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STEP 3 > USMLE World > Flashcards

USMLE World Flashcards

0
Q

Describe the presentation of measles (rubeola)?

A
  1. Cough
  2. Coryza (thick runny nose)
  3. Conjunctivitis
  4. Koplik spots on buccal mucosa (gray pearl on a red base)
  5. Morbiliform rash (blotchy)
  6. Complications:
    • Otitis media
    • SSPE (Subacute Sclerosing Panencephalitis): total demylenation and scarring of the brain
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1
Q

Describe the pathophysiology of rubella (German measles) infection.

A
  1. Couple days of fever
  2. Swollen lymph nodes behind ear and neck
  3. Forscheimer spots (patchy erythema on soft palate)
  4. Dangerous to fetuses in first trimester
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2
Q

Which viral infection is complicated by SSPE (Subacute Sclerosing Panencephalitis)?

A

Rubeola

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3
Q

What is the presentation of Roseola?

A
  1. High fever

2. Rash after fever resolves (trunk -> extremities)

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4
Q

What is the most common cause of morbidity and mortality in SLE patients?

A

Renal involvement

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5
Q

Initial management of lupus patient with renal abnormalities?

A

Kidney biopsy

- If extensive abnormalities treat with IV Methylprednisolone

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6
Q

How do you monitor disease activity in patients with lupus nephritis?

A
  1. Serum complement or

2. Anti-ds DNA

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7
Q

What is the treatment for tuberculosis during pregnancy?

A
  • Isoniazid, Rifampin, and Ethambutol for a period of nine months.
    Multi drug-resistant tuberculosis
    – Isoniazid, Rifampin, Ethambutol, and Pyrazinamide
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8
Q

What is the most well-known side effect of ginkgo biloba?

A

Increased risk of bleeding and potentiation of the side effects of anticoagulation therapy through various mechanisms, including the inhibition of platelet activating factor.

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9
Q

What is the mechanism of action of alpha-1 blockers such as prazosin?

A
  1. Treatment of benign prosthetic hypertension
  2. Beneficial in patients with type two diabetes mellitus because it increase insulin sensitivity
  3. Decreases LDL cholesterol
  4. Increases HDL cholesterol
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10
Q

What is the treatment of torsade de pointes?

A

In an unstable patient
– Immediate non-synchronized electric defibrillation
If patient is stable
– Magnesium sulfate

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11
Q

Describe erysipelas

A
  1. Group a streptococcus
  2. A form of cellulitis
  3. Red, painful, and edematous, and elevated.
  4. Abrupt onset with the presence of systemic symptoms (fever, chills, malaise)
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12
Q

What puts a baby most at risk for intentional head trauma?

A
  1. Babies who are fussy
  2. Born to first-time parents
  3. Parents with no close family support
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13
Q

What is a common finding it and majority of infants with shaken baby syndrome?

A

Bilateral retinal hemorrhage (flame shaped)

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14
Q

What is the significance of blood seen on ultrasound in Morrison’s pouch?

A

This suggests that greater than 500 cc of free blood is present in the abdomen

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15
Q

What is the best testing modality for confirmation of acute aortic dissection?

A

Transesophageal echocardiography

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16
Q

What is the initial drug of choice for patients with aortic dissection?

A

Intravenous beta blockers (propranolol or labetalol)

– Goal: Reduce the systolic blood pressure to 100 to 120 mmHg and heart rate to less than 60 bpm

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17
Q

Describe Ménière’s disease

A

Classic triad

  1. Periodic vertigo
  2. Unilateral hearing loss
  3. Tinnitus
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18
Q

What is the next best step in patients with positive ELISA anti-HCV antibodies?

A

Confirm diagnosis by high-specificity testing (usually HCV RNA)

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19
Q

What is the pathophysiology of chronic myeloid leukemia?

A
  1. Translocation of chromosomes 9 and 22, which produces the Philadelphia chromosome
  2. The presence of the BCR/ABL fusion protein is diagnostic and results in unregulated tyrosine kinase activity
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20
Q

What is the initial treatment of choice for chronic myeloid leukemia?

A

Tyrosine kinase inhibitors such as IMATINIB

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21
Q

Before deciding to medically, surgically, or conservatively manage an incidentally detected unilateral adrenal mass what should you do?

A

Evaluation for hormone production should be completed first

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22
Q

What antibiotic is used in the treatment of all dog and cat bites?

A

Amoxicillin/clavulanate

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23
Q

Describe the evaluation of renal masses

A

Low likelihood of malignancy
– Ultrasound
If solid tumor is discovered on ultrasonography
– CT scan required for staging

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24
Q

Describe the presentation of renal cell cancer.

A
  1. Flank pain
  2. Palpable mass
  3. Non-glomerular hematuria
  4. Increase hemoglobin and hematocrit
  5. Smoking is a major risk factor
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25
Q

What is the initial treatment of Parkinson’s disease?

A

Dopamine agonist, such as pramipexole.

– Particularly in younger patients due to concerns about the long-term efficacy and side effects of Levodopa

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26
Q

What is a Kleihauer-Betke test?

A

– Measures fetal cells in maternal circulation

– Indicated when there’s a large antepartum bleed in a mother who is Rh negative

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27
Q

What is a subchorionic hematoma?

A

Bleeding in the gestational sack

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28
Q

How do you diagnose a subchorionic hematoma?

A

Ultrasound, which should be reevaluated with a repeat ultrasound one week later.

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29
Q

What is the treatment of a subchorionic hematoma?

A

– There are no known therapeutic interventions for this condition
– Women with this condition are managed expectantly

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30
Q

Describe gestational trophoblastic disease

A

– Aggressive malignant cancer in the uterus
– Only occurs after pregnancy
– Continued vaginal bleeding in a woman with recent history of hydatidiform mole, abortion, or term pregnancy.

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31
Q

What is the most troubling known complication of subchorionic hematoma?

A

Spontaneous abortion

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32
Q

Presentation of achalasia

A

– Difficulty in swallowing both solids and liquids

– Dysmotility type dysphasia

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33
Q

What is the gold standard for diagnosing active tuberculosis?

A

Sputum cultures (three specimens)

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34
Q

How do you diagnose latent tuberculosis infection?

A

– Tuberculin skin test

– Interferon gamma release assay (IGRA)

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35
Q

What is the marker for infectivity and tuberculosis?

A

Sputum microscopy for acid-fast bacilli
– Three negative sputum microscopy smears considered noninfectious
– However, patients with negative smears may still have active infection which will require treatment (treat while waiting for sputum culture results)

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36
Q

Which antihypertensive medication is commonly associated with photosensitivity reaction as a side effect?

A

Hydrochlorothiazide

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37
Q

Describe meningovascular syphilis

A

A condition where low-grade infection in the subarachnoid space affects the intracranial vessels and can eventually result in stroke.
– Treat with penicillin

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38
Q

What is the initial laboratory evaluation in patients suspected to have lead poisoning?

A

– CBC
– Serum iron and ferritin
– Reticulocyte count

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39
Q

What is progressive multifocal leukoencephalopathy?

A

An opportunistic infections seen in immunocompromised patients
– Predominately involves the cortical white matter
– Symptoms include: hemiparesis and disturbances in speech, vision and gate.

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40
Q

What is the best modality to confirm progressive multifocal leukoencephalopathy?

A

MRI

– Findings include: multiple demyelinating, non-enhancing lesions with no mass effect

41
Q

What is the most common long-term complication of a transurethral resection procedure (TURP)?

A 
Retrograde ejaculation (dry ejaculate)
– The bladder neck fails to close after the procedure, and enables the sperm to flow backward to the bladder.
42
Q

Common side effect of Clozapine?

A

Agranulocytosis

– Requires close monitoring of the white blood cell count

43
Q

Common side effect of valproic acid

A

Hepatotoxicity

– Patient requires regular monitoring of liver function test

44
Q

Common side effect of Lithum

A

– Hyperthyroidism

– Diabetes insipidus

45
Q

What must be checked before initiating lithium therapy?

A

Thyroid and kidney function

46
Q

What is the protocol for someone who has had percutaneous or mucous membrane exposure to HIV-infected bodily fluids?

A

4 weeks
Source patient has asymptomatic infection or low viral load
– 2 drug regimen using nucleoside reverse transcriptase inhibitors
Patient with high viral load
– Add a protease inhibitor to the above

47
Q

Systemic Inflammatory Response Syndrome (SIRS) criteria

A

Temperature: < 36°C or >38°C
Heart rate: >90 per minute
Respiratory rate: > 20 per minutes or PaCO2 < 32 mmHg
WBC: 12,000/mm3, or 10% bands

48
Q

What is the treatment in a patient with a possibly infected Hickman catheter presenting with symptoms of SIRS?

A

– Catheter removal is indicated, especially in patients who are hemodynamically unstable

Vancomycin:
– As the majority of catheter associated infections are due to coagulase negative Staphylococcus, and the majority of those are methicillin-resistant.
– Cefepime:
– Cephalosporin
– Pt with neutropenia or sepsis should receive gram-negative coverage as well

49
Q

What is the investigational procedure of choice for vertebral osteomyelitis?

A

MRI

50
Q

Describe McMurray’s maneuver

A

Used to detect presence of meniscal tears

  • Pt in supine position with the knee in maximum flexion.
  • One hand of the examiner is placed on the posteromedial margin of the involved knee, with the other hand supporting the foot.
  • The tibia is then externally rotated, and the knee is extended slowly
    • Positive: Audible click or popping sensation during extension
51
Q

Describe patellar tendon rupture

A
  • Excrucuating pain
  • Swelling in the anterior part of the knee
  • Inability to maintain passive extension of the knee against gravity
52
Q

What is the most common cause of secondary hypertension in young patients?

A

Reno parenchymal disease

53
Q

What is erythema nodosum?

A

– An initial manifestation of sarcoidosis

– Presents as erythematous and tender subcutaneous nodules over the lower legs, usually over the pretibial region

54
Q

What radiographic chest x-ray finding do you expect in patients with sarcoidosis?

A

Bilateral hilar adenopathy with or without right tracheal lymph node enlargement

55
Q

What is the most common complication of patients admitted to the hospital for acute variceal bleeding?

A

Bacterial infections
– Urinary tract infection, Spontaneous bacterial peritonitis, Respiratory infection, Aspiration pneumonia, Primary bacteremia

Prophylactic treatment with antibiotics for 7 to 10 days is preferred usually a fluoroquinolone (ofloxacin, norfloxacin, or ciprofloxacin)

56
Q

What is a hepatorenal syndrome?

A

A common cause of acute renal failure in patients with cirrhosis
– Diagnosis of exclusion: a fluid bolus is needed to confirm that renal failure is not secondary to intravascular volume depletion

57
Q

What is the treatment of choice for hepatorenal syndrome?

A

A combination of Midodrine and Octreotide along with albumin

– Only definitive treatment is liver transplant

58
Q

Describe iritis

A

– Characterized by: pain, redness, variable visual loss, and a constricted and irregular pupil
– Diagnosis confirmed by: visualization of leukocytes in the anterior segment

59
Q

What drug do you use to diagnose superventricular tachycardia’s?

A

Adenosine: by increasing the patient’s vagal tone (this can also be achieved with the Valsalva maneuver)

60
Q

What is the relationship between glucocorticoids and calcium?

A

– Decreases intestinal absorption
– Increases excretion in the urine

(Treatment should include administration of supplemental calcium and vitamin D)

61
Q

What is the relationship between patients treated with corticosteroids and bone density testing?

A

They should be evaluated with a baseline densitometry, and the test repeated every year as long as therapy continues

62
Q

Describe the standardized mortality ratio (SMR)

A

SMR = observed number of deaths/expected number of deaths

63
Q

How is neonatal polycythemia diagnosed?

A

When the peripheral venous hematocrit is higher than 65%

64
Q

What is the presentation of neonatal polycythemia?

A 
– Irritability
– Drowsiness
– Poor feeding
– Abdominal distention
– Hypotonia
– Apnea
– Hypoglycemia
– Hyperbilirubinemia
– Cardiac and respiratory compromise
65
Q

What is the treatment of neonatal polycythemia?

A

Adequate hydration and partial exchange transfusion

66
Q

What is the general description of potentially malignant nipple discharge?

A

– Spontaneous
– Unilateral
– Guaiac positive or grossly bloody
Screen for breast cancer with a mammogram

67
Q

What is Nelson’s syndrome?

A

Pituitary enlargement, hyperpigmentation, and visual field defect following bilateral adrenalectomy for Cushing’s disease

68
Q

What is the treatment for Nelson’s syndrome?

A

Surgery &/or local radiation

69
Q

What are some clues for diagnosing mitral stenosis?

A

– Low pitch, rumbling diastolic murmur
– Prominent pulmonary arteries at the hilum
– Elevation of the left mainstem bronchus
– Left atrial enlargement with a flattening of the left heart border
– Most commonly linked to a remote episode of rheumatic fever

70
Q

How do you manage pregnant patients with Eisenmenger syndrome?

A

– Recommend an elective termination of pregnancy

All patients with cyanotic congenital heart disease should be advised the same

71
Q

Describe the typical symptoms of diabetic gastroparesis

A 
– Early satiety
– Postprandial fullness
– Constipation
– Sweating during meals
– Labile glucose control
72
Q

With diabetic gastroparesis what is the difference in obtaining an upper G.I. endoscopy versus a nuclear gastric emptying study?

A

Upper gastrointestinal endoscopy or barium swallow
– Used to rule out a mechanical obstruction
Nuclear gastric emptying study
– Used to CONFIRM the diagnosis

73
Q

What is the treatment of diabetic gastroparesis?

A

Initially, dietary modification
– Smaller, more frequent meals with decreased fat and fiber intake
If dietary changes are insufficient promotility agents maybe used
– Erythromycin or Metoclopramide

74
Q

What medications are used to treat diabetic gastroparesis?

A

Erythromycin and Metoclopramide

– Promotility agents

75
Q

What’s fungal infection is common in bone marrow transplant recipients?

A

Invasive aspergillosis

– Typically involves the respiratory tract, including the lungs and sinuses

76
Q

In patients with PCP pneumonia, when is treatment with corticosteroids recommended?

A

– Alveolar to arterial gradient of 35 mmHg or more

– Arterial oxygen tension (PaO2) of 70 mm or less on room air

77
Q

What is acute retroviral syndrome?

A

Primary HIV infection
– Characterized by: low-grade fever, fatigue, maculopapular rash, headache, lymphadenopathy, pharyngitis, myalgias and arthralgias, gastrointestinal symptoms, night sweats, and oral ulcers or thrush
– Thrombocytopenia and leukopenia may also be noted

78
Q

What is the treatment for symptomatic, severely thrombocytopenic children with ITP?

A

Corticosteroids and/or intravenous immunoglobulin

79
Q

A previously vaccinated person who is potentially reexposed to rabies should receive what?

A

Only active immunization with a rabies vaccine

80
Q

A previously unvaccinated individual who is exposed to a potential source of rabies should receive what?

A

Both active (rabies vaccine) and passive (rabies immunoglobulin) immunization

81
Q

What is the initial test for diagnosis of suspected CAD?

A

Exercise electrocardiography

82
Q

What is the treatment for Paget disease of the bone?

A

Calcitonin or Bisphosphonate (reduces bone turnover) therapy

– May slow the progression of hearing loss, but does not appear to reverse the loss that has already occurred

83
Q

What is the management of patients with symptomatic lower extremity varicose veins?

A

Initially conservative measures
– Leg elevation
– Weight reduction
– Compression stockings

84
Q

When would you use injection sclerotherapy for a person with varicose veins?

A

Patients who have failed at least 3 to 6 months of conservative treatment (leg elevation, weight reduction, and compression stockings)

85
Q

How do you obtain sputum samples in children?

A

Morning gastric aspirate

– Often used to obtain bacteriologic samples from sputum swallowed during the night

86
Q

What is the treatment for latent tuberculosis?

A 
First-line: Isoniazid
– Nine months (children and adults)
Second-line (Isoniazid resistance): Rifampin
– Six months (children)
– Four months (adults)
87
Q

What is the protocol for a patient who has had unprotected sexual intercourse with an individual who is HIV-positive?

A

Two nucleoside reverse transcriptase inhibitors

– For 4 weeks

88
Q

What is the best diagnostic test for superior vena cava syndrome?

A

Contrast CT scan of the chest and neck

89
Q

What is the common presentation of superior vena cava syndrome?

A

– Dyspnea
– Orthopnea
– Neck pain and swelling
– Cervical and upper extremity venous dilation

90
Q

What strategy has been useful in decreasing mortality in ARDS patients?

A

Mechanical ventilation with low tidal volume

91
Q

Describe capillary hemangiomas

A

– Benign vascular lesion
– Evident at birth
– May undergo subsequent growth for a period of several months
– Spontaneous regression is usual

92
Q

What is the treatment for capillary hemangiomas?

A

Observation
– If, small in size, do not affect normal functioning, and do not constitute a significant cosmetic problem
Laser treatment
– Lesions at the site of potential functional impairment and on the face
Corticosteroids
– Used to treat rapidly growing lesions

93
Q

Which issues can an adolescent be treated for, without parental consent?

A 
– Pregnancy
– Contraception
– Sexually transmitted diseases
– Substance use
– Emotional illness
94
Q

What is the difference in presentation in patients with peritonitis, versus those with renal colic?

A

Peritonitis
– Tend to lie flat and motionless to limit irritation of the peritoneum
Renal colic
– Tend to writhe in pain

95
Q

What is the best modality to detect possible rupture of the bowel leading to a pneumoperitoneum?

A

Upright chest x-ray

This position insures that any air within the peritoneal cavity can be visualized beneath the diaphragm

96
Q

What you use to confirm the diagnosis of acute pancreatitis?

A

Elevated LFTs including serum lipase (more sensitive and specific than amylase)

97
Q

What is the treatment for mild acute pancreatitis?

A

Adequate pain control (narcotics) and intravenous fluid resuscitation

98
Q

Describe malignant otitis externa

A

– Typically seen in elderly patients with diabetes mellitus
– Marked pain (otalgia)
– Purulent drainage or discharge (otorrhea)
– Granulation tissue at the floor of the bone-cartilage junction in the external auditory canal is pathognomonic
– Pseudomonas aeruginosa is the usual causative organism

99
Q

What is the treatment of malignant otitis externa?

A

Anti-pseudomonal antibiotic therapy
– Fluoroquinolones (ciprofloxacin), antipseudomonal penicillins (piperacillin, ticarcillin) with our without aminoglycosides, and third-generation cephalosporins (Ceftazidime)
– All patients should be treated with IV antibiotics initially then switched to oral, to complete 6 to 8 weeks

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