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Step 2 > USMLE Q-bank > Flashcards

USMLE Q-bank Flashcards

1
Q

Signs/Sx of Patget disease in terms of:

Skull/bones:

Lab/Imaging findings:

Dx:

Txt:

A

Skull/bones: hearing loss, dizziness, bone pain, fracture, osteosarcoma or giant cell tumors, nerve impingement causing neuropathy

Lab/Imaging findings: Elevated serum and bone-specific AlkPhos, normal Ca&PO4, plain film shows osteolysis or slerosis

Diagnosis: radiographic findings, elevated AlkPhos

Txt: Bisphosphonates

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2
Q

What is a test to differentiate between elevated AlkPhos from liver vs bone?

A

Gamma-glutamyl transpeptidase is elevated in liver origin

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3
Q

Migraines:

Sx:

Preventive Txt:

Abortive Txt:

A

Sx: young females, aura or neurological Sx preceding HAs, unilateral, pulsating, lasting 4-72hrs, associated with photophobia and phonophobia, lack of other Sx such as F, meningeal signs, focal neurological deficits

Preventive txt: Amitriptyline, propranolol

Abortive txt: NSAIDs, triptans (starts early), and antiemetics (chlorpromazine, prochlorperazine, or metoclopramide)

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4
Q

Polymyalgia rheumatica vs rheumatoid arthritis vs viral arthritis vs acute rheumatic fever?

A

Polymyalgia rheumatica: pain and stiffness of the pelvis and shoulders in older pts; elevated ESR

Rheumatoid arthritis: polyarticular, symmetric arthritis, joint swelling, morning stiffness, systemic symptoms, and present for at least 6 weeks

Viral arthritis: mimic inflammatory arthritis, but morning stiffness lasting less than 30 min, lack of systemic sx

Acute rheumatic fever: recent streptococal infection, with poly-arthritis, carditis, chorea, erythema marginatum and subQ nodules

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5
Q

Mechanism of action of nitroglycerin in angina relief?

A

Primary effect: Dilation of veins (capacitance vessels) –> decrease preload –> decrease oxygen requirement of heart

Secondary effect: some arterial dilation –> decreases afterload

Minor effect: increase contractility and reflex tachycardia

Note: in healthy subjects it also increase coronary blood flow, but this might not be true in pts with angia

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6
Q

What is Wernicke’s encephalopathy? Triad?

Presentation?

How is it different from Colabamin (B12) deficiency?

A

Thiamine deficiency in alcoholic patients.

Triad of encephalopathy, oculomotor dysfuction, and gait ataxia

They present with altered mental status, gait instability, nystagmus, and conjugate gaze palsy. There is also reduced ankle reflex.

B12 deficiency causes neurologic deficits including impaired vibratory and position sense, gait abnormalities, and megaloblastic anemia. Occulomotor symptoms are unusual.

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7
Q

What is the severe form of Wernicke’s encephalopathy?

A

Korsakoff’s syndrome, with irreversible amnesia, confabulation, and apathy

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8
Q

Lewy body dementia:

Presentation:

Pathology:

Txt:

A

**Presentation: **Alterations in consciousness, disorganized speech, visual hallucination, extrapyramidal symptoms (inc lower ext tone), and compromised executive functions

Pathology: Lewy bodies = eosinophilic intracytoplasmic inclusions representing accumulations of alpha-synuclein protein. Seen in substantia nigra, locus ceruleus, dorsal raphe, and substantia innominata

**Txt: **acetylcholinesterase inhibitors like rivastigmine, or atypical antipsychotics

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9
Q

Side effects of:

Simvastatin:

Angiotensin receptor blocker:

A

Simvastatin: muscle injury, causing rhabdomyolysi, leading to renal failture. Lab shows elevated creatine phosphokinase. It can also cause elevated transaminases

Antiotensin receptor blocker: hyperkalemia, hypotension, and renal failure

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10
Q

Pheochromocytoma: what are released, presentation, lab finding, and txt

A

Released substance: catecholamine (epinephrine, norepinephrine, dopamine)

Presentation: paroxysmal Sx of high BP, palpitation, abdominal pain, tremor, excessive sweating

Lab: elevated urinary vanilylmandelic acid level

Txt: alpha blocker first, then followed by beta blockers. Only beta blocker is dangerous because there is unopposed alpha activation, leading to spike in BP

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11
Q

Non-ketotic hyperglycemia:

Cause:

Dx:

A

Cause: stressor like infection causes elevation of cortisol and catecholamine –> counter insulin

Dx: Serum glulose > 600mg/dL –> serum hyperosmolarity

Sx: Dehydration by osmotic diuresis, altered consciousness, blurry vision (change in lense thickness and intraocular hypotension)

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12
Q

Sx of Creutzfeld-Jakob disease?

A

Also called Spongiform Encephalopathy

Sx: rapid progressive dementia, myoclonus and sharp, triphsic, synchronous discharges

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13
Q

Pathogenesis of Parkinson’s disease? Sx?

A

Progressive loss of nigrostriatal dopaminergic neurons

Sx: bradykinesia, resting tremors, cogwheel rigidity, shuffling gaite and masked facies

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14
Q

Pathogenesis and Sx of Huntington’s dementia?

A

A defect in autosomal dominant gene on chromosome 4 causes striatal neuro-degeneration.

Early onset of dementia between 35-50 years old, progressive choreiform movements of all limbs, grimacing and ataxic gait

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15
Q

Alzheimer’s dementia: histopathological findings

A

Amyloid plaques, neurofibrillary tangles, and selective loss of cholinergic neurons

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16
Q

Pick’s disease: Presentation, Sx and pathogenesis?

A

Presentation and Sx: Females in their 50s, changes in personality and language, some in cognitive

Pathogenesis: neurodegenerative disease of the frontal and temporal lobe

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17
Q

What is the antidote for:

  • Opiate intoxication
  • Benzodiazepine O/D
A

**Opiate intoxication: **naloxone

**Benzodiapezine O/D: **competitive antagonist of the GABA receptor, such as flumazenil

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18
Q

Presentation of central retinal vein occlusion?

Prediposing conditions?

A

Acute, painless, monocular loss of vision, with “blood and thunder” appearance on fundoscopic exam, including optic disk swelling, retinal hemorrhage, dilated vein, and cotton wool spots

Associated with coagulopathy, hyperviscosity, chronic glaucoma, and atherosclerotic risk factors

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19
Q

Complications and treatments for increased serum homocysteine?

A

**Complications: **venous thrombosis, PE, and atherosclerosis due to vacular damage, activation of clotting mechanism, and inhibition of antithrombotic pathways.

**Treatments: **Start pt on heparin and warfarin therapy. Then also add B12, folate and cobalamine because these are co-enzymes for the breakdown pathways of homocysteine. These might lower the level of homocysteine, but might not reserve hypercoagulability.

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20
Q

What medication can precipitate acute angle glaucoma vs treat it?

A

Atropine can dilate pupil and thus worsens glaucoma

Txt: IV mannitol (osmotic diuretic); topical acetazolamide (carbonic anhydrase inhibitor, reduces aqueous humor production), topical Pilocarpine (opens up the canal of Schlemm to allow drainage), topical timolol (decreases production of aqueous humor)

21
Q

What is blastomycosis? Presentation? Txt?

A

Blastomycosis: fungal disease

Presentation: pt from Wisconsin, Ohio River basins, with pulmonary sx (coughing, night sweat, F, wt loss), verrucous, crusted skin lesions, bone lytic lesions

Txt: Itraconazole or amphotericin B

22
Q

What medical condition is pretibial myxedema associated with? Presentation?

A

Grave’s disease hyperthyroidism

Presentation: nonpitting thickening and induration and induration of the skin over the lower legs, pretibial area, or dorsum of feet.

23
Q

What is a quick test for lactose intolerance? Mechanism?

A

Hydrogen breath test

A sign of bacterial carbohydrate metabolism

24
Q

What are the different androgens and their source in a female?

A

Ovaries: Testosterone, androstenedione (AS), and dehydroepiandrosterone (DHEA)

Adrenal gland: DHEA-S

Note: DHEA-S and HDEA are converted to testosterone by 5-alpha reductase in the peripheral tissues

25
Q

What are the complications of subarachmoid hemorrhage?

A

Within the first 24 hr: rebleeding

After 3 days: vasospasm and infarction

Hydrocephalus/increased intracranial pressure

Seizures

Hyponatremia

26
Q

What is pseudotumor cerebri? Risk factors? Txt?

A

Pseudotumor cerebri is idiopathic intracranial hypertension

**Risk factors: **overweight women of childbearing age, vitamin A (isotretinoin), tetracycline

**Txt: **- Stop the offending medications

   - Weight loss
   - Acetazolamide (carbonic anhydrase inhibitor)
27
Q

Normopressure hydrocephalus: cause, population, presentation?

A

**Cause: **impaired absorption of cerebrospinal fluid

Population: elderly patients

**Sx: **triad of impaired gait, cognitive difficulties, and urinary incontinence. Ct scan shows enlarged ventricles

28
Q

Multiple Endocrine Neoplasia Type 2 (MEN2): A vs B

  • Which is more aggressive?
  • Type of cancers?
  • Diagnosis?
A

- 2B is more aggressive

- 2A is associated with medullary thyroid cancer (METC), pheochromocytoma, and primary hyperparathyroidism

2B is associated with MTC and pheochromocytoma but no parathyroid, and also marfanoid habitus and mucosal neuromas.

- Diagnosis: PCR of the RET proto-oncogne

If positive, remove thyroid in childhood

29
Q

Describe the findings of diabetic retinopathy:

  • Simple retinopathy
  • Pre-proliferative
  • Proliferative
A

**- Simple retinopathy: **microaneurysms, hemorrhages, exudates, and retinal edema

- Pre-proliferative retinopathy: with cotton wool spots

- Proliferative retinopathy: newly formed blood vessels

30
Q

Restless leg syndrome: secondary causes, txt

A

Secondary causes: Iron deficiency, uremia, DM, MS, Parkinson disease, pregnancy, antidepressants, metoclopramide

**Txt: **- Iron supplement

  • Supportive measures (leg massage, heating pads, exercise, sleep well, stop medication)
  • Dopamine-agonists for moderate/severe symptoms, then alpha-2-delta calcium channel ligands (gabapentin)
31
Q

Primary biliary cirrhosis (PBC): cause, presentation, and txt?

A

Cause: antimitochondrial antibodies causing destruction of the intrahepatic bile ducts leading to bile stasis and cirrhosis

**Presentation: **pruritis, jaundice, steatorrhea, hepatosplenomegaly, increased alkaline phosphatase, serum bilirubin

**Txt: **initially give ursodeoxycholic acid, a bile acid. Definitive treatment is transplant

32
Q

Differentiate between chalazion, hordeolum, and style

A

**Chalazion: **chronic, sterile, granulomatous inflammatory lesion of meibomian glands ( a sebaceous gland at the rim of the eyelid)

**Hordeolum: **a purulen Staph infection of eyelid

**Style: ** a small, external hordeolum of Zeis’s or Moll’s glands

33
Q

Trichinellosis: life cycle

A

Ingestion of uncooked pork in Mexico or Asia –> 1 week later gastric acid releases larva –> they invade the small intestines and develop into worms –> 1 month later female worms release larvae whith migrates and encyst in striated muscle

34
Q

Location and clinical presentation of lacular infacrt?

A

Location: small vessels infarct affecting the deep subcortical structures.

Clinical presentation: face, arm and legs are equally affected. Usually unilateral pure motor or pure sensory, or sensorimotor mix, dysarthria-clumpsy hand, and ataxic hemiparesis

35
Q

Clinical presentation of middle cerebral artery stroke

A

Contralateral motor and/or somatosensory deficits. More pronounced in the face or upper limb than lower limb.

Involves homonymous hemianopsia or quadrantanopia

If the dominant lobe is involved, pt has aphasia; non-dominant lobe: hemineglect or anosognosia (lack of awareness)

36
Q

Presentation of anterior cerebral artery stroke?

A

Contralateral motor and/or sensory deficits, more pronounced nn the lower limbs than the upper limbs

There might be urinary incontinence from damage of the cortical micturition of the mesial frontal lobe

Gait dyspraxia, primitive reflexes (grasp etc), lack of will (abulia), and emotional disturbances

37
Q

Presentation of sarcoidosis

Pulmonary sx:

Non-pulmonary:

Lab:

Path:

A

Pulmonoary: cough, dyspnea. On CXR, paratracheal adenopathy and reticulonodular infiltrates

Non-pulmonary: erythema nodosum, anterior uveitis, and actue polyarthritis.

Lab: increased ACE level

Path: non-caseating granulomas

38
Q

What are acrochordons? Where can be find them?

A

Skin tags, or pedunculated outgrowths of normal skin.

Present on areas of acanthosis nigricans, or with pregnancy, or crohn disease

39
Q

Medication to treat arrhythmia:

Ventricular tachycardia:

Stable sustained monomorphic ventricular tachy:

Unstable arrhythmia(hypotention etc):

Atrial fibrillation with rapid ventricular rate:

Wolf-Parkinson-White (skipping AV node):

A

Ventricular tachycardia: Lidocaine

Stable sustained monomorphic ventricular tachy: antiarrhythmics (amiodarone, lidocaine, procainamide)

Unstable arrhythmia(hypotention etc): cardioversion

Atrial fibrillation with rapid ventricular rate: AV node blockers (beta-blocker, Ca chan., digoxin, and adenosine)

Wolf-Parkinson-White (skipping AV node): antiarrhythmic medications like procainamide, or cardioversion. **Avoid **AV node blockers

40
Q

Myasthenia gravis: pathogenesis, Dx, txt

A

Acetylcholine receptor antibodies that block these receptor, causing muscle weakness and fatigue

Dx: improved Sx with a short acting anti-cholinesterase, Edrophonium

Txt: Oral anticholinesterase, such as pyridostigmine, or neostigmine.

Atropine is used to counter side effects of muscarinic receptor activation

41
Q

Vasovagal syncope:

Inciting events: Young vs > 60yo

Sx:

Dx:

A

Inciting events: Emotional/orthstatis stress, vs micturion, cough, defecation

Sx: pallor, dizziness, nausea, diaphoresis, short duration syncope w rapid recover of consciousness, no confusion (postictal state)

Dx: upright tilt table testing

42
Q

Describe the 4 types of lung cancer: %, location, x

A

Adenocarcinoma: 50%, peripheral, clubbing, hypertrophic osteoarthropathy

Squamous cell carcinoma: 20%, central, necrosis, cavitation, hypercalcemia

Small cell carcinoma: 10%, central, Cushing syndrome, SIADH, Lambert-Eaton syndrome

Large cell carcinoma: 5%, peripheral, gynecomastia, galactorrhea

43
Q

Sx of systolic heart failure (eg cardiomyopathy) vs pericarditis

Similar:

Different:

A

Similar: weakness, exertional dyspnea, history of URI, hypotenstion, Right heart failure with jugular venous distension, peripheral edema

Different:

Cardiomyopathy: Left heart failure with pumonary crackles, S3

Pericarditis: cardiac tamponade, triad of hypotension, distended neck veins, muffled heart sounds, pulsus paradoxus with >10mmHg drop in systolic BP during inspiration (lower thoracic pressure –> more blood return –> enlarged RV pushing LV further), clear lungs, increased cardiac contractility and heart rate as compensation

44
Q

Neurological condition and associated imaging finding:

Alzheimer’s dementia:

Huntington’s:

Wilson’s disease:

Pick’s disease:

A

Alzheimer’s dementia: diffuse atrophy of the cerebral cortex

Huntington’s: atrophy of the caudate nucleus

Wilson’s disease: atrophy of tenticular nucleus

Pick’s disease: atrophy of the frontal and/or temporal lobes

45
Q

What is the Light criteria?

A

To differentiate between exudates and transudates

Pleural fluid/serum ratios of:

Protein: > 0.5

LDH: >0.6

Pleural fluid LDH > 2/3 of upper normal level serum LDH

46
Q

Which organism can cause similar Sx like TB in an immunocompromised pt?

Gram stain?

A

Norcadia!

Pneumonia with multiple nodules and cavitations.

However, 50% of pts have extrapulmonary dissemination to brain and skin

Branching, filamentous bacteria that is partially acid-fast (TB has no gram stain, and is full acid-fast)

47
Q

What are the step in treating ascites from chronic cirrhosis?

A

Start out with Na and water restriction (2L/day)

–> Spironolactone diuretic

–> furosemide to achieve <1 L per day

–> After medications are maxed out, do frequent abdominal paracentesis (2-3L/day) as long as renal function is okay

Shunts are reserved for bleeding from varices

48
Q

What is the Wallenberg syndrome?

A

Lateral medullar infarct, with vestibullo cerebellar findings.

Ipsilateral sensory and motor loss on face, but contralateral trunk/limbssensory sx.

49
Q

What are the 4 mechanisms of hypercalcemia in cancer patients?

A
  1. PTHrP production: 80% of the time! SCCa, breast, GU & GYN cancers
  2. Vit D production: lymphomas, causing inc Ca absorption from guts
  3. Bone mets: release of local factors to absorp bones.
  4. Ectopic PTH production: super rare

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