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Step 2 CK > Third 100 > Flashcards

Third 100 Flashcards

1
Q

How does TCA overdose present?

Indicator of severity? Treatment?

A

•Anticholinergic (dry, hot, crazy etc) as well as QRS PROLONGATION and hypotension with hyperthermia
– TCA: ThermiaTension, Cardiac (QRS), Antichol
•QRS is the indicator of severity - give sodium bicarb

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2
Q

Antidote for ethylene glycol poisoning? (2)

A

Ethanol OR fomepizole (foamy piss?)

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3
Q

How does beta blocker OD present?

Treatment?

A

Bradycardia, AV BLOCK, diffuse wheezing and hypotension

Give glucagon

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4
Q

How does TCAs cause QRS prolongation?

How does sodium bicarb help?

A

It inhibits cardiac fast sodium channels causing QRS prolongation

It increases extracellular sodium conc.

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5
Q

Most common cardiac congenital defect?

A

VSD

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6
Q

Cyanotic baby - list the heart defect

A 
Truncus arteriosus (1 arterial vessel for both ventricles)
Transposition of the greats (2 switched)
Tricuspid atresia (3)
Tetralogy of Fallot (tetra = 4)
Total anomalous pulm. venous return (5 words)
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7
Q

List conditions with VSD in kids

A

TORCH, FAS, Down’s, cri-du-chat

‘Torch was (fas) down, heard cat cry or something’
- also VSD = VaSDown

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8
Q

Kid with conjunctivitis and pannus (neovascularization) - mcc?

Next step to diagnose?
Treatment?

A

Chlamydia trachomatis (trachoma) A-C
Diagnose with giemsa stain
Topical tetracycline or oral azithromycin

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9
Q

Baby with wheezing, relieved by neck extension

A

Vascular ring compressing airway

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10
Q

Most common cause of congenital hypothyroidism (in the USA)?

A

Thyroid dysgenesis

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11
Q

Normal CSF values?

A

Protein <40
Glucose 40-70
Pressure 70-180

PSP 4718

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12
Q

How will viral meningitis show up in CSF?

Treatment?

A

Normal glucose, high protein, lotsa lymphocytes

Treatment - supportive. Will resolve in 7-10 days

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13
Q

Describe Kawasaki disease

A

Konjunctivitis (bilateral, non-purulent), All-over rash, Week-long fever (5days minimum), Adenopathy (cervical, unilateral), Strawberry tongue, Aspirin (high dose), Koronary artery aneurism (complication), KIvig (treatment)

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14
Q

How to differentiate between NFM1 and 2?

A

NFM-2 must have cataracts and acoustic neuromas

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15
Q

Adolescent with mass in the nose, frequent nosebleeds
MCC?
Treatment?

A

Juvenile angiofibroma

Surgical excision by a specialist

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16
Q

CAH - inheritance?
How will it present?
Deficiency?
How is it diagnosed? (2 tests)

A

Autosomal recessive
Virilization of female or over androgenization of male.
21-hydroxylase deficiency (90% of cases) - resulting in high 17-α-hydroxyprogesterone
Test for levels of 17-α, confirm with ACTH stimulation test

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17
Q

Sluggish baby with large tongue and umbilical hernia

A

Congenital hypothyroidism

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18
Q

2 causes of floppy baby

A
  1. Infant botulism (remember - NOT due to ingestion of preformed toxins, toxins formed once inside)
  2. Werdnig-Hoffman syndrome : AR syndrome with degeneration of anterior horn cells cranial nerve motor nucleii
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19
Q

Mst common cause of nephropathy in kids? Adults?

A

Kids - minimal change disease, adults - membranous glomerulonephritis
MCD - nothing, normal biopsy
Memb. G..is - diffuse thickening of BM and subepithelial spikes

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20
Q

WTF is NAS?
Caused by?
Presents how?
Treatment?

A

Neonatal abstinence syndrome
Caused by opioid withawel (2/2 mom taking them)
Presents in the first days of life with a high-pitched cry, irritability, tremors, sweating, seizures etc.
Treatment - supportive

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21
Q

Who gets screened for chlamydia?

A

24 and younger, also those with new or numerous partners or hx of STD

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22
Q

Timeframe for HPV vaccine

A

9-26

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23
Q

AAA screening?

A

65-75 yo with hx of smoking - do abd u/s

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24
Q

Timeline for mammograms?

A

Every 2 years between 50 and 75. Nothing before or after

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25
Q

CDC guidelines for pneumococcal vaccine?

A

Once to pts 65+, but also to pts with chronic disease (heart, lung, liver or kidneys) and DM or immunosuppression.

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26
Q

Vaccines for newborns - according to chronological age or gestational age?

A

All vaccines - live and not - should be given by chronological age

Remember - a baby must be 2kg before HepB vaccine!!

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27
Q

Limit of viral load for contraindication of MMR in HIV pts?

A

200 - less than this, no vaccine (since its live and all)

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28
Q

Pneumococcal vaccine induces immunity how ..?

A

T-cell independent B-cell response

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29
Q

What to give for Torsades?

A

Magnesium sulfate (also stop offending drug)

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30
Q

When to give amiodarone?

A

Ventricular and atrial tachycardia

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31
Q

When to give calcium gluconate?

A

Hyperkalemia

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32
Q

Wheto give sodium bicarb?

A

TCA and ASA overdose

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33
Q

When to give atropine?

A

Bradycardia, asystoly and PEA

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34
Q

When to give adenosine?

A

SVT (look for WPW)

“AndThenYouSee —- WPW!)

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35
Q

Name 5 drugs that can cause torsades

A

TCAs
Amiodarone, sotalol (antiarrhythmics)
Fluconazole, mixofloxacin

Stop these when torsades show up, and give mag sulfate

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36
Q

How will phenytoin toxicity present?

A

Horizontal nystagmus, cebellar ataxia, confusion

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37
Q

How to calculate anion gap?

A

Sodium minus (chloride + bicarb)

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38
Q

Metabolic acidosis - what is the formula for resp compensation?

What is the name of the formula?

A

PaCO2 = 1.5 (bicarb)+8&raquo_space; if this is the value of the CO2 in the ABG, there is resp comp. if not, think of resp. Alk/acid ontop of the metabolic.

Winter’s formula

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39
Q

High calcium with high/normal PTH - 2 top MCC?

A 
Familial hypocalciuric hypercalcemia (look for low urine/creatinine clearance ratio) OR
Primary hyperparathyroidism (this will have high urine excretion)
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40
Q

High calcium with low PTH?

A

Think of Vit. D OD, sarcoidosis, multiple myeloma, renal cell carcinoma

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41
Q

Aldosterone keeps water at the expense of..?

A

Hydrogen and potassium

42
Q

Treatment for acute hyperkalemia?

A
  1. Calcium gluconate - stabillizing the heart
  2. Lower K+ quick : beta2agonists, glucose&insulin or sodium bicarb
  3. Lower K+ longterm : kayexalate
43
Q

Hyperpigmentation of the skin with fatigue etc?

A

Addisons - look for hypokalemia, hyponatremia

44
Q

What factor could affect high/low calcium?

A

Albumin - ad/subtract 0.8 calcm for every 1 albumin above/below 4.0

45
Q

Firstline treatment of CHF

46
Q

Wheezing following NSAIDs or ASA - diagnosis?

Commonly associated with?

A

Aspirin Exacerbation Resp Disease (AERD)

Nasal polyps

47
Q

Patient shows up with trying to lose weight and low TSH with high T3/4 - whats up?

What will thyroid look like with biopsy?

A

Exogenous thyroid hormone

Follicular atrophy

48
Q

Pain and weakness in the hips and shoulders - diagnosis?
How to differentiate between drug-induced and inflammatory?
Treatment?

A

Inflammatory myopathy (polymyositis or dermatomyositis most common)
If the ESR and CK is high - this shows inflammatory
Steroids

49
Q

Initial scan for diverticulitis?

50
Q

Next step with PBC patient?

A

Ursodeoxycholic acid

51
Q

Pt presents with non-healing ulcer(s), lung issues and possibly renal problems - top of ddx?
Lab tests show?
Treatment?

A

Wegener’s (granulomatosis with polyangiitis)
Lab shows positive C-ANCA and elevated CRP
Treat with cyclophosphamide

52
Q

Treatment for cluster headache?

A

100% oxygen

53
Q

Pt presents with severe pIn upon the slightest touch, together with hemianesthesia - what happened?

A

Thalamic stroke

54
Q

Treatment for Alzheimer’s?

55
Q

Older pt with increased itching after baths, lab shows increased RBC, WBC and platelets - top of ddx?
What will labs show?

A

Polycythemia Vera
Normal ESR, hypercellular bonemarrow, high LAP, low erythropoetin
(LAP > ESR > erythropoetin)

56
Q

Which type of lung cancer causes PTHrP?

A

Squamous cell (SCa++mous cell)

57
Q 
Pt presents with spherocytes, anemia and splenomegaly
Diagnosis?
Hereditary type?
What should this person be on?
Is there a cure?
A

Hereditary spherocytosis
AD
Folic acid
Yes - splenectomy

58
Q

How will HIT be described?

A

Antibody-mediated platelet activation

59
Q

Iron deficiency - think WHAT first?

A

Chronic bleeding - often GI

60
Q

2 major macrocytic anemias - how to distinguish?

A

Folate and B12

B12 will have NEUROLOGIC SIGNS, methyl malonyl CoA in urine, positive Schilling test. Folate def. will not

61
Q

Treatment for chemo-induced nausea?

A

Serotonin antagonist (ondansetron)

62
Q

B12 deficiency can lead to what long-term complication?

A

Gastric cancer

63
Q

What does a positive Coombs test mean?

A

Hemolytic anemia

64
Q

Bone mets with neurologic symptoms - next step?

What then?

A

Glucocorticoids (dexamethasone FIRST)

Then MRI of spine

65
Q

Patient with recurrent pulmonary and GI infections throughout life - cause?

What else might they exhibit?

A

IgA deficiency

Anaphylactic transfusion reactions

66
Q

Sickle cell patient with sudden drop in H/H and low/no retic count - what is happening?
What can set this off?
Treatment?
What else causes a sudden H/H drop, and what is different?

A

Aplastic crisis (NOT aplastic anemia)
parvo B19 virus
Blood transfusion
Hyperhemolytic and splenic sequestration - retic count will be high in both, with SS also showing splenomegaly

67
Q

What is the cause of warfarin necrosis?

A

Protein C inhibition/deficiency

68
Q

Which clotting factors does warfarin bind?

A

Factors II, VII, IX, X, C, S (2+7=9, add 10)

69
Q

Kid presents with exzema, multiple previous infections and low platelets - top of ddx?
How will the platelets be described?
Infections usually due to..?
Cause of thrombocytopenia?

A

Wiskott-Aldrich syndrome
Few (<50,000) and decreased volume (small)
SHIN infections
Decreased platelet production

70
Q

Teen with polyps and a brain tumour - diagnosis?

Inheritance pattern?

A

Turcot’s syndrome - a combo of brain tumours and either FAP or HNPCC
Autosomal recessive

71
Q

What will you see with Gardener’s syndrome

A

Look for polyps (possibly familial) and supernumary teeth with osteonecrosis of the jaw

72
Q

Key words - ‘sunburst appearance’ and ‘codman’s triangle’

Treatment?

A

Osteosarcoma

Surgery

73
Q

Treatment for elevated homocysteine?

A

Folate & B6 (pyridoxine)

74
Q

Key words - ‘starry sky appearance’

A

Burkitt lymphoma

75
Q

Kid with massive WBC count and positive PAS reaction

76
Q

2 MCC of acquired coagulopathies in a hospital setting?

What differentiates them?

A

Liver disease and DIC

DIC has depressed levels of Factor VIII

77
Q

Blood smear with schistocytes, low plt and high CK - diagnosis?

Treatment? What is contraindicated?
What else to keep in mind, and how to differentiate?

A

TTP
Treat with steroids, plasma replaceent and plasmaphoresis
Nevr give platelets!!! TTP is caused by clumping, and added plts make it worse
HUS (renal failure) & HELLP (pregnant, pre-eclampsia)

78
Q

Key word : hypersegmented neutrophil

A

Megaloblastic anemia

79
Q

Hypersegmented PMN with elevated homocysteine, normal MMA

What if the MMA was elevated?

A

Folate has normal MMA and high homocyst

B12 def has elevated MMA and homocyst

80
Q

African american male who took quinine - now at risk for?

A

G6PD deficiency

81
Q

Normocytic, hemolytic anemia with neurological problems and low grade fever - what will be on labs?
Diagnosis?
Next step?
Treatment?

A

Labs - high retic, high indirect bili
Diagnosis - TTP
Peripheral blood smear (possibly schistocytes)
Plasma exchange

82
Q

Key words - anti-Jo antibodies

A

Polymyositis diagnosis

83
Q

Key words: anti-RNP antibodies

A

Connective tissue disease

84
Q

Kid shows with aplastic anemia, abnormal thumbs and/or skin and ear manifestations - diagnosis?
What will the ears and skin show?
Treatment?
What else?

A

Fanconi anemia
Ears - lowset, middle ear comp.; skin - hypopig, cafe.., freckles
Treat -stem cell transplant
At risk for cancer, AR or X-linked (chromosomal breaks)

85
Q

Exposure to what causes aplastic anemia?

86
Q

Side effect from isoniazid?

A

Pyridoxine deficiency (give B6 for sideroblastic anemia)

87
Q

What is Zoledronic acid?

A

Bisphosphonate

88
Q

Hypercalcemia in chemo setting -
Probable cause?
Treatment?

A

PTHrP secretion

Treat with bisohosphonates

89
Q

What is Lynch syndrome?

What else should be checked?

A

HNPCC

Apart from colorectal cancer, also screen for endometrial cancer

90
Q

Treatment for hairy cell leukemia?

Side effects of this treatment?

A

Cladribine

Neuro and kidney damage

91
Q

Presence of cord-like veins or red streaks on arms and/or chest -think of?
Also check?
Pt at risk for?

A

Migratory thrombophlebitis (Trousseau’s syndrome)
CT of chest for primary tumour (prob pancreatic or lung)
Pulm embolism!

92
Q

Hard painless mass in testes - next step?

If positive, what then?

A

Ultrasound

If solid, hard (no hydrocele) - remove it

93
Q

Recurrent infections with multiple myeloma - why the infections?

A

Decrease in total antibodiesand possible leukopenia (due to crowding of cells)

94
Q

When seeing high calcium, think of which 2 things always?

Expand on the second one

A

Multiple myeloma and hyperparathyroidism
With hyperpara, think of MEN1 and 2
MEN 1 (pee, papa) - pituitary, pancreas, parathyroid
MEN2A - (vee met para) pheo, medullary CA, parathyroid
MEN2B - (vee met almal) pheo medullary CA, neuromas

95
Q

Diffuse telengiectasias - think of..?

A

CREST or OslerWeberRandau

96
Q

Pt with high plasma homocysteine levels - treatment?

A

Pyridoxine (B6)

97
Q

Pt with multiplemyeloma - next step in diagnosis?

A

Serum immunoelectrophoresis (will show abnormal M-spike due to IgG Ab production)

98
Q

Breast CA - how does ER/PR and Her2 expression change prognosis?

A

ER+ and PR+ are good prognostic factors

Her2/neu overexpression is bad

99
Q

Treatment for CML?

A

Tyrosine kinase inhibitors (Imatinib)

100
Q

What does hydroxyurea do?

Side effects?

A

Increases fetal hemoglobin

Bone marrow suppression

Step 2 CK (6 decks)

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