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UWorld Step 2 CK > NTK > Flashcards

NTK Flashcards

1
Q

Murmurs needing further work up

A

Systolic III or greater Any diastolic

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2
Q

Rumbling diastolic with opening snap = Tx?

A

Mitral stenosis Balloon valvuloplasty Surgery later

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3
Q

Pathology of aortic insufficiency

A

Infection Infarction Aortic Dissection

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4
Q

Acute aortic insufficiency =

A

Cardio gen I shock Flash pulmonary edema

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5
Q

Chronic aortic insufficiency

A

CHF Chest pain

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6
Q

Rumbling diastolic murmur right sternal border second intercostal space =

A

Aortic insufficiency

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7
Q

Pathogenesis of aortic stenosis

A

Atherosclerosis Older men

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8
Q

Crescendo, descrescendo systolic murmur at right sternal border 2nd ic space

A

Aortic stenosis

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9
Q

Systolic, high pitched, HOLOSYSTOLIC murmur at the apex of the heart

A

Mitral insufficiency (regurgitation)

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10
Q

Two murmurs More blood - less murmur

A

HCM and MVP

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11
Q

Common meds leading to exposing G6PD

A

Dapsone TMP-SMX Nitrofurantoin

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12
Q

When to check G6PD level?

A

6-8 weeks after an attack

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13
Q

Coombs positive for IgG = warm autoimmune hemolytic anemia Conditions?

A

Autoimmune diseases Cancer

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14
Q

Diagnosis of PNH? Tx?

A

Flow cytometry Eculizumab

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15
Q

Female pt Elevated T4 Cold Thyroid uptake scan Next step?

A

Sestamibi of Ovaries Struma ovarii

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16
Q

Thyroid Storm Tx steps

A

Cool down - IVF, Cold blankets Propranolol PTU/Methimazole Steroids

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17
Q

Radioactive iodine better for (3)

A

Multinodular goiter Toxic adenoma Struma ovarii

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18
Q

Anterior Pituitary secretes

A

ACTH TSH GH FSH/LH

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19
Q

Prolactinomas Macroadenoma more likely in? Micro?

A

Men get macro Women get micro

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20
Q

Prolactinoma treatment

A

Dopamine agonists CABERGOLINE, bromocriptine

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21
Q

What releasing hormone can cause elevations of prolactin?

A

TRH

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22
Q

Acromegaly work up steps

A

ILGF-1 Glucose suppression test + equals failed to suppress MRI SURGERY

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23
Q

Pyramid of importance of pituitary hormones (In descending order)

A

ACTH TSH GH LH/FSH

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24
Q

Three MCC of Chronic Hypopituitary

A

Autoimmune Deposition disease - sarcoidosis, amyloidosis Tumor

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25
Q

Lung cancer with SIADH

A

Small cell

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26
Q

Treatment for nephrogenic DI when all else fails

A

Gentle dieresis w/ HCTZ +- Ameloride

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27
Q

Remnants of nuclear material in RBC’s

A

Howell Jolly Bodies Indicates splenectomy or functional hyposplenism

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28
Q

Hemoglobin precipitates in RBC’s

A

Heinz bodies

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29
Q

Dofetilide Type of med? Side effects?

A

Class III antiarrhythmic for management of atrial arrhythmias dose dependent QT prolongation

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30
Q

Horizontal nystagmus, cerebellar ataxia, confusion Toxicity?

A

Phenytoin

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31
Q

Tremor, hyperreflexia, ataxia, seizures Toxicity?

A

Lithium

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32
Q

Nonpregnant patients with syphilis and anaphylactic penicillin allergy Tx?

A

Doxycycline

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33
Q

Steps for lead screening (If positive risk factors)

A

Capillary lead >5 Confirm with Venous lead Level 45-69 = DMSA Level >70 = Dimercaprol + EDTA

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34
Q

Abnormal eosin-5-maleimide binding test =

A

Hereditary spherocytosis

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35
Q

Congenital Rubella triad

A

Cataracts/glaucoma Sensorineural hearing loss Congenital heart disease

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36
Q

Key difference between bulimia and anorexia

A

Weight Bulimia = normal weight Anorexia = low weight

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37
Q

MCC of spontaneous lobar hemorrhage in adults over 60 Most common lobes involved?

A

Cerebral amyloid angiopathy Parietal and Occipital

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38
Q

MCC intracranial hemorrhage in children

A

AVM

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39
Q

Ischemic stroke appears _______ on CT

A

Hypodense on CT

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40
Q

Signs of posterior urethral injury Diagnostic imaging study of choice

A

Blood at meatus High riding prostate Perineal or scrotal hematoma Retrograde urethrogram

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41
Q

Trimethoprim mechanism of hyperkalemia

A

Blocks Na channels in collecting tubule (Similar to amiloride)

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42
Q

Galactosemia quartet Deficient enzyme

A

FTT Bilateral cataracts Jaundice Hypoglycemia galactose-1-phosphate Uridyl transferase

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43
Q

Treatment of warm Autoimmune Hemolytic anemia

A

High dose glucocorticoids first

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44
Q

Alcoholic dilated cardiomyopathy Tx?

A

Abstinence Return to function or normalization is possible

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45
Q

Trial of labor contraindicated for what two prior surgeries?

A

Vertical c section Abdominal myomectomy with UTERINE CAVITY ENTRY

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46
Q

Most common transfusion reaction is?

A

Febrile nonhemolytic

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47
Q

Fever and chills within 1-6 hours of transfusion = D/t?

A

Febrile nonhemolytic reaction Cytokines accumulated during blood storage

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48
Q

Fever, flank pain, hemoglobinuria, renal failure and DIC within an hour of transfusion = Causes by?

A

Acute Hemolytic ABO incompatibility Positive direct Coombs , Pink plasma

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49
Q

Mild fever and hemolytic anemia 2-10 days after transfusion= Due to?

A

Anamnestic antibody response Positive direct Coombs, positive new antibody screen

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50
Q

Anaphylactic transfusion reaction is due to?

A

IgA deficiency Anti-IgA antibodies

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51
Q

Respiratory distress, noncardiogenic pulmonary edema within 6 hours of transfusion =

A

TRALI Donor anti-leukocyte antibodies

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52
Q

Risk factor most common for TAA and AAA

A

Atherosclerosis

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53
Q

Risk factor most common for aortic dissection

A

Hypertension

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54
Q

Stable SVT tx Unstable?

A

Adenosine Shock

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55
Q

Stable Afib tx Unstable

A

Rate control - BB Shock

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56
Q

Stable Torsades tx Unstable

A

Magnesium Shock

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57
Q

Stable Vtach tx Unstable?

A

Amiodarone Shock

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58
Q

MCC of prolonged or arrested second stage

A

Fetal malposition

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59
Q

Major side effect of Hydroxychloroquine

A

Retinopathy Regular eye exams

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60
Q

Vast majority medulloblastomas occur where?

A

Cerebellar vermis

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61
Q

Most common hemispheric tumors in children

A

Low grade Astrocytomas

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62
Q

What type of tumor is associated with Parinaud syndrome?

A

Pineal gland tumor

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63
Q

Observation and analgesics is appropriate for acute otitis media under what conditions?

A

Age over 2 years Normal immune system Symptoms mild and unilateral

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64
Q

Secretory diarrhea vs Osmotic diarrhea Stool osmotic gap

A

Low in secretory Elevated in osmotic

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65
Q

Amantadine side effects

A

Livedo reticularis Ankle edema

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66
Q

Two tests for Chronic Granulomatous Disease

A

Nitroblue tetrazolium Dihydrorhodamine

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67
Q

Which alcohol ingestion is not associated with high anion gap or acidosis

A

Isopropyl alcohol Methanol, ethylene glycol, and alcohol ketoacidosis are all associated with High gap acidosis

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68
Q

Mechanism of decreased vital capacity in COPD

A

Air trapping during expiration

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69
Q

Intranuclear and intracytoplasmic inclusions = Intranuclear only =

A

CMV HSV

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70
Q

Most common complication of asymptomatic bacteriuria in pregnant women Why?

A

Acute pyelonephritis Progesterone of pregnancy relaxes smooth muscle and causes ureteral dilatation Also associated with pre term labor and low birth weight

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71
Q

Increased risk of vibrio infection with what underlying disease?

A

Liver disease (Like hemochromatosis, cirrhosis, hepatitis)

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72
Q

Tachypnea beginning shortly after birth but resolving by day 2 Imaging findings

A

Transient tachypnea of newborn Bilateral perihilar linear streaking

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73
Q

Tachypnea and severe cyanosis in term or post term infant

A

Persistent pulmonary hypertension

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74
Q

Patients with CPPD should be evaluated for what underlying causes?

A

Hyperparathyroid Hypothyroid HEMOCHROMATOSIS (especially with family history of diabetes)

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75
Q

Chrondrocalcinosis is seen in?

A

CPPD NOT RA OR GOUT

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76
Q

Hookworms 2 Disease Tx?

A

Ancylostoma caninum and braziliense Cutaneous Larval migrans Ivermectin

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77
Q

Work up of chronic cough that worsens at night and doesn’t improve with anti histamines

A

PFT’s Or Trial of corticosteroids

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78
Q

Young person Unsteady gait and weakness of lower limbs Decreased vibratory and position sense High plantar arches MRI shows atrophy of spinal cord, minimal cerebellar atrophy T wave inversions on ekg

A

Friedrichs Ataxia Trinucleotide repeat disorder GAA

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79
Q

aortic regurgitation best heard in right sternal border = Combined with 2:1 AV block and IVDA

A

Aortic root disease Perivalvular abscess

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80
Q

Trichomoniasis Treat patient and partner or just patient?

A

Patient and partner

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81
Q

Nocturia on an AA patient

A

Hyposthenuria Related to Sickle Cell trait - family history

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82
Q

Elderly Bone pain Hypercalcemia Renal insufficiency Granular casts on urinalysis

A

Multiple myeloma Monoclonal protein production

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83
Q

Scotch tape tests positive Organism? TreatMent?

A

Enterobius vermicularis Albendazole or pyrantel pamoate For patient and all household contacts

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84
Q

Agents causing idiosyncratic liver reactions

A

Isoniazid Chlorpromazine Halothane Antiretrovirals

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85
Q

Raised lesions, <1cm Dimples in the center when edges are pinched Dx

A

Dermatofibroma Buttonhole sign

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86
Q

Predominant leukemia in children 2-10 Diagnostic?

A

ALL Presence of >25% lymphoblasts in the marrow PAS positive aggregates TdT positive

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87
Q

IUGR Closed fists with overlapping fingers Dx? Other findings

A

Trisomy 18 Micrognathia Prominent occiput Rocker-bottom feet

88
Q

Electrical alternans with sinus tach Highly specific for?

A

Pericardial effusion

89
Q

3-4 months Doll like face Seizures Lactic acidosis Hypoglycemia

A

Von Gierke disease Glucose-6-phosphatase

90
Q

Isolated enuresis in children Stepwise treatment

A

1- enuresis alarms 2- desmopressin 3- tricyclics (imipramine, desimpramine)

91
Q

Diffuse telangiectasias Recurrent nosebleeds Arteriovenous malformations widespread Dx?

A

Osler-Weber-Rendu

92
Q

Immediate intervention for CRAO

A

Ocular massage and high flow O2

93
Q

25% false negative rate during first week of symptoms for what disease

A

Infectious Mono EBV

94
Q

2nd degree block - Mobitz I

A

Constant p-p INCREASING P-R interval Decreasing R-R Prolonging to dropped beat

95
Q

MEN 1

A

PRIMARY HYPERPARATHYROID Pituitary tumors Pancreatic

96
Q

MEN 2A

A

MEDULLARY THYROID CANCER Pheochromocytoma Parathyroid hyperplasia

97
Q

MEN 2B

A

MEDULLARY THYROID CANCER Pheochromocytoma Mucosal neuromas, MARFANOID habitus

98
Q

MCC of erysipelas Involvement of what is particularly suggestive?

A

Group A Strep Strep pyogenes External ear involvement

99
Q

Management shoulder dystocia

A

Breathe, do not push Elevate legs - Mcroberts Call for help Apply suprapubic pressure L- enlarge vaginal opening Maneuvers - Rubin, gaskin, zavanelli

100
Q

Early decelerations =

A

Fetal head compression

101
Q

Late decelerations=

A

Uteroplacental insufficiency

102
Q

Variable decelerations=

A

Cord compression, cord collapse, oligohydramnios

103
Q

MCC of osteomyelitis in normal pt Sickle cell?

A

Staph aureus Salmonella

104
Q

Most consistent reversible risk factor for pancreatic cancer

105
Q

Lab findings in Pagets disease of bone

A

Normal Ca Normal Phos Elevated Alk Phos Elevated Urine Hyodroxyproline

106
Q

Croup = what virus? Bronchiolitis =?

A

Parainfluenza RSV

107
Q

RSV vs Croup

A

Croup has inspiratory stridor and barky cough 3-36 months RSV has no stridor or cough <2 years

108
Q

Medical treatment for HCM

A

1) Beta blockers 2) CCB’s

109
Q

Medications associated with idiopathic intracranial hypertension

A

Vit A Tetracyclines Growth Hormone

110
Q

Why do patients with acute ischemia of CN III have preserved pupillary response

A

Parasympathetic fibers associated with the pupil response are on the outside of the nerve (I.e closer to the blood supply) Nerves to Muscles supplied by CN3 are further away from blood supply

111
Q

Hypocalcemia after massive transfusion more likely in patients with underlying?

A

Liver disease or damage

112
Q

Most effective nonpharmacologic method to decrease BP in overweight individuals

A

Weight loss 10% reduction

113
Q

HCG purpose

A

Maintains corpus luteum Syncytiotrophoblasts

114
Q

Endometriosis vs vaginismus vs vulvodynia

A

Painful deep penetration + dysmenorrhea Involuntary muscle contraction on speculum insertion Pain to superficial touch of the vaginal vestibule

115
Q

Sudden loss of conscious + loss of postural tone + delayed return to consciousness =

A

Seizure Possible aura prior Tongue lacerations on exam

116
Q

J❤️NES criteria of acute rheumatic fever

A

Joints - migratory arthritis Carditis Nodules Erythema marginatum Sydenham chorea

117
Q

An evanescent pink rash with sharp edges

A

Erythema marginatum

118
Q

Breast feeding decreases risk of what two cancers in women

A

Breast and ovarian

119
Q

Breast feeding benefits to infant

A

Improved immunity Prevention of otitis media and respiratory illnesses

120
Q

Precocious puberty in a child Bleeding, endometrial hyperplasia in postmenopausal woman Adnexal mass

A

Granulosa cell tumor Increased estrogen

121
Q

Woman under 30 Increased LDH or b-HCG Ovarian mass

A

Dysgerminoma

122
Q

Most common benign ovarian neoplasm

A

Serous cystadenoma

123
Q

Concentric hypertrophy seen in

A

Valvular aortic stenosis Untreated hypertension

124
Q

Eccentric hypertrophy seen in

A

Valvular regurgitation

125
Q

Eczema, regurgitation, painless bloody stools in an infant

A

Milk protein induced enterocolitis Eliminate all dairy and soy Switch to hydrolyzed formula

126
Q

Drugs that can cause folic acid deficiency

A

Phenytoin Primidone Phenobarbital Trimethoprim Methotrexate

127
Q

Most common primary bone tumor of children and young adults Characteristic findings on imaging, physical exam

A

Osteosarcoma Sunburst pattern Codman triangle Tender soft tissue mass in metaphyses of long bone

128
Q

Ewing sarcoma characteristic appearance on x ray

A

Onion skinning

129
Q

Ovulation induction agent in PCOS

A

Clomiphene citrate SERM

130
Q

Extended wrist, hyperextended MCP joints, flexed IP joints, absent grasp reflex Infant with shoulder dystocia What’s the name of the paralysis? Nerve levels?

A

Klumpke paralysis C8-T1 Also includes Horner syndrome commonly

131
Q

Most common congenital cause of aplastic anemia Other findings?

A

Fanconi Short stature. ABNORMAL THUMBS Hypo or hyperpigmented areas, cafe au lait spots Strabismus, low set ears

132
Q

Diagnosis of Fanconi anemia made by?

A

Chromosomal breaks on genetic analysis + clinical findings

133
Q

Correction for albumin and calcium

A

Decreases by .8 for every 1g decrease in albumin

134
Q

Empiric antibiotic treatment for human bite

A

Augmentin (amox-clav)

135
Q

2 MCC of unilateral lymphadenitis

A

Staph aureus, Strep pyogenes

136
Q

Indications for addition of corticosteroids to TMP-SMX in PCP pneumonia

A

PaO2 <70 A-a gradient > 25

137
Q

Antipseudomonal antibioti s

A

Ticarcillin, Piperacillin Ceftazidime, Cefepime Amikacin, gentamicin, tobramycin Cipro, levoquin Aztreonam Imipenem, meropenem

138
Q

Abx of choice for malignant otitis externa

A

IV ciprofloxacin

139
Q

Obstructive lung disease FEV1 FEV1/FVC FVC

A

<80% <70% Normal to decreased

140
Q

Restrictive lung disease including obesity FEV1 FEV1/FVC FVC

A

<80% >70% <80%

141
Q

Useful differentiating for asthma vs COPD

A

DLCO is normal in asthma or increased Asthma is REVERSIBLE

142
Q

Rapid onset hirsutism Labs?

A

Testosterone and DHEAS NOT LH FSH

143
Q

Atelectasis most severe post surgery what day?

A

Post op day 2

144
Q

Compensation for hypoxemia Labs?

A

Hyperventilate Respiratory alkalosis Decreased PaCO2

145
Q

Common etiologies of small intestine bacterial overgrowth

A

Anatomical abnormalities - strictures, surgical Motility disorders - sclerosis, DM Other - ESRD, AIDS, CIRRHOSIS, advanced age

146
Q

Gold standard dx for small intestine bacterial overgrowth

A

Endoscopy with jejunal aspirate >10^4 organisms

147
Q

What effect does estrogen have on thyroid hormones

A

Increased TBG Thyroxine dose would need to be increased in hypothyroid patients

148
Q

Rifampin, phenytoin, carbamazepine effect on thyroid

A

Increased thyroid hormone metabolism

149
Q

Bile acid binding agents Iron, calcium, aluminum hydroxide PPI, sucralfate Effect on levothyroxine

A

Decreased absorption

150
Q

When to give prophylactic antiviral for pregnant women with herpes

A

Starting at 36 weeks

151
Q

Which cause of pericarditis typically doesn’t cause the diffuse ST changes?

152
Q

Neonatal sepsis needs to be high on the differential with what two symptoms

A

Decreased activity Poor feeding

153
Q

Pulmonary nodules with surrounding ground glass opacities

A

Invasive aspergillosis “Halo sign”

154
Q

Physical exam findings of alcoholic cerebellar degeneration

A

Progressive gait dysfunction Truncal ataxia Nystagmus Intention tremor or dysmetria Dysdiadichokinesia

155
Q

Amenorrhea for >6 months or 3 cycles Negative bHCG Next?

A

Prolactin, TSH, FSH

156
Q

Intrauterine fetal demise = Follow up test? Tx?

A

fetal death >20 weeks Transvaginal US Followed by D&E or vaginal delivery (>24 weeks)

157
Q

Syringomyelia is associated with

A

Arnold Chiari type I malformation

158
Q

Pre eclampsia symptoms at less than 20 weeks can be a complication of?

A

Hydatidiform mole

159
Q

Most common cause of nonsurgical hypoparathyroid

A

Autoimmune

160
Q

Emboli ischemic strokes typically have what type of onset?

A

Abrupt Worst at the start

161
Q

Olanzapine and Clozapine highly associated with?

A

Metabolic syndrome Get fasting lipids and glucose after 3 months of therapy

162
Q

Acute febrile illness and altered mental status No rash Tick exposure +

A

Erlichiosis Doxycycline Can see elevated LFT’s and leukopenia or thrombocytopenia

163
Q

Is chorioamnionitis an indication for C section?

A

NO Augment delivery instead Unless another indication for CS is present

164
Q

Phenazyridine

A

Analgesic for the urinary tract Cystitis treatment

165
Q

Delayed (slow rising) and diminished (weak) pulses

A

Pulsus parvus et tardus

166
Q

Preferred treatment for bipolar in patient with kidney disease

A

Valproate Lithium contraindicated Quetta pine and Lamotrigine have efficacy as well

167
Q

Uniformly enlarged uterus found in? Other symptoms?

A

Adenomyosis Pelvic pain and extremely painful menses with heavy bleeding

168
Q

Gait associated with Parkinson’s

A

Hypotonic gait

169
Q

Urine culture reserved for?

A

Those who fail initial therapy

170
Q

Elevated PaCO2 and low O2 suggest what type of post surgical lung process?

A

Alveolar hypoventilation

171
Q

Deficient enzyme in Niemann Pick Differentiation from Tay Sachs?

A

Sphingomyelinase Hepatosplenomegaly

172
Q

Abdominal pain following trauma Dilated bowel loops on x ray with no distinct transition point

A

Paralytic ileus

173
Q

Diarrhea in AIDS patients <180 cd4 <100 <50 <50

A

Cryptosporidium - watery diarrhea with fever Microsporidium/Isosporidium - diarrhea WITHOUT fever MAC - high fever CMW - hematochezia, frequent small bowel movements

174
Q

In developing countries and endemic areas TB is a common cause of what heart condition?

A

Constrictive pericarditis

175
Q

Steps of work up in bilious emesis of a neonate

A
  1. Abd X-ray 2. Contrast enema (pending no pneumoperitoneum on X-ray)
176
Q

First step in meconium ileus of neonate

A

Hyperosmolar enema Then surgery

177
Q

Three causes of hyperandrogenism in pregnancy

A

Luteoma Theca lutein cyst Krukenberg tumor

178
Q

Fair hair and eyes Developmental delay Cerebrovascular accident Tall stature

A

Homocystinuria

179
Q

Mild hypothermia temp Moderate Severe

A

32-35 C (90-95) 28-32 C (82-90) <28 C (82)

180
Q

P2Y12 blockers

A

Clopidogrel Ticagrelor Prasugrel

181
Q

5 therapies shown to improve morbidity and mortality in known CAD

A

Dual antiplatelet aspirin+ P2Y12 Beta blocker ACE-I/ARB STATINS Aldosterone antagonists

182
Q

First line treatment for uremic pericarditis

A

Hemodialysis NSAID’s if that fails

183
Q

Primary biliary cholagnitis antibody? Tx?

A

Anti-mitochondrial Ursodeoxycholic acid

184
Q

Primary dose limiting side effect of hydroxyurea

A

Myelosuppression

185
Q

Glucocorticoids affect thyroid hormones how

A

Decrease peripheral conversion of T4-T3

186
Q
  1. Components of thyroid storm treatment
A

Beta blocker Thionamide Iodine Glucocorticoids

187
Q

Long standing rheumatoid arthritis + neutropenia + splenomegaly

A

Felty syndrome

188
Q

Warfarin induced skin necrosis due to?

A

Protein C deficiency

189
Q

Hypokalemia Alkalosis Normotensive 4 conditions?

A

Vomiting Diuretic abuse Bartter Gittelman

190
Q

Most important thing to do with acute psychosis in an adolescent or child

A

Rule out medical or substance related causes

191
Q

Most common risk factor for preterm birth

A

Prior preterm birth

192
Q

Recommended dietary change for chronic calcium oxalate stones

A

Low sodium diet

193
Q

Proximal muscle weakness, nontender Tachycardia, weight loss, muscle atrophy

A

Hyperthyroidism Acute thyrotoxic myopathy Muscle atrophy is a EARLY finding here compared to late with polymyositis

194
Q

Why is the BUN elevated in pre-renal acute kidney injury

A

RAA axis = reabsorption of Na and water = passive reabsorption of urea

195
Q

Primary prophylaxis for esophageal varices

A

Nadolol or propranolol Ligation (first)

196
Q

NRTI’s with good placental transfer

A

Zidovudine Tenofovir

197
Q

Neonatal Polycythemia

198
Q

Prenatal, Intrapartum, and Postnatal Management of HIV infection

199
Q

Bronchiolitis

200
Q

Henoch-Schonlein Purpura

201
Q

Flaccid Paralysis Differential

203
Q

Malignancy Related Hypercalcemia COnditions

204
Q

Acute Abd in Women

205
Q

Antiplatelet/Antithrombotic Therapy in Acute Ischemic Stroke

206
Q

Chikungunya

207
Q

Disorders of Sex Development

208
Q

Hereditary Thrombophilias

210
Q

Serum Sickness Syndrome

211
Q

Wallenberg Syndrome

212
Q

Routine Prenatal Studies

213
Q

Rabies PEP

214
Q

Polycythemia vera pathophysioloy

A

JAK2 mutation

increased ERYTHROCYTE PRODUCTION irrespective of EPO, EPO levels are low

215
Q

Restrictive lung disease PFT values

A

FEV1 >75%

FEV1/FVC >70

Total lung capacity <80 (decreased residual volume)

UWorld Step 2 CK (3 decks)

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