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USMLE Step Two > Random Subject Review Part I > Flashcards

Random Subject Review Part I Flashcards

1
Q

complication of LP in patient with elevated intracranial presure

A

uncal herniation

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2
Q

diagnosis: child presents to ER with altered mental status, hypoglycemia, and lesions suggestive of chickenpox

A

rye’s syndrome (hepatoencephalopathy)

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3
Q

symptoms of basilar artery stroke

A

cranial nerve deficits, altered mental status/coma, contralateral full body weakness and decreased sensation, vertigo

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4
Q

TCA overdose signs and management

A

anticholingeric symptoms, cardiac and CNS toxicity

treat cardiac with sodium bicarb, and CNS with benzos

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5
Q

treatment for lithium induced nephrogenic diabetes insipidus

A

HCTZ and amiloride (binds lithium stimulated sodium channels)

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6
Q

treatment of acute dystonia

A

anticholinergics (benadryl, benztropine)

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7
Q

treatment of tardive dyskinesia

A

discontinue typical antipsychotic, switch to atypical antipsychotic

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8
Q

EEG pattern seen in absence seizures

A

3 cycle/second spike and wave pattern

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9
Q

typical complaint of patient with retinal detachment

A

sudden painless onset of flashing lights, floaters, and shade coming down over vision unilaterally

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10
Q

treatment for benign paroxysmal positional vertigo

A

epply maneuver to reposition otoliths

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11
Q

todd’s paralysis

A

post-ictal hemiparesis < 24 hours

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12
Q

drugs combined with SSRIs known for causing serotonin syndrome

A

SSRIs, SNRIs, MAOIs, levadopa, mepiridine, lithium, amphetamines, cocaine, ecstasy, LSD, st. john’s wort

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13
Q

most common cause of sensorineural hearing loss

A

prebycusis (progressive symmetric high-frequency loss of the elderly)

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14
Q

most common cause of conductive hearing loss

A

otosclerosis

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15
Q

most common complication of recurrent otitis media

A

hearing loss

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16
Q

medications used in ADHD

A

stimulants, TCAs, buproprion, alpha-2 agonists (clonidine)

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17
Q

medications used in tourette’s

A

fluphenazine, pimizide, tetrabenazine

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18
Q

most worrisome side effect of ADHD drug atomoxetine

A

increased suicidal ideation, hepatotoxicity

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19
Q

diagnosis: patient presents with hearing loss and vertigo, grayish-white “pearly” TM lesion apparent on PE

A

cholesteatoma

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20
Q

symptoms of basilar skull fracture

A

raccoon eyes (orbital fracture)
battle sign (bruising over mastoid process)
blood behind tympanic membrane
CSF coming out of nose or ears

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21
Q

diagnosis and next step: chest trauma, hypotension, JVD, and distant heart sounds

A

cardiac tamponade

pericardiocentesis

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22
Q

diagnosis and next step: chest trauma, JVD, hypotension, and respiratory distress

A

tension pneumothorax

needle decompression and chest tube placement

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23
Q

how to evaluate neck trauma

A

neck zone 1: CT angiogram
neck zone 2: surgical exploration
neck zone 3: CT angiogram and triple endoscopy

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24
Q

how to manage elevated ICP

A 
elevated head of bed
lidocaine prior to intubation
mannitol
hyperventilation
decompressive surgery
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25
Q

next step: pelvic fracture, DPL shows blood in pelvis

A

emergent laparotomy

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26
Q

next step: pelvic fracture, DPL shows urine in pelvis

A

urgent laparotomy (bladder injury)

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27
Q

next step: pelvic fracture, DPL shows nothing but there is hemodynamic instability

A

suspect retroperitoneal hematoma, angiography with possible embolization

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28
Q

next step: blunt abdominal trauma, unstable vital signs, FAST shows fluid in pelvis

A

emergent laparotomy (assume it is blood)

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29
Q

next step: blunt abdominal trauma, unstable vital signs, FAST shows no fluid in pelvis

A

retroperitoneal hematoma, angiogram with possible embolization

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30
Q

next step: blunt abdominal trauma, unstable vital signs, FAST inconclusive

A

perform DPL

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31
Q

empiric treatment for brain abscess

A

antibiotics, needle aspiration, corticosteroids

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32
Q

treatment for cluster headaches

A

100% oxygen

triptans and ergotamines

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33
Q

when are triptans contraindicated for headaches

A

pregnancy, CAD, prinzmetal’s angina

cause vasoconstriction

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34
Q

side effects of theophylline overdose

A

seizures, excessive muscle contraction, hyperthermia, hypotension, cardiac tachyarrhythmias

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35
Q

ST elevation in multiple arteries

A

acute pericarditis

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36
Q

diagnosis: cardiac cath shows equal pressure in all chambers

A

constrictive pericarditis

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37
Q

antidote for methanol

A

fomepazole

2nd line: alcohol

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38
Q

antiode for ethylene glycol

A

fomepazole

2nd line: alcohol

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39
Q

antiode for arsenic

A

dimercaperol, succimer, or penicillamine

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40
Q

burn patient fluid replacement

A

lactate ringers
4 mL/kg x % burn area + maintenance fluids
1/2 first 8 hours
1/2 next 16 hours

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41
Q

treatment for neuroleptic malignant syndrome

A

discontinue offending medication
IV fluids and dantrolene (stops muscle contraction)
2nd line: bromocriptine or amantidine

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42
Q

paget’s disease lab abnormalities

A

elevated alkaline phosphatase

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43
Q

osteomalacia/rickets lab abnormalities

A

vitamin D deficiency
decreased calcium
increased PTH
increased or normal alkaline phosphatase

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44
Q

osteoperosis lab abnormalities

A

all values normal

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45
Q

osteopetrosis lab abnormalities

A

all values normal

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46
Q

pseudohypoparathyroidism lab abnormalities

A

decreased calcium
increased phosphate
increased PTH
(defective receptors)

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47
Q

diagnosis: hypertension, depression, kidney stones

A

hyperparathyroidism

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48
Q

complications arising from using vasopressors in shock

A

ischemia and necrosis of distal extremities

mesenteric ischemia and renal failure

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49
Q

most effective intervention for reducing blood pressure

A

weight loss

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50
Q

preferred initial antihypertensive in a patient with no comorbidities

A

HCTZ or chlorthalidone

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51
Q

first-line hypertensive for diabetics

A

ACE-inhibitor

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52
Q

first-line hypertensive for CHF patients

A

ACE-inhibitor

beta-blocker and spironolactone

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53
Q

first-line hypertensive for BPH

A

alpha-blocker

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54
Q

first-line hypertensive for LVH

A

ACE-inhibitor

considered pre-CHF

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55
Q

first-line hypertensive for hyperthyroidism

A

non-selective beta-blocker

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56
Q

first-line hypertensive for osteoporosis

A

HCTZ

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57
Q

first-line hypertensive for benign essential tremor

A

beta-blocker

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58
Q

first-line hypertensive for post-menopausal female

A

HCTZ

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59
Q

first-line hypertensive for migraines

A

beta-blocker

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60
Q

most likely cause of secondary HTN with proteinuria

A

renal disease

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61
Q

most likely cause of secondary HTN with hypokalemia

A

hyperaldosteronism

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62
Q

most likely cause of secondary HTN with tachycardia, diarrhea, and heat intolerance

A

hyperthyroidism

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63
Q

most likely cause of secondary HTN with hyperkalemia

A

renal artery stenosis and renal failure

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64
Q

most likely cause of secondary HTN with episodic sweating, tachycardia

A

pheochromocytoma

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65
Q

antihypertensive side effect profile: first dose orthostatic hypotension

A

alpha-blocker

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66
Q

antihypertensive side effect profile: hypertrichosis

A

minoxidil

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67
Q

antihypertensive side effect profile: dry mouth, sedation, rebound HTN

A

clonidine

must be dosed every three hours

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68
Q

antihypertensive side effect profile: bradycardia, impotence, asthma exacerbation

A

non-selective beta-blocker

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69
Q

antihypertensive side effect profile: reflex tachycardia

A

vasodilators

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70
Q

antihypertensive side effect profile: cough

A

ACE-inhibitor

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71
Q

antihypertensive side effect profile: sulfa allergy

A

HCTZ, loop diuretics

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72
Q

antihypertensive side effect profile: angioedema

A

ACE-inhibitor or less likely ARB

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73
Q

antihypertensive side effect profile: drug-induced lupus

A

hydralazine

anti-histone antibodies

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74
Q

antihypertensive side effect profile: cyanide toxicity

A

nitroprusside

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75
Q

vasodilating effects of nitroglycerin and dihyropyridine calcium channel blockers

A

venodilators

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76
Q

vasodilating effects of nitroprusside

A

arteriodilators and venodilators

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77
Q

JONES criteria for rheumatic heart disease

A 
J - joint polyarthritis
O - pancarditis
N - nodules
E - erythema nodosum
S - syndenham's chorea
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78
Q

major DUKE criteria for endocarditis

A

serial positive blood cultures
presence of vegetations or cardiac abscess on ECHO
new onset valvular regurgitation
blood culture positive for Coxiella

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79
Q

minor DUKE criteria for endocarditis

A

predisposing heat condition or IV drug use
fever > 38C
vascular phenomenon (septic emboli, infarc, mycotic aneruysm, intracranial hemorrhage, janeway lesions)
immunologic phenomenon (glomerulonephritis, osler’s nodes, roth spots, positive rheumatoid factor)
positive cultures not meeting requirements for major criteria or serologic evidence of infection without positive culture

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80
Q

most common nephritic syndrome

A

membranous glomerulonephritis

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81
Q

endocarditis prophylaxis for oral surgery

A

amoxicillin before and after the procedure

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82
Q

endocarditis prophylaxis for GI/GU surgery

A

amipicillin + gentamicin before and amoxicillin after the procedure

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83
Q

treatment for mild unconjugated hyperbilirubinemia

A

UV therapy

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84
Q

when is the greatest risk for post-op MIs

A

first 48 hours

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85
Q

pressor causes vasoconstriction with bradycardia

A

phenylephrine

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86
Q

high dose pressor that maximizes alpha-1 constriction

A

epinephrine

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87
Q

when to stop warfarin prior to surgery

A

3-4 days

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88
Q

when to stop aspirin prior to surgery

A

5-7 days

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89
Q

treatment for DIC

A

FFP and possibly platelets

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90
Q

preferred placement of swan-ganz catheter

A

right IJ or left subclavian

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91
Q

protective measures for kidney with IV contract

A

n-acetylcysteine
IV fluids
sodium bicarbonate

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92
Q

treatment for cluster headaches

A

100% oxygen

triptans, ergotamines

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93
Q

antihypertensive contraindicated in bilateral renal artery stenosis

A

ACE-inhibitors

unilateral okay

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94
Q

antihypertensive contraindicated in advanced renal failure

A

ACE-inhibitors if they have hyperkalemia, otherwise okay

no potassium-sparing diuretics

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95
Q

antihypertensive contraindicated in gout

96
Q

heart defect seen in chromosome 22q11 deletions

A

truncus arteriosus, tetralogy of fallot

97
Q

heart defect seen in down syndrome

A

endocardial cushion defects

98
Q

heart defect seen in congenital rubella

A

PDA, pulmonary artery stenosis

99
Q

heart defect seen in turner’s syndrome

A

coarctation of the aorta

100
Q

heart defect seen in marfan’s syndrome

A

aortic regurgitation

101
Q

medication combination used in treatment of TB meningitis

A

RIPE drugs

102
Q

features of a patient presenting with pericarditis

A

pleuritic chest pain, dyspnea, fever, cough

pain worse in supine position, pulsus paradoxus

103
Q

classic ECG appearance in atrial flutter

A

saw-tooth pattern 2:1 or 3:1 P wave to QRS complex

104
Q

60 year old obese patient with dirty, velvety patches on back of neck

A

acanthosis nigricans

fingerstick glucose and assess for visceral malignancies

105
Q

most common cause of hypothyroidism

A

hashimoto’s thyroiditis

106
Q

type of bias introduced when screening detects a dsiease earlier and thus lengthens the time from diagnosis to death

A

lead-time bias

107
Q

exceptions to the requirement of informed consent

A

unable to give consent (mentally disabled)
emergency decisions
patients who waive the right for informed consent

108
Q

palpable flank mass, hematuria, and U/S showing bilateral enlarged kidneys with cysts, what brain anomaly is associated

A

berry aneurysm

109
Q

four main causes of microcytic anemia

A

iron deficiency anemia
thalassemia
anemia of chronic disease
lead poisoning

110
Q

US region where lyme disease is endemic

A

northeast US

111
Q

hand joints affected in rheumatoid arthritis

A

MCP and PIP

112
Q

xerostomia + parotid enlargement + xerophthalmia + anti-La antibodies

A

sjogren’s syndrome

113
Q

most common cause of seizures in young adults

A

trauma, alcohol withdrawal, brain tumors

114
Q

most common cause of non-obstetric postpartum death

A

thromboembolic disease

115
Q

immunodeficiency presenting with eczema, thrombocytopenia, and high levels of IgA

A

wiskott-aldrich syndrome

116
Q

defense mechanism displayed when a woman calmly describes a gory murder in great detail

117
Q

treatment for mild, persistent asthma

A

low-dose inhaled corticosteroid

118
Q

EKG with peaked T waves and widened QRS

A

hyperkalemia

119
Q

treatment for iron overdose

A

deferroxamine

120
Q

imaging study used to diagnose DVT

A

compressive venous U/S

121
Q

radiographic study used to diagnose injury to the urethra

A

retrograde cystourethrogram

122
Q

drug of choice for trigeminal neuralgia

A

carbamazepine

123
Q

treatment for normal pressure hydrocephalus

124
Q

treatment for normal pseudotumor cerebri

A

weight loss. acetazolamide

if refractory, consider serial LPs

125
Q

treatment for guillain-barre syndrome

A

endotracheal intubation

plasmapheresis or IVIG (not both)

126
Q

somogyi effect v. dawn phenomenon

A

somogyi: 3am glucose low
dawn: insufficient NPH insulin, 3am glucose high

127
Q

when does chronic COPD qualify for home O2

A

pulse ox < 88%

pulmonary HTN, peripheral edema, or polycythemia

128
Q

method used to calculate fluid repletion in burn victims

A

4 mL/kg x %burn
first half in 8 hours
second half in next 16 hours

129
Q

salicylate ingestion results in what type of acid-base disorder

A

respiratory alkalosis

metabolic acidosis

130
Q

medication commonly used to induce ovulation

A

clomiphene citrate

second life: pulsatile leuprolide

131
Q

psychiatric condition when personal travels a long distance and takes a new name and has no memory of prior life

A

dissociative fugue

132
Q

congenital infection may present with a “blueberry-muffin” rash

133
Q

breast cancer that increases future risk of invasive carcinoma in both breasts

134
Q

classic symptoms of placenta previa

A

painless bleeding

135
Q

anterior knee pain in active 14-year-old boy

A

oshgood-schlotter disease

136
Q

rhomboid-shaped, positively birefringent crystals in joint space

A

pseudogout

137
Q

oral infection with branching rods

A

actinomyces

138
Q

next step in evaluation of patient with two consecutive pap smears with ASCUS

A

colposcopy with ECC

139
Q

45-year-old obese female with pruritis, clay-colored stools, dark urine, elevated alkaline phosphate and elevated bilirubin

A

biliary tract obstruction

140
Q

infection causing diarrhea and pseudoappendicitis

141
Q

most likely cause of acute lower GI bleed in patients older than 40

A

diverticulosis

142
Q

most common underlying cause of pathologic fractures in elderly thin women

A

osteoporosis

143
Q

causative agent in pityriasis versicolor

A

malassia furur

144
Q

chest pain in young patient with angina at rest, T-segment elevation, normal cardiac enzymes

A

prinzmetals angina

145
Q

hypercholesterolemia medication causing flushing and pruritis

146
Q

target lesions with red center, pale zone, and dark outer ring appearing on palms and soles with a prodrome of malaise and myalgias

A

erythema multiforme

147
Q

what percentage of the population falls within 1SD, 2SD, and 3SD

A

1 standard deviation: 68%
2 standard deviations: 95%
3 standard deviations: 99.7%

148
Q

equation for odds ratio

149
Q

equation for relative risk

A

A/(A+B) / C/(C+D)

150
Q

when is odds ratio a good approximation of relative risk

A

when disease is very rare

151
Q

what does it mean when relative risk is equal to one

A

no association

152
Q

what to do when parents refuse life-saving treatment for a child in an emergent situation

A

perform therapy and go to ethics board after

153
Q

patient is emergently intubated after MVA, after family brings a signed DNR stating what she did not wish to be intubated, what do you do

154
Q

patient tells you she does not want to know the results of her lung biopsy but her family is begging you to tell them, what do you do

A

withhold information

155
Q

study shows that taking 325 mg of aspirin has no effect on ischemic cardiac events, what type of error is this

A

type II error

156
Q

treatment for acute mesenteric ischemia

A

broad spectrum antibiotics, NG tube decompression, diagnose with angiogram, heparin to anticoagulate, reduce arterial vasospasm with papaverine, embolectomy, resection of necrotic bowel

157
Q

when is rifampin prophylaxis indicated for bacterial meningitis

A

close contacts of neisseria or haeomphilus

158
Q

treatment for acromegaly

A

transsphenoidal surgical resection, external beam therapy, or ocreotide
last choice: cabergoline dopamine agonist

159
Q

COPD patient comes to ER with tachycardia and hypotension, begins to have seizures, what is the most likely etiology

A

theophylline intoxication

160
Q

ACLS treatment for asystole

A

transcutaneous pacing
CPR, alternative epinephrine and atropine
cannot give more than 1mg IV atropine x 3 doses
do not shock these patients

161
Q

treatment for febrile seizures

A

evaporative cooling

162
Q

empiric treatment for pneumonia in a 2-month old

A

macrolide +/- cefotaxime

163
Q

empiric treatment for pneumonia in a 2-year old

A

amoxicillin or ampicillin

164
Q

autoimmune complication occurs 2-4 weeks after an MI

A

dressler’s syndrome (autoimmune pericarditis)

165
Q

name given to stress-related hair loss and what is the treatment

A

tilogen effluveum, just reassure, should go away with stress

166
Q

most common cause of cushing’s syndrome

A

exogenous steroid use

second most common is pituitary tumor

167
Q

most likely cause of galactorrhea, impotence, and decreased libido in a patient with a history of schizophrenia

A

medication (dopamine antagonist)

168
Q

ethical problem if doctor refers patient for MRI at a facility he owns

A

conflict of interest

169
Q

two most common foodborne bacterial GI tract infections in the US

A

salmonella and campylobacter

170
Q

diagnostic test for hereditary spherocytosis

A

osmotic fragility test

171
Q

bullous skin disease with negative nikolsky sign

A

bullous pemphigoid

172
Q

white plaques on tongue and back of throat that can be scraped off with a tongue depressor

A

candida albicans, screen for HIV

173
Q

young male with hip and back pain along with stiffness that improves with activity and worsens with rest

A

ankylosing spondilitis

174
Q

cold water is flushed into a patients ear and fast phase of nystagmus is towards the opposite side

175
Q

findings expected in post-term pregnancy > 42 weeks

A

oligohydramnios, passage of meconium in utero, dry peeling skin, mature placenta with calcifications

176
Q

annual screening recommended for women with strong family history of ovarian cancer

A

CA-125 and transvaginal U/S

177
Q

defense mechanism used by pedophile who enters a monastery

A

reaction formation

178
Q

causes of exudative pleural effusion

A

pneumonia, malignancy, tuberculosis, pulmonary emboli, pancreatitis

179
Q

eosinophilic casts found in urine

A

acute interstitial nephritis (drug-induced)

180
Q

side effects of corticosteroids

A

hyperglycemia, hypertension, emotional lability, insomnia, cataracts, osteoporosis, thin skin, cushingoid features

181
Q

classic findings of henoch-schonlein purpura

A

abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs

182
Q

ranson’s criteria for pancreatitis

A

hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L

183
Q

entamoeba histolytica diarrhea treatment

A

metronidazole

184
Q

giardia lamblia treatment

A

metronidazole

185
Q

salmonella treatment

A

fluoroquinolone/TMP-SMX only in severe case (increases carrier state)

186
Q

shigella treatment

A

fluoroquinolone/TMP-SMX only in severe case

187
Q

campylobacter treatment

A

erythromycin

188
Q

vasculitis with weak pulses in upper extremities

A

takayasu’s arteritis (pulseless disease)

189
Q

vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis

A

wegener’s granulomatosis

190
Q

vasculitis with necrotizing immune complex inflammation of visceral and renal vessels

A

polyarteritis nodosa

191
Q

vasculitis of young male smokers

A

buerger’s disease

192
Q

vasculitis of young asian women

A

takayasu’s arteritis

193
Q

vasculitis of young asthmatics

A

cherg-strauss

194
Q

vasculitis of infants and young children involving coronary arteries

A

kawasaki disease

195
Q

most common vasculitis

A

giant cell arteritis (temporal arteritis)

196
Q

vasculitis associated with hepatitis B infection

A

polyarteritis nodosa

197
Q

vasculitis where occlusion of ophthalmic artery can lead to blindness

A

giant cell arteritis

198
Q

vasculitis with perforation of nasal septum

A

wegener’s granulomatosis

199
Q

vasculitis with unilateral headache and jaw claudication

A

giant cell arteritis

200
Q

lipid lowering agent that causes facial flushing

201
Q

lipid lowering agent that causes elevated LFTs and myositis

A

statins and fibrates

202
Q

lipid lowering agent that causes GI discomfort and bad taste

A

cholestyramine

203
Q

lipid lowering agent that causes best effect on HDL

204
Q

lipid lowering agent that causes best effect on triglycerides and VLDL

205
Q

lipid lowering agent that causes best effect on LDL and cholesterol

206
Q

lipid lowering agent that binds c. diff toxin

A

cholestyramine

207
Q

drug known for causing elevated prolactin levels

A

dopamine antagonists, verapamil, methyl-dopa

208
Q

classic findings of henoch-schonlein purpura

A

abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs

209
Q

ranson’s criteria for pancreatitis

A

hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L

210
Q

entamoeba histolytica diarrhea treatment

A

metronidazole

211
Q

giardia lamblia treatment

A

metronidazole

212
Q

salmonella treatment

A

fluoroquinolone/TMP-SMX only in severe case (increases carrier state)

213
Q

shigella treatment

A

fluoroquinolone/TMP-SMX only in severe case

214
Q

campylobacter treatment

A

erythromycin

215
Q

vasculitis with weak pulses in upper extremities

A

takayasu’s arteritis (pulseless disease)

216
Q

vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis

A

wegener’s granulomatosis

217
Q

vasculitis with necrotizing immune complex inflammation of visceral and renal vessels

A

polyarteritis nodosa

218
Q

vasculitis of young male smokers

A

buerger’s disease

219
Q

vasculitis of young asian women

A

takayasu’s arteritis

220
Q

vasculitis of young asthmatics

A

cherg-strauss

221
Q

vasculitis of infants and young children involving coronary arteries

A

kawasaki disease

222
Q

most common vasculitis

A

giant cell arteritis (temporal arteritis)

223
Q

vasculitis associated with hepatitis B infection

A

polyarteritis nodosa

224
Q

vasculitis where occlusion of ophthalmic artery can lead to blindness

A

giant cell arteritis

225
Q

vasculitis with perforation of nasal septum

A

wegener’s granulomatosis

226
Q

vasculitis with unilateral headache and jaw claudication

A

giant cell arteritis

227
Q

lipid lowering agent that causes facial flushing

228
Q

lipid lowering agent that causes elevated LFTs and myositis

A

statins and fibrates

229
Q

lipid lowering agent that causes GI discomfort and bad taste

A

cholestyramine

230
Q

lipid lowering agent that causes best effect on HDL

231
Q

lipid lowering agent that causes best effect on triglycerides and VLDL

232
Q

lipid lowering agent that causes best effect on LDL and cholesterol

233
Q

lipid lowering agent that binds c. diff toxin

A

cholestyramine

234
Q

drug known for causing elevated prolactin levels

A

dopamine antagonists, verapamil, methyl-dopa

235
Q

how to differentiate between microcytic anemia of iron deficiency and thalassemia

A

iron deficiency: high RDW > 20% and low reticulocyte count

thalassemia: normal RDW and high reticulocyte count

USMLE Step Two (17 decks)

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