STEP 2 CK USMLE incorrect Flashcards
1
Q
Severe isolated thrombocytopenia with normal hematocrit and WBC
A
Immune thrombocytopenia
2
Q
Treatment for ITP if plts <30,000 OR bleeding
A
IVIg OR steroids
3
Q
treatment for ITP >30,000 w/o bleeding
A
observe
4
Q
Mild thrombocytopenia, giant platelets, bleeding out of proportion to thrombocytopenia
A
Bernard-Soulier syndrome (AR)
5
Q
joint pain and tumors with chalky white appearance
A
Tophaceous gout
6
Q
Characteristics or malignant renal cystic mass
A
- thick irregular wall
- multilocular
- multiple septae
- Contrast enhancement
- pain, hematuria or HTN
7
Q
Dry cough, malaise for 2 mo and bilateral hilar adenopathy
A
Sarcoid
8
Q
Treatment for HTN in pts with renal artery stenosis
A
ACEIs or ARBs
* if bilateral stenosis need careful monitoring
9
Q
infective endocarditis with AV block
A
Perivalvular abscess
10
Q
Murmur for tricuspid endocarditis
A
holosystolic murmur louder with inspiration.
11
Q
pathophys of hepatorenal syndrome
A
cirrhosis->splanchnic arterial dilation->RAAS->renal vasoconstriction->decreased perfusion and GFR
12
Q
first line treatment for erectile dysfunction
A
oral sildenafil
13
Q
Most common complication of influenza
A
secondary bacterial pneumonia
younger: CA-MRSA
14
Q
Medications that cause acute glaucoma
A
decongestants, antiemetics, anticholinergics (trihrxyphenidyl)
15
Q
Tx for hemodynamically unstable SVT
A
Synchronized cardioversion
16
Q
tx for hemodynamically stable SVT
A
IV amiodarone or IV procainamide
17
Q
Age >50
BL pain and morning stiffness >1mo
involving: neck, shoulders, prox hip, constitutional
w/ elevated ESR
A
Polymyalgia rheumatica
18
Q
Tx for poly myalgia rheumatica
A
Glucocorticoids
19
Q
signs of early lyme disease
A
Erythema migrans, malaise, fatigue, arthralgia, meningitis, CN palsy, AV block
20
Q
Antimitochondrial antibody
A
PSC
21
Q
Anti- RNA pol III ab
A
Diffuse cutaneous scleroderma
22
Q
Anticentromere ab
A
Limited cutaneous scleroderma
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
24
Q
Cause of potassium shift into cell
A
- Beta-adrenergic agonist
- increased insulin
- alkalosis
- hematopoiesis
25
Drug therapy for recurrent nephrolithiasis
Thiazide
Urine alkalization (potassium citrate)
Allopurinol
26
Dietary changes to treat recurrent nephrolithiasis
```
>2L/day
low sodium and protein
nl ca intake
increase citrate
reduced oxalate diet (for ox stones)
```
27
consequences of nephrotic syndrome
```
Hypoalbuminemia
elevated liver protein and lipid synthesis->hyperlipidemia
Hypercoagulability
Edema
Hypovolemia
```
28
sx and labs ethylene glycol poisoning
Acute renal failure, envelope-shaped calcium oxalate crystals
gap met acid
29
signs of methanol intoxication
blindness
| gap met acid
30
treatment of SIADH
Fluid restriction+/- salt tabs
| Hypertonic (3%) saline for severe (confusion, seizures, coma)
31
Causes of SIADH
CNS disturbance (stroke, hemorrhage, trauma)
Medications (carbamazepine, SSRI, NSAIDs)
Lung disease (PNA)
Ectopic ADH secretion (SC lung cancer)
pain or nausea
32
Flank pain, hematuria, palpable renal mass, Left-sided scrotal varicoceles plus constitutional symptoms
RCC
33
middle ear effusion with no signs of acute infection in immunocompromised
Serous otitis media
34
Signs of serous otitis media
conductive hearing loss
| dull, hypomobile TM
35
when to start treating Graves with antithyroid drugs alone
mild disease, small goiters, low TSH receptor Ab titers
Pregnant woman or Older pts
(sometimes just pretreatment due to risk for complications from RAI)
36
Pathogenesis of NAFLD
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
37
Clinical presentation of thyroid storm
```
FEVER
tachycardia, HTN, CHF, fib
Agitation, delirium
Goiter, LID lag, tremor
N/v, d, jaundice
```
38
Treatment for acute adrenal insufficiency
fluids and IV dexa
39
signs of acute adrenal insufficiency
```
hypotension
tachycardia
Abd pain
vomiting
weakness
```
40
elevated free plasma metanephrines are a sign of...
pheochromocytoma
41
Imaging for gallstone pancreatitis
abd US
42
clinical: Cranial nerve VII palsy w/ lesion below pons
ipsilateral can't raise eyebrow or close eye, drooping mouth corner, no nasolabial fold
(decreased tearing, hyperacusis, loss of taste ant 2/3)
43
Most common paroxysmal supra ventricular tachycardia
Atrioventricular nodal reentrant tachycardia
44
Who gets AVNRT
young pts with normal hearts
45
Signs of AVNRT
PALPITATIONS
| dizziness, SOB, CP
46
Cause of AVNRT
two conduction pathways in AV node (reentry mechanism)
47
Treatment for AVNRT
Vagal maneuvers to increase parasympathetic tone and slow AV node and increase refractory period
48
palpable purpura, proteinuria, hematuria, hx or IVDU, hepatosplenomegaly
Mixed cryoglobulinemia
| usually have underlying HCV
49
Treatment for Ehrlichiosis
Doxycycline or minocycline
50
SE amiodarone
Pulm: CHRONIC interstitial pneumonitis
Cardiac: QT prolongation
Endocrine: thyroid
GI: transaminitis
Opitc: neuropathy
51
Signs of interstitial pneumonitis 2/2 amiodarone
dyspnea, nonproductive cough, new ground glass opacities on CXR
52
Diffuse telangiectasis, recurrent epistaxis, widespread AVM (mucous membranes), clubbing
Hereditary telangiectasia (Osler-Weber-Rendu syndrome)
| chronic hypoxemia and reactive polycythemia
53
Clinical manifestations of amyloidosis
```
Renal (nephrotic)
Cardiac (restrictive cardiomyopathy, arrhythmia)
Heme (easy bruising, splenomegaly)
GI (hepatomegaly)
Neurologic (neuropathy)
```
54
Causes of restrictive cardiomyopathy
```
infiltrative Dz (sarcoid, amyloid, loftier syndrome)
Storage dz (hemochromatosis)
Endomycardial fibrosis
radiation
```
55
asthmatic symptoms, nasal and ocular sx, facial flushing
Aspirin exacerbated respiratory disease
pt with hx asthma or chronic rhinosinusitis with nasal polyposis
56
CYP450 inhibitors
```
APAP
Antibiotics
amiodarone
Cimetidine
cranberry juice
omeprazole
Thyroid hormone
SSRI
```
57
Effect of CYP450 inhibitors on warfarin
increased risk of bleeding
58
Treatment for fibromyalgia
aerobic exercise, good sleep hygiene, TCAs
59
Liver mass in patient on long-term oral contraception
Hepatic adenoma
60
Liver mass with anomalous arteries and arterial flow w/ central scar on imaging
Focal nodular hyperplasia
61
liver mass with elevated alpha-fetoprotein
Hepatocellular carcinoma
62
what is a concerning temp in cirrhosis?
>37.8
63
SBP clinical presentation
diffuse abdominal tenderness and/or mental status change
| hypotension, hypothermia, paralytic ileum --> severe
64
SBP ascitic fluid
PMN>250
positive culture (GN)
protein <1
SAAG >1.1
65
HIV pt with fevers, headache worsening over 2 weeks, and signs of ICP
Cryptococcal meningitis
66
PPx for esophageal varices
nonselective beta blocker (propranolol, nadolol)
67
Treatment for actively bleeding esophageal varies
Octreotide
68
Test for lactose intolerance
Hydrogen breath test
Low stool pH
Increased stool osmotic gap
69
Elderly pt with hypercalcemia, normocytic anemia, renal insufficiency, and protein gap
Multiple myeloma
70
SE Levodopa/carbidopa
hallucinations, anxiety
n, arrhythmias, orthostatic hypotension
involuntary movements (5-10yrs)
71
ulnar compression most commonly happens at the...
elbow
72
episodic flushing and wheezing, diarrhea, valvular heart disease w/ tricuspid regurg
Carcinoid syndrome
73
Sx carcinoid syndrome
Episodic flushing and wheezing
diarrhea
valvular heart disease w/ tricuspid regurg.
Niacin deficiency(later)
74
Niacin deficiency
pellagra (diarrhea, dermatitis, dementia) also glossitis and angular stomatitis
75
Elevated alk phos in asymptomatic elderly patient
Paget disease of the bone
usually effects long bones, skull (HA, hearing loss) and spine
76
timing of fat embolism after trauma
12-24hrs
77
Sx fat embolism
Dyspnea
Neuro deficits (confusion, seizures, focal deficits)
Petechial rash
78
Signs of acute hypocalcemia
```
muscle cramps
chvostek and trousseau signs
Paresthesias
Hyperreflexia
Seizures
```
79
Sx hyperMg
hypOreflexia
paralysis
apnea
Cardiac arrest
80
Test for acute hep B
HBsAg and IgM Anti-HBc
81
Timing of post MI pericarditis
First few days
82
Timing of Dressler's syndrome
weeks post MI
83
Sx Dressler's syndrome
pericarditis
malaise
+/- fever
Elevated ESR
84
tx dressler's syndrome
NSAIDs
| or steroids
85
Lab abnormalities with hypothyroid
hyperlipidemia, hyponatremia, elevated CK and transaminases
86
AST and ALT in alcoholic hepatitis
elevated
<300
AST: ALT >2
87
SE methotrexate
```
Macrocytic anemia and pancytopenia
Nausea
stomatitis
rash
hepatotoxicity
ILD
alopecia
fever
```
88
Intensely pruritus, migrating, reddish-brown tracks on lower extremity after walking on a beach
Cutaneous larva migrans
| hookworm larvae
89
PFTs for restrictive lung disease
decreased lung volumes
Normal/elevated FEV1/FVC
decreased diffusion lung capacity
Decreased pulm compliance
90
What does pulmonary capillary wedge pressure indicate
left atrial pressure
91
pattern of central cord syndrome
post hyperextension of neck in elderly
weakness more pronounced in upper extremities than lower
92
what is amaurosis fugax
transient monocular blindness lasting seconds
| 2/2 embolus in ophthalmic artery
93
Signs of ICP
```
papilledema
enlarged blindspots
Headaches worse in the morning
Nausea/v
decreased consciousness
```
94
High TSH
| High free T3 and T4
Secondary hyperthyroidism
| central--pituitary adenoma?
95
Most common cause of CAP
S. pneumo
96
timing to diagnose chronic bronchitis
3 consecutive months of productive cough in 2 successive years
97
Causes of recurrent pneumonia in same region of lung
Local airway obstruction (extrinsic-neoplasm or adenopathy or intrinsic-bronchiectasis or FB)
Recurrent aspiration
98
cause of recurrent pneumonia in different regions of lung
Immunodeficiency
Sinopulmonary dz
Noninfectious (vasculitis, BOOP)
99
Signs of acute right heart strain
EKG with new RBBB or s1q3t3
bulging neck veins
Echo- dilated RV and decreased wall motion
100
Who needs low dose CT scan screening for lung cancer yearly?
55-80yo
30pk yr
quit <15y
101
categorization of high malignancy risk for solitary pulmonary nodule
```
Size: >2cm
Surface: Spiculated
Smoker: current
Cessation: <5yrs
Self (age): >60
```
102
Low malignancy risk factors for solitary pulmonary nodule
Size: <8mm
Surface: smooth
Smoker: never
Self (age): <45
103
Treatment for COPD
Muscarinic antagonist (ipratropium and tiotropium)
104
Features of OHS
```
daytime hypercarbia
Dyspnea
Polycythemia
Resp Acid
Pulm HTN
Cor pulmonale
```
105
Most sensitive lab value for hypovolemia
Decreased urine sodium
106
When can a patient with HIV not get varicella vaccine?
CD4<200
107
symptoms of phenochromocytoma
```
Paroxysmal
Pain (HA)
Pressure (HTN)
Palp (tachy)
Perspiration
Elevated BGL
```
108
Treatment for Paroxysmal supra ventricular tachycardias
Vagal maneuvers or IV adenosine
109
SE of phosphodiesterase-5 inhibitors
```
Hypotension (esp w alpha blockers and nitrates)
Blue discoloration of vision
Priapism
vision changes
Flushing
HA
Hearing loss
```
110
Diabetes medications that do not cause weight gain
Weight neutral: Metformin, DPP4 inhibitor
Weight loss: GLP-1 agonist
111
Causes of tachycardia-mediated cardiomyopathy
```
AF
A flutter
V tach
Incessant atrial tacky
AVNRT
```
112
Weight gain, proximal muscle weakness, HTN, hyperglycemia
anxiety
Hirsutism
Hypercortisolism (cushing syndrome)
113
Causes of cushing syndrome
Exogenous steroids
ACTH-producing putituary tumor
Ectopic ACTH production
Primary adrenal disease
114
Diagnosis of cushings disease
overnight low-dose dexamethasone suppression test
Late night salivary cortisol
24-hr urine free cortisol
115
Next step in eye exam if suspicious of intraocular foreign body after pen light
Fluorescein exam
116
signs of cardiac tamponade
hypotension
tachycardia
distended neck veins
pulsus paradoxus
117
Sx invasive aspergillosis
Fever, CP, hemoptysis
Pulm nodules with halo sign
118
Inpt (non-ICU) tx for CAP
FQs (levo or moxi)
OR
Beta-lactam + macrolide
119
Causes of bronchiectasis
```
Airway obs (cancer)
Rheum dz
Chronic or prior infection (aspergillosis, mycobacteria)
Immunodeficiency
Congenital
```
120
Dx bronchiectasis
HRCT
121
Pathogenesis of clubbing
Megacaryocytes get stuck in distal vasculature and produce VEGF and PDGF
122
Causes of clubbing
Intrathoracic neoplasms
Intrathoracic suppurative dz (abscess, empyema, CF, fungal)
Lung dz (ILD, Asbestosis, AVM)
Cyanotic congenital heart dz
123
When to do a CT for a PE?
After assessing if patient can get anticoagulant
if yes then treat before further workup
124
What tumor produces AFP and beta-hCG?
nonseminomatous germ cell tumors
| found in anterior mediastinum
125
recurrent sinusitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria
granulomatosis with polyangiitis
126
Sx of GPA
upper resp: sinusitis/otitis, saddle nose deform
Lower resp: lung nodules/cavitations
Renal: RPGN
Skin: lived reticulais, non healing ulcers
127
Signs of respiratory failure in asthma exacerbation
```
elevated or normal PaCO2
Decreased breath sounds
Absent wheezing
AMS
Marked hypoxia w cyanosis
```
128
Lung dz after asbestosis exposure and smoking
Bronchogenic carcinoma
| bilateral pleural plaques
129
Pleural plaques in pleural mesothelioma
unilateral with pleural effusion
130
Indication for long-term home O2 therapy
Resting: PaO2<55 or SaO2<88%RA
Corpulm, RHF, HCT>55%: PaO2<59 or SaO2<89%
131
Definition of pulm HTN
mean pulmonary arterial pressure > 25 rest or 30 w/ exercise
132
Class 1 pulm HTN
pulmonary artery HTN
| Idiopathic, familial, drugs/toxins, associated conditions (HIV, shunts, connective tissue dz)
133
Clinical features of Pulm HTN
Dyspnea, weakness, fatigue
| CP, hemoptysis, syncope, hoarseness
134
CXR findings pulm HTN
enlargement pulm arteries and enlargement of R ventricle
135
Class 2 Pulm HTN
Left heart Dz (LV dysfunction or valvular)
136
Class 3 pulm HTN
Lung dz and/or chronic hypoxia
COPD, OSA, etc
137
Class 4 pulm HTN
Chronic thromboembolic
138
Class 5 pulm HTN
```
misc:
Heme: chronic hemolytic anemia, splenectomy
Systemic: sarcoid, LAM, vasculitis
Metabolic: glycogen storage, thyroid
Other: obstruction
```
139
Myasthenia gravis S/S
muscle fatigue that worsens after use
ocular sx (ptosis, diplopia)
Bulbar dysfx
fatigue chewing, dysphagia, dysarthria
140
Associated disorder myasthenia gravis
thymoma, thymic hyperplasia
141
Tx myasthenia gravis
pyridostigmine
142
Most common cause of acquired angioedema
ACE inhibitor
143
Adverse effects of BB
bradycardia
AV block
Brohchoconstriction
Male sexual dysfunction
144
Treatment for hypovolemic hypernatremia
Sx: 0.9% saline (isotonic) then D5
ASx: D5
145
what does a positive direct coombs suggest in anemia
Autoimmune hemolytic anemia
Warm: + anti-IgG
Cold: + anti-IgM
146
Causes of cold AIHA
infections (mycoplasma pneumoniae)
| lymphoproliferative disorders
147
Causes of warm AIHA
```
Drugs (penicillin)
Virals infx
Autoimmune
immunodeficiency
Lymophoproliferative (CLL)
```
148
Tx of warm AIHA
high-dose steroids
149
Acid base in OSA
Chronic resp acidosis with chronic metabolic alkalosis
150
SE trastuzumab
Cardiotoxicity
151
Tx of WPW afib
Procainamide
152
S/S arsenic poisoning
Acute: Garlic breath, v, d, QTc prolongation, pancytopenia
Chronic: Hypo/hyperpig, hyperkeratosis, stocking-glove neuropathy
153
fundiscopic findings with central retinal vein occlusion
Venous dilation, tortuosity.
Diffuse hemorrhages
cotton wool spots
Disk swelling
154
ARP=
(RR-1)/RR
155
Iron studies in iron deficiency
Iron low
Ferritin Low
Transferrin Low
TIBC HIGH
156
Iron studies in anemia of chronic disease
Iron Low
TIBC Low
Ferritin HIGH/nl
Transferrin Low/nl
157
Tx for botulism
supportive
| Equine serum heptavalent antitoxin
158
Treatment for hyperosmolar hyperglycemic state
IV NS
IV insulin
Monitor K
159
Irregular menses, hirsutism, elevated T, acne
PCOS
160
Pathophysiology of zenker
Sphincter dysfunction and esophageal dysmotility
161
Where does giant cell tumor of bone appear
in the epiphyseal region of long bones (distal femur and proximal tibia)
162
Tetanus tx for pt who has clean or minor wound and has had 3 or more tetanus toxoid doses
Tdap if last dose was >10yrs
| No TIG
163
When to give TIG for possible tetanus infection
Dirty or sever wounds in pts who have not has at least 3 doses of tetanus or who has unknown vaccine status
164
sounds of aortic stenosis
Mid to late peaking systolic murmur
soft S2
S4
165
Mid to late diastolic murmur at cardiac apex
mitral stenosis
also opening snap
166
Conditions with S3
chronic severe mitral regurg
chronic aortic regurg
HF
167
cause of arrhythmias w/in 10min of MI
immediate or phase 1a ventricular arrhythmia
Cause: reentrant
168
Cause of arrhythmia 10-60 min after MI
abnormal automacity
169
Most common cause of sudden cardiac arrest right after MI
Reentrant ventricular arrhythmias (e.g. V fib)
