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USMLE Step 3 > USMLE STEP 3 > Flashcards

USMLE STEP 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

What distinguishes septic shock from other causes such as cardiogenic shock and hypovolemic shock?

A

-septic shock has DECREASED SVR and INCREASED mixed venous oxygen saturation

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2
Q

findings in cardiogenic shock

A

-low cardiac index (pump function), increased PCWP (surrogate for left atrial pressure), and increased SVR

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3
Q

cardiac tamponade hemodynamic findings

A

-increase in right atrial and ventricular pressures, along with a equalization of right atrial, right ventricular end diastolic, and PCWPs

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4
Q

PE hemodynamic findings

A
  • increased right atrial, right ventricular, and pulmonary artery pressures
  • may have HYPERdynamic left ventricular function w/ increased CI
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5
Q

Pts w/ significant left ventricular dysfunction and cardiogenic shock have DECREASED cardiac index and INCREASED PCWP. SVR is typically increased.

A

.

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6
Q

causes of fetal dilated cardiomyopathy

A
  • inherited metabolic disorders, intrauterine infections, and malformation syndromes such as cri du chat syndrome
  • will show diffuse 4 chamber dilatation on echo
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7
Q

hypoplastic left heart syndrome

A
  • hypoplastic left ventricle on echo

- infants appear stable at birth but experience heart failure and shock following closure of the ductus arteriosus

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8
Q

Ebstein’s anomaly

A
  • atrialized right ventricle
  • seen in infants of mothers who have taken lithium during pregnancy
  • pts present w/ tricuspid regurgitation and cyanosis in infancy
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9
Q

thickened pericardium may cause pericardial tamponade

A

.

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10
Q

Maternal hyperglycemia during pregnancy

A
  • may result in excessive glycogen deposition in the fetal myocardium. This causes fetal hypertrophic cardiomyopathy and possible CHF. The INTERVENTRICULAR SEPTUM is the most commonly affected, resulting in ventricular outflow obstruction
  • may also cause macrosomia, hypocalcemia, hypoglycemia, hyperviscosity due to polycythemia, respiratory difficulties, cardiomyopathy, and CHF.
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11
Q

The interventricular myocardial hypertrophy and outflow obstruction that may occur in an infant born to a diabetic mother w/ poor glycemic control during gestation typically resolves spontaneously following birth.

A

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12
Q

Post-op urinary retention

A
  • risk factors: age > 50, surgery > 2 hrs, > 750mL intraop fluids, regional anesthesia, neurologic disease, underlying bladder dysfunction, previous pelvic surgery
  • clinical features: decreased urine output, abdominal distention, suprapubic pressure/pain
  • management: indwelling catheter, clean intermittent catheterization
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13
Q

aggressive volume replacement and anesthesia during surgery may cause bladder dysfunction, resulting in post-op urinary retention (inability to void). Management includes urinary catheter placement, which is both diagnostic and therapeutic.

A

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14
Q

Abrupt cessation of an antiepileptic drug is NOT recommended. Any antiepileptic drug that needs to be withdrawn due to intolerable side effects should be tapered gradually (over days to weeks) to prevent seizure relapse.

A

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15
Q

Pts w/ signs and symptoms of phenytoin toxicity (nystagmus on far lateral gaze, blurred vision, diplopia, ataxia, slurred speech, dizziness, drowsiness, lethargy, and decreased mentation) should be initially managed by altering the drug dosage or tx schedulee to minimize drug peak levels.

A

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16
Q

how to diagnose intussusception

A

barium enema

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17
Q

how to diagnose infantile hypertrophic pyloric stenosis

A

ultrasound

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18
Q

how to diagnose duodenal atresia or malrotation

A

abdominal x-rays

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19
Q

Infantile hypertrophic pyloric stenosis

A
  • male infant aged 3-6 wks who develops postprandial projectile vomiting, non-bilious, non-hematogenous
  • palpable olive-shaped mass in RUQ
  • hypochloremic, hypokalemic metabolic alkalosis
  • diagnosed w/ US (or possibly upper GI contrast study)
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20
Q

Electrolyte derangements and dehydration must be corrected before proceeding w/ surgical correction of infantile hypertrophic pyloric stenosis!

A

.

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21
Q

usage of which antibiotic is associated w/ the development of infantile hypertrophic pyloric stenosis?

A

-ERYTHROMYCIN

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22
Q

Nicotine replacement therapy is helpful in ameliorating the sx of nicotine withdrawal during smoking cessation. Combining a long-acting NRT (eg, patch) w/ a short-acting NRT (eg, gum, lozenge, nasal spray), termed a “patch-plus” regimen, is more effective than either modality alone. Varenicline is proven effective, but watch out for suicidal thoughts and depressed mood. Buproprion is effective, but contraindicated in those w/ seizure hx or eating disorder because it lowers seizure threshold.

A

.

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23
Q

Pts w/ peri-infarction pericarditis typically have pleuritic chest pain and a pericardial friction rub <4 days following an acute MI. The characteristic ECG changes of diffuse PR depression and ST elevation may also be present, but can be masked by ECG changes of recent MI. Tx is high dose aspirin.

A

.

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24
Q

When pharmacologic therapy is needed, high-dose aspirin is the tx of choice for symptomatic management of peri-infarction pericarditis. Stronger anti-inflammatory agents (eg, NSAIDS, corticosteroids) should be avoided as they may impair myocardial healing and increase the risk of ventricular septal or free wall rupture.

A

.

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25
Q

A “hot” nodule within a “cold” thyroid on radioiodine uptake scan

A

-indicates presence of a hyperfunctioning adenoma

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26
Q

Diffusely increased uptake on radioiodine scan of thyroid

A
  • Graves’ disease
  • due to anti-thyrotropin receptor autoantibodies that stimulate iodine uptake and thyroid hormone synthesis
  • T3 is more elevated than T4
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27
Q

Increased patchy radioiodine uptake of thyroid

A
  • toxic multinodular goiter (TMG)
  • most common in older pts, and thyrotoxic sx are generally subtle, if present at all
  • thyroid diffusely enlarged, but usually not tender
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28
Q

Subacute thyroiditis (de Quervain’s thyroiditis or granulomatous thyroiditis)

A
  • hyperthyroid sx w/ fever and a PAINFUL, diffusely enlarged thyroid
  • caused by inflammatory infiltrate in the thyroid w/ subsequent release of PREFORMED thyroid hormone, leading to suppressed TSH and DECREASED radioactive iodine uptake
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29
Q

common causes of thyroiditis w/ thyroid pain and tenderness

A
  • subacute thyroiditis (postviral inflammation)
  • infections (bacterial suppuration)
  • radiation thyroiditis
  • vigorous palpation - or trauma-induced thyroiditis
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30
Q

subacute thyroiditis is a self-limited condition. Tx consists of NSAIDS for pain relief and beta-blockers to minimize hyperthyroid sx. Pts w/ pain that is severe or does not respond to initial measures may require corticosteroid therapy.

A

.

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31
Q

cosyntropin test

A

-usually used in evaluation of pts w/ adrenal insufficiency

32
Q

plasma ACTH levels

A
  • measured when screening test for Cushing’s syndrome (overnight dexamethasone suppression test) is positive
  • ACTH levels are always interpreted w/ simultaneous measurements of plasma cortisol
33
Q

Incidentally discovered small lesions in the sellar region (pituitary incidentaloma) are very common. Pts w/ small mass or lesion without any hormonal dysfunction can be safely followed by periodic assessment of the pituitary gland w/ MRI.

A

.

34
Q

The area under the curve (AUC) of a receiver-operating characteristic (ROC) curve is a reflection of DIAGNOSTIC ACCURACY. A larger AUC means better discrimination and higher diagnostic accuracy.

A

.

35
Q

Receiver-operating characteristic (ROC) curve

A
  • fora given diagnostic test, plots sensitivity on y-axis and (1-specificity) on x-axis
  • can help determine the best cutoff point to use depending on the optimal desired parameters for sensitivity and specificity
36
Q

methotrexate

A
  • dihydrofolate reductase inhibitor

- used in management of ectopic pregnancy in hemodynamically stable pts

37
Q

misoprostol

A
  • synthetic prostaglandin
  • causes uterine contractions and expulsion of retained products of conception
  • used in medical management of spontaneous abortion
38
Q

Pts w/ septic abortion

A
  • have fever, tachycardia, hypotension, lower abdominal pain, and mucopurulent cervical discharge
  • medical emergency! managed w/ broad-spectrum IV antibiotics and surgical evacuation of the uterine contents via suction curettage
39
Q

gestational diabetes mellitus (GDM)

A
  • pts can discontinue anti-hyperglycemic therapy after delivery
  • however, pts w/ GDM are screened 6-12 wks postpartum w/ a 2-hour oral glucose tolerance test due to the association between GDM and type 2 DM
40
Q

meralgia paresthetica

A
  • very common syndrome that is caused by the entrapment of the lateral femoral cutaneous nerve
  • exam reveals an area of decreased sensation over the anterolateral thigh without any muscle weakness or deep tendon reflex abnormalities
41
Q

femoral nerve lesion

A
  • causes anterior and anteromedial thigh paresthesia

- accompanied by quad muscle weakness and decreased knee jerk reflex

42
Q

L5 and S1 radiculopathies are typically accompanied by back pain that radiates down the lateral or posterior aspect of the leg. Weakness of the muscles supplied by the corresponding segment is usually present.

A

.

43
Q

obturator nerve lesion

A

-sensory loss over medial thigh and weakness in leg ADDuction

44
Q

meralgia paresthetica

A
  • clinical diagnosis

- benign condition, and tx includes reassurance, weight loss, and the avoidance of tight-fitting garments

45
Q

ABCDE criteria for assessing likelihood of malignancy in a pigmented skin lesion

A
  • A: assymetry
  • B: border irregularities
  • C: color variegation
  • D: diameter >6 mm
  • E: evolving size, shape, or color
46
Q

cafe-au-lait macules

A

-characteristic feature of neurofibromatosis

47
Q

a Herald Patch

A
  • pruritic 2-10cm pink/tan colored lesion which usually appears on the back and is an early sign of PITYRIASIS ROSEA
  • within several days, numerous similar but small lesions are usually seen
48
Q

Acanthosis nigricans

A

-abnormal pigmentation of flexural areas and is often associated w/ insulin resistance

49
Q

Pts w/ skin lesions suspicious for melanoma should have excisional biopsy to include the entire lesion w/ 1-3mm margins of the surrounding skin and subcutaneous fat.

A

.

50
Q

Pulmonary contusion

A
  • most common lung parenchymal injury seen in pts w/ blunt chest trauma
  • chest x-ray generally reveals homogenous opacification of the lung fields that do not conform to a specific anatomic segment of the lung
51
Q

all pts w/ significant blunt chest trauma and pulmonary contusion should be admitted to the hospital and monitored for signs of clinical deterioration.

A

.

52
Q

Peritonitis from hollow viscus perforation should be suspected in pts experiencing sudden-onset abdominal pain w/ significant tenderness and guarding. Pts w/ peritonitis tend to lie still to minimize peritoneum irritation. An upright chest x-ray showing pneumoperitoneum can identify perforation.

A

.

53
Q

Barium esophagram

A
  • indicated for the evaluation of dysphagia (eg, pts w/ suspected hiatal hernia, achalasia, esophageal webs)
  • contraindicated in pts w/ suspected perforation
54
Q

Octreotide infusion

A

-most commonly used for bleeding esophageal varices

55
Q

In preparation for expedited surgical intervention, pts w/ suspected or confirmed peptic ulcer perforation should receive IV fluid resuscitation, broad-spectrum IV abx, and IV PPIs

A

.

56
Q

Ogilvie’s syndrome (aka acute colonic pseudo-obstruction)

A
  • dilation of the cecum and right colon in the absence of a mechanical obstruction to the flow of intestinal contents
  • tends to involve the right side of the colon and not the small intestine
57
Q

Post-op adhesions are the most common cause of small bowel obstruction in pts w/ a hx of abdominal surgery. What are other common causes?

A

-hernia, neoplasm, volvulus, intussusception, stricture formation in pts w/ inflammatory bowel disease

58
Q

Pts w/ acute decompensated heart failure and evidence of fluid overload should be treated w/ IV diuretics as part of initial therapy.

A

.

59
Q

IV vasodilators (nitroglycerine or nitroprusside) should be used in addition to IV diuretics for rapid symptomatic relief in pts w/ acute pulmonary edema and severe, uncontrolled hypertension.

A

.

60
Q

An echo should be obtained in all pts w/ pulmonary edema to evaluate for potential precipitating causes of acute decompensated heart failure. .

A

.

61
Q

Relative risk (RR)

A
  • measure of effect that can be calculated in follow-up studies
  • ratio of: risk of a certain outcome in a given group, divided by, risk of that same outcome in another group
  • RR >1 indicates increased risk in the group in the numerator
  • RR <1 indicates decreased risk in the group in the numerator
  • RR=1 (null value) indicates no difference in risk between the groups
  • A CONFIDENCE INTERVAL THAT DOES NOT INCLUDE THE NULL VALUE REFLECTS STATISTICALLY SIGNIFICANT RESULTS
  • when assessing measures of effect, its important to recognize which groups are being compared as the interpretation of the measures can differ
62
Q

If the relative risk (RR) of an outcome in group A as compared to group B is x, then the RR in group B as compared to group A is 1/x.

A

.

63
Q

Toxic thyroid nodules (toxic adenoma)

A
  • increased radioiodine uptake in the nodule and suppressed uptake in the remainder of the gland
  • definitive tx w/ surgery or radioactive iodine ablation is recommended for pts w/ overt hyperthyroidism; surgery is preferred for those w/ large goiters, obstructive sx, or suspected thyroid cancer
  • pts should be pre-treated w/ antithyroid drugs (usually methimazole) to achieve euthyroidism prior to surgery; methimazole is preferred over propylthiouracil for most pts (except hyperthyroidism in pregnant women diagnosed in the first trimester of pregnancy)
64
Q

oral contraceptives increase the serum concentration of thyroid binding globulin (TBG). In normal pts, feedback loops promote increased endogenous production of thyroid hormones to compensate for the increased number of bound thyroid hormone molecules. However, pts w/ hypothyroidism cannot adequately compensate and an increased dose of levothyroxine is usually necessary.

A

.

65
Q

phenobarbital, phenytoin, carbamazepine, and rifampin all increase (ramp up) hepatic metabolism of thyroid hormones

A

.

66
Q

Chlamydia pneumonia in children

A
  • ABSENCE of fever, staccato cough, hx of or concurrent conjunctivitis, and auscultatory and radiographic findings out of proportion to the healthy appearance of the child.
  • although transmission takes place at birth, sx appear between 2 and 19 wks
67
Q

Adolescents do not need parental consent for contraception in most states. Pts should receive the type of contraception they prefer after a risk assessment and comprehensive counseling. Condoms should be used in conjunction w/ non-barrier contraceptives to prevent sexually transmitted infections.

A

.

68
Q

In digital injuries, tendons are more likely to be injured than arteries, veins, or nerves due to their relative, vulnerable, anatomic location.

A

.

69
Q

Paroxysmal supraventricular tachycardia (PSVT) and sinus tachycardia

A
  • common tachyarrhythmias
  • sinus tachycardia often has a gradual onset w/ normal P waves and narrow and regular QRS complexes
  • PSVT has sudden onset, often w/ unidentifiable P waves
  • different types of SVT, including atrioventricular nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia (AVRT), and atrial tachycardia; the term PSVT excludes atrial fibrillation and atrial flutter, other common forms of supraventricular arrhythmias
  • in PSVT: stable pts, next step is to identify type of SVT w/ use of IV adenosine or vagal maneuvers; unstable pts, need urgent cardioversion
70
Q

ECG in a. fib

A

-irregular rhythm w/ absent P waves

71
Q

ECG in a. flutter

A
  • “flutter waves” in a sawtooth pattern

- HR w/ 2:1 conduction is usually around 150/min

72
Q

ECG in ventricular tachycardia

A

-wide QRS complexes (>0.12 sec)

73
Q

ECG in sinus tachycardia

A
  • gradual onset

- normal P waves and narrow QRS complexes

74
Q

Wolff-Parkinson-White (WPW) syndrome

A

-ECG shows short PR interval (<0.12 sec), a delta wave at the beginning of the QRS complex, and widening of the QRS complex

75
Q

Anemia of chronic disease (anemia of chronic inflammation)

A
  • common complication of inflammatory conditions such as rheumatoid arthritis
  • management: treat underlying condition and ruling out concurrent causes of anemia
  • anti-TNF-a agents improve anemia of chronic disease in pts w/ RA
76
Q

Early neurosyphilis

A
  • may present w/ symptomatic meningitis, ocular syphilis, and otosyphilis
  • pts w/ syphilitic meningitis are usually not as sick as those w/ bacterial meningitis and frequently have a prodrome several days preceding presentation of meningitic sx
  • cranial neuropathies, especially of the optic, facial, or auditory nerves, can occur

USMLE Step 3 (1 decks)

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