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STEP 2 > Step Up To Medicine Quick Hits > Flashcards

Step Up To Medicine Quick Hits Flashcards

1
Q

Workup of Myasthenia Gravis ?

A

AcH Ab test: If positive
EMG: decremental response to repetitive stim
CT: of Thorax to rule out thymoma
Edrophonium ( Tensilon Test ): Trial of Ach Medication.

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2
Q

Treatment of Myasthenia Gravis

A
  1. Pyridostigmine: Ach Inhibitor
  2. Thymectomy: Can be beneficial even if no adenoma. If there is an adenoma it is an indication for surgery
  3. Immuno-supression: Corticosteroids azoth
  4. IVIG and Plasmapheresis
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3
Q

Vertigo tinnitus and hearing loss

A

Meniere’s Disease.

Treatment: Na restriction and diuretics

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4
Q

Vertigo with head movements

A

BPV

Treat with Mezclizine.

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5
Q

Focal neurologic exam, Bidirectional Nystagmus, Responds to tilt test every time without refractory period.

A

Central Vertigo, Get brainstem MRI, Eval for CV risk factors.

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6
Q

Syncope, you suspect vasovagal. Best Test ?

A

ECG / RO structural heart disease + Tilt Table Test.

Treat with Beta blockers or Disopyramide.

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7
Q

How can you differentiate syncope from seizures ?

A

In syncopal episodes bowel and bladder fx will be retained. Also the LOC will be very brief.

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8
Q

Syncope with exertion

A

Hypertrophic Cardiomyopathy or Aortic Stenosis.

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9
Q

Main goal with working up syncope ?

A

Rule out cardiac cause.

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10
Q

Simple vs generalized seizures

A

Simple originate in one area of the brain.

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11
Q

Simple Partial

A

Consciousness remains intact, originates in a focal area of the brain

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12
Q

Simple complex

A

Origionates in a focal area of the brain, consciousness is lost.

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13
Q

Generalized

A

Electrical activity to the entire brain is interrupted.

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14
Q

Petite Mal

A

Absence Seizure

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15
Q

Grand Mal

A

Tonic-Clonic

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16
Q

Status Epilepticus Treatment

A

Airway, IV Diazepam, IV Phenytoin, 50g Dextrose

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17
Q

Tonic Clonic and partial seizures

A

Phenytoin and Carbamazepine

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18
Q

Absence Seizures

A

Ethosuxamide and Valproic Acid.

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19
Q

MCC aphasia

A

cerebrovascular disease. If speech is fluent lesion is posterior to central sulcus. If speech is not fluent lesion is anterior to central sulcus.

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20
Q

DD of facial Palsy

A 
Trauma: Temporal bone / Forceps Delivery
Lyme Disease: NO STEROIDS
Tumor: Acoustic Neuroma
Guillain-Barre: Bilateral
Herpes Zoster
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21
Q

Workup of Trigeminal Neuralgia

A

Clinical, bursts of intense pain. MRI to rule out CP angle tumor
Treat with Carbamazepine.

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22
Q

Lung tumor that presents with horners syndrome ?

A

Pancoast Tumor

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23
Q

Facial Fullness, Facial and arm edema

A

Superior Vena Cava syndrome

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24
Q

Pleural Fluid with elevated amylase

A

Esophageal rupture, pancreatitis, malignancy

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25
Q

Pleural Fluid milky, opaque,

A

Chylothorax: Lymph fluid in pleural space.

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26
Q

Pleural fluid with frank pus

A

Empyema

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27
Q

Pleural Fluid with pH

A

Parapneumonic effusion / empyema

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28
Q

Pleural Fluid is transadate or exudate ?

A

One Criteria must me met to be exudative.

Protein (Pleural) / Protein (serous) = > 0.5
LDH (Pleural) / LDH (serum) = > 0.6
LDH is greater than upper 2/3 of serum LDH.

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29
Q

Workup of Sarcoid ?

Treatment?

A

CXR: Hilar Adenopathy
Transbronchial Bx: Noncaseating Granuloma

Treat with systemic corticosteroids or mtx.

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30
Q

pANCA

A

Churgg Strauss (asthma) / Goodpasteurs (Anti-GBM)

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31
Q

Pleural Plaques

A

Asbestos, risk of bronchogenic carcinoma

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32
Q

Egg shell calcifications

A

Silicosis.

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33
Q

Hypoxia

A

PaO2 50

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34
Q

Hypercapnea

A

PaCO@ >50

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35
Q

Pathophysiology of ARDS

A

Massive intrapulmonary shunting (Widespread atelectus)`

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36
Q

Currant Jelly Sputum or thick mucoid capsule.

A

Klibsella Pneumonia.

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37
Q

Bleeding esophageal varicies in an alcoholic

A

ABC’s then stabilize the patient, Check for clotting deficiencies, (FFP + Vit K)

If no bleeding history use Beta Blockers.

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38
Q

Prospective study will show you ?

A

Incidence and Relative Risk

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39
Q

Retrospective Study will show you ?

A

Odds Ratio

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40
Q

Type 1 error

A

Claiming a difference when none exists. P value gives you the chance of this.

41
Q

Heparin is monitored with

A

PT

42
Q

Warfarin is monitored with

A

PTT

43
Q

Atrial Fibrillation. How does management change when the condition is chronic?

A

Rate control with Beta/CCB/digoxin and rhythm control with amiodarone/procainamide/DC cardioversion.

If chronic start with anticoagulation

44
Q

WPW

A

procainamide or quinidine

45
Q

V-Tach

A

Immediate defibrillation.

46
Q

PVC’s

A

If asymptomatic do not treat. If symptomatic Beta Block or use Amidarone.

47
Q

How do you recognize 1st degree AV block ?

A

PR interval more than 0.2 sec.

48
Q

When do you treat Hypercholesterol with no risk factors ?

  • 2 Risk Factors
  • CHD equivalent
  • Very High Risk
A

> 190
130
100
70

49
Q

What is the pneumonic for statin strength ?

A 
First Lets Pray Some Are Religious 
Fluvastatin
Lovastatin
Pravastatin
Simvastatin
Arorvastatin (High Strength)
Riuvastatin (High Strength)
50
Q

Hypertension, Bradycardia, Respiratory Depression

A

Cushings Reflex. In trauma an epidural hematoma can be augmented by fluid resuscitation.

51
Q

Progression of Uncal Herniation

A
  1. Crus Cerebri –> Ipsilateral hemiparesis
  2. Ipsilateral occulomotor –> Midrasis (Early) and down and out gaze
  3. Posterior Cerebral Artery: Homonymous Hemianopsia
  4. Reticular Formation: Altered Consciousness.
52
Q

Conjugated chronic hyperbilirubinemia with black hepatocytes

A

Dubin Johnson Syndrome. Black sand in Dubai

Diagnose with urine Coproporphyrin

53
Q

Defect in hepatic storage of conjugated bilirubin. Direct hyperbilirubinemia. Liver is not black

A

Rotor syndrome. Differentiated from Dubin- Johnson in that the liver is not stained black.

54
Q

Significant unconjugated hyperbilirubinemia

A

Criagler Najar, phototherapy and plasmapheresis can help for a while but liver transplant is the only cure.

55
Q

Still Birth Delivery Options

A

2nd Trimester: D&C Induction and Spontaneous Vaginal Delivery

3rd Trimester: Induction, C-Section,

56
Q

Best screening test for chylamida and gonnorrhea ?

A

Nucleic Acid Amplification Test.

57
Q

Universal dyslipidemia screening

A

9 - 11 and 17 - 21 Lipids right before and after puberty are the best intervals to screen at.

58
Q

Management options for miscarriage

A

Expectant- Outpatient, not good for a patient who is bleeding or who has unstable vitals.

Medical- Oxytocin, good in the first and second trimester.

Surgical- Hemodynamic Instability.

59
Q

Polyarthritis, erythema marginatum, fever, elevated CRP and ESR

A

Jones Criteria are met for acute rheumatic fever.

60
Q

Coombs Negative hemolytic Anemia, Jaundice, Splenomegaly. spherocyosis. Next test ?

A

Acidified glycerol test for spherocytosis.

61
Q

Kawasaki disease vs scarlett fever.

A

Scarlet Fever presents with exudative pharyngitis and a sandpaper like rash.

62
Q

Mononucleosis reaction after amoxicillin vs Type 1 drug hypersensitivity after amoxicillin.

A

After administration of amoxicillin a rash will generally develop within 24 hours. The patient will also have fatigue, exudative pharyngitis, and posterior cervical lymphadenopathy.

Drug reaction the rash will be immediate following the administration. Give an antihistamine.

63
Q

AIDS patient with retinal necrosis, eye pain, and vision loss ?

A

VZV and HSV.

64
Q

Severe unrelenting ear pain, purulant discharge, drainage and sense of fullness in an elderly diabetic ?

Bug and drug ?

A

Malignant otitis externa, Pseudomonas, IV Cipro

65
Q

Cholesteatoma

A

Chronic granulamatous growth in the external ear canal.

66
Q

What differentiates malignant otitis external from otitis externa ?

A

Extreme Pain, Granulation Tissue, ESR.

Topical neomycin and corticosteroids can treat OE, but MOE needs IV Cipro

67
Q

Immune defect in bullious phemphegoid ?

A

IgG and C3 deposits at the dermal epidermal junction.

68
Q

Pemphigus

A

IgG to the desmogelin which hold epithelial cells together.

69
Q

Blurred vision in a patient with nonketotic hyperosmolar state

A

Myopic increase in lens length and intraoccular hypotension secondary to hyperosmolarity.

70
Q

High yield survalence in patients with ulcerative colitis

A

Colorectal carcinoma screening. There is not method to screen for toxic megacolon.

71
Q

Difference in adenopathy between strep and mono.

A

Mono will be diffuse cervical, strep will be anterior cervical.

72
Q

Hyperpigmented nodule on the lower extremity

A

Dermatofibroma.

73
Q

Baby born with nail and digit hypoplasia, dysmorphic facies, and mental retardation.

A

Fetal Hyandation Syndrome. Exposure to Phenytoin.

74
Q

Difference between cardia equine syndrome and conus medularis syndrome .

A

Conus

75
Q

What INR is the threshold for transfusing FFP ?

A

1.6 or so.

76
Q

PRBC transfusion threshold for a stable patient

A
77
Q

PRBC transfusion threshold for an unstable patient

A
78
Q

Bladder pain relieved with voiding. Anterior vaginal pain. . Normal urinalysis.

A

Interstital cystitis.

79
Q

Edema of the face mouth lips tongue and glottis.

A

Angioedema. ACE Inhibitor side affect.

80
Q

Bradycardio, AV Block, Bronchoconstriction.

A

Beta Blocker Tox.

81
Q

Preysbopia

A

Nearsightedness caused by loss of elasticity in the lens.

82
Q

With the classical clinical and lab findings in appendicitis, do you need to confirm with imaging before you take them to the OR ?

A

No, they can go right to surgery.

83
Q

Vasa Previa vs Placenta Previa

A

Vasa Previa will have rapid deterioration of the fetal tracing.

84
Q

How do you work up and treat hereditary angioedema ?

A

C3 esterase inhibitor

85
Q

Recurrent lung and sinus infections in a 7 month old with encapsulated bacteria.

A

Burtons Agammaglobinemia, X-Linked Recessive, little or absent B cells.

86
Q

What causes SCID

A

Adenosine Deaminase Deficiency –> B and T cell defects

87
Q

Do CCB or thrombolytics help in unstable angina ?

A

NO.

88
Q

Essence trial proved ?

A

In unstable angina LMWH is superior to unfractionated.

89
Q

Long term medical management of CAD

A

Asprin, B Block, and Nitrates.

90
Q

Agents that reduce mortality in MI

A

Asprin, B-Block, ACE-Inh.

91
Q

Is Heparin used for stable angina ?

A

NO

92
Q

What test do patients get after MI before leaving the hospital ?

A

Stress Test to see if they need angio.

93
Q

What reduces mortality more, PTCA or Thrombolytic ?

A

PTCA.

94
Q

Anti Coag after bare metal stent ?

After drug eluting stent ?

A

30 Days

6mo

95
Q

Standard Treatment of CHF

A

Loop Diuretic
ACE INH.
B-Block.

96
Q

What decreases mortality in post MI CHF

A

Beta Bloker.

97
Q

Difference in treatment of L-CHF and R-CHF

A

In right sided failure you will not use spironolactone

98
Q

Most important treatment of flash CHF ?

A

Lasix.

STEP 2 (9 decks)

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