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

Set 3 Flashcards

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USMLE® Step 1 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
Q

Hypovolemic shock. What is increased/decreased?

Cardiac output, SVR, PCWP

A

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

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26
Q

Septic shock. What is increased/decreased?

Cardiac output, SVR, PCWP

A

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

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27
Q

Neurogenic shock. What is increased/decreased?

Cardiac output, SVR, PCWP

A

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

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28
Q

What is the only type of shock that has increased cardiac output?

A

Septic shock

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29
Q

What is the only type of shock that has increased PCWP?

A

Cardiogenic shock

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30
Q

In hypovolemic shock – why does cardiac output decrease?

A

Decreased right ventricular preload

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31
Q

Which hemorrhoids are painful and which are not?

A

External hemorrhoids = painful

Internal hemorrhoids = less pain

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32
Q

What is the mechanism of graft-vs-host disease? What are the symptoms?

A 
Mechanism = Activation of donor T-lymphocytes
Symptoms = 
Skin (Rash on palms, soles, face)
Intestine (bloody diarrhea)
Liver (High LFTs, Jaundice)
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33
Q

Phenytoin side effect: what vitamin deficiency?

A

Folic acid deficiency

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34
Q

Inflammatory arthritis
Splenomegaly
Neutropenia
Dx?

A 
Felty syndrome
(An autoimmune conditions that is most common in patients with long-establish rheumatoid arthritis)
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35
Q

What type of dementia is associated with visual hallucinations?

A

Lewy body dementia

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36
Q

Key features that help to distinguish this stroke from other strokes:
Anterior Cerebral Artery Stroke

A
  • Lower extremity more affected than upper

- Urinary incontinence

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37
Q

Key features that help to distinguish this stroke from other strokes:
Middle Cerebral Artery Stroke

A
  • Homonomous hemianopsia
  • Eye deviation to affected side
  • Hemineglect
  • IF dominant hemisphere then = Aphasia
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38
Q

Key features that help to distinguish this stroke from other strokes:
Posterior Cerebral Artery Stroke

A
  • 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)
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39
Q

Sudden cessation of what drug can lead to seizures?

A

Short acting benzodiazapines (e.g. alprazolam)

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40
Q

Variable decelerations. Dx? Tx?

A

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

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41
Q

What type of murmur is heard in bicuspid aortic valve?

A

Bicuspid aortic valve can cause aortic regurgitation.

= Diastolic decrescendo murmur

42
Q

What type of murmur is heard in hypertrophic cardiomyopathy?

A

Systolic crescendo decrescendo murmur

43
Q

Guidelines for colonoscopy for patients with ulcerative colitis.

A

8 yrs after initial diagnosis
AND
afterwards repeat every 1-3 yrs

44
Q

Guidelines for colonoscopy for patients with family history of adenomatous polyps or colorectal cancer.

A
  • Age 40 or 10 yrs before diagnosis of affected relative

- Repeat every 5 yrs

45
Q

Guidelines for colonoscopy for patients with Hereditary Nonpolyposis Colorectal Cancer

A
  • 1st colonoscopy at age 20-25

- Repeat every 1-2 yrs

46
Q

Guidelines for colonoscopy for patients with Classic familial adenomatous polposis

A
  • 1st colonoscopy at age 10-12

- Repeat annually

47
Q

How to differentiate between erysipelas and cellulitis.

A

Erysipelas has a raised border.

Cellulitis has a flat border.

48
Q

Timetable for alcohol withdrawal seizures.

A

12-48 hrs. after last drink

49
Q

What heart defects are present in Marfan’s? What murmurs are heard?

A

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
Q

Compare the sounds made by:

Mitral stenosis vs Mitral regurgitation

A

Mitral stenosis = opening snap + mid-diastolic rumble

Mitral regurgitation = mid-systolic click + mid-to-late systolic murmur

51
Q

Pericordial friction rub. Dx?

A

Pericarditis

52
Q

Pulsus parvus et tardus. Dx?

A

Pulsus parvus et tardus = weak and delayed arterial pulses

Dx = severe aortic stenosis

53
Q

Categorize the types of lung cancer based on their location in the lung.

A

Squamous Cell Carcinoma - Central
Small Cell Carcinoma - Central
Large Cell Carcinoma - Peripheral
Adenocarcinoma - Peripheral

54
Q

Clinical Associations of

Adenocarcinoma of the Lung

A
  • Clubbing

- Hypertrophic osteoarthropathy

55
Q

Clinical Association of

Squamous Cell Carcinoma of the Lung

A

Hypercalcemia

56
Q

Clinical Associations of

Small Cell Lung Cancer

A
  • SIADH
  • ACTH (Cushing)
  • Lambert-Eaton Syndrome
57
Q

Clinical Association of

Large Cell Lung Cancer

A
  • Gynecomastia

- Galactorrhea

58
Q

The predominant type of lung cancer seen in nonsmokers.

A

Adenocarcinoma

59
Q

What criteria to use to decide if patient with community acquired pneumonia should be hospitalized.

A

CURB-65:

  • Confusion
  • Urea (BUN) > 20
  • Respirations > 30
  • BP < 90/60
  • Age > 65
  • if score is >3 then hospitalize the patient
60
Q

What is the treatment of community acquired pneumonia in outpatient vs inpatient?

A

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
Q

Right atrium pressure (preload) is increased in only what type of shock?

A

Cardiogenic shock

62
Q

PCWP (preload) is increased in only what type of shock?

A

Cardiogenic shock

63
Q

Cardiac index (pump function) is increased in only what type of shock?

A

Septic shock

64
Q

SVR (afterload) is decreased in only what type of shock?

A

Septic shock

65
Q

Mixed venous oxygen saturation is increased in only what type of shock?

A

Septic shock

66
Q

IV drug user has AV block. Dx?

A

Dx = Perivalvular abscess (most often from aortic valve endocarditis)
NOT tricuspid if AV block

67
Q

What is the animal resevoir of Ecchinococcus granulosus?

A

Dog tapeworm (sheep intermediate host)

68
Q

Tapeworm from pigs that can cause seizures

A

Taenia solium

69
Q

Liver cyst associated with diarrhea. What is the organism?

A

Entamoeba histolytica

70
Q

Entamoeba histolytica and Ecchinococus granulosus both present with liver findings. Which one is associated with fever?

A

Liver + Fever = Entamoeba histolitica

+ diarrhea

71
Q

What 2 organisms can be transmitted in undercooked fish. What are the symptoms?

A 
Clonorchi sinesis (liver fluke) = cause biliary disesase
Diphyllobothrium latum (fish tapeworm) = megaloblastic anemia due to Vit B12 deficiency
72
Q

In burn patients – at what carboxyhemoglobin level is intubation warranted?

A

> 10 % carboxyhemoglobin = intubate

73
Q

Sphincter of Oddi dysfunction presents with RUQ pain. The pain can be worsened if pt is given what medication?

A

Morphine

74
Q

Rash after amoxicillin. Diagnosis?

A

Infectious Mononucleosis

75
Q

Initial treatment for patient with cocaine-associated chest pain.

A

IV benzodiazepines

76
Q

In cocaine-associated chest pain, what medication is contraindicated and why?

A

Beta blockers are contraindicated

because they may cause unopposed alpha adrenergic stimulation, worsening coronary vasoconstriction

77
Q

Symptoms of retinal detachment

A

Floaters

Curtain (starting from periphery)

78
Q

Both retinal artery and retinal vein occlusion can result in painless monocular vision loss. How do you differentiate them on fundoscopy?

A

Retinal artery occlusion = cherry red macula

Retinal vein occlusion = diffuse hemorrhages and cotton wool spots

79
Q

Melanoma size.

A

> 6mm diameter

80
Q

4 Physical findings in Trisomy 18 (Edward’s syndrome)

A
  • Closed fists
  • Overlapping fingers
  • Rocker-bottom feet
  • Micrognathia
81
Q

4 Physical findings in Trisomy 13 (Patau)

A
  • Cutis aplasia (absence of epidermis over skull)
  • Holoprosencephaly (1 eye)
  • Omphalocele (abdominal organs outside of body)
  • Polydactyly (extra fingers)
82
Q

Uric acid stone. Treatment?

A

Alkalization of urine with potassium citrate.

83
Q

Unilateral cryptorchidism can be monitored until age ______. Surgery is indicated before age ______ to reduce risk of testicular torsion, infertility and testicular malignancy.

A

Monitor until age: 6 months

Surgery by age: 1 yr

84
Q

Muscular dystrophy.

BEST TEST to confirm diagnosis

A

Genetic testing (for dystrophin gene)

85
Q

Cellulitis in the submandibular/sublingual spaces.
Dx?
Complication?

A 
Dx = Ludwig angina
Complication = Airway obstruction due to displacement of the tongue posteriorly
86
Q

TCA overdose treatment

A

Sodium bicarbonate

87
Q

Patient less than 40 with back pain that is relieved with exercise but NOT rest. Dx?

A

Ankylosing spondylitis

88
Q

What is the ophthalmologic complication of ankylosing spondylitis?

A

Anterior uveitis

89
Q

What is the lung complication of ankylosing spondylitis?

A

Restrictive lung pathology, due to reduced chest expansion and spinal mobility

90
Q

Ischemic optic neuropathy is a complication of ________

A

Temporal arteritris

91
Q

What is episcleritis? What conditions is it associated with?

A

Episcleritis = inflammation at the white of the eye

Associated with Rhematoid Arthritis and Inflammatory Bowel Disease

92
Q

What is the cardiac complication of ankylosing spondylitis?

A

Aortic regurgitation

93
Q

What is the cardiac complication of Turner’s?

A

Aortic coarctation

94
Q

Initial treatment for Rheumatoid Arthritis?
What are the side effects?
What medication is used to reduce the side effects?

A

Tx = Methotrexate
Side effects = Stomatitis, Hepatotoxicity, Cytopenia
Reduce side effects with Folic Acid supplementation.

95
Q

Type 1 diabetic with facial pain and fever. Dx? Tx?

A 
Dx = Mucormycosis
Tx = Surgical debridement and Amphoterecin B
96
Q

Lead poisoning therapy

A

Chelation therapy with calcium disodium EDTA

97
Q

What are the symptoms of diphenhydramine overdose

A

Diphenhydramine causes antihistaminic and anticholinergic effects.
Antihistaminic = Drowsiness and Confusion
Anticholinergic = Dilated pupils, blurred vision, dry mouth, reduced bowel sounds, urinary retension

98
Q

What is the treatment of diphenhydramine overdose

A

Physostigmine (a cholinesterase inhibitor), to couteract the anticholinergic effects of diphenhydramine

99
Q

Salicylate intoxication symptoms and treatment.

A

Symptoms =
- Mixed metabolic acidosis and respiratory alkalosis
- Tinnitus
- Nausea/vomiting
- Fever
Tx = Sodium bicarbonate to alkalize urine

100
Q

Theophylline overdose symptoms

A

Seizures
Hyperthermia
Arrhythmia

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

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