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STEP 2 CK > STEP 2 CK USMLE incorrect > Flashcards

STEP 2 CK USMLE incorrect Flashcards

1
Q

Severe isolated thrombocytopenia with normal hematocrit and WBC

A

Immune thrombocytopenia

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2
Q

Treatment for ITP if plts <30,000 OR bleeding

A

IVIg OR steroids

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3
Q

treatment for ITP >30,000 w/o bleeding

A

observe

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4
Q

Mild thrombocytopenia, giant platelets, bleeding out of proportion to thrombocytopenia

A

Bernard-Soulier syndrome (AR)

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5
Q

joint pain and tumors with chalky white appearance

A

Tophaceous gout

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6
Q

Characteristics or malignant renal cystic mass

A
  • thick irregular wall
  • multilocular
  • multiple septae
  • Contrast enhancement
  • pain, hematuria or HTN
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7
Q

Dry cough, malaise for 2 mo and bilateral hilar adenopathy

A

Sarcoid

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8
Q

Treatment for HTN in pts with renal artery stenosis

A

ACEIs or ARBs

* if bilateral stenosis need careful monitoring

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9
Q

infective endocarditis with AV block

A

Perivalvular abscess

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10
Q

Murmur for tricuspid endocarditis

A

holosystolic murmur louder with inspiration.

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11
Q

pathophys of hepatorenal syndrome

A

cirrhosis->splanchnic arterial dilation->RAAS->renal vasoconstriction->decreased perfusion and GFR

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12
Q

first line treatment for erectile dysfunction

A

oral sildenafil

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13
Q

Most common complication of influenza

A

secondary bacterial pneumonia

younger: CA-MRSA

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14
Q

Medications that cause acute glaucoma

A

decongestants, antiemetics, anticholinergics (trihrxyphenidyl)

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15
Q

Tx for hemodynamically unstable SVT

A

Synchronized cardioversion

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16
Q

tx for hemodynamically stable SVT

A

IV amiodarone or IV procainamide

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17
Q

Age >50
BL pain and morning stiffness >1mo
involving: neck, shoulders, prox hip, constitutional
w/ elevated ESR

A

Polymyalgia rheumatica

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18
Q

Tx for poly myalgia rheumatica

A

Glucocorticoids

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19
Q

signs of early lyme disease

A

Erythema migrans, malaise, fatigue, arthralgia, meningitis, CN palsy, AV block

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20
Q

Antimitochondrial antibody

A

PSC

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21
Q

Anti- RNA pol III ab

A

Diffuse cutaneous scleroderma

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22
Q

Anticentromere ab

A

Limited cutaneous scleroderma

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23
Q

Diffuse cutaneous scleroderma characteristics

A

Scleroderma on trunk and UE
Prominent internal organ involvement: ILD, Myocardial ischemia, renal crisis
Anti-Scl-70 ab
Anti-RNA pol III ab

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24
Q

Cause of potassium shift into cell

A
  • Beta-adrenergic agonist
  • increased insulin
  • alkalosis
  • hematopoiesis
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25
Q

Drug therapy for recurrent nephrolithiasis

A

Thiazide
Urine alkalization (potassium citrate)
Allopurinol

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26
Q

Dietary changes to treat recurrent nephrolithiasis

A 
>2L/day
low sodium and protein
nl ca intake
increase citrate
reduced oxalate diet (for ox stones)
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27
Q

consequences of nephrotic syndrome

A 
Hypoalbuminemia
elevated liver protein and lipid synthesis->hyperlipidemia
Hypercoagulability 
Edema
Hypovolemia
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28
Q

sx and labs ethylene glycol poisoning

A

Acute renal failure, envelope-shaped calcium oxalate crystals
gap met acid

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29
Q

signs of methanol intoxication

A

blindness

gap met acid

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30
Q

treatment of SIADH

A

Fluid restriction+/- salt tabs

Hypertonic (3%) saline for severe (confusion, seizures, coma)

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31
Q

Causes of SIADH

A

CNS disturbance (stroke, hemorrhage, trauma)
Medications (carbamazepine, SSRI, NSAIDs)
Lung disease (PNA)
Ectopic ADH secretion (SC lung cancer)
pain or nausea

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32
Q

Flank pain, hematuria, palpable renal mass, Left-sided scrotal varicoceles plus constitutional symptoms

A

RCC

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33
Q

middle ear effusion with no signs of acute infection in immunocompromised

A

Serous otitis media

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34
Q

Signs of serous otitis media

A

conductive hearing loss

dull, hypomobile TM

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35
Q

when to start treating Graves with antithyroid drugs alone

A

mild disease, small goiters, low TSH receptor Ab titers

Pregnant woman or Older pts

(sometimes just pretreatment due to risk for complications from RAI)

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36
Q

Pathogenesis of NAFLD

A

increased transport of FFA from adipose tissue to liver, decreased FFA ox in liver, or decreased clearance FFA

Related to insulin resistance–> increased peripheral lipolysis

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37
Q

Clinical presentation of thyroid storm

A 
FEVER
tachycardia, HTN, CHF, fib
Agitation, delirium 
Goiter, LID lag, tremor
N/v, d, jaundice
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38
Q

Treatment for acute adrenal insufficiency

A

fluids and IV dexa

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39
Q

signs of acute adrenal insufficiency

A 
hypotension 
tachycardia
Abd pain
vomiting
weakness
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40
Q

elevated free plasma metanephrines are a sign of…

A

pheochromocytoma

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41
Q

Imaging for gallstone pancreatitis

A

abd US

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42
Q

clinical: Cranial nerve VII palsy w/ lesion below pons

A

ipsilateral can’t raise eyebrow or close eye, drooping mouth corner, no nasolabial fold

(decreased tearing, hyperacusis, loss of taste ant 2/3)

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43
Q

Most common paroxysmal supra ventricular tachycardia

A

Atrioventricular nodal reentrant tachycardia

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44
Q

Who gets AVNRT

A

young pts with normal hearts

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45
Q

Signs of AVNRT

A

PALPITATIONS

dizziness, SOB, CP

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46
Q

Cause of AVNRT

A

two conduction pathways in AV node (reentry mechanism)

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47
Q

Treatment for AVNRT

A

Vagal maneuvers to increase parasympathetic tone and slow AV node and increase refractory period

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48
Q

palpable purpura, proteinuria, hematuria, hx or IVDU, hepatosplenomegaly

A

Mixed cryoglobulinemia

usually have underlying HCV

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49
Q

Treatment for Ehrlichiosis

A

Doxycycline or minocycline

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50
Q

SE amiodarone

A

Pulm: CHRONIC interstitial pneumonitis

Cardiac: QT prolongation
Endocrine: thyroid
GI: transaminitis
Opitc: neuropathy

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51
Q

Signs of interstitial pneumonitis 2/2 amiodarone

A

dyspnea, nonproductive cough, new ground glass opacities on CXR

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52
Q

Diffuse telangiectasis, recurrent epistaxis, widespread AVM (mucous membranes), clubbing

A

Hereditary telangiectasia (Osler-Weber-Rendu syndrome)

chronic hypoxemia and reactive polycythemia

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53
Q

Clinical manifestations of amyloidosis

A 
Renal (nephrotic)
Cardiac (restrictive cardiomyopathy, arrhythmia)
Heme (easy bruising, splenomegaly)
GI (hepatomegaly)
Neurologic (neuropathy)
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54
Q

Causes of restrictive cardiomyopathy

A 
infiltrative Dz (sarcoid, amyloid, loftier syndrome)
Storage dz (hemochromatosis)
Endomycardial fibrosis 
radiation
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55
Q

asthmatic symptoms, nasal and ocular sx, facial flushing

A

Aspirin exacerbated respiratory disease

pt with hx asthma or chronic rhinosinusitis with nasal polyposis

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56
Q

CYP450 inhibitors

A 
APAP
Antibiotics
amiodarone
Cimetidine
cranberry juice
omeprazole
Thyroid hormone
SSRI
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57
Q

Effect of CYP450 inhibitors on warfarin

A

increased risk of bleeding

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58
Q

Treatment for fibromyalgia

A

aerobic exercise, good sleep hygiene, TCAs

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59
Q

Liver mass in patient on long-term oral contraception

A

Hepatic adenoma

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60
Q

Liver mass with anomalous arteries and arterial flow w/ central scar on imaging

A

Focal nodular hyperplasia

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61
Q

liver mass with elevated alpha-fetoprotein

A

Hepatocellular carcinoma

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62
Q

what is a concerning temp in cirrhosis?

A

> 37.8

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63
Q

SBP clinical presentation

A

diffuse abdominal tenderness and/or mental status change

hypotension, hypothermia, paralytic ileum –> severe

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64
Q

SBP ascitic fluid

A

PMN>250
positive culture (GN)
protein <1
SAAG >1.1

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65
Q

HIV pt with fevers, headache worsening over 2 weeks, and signs of ICP

A

Cryptococcal meningitis

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66
Q

PPx for esophageal varices

A

nonselective beta blocker (propranolol, nadolol)

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67
Q

Treatment for actively bleeding esophageal varies

A

Octreotide

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68
Q

Test for lactose intolerance

A

Hydrogen breath test
Low stool pH
Increased stool osmotic gap

69
Q

Elderly pt with hypercalcemia, normocytic anemia, renal insufficiency, and protein gap

A

Multiple myeloma

70
Q

SE Levodopa/carbidopa

A

hallucinations, anxiety
n, arrhythmias, orthostatic hypotension

involuntary movements (5-10yrs)

71
Q

ulnar compression most commonly happens at the…

A

elbow

72
Q

episodic flushing and wheezing, diarrhea, valvular heart disease w/ tricuspid regurg

A

Carcinoid syndrome

73
Q

Sx carcinoid syndrome

A

Episodic flushing and wheezing
diarrhea
valvular heart disease w/ tricuspid regurg.
Niacin deficiency(later)

74
Q

Niacin deficiency

A

pellagra (diarrhea, dermatitis, dementia) also glossitis and angular stomatitis

75
Q

Elevated alk phos in asymptomatic elderly patient

A

Paget disease of the bone

usually effects long bones, skull (HA, hearing loss) and spine

76
Q

timing of fat embolism after trauma

A

12-24hrs

77
Q

Sx fat embolism

A

Dyspnea
Neuro deficits (confusion, seizures, focal deficits)
Petechial rash

78
Q

Signs of acute hypocalcemia

A 
muscle cramps
chvostek and trousseau signs
Paresthesias
Hyperreflexia
Seizures
79
Q

Sx hyperMg

A

hypOreflexia
paralysis
apnea
Cardiac arrest

80
Q

Test for acute hep B

A

HBsAg and IgM Anti-HBc

81
Q

Timing of post MI pericarditis

A

First few days

82
Q

Timing of Dressler’s syndrome

A

weeks post MI

83
Q

Sx Dressler’s syndrome

A

pericarditis
malaise
+/- fever
Elevated ESR

84
Q

tx dressler’s syndrome

A

NSAIDs

or steroids

85
Q

Lab abnormalities with hypothyroid

A

hyperlipidemia, hyponatremia, elevated CK and transaminases

86
Q

AST and ALT in alcoholic hepatitis

A

elevated
<300
AST: ALT >2

87
Q

SE methotrexate

A 
Macrocytic anemia and pancytopenia
Nausea
stomatitis
rash 
hepatotoxicity 
ILD
alopecia 
fever
88
Q

Intensely pruritus, migrating, reddish-brown tracks on lower extremity after walking on a beach

A

Cutaneous larva migrans

hookworm larvae

89
Q

PFTs for restrictive lung disease

A

decreased lung volumes
Normal/elevated FEV1/FVC
decreased diffusion lung capacity
Decreased pulm compliance

90
Q

What does pulmonary capillary wedge pressure indicate

A

left atrial pressure

91
Q

pattern of central cord syndrome

A

post hyperextension of neck in elderly

weakness more pronounced in upper extremities than lower

92
Q

what is amaurosis fugax

A

transient monocular blindness lasting seconds

2/2 embolus in ophthalmic artery

93
Q

Signs of ICP

A 
papilledema 
enlarged blindspots
Headaches worse in the morning
Nausea/v
decreased consciousness
94
Q

High TSH

High free T3 and T4

A

Secondary hyperthyroidism

central–pituitary adenoma?

95
Q

Most common cause of CAP

A

S. pneumo

96
Q

timing to diagnose chronic bronchitis

A

3 consecutive months of productive cough in 2 successive years

97
Q

Causes of recurrent pneumonia in same region of lung

A

Local airway obstruction (extrinsic-neoplasm or adenopathy or intrinsic-bronchiectasis or FB)

Recurrent aspiration

98
Q

cause of recurrent pneumonia in different regions of lung

A

Immunodeficiency
Sinopulmonary dz
Noninfectious (vasculitis, BOOP)

99
Q

Signs of acute right heart strain

A

EKG with new RBBB or s1q3t3
bulging neck veins
Echo- dilated RV and decreased wall motion

100
Q

Who needs low dose CT scan screening for lung cancer yearly?

A

55-80yo
30pk yr
quit <15y

101
Q

categorization of high malignancy risk for solitary pulmonary nodule

A 
Size: >2cm
Surface: Spiculated
Smoker: current
Cessation: <5yrs
Self (age): >60
102
Q

Low malignancy risk factors for solitary pulmonary nodule

A

Size: <8mm
Surface: smooth
Smoker: never
Self (age): <45

103
Q

Treatment for COPD

A

Muscarinic antagonist (ipratropium and tiotropium)

104
Q

Features of OHS

A 
daytime hypercarbia
Dyspnea
Polycythemia
Resp Acid
Pulm HTN
Cor pulmonale
105
Q

Most sensitive lab value for hypovolemia

A

Decreased urine sodium

106
Q

When can a patient with HIV not get varicella vaccine?

A

CD4<200

107
Q

symptoms of phenochromocytoma

A 
Paroxysmal
Pain (HA)
Pressure (HTN)
Palp (tachy)
Perspiration 
Elevated BGL
108
Q

Treatment for Paroxysmal supra ventricular tachycardias

A

Vagal maneuvers or IV adenosine

109
Q

SE of phosphodiesterase-5 inhibitors

A 
Hypotension (esp w alpha blockers and nitrates)
Blue discoloration of vision 
Priapism 
vision changes
Flushing
HA
Hearing loss
110
Q

Diabetes medications that do not cause weight gain

A

Weight neutral: Metformin, DPP4 inhibitor

Weight loss: GLP-1 agonist

111
Q

Causes of tachycardia-mediated cardiomyopathy

A 
AF
A flutter
V tach
Incessant atrial tacky
AVNRT
112
Q

Weight gain, proximal muscle weakness, HTN, hyperglycemia
anxiety
Hirsutism

A

Hypercortisolism (cushing syndrome)

113
Q

Causes of cushing syndrome

A

Exogenous steroids
ACTH-producing putituary tumor
Ectopic ACTH production
Primary adrenal disease

114
Q

Diagnosis of cushings disease

A

overnight low-dose dexamethasone suppression test
Late night salivary cortisol
24-hr urine free cortisol

115
Q

Next step in eye exam if suspicious of intraocular foreign body after pen light

A

Fluorescein exam

116
Q

signs of cardiac tamponade

A

hypotension
tachycardia
distended neck veins
pulsus paradoxus

117
Q

Sx invasive aspergillosis

A

Fever, CP, hemoptysis

Pulm nodules with halo sign

118
Q

Inpt (non-ICU) tx for CAP

A

FQs (levo or moxi)
OR
Beta-lactam + macrolide

119
Q

Causes of bronchiectasis

A 
Airway obs (cancer)
Rheum dz
Chronic or prior infection (aspergillosis, mycobacteria)
Immunodeficiency
Congenital
120
Q

Dx bronchiectasis

A

HRCT

121
Q

Pathogenesis of clubbing

A

Megacaryocytes get stuck in distal vasculature and produce VEGF and PDGF

122
Q

Causes of clubbing

A

Intrathoracic neoplasms
Intrathoracic suppurative dz (abscess, empyema, CF, fungal)
Lung dz (ILD, Asbestosis, AVM)
Cyanotic congenital heart dz

123
Q

When to do a CT for a PE?

A

After assessing if patient can get anticoagulant

if yes then treat before further workup

124
Q

What tumor produces AFP and beta-hCG?

A

nonseminomatous germ cell tumors

found in anterior mediastinum

125
Q

recurrent sinusitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria

A

granulomatosis with polyangiitis

126
Q

Sx of GPA

A

upper resp: sinusitis/otitis, saddle nose deform
Lower resp: lung nodules/cavitations
Renal: RPGN
Skin: lived reticulais, non healing ulcers

127
Q

Signs of respiratory failure in asthma exacerbation

A 
elevated or normal PaCO2
Decreased breath sounds
Absent wheezing
AMS
Marked hypoxia w cyanosis
128
Q

Lung dz after asbestosis exposure and smoking

A

Bronchogenic carcinoma

bilateral pleural plaques

129
Q

Pleural plaques in pleural mesothelioma

A

unilateral with pleural effusion

130
Q

Indication for long-term home O2 therapy

A

Resting: PaO2<55 or SaO2<88%RA

Corpulm, RHF, HCT>55%: PaO2<59 or SaO2<89%

131
Q

Definition of pulm HTN

A

mean pulmonary arterial pressure > 25 rest or 30 w/ exercise

132
Q

Class 1 pulm HTN

A

pulmonary artery HTN

Idiopathic, familial, drugs/toxins, associated conditions (HIV, shunts, connective tissue dz)

133
Q

Clinical features of Pulm HTN

A

Dyspnea, weakness, fatigue

CP, hemoptysis, syncope, hoarseness

134
Q

CXR findings pulm HTN

A

enlargement pulm arteries and enlargement of R ventricle

135
Q

Class 2 Pulm HTN

A

Left heart Dz (LV dysfunction or valvular)

136
Q

Class 3 pulm HTN

A

Lung dz and/or chronic hypoxia

COPD, OSA, etc

137
Q

Class 4 pulm HTN

A

Chronic thromboembolic

138
Q

Class 5 pulm HTN

A 
misc: 
Heme: chronic hemolytic anemia, splenectomy
Systemic: sarcoid, LAM, vasculitis
Metabolic: glycogen storage, thyroid
Other: obstruction
139
Q

Myasthenia gravis S/S

A

muscle fatigue that worsens after use
ocular sx (ptosis, diplopia)
Bulbar dysfx
fatigue chewing, dysphagia, dysarthria

140
Q

Associated disorder myasthenia gravis

A

thymoma, thymic hyperplasia

141
Q

Tx myasthenia gravis

A

pyridostigmine

142
Q

Most common cause of acquired angioedema

A

ACE inhibitor

143
Q

Adverse effects of BB

A

bradycardia
AV block
Brohchoconstriction
Male sexual dysfunction

144
Q

Treatment for hypovolemic hypernatremia

A

Sx: 0.9% saline (isotonic) then D5

ASx: D5

145
Q

what does a positive direct coombs suggest in anemia

A

Autoimmune hemolytic anemia

Warm: + anti-IgG
Cold: + anti-IgM

146
Q

Causes of cold AIHA

A

infections (mycoplasma pneumoniae)

lymphoproliferative disorders

147
Q

Causes of warm AIHA

A 
Drugs (penicillin)
Virals infx
Autoimmune 
immunodeficiency 
Lymophoproliferative (CLL)
148
Q

Tx of warm AIHA

A

high-dose steroids

149
Q

Acid base in OSA

A

Chronic resp acidosis with chronic metabolic alkalosis

150
Q

SE trastuzumab

A

Cardiotoxicity

151
Q

Tx of WPW afib

A

Procainamide

152
Q

S/S arsenic poisoning

A

Acute: Garlic breath, v, d, QTc prolongation, pancytopenia

Chronic: Hypo/hyperpig, hyperkeratosis, stocking-glove neuropathy

153
Q

fundiscopic findings with central retinal vein occlusion

A

Venous dilation, tortuosity.
Diffuse hemorrhages
cotton wool spots
Disk swelling

154
Q

ARP=

A

(RR-1)/RR

155
Q

Iron studies in iron deficiency

A

Iron low
Ferritin Low
Transferrin Low
TIBC HIGH

156
Q

Iron studies in anemia of chronic disease

A

Iron Low
TIBC Low
Ferritin HIGH/nl
Transferrin Low/nl

157
Q

Tx for botulism

A

supportive

Equine serum heptavalent antitoxin

158
Q

Treatment for hyperosmolar hyperglycemic state

A

IV NS
IV insulin
Monitor K

159
Q

Irregular menses, hirsutism, elevated T, acne

A

PCOS

160
Q

Pathophysiology of zenker

A

Sphincter dysfunction and esophageal dysmotility

161
Q

Where does giant cell tumor of bone appear

A

in the epiphyseal region of long bones (distal femur and proximal tibia)

162
Q

Tetanus tx for pt who has clean or minor wound and has had 3 or more tetanus toxoid doses

A

Tdap if last dose was >10yrs

No TIG

163
Q

When to give TIG for possible tetanus infection

A

Dirty or sever wounds in pts who have not has at least 3 doses of tetanus or who has unknown vaccine status

164
Q

sounds of aortic stenosis

A

Mid to late peaking systolic murmur
soft S2
S4

165
Q

Mid to late diastolic murmur at cardiac apex

A

mitral stenosis

also opening snap

166
Q

Conditions with S3

A

chronic severe mitral regurg
chronic aortic regurg
HF

167
Q

cause of arrhythmias w/in 10min of MI

A

immediate or phase 1a ventricular arrhythmia

Cause: reentrant

168
Q

Cause of arrhythmia 10-60 min after MI

A

abnormal automacity

169
Q

Most common cause of sudden cardiac arrest right after MI

A

Reentrant ventricular arrhythmias (e.g. V fib)

STEP 2 CK (2 decks)

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