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USMLE Step 2 CK > Medicine Part II > Flashcards

Medicine Part II Flashcards

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USMLE® Step 1 flashcards
1
Q

Leukomoid reaction

A

high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase

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2
Q

Thrombocytopenia with thrombus progression 3 days into heparin therapy?

A

Type 2 herarin-induced thrombocytopenia

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3
Q

Acral lentiginous melanoma

A

Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces

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4
Q

Cytochemical features of hairy cell leukemia?

A

Tartrate-resistant acid phosphotase (TRAP)

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5
Q

cells iwth convoluted nuclei and highly vacuolated cytoplasm?

A

infectious Mononucleosis (EBV)

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6
Q

How to manage HIT?

A

Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)

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7
Q

Physicial manifestations of Hemophilia A & B?

A

delayed/prolonged bleeding after mild trauma

Hemarthrosis, hemophilic arthropathy

Intramuscular hematomas

Gastrointestinal or genitourinary tract bleeding

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8
Q

How do you treat polycythemia vera?

A

Aspirin and phlebotomy

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9
Q

Auer Rods Cancer?

A

Acute Myeloid Leukemia

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10
Q

thrombocytopenia and microangiopathic hemolyutic anemia

A

Thrombotic microangiopathy

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11
Q

Pain, itching, red streaks on an arm that presented in a different location preciously?

Next step?

A

Migratory superficial thrombophlebitis (Trousseau’s syndrome)

CT of the abdomen due to association with pancreatic cancer

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12
Q

What drug is used to treat hairy cell leukemia? Side effects?

A

Cladribine; neurological and kidney damage

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13
Q

Ruby-colored papules on lips that blanch partially with pressure?

A

Arteriovenous shunting (Osler-Weber-Syndrome)

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14
Q

Gilbert Syndrome

A

Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient

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15
Q

How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?

A

No follow-up imaging

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16
Q

Transfusion-related acute lung injury

A

Fever, dyspnea, diffuse pulmonary infiltrates and hypocia

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17
Q

What is the most common complication of HIT?

A

Additional venous thrombosis

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18
Q

What is the role of heptoglobin?

A

Binds free hemoglobin and promotes its excretion by the reticuloendothelial system

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19
Q

Facial Rash and symmetric oligoarthritis are highly suggestive of?

A

Systemic Lupus Erythematosus

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20
Q

How to manage a patient with a blood smear showing platelet clumping?

A

Repeat platelet count

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21
Q

Osteolytic lesions, fractures, hypercalcemia, anemia

A

Multiple myeloma

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22
Q

Inheritance pattern of Hemophilia?

A

X-linked recessive

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23
Q

MoA of HIT?

A

IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)

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24
Q

Without a clear provoking factors, what procedures should be conducted?

A

Age-appropriate cancer screening and CXR

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25
Q

What vitamin deficiency is associated with pernicious anemia?

A

B12, megaloblastic anemia

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26
Q

Laboratory findings for lead poisoning

A

microcytic anemia,, basophilic stippling, high lead levels

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27
Q

G6PD deficiency laboratory signs?

A

Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin

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28
Q

Heredity hemochromoctoma- risk factors?

A

Hepatocellular carcinoma

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29
Q

What factor contributes to Warfarin necrosis?

A

Protein C (primary) and S deficiency

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30
Q

Charcot Triad

A

Pain, fever, jaundice

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31
Q

How do you treat single nodule colorectal mets?

A

Regional hepatectomy

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32
Q

How to do treat BPH?

A

5-alpha reductase inhibitor

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33
Q

How are leukomoid reactions caused by severe infections?

A

Mobilization of mature and immature leukocytes from bone marrow

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34
Q

BRBPR and pain with defectation?

A

Anal Fissure

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35
Q

When do you see Auer rods? How does it present?

A

Acute myeloid leukemia

Presents with pancytopenia (bleeding or infection) and myeloblasts would be expected

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36
Q

Microscopic colitis?

A

chonic watery diarrhea without bleeding

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37
Q

Treatment for Ulcerative Colitis?

A

Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine

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38
Q

When do sideroblasts form?

A

When iron is available, but is unable to be incorporated into hemoglobin

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39
Q

IBS - Symptoms and Treatment

A

Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.

Must have 2 of the following:

  1. Pain relived by a bowel movement
  2. Onset of pain in related to a change in frequency of stool
  3. Onser ot pain is related to a change in the appearance of stool

Tx- reassurance and high-fiber diet

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40
Q

What should you screen for in patients with hepatitis B?

A

Hepatocellular carcinoma

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41
Q

Signs of autoimmune hemolytic anemia?

A

Spherocytes and positive direct antiglobulin test

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42
Q

Biological role of vitamin B12?

A

Formation of thmidylate and purine molecules for DNA

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43
Q

First step in screening for thalassemia anemia?

A

Complete blood count

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44
Q

Isolated thrombocytopenia without anemia or leukopenia?

A

Idiopathic thrombocytopenia purpura

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45
Q

Chronic myeloid leukemia laboratory findings?

A

leukocyte alkaline phosphotase = low

high number of myelocytes to melamyelocytes

Presence of absolute basophilia

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46
Q

What should all patients diagnosed with ITP be tested for?

A

HIV

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47
Q

Target for treatment o

A
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48
Q

Side effect of phenytoin?

Treatment?

A

Mild megaloblastic anemia caused by reduction in folic acid levels

Tx- folic acid supplementation

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49
Q

Physical sign of acute cholecystitis?

A

Pain in the right upper abdominal area, positive Murphey’s sign

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50
Q

Lentigo Maligna?

A

Slow growing melanoma seen on the sun-exposed areas of the face

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51
Q

Signs of an epidural spinal cord compression?

A

lower extremity motor weakness, hyperreflexia, and bladder dysfunction

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52
Q

Signs of polycythemia vera?

A

Increased hemoglobin, increase leukocytes, increased platelets

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53
Q

What cancer has retinoic acid receptor present?

A

Acute promyelocytic leukemia, presents with pancytopenia

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54
Q

How to manage pain in terminal cancer patients?

A
  1. Try non-narcotics first (short-acting morphine is first)
  2. Do not be afraid to give narcotics
  3. Prescribe adequate amounts of medication
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55
Q

Brownish skin pigment? Disease?

A

Bronze diabetes, hereditary hemochromatosis

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56
Q

Hemophilia laboratory findings?

A

Prolonged aPPT, decreased or absent Factor VIII or IX activity

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57
Q

Mutations that causes primary polycythemia vera?

A

Jak2 mutation

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58
Q

Hard unilateral head and neck lymph nodes in an older patient with smoking history?

A

Squamous cell carcinoma

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59
Q

Acute treatment for PE or DVT with subtheraputic INR on warfarin?

A

Rivaroxaban

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60
Q

Management for epidural spinal cord compression?

A

Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation

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61
Q

How to treat chemotherapy-induced nausea and vomiting?

A

Serotonin receptor antagonist (5HT)

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62
Q

Facial plethora with normal oxygen saturations and low EPO?

A

Polycythemia Vera

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63
Q

What anticoagulant can lead to low levels of Protein C and S?

A

Warfarin

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64
Q

Signs of lead poisoning?

A

Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN

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65
Q

How to treat a patient with stage III colon cancer s/p hemicolectomy?

A

Adhyvant chemotherapy

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66
Q

What is the first step in managing iron deficiency?

A

Determining the cause (Fecal occult blood)

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67
Q

How does multiple myeloma cause infections? Most common types?

A

Impairs normal lymphocyte populations -> ineffective antibody production and hypogammaglobulinemia

Respiratory (streptococcal pneumonia) and UTI

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68
Q

How to you treat prostate cancer?

A

Androgen deprivation therapy

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69
Q

Signs of vitamin D toxicity?

A

vomiting, confusion, polyuria, polydipsia

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70
Q

Salvage therapy?

A

treatment for a disease when standard treatment fails

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71
Q

Leukoreduction

A

reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV

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72
Q

Blood transfusion reaction that occurs between 1 and 6 hours?

How to prevent?

A

Febrile non-hemolytic transfusion

Leukoreduction

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73
Q

Multiple miscarraiges and DVTs with SLE?

A

Antiphospholipid syndrome

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74
Q

Monoclonal gammopathy of unknown significance

A

Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage

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75
Q

Neoadjuvant therapy?

A

Treatment given before the standard therapy

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76
Q

How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?

A

7-10 days

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77
Q

What is leukocyte alkaline phosphatase?

A

An active enzyme found within mature blood cells

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78
Q

How to treat acute cholecystitis?

A

ERCP

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79
Q

Monorrhagia is common in which bleeding disorder?

A

Willebrand disease

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80
Q

Drop in platelets in 5-10 days puts a patient at risk for?

A

Arterial thrombosis

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81
Q

Bite cells with normal G6PD?

A

Glucose-6-phosphate dehydrogenase deficiency

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82
Q

Acute radiation proctitis-cause, diagnostic method

A

Patient who receive pelvic radiation exposure and develop diarrhea.

Diagnosis is done via flexible sigmoidoscopy

Look for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis

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83
Q

Lab findings in multiple myeloma?

A

Hypercalcemia and anemia, excessive production of a single monocloncal protein

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84
Q
A
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85
Q

Expansile and eccentrically places lytic area in the epiphysis of the distal femur?

A

Giant cell tumor, “Soap bubble” appearance

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86
Q

Renal findings in multiple myeloma?

A

Bland with granular casts; nephritic disease

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87
Q

What cancer contains reed sternberg cells?

A

Hodgkin’s lymphoma

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88
Q

How do you treat antiphospholipid syndrome?

A

Indefinately continue warfarin

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89
Q

Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?

A

Immune thrombocytopenia (idiopathic thrombocytopenic purpura

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90
Q

Causes of macrocytic anemia?

A

Folate deficiency

B12 deficiency

Myelodysplastic syndrome

Acute myeloid leukemias

Drug induced (chemotherapy agents)

Liver Dx

Alcohol abuse

Hypothyroidism

91
Q

How to manage blood products in a patient who has experiences prior anaphylatic reactions?

A

Wash samples

92
Q

How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?

A

Refer to colposcopy

93
Q

a-thalassemia trait characteristics

A

mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults

94
Q

Elderly patient with severe lumphocytosis (>40000) lymphadenopathy, and bicytopenia suggests?

A

Chronic lymphocytic leukemia

95
Q

How to treat diffuse large B-cell NHL?

A

Abbreviated course of chemotherapy followed by radiation

96
Q

Most common drugs assoicated with dyspepsia? Alternative tx?

A

NSAIDS, Initiate PPI is unable to stop NSAIDS

97
Q

How do you treat cancer-related anorexia/cachexia syndrome?

A

Progesterone analogs *megestrol acetate)

98
Q

How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?

A

Discontinue pap smears

99
Q

Waldenstrom macroglobulinemia

A

production of monoclonal IgM antibodies

hymphadenopathy and hepatosplenomegaly may be present

100
Q

How to diagnose CLL?

A

Flow cytometry of peripheral blood

101
Q

Facial plethora and high hemoglobin?

Tx?

A

Polycythemia Vera

Phlebotomy, may add hydroxyuria in cases with high risk of thrombosis

102
Q

Management of a patient with a new onset breast nodule that was negative on mammorgram?

A

Aspiration or Biospsy

103
Q

When is the best time to initiate evaluation of thrombophilia?

A

2-4 weeks following completion of wargarin therapy

Stops false positives and false negatives

104
Q

Foul-smelling diarrhea, weight loss, fatigue

A

Steatorrhea and malabsorption

105
Q

Effect of malabsorption on calcium levels

A

Inhibits absorption of Vit. D -> low calcium, low phosphate

106
Q

First step in the evaluation of a thyroid nodule > 1cm?

A

TSH levels and U/S

107
Q

Effects of hypopituitarism?

A

glucocorticoid deficiency, hypogonadism, hypothyroidism

108
Q

Features of glucogonoma?

A

Necrolytic migratory erythema- face, perineum, extremities

DM

GI- diarrhea, anorexia

Weight loss

109
Q

Signs of glucogonoma?

A

Hyperflycemia with elevated glucagon > 500pg/mL

110
Q

Painless thyroiditis

A

acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH

111
Q

What DM medications cause weight loos?

A

GLP-1 agonists (exenatide)

112
Q

What DM medications are weight neutral?

A

DDP-4 inhibitors (sitagliptin)

113
Q

Treatment for diabetic neuropathy in young patients?

Older?

A

Young- amitriptyline

Old: Pregabalin

114
Q

Signs of thyroid storm?

A

Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v

115
Q

After confirming a normal TSH, what is the next step in working up suspected Cushings?

A

24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression

2 must be abnormal

116
Q

Carcinoid tumors put you at risk for deficiency of what?

A

Niacin (diarrhea, dermatitis, dementia)

117
Q

Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?

A

MEN2a or 2b

Ret mutation

118
Q

Milk-alkali syndrome

A

Overconsumption of calcium and absorbable alkali -> hypercalcemia -> renal vasoconstriction and decreased GFR

119
Q

Workup for hypocalcemia?

A

Recheck-> drug-> PTH-> 25-hydrocy vitamin D levels

120
Q

Signs of generalized resistance to thyroid hormones?

A

Normal TSH and high T3 and T4 with signs of hypothyroidism

121
Q

Subclinical hypothyroidism

A

Mildly elevated serum TSH and normal T3 and T4

Do not have clinical signs

122
Q

Signs of hypercortisolism?

A

Weight gain, psychiatric symptoms, HTN, hyperglycemia

123
Q

oligomenorrhea, hirutism, elevated testosterone levels?

Tx?

A

Polycystic ovarian syndrome

Tx: Weight loss and oral estrogen/progestin contraceptives

124
Q

Side-effect of radioiodine ablation?

A

Worsening of opthalmopahty

125
Q

Role of large and small fibers in DM?

A

Large- numbness, proprioception, vibration

Smal- pain, paresthesias, allodynia

126
Q

How does pregnancy affect thyroid levels?

A

Causes a 30% increase in the first trimester

127
Q

How to you manage an adrenal incidentoma?

A

Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels

128
Q

Galactorrhea and signs of secondary amenorrhea, next step?

A

Obain prolactin levels

129
Q

In a young patient with suspected DM, what should be the first step in management?

A

Check for pancreatic autoantibodies to rule in/out DM type 1

130
Q

In a younger patient presenting with osteoporosis, what should be the first step in workup?

A

Find an underlying cause.

131
Q

fatigue, weight gain, erectile dysfunction and hyponatremia suggest?

A

panhypopituitarism

132
Q

How to treat pituitary apoplexy?

A

Neurosurgery consult and glucocorticosteroids

133
Q

hypernatremia with hypokalemia with htn? Diagnostic test?

A

Hyperaldosteronism, aldosterone to plasma renin

134
Q

How to diagnose cushing’s disease?

A

24-hour urine cortisol measurments

135
Q

If a patient is taking steroids and gets sick, what should happen?

A

Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis

136
Q

Calcium pyrophosphate dihydrate disease?

A

Presents like OA, but with atypical joints (hands)

137
Q

Treatment for fibromyalgia with or without depression?

A

Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran

138
Q

Presentation of OA of the hand?

A

Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP

139
Q

How to treat a patient with SLE and suspected lupus nephritis?

A

High-dose steroids

140
Q

Back pain in an individual with Chron’s disease?

A

Enteropathic arthritis

141
Q

Henoch-schonlein purpura

A

purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuria

skin biopsies reveal leukocytoclastic vasculitis

142
Q

pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night

A

Pes anserine bursitis

143
Q

Still disease

A

daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin

144
Q

Treatment for RA?

A

Methotrexate

145
Q

In RA refractory to Methotrexate, what is next?

A

Add monoclonal antibody, etanercept

146
Q

Inelastic pericardium - AKA? Signs? Risk?

A

AKA- restrictive pericarditis

Signs-increased JVP, peripheral edema, ascites, hepatic congestion with hepatomegaly

Risk- late complication of radiation therapy

147
Q

dyspnea, third heart sound, bibasilar crackles, low ejection fraction?

A

decompensated congestive heart failure due to LV systolic dysfunction

148
Q

Alcoholic cardiomyopathy

A

Dilated cardiomyopathy in an alcoholic, when everything else has been rules out

149
Q

Reversible risk factors for premature atrial contracitons?

A

Alcohol and tobacco, caffeine, stress

150
Q

Premature atrial contractions-treatment?

A

Cessation of alcohol, tobacco, caffeine, stress, initiation of beta-blockers (if symptomatic)

151
Q

Ludwig angina

A

Rapidly progresive cellulitis of the submandibular and sublingual spaces

152
Q

Ceftriaxome with azithromycin- treatment?

A

Community acquired pneumonia

153
Q

vanomycin with piperacillin-tazobactam-treatment?

A

Hospital-acquired pneumonia

154
Q

Low-pitched, early diastolic heart sound, think?

A

Heart failure (third heart sound)

155
Q

dypnea, hypoxemia, diffuse pulmonary crackles with third heart sound?

A

decompensated heart failure

156
Q

Treatment for severe heart failure associated with severe left ventricular systolic dysfunction and cardiogenic shock? MoA?

A

Dobutamine, beta-1 receptor

MoA- increased myocardial contractilit -> greater colume of forward blood efection -> decreased left ventricular end-systolic volume

157
Q

holosystolic murmur that increases with inspiration?

A

Tricuspid involvement

158
Q

Systemic murmur that increases when the patient stands up?

A

hypertrophic cardiomyopathy

159
Q

Mechanical complications post MI?

A

RC failure- acute

Papillary muscle rupture- Acute, 3-5 days

Interventricular septum rupture/defect- Acute, 3-5 days

Free wall rupture- 5 days to 2 weeks

160
Q

How to calculate attributed risk percent?

A

ARP= (RR-1)/RR

161
Q

Signs of cardiogenic shock?

A

Hypotension, reduced urine outpout, cool extremities

Classic finding: Beck triad-hypotension, elevated jugular venous pressure, distant heart sounds

162
Q

hypoxia vasoconstriction in the lung

A

vessels shrink and divert blood to maintain V and Q matching

163
Q

Intrapulmonary shunting

A

shunting of blood away from blocked alveolar consolidation and shunts it to other areas -> can cause V and Q mismatch

164
Q

Continuous murmur throughout thorax with high blood pressure and headaches? Imaging?

A

Coarctation of the aorta

X-ray findings- inferior notching of the third to eighth rib, “3” sign due to aortic indentation

ECG: Left ventricular hypertrophy

Echo: diagnostic confirmation

165
Q

Upturning of the cardiac apex- AKA, cause?

A

boot-shaped heart, caused by Tetralogy of Fallot, d/t pulmonic stenosis

166
Q

Commonly associated SLE rashes

A

Malar rash, discoid plaques, ulcers

167
Q

What causes drug induced acne? What do they look like? Management?

A

Glucocorticoids, androgens, azathioprine, EGFR inhibitors, anticonvulsants, antituberculosis

Description, monomorphic papules or pustules, no comedones, cysts, nodules

Management: D/C offending medication, standard acne therapy unlikely to be effective

168
Q

What populations have a 5mm PPD/TST induration limit?

A

HIV-positive, recent contacts of known TB, nodular fibrotic changes of CXR consistent with previously healed tb, organ transplant recipients, and other immunosuppressed patients

169
Q

Treatment for latent tb?

A

Isoniaxid and pyriodoxine

170
Q

Drug-resistent HTN, and a midabdominal bruit?

A

Rebal artery stenosis

171
Q

Highly specific finding in renal artery stenosis?

A

syustolic-diastolic abdominal bruit

172
Q

What drugs can lithium interact with to cause toxicity?

A

ibuprofen, NSAIDS, thiazide diuretics, ACE-I, tetracyclines, metronidazole -> decrease renal clearance of lithium

173
Q

Back pain with increased ESR/CRP, but normal X-rays, next step?

A

MRI, bone scanning using gallium (if MRI contraindicated)

174
Q

MoA of beta blockers?

A

reducing cardiac oxygen deman through a decrease in heart rate and myocardial contractility

175
Q

Treatment regimine for stable angina?

A

Beta blockers, aspirin, sublingual nitroglycerine

176
Q

Signs of Alcoholic cerebellar degeneration?

A

Trucal coordination impairment (tandem gait), wide-based gait, postural instability, with intact limb coordination (finger-nose test)

177
Q

Signs of hypokalemia?

A

Muscle weakness, arrhythmias, EKG changes

178
Q

Chikungunya fever? Vector?

A

High fevers, polyarthralgias, maculopapular rash, lymphop[enia, thrombocytopenia

Vector: Ades mosquito

179
Q

Cyclosporine side effects:

A

Nephrotoxicity- hyperkalemia, hypophosphatemia, hypomagnesemia

HTN: renal vasoconstriction and sodium retension

Neurotoxicity: headache, visual disturbances, seizures

Glucose intolerace

180
Q

Dermatofibroma

A

benign fibroblast proliferation

firm, hyperpgmented nodule, most often on lower extremties

181
Q

epidermal inclusion cyst? Diagnosis?

A

Discrete benign nodule lined with dquamous epithelium, that containes semisolid core of keratin and lipid.

Diagnosis: clinical with a firm, freely movable, dome-shaped cyst iwth central punctum

182
Q

Cor pulmonale? X-ray findings? Diagnosis?

A

exertion symptoms over time, loud P2, tricuspid regurgitation, elevated JVP, hepatomegaly

X-Ray- enlarged central pulmonary arteries, right ventricular hypertrophy, right atrial enlargement

Diagnosis- fold standard is right heart catheterization

183
Q

Priapism

A

persistent, painful ereation that develops without sexual stimulation and has a long duration

184
Q

Post-void residual volume in UTI?

A

Low, due to frequent urination

185
Q

b-HCG and AFP producing tumors in young males?

A

Nonseminomatous germ cell tumors

186
Q

Seminoma vs nonseminomatous germ cell tumors

A

Nonseminomatous germ cell tumors - product AFP and b-HCG

Seminoma produce b-HCG

187
Q

Site of nonseminomatous germ cell tumors in young males

A

mediastinal mass, testicular

188
Q

pityriasis rosea?

A

numerous oval, scaly plaques that follow the cleavage lines fo the trunk, often presents with an inital, larger lesion, a herald patch

189
Q

TInea corporis

A

pruritic rahs with scaly, erythematous border and central clearing

190
Q

Ichthyosis vularis? Treatment

A

Chronic inherited skin disorder with diffuse dermal scaling, caused by mutation in filaggrin gene

Treatment -emollients, severe cases male require keratolytics (coal tar, salicylic acid, and topical retinoids

191
Q

How to calculate sensitivity? Specificity?

A

Sensitivity- TP/(TP+FN)

Specificity = TN/(TN+TP)

192
Q

Untreated AIDS, progressive neurological symptoms, nonenhancing white matter lesions suggest? Diagnosis?

A

Progressive multifocal leukoencephalopathy, caused by JC virus

Diagnosis: LP with PCR for JC

193
Q

HIV-associated dementia?

A

deep gray matter structures affected, causing subacute connitive, behavioral, and motor deficits

194
Q

Subacute sclerosing panencephalitis

A

progressive, fetal disease caused years after measles infections

195
Q

Signs of peripheral nerve compression

A

Transient, unilateral foot drop, impaired anbkle dorsiflecion, preseved plantar flexion

196
Q

How to rule out primary psychiatric disorders in physical manifestations?

A

Symptoms are explained by distribution along a single nerve

197
Q

Arteriovenous fistula signs?

A

widenedd pulse presure, brish carotid upstroke, systolic flow murmur, tachycardia, flushed extremities, left ventricular hypertrophy

198
Q

Hypertrophic cardiomyopathy vs AVF murmur

A

HCM- crescendo-decrescendo, increasing with valsava

AVF- systolic murmur, no increase with valsava

199
Q

Treatment for torsades de pointes?

A

IV magnesium sulfate

200
Q

What drugs should be withheld 48 hours prior to cardiac stress tests?

A

Beta-blockers, calcium channel blockers, nitrates

201
Q

Signs of secondary syphillis?

A

Diffuse rash (begins on the trunk, extends to the extremities, involsing palms and soles), widespread lymphadenopathy, grey mucosal patches, raised grey genital lesions (condylomata lata), epitrochlear lymphadenopathy (pathognomonic)

202
Q

Disseminated gonococcus signs

A

tenosynovitis, polyarthralgia, skin rash consting of a few pustules

203
Q

What causes cardiac tamponade?

A

Decreased left ventricular preload

204
Q

Signs of restrictive pericarditis?

A

Progressive peripheral edema, ascities, elevated JVP, pericaridal knowck, pericardial calcifications

205
Q

How often are mammograms performed?

A

Every 2 years.

206
Q

Disseminated mycobacterium avium complex infection signs?

A

fever, cough, diarrhea, splenomegaly, elevated alkaline phosphatase

207
Q

Most common cause of community acquired vacterial meningitis?

A

Strep pneumoniae

208
Q

Drugs that can cause angioedema?

A

Ace inhibitors -> increased bradykinin

209
Q

Organs affected in Goodpasteur’s syndrome?

A

Renal and pulmonary

210
Q

How to improve quality of care when transitioning between facilities?

A

Pharmacist-directed interventions

211
Q

Drugs with photosensitivity reactions

A

Tetracyclines, chlorpromazine, prochlorperazine, hurosemide, hydrochlorothiazide, amiodarone, promethazine, piroxicam

212
Q

Side effects of Erythromycin?

A

GI upset, cholestatic jaundice (estolate base)

213
Q

Cause of ARDS in pancreatitis?

A

Phosphilipase A2 crosses pulmonary capillaries and increases inflammatory response

214
Q

What is the negative predictive value?

A

Probability of being free of disease, if the test is negative

215
Q

Positive predictive value, meaning?

A

Likelihood that a positive test means you have the disease.

216
Q

Tinea versicolor causal organism? Trreatment?

A

Malassezia species

Tx: selenium sulfide, ketoconazole

217
Q

Signs of atrial fibrillation?

A

palpitations, weakness, dizziness, presyncope, dyspnea, and/or chest pain

218
Q

Conditions associated with atrial fibrillation?

A

CHF, Hypertrophic cardiomyothy, hypertensive heart disease (most common), obstructive sleep apnea, obesity, endocrine

219
Q

Valvular involvement in infective endocarditis?

A

Mitral-damaged heart valces

Tricuspid- intravenous drug abuse

220
Q

Signs of CMV in an AIDS patient? CD4+ count? Diagnostic test? Treatment?

A

Frequent, small volume diarrhea; hematochezia’ abdominal pain

CD4+ < 50

Diagnostic test: colonoscopy with biopsy (eosinophilic intranuclear and basophilic intracytoplasmic inclusion

Treatment: ganciclovir

221
Q

Epinephrine vs antihistamines

A

Antihistamines treat uticaria, pruritus in anaphalaxis, however, they do not relieve upper airway edema or hypotension

222
Q

Streptococcus gallolyticus

A

Streptococcus bovis (biotype 1) highest risk of colon cancer

223
Q

Vibrio vulnificus? Treatment? Manifestations?

A

Gram-negative, free-living in marine environments

Increased risk in those with liver disease

Manifestations: rapidly progressive, septicemia, cellulitis (hemorrhagic bullae, necrotizing fascitis)

Treatment: IV ceftriaxone, doxycycline

USMLE Step 2 CK (12 decks)

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