistosomiasis
Praziquantel
54
Presentation - microthrombocytopenia, eczema, recurrent infections
Wiskott-Aldrich syndrome
55
Inheritance pattern, mutation, and pathophysiology of Wiskott-Aldrich syndrome?
X-linked recessive
Defect in WAS protein gene
Impaired cytoskeleton changes in leukocytes, platelets
56
Rx Wiskott-Aldrich syndrome
Stem cell transplant
57
Most common cause of urinary tract obstruction in newborn boys?
Posterior urethral valves
58
Dx intraamniotic infection?
Maternal fever PLUS 1+ of the following:
- Fetal tachycardia (>160)
- Maternal luekocytosis
- Purulent amniotic fluid
59
Define preterm premature rupture of membranes (PPROM).
Rupture of membranes prior to 37 weeks in the ABSENCE of contractions
60
Management of PPROM?
Expectant until 34 weeks -> delivery
| Prior to 34 weeks -> corticosteroids for fetal lung maturity, course of prophylactic broad-spectrum ABX
61
Management of PPROM + intraamniotic infection?
Delivery, regardless of gestational age
62
Define uterine size-dates discrepancy.
>2 cm difference in fundal heigh measurement from gestational age
63
Who receives anti-viral therapy (eg, oseltamivir) in the setting of influenza?
Risk factors for influenza complications (eg, age 65+, chronic medical problems, pregnancy)
Those without risk factors who come to the office within 48 hours of system onset (may reduce symptom duration)
Do not give vaccine until symptoms abate if moderate or severe illness
64
Patients with typical GERD symptoms require an upper GI endoscopy in what situations?
If they have alarm symptoms (dysphagia, odynophagia, weight loss, anemia, GI bleeding, recurrent vomiting)
Men >50 with chronic (>5 years) symptoms and cancer risk factors
65
If a patient has symptoms consistent with GERD and no reason to get an endoscopy, what should be done?
Once daily PPI for 2 months
66
If GERD is refractory to PPI?
Switch PPIs or increase to 2x daily
67
If GERD symptoms persist?
Consider endoscopy or esophageal pH monitoring
68
___ presents with anorexia, N/V, early satiety, postprandial fullness, and impaired glycemic control. What medication can relieve these symptoms?
Diabetic gastroparesis; metoclopramide (prokinetic and antiemetic properties)
Alternative -> erythromycin
69
___ are useful in the palliation of anorexia and in promoting weight gain in patients with cancer-related anorexia/cachexia syndrome.
Progesterone analogs (eg, megestrol acetate, medroxyprogesterone acetate)
70
What are the Light criteria for exudative pleural effusions?
Pleural fluid protein/serum protein ratio >0.5
Pleural fluid LDH/ serum LDH ratio >0.6
Pleural fluid LDH> 2/3 upper limit of normal of serum LDH
71
Features of rheumatoid effusions?
Exudative effusion with:
- Very LOW glucose (<50)
- Very HIGH LDH (>700)
- Possible low pH
72
Presentation - diarrhea acquired during international travel, abdominal cramps, foul-smelling stools, bloating, and benign abdominal findings
Giardiasis
73
Dx Giardiasis?
Stool antigen assay
| May also use stool microscopy to identify oocysts and trophozoites
74
Rx giardiasis?
Metronidazole
75
Empiric treatment for traveler's diarrhea (most commonly due to E. coli)?
Short course of ciprofloxacin
76
Presentation - pruritic, purple/pink, polygonal papules and plaques on flexor surfaces of wrists and ankles, may have lacy, white network of lines (Wickham striae)
Lichen planus
77
What disease is lichen planus associated with?
Hepatitis C
78
What medications is lichen planus associated with?
ACEIs
| Thiazides
79
Rx lichen planus
Topical high-potency glucocorticoids (eg, betamethasone)
If widespread, systemic glucocorticoids, phototherapy
80
Presentation - pruritic rash affecting the flexor surfaces, presenting in childhood
Atopic dermatitis
81
Presentation - intensely pruritic, erythematous papules and vesicles on the elbows, back, knees, and buttocks; associated with?
Dermatitis herpetiformis; celiac disease
82
Presentation - targetlike plaques with central clearing that begin on the extensor surfaces of the distal extremities and spread centripitally; common to have oral lesions and a febrile prodrome
Erythema multiforme
83
Presentation - sharply demarcated erythematous plaques with a thick, silvery scale, involves the scalp, knees, and extensor surfaces
Psoriasis
84
Presentation - round/ovoid annular plaques with a scaly border and central clearing
Tinea corporis
85
DDx - normal AG metabolic acidosis
```
Diarrhea
Fistulas
Carbonic anhydrase inhibitors
Renal tubular acidosis
Ureteral diversion
Iatrogenic
```
86
Anion gap = ?
Na - Cl - HCO3
87
Presentation - non-anion gap metabolic acidosis + hyperkalemia out of proportion to the renal dysfunction
Rental tubular disorder
88
Define rental tubular acidosis.
Group of disorders characterized by non-anion gap metabolic acidosis in the presence of preserved kidney function
89
Loop diuretics cause what 2 electrolyte abnormalities?
Hypokalemia
| Metabolic alkalosis
90
Role of aldosterone?
Saves sodium
| Pushes potassium out
91
What is incidence?
Measure of new cases
92
What is prevalence?
Measure of total number of cases at a point in time
93
How do prevalence and incidence of diseases change with improved treatments?
Prevalence increases
| Incidence is not affected
94
What is the most effective lifestyle intervention for reducing blood pressure in obese patients?
Weight loss > DASH diet > Exercise > reduced dietary sodium > reduced alcohol intake
95
Define hypertension.
Systolic >130 and/or diastolic >90
96
___ is painless dilation of the cervix that may cause T2 delivery and presents with vaginal spotting, pelvic pressure, and increased vaginal discharge in the absence of preterm labor.
Cervical insufficiency
97
DDx - metabolic acidosis with both an AG and an osmolar gap?
Intoxication with:
- Ethylene glycol
- Methanol
- Ethanol
98
Specific finding in ethylene glycol poisoning?
Calcium oxalate crystals (rectangular, envelope-shaped)
99
DDx - high anion gap metabolic acidosis
1. Drug ingestion (salicylates, isoniazid, iron)
2. Lactic acidosis 2/2 hypoperfusion
3. Uremia (increased BUN from renal failure)
4. DKA (increased urine and serum ketones)
5. Osmolar gap (ethylene glycol, methanol, propylene glycol)
100
Methanol poisoning can lead to ___.
Blindness
101
Calculate osmolar gap?
Measured serum Osm - calculated serum Osm
102
Calculated serum osm?
2Na + glucose/18 + BUN/2.8
103
Major complication of ethylene glycol poiosoning?
Acute renal failure
104
Why does uremia cause an AG metabolic acidosis?
Because acid excretion (through formation of ammonium) is impaired
105
What should be considered in patients typical risk factors for COPD (eg, age 45 or less), those with atypical features (eg, basilar-predominant disease), or unexplained liver disease?
A1AT deficiency
106
How does the emphysema of smoking-induced COPD and COPD 2/2 A1AT deficiency differ anatomically?
Smoking-indued: centrilobular, affects upper lobes
A1AT: panacinar, affects lower lobes
107
A1AT deficiency is frequenctly associated with ___ disease.
Liver
108
Describe the mechanism of type 2 heparin-induced thrombocytopenia.
Heparin + PF4 + IgG + platelet -> immune complex -> BOTH
1. Thrombocytopenia via splenic macrophages removing the complex + thrombus formation leading to consumption
2. Arterial and venous thrombosis via platelet activation/release/aggregation
109
What is the Jarisch-Herxheimer reaction?
Acute febrile reaction that commonly occurs <12 hours (within 6-48 hours) after initial treatment of early syphilis
110
What is immune reconstitution inflammatory syndrome?
Paradoxical worsening of infectious symptoms in patients with HIV initiated on HAART (due to immune system improvement)
111
Presentation - unilateral orbitofrontal headache associated with N/V, severe unilateral eye pain (+/- halos around lights) with conjunctival injection, and a dilated pupil with poor light response
Acute angle-closure glaucoma
112
Features of sideroblastic anemia?
Microcytic/hypochromic anemia, dimorphic RBC population on smear, elevated serum iron, decreased TIBC
113
In patients with an identifiable cause of vitamin B6 deficiency leading to sideroblastic anemia, administration of ___ can easily correct the problem.
Pyridoxine
114
Cause of sideroblastic anemia?
Defective heme synthesis
115
Presentation - ptosis, down-and-out gaze, diplopia, normal pupillary response
Ischemic CN III palsy (damage to inner somatic fibers, spares more peripheral parasympathetics
