Step 2 CK Flashcards
Class EKG finding in atrial flutter
Sawtooth P waves
Definition of unstable angina
Angina is new or worsening with no increase in troponin level
Beck’s triad
Triad for cardiac tamponade:
- Hypotension
- Distant heart sounds
- JVD
Drugs that slow heart rate
Beta blockers
Calcium channel blockers
Digoxin
Amiodarone
Hypercholesterolemia treatment that leads to flushing and pruritis
Niacin
HCM murmur
Systolic ejection murmur heard at lateral sternal border
Increases with decreased preload (aka Valsalva maneuver)
Aortic insufficiency murmur
"Austin Flint murmur" Diastolic, decrescendo, low-pitched Blowing murmur Best heard sitting up Increased with increased afterload (handgrip maneuver)
Aortic stenosis murmur
A systolic crescendo-decrescendo murmur that radiates to the neck
Increases with increased preload (squatting maneuver)
Mitral regurgitation murmur
Holosystolic murmur
Radiates to the axilla
Increased with increased afterload (handgrip maneuver)
Mitral stenosis murmur
Diastolic, mid- to late, low-itched murmur with opening snap
Treatment for a fib and a flutter
Cardiovert if unstable
If stable/chronic, rate control with CCBs or beta blockers
Treatment for v fib
Cardiovert
What is Dressler syndrome? When does it occur?
Autoimmune reaction with fever, pericarditis and elevated ESR
2-4 weeks post-MI
What does is pulsus paradoxus? What does it represent?
Decrease in systolic BP of more than 10 mmHg with inspiration
Seen in cardiac tamponade
EKG findings in pericarditis
Low-voltage, diffuse ST-segment elevation
When should AAA be repaired surgically?
5.5+ cm
rapidly enlarging, symptomatic, or ruptured
How is ACS treated?
ASA heparin clopidogrel morphine oxygen sublingual nitroglycerin IV beta blockers
Which coronary artery supplies the anterior wall?
LAD/diagonal
Which coronary artery supplies the inferior wall?
PAD
Which coronary artery supplies the posterior wall?
left circumflex/oblique, RCA/marginal
Which coronary artery supplies the septum?
LAD/diagonal
What is the antibioitic used for endocarditis prophylaxis?
Amoxicillin
What is Virchow’s triad?
Stasis
Hypercoagulability
Endothelial damage
What is the most common cause of hypertension in young men?
Excessive EtOH
What does the “Figure 3” sign represent?
aortic coarctation
What does a water bottle-shaped heart represent?
Pericardial effusion
- look for pulsus paradoxus
What does a positive Nikolsky sign represent?
Pemphigus vulgaris
What does a negative Nikolsky sign represent?
Bullous pemphigoid
What does an irislike target lesion represent?
Erythema multiforme
Flat, often hypopigmented lesions on the chest and back
KOH prep has a spaghetti-and-meatballs appearance
Tinea (pityriasis) versicolor
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
Inflammation and epithelial thinning of the anogenital area, predominately in postmenopausal women
Lichen sclerosus
Exophytic nodules on the skin with scaling or ulceration; the second most common type of skin cancer
Squamous cell carcinoma
Signs and symptoms:
Hypertension
hypokalemia
metabolic alkalosis
Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)
Signs and symptoms: tachycardia wild swings in BP headache diaphoresis altered mental status sense of panic
Pheochromocytoma
What is first line treatment of pheochromocytoma?
First: alpha-antagonists (phenoxybenzamine)
Second: beta antagonists
Signs and symptoms:
patient with history of lithium use with copious amounts of dilute urine
Nephrogenic diabetes insipidus
How is central diabetes insipidus treated?
Administration of DDAVP and free-water restriction
Signs and symptoms:
post-op patient with significant pain presents with hyponatremia and normal volume status
SIADH due to stress
Which antidiabetic agent is associated with lactic acidosis?
Metformin
Signs and symptoms: weakness nausea vomiting weight loss new skin pigmentation hyponatremia hyperkalemia
Primary adrenal insufficiency (aka Addison disease)
Treat with glucocorticoids, mineralcorticoids, and IV fluids
signs and symptoms:
bone pain
hearing loss
Increased alk phos
Paget disease
What does elevation in IGF-1 usually mean?
acromegaly
What does elevation in 17 hydroxyprogesterone usually mean?
21-hydroxylase deficiency (CAH)
What is the difference between a cohort and a case-control study?
Cohort divides groups by an exposure and looks for development of disease
Case-control divides groups by a disease and assigns controls, and then goes back and looks for exposures
What is attributable risk?
The difference in risk in the exposed and unexposed groups (aka the risk that is attributable to the exposure)
What is relative risk?
Incidence in the exposed group divided by the incidence in the non-exposed group
Diagnostic modality used with ultrasonography is equivocal for cholecystitis
HIDA scan
Murphy sign
Inspiratory arrest during palpation of the RUQ
Seen in acute cholecystitis
What is the most common cause of small-bowel obstruction in patients with no history of abdominal surgery?
hernia
How is IBD treated?
5-ASA agents
Steroids during acute exacerbations
Charcot triad
RUQ pain
jaundice
fever and chills
Reynolds pentad
RUQ pain jaundice fever and chills (aka Charcot triad) shock mental status changes
Which drugs can cause hepatitis?
TB meds (INH, rifampin, pyrazinamide)
acetaminophen
tetracycline
Which hernia has the highest risk of incarceration?
femoral hernia
Signs and symptoms: Watery diarrhea Dehydration Muscle weakness Flushing
VIPoma
Treatment: replace fluids and electrolytes, may need to surgically resect tumor and/or use octreotide
Courvoisier sign
Palpable, nontender gallbladder
Sign of pancreatic cancer
Causes of microcytic anemia
Thalassemia
Iron deficiency
Anemia of chronic disease
Sideroblastic anemia
What is the diagnostic test for hereditary spherocytosis?
Osmotic fragility test
What is a pure RBC aplasia?
Diamond-Blackfan anemia
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia
Fanconi anemia
What meds and viruses can cause aplastic anemia?
Chloramphenicol Sulfonamides Radiation HIV chemotherapeutic agents hepatitis parvovirus B19 EBV
What are the signs of thrombocytic thrombocytopenic purpura?
"FAT RN" fever anemia thrombocytopenia renal dysfunction neurologic abnormalities
How is TTP treated?
Emergent large-volume plasmapheresis
Corticosteroids
Antiplatelet drugs
NOTE: platelet transfusion is contraindicated!
How is ITP treated?
Usually resolves spontaneously
May require IVIG and/or corticosteroids
What happens in DIC to fibrin, d-dimer, fibrinogen, platelets, and hematocrit?
Fibrin split products: increased d-dimer: increased platelets: decreased fibrinogen: decreased hematocrit: decreased NOTE: in DIC, Factor VIII is also low
What do Reed-Sternberg cells indicate?
Hodgkin lymphoma
What do Auer rods indicate?
AML, particularly M3 (which is also known as APL)
Which AML is associated with DIC? How is it treated?
AML M3
Treated with retinoic acid
What are the electrolyte changes in tumor lysis syndrome?
Decreased calcium
Increased potassium, phosphate, and uric acid
Signs and symptoms: early satiety splenomegaly bleeding cytogenics with t(9;22)
CML
What is the most common predisposing factor for acute sinusitis?
Viral URI
To which organisms are asplenic patients particularly susceptible?
Encapsulated organisms: pneumoccocus, meningococcus, h flu, klebsiella
signs and symptoms: from California or Arizona fever malaise cough night sweats
Coccidioidomycosis
Treat with amphotericin B
What are the signs of tertiary syphilis?
Tabes dorsalis General paresis Gummas Argyll Robertson pupil aortitis aortic root aneurysm
What do cold agglutinins indicate?
Mycoplasma
When should you start prophylaxing for PCP?
less than 200 CD4 (treat with TMP-SMX)
When should you start prophylaxing for MAC?
less than 50-100 CD4 (treat with clarithromycin/azithromycin)
What are the kind of crystals in gout?
Needle-shaped, negatively birefringent crystals
Seen on joint fluid aspirate
What are the kind of crystals in pseudogout?
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate
Signs and symptoms: Elderly pain and stiffness of shoulders and hips anemia elevated ESR
Polymyalgia rheumatica
Which nerve can be damaged with humeral fracture?
Radial nerve
What are the signs suggestive of radial nerve damage?
Wrist drop
Loss of thumb abduction
How is prolactinoma treated?
Dopamine agonist (eg bromocriptine)
What kind of aphasia is “broken speech”? Which lobe? Which vascular distribution?
Broca aphasia
Frontal lobe
Left MCA distribution
What are the signs of Guillain-Barre on LP?
Albuminocytologic dissociation
Elevated protein in CSF without a significant increase in cell count
What is the normal reaction to water flushed into patient’s ear?
Fast phase of nystagmus toward opposite side
When should carotid endarterectomy be performed?
70% lesion
How is Guillain Barre treated?
IVIG or plasmapheresis
Avoid steroids
Signs and symptoms: Port-wine stain in the V1 distribution Intellectual disability Seizures in childhood Ipsilateral leptomeningeal angioma
Sturge-Weber syndrome
Tx: symptomatic, possible focal cerebral resection of the affected lobe
Signs and symptoms: Hyperphagia Hypersexuality Hyperorality Hyperdocility
Kluver-Bucy syndrome (affects amygdala)
How is myasthenia gravis diagnosed?
Edrophonium
What is the chromosomal pattern of a complete mole?
46XX
Which antibiotics are teratogenic?
Tetracycline
Fluoroquinolones
Aminoglycosides
Sulfonamides
How is urge incontinence treated?
Anticholinergics (oxybutynin) or beta adrenergics (metaproterenol)
How is stress incontinence treated?
Surgery
Kegel exercises
Estrogen
Pessaries for stress incontinence
Which breast cancer type increases the future risk of invasive carcinoma in both breasts?
Lobular carcinoma in situ
What nontender abdominal mass is associated with elevation in vanillylmandelic acid (VMA) and homovanillic acid (HVA)?
Neuroblastoma
Signs and symptoms:
Bilious emesis within hours after the first feeding
Duodenal atresia
Which immunodeficiency is seen in boys with chronic respiratory infections? Nitroblue tetrazolium test is negative
Chronic granulomatous disease
Which immunodeficiency is seen in child with eczema, thrombocytopenia, and high levels of IgA?
Wiskott-Aldrich syndrome
Which immunodeficiency is seen in 4-month-old boy with life-threatening Pseudomonas infection?
Bruton’s x-linked agammaglobulinemia
Signs and symptoms:
Mental status changes
Emesis
Liver dysfunction after ASA intake
Reye syndrome
What cancer does retinoblastoma increase risk for?
Osteosarcoma
Which vaccinations are given at 6-month well-child visit?
HBV, DTaP, Hib, IPV, PCV, rotavirus
Signs and symptoms: Red "currant-jelly" stools Colicky abdominal pain Billous vomiting Sausage-shaped mass in the RUQ
Intussusception
What is the most common pathogen causing croup?
Parainfluenza virus type 1
Signs and symptoms:
Obese boy
Sudden onset of limp
Slipped capital femoral epiphysis
Dx with AP and frog-leg lateral radiographs
Signs and symptoms:
Active boy
Anterior knee pain
Osgood-Schlatter disease
What are the key side effects of atypical antipsychotics?
Weight gain
Type 2 DM
QT segment prolongation
How is acute dystonia treated?
Benztropine or
Diphenydramine
Which meds should be avoided in patients with PTSD?
Benzodiazepines (high addiction potential) - patients commonly have a hx of substance abuse
What are Light’s criteria for exudative effusion?
Pleural/serum protein >0.5
pleural/serum LDH >0.6
What are causes of exudative effusion?
Think of leaky capillaries: malignancy, TB, bacterial or viral infection, PE with infarct, and pancreatitis
What are causes of transudative effusion?
Think of intact capillaries: CHF, liver or kidney disease, and protein-losing enteropathy
What are the PFTs like in obstructive pulmonary disease?
Low FEV/FVC
What are the PFTs of restrictive pulmonary disease?
Increased FEV/FVC, low TLC
What does honeycomb pattern on chest radiograph indicate?
Diffuse interstitial pulmonary fibrosis
Treat with supportive care; antifibrotic agents may help
How is SVC syndrome treated?
Radiation
What is the acid-base disorder in PE?
Respiratory alkalosis with hypoxia and hypocarbia
Which non-small cell lung cancer is associated with hypercalcemia?
Squamous cell carcinoma
Which lung cancer is associated with Lambert Eaton syndrome?
Small cell lung cancer
Which non-small cell lung cancer is associated with SIADH?
Small cell lung cancer
Which lung cancers are highly related to cigarette exposure?
small cell lung cancer, squamous cell carcinoma
What are the classic chest radiographic findings for pulmonary edema?
Cardiomegaly Prominent pulmonary vessels Kerley B lines "bat's wing" appearance of hilar shadows Perivascular and peribronchial cuffing
Renal tubular acidosis associated with abnormal H+ secretion and nephrolithiasis
Type I (distal) RTA
Renal tubular acidosis associated with abnormal bicarb reabsorption and rickets
Type II (proximal) RTA
Renal tubular acidosis associated with low aldosterone state
Type IV (distal) RTA
T-wave flattening and U waves
hypokalemia
Peaked T-waves and widened QRS
hyperkalemia
How is hyperkalemia treated?
"C BIG K" calcium gluconate bicarb insulin glucose kayexalate
How should nephrolithiasis be diagnosed?
noncontrast CT
Signs and symptoms:
nephritic syndrome
3 days after URI
normal C3
IgA nephropathy (Berger disease)
Glomerulonephritis with hemoptysis
Granulomatosis with polyangiitis
Goodpasture syndrome
Eosinophils in urine sediment
Allergic interstitial nephritis
Which testicular cancer is associated with beta-hcg?
Choriocarcinoma
What is the complication of overly rapid correction of hyponatremia?
Central pontine myelinolysis
Which acid-base disturbance is commonly seen in pregnant women?
Respiratory alkalosis
Treatment for benzodiazepine overdose?
Flumazenil
Treatment for malignant hypertension?
Nitroprusside
Treatment of SVT
If stable, rate control with carotid massage or other vagal stimulation
If unsuccessful, consider adenosine
Macrocytic, megaloblastic anemia with neurological symptoms
B12 deficiency
Macrocytic, megaloblastic anemia without neurological symptoms
Folate deficiency
What is the most common organism in burn-related infections?
Pseudomonas
How is fluid repletion in burn patients calculated?
Parkland formula: 24h fluids = 4 x kg x %BSA
What are the Cushing triad signs of ICP
hypertension
bradycardia
abnormal respirations
What is the CO, PCWP, and PVR for hypovolemic shock?
CO down
PCWP down
Increased PVR
What is the CO, PCWP, and PVR for cardiogenic shock?
CO down
PCWP up
PVR up
What is the CO, PCWP, and PVR for distributive shock?
CO up
PCWP down
PVR down
Which thyroid cancer is associated with increased calcitonin?
Medullary cancer
How does papillary thyroid cancer spread?
Lymphatics
How does follicular thyroid cancer spread?
Hematologic
How is acromegaly treated?
Octreotide or lanreotide (somatostatin analogues)
How is central diabetes insipidus treated?
DDAVP: desmopressin acetate, a synthetic analogue of ADH
How is nephrogenic diabetes insipidus treated?
Salt restriction and water intake; thiazide diuretics can be used to promote mild volume depletion and to stimulate increased water absorption
How is SIADH treated?
Restrict fluid
Cautiously give hypertonic saline if patient is very symptomatic - must monitor in ICU to prevent central pontine myelinolysis
Demeclocycline, an ADH receptor antagonist, can help normalize serum sodium
What is associated with MEN type I?
Gastrinomas (ZES), insulinomas, and VIPomas aka pancreatic islet cell tumors
Parathyroid hyperplasia
Pituitary adenomas
MEN 1 affects “P” organs: pancreas, pituitary, parathyroid
What is associated with MEN type 2A?
2 P's: parathyroid and pheo Medullary carcinoma of the thyroid Pheo or adrenal hyperplasia Parathryoid gland hyperplasia NOTE: due to mutations in the RET proto-oncogene
What is associated with MEN type 2B?
1 P: pheo
Medullary carcinoma of the thyroid, pheo, oral and intestinal ganglioneuromatosis (mucosal neuromas), marfinoid habitus
NOTE: due to mutations in the RET proto-oncogene
How can etiology of ascites be identified?
SAAG (serum-ascites albumin gradient): SAAG = serum albumin - ascites albumin
1.1+ indicates portal hypertension (right HF, budd-chiari, cirrohsis, splenic or portal vein thrombosis)
less than 1.1 indicates nephrotic syndrome, TB, or malignancy (NOT portal hypertension)
What is Libman-Sacks endocarditis?
Noninfectious vegetations often seen on the mitral valve in association with SLE and APS
What is the biceps reflex?
C5 nerve root
What is the triceps reflex?
C7 nerve root
What is the patellar reflex?
L4 nerve root
What is the Achilles reflex?
S1 nerve root
Which med should not be given to someone with VWD?
aspirin
How can tumor lysis syndrome be prevented?
Patients should be well hydrated
Patients can be started on allopurinol or rasburicase if WBC are up
What’s with hypocalcemia and blood transfusions?
Blood products often contain citrate, which binds to serum calcium, leading to hypocalcemia
Which electrolyte abnormality can cause prolonged QT?
hypocalcemia
Which blood cancer has t(9;22)?
CML
This is the BCR-ABL translocation
How is CML treated?
Imatinib (Gleevec)
Which blood cancer stains with TRAP?
Hairy Cell Leukemia
Which HIV med causes crazy dreams?
Efavirenz
Which HIV med can cause a hypersensitivity reaction?
Abacavir
Which tumor looks like a bunch of grapes coming out of the vagina?
sarcoma botryoides
