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STEP 2 CK > STEP 2 CK > Flashcards

STEP 2 CK Flashcards

1
Q

rWhat are the clinical features of TTP?

A
  1. Hemolytic anemia 2. Thrombocytopenia 3. Mild acute renal failure 4. fever 5. transient neurologic signs.
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2
Q

How do you treat TTP?

A
  1. Plasmapheresis 2. Corticosteroids and splenoctomy 3 NO PLATELET TRANSFUSIONS, BECAUSE YOU HAVE PLATELET THROMBI OCCLUDING SMALL VESSELS
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3
Q

MEN Type I

A

Primary Hyperparathyroidism enteropancreatic tumor pituitary tumors

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4
Q

MEN Type 2a

A

Medullary thyroid cancer pheochromocytoma parathyroid hyperplasia

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5
Q

MEN Type 2b

A

Medullary thyroid cancer pheochromocytoma other ( mucosal and intestinal neuromas and marfanoid habitus)

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6
Q

Wells Criteria

A

Score 3 pts if: clinical signs of DVT, no alternative ddx Score 1.5 pts if: previous PE or DVT, HR more than 100, recent surgery or immobilization Score 1 pt if: hemoptysis or cancer 6 high risk

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7
Q

Common Variable Immunodeficiency

A

Normal B and T, but all Igs are low Presentation: any sex and chronic sinopulmonary problems Treat with IVIG

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8
Q

X Linked Bruton Agammaglobulinemia

A

Low B cells and low lymphoid tissues Normal T cells Only in males Treat with IVIG

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9
Q

SCID

A

Low B and T cells Treat with bone marrow transplant

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10
Q

IgA deficiency

A

gave someone blood and now they got a rxn. wash that blood.

Will also see giardia, because IgA is in the bowel

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11
Q

Hyper IgE syndrome

A

Skin infections with Staph maybe prophalactically treat with dicloxacilin or cephalexin

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12
Q

Wiskott Aldrich Syndrome

A

Exczema and thrombocytopenia. . Need Bone Marrow transplant

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13
Q

Chronic granulamatous disease

A

Lymph nodes with purulent material. Will see weird organisms like: staph, nocardia, aspiregellus and burkholderia.

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14
Q

Kussmall sign

A

increase in JVP on inhalation, signs of constrictive pericarditis.

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15
Q

S4

A

sound of a atrial systole as blood is ejected from the atrium into a stiff ventricle. Associated with acute coronary syndrome.

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16
Q

V2 to V4

A

anterior wall of the left ventricle. worse place for an MI

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17
Q

II, III, and avF

A

Inferior wall of the left ventricle

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18
Q

V1 and V2

A

posterior wall MI

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19
Q

Aortic stenosis (maneuvers)

A

Squatting/leg raising and amyl nitrate, WILL INCREASE Standing/Valsalva and Handgrip WILL DECREASE

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20
Q

Mitral stenosis (maneuvers)

A

Squatting/leg raising WILL INCREASE Standing/valsalva WILL DECREASE

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21
Q

Mitral and Aortic regurg (maneuvers)

A

Squatting/leg raising and handgrip WILL INCREASE Standing/valsalva and amyl nitrate WILL DECREASE

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22
Q

Mitral valve prolapse and HOCM (maneuvers)

A

Squatting/leg raising and handgrip WILL DECREASE Standing/valsalva and amyl nitrate WILL INCREASE

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23
Q

Syphillis in babies

A

Rash on the palms and soles, snuffles, frontal bossing, Hutchinson eigth nerve palsy and saddle nose

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24
Q

Rubella in babies that are just born

A

PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, and hyprbilirubinemia.

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25
Q

CURB65

A

If you have 2 or more admit: Confusion Uremia Respiratory distress BP low >65

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26
Q

Primary Biliary Cirrhosis (Presentation)

A

Women in 40s or 50s Fatigue and itching Normal bilirubin and elevated alk phos high IgM levels Xanthelasma/Xanthoma Osteoporosis Postive antimitochondrial antibody (most accurate blood test) liver biopsy

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27
Q

Primary Biliary Cirrhosis (Managment)

A

Ursodeoxycholic acid (shown to slow progression)

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28
Q

basal ganglia stroke

A

Contralateral hemiparesis and hemisensory loss homonynous heminopsia gaze palsy

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29
Q

Cerebellum stroke

A

usually no hemiparesis facial weakness ataxia and nystagmus occipital HA and neck stiffness

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30
Q

Thalamus

A

Contralateral hemiparesis and hemisensory loss Nonreactive miotic pupils upgaze palsy eyes deviate Towards hemiparesis

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31
Q

Cerebral lobe

A

Contralateral hemiparesis (frontal lobe) Contralateral hemisensory loss (parietal lobe) Homonymous hemianopsia (occipital lobe) eyes deviate away from hemiparesis high incidence of seizures

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32
Q

Pons

A

Deep coma and total paralysis within minutes Pinpoint reactive pupils

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33
Q

Aortic Regurgitation

(due to valvular disease)

A

diastolic decresendo murmur best heard at the left sternal border at full inspiration

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34
Q

Tricuspid regurgitaton

A

most frequent site of IV drug user endocarditis

systolic murmur, holosystolic that is accentuated by inspiration

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35
Q

Complete or third degree AV block

(presentation)

A

Syncope, dizziness, acute heart failure, hypotension and cannon a waves.

on ekg, THE P WAVES WILL NOT GO WITH THE QRS

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36
Q

Complete/Third degree Av block

(treatment)

A

pacemaker placement

remember second degree can become a third degree

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37
Q

COPD exacerbations

(Medications)

A

O2

Inhaled bronchodilators (albuterol, ipratropium)

glucocorticoids

antibiotics

NPPV

or intubation

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38
Q

Acute tubular necrosis

A

muddy brown granular cast (renal tubular epithelial cells)

can be caused by hypotension

39
Q

Glomerulnephririts

A

RBC casts

40
Q

Interstitial nephritis and pyelonephririts

A

WBC casts

41
Q

Nephrotic syndrome

A

Fatty casts

42
Q

Chronic renal failure

A

Broad and waxy casts

43
Q

Focal segmental glomenephrosis

A

African American, Hispanic, Obesity, HIV or IV drug user.

Most common in adults

More than 3.5 g protein exretion

Hypoalbunemia

edema

44
Q

membranous nephropathy

A

adenocarcinoma, NSAIDs, hep B, SLE

serum c3 will be low when membranous is associated to hep b

45
Q

membranoproliferative glomerulonephritis

A

Hep B & C, lipodystrophy

46
Q

Minimal change disease

A

NSAIDs, lymphoma

47
Q

IgA nephropathy

A

gross hematuria after URI

48
Q

Aortic Regurg

(MURMUR)

A

Diastolic decresendo murmur at the left sternal border. The most common cause in an elderly person is aortic dilatation

49
Q

Guillian Barre

(CSF)

A

WBC will be normal

glucose will be normal albumniocytolic dissociation

protein will be elevated

normal RBC

50
Q

right aterial pressure

pulmonary artery pressure

PCWP

(normal values)

A

right aterial pressure

4 to 6 mmhg

Pulmonary artery pressure

no more than 25/15

PCWP

6-12 mmhg

51
Q

Rubella

A

The 3 Cs: cervical lympadenopahty, coryza and conjunctivitis with a koplick spots

cephalocaudal spread of rash

52
Q

Measles

A

High fever 104

coryza malaise

gradual rash that is red-brownish

koplick spots

53
Q

Becks triad

A

Cardiac tamponade

muffle heart sounds, hypotension, distended JVD

54
Q

Kawasaki Disease

A

fever for more than 5 days and 4 or more of the following:

oral mucosa changes (strawberry tongue, crackled lips)

bilateral conjunctiva with limbal sparing

cervical lymphadenopathy

rash

erthyema or edema of the hands or feet

55
Q

Kawasaki Disease

(treatment)

A

Immunoglobulins and ASA

you worry about coronary artery disease.

56
Q

Cryptococcal Meningitis

A

Absent Meningeal signs

HIV pt

CSF

low glucose, high protein, high WBC with monocytic predominance and increased opening pressure

57
Q

Tetralogy of Fallot

(components)

A

Overriding aorta

pulmonary stenosis

right ventricular hypertrophy

VSD

58
Q

Tetralogy of Fallot

(Presentation)

A

Cyanosis

holosystolic murmus at the left lower sternal border (VSD)

squating helps (increases systemic pressure)

boot shaped heart

decreased vascular markings

59
Q

Transposition of Great Vessels

A

You need a PDA/ADS/VSD for survival (give prostaglandin E1

common in neonates

single S2

“egg on a string” x ray

60
Q

Hypoplastic left heart syndrome

A

left ventricular hypoplasia

mitral valve atresia

aortic valve lesions

globular shaped heart

give prostagland E1 (depends on ASD/PDA)

absent pulses with single S2

increased RV impulse

gray cyanosis

61
Q

Truncus arteriosis

A

one vessel overides VSD

pulmonary HTN

mild cyanosis

62
Q

VSD

A

Holosystolic/pansystolic murmur at lower left sternal border

loud pulmonic s2

left to right shunt

can cause pulmonary htn (bc of increased load towards the lungs) causing SOD on exertion

treat with diuretic and digoxin

a diastolic rumble could be heard due to increase flow through the mitral valve

63
Q

Einsenmenger Syndrome

A

reverse of blood flow to right to left because of hypertrophy of right ventricle (its stronger)

64
Q

PDA

A

can be seen in premature babies or babies with pulmonary problems

machine like murmur

wide pulse pressure

bounding pulses

give indotheacin

65
Q

ASD

A

fixed wide splitting of S2 in both expiration and inspiration

66
Q

Coarctation of the aorta

A

Turner syndrome

after cephalic branches

different blood pressure (lower vs upper)

rib notching

can develop CHF and respiratory distress

67
Q

CSF in viruses

A

lymphocytic pleocytosis (decreased WBC)

increased protein

increased rbc count

normal glucose

68
Q

autosomnal dominant polycystic kidney disease

(presentation)

A

HTN, palpable bilateral abdominal masses and microhematuria.

69
Q

autosomanl dominant polycysitc kidney disease

A

Intracranl berry aneurysm is a common complication. (scrrening not recommended)

Hepatic cysts is the most common extrarenal manifestations

valvular disease-MVP or AR

colonic diverticular

abdominal wall and inguinal hernia

70
Q

Biliary atresia

A

jaundice

light colores stools

hepatomegaly

direct conjucgated hyperbilirubinemia

71
Q

ARDS

A

impaired gas exchange

decreased lung compliance

pulmonary hypertension

72
Q

Hepatorenal syndrome

A

severe liver disease (cirrhosis)

new onset renal failure with no other explanation

very low urine Na

elevated BUN:creatinine ration

only treatment proven to help is liver transplant

73
Q

primary hyperaldosteronism

A

think if you have HTN and hypokalemia

next step is aldosterone/renin ratio

74
Q

antiphospholipid antibody syndrome

A

elevated PTT normal PT and normal INR

history of spontaneous abortion

liveido reticularis

thrombocytopenia

clotting

PTT will remain elevated in mixing study

most specific test is Russel viper venom test

75
Q

Consolidation of the lung

(physical exam findings)

A

dullness to percussion

bronchial breath sounds (Assuming patent airways)

egophony

76
Q

CML

(symptoms)

A

splenomegaly with early satiety, abdominal fullness

increased WBC

normocytic anemia

leukocyte alkaline phosphatase is low

77
Q

intrahepatic cholestatasis of pregnancy

A

intense pruritus

elevated bile acids

elevated levels of liver aminotransferases

DDX of exclusion

78
Q

HELLP

A

preeclampsia

right upper quadrant pain

nausea/vomiting

hemolysis

moderately elevated liver aminotransferases

thrombocytopenia

79
Q

acute fatty liver of pregnancy

A

malaise right upper quadrant pain

nausea/vomiting

sequelae of liver failure

hypoglycemia

mildly elevated liver aminotransferases

elevated bilirubin

possible dic

80
Q

wegners/granumalotosis with polyangitis

A

systemic vasculitis

upper and lower airway granulomatosis inflamation

glomerulonephritis

positive c-anca

81
Q

aortic stenosis

A

single and soft s2, audible s4

delayed and diminished carotid pulses-pulsus pravus et tardus

82
Q

B1 (thiamine)

A

beriberi (peripheral neuropathy, heart failure)

wernicke-korsakoff syndrome

83
Q

B2 Riboflavin

A

angular cheilosis (fissure at corners of lips)

stomatitis (hyperemic/edematous orpharyngeal mucous membranes, sore thoat)

glositis

normocytic anemia

seborrheic dermatitis

84
Q

B3 Niacin

A

Pellagra (dermatitis, diarrhea, delusions/dementio, glossitis)

85
Q

B6 (pyridoxine)

A

cheilosis, stomatitis, glossitis

irritability, confusion, depression

86
Q

B9 (folate, folic acid)

A

megaloblastic anemia

neural tube defects

87
Q

B12 (cobalamin)

A

megaloblastic anemia

neurologic deficits (confusion, paresthesias, ataxia)

88
Q

Vitamine C (ascorbic acid)

A

scurvy (punctate hemorrhage, gingivitis, corkscrew hair)

89
Q

methotrexate

(side effects)

A

hepatotoxicity

stomatitis (inflammation of the mucus memebranes)

cytopenias

90
Q

leflunomide

(disease modifying antirheumatic drugs)

side effects

A

hepatotoxicity

cytopenias

91
Q

Hydroxychloroquine

(disease modifying antirheumatic drugs)

TNF & IL-1 suppressor

(side effects)

A

retinopathy

92
Q

Sulfasalazine

(disease modifying antirheumatic drugs)

TNF & IL-1 suppressor

(side effects)

A

hepatotoxicity

stomatitis

hemolytic anemia

93
Q
A

STEP 2 CK (1 decks)

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