Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

2019 ABIM > Oct 27 2019 > Flashcards

Oct 27 2019 Flashcards

(86 cards)

Start Studying
1
Q

Name and Associated condition

A

Dermatitis Herpetiformis

(found on extensor surfaces of elbows, knees, back and buttocks)

Intensely pruritic, erythematous papules, vesicles adn bullae.

Gluten-sensitive enteropathy (celiac disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Acanthosis nigracans and associated conditions?

A

Increased pigmentation especially in axilla

Insulin resistance and GI malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are multiple skin tags associated with?

A

Insulin resistance

Pregnancy

Chron disease (when found perianal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name and associated condition?

A

Porphyria cutanea tarda

Blistering lesions on skun exposed areas, can progress to hypertrichosis, hyperpigmentation and sclerodermatous thickening.

Associated with Hepatitis C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What skin conditions are associated with Hepatitis C

A

Porphyria cutanea tarda, Cutaneous leukocytoclastic vasculitis and Lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name and associated condition?

A

Cutaneous Leukocytoclastic Vasculitis (Palpablue purpura)

Hepatitis C (Caused by secondary cryoglobulinemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name and associated condition?

A

Molluscum contagiosum virus (benign single or multiple rounded, dome shaped, pink, waxy papules 2-5mm)

HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What skin conditions are associated with HIV?

A

Sudden-onset, severe psoriasis

Recurrent herpes zoster

Disseminated molluscum contagiosum

Severe seborrheic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What skin conditions are associated with GI malignancy?

A

Explosive onset multiple, itchy sevorrheic keratoses

Acanthosis nigricans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name and associated conditions?

A

Severe seborrhic dermatitis

HIV and Parkinsons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is sudden onset of multiple, itchy seborrheic keratosis associated with?

A

GI malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name and associated condition?

A

Pyoderma gangrenosum

Inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes anemia in celiac?

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will a biopsy of dermatitis herpetiformis show?

A

DIF of perilesional skin shows granular IgA deposits in ther dermal papillae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Patient with elevated MCHC, microcytosis anemia with spherocytes. Differential and w/u?

A

Most likely are AIHA or HS

DAT or Coombs can help differentiate (positive in AIHA)

eosin-5-maleimide binding (flow cytometry) or acidified glycerol lysis test can confirm HS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you treat Hereditary Spherocytosis (HS)?

A

RBC transfusion for symptomatic anemia, folic acid supplements, splenectomy for severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the common and less common causes of peripheral spherocytes?

A

AIHA, HS

Clostridial sepsis, snake bites, G6PD deficiency, MAHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications for irradiated RBC transfusion?

A

BMT recipients

Acquired or congenital cellular immunodeficiency

Blood components donated by first or second degree relatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are indications for leukoreduced PRBC?

A

Chronically transfused patients

CMV seronegative at risk pt (AIDS, Transplant)

Potential transplant recipients

Previous febrile non-hemolytic transfusion reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are indications for Washed PRBC?

A

IgA deficiency

Complement-dependent AIHA

Continued allergic reactions with PRBC despite anti-histamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the most common form of Diffuse Parenchymal lung disease and its associated histopath?

A

IPF, Usual interstitial pneumonia (UIP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Common age of onset of IPF?

A

50-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HPI of IPF?

A

>6 month dry cough that disturbs daily activities

DOE

No history of potential cuases of fibrosis

~50% have a smoking history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Objective findings in IPF?

A

Velcro early inspiratory crackles with base predominance

~50% clubbing

Decreased lung volumes on CXR

Bibasilar septal line thickening with reticular changes and bronchiectasis when more severe

Honeycombing, cystic changes and traction bronchiectasis prominent in bases and subpleural areas on HRCT

May have s/s of Right CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is required to diagnose IPF?
\>6month cough Imaging findings consistent with UIP No known cause Lung biopsy not necessary if imaging is consistent
26
Natural progression of IPF?
Progressive Median survivial of 3-5 years post diagnosis Stepwise decline, periods of stability with acute declines (may be triggered or idiopathic)
27
Treatment of IPF?
Manage comorbidities (obesity, CHF, deconditioning, OSA, Pulmonary HTN) Supplemental oxygen Pulmonary rehab for those with deconditioning Nintedanib and pirfenidone Lung transplant - early referral appropriate If not a transplant candidate recommend against mechanical ventilation and referr to palliative
28
How do nintedanib and pirfenidone work? Common side effects?
Target fibroblasts (considered central in progression of IPF) Not curative, delay progression Diarrhea, elevated liver associated enzymes, increased risk of MI for Nintedanib Diarrhea, nausea, headache, dyspepsia/GERD, anorexia, weight loss for pirfenidone
29
What did the trials show for nintedanib?
INPULSIS 1 trial (2014) -Decreased FVC decline (114 vs 239) did not reduce time to first exacerbation INPULSIS 2 trial (2014) -Decreased FVC decline (113 vs 207) did not reduce time to first exacerbation TOMORROW trial (2011) -reduced decline in FVC and acute exacerbations
30
What did the trail for pirfenidone show?
ASCEND trial (2014) - Reduced risk of progression by 30%, lower progression of FVC \>10% 16.5% vs 31.8%. SP3 trial (2010), CAPACITY 1 & 2 (2010) reduce the FVC decline and progression-free survival (no survival benefit).
31
Risk factors for AAA? Risk factors for expansion and rupture?
Age \>60 Male gender 6:1 HTN Cigarettes White Atherosclerosis FH of AAA =================================== \>5.5 cm rate of expansion \>= 0.5 cm every 6 mo or 1cm/yr Active cigarette smoking (highest rate of AAA rupture)
32
Diagnosis of AAA?
AP diameter \>3.0cm 75% asymptomatic
33
Screening guidelines for AAA?
Men 65-75 who have smoked at least 100 cigs select screening in Men who have never smoked
34
Surveillance for AAA?
\<=4cm every 2-3 years (rupture risk \<0.5%/yr) 4.1-5.4cm 6-12 months (rupture risk 0.5-10%) \>5.5cm repair (rupture risk \>10%) should have CTA or MRA for surgical planning.
35
Treatment for AAA?
\>=5.5 cm, expansion \>0.5cm/yr or symptoms (abd/back pain) - Aortic repair Suprarenal/juxtarenal - usually open surgical repair EVAR more sutable to infrarenal Risk factor modification for non-surgical AAA
36
What are the differences between AAA repair options?
EVAR - decreased short term morbidity/mortality, no difference in long term M/M increased need for repeat intervention, higher endoleak, device failure, postimplantation syndrome (fever, leukocytosis, elevated CRP)
37
When are aldosterone antagonists recommended post MI?
STEMI LVEF \<= 40% while on ACE and BB diabetes or symptomatic CHF
38
What are the two options for cardiac rehab?
Office based or Home based Consider home based for low risk pt who desires home based (\<=75, NYHA
39
Recommended CAP therapies (class)?
**Outpatient** Healthy (Macrolide or Doxy) Healthy \>25% macrolide resistance of S. Pneumoniae (Fluoroquniolone or beta-lactam + macrolide) Comorbidities or Ab use in last 3 months (Fluoroqunilone or beta-lactam + macrolide) **Inpatient (non-ICU)** Fluoroquniolone or beta-lactam + macrolide **Inpatient (ICU)** Beta-lactam + azithromycin or beta-lactam + fluoroqinolone If PCN allergy, Fluoroquinolone + aztreonam **Risk factor for Pseudomonas** Anti-pseudomonal beta-lactam, fluoroquniolone or addition of aztreonam **Risk factor for CA-MRSA** Add Vanc or linezolid
40
For inpatient treatment of CAP when can you consider transition to oral therapy?
clinically improving within 48-72hrs tolerate oral diet
41
Therapy duration for CAP?
5-7 days unless: resistant organism extrapulmonary infection less common organisms (P. aeruginosa, S. aureus, Legionella) Complicated PNA (empyema, lung abscess, necrotizing PNA)
42
CAP organsisms associated with heavy EtOH use?
S. pneumoniae, oral flora, Klebsiella pneumoniae
43
CAP organisms associated with COPD?
H. influenzae S. pneumoniae Moraxella catarrhalis Legionella pneumophilia P. aeruginosa
44
CAP organisms associated with structural lung disease?
(ie. bronchiectasis, CF) P. aeruginosa Burkholderia cepacia Stenotrophomonas maltophilia S. aureus
45
CAP organsisms associated with aspiration and causes?
(seizures, neurologic impairment, LOC, GERD, EtOH or Drugs, stroke, poor dentition, vomiting) Oral anaerobes Enterobacteriacae
46
CAP organsisms associated with age \>65
Influenza virus S. pneumoniae rhinovirus
47
CAP organisms associated with post viral illness?
S. aureus Streptococcus pyogenes S. pneumoniae
48
CAP organsism associated with bird exposure?
Chlamydophila psittaci Histoplasma capsulatum Cryptococcus neoformans
49
CAP organisms associated with dog exposure?
Bordetella bronchiseptica
50
CAP organism associated with cat exposure?
Pasteurella multocida
51
CAP organsism associated with fam animals or domesticated pregnant animals?
Coxiella burnetii Brucella spp
52
CAP organism associated with horses?
Rhodococcus equi
53
CAP organism associated with rodent droppings?
Hantavirus
54
CAP organism associated with rabbits?
Francisella tularensis
55
CAP organism associated with Hot Tubs?
Legionella pneumoniae Atypical mycobacteria (causing a hypersensitivity pneumonitis)
56
CAP organism considerations by geography?
**Eastern US** Histoplasma capsulatum Blastomyces dermatitidis **Southwest US** Coccidiodies **Southeast Asia** Burkholderia pseudomallei SARS Avian influenza **Middle East** MERS
57
CAP organisms by time of year?
Late fall, winter early spring: Influenza virus Parainfluenza virus Rhinovirus
58
Most common organisms by treatment environment?
**Outpatient** S. pneumoniae Mycoplasma Chlamydophilia Respiratory viruses **Inpatient (non-ICU)** S. pneumoniae Mycoplasma Chlamydophilia H. influenzae Legionella Oral anaerobes Respiratory Viruses **Inpatient (ICU)** S. pneumoniae S. aureus H. influenzae Legionella Gram-negative bacilli
59
When should negative CXR prompt further imaging in suspected CAP?
If high suspicion with negative initial imaging can repeat in 24 hours High risk patients (febrile neutropenia, risk for anthrax, ARDS) perform chest CT
60
Radiographic patterns and associated organism in CAP?
**Lobar PNA** S. pneumoniae **RLL PNA** Oral anerobes (aspiration) **Lung Abscess/cavitary lesion** Oral anaerobes S. aureus Klebsiella pneumoniae Nocardia Actinomyces Rhodococcus Mycobacteria Endemic fungi **Interstitial infiltrate** Atypical pathogens Legionella Mycoplasma Chlamydophilia Viruses **Pleural effusion/empyema** Oral anaerobes Anginosus-constellatus group streptococci S. aureus S. pneumoniae
61
When should microbiologic studies be obtained in CAP?
In the ICU If it would change care in non-ICU hospitalized patients Non-response to outpatient therapy Cavitary lung lesions Underlying structural lung disease
62
How sensitive are blood cultures in pneumococcal PNA?
20-25%
63
How sensitive is pneumococcal urinary antigen?
70%, not affected by antimicrobial administration
64
What does legionella urinary antigen test for?
L. pneumophilia serotype 1 Can remain positive for prolonged period post infection
65
When should thoracentesis be performed in CAP?
Unknown cause or effusions \>1cm To exclude concomitant empyema that requires drainage
66
When should bronchoscopy with transbronchial biopsy be performed in CAP?
unrevealing non-invasive evaluation who do not respond to empiric therapy.
67
When should you consider MRSA coverage in CAP?
Suspicious gram stain (G+ cocci in clusters Conventional therapy failure Pleural-based lung nodules (suggest septic pulm emboli) Cavitary lung lesions IVDU
68
Of MRSA options, which cannot be used in PNA?
Daptomycin binds to surfactant resulting in negligible alveolar levels and is not effective in PNA
69
When should you consider coverage for P. aeruginosa?
Immunocompromised patients Structural lung disease (Bronchiectasis, CF) Repeated Ab due to medical condition
70
What conditions would allow a 5 day course of Ab in CAP vs longer course?
**5 Day** Clinical improvement and defervescence in 48-72 hours **7 Day or longer** Cavitary disease Lung abscess empyema concomitant bacteremia extrapulmonary infection ongoing instability (fever, abnormal VS, hypoxia) **\>14 Days** S. aureus Enterobacteriaceae Fungal Mycobacteria
71
What are pulmonary complications of CAP?
Non-resolving PNA (resistant infection, non-infectious causes) Lung Abscess (prolonged Ab) Empyema (Chest tube drainage) ARDS (Ventilation, steroids)
72
What are neurologic complications of PNA?
Delirium (may be 2/2 hypoxemia, hypercarbia, ICU)
73
What are hematologic complications of PNA?
Leukopenia (2/2 Sepsis, medications) Thrombocytopenia (2/2 sepsis, medications)
74
What are cardiac complications of PNA?
ACS (5-10% of hospitalized patients) Arrhythmias (most common a-fib)
75
What are renal complications of PNA?
AKI (hypotensive, medication)
76
What are endocrine complications of PNA?
Adrenal insufficiency (Waterhouse-Friderichsen in setting of overwhelming bacterial infection or septic shock)
77
Based on a recent study, what adjunctive therapy MAY help reduce morbidity in PNA?
In high risk patient's for ARDS glucocorticoids may help reduce mortality, mechanical ventilation needs and shorten hospitalization.
78
What is the primary reason for repeat chest imaging in PNA?
r/o Postobstructive PNA (Bronchial carcinoma most commonly) Imaging in 2-3 months especially in age \>50 or smoking history
79
What additional medicaion can provide symptom and mortality benefit in AA with CHF?
In NYHA class III or IV AA patients with LV failure (EF \<40%), when on appropriate GDMT Addition of hydralazine + long acting nitrate therapy can provide symptom and mortality benefit
80
What are levels concerning for hereditary hemochromatosis?
Ferritin \>1000 ng/mL or transferrin saturation \>45-50%
81
What are the typical levels and ratio of transaminases in NAFLD?
2-5 times upper limit of normal and AST to ALT \<1
82
What is the presentation of Acute Eosinophilic PNA?
Idiopathic, more common in new onset/resumption of smoking High fever \<3wk Non-prod cough, dyspnea Bibasilar inspiratory crackles Hypoxemic resp failure
83
What is the presentation of chronic eosinophilic PNA?
More common in women, non-smokers, asthmatics, post radiation (breast CA) Fever, cough, progressive dyspnea Wt loss, night sweats Resp failure rare
84
Diagnosis of acute eosinophilic PNA?
Neutrophil predominant leukocytosis that progresses to eosinophilia Chest imaging: b/l diffuse ground glass and reticular opacities BAL \>25% eosinophils Lung biopsy: diffuse alveolar damage, increased interstitial eosinophils
85
Diagnosing Chronic Eosinophilic PNA?
Peripheral eosinophilia Elevated ESR/CRP Iron deficiency anemia with elevated Plt Imaging: b/l peripheral/pleural based infiltrates, sparing of the perihilar and central lung BAL \>25% eosinophils Lung biopsy: interstitial & alveolar eosinophils, multi-nucleated giant cells
86

2019 ABIM (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions