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Dedicated - Step 2 > Last Minute > Flashcards

Last Minute Flashcards

1
Q

6 possible exogenous causes of hyponatremia?

A 
Oxytocin
Surgery
Narcotics
Inappropriate IV fluid administration
Diuretics
Antiepileptics
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2
Q

ECG findings in electrolyte disturbances?

A

HyperK - tall, tented T waves
HypoK - loss of T waves/T-wave flattening and U waves
HyperCa - QT shortening
HypoCa - QT prolongation

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3
Q

Mainstays of therapy for CHF?

A

Sodium restriction
Diuretics (furosemide, spironolactone, metolazone)
ACEIs (first line)
Beta-blockers (if stable)

Digoxin (ONLY moderate-to-severe CHF with low EF or systolic dysfunction)
Vasodilators

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4
Q

Most common type of esophageal cancer and cause? Second most common and causes?

A

Most common - adenocarcinoma 2/2 long-standing reflux and Barrett esophagus

2nd most common - SqCC - smoking and alcohol

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5
Q

Screen for hereditary hemochromatosis?

A

Transferrin saturation test (serum iron/TIBC) and ferritin

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6
Q

Cause of bronchiolitis vs. croup?

A

B - RSV, parainfluenza, influenza

C - parainfluenza, influenza

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7
Q

Rx bronchiolitis vs. croup?

A

B - humidified O2, bronchodilators (?), ribavirin if severe

C - dexamethasone, nebulized epinephrine, humidified O2

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8
Q

3 sequelae of strep infection? Which are prevented by treatment?

A

Rheumatic fever*
Scarlet fever*
PSGN

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9
Q

Odds Ratio =?

A

AD/BC

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10
Q

RR = ?

A

(A/A+B)/(C/C+D)

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11
Q

Attributable Risk?

A

A/A+B - C/C+D

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12
Q

The P-value reflects the likelihood of making a ___ error.

A

Type 1

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13
Q

Causes of low maternal serum AFP?

A

Down syndrome
Inaccurate dates (most common)
Fetal demise

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14
Q

Causes of high maternal AFP?

A

Neural tube defects
Ventral wall defects
Inaccurate dates
Multiple gestation

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15
Q

Always perform ___ before ___ in the setting of third trimester bleeding in case placenta previa is present.

A

U/S; pelvic exam

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16
Q

Humeral fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Wrist drop
Back of forearm and hand (first 3 digits)
Radial

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17
Q

Elbow dislocation may present with what motor/sensory dysfunction? Nerve involved?

A

Claw hand
Front and back of last 2 digits
Ulnar nerve

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18
Q

Carpal tunnel syndrome and humeral fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired pronation, thumb opposition
Palmar surface of hand (first 3 digits)
Median nerve

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19
Q

Upper humeral dislocation or fracture may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired abduction, lateral rotation
Lateral shoulder
Axillary nerve

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20
Q

Knee dislocation may present with what motor/sensory dysfunction? Nerve involved?

A

Impaired dorsiflexion/eversion, possible foot drop
Dorsal foot, lateral leg
Peroneal nerve

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21
Q

Compare the presentation, symptoms/signs, and treatment of LCPD vs. SCFE.

A

LCPD: 4-10 y/o, short male with delayed bone age; Rx with orthoses

SCFE: 9-13 y/o, overweight M adolescent; Rx with surgical pinning

BOTH have knee, thigh, groin pain, limp

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22
Q

Pulsatile abdominal mass + hypotension = ruptured AAA until proven otherwise. Immediate next step?

A

Immediate laparotomy

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23
Q

BPH can present as acute renal failure. Patients have what exam findings? Management?

A

Distended bladder and bilateral hydronephrosis on U/S without “medical” renal disease

Drain the bladder first (cath), then TURP

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24
Q

Metabolic derangements caused by thiazide diuretics?

A

Hyper: Ca, glycemia, uricemia, lipidemia

Hypo: Na, K (metabolic alkalosis), volemia

Watch out for sulfa allergy

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25
Q

Metabolic derangements of loop diuretics?

A

Hypokalemic metabolic alkalosis
Hypovolemia
Ototoxicity
Hypocalcemia

Watch out for sulfa allergy

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26
Q

Metabolic deranagemnets of carbonic anhydrase inhibitors?

A

Metabolic acidosis

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27
Q

What are the potassium-sparing diuretics?

A

Spironolactone

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28
Q

Benzodiazepine OD - antidote?

A

Flumazenil

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29
Q

Beta blocker OD - antidote?

A

Glucagon

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30
Q

Cholinesterase inhibitor OD - antidote?

A

Atropine, pralidoxime (anticholinergics)

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31
Q

Copper or gold OD - antidote?

A

Penicillamine

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32
Q

Lead OD - antidote?

A

Edetate (EDTA); succimer in children

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33
Q

Methanol or ethylene glycol OD - antidote?

A

Fomepiazole, ethanol

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34
Q

Muscarinic blockers - antidote?

A

Physostigmine

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35
Q

Quinidine or TCA OD - antidote?

A

Sodium bicarbonate (cardioproective)

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36
Q

Aspirin OD can be fatal and classically leads to what metabolic derangements

A

Both metabolic acidosis and respiratory alkalosis

[Look for coexisting tinnitus, hypoglcyemia, vomiting, history of swallowing pills

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37
Q

Alkalosis and acidosis can cause symptoms of K and/or Ca derangement. What should be done in these settings and what derangements are caused?

A

Alkalosis - hypoK, hypoCa

Acidosis - hyperK, hyperCa

Rx the acid-base disturbance, not the levels

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38
Q

What can make hypoCa and hypoK unresponsive to replacement therapy?

A

Hypomag

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39
Q

Hemolysis can falsely elevate what lab?

A

K

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40
Q

Hypoalbuminemia can falsely decrease what lab?

A

Ca

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41
Q

Hyperglycemia can falsely decrease what lab?

A

Na

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42
Q

“Bitot spots”

A

Vitamin A deficiency

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43
Q

Cherry-red spot on the macula WITHOUT HSM

A

Tay-Sachs

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44
Q

Cherry-rod spot on the macula WITH HSM

A

Niemann-Pick disease

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45
Q

Cafe-au-lait spots with normal IQ

A

NF

46
Q

Cafe-au-lait spots with intellectual disability

A

McCune-Albright or Tuberous sclerosis

47
Q

Postpartum fever unresponsive to broad-spectrum ABX?

A

Septic pelvic thromboplehbitis

48
Q

Low grade fever in the first 24 hours after surgery?

A

Atelectasis

49
Q

Claudication and atrophy of the buttocks with impotence?

A

Aortoiliac occlusive disease (aka Leriche syndrome)

50
Q

True or false - the body does not compensate beyond a normal pH.

A

True

51
Q

Should you give bicarbonate to a patient with acidosis?

A

For boards, almost never. First try IV fluids and correction of the underlying disorder. If all other measures fail and pH remains less than 7.0, then give bicarbonate.

52
Q

Signs and symptoms of hyponatremia?

A 
Lethargy
Seizures
Mental status changes or confusion
Cramps
Anorexia
Coma
53
Q

Rx SIADH if water restriction fails?

A

Demeclocycline (induces nephrogenic DI)

54
Q

Rate of correction in chronic, severe symptomatic hyponatremia?

A

Should not exceed 0.5 to 1.0 mEq/L/hr

55
Q

Once glucose is >200, sodium decreases by ___ for each rise of ___ in glucose.

A

1.6 mEq/L; 100 mg/dL

56
Q

Signs and symptoms of hypernatremia?

A

AMS
Seizures
Hyperreflexia
Coma

57
Q

Rx hypernatremia?

A

Water replacement (usually severely dehydrated) -> NS, then switch to 1/2 NS when hemodynamiccaly stable

NEVER D5W

58
Q

Signs and symptoms of hypokalemia?

A 
Muscle weakness (paralysis, ventilatory failure, ileus, hypotension)
EKG - T wave loss/flattening, U waves, PVCs, PACs, tachyarrhythmias
59
Q

Potassium levels should be monitored carefully in all patients taking ___.

A

Digoxin

60
Q

Signs and symptoms of hyperkalemia?

A

Weakness and paralysis

EKG - tall peaked T waves, QRS widening, PR prolongation, loss of P waves, sine wave

61
Q

First consideration in an asymptomatic patient with a normal EKG and hyperkalemia?

A

Hemolysis of lab specimen -> repeat the test

62
Q

Rx hyperkalemia

A

In general, decrease K intake and given Kayexalate (resin)

If >6.5 or cardiac toxicity is apparent ->
1. Calcium gluconate (cardioprotective)
2. Sodium bicarbonate (alkalosis -> shifts K inside cells)
3. Glucose with insulin (ditto)
Beta2 agonists are an option
Dialysis if failure or renal failure

63
Q

Signs and symptoms of hypocalcemia?

A

Tetany (Chvostek, Trousseau)
Convulsions/seizures
EKG - QT prolongation

64
Q

Signs and symptoms of hypercalcemia?

A 
Often asymptomatic
Osteopenia
Kidney stones/polyuria
Abdominal pain, N/V, constipation, anorexia
Depression, psychosis, AMS
EKG - QT shortening
65
Q

Rx hypercalcemia

A
  1. IV fluids
  2. Once well-hydrated, give furosemide (calcium diuresis)
    +/- phosphorus administration, calcitonin, bisphosphonates, plicamycin, prednisone, etc.
66
Q

In what clinical scenario is hypomagnesemia usually seen?

A

Alcoholism

67
Q

Signs and symptoms of hypomagnesemia?

A

Similar to hypocalcemia (prolonged QT, tetany)

68
Q

Signs and symptoms of hypermagnesemia?

A

Decreased DTRs, hypotension, respiratory failure

Rx of preeclampsia, renal failure

69
Q

Maintenance fluid of choice for patients who are not eating?

A

Half normal saline with 5% dextrose (adults)

Add KCl to prevent hypokalemia

70
Q

What may happen if you give glucose WITHOUT thiamine?

A

Precipitate Wernicke (give thiamine BEFORE glucose)

71
Q

Rx bleeding esophageal varices?

A
  1. ABCs
  2. IV fluids and blood if needed.
  3. Correct clotting factor deficiencies with FFP, fresh blood, and vitamin K, if needed.
  4. Upper endoscopy -> sclerotherapy (cauterization, banding, or vasopressin)
72
Q

Rx varices with no history of bleeding?

A

Non-selective beta blockers (propranolol, nadolol, timolol) to relieve portal HTN (so long as there is no contraindication)

73
Q

If a question asks you to calculate the RR from retrospective data, what is the answer?

A

None of the above or cannot be calculated

74
Q

Positive skew is an asymmetric distribution with an excess of ___ values; the tail of the curve is on the ___. Relationship between mean, median, and mode?

A

High; right; mean > median > mode

75
Q

The incidence of a disease is equal to the absolute or total risk of developing a condition (as distinguished from relative or attributable risk).

A

Cool beans.

76
Q

What test compares percentages or proportions (non-numeric or nominal data)?

A

Chi-squared test

77
Q

What is a type II error?

A

Null hypothesis is accepted when in fact it is false (null should be rejected but isn’t)

78
Q

Rx MI.

A
  1. Early reperfusion (fibrinolysis, PCI, etc.)
  2. EKG monitoring (if VTach -> amiodarone)
  3. O2 (>90%)
  4. Morphine
  5. Aspirin
  6. Nitroglycerin
  7. Beta blockers (unless contraindicated)
  8. Clopidogrel
  9. Unfractionated or LMWH (unstable angina, cardiac thrombus, CHF on echo, unless contraindicated)
  10. ACEI or ARB within 24 hours
  11. Statin
79
Q

Presentation of variant (Prinzmetal) angina? Rx?

A

Pain at rest (unrelated to exertion) + ST-segment elevation with NORMAL cardiac enzymes

Responds to nitroglycerin, Rx long term with CCBs

80
Q

Late diastolic blowing murmur best heard at the apex

+/- opening snap, loud S1, AF, LA enlargement, pulmonary hypertension

A

Mitral stenosis

81
Q

Early diastolic decrescendmo murmur best heard at apex

+/- widened pulse pressure, LVH, LV dilation, S3

A

Aortic regurgitation

82
Q

Harsh systolic ejection murmur, best heard at aortic area, radiates to carotids

+/- slow pulse upstroke, S3/S4, ejection click, LVH, cardiomegaly, syncope, angina, heart failure

A

Aortic stenosis

83
Q

Midsystolic click, late systolic murmur

+/- panic disorder

A

Mitral prolapse

84
Q

Holosystolic murmur that radiates to the axila

+/- soft S1, LAE, PH, LVH

A

Mitral regurgitation

85
Q

Rx mitral stenosis

A

Balloon valvotomy or surgery if severe

Medical management (diuretics, digoxin, beta blockers) is ONLY adjunctive.

86
Q

Rx mitral regurgitation?

A

Corrective surgery if indicated (flail leaflet, severe regurgitation)

Vasodilators (nitroprusside, hyralazine) if symptomatic

AFIb is common

87
Q

Rx aortic stenosis

A

Aortic valve replacement if symptomatic (essentially all patients)

88
Q

Rx aortic regurgitation?

A

Replacement or repair if symptomatic, or asymptomatic with certain indications (progressive LV enlargement)

Vasodilators to reduce hemodynamic burden

89
Q

Rx superficial thrombophlebitis (erythema, tenderness, edema, palpable clot in superficial vein)

A

NSAIDs and warm compress

90
Q

How are heparin, warfarin, and aspirin monitored?

A

Heparin -> PTT
Warfarin -> PT/INR
Aspirin -> Bleeding time (platelet function)

Note - LMWH doe snot affect any of these

91
Q

Reverse heparin/LMWH?

A

Protamine

92
Q

Reverse warfarin?

A

FFP (immediate) and/or vitamin K (several days)

93
Q

Reverse aspirin?

A

Platelet transfusions

94
Q

Rx acute CHF?

A

Inpatient
O2, diuretics, positive inotropes
Digoxin if stable
IV sympathomimetics (dobutamine, dopamine, amrinone) if severe

95
Q

Rx 1st degree heart block

A

None; avoid BBs, CCBs (slow conduction)

96
Q

Rx 2nd degree heart block

A

Mobitz type I - pacemaker or atropine only if symptomatic

Mobitz type II - pacemaker in all patients

97
Q

Rx 3rd degree heart block

A

Pacemaker

98
Q

Rx WPW syndrome

A

Procainamide or quinidine

NO digoxin or verapamil

99
Q

Rx VTach

A

Pulseless - immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine

Pulse - amiodarone and synchronizde cardioversion

100
Q

Rx VFib

A

Immediate defibrillation followed by epi, vasopressin, amiodarone, or lidocaine

101
Q

Rx PVCs

A

Usually not treated; if severe and symptomatic, BBs or amiodarone

102
Q

Major risk factors for CHD?

A

Age (M 45+, F 55+ or with premature menpause)
Family history of premature heart attacks (MI or sudden death in F/first degree M relative <55, mother/first degree F relative <65)
Cigarette smoking
HTN
DM
Low HDL (<40)

103
Q

LDL = ?

A

Total cholesterol - HDL - (TG/5)

104
Q

Macule and patch?

A

Flat spot (<1 cm and >1 cm)

105
Q

Papule and plaque?

A

Solid, elevated (<1 cm, >1 cm)

106
Q

Dry, well-circumscribed, silverly, scaling papules and plaques that are NOT pruritic

A

Psoriasis

107
Q

Rx pityriasis rosea?

A

Reassurance

108
Q

Causes of erythema multiforme?

A

Sulfa drugs, penicillins
Herpes
SJS if severe

109
Q

Squamous cell cancer often develops in areas with pre-existing ___ or burn scars.

A

Actinic keratoses (hard, sharp, red, often scaly lesions in sun-exposed areas)

110
Q

Best prognostic factor of malignant melanoma?

A

Thickness of tumor

111
Q

Potential concern of giving beta-blockers to hypoglycemic diabetic patients?

A

May mask hypoglycemia symptoms (caused by catecholamine release)

Dedicated - Step 2 (22 decks)

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