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Step 2 CK UW > 7/19/16 > Flashcards

7/19/16 Flashcards

1
Q

what dx should be suspected in a pt who develops rapid-onset dyspnea, tachycardia, tachypnea, hypotension, and distention of the neck veins after subclavian central venous catheter placement?

A

tension pneumothorax

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2
Q

what virus is associated with Kaposi sarcoma?

A

human herpesvirus-8 (HHV-8)

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3
Q

what fungal infection causes hepatosplenomegaly when disseminated in immunocompromised pts (HIV pts with CD4 count less than 100)?

A

histoplasmosis

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4
Q

what is the preferred treatment for mild to moderate histoplasmosis?

A

itraconazole

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5
Q

what should be given when a pt develops serious bleeding due to excess anticoagulation with warfarin? heparin?

A

warfarin: vitamin K and prothrombin-complex concentrate
heparin: protamine sulfate

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6
Q

describe cyanotic and pallid breath holding spells

A

cyanotic: crying followed by breath-holding, CYANOSIS, and loss of consciousness
pallid: minor TRAUMA followed by breath-holding, PALLOR, diaphoresis, and loss of consciousness

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7
Q

seizures are associated with withdrawal of what type of medication?

A

short-acting benzodiazepines (i.e., alprazolam [Xanax])

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8
Q

medication for pt with depression who is fearful of weight gain or sexual side effects or is a smoker trying to quit

A

bupropion

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9
Q

side effect(s) of bupropion

A

seizures

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10
Q

side effect(s) of mirtazapine

A

weight gain, sedation

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11
Q

side effect(s) of trazodone

A

priapism

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12
Q

side effect(s) of lithium

A

tremors, weight gain, NEPHROTOXIC, leukocytosis, DIABETES INSIPIDUS

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13
Q

side effect(s) of valproic acid

A

ACUTE PANCREATITIS, HEPATOTOXIC

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14
Q

side effect(s) of lamotrigine

A

stevens-johnson syndrome

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15
Q

name SNRIs and their side effects

A

duloxetine, venlafaxine, desvenlafaxine; hypertension, blurry vision, weight changes, sexual side effects

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16
Q

name some tricyclic antidepressants and list their side effects

A

hypo/hypertension, dry mouth, constipation, confusion, ARRHYTHMIAS, sexual side effects, weight gain

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17
Q

duration of sx for brief psychosis, schizophreniform, schizophrenia

A

brief psychosis: 1 day to 1 month

schizophreniform: 1 month to 6 months
schizophrenia: more than 6 months

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18
Q

symptoms and treatment for serotonin syndrome

A

agitation, hallucinations, HYPERTHERMIA, nausea, diarrhea, shivering, MYOCLONUS (sudden involuntary jerky contraction of muscles); cyproheptadine

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19
Q

mnemonic for atypical antipsychotics

A

it’s atypical for old closets to quietly risper from A to Z (olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone)

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20
Q

side effect(s) of olanzapine

A

diabetes, weight gain (avoid in diabetics and obese pts)

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21
Q

side effect(s) of risperidone

A

increased prolactin, movement disorders

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22
Q

side effect(s) of quetiapine

A

lower incidence of movement disorders, appropriate to use in pts with preexisting movement disorders

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23
Q

side effect(s) of ziprasidone

A

increased risk of QT prolongation (avoid in pts with conduction deficits)

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24
Q

side effect(s) of clozapine

A

agranulocytosis; need to monitor CBC on regular basis, never use as first-line treatment

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25
Q

what type of drug is aripiprazole?

A

partial dopamine agonist

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26
Q

what is the only antipsychotic in pregnancy category B?

A

lurasidone

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27
Q

what are the atypical antipsychotics that are least likely to cause weight gain or metabolic syndrome?

A

aripiprazole, ziprasidone

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28
Q

what atypical antipsychotic should be given in a pt with an existing movement disorder?

A

quetiapine

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29
Q

what atypical antipsychotic should be avoided in pts with conduction defects?

A

ziprasidone

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30
Q

compare parkinsonian and benign essential tremors

A

parkinsonian tremors are improved by action and present at rest, whereas benign essential tremors are seen during goal-directed activities (reaching for an object) and are improved with alcohol

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31
Q

tx for benign essential tremor

A

propranolol

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32
Q

which types of medications are commonly associated with drug-associated photosensitivity?

A

tetracyclines (doxycycline), diuretics, antiemetics, antipsychotics

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33
Q

treatment for uric acid stones

A

alkalinization of urine to pH 6.0-6.5 with oral potassium citrate (uric acid stones are highly soluble in alkaline urine; also, citrate is a stone inhibitor and reduces crystallization)

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34
Q

how do thiazide diuretics affect calcium metabolism?

A

they decrease urinary calcium excretion (they Keep Kalcium; whereas Loops Lose calcium)

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35
Q

what are the signs (including temperature) of severe hypothermia

A

less than 82F (28C), coma, cardiovascular collapse, ventricular arrhythmias

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36
Q

which mutations are typically more severe than the others? missense, nonsense, or splice-site?

A

nonsense/frameshift mutations are typically more severe than missense or splice-site mutations

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37
Q

what class of medication can cause extrapyramidal symptoms other than antipsychotics?

A

antiemetics (metoclopramide)

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38
Q

symptoms of neurofibromatosis, type 2

A

bilateral acoustic neuromas, multiple meningiomas, cafe au lait spots, subcutaneous neurofibromas, cataracts

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39
Q

which pneumococcal vaccine should post-splenectomy pts be given?

A

PCV13 two weeks later, followed by PPSV23 at least eight weeks later

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40
Q

what is pulsus paradoxus and what conditions are associated with it?

A

exaggerated fall in systemic BP greater than 10 mmHg during inspiration; cardiac tamponade, severe asthma, COPD

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41
Q

brain abscess sx

A

fever, severe headaches (nocturnal or morning), focal neurologic changes, seizures

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42
Q

what should be given to exclusively breastfed PRETERM infants?

A

iron (full-term infants are born with adequate iron stores to prevent anemia for first 4-6 months of life)

43
Q

define hypertensive urgency

A

severe hypertension (usually greater than or equal to 180/120 mm Hg) with no sx or acute end-organ damage

44
Q

define hypertensive emergency

A

severe hypertension with acute, life-threatening, end-organ complications (malignant hypertension or hypertensive encephalopathy)

45
Q

define malignant hypertension

A

severe hypertension with retinal hemorrhages, exudates, or papilledema (usually seen in pts with long-standing and uncontrolled HTN)

46
Q

define hypertensive encephalopathy

A

severe hypertension with cerebral edema and non-localizing neurologic sx (cerebral edema is due to breakthrough vasodilation from failure of autoregulation; can present with restlessness, confusion, seizures or coma)

47
Q

what is the recommended maintenance pharmacotherapy for bipolar disorder?

A

lithium or valproic acid plus an atypical antipsychotic (e.g., quetiapine)

48
Q

list the most common primary sites of origin of brain metastasis in order of decreasing frequency

A

lung, breast, unknown primary, melanoma, colon

49
Q

if there are multiple brain metastases, what cancers should you think of?

A

lung cancer and melanoma

50
Q

what mothers should receive GBS prophylaxis with penicillin in addition to those who test positive within 5 weeks of labor?

A

those with history of GBS bacteriuria or UTI anytime during current pregnancy (regardless of treatment), prior birth to an infant with early-onset GBS disease, or unknown GBS status PLUS less than 37 weeks gestation, intrapartum fever, or rupture of amniotic membranes for more than 18 hours

51
Q

is the A-a gradient in PE elevated or decreased? what about arterial CO2?

A

elevated (alveoli are still ventilated but not perfused); decreased due to hyperventilation

52
Q

what type of cancer is most common on eyelid margin and what dermatologic condition is it often confused with?

A

basal cell carcinoma, chalazion (painful swelling that progresses to a painless, nodular rubbery lesion)

53
Q

what does chronic kidney disease do to calcium and phosphate levels and why?

A

low serum calcium and high phosphate. CKD leads to low levels of activated vitamin D, which leads to decreased intestinal calcium absorption. CKD also causes phosphate retention. low calcium and high phosphate leads to secondary hyperparathyroidism.

54
Q

what is the BUN:Cr ratio in prerenal azotemia?

A

greater than 20:1

55
Q

what medications can cause crystal-induced AKI (renal tubular obstruction)?

A

SAMP(L)E sale of CRYSTAL jewelry: Sulfonamides, Acyclovir (IV), Methotrexate, Protease inhibitors, Ethylene glycol

56
Q

what is the purpose of supportive psychotherapy?

A

build up adaptive defensive mechanisms and reinforce coping skills

57
Q

what is the purpose of psychodynamic psychotherapy?

A

exploration of transference (feelings that the pt has toward another person which they unconsciously redirect toward the therapist), break down defense mechanisms

58
Q

what is the purpose of cognitive behavioral therapy?

A

identify and challenge maladaptive thoughts, reduce automatic negative thoughts

59
Q

what medications can cause hypokalemia by increasing potassium entry into cells?

A

insulin and beta-adrenergic agonists (i.e., epinephrine, albuterol); adrenergic agents also stimulate release of insulin

60
Q

does acidosis cause hypo- or hyperkalemia?

A

hyperkalemia

61
Q

what diuretics cause hypokalemia? what do these diuretics also cause?

A

loop and thiazide; metabolic alkalosis

62
Q

loop diuretic side effects mnemonic

A

OH DANG: Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout

63
Q

thiazide diuretics side effects mnemonic

A

HyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia

64
Q

side effects of methotrexate

A

macrocytic anemia (inhibits dihydrofolate reductase = interferes with cellular utilization of folic acid!), stomatitis, HEPATOTOXICITY, interstitial lung disease, alopecia, PANCYTOPENIA (check CBC every 3 months)

65
Q

urethral drainage with catheterization of greater than ______ mL confirms urinary retention

A

150

66
Q

what are the indications for statin therapy?

A

any of the following: clinically significant atherosclerotic disease, LDL greater than 190 mg/dL, age 40-75 with diabetes, and estimated 10-year ASCVD risk greater than 7.5% by pooled cohort equations

67
Q

what is the Cushing’s triad and what is it a sign of?

A

hypertension, bradycardia, respiratory depression; elevated ICP

68
Q

sx of transtentorial (uncal) herniation

A

ipsilateral hemiparesis (compression of contralateral crus cerebri); ipsilateral mydriasis (pupillary dilation), ptosis, and down-and-out gaze (compression of CN3=oculomotor); CONTRALATERAL hemianopsia (compression of PCA), and altered mentation

69
Q

what is the etiology of epidural hematomas vs subdural hematomas vs subarachnoid hemorrhage?

A

epidural: rupture of middle meningeal artery
subdural: rupture of bridging veins
subarachnoid: rupture of aneurysm

70
Q

what intracranial hemorrhage causes a lens shape on CT? crescent shape?

A

lens: epidural hematoma
crescent: subdural hematoma

71
Q

name the paraneoplastic syndromes associated with small cell lung cancer vs. squamous cell lung cancer

A

small cell: SIADH, Eaton-Lambert syndrome, ACTH

squamous cell: PTHrP

72
Q

what are the tx options for diabetic neuropathy and their respective considerations?

A

TCAs (can worsen urinary sx and orthostatic hypotension), gabapentin, NSAIDs (avoid in pts with renal dysfunction)

73
Q

side effects of PTU and methimazole

A

both: agranulocytosis
PTU: HEPATIC FAILURE
methimazole: cholestasis

74
Q

strawberry vs cherry hemangiomas

A

strawberry = infantile; cherry = elderly

75
Q

sx of adult Still’s disease

A

inflammatory disorder wth recurrent high fevers, rash, and arthritis

76
Q

define the following sx of infective endocarditis: janeway lesions, osler nodes, roth spots

A

janeway lesions: macular, erythematous, NONTENDER lesions on palms and soles
osler nodes: PAINFUL, violaceous nodules on fingertips and toes
roth spots: edematous and hemorrhagic lesions of the retina

77
Q

what disease affects the lungs and kidneys?

A

goodpasture’s disease (IgG antibodies against basement membrane of glomeruli and alveoli)

78
Q

most common EKG finding in PE

A

nonspecific ST segment changes

79
Q

what signs should make you suspect massive PE in a postoperative pt?

A

hypotension, jugular venous distention, and new-onset right bundle branch block

80
Q

pathophysiology and sx of creutzfeldt-jakob disease

A

spongiform encephalopathy caused by a prion; rapidly progressive dementia, myoclonus and sharp, triphasic, synchronous discharges on EEG

81
Q

which cardiovascular risk factor is most associated with strokes?

A

hypertension

82
Q

abx for endometritis

A

clindamycin and gentamicin

83
Q

mutations in what genes causes blue sclerae?

A

type 1 collagen

84
Q

what type of pts should not use metformin?

A

renal insufficiency (metformin will accumulate and cause lactic acidosis)

85
Q

which drug class should be added to metformin in diabetic pts who need to lose weight? what is the serious side effect of this drug class?

A

GLP-1 agonists (exenatide or liraglutide); acute pancreatitis

86
Q

mechanism of sulfonylureas in tx of diabetes

A

increase insulin release from pancreas (leads to weight gain because this drives glucose intracellularly)

87
Q

which oral hypoglycemic medication class is contraindicated in CHF patients?

A

thiazoladinediones (pioglitazone); they can increase fluid overload

88
Q

which oral hypoglycemic medication classes are weight-neutral?

A

metformin (biguanide), DPP-IV inhibitors

89
Q

mechanism of DPP-IV inhibitors in tx of diabetes

A

block the degradation of incretins (GI and GLP), which help to increase insulin release and decrease glucagon release from the pancreas

90
Q

which oral hypoglycemic medication class has the greatest risk of hypoglycemia?

A

sulfonylureas

91
Q

when should insulin be added to metformin for tx of diabetes?

A

when HBA1C is greater than 8.5%

92
Q

side effects of insulin therapy

A

significant weight gain, hypoglycemia

93
Q

what medication can be given to treat platelet dysfunction in pts with chronic renal failure?

A

DDAVP (increases release of factor VIII:von Willebrand factor multimers from endothelial storage sites)

94
Q

first-line tx for prolactinoma

A

dopaminergic agonists (carbergoline, bromocriptine) will normalize prolactin levels and reduce tumor size

95
Q

what vitamin deficiency can be caused by carcinoid syndrome?

A

niacin (vitamin B3); serotonin is synthesized in carcinoid cells from tryptophan, which is also used in production of niacin or nicotinic acid

96
Q

sx of niacin (B3) deficiency

A

pellagra (diarrhea, dermatitis, glossitis, angular stomatitis, dementia)

97
Q

what dx should be suspected when epigastric pain is worse when walking and lying supine and is improved with sitting up or leaning forward?

A

acute pancreatitis

98
Q

complications of acute pancreatitis

A

pleural effusion, acute respiratory syndrome, ileus, renal failure

99
Q

what is the most common cause of isolated, asymptomatic elevation of alkaline phosphatase in an elderly pt?

A

paget disease of bone

100
Q

cancer associated with B12 deficiency

A

gastric cancer (anti-parietal cell antibodies cause chronic atrophic gastritis)

101
Q

what are the key differences between sx of ovarian torsion and ruptured ovarian cyst?

A

ovarian torsion causes nausea and vomiting and shows decreased blood flow on Doppler velocimetry, ovarian cyst rupture usually happens immediately after strenuous or sexual activity

102
Q

what are the PFT findings associated with restrictive lung disease?

A

decreased lung volumes, increased FEV1/FVC, low diffusing capacity for carbon monoxide

103
Q

what is dystonia?

A

sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures

104
Q

what is torticollis?

A

a focal dystonia of the SCM muscle that presents as periodic involuntary head turning and head fixation to one side accompanied by a hypertrophied SCM muscle

Step 2 CK UW (12 decks)

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