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MS3 - USMLE Step 2 CK > UWorld Q Bank: Week of 05/07/18 (#2) > Flashcards

UWorld Q Bank: Week of 05/07/18 (#2) Flashcards

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USMLE® Step 1 flashcards
1
Q

How can you use the woman’s cycle to differentiate between ovarian cyst rupture and ectopic pregnancy rupture?

A

Ectopic pregnancies usually rupture weeks into a gestation, so if a woman had a period in the last 4 weeks and normally has a regular cycle, ectopic pregnancy is extremely unlikely.

Also, ovarian cysts usually rupture in the second half of a woman’s cycle, so if a woman presents with sudden-onset lower-quadrant pain 3 weeks after her LMP, then this is highly likely to be ovarain cyst.

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2
Q

Although heavy peritoneal bleeding does not usually occur with ruptured ovarian cysts, they can in women who _______________.

A

are on anticoagulation

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3
Q

Those with major depression typically have increased levels of what lab marker?

A

Cortisol

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4
Q

How does sleep change in those with depression?

A

They have decreased REM latency and slow-wave sleep

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5
Q

The best treatment for acute stress disorder is ____________.

A

to educate the person on the range of responses to stress

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6
Q

IUFD after ______ weeks gestation should only be managed with vaginal delivery.

A

24

Prior to that, vaginal delivery or dilation and evacuation can be offered.

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7
Q

Those with Beckwith-Wiedemann synrome have the following features:

  • Hemihypertrophy
  • Macroglossia
  • Umbilical hernia
  • _____________
  • _____________
  • _____________
A

Wilms tumor; macrosomia (continuing to be large until age 4); hypoglycemia

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8
Q

A red, sharply defined rash surrounding the anus of a young child is likely ________________.

A

perianal Streptococcal dermatitis

This presents with itching, pain, and sometimes bleeding with defecation.

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9
Q

Papillary muscle rupture typically presents after occlusions to what artery?

A

RCA

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10
Q

What is cardioversion?

A

Synchronized shock of the QRS complex which can sto the arrhythmia without leading to ventricular fibrillation (which can occur if you shock during repolarization).

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11
Q

Cardiovert all tachyarrhythmias that are ____________.

A

unstable

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12
Q

How quickly can alcoholics develop megaloblastic anemia?

A

5 to 10 weeks!

Alcohol inhibits the absorption and enterohepatic circulation of folate.

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13
Q

A person has an unprovoked DVT. Subsequent testing reveals high levels of homocysteine. What can you give to reduce the risk of future DVTs?

A

B6

Pyridoxine stimulates the conversion of homocysteine to methionine, thus lowering the thrombotic effects of elevated homocysteine.

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14
Q

True or false: hypothyroidism with hoarseness is suggestive of malignant thyroid cancer.

A

False

Hypothyroidism can cause hoarseness on its own.

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15
Q

Vascular surgery for renal artery stenosis is only indicated when ____________.

A

the person’s BP is refractory to multiple medicines

Bonus points: don’t forget to manage the vascular risk factors with statins, ASA, diabetes management, and exercise.

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16
Q

Well-defined skin lesions that come and go quickly are very likely ____________.

A

urticaria

Hives are one of the only lesions to rapidly wax and wane.

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17
Q

When do you need to do a colonoscopy/sigmoidoscopy in the evaluation of hemorrhoids?

A
  • Person > 50, blood mixed with stool, or any other symptoms suggestive of cancer: colonoscopy
  • Person 40-49, no blood mixing or worrisome features: sigmoidoscopy
  • Person < 40 with no worrisome features and no mixing: anoscopy
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18
Q

Those with nephrotic syndrome have accelerated rates of _____________.

A

atherosclerosis (due to the hyperlipidemia)

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19
Q

Bronze skin, diabetes, cirrhosis, and ___________ are features of hemochromatosis.

A

decreased libido (due to deposition of iron in the pituitary)

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20
Q

What calculation can differentiate ethylene glycol toxicity from other causes of anion gap metabolic acidosis?

A

Osmolar gap greater than 10

They need to give you a measured osmolality. From that, you subtract the calculated osmoloarity: (2 x Na) + (BUN / 2.8) + (glucose/18)

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21
Q

____________ permission must be given before a physician can discuss medical care with a third party.

A

Verbal or written

Meaning a patient can tell a doctor that it is ok for him or her to discuss their care with their employer.

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22
Q

Classs IC drugs cause ________ at faster heart rates.

A

QRS widening

They are use-dependent, so the QRS effects are seen most at fast heart rates.

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23
Q

Explain the rule of the “rare disease assumption” in statistics.

A

When diseases are extremely rare, the odds ratio is taken to approximate the RR since the RR would be extremely difficult to measure.

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24
Q

If a question tells you that a hospitalized patient had a “visitor” and then had a change in status, then they’re telling you that _____________.

A

the visitor brought them recreational drugs

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25
Q

HIV and pulmonary pathologies like PCP can cause what electrolyte imbalance?

A

SIADH

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26
Q

Describe the differences between macular degeneration and diabetic retinopathy.

A

• Macular degeneration:

  • Central vision loss / scotoma
  • Wet (angiogenesis) and dry (yellow exudate) usually without arterial changes

•Diabetic retinopathy:

  • Decreased visual acuity overall
  • Arterial nicking, cottonwool spots, and macular edema
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27
Q

In which cases should you give RhoGAM?

A
  • Rh-negative mother with uncertain or Rh+ father at 28 weeks and within 72 hours
  • After threatened abortions
  • Abdominal trauma
  • Procedures
  • Cephalic version
  • Molar pregnancy
  • Ectopic pregnancy
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28
Q

Interventions targeted at _______________ have been shown to decrease medication reconciliation issues.

A

pharmacists

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29
Q

Effervescent rash (a rash that worsens with fever) is characteristic of __________________.

A

juvenile idiopathic arthritis

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30
Q

Infants born SGA have increased risk of what future complications?

A
  • Hypoxia
  • Polycythemia (secondary to hypoxia)
  • Hypoglycemia
  • Hypocalcemia
  • Meconium aspiration
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31
Q

When is screening for toxoplasmosis done?

A

Only with symptoms (so not a true screen)

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32
Q

In those with CAIS, you do a gonoadectomy __________.

A

after puberty

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33
Q

True or false: in a person with combined folate and B12 deficiency, giving folate will correct the megaloblastosis.

A

True

But their neurologi findings will likely worsen.

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34
Q

MRI showing a diffuse increase in the intensity of white matter is likely _______________.

A

HIV-associated neurocognitive disorders (HAND)

PML, by contrast, will show asymmetric, isolated white-matter lesions that enhance.

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35
Q

Panacinar emphysema is caused by ___________.

A

alpha-1 antitrypsin deficiency

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36
Q

What is a factorial design?

A

A study in which people are first randomized to one group and then re-randomized to another subgroup

Example:
Patients are divided first into receiving amlodipine or lisinopril and then divided into a high-BP or low-BP subgroup.

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37
Q

In what form is epinephrine given to those with anaphylaxis?

A

Intramuscular

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38
Q

What infection can mimic sarcoidosis?

A

Histoplasmosis

  • Hilar LAD
  • Erythema nodosum
  • Cough
  • Non-caseating granulomas that are negative on AFB stain and Gram stain
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39
Q

True or false: physicians cannot accept any gifts from patients.

A

False

There is no official rule on this, so physicians ought to handle gifts on a case-by-case basis. The intent, type of gift, value, and patient’s mental state need to be taken into account.

40
Q

How do you treat scabies?

A

Pemethrin or ivermectin

41
Q

What should you do when a patient has extrapyramidal symptoms on a first-generation antipsychotic?

A

Switch to a second-generation one

42
Q

Which second-generation antipsychotics should you avoid in those with diabetes?

A

Olanzapine and clozapine

43
Q

The main reason asymptomatic bacteriuria is treated in pregnancy is ______________.

A

that pregnant women are more prone to pyleonephritis secondary to the effects of estrogen on the ureter

44
Q

Why does Bactrim cause a mild RTA type 4?

A

Trimethoprim blocks sodium channels in the collecting duct –like amiloride or triamterene –which induces the RTA 4 (hyperkalemia and metabolic acidosis).

45
Q

How can you slow the progression of diabetic nephropathy once proteinuria has begun?

A

Intensive BP control (< 140/90 or even < 130/80)

Recall that the pathophysiology of diabetic nephropathy starts as hyperfiltration due to hypertension. This stretches the mesangium and leads to protein. Stopping the hypertensive hyperfiltraiton is key to slowing the disorder.

46
Q

Cat-scratch disease presents with LAD and ____________.

A

a papule at the site

47
Q

Any murmur that is ______________ requires further workup.

A

diastolic

A midsystolic murmur is common in some young adults and doesn’t indicate workup by itself.

The Still’s murmur is a musical, vibratory murmur heard over the left sternal border during systole. Most commonly during ages 2-7.

48
Q

Kidney involvement is less common in ___________ lupus.

A

drug-induced

49
Q

Although most places will likely have an autoimmune panel that includes a slew of SLE labs, what is the “right” order to do the tests in diagnosing lupus?

A

1) ANA
2) Anti-dsDNA
3) Others that are case-dependent (like anti-histone for drug-induced lupus)

The reason you do it in this order is that ANA is the most sensitive. If this is negative, you can stop here. The anti-dsDNA is more specific and has prognostic value.

50
Q

Echinococcus cysts must have history that includes exposure to ___________.

A

dogs and sheep

51
Q

Viral arthritis can last up to _____________.

A

weeks

52
Q

Review the side effects of methimazole and propylthiouracil.

A
  • Methimazole: agranulocytosis, teratogen, cholestasis

* PTU: agranulocytosis, hepatic failure, ANCA vasculitis

53
Q

The only PFT affected by pulmonary hypertension is _____________.

A

decreased DLCO

54
Q

Those with Crohn’s can get osteomalacia due to _____________.

A

impaired vitamin D and calcium absorption with resultant secondary hyperparathyroidism

55
Q

Babies with Edward’s syndrome have the following constellation of symptoms:

  • Prominent occiput
  • Micrognathia
  • Low-set ears
  • Rocker-bottom feet
  • ____________
  • ____________
A

VSD; renal anomalies

Think of edVard to remember that it is Vsd and not asd.

56
Q

If you had to pick one agent to treat neutropenic fever, the best option would be _____________.

A

Zosyn

Neutropenic fever is most commonly caused by translocation of gut bacteria, with Pseudomonas being the most common. Gram-positive bacteria and anaerobic bacteria can also cause neutropenic fever, however, so you need to cover for these organisms as well.

57
Q

Thyrotoxicosis can cause hypertension through what effect?

A

Increased myocardial contractility

Hyperthyroidism most often causes a systolic hypertension through inotropic effects.

Note: don’t be tricked into thinking it is through increased SVR. Although catecholamines can cause this, the levels have to be extremely high to induce increased SVR.

58
Q

An injury with a negative knee exam but pain over the anterior medial tibia is likely _____________.

A

pes anserine bursitis

Look for this when a person has chronic knee pain with point tenderness over this area with no other positive findings.

59
Q

Verrucous skin lesions and lytic bone lesions are likely what syndrome?

A

Blastomycosis

Blasto causes an ulcerated, warty lesion. It can also erode bone.

60
Q

What is the pathophysiology of non-classical congenital adrenal hyperplasia?

A

Decreased activity of the enzyme that converts 17-OH to 11-ß

This leads to elevated DHEAS and testosterone without any BP or electrolyte abnormalities.

61
Q

Steroids can hasten the resolution of interstitial nephritis. Why are they not used, usually?

A

Interstitial nephritis most often results from antibiotics, which are usually given for infections. The person may have residual infection, so giving immunosuppresive doses of steroids would be dangerous.

62
Q

The HACEK organisms commonly arise from what predisposing condition?

A

Periodontal disease

This is even in those with normal native valves.

63
Q

The presentation of cryptococcal meningitis is different from other types of meningitis in that ________________.

A

there is usually no neck stiffness or photophobia

64
Q

In considering treatment with sildenafil for those with ED, it is important to note that _______________.

A

loss of libido may be a consequence of ED (i.e., sildenafil can treat those with loss of libido)

65
Q

Do not treat with testosterone unless the ______________.

A

the level is low

66
Q

In treating someone with ARDS, it is important to wean the FiO2 < ___% as soon as possible, provided PEEP can maintain their PaO2 > 60 mm Hg.

A

60

67
Q

A woman in her 30’s presents with S3, bibasilar crackles, and a holosystolic apical murmur. Her pathology likely began as _____________.

A

myxomatous degeneration of the mitral valve

Severe mitral regurgitation can lead to dilated cardiomyopathy and atrial fibrillation in young people.

68
Q

You cannot give indomethacin after ________ weeks due to the potential to close the DA.

A

32

Thus, if a woman presents with preterm labor after this point, use nifedipine.

69
Q

Parents refuse to give chemotherapy for their 10-year-old daughter. If they continue to refuse despite extensive education on the risks and benefits, the ultimate course of action would be to ______________.

A

get a court order

Parents can’t refuse life-saving therapies for their kids.

70
Q

The initial treatments for amaurosis fugax are _______________.

A

(1) ocular massage, which can help push emboli further down the arterioles and possibly even break them up, and (2) decreasing intraocular pressure with the aid of glaucoma drugs and fluid extraction to lessen the external pressure on the blocked arteries

71
Q

Review the initial mangagement of chronic cough.

A
  • Asthma: PFTs with bronchodilator response, methacholine challenge
  • UACS: H1 antagonist
  • GERD: PPI trial
  • ACE inhibitor: stop the ACE
72
Q

In addition to Sertoli-Leydig tumors of the ovaries, ___________ can also lead to virilization.

A

adrenal tumors secreting DHEAS

73
Q

What are Light’s criteria?

A
  • PE protein : S protein > 0.5
  • PE LDH : S LDH > 0.6
  • PE LDH > 2/3 the upper limit of normal
74
Q

In tumor lysis syndrome, two electrolytes are increased and one is decreased: ________________.

A

phosphate and potassium are increased and calcium is decreased (due to binding to intracellular anions)

Uric acid is not an electrolyte, but it is also elevated in TLS.

75
Q

If they give you a stem that looks like heart failure (edeam, JVP, ascites) but they bend over backwards to tell you that the ventricles, valves, and lungs are normal, then the answer is likely ______________.

A

constrictive pericarditis

Look for a past heart surgery or radiation.

76
Q

Burr cells are seen in ____________.

A

those with advanced liver disease or ESRD

77
Q

How does renal crisis in diffuse scleroderma present?

A
  • Hypertensive crisis
  • AKI
  • MAHA
78
Q

What does peeling of the hands and feet indicate in a neonate?

A

Adaptation to the extrauterine environment (i.e., a totally normal finding)

79
Q

A patient with mitral-valve prolapse develops fever, leukocytosis, LUQ pain, and left pleural effusion. What’s going on?

A

This is likely infective endocarditis with subsequent splenic abscess.

The triad of LUQ pain, fever, and leukocytosis suggests splenic abscess. (CT could show perisplenic fluid.) This is most commonly due to some form of bacteremia, either endocarditis or IV drug use.

80
Q

The preferred initial diagnostic for suspected kidney stones is _______________.

A

ultrasound

Although non-con CT is better at detecting kidney stones, US has almost no risk and can detect dilations in the ureter and kidney that would suggest a stone.

81
Q

Zollinger-Ellison presents with multiple duodenal ulcers, elevated gastrin, and _______________.

A

steatorrhea due to acidic inactivation of pancreatic enzymes

82
Q

Low Ig levels (all of them) and absent CD3 indicates ____________.

A

SCID

CD3 is the receptor for T cells.

83
Q

The treatment for SCID is _____________.

A

stem cell transplant

84
Q

Why does complete molar pregnancy lead to ovary enlargement?

A

ß-hCG leads to growth of the corpus lutea

85
Q

How do you treat rheumatic fever after the JONES symptoms have resolved?

A

Penicillin G

Even in those with no symptoms should be given Q4W penicillin G to eradicate any remaining GAS as well as to prevent future attacks. It is important to prevent future infections because repeat GAS infections lead to worsened rheumatic heart disease.

86
Q

Hypotonic hyponatremia with urine osmolarity < 100 indicates what two potential disorders?

A
  • Beer potomania

* Primary polydipsia

87
Q

True or false: SAAG < 1.1 indicates SBP.

A

False

SBP, because it results from cirrhosis, usually has a SAAG > 1.1.

88
Q

Once again, loss of peripheral vision with increased cupping?

A

Open angle glaucoma

89
Q

Primary autoimmune adrenalitis is common in what demographic?

A

Postpartum women

90
Q 
EBV can cause these symptoms and lab findings: 
•Fever
•Tonsillar exudate
•Cervical lymphadenopathy
•\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
•\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
•\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
A

Thrombocytopenia; Transaminitis; Autoimmune hemolytic anemia

91
Q

Recall that contact dermatitis includes both the immune and ____________ subtypes.

A

irritant

So healthcare workers with dermatitis on their hands –like you–have contact dermatitis.

92
Q

If they give you an HIV esophagitis story but note that (1) the pain is severe and (2) the patient has no thrush, they are telling you that _______________.

A

the patient has viral esophagitis, eithe HSV or CMV

93
Q

Fever 1-6 hours after an RBC transfusion most likely was caused by ________________.

A

failure of leukoreduction

Febrile nonhemolytic reactions are caused by WBCs in the donor RBCs that release cytokines after they die.

94
Q

Urticarial reactions to blood are usually due to ______________.

A

IgE attacking proteins in the blood

95
Q

Bloody diarrhea and diffuse pneumonia in a post-organ transplant patient?

A

CMV

MS3 - USMLE Step 2 CK (91 decks)

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