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Step 2 high yield review > U World questions 2 > Flashcards

U World questions 2 Flashcards

1
Q

Pt states they have severe back pain for last 3 hours. Had intermittent back pain for last 3 wks. Has had trouble walking and urinating for last three weeks. Currently have increased DTRs and loss of sensation on LE. States pain is worse when lying down at night. PE pt’s vitals are WNL , point tenderness over T10.
Dx and Tx?

A

Dx: Spinal cord compression
Tx: IV glucocorticoids
*seen in pts with advanced prostate cancer

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2
Q

Pt presents and dx with TB. He has had wt loss, fatigue, fever and cough. Your attending states the TB has disseminated. What electrolyte abnormalities would you expect if it went to the adrenal gland?

A

Hyperkalemia, hyponatremia, hypoglycemia
See borderline hypotension as well.
*Adrenal insufficiency leads to decreased cortisol, sex hormones and aldosterone (Saves Sodium) and secretes potassium and H ions. Low aldo–> Na loss, retain K and H+ === normal anion gap metabolic acidosis

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3
Q

Conditions leading to elevated anion gap

A

Ketoacidosis (alcohol, starvation, diabetic), intoxicatin ( methanol, salicylate, ethylene glycol, isoniazide, metformin), tissue hypoxia (ischemia, CO or CN poison_ and renal fail or uremia

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4
Q

Excessive vomitting, hyperaldo and excessive volume contraction (thiazide or loops) lead to the acid base disturbance

A

Metabolic alkalosis

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5
Q

What leads to respiratory acidosis?

A

Conditions causing improper ventilation

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6
Q

What conditions cause hyperventilation?

What acid/base disturbance results?

A

Pulmonary parenchymal disease–> respiratory fail. you see tachypnea and dyspnea
Causes respiratory alkalosis

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7
Q

Vit deficiency/toxicity: angular cheilosis, stomatitis, glossitis with normocytic anemia and seborheic dermatitits

A

Riboflavin or B2 deficiency

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8
Q

Vit deficiency/toxicity causes cheilosis, stomatitis and glossitis with irritability, confusion and depression?

A

Pyridoxine or B6

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9
Q

Patient comes in with cold intolerance, wt gain, oligomenorrhea. Labs show low T4 and elevated TSH with +TPO antibodies. What cancer is she at increased risk for?

A

Hashimoto thyroiditis

60 times higher chance of developing thyroid lymphoma

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10
Q

What is the classic triad seen in renal cell carcinoma?
What are other signs of RCC?
What test do you order to dx?

A

flank pain, hematuria, palpable abdominal mass
*hematuria= tumor in collecting system
Scrotal varicoceles that fail to empty is sign
*may have ectopic production of EPO–> polycythemia
Test: get Abdominal CT!!!

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11
Q

PSVT is the most common paroxysmal tachycardia in people w/out structual heart dx. Attacks start abruptly–> HR btwn 160-220 with palpitations. OFten d/t re-entry into AV node. What can people do to end the attacks?

A

Vagal maneuvers: valsalva, carotid sinus massage or immersion in cold water
Works by increasing vagal tone and decreasing conduction through AV node.
Otherwise use Adenosine; short acting AV node blocker

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12
Q

Pt comes in and you suspect acromegaly. What test do you order first?
If that test is abnormal, what is the next step?
And the last step?

A
  1. IGF-1 level; if ELEVATED then get next test
  2. Oral glucose suppression test; if adequte GH suppression order it’s NOT acromegaly.
    Inadequate suppresion–> next test
  3. MRI of brain; may see pituitary mass
    If NO mass eval for extra-pit causes of acromegaly
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13
Q

Pt comes in with left arm weakness… several months ago she experienced vertigo that went away after a few weeks. On PE she is asked to close her eyes and stretch her arms out with palms up. Seconds later the left arm drifts down with palm facing the floor. Why? Where is the lesion?

A

Pyramidal tract disease (Pronator drift is very specific for Upper motor neuron dx)
Pt likely has MS ( neurodeficiets disseminated in space and time)

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14
Q

What happens to cortisol, ACTH and Aldosterone in Chronic glucocorticoid therapy (Central Adrenal insufficiency)?

A

Decrease Cortisol
Decrease ACTH
normal Aldosterone (however, may see low Na d/t elevated ADH)

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15
Q

What happens to cortisol, ACTH and Aldosterone in Primary Adrenal insufficiency?

A

all will be DECREASED

see hyperpigmentation, hyperK, hypoNa, hypotension

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16
Q

What is the inheritance pattern for myotonic dystrophy?
What about for Becker dystrophy?
Duchenne?

A

Myotonic is Auto.Dominant (CTG repeat); onset 12-30 yo w /facial weakness, hand grip myotonia and dysphagia. see cataracts, balding, testicular atrophy
Becker: X-link Recessive del of dystrophin; less severe–onset age 5-15 with death at 40-50 HF
Duchenne: Xlink Recessive; del of dystrophin; onset 2-3 w/ Gower sign death from heart or respiratory fail

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17
Q

Common findings of PE:
Less common findings of PE:
RF of PE

A

Dyspnea, tachypnea, tachycardia
less common: hemoptysis from peripheral pulm artery by thrombus–> pulmonary infarct. lead to pleuritic chest pain
RF: immobilizatin, hx PE,

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18
Q

When do you see elevated oligoclonal bands in CSF?

A

In MS!

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19
Q

Condition in new moms holding their babies with thumb outstretched; abducted and extended; abductor pollicis longus and extensor pollicus longus are affected

A

De Quervain tenosynovitis

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20
Q

Tx of choice for pregnant or lactating women or children under the age of 6 with Lyme’s disease?

A

Tx w/ Amoxicillin (doxycycline contraindicated in preggers d/t teeth staining)

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21
Q

What is the gold standard to dx Duchenne muscular dystrophy?

A

Genetic Testing; XLR

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22
Q

Patient presents with BP of 97/50, distant heart sounds and JVD. Likely dx

A

cardiac tamponade

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23
Q

Mg is excreated by the ____

A

kidneys!
if elevated creatinine in patient, may need less Mg then expected or can lead to Mg toxicity
Tx: calcium gluconate

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24
Q

What meds can you give pt suffering from migraine + nausea and photophobia?

A

IV antiemetics; chlorpromazine, prochlorperazine or metoclopramide
*amitriptyline better for prophylaxsis

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25
Q

Recurrent infections in little kids. Have low platelets and dry, scaly skin. Likely dx?
Cause?
Tx?

A

Dx: Wiskott- Aldrich syndrome
Cause: X linked recessive defect in WAS gene–> issue w/ hematopoetic cells and cytoskeleton dysfnx
Tx: hematopoietic stem cell transplant

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26
Q

What are the Sx of Waldenstroms macroglobulinemia?

how do you dx it?

A

Sx: hepatospelnomegaly and enlarged LN, night sweats, peripheral neuropathy, anemia, headach and dizzy with vision problems
Issue with terminally dif B cells –> spike in IgM and hyperviscocity of blood!

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27
Q

What do the immunoglobulins look like in multplile myeloma?

A

Either elevated IgA or IgG

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28
Q

Hemolysis leading to hemoglobinuria
Cytopenias leading to fatigue and dyspnea
Hypercoaguable state–acute abdominal pain form severe hemolysis or portal vein thrombosis
usually apreas by 4th decade. Pt have ELEVATED bilirubin and LDH with LOW haptoblobin
Dx and mechanism?

A

Paroxsymal nocturnal hemoglobinuria
autoimmune hemolytic dx w/ intra and extravascular hemolysis. Genetic defecct of cell surface anchor making them vulnerable to MAC and complement

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29
Q

Describe focal seizures and what is seen on EEG with hyperventilation.
Post ictal state?

A

From abnormal neural discharge in one hemisphere; see motor (head turning), sensory (paresthesias) or autonomic (sweating). Hyperventilation does NOT trigger seizure
See jacksonian march. EEG shows distinct start and stop different from normal background

30
Q

Describe Absence seizures:

hyperventilation induced? pattern on EEG? is there postical state?

A

they are generalized from both cerebral hemistpheres, there is NO postictal state
easily induced by hyperventilation and last for 10-20 seconds with abrupt on and offset

31
Q

two most important things to do when pt comes in with diabetic ketoacidosis?

A

rapid IV of normal saline and regular insulin

NPH has slow onset, use it later once pt is stable!

32
Q

40 yoF Pt presents for routine physical and has had complaints of fatigue and itching. She gets labs drawn and found to have elevated Alk Phos. RUQ ultrasound is normal but pt found to have elevated antimitochondiral antibodies. What is dx and tx?

A

Dx: Primary biliary cholangitis; chronic progressive liver disease with cholestasis and destruction of intrahepatic bile ducts.
Tx: Ursodeoxycholic acid

33
Q

3 mo old baby presents with enlarged tongue, and umbilical hernia. He is in the 99% for head circumference, wt and height. Mom is concerned bc he hasn’t been moving his right arm or leg.
Dx?
Recommended screening/imaging?

A

Beckwith Weidemann; deregulation of imprinted gene in 11p15.. complication is Wilms tumor and hepatoblastoma so get abdominal/renal US and serum AFP

34
Q

What is a side effect of Tamoxifen?

A

Although it is an estrogen antagonist on breast tissue; it has AGONIST effects on UTERUS thus increase risk of endometrial polyps, hyperplasia and cancer

35
Q

14 yoM presents with knee pain. Hurts mostly after playing sports and helped some with NSAIDs. Xray shows lifting of the tubercle from the shaft on the tibia. Dx?

A

Osgood Schlatter or traction apophysitis

36
Q

What are the S/Sx of patellofemoral stress syndrome?

A

Overuse injury seen more in runners. Have anterior knee pain worse on descending steps or hills. Localized to patella and no radiographic abnormalities are present.

37
Q

Common side effect of metoclopromide (use to tx nauseau and vomitting)

A

Cause extrapyramidal Sx (tardive dyskinesia, dystonic rxn, torticolis) as it is a dopamine receptor antagonist

38
Q

What are first line meds to use for maternal hypertensive crisis?

A

IV labetalol, IV hydralazine, oral nifedipine

39
Q

Ten yoM comes in with HA, vomitting and nausea for 2 weeks. On exam he has upper eyelid retraction and sluggish pupil response to light with a limited upward gaze. Likely dx?

A

Pinealoma; likely in qudrigeminal cistern; called parinaud syndrome as it compresses CN III and mass affects CSF drainage thus increased pressure

40
Q

AIDs pt comes to clinic for eye exam. Non compliant with medication and CD4 of 30. Eye shows yellow-white patches of retinal opacification and retinal hemorrhages. Likely dx?

A

CMV retinitis (seen in CD4

41
Q

HIV pt presents for annual eye exam. last year there were cotton wool spots noted under opthalmascope. You recheck and everything looks normal. Dx?

A

HIV retinopathy; cotton wool spots, no Sx and can spontaneously remit

42
Q

What antibody is associated with scleroderma?

A

anti-topoisomerase I and antinuclear autoantibodies

43
Q

How do you manage an unstable patient with a bradyarrythmia?

A

IV atropine every 3-5 mins

then switch to transcutaneous pacing or IV dopamine or IV epinephrine

44
Q

Patient comes in with SVT. What medicine can you give to provide a transient block of impulse conduction at the level of the AV node?

A

Adenosine

45
Q

What antiarrhythmic drug is used for either SVT and ventricular tachycardias to slow the impulse generation or conduction in the SA and AV node?

A

Amiodarone

46
Q

What do you give a patient that you suspect has had beta blocker or CCB toxicity?

A

IV glucagon

47
Q

What arrythmia is most commonly seen with digoxin toxicity?

A

Atrial tachycardia with AV block; see it has slower rate than atrial flutter (150-250 vs 250-350)

48
Q

Affects central vision and occurs in two forms that cause slowly progressive, bilateral vision loss OR unilateral aggressive loss

A

Macular degeneration
Dry is slow– see drusen and patchy depigmentation
Wet is fast

49
Q

Insidious onset with gradual loss of peripheral vision resulting in tunnel vision; have increased IOP with cupping of optic disc on exam

A

Open angle glaucoma

50
Q

Unilateral and sudden feeling of curtain falling in front of the eye that obscures part or all of vision field

A

detached retina

51
Q

Opacification of lens with painless blured vision creating halos around lights

A

Cataracts

52
Q

Pt presents with fatigue and low back pain that is worse with exercise and somewhat relieved by acetaminophen. She suffers from osteopenia and started Vit D and Ca++ supplements a few months ago which her labs were normal at the time. Her Ca=10.9, Cr is now 2.5 with a H&H of 10&20. What could be going on?

A 
Multilple myeloma
Calcium
Renal
Anemia
Bone lesions/pain
53
Q

Pt comes in with Graves disease and opts for medical managment. What do you Rx and what are the SE of those drugs?

A

Methimazole; agranuloctytosis; if pt devos sore throat on this drug STOP it and check a CBC
Propylthiouricil; use for preggers–> hepatic fail and ANCA

54
Q 
Pt comes in with DKA. 
How do you manage fluids?
Insulin?
Potassium?
Bicarb?
Phostphate?
A

Fluids; NS and add dextrose once glucose

55
Q

why do patients with angina feel better with nitroglycerine?

A

causes systemic venodilation to lower preload and lower left ventricular end-diastolic volume thus reduces myocardial oxygen demand thus reduces wall stress

56
Q

persistant seizure activity > 5 mins can lead to damage in which part of the brain?

A

Cortex; see cortical laminar necrosis

57
Q

What does Modafinil and armodafinil help treat?

A

Stimulant to tx narcolepsy

58
Q

27 yo is dx with hypertension and stared on a thiazide, two weeks later he come to the ED w/ muscle cramps, weakness and palpitations. BP 150/90 and pulse is 85. Labs show HypoK. What’s going on?

A

pt likely has primary hyperaldosteronism. Very sensitive to diuretics and need to get a plasma renin/aldosterone level

59
Q

What is the diagnosis and treatment for essential tremor?

A

progressive,begins in adulthood.
Tx with
Beta blockers UNLESS pt has COPD or bradycardia
Primidone; you can get acute intermittent porphyria–> check urine porphobilogen

60
Q

What antihypertensive leads to pedal edema?

A

Calcium channel blockers (amlodipine or nifedipine) cause potent arteriolar dilation.

61
Q

What are three markers for SLE?

Which is most specific?

A

Anit-ds antibodies, anti-smith, Anti nuclear antibodies

ANA is MOST SPECIFIC

62
Q

What is a specific marker for drug induced lupus?

A

anti-histone antibodies

63
Q

What is a antiB marker specific for rheumatoid arthritis?

A

anti-cyclic citrullinated antibodies

64
Q

Pediatric tumor that causes headaches, vomiting and ataxia?

A

Medulloblastoma; usually in the posterior fossa at the cerebellar vermis

65
Q

Tumors arising from sympathetic ganglion cells and mass that crosses midline.

A

Neuroblastoma; associated with mets to bone and liver

66
Q

Tumor that is usually supratentorial, from astrocytes and present with seizures and increased ICP

A

Glioblastoma

67
Q

Glial cell tumor that can cause obstruction of CSF and increases ICP. Most often in 4th ventricle in kids

A

Ependymoma

68
Q

40 yo male presents with 6 mo of wt loss. Currently have headache, fatigue, neck stiffness and lymphadenopathy. LP shows an elevated opening pressure, low glucose and elevated protein.
Likely dx?
Next step?

A

Dx: Cryptococcal meningitis; pt likely has HIV
you need to tx with amphotericin B and flucytosine; get infection under control prior to initiating HIV therapy to prevent immune reconstitution syndrome

69
Q

What imaging do you want to get when you suspect trauma or stroke in a pt?

A

Get a NON-contrast CT

70
Q

Difference between HSV retinitis and CMV retinitis in HIV patient?

A

HSV: rapidly progressing PAINFUL bilateral necrotizing–> conjunctivitis with eye pain and widespread pale, peripheral lesions and central necrosis of retina
CMV: more common, usually PAINLESS and see fluffy or granular retinal lesions by retinal vessels and hemorrhages but doesn’t cause keratitis

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