USMLE 2 Review Flashcards
What gallbladder disease is associated with ulcerative colitis?
Sclerosing cholangitis
What are the s/sx of a partial bowel obstruction? What is the appropriate treatment?
- Bilious emesis, but still able to pass flatus
- NPO, IVFs, and NG suction. O/w supportive
What are the s/sx of a complete bowel obstruction? What is the appropriate treatment?
- Bilious emesis, inability to pass flatus.
- Emergent laparotomy
What is the most common cause of death of patients with mitral stenosis 2/2 rheumatic fever?
CHF
What are the 6 P’s of compartment syndrome?
Pain Pulselessness Paresthesias Passive stretch pain Pallor Paralysis
What is the diagnostic test and treatment of choice for cholangitis?
ERCP
Air in the gallbladder wall = ?
Emphysematous cholecystitis (caused by gas producing bacteria)
Patient who are allergic to PABA cannot receive which local anesthetic class?
esters
What is the order of loss of nerve conduction sensations with local anesthetics? (5)
Pain Temp Touch Proprioception Skeletal muscle tone
What parts of the body should not receive local anesthetics with vasoconstrictors? (4)
Nose
Digits
Penis
Ear
What, technically, is an abrasion?
Superficial loss of epithelial elements, with portions of the dermis remaining intact
What are the three major phases of wound healing?
-
What are the different types of chronic wounds (4)?
- Pressure ulcers
- venous Stasis
- Arterial insufficiency
- Diabetic neuropathic ulcers
What is the treatment for pressure ulcers?
Movement
Saline moistened gauze
What is the treatment of venous stasis ulcers?
Compression
What causes the skin pigmentation associated with venous stasis ulcers?
Deposition of hemosiderin
What causes arterial insufficiency ulcers?
Plaque buildup lowers arterial blood delivery`
What is the treatment for arterial insufficiency ulcers?
Re Cannulate the artery or
What is the treatment for flash pulmonary edema 2/2 a-fib?
Cardioversion
What is Legg-Calve-Perthes disease?
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.
What is the size of a carcinoid tumor at the appendix that is an indication for a right hemicolectomy?
More than 2 cm
What are the s/sx of a complete bowel obstruction?
Crampy, intermittent abdominal pain, increased BSm obstipation
What are the s/sx of paralytic ileus?
No BS
No focal TTP
Air throughout colon and small intestines
What are the IQ levels of mild, moderate, severe, and profound MR?
Mild = 50-70 Moderate = 35-49 Severe = 20-34 Profound = less than 20
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
What are the CXR findings suggestive of miliary TB?
Reticulonodular infiltrates spread evenly throughout both lung fields
Over how many centimeters are pulmonary nodules suspicious for cancer? What growth rate?
more than 3 cm
If doubles faster than every 2 years
What are the classic s/sx of an epidural abscess?
Fever, back pain, and midline spinal TTP
What is the imaging modality of choice for a suspected epidural abscess?
MRI
What are the classic histological findings for sarcoidosis?
Schaumann bodies and asteroid bodies
What is the classic pathogen that causes meningitis with elevated opening pressure in AIDS pts?
Cryptococcus neoformans
What labs are needed to to start a pt on an anti-HTN med? (3)
BMP
UA
Lipids
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
What type of hypersensitivity rxn is psoriasis?
Type IV
What are the classic PE findings of psoriasis?
Silvery plaques over extensor surfaces that bleed when scraped. Npt painful or pruritic.
What translocation produces follicular lymphoma?
t(14;18)
Which lymphoma does not need to be treated until symptomatic?
Follicular lymphoma
What needs to be checked frequently in patients with controlled pseudotumor cerebri?
Eyes–perimetry field testing
What is the therapy for pseudotumor cerebri (idiopathic intracranial HTN)? (2)
Lose weight
Acetazolamide
What is the first line drug in the treatment of thyroid storm?
Beta blockers
What is the treatment regimen for hyperthyroidism in pregnancy?
PTU for first trimester, then methimazole for second
What type of vaccine is the varicella vaccine?
Live attenuated
What is factitious thyrotoxicosis?
Administration of thyroid hormone in an attempt to lose weight
What malignancy is notorious for causing DI?
Langerhans cell histiocytosis
What is the hematological effect of desmopressin?
Increases vWF
Which abx can be used to treat SIADH? MOA (abx effect)?
Demeclocycline
Binds reversibly to 30x ribosomal subunit
What is the medical prophylaxis for small-medium esophageal varices? MOA?
Non-selective Beta blockers
Block adrenergic dilator tone in mesenteric arterioles
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.
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.
What are the three classic GI problem associated with Henoch-schonlein purpura?
Intussusception
Pancreatitis
Cholecystitis
What is the eye condition that patients with HLA-b27 are at increased risk of developing?
Anterior uveitis
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.
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
How long does it take HIT to develop?
4-10 days if this is first exposure
What happens with HIT?
Thrombocytopenia, and a hypercoagulable state 2/2 platelet activation
What is the treatment for HIT?
Stop heparin, and switch to direct thrombin inhibitor, like argatroban or lepirudin
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
What are the extrarenal symptoms of ADPKD?
Intracranial berry aneurysms
Mitral valve prolapse
What are the kidneys like with ADPKD? ARPKD?
Big with ADPKD
Small with ARPKD
What is the major extrarenal manifestation of ARPKD?
Liver cysts
What renal disease is associated with Hep B? What is the classic bx appearance of this?
Membranous nephropathy
Spike and dome
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
Which opioid can cause serotonin syndrome?
Meperidine
What is the MOA of phenelzine?
MAOI
What is the enzymatic deficiency of Gaucher’s disease?
glucocerebrosidase
Are bence jones proteins detected on a normal UA?
No
What are the classic CXR features of silicosis?
Calcifications of the hilar lymph nodes
What is POEMS syndrome?
Polyneuropathy Organomegaly Endocrinopathy Monoclonal protein Skin changes
What are the s/sx of POEMS syndrome, besides the POEMS symptoms?
Sclerotic bone lesions
Anemia
hyperuricemia
What is the diagnostic test for POEMS syndrome? What does this show?
Urine and serum electrophoresis
Shows a monoclonal M spike
Is the rash in pityriasis rosea pruritic?
Yes
What is the prognosis for pityriasis rosea?
Self limiting within a few months
What are the two major sulfonylureas?
Glipizide
Glyburide
What are the electroscopic findings of carcinoid tumors?
Dense core granules
Pleural plaques on CXR = ?
Asbestosis
What are the auscultatory findings of asbestosis?
Fine end inspiratory crackles
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
What is the pathophysiology of the restrictive lung disease caused by coal pneumoconiosis?
Macrophages eat up the coal, and fibrosis in response
What are the cardiac manifestations of silicosis?
cor pulmonale
RVH
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
What psychiatric phenomenon can be seen with neurosyphilis?
Bipolar mania
What are the first and second most common causes of erythema nodosum?
Idiopathic
2/2 post strep infx
What are the skin findings of erythema nodosum?
Diffuse, tender, erythematous, indurated patches and nodules, usually over the anterior aspects of the tibias.
What is the major difference in presentation between ARDS and hemodynamic pulmonary edema?
Normal capillary wedge pressure in ARDS since not a cardiac issue.
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.
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
What is the treatment for hepatic abscesses caused by schistosomiasis?
Praziquantel
What is the MOA of praziquantel?
Increases parasite cell membrane permeability to Ca, causing paralysis and contracture of the parasite
Which diuretic class has a detrimental effect on lipids?
Thiazides
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
What is the primary acid/base disturbance seen in a SBO? Why?
Metabolic alkalosis 2/2 emesis, causing a hypokalemic, hypochloremic, metabolic alkalosis
Which type of study is used to calculate relative risk?
Cohort study
When should K supplementation begin in the treatment of DKA?
When K levels are below or = to 4.5
Where in the prostate is the most common site of CA formation?
Peripheral zone
What is the appearance of a hematoma on CT?
solitary, well circumscribed nodule with a characteristic popcorn calcification pattern.
What is the second line treatment for minimal change disease?
cyclophosphamide
What is the MOA of ketoconazole in the treatment of Cushing’s disease?
Inhibits 17alpha hydroxylase
What metabolic disturbance should be expected s/p parathyroid adenoma surgery?
Hypocalcemia
What is the therapy for vertebral compression fractures in the absence of neurological signs?
Oral analgesics
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.
What are the three common bacteria that cause sinusitis?
Haemophilus
Strep pneumo
Moraxella catarrhalis
True or false: if a pt has dyslipidemia and DM, you should immediately start statins
True
What is the first line therapy for open angle glaucoma?
Topical latanoprost or bimatoprost
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
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
What are the components of Cushing’s triad, and what does this suggest?
HTN
Bradycardia
Irregular respirations
What is the most common CXR finding of histoplasmosis?
Solitary lung nodule
What are the associations of histoplasmosis?
Birds
Travel to the midwest
What are rales?
Low pitched, continuous crackles
What are rhonchi?
Lower pitched wheezes
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
What should be done with a CENTOR score of: 0-1
Symptomatic treatment
What should be done with a CENTOR score of: 2-3
Rapid strep test
What should be done with a CENTOR score of: 4-5
Treat empirically with abx
What is the cardinal feature of acute bronchitis?
Productive cough of more than 5 days duration
What are the only two indications for starting antivirals after 48 hours of influenza?
- if the patient has moderate to severe community acquired pneumonia with findings consistent with influenza
- if the patient is clinically worsening at the time of the initial outpatient visit
What is the recommended abx for typical and atypical PNU in children 3 months to adolescence?
Typical = amoxicillin Atypical = macrolides (e.g azithromycin)
When can a child return to school with the flu?
After not having a fever for 24 hours
If atypical PNU is suspected in a child, when should they get a cxr?
IF they’re hypoxic or being admitted
What are the abx of choice for pnu in a neonate?
Ampicillin and gentamicin
What are the abx of choice for pnu in a child 3 weeks - 3 months?
Ampicillin or PCN G or ceftriaxone
What are the abx of choice for pnu in a child 3 months to 5 years?
Ampicillin or PCN G or amox
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.
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
Over when BMI should children get a cholesterol screen?
Over the 85th percentile
What LDL level indicates the need to begin treatment for children with, and without other risk factors?
Without = over 190 With = over 160
Drug treatment for hypercholesterolemia is appropriate for children in which tanner stage?
stage 2 OR achieved menarche.
What is the prevalence of obesity in adolescents in the United States?
20%
The American Academy of Pediatrics expert committee recommends:
- 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:
- 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.
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.
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
What are the components of the timed, up, and go test?
- Sit in the chair with your back to the chair and your arms resting in your lap.
- Without using your arms, stand up from the chair and walk 10 ft. (3m).
- Turn around, walk back to the chair, and sit down again.
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
What part of the heart secretes BNP? What chronic diseases can it be elevated in?
Ventricles
LVH or chronic CHF
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
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)
What drugs are first line therapy in treating HTN in a pt post stroke, for prevention of further strokes?
Thiazides or CCBs
True or false: Low dose aspirin; confers equivalent benefit to high dose, and less bleeding risk
True
What medication is recommended as first-line therapy for secondary prevention of noncardioembolic TIA or noncardioembolic stroke?
ASA
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
What drug has been shown to improve outcomes in a stroke pt that is past the 4.5 hour mark for tPA?
ASA
What is the risk of treating hypernatremia too quickly? Hyponatremia?
Treating hypernatremia = cerebral edema
Treating hyponatremia = pontine demyelination
Trigeminal neuralgia caused by underlying MS is different from primary trigeminal neuralgia how?
MS usually causes bilateral pain
What is preferred for first line treatment for gout: allopurinol or colchicine? Why?
Allopurinol since it has fewer side effects
What is the MOA of allopurinol?
Xanthine oxidase inhibitor
What does the presence of Howell-Jolly bodies indicate?
Asplenic pt
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
What is the treatment for status epilepticus?
IV lorazepam + loading dose of phenytoin
What is the Somogyi effect?
Nocturnal hypoglycemia induce morning hyperglycemia
What drug (not oxygen) is used for treatment of acute cluster headaches? Prophylaxis?
ACute = SQ sumatriptan Prophylaxis = verapamil and/or topiramate
What is the most common primary brain tumor in adults? Histological characteristics?
Glioblastoma multiforme
Palisading necrosis
What is the DOC for HTN with concurrent BPH?
Prazosin
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
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
When should you withhold vaccinations for kids (without immunodeficiency)?
Only if moderately or significantly sick
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?
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
What is the age that a child can be diagnosed with ADHD?
6+ years
What are the components of the APGAR score?
Appearance Pulse Grimace ACtivity Respiration
When should a neonate have returned to their birth weight?
After 2 weeks
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.
When does an infant turn their head toward familiar sounds and faces?
4 weeks
When can an infant begin to move their head from one side ot the other?
4 weeks
When does an infant have smooth movements of their extremities?
4 weeks
When does the rooting reflex disappear?
4 months
When does baby colic start, peak, and end, usually?
- Starts around two weeks
- Peaks around 6 weeks
- Ends around 12 weeks
What are the s/sx of GERD in babies?
regurgitation
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.
An infant under what age with a fever requires admission to the hospital?
2 months
How many hours a day are spent crying in a: 2 week old?
2 hours / day
How many hours a day are spent crying in a: 6 week old
3 hours/day
How many hours a day are spent crying in a: 3 month old
1 hour a day
What are the PHQ-2 questions for postpartum depression screening?
During the past two weeks have you:
- been depressed/down
- had anhedonia
What are the three major screening tools for postpartum depression?
Edinburgh postnatal depression scale
PHQ-2
PHQ-9
How long do the postpartum blues last?
10 days
How long after delivery can postpartum depression be diagnosed?
6 months
When do Crigler-Najjar and gilbert syndromes usually present?
in adolescents
How does biliary tract atresia present?
acholic stools over the first few weeks of life.
How long can it take for milk production to begin after delivery?
72 hours
What is progressive supranuclear palsy?
A parkinson’s disease-plus syndrome, that has onset at age 40, and consists of vertical ocular gaze paresis
What is a major risk factor for the development of infective endocarditis in rheumatic heart disease?
Mitral valve prolapse
What will a PBS show with DIC?
Schistocytes
The cavernous sinus communicates directly with what vein?
Superior ophthalmic vein
Which CNs are in the cavernous sinus?
III
IV
V (V1 and V2)
VI
Heroin can cause what renal pathology?
FSGS
If a patient presents with HTN, increased aldosterone, and increase renin activity, what is the underlying diagnosis?
Renovascular HTN or renin secreting tumor
What is the effect of aldosterone on H+ levels?
Decreases since K follows H
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
Who should be offered surgery for a PTH secreting adenoma or hyperparathyroidism?
Symptomatic hypercalcemia
Younger than 50 yo
Complications
What has the best long term treatment option for patient with ESRD?
Renal transplant from a related individual
What happens to diabetic neuropathy with dialysis vs renal transplant?
Transplants stops progression of neuropathy, whereas dialysis does nothing to halt disease
What are the three major antiemetics that can cause EPS?
Metoclopramide
prochlorperazine
Promethazine
What is the classic cause of pneumaturia without systemic s/sx of infection or CVA TTP?
Colovesical fistula, 2/2 diverticulitis
What is the diagnostic imaging choice for colovesical fistula?
Oral or rectal contrast CT
When is emergent treatment of hyperkalemia indicated?
If symptomatic and/or above 7.0
What are the three EKG changes that occur with hyperkalemia?
Peaked T waves
Short QT
QRS widening
Which STD usually precipitates episodes of reactive arthritis?
Chlamydia
What is the MOA of demeclocycline?
Decreases responsiveness to ADH
Analgesic use causes what type of AKI?
Interstitial nephritis
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)