USMLE 2 Review Flashcards
1
Q
What gallbladder disease is associated with ulcerative colitis?
A
Sclerosing cholangitis
2
Q
What are the s/sx of a partial bowel obstruction? What is the appropriate treatment?
A
- Bilious emesis, but still able to pass flatus
- NPO, IVFs, and NG suction. O/w supportive
3
Q
What are the s/sx of a complete bowel obstruction? What is the appropriate treatment?
A
- Bilious emesis, inability to pass flatus.
- Emergent laparotomy
4
Q
What is the most common cause of death of patients with mitral stenosis 2/2 rheumatic fever?
A
CHF
5
Q
What are the 6 P’s of compartment syndrome?
A
Pain Pulselessness Paresthesias Passive stretch pain Pallor Paralysis
6
Q
What is the diagnostic test and treatment of choice for cholangitis?
A
ERCP
7
Q
Air in the gallbladder wall = ?
A
Emphysematous cholecystitis (caused by gas producing bacteria)
8
Q
Patient who are allergic to PABA cannot receive which local anesthetic class?
A
esters
9
Q
What is the order of loss of nerve conduction sensations with local anesthetics? (5)
A
Pain Temp Touch Proprioception Skeletal muscle tone
10
Q
What parts of the body should not receive local anesthetics with vasoconstrictors? (4)
A
Nose
Digits
Penis
Ear
11
Q
What, technically, is an abrasion?
A
Superficial loss of epithelial elements, with portions of the dermis remaining intact
12
Q
What are the three major phases of wound healing?
A
-
13
Q
What are the different types of chronic wounds (4)?
A
- Pressure ulcers
- venous Stasis
- Arterial insufficiency
- Diabetic neuropathic ulcers
14
Q
What is the treatment for pressure ulcers?
A
Movement
Saline moistened gauze
15
Q
What is the treatment of venous stasis ulcers?
A
Compression
16
Q
What causes the skin pigmentation associated with venous stasis ulcers?
A
Deposition of hemosiderin
17
Q
What causes arterial insufficiency ulcers?
A
Plaque buildup lowers arterial blood delivery`
18
Q
What is the treatment for arterial insufficiency ulcers?
A
Re Cannulate the artery or
19
Q
What is the treatment for flash pulmonary edema 2/2 a-fib?
A
Cardioversion
20
Q
What is Legg-Calve-Perthes disease?
A
Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the femoral head that occurs most commonly in boys 4-10 years old. The parent typically reports that the child limps and complains of occasional hip or knee pain, as in this case. Early x-ray studies will show an increase in the density of the femoral head compared with the asymptomatic side.
21
Q
What is the size of a carcinoid tumor at the appendix that is an indication for a right hemicolectomy?
A
More than 2 cm
22
Q
What are the s/sx of a complete bowel obstruction?
A
Crampy, intermittent abdominal pain, increased BSm obstipation
23
Q
What are the s/sx of paralytic ileus?
A
No BS
No focal TTP
Air throughout colon and small intestines
24
Q
What are the IQ levels of mild, moderate, severe, and profound MR?
A
Mild = 50-70 Moderate = 35-49 Severe = 20-34 Profound = less than 20
25
Who is more likely to develop HTN from OCPs? (4)
- h/o pregnancy related HTN
- obese women
- over 35 years old
- Long time taking OCPs
26
What are the CXR findings suggestive of miliary TB?
Reticulonodular infiltrates spread evenly throughout both lung fields
27
Over how many centimeters are pulmonary nodules suspicious for cancer? What growth rate?
more than 3 cm
| If doubles faster than every 2 years
28
What are the classic s/sx of an epidural abscess?
Fever, back pain, and midline spinal TTP
29
What is the imaging modality of choice for a suspected epidural abscess?
MRI
30
What are the classic histological findings for sarcoidosis?
Schaumann bodies and asteroid bodies
31
What is the classic pathogen that causes meningitis with elevated opening pressure in AIDS pts?
Cryptococcus neoformans
32
What labs are needed to to start a pt on an anti-HTN med? (3)
BMP
UA
Lipids
33
What is the role of citrate in the treatment of uric acid renal stones?
Turns to bicarb in the liver, and causes alkalinization of the urine
34
What type of hypersensitivity rxn is psoriasis?
Type IV
35
What are the classic PE findings of psoriasis?
Silvery plaques over extensor surfaces that bleed when scraped. Npt painful or pruritic.
36
What translocation produces follicular lymphoma?
t(14;18)
37
Which lymphoma does not need to be treated until symptomatic?
Follicular lymphoma
38
What needs to be checked frequently in patients with controlled pseudotumor cerebri?
Eyes--perimetry field testing
39
What is the therapy for pseudotumor cerebri (idiopathic intracranial HTN)? (2)
Lose weight
| Acetazolamide
40
What is the first line drug in the treatment of thyroid storm?
Beta blockers
41
What is the treatment regimen for hyperthyroidism in pregnancy?
PTU for first trimester, then methimazole for second
42
What type of vaccine is the varicella vaccine?
Live attenuated
43
What is factitious thyrotoxicosis?
Administration of thyroid hormone in an attempt to lose weight
44
What malignancy is notorious for causing DI?
Langerhans cell histiocytosis
45
What is the hematological effect of desmopressin?
Increases vWF
46
Which abx can be used to treat SIADH? MOA (abx effect)?
Demeclocycline
| Binds reversibly to 30x ribosomal subunit
47
What is the medical prophylaxis for small-medium esophageal varices? MOA?
Non-selective Beta blockers
| Block adrenergic dilator tone in mesenteric arterioles
48
What is the protocol regarding vaccinations in a pt s/p bone marrow transplant?
vaccinate 3-6 months post op, avoid live attenuated for 24 months.
49
How does calcium restriction lead to an increase in renal stone formation?
Less Ca in diet mean more oxalate is absorbed from intestines, since no Ca to bind it. Oxalate then precipitates into kidneys, and pulls Ca with it, causing stones.
50
What are the three classic GI problem associated with Henoch-schonlein purpura?
Intussusception
Pancreatitis
Cholecystitis
51
What is the eye condition that patients with HLA-b27 are at increased risk of developing?
Anterior uveitis
52
What are the sizes of thyroid nodules that require bx if the TSH is normal?
If the nodule is solid and over 1 cm, FNA is indicated
| If the nodule is mixed cystic and solid, 1.5 cm is needed.
53
What are the indications to begin statin therapy? (4)
DM
Atherosclerotic disease
LDL-C of 190 or higher
10 ASCVD risk of 7.5% or greater
54
How long does it take HIT to develop?
4-10 days if this is first exposure
55
What happens with HIT?
Thrombocytopenia, and a hypercoagulable state 2/2 platelet activation
56
What is the treatment for HIT?
Stop heparin, and switch to direct thrombin inhibitor, like argatroban or lepirudin
57
What is the MOA of carbidopa in the treatment of PD?
Increases L-dopa entry into the brain, by preventing its peripheral conversion to dopamine
58
What are the extrarenal symptoms of ADPKD?
Intracranial berry aneurysms
| Mitral valve prolapse
59
What are the kidneys like with ADPKD? ARPKD?
Big with ADPKD
| Small with ARPKD
60
What is the major extrarenal manifestation of ARPKD?
Liver cysts
61
What renal disease is associated with Hep B? What is the classic bx appearance of this?
Membranous nephropathy
| Spike and dome
62
If a pt has a first degree relative diagnosed with colon cancer before age 50, when should they receive a colonoscopy?
10 years prior to their parent's diagnosis
63
Which opioid can cause serotonin syndrome?
Meperidine
64
What is the MOA of phenelzine?
MAOI
65
What is the enzymatic deficiency of Gaucher's disease?
glucocerebrosidase
66
Are bence jones proteins detected on a normal UA?
No
67
What are the classic CXR features of silicosis?
Calcifications of the hilar lymph nodes
68
What is POEMS syndrome?
```
Polyneuropathy
Organomegaly
Endocrinopathy
Monoclonal protein
Skin changes
```
69
What are the s/sx of POEMS syndrome, besides the POEMS symptoms?
Sclerotic bone lesions
Anemia
hyperuricemia
70
What is the diagnostic test for POEMS syndrome? What does this show?
Urine and serum electrophoresis
| Shows a monoclonal M spike
71
Is the rash in pityriasis rosea pruritic?
Yes
72
What is the prognosis for pityriasis rosea?
Self limiting within a few months
73
What are the two major sulfonylureas?
Glipizide
| Glyburide
74
What are the electroscopic findings of carcinoid tumors?
Dense core granules
75
Pleural plaques on CXR = ?
Asbestosis
76
What are the auscultatory findings of asbestosis?
Fine end inspiratory crackles
77
How can NSAIDs worsen dilated cardiomyopathy?
increase afterload and affect cardiac output by inhibiting prostaglandin synthesis (eliminated their effects on vasodilation) and by counteracting the benefits of ACEIs
78
What is the pathophysiology of the restrictive lung disease caused by coal pneumoconiosis?
Macrophages eat up the coal, and fibrosis in response
79
What are the cardiac manifestations of silicosis?
cor pulmonale
| RVH
80
What is the Na, K , and acid/base status of a pt with addison's disease?
Hyponatremic, hyperkalemic acidosis
| aldosterone causes H and K secretion
81
What psychiatric phenomenon can be seen with neurosyphilis?
Bipolar mania
82
What are the first and second most common causes of erythema nodosum?
Idiopathic
| 2/2 post strep infx
83
What are the skin findings of erythema nodosum?
Diffuse, tender, erythematous, indurated patches and nodules, usually over the anterior aspects of the tibias.
84
What is the major difference in presentation between ARDS and hemodynamic pulmonary edema?
Normal capillary wedge pressure in ARDS since not a cardiac issue.
85
What is the major difference between CML and AML?
AML has blasts in premature stages, whereas CML has blasts in many stages, including fully differentiated ones.
86
If a pt only wants a sigmoidoscopy for colorectal CA screening, how many times must they get a stool guaiac test?
guaiac every three years, sigmoid every 5 years
87
What is the treatment for hepatic abscesses caused by schistosomiasis?
Praziquantel
88
What is the MOA of praziquantel?
Increases parasite cell membrane permeability to Ca, causing paralysis and contracture of the parasite
89
Which diuretic class has a detrimental effect on lipids?
Thiazides
90
What is the acute treatment for adrenal insufficiency?
Dexamethasone--not hydrocortisone/fludrocortisone acutely, since Na can be replaced with NS. These are long term drugs.
Hydrocortisone is preferred however if the patient is hyperkalemic
91
What is the primary acid/base disturbance seen in a SBO? Why?
Metabolic alkalosis 2/2 emesis, causing a hypokalemic, hypochloremic, metabolic alkalosis
92
Which type of study is used to calculate relative risk?
Cohort study
93
When should K supplementation begin in the treatment of DKA?
When K levels are below or = to 4.5
94
Where in the prostate is the most common site of CA formation?
Peripheral zone
95
What is the appearance of a hematoma on CT?
solitary, well circumscribed nodule with a characteristic popcorn calcification pattern.
96
What is the second line treatment for minimal change disease?
cyclophosphamide
97
What is the MOA of ketoconazole in the treatment of Cushing's disease?
Inhibits 17alpha hydroxylase
98
What metabolic disturbance should be expected s/p parathyroid adenoma surgery?
Hypocalcemia
99
What is the therapy for vertebral compression fractures in the absence of neurological signs?
Oral analgesics
100
Which is more important to bx in a lung CA, the main mass, or nodes that are suspected to be involved?
Nodes, since staging information comes with it.
101
What are the three common bacteria that cause sinusitis?
Haemophilus
Strep pneumo
Moraxella catarrhalis
102
True or false: if a pt has dyslipidemia and DM, you should immediately start statins
True
103
What is the first line therapy for open angle glaucoma?
Topical latanoprost or bimatoprost
104
Why do HAs caused by brain tumors get better after vomiting, and are their worst in the morning?
Decreases ICP with emesis
| Lying all night causes increased ICP
105
What is osler-Weber-rendu syndrome?
an AD fibrovascular dysplasia, in which vascular lesions (e.g. telangiectasias, AV malformations, aneurysms) are found throughout the body
106
What are the components of Cushing's triad, and what does this suggest?
HTN
Bradycardia
Irregular respirations
107
What is the most common CXR finding of histoplasmosis?
Solitary lung nodule
108
What are the associations of histoplasmosis?
Birds
| Travel to the midwest
109
What are rales?
Low pitched, continuous crackles
110
What are rhonchi?
Lower pitched wheezes
111
What are the age range and points allotted in the CENTOR scoring system?
Age 3 to 14 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 point
112
What should be done with a CENTOR score of: 0-1
Symptomatic treatment
113
What should be done with a CENTOR score of: 2-3
Rapid strep test
114
What should be done with a CENTOR score of: 4-5
Treat empirically with abx
115
What is the cardinal feature of acute bronchitis?
Productive cough of more than 5 days duration
116
What are the only two indications for starting antivirals after 48 hours of influenza?
1. if the patient has moderate to severe community acquired pneumonia with findings consistent with influenza
2. if the patient is clinically worsening at the time of the initial outpatient visit
117
What is the recommended abx for typical and atypical PNU in children 3 months to adolescence?
```
Typical = amoxicillin
Atypical = macrolides (e.g azithromycin)
```
118
When can a child return to school with the flu?
After not having a fever for 24 hours
119
If atypical PNU is suspected in a child, when should they get a cxr?
IF they're hypoxic or being admitted
120
What are the abx of choice for pnu in a neonate?
Ampicillin and gentamicin
121
What are the abx of choice for pnu in a child 3 weeks - 3 months?
Ampicillin or PCN G or ceftriaxone
122
What are the abx of choice for pnu in a child 3 months to 5 years?
Ampicillin or PCN G or amox
123
Why is the BMI age and sex specific in children?
The amount of body fat changes with age.
| The amount of body fat differs between girls and boys.
124
What are the BMI values for healthy, overweight, and obese in children?
```
Healthy = 5th-85th percentile
overweight = 85-95th percentile
Obese = Greater than 95th percentile
```
125
Over when BMI should children get a cholesterol screen?
Over the 85th percentile
126
What LDL level indicates the need to begin treatment for children with, and without other risk factors?
```
Without = over 190
With = over 160
```
127
Drug treatment for hypercholesterolemia is appropriate for children in which tanner stage?
stage 2 OR achieved menarche.
128
What is the prevalence of obesity in adolescents in the United States?
20%
129
The American Academy of Pediatrics expert committee recommends:
1. Children younger than (__) years old who have a BMI at or above the (__) percentile without secondary complications should attempt to maintain their weight.
Those with complications should pursue weight loss until their BMI is at or below the 85th percentile. The general recommendation is about one pound per month.
The American Academy of Pediatrics expert committee recommends:
1. Children younger than seven years old who have a BMI at or above the 95 percentile without secondary complications should attempt to maintain their weight. Those with complications should pursue weight loss until their BMI is at or below the 85th percentile. The general recommendation is about one pound per month.
130
What is the goal total and LDL cholesterol in children?
The guideline for normal cholesterol is less than 170 mg/dl for the total cholesterol level and the goal LDL level is less than 130 mg/dl.
131
For children with LDL of greater than (___) mg/dl it is likely they have a familial hypercholesterolemia and should be referred to a pediatric lipid specialist.
190 mg/dL
132
What are the components of the timed, up, and go test?
1. Sit in the chair with your back to the chair and your arms resting in your lap.
2. Without using your arms, stand up from the chair and walk 10 ft. (3m).
3. Turn around, walk back to the chair, and sit down again.
133
What are the values for the timed up and go test?
<10 secs=Freely mobile
< 20 secs=Mostly independent
20-29 secs= Variable mobility
> 30 secs=Impaired mobility
134
What part of the heart secretes BNP? What chronic diseases can it be elevated in?
Ventricles
| LVH or chronic CHF
135
If a pt has a hemorrhagic condition that prevents them from being candidates for warfarin, what is the appropriate antiplatelet therapy?
Either ASA or clopidogrel, but not both since both increased bleeding risk similar to coumadin in these pts
136
What are the components of the CHAD2DS2 VASc score?
```
CHF (or LV systolic dysfunction)
HTN
Age over 75 (2)
DM
Stroke or TIA or thromboembolism
Vascular disease
Age 65-74
Sex, female (2)
```
137
What drugs are first line therapy in treating HTN in a pt post stroke, for prevention of further strokes?
Thiazides or CCBs
138
True or false: Low dose aspirin; confers equivalent benefit to high dose, and less bleeding risk
True
139
What medication is recommended as first-line therapy for secondary prevention of noncardioembolic TIA or noncardioembolic stroke?
ASA
140
What is the screening recommendation for lung CA?
Age 55-80 with a 30 or more pack year history who are currently smoking or quit smoking in the last 15 years
141
What drug has been shown to improve outcomes in a stroke pt that is past the 4.5 hour mark for tPA?
ASA
142
What is the risk of treating hypernatremia too quickly? Hyponatremia?
Treating hypernatremia = cerebral edema
| Treating hyponatremia = pontine demyelination
143
Trigeminal neuralgia caused by underlying MS is different from primary trigeminal neuralgia how?
MS usually causes bilateral pain
144
What is preferred for first line treatment for gout: allopurinol or colchicine? Why?
Allopurinol since it has fewer side effects
145
What is the MOA of allopurinol?
Xanthine oxidase inhibitor
146
What does the presence of Howell-Jolly bodies indicate?
Asplenic pt
147
What is the appropriate treatment for an asplenic sickle cell pt presenting with a significant fever, but is without pain? Why?
Start Vanco + ceftriaxone + supportive measures
At risk for postsplenectomy crisis--a rapidly fatal illness from encapsulated organisms
148
What is the treatment for status epilepticus?
IV lorazepam + loading dose of phenytoin
149
What is the Somogyi effect?
Nocturnal hypoglycemia induce morning hyperglycemia
150
What drug (not oxygen) is used for treatment of acute cluster headaches? Prophylaxis?
```
ACute = SQ sumatriptan
Prophylaxis = verapamil and/or topiramate
```
151
What is the most common primary brain tumor in adults? Histological characteristics?
Glioblastoma multiforme
| Palisading necrosis
152
What is the DOC for HTN with concurrent BPH?
Prazosin
153
What is the dosing of amoxicillin for strep throat in children?
Amoxicillin dosing is 50 mg/kg divided 2-3 times a day for 10 days
154
What is the best abx to use for strep throat?
PCN V since it had the narrowest spectrum of activity, and is the least likely to contribute to abx resistance
155
When should you withhold vaccinations for kids (without immunodeficiency)?
Only if moderately or significantly sick
156
What are the recommendations for screening for Pb toxicity? (3)
- Does your child live in or regularly visit a house or child care facility built before 1950?
- Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been renovated or remodeled (within the last six months)?
- Does your child have a sibling or playmate who has or did have lead poisoning?
157
What kids need to be screened for TB? (4)
- Children infected with HIV
- Incarcerated adolescents
- Family member with TB
- Born in/traveled to high risk country
158
What is the age that a child can be diagnosed with ADHD?
6+ years
159
What are the components of the APGAR score?
```
Appearance
Pulse
Grimace
ACtivity
Respiration
```
160
When should a neonate have returned to their birth weight?
After 2 weeks
161
If a mother only produces a small amount of colostrum at the beginning of breastfeeding, is this a concern?
Not really-babies are adapted to not have much milk output in the first few days.
162
When does an infant turn their head toward familiar sounds and faces?
4 weeks
163
When can an infant begin to move their head from one side ot the other?
4 weeks
164
When does an infant have smooth movements of their extremities?
4 weeks
165
When does the rooting reflex disappear?
4 months
166
When does baby colic start, peak, and end, usually?
- Starts around two weeks
- Peaks around 6 weeks
- Ends around 12 weeks
167
What are the s/sx of GERD in babies?
regurgitation
168
What is the Wessel defintion (rule of threes) to diagnose colic
Unexplained paroxysmal bouts of fussing and crying that lasts at least three hours a day, at least three times a week, for longer than three weeks.
169
An infant under what age with a fever requires admission to the hospital?
2 months
170
How many hours a day are spent crying in a: 2 week old?
2 hours / day
171
How many hours a day are spent crying in a: 6 week old
3 hours/day
172
How many hours a day are spent crying in a: 3 month old
1 hour a day
173
What are the PHQ-2 questions for postpartum depression screening?
During the past two weeks have you:
- been depressed/down
- had anhedonia
174
What are the three major screening tools for postpartum depression?
Edinburgh postnatal depression scale
PHQ-2
PHQ-9
175
How long do the postpartum blues last?
10 days
176
How long after delivery can postpartum depression be diagnosed?
6 months
177
When do Crigler-Najjar and gilbert syndromes usually present?
in adolescents
178
How does biliary tract atresia present?
acholic stools over the first few weeks of life.
179
How long can it take for milk production to begin after delivery?
72 hours
180
What is progressive supranuclear palsy?
A parkinson's disease-plus syndrome, that has onset at age 40, and consists of vertical ocular gaze paresis
181
What is a major risk factor for the development of infective endocarditis in rheumatic heart disease?
Mitral valve prolapse
182
What will a PBS show with DIC?
Schistocytes
183
The cavernous sinus communicates directly with what vein?
Superior ophthalmic vein
184
Which CNs are in the cavernous sinus?
III
IV
V (V1 and V2)
VI
185
Heroin can cause what renal pathology?
FSGS
186
If a patient presents with HTN, increased aldosterone, and increase renin activity, what is the underlying diagnosis?
Renovascular HTN or renin secreting tumor
187
What is the effect of aldosterone on H+ levels?
Decreases since K follows H
188
Why is it that PTH causes net Ca loss, but increased renal resorption of Ca?
Increased bone resorption overwhelms the kidney's ability to absorb
189
Who should be offered surgery for a PTH secreting adenoma or hyperparathyroidism?
Symptomatic hypercalcemia
Younger than 50 yo
Complications
190
What has the best long term treatment option for patient with ESRD?
Renal transplant from a related individual
191
What happens to diabetic neuropathy with dialysis vs renal transplant?
Transplants stops progression of neuropathy, whereas dialysis does nothing to halt disease
192
What are the three major antiemetics that can cause EPS?
Metoclopramide
prochlorperazine
Promethazine
193
What is the classic cause of pneumaturia without systemic s/sx of infection or CVA TTP?
Colovesical fistula, 2/2 diverticulitis
194
What is the diagnostic imaging choice for colovesical fistula?
Oral or rectal contrast CT
195
When is emergent treatment of hyperkalemia indicated?
If symptomatic and/or above 7.0
196
What are the three EKG changes that occur with hyperkalemia?
Peaked T waves
Short QT
QRS widening
197
Which STD usually precipitates episodes of reactive arthritis?
Chlamydia
198
What is the MOA of demeclocycline?
Decreases responsiveness to ADH
199
Analgesic use causes what type of AKI?
Interstitial nephritis
200
What are the common lab findings of multiple myeloma? (3)
- Hypercalcemia
- Normocytic anemia
- Protein gap (difference between total proteins and albumin over 4 g/dL)
