STEP 2 part 2 Flashcards
What is the next best diagnostic test for Mesenteric ischemia?
CT Angiography
What is the management of myocarditis?
Supportive with use of diuretics, ACE inhibitors, and nitroglycerin.
What are the major differences between Progressive Supranuclear Palsy and Parkinsonian sndrome?
in PSP tremor is less common, rigidity tends to be more axial than peripheral.
When is a CT scan indicated prior to performing a lumbar puncture? (6)
- Immunocompromised state
- Prior CNS disease
- New onset seizure within one week of presentation
- papilledema
- decreased level of consciousness
- focal neurological deficits
What does legionella look like on microscopic examination?
Intracellular organisms when stained with silver stain.
What is the most common test used to confirm measles infection?
Measurement of acute and convalescent serum IgM and IgG antibodies.
What likely mechanism should be suspected in a patient who presents with apparent overdose with eye examination shows afferent pupillary defect, mydriasis, retinal sheen from edema, and hyperemia of the optic disk?
Methanol overdose
If a patient with recent liver transplant starts presenting with liver failure, and causes of organ failure such as Obstructive biliary process/ portal vein thrombosis have been ruled out, what should be done next?
Biopsy of the liver is necessary for definitive diagnosis.
What is the currently recommended antibiotic therapy for a hospitalized patient with community-acquired pneumonia?
Second or third generation cephalosporin, plus a macrolide or doxycycline or monotherapy with a fluoroquinolone for 5-7 days.
What is the treatment for patients with Alport syndrome?
Focus on control of hypertension – often accomplished with ACE inhibitors/ARBS
What is the rate and depth that ACLS should be provided?
Chest compression at 100 compressions/ minute and a depth of at least 2 inches.
What is the immediate treatment for patients suspected of having testicular torsion?
Immediate surgical exploration and detorsion.
What is the appropriate treatment for TTN?
Conservative management, maintaining appropriate thermal environment, bulb suction, blow-by oxygen if needed.
What is an endodermal sinus tumor and what tumor marker is commonly associated with it?
Yolk Sac Tumor
Alpha Fetoprotein (AFP) is associated.
What is the next step in management of a patient who presents with a clear diagnosis of Graves’ disease?
Atenolol
What is the first step in the process of hemodialysis?
Vein mapping.
What is the next best step in a patient who presents with symptoms of achalasia?
Esophageal manometry.
What are the EKG findings in a patient who has pulmonary hypertension?
- Right axis deviation
- Increased P wave amplitude
- Right ventricular hypertrophy.
What is the immediate treatment of a patient who presents with possible ALL and is febrile?
Antibiotics while diagnosis diagnosis is being confirmed.
What medication can prevent infection by RSV in infants?
Palivizumab
What type of murmur presents with a click and a late systolic crescendo, and what maneuver will increase the intensity of the murmur?
Mitral valve prolapse
Valsalva maneuver decreases venous return to the heart, results in decreased blood in the left ventricle, the prolapse occurs earlier and to a greater extent, augmenting the murmur.
What is the preferred initial test for a patient who presents with high pretest probability of DVT?
Compression ultrasonography.
What blood conditions can occur with patients who present with Infectious Mononucleosis?
- Autoimmune hemolytic anemia
2. Thrombocytopenia
What findings are found in Tricuspid valve atresia?
- Left Axis deviation on EKG
2. Decreased pulmonary markings on chest radiograph
What maneuver is performed alongside a cesarian section for treatment of shoulder dystocia?
Zavanelli maneuver - should not be performed until all other maneuvers for shoulder dystocia have been exhausted.
Administration of terbutaline/NO to relax uterus, fetal head placed back into the uterus and C-section performed.
What antibiotics are necessary for treatment of health care associated pneumonia?
Vancomysin – for mRSA
Cefepime/Cipro – Pseudomonas
What is the anatomical relation of the esophagus to the aortic arch and thoracic aorta?
Esophagus passes posterior to the aortic arch and anterior to the thoracic aorta.
If a patient is pregnant and has obesity, what additional test should be done during her first appointment?
One hour glucose challenge test due to increased risk of pre-gestational diabetes due to her obesity.
When should the ultrasound date be used over the LMP date?
At less than 8+6 weeks’ gestation and if there is a discrepancy of 5 days or more.
What type of inheritance is Alport Syndrome?
X-linked dominant
What is the treatment for a 4yo girl who presents with fever and sore throat, and no exudate and scattered 2-4 grayish white vesicular lesions on the soft palate, tonsils, and posterior pharynx.
Ibuprofen or Acetaminophen for pain and fever and encourage oral fluids.
What is the most likely cause of a patient who spontaneously bleeds out of IV site, also with inadequate dietary intake, intestinal malabsorption, hepatocellular disease, and recent broad spectrum abx administration?
Vitamin K deficiency.
Sleep terrors are classified as what type of sleep disorder?
Non-rapid eye movement sleep arousal disorder
What is the treatment of a patient with CKD who develops metabolic acidosis due to decreased GFR?
Sodium Bicarbonate – slows progression to end-stage renal disease.
What is the next step if a patient presents with PPROM and the only information about fetus is adequate heart rate and oligohydramnios?
Fetal stress test to determine if fetus is in severe distress and requires immediate delivery.
What is the most specific diagnostic test for encephalitis?
MRI
MLD: patient with GVHD and presents with hypernatremia?
Insensible losses due to skin loss of fluids.
What are the main diagnostic tools for Legg-Calve-Perthes disease?
Plain radiographs.
What nerve root supplies the triceps reflex and also results in weakness of triceps muscle and finger extensors if it is involved in radiculopathy?
C7
What is the first step in management of a hemothorax?
Chest tube placement
What is the treatment for obstructive lesions and mild inflammatory lesions limited to face?
Tretinoin and topical benzoyl peroxide
What type of glucocorticoid administration is warranted in an asthma exacerbation?
Oral or IV glucocorticoids.
What is the next step in treating a patient who has positive hepatitis C RNA?
Patient should undergo genotype testing to determine which treatment is most appropriate and for prognostication.
What is the most appropriate treatment for GERD if rebound GERD is wanted to be prevented upon cessation of the medication?
Famotidine - an H2 antagonist.
What is the classic pentad of DiGeorge syndrome?
- congenital heart disease
- facial dysmorphia
- thymic hypoplasia
- cleft palate
- hypocalcemia.
What test must be administered in a patient who presents with possible septic arthritis?
Urgent synovial fluid analysis – cell count, gram stain, culture
What is the first step in treating a patient who has suspected infective endocarditis?
Minimum of 3 blood cultures be obtained from separate venipuncture sites over a specific period prior to initiating antibiotic therapy
What gene mutation is commonly associated with renal cell carcinoma?
VHL
What is an alternative for diagnosing pulmonary embolism in patients when iodinated contrast is contraindicated?
V/Q scans.
What is the treatment for a patient who has galactosemia?
Change to a lactose-free infant formula.
What is a patient at increased risk for if they present with placenta previa and prior cesarean section?
Increased risk for placental invasion through the endometrium into the myometrium
What should be done when a patient presents with hypertensive urgency?
An ECG and basic laboratory investigations are important to rule out evidence of end-organ dysfunction.
What psychiatric illness is often associated with MVP?
anxiety disorders
What three components do B. anthracis produce that are necessary for infection?
- Protective antigen
- Edema factor
- Lethal Factor
What medications should be withheld from a diabetic patient undergoing surgery?
All oral hypoglycemic drugs (metformin and glipizide) and non insulin injectables should be withheld the morning before.
What is the treatment for a patient who presents with pyelonephritis and is symptomatic?
Admitted to the hospital for treatment with IV ceftriaxone.
What are Charcot-Leyden crystals?
Rhomboid crystals composed of major basic protein produced by eosinophils and represent an eosinophilic response usually associated with an allergic/parasitic process.
What medications are warranted for lowering the BP of someone in hypertensive urgency?
Oral captopril, furosemide, or clonidine are recommended for lowering BP over period of hours.
What are the three tests considered appropriate for diabetes screening in a patient?
- Two hour glucose tolerance test
- Fasting plasma glucose
- Glycated hemoglobin A1c
What core principle states that healthcare providers should help their patients and that the aim of any care/intervention should be to help a patient?
Beneficence
What is a key feature of squamous cell carcinoma of the lung?
Squamous keratin pearls, stem from abundant keratinization by malignant squamous cells and intercellular bridges.
What is the treatment for a patient who has community acquired pneumonia and admitted to the ICU?
Levofloxacin and Vancomycin
Most common pathogens: Strep pneumo, h. influenza, atypical bacteria, chlamydia and legionella species.
Vancomycin is given due to MRSA concern.
What test must be performed to evaluate polycythemia?
Check EPO levels.
What is the next step in treatment for a patient with essential tremor refractory to medical therapy?
Deep brain stimulation of the thalamus.
What is the best diagnostic test for a IV drug user who presents with midline tenderness from T3-T4?
MRI of thoracic spine with contrast.
What is an autosomal dominant disorder chracterized by hearing loss, dystopia canthorum (broad, flat nasal bridge and folds of skin covering inner corners of eyes) and pigmentary abnormalities?
Waardenburg Syndrome.
What paraneoplastic syndromes are associated with large cell lung cancer?
gynecomastia and galactorrhea
What is the first line treatment for mild babesiosis?
Atovaquone and azythromycin.
What is the next step in diagnosis of cholecystitis is a RUQ ultrasound is equivocal?
HIDA scan
What is the treatment for isolated duodenal hematoma following blunt abdominal trauma in a child?
Conservative tx with nasogastric suction and parenteral nutrition.
What maneuver will increase the intensity of a patient with HOCM?
valsalva maneuver
What does abruptio placentae put the mother at risk for?
Hypovolemic shock and disseminated intravascular coagulation.
MLD: patient presents with septic shock and develops AST/ALT elevations one day later.
Ischemic injury/ shock liver.
What is the pathophys by which breast cancer commonly causes hypercalcemia?
Breast cancer produces PTHrP either systemically or locally by bone metastases.
What type of hyperbilirubinemia is typically seen in someone with liver disease?
Primarily Direct bilirubin increase.
What hormone is most associated with MEN2a/2b?
Calcitonin - Medullary Cancer
What is Illness Anxiety Disorder?
Also known as Hypochondriasis
Exaggerated concern with health and illness, while symptoms and actual disease are minimal or absent.
What is the classic triad of histiocytosis?
Lytic bone lesions
Exophthalmos
Central diabetes insipidus
What is the drug of choice for a patient who exhibits atypical depression and hx of eating disorder?
SSRI
What is the treatment for lymphadema
Lymphatic compression therapy
What is a hyphema?
A pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris). The blood may cover most or all of the iris and the pupil, blocking vision partially or completely. A hyphema is usually painful.
What CN is responsible for corneal sensation?
Ophthalmic branch of the trigeminal nerve.
MLD cause: AIDS patient with rapidly progressive bilaterally necrotizing retinitis, associated with pain, keratitis, uveitis.
HSV
MLD: 7 year old male with precocious puberty and luteinizing hormone levels are low at baseline and do not increase after stimulation with GNRH agonist?
Late onset, non classic, congenital adrenal hyperplasia caused by 21-hydroxylase deficiency.
What is the next best treatment for a woman experiencing recurrent variable decelerations, and does not respond to maternal repositioning, administration of oxygen and fluid bolus?
Amnioinfusion.
What is the most likely cause for a preeclamptic patient treated with magnesium who then presents with hypermagnesemia?
Renal insufficiency - magnesium is strictly excreted by the kidneys.
MLD: Patient with cirrhosis, ascites, presents with low-grade fever, abdominal discomfort, or altered mental status.
Spontaneous bacterial peritonitis (SBP)
What happens to the FSH and LH levels of women who are undergoing premature ovarian failure?
They both increase due to loss of inhibition of estrogen. FSH levels are more elevated due to slower clearance of FSH from circulation.
What is the most likely cause of NPH?
Diminished CSF absorption at the arachnoid villi or obstructive hydrocephalus.
What vaccinations are required for a patient with cirrhosis under the age of 65?
TDAP HAV HBV Influenza PPSV 23 (required immediately)
PCV 13 should be given at age 65 along with a booster of PPSV23
What type of strokes are not usually appreciated on CT scan and what is the underlying cause of them?
Lacunar strokes - microatheroma formation and lipohyalinosis in small penetrating arteries of the brain.
What is the best treatment to prevent future calcium stones in patients in addition to increased fluid intake and normal dietary calcium intake?
Restrict sodium intake. Increased sodium intake enhances calcium excretion.
Low sodium intake promotes sodium and calcium reabsorption.
What is the most common pathogenic organism in young children with CF, especially in setting of concurrent influenza infection?
Staph Aureus.
What lab test is used to diagnose acromegaly and why?
Insulin like Growth factor -1 (IGF1) because levels remain constant throughout the day. Unlike GH which fluctuates in diurnal pattern.
What is indicated when there is reversible defect noted on stress and rest images of Single photon emission CT scan for CAD? and what treatment should be given?
Inducible Ischemia, should be treated with Antiplatelet therapy.
What is the immediate treatment of uterine inversion?
Immediate manual replacement of the uterus.
MLD: Dyspnea, pounding heart sensation, widened pulse pressure?
Aortic Regurgitation.
MLD: infertility, chronic pelvic pain and cystic ovarian mass on pelvic ultrasound?
Endometriosis with endometrioma.
How does Arteriovenous fistula cause high output cardiac failure?
Shunts blood from arterial to venous side, increases cardiac preload. Patient develops heart failure despite maintaining a normal or high cardiac output because the circulation is unable to meet the oxygen demand of the peripheral tissues.
MLD: progressive bilaterally symmetric hearing loss with subjective tinnitus, advanced age, and absence of other neurologic signs?
Presbycusis
What test should all patients with cirrhosis undergo?
Diagnostic endoscopy to exclude varices, determine risk of variceal hemorrhage, and indicate strategies for primary prevention of variceal hemorrhage.
What is the preferred modatlity for diagnosing a ureteral stone? (2)
- Ultrasonography
2. Noncontrast spiral CT
What is the cause of Plantar warts?
Human Papillomavirus, most commonly occur in young adults and immunocompromised individuals.
What is the most effective measure for decreasing risk of UTI in patients requiring bladder catherization?
Intermittent catherization - associated with significantly lower risk of uti as compared to use of indwelling catheters.
What test can be done to confirm carpal tunnel syndrome?
Nerve conduction studies.
what should be offered to a patient who has a confirmed diagnosis of syphillis?
HIV antibodies by ELISA – patient is likely involved in high-risk sexual activity.
MLD:
Mild asymptomatic hypercalcemia and inappropriately high-normal to borderline elevated PTH Levels
Low urinary calcium levels
Familial Hypocalciuric hypercalcemia.
What is the most common form of nephrotic syndrome in patients with Hodgkin lymphoma?
Minimal change disease.
MLD: young adolescent boy comes with bone pain that is relieved with NSAIDS. Commonly found in the proximal femur or long bones and the spine.
Osteoid osteoma
What is the best next step in a patient with extensive hx of alcohol and tobacco abuse who presents with a lymph node positive for squamous cell carcinoma?
Panendoscopy to detect the primary tumor.
Panendoscopy = triple endoscopy: esophagoscopy, bronchoscopy, laryngoscopy.
Randomization to assign treatments and populations in a study is a good way to control what?
Confounders.
What is the pathogenesis of fibroids?
Proliferation of smooth muscle within the myometrium. Can cause profuse menses as well as irregular uterine enlargement.
What is the best immediate treatment for patient who presents with thromboembolic occlusion due to afib and immediately threatened limb?
Anticoagulation with heparin.
If a patient is suspected of having pancreatic cancer. What tests should be done if the patient has jaundice? If the patient does not have jaundice?
Jaundice - abdominal US to rule out cancer in head of pancreas.
No Juandice - abdominal CT scan.
Most likely location of lesion: Infant with shoulder dystocia and Klumpke palsy with hand paralysis, ipsilateral miosis and ptosis.
Damage to C8/T1
What shoudl be suspected in a patient who has new weight gain, significant muscle weakness over last thre emonths, smoking history, elevated BP, right hilar fullness and possible mediastinal lymphadenopathy on x-ray?
Small Cell Lung Cancer - ectopic ACTH causing Cushing syndrome.
What is the most common cause of steatorrhea?
Chronic pancreatitis due to alcohol abuse.
What is the most likely defect when a patient is asked to exhale completely, lean forward, and a decrescendo early diastolic murmur is heard?
Aortic regurgitation - most common cause in young adults is bicuspid aortic valve.
What is the most specific arrhythmia for digitalis toxicity?
Atrial tachycardia with AV block.
What is the most likely causative organism of Erysipelas?
Group A beta-hemolytic strep.
MLD: prolonged surgery characterized by hypotension, extensive blood loss, and massive blood replacement. Pt then presents with jaundice, and elevated alk phos second post op day?
Postoperative cholestasis
What are three major differences between Cauda equina syndrome and conus medullaris syndrome?
CE: Radicular pain, asymmetric motor weakness, hyporeflexia
Conus Medullaris: Sudden onset severe back pain, symmetric motor weakness, hyperreflexia
What are the options to manage akathisia?
Reduction of antipsychotic dose and treatment with beta blocker or benzodiazepine.
What tests must be checked prior to starting lithium therapy?
Creatinine - lithium is contraindicated in CKD
Thyroid Function tests
What anticoagulation is preferred for pulmonary embolism in a patient who has renal insufficiency (estimated GFR
Unfractionated heparin
What is seen on chest x-ray of Boerhaave syndrome?
Unilateral pleural effusion w/ w/o pneumothorax, subcutaneous/mediastinal emphysema, widened mediastinum
Pleural fluid analysis high in amylase.
What protein/creatinine ratio signifies proteinuria?
greater than or equal to 0.3
What are first line antihypertensives for pregnant women in hypertensive emergency?
IV labetalol or hydralazine
What population of hyperthyroid patients is most likely to develop hypothyrodism following radioactive therapy?
Patients with Graves’ disease
What is the treatment for patients with sustained monomorphic ventricular tachycardia and hemodynamically stable?
Antiarrhythmics: amiodarone, lidocaine, procainamide.
Amiodarone typically preferred.
What is the initial treatment for patients with Atrial fibrilation with rapid ventricular response and are hemodynamically stable?
Rate control with beta blockers or calcium channel blockers
Patients with rheumatoid arthritis are at increased risk for developing what bone diseases?
Osteopenia, Osteoporosis, bone fractures
What three tests are recommended screening in pregnant women regardless of their risk factors?
Syphilis
HIV
Hepatitis B
What diagnostic test is used to confirm retroperitoneal hematoma?
Non-contrast CT scan of abdomen and pelvis or abdominal US
What is the major source of estrogen in menopausal women?
Peripheral conversion of adrenal androgens by aromatase enzymes present in adipose tissue.
What is the most common congenital gastrointestinal anomaly that should be suspected in all children with recurrent intussusception?
Meckel’s diverticulum
What is the preferred treatment when patient presents with systemic signs of cellulitis?
Intravenous nafcillin or cefazolin.
What is seen on EKG of patients with pericarditis?
Diffuse ST elevation
Depression of PR segments in limb and left precordial leads
What is the definitive diagnostic test for bronchiectasis?
High resolution CT
What is the preliminary investigation of choice in management of pleural effusion?
Diagnostic thoracentesis – Except if patient has classic signs of symptoms of congestive heart failure. Trial Diuretic.
What medications have been shown to increase appetite and weight gain in patients with cancer-related anorexia/cachexia syndrome?
Progesterone analogues
Corticosteroids
What but method do vagal maneuvers and medications help resolve PSVT?
decreasing conduction through the AV node.
MLD: bone marrow biopsy reveals markedly hypocellular marrow with decreased megakaryocytes and precursors of erythroid and myeloid cell lines after antibiotic treatment 2 weeks prior
Acquired aplastic anemia - injury to bone marrow after drugs, insecticides, toxins, infections.
What is the diagnostic test of choice for suspected Zenker’s Diverticulum?
Contrast esophagram
What is the next step after a nonreactive NST?
further evaluation with biophysical profile or contraction stress test.
What are the most common renal conditions in analgesic nephropathy?
Papillary necrosis
Tubulointerstitial nephritis
What are the symptoms of renal vein thrombosis and what glomerulopathy is it most commonly associated with?
acute abdominal pain, fever and hematuria. Most associated with membranous glomerulopathy.
MLD: Right heart failure characterized by peripheral edema, ascites, elevated JVP, pericardial knock, and pericardial calcifications with clear lung fields on chest radiograph?
Constrictive pericarditis.
MLD: euvolemic hyponatremia, decreased serum osmolarity, elevated urine osmlarity and increased urine sodium concentration.
Inappropriate secretion of SIADH.
What is the underlying cause for systolic hypertension in thyrotoxicosis?
Hyperdynamic circulation due to increased myocardial contractility and heart rate.
What is suggested by a widened mediastinal silhouette, increased aortic knob, and tracheal deviation, and what is the most likely undelrying cause?
Descending aortic aneurysms, likely due to atherosclerosis.
What is the underlying cause of obstructive sleep apnea causing polycythemia?
Hypoxemia-induced increases in erythropoietin production, responsible for polycythemia observed OSA.
How does malrotation present and what is the gold standard for diagnosing?
In neonates with bilious vomiting and abdominal distension
Upper GI contrast study is gold standard for diagnosing
What should be suspected in an immunocompromised patient with focal neurological deficits who’s MRI has multiple demyelinating non ehancing lesions with no mass effects?
Progressive multifocal leukoenceophalopathy
What is worse? missense or nonsense mutations?
Nonsense/frameshift mutations
What are the differences in symptoms between frontotemporal dementia and Alzheimer’s dementia presentation?
Age of onset in FT dementia is earlier (40-60 yo). FT exhibits more personality changes and loss of social restraints initially then disorientation and memory loss later.
Alzheimer’s is opposite
What is the first line pharmacological treatment for social anxiety?
SSRI - even if sleep deprived
What is a major distinction between embolic and hemorrhagic stroke?
Embolic stroke symptom onset is typically abrupt and usually maximal at the start.
Intracerebral hemmorrhage - typically symptoms progress over course of minutes to hours
Subarachnoid hemmorhage - severe headache complaint
What is the primary way by which cyanide toxicity leads to metabolic acidosis?
Cyanide binds to ferric iron in cytochrome oxidase a 3 in mitochondrial electron transport chain and blocks oxidative phosphorylation, promotes anaerobic metabolism.
What is the preferred antifungal treatment for histplasmosis?
Itraconazole
What joints does RA most commonly affect?
Cervical Spine Joints in the axial skeleton
MLD: hx of rheumatoid arthritis, enlarged kidneys, hepatomegaly, with high degree of proteinuria.
AA amyloidosis
RA is the most common cause of AA amyloidosis in the US
What is an effective and quick method for rapid diagnosis of acute aortic dissection?
Transesophageal echocardiogram
What is somatic symptom disorder
Time consuming preoccupation with symptoms despite multiple negative diagnostic evaluations.
What is the treatment for acute bacterial rhinosinusitis?
Oral amoxicillin - clavulanic acid
MLD: neonate well appearing, jaundice, light-colored stool, hepatomegaly and direct hyperbilirubinemia
Biliary atresia
What is the initial pharmacological treatment of OA?
NSAIDS
diclofenac is an NSAID
What most likely mechanism of a patient who presents with recurrent candidal infections?
Impaired cell-mediated immunity
What is the mechanism by which SBO occurs in Crohn’s disease?
Small-bowel fibrotic stricture. This is the same reason why the “string sign” is see
MLD: 10 month old infant brought in for labored breathing 1 hour w/ cough, coryza, and fever for 18 hours. Bilateral wheezes and basilar crackles heard.
RSV - community acquired viral disease
What is the next best step in treating a patient who’s chest x-ray shows atelectasis at both lung bases and ECG shows nonspecific ST-T wave changes besides O2 therapy?
CT scan
What is the most appropriate next step in diagnosis for early intussusception?
Contrast enema - both diagnostic and therapeutic
