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Step 2 UWorld > Test 1: Incorrect > Flashcards

Test 1: Incorrect Flashcards

1
Q

H&P: Viral Arthritis

A
  • Symmetric Arthritis (MC: MCP, PIP, Wrist Joints)
  • Acute Onset (differentiates it from RA)
  • No elevated ESR
  • Resolution w/in 2 mos.

Note: Adults who work with children

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2
Q

MCC: Viral Arthritis

A

Parvovirus B19

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3
Q

5H’s & T’s

A 
H's:
Hypovolemia
Hypoxia
Hypo-/Hyper-[K+]
Hydrogen ions (acidosis)
Hypothermia
T's
Tension PTX
Tamponade (Cardiac)
Toxins (BZDs, Narcotics)
Thrombosis (PE, Cardiac)
Trauma
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4
Q

Early defibrillation is tx for what rhythms?

A

VFib

Pulseless VT

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5
Q

IV Lidocaine is used to tx what rhythm?

A

IV Lidocaine is a 2nd-line agent for HD stable monomorphic VT

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6
Q

Immediate synchronized electrical cardioversion is used in what rhythm?

A
  1. Symptomatic or sustained monomorphic VT (unresponsive to anti-arrhythmics)
  2. HD UNstable AFib with RVR
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7
Q

Pathologic Causes of Sinus Bradycardia?

A
  • Sick Sinus Syndrome
  • Myocardial ischemia/infarction
  • OSA
  • Hypothyroidism
  • Increased ICP
  • Medication overdose/overuse (i.e. Beta Blockers, CCBs…)
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8
Q

S/Sx of Symptomatic sinus bradycardia?

A
  • fatigue
  • dizziness
  • light-headedness
  • hypotension
  • syncope
  • angina
  • CHF
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9
Q

S/Sx of Exertional Heat Stroke

A
  • Core Body Temp > 40.5°C (105°F)
  • Acute confusion
  • Tachycardia
  • Coagulopathic Bleeding
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10
Q

Criteria to ddx Toxic Megacolon

A
  1. Radiographic evidence of colonic dissension (>6cm)

PLUS at least 3 of the following:

  • Fever >38°C
  • HR > 120
  • PMN Leukocytosis > 10,200/mL
  • Anemia

PLUS at least 1 of the following:

  • volume depletion
  • Altered sensorium
  • Electrolyte disturbances
  • Hypotension
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11
Q

Initial test of choice for toxic megacolon

A

AXR

Will show Total Segmental Non-obstructive Colonic dilatation > 6cm

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12
Q

Management of Toxic Megacolon

A 
Conservative:
- Bowel Rest (NPO, NGT placement)
- IF IBD (+):  IV prednisone
- IF Infection (+): ABx
If no response or worsening condition:
- Surgery: subtotal colectomy + end-ileostomy
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13
Q

Barium Enema in Toxic Megacolon - Good or bad?

A

BAD!

Barium enema is contraindicated in toxic megacolon due to concerns of colonic perforation

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14
Q

Causes of Toxic Megacolon

A

MCC: IBD (UC > Crohn’s Dx)

  • ischemic colitis
  • volvulus (children)
  • diverticulitis
  • infection (c. diff)
  • Obstructive Colon CA (least common)
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15
Q

When are IBD patients at most risk for toxic megacolon?

A

First 3 years of disease

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16
Q

S/Sx of toxic megacolon

A
  1. Lower Abdominal Pain
  2. Severe Bloody Diarrhea
  3. Tenesmus
  4. Acutely worsening Systemic S/Sx c/w sepsis
17
Q

Caustic Ingestion with Sodium Hydroxide (Lye):

- Clinical Features

A

Chemical Burn or liquefaction necrosis:

  • Laryngeal damage: Hoarseness, stridor
  • Esophageal damage: Dysphagia, odynophagia
  • Gastric Damage: Epigastric pain, bleeding
18
Q

Caustic ingestion with sodium hydroxide (lye):

- management

A
  • ABCs
  • Decontamination: remove clothing, chemicals, irrigate exposed skin
  • CXR if reps. Sx

If HD stable: Early Endoscopy w/in 24hrs in patients w/o ARDS or perf.

If HD UNstable: Surgery (possible esophagectomy)

19
Q

Caustic ingestion with sodium hydroxide (lye):

- Complications

A
  • Upper airway compromise
  • perforation (3-4 days s/p ingestion), can lead to mediastinitis. R/o with serial CXR & AXR
  • strictures/ stenosis (2-3weeks)
  • ulcers
  • CA
20
Q

If you suspect an upper GI perforation, what type of solution should you use to visualize the perf?

A

water-soluble contrast Upper GI XRay

21
Q

Before SIADH is ddx, what two conditions should be r/o?

A
  • Hypothyroidism

- Adrenal insufficiency

22
Q

SIADH lab findings

A

Euvolemic Hypotonic Hyponatremia
Low sOsm: 100-150mOsm/kg) is diagnostic

Also: low BUN and normocytic anemia 2/2 hemodilution

23
Q

SIADH is characterized by____?

A

persistently elevated ADH in the absence of hypertonicity.

24
Q

most important treatment step in non-ketotic hyperglycemic coma is _____?

Other management steps include?

A

Fluid replacement with nml saline.

Step 1: 0.9% NS
Step 2: 0.45% 1/2 NS once hypovolemia is corrected.
Step 3: 5% Dextrose given once s[Glc]

25
Q

Waldenstrom’s Macroglobulinemia

A
  • Rare
  • Chronic, Plasma Cell Neoplasm
  • Abnormal Plasma Cell replication and invasion of bone marrow, lymph nodes, and spleen
  • Excessive amounts of IgM are produced –> hyper viscosity of blood
26
Q

S/Sx of Waldenstrom’s Macroglobulinemia

A
  1. Splenomegaly +/- Hepatomegaly, and inc. size of some lymph nodes
  2. Tiredness MC 2/2 anemia (bone marrow RBCs are not present since they are forced out by abnormal B-cells)
  3. Easy bleeding & Bruising (low PLT count)
  4. Night sweats
  5. HA, Dizziness
  6. Multiple Visual Problems
  7. pain and numbness of extremities 2/2 demyelinating sensorimotor neuropathy
27
Q

Disorders/ Diseases with extremely elevated Igs?

A

IgM:

  • Waldenstroms Macroglobulinemia
  • MGUS (monoclonal gammopathy)

IgG:
Multiple Myeloma

IgA:
Multiple Myeloma
Abdominal Lymphoma

28
Q

Potentially reversible causes of Urinary Incontinence in the Elderly

A

DIAPPERS

Delirium
Infection (MC UTI)
Atrophic urethritis/vaginitis
Pharmaceuticals (alpha blockers, diuretics, sedative/hypnotics, anti-cholinergics, alcohol)
Psychological (e.g. depression)
Excessive UOP (e.g. DM, CHF, diuretics)
Restricted mobility (e.g. post-surgery)
Stool impaction
29
Q

Management of Urinary incontinence in the elderly

A

Step 1: UA with Cx

Step 2: ID & Tx reversible causes (inc. infection)

30
Q

Most likely Electrolyte Derangement in post-op patient with hyperactive DTRs/muscle cramps/convulsions with significant blood loss?

A

Hypocalcemia

- Can occur in the immediate post-op period in patients who required multiple transfusions (2/2 citrate binding)

31
Q
  • Crescendo-decrescendo murmur
  • LSB
  • NO carotid radiation
A

HOCM

32
Q

S/Sx of HOCM

A
  • Syncope
  • Dyspnea
  • CP
33
Q

AV node conduction delay is MC due to ___?

A
  • Beta blocker overdose

- Ischemic Heart Disease

34
Q

Exercise related syncope - causes?

A
  • HOCM

- Rare: Isolated Aortic Stenosis (MC: Bicuspid)

35
Q
  • Crescendo-Decrescendo Murmur
  • URSB
  • (+) Carotid radiation
A

Aortic Stenosis

36
Q
  • Holosystolic Murmur

- LSB

A

Mitral Valve Regurgitation

Step 2 UWorld (2 decks)

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