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STEP 2 > Step up 3 > Flashcards

Step up 3 Flashcards

1
Q

Diverticulitis with abscess formation.

A

CT guided percutaneous drainage.

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2
Q

Rash localized to the nipple with an eczematous appearance. Biopsy shows cells with a clear halo around them.

A

Piagets disease of the breast. She is at a high risk for adenocarcinoma.

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3
Q

Patient with a diaphragmatic hernia develops respiratory distress and is satting 88% on room air.

A

Intubate. Bag mask is contraindicated in this patient.

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4
Q

Swollen epiglottis on lateral xray

A

epiglottitis

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5
Q

Subglottal narrowing on lateral xray

A

Croup.

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6
Q

Hypercalcemia and a lytic bone lesion in a child

A

Langerhand Histiocytosis.

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7
Q

Contraindications for tDAP vaccine

A

Anaphylaxis, neurologic deficite, and encephlopathy

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8
Q

How do you find the risk of getting a disease

A

Divide the number of people with the disease by the total number of people at risk.

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9
Q

Rapid ascending paralysis with no history of a viral illness . Went hiking in colorado. What is the next best step ?

A

Search for the tick. In tick born paralysis rapid removal of the tick will result in rapid resolution of the symptoms.

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10
Q

Best way to diagnose B12 Deficiency

A

Methmalonic Acid Levels and Homocysteine Levels

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11
Q

Standing, Valsalva, and leg raises decreases the quality of which murmers ?

A

All except HCM and MVP

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12
Q

HCM and handgrip ?

A

Diminishes intensity of murmur because SVR increases lessening the gradient across the aortic valve.

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13
Q

Squatting increases the intensity of which murmurs ?

A

All except MVP and HCM

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14
Q

Systolic ejection murmur at LLSB with dual carotid upstroke and loud S4.

A

HCM

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15
Q

What intensifies HCM murmur

A

Valsalva and standing

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16
Q

What diminishes HCM murmur

A

Squatting, Lying Down, Straight Leg raise.

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17
Q

ECG finding specific for pericarditis

A

PR depression.

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18
Q

Chest Pain, Pericardial friction rub, PR depression / ST elevation

A

Pericarditis, supportive treatment with NSAIDS, Eco for pericardial effusion, watch for tamponade.

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19
Q

Dysfunction in restrictive pericarditis

A

Rapid filling in early diastole and an abrupt halt in late diastole.

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20
Q

Clinical signs of cirrhosis and distended neck veins

A

ECG Eco and CT looking for constrictive pericarditis

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21
Q

ECG findings in constrictive pericarditis

A

Low voltage QRS with T wave flattening.

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22
Q

Becks Triad

A

Hypotension, Muffled Heart Sounds, JVD.

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23
Q

Workup of Lung Cancer

A

CXR, CT, Tissue Biopsy

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24
Q

Lung Cancer with SIADH

A

Small Cell

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25
Q

Lung Cancer with ectopic ACTH

A

Small Cell

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26
Q

Lung Cancer with Eaton Lambert

A

SCLC

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27
Q

How do you biopsy peripheral tumors

A

CT guided needle biopsy

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28
Q

How do you biopsy central tumors

A

Bronchoscopy or cytologic examination of spitum

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29
Q

Lung cancer with central cavitation

A

SCC

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30
Q

Peripheral Lunc Cancers

A

Adeno and LCC

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31
Q

Lunc cancer that narrows the bronchi

A

SCLC

32
Q

Hypoxemia with normal A-a gradient

A

hypoventilation

33
Q

Hypoxia with normal CO2, responds to 100% O2

A

V/Q mismatch

34
Q

2 types of hypoxemic respiratory failure

A

V/Q mismatch or shunting.

35
Q

Workup of respiratory failure.

A

ABG

36
Q

Hypoxia

A

PaO2 50

37
Q

Hypercapnia

A

Partial Pressure CO2 > 50

38
Q

What is oxygenation measured by

A

Saturation %, controlled by FiO2 and PEEP

39
Q

What is ventilation measured by

A

PaCO2, controlled by RR and Vt

40
Q

Hypoxemic respiratory failure

A

Low PaO2 with a PaCO2 that is either low to normal. Usually by a cause intrinsic to the lung.

41
Q

Hypercarbic respiratory failure

A

Defect in mechanical ventilation of the lung. A-a Gradient is normal. Increased physiologic dead space. COPD, Asthma, CF.

42
Q

Workup of ARDS

A

CXR
ABG
Pulmonary Artery Catheter
Bronch & BAL

43
Q

Clinical monitoring of COPD patients

A

Serial FEV-1, Pulse Ox, Exercise Tolerance.

44
Q

Workup of COPD

A

PFT’s
CXR
Alpha-1 AT level
ABG- Chronic resp acidosis with met alkylosis.

45
Q

Nonproductive cough with viral like diarrhea and eosinophillia

A

Ascariasis

46
Q

Retro-orbital pain, rash, myalgias and arthralgias

A

Dengue Fever

47
Q

Painful periorbital swelling, sublingual splinter hemorrhages, diarrhea, muscle pain. eosinophillia

A

Trichinellosis- mexican worm that encysts into stiraited muscle.

48
Q

Chronic cough (Over 4 mo) with minimal white sputum production. Wakes the patient up at night. CXR is normal, next step ?

A

PFT’s. A cough that wakes a patient up at night is typically asthma. Metacholine challenge test or trial of inhaled glucocortacoids.

49
Q

Post op from abdominal aortic aneurysm repair, how do you prevent post op pneumonia ?

A

Spirometry, even if you thing the incision may have been made through the ribs.

50
Q

Constipation, Back pain, anemia, inc. ESR, and renal dysfunction.

A

MM. The hypercalcemia from bone lysis can cause constipation.

51
Q

Lady is found unconscious laying face down with a body temp of 90. She is taking fluphenazine and amytriptline

A

Fluphenazine can disrupt thermoregulation and induce hypothermia.

52
Q

Painful Necrotizing retinitis in HIV patient

A

HSV retinitis.

53
Q

Painless retinitis with fluffy granular lesions in HIV patient

A

CMV retinitis

54
Q

Td and Tdap recomendations for HIV patients

A

Tdap once in their adult life followed by Td booster q10 years.

55
Q

Difference between CVID and SCID

A

CVID has some B cells.

56
Q

Diagnostic criteria for X-Linked Agammaglobinemia

A
  1. Recurrent bacterial infections within the first 5 years of life
  2. IgG IgM and IgA are 2SD below normal
  3. Absent Immunoglobins and poor response to vaccines.
  4. Less than 2% CD19+ b cells in circulation
57
Q

Young child with eczema, thrombocytopenia, and recurrent encapsulated infections

A

Wilscott Aldrich syndrome, X Linked recessive. Low IgM, High IgA and IgE levels.

58
Q

Nitroblue terazolium test

A

Chronic Granulamatous disease.

59
Q

Acute dyspnea and difficulty swallowing in a patient with numerous allergies.

A

Aspiration of something they are allergic to which induces bronchioconstriction.

60
Q

Patient had a seizure and now is holding her arm adducted and internally rotated. What type of dislocation ?

A

Posterior.

61
Q

Patient with bells palsy, how can you tell if the lesion is in the pons or downstream ?

A

In the pons the facial nerve will spare the forhead.

62
Q

How do you differentiate MGUS from MM ?

A

MGUS does not have hypercalcemia, lytic bone lesions, hypercalcemia

63
Q

Concerns with a pregnant woman with chronic Hep C

A

Acute hepatitis with chronic Hep C will most likely be fatal. Thus vaccinate with live attenuated strain of vaccine for Hep A and Hep B.

64
Q

How do you differentiate leukmoid reaction from CML ?

A

Increased Leukocyte alkyline phosphatase score in Leukmoid reaction.

65
Q

Baby with cutaneous lesions on hands and soles, hepatomegaly, jaundice, anemia, rinorrhea.

A

Syphillis

66
Q

Patient with DKA or HHS. What is the deal with their K levels.

A

K is moved out of the cells in reponse to acidosis and is lost due to the osmotic diuresis of glucose. Thus, they are total K depleted but have a normal value.

67
Q

Patient with RA develops nephrotic syndrome, Why?

A

RA predisposes the patient to amyloidosis.

MM also predisposes patients to developing amyloidosis.

68
Q

Idiopathic Intercranial HPTN, first line treatment is repeated LP or Acetazolamide

A

Acetazolamide + / - Furosamide.

69
Q

Rash, Periorbital Edema, and Proximal extensor weakness. Scaley papules on the joints.

A

Dermatomyositis. Anti Jo-1 and Anti-M2. Look for malignancy

70
Q

Patient on an Anti-TB regimen has mild elevation in LFT’s (

A

Continue the drugs. Side affect of isoniazid.

71
Q

Tests to prove hereditary spherocytosis.

A

Acidified glycerol test and eosine-5-malenide test. Increased MCHC due to acellular dehydration and membrane loss.

72
Q

CD 55 and CD 59 are used to diagnose ?

A

PNH

73
Q

Low Hb, reticulocytosis, and + coombs/ acidified glycerol

A

Autoimmune hemolytic anemia.

74
Q

Patient with nephrotic syndrome develops sudden flank pain and gross hematuria

A

Renal Vein thrombosis secondary to AT3 loss in the urine. THis is most commonly found with membranous nephropathy.

75
Q

Upper respiratory tract infection, patient then develops microscopic hematuria and proteinurea

A

IgA nephropathy.

76
Q

Baby born with decreased activity horse cry and jaundice. super high TSH and low T4

A

Thyroid hypoplasia.

STEP 2 (9 decks)

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