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USMLE Step 2 CK > Medicine > Flashcards

Medicine Flashcards

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USMLE® Step 1 flashcards
1
Q

Polymyalgia rheumatica

QID: 3317

A

Age >50, subacute to chronic (1+ month) pain in shoulder and hip girdles
- Elevated ESR (>40)

  • Tx: Low dose prednisone
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2
Q

Fibromyalgia

QID: 3317

A
  • Widespread pain
  • POINT TENDERNESS
  • Tx: Regular aerobic exercise + good sleep hygiene
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3
Q

Irritable bowel syndrome

QID: 4595

A
  • ROME diagnostic criteria: recurrent abd pain/discomfort for 3+ days/month for past 3 months with at least 2 of: improvement with BM, change in frequency of stool, change in form of stool
  • Normal colonic mucosa on colonscopy
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4
Q 
Toxic adenoma(TA)/Toxic Multinodular goiter (MNG)
QID: 4307
A
  • Most common causes of hyperthyroidism after Graves
  • Activating mutations at TSH receptor –> Follicular hyperplasia
  • Initial tx: beta blocker + thionamide (MMI or PTU)
  • Definitive tx: RAI or surgery
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5
Q

Thyroid hormone effects

QID: 4307

A
  • leads to increased osteoclastic bone resorption

- Cardiovascular effects = tachycardia, increased SBPs, increased pulse pressure, tachyarrhythmias (AFib)

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6
Q

Atheroembolism

QID: 2310

A

Complication post cardiac cath or vascular procedure

Skin manifestations:

  • blue toe syndrome (cyanosis with intact pulses)
  • livedo reticularis (reticular, lacy skin discoloration/erythema that BLANCHES)
  • Gangrene and ulcers
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7
Q

Polycythemia vera

QID: 2883

A
  • HTN (incr. blood viscosity),
  • ERYTHROMELALGIA (burning cyanosis in hands/feet),
  • TRANSIENT VISUAL DISTURBANCES

PE: Facial plethora (ruddy cyanosis) + Cyanosis
Complications: Thrombosis + Myelofibrosis/Acute leukemia
Tx: Phlebotomy + Hydroxyurea

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8
Q

Tumor lysis syndrome

QID: 2641

A

Initiation of cytotoxic chemo

  • Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
  • Comp: AKI (due to uric acid and phos) + Arrhythmias
  • IVF + Allopurinol/rasburicase
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9
Q

Dehydroepiandrosterone sulfate (DHEAS)

A

produced predominantly in the adrenals

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10
Q

Acute respiratory distress syndrome (ARDS)

QID: 3020

A

RF: infection, trauma, massive transfusion, acute pancreatitis

Pathophys: lung injury with leakage of proteins and inflammatory cytokines and neutrophils into alveoli

  • Decreased lung compliance
  • V/Q Mismatch
  • Pulmonary HTN - Hypoxic vasoconstriction, parenchymal destruction, loss of surfactant with alveolar collapse
  • Increased A-a gradient

Dx: B/l lung opacities (noncardiogenic pulm edema)
- Hypoxemia with PaO2/FiO2 < 300 mmHg

Tx: Mechanical ventilation (low TV, high PEEP, permissive hypercapnia

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11
Q

Ulcerative colitis

QID: 2581

A
  • Pseudopolyps, mucosal and submucosal inflammation, crypt abscesses
  • Comp: Toxic megacolon, PSC, colorectal CA, Erythema nodosum, PYODERMA gangrenosum, spondyloarthritis
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12
Q

Pneumococcal vaccination

QID: 3892

A

PPSV23 x ONCE = adults < 65, current smokers or chronic medical conditions (heart/lung dz, DM, chronic liver dz)

PCV 13 + PPSV23 (6-12 mo later) x ONCE = ALL adults > 65

SEQUENTIAL PCV13+PPSV23 = high risk patients (CSK leak, cochlear implants, sickle cell disease, asplenia, Immunocompromised (HIV/malignancy), CKD)

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13
Q

Tdap

QID: 3892

A

Patient gets Td booster q10 years with one time dose of Tdap in place of Td

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14
Q

Prerenal azotemia/AKI

QID: 4435

A
  • Can be 2/2 to diuretic use

Features:

  • Increased Cr,
  • BUN:Cr > 20
  • Elevated AGMA - 2/2 uremia
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15
Q

Glucocorticoids and BUN

QID: 4435

A

Steroids are catabolic –> Increased BUN, no effect on Cr

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16
Q

Early localized Lyme (days to 1 mo)

QID: 3243

A
  • Erythema chronicum migrans (ECM), Fatigue + HA, myalgia + arthralgia
  • ECM is pathognomonic for lyme; allows for clinical dx
  • No serology (too insensitive)
  • IgM in 1-2 weeks
  • IgG in 2-6 weeks
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17
Q

Early disseminated Lyme (weeks to months)

QID: 3243

A
  • Multiple ECM, Unilateral or B/L Bell’s palsy, meningitis, carditis (AV block), migratory arthralgias
  • Test serology
18
Q 
Late Lyme (months to years)
QID: 3243
A
  • Arthritis, encephalitis, peripheral neuropathy

- Test serology

19
Q

Peripheral artery disease (PAD)

QID: 8927

A

PAD with intermittent claudication is a strong predictor for future risk of cardiovascular M&M

20
Q

Acute angle-closure glaucoma (AACG)

QID: 3429

A
  • Sudden onset eye pain, headache, nausea
  • Conjunctival erythema, corneal opacification, and non-reactive, mid-dilated pupil

Dx: Gonioscopy (gold standard) or ocular tonometry (to measure IOP)

21
Q

Infectious mononucleosis

QID: 3007

A
  • Tonsillitis/pharyngitis WITH exudates
  • Posterior or diffuse cervical LAD
  • Hepatosplenomegaly (no contact sports for 4+ weeks)
  • RASH with amoxicillin
22
Q

Factor V Leiden (FVL)

QID: 3999

A
  • MOST COMMON inherited hypercoag disorder
  • AD Point mutation in factor V gene –> unable to respond to inactivation by activated protein C –> continued thrombin formation and slow degrad. of factor 8
  • PT/PTT can be normal
23
Q 
Hereditary telangiectasias (Osler-Weber-Rendu)
QID: 4447
A
  • Diffuse telangiectasias, recurrent epistaxis, widespread AVM formation (mucous membranes, skin, GI tract, and less in liver, brain, and LUNG)
  • Lung AVMs –> R to L SHUNT + chronic hypoxemia and reactive polycythemia, hemoptysis
24
Q

Polycythemia

QID: 4447

A

Causes:

  • Myeloproliferative (PV)
  • Hemoconcentration (loss of plasma volume)
  • Reactive (hypercarbia, CO poisoning

Can cause:
- Pulmonary HTN (due to increased viscosity)

25
Q

Alpha-1 Antitrypsin deficiency

QID: 2919

A
  • Leads to COPD and liver (cirrhosis, HCC) and skin (panniculitis) disease

Dx: Serum AAT and PFTs
Tx: Bronchodilators and steroids, transplant

26
Q

Zollinger-Ellison syndrome/Gastrinoma

QID: 3591

A
  • Patient with multiple ulcers and thickened gastric folds on endoscopy
  • Common in MEN1
  • Very distal ulcers (e.g. jejunum)
  • Dx: Fasting gastrin off PPI for 1 week > 1000 pg/mL diagnostic; if equivocal, secretin stimulation test (normally inhibits gastrin, but stimulates in gastrinoma)
27
Q

Calcium infusion study

QID: 3591

A
  • Increases serum gastrin in those with gastrinoma
  • Used after negative secretin stimulation test in patient suspected of having gastric acid hypersecretion due to gastrinoma
28
Q

Serum chromogrannin A

QID: 3591

A
  • Used in WELL-DIFFERENTIATED NEUROENDOCRINE TUMOR

- High in carcinoid, hyperthyroidism, chronic atrophic gastritis, and even chronic PPI therapy

29
Q

MEN 1

QID: 2630

A

AD disease with 3 P’s

  • Parathyroid adenomas/hyperplasia
  • GI/Pancreatic endocrine tumors (e.g. Gastrinoma/ZES)
  • Pituitary adenomas
30
Q

Milk alkali syndrome

QID: 2630

A
  • Hypercalcemia, renal insufficiency, and metabolic alkalosis
31
Q

Familial hypocalciuric hypercalcemia

QID: 2165

A

Mutation in CaSR –> low sensing of serum Ca with higher level needed to inhibit PTH –> uninhibited PTH –> reuptake of Ca in urine
- Asymptomatic hypercalcemia, elevated or inappropriately normal PTH, low Uca excretion

vs. primary hyperparathyroidism
- High Uca/Ucr ratio

32
Q

Focal segmental glomerulonephritis

QID: 2223

A

Associated with:

  • AA and hispanic ethnicity
  • Obesity
  • HIV and heroin abuse
33
Q

Membranous nephropathy

QID: 2223

A

Associated with:

  • Adenocarcinoma (breast and lung)
  • NSAIDs
  • Hepatitis B
  • SLE
34
Q

Membranoproliferative glomuerlonephritis

QID: 2223

A

Associated with:

  • Hepatitis B and C
  • Lipodystrophy
35
Q

Minimal change disease

QID: 2223

A

Associated with:

  • NSAIDs
  • Lymphoma (usually Hodgkin)
36
Q

IgA nephropathy

QID: 2223

A

Associated with:

- URI

37
Q

Spherocytes

QID: 2248

A

Can be seen in:

  • Autoimmune hemolytic anemia (AIHA): Positive Coombs, negative FHx
  • Hereditary spherocytosis (negative coombs + positive family history)
38
Q

Hypovolemia

QID: 3958

A
  • Most sensitive indicator of volume status = urine sodium

- RAA system –> aldosterone –> decreased urine sodium –> decreased UNa –> Decreased FeNa <1%

39
Q

BUN/Cr in GI Bleed

QID: 4303

A

Increased BUN/Cr due to increased urea production (intestinal breakdown of Hgb) and increased reabsorption of urea (due to hypovolemia)

40
Q

Right ventricular MI

QID: 2726

A
  • Inferior wall MI with ST elevations in II, III, aVF
  • JVD and Kussmaul sign (increased JVD on inspiration)
  • Hypotension worsens with NTG therapy
41
Q

Pulmonary embolus

QID: 2726

A
  • ECG findings with nonspecific ST or T changes, new onset RBBB, or S1Q3T3 pattern
42
Q

Nitrites

QID: 4741

A
  • Systemic vasodilation > coronary vasodilation

- Lowers preload and LV end-diastolic volumes

USMLE Step 2 CK (3 decks)

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