Step 2 uWorld Flashcards Set #2
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Questions and Answers

TB is a common cause of exudative pleural effusions. It is characterized by pleural fluid with which 3 characteristics?

Very elevated protein (>4 g/dL), Lymphocytic leukocytosis, Low glucose levels

What is the most common cause of aortic stenosis in elderly patients?

  • Bicuspid aortic valve
  • Degenerative calcification of aortic valve leaflets (correct)
  • Rheumatic valve disease
  • None of the above

Name 2 mast cell stabilizing agents indicated for the treatment of allergic conjunctivitis.

Olopatadine, Azelastine

What are the 3 most common causes of secondary digital clubbing?

<p>Lung malignancies, Cystic fibrosis, Right-to-left cardiac shunts</p> Signup and view all the answers

High titers of anti-TPO antibodies are associated with an increased risk of which complications in women with Hashimoto thyroiditis?

<p>Miscarriage in both euthyroid and hypothyroid women</p> Signup and view all the answers

Which of the following medications can be used for malaria chemoprophylaxis?

<p>Doxycycline (B), Mefloquine (C), Atovaquone-proguanil (D)</p> Signup and view all the answers

What is the treatment for uremic encephalopathy?

<p>Urgent hemodialysis</p> Signup and view all the answers

What is used to confirm the diagnosis of Primary Biliary Cholangitis (PBC)?

<p>Serum anti-mitochondrial antibody titers</p> Signup and view all the answers

What complication should be suspected in patients presenting with right-sided heart failure after pacemaker or defibrillator placement?

<p>Severe tricuspid regurgitation</p> Signup and view all the answers

____ can occur as a catastrophic complication of a AAA and should be suspected in patients with hypotension, tachycardia, distended neck veins, and pulsus paradoxus.

<p>Cardiac tamponade</p> Signup and view all the answers

Name the 2 most common peripheral artery aneurysms associated with AAA.

<p>Popliteal artery, Femoral artery</p> Signup and view all the answers

Post-cardiac surgery pleural effusions that are small to moderate in size and not enlarging can be managed with ____.

<p>observation only</p> Signup and view all the answers

What is likely the diagnosis for a patient with nausea, dysphagia, chest pain, and a retrocardiac air-fluid level on imaging?

<p>Paraesophageal hiatal hernia (PEH)</p> Signup and view all the answers

What is the next step in managing complicated diverticulitis?

<p>Percutaneous abscess drainage under CT guidance</p> Signup and view all the answers

What should be noted on imaging for focal nodular hyperplasia?

<p>Arterial flow and central, stellate scar</p> Signup and view all the answers

Name 4 causes of anorectal fistula.

<p>Rupture of perianal abscess, Crohn disease, Malignancy/radiation proctitis, Infection (lymphogranuloma venereum)</p> Signup and view all the answers

What are the next steps for a patient diagnosed with postcholecystectomy syndrome?

<p>Abdominal ultrasound, ERCP</p> Signup and view all the answers

What should patients on warfarin who require urgent surgery with a high risk of bleeding receive?

<p>Prothrombin complex concentrate (PCC) and IV vitamin K</p> Signup and view all the answers

What is the treatment for emphysematous cholecystitis?

<p>Emergent cholecystectomy and broad-spectrum antibiotics with Clostridium coverage (pip-tazo)</p> Signup and view all the answers

What is a common cause of sialadenosis?

<p>Chronic alcohol use</p> Signup and view all the answers

Flashcards

Exudative Pleural Effusion in TB

A type of pleural effusion in tuberculosis characterized by high protein levels (>4 g/dL), lymphocytic leukocytosis, and low glucose levels (<60 mg/dL).

Degenerative Calcification of Aortic Valve

A common cause of aortic stenosis in the elderly, where the aortic valve leaflets become hardened and thickened due to calcium deposits.

Bicuspid Aortic Valve

A congenital heart defect where the aortic valve has only two leaflets instead of three, increasing the risk of aortic stenosis in younger individuals.

Rheumatic Valve Disease

A condition caused by rheumatic fever, leading to inflammation and damage to heart valves, including the aortic valve, causing stenosis in underdeveloped countries.

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Mast Cell Stabilizers

Medications that prevent mast cell degranulation and the release of inflammatory mediators, used to treat allergic conjunctivitis.

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Olopatadine & Azelastine

Two mast cell stabilizers indicated for the treatment of allergic conjunctivitis.

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Secondary Digital Clubbing

A condition where the fingertips become wide and bulbous, often seen in patients with chronic lung diseases, cystic fibrosis, or right-to-left cardiac shunts.

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Hashimoto Thyroiditis

An autoimmune disease attacking the thyroid gland, leading to hypothyroidism, with strong association with anti-TPO antibodies.

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Anti-TPO Antibodies

Antibodies specifically targeting thyroid peroxidase, commonly found in patients with Hashimoto thyroiditis, indicating an autoimmune attack on the thyroid.

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Malaria Chemoprophylaxis

Preventive medication taken before, during, and after travel to areas with malaria to prevent infection.

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Chloroquine Resistance

Malaria parasites becoming resistant to chloroquine, requiring alternative medications for chemoprophylaxis in endemic areas.

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Mefloquine, Doxycycline, Atovaquone-Proguanil

Alternative medications to chloroquine for malaria chemoprophylaxis in cases of chloroquine resistance.

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Asterixis

A neurological sign characterized by flapping tremor of the hands, seen in conditions like hepatic encephalopathy, uremic encephalopathy, or hypercapnia.

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Hepatic Encephalopathy

A brain dysfunction caused by liver failure, leading to asterixis, treated with lactulose.

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Uremic Encephalopathy

Brain dysfunction caused by kidney failure, leading to asterixis, requiring urgent hemodialysis.

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Primary Biliary Cholangitis

A chronic liver disease characterized by autoimmune destruction of small bile ducts, mainly affecting middle-aged women, causing fatigue and itching.

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Anti-Mitochondrial Antibodies

Antibodies targetting mitochondria, present in patients with primary biliary cholangitis, confirming the diagnosis.

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Transvenous Lead Placement Complications

Complications associated with placing leads for pacemakers or defibrillators in the heart, sometimes damaging the tricuspid valve, leading to regurgitation.

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Cardiac Tamponade and AAA

A life-threatening complication of abdominal aortic aneurysm (AAA) where the aorta ruptures, causing blood to collect around the heart and compress it.

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Study Notes

Exudative Pleural Effusions in TB

  • Characterized by very elevated protein levels (> 4 g/dL)
  • Lymphocytic leukocytosis is common
  • Low glucose levels present (often < 60 mg/dL)

Aortic Stenosis Causes

  • Elderly: Degenerative calcification of aortic valve leaflets
  • Younger individuals: Bicuspid aortic valve
  • Nondeveloped countries: Rheumatic valve disease

Mast Cell Stabilizers

  • Two agents indicated for allergic conjunctivitis:
    • Olopatadine
    • Azelastine

Secondary Digital Clubbing Causes

  • Most common causes include:
    • Lung malignancies
    • Cystic fibrosis
    • Right-to-left cardiac shunts

Hashimoto Thyroiditis and Anti-TPO Antibodies

  • Over 90% of patients have antithyroid peroxidase (anti-TPO) antibodies
  • High anti-TPO titers increase risk of progression to overt hypothyroidism
  • Associated with increased risk of miscarriage in both euthyroid and hypothyroid women

Malaria Chemoprophylaxis

  • High rates of chloroquine resistance in endemic countries
  • Recommended chemoprophylaxis should start 2 weeks before travel, continue during, and for 4 weeks after
  • Potential medications:
    • Mefloquine
    • Doxycycline
    • Atovaquone-proguanil

Asterixis Causes and Treatments

  • Can occur due to hepatic encephalopathy (HE), uremic encephalopathy, or hypercapnia
  • Treatment for HE: Lactulose
  • Treatment for uremic encephalopathy: Urgent hemodialysis

Primary Biliary Cholangitis (PBC)

  • Chronic liver disease due to autoimmune destruction of small bile ducts
  • Common in middle-aged women, symptoms include fatigue and pruritus
  • Diagnosis confirmed by serum anti-mitochondrial antibody titers

Transvenous Lead Placement Complications

  • Can lead to severe tricuspid regurgitation due to valve leaflet damage
  • Symptoms to suspect: Right-sided heart failure after pacemaker or cardioverter-defibrillator placement

Cardiac Tamponade and AAA

  • Can occur as a catastrophic complication of abdominal aortic aneurysm (AAA)
  • Signs: Hypotension, tachycardia, distended neck veins, pulsus paradoxus, sudden onset tearing chest pain radiating to the back

Peripheral Artery Aneurysms

  • Two most common peripheral artery aneurysms associated with AAA:
    • Popliteal artery
    • Femoral artery

Post-Cardiac Surgery Pleural Effusions

  • Manage with observation if:
    • Small to moderate size
    • Early onset (post-operative day 1 or 2)
    • No respiratory symptoms present

Paraesophageal Hiatal Hernia

  • Symptoms include nausea, dysphagia, chest pain, and retrocardiac air-fluid levels on imaging
  • Condition characterized by the gastric fundus migrating into the thoracic cavity

Complicated Diverticulitis Management

  • Refers to diverticulitis with abscess, perforation, obstruction, or fistula
  • Next step: Percutaneous abscess drainage under CT guidance
  • Surgical drainage if percutaneous method fails

Focal Nodular Hyperplasia Imaging

  • Associated with anomalous arteries
  • Imaging findings: Arterial flow and central, stellate scar

Causes of Anorectal Fistula

  • Secondary to several conditions, including:
    • Rupture of perianal abscess
    • Crohn's disease
    • Malignancy/radiation proctitis
    • Infection (lymphogranuloma venereum)

Postcholecystectomy Syndrome

  • Next steps in management include:
    • Abdominal ultrasound
    • Endoscopic retrograde cholangiopancreatography (ERCP)

Urgent Surgery for Warfarin Patients

  • Patients requiring urgent surgery and are on warfarin should receive:
    • Prothrombin complex concentrate (PCC) and IV vitamin K
  • Alternative if PCC is unavailable: Fresh frozen plasma (FFP)

Emphysematous Cholecystitis Treatment

  • Management requires emergent cholecystectomy
  • Broad-spectrum antibiotics with Clostridium coverage (e.g., piperacillin-tazobactam)

Sialadenosis

  • Benign, non-inflammatory enlargement of salivary glands
  • Commonly associated with chronic alcohol use

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Description

This quiz covers important medical concepts related to exudative pleural effusions and aortic stenosis. Test your knowledge on the characteristics of pleural fluid in TB and the causes of aortic stenosis across different demographics. Perfect for medical students preparing for their Step 2 examinations.

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