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Step2 > USMLE Test 1 > Flashcards

USMLE Test 1 Flashcards

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1
Q

what is the greatest risk to a patient when giving them TPN

A

CLABSI

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2
Q

what is the most common infection associated with TPN

A

coagulase negative staph and klebsiella or pseudomonas

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3
Q

what is the risk with TPN after greater than 2 weeks

A

cholestasis

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4
Q

what would the ph, Po2, Pco2, and Hco3 be for ethylene glycol poisoning

A

low, normal, normal, bicarb is low

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5
Q

symptoms of ethylene glycol ingestion

A

flank pain, hematuria, oliguria, CN palsies, tetany- calcium oxalate crystals in the urine

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6
Q

symptoms of methanol ingestion

A

visual blurring, scotomoata, afferent pupillary defect, altered mentation

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7
Q

symptoms of isopropyl alcohol ingestion

A

CNS depresseion, disconjugate gaze, absent cilliary reflex, no increased anion gap or metabolic acidosis

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8
Q

what is a nonstress test and when is it reassuring

A

it is reactive and normal if during a 20 minute interveal the baseline is 110-160 there is moderate variability and there are >2 heart rate accelerations that peak >15 min over the baseline and last >15 seconds.

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9
Q

what does it mean if the Non stress test is reassuring

A

that means there is adequate fetal oxygenation and sufficient uteroplacemental fetal blood flow

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10
Q

what does a biophysical profile include

A

NST and ultrasound evaluation of amniotic fluid volume and of fetal tone, breathing, and general movements

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11
Q

what is a contraction stress test

A

administering oxytocin or using nipple stimulation until 3 contractions occur in 10 minutes and then observing the fetal heart tracing. This helps determine if the fetus is having a sleep cycle or hypoxia

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12
Q

what is vibroacoustic stimulation used for during preg

A

it can provoke fetal movement to determine if an NST is non-reactive due to deal sleep

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13
Q

lesion on food that progresses rapidly from a small erythematous macule to a larger non tender nodule with necrosis- what is the infection

A

ecthyma gangrenosum is from pseudomonas bacteria and it is from invastion through the media and adventitia of blood vessel

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14
Q

what type of infections are people who recently had chemo are more susceptible to– great negative or gram positive

A

gream negative

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15
Q

what is the medication associated with men with orthostatic hypotension

A

alpha blockers- tarazosin

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16
Q

patient had sore throat and dry cough with retrosternal chest pain radiating to the left arm- weakness, dizziness, and syncope- what is happening and loss of pulse during inspiration

A

this is pericardial terminate and there is pulses paradoxes from it because of the large decrease in the systolic blood pressure on inspiration. This pericardial tamponade can be from an acute myocarditits

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17
Q

what is the mot common cause of infectious myocarditis and pericardititsi

A

coxsackie virus

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18
Q

patient presents with fever, headache, seizures, confusion, stupor, over a few days- what is it

A

HSV encephalitits

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19
Q

what is the CSF for HSV encephalitits

A

lymphoctic pleocytosis, increased protein, increased RBC, and normal glucose. The eleavted RBC is from the hemorrhagic destruction of the frontotemporal lobes

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20
Q

when is the FEV1/FVC remaining normal or increased in the case of SOB

A

intersitisal lung disease or fibrosis- this has crackles as well. There is a decreased FEV1, FVC and TLC.

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21
Q

causes of interstitial lung disease

A

chronic dust eposure, drug toxicity, connective tissue disease. over 50 is most common, Usuallysmoking histroy

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22
Q

what is happening if the person has lower extremity pain with extension of the spin and spinal flexion resolves the pain- what test should you get to confirm

A

lumbar MRI for lumbar spinal stenosis

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23
Q

patient has hyper pigmentation, mediately mass what is being produced and what does it look like

A

it looks like Cushing and it is ectopic corticotropin

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24
Q

what kind of hormone is ACTH

A

polypeptide

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25
Q

what should you do if there is a prolonged act phase of labor and they are 7 minutes apart and the fetus is at -4

A

give oxytocin to augment

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26
Q

patient has a TIA from fib, what should you give to them asa medication to prevent continuation of this

A

rivaroxaban or heparin or warddarin.

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27
Q

what is specific for a TB pleural effusion

A

very high protein levels, lymphocytic leukocytosis, and low glucose levels,

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28
Q

patient has headaches, whose when leaving forward, one sided JVD, and facial swelling- what does the patient have and what should you do

A

probably lung cancer like small cell or lymphoma. May need to o endogenous stunting followed by radiation- palliative overall

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29
Q

what modifications can you do to prevent aspiration of food after stroke

A

raise the head of the bed

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30
Q

do NG tubes or PEGs reduce aspiration

A

no

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31
Q

what is sub epidermal bullae assoctied eith

A

bullous pemphigoid

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32
Q

MRI has multiple ring enahnging lesions at the grey white junction

A

metastatic cancer

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33
Q

when should folic acid supplementation be started for pregnancy

A

before pregnancy

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34
Q

when does the neural tube close

A

3-4 weeks

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35
Q

patient has progressive symmetric proximal muscle weakness and as what

A

polymyositits

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36
Q

what is the typical mark of myositits

A

Anti Jo1 and CK

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37
Q

what does tension pneumothorax do to venous return

A

it impedes venous return because the high intrathoracic pressure causes the right side of the heart to collapse

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38
Q

if a patient has UMN and LMN signs, what doe they have

A

ALS

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39
Q

what is preserved in ALS

A

sensation

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40
Q

pateint has starring spells, leg dragging, and confusion afterwards, what do they have

A

temporal lobe epilepsy

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41
Q

what is Todds paralysis

A

it is transient post seizure neurologic symptoms

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42
Q

what are the three things that are most common with gestational diabetes

A

respiratory distress syndrome, preterm delivery, fetal macrosomia

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43
Q

patient has pleuritic chest pain with pleural and pericardal effusion with an enlarged cardiac sillouette. This has elevated Creatinine, and is black what do why have

A

it is SLE

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44
Q

what are positive for SLE

A

antinuclear antibody, anti smooth muscle antibody, anti double stranded DNA, and antiphospholipid

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45
Q

what do you give for stable ventricular tachycardia

A

loading dose of IV amniodarone

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46
Q

what is adenosine used to treat

A

supraventricular tachycardia

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47
Q

person had a stricture that was dilated then has post-procedure neck pain, chest pain, and abdominal pain- what do they have

A

rupture and esophageal perforation

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48
Q

how do you confirm the diagnosis of esophageal perforation

A

need to do a contrast esophagram and or chest CT

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49
Q

what should you think if there are multiple calcifications on the pancreatic duct

A

chronic pancreatitis which are characteristic of chronic alocholics and they can have steatorrhea from it as well.

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50
Q

why would ABI values be elevated

A

calcifications with diabetes

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51
Q

patinet has weakness, leg cramps, that are persistent after the initiation of a thiazide diuretic, what is the primary issue. She also has HTN refractory to treatment. What is the disorder, what are the cramps from and what is the best screening and what is the treatment

A

primary hyperaldoseronism, should do CT, and spirolactone would help, they will have hypokalemia

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52
Q

severe hypercalcemia, localized pain, and increased phosphorus- what is it probably from

A

lung cancer, and this is from overproduction of 1,25 dihydroxyvitamin D, bone metals, and theis is hypercalcemia of malignancy

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53
Q

what is a very common side effect of roux-en-Y gastric bypasses?

A

gallstones

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54
Q

why are gallstones more common after gastric bypass

A

more common because they have gallstones from the weight loss. Prophylactic is ursodeoxycholic acid and is often administered for 6 months

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55
Q

what is a complication a few days after Roux en Y and presentation of it

A

anastomatic lead that is fever, tachycardia, tachypnea, and abdominal pain

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56
Q

patient has tonsillitis and proteinuria and dysmorphic red blood cells- what will be seen

A

red cell casts and dysmorphic red blood cells- usually ten or more days following

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57
Q

hypocalcemia and hyperphosphatemia in the setting of CKD. what is going on

A

secondary hyperparathyroidsim

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58
Q

what do you give for neurogenic bladder

A

cholinergic agents

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59
Q

what is used to treat urge incontince

A

muscarinic antagonists

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60
Q

systolic ejection murmur at the right upper sternal border that radiates to the carotids— what is it and why

A

aortic stenosis from degenerative calcification of the aortic valve leaflets

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61
Q

what counts indicated SBP

A

neutrophil over 250 and albumin grdient over 1.1.

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62
Q

what is the treatment for SBP

A

broad spectrum abx, which include third generation cephalosporins, and Fqs

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63
Q

patient with cirrhosis, confusion, and hepatic encephalpoathy- what is a common cause of high nitrogen states

A

GI bleeding can increase the nitrogen which would cause probelms

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64
Q

do you want to eat more or less protein during cirrhosis

A

low protein

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65
Q

what kind of becarb, Pco2 and ph is septic shock

A

metabolic acidosis, hyper metabolic state so there is a buildup of lactic acid from increased anaerobic metabolism.

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66
Q

patient with preceding URI t=hen heart failure

A

myocarditits

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67
Q

what commonly causes myocarditis

A

coxsackie B

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68
Q

eryhtematous plaques with silver scale and on the extensor surfaces

A

psoriasis

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69
Q

scaly puritic patches or plaques

A

cutaneous T cell lympoma

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70
Q

jaundice, weight loss, and abdominal discomfort-what is it

A

pancreatic cancer

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71
Q

child is vomiting blood, nausea, diarrhea and green diarrhea- have hypovolemic shock and lactic acidosis- what did the child consume

A

iron toxicity

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72
Q

what is a long term complication of iron ingestion from toxicity

A

bowel obstruction from scarring

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73
Q

what is acetominophen toxicity look like

A

nausea, vomiting, and heaptic toxcitiy, but not GI hemoorhage

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74
Q

back pain, subactue intermittent fevers with spinal and pulmonary disease- what is it

A

TB

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75
Q

TB usually hits what part of the lung

A

apices because higher oxygen tensions and slower lymph outflow and cavitary lesions

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76
Q

what other condition could cause atrial fib in an older adult

A

hyperthyroidism

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77
Q

acute pain and limited joint extension from twisting injury, slowly developing effusion, tenderness at thejoint line

A

it is a meniscal tear

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78
Q

in astrocytoma, what is the most important prognostic factor

A

these are graded by anaplasia

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79
Q

patient have multiple chain lymphadenopathy, splenomegatly, mild cytosine, and marked lymphocytic predominant leukocytosis- confirmed with what, and what is this and how is it treated

A

chronic lymphocytic anemia with smudge cells, and treated with rituximab and monoclonal antibody against CD20 expressed on B lymphocytes it is common first line therapy

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80
Q

patient is an IV drug user with fever and neurologic symptoms with infective endocarditis what do they have and what is the bug

A

viridans strep, staph aureus, and brain abscess.

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81
Q

what can confirm the diagnosis of brain abscess

A

gadolinium enhanced brain MRI

82
Q

sickle cell kid with septic shock and bacteria what do they have

A

strep penumo

83
Q

sickle cell with meningitits

A

stre prnumo

84
Q

sickle cell with bacterimia

A

strep prnumo or hflu

85
Q

osteomyelitits sickle cell

A

staph, or slamonella

86
Q

pneumonia in sickle cell

A

strp pneumo

87
Q

what alves do you have to do antibiotic prophylaxis for

A

prosthetic heart valve, previously history of endocardititss, structurally abnormal valve in a transplanted heart, certain congentital heart disease,

88
Q

acute dystonia- how to treat

A

diphenhydramine

89
Q

what is the most common type of ovarian cancer in o post menopausal women

A

epithelial ovarian carcinoma

90
Q

what is the most common tumor type in younger ovarian cancer

A

dysgerminoma in adolescents

91
Q

ovarian tumor with hyperestrogenism what is that

A

granolas cell tumor

92
Q

what is Meigs sundrome

A

ascites and pleural effusion which is from ovarian fibroma and is benign

93
Q

symptoms of SBO

A

severe colickly abdominal pain, vomiting, failure to pass flatus, stool, abdominal distention, and diffuse tenderness. Increased pain with hyperactive bowel sounds

94
Q

what is the triad of acute cholecystitis

A

constant right upper quadrant or epigastric pain, fever, and leukocytosis. Guarding from peritoneal abdominal irritation. This is from a setting of cystic duct obstruction of the cystic duct by gallstones.

95
Q

what are common risk factors of gallstones

A

obese, female, sex, older age, and pregnancy.

96
Q

what are other risks of gallbladder

A

rapid weight loss, hemolytic anemia, hyperlipidemia, billiard stasis

97
Q

what is the best treatment for PCOS trying to get pregnant

A

weight loss

98
Q

what is the treatment for BPH

A

this is from repositioning and reposting the displaced otoliths and techniques like the Epley maneuver

99
Q

mid-shaft break of the humerus disturbs what nerve

A

radial nerve

100
Q

supracondylar fracture of the humerus

A

median nerve

101
Q

medial epicondyle injury

A

ulnar nerve

102
Q

palliative intervention for pancreatic adenocarcinoma

A

endoscopic stent placement to relieve the CBD obstruction. Less invasive and risky than surgery.

103
Q

progressive large nonpainful unilateral pleural effusion with rapid weight loss- what is it

A

maligngat pleural effusion usually related to breast or lung cancer.

104
Q

what is the pleural fluid like in malignant plueral effusion

A

high lactic dehydrogenase levels

105
Q

sickle cell with anemia, leukocytosis, and signs of hemolysis, and has vaoocclusive pain on the thig

A

it is from microvascular occlusion from sickled disease. pain crisis on the top

106
Q

atrial fibrillation treatment

A

rate control with beta blockers

107
Q

wide fixed split S2- mid systolic ejection murmur

A

ASD more symptomatic in teen years

108
Q

eosinohillic poop

A

probably parasites

109
Q

intratubular cast formation with toxicity and neuphropathy

A

multiple myeloma

110
Q

what is the gene and for fragile X and what is the mental effects

A

it is FMR1 gene on the X chromosome and they are autistic

111
Q

delirum is treated with

A

haloperidol

112
Q

VSD murmur

A

oxygen saturation and increased right sided heart pressures. and low CO

113
Q

what would you see on cardiac catherrization for pulmonary embolism

A

low cardiac output, increased RAP, increased right ventricular pressure, elected pulmonary artery pressure

114
Q

what bugs tend to cause septic arthritis

A

gram positive and staph aureus

115
Q

why does a Meckles bleed

A

gastric mucosa erodes surrponding tissue

116
Q

if fibrinogen is low then

A

it is being used up so DIC would be an issue

117
Q

low pitched rumbling during diastole

A

rheumatic mitral stenosis

118
Q

how often do you mammogram

A

every 2 years

119
Q

what is the genetics behind hypertrophic cardiomyopathy

A

autosomal dominant genetic disorder of the cardiac sarcomere.

120
Q

what should the first intervention be for an early pressure ulcer

A

it would relieve pressure on the heals from pressure ulcers like pillows

121
Q

if there is a reaccumulation of pleural effusion after a thoracentisis what should be suspected

A

thoracentesis and it is difficulty breathing and hemodynamic instability right after the thoracentesis

122
Q

when the cremasteric reflex is gone, what is going on and what is the diagnostic step

A

testicular torsion and doppler ultrasound

123
Q

side effect of cisplatn

A

renal toxicity and hearing loss

124
Q

edema, proteinuria, and hhypoalbuminuria, with african descent and HIV infection- what is the cause

A

focal segmental glomerulosclerosis

125
Q

what nephritic syndrome is from hepatitis B and C

A

it is from membranoproliferazive glomerulonephritits

126
Q

hypoxia, acute respiratory distress and tachymea and hype without blood and pleural effusion after MVA

A

blunt thoracic trauma

127
Q

progression from absence seizure to myoclonic seizures and then generalized tonic clonic with urinary incontince- what kind is that

A

juvenile myoclonic epilepsy

128
Q

Lennox Gestalt is

A

diagnosed in underu7 with lots of seizures of various types and mental retardation

129
Q

what decreases the chest pain from reperfusion

A

venous dilation that decreased preload so oxygen demalnd will decrease

130
Q

kid corckscrew gut in the gut with contrast

A

midgut volvuls

131
Q

immunocompromised and over 50 are at risk for what type of meningitis besides neisseria and group B strep and hflu

A

listeria monocytogenes

132
Q

what is the best thing after the first treatment of gout

A

alcohol cessation and weight loss are firstline

133
Q

what is the parkinson in the brain pathology

A

decreased dopaminergic activity in the brain

134
Q

pancoast tumors

A

horner syndromes, shoulder pain, and C8-T2 neurological involvement- weakness or atrophy of the intrinsic hand muscles, pain and prosthesis of 4th and 5th digits, medial arm, and forearm, supraclavicular lymph node enlargement

135
Q

what is the murmur for AR

A

decrescendo diastolic murmur- this could be from aortic root dilation

136
Q

GBS CSF

A

elevated protein count and normal leukocyte counts

137
Q

what is the most common organism for the spinal abscess

A

staph aureus

138
Q

what is most common with vesicles on the palate and tonsillar pillars

A

herpangina and coxsackie A virus

139
Q

decreased SVR< decreased PCWP, and elevated mixed O2 saturation, cardiac index increases

A

districbutive or septic hock

140
Q

myelodysplasitic syndrome

A

hematopeotic stem cell neoplasm with dysplasia and cytopenias, and granulates and hepatospendomegative and ovalocytosis

141
Q

patient with high K should give what first

A

calcium gluconate

142
Q

pheo management

A

sustained and intermittent hypertension controlled by alpha and beta adrenergic blackout and alpha needs to go first

143
Q

chemo and now has a fever

A

neutropenia and then gets an infection

144
Q

transient paranoid ideation and depersonilzation- and poor sense of self

A

borderline personality disorder

145
Q

what endocrine thing can cause psychosis

A

hypothyroid

146
Q

what makes DKA patients nauseous

A

fatty acid breakdown

147
Q

what should be the first fluid for DKA

A

isotonic fluids with potassium supplementation

148
Q

what cells are seen with CLL

A

smudge cells because of increased fragility

149
Q

what is the most common infection of clabsi

A

coagulase negative strep

150
Q

pregnant woman has normal ventilation and perfusion scan and pain on the other side of the chest

A

they need a ventilation perfusion scan. Pregnant women cannot use d dimer

151
Q

what is another risk of spherocytosis

A

gallstones from hemolysis

152
Q

weird dreams on HIV medication

A

efavirenz

153
Q

what is urge incontinence and how do you fix it

A

detrusor overactivity and start with bladder training

154
Q

what is the gold standard for diagnosing placenta previa

A

transabdominal ultrasound

155
Q

blunt chest trauma and wide mediastinum and stable what should you do diagnostically

A

use a CT scan or a TEE

156
Q

what should you do for a bartholin cyst

A

I/D

157
Q

what is the other medication you cannot combine with a triptan and another migraine med

A

ergot derivatives because there is elevated bp

158
Q

treatment of kawaskai

A

IVIG and aspirin

159
Q

painless eye blurring, glair, halos around lights, and worsening distance vision- what is lost and what is there

A

cataracts and opacification and loss of the red reflex

160
Q

what is often a complication of splenectomy

A

secondary thrombocytosis

161
Q

what is common with urethritis and cystitis and sterile pyuria

A

it is treated chlamyydia

162
Q

what is the medication that increased longterm CHF persons

A

Beta blockers

163
Q

what endocrine disorder can lead to hyperprolactinemia

A

hypothyroidism

164
Q

what are risk factors for carpal tunnel syndrome

A

obesity, diabetes, and hypothyroid, and third trimester

165
Q

what is the best tocolytic for 32-34weeks gestation

A

nifedipine but it can cause flushing, headache, tachycardia, and palpiation

166
Q

what medication should be given for someone with lipemia serum

A

familial dysbetaproteinemia- with alcohol can lead to chronic pancreatitis- use fenofibrate for it

167
Q

when do you give steroids during preterm labor

A

<37 weeks who are at risk. also

168
Q

at 32 weeks and preterm labor then what to do

A

penicillin for strep B, and magneusm sulfate and toxolysis

169
Q

what nerve is compressed when the fifth and fourth fingers are numb

A

ulnar at the elbow

170
Q

slapped cheek rash

A

parvo B19

171
Q

rash on the chest a nd thorax

A

HHV6

172
Q

how to trat raynaud

A

nifedipine

173
Q

whatdo you see on urinalysis for rhabdo

A

false positive for blood

174
Q

broad waxy casts are seen when

A

in heavy CKD

175
Q

what is a child with chronic airway inflammation and hemotysis

A

CF

176
Q

what cancer risk is decreased with OCP

A

ovarian cancer

177
Q

what is the treatment for torsades

A

Magneusm

178
Q

painless monocular vision loss

A

retinal atherosclerotic lesion

179
Q

what is the best protection for cancer in kids from the sun

A

use of protective clothing

180
Q

five days of fever, malaise, headache, and nonpruritic painless pigmented maculopapular rash over the palms and souls with the diffuse lymphadenopathy

A

syphillus

181
Q

what is the mechanism of action of cdiff in the gut

A

toxin induced inflammation of the colonic mucosa

182
Q

late systolic murmur following a click heard at the apex

A

MVP

183
Q

eosinophils in the hepatic triads

A

allograft rejection

184
Q

if there is increased induration of TB test with negative CXR what do you do

A

begin isoniazid and B6 therapy

185
Q

relative the incidence of fractures was 10% of drug group X and 20% in the procedue group. Which of the following was most likelyy presented as the 50% reduction in fractures- what is the statistical test for it

A

relative risk reduction

186
Q

what antibiotics should you use for prophylaxis on knee replacement

A

parenteral cefazolin

187
Q

what does cefazolin cover

A

staph and strep and some negative coverage

188
Q

what does organophosphate poisoning hit- receptor site

A

peripheral muscarinic receptors

189
Q

what treats impetigo

A

topical mupirocin

190
Q

what should be used for newborn with onset of fever

A

IV administration of ampicillin and gentamycin

191
Q

what is primary hemophilia factor deficiency

A

factor VIII deficiency

192
Q

what are the PFT for asthma

A

FEV1 decreased, FVC normal, and TLC increased

193
Q

friable cervical ulcer that is bleeding and pregnant women is what

A

cervical cancer

194
Q

what is DIP changes are for

A

degenerative joint disease

195
Q

how do you prevent progression of CKD to failure in a child

A

restrict intake of phosphorus

196
Q

what is high decibel hearing loss from

A

exposure to high decibel sound

197
Q

what do you do for increased PPD skin test and negative CXR

A

isoniazid

198
Q

what is ascariasis cause

A

round worm and GI and lung

199
Q

what does enterobeous cause

A

pin worm

200
Q

what does trichophytan cause

A

ring worm

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