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1 USMLE Step 2 -- DEDICATED !!! > Set 3 > Flashcards

Set 3 Flashcards

1
Q

What are the skin manifestations of sarcoidosis?

A

Erythema nodosum (painful subcutaneous erythematous nodules)

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2
Q

What is seen on X-ray in sarcoidosis?

A

Bilateral hilar lymphadenopathy
&
Pulomonary reticular infiltrates

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3
Q

What is see on biopsy of sarcoidosis?

A

Noncaseating granulomas

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4
Q
  • Headache
  • Sudden loss of vision
  • Elevated ESR
    Dx?
A

Giant cell arteritis

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5
Q

Tx for giant cell arteririts

A

Giant Cell Arteritis without vision loss Tx = Intermediate to high dose oral glucocorticoids (prednisone 40-60 mg daily)

Giant Cell Arteritis With vision loss = High-dose IV glucocorticoids (e.g. methylprednisolone 1000 mg daily) for 3 days followed by intermediate to high dose oral glucocorticoids

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6
Q

What is the PaO2/FiO2 in Acute Respiratory Distress Syndrome?

A

PaO2/FiO2 < 300

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7
Q

What are the symptoms of digoxin toxicity?

A

GI (Nausea, vomiting, diarrhea)
Cardiac (Arrhythmia)
Vision

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8
Q

Weak and slow-rising carotid pulse. Dx?

A

Weak and slow-rising carotid pulse =
“pulsus parvus and tardus”
Dx = Aortic stenosis

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9
Q

Blood pressure differential between upper and lower extremities. Dx?

A

Coarctation of aorta

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10
Q

Cardiac auscultation demonstrates an opening snap. Dx?

A

Mitral stenosis

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11
Q

Prominant capillary pulsations in the fingertips. Dx?

A

Aortic regurgitation

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12
Q

Exertional syncope in elderly pt. What is a likely cardiac cause?

A

Aortic stenosis

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13
Q

What is the pathological view of diabetic nephropathy?

A

Nodular glomerulonephrosis (Kimmelstiel-Wilson nodules)

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14
Q

What is the difference between the hearing loss of presbycusis and osteosclerosis?

A

Presbycusis is sensorinural hearing loss. It is seen after the 6th decade of life. It presents with loss of high-frequency noises.

Osteosclerosis is conductive hearing loss. It is seen in middle-age. It presents with loss of low-frequency.

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15
Q

Morning pain and stiffness in neck, shoulders and pelvis. + Elevated ESR. Dx? Tx?

A 
Dx = Polymyalgia rheumatica
Tx = low-dose glucocorticoids
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16
Q

If pt develops hypocalcemia after blood transfusion. What is the mechanism?

A

Whole blood is stored with citrate anticoagulant.

Citrate can chelate serum calcium, causing hypocalcemia.

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17
Q

What is 3rd degree or complete AV block? What is the treatment?

A 
3rd degree (complete AV block) = complete dissociation of QRS and P waves
Tx = permanent pacemaker
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18
Q

Location of Charcot joint. Mechanism of Charcot joint.

A

Charcot joint = Neuropathic arthropathy
It occurs in weightbearing joints (e.g. ankle).
Patients with type 2 DM have decreased sensation in the lower extremity, unknowingly traumatize weighbearing joints, leading to joint degeneration.

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19
Q

Mechanism of Dupuytren contracture

A

Progressive fibrosis of the palmar fascia

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20
Q

Pt has MI with pulmonary edema. What medication to give? What medication to avoid?

A

Give: diuretic (Intravenous Furosemide)

Avoid beta blockers in pulmonary edema.

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21
Q

Claw hand. Dx? What Nerves are involved?

A 
Dx = Klumpke palsy
Nerves = C8, T1
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22
Q

If pediatric pt has claw hand. What other symptoms may occur? Why?

A

Horner’s syndrome (Miosis and Ptosis)

Sympathetics fibers run along C8, T1

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23
Q

“Waiter-tip” arm. Dx? What Nerves are involved?

A 
Dx = Erb-Duchenne palsy
Nerves = C5, C6
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24
Q

Cardiogenic shock. What is increased/decreased?

Cardiac output, SVR, PCWP

A

Cardiac output (decreased)
SVR (increased)
PCWP (increased)

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25
Hypovolemic shock. What is increased/decreased? | Cardiac output, SVR, PCWP
Cardiac output (decreased) SVR (increased) PCWP (decreased)
26
Septic shock. What is increased/decreased? | Cardiac output, SVR, PCWP
Cardiac output (increased) SVR (decreased) PCWP (decreased)
27
Neurogenic shock. What is increased/decreased? | Cardiac output, SVR, PCWP
Cardiac output (decreased) SVR (decreased) PCWP (decreased)
28
What is the only type of shock that has increased cardiac output?
Septic shock
29
What is the only type of shock that has increased PCWP?
Cardiogenic shock
30
In hypovolemic shock -- why does cardiac output decrease?
Decreased right ventricular preload
31
Which hemorrhoids are painful and which are not?
External hemorrhoids = painful | Internal hemorrhoids = less pain
32
What is the mechanism of graft-vs-host disease? What are the symptoms?
``` Mechanism = Activation of donor T-lymphocytes Symptoms = Skin (Rash on palms, soles, face) Intestine (bloody diarrhea) Liver (High LFTs, Jaundice) ```
33
Phenytoin side effect: what vitamin deficiency?
Folic acid deficiency
34
Inflammatory arthritis Splenomegaly Neutropenia Dx?
``` Felty syndrome (An autoimmune conditions that is most common in patients with long-establish rheumatoid arthritis) ```
35
What type of dementia is associated with visual hallucinations?
Lewy body dementia
36
Key features that help to distinguish this stroke from other strokes: Anterior Cerebral Artery Stroke
- Lower extremity more affected than upper | - Urinary incontinence
37
Key features that help to distinguish this stroke from other strokes: Middle Cerebral Artery Stroke
- Homonomous hemianopsia - Eye deviation to affected side - Hemineglect - IF dominant hemisphere then = Aphasia
38
Key features that help to distinguish this stroke from other strokes: Posterior Cerebral Artery Stroke
- Homonomous hemianopsia - CNIII palsy = paresis of vertical and horizontal eye movement - Visual hallucinations - IF dominant hemisphere then = Alexia without agraphia (can't read, but can write)
39
Sudden cessation of what drug can lead to seizures?
Short acting benzodiazapines (e.g. alprazolam)
40
Variable decelerations. Dx? Tx?
Dx = umbilical cord compression Tx = depends on how often the variable decels (<30 sec decels) occur IF umbilical cord compression (variable decels) occur with <50% of contractions then NO intervention required. IF umbilical cord compression (variable decels) occur with >50% of contraction then: Primary Tx = maternal repositioning Secondary Tx = amnioinfusion
41
What type of murmur is heard in bicuspid aortic valve?
Bicuspid aortic valve can cause aortic regurgitation. | = Diastolic decrescendo murmur
42
What type of murmur is heard in hypertrophic cardiomyopathy?
Systolic crescendo decrescendo murmur
43
Guidelines for colonoscopy for patients with ulcerative colitis.
8 yrs after initial diagnosis AND afterwards repeat every 1-3 yrs
44
Guidelines for colonoscopy for patients with family history of adenomatous polyps or colorectal cancer.
- Age 40 or 10 yrs before diagnosis of affected relative | - Repeat every 5 yrs
45
Guidelines for colonoscopy for patients with Hereditary Nonpolyposis Colorectal Cancer
- 1st colonoscopy at age 20-25 | - Repeat every 1-2 yrs
46
Guidelines for colonoscopy for patients with Classic familial adenomatous polposis
- 1st colonoscopy at age 10-12 | - Repeat annually
47
How to differentiate between erysipelas and cellulitis.
Erysipelas has a raised border. | Cellulitis has a flat border.
48
Timetable for alcohol withdrawal seizures.
12-48 hrs. after last drink
49
What heart defects are present in Marfan's? What murmurs are heard?
Marfan's = Aortic root dilation (aortic regurgitation) and Mitral valve prolapse (mitral regurgitation) Aortic regurgitation = early diastolic decrescendo murmur Mitral Regurgitation = mid-to-late systolic murmur.
50
Compare the sounds made by: | Mitral stenosis vs Mitral regurgitation
Mitral stenosis = opening snap + mid-diastolic rumble | Mitral regurgitation = mid-systolic click + mid-to-late systolic murmur
51
Pericordial friction rub. Dx?
Pericarditis
52
Pulsus parvus et tardus. Dx?
Pulsus parvus et tardus = weak and delayed arterial pulses | Dx = severe aortic stenosis
53
Categorize the types of lung cancer based on their location in the lung.
Squamous Cell Carcinoma - Central Small Cell Carcinoma - Central Large Cell Carcinoma - Peripheral Adenocarcinoma - Peripheral
54
Clinical Associations of | Adenocarcinoma of the Lung
- Clubbing | - Hypertrophic osteoarthropathy
55
Clinical Association of | Squamous Cell Carcinoma of the Lung
Hypercalcemia
56
Clinical Associations of | Small Cell Lung Cancer
- SIADH - ACTH (Cushing) - Lambert-Eaton Syndrome
57
Clinical Association of | Large Cell Lung Cancer
- Gynecomastia | - Galactorrhea
58
The predominant type of lung cancer seen in nonsmokers.
Adenocarcinoma
59
What criteria to use to decide if patient with community acquired pneumonia should be hospitalized.
CURB-65: - Confusion - Urea (BUN) > 20 - Respirations > 30 - BP < 90/60 - Age > 65 * if score is >3 then hospitalize the patient
60
What is the treatment of community acquired pneumonia in outpatient vs inpatient?
Outpatient if patient is healthy = Macrolide OR Doxycycline Outpatient if pt has comorbidities = Respiratory Fluoroquinolone (levofloxacin, moxifloxacin) or beta-lactam + macrolide Inpatient = Respiratory fluoroquinolone (IV) OR Beta-lactam + Macrolide (IV)
61
Right atrium pressure (preload) is increased in only what type of shock?
Cardiogenic shock
62
PCWP (preload) is increased in only what type of shock?
Cardiogenic shock
63
Cardiac index (pump function) is increased in only what type of shock?
Septic shock
64
SVR (afterload) is decreased in only what type of shock?
Septic shock
65
Mixed venous oxygen saturation is increased in only what type of shock?
Septic shock
66
IV drug user has AV block. Dx?
Dx = Perivalvular abscess (most often from aortic valve endocarditis) NOT tricuspid if AV block
67
What is the animal resevoir of Ecchinococcus granulosus?
Dog tapeworm (sheep intermediate host)
68
Tapeworm from pigs that can cause seizures
Taenia solium
69
Liver cyst associated with diarrhea. What is the organism?
Entamoeba histolytica
70
Entamoeba histolytica and Ecchinococus granulosus both present with liver findings. Which one is associated with fever?
Liver + Fever = Entamoeba histolitica | + diarrhea
71
What 2 organisms can be transmitted in undercooked fish. What are the symptoms?
``` Clonorchi sinesis (liver fluke) = cause biliary disesase Diphyllobothrium latum (fish tapeworm) = megaloblastic anemia due to Vit B12 deficiency ```
72
In burn patients -- at what carboxyhemoglobin level is intubation warranted?
> 10 % carboxyhemoglobin = intubate
73
Sphincter of Oddi dysfunction presents with RUQ pain. The pain can be worsened if pt is given what medication?
Morphine
74
Rash after amoxicillin. Diagnosis?
Infectious Mononucleosis
75
Initial treatment for patient with cocaine-associated chest pain.
IV benzodiazepines
76
In cocaine-associated chest pain, what medication is contraindicated and why?
Beta blockers are contraindicated | because they may cause unopposed alpha adrenergic stimulation, worsening coronary vasoconstriction
77
Symptoms of retinal detachment
Floaters | Curtain (starting from periphery)
78
Both retinal artery and retinal vein occlusion can result in painless monocular vision loss. How do you differentiate them on fundoscopy?
Retinal artery occlusion = cherry red macula | Retinal vein occlusion = diffuse hemorrhages and cotton wool spots
79
Melanoma size.
> 6mm diameter
80
4 Physical findings in Trisomy 18 (Edward's syndrome)
- Closed fists - Overlapping fingers - Rocker-bottom feet - Micrognathia
81
4 Physical findings in Trisomy 13 (Patau)
- Cutis aplasia (absence of epidermis over skull) - Holoprosencephaly (1 eye) - Omphalocele (abdominal organs outside of body) - Polydactyly (extra fingers)
82
Uric acid stone. Treatment?
Alkalization of urine with potassium citrate.
83
Unilateral cryptorchidism can be monitored until age ______. Surgery is indicated before age ______ to reduce risk of testicular torsion, infertility and testicular malignancy.
Monitor until age: 6 months | Surgery by age: 1 yr
84
Muscular dystrophy. | BEST TEST to confirm diagnosis
Genetic testing (for dystrophin gene)
85
Cellulitis in the submandibular/sublingual spaces. Dx? Complication?
``` Dx = Ludwig angina Complication = Airway obstruction due to displacement of the tongue posteriorly ```
86
TCA overdose treatment
Sodium bicarbonate
87
Patient less than 40 with back pain that is relieved with exercise but NOT rest. Dx?
Ankylosing spondylitis
88
What is the ophthalmologic complication of ankylosing spondylitis?
Anterior uveitis
89
What is the lung complication of ankylosing spondylitis?
Restrictive lung pathology, due to reduced chest expansion and spinal mobility
90
Ischemic optic neuropathy is a complication of ________
Temporal arteritris
91
What is episcleritis? What conditions is it associated with?
Episcleritis = inflammation at the white of the eye | Associated with Rhematoid Arthritis and Inflammatory Bowel Disease
92
What is the cardiac complication of ankylosing spondylitis?
Aortic regurgitation
93
What is the cardiac complication of Turner's?
Aortic coarctation
94
Initial treatment for Rheumatoid Arthritis? What are the side effects? What medication is used to reduce the side effects?
Tx = Methotrexate Side effects = Stomatitis, Hepatotoxicity, Cytopenia Reduce side effects with Folic Acid supplementation.
95
Type 1 diabetic with facial pain and fever. Dx? Tx?
``` Dx = Mucormycosis Tx = Surgical debridement and Amphoterecin B ```
96
Lead poisoning therapy
Chelation therapy with calcium disodium EDTA
97
What are the symptoms of diphenhydramine overdose
Diphenhydramine causes antihistaminic and anticholinergic effects. Antihistaminic = Drowsiness and Confusion Anticholinergic = Dilated pupils, blurred vision, dry mouth, reduced bowel sounds, urinary retension
98
What is the treatment of diphenhydramine overdose
Physostigmine (a cholinesterase inhibitor), to couteract the anticholinergic effects of diphenhydramine
99
Salicylate intoxication symptoms and treatment.
Symptoms = - Mixed metabolic acidosis and respiratory alkalosis - Tinnitus - Nausea/vomiting - Fever Tx = Sodium bicarbonate to alkalize urine
100
Theophylline overdose symptoms
Seizures Hyperthermia Arrhythmia

1 USMLE Step 2 -- DEDICATED !!! (4 decks)

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