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Rapid Review > Step 2 CK > Flashcards

Step 2 CK Flashcards

1
Q

Class EKG finding in atrial flutter

A

Sawtooth P waves

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2
Q

Definition of unstable angina

A

Angina is new or worsening with no increase in troponin level

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3
Q

Beck’s triad

A

Triad for cardiac tamponade:

  • Hypotension
  • Distant heart sounds
  • JVD
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4
Q

Drugs that slow heart rate

A

Beta blockers
Calcium channel blockers
Digoxin
Amiodarone

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5
Q

Hypercholesterolemia treatment that leads to flushing and pruritis

A

Niacin

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6
Q

HCM murmur

A

Systolic ejection murmur heard at lateral sternal border

Increases with decreased preload (aka Valsalva maneuver)

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7
Q

Aortic insufficiency murmur

A 
"Austin Flint murmur"
Diastolic, decrescendo, low-pitched
Blowing murmur
Best heard sitting up
Increased with increased afterload (handgrip maneuver)
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8
Q

Aortic stenosis murmur

A

A systolic crescendo-decrescendo murmur that radiates to the neck
Increases with increased preload (squatting maneuver)

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9
Q

Mitral regurgitation murmur

A

Holosystolic murmur
Radiates to the axilla
Increased with increased afterload (handgrip maneuver)

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10
Q

Mitral stenosis murmur

A

Diastolic, mid- to late, low-itched murmur with opening snap

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11
Q

Treatment for a fib and a flutter

A

Cardiovert if unstable

If stable/chronic, rate control with CCBs or beta blockers

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12
Q

Treatment for v fib

A

Cardiovert

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13
Q

What is Dressler syndrome? When does it occur?

A

Autoimmune reaction with fever, pericarditis and elevated ESR
2-4 weeks post-MI

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14
Q

What does is pulsus paradoxus? What does it represent?

A

Decrease in systolic BP of more than 10 mmHg with inspiration
Seen in cardiac tamponade

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15
Q

EKG findings in pericarditis

A

Low-voltage, diffuse ST-segment elevation

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16
Q

When should AAA be repaired surgically?

A

5.5+ cm

rapidly enlarging, symptomatic, or ruptured

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17
Q

How is ACS treated?

A 
ASA
heparin
clopidogrel
morphine
oxygen
sublingual nitroglycerin
IV beta blockers
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18
Q

Which coronary artery supplies the anterior wall?

A

LAD/diagonal

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19
Q

Which coronary artery supplies the inferior wall?

A

PAD

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20
Q

Which coronary artery supplies the posterior wall?

A

left circumflex/oblique, RCA/marginal

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21
Q

Which coronary artery supplies the septum?

A

LAD/diagonal

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22
Q

What is the antibioitic used for endocarditis prophylaxis?

A

Amoxicillin

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23
Q

What is Virchow’s triad?

A

Stasis
Hypercoagulability
Endothelial damage

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24
Q

What is the most common cause of hypertension in young men?

A

Excessive EtOH

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25
Q

What does the “Figure 3” sign represent?

A

aortic coarctation

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26
Q

What does a water bottle-shaped heart represent?

A

Pericardial effusion

- look for pulsus paradoxus

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27
Q

What does a positive Nikolsky sign represent?

A

Pemphigus vulgaris

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28
Q

What does a negative Nikolsky sign represent?

A

Bullous pemphigoid

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29
Q

What does an irislike target lesion represent?

A

Erythema multiforme

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30
Q

Flat, often hypopigmented lesions on the chest and back

KOH prep has a spaghetti-and-meatballs appearance

A

Tinea (pityriasis) versicolor

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31
Q

A premalignant lesion from sun exposure that can lead to squamous cell carcinoma

A

Actinic keratosis

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32
Q

Inflammation and epithelial thinning of the anogenital area, predominately in postmenopausal women

A

Lichen sclerosus

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33
Q

Exophytic nodules on the skin with scaling or ulceration; the second most common type of skin cancer

A

Squamous cell carcinoma

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34
Q

Signs and symptoms:
Hypertension
hypokalemia
metabolic alkalosis

A

Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)

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35
Q 
Signs and symptoms:
tachycardia
wild swings in BP
headache
diaphoresis
altered mental status
sense of panic
A

Pheochromocytoma

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36
Q

What is first line treatment of pheochromocytoma?

A

First: alpha-antagonists (phenoxybenzamine)
Second: beta antagonists

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37
Q

Signs and symptoms:

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

A

Nephrogenic diabetes insipidus

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38
Q

How is central diabetes insipidus treated?

A

Administration of DDAVP and free-water restriction

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39
Q

Signs and symptoms:

post-op patient with significant pain presents with hyponatremia and normal volume status

A

SIADH due to stress

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40
Q

Which antidiabetic agent is associated with lactic acidosis?

A

Metformin

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41
Q 
Signs and symptoms:
weakness
nausea
vomiting
weight loss
new skin pigmentation
hyponatremia
hyperkalemia
A

Primary adrenal insufficiency (aka Addison disease)

Treat with glucocorticoids, mineralcorticoids, and IV fluids

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42
Q

signs and symptoms:
bone pain
hearing loss
Increased alk phos

A

Paget disease

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43
Q

What does elevation in IGF-1 usually mean?

A

acromegaly

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44
Q

What does elevation in 17 hydroxyprogesterone usually mean?

A

21-hydroxylase deficiency (CAH)

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45
Q

What is the difference between a cohort and a case-control study?

A

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

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46
Q

What is attributable risk?

A

The difference in risk in the exposed and unexposed groups (aka the risk that is attributable to the exposure)

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47
Q

What is relative risk?

A

Incidence in the exposed group divided by the incidence in the non-exposed group

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48
Q

Diagnostic modality used with ultrasonography is equivocal for cholecystitis

A

HIDA scan

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49
Q

Murphy sign

A

Inspiratory arrest during palpation of the RUQ

Seen in acute cholecystitis

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50
Q

What is the most common cause of small-bowel obstruction in patients with no history of abdominal surgery?

A

hernia

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51
Q

How is IBD treated?

A

5-ASA agents

Steroids during acute exacerbations

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52
Q

Charcot triad

A

RUQ pain
jaundice
fever and chills

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53
Q

Reynolds pentad

A 
RUQ pain
jaundice
fever and chills (aka Charcot triad)
shock
mental status changes
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54
Q

Which drugs can cause hepatitis?

A

TB meds (INH, rifampin, pyrazinamide)
acetaminophen
tetracycline

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55
Q

Which hernia has the highest risk of incarceration?

A

femoral hernia

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56
Q 
Signs and symptoms:
Watery diarrhea
Dehydration
Muscle weakness
Flushing
A

VIPoma

Treatment: replace fluids and electrolytes, may need to surgically resect tumor and/or use octreotide

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57
Q

Courvoisier sign

A

Palpable, nontender gallbladder

Sign of pancreatic cancer

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58
Q

Causes of microcytic anemia

A

Thalassemia
Iron deficiency
Anemia of chronic disease
Sideroblastic anemia

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59
Q

What is the diagnostic test for hereditary spherocytosis?

A

Osmotic fragility test

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60
Q

What is a pure RBC aplasia?

A

Diamond-Blackfan anemia

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61
Q

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia

A

Fanconi anemia

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62
Q

What meds and viruses can cause aplastic anemia?

A 
Chloramphenicol
Sulfonamides
Radiation
HIV
chemotherapeutic agents
hepatitis
parvovirus B19
EBV
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63
Q

What are the signs of thrombocytic thrombocytopenic purpura?

A 
"FAT RN"
fever
anemia
thrombocytopenia
renal dysfunction
neurologic abnormalities
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64
Q

How is TTP treated?

A

Emergent large-volume plasmapheresis
Corticosteroids
Antiplatelet drugs
NOTE: platelet transfusion is contraindicated!

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65
Q

How is ITP treated?

A

Usually resolves spontaneously

May require IVIG and/or corticosteroids

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66
Q

What happens in DIC to fibrin, d-dimer, fibrinogen, platelets, and hematocrit?

A 
Fibrin split products: increased
d-dimer: increased
platelets: decreased
fibrinogen: decreased
hematocrit: decreased
NOTE: in DIC, Factor VIII is also low
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67
Q

What do Reed-Sternberg cells indicate?

A

Hodgkin lymphoma

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68
Q

What do Auer rods indicate?

A

AML, particularly M3 (which is also known as APL)

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69
Q

Which AML is associated with DIC? How is it treated?

A

AML M3

Treated with retinoic acid

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70
Q

What are the electrolyte changes in tumor lysis syndrome?

A

Decreased calcium

Increased potassium, phosphate, and uric acid

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71
Q 
Signs and symptoms:
early satiety
splenomegaly
bleeding
cytogenics with t(9;22)
A

CML

72
Q

What is the most common predisposing factor for acute sinusitis?

A

Viral URI

73
Q

To which organisms are asplenic patients particularly susceptible?

A

Encapsulated organisms: pneumoccocus, meningococcus, h flu, klebsiella

74
Q 
signs and symptoms:
from California or Arizona
fever
malaise
cough
night sweats
A

Coccidioidomycosis

Treat with amphotericin B

75
Q

What are the signs of tertiary syphilis?

A 
Tabes dorsalis
General paresis
Gummas
Argyll Robertson pupil
aortitis
aortic root aneurysm
76
Q

What do cold agglutinins indicate?

A

Mycoplasma

77
Q

When should you start prophylaxing for PCP?

A

less than 200 CD4 (treat with TMP-SMX)

78
Q

When should you start prophylaxing for MAC?

A

less than 50-100 CD4 (treat with clarithromycin/azithromycin)

79
Q

What are the kind of crystals in gout?

A

Needle-shaped, negatively birefringent crystals

Seen on joint fluid aspirate

80
Q

What are the kind of crystals in pseudogout?

A

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate

81
Q 
Signs and symptoms:
Elderly
pain and stiffness of shoulders and hips
anemia
elevated ESR
A

Polymyalgia rheumatica

82
Q

Which nerve can be damaged with humeral fracture?

A

Radial nerve

83
Q

What are the signs suggestive of radial nerve damage?

A

Wrist drop

Loss of thumb abduction

84
Q

How is prolactinoma treated?

A

Dopamine agonist (eg bromocriptine)

85
Q

What kind of aphasia is “broken speech”? Which lobe? Which vascular distribution?

A

Broca aphasia
Frontal lobe
Left MCA distribution

86
Q

What are the signs of Guillain-Barre on LP?

A

Albuminocytologic dissociation

Elevated protein in CSF without a significant increase in cell count

87
Q

What is the normal reaction to water flushed into patient’s ear?

A

Fast phase of nystagmus toward opposite side

88
Q

When should carotid endarterectomy be performed?

A

70% lesion

89
Q

How is Guillain Barre treated?

A

IVIG or plasmapheresis

Avoid steroids

90
Q 
Signs and symptoms:
Port-wine stain in the V1 distribution
Intellectual disability
Seizures in childhood
Ipsilateral leptomeningeal angioma
A

Sturge-Weber syndrome

Tx: symptomatic, possible focal cerebral resection of the affected lobe

91
Q 
Signs and symptoms:
Hyperphagia
Hypersexuality
Hyperorality
Hyperdocility
A

Kluver-Bucy syndrome (affects amygdala)

92
Q

How is myasthenia gravis diagnosed?

A

Edrophonium

93
Q

What is the chromosomal pattern of a complete mole?

A

46XX

94
Q

Which antibiotics are teratogenic?

A

Tetracycline
Fluoroquinolones
Aminoglycosides
Sulfonamides

95
Q

How is urge incontinence treated?

A

Anticholinergics (oxybutynin) or beta adrenergics (metaproterenol)

96
Q

How is stress incontinence treated?

A

Surgery
Kegel exercises
Estrogen
Pessaries for stress incontinence

97
Q

Which breast cancer type increases the future risk of invasive carcinoma in both breasts?

A

Lobular carcinoma in situ

98
Q

What nontender abdominal mass is associated with elevation in vanillylmandelic acid (VMA) and homovanillic acid (HVA)?

A

Neuroblastoma

99
Q

Signs and symptoms:

Bilious emesis within hours after the first feeding

A

Duodenal atresia

100
Q

Which immunodeficiency is seen in boys with chronic respiratory infections? Nitroblue tetrazolium test is negative

A

Chronic granulomatous disease

101
Q

Which immunodeficiency is seen in child with eczema, thrombocytopenia, and high levels of IgA?

A

Wiskott-Aldrich syndrome

102
Q

Which immunodeficiency is seen in 4-month-old boy with life-threatening Pseudomonas infection?

A

Bruton’s x-linked agammaglobulinemia

103
Q

Signs and symptoms:
Mental status changes
Emesis
Liver dysfunction after ASA intake

A

Reye syndrome

104
Q

What cancer does retinoblastoma increase risk for?

A

Osteosarcoma

105
Q

Which vaccinations are given at 6-month well-child visit?

A

HBV, DTaP, Hib, IPV, PCV, rotavirus

106
Q 
Signs and symptoms:
Red "currant-jelly" stools
Colicky abdominal pain
Billous vomiting
Sausage-shaped mass in the RUQ
A

Intussusception

107
Q

What is the most common pathogen causing croup?

A

Parainfluenza virus type 1

108
Q

Signs and symptoms:
Obese boy
Sudden onset of limp

A

Slipped capital femoral epiphysis

Dx with AP and frog-leg lateral radiographs

109
Q

Signs and symptoms:
Active boy
Anterior knee pain

A

Osgood-Schlatter disease

110
Q

What are the key side effects of atypical antipsychotics?

A

Weight gain
Type 2 DM
QT segment prolongation

111
Q

How is acute dystonia treated?

A

Benztropine or

Diphenydramine

112
Q

Which meds should be avoided in patients with PTSD?

A

Benzodiazepines (high addiction potential) - patients commonly have a hx of substance abuse

113
Q

What are Light’s criteria for exudative effusion?

A

Pleural/serum protein >0.5

pleural/serum LDH >0.6

114
Q

What are causes of exudative effusion?

A

Think of leaky capillaries: malignancy, TB, bacterial or viral infection, PE with infarct, and pancreatitis

115
Q

What are causes of transudative effusion?

A

Think of intact capillaries: CHF, liver or kidney disease, and protein-losing enteropathy

116
Q

What are the PFTs like in obstructive pulmonary disease?

A

Low FEV/FVC

117
Q

What are the PFTs of restrictive pulmonary disease?

A

Increased FEV/FVC, low TLC

118
Q

What does honeycomb pattern on chest radiograph indicate?

A

Diffuse interstitial pulmonary fibrosis

Treat with supportive care; antifibrotic agents may help

119
Q

How is SVC syndrome treated?

A

Radiation

120
Q

What is the acid-base disorder in PE?

A

Respiratory alkalosis with hypoxia and hypocarbia

121
Q

Which non-small cell lung cancer is associated with hypercalcemia?

A

Squamous cell carcinoma

122
Q

Which lung cancer is associated with Lambert Eaton syndrome?

A

Small cell lung cancer

123
Q

Which non-small cell lung cancer is associated with SIADH?

A

Small cell lung cancer

124
Q

Which lung cancers are highly related to cigarette exposure?

A

small cell lung cancer, squamous cell carcinoma

125
Q

What are the classic chest radiographic findings for pulmonary edema?

A 
Cardiomegaly
Prominent pulmonary vessels
Kerley B lines
"bat's wing" appearance of hilar shadows
Perivascular and peribronchial cuffing
126
Q

Renal tubular acidosis associated with abnormal H+ secretion and nephrolithiasis

A

Type I (distal) RTA

127
Q

Renal tubular acidosis associated with abnormal bicarb reabsorption and rickets

A

Type II (proximal) RTA

128
Q

Renal tubular acidosis associated with low aldosterone state

A

Type IV (distal) RTA

129
Q

T-wave flattening and U waves

A

hypokalemia

130
Q

Peaked T-waves and widened QRS

A

hyperkalemia

131
Q

How is hyperkalemia treated?

A 
"C BIG K"
calcium gluconate
bicarb
insulin
glucose
kayexalate
132
Q

How should nephrolithiasis be diagnosed?

A

noncontrast CT

133
Q

Signs and symptoms:
nephritic syndrome
3 days after URI
normal C3

A

IgA nephropathy (Berger disease)

134
Q

Glomerulonephritis with hemoptysis

A

Granulomatosis with polyangiitis

Goodpasture syndrome

135
Q

Eosinophils in urine sediment

A

Allergic interstitial nephritis

136
Q

Which testicular cancer is associated with beta-hcg?

A

Choriocarcinoma

137
Q

What is the complication of overly rapid correction of hyponatremia?

A

Central pontine myelinolysis

138
Q

Which acid-base disturbance is commonly seen in pregnant women?

A

Respiratory alkalosis

139
Q

Treatment for benzodiazepine overdose?

A

Flumazenil

140
Q

Treatment for malignant hypertension?

A

Nitroprusside

141
Q

Treatment of SVT

A

If stable, rate control with carotid massage or other vagal stimulation
If unsuccessful, consider adenosine

142
Q

Macrocytic, megaloblastic anemia with neurological symptoms

A

B12 deficiency

143
Q

Macrocytic, megaloblastic anemia without neurological symptoms

A

Folate deficiency

144
Q

What is the most common organism in burn-related infections?

A

Pseudomonas

145
Q

How is fluid repletion in burn patients calculated?

A

Parkland formula: 24h fluids = 4 x kg x %BSA

146
Q

What are the Cushing triad signs of ICP

A

hypertension
bradycardia
abnormal respirations

147
Q

What is the CO, PCWP, and PVR for hypovolemic shock?

A

CO down
PCWP down
Increased PVR

148
Q

What is the CO, PCWP, and PVR for cardiogenic shock?

A

CO down
PCWP up
PVR up

149
Q

What is the CO, PCWP, and PVR for distributive shock?

A

CO up
PCWP down
PVR down

150
Q

Which thyroid cancer is associated with increased calcitonin?

A

Medullary cancer

151
Q

How does papillary thyroid cancer spread?

A

Lymphatics

152
Q

How does follicular thyroid cancer spread?

A

Hematologic

153
Q

How is acromegaly treated?

A

Octreotide or lanreotide (somatostatin analogues)

154
Q

How is central diabetes insipidus treated?

A

DDAVP: desmopressin acetate, a synthetic analogue of ADH

155
Q

How is nephrogenic diabetes insipidus treated?

A

Salt restriction and water intake; thiazide diuretics can be used to promote mild volume depletion and to stimulate increased water absorption

156
Q

How is SIADH treated?

A

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

157
Q

What is associated with MEN type I?

A

Gastrinomas (ZES), insulinomas, and VIPomas aka pancreatic islet cell tumors
Parathyroid hyperplasia
Pituitary adenomas
MEN 1 affects “P” organs: pancreas, pituitary, parathyroid

158
Q

What is associated with MEN type 2A?

A 
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
159
Q

What is associated with MEN type 2B?

A

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

160
Q

How can etiology of ascites be identified?

A

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)

161
Q

What is Libman-Sacks endocarditis?

A

Noninfectious vegetations often seen on the mitral valve in association with SLE and APS

162
Q

What is the biceps reflex?

A

C5 nerve root

163
Q

What is the triceps reflex?

A

C7 nerve root

164
Q

What is the patellar reflex?

A

L4 nerve root

165
Q

What is the Achilles reflex?

A

S1 nerve root

166
Q

Which med should not be given to someone with VWD?

A

aspirin

167
Q

How can tumor lysis syndrome be prevented?

A

Patients should be well hydrated

Patients can be started on allopurinol or rasburicase if WBC are up

168
Q

What’s with hypocalcemia and blood transfusions?

A

Blood products often contain citrate, which binds to serum calcium, leading to hypocalcemia

169
Q

Which electrolyte abnormality can cause prolonged QT?

A

hypocalcemia

170
Q

Which blood cancer has t(9;22)?

A

CML

This is the BCR-ABL translocation

171
Q

How is CML treated?

A

Imatinib (Gleevec)

172
Q

Which blood cancer stains with TRAP?

A

Hairy Cell Leukemia

173
Q

Which HIV med causes crazy dreams?

A

Efavirenz

174
Q

Which HIV med can cause a hypersensitivity reaction?

A

Abacavir

175
Q

Which tumor looks like a bunch of grapes coming out of the vagina?

A

sarcoma botryoides

Rapid Review (8 decks)

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