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Step 2 CK > Fourth 100 > Flashcards

Fourth 100 Flashcards

1
Q

Pt c/o diffuse headache, worse when leaning forward. No edema, but JVD is obvious.
Top diagnosis?
Treatment?

A

SVC syndrome - something is compressing the vena cava.
Top cause - malignancy (either lymphoma or lung CA)

Treatment - treat the CA. Usually radiation.

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2
Q

Patient presents with both UMN and LMN issues - diagnosis?
Usual age of onset?
Next step?

A

ALS
Over 40
Nerve conduction, EMG, neuroimaging to rule out other causes

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3
Q

Common cause of complex partial seizures in adults?

A

Temporal lobe epilepsy

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4
Q

Patient with multiple issues, including shiny, hairless thin-skinned foot. Cause of the foor presentation?
Next step?
How to interpret this?

A

Peripheral vascular disease (he prob has diabetes or something similar)
Ankle-Brachial Index
Normal: 1.0-1.3 … PVD: 0.4-0.9 … Severe ischemia: <0.4

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5
Q

What drug can be given prophylactically to minimize gallstone formation?

A

Ursodeoxycholic acid

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6
Q

How will phosphate & calcium levels change with CKD?

How will the parathyroids react?

A 
High phosphorus (phosphate retention by kidneys) and 
Low calcium (abnormal Vit. D processing by kidneys)

Parathyroids will hypertrophy

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7
Q

Plasma and urine osmolalities with SIADH?

A

Plasma osmo - low (200)

Urine sodium - high (>40)

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8
Q

Normal values for plasma osmo, urine osmo and urine sodium

A

Plasma osmo: 275-290
Urine osmo: 50-1400
Urine sodium: 30-40

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9
Q

What medication to give for overflow incontinence?

A

Cholinergic agonist (bethanechol)

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10
Q

First line treatment to prevent esophageal varicies?

What then?

A

B-blockers

If this fails, TIPS, band ligation or nitrates

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11
Q

Potential lethal SE of PTU (and what other drug)?
Next steps?
How will labs influence decision?

A

Agranulocytosis

1) stop PTU or methimazole
2) throat culture, abx (incl pseudomonas), and WBC count
3) if WBC1500, look for another source of throat infxn

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12
Q

Reason for bone issues with Vit. D deficiency? In adults?

In kids?

A

Defective mineralization of bone in adults, bone AND cartilage in kids

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13
Q

What are the 3 forms of calcium?
Which one is the active form?
How does pH affect these?

A

Ionized (45), albumin-bound (40) and anion-bound (15)
Ionized Ca
Increased pH (alkalosis) increases albumin affinity, so that goes up, ionized Ca goes down - presents with hypocalcemia

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14
Q

First step with asymptomatic hyperparathyroidism?

A

Sestamibi scan (scan to localize the adenoma and assess its weight in relation to the gland)

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15
Q

Previously healthy pt with new HTN, weakness, muscle cramps and fatigue - top of ddx?
What is causing the symptoms?

A

Hyperaldosteronism

Body hangs on to sodium (HTN) with subsequent loss of potassium (cramps, weakness)

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16
Q

Compare DI with SIADH & polygenic polydipsia

Treatments?

A

DI - dilute urine with high plasma osmo, treat w DDAVP (nasal)
SIADH - conc. urine (high osmo) w low plasma osmo, treat with demeclocycline
Poly.Polydipsia - dilute urine with dilute plasma, stop drinking!

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17
Q

Dilute urine with high plasma osmo - next step?

What will that tell us?

A

DI - give water deprivation followed by vasopressin (AVP) test

If urine osmo increases with AVP, think CENTRAL DI
If urine osmo stays unchanged, think NEPHROGENIC DI

18
Q

Treatment for nephrogenic DI?

A

Indomethacin (NSAID) and HCTZ

If lithium is the cause, treat with Amiloride

19
Q

Symptomatic sudden hyperthyroidism - initial treatment?

What then?

A

Beta blocker (propranolol)

Radioactive iodine (unless pregnant, then PTU)

20
Q

Which antibodies are present in pts with Hashimoto’s?

A

Anti-TPO Abs

21
Q

Pts with Hashimoto’s have increased risk for what type of CA?

A

Lymphoma of the thyroid

22
Q

Patient presents with new onset muscle pains, high CK, & weakness - top of ddx?

A

Hypothyroidism

23
Q

Think of what when a patient prefers ice water?

A

Diabetes insipidus

24
Q

Top 2 causes of benign thyroid nodules?

A
  1. Colld nodules
  2. Follicular adenoma

(Most common MALIGNANT = papillary)

25
Q

How to spot Bartter syndrome?

A

Same as renin-secreting tumour (high renin, high aldosterone) but with normal sodium (renin tumour will have high sodium)

26
Q

Test for thalassemia?

A

Hemoglobin electrophoresis

27
Q

Bleeding in hospital with normal everything and NPO of a few days…?

A

Vit. K deficiency

28
Q

Key words: Auer rods

A

AML

29
Q

Common side effect of acyclovir?

A

Nephrotoxicity (renal tubular obstruction)

30
Q

Treatment for early Parkinson’s with mainly tremor?

A

Trihexyphenidyl (Try heksie, funny ding)

31
Q

Key words: oligoclonal bands in CSF

A

Multiple sclerosis

32
Q

What is a contraindication to the use of succinylcholine?

What do you use in the place of it then?

A

Hyperkalemia. It should not be given to pts with this, or at risk for it (crush, burn etc)

Vecuronium or ..curonium

33
Q

Pt presents with headache, periorbital edema, CN palsies(!) & low-grade fever - diagnosis?
Next step (to diagnose)?
Treatment?

A

Cavernous sinus thrombosis

MRI or CT scan of orbits with contrast

IV broad-spectrum Abx

34
Q

Mst appropriate test for lung function with GBS?

A

Vital capacity (risk is specially high if below 15mL/kg)

35
Q

Cancer assoc with chronic wound sites?

A

SCC

36
Q

How will a Baker’s cyst be described?

A

Inflamed synovium behind the knee

37
Q

Pt presents from a cruise ship or hotel with lung complaints - think what first?

Treatment?

A

Legionella

Azithromycin

38
Q

Chronic pelvic pain with urinary urgency and nothing else - diagnosis?
What will be seen on cystoscopy?

A

Interstitial cystitis

Submucosal petechiae or ulcerations

39
Q

Side effects of methotrexate?

A

HAMMER

Hepatotoxicity, Anemia (Megaloblastic / Macrocytic), Enterstitial lung disease, Rash

40
Q

Treatment for EPS symptoms following haldol?

A

For non-NMS: diphenhydramine & anticholinergics (trihexyphenidyl or benztropine)

NMS: dantrolene

Step 2 CK (6 decks)

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