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USMLE Step 2 > Medicine Clerkship > Flashcards

Medicine Clerkship Flashcards

1
Q

Doxazosin

A

Alpha-1 selective blocker used to tx hypertension and BPH

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2
Q

Doxazosin and sildenaphil

A

Give at least 4 hours apart to reduce the risk of hypotension.

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3
Q

MEN 2

A

Both: medullary carcinoma of the thyroid and pheo.
2A: hyperparathyroidism
2B: mucosal neuromas and marfanoid habitus

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4
Q

MEN 1

A

3 P’s: pitutary adenoma, pancreatic islet cell tumor, hyperparathyroidism

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5
Q

Choriocarcinoma in males (associated hormone)

A

beta-hCG

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6
Q

Hormone elevation in teratoma

A

Increase in AFP or beta-cCG

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7
Q

Hormone elevation in seminomas

A

Serum tumor markers are usually normal (beta-hCG may be elevated)

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8
Q

Hormone elevation in Yolk sac tumor

A

AFP

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9
Q

What happens to LH and FSH in Leydig cell tumor?

A

Leydig cell tumors cause increased estrogen production –> inhibition of LH and FSH

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10
Q

B12 and Folic acid supplementation in strict vegetarians

A

Suspect B12 deficiency if there are neurological complications and anemia. Folic acid will correct the anemia but NOT THE NEUROLOGIC COMPLICATIONS!

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11
Q

Characteristics of Hairy cell leukemia

A

Lymphocytes have fine, hair-like, irregular projections. Stains with tartrate-resistant acid phosphatase (TRAP).

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12
Q

Treatment for hairy cell leukemia

A

Cladribine

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13
Q

What happens to the bone marrow in hair cell leukemia

A

It becomes fibrotic, leading to dry taps

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14
Q

“Soap bubble appearnace” on x-ray

A

GIANT CELL TUMOR OF BONE

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15
Q

Treatment of CML

A

Imatinib –> binds the ATP binding site of the BCR-ABL protein (prohibiting the conformation change to its active form)

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16
Q

What is the mutation of CML?

A

reciprocal translocation of chromosome 9 & 22 containing the BCR/ABL fusion gene

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17
Q

What is used to treat HER2+ breast cancer?

A

Trastuzamab

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18
Q

Major side effect of trastuzumab

A

cardiac toxicity (get an ECHO before beginning treatment)

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19
Q

Differential for microcytic/hypochromic anemia

A
  1. Iron deficiency
  2. Defective utilization of storage iron (anemia of chronic disease)
  3. Reduced globin (thalassemias)
  4. Reduced heme synthesis (pb poisoning, sideroblastic anemia)
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20
Q

Iron studies in iron-deficiency anemia

A

Depressed serum iron, increased TIBC, decreased serum ferritin

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21
Q

Iron studies in thalassemias

A

Normal to high serum iron and ferritin levels

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22
Q

Iron studies in Anemia of chronic disease

A

Below normal TIBC; normal or increased serum ferritin level

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23
Q

Iron studies in sideroblastic anemia

A

Normal to high serum iron and ferritin values

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24
Q

How can the level of HER2 expression be determined in breast cancer?

A

Immunohistochemical staining of FISH

–positvely predicts a positive response to trastuzumab and anthracycline chemo

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25
Q

Pagophagia

A

Pica for ice (quite specific for iron deficiency anemia)

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26
Q

Why are post-splenectomy patients at risk for sepsis?

A

They are at increased risk for sepsis from encapsulated organisms due to impaired antibody-mediated opsonization in phagocytosis

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27
Q

What does tamoxifen increase the risk of?

A

Endometrial cancer and venous thrombosis

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28
Q

Shat drugs can cause folic acid deficiency?

A
  • -Antiepileptic drugs (phenytoin, primidone, phenobarbital)
  • trimethoprim
  • methotrexate
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29
Q

How can blood transfusions cause paresthesias?

A

Packed cells contain citrate, which can chelate serum calcuium

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30
Q

Does hypocalcemia or hypercalcemia cause paresthesias?

A

Hypocalcemia

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31
Q

What is the drug of choice for mild to moderate hypercalcemia due to malignancy?

A

Bisphophonates (IV fluids and furosemid are used in the treatment of hypercalcemic crisis)

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32
Q

Waht is the cause of senile purpura (bruising on extensor surfaces of old people)?

A

Perivascular connective tissue atrophy

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33
Q

What is seen on peripheral smear with lead poisoning?

A

Basophilic stippling

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34
Q

Treatment for lead poisoning?

A

Lead chelator (EDTA or succimer)

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35
Q

TTP

A

Consumptive thrombocytopenia caused by widespread platelet thrombi that form in the microcirculation.

  1. Thrombocytopenia
  2. Microangiopathic hemolytic anemia
  3. Fever
  4. Neurological signs
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36
Q

HUS

A

Similar to TTP:

  1. Thrombocytopenia
  2. Microangiopathic hemolytic anemia
  3. Fever
  4. Renal failure (NOT neurological signs)
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37
Q

What type of breast cancer is associated with Paget’s disease of the breast?

A

Adenocarcinoma

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38
Q

What type of cancer is the vast majority of head and neck cancer?

A

Squamous Cell Carcinoma

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39
Q

What does heparin induced thrombocytopenia increase your risk for?

A

Arterial and venous clots (this is paradoxical)

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40
Q

S/sx of obstructive sleep apnea?

A

excessive daytime sleepiness, snoring, morning headaches, impotence, arterial hypertension. OSA –> short term hypoxemia, which is sensed by the kidneys –> increased EPO!!

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41
Q

What is the cause of acquired sideroblastic anemia?

A

Defective heme synthesis

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42
Q

What vitamin must be administered with INH?

A

Pyridoxine

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43
Q

Diagnosis in a patient with new-onset diabetes, arthropathy, and hepatomegaly?

A

hemochromatosis

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44
Q

What is the role of G6PD in RBCs?

A

G6PD is the enzyme involved in creating NADPH (a cofactor for glutathione, which prevents the oxidation of hemoglobin)

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45
Q

What are the characteristics of paroxysmal nocturnal hemoglobinuria?

A

Combination of:

  1. hemolytic anemia
  2. venous thrombosis
  3. diminished hematopoiesis (anemia)
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46
Q

What is the treatment of MALT without any METS?

A

Eradicate H. Pylori (omperazole, clarithromycin, amoxicillin)

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47
Q

Trousseau’s syndrome

A

Migratory thrombophlebitis (pain, itching, red streaks, cord like veins). It is typically in the chest and arms. Suggestive of underlying malignancy (esp adenocarcinoma)

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48
Q

Treatment of FAP?

A

Procto-colectomy at the time of diagnosis (100% go to colon cancer)

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49
Q

What does protein electrophoresis reveal for Waldenstrom’s Macroglobulinemia?

A

IgM Spike

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50
Q

Differential diagnosis for a mediastinal mass?

A

4 T’s: Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma

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51
Q

What bone cancer has Codman’s Triangle (periosteum lifted)

A

Osteosarcoma

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52
Q

Radiographic findings for osteosarcoma

A
  1. Codman’s Triangle

2. Sunburst Appearance

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53
Q

Waht is the characteristic radiographic findings in Ewing Sarcoma?

A

Onion Skinning

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54
Q

What is the characteristic radiographic finding for Giant Cell Tumor?

A

Soap Bubble Appearance

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55
Q

Soap Bubble Appearance

A

Giant Cell Tumor of Bone

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56
Q

Onion skinning on radiography

A

Ewing Sarcoma

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57
Q

Smudge Cells

A

Characteristic for CLL

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58
Q

What is the classic triad of glucagonoma?

A

Hyperglycemia, necrotizing dermatitis, and weight loss

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59
Q

Necrolytic Migratory Erythema

A

Erythematous, scaly plaques on the face and buttocks associated with glucagonoma.

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60
Q

Leukocyte Alkaline Phosphatase

A

Typically elevated in leukemoid reactions and low in CML

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61
Q

What is seen on bone marrow examination in multiple myeloma?

A

Overproliferation of plasma cells

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62
Q

What is the treatment for stroke secondary to sickle cell crisis?

A

Exchange transfusion

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63
Q

What is the first line treatment for a patient with severe symptomatic hypercalcemia?

A

Vigorous hydration with IV Normal Saline

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64
Q

What is the effect of aldosterone on sodium and potassium?

A

Aldosterone Saves Sodium and loses potassium

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65
Q

How does diabetes insipidus present?

A

Polyuria, polydipsia, and excretion of dilute urine in the presence of elevated serum osmolality

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66
Q

How does primary polydipsia present?

A

From excessive water drinking: both plasma and urine are diluted

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67
Q

How does SIADH present?

A

Hyponatremia, low serum osmolality, and inappropriately high urine osmolality.

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68
Q

What beta blockers can be used to treat pheo?

A

Labetolol- because it has both alpha- and beta-blocking activity

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69
Q

What are the 4 main conditions that present with hypokalemia, alkalosis, and normotension?

A
  1. Surreptitious vomiting
  2. Diuretic abuse (urine chloride is HIGH)
  3. Bartter Syndrome (urine chloride is HIGH)
  4. Gitelman’s Syndrome
70
Q

What is the most common cause of death in acromegaly?

A

Congestive Cardiac Failure

71
Q

What are the characteristics of primary hyperaldosteronism?

A

hypertension, hypokalemia, metabolic alkalosis, suppressed plasma renin activity, and elevated plasma aldosterone

72
Q

How do you calculate the serum osmolality?

A

2(serum Na) + blood glucose/18 + BUN/2.8

73
Q

Orphan Annie Nuclei

A

Associated with papillary thyroid cancer

74
Q

Papillary thyroid cancer

A

Orphan Annie nuclei are present. This is usually a solitary thyroid nodule or neck mass. GOOD PROGNOSIS.

75
Q

What happens to Ca when there is an increase in pH?

A

An increase in extracellular pH causes an increase in the affinity of serum albumin to calcium –> decreased free calcium

76
Q

Somogyi Effect

A

When nocturnal hypoglycemia leads to morning hyperglycemia (low glucose leads to an increase in the levels of counterregulartory hormones (epinephrine NE, and glucagon)

77
Q

Increasing hat size in an old male

A

Paget’s Disease of the bone (problem with remodeling)

78
Q

What is the most common pituitary tumor?

A

lactotroph adenoma

79
Q

What hormone do lactotroph adenomas produce?

80
Q

Treatment for severe symptomatic hyponatremia

A

Hypertonic (3%) saline

81
Q

How is non-ketotic hyperglycemic coma treated?

A

Fluid replacement with normal saline

82
Q

What causes the hypertension in thyrotoxicosis?

A

The hyperdynamic circulation

83
Q

What is a positive anti-thyroperoxidase (TPO) antibodies associated with?

A

Hashimoto’s thyroiditis

84
Q

What cancer are you at increased risk for after Hashiomoto’s Thyroiditis?

A

Thyroid Lymphoma

85
Q

Sick euthyroid syndrome

A

Abnormal thyroid function tests in an acute, severe illness. Usually results in a fall in total and free T3 levels with normal T4 and TSH levels “low T3 syndrome”

86
Q

What thyroid cancer is associated with secretion of calcitonin?

A

Medullary cancer of the thyroid

87
Q

What thyroid cancer has Hurthle Cells?

A

Follicular and Papillary Cancers

88
Q

What thyroid cancer has psomma bodies?

A

Papillary thyroid cancer (most common thyroid malignancy)

89
Q

What is the effect of vitamin D deficiency on bone architecture?

A

Causes defective mineralization of bone (from decreased availability of Ca and Phos at mineralization sites)

90
Q

What is the difference between osteomalacia and rickets?

A

Osteomalacia (vit d deficiency in adults) results from defective mineralization of bone while rickets results from defective mineralization of bone and cartilage

91
Q

How is acromegaly diagnosed?

A

Measure GH levels following an oral glucose load (most ind suppress GH with glucose, whereas patients with acromegaly have increased GH with glucose)

92
Q

What is used for prevention of gout?

A

allopurinol and probenecid

93
Q

What is used for the treatment of gout?

A

Colchicine, NSAIDs, and steroids

94
Q

What is the most common cause of prosthetic joint septic arthritis?

95
Q

What is the range in synovial WBC count in septic arthritis?

A

50,000-150,000 (a WBC count of 10,000-50,000 may be found in crystal-induced arthritis)

96
Q

What does osteoarthritis look like on Xray?

A

Joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts (most commonly in the DIP joints)

97
Q

What is the main mechanism of kidney damage in SLE?

A

immune complex-mediated damage

98
Q

What are the predisposing factors for avascular necrosis?

A
  1. chronic corticosteroid therapy
  2. alcoholism
  3. hemoglobinopathies
99
Q

How is avascular necrosis of the hip diagnosed (gold standard)?

100
Q

What are the crystals in pseudogout?

A

Rhomboid, positively birefringent

101
Q

What are the crystals in gout?

A

Needle-shaped and negatively birefringent

102
Q

What is the first line treatment for rheumatoid arthritis?

A

Methotrexate

103
Q

Enthesitis

A

Inflammation and pain at sites where tendons and ligaments attach to bone

104
Q

What are the most common agents in cellulitis?

A

Group A Strep and S. Aureus

105
Q

What joints are affected with rheumatoid arthritis?

A

MCPs, PIPs, wrists, and knees

106
Q

Common findings for rotator cuff tear?

A

Pain worsened by pushing, pulling, lifting the arm above the head; limitations of mid arc abduction and external rotation

107
Q

What diagnosis do you consider in a patient that appears to have RA but with acute onset, morning stiffness lasting <6 weeks?

A

Viral Arthritis (Parvovirus)

108
Q

What is the most reliable index for monitoring the response to treatment in patients with DKA?

A

Arterial pH or anion gap

109
Q

Melanosis Coli

A

Dark brown discoloration of the colon with lymph follicles shining through as pale patches. Seen with laxative abuse.

110
Q

Organism in Cat Scratch Disease?

A

Bartonella henselae

111
Q

What is the treatment of cat scratch disease?

A

5 days of azithromycin

112
Q

What is the classic tetrad of multiple myeloma?

A

“CRAB:”

  1. Calcium (hypercalcemia)
  2. Renal Impairment
  3. Anemia
  4. Bones (bone pain, lytic lesions, fractures)
113
Q

What is a common picture of an old plethoric male who complains of pruritus after bathing?

A

Polycythemia Vera

114
Q

What percent of of the body is involved in Stevens Johnsons?

115
Q

What is Stevens Johnsons called if >30% of the body is involved?

A

Toxic Epidermal Necrolysis (TEN)

116
Q

What is the cause of refractory hypokalemia in alcoholics?

A

Hypomagnesemia (important cofactor for potassium uptake and maintenance of intracellular potassium levels

117
Q

What is the most common presentation of mesenteric ischemia (for boards)?

A

Pain out of proportion of the exam

118
Q

What type of benign vascular tumor in children appear during the first weeks of life, grow rapidly, and regress by 5-8 yo?

A

Strawberry Hemangiomas (capillary hemangiomas)

119
Q

What anti-opportunstic infection meds should transplant patients receive?

A

TMP-SMX, vaccines for influenza, pneumococcus, and hep B

120
Q

What type of acid-base disturbance does aspirin toxicity cause?

A

Mixed respiratory alkalosis and metabolic acidosis (resp alk from increased respiratory drive and metabolic acidosis from the accumulation of salicylate and organic acids)

121
Q

What antiretro viral can cause crystal-induced nephropathy?

A

Indinavir (protease inhibitor)

122
Q

Common SE of didanosine (antiretro viral)

A

Induced Pancreatitis

123
Q

Common SE the antiretroviral abacavir

A

hypersensitivity syndrome

124
Q

Common SE the antiretroviral NRTI’s as a class

A

lactic acidosis

125
Q

Common SE the antiretroviral NNRTI’s as a class

A

stevens-johnson

126
Q

Common SE the antiretroviral nevirapine

A

liver failure

127
Q

What type of lung cancer causes PTHrP?

A

Squamous Cell Carcinoma (sCa++mous)

128
Q

How does PTH increase Ca in the blood?

A

It increases calcium resorption from the bones and increases renal calcium resorption in the distal tubule

129
Q

Antibodies in primary biliary sclerosis

A

Anti mitochondrial

130
Q

Antibodies in Sjögren’s syndrome

A

Ro (ssa) and/or La (ssb)

131
Q

What antvirals are ONLY active against influenza A?

A

Amantadine and rimantadine

132
Q

What antivirals are activate against both influenza A and B?

A

Neuraminidase inhibotrs (zanamivir and oseltamivir)

133
Q

What does ferritin represent?

A

Ferritin is representative of the body’s iron stores

134
Q

How is transferrin saturation calculated?

135
Q

What skin condition is associated with Parkinson’s disease?

A

Seborrheic Dermatitis

136
Q

What is the long term AE of cyclophosphamide?

A

Acute hemorrhagic cystitis and bladder carcinoma

137
Q

What is the murmur associated with hypertrophic cardiomyopathy?

A

Crescendo-decrescendo murmur at the left lower sternal border; it increases during valsalva maneurver (due to decreased preload)

138
Q

What happens to murmurs with valsalva?

A

They decrease; EXCEPT in hypertrophic cardiomyopathy (it increases in this)

139
Q

What is chlordiazepoxide?

A

Librium- a benzodiazipine

140
Q

What lung cancer is SIADH?

A

Small cell carcinoma

141
Q

How do you diagnose UTI with urinalysis?

A
  1. Nitrites
  2. leukocyte esterase
  3. > 5 WBC/HPF
142
Q

How is benzodiazepine overdose distinguished from opiod overdose?

A

Both present wiht slurred speech, unsteady gait, and drowsiness.
**Benzo OD lacks respiratory depression and lack of pupillary constriction

143
Q

How can benzo and phenytoin OD be distinguished?

A

Phenytoin OD has nystagmus

144
Q

What is the development of a palpable mass in the epigastrium 4 weeks after the onset of acute pancreatitis suggestive of?

A

Pseudocyst formation

145
Q

What is the most sensitive test for disseminated histoplasmosis?

A

Antigen detection in the urine or serum

146
Q

Treatment of choice for histoplasmosis

A

Itraconazole

147
Q

Amaurosis fugax

A

Transient monocular blindness that only lasts a few minutes and is vascular in origin.

148
Q

What is pseudotumor cerebri

A

Idiopathic intracranial hypertension

149
Q

What HLA is associated with SLE?

A

HLA-DR2 and DR3

150
Q

What are pregnant women with prior fetal loss and the presence of antiphospholipid antibodies treated with?

A

Low-dose heparin

151
Q

How do you treat dermatomyositis and polymyositis?

A

Corticosteroids

152
Q

What is the profile of a transudate?

A
  1. Pleural:serum protein < 2/3 of the ULN
153
Q

What should you avoid in acute angle glaucoma?

154
Q

What are the three major types of gallstones?

A

Cholesterol Stones
Pigment stones (composed of calcium bilirubinate)
Mixed stones

155
Q

What is the treatment for a patient with hyperkalemia who develops significant EKG changes?

A

Calcium gluconate

156
Q

What is the best initial test for SCC of the neck?

A

Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy) to detect the primary tumor, which is then biopsied.

157
Q

What are spherocytes without central pallor typically seen in?

A
  1. Hereditary Spherocytosis
  2. Autoimmune Hemolytic Anemia
    * *Both are extravascular hemolytic anemias
158
Q

What is the difference between Hereditary Spherocytosis and Autoimmune Hemolytic Anemia?

A

Herediatary Spherocytosis has a strong family history (AD) & negative Coombs test while AIHA negative family history and positive Coombs test.

159
Q

What is the best initial test for SCC of the neck?

A

Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy) to detect the primary tumor, which is then biopsied.

160
Q

What are spherocytes without central pallor typically seen in?

A
  1. Hereditary Spherocytosis
  2. Autoimmune Hemolytic Anemia
    * *Both are extravascular hemolytic anemias
161
Q

What is the difference between Hereditary Spherocytosis and Autoimmune Hemolytic Anemia?

A

Herediatary Spherocytosis has a strong family history (AD) & negative Coombs test while AIHA negative family history and positive Coombs test.

162
Q

How do you calculate corrected calcium?

A

Corrected Ca++ = 0.8 (normal albumin-measured albumin) + measured Ca++

163
Q

What is Meniere’s Disease?

A

Disorder of unclear etiology in which there is an abnormal accumulation of endolymph within the inner ear. characterized by vertigo + ear fullness

164
Q

Where is plasmodium falciparum most common?

A

Sub-Saharan Africa and the Indian Subcontinent (India, Pakistan, and Bangladesh)

165
Q

What is the drug of choice for plasmodium falciparum?

A

Mefloquine (plasmodium falciparum is chloroquine-resistant)

166
Q

What is the prophylaxis and treatment for Plasmodium vivax or Plasmodium ovale?

A

Primaquine

167
Q

Diagnosis for a patient with central scotoma, afferent pupillary defect, changes in color perception, and decreased visual acquity?

A

Optic Neuritis

168
Q

What disease is optic neuritis associated with?

A

Multiple Sclerosis

169
Q

What are gallstones made up of?

A

Cholesterol or calcium bilirubinate

170
Q

SIRS Criteria

A

Fever greater than 38°C or hypothermia less than 36°C
Hyperventilation rate greater than 20 breaths per minute or PaCO2 lesson 32
Tachycardia > 90 bpm
Increased white blood cell count >12,000 cells/high-power field or 10% bands

USMLE Step 2 (10 decks)

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