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Step 2 CK > Medicine 3 > Flashcards

Medicine 3 Flashcards

1
Q

Management of Asx Lymphadenopathy?

A

If ≤1.0 cm + No Symptoms = OBSERVE (even if multiple and painless)

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2
Q

Hemochromatosis patients @increase risk for infection with (3)?

A

Listeria
Vibrio Vulnificus
Yersinia

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3
Q

Patient with persistent respiratory complaints and known viral URI comes with purulent cough, hemoptysis. CXR with many small thin cavities. Dx?

A

Acute Necrotizing PNA with Pneumatoceles (Staph Aureus complication of viral URI)

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4
Q

Endophthalmitis

  • MCC
  • Definition
  • Key PE Finding in Eye
  • W/U (2)
  • Tx (2)
A
  • MCC: s/p cataract surgery
  • Definition: infection within the eye (vitreous)
  • Key PE Finding in Eye: Hypopyon (~severe uveitis)
  • W/U (2): Cx + Gram Stain of Vitreous
  • Tx (2): intra-vitreous Abx —> vitrectomy
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5
Q

4 Anterior Mediastinal Masses

A

4 Anterior Mediastinal Masses

- Teratoma (and other Germ Cells), Terrible Lymphoma, Thymoma, Thyroid

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6
Q

5 Germ Cell Tumors

A

Seminoma (xAFP, aka dysgerminoma in women), Chorio (hCG), Endodermal Yolk (AFP), Teratoma, Embryonal

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7
Q

2 Stromal Tumors

A

Leydig + Sertoli / Granulosa + Theca

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8
Q

3 Transplant Rejection

  • Timing
  • Paph
  • Tx
A
  1. Hyperacute
    - Timing: minutes
    - Paph: pre-formed antibodies –> vascular occlusion –> ischemic/necrosis
  2. Acute
    - Timing: weeks-months
    - Paph: Host CTL against graft –> perivascular lymphocytic vasculitis
    - Tx: Immunosuppresion/steroids
  3. Chronic
    - Timing: months-years
    - Paph: non-self MHC are viewed by host CTLs as self MHCs presenting foreign peptides —> Fibrosis
    - Tx: none, irreversible
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9
Q

Charcot Joint

  • MCC (2)
  • Paph
  • XRay Findings (3)
  • Management
A
  • MCC (2) = DM + B12
  • Paph: xProtopathic/epicritic –> increase trauma
  • XRay Findings (3): effusion, osteophytes, loose fragments
  • Management: underlying conditions + low weight-bearing device
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10
Q

Heat Stroke

  • Criteria (4)
  • Paph
  • Tx
A

Criteria

  1. Temp >104 (40)
  2. Collapse
  3. CNS Dysfunction
  4. End Organ Damage (ARF, Rhabdo, Nose Bleeds)

Paph: elevated central temperature = inability of hypothalamus to regulate body cooling

Tx = rapid cooling with ice water immersion

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11
Q

(T/F) In Sheehan’s postpatum necrosis:

  • Aldosterone level is low
  • Na is low, K is high
A

FALSE; recall the zona glomerulosa is ACTH independent (AngII dependent).

Bottom Line: primary adrenal failure = xAldosterone, but secondary adrenal failure = normal Aldosterone

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12
Q

Paph of Malignant Hyperthermia

A

Autosomal dominant inheritance of abnormal Ca cells in myocytes; increase risk with halothane/succinylcholine

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13
Q

Patient with primary hyperAldo is given spironolactone for control of aldosterone. Develops gynecomastia. Next step?

A

Switch to eplerenone (selective mineralocorticoid antagonist)

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14
Q

Tx of Warm (3) vs. Cold (1) AIHA

A

Warm: steroids –> rituximab –> splenectomy

Cold: warm them!

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15
Q

Describe Heinz bodies. When should you measure G6PD enzyme activity level in a symptomatic patient?

A

Heinz Bodies = ferrous –> ferric state

G6PD levels in ACUTE attack are NORMAL b/c all the abnormal RBC are hemolyzed; measure 120 days later

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16
Q

MCC risk factor for aortic dissection?

A

Systemic HTN

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17
Q

Rx approved for treatment + prophylaxis of secondary amyloidosis?

A

Colchicine

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18
Q

Acromegaly

  • Screening Test
  • Diagnostic Test
A

Screening: IGF1 b/c if low rules out acromegaly

Diagnostic: Glucose load GH suppression test (just like how saline load suppression for hyperAldo and dexamethasone suppression for Cushings)

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19
Q

Triad for Disseminated GC infection?

A

Think PST

  • Polarthritis
  • Skin Rash (PAINLESS vesicopustular lesions)
  • Tenosynovitis
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20
Q

____ worsens wafarin vs. _____ inhibits warfarin.

___ Increase risk for warfarin induced skin necrosis

A

Acetaminophen worsens Warfarin (increase bleeding)

Spinach (VitK = replenish clotting factors) antagonizes Warfarin

Protein C deficiency increases risk for necrosis

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21
Q

Renal Papillary Necrosis

  • 3 Populations
  • UA will show _____
A

Populations

  1. Sickle Cell
  2. DM
  3. Chronic Analgesia Users (HA Patient with Gross Hematuria)

UA will show UNCHANGED RBC

22
Q

Beta blocker toxicity triad + treatment?

A

Bradycardia + AV Block + Wheezing —> Glucagon

23
Q

McMurray’s Sign

A

Palpable, audible snap with fingers in jt groove @knee on extension while giving tibial torsion; sensitive for MEDIAL meinsicus tear

24
Q

4 Classes of Rx –> Esophagitis (BANS)

A

Bisphosphonate
ABx (Doxy)
NSAID
Supplements (KCl, Fe)

25
Q

Patient with signs of hyperthyroidism has non palpable thyroid. Next step? Confirmatory test for exogenous vs. thyroiditis?

A

next step = radioactive uptake (if low = DDx Exogenous vs. Thyroiditis)

  • thyroiditis = increase thyroglobulin in serum b/c damaged cells
  • exogenous = low throgobulin
26
Q

Next best step in patient with progressive proximal muscle pain / weakness. CPK is elevated?

A

TSH

27
Q

Diagnostic test in lactose intolerance?

A

H+ Breath Test

- Lactose = increase lactic acid in GI tract = increase H+ out

28
Q

Osteosclerosis

  • 2 Populations
  • Rinne + Weber Tests
A

Populations = AI process in mid-age women vs. Paget’s disease

Rinne Test: AC

29
Q

Tick-borne Paralysis

  • P/w
  • Next best step
A

P/w: ASYMMETRIC ascending paralysis (≠GBS, no prodrome); occurs 2/2 neurotoxin released from tic

Next step = find tick, it goes away

30
Q

Factorial Design Study Defintion

A

≥2 experimental interventions (3 different anti-HTN Rx)

AND

≥2 end points (SBP and serum K)

31
Q

Rx Indicated and Contraindicated in Prinzmetals

A 
Indicated = CCB
CI = beta blocker (worsen's vasospasm)
32
Q

MC Middle Ear Pathology in AIDS

A

EFFUSION 2/2 obstructive lymphomas/lymphadenopathy; think retracted NON inflamed TM

33
Q

4 Criteria for HCV Treatment***
2 Contraindications to HCV Treatment
2 Rx for Treatment

A

4 Criteria

  1. ≥18
  2. HCV RNA in Serum
  3. Biopsy with evidence of chronic hepatitis (fibrosis)
  4. Compensated liver disease (INR
34
Q

Trichinosis: Bug, Transmission, 3 Phases (with Triad in 3rd Phase)

A 
Bug = Trichinella (roundworm vs. Cystercercosis/Taeina = pork tapework)
Tx = Eating undercooked pork (vs. Cyster = eating eggs in poop)

Phases

  1. Larva enter GI tract (GI complaints)
  2. Larva Migration (Systemic Hypersensitivity) = Splinter Hemorrhage
  3. Larva Enter Skeletal Muscle = Triad of All Phases
    * Myositis
    * Periorbital Edema
    * Eosinophilia

(Don’t confuse with taenea solium = cystercisosis)

35
Q

Review 3 PPx Measures in HIV Patients @____CD4 Counts

A
  1. CD4
36
Q

(T/F) A negative FOBT at visit excludes GI bleed.

A

FALSE, still get a colonoscopy if it’s an older ANEMIC person.

37
Q

Patient with inferior MI infarct is started on Nitro drip. Found to be hypotensive. Next 2 steps?**

A
  1. Stop NITRO (CI in RV MI, Aortic Stenosis, PDE-I use)
  2. Start IVF

**Recall, IVF are the mainstay of RV Infarct management b/c the body is preload dependent

38
Q

When to start DM screening?

A

ADA recommends @45 in asymptomatic patients***

39
Q

Classification of AFibb

A
  1. Paroxysmal: recurrent (≥2x) terminating within 7 days
  2. Persistent: >7 days duration
  3. Longstanding Persistent: ≥1 year duration
  4. Permanent: persistent without plans for rhythm control
40
Q

Adult with epiglottitis has all immunizations?

A

GAS

41
Q

DDx Thyrotoxicosis with low RIUS? (4)

A
  1. Subacute Granulomatous Thyroiditis (DeQuervain’s PAINFUL)
  2. Subacute Lymphocytic Thyroiditis (Painless)
  3. Iodine Induced Thyrotoxicosis
  4. Exogenous levothyroxine
42
Q

What does struma ovarii produce?

A

Thyroid hormones (≠TSH)

43
Q

MCC PNA in NH Residents?

A

Still Strep Pneumo!!!

This is why we give PNA vaccine >65

44
Q

What three ∆Lytes cause QT Prolonagation?

A

HypoK
HypoCa
HypoMg

45
Q

EKG ∆ with:

  • HypoK (4)
  • HyperK (2)
A

HypoK

  • T Wave Flattening
  • U Waves
  • increase QT Interval
  • PVCs

HyperK

  • Tall peak T waves
  • Prolongation of QRS complex
46
Q

Pt with generalized LE swelling, pain and linear streaks of erythema. Dx? Tx?

A

Dx = Cellulitis

Start Nafcillin

47
Q

How often to screen for lipids after 35 / 45 ?

A

q5 years

48
Q

3 Most important factors for patient survival in sudden cardiac arrest?

A
  1. Adequate Bystandard CPR
  2. Prompt Rhythm Analysis
  3. Defibrillation

NOT time to cath lab

49
Q

MC Complication of Radiactive I131 for Grave’s?

A

HYPOTHYROIDISM (not worsening of optho or hypoPTH (surgery))

Note, corticosteroids before and after RI131 can decrease optho consequences

50
Q

AEIOU Indications for Dialysis

A
  1. Acidosis (refractory metabolic acidosis
51
Q

HOCM murmur increases on intensity with _______ and decreases on intensity with ________. What other murmur does this and why?

A

HOCM increases with valsalva (decrease VR = decrease LVEDV = increase obstruction) and decreases with squatting (increase afterload = increase LVEDP/distention)

MVP does the same

  • decrease VR = decrease LVEDV/distention = decrease strain on chorda tendinae = easier to prolapse
  • increase VR = increase LVEDV/distention = increase strain on chorda tendinae = hard to prolapse, keeps valve shut
52
Q

Most effective way of preventing UTI in neurogenic bladder?

A

Intermittent cath / diapers

Step 2 CK (8 decks)

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