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USMLE Step 2 CK > UWorld Pass 2b > Flashcards

UWorld Pass 2b Flashcards

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USMLE® Step 1 flashcards
1
Q

Hypercalcemia in sarcoidosis, how?

A

1-alpha hydroxylase is produced in granulomatous activity -> increased 1.25-dihydroxyvitamin D

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2
Q

Tacrolimus side effects?

A

neurotoxicity, glucose intolerance,diarrhea

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3
Q

Treatment for pseudomonas?

A

gluoroquinolone

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4
Q

Causes of ACL injury? Signs?

A

Rapid deceleration, direction changes

Signs: “popping” sensation, significant swelling (effusion/hemarthrosis), joint instability

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5
Q

Primary biliary cholengitis- clinical findings?

A

fatigue, hepatomegaly, pruritis, icterus

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6
Q

Drugs that can cause pill esophagitis?

A

KCL, tetracyclines, bisphosphonates, NSAIDs

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7
Q

First step in anticoagulation with renal failure?

A

unfracitonalized herparin

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8
Q

Liver mass with central scar?

A

gocal nodular hyperplasia

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9
Q

Most common physical symptoms from pancoast tumor?

A

Shoulder pain

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10
Q

Diagnostic requirements for nacrolepsy

A

recurrent lapses in sleep or naps (3x/week for 3 months

plus 1 of the following:

  • cataplexy (brief loss of muscle tone precipitated by strong emotion)
  • low cerebrospinal fluid levels of hypocreit-1, shortened REM sleep latency
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11
Q

Thromboangitis obliterans Signs? AKA? Evaluation? Treatment:

A

AKA: buerger disease

Less than 45, smoking history, distal lumb ischemia, ulcerations due to nonatherosclerotic occlusion

Evaluation: ischemia on bascular studies (digital plethysmography), segmental occlusion of small and medium vessels on agiography

Treatment: smoking cessation

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12
Q

MCL tear cause? Signs

A

Cause: pivoting/twisting, lateral impacts

Signs-minimal swelling

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13
Q

Most common cause of spontaneous lobar hemorrhage over > 60?

A

amyloid angiopathy

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14
Q

Progressive loss of peripheral vision? Treatment?

A

open-angle glaucoma

Treatment: Mannitol

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15
Q

Abnormal thumbs, hypopigmented/hyperpigmented skin area, cafe au lait spots, middle ear abnormalities, aplastic anemia? Inheritance?

A

Ganconi anemia

Autosomal recessive or X-linked

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16
Q

Cardiac temponade is

A

rapid accumulation of blood in the pericardial sack

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17
Q

First step in management after exposure to infectious hep B?

A

Immunoglobulin and vaccinate

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18
Q

Affects of beta HCG on homrone levels?

A

total T4 increased,

free T4, unchanged/mildly increased

TSH decreased

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19
Q

Raynaud phenomenia- presentation

A

Bilateral upper hands

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20
Q

Signs of thyroid lympgoma?

A

hashimoto thyroiditis, rapidly enlarging, firm guiter with compressive symptoms and systemic B symptoms

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21
Q

Signs of secondary amyloidosis?

A

Extracellular deposits of polymeric protein, inflammatory arthritis, chronic infections, IBD, mmalignancy lymphona) vasculitis, aymptomatic proteinuria, nephrotic syndrome

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22
Q

Abdomianl pain with hip extension, think?

A

Appendicitis, psoas sign

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23
Q

Uncel herniation

A

dilation of the pupil ipsilateral, (oulomotor nerve compression) along with ipsilateral hemiparesis

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24
Q

Diagnosis?

A

Allergic conjunctavitis

associated with pruritus, nasal symptoms, no skin rash, watery discharge, URI signs

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25
Q

Signs of lead poisoning?

A

basophilic stippling, neurological deficits (foot/wrist drop, congitive dysfunction), GI pain, constipation, joint pain, muscle aches, microcytic hypochromatic anemia

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26
Q

common variable immunodeficiency? Treatment?

A

Presents in adolescence/adulthood, low levels of immunoglobulins from abnormal B-cell differentiation. Increased risk for respiratory infections from encapsulated organisms, giarfia lamblia

Treatment: immuniglobulin infusion

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27
Q

Chorionic villus sampling use? Time?

A

Use: definitive karyotupic diagnosis

Time 10-13

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28
Q

distented bowel loop in an inverted “U” shape? Cause?

A

dilated colon

Cause: Sigmoid volvulus

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29
Q

Lower abdominal tenderness, right upper quadrant tenderness, intermentral spotting?

A

Pelvic inflammatory disease

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30
Q

Bleedng disorder in antiphospholipid syndrome?

A

Prolonger partial thromboplastin time, nut not prothrombin time

Prothrombin time in normal due to binding of the lupus anticoagulant in vitro

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31
Q

Primary ciliary dyskinesia vs CF?

A

PCD has situs inversus, due to immobile spermatozoa, normal growth

CF- pacnreatic insuffiency, infertility due to absent vas deferens, failure to thrive

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32
Q

Treatment for severe hypercalcemia?

A

Aggressive hydration with normal saline, calcitonin to reduce serum calcium

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33
Q

Amikacin

A

aminoglycoside 0> can cause renal failure

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34
Q

Erysipelas? Diagnosis? Treatment?

A

Group A strep

infection of upper dermis and superfiscial lymphatic system

rapid development of symptoms due to inflammation, trauam, etc

rash is notable for raised, sharply demarcated borders

highly suggestive is involvement of outer ear

Diagnosis: blood cultures

Treatment: IB antibiotics (ceftriacone, cegazolin, amoxicillin (if not systemic)

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35
Q

Lorazapam vs chlordiazepoxide?

A

Chlordiazopoxide contraindivated in liver disease

Lorazapam-shorter acting, not metabolized by the liver

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36
Q

Mydruasus

A

Dilation of the pupil

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37
Q

chronic, watery diarrhea without eveidence of systemid symptoms and lactose deficiency? Signs? Pathology?

A

Microscopic colitis

Watery diarrhea, fecal urgency, incontinence, nocturnal diarrhea

Path: mononuclear infiltrate

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38
Q

What therapy can cause thickening and fibrosis of the pericardium?

A

Radiation therapy to the chest of rHodgkin lymphoma

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39
Q

Septic shock with elecated lvier enzymes?

A

Iscemic hepatic injury

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40
Q

Common causes of infective endocarditis?

A

Staphylococcal - healthcare-associated

stretococcal - community acquired

enterococci - nosocomial-acquired (Especially UTI)

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41
Q

Medications for colds that can cause hallucinations?

A

antihistamines

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42
Q

HIV patient with white matter lesions with no enhancement/edema? lumbar puncture findings? Treatment?

A

progressive multifocal leukoencephalopathy (JC virus)

LP: CSF PCR for JC virus

Treamtne: antiretroviral therapy

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43
Q

Cardiac manifestations of COPD?

A

4th heart sound

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44
Q

Contraindications to copper IUD?

A

anemia, heavy menstral bleeding

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45
Q

Ascertainment bias?

A

results from atypical population are extrapolated to the entire population

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46
Q

Treatment for heparin induced thrombocytopenia?

A

D/C heparin, anticoagulate with non heparin medication (argatroban, hondaparinux)

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47
Q

Signs of spontaneous bacterial peritonitis?

A

Temp > 100, abdominal pain/tenderness, altered mental status, hypotension,paralytic ileus with severe infection

(no nausea/vomiting/etc)

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48
Q

Bicept tendor ruptor cause? signs?

A

Cause-forceful flexion of the arm

Signs: sudden pain with an audible pop and visiblee pulge, where the muscle retacts into the arm

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49
Q

shiny tongue and macrocytic anemia?

A

B12 deficiency

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50
Q

non-anion gap acidosis and preserved kidney function

A

rental tubular acidosisr

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51
Q

Signs of hip dysplasia?

A

Child was limp “trendelenburg gait” when learning to walk

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52
Q

soft, rounded, well-demarcated dwelling at the point of the elbow? ROM?

A

chronic olecranon bursitis, range of motion is normal

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53
Q

After starting amiodarone therapy, how long before pneumonitis can present?

A

Months

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54
Q

midline defects, polydactyly, curis aplasia?

A

Patau (trisomy 13)

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55
Q

Aflatoxin B1 association?

A

Hepatocellular carcinoma

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56
Q

X-rays in chronic gout?

A

punched-out erosions with an overhanging rim of cortical bone known as a “rat bite”

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57
Q

familial adenomatous polyposis

A

colorectal cancer, desmoids, osteomas, brain tumors

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58
Q

Congenital effect of carbomazepine? Treatment?

A

folic acid deficiency, supplement with 4mg of folic acid

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59
Q

Fever, chest pain, hemoptysis

pulmonary nodules with halo sign

in immunocompromised patient?

A

Invasive aspergillosis

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60
Q

Decrease active and passive ROM?

A

adhesive capsulitis

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61
Q

Signs of hemochromatosis?

A

diabetes, hyperpigmented skin (sun exposed), elevated liver enzymes

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62
Q

How to reduce risk of HIV infection?

A

Circumcision of the infection partner, postexposure prophylacis

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63
Q

Organism responsible for infections in deep puncture wounds? Time?

A

P. aeruginosa

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64
Q

Tinea cruris- sign? Diagnosis?

A

Sign: annular lesions with partial central clearing, scay raised border

Diagnosis: KOH prep with septated (segmented) hyphae

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65
Q

baby with irregular breathing at birth?

A

considere positive pressure ventilation

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66
Q

Babesiosis? Risks?

A

intraerythrocytic rings (maltese cross), glu-like symptoms, anemia, thrombocytopenia, NE US

Protozoal illness, Ixodes scapularis

Rosl? splenectomy

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67
Q

what is clobeasol?

A

high potency steroid

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68
Q

Papillary muscle rupture post MI?

A

2-7 days post

Acute, severe, MR (hypotension, pulmonary edema, cardiogenic shock), no persist ST changes

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69
Q

CNS findings in fetal alcohol syndrome?

A

ADHD, learning disabilities, mental retardation

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70
Q

Disultram candidate?

A

Abstinent and highly motivated

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71
Q

Ovarian torsion vs rupture, doppler?

A

Ovarian torsion-decreased

rupture-normal

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72
Q

Diagnosis?

A

Arthritis mutilans

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73
Q

Preferred deliver method in preeclampsia?

A

Vaginal delivery, c-sections reserved for failed induction, or nonreassuring fetal heart tones

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74
Q

What are the B vitamins?

A

B1- thiamine

B2 - riboflavin

B3 - niacin

B6 - pyridoxine

B9 - folate, folinic acid

B12 - cobalamin

C - ascorbic acid

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75
Q

Cause of ARDS?

A

lung injury -> fluid/cytokine leakage into alveoli -> impaired gas exchange -> decreased lung compliance, PHTN

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76
Q

RBC casts?

A

glomerular nephritis

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77
Q

Theophylline? toxicity?

A

Theophylline-bronchodilator, used in asthma

Toxicity- CNS stomulation *headahce, insomnia, seizures, HI) cardiac toxicity (arrhythmia)

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78
Q

Most common symptoms on bronchietasis?

A

mucopurulent sputum streaked with blood, fatigue, weight loss

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79
Q

Post-menopausal woman with new breast mass, first step? Signs of malignancy?

A

Mammorgram

Signs: calcification

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80
Q

Granulomatous inflammation in growth, think?

A

syphilis

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81
Q

CMV pneumonia

A

duspnea, nonproductive cough, low-grade feve, patchy or diffuse ground-glass opacities

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82
Q

Signs of lateral epicondylitis?

A

pain with resisted wrist extension, pain with passive wrist flexion

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83
Q

How often should infants be fed?

A

Every 2-3 hours

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84
Q

Cholangitis vs acalculous cholecystitis?

A

Cholangitis has juandice, caused by gallstone or malignancy, elevated alk phos

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85
Q

Wiskott-Aldrich syndrome

A

Eczema, micriThrombocytopenia, recurrent infections

X-linked recessive defect in WAS protein

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86
Q

What bilirubin is elevated in hemolytic diseases?

A

Unconjugated (indirect)

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87
Q

Sertonin syndrome vs TCA

A

Serotonin has increased bowel sounds, hperreflexia, clonus

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88
Q

Risk factors for necrotizing enterocolitis?

A

Prematurity, very low birth weigh, reduced mesenteric perfusion (congenital heart disease), enteral feeding (formula > breast milk)

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89
Q

Location of damage in alcoholic cerebellar degeneration?

A

Cerebellar vermis

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90
Q

UMN signs and sisolated symmetric lower-extremity sumptoms

A

spinal cord compression

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91
Q

Risk associated with infectious mononucleosis?

A

Acute airway obstruction

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92
Q

Peutz-Jeghers syndrome

A

GI tract polyposis and mucocutaneous pigmentation, prococious puberty

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93
Q

bradycardia, AV block, hypotension, diffuse wheezing, overdose? Antidote?

A

Bet bloackers

Treatment: IV atropine, fluids -> glucagon (increased intracellular cAMP

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94
Q

What disease is associated with myasthenia gravis?

A

thymoma

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95
Q

c-section with severe abdominal pain, peritoneal signs, hemodynamic instability, vagnal bleeding?

A

Uterine dehiscence

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96
Q

igns of compartment syndrome

A

Pain out of proportion to injury, increased pain on passive stretch

Parasthesia in the first sign

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97
Q

Type of lesion in lung squamous cell carcinoma?

A

Cavitary

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98
Q

Cardiac manifestations of TCA toxicity?

A

QRS widening

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99
Q

Benztropine treatts?

A

dystonias and parkinsonism

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100
Q

INR target for heart valve replacement?

A

2.5-3.5 mitral, 2.0-3.0 aortic

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101
Q

saying for primary hyperaldosterism?

A

Aldosterone saves socium and pushes potassium out

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102
Q

What does an odds ratio less than 1 suggest?

A

negative association (decreased risk)

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103
Q

Why is serotonin syndrome increased when taking tramadol?

A

Tramadol is an analgeic medication with sertonergic activity

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104
Q

Diagnosis of walkenstrom macroglubulinemia?

A

serum protein electrophorisis (igM spike) and bone marrow biopsy

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105
Q
A
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106
Q

Affect of PE on the heart?

A

Decreased cardiac outpout to right ventricular dysfunction

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107
Q

In suspected pancreatic cancer, what is the first step in diagnosis?

A

US/CT, followed by ERCP

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108
Q

Mycophenolate side effects?

A

bone marrow suppression

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109
Q

Disease most commonly causing nephrotic syndrome in adults?

A

membranous glomerulopathy

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110
Q

Signs of CMV in AIDS patients?

A

CD4 < 50, frequency small volume diarrhea, hematochezia, abdominal pain

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111
Q

Amniocentesis Use?

Time?

A

Use Definitive karytupic diagnosis

Time: 15-20 weeks

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112
Q

Risks of herarin-induced thromocytopenia

A

Thrombocytopenia,

thrombus-HIT antobodies -> arterial and venous thrombus

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113
Q

Late diastolic murmur at cardiac apex?

A

Mitral stenosis

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114
Q

progressive confusion and lethargy over several hours and hyperdensity on head CT?

A

cerebral amyoid angiopathy

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115
Q

Signs of hypothalamic amenorrhea? Cause?

A

Cause: excessive weight loss, strenuous activity, chronic illness, eating disorder

Decreased FSH, LH, estrogen -> amenorrhea, bone loss

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116
Q

most commonca use of chronic renal insufficiency in children?

A

Posterior urethral valves

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117
Q

Cause of hyper IgM?

A

c-linked genetic defect in CD40 ligand

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118
Q

Management of esophageal perforation?

A

Antibiotics and supportive caure

surgical repair for significant leakage with systemic inflammatory response

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119
Q

sudden-onset neurological deficits with irregular heart beat?

A

Cardioembolic stroke

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120
Q

How to diagnose Borrelia burgdorferi?

A
  1. Clinical (if erythema migrans)
  2. serology (ELISA, then Western Blot)
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121
Q

Most common cause of renal disease in cirrhosis?

A

hypoprofusioin disease ue to hepatorenal sydrome

cause increased renin -> hyponatremia

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122
Q

Management of pimary biliary cholangitis?

A

Ursodeoxycholic acid, transplave if severe

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123
Q

> 40, chronic cough, significant tobacco use, progressive dyspnea?

A

COPD, evaluate with spirometry

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124
Q

IBD with crypt abscess?

A

Ulcerative colitis

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125
Q

indications for lung cancer screening?

A

Low-dose CT yearly in patients 55-80 with more than 30 pack-year histories and active smoking within the last 15 years

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126
Q

acalculous cholecustitis? population? Predispositions? Presentation

A

acute inflammation of the gallbladder without stones

Population-critically ill

Predisposures: surgery, severe trauma;

Presentation: unexplained fever, RUQ pain, leukyctosis

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127
Q

How to treat viral pleuritis?

A

Supportive and NSAIDs for pain

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128
Q

X-ray findings of gallstone ileus?

A

Pneumobilia and gallstones

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129
Q

Signs of mineralocorticoid deficiency?

A

orthostatic hypotension

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130
Q

Diagnosis of acute pancreatitis? Complications?

A

Acuteepigastric abdominal pain

increased amylase/lipase (3 times normal)

ComplicationsL Pleural effusion, Ileus, pancreatic pseudocyst/abscess/necrosis, ARDS

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131
Q

recurrent seizures and muscle spams in a newborn with cleft palate?

A

Hypocalcemia in DiGeorges syndrome

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132
Q

fever, night sweats, rapid enlarging medistinal mass?

A

Diffuse B cell lymphoma (an AIDS defining illness

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133
Q

Uncal herniation? Sign?

A

mass effect pushes part of the temporal lone laterally and downward agains the tentorium cerebeli

Compression of the third cranial nerce -> dilated, non-reactive ipsolateral pupil, contralateral extensor posturing, come, respiratory compromise

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134
Q

Greatest risk factor for TB?

A

Recent arrival from an edemic area

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135
Q

First line treatment of alcohol use disorder?

A

Naltrexone

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136
Q

Diagnosis of Sjogran syndrome

A

Schirmer test (fluid absorption onto a paper in 5 min)

Anti-Ro, Anti-La testing

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137
Q

What causes symptomatic hypocalcemia in patients with liver problems and blood transfusions

A

chelation of calcium by citrate

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138
Q

Alternative name for hear failure with preserved efection fraction? (HFpEF)? Cause?

A

Diastolic dysfunction

Cause: HTN, left ventricular hypertrophhy

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139
Q

Treatment for herpes?

A

Acyclovir, hamciclocir, valacyclovir

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140
Q

Rheumatic heart disease?

A

Mitral stenosis

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141
Q

Severe left atrial enlargement, concentric left ventricular hypertrophy, ejection fraction 65%?

A

diastolic heart failure

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142
Q

chronic fluctuating mood disturtabces? How long?

A

Cyclothymic disorder

More than 2 years (1 year in children)

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143
Q

macrocutic red blood cells, hypersegmented neutrophils, normal methylmalonic acid? Signs, if severe?

A

Folate deficiency

Severe can be pancytopenia

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144
Q

jaundice, tender hepatomegaly, mild elevation and AST:ALT 2:1, macrocytic anemia

A

heavy alcohol abuse

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145
Q

child, acute onset of ataxia with disturbances in gain and coordination, symmetric and staggaring fain? Diagnosis? Treatment?

A

Acute cerebellar ataxia (post-infectious)

Diagnosis-none

Treatment-supportive

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146
Q

oral succimer use?

A

moderate lead poisoning

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147
Q

What does a cross-sectional trial measure?

A

prevalence

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148
Q

Fatigue, anorexia, nausea, blurred visoin, disturbed color perception, caridac arrhythmias? Overdose?

A

Digoxin

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149
Q

Manifestations of sheehan syndrome?

A

hypotension, inability to breastfeed, amenorrhea

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150
Q

How is niacin synthesized?

A

From tryptophan

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151
Q

sudden onset of hypotension, tachycardia, flat neck veins after catheterization on heparin?

A

retroperitoneal hematoma

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152
Q

Action of dobutamine?

A

inotrophic agen that cause cause significant vasodilation, hypotension

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153
Q

diagnosis fo hiolain barre syndrome?

A

Lumbar puncture

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154
Q

How to confirm ovarian torsion?

A

pelvic ultrasound showing an adndexal mass with absent doppler flow

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155
Q

Significant hypoxia with chest pain?

A

Pulmonary embolism

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156
Q

Name? Cause?

A

Livedo reticularis

Cause: vasculic (polyarteritis nodosa, SLE) or vascocclusive (cholesterol emobolization, antiphospholipid syndrome, cyroglobulinemia)

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157
Q

Treatment for aactinomyces?

A

Penicillin or surgery in extreme cases

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158
Q

Signs of serum sickness? Treatment?

A

fever, urticaria, polyarthralgia without mucosal involvement, 1 week after exposure to beta lactams, acute hep. B

Treatment: stop offending agent

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159
Q

Cause of hypoxia in OSA? pCO2 level?

A

hypoventilation -> increased pCO2

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160
Q

HTN and cocaine use puts you at risk for what?

A

hypertensive vasculopathy -> spontaneous intracranial hemorrhage

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161
Q

advanced bone age in a child with high lutenizing hormone?

A

Brain MRI with contrast

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162
Q

Diagnosis?

A

Tophaceous gout

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163
Q

What is oxytocin structurally similar to?

A

ADH

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164
Q

Common trigger for bronchoconstriction in asthma patients?

A

Aspirin (most comone) beta blockers

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165
Q

Signs of retrosternal expansion of thyroid lymphoma?

A

facial plethora, raising arms above head causes head swelling

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166
Q

holosystolic murmur at cardiac apex after mitral valve replacement

A

paravalvular regurgitation due to valvular dysfunction

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167
Q

Waldenstrom macroglobulinemia?

A

high IgM, hepatosplenomegaly, hyperviscosity syndrome, bleeding

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168
Q

Pulmonary hypertension

A

mean pulmonary aterial pressure more than25 at rest

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169
Q

Diabeted with protinuria, RBC casts, and hematuria, management?

A

kidney biopsy

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170
Q

Treatment for hoarding?

A

CBT, targeting hoarding behavior

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171
Q

Ludwig Angina?

A

cellulitis of the sublingual or submandibular space, caused from bacterial spread from adjacent spread of infection (dental abscess or tongue infection

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172
Q

What drugs significantly reduce the risk of acute arterial occlusion in thromboembolism in the setting of atrial fibrillation?

A

Apixaban, dabigatran, rivaroxaban, edoxaban, warfarin

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173
Q

osteolytic lesions, fractures, anemia are characteristic of what cancer?

A

Multiple myeloma

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174
Q

CMV esophagitis? CD4 count?

A

CD 4 <50

sever odynophagia, without trouble swallowing

long. linear lesions

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175
Q

Diastolic heart failure leads to pulomary arterial HTN, how?

A

pulmonary venous hypertension

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176
Q

How to calculate specificity from false positive rate?

A

1-specificity

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177
Q

Bupropion - MoA

A

norepinerphrine doapmine reuptake inhibitor

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178
Q

SLE vs post-streptococcal glomerulonephritis?

A

SLE has thrombocytopenia photosensitive skin (rash), PSGN does not

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179
Q

Emergent reversal of warfarin?

A

Fresh drozen plasma

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180
Q

Which SSRI is associated with what congenital malformation?

A

Paroxitine, cardiac malformation

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181
Q

*rubicine affects on the heart?

A

Oxidative damage to cellular membranes of cardiomyocyte -> fibrotic replacement

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182
Q

Treatment for adrenal crisis?

A

hydrocortisone, dexamethoasone

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183
Q

Pharmacotherapy for anal fissures?

A

topical anesthetics and vasodilators

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184
Q

Treatment for ingantile hemangiomas?

A

Monitor

Timolol if on face

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185
Q

What causes the warfarin skin nexrosis?

A

Protein C deficiency

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186
Q

Causes of lumbar stenosis?

A

defenerative arthritis, degernative disk disease, thickeing of the ligamentus glavum

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187
Q

Pellagra?

A

Rough skin, dermatitis, diarrhea, dementia

Caused by niacin deficiency,

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188
Q

Organisms that can cause bloody diarrhea?

A

E. Coli, shigella, campylobacter

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189
Q

Cause of spinder angiomas?

A

hyerestrinism due to impaired hepatic metabolism of circulating estrogens

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190
Q

Mean corpuscular hemoglobin concentration

A

hemoglobin/hematocrit =hemoglobin conventration of each erythrocyte

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191
Q

Reversal for warfarin?

A

Vitamin K and prothrombin complex concentrate

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192
Q

Teenager that experiments with marijuana, alcohol, sexual curiosity, increasing need for privacy and transient oppositional behavior?

A

Normal

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193
Q

Turner syndrome karyotyoe?

A

45 XO

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194
Q

Polymyalgia rheumatica? Treatment?

A

Mornign stiffness (proximal joints), age >50, ESP >40,

Treatment: low-dose steroids

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195
Q

What does fish oil reduce?

A

Triglycerides

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196
Q

Tinea versicolor? Organism? KOH findings? Treatment

A

Malassezia

Salmon-colored, hypo/hyperpigmented macules (hypo after sun exposure)

KOH- blunt hphae and thick walled budding yeast

Treat with selenium sulfide or ketconazole

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197
Q

Hodgkin lymphoma

A

painless lympadenopathy and B symptoms (night sweats, fevers) with normal peripheral smear and CBC

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198
Q

When do galactoceles occur? Pathogenesis?

A

Weeks to months after cessation of breastfeeling

due to stagnaget milk

Caused by deposit proteins in the lactiferous duct forming a blockage

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199
Q

Chondrosarcoma?

A

50-60, signs of acial involvement (back pain)

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200
Q

Coinfections common with gonorrhea?

A

Chlamydia, HIV, syphilis, hepatitis B

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201
Q

What factor affects a teenager used aof safe sexual practices

A

Use by peers

202
Q

Inferior wall MI ECG?

A

ST elevation in II, III, aVF

203
Q

Direct inguinal ligament? Cause

A

older men, weakness of transverse fascia

medial to inferior epigastric vessels

204
Q

How to calculate the anion gap?

A

sodium-(Chloride and bicarb)

205
Q

cause of chronic bursitis?

A

pressure, driction, overuse, AI disease

206
Q

Breast feeding jaundice vs breast mild jaundice

A

Breastfeeding - first week of life, lactation failure (decreased bilirubin eliination), signs of dehydration, suboptimal feeding

Breast mild- starts peaks 2 weeks, high levels of beta-gluronidase in breast milk, adequate breastfeeding/examination

207
Q

Signs of adenoid hypertrophy? concurrent findings? Diagnosis?

A

nasal congestion, refractory to medical management, recurrent sinal and ear infections, snoring, mouth breathing

Concurrent findings: tonsilar hypertrophy

Diagnosis is clinical

208
Q

HUS signs?

A

shiga toxin cause from E. Coli O157:H7 or shigella

anemia, thrombocytopenia, acute renal failure

209
Q

Rett syndrom: Signs? Cause?

A

Cause: MECP2 gene

Signs: deceleration in head growth, loss of communicative skills, stereotypical hand movements

210
Q

Reversal of hepain?

A

Protamine sulfate

211
Q

Signs of cerebral palsy?

A

spastic diplegia - hypertonia, hyperreflexia

intellectual disability

212
Q

What parts of the hypothalamic-pituitary axis does respiradone affect?

A

Causes hyperprolactinoma alone

213
Q

Murmur in pregnancy woman?

A

systolic ejection murmur

214
Q

Rotator cuff impingement

A

pain with abdumction, external rotation, subacromial tenderness, normal ROM, positive impingement tests

215
Q

Vesicouretheral reflex?

A

urinary reflux from bladder into the kidneys -> scarring

216
Q

Shin splints vs stress fracture

A

Stress fracture demonstrated point tenderness, where as shin splints is more diffuse

Shin splints are also more common in overweight individuals

217
Q

Inferior MI symptoms?

A

Hypotension, bradycardia, artioventricular block

218
Q

Cholchocine -MoA, side effects? Contraindication?

A

inhibits polymerization of beta-tubulin into microtubules -> prevents migration and activation of neutrophils

Side effects: nausea, abdominal pain, diarrhea

Contraindications - elderly,severe renal dysfunction

219
Q

fatigue and pruritis scleral itcherus and and elevated alk phos? Association? Cancer risk?

A

primary sclerosis cholangitis

Association with IBS, mainly UC

Cancer: cholangiocarcinoma

220
Q

Treatment for NMS?

A

damtrolene or bromocriptine

221
Q

peripheral neuropathy is associated with what type of urinary dysfunction?

A

Overflow incontinence

222
Q

AIN Signs? Drugs?

A

Signs: 7-10 days after medication exposure, skin rash, eosinophilia, pyuria,

Drugs: beta lactams, propon pump inhibitors

223
Q

Renal findings in Alport syndrome? Urinalysis?

A

Hist: thinned and thickened capillary loops with splitting of the glomerular basement membrane

Urinalysis: hematura and protein

224
Q

Risk factors for retained placenta?

A

gestations age 24-27 weeks, stillbirth

225
Q
A

olecranon bursitis

226
Q

high fever, lead pipe rigidity, mental status changes, autonomic instability? Causes? Treatment:

A

neuroleptic malignancy syndrome?

Causes: drugs, anti-psychotics,

Treatment: stop drug, supportive, dantolene or dopaminergic agents

227
Q

constipation, back pain, anemia, renal insufficiency, hypercalcemia

A

Mulitple myeloma

228
Q

Reasons to report a physician? Who to?

A

medical psychiatric, substance use

physician health program -> state iicensing board

229
Q

BRCA cancer risks?

A

Breast, ovarian

230
Q

Heart valve replacement with symptoms of heart failure?

A

prosthetic valve thrombosis (mitral > aortic)

231
Q

Signs of low serum testosterone?

A

Decreased libido, gynecomastia, testicular atrophy with gradual onset

232
Q

How to diagnose anal cancer?

A

biopsy of the lesion

233
Q

Diagnosis? Treatment?

A

Complete heart block

Cardiac pacing

234
Q

When does vitamin K reverse warfarin?

A

Over time, when warfarin is stopped. Not approved for ermegency situations

235
Q

Tremor that worsens at rest, improves with movement? Treatment?

A

Parkinson’s disease

Treatment: anticholinergics (trihexylphenidyl)

236
Q

Inheritance pattern in hredrich atarix?

A

autosomal recessive

237
Q

plasma renin activity use?

A

Primary aldosterism diagnosis

238
Q

Diagnosising a supraspinatus tear?

A

Drop arm test,

unable to lower arm smoothly and will drop mid-adduction

239
Q

recent URI, persistent cough productive of yellow, blood-tinged sputum?

A

acute bronchitis

240
Q

Complications from heat stroke

A

Rhabdomyolysis, renal failure, ARDS< coagulopathic bleeding

241
Q

Substances that can ellicit porphria cutanea tarda?

A

estrogens, ethanol, hepatitis C

242
Q

Left ventricular end-diastolic volume and CI in heart failure?

A

Cardiac index, decreased

LVEDV-increased

243
Q

What is the risk factor for developmental dysplasia of the hip?

A

Breach presentation

244
Q

General signs of Fetal alcohol syndrome?

A

fetal growth restirction, microcephaly, facial dysmorpholgy

245
Q

Drugs to decrease ammonia concentration in hepatic encephalopathy?

A

Laculose to reduce serum levels, and rifaxmin (nonabsorbable antibiotic) , decreasing ammonia producng bacteria

246
Q

Signs of acute adrenal insufficiency

A

hypotension/shock nausea, vomiting, abdominal pain, weakness, fever

247
Q

micrognathia

A

undersized jaw

248
Q

Patient over 50 that is immunocompromised, presenting with meningitis symptoms, iwth waters diarrhea, nausea, vomiting

A

Listeria

249
Q

Diagnosis?

A

Paget disease

250
Q

When do aneurysms occure after heart attack? Signs?

A

5 days - 3months

ECG: persistent ST_segment elevation and recent MI, deep Q waves

Diagnosis is ECHO

251
Q

Immediate management of panic disorder? Long-term?

A

Short- benzo

Long- SSRI

252
Q

What does winter’s formula calculate for expected PCO2 level?

A

1.5 * bicarb + 8+/-2

253
Q

What causes diastolic dysfunction?

A

impaired myocardial relaxation and LV stiffness -> increased LV end diastolic pressure

254
Q

Treatment for urge incontinence?

A

Bladder training, antimuscarinics (oxybutynin, tolterodine)

255
Q

What lymphnode changed can be observed?

A

soft, mobile, less than 2 cm, no systemic symptoms

256
Q

What are nasal polyps associated with? How to examine?

A

Associated with: cystic fibrosis

Examine by looking into nostrils

257
Q

Probenecid - MoA

A

Promte renal excretion of uric acid crystals in the urine

Second-line if allopurinol of febuxostat is ineffective

258
Q

Signs of hypocalcemia

A

Muscle cramps, chvotek and trousseau sign, paresthesias, hyperreflecia/tetany seizures

259
Q

Gouty arthitis findings on aspiration? Treatment

A

neddle-shaped, negative birefringement cyrstals

Treatment: NSAIDS (when no contraindications), colchicine. glucorticoids

260
Q

Ertapenem?

A

carbapenem that treats many multidrug-resistant organisms,

261
Q

Where is histoplasmosis found?

A

Ohio and mississippi valley

262
Q

Neurological risk of chronic hypothyroidism?

A

calcium deposition in the basal ganglia -> extrapryamidal manifestations (movement disorders)

Also develop nephrocalcinosis and cataracts

263
Q

First step in management peripheral artery disease?

A

smoking cessation, statin, aspirin

264
Q

reactive arthritis triad?

A

nongonococcal urethritis, asymmetric iligoarthritis, conjunctivitis

265
Q

Dressler syndrome?

A

pericarditis weeks after an MI

Treatment: NSAIDS

266
Q

Manifestations of prophyria cutanea tarda? Treatment?

A

blisters that heal with scarring, hyperpigementation

Treatment: phlebotomy, hydroxychloroquine

267
Q

Antibiotics for septic hip?

A

vancomycin

268
Q

Signs of hypoglycemia

A

low vlood sugar, systolic hypertension, widened pulse pressure

269
Q

Signs of moderate to severe group? When to intubate?

A

Corticosteroids and nebulized epinephrine

Intubate if epi fails

270
Q

Decreased T3 levels, normal T4 and TSH?

A

euthyroid sick syndrome

271
Q

What is required for bipolar II disorder?

A

MDD plus functional mania

272
Q

Describe a Bartholin duct cyst?

A

soft, mobile, nontender mass, at the based of the labium major

273
Q

Polymyalgia rheumatica? Treatment?

A

> 50

malaise, fever, proximal muscle pain, weakness, elevated ESR/CRP

prednisone

274
Q

Hypotension, teachycardia, distended jugular veins, respiratory variantion in systolic blood pressus is?

A

cardiac temponate

275
Q

Cause of testicular torsion?

A

Twisting of the spermatic cord, due to inadequate fixation

276
Q

Adjustment disorder? Treatment?

A

identifiable stressor, onset within 3 months, significant impairment, does not meet MDD

Treatment: psychotherapy

277
Q

Cause of trenelenburg sign?

A

Gluteus medius and minimus muscle, innervated by the superior gluteal nerve

278
Q

Defects associated with cigarette smoking in pregnancy?

A

IUGR, fetal demise, cleft lip/palate

279
Q

porphyria cutanea tarda - cause?

A

deficiency of uroporphyrinogen decarboxylase

280
Q

X-ray findings in pagent disease?

A

osteolytic or mixed lytic/schlerotic lesions

281
Q

Bilirubin problems in asian children?

A

Decreased uridine diphosphogluconurate glucuronosylthransferase

282
Q

Crest syndrome

A

Calcium deposits

Raynaud

Esophageal dysfunction

Sclerodactyly

Telangiectasias

283
Q

First step in altered mental status?

A

Thiamine, followed by glucose

284
Q

Electrolyte causes of Torsades?

A

hypomagnesiium, hypokalemia

285
Q

Diagnosis? Treatment? Risk?

A

Actinic keratosis

Risk: squamous cell carcinoma

Treatment cryotherapy, fluorouracil

286
Q

Common risk factor for hypermagnesium in preeclampsia?

A

Renal insufficiency

287
Q

Most common congenital CMV findings?

A

periventricular calcifications and microcephaly

288
Q

Management of retained placenta?

A

Uterine massage -> oxytocin -> D and C

289
Q

Sing sof central adrenal insufficiency?

A

Decreased cortisol, ACTH

normal aldosterone

290
Q

First-line treatment for condylomata acuminata during pregnancy?

A

Topical trichlorroacetic acid

291
Q

Suspected urethritis, but negative gram stain? gram-negative cocci?

A

Chlamydia trachomatis

Gram negative cocci- gonorrhea

292
Q

Signs of sarcoidosis?

A

Cough, dyspnea, bilateral hilar adenopathy, noncaseating granulomas, hypercalcemia, percalciuria

293
Q

invasive cords of squamous cells with keratin pearls?

A

Squamous cell carcinoma

294
Q

Side effects of niacin use in diabetes?

A

Worsening glucose control

295
Q

What is seborrheic dermatitis assoicated with? Treatment?

A

Parkinson disease and HIV

Treatment: topical antifungals

296
Q

HSV esophagitis? CD4 count?

A

<50

round ovoid lesions, concurrent perioral/oral involvement

297
Q

Why do vondylomata acuminata increase during pregnancy? Subtypes?

A

HPV becomes more active due to natural immunosuppressive state and hormonal alterations

Tyles 6, 11

298
Q

High output heart failure? Cause?

A

Severe anemia, hyperthyroidism, beriberi, paget disease, AV fistulas

299
Q

joint pain, facial rash, glomerulonephritis in an AA female

A

SLE

300
Q

PaO2 level for COPD oxygen supplementation?

A

less than 59mmg Hg with cor pulonale or 55 without

301
Q

Myxonamtous valve disease, what valve?

A

Mitral valve prolapse

302
Q

Nerve involvement in shingles?

A

Sensory

303
Q

Cardiac findings in down syndrome

A
  1. Loud S2 due to pulmonary HTN
  2. Systolic ejection murmur from increased flow across the pulmonary valve from left to right across ASD
  3. holosystolic mumur from VSD
304
Q

Bruit in an av fistula?

A

Continious, palpable thrill

305
Q

What type of spondyloarthropathy is reactive arthritis?

A

seronegative

306
Q

Risks for developing penile cancer?

A

Cigarette smoking, HPV, phimosis (tight foreskin stuck over penis)

307
Q

Allergic bronchopulmonary aspergillosis-history, chest imaging, diagnosis? Treatment?

A

History of asthma, CF

Imaging-recurent, fleeting ingiltrates, bronchiectasis (on CT)

Diagnosis: Eosinophilia, positive skin test for Aspergillus, Aspergillus-specific IgGm elevated aspergillus specific and total IgE
Treatment: corticosteroids for several months and itrazonazole

308
Q

Palpable thril and a loud, harsh holosystolic murmur in the fourth intercostal space?

A

VSD

309
Q

CDrugs that can cause cyrstal-induced acute kidney injury? Signs?

A

Acyclovir, sulfonamides, methotrexate, ethylene glycol, protease inhibitors

Signs: elevated creatinine within 1-7 days after starting drugs

310
Q

TreaTreatment for invasive aspergillosis?

A

Voriconazole plus caspofungin

311
Q

What is chlorperazine? Name others.

A

Antiemetic with dopamine activity (can cause EPS)

promethazine, metclopramide

312
Q

Subclinical hypothyroidism

A

elevates TSH with normal T4, T3

313
Q

patient is immobilized with hypercalcemia, cause? Treatment?

A

Immobilization 0> osterclastic bone reabsorption increase

TreatmentL bisphosphonates

314
Q

Manifestations of rosacea?

A
  1. Erythematotelangiectatic-erythema and facial flushing, roughness or scaling, burning discomfort
  2. papulopustular rosacea- small papules and pustules resembling acne
  3. chronic, irregular thickening or the skin, urually involving the nose
  4. ocular - cornea, conjunctive, lids with burning (foreign body) sensation, blepharitis, keratitis, conjunctivits, corneal ulcers, recurrent chalazia
315
Q

inflammation, fibrosis and stricturing of the intrahepatic and extrahepatic ducts should a “bear and string” batern

A

primary sclerosing cholangitis

316
Q

Signs of acute mesenteric ischemia

A

severe periumbilical pain out of proportion to examination findings, elevated amylase, metabolic acidosis

317
Q

feeding intolerance, increaseing abdominal girth, bloody stools, vomiting in an infant?

A

Necrotizing enterocolitis

318
Q

Laboratory findings for neuroblastoma

A

elevated catecholamines and metabolistes (VHA, VMA)
flank mass with calcifications

319
Q

Most comon fort os paroxysmal supraventircular tachycard?

A

atruiventricular nodal reentrant tachycardia

320
Q

Listeria, gram stain?

A

gram-positive bacillus

321
Q

After describing a procedure to a patient, what should be the next step if he denies the procedure?

A

Ask why

322
Q

What is strongly associated with nasopharynheal carcinoma? Endemic location?

A

Ebstein-Barr virus, endemic to southern China

323
Q

Diagnosis?

A

Osteoclastoma, giant cell tumor “soap bubble”

324
Q

Causes of uric acid crystals?

A

Tumor lysis syndrome, gout, acidic urine

325
Q

Neurogenic arthropathy? Cause? Management

A

Charcot joint

decreased prorioception, pain, temperature caused by diabetes, tabes dorsalis, etc

Management: treating underlying disease, mechanical devices to assist in weight bearing, decrease further trauma

326
Q

Respiratory papillomatosis?

A

Perinatal transmission of HOV leading to benign warty tumors on the larynx and/or vocal cords

recommend c-section if large

327
Q

Urinary frequency and painful, erythematous mass in scrutum over 35? Under 35?

A

Over 35-Acute epididymitis, E coli

Under 35- acute epididymitis due to Chalymidia/gonorrhea

328
Q

GI symtoms, high fever, with relative bradycardia, pulmonary infiltrate, suspect? Diagnosis?

A

Legionelia pneumonophila pneumonia

Diagnosis: urine lesionella antigen

329
Q

Dysthymia (persistent depressive disorder)

A

chronic depressed moood for more than 2 years, no symptom free period >2 months, MDD criteria not met

330
Q

When can candida cause osteomyelitis?

A

Injection drug users

331
Q

Liver failure with very low alkaline phosphtase levels, suspect?

A

Wilson’s disease

332
Q

Walkenstrom macroglobunemia treatment?

A

plasma exchange -> reduces blood viscosity

333
Q

TCA overdose signs?

A

dilated pupils, hyperthermia, flushed skin, decreased bowel sounds, seizure, QRS widening

334
Q

Anterior should pain with lifting, carrying, or overhead reaching?

A

noceps tendinopathy/rupture

335
Q

Treatment for endometritis?

A

Flindamycin and gentamicin

336
Q

When to perform TIPS? What can is worsen?

A

Patient has ascites and does not respond to diuretics or ongoing active or recurrent bleeding after appropriate treatment

Can worsen hepatic encephalopathy

337
Q

azathioprine side effects?

A

dise-related diarrrhea, leukopenia, and hepatotoxicity

338
Q

Job syndrome?

A

Hyper IgEm recurrent skin and lung infections

339
Q

How to calculate the positive predictive value?

A

True positive/(true positive + false positive)

340
Q

HOw to confirm the diagnosis of esophageal performation?

A

Gastrogragin-contrast esophagram or CT esophagram

341
Q

Side effects of magnesium toxicity?

A

Hyporeflexia, lethargy, headache, respiratory failure, cardiac arrest

342
Q

Spondylolisthesis? Signs?

A

forward slip of the vertebrae (L5 over S1),

Signs: chronic back pain, neurological symptoms

343
Q

Risks associated with multiple myeloma?

A

hpogammaglobulinemia, increased risk of infection due to bone marrow infiltratoin

344
Q

koplik spots?

A

Measles

345
Q

Fever and otalgia, deviation of the ear, inflammation of the mastoid bone? diagnostic requirments

A

Acute mastitis, diagnosis is clincal

Treat with intravenous antibiotics and drainage

346
Q

Asbestosis signs? FEV pattern seen?

A

Progressive dyspnea over months, no cough, etc.

Digital clubbing and bibasilar end-inspiratory crackles

Pattern: restrictive

347
Q

Posterior wall MI

A

ST-segment depression in V1 and C2

348
Q

Signs of amniotic embolism?

A

postpartum respiratory collapse (hypotension, tachycarida, loss of consciousness) DIC,

349
Q

AFP in hepatocellular carcinoma?

A

Increased

350
Q

Invasive aspergillosis diagnosis?

A

galactomannan assay, beta-D-glucan

351
Q

Signs of ascorbic acid deficiency? Name?

A

Vitamin C

Scury (punctate hemorrhage, gingitivis, corkscrew hair

352
Q

What drugs cause leukocytosis?

A

Ststemic glucocorticosteroids

353
Q

click with late systolic murmur?

A

Mitral regurgitation, best heart at the apex

354
Q

Signs of malignanct hypertension?

A

Papilledema

355
Q

Who should receive the high dose of folic acid supplementation?

A

Prior NTD in pregnancy, or anticonvulsant medications

356
Q

Types of granulomas in UC and crohn’s?

A

UC- non

Crohn- noncaseating

357
Q

What type of urine will cause uric acid crystals to form?

A

concentrated, acidic urine

358
Q

Indirect inguinal hernia?

A

patent processus vafinalis

protrudes through deep inguinal ring

travels lateral to inferior epigastric vessels

359
Q

What diseases have IgE infiltration in the lungs?

A

asthma, eosinophilic granulomatosis with polyangiitis (CHurg-Strauss), drug induced pneumatitis, parasitic lung infections, allergic bronchopulmonary aspergillosis

360
Q

Kallman karytyope?

A

46 XX, XY

361
Q

Hemodynamically unstable womanw ith inevitable abortion??

A

suction curettage

362
Q

X-ray findings in invasive aspergillosis?

A

nodules with surrounding ground-glass opacities

363
Q

High temperature, elevated creatinin, muscle regidity, leukocytosis? Management?

A

neuroleptic malignanc syndrome

Mangement: stop neuroleptics, restart dopamine agent, supportive, dantrolene/bromocriptine

364
Q

piloerection is associated with?

A

heroin withdrawal, hairs standing on end

365
Q

developmental delay, jerky gait, happy demeanor, hand flapping, seizures

A

angelman syndrome, Chromosome 15

366
Q

Alternative to doxycycline for lyme disease?

A

oral amoxicillin or cefuroxime

367
Q

Substance use disorder?

A

continued use despite significant substance-related cognitive, behabioral and physiological symptoms

368
Q

Presentation of B12 deficiency?

A

peripheral neuropathy, cognitive dysfunction, subacute combined degeneration, megaloblastic anemia with hypersegmented neutrophils

369
Q

Treatment for symptomatic sarcoidosis?

A

Glucocorticosteroids

370
Q

Candida- diagnosis? Treatment:

A

KOH prep

pseudohyphae wth budding yeast forms (blastoconidia)

Treatment: nystatin, miconazole

371
Q

Alternative to carpel tunnel therapy if splinting failure?

A

Glucocorticoids

372
Q

What screening should all patients with cirrhosis undergo?

A

Endooscopy to exclude varicies

373
Q

Isoniazide hypersensitivity?

A

maculopapular rash, pruritis, fever, hepatitis

374
Q

Acute pericarditis post infarction timframe? ECG findings? Treatment?

A

< 4 days following MI, pleuritic chest pain,

ECG: Diffuse ST-segment elevation

Treatment: supportive, avoid NSAIDs`

375
Q

Erysipelas cause?

A

Group A strep (streo pyogenes

376
Q

Clotrimazole

A

Anti-fungal treatment for tinea pedis

377
Q

Signs of dementia with Lewy body?

A

fluctation congition/attention, visual hallucinations, motor manifestations of parkinsonism (postural instability), , visual spacial defects (clock drawing) with memory intact

378
Q

Diagnosis and treatment fo acalculous cholcystilis?

A

Diagnosis: US (preferred), HIDA, CT

Treatment: Abx, percutaneous draining, cholecystecctomy once stable

379
Q

Cerebeller tonsilar herniation signs?

A

Neck tilt, flaccid paralysis, coma, blood pressure instability, respiratory arrest, extensor posturing

NO PUPILLARY DYSFUNCTION

380
Q

Contraindications to NSAIDS in the treatment of gout?

A

anticoagulation, acutely worsen heart failure

381
Q

How to confirm measles?

A

PCR

382
Q

adjuvant therapy? Salvage?

A

adjuvant- In addition to stardard therapy (chemo and radiation

salvage-treatment for a disease when stardard therapy fails

383
Q

Signs of lead poisoning?

A

Occupation exposure (pain, batteries), anemia, cognitive deficits, peripheral neyropathy, anemia

384
Q

Entamoeba histolytica signs? Organism type? Treatment

A

Protozoan

Right upper quadrant pain and fever

hepatomegaly

single subcapsular cyst in right hepatic lobe

Treatment: metronidazole and intraluminal antibacterial (paromomycin)

385
Q

What drug has been shown to reduce PTSD nightmares?

A

Prazosin

386
Q

Blastomycosis-extramedullar organ affected?

A

Skin, bone, prostate

387
Q

mucosal atrophy and granulation tissue in GI tract?

A

Chronic ischemic colitis

388
Q

What medications are contra indications with sildenafil? MoA?

A

Phosphodiesterase-5 inhibitor

Contraindications: alpha-blockers, nitrates

389
Q

Subchorionic hematoma

A

abnormal collection of blood between the placenta and uterus

390
Q

Legg-calve perthes

A

idiopathic osteonecrosis of the femoral head, which presents in boys 4-10

presents with mild chronic hip or knee pain of insidious onset as well as antalgic gain

391
Q

What is the calcium phosphorus produce?

A

Risk of soft tissue calcification (serum Ca * serum phosphorus > 55

392
Q

Cause of hereditary hemochromatosis? Treatment?

A

HFE mutation, serial phlebotomy

393
Q

HIV associated dementia? Imaging?

A

deep gray matter structures and causes subacute congitive, behavioral, and motor deficits

Imaging: cerebral atrophy with ventricular enlargement

394
Q

treatment for ocular rosacea?

A

lid scrubs, topical antibiotics (metronidazole, erythromycin) and ocular lubricants

395
Q

24-hour urine cortisol use?

A

Cushings

396
Q

Clincal findings at different bone sites for pagent disease?

A

Skill- headache, hearing loss

spine- spinal stenosis, radiculpathy

long bones- bowing,gracture, arthritis of adjacent joints

397
Q

Acamprosate use?

A

Maintain abstinence in a patient who has already stopped drinking

398
Q

Lynch syndrome cancer risks? Cause?

A

Colorectal, endometrial, ovarian

Cause: DNA mismatch repair

399
Q

Glucocorticoid deficiency signs?

A

fatigue, loss of apetite, weight loss

400
Q

Diagnosis? Cause? Signs? Histo findings?

A

Melanosis coli, chronic laxative use

Signs: loctural bowel movements, watery, frequent, hypokalemia

Histology: pigment in the macrophages of the lamina propria

401
Q

Findings in CLL?

A

Extreme fatigue, hepatosplenomegaly, smudge cells, lymphocytosis with mature lymphocytes

402
Q

Electrolye abnormalities with furosemide?

A

Hypokalemia, hypomagnesia

403
Q

Shilling test detects?

A

pernicious anemia

404
Q

What labs should be checked prior to starting lithium?

A

Creatinine, thyriod function

405
Q

Signs of TSH secreting pituitary adenoma?

A

overproduction of alpha subunit, with elevated TSH, T4

406
Q

cerumen?

A

Ear wax

407
Q

Hearing loss with bone pain in an older adult?

A

Pagents disease, osteoclast dysfunction

408
Q

Major complication of pseudotumor cerebri?

A

Blindness

409
Q

Muddy brown casts?

A

Acute tubular necrosis, renal tubular epitherlial cells

410
Q

Over 40 and diagnosed with DM type 2, what drug should be added?

A

Statin

411
Q

Next step after diagnosing myasthenia gravis?

A

CT imaging to evaluate thymoma

412
Q

Side effects of Cyclosporine?

A

nephrotoxicity, hyperkalemia, HTN, gum hypertroophy, hirsutism, tremor

413
Q

Diagnosis?

A

Ruptured berry aneurysm

414
Q

When can a gift be accepted by a physician?

A

When they are small and directly benefit patient care

415
Q

Hemoglobin levels in fragmentation from prostetic heart valves?

A

Low

416
Q

Treatment for borderline personality disorder?

A

Dialectival behavioral therapy

417
Q

Microphthalmia and cutis aplasia?

A

small eyes and absence of the epidermis over the skull, associated with trisomy 13 (Patau

418
Q

low-grade fever and violaceous skin lesions with scrappings demonstrating yeast?

A

vlastomycosis

419
Q

Features associated with narcolepsy?

A

hypnagogic or hypnopompic hallucinations

sleep paralysis

420
Q

Good prognostic factors for schizophrenia?

A

positive psychotic symptoms (hallucinations, delusions) as opposed to negative symptoms (flat affect, loss of motivation, anhedonia)

421
Q

Side effects of oxytocin?

A

hyponatremia, hypotension, tachysystole

Seizures

422
Q

Serosanguineous draining and incision pain cause? Risk factors?

A

incisionla hematoma

Risk factors: obesity, hypocoagubility

423
Q

Behcet syndrome

A

painful ulcers on oral and genital areas

heal spontaneously within 1-3 weeks

424
Q

Is a hematocele painful?

A

Yes

425
Q

Severe hot flashes, episodic pounding sensationchronic diarrhea, weight loss, valvular heart disease with tricuspid regurgitation

A

Carcinoid syndrome

426
Q

Trastuzumab cardiotoxicity?

A

Myocardial stunning/hibernation without destruction -> reversible

427
Q

Open angle glaucome? Population Treatment:

A

Population: AA

Gradual loss of peripheral vision of years, eventually tunnel vision

intraocular pressure is high -> cupping of the optic disk

Treatment: Timolol, laser trabeculoplasty

428
Q

Name? Diagnosis

A

Koplik spot, measles

429
Q

How do uric acid stones form?

A

chronic bicarb loss through diarrhea -> acid urine -> crystal deposition

430
Q

How to get urine samples from infants and toddlers in diapers with suspected UTI?

A

Cath to obtain a sterile specimen

431
Q

Lab findings in autoimmune hepatitis, most common group affected?

A

Lab: increase AST/ALT/ALK, total bilirubin levels

Most effected: young woman

432
Q

Treatment of lyme disease for pregnant, lactating, and children under 8? Alernative, if allergic?

A

Amoxicillin, Alt. Azithromycin

433
Q

Acute fever, confusion, headache, neck stiffness, cerebrospinal fluid eveidence of neutrophilic pleocytosis?

A

bacterial meningitis

434
Q

Effects of H1-antihistamines in the elderly?

A

Anticholinergics -> acute urinary retention due to hypoactive detrusor

435
Q

Dress syndrome? Time?

A

Drug - allopurinol and antiepileptics are more common

Reaction (morbiliform eruption that starts of face or upper trunk and becomes diffuse

Eosinophilia

Systemic symptoms - fever, malaise, diffuse lympadenopathy

Time: 2-8 weeks after starting drug

436
Q

Signs of myasthenic crisis? Treatment?

A

revere respiratory weakness -> respiratory failure

Increased feneralized and bulbar muscle weakness

Precipitated by infection

Treatment: plasma phoresis

437
Q

Acute rheumatic fever?

A

grank arthritis, erythema marginatum, fever

438
Q

Clinical manifestations of hereditary hemochromatosis?

A

elevated liver enzymes, diabetes mellitus, arthropathy (calcium pyrophospate crystal deposition), skin pigmentatio, hypogonadism (dec. labido, erectile dysfunction), restrictive cardiomyopathy

439
Q

Use of ultrafiltration?

A

massive volume voerload whose condition does not response adequately to diuretics

440
Q

Defect in osteogenesis inperfecta?

A

type 1 collagen mutations

441
Q

Side effects of beta-2agonists?

A

reduce serum potassium by driving intracellularly

442
Q

Hemoglobinopathy?

A

Thalasemia

443
Q

focal parenchymal scarring and blunted calyces, think? Diagnosis?

A

Vesicoureteral reflux

Diagnosis: voiding cystourethrogram

444
Q

Treatment for sickle cell acute chest syndrome?

A

Transfusion exchange

445
Q

progressive dyspnea, nonproduce cough, bilateral check crackles, pulmonary infiltrate in someone with antiarrhthymias?

A

Amiodarone-induced insterstitial pneumonitis

446
Q

Diagnosis? Description?

A

Osteosarcoma

“sunburst pattern”

447
Q

rubbery, mobile mass in young woman? Timing?

A

fibroadenoma, most commonly found premenstrual

448
Q

Hematoma presentation

A

tender, ecchymotic, indurated firm, mass

449
Q

“popping” sensation followed by serosanguieous drainage and an incision bulge

A

fascial dihiscence

450
Q

Signs of testicular cancer?

A

Age 15-35

Signs: unilateral painless testicular nodule, firm, ovoid mall

Diagnosis: AFP, beta HCG

scrotalultrasound

Treatment: orchiectomy

451
Q

Short stature, primary amenorrhea, absent thelarche?

A

Turnery syndrome

452
Q

scaly papules or plaques on fair-skiin individuals? Risk factors?

A

Actinic kertosis, chronic sun exposure

453
Q

What happens in hyperventilation?

A

Increased bicarb in the urine to reduce the alkylosis

454
Q

Antibodies found in hashimoto thyroiditis?

A

antithyroid perocidase

455
Q

Hyperemesis gravidarum vs normal nausea

A

Ketones present in the urine define HG

456
Q

periodic sharp waves of EEG?

A

Creutzfeldt-Jakob disease

457
Q

Temporal mandibular joint syndrome?

A

noctural teeth drinding -> TMJ

458
Q

Signs of carcinoid syndrome?

A

Flushing, secretory diarrhea, cutaneous telangiectasias, bronchospasm, tricuspid regurgitation

459
Q

What type of dementia is associated with primitive refleces?

A

frontal release isngs -> frontotemporal dementia

460
Q

Breast cancer that presents with dimpiling?

A

Inglammatory breast carcinoma “peau d’orange”

461
Q

Anticholinergic toxicity

A

hyperthermia, delirium ,dyriasis, dry mucous membranes, urinary retention, decreased bowel sounds

462
Q

Diagnosis? Treatment?

A

Acne vulagaris

Treatment: topical retinoids plus organic acids or benzoyl peroxide

463
Q

Sodium bicarbonate treats what overdose?

A

Tricyclic and aspirin

464
Q

How to treat atrioventricular nodal reentrant tachycardia?

A

vagal maneuvers that increase parasympathetic tone and slow the AV node conduction and increase refractory period

465
Q

Side effects of SSRI?

A

decreased labido, decreased arousa, erectile dysfunction, anorgasmia in woman, increased efaculation latency in men

466
Q

Mst common cardiac defect in down syndrome?

A

complete atrioventricular septal defect

467
Q

Diagnosis? Cause? Treatment?

A

Intertrigo, candida special

Causes: disruption of skin barrier, excessive moisture

Signs: “mirror imaging” pattern across skin forl, satelite lesions

468
Q

When to use tetanus IG?

A

When patient has symptomatic tetanus, otherwise just give tetanus vaccine

469
Q

Laboratory findings in primary adrenal deficiency?

A

Decraese aldosterone, cortisol

increased ACTH

hyperkalemia, hyponatremia

470
Q

Signs of fiardiasis infection?

A

watery diarrhea, weight loss, abdominal pain

471
Q

How to treat SIADH initially?

A

fluid restriction

472
Q

Signs that suggest amyloidosis? HIstology?

A

rheumatoid arthritis (predisposes to amyloidosis), enlarged kidneys and hepatomegaly

Histology: amyloid deposits that stain with congo red

473
Q

Why is protein restriction contraindicated in cirrhoses?

A

malnourishment

474
Q

Risk associated with thyroid surgery?

A

Removal of the parathyroid

475
Q

Developmental dysplasia of the hip

A

limping as a tolder, painful degerative joint disease

476
Q

Best trial to measure incidence?

A

Cohort

477
Q

Lab findings in pagent disease?

A

Elevated Alk Phos, PINP, urine hydrocyproline

Normal calcium, phosphorus

478
Q

Elevated conjugated hyperbilirubinemia and elevated level sof alkaline phosphatase

A

cholestasis, US

479
Q

non functioning gonadotroph adenomas primarily secrete what?

A

Alpha subunit

480
Q

What type of aneurysm is a berry?

A

Subarachnoid, also known as a saccular aneurysm

481
Q

Polycystic kidney disease

A

flank pain, hematuria, renal failure, HTN, larege palpable kidneys

No protienuria

482
Q

Systemic action of Calcium channel blockers? Cause?

A

Dilation of precapillary vessels (arteriolar dilation)

Cause: increased capillary hydrostatic pressure

483
Q

Acute Mesenteric ischemia diagnosis?

A

CT angiogram

484
Q

red cell distribution use?

A

Early measurment of iron deficiency, elevated >20% are suggestive

485
Q

Side effect of carbamazepine?

A

SIADH via increasinf vasopressin-2 receptors

486
Q

Diagnostic method for fibroids?

A

Sonohysterography

487
Q

Complications from liver cirrhosis on males?

A

Testicular atrophy, gynecomastia, loss of sexual hair

488
Q

Signs of entamoeba histolytica? Diagnosis? Treatment?

A

Developing nations, contaminated food/water, fecal oral rout (rare)

Findings: colitis (diarrhea, bloody stool with mucus, abdominal pain, liver abscess (RUQ pain, fever)

Diagnosis: stool ova and parasites, stool antigen testing, E. histolytica serology (liver abscess)

Treatment: metronidazole

489
Q

What does increasing study size do to precision? Accuracy?

A

Increased precision

No change in accuracy

490
Q

What factors have the greatest impact at improving blood pressure?

A

Weight loss, DASH diet

491
Q

Hallmark of vertricular aneurysm?

A

persistent STS segment elevation

492
Q

Stress-induced cardiomyopathy

A

“apical ballooning syndrome” transient systolic dusfunction of apical and/or mid segments of the left ventricle with hyperkinesis of the basal segments causing “balloon-like” appearance

493
Q

Treatment of septic pelvic thrombophlebitis?

A

anticoagulation, broad spectrum antibiotics

494
Q

Most common congenital infection worldwde?

A

CMV

495
Q

In acute pneumonia, what is responsible for hypocemia?

A

right-to-left intrapulmonary shunting

496
Q

Treatment for myocarditis?

A

supportive, dieretics, inotropes

497
Q

Colonoscopy findings of C. Diff?

A

bowel wall edema, eerythema, friability

498
Q

mosquito with dormant phase?

A

p vivax, hides in liver

499
Q

penetrating abdominal trauma and perotonitis?

A

Ex lap

500
Q

Hormone levels in cushings syndrome?

A

Increased cortisol

decreased ACTH, DHEA

no suppression by dexamethasone

USMLE Step 2 CK (12 decks)

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