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USMLE Step 2 Flashcards

1
Q

Achalasia produced dysphagia to both solids and liquids at the same time.

A

Manometry is the most accurate test, endoscopy is useful to exclude malignancy.

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2
Q

Achalasia treatment

A

Mechanical dilation of the esophagus.

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3
Q

Esophageal cancer diagnostic testing

A

Endoscopy and biopsy is the only that can diagnose cancer. Barium is the best initial test. Tx is surgical resection.

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4
Q

Diffuse esophageal spasm diagnostic test

A

manometry (most accurate), Tx: CCB, nitrates, PPI’s.

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5
Q

Eosinophilic esophagitis test and treatment

A

Most accurate test is an endoscopy with biopsy, which shows multiple concentric rings. Best initial treatment PPI’s and the elimination of allergic foods.

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6
Q

Infectious esophagitis cause

A

90% due to candida, 10% due to CMV and herpes

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7
Q

Scleroderma test

A

Manometry- decreased lower esophageal sphincter pressure from an inability to close LES. Tx with PPI’s.

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8
Q

Alcohol and tobacco do not cause ulcers,

A

They delay the healing of ulcers.

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9
Q

We can not diagnose ulcers due to symptoms alone.

A
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10
Q

H pylori testing

A

Biopsy is the most accurate test

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11
Q

H pylori treatment

A

PPI’S + 2 antibiotics (clarithromycin and amoxicillin)
If no response, metronidazole, levofloxacin or tetracycline are allowed (only use of tetracycline).
Adding bismuth to a change in tx, may help to resolve tx resistant ulcers.
Retest for eradication.
Repeat endoscopy to exclude cancer as a reason for not getting better.

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12
Q

Platelet transfusion indication

A

When count is < 50,000 and there is active bleeding.

When count is < 10,000-20,000 to prevent spontaneous bleed.

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13
Q

Esophageal and gastric varices management

A

Octeotride (somatostatin) to decrease portal pressure.
Banding to obliterates esophageal varices.
Transjugular intrahepatic portosystemic shunting (TIPS)
Propanolol or nadolol to prevent subsequent episodes of bleeding.

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14
Q

Antibiotic-associated diarrhea best initial test and most accurate test and Tx.

A

stool C. diff toxin test, the most accurate test is PCR or NAAT. Tx is oral vancomycin, if there is no response, switch to fidaxomicin.

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15
Q

After multiples recurrences, use ______, or do a fecal _______. For fulminant, life-threatening infection, use _______ with _______.

A

Bezlotoxumab, transplantation, vancomycin plus metronidazole.

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16
Q

Whipple disease tx.

A

Ceftriaxone followed by TMP/SMX

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17
Q

How to differentiate between chronic pancreatitis and gluten sensitive enteropathy…

A

The presence of iron deficiency.

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18
Q

Celiac disease tests:

A

Anti-tissue transglutaminase (TTG) is the first test
Antiendomysial antibody
IgA antigliadin antibody
The most accurate diagnostic test is a small bowel biopsy.

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19
Q

Most accurate test in chronic pancreatitis is _____:

A

Secretin stimulation test

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20
Q

Carcinoid syndrome tx and best initial diagnostic test is ________.

A

Octeotride, urinary 5-HIAA test.

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21
Q

Irritable bowel syndrome tx:

A

Antispasmodic agents such as hyoscyamine, dicyclomine, peppermint oil, tricyclic antidepressant.

For diarrhea-predominant IBS: rifaximin, alosentron, eluxadoline.

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22
Q

When should screening occur in IBD?

A

8-10 years of colonic involvement, with colonoscopy every 1-2 years.

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23
Q

Which are the diagnostic test for IBD?

A

Endoscopy (MAT), radiologic testing (barium study), serologic testing when the diagnosis is still unclear.

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24
Q

Tx for IBD:

A

5-ASA derivatives (mesalamine)
UC: Asacol (mesalamine) or Rowasa if limited to the rectum.
CD: Pentasa or ciprofloxacin + metronidazole for perinatal CD.
Azathioprine and 6-MP, to wean patient off steroids.
Calcium an Vit D for all.

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25
Neither of the IBD is treated with surgery, only in the case of ______.
Obstruction in CD, but tend to recur at site of surgery.
26
Short bowel syndrome tx is ___, ____ and ____.
IV hyperalimentation, loperamide or Teduglutide (GLP agonist) and vitamin supplementation.
27
The loss of iliocecal valve causes____.
It lets the bacteria in. Tx with rifaximin.
28
Diverticulosis MAT is _____, BIT is _____.
Colonoscopy, CT scan.
29
Diverticulitis tx is ______ + _____.
Ciprofloxacin + metronidazole, ceftriaxone + metronidazole.
30
The most common complication after diverticulitis is ______.
Abscess formation
31
Colon cancer screening :
Routine test: beginning at 50, every 10 years If previous adenomatous polyp: every 3-5 years If history of colon cancer: 1 year after, then every 5 years. If family history of colon cancer: Single family member: screen 10 years earlier than the year at which family member developed cancer, then every 5 years. 3 family member (2 gen.)(HNPCC): screening at age 25 years with colonoscopy every 1-2 years. FAP: beginning at age 12, then every year.
32
Peutz-Jeghers syndrome is associated with:
Melanotic spots in lips and skin, increased frequency of breast, gonadal and pancreatic cancer. Frequency of colonoscopy is increased to every 3 years, starting at age 8.
33
Turcot syndrome is colon cancer associated with:
CNS malignancy
34
Juvenile polyposis is colon cancer in association with:
Multiple hamartomatous polyps.
35
Acute pancreatitis diagnosing tests:
Amylase and lipase (BIT) CT scan or MIR (MST): disease severity strongly correlates with the degree of necrosis seen on CT scanning. MRCP to determine etiology of the disease.
36
Autoimmune Pancreatitis association:
Unique feature of ANA and rheumatoid factor. Is associated with Sjogren syndrome, autoimmune thyroiditis, interstitial nephritis and sclerosing cholangitis. Tx is steroids.
37
Everyone with cirrhosis should get an U/S every:
6 months to screen for cancer.
38
Serum ascites albumin gradient (SAAG) is:
the difference or gradient between the serum and ascites, SAAG>1.1 is hilly suggestive of portal hypertension.
39
Acute alcohol hepatitis discriminant factor:
Discriminant factor = 4.6 x (patient's PT - control PT) + bilirubin If DF>32, treat with steroids.
40
In hepatopulmonary syndrome, look for _____.
Orthodeoxia, hypoxia upon sitting upright. Tx: transplantation
41
Viral hepatitis/ alcoholic hepatitis
ALT/AST
42
Primary billiard cholangitis presents with:
Normal bilirubin with an elevated alkaline phosphatase, fatigue, itching, xanthelasma, xanthomas, and osteoporosis.
43
Diagnostic test for primary biliary cholangitis includes:
Liver biopsy (most accurate, antimitochondrial antibody (most accurate blood test)
44
An important difference between Primary sclerosis cholangitis and Primary biliary cholangitis is:
PBC (cirrhosis) presents with normal bilirubin, and PSC (sclerosing) presents with elevated bilirubin.
45
Diagnostic test for primary sclerosing cholangitis:
MRCP or ERCP (MAT). No treatment is effective for PSC.
46
Hemochromatosis diagnostic tests:
``` Iron study (BIT) Liver biopsy test (MAT) ```
47
Tx for hemochromatosis is:
Phlebotomy; liver fibrosis can resolve if phlebotomy is begun before cirrhosis develops. If phlebotomy is contraindicated or of patient is anemic and has hemochromatosis from over transfusion, use chelation therapy with deferasirox, deferiprone or deferoxamine.
48
Hepatitis diagnostic tests:
Bilirubin, ALT, ALP. Aditional, there are disease-specific tests: IgM antibody (BIT), and PCR for Hep B and C. PCR is the first thing to improve with treatment and is best correlate of treatment failure.
49
Hepatitis tx:
Anti- CD20 medications: rituximab, ofatumumab, obinutuzumab. | Anti- CD52: alemtuzumab
50
Hep C tx:
Sofosbuvir plus ledipasvir or/ sofosbuvir plus velpatasvir.
51
Wilson disease diagnostic testing:
Slit-lamp examination for Kayser-Fleischer rings, a brownish ring around the eye from copper deposition (BIT) Urine test: increased copper excretion (MAT) Liver biopsy (most sensitive and specific)
52
Non-alcoholic fatty liver disease tx:
Use vit. E in everyone; obeticholic acid decreases progression, but it will not reverse severe fibrosis. If there is NASH plus diabetes, the tx is pioglitazone.
53
Focal nodular hyperplasia imaging shows:
Central stellate scarring, which is how you know it is benign.
54
Empty sella turca is associated with:
surgery, obesity, radiation therapy, and 70% are idiopathic.
55
When asking how to manage asymptomatic Empty sella turca:
Check thyroid and adrenal function
56
When testing for GH deficiency, do a:
Insulin stimulation test, GH increases glucose levels because is a stress hormone. Insulin-induced hypoglycemia is always the wrong answer.
57
Acromegaly BIT:
insulin like growth factor levels
58
Acromegaly MAT:
Glucose suppression test
59
Acromegaly tx is:
Transphenoidal resection of pituitary
60
Acromegaly medications:
Cabergoline (dopamine inhibits GH release) Octeotride (somatostatin inhibitor) Pegvisomant (GH receptor antagonist, inhibits IGF release from the liver)
61
Causes of elevated prolactin:
pregnancy, intense exercise, renal insufficiency, increased chest wall stimulation, hypothyroidism, acromegaly because prolactin can be consecrated with GH, antipsychotics, methyldopa, metoclopramide, opioids, tricyclic antidepressants and verapamil.
62
In hyperprolactinemia, diagnostic test includes:
Thyroid function test, pregnancy test, BUN/Creat (kidney disease elevates prolactin), LFT's.
63
Tx for prolactinemia
``` dopamine agonists (cabergoline) transphenoidal surgery ```
64
A follicular adenoma is a histologic reading that cannot exclude cancer. The only way to exclude thyroid malignancy is to remove the entire nodule. This is an in indeterminant finding on fine-needle aspiration.
65
Hypercalcemia on a EKG:
short QT and hypertension
66
Tx for hypercalcemia:
saline hydration, bisphosphonates (pamidronate, zoledronic acid), calcitonin (works faster) and prednisone when due to sarcoidosis or granulomatous disease.
67
Hypocalcemia can be due to hypomagnesemia due to:
Magnesium is necessary for PTH to me release from the gland. Low magnesium will lead to increased urinary loss of calcium.
68
Vit D deficiency test
25-hydroxyvitamin D
69
Hypocalcemia on an EKG:
prolonged QT, that can cause arrhythmia. Slit lamp exam shows early cataracts.
70
Paget disease of the bone diagnostic testing:
Technetium nuclear bone scan with findings of patchy areas of osteoblastic activity (MAT)
71
Paget disease of the bone tx:
asymptomatic: no tx needed, pain: bisphosphonates for main NSAID's, then calcitonin
72
Hypercortisolism BIT:
24hrs cortisol test or 1mg overnight dexamethasone suppression test. Expect some false positive in the presence of depression, alcoholism and obesity.
73
Best initial test to determine the cause or location of hypercortisolism is:
ACTH testing
74
Tx for hypercortisolism if surgery, but if not allowed or failed:
Pasireotide (somatostatin analog if surgery is not successful) Mifepristone (cortisol receptor inhibitor, if surgery os not possible)
75
Mitotane is given when:
Adrenal tumor that is not resectable, it acts as an inhibitor of steroidogenesis that is also cytotoxic to adrenal tissue.
76
Addison disease MST:
Cosyntropin stimulation test (synthetic ACTH, Cortisol level is measured before and after the administration of cosyntropin)
77
In patient suspected of adrenal insufficiency, it is critical to administer hydrocortisone. Tx is more important than diagnose.
Hydrocortisone possesses sufficient mineralocorticoid activity to be lifesaving.
78
BIT and MAT in hyperaldosteronism:
BIT: Ratio of plasma aldosterone to plasma renin; an elevated plasma renin excludes primary hyperaldosteronism. MAT: Sample the venous blood draining the adrenal.
79
Tx for hyperaldosteronism:
Laparoscopy for unilateral adenoma or eplenerone or spironolactone for bilateral hyperplasia or patients who can not have surgery.
80
BIT for pheochromocytoma:
levels of free metanephrines in plasma
81
Risk of death in DKA measure?
Serum bicarbonate level is a way of saying "anion gap", if bicarbonate is low, the anion gap is increased and the patient is at risk of death.
82
ACE int and ARB's are proven to decrease the rate of progression of nephropathy by decreasing intraglomerular hypertension.
83
DM decreases the ability of the gut to sense the stretch of the walls of the bowel. Stretch is the main stimulant to gastric motility.
Tx is metoclopramide or erythromycin, which increases gastric motility. If no response, choose a gastric pacemaker.
84
Neuropathy pain management:
Pregabalin, gabapentin or tricyclic antidepressants.
85
Renal insufficiency decreases insulin requirements.
86
Hirsutism causes:
Medications as: minoxidil, valproic acid, phenytoin, emotional distress, depression, polycystic ovarian syndrome, Cushing syndrome, congenital adrenal hyperplasia, androgen medication use, androgen-secreting tumor, or carcinoma.
87
Hirsutism management:
OCP, Espironolactone, Finasteride, Metformin (only in PCOS)
88
PCOS criteria diagnosis:
2 of the following: hirsutism and/or high testosterone, irregular menstruation, or 10+ cysts on pelvic sonogram with enlarged ovary (>10cm). Sonogram is not always necessary.
89
CHF (systolic dysfunction) causes:
HTN, infarction, cardiomyopathy, valve disease, alcohol, virus, radiation, adramycin, Chagas, hemochromatosis, thyroid disease, permpartum cardiomyopathy and thiamine deficiency.
90
Diagnostic testing in CHF:
- Echo (most important) - TTE (BIT) - MUGA - Nuclear ventriculogram (most accurate/most precise) - TEE
91
CHF most important Dx test, BIT:
Echocardiogram is the most important test and TTE is the best initial test. Other tests: MUGA, TEE, Nuclear ventriculogram, and BMP levels.
92
Tx for CHF:
ACEI/ARB: decreases mortality Sacubutril/valsartan: provides mortality benefit Betablockers: not mortality beneficial proven Mineralocorticoid receptor antagonist: (eplenerone) lowers mortality Digoxin: has not been proven to lower mortality. Diuretics: do not lower mortality.
93
Do not give beta blockers in the acute treatment of CHF.
94
CHT tx devices:
Implantable defibrillator, life vest, biventricular pacemaker( dilated cardiomyopathy and low EF)
95
Inhalation will increase venous return to the right side of the heart.
Right heart murmurs increases in intensity.
96
Exhalation will increase blood out of the lungs, (squeeze), to the left heart
increases left side murmurs.
97
Valvular diseases diagnostic tests:
Echocardiogram: MIT TEE: more sensitive/specific than TTE Cath: most accurate test.
98
Stenosis valvular disease tx:
Aortic: replacement Mitral: balloon dilation
99
For regurgitant valvular lesions vasodilator therapy with ACEI's/ARB's, nifedipine or hydralazine.
Mitral stenosis is defined as a valve surface area <1 cm.
100
Diagnostic test for Mitral Stenosis:
TEE (BIT) | Cath (MAT)
101
Dx test for mitral stenosis:
TEE (BIT), Cath (MAT)
102
Aortic stenosis murmurs heard at:
Valsalva and standing improve or decrease the intensity of the murmur from decreased venous return to the heart. Handgrip softens the murmur because of decreased ejection of blood.
103
Dx test for aortic stenosis
TTE, then TEE, then Cath.
104
Mitral regurgitation murmur increases with;
Handgrip, expiration, squatting and leg raising.
105
Aortic regurgitation physical findings:
Wide pulse pressure, bounding pulse, pulsating nail beds, Hill sign (BP in legs as much as 40mm Hg above BP in arms), head bobbing, diastolic decrescendo murmur, Valsalva makes it better; Handgrip, which increases after load by compressing the arteries of the arms, makes it worse.
106
MVP murmur will increase with:
Decreasing venous return (Valsalva, Standing).
107
MVP murmur will decrease with
squatting or handgrip

USMLE Step 2 (1 decks)

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