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USMLE Step Two > Random Subject Review Part III > Flashcards

Random Subject Review Part III Flashcards

1
Q

indications for carotid endarterectomy

A

70 - 99% stenosis symptomatic

80 - 99% stenosis asymptomatic

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2
Q

most common leukemia in children (peak age 3-4)

A

ALL

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3
Q

most common leukemia in adults (average age of onset 50)

A

CLL

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4
Q

philadelphia chromosome is almost always seen in this leukemia

A

CML

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5
Q

smudge cells on peripheral smear

A

CLL

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6
Q

peripheral blasts are PAS+ and TdT+

A

ALL

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7
Q

peripheral blasts are PAS-, myeloperoxidase+, and have Auer rods

A

AML

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8
Q

pancytopenia in a Down syndrome patient

A

ALL

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9
Q

next step in management of testicular torsion confirmed with US

A

external manipulation followed by surgical pinning bilaterally

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10
Q

causes of hypovolemic hyponatremia

A

diuretic use, vomiting, addison’s disease, ACE-I use, fluid sequestration

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11
Q

diagnosis: fever, rash, elevated creatinine, eosinophilia

A

acute interstitial nephritis

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12
Q

what distinguishes primary biliary cirrhosis from primary sclerosing cholangitis

A

PBC: females, anti-mitochondrial antibodies, intrahepatic duct disease
PSC: males, P-ANCA, intra/extrahepatic duct disease, ERCP “beads on a string”

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13
Q

treatment for Whipple disease

A

TMP-SMX x 1 year

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14
Q

HBsAg negative
HBsAb negative
HBcAb positive

A

“window period” of acute hepatitis B infection

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15
Q

HBsAg positive
HBsAb negative
HBcAb positive

A

chronic hepatitis B infection

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16
Q

HBsAg negative
HBsAb positive
HBcAb negative

A

immunized for hepatitis B

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17
Q

HBsAg negative
HBsAb positive
HBcAb positive

A

past hepatitis B exposure

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18
Q

differential diagnosis for ground-glass infiltrates on CXR

A

interstitial pneumonia, PCP, pulmonary edema (CHF, ARDS) pulmonary hemorrhage, hypersensitivity pneumonitis

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19
Q

medication used to close a PDA

A

indomethacin

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20
Q

complications arising from electrical burns

A

visceral damage, cardiac dysrhythmias, compartment syndrome, myoglobinuria, bony injuries, various neurologic disturbances

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21
Q

eye abnormality seen in lesion to oculomotor nerve

A

down and out, fixed and dilated (interruption of parasympathetics)

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22
Q

differing presentations of alzheimer’s dementia, pick’s disease, and lewy body dementia

A

alzheimer’s: most common cause
pick’s: personality changes
lewy body: visual hallucinations, parkinsonian symptoms, unexpected falls

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23
Q

diagnosis and management: 55-year-old man has sudden onset of pain in first metatarsophalangeal joint after a night of drinking red wine

A

gout, aspirate joint to find negatively birefringent needle shaped crystals
treat acute exacerbation with colchicine, NSAIDs
treat chronically with prebenicid, colchicine, or allopurinol

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24
Q

patient with history of lithium use presents with copious amounts of dilute urine

A

nephrogenic diabetes insipidus

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25
Q

most common pituitary tumor and what is the treatment

A

prolactinoma
dopamine agonist (bromocriptine)
ocreotide or transphenoidal resection

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26
Q

diagnosis: male with testicular mass is found to have elevated beta-hCG

A

testicular choriocarcinoma

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27
Q

cardinal movements of labor

A

engagement, distent, flexion, internal rotation, extension, external rotation, expulsion

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28
Q

50 year-old female smoker presents with hematuria

A

bladder cancer

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29
Q

30 year-old female African immigrant presents with hematuria

A

schistosoma infection

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30
Q

therapies used for polycystic ovarian syndrome

A

weight loss, OCPs (to avoid hyperestrogenism), spironolactone, metformin

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31
Q

what type of bone fracture is most likely to result from falling on outstretched hand

A 
colles fracture (distal radius fracture)
common in osteoporosis
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32
Q

two-month-old with projectile, nonbilious emesis, what is the first step in management

A

pyloric stenosis, correct metabolic abnormalities first

ultrasound to find hypertrophied pyloric muscle, surgical myomectomy

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33
Q

16-year-old female has left arm paralysis after her boyfriend dies in a car crash, no medical cause is found

A

conversion disorder

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34
Q

patient presents to the ER after an MVA with hypertension, bradycardia, and abnormal respirations, what is the next step after ABCs

A

cushing’s triad of elevated ICP

elevate bed, hyperventilate, give mannitol, consult neurosurgery

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35
Q

normalizing PCO2 in a patient having an asthma exacerbation may indicate what problem

A

fatigue and impending respiratory failure

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36
Q

patient has dyspnea, hilar lymphadenopathy on CXR, and hypercalcemia

A

sarcoidosis

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37
Q

chvostek’s and trousseau’s signs

A

tap on face and tap on wrist

hypocalcemia spasms

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38
Q

young patient whose father died at age 30 in an MVA suddenly collapses and dies while exercising

A

hypertrophic cardiomyopathy

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39
Q

diagnosis: gynecologic exam of a postmenopausal woman reveals inflammation and epithelial thinning of the anogenital area

A

lichen sclerosis

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40
Q

diagnosis and management: IV drug user has JVD and holosystolic murmur at left sternal border

A

bacterial endocarditis with tricuspid regurgitation
treat heart failure, replace tricuspid valve
4-6 weeks IV vancomycin

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41
Q

classic ECG finding in pericarditis

A

low voltage diffuse ST segment elevation

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42
Q

renal tubular acidosis associated with abnormal bicarbonate and rickets

A

RTA type II

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43
Q

treatment for neuroleptic malignant syndrome

A

dantrolene, stop offending agent

also can use dopamine agonist like bromocriptine

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44
Q

child has flesh-colored, umbilicated lesions on the face, what are these lesions and where do they appear in adults

A

molluscum contagiosum, in genital or perianal region in adults

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45
Q

medication used more than any other in the treatment for parkinsons

A

levo-dopa with carva-dopa

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46
Q

diagnostic test differentiates central from nephrogenic diabetes insipidus

A

desmopressin stimulation test and measure urine osmolality

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47
Q

post-op patient with significant pain presents with hyponatremia and normal volume status, what is the diagnosis

A

SIADH due to stress

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48
Q

elderly female presents with pain and stiffness of the shoulders and hips, cannot lift arms above her head, lab shows elevated ESR

A

polymyalgia rheumatica

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49
Q

child presents with oliguria, petechias, and jaundice following an illness with bloody diarrhea, what is the most likely diagnosis and infectious cause

A

HUS from enterohemorrhagic e. coli

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50
Q

11-year-old boy with fever, weight loss, and night sweats, radiology reveals anterior mediastinal mass, what do you suspect, what would you suspect if the patient was 30 years old

A

non-hodgkin’s lymphoma, suspect hodgkin’s lymphoma if 20-40 or > 60

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51
Q

prophylactic medication indicated in HIV patient w/CD4 less than 100

A

TMP-SMX for PCP prophylaxis

azithromycin for MAC prophylaxis

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52
Q

most common testicular cancer

A

seminoma

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53
Q

child presents with palpable purpura on the legs, abdominal pain, and arthritic pain in numerous joints, what is the diagnosis and treatment

A

henoch-schloein purpura

treatment: self-limited, may use steroids for severe GI symptoms

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54
Q

anti-centromere antibodies

A

CREST scleroderma

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55
Q

diagnosis: hyperphagia, hyperorality, hyperdocility, and hypersexuality

A

kluver-bucy’s syndrome, bilateral amygdala lesion

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56
Q

diagnosis: after a minor accident, a woman wears a neck brace and requests permanent disability

A

malingering

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57
Q

what medication is given to accelerate fetal lung maturity, for how long, and at what gestational age is it no longer necessary

A

betamethasone or dexamethasone (long acting steroids) prior to 34 weeks given for 48 hours

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58
Q

patients with silicosis are at higher risk for what type of infection

A

tuberculosis

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59
Q

diagnosis: patient has exopthalmos, pretibial myxedema, and a decreased TSH

A

grave’s disease

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60
Q

diagnosis: PFTs show decreased FEV1/FVC

A

obstructive lung disease

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61
Q

postmenopausal female presents with vaginal bleeding for the last 5 days, what is the next step

A

endometrial biopsy

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62
Q

what type of lung cancer is associated with hypercalcemia

A

squamous cell lung cancer

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63
Q

blood cell pathology associated with EBV in africa

A

burkitt’s lymphoma

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64
Q

blood cell pathology associated with reed-sternbeg cells, cervical lymphadenopathy, and night sweats

A

hodgkin’s lymphoma

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65
Q

blood cell pathology associated with bence-jones proteins, osteolytic lesions, high calcium

A

multiple myeloma

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66
Q

blood cell pathology associated with translocation 14;18

A

follicular lymphoma

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67
Q

most common lymphoma in the US

A

diffuse large B-cell lymphoma

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68
Q

blood cell pathology associated with translocation 8;14

A

burkitt’s lymphoma

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69
Q

blood cell pathology associated with translocation 9;22

A

philadelphia chromosome CML and less commonly adult ALL

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70
Q

blood cell pathology associated with “starry-sky pattern” due to phagocytosis of apoptotic tumor cells

A

burkitt’s lymphoma

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71
Q

blood cell pathology associated with high H/H, pruritis, burning pain in hands or feet

A

polycythemia vera

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72
Q

blood cell pathology associated with hair-like projections and splenomegaly

A

hairy-cell leuekemia

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73
Q

classic features that distinguish orbital cellulitis from periorbital cellulitis

A

orbital cellulitis: pain with eye movement, proptosis, opthalmoplegia, double vision, decreased vision

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74
Q

in which patients is buproprion contraindicated

A

history of seizures, bulemics

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75
Q

treatment for serotonin syndrome

A

stop SSRI, benzo sedation

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76
Q

how is benign paroxysmal positional vertigo diagnosed and treated

A

classic history, worse when laying down, getting up

treatment: eply maneuver

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77
Q

treatment for acute angle-closure glaucoma

A

glaucoma drugs: mannitol, acetazolamide, beta-blockers, prostaglandins, alpha-adrenergic agonists, cholinergic agonists

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78
Q

antidote: anticholinesterases, organophosphates

A

atropine, pralidoxime

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79
Q

antidote: mercury

A

dimercaparol, succimer

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80
Q

antidote: carbon monoxide

A

100% or hyperbaric oxygen

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81
Q

antidote: heparin

A

protamine sulfate

82
Q

antidote: isoniazid

A

pyridoxine (B6)

83
Q

diastolic murmur heard best in left lower sternum that increases with inspiration

A

tricuspid stenosis

84
Q

late diastolic murmur with an opening snap

A

mitral stenosis

85
Q

systolic murmur heard best int he second right interspace

A

aortic stenosis

86
Q

systolic murmur heard best in the second left interspace

A

pulmonic stenosis

87
Q

late systolic murmur best heart at the apex

A

mitral prolapse

88
Q

diastolic murmur with a widened pulse pressure

A

aortic regurgitation

89
Q

holosystolic murmur louder with inspiration at left lower sternal border

A

tricuspid regurgitation

90
Q

holosystolic murmur heart at the apex and radiates to the axilla

A

mitral regurgitation

91
Q

blood cell pathology associated with EBV in africa

A

burkitt’s lymphoma

92
Q

blood cell pathology associated with reed-sternbeg cells, cervical lymphadenopathy, and night sweats

A

hodgkin’s lymphoma

93
Q

blood cell pathology associated with bence-jones proteins, osteolytic lesions, high calcium

A

multiple myeloma

94
Q

blood cell pathology associated with translocation 14;18

A

follicular lymphoma

95
Q

most common lymphoma in the US

A

diffuse large B-cell lymphoma

96
Q

blood cell pathology associated with translocation 8;14

A

burkitt’s lymphoma

97
Q

blood cell pathology associated with translocation 9;22

A

philadelphia chromosome CML and less commonly adult ALL

98
Q

blood cell pathology associated with “starry-sky pattern” due to phagocytosis of apoptotic tumor cells

A

burkitt’s lymphoma

99
Q

blood cell pathology associated with high H/H, pruritis, burning pain in hands or feet

A

polycythemia vera

100
Q

blood cell pathology associated with hair-like projections and splenomegaly

A

hairy-cell leuekemia

101
Q

classic features that distinguish orbital cellulitis from periorbital cellulitis

A

orbital cellulitis: pain with eye movement, proptosis, opthalmoplegia, double vision, decreased vision

102
Q

in which patients is buproprion contraindicated

A

history of seizures, bulemics

103
Q

treatment for serotonin syndrome

A

stop SSRI, benzo sedation

104
Q

how is benign paroxysmal positional vertigo diagnosed and treated

A

classic history, worse when laying down, getting up

treatment: eply maneuver

105
Q

treatment for acute angle-closure glaucoma

A

glaucoma drugs: mannitol, acetazolamide, beta-blockers, prostaglandins, alpha-adrenergic agonists, cholinergic agonists

106
Q

antidote: anticholinesterases, organophosphates

A

atropine, pralidoxime

107
Q

antidote: mercury

A

dimercaparol, succimer

108
Q

antidote: carbon monoxide

A

100% or hyperbaric oxygen

109
Q

antidote: heparin

A

protamine sulfate

110
Q

antidote: isoniazid

A

pyridoxine (B6)

111
Q

diastolic murmur heard best in left lower sternum that increases with inspiration

A

tricuspid stenosis

112
Q

late diastolic murmur with an opening snap

A

mitral stenosis

113
Q

systolic murmur heard best int he second right interspace

A

aortic stenosis

114
Q

systolic murmur heard best in the second left interspace

A

pulmonic stenosis

115
Q

late systolic murmur best heart at the apex

A

mitral prolapse

116
Q

diastolic murmur with a widened pulse pressure

A

aortic regurgitation

117
Q

holosystolic murmur louder with inspiration at left lower sternal border

A

tricuspid regurgitation

118
Q

holosystolic murmur heart at the apex and radiates to the axilla

A

mitral regurgitation

119
Q

what does fall in systopic BP > 10 mmHg with inspiration indicate

A

pulsus paradoxus seen with cardiac tamponade and COPD

120
Q

laparoscopic findings seen in endometriosis

A

extra-uterine endometrial implants, “chocolate cysts”

121
Q

hypertension, hypernatremia, hypokalemia, and metabolic alkalosis

A

hyperaldosteronism

122
Q

LDL goal in patient diabetes

A

< 100

if concurrent vessel disease, < 70

123
Q

8 year-old child requires emergency blood transfusion, parents are not present, but child states that she is a jehovah’s witness

A

treat child immediately, consent is implied

124
Q

young man presents with pain and watery diarrhea after meals, exam shows fistulas between bowel and skin and nodular lesions on his tibias

A

crohn’s disease

125
Q

40-year-old female presents with discrete area of complete hair loss on the scalp that has worsened over weeks, what is the treatment

A

alopecia areata, often resolves on its own, or consider intralesional steroids

126
Q

CSF analysis shows low glucose, elevated neutrophils, and gram positive diplococci

A

strep pneumo meningitis

127
Q

characteristic findings in tertiary syphillis

A

loss of proprioception, gumma formation, argyl-robertson pupils, thoracic aortic aneurysm, aortic regurgitation

128
Q

young child presents with thigh muscle weakness, waddling gait, and pronounced calf muscles

A

muscular dystrophy

129
Q

diagnosis and management: female born in breech position is found to have asymmetric inguinal and gluteal skin folds on her newborn exam

A

developmental dysplasia of the hip, requires pavlik harness

130
Q

seizure prophylaxis medication in severe preeclampsia

A

magnesium sulfate

131
Q

cause of erythroblastosis fetalis

A

Rh hemolytic anemia of the newborn, maternal antibodies attacking fetal antigens

132
Q

treatment of hypertension in pheochromocytoma

A

alpha-blocker and surgical resection

never give a beta-bocker by itself

133
Q

diagnosis and management: young boy with hemarthrosis, increased PTT

A

hemophilia, factor supplementation

134
Q

diagnosis and management: tall, white male presents with acute shortness of breath

A

spontaneous pneumothorax

treatment: oxygen supplementation, will resolve on its own, if large, chest tube placement

135
Q

diagnosis: 22-year-old male has 4 months of social withdrawal, worsening grades, decreased emotional expression, and concrete thinking

A

schizophreniform

136
Q

diagnosis and management: honeycomb pattern on CT scan of the chest

A

diffuse interstitial pulmonary fibrosis, steroids, azathioprine/cyclophosphamide, N-acetylcysteine

137
Q

diagnosis: young cihld has loss of the red light reflex

A

retinoblastoma

138
Q

why is thiamine administered in glucose infusion to alcoholics with hypoglycemia

A

glucose infusion will worsen wernicke’s encephalopathy

139
Q

two most common primary brain tumors in adults

A

glioblastoma multiform, meningioma

140
Q

three most common primary brain tumors in children

A

astrocytoma, medulloblastoma, ependymoma

141
Q

medications and interventions for cerebral palsy

A

dantrolene, baclofen, boutlinum toxin to relax muscles

exercise and physical therapy, surgery may relieve contractures

142
Q

ACLS treatment for ventircular fibrillation

A

CPR, defibrillation with monophasic 360 or biphasic 200 followed by epinephrine (or vasopressin first dose)

143
Q

vasopressor theoretically causes renal vasodilation

A

dopamine

144
Q

vasopressor high doses optimize alpha-1 vasoconstriction

A

epinephrine

145
Q

vasopressor ADH analogue

A

vasopressin

146
Q

best vasopressor for anaphylactic shock

A

epinephrine

147
Q

best vasopressor for septic shock

A

norepinephrine

148
Q

best vasopressor for cardiogenic shock

A

dobutamine

149
Q

vasopressor causes vasoconstriction with bradycardia

A

phenylephrine

150
Q

next step in evaluating injuries in different zones of the neck

A 
zone 1 (clavicle to cricoid cartilage): CT angiogram
zone 2 (cricoid cartilage to angle of the mandible): surgery
zone 3 (angle of the mandible upward): CT angiogram and triple endoscope
151
Q

how can flushing reaction of niacin be prevented

A

aspirin

152
Q

EKG finding seen in wolff-parkinson-white syndrome, what causes WPW

A

delta wave prior to QRS complex, caused by reentry through accessory conduction pathway

153
Q

how does treatment of SVT due to WPW differ from treatment of SVT due to other causes

A

WPW: treat with procainamide, amiodarone

other SVT: treat with adenosine

154
Q

most sensitive and specific lab test for chronic pancreatitis

A

low fecal elastase

155
Q

supplement to be given to women on anticonvulsants during pregnancy

A

folate 4 mg/day

also vitamin K supplementation in last month to augment coagulability

156
Q

next step in management of AGUS pap smear

A

colposcopy and ECC (endocervix likely where glandular cells are coming from)
if > 35, endometrial biopsy

157
Q

first-line treatment for pediculosis pubis and pediculosis capitis

A

permethrin cream

158
Q

immunodeficiency suspected in patient with recurrent infections, thrombocytopenia, and eczema

A

wiskott-aldrich syndrome

159
Q

what causes a cild to have mental retardation, microcephaly, short palebral fissures, midfacial hypoplasia, and cardiac defects

A

fetal alcohol syndrome

160
Q

management: 18 year-old female with no history of abnormal paps now has a first-time ASCUS pap

A

follow-up pap smear in 6 months - 1 year

in a non-adolescent, perform HPV screening and repeat pap smear in 6 months

161
Q

treatment for clavicle fracture

A

very conservative management, figure-of-eight or sling, do not treat clavicle fractures at birth, physical therapy okay if associated with erb’s palsy

162
Q

diagnosis: 40 year-old female has persistent erythema on her nose and cheeks with recurrent facial flushing especially with alcohol and spicy foods

A

rosacea

163
Q

diagnosis: patient with cirrhosis presents to ER to have ascites drained, fluid reveals an absolute neutrophil count > 250

A

spontaneous bacterial peritonitis

164
Q

diagnosis and management: otoscopy in child presenting with acute onset of ear pain reveals large, reddish vesicles on the tympanic membrane

A

bullous meringitis caused by mycoplasma

treatment: oral macrolides

165
Q

treatment for pilonidal cyst

A

I&D

166
Q

treatment for rectal fistula

A

fistulotomy

167
Q

diagnosis: patient on isotretinoin for acne begins to develop daily, persistent, pulsatile headaches, exam reveals papilledema

A

pseudotumor cerebri

168
Q

18-year-old male found to have systolic heart murmur heard at apex and left lower sternal border, increases in intensity while standing after squatting

A

hypertrophic cardiomyopathy

169
Q

disorder that classically presents with triad of cognitive impairment, urinary incontinence, and abnormal gait

A

normal pressure hydrocephalus

170
Q

underlying cause of late fetal decelerations on contraction stress test

A

uteroplacental insufficiency

171
Q

treatment: middle-aged man presents with knee pain and x-ray reveals bilateral calcifications of the articular cartilage

A

pseudogout treated with NSAIDs or colchine

172
Q

next step in management of a positive PPD

A

CXR to look for active infection, INH + B6 for 9 months if no active infection, if active then RIPE therapy

173
Q

25-year-old male diagnosed with solid testicular mass by ultrasound, what is the next step in management

A

do not biopsy, just remove the mass

174
Q

teenager on antibiotics for acne presents with severe sunburn, what antibiotic was he taking

A

tetracycline

175
Q

next step in management of female with poor uterine tone after delivery of the placenta

A

uterine massage and oxytocin

176
Q

breast cancer screening

A

40-49: mammogram 1-2 years
50-69: mammogram annually
70+: decrease screening when life expectancy < 10 years

177
Q

hypertension screening

A

begins at age 18, check every 2 years for normotensive patients

178
Q

cholesterol screening

A

men: begin at age 35
women: begin at age 45
screen every 5 years

179
Q

smoking cessation

A

counsel to quit at every encounter
ask, assess, advise, assist, arrange
get patients to set a date
nicotine replacement doubles the quit rate
varenicline (chantix): causes nausea and suicidal ideation
bupropion (welbutrin): instruct patients to quit 1 week after starting medication, contraindicated in seizures, eating disorders

180
Q

vitamin deficiency that causes increased RBC fragility

A

vitamin E

181
Q

vitamin deficiency that causes dermatitis, cheilosis, and glossitis

A

iron deficiency/B complex deficiency

182
Q

vitamin defeciency that causes peripheral neuropathy, angular chelosis, and glossitis

A

vitamin B12

183
Q

vitamin deficiency that causes hemorrhagic disease

A

vitamin K

184
Q

vitamin deficiency that causes neural tube defects

A

folate

185
Q

vitamin deficiency that causes dermatitis, diarrhea, and dementia

A

niacin

186
Q

vitamin deficiency that causes megaloblastic anemia

A

vitamin B12 and folate

187
Q

vitamin deficiency that causes pernicious anemia

A

vitamin B12

188
Q

vitamin deficiency that causes bitot spots, keratomalacia, and xeropthalmia

A

vitamin A

189
Q

vitamin deficiency that causes osteomalacia

A

vitamin D

190
Q

vitamin deficiency that causes rickets

A

vitamin D

191
Q

vitamin that can be used to treat acne and psoriasis

A

vitamin A

vitamin D can also treat psoriasis

192
Q

vitamin that is involved in hydroxylation or prolyl residues

A

vitamin C

193
Q

vitamin that requires intrinsic factor for absorption

A

vitamin B12

194
Q

vitamin deficiency that may result from kidney disease

A

vitamin D

195
Q

vitamin that is given prophylactically to newborns

A

vitamin K

196
Q

vitamin that can be used to elevate HDL and lower LDL

A

niacin

197
Q

vitamin deficiency that can be caused by isoniazid

A

vitamin B6

198
Q

cobalt is found in this vitamin

A

vitamin B12 (cobalamine)

199
Q

how tension pneumothorax induces hypotension

A

trachea deviation causes high intrathoracic pressure that decreases venous return and causes hypotension

200
Q

calculation for serum osmolality

A

(2 x Na) + (BUN / 2.8) + (glucose / 18)

201
Q

treatment for infertility in PCOS

A

weight loss, clomiphene, or metformin

USMLE Step Two (17 decks)

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