UWorld Step 2 CK Form 2 Flashcards
Differentiate galactocele and plugged duct.
A galactocele is a milk-filled cyst that arises in the subareolar area typically a month or two after women stop breast feeding. It is usually large (> 4 cm) and fluctuant.
A plugged duct is a focal occlusion of a breast duct that can happen anywhere in the breast and is small (< 2 cm). Because plugged ducts are caused by deposition of protein, they are firmer than galactoceles.
In primary adrenal insufficiency, you need to treat with ______________.
hydrocortisone and fludrocortisone
Bile leak can present with what somewhat surprising lab pattern?
Obstructive biliary labs (elevated alkaline phosphatase and direct bilirubin)
This can present even with no bile obstruction (as proved by absence of bile duct dilation on US).
How are confidence intervals calculated?
Mean +/- 1.96 x the standard error of the mean
Standard error of the mean = SD / square root N
This formula shows why an increased N leads to a narrower CI.
Don’t forget that early Lyme disease can present with ______________.
lymphocytic meningitis
If you witness a colleague have impairment (medical, psychiatric, or substance-use-related) that endangers patients, you first need to _____________.
report them to your hospital or practices physician health program (PHP)
Only contact the state licensing board when the physician fails to comply with the PHP’s recommendations
Spermatoceles (cystic collections of sperm) typically arise where?
In the epididymis
Describe the themes in managing intimate-partner violence.
- Validate (“You were right to seek help.”)
- Support (“I will do whatever I can to help you. Know that I am always here for you.”)
- Do not suggest a specific option (e.g., don’t say “You need to confront you husband about this.”)
Deceleration in head growth is suggestive of _____________.
Rett syndrome
In which cases of intense cancer pain should you add a long-acting opioid?
- When the pain awakens the person overnight
* When the pain is not controlled with Q4H doses
A woman has an intertriginous rash beneath her left breast. Microscopic exam is likely to show?
Pseudohyphae with budding yeast
Candida appears as the above description on microscopy.
Note Tinea appears as segmented hyphae on KOH prep.
Petechiae are common in which congenital infections?
Most of them (it is a nonspecific finding)
Many infections cause some degree of defective hematopoiesis.
True or false: congenital CMV causes macrocephaly due to hydrocephalus.
False
CMV actually causes microcephaly more commonly.
True or false: instead of NSAIDs, you should use colchicine in those with gout and renal failure.
False
Colchicine is contraindicated in those with renal failure.
In which cases should you avoid NSAIDs in those with gout?
Those who are on multiple blood-thinners should be given colchicine instead of indomethacin.
All NSAIDs are blood thinners, so be cautious if someon is already on multiple anticoagulants (like clopidogrel and apixaban).
Blepharitis is ___________.
eyelid swelling
What is a chalazia?
A benign swelling in the eyelid caused by a blocked meibomian gland
What is a serious form of rosea?
Ocular rosea
Think of this is a person presents with rosea on their nose and cheeks (telangiectasias and small pustules) and complains of “something in my eye” for the last couple weeks.
It is serious because it can cause blindness. Ophthalmology workup is indicated.
The triad of acute liver failure is _______________.
AMS, prolonger INR, and transaminitis
Carbamazepine causes NTD by what mechanism?
Folate antagonism
What is lochia?
The normal postpartum uterine discharge
It can last up to 28 days. Rubra, serosa, and alba are the three stages.
A long-time smoker with COPD desires elective surgery. What two things can you do in the preoperative period to decrease the risk of post-operative pneumonia?
- Smoking cessation > 8 weeks prior to surgery
* Physical therapy to increase respiratory strength (e.g., aerobic exercise, pulmonary PT)
Buerger disease is also called ____________.
thromboangiitis obliterans
Remember, the ONLY treatment is smoking cessation.
Allergic bronchopulmonary aspergillosis (ABPA) typically occurs in those with _______________.
asthma or cystic fibrosis
Describe the presentation of prosthetic valve thrombosis.
Usually caused by inadequate anticoagulation (the INR needs to be 2.5 - 3.5 in those with mechanical mitral valves and 2.0 - 3.0 in those with mechanical aortic valves), prostehtic valve thrombosis presents with acute-onset heart failure and emoblic stroke.
Bronchiectasis can be caused by even _______________.
one severe pulmonary infection
A severe, necrotizing pneumonia can lead to significant tissue damage that impairs bacterial clearance.
Discuss the differences in hypomania and mania.
- Mania is characterized by > 1 week of DIGFAST symptoms along with marked impairment in social functioning (like calling out of work or getting into legal trouble). Any psychotic features or hospitalizations are diagnostic regardless of timing.
- Hypomania is characterized by < 1 week of DIGFAST symptoms with no appreciable impairment in function.
The recommended management of preeclampsia with severe features is ____________.
induction of labor
C-section is done only for eclampsia and any sign of non-reassuring FHT.
True or false: the adenoids are smallger lymph glands embedded on the posterior side of the tonsils.
False
The adenoids are lymph glands superior to the soft palate of the oropharynx. They are not visible on physical exam.
The most common cause of recurrent AOM and rhinosinusitis is ______________.
adenoidal hypertrophy, which blocks the drainage of the sinuses and the Eustachian tubes
In addition to the nitrazine test, ___________ can also be used to determine if a woman will start labor within one week.
fetal fibronectin
This is a protein found at the placenta-uterus junction. Labor disrupts this junction and causes fetal fibronectin to leak into the vagina.
In whom do you skip GBS testing and go straight to treatment?
- Women with past pregnancies complicated by GBS
* Women with a recent UTI caused by GBS
In which cases should you opt for a copper IUD and in which cases should you opt for a progesterone IUD?
- Copper IUDs can cause menorrhagia, so avoid these in women with heavy periods.
- Progesterone IUDs cannot be given to women with breast cancer or liver disease.
- Active PID is a contraindication to both.
- Both can be given while a woman is menstruating.
The most common reason patients don’t take medicines is ______________.
being asymptomatic (particularly common with antihypertensives and diabetes meds!)
Describe the diagnosis and treatment of mastoiditis.
- Mastoiditis is diagnosed clinically. History of inadequately treated AOM, PE showing displacement of the ear, and systemic infectious signs (fever, tachycardia, increased RR) all point to a diagnosis.
- Treat with IV antibiotics.
- If IV antibiotics fail, then consult surgery for T-tube placement or debridement of necrotic bone.
What is colonic pseudo-obstruction?
A syndrome that looks like large intestine obstruction (tympany, obstipation) without evidence of anatomic obstruction on x-ray.
Gas in the rectum on an x-ray showing SBO indicates ______________.
partial obstruction
How should you manage SBO?
- Diagnosis with history, PE, and x-ray.
- For patients with signs of peritonitis or strangulation, take for laparotomy immediately.
- For patients without the above signs, manage with NG decompression and water-soluble contrast.
True or false: achild born to woman with no history of STIs or risk factors does not need prophylactic erythromycin.
False
Because erythromycin is so safe and the potential consequences of gonorrheal conjunctivitis are so severe, erythromycin is given to all infants.
Livedo reticularis can be a sign of ____________.
antiphospholipid antibody syndrome
True or false: the PTT and PT are prolonged in those with APLAS.
False!
Only the PTT.
A patient s/p thyroidectomy 8 years prior presents with with tremor and instability. CT shows massive calcifications in the basal ganglia. What happened?
Calcifications in the basal ganglia are a complication of high phosphate-calcium product (typically greater than 55). In this case, this patient likely stopped taking their hypoparathyroidism meds, leading to a high phosphate.
Why is there afferent dilation and efferent constriction in diabetic nephropathy?
Afferent dilation occurs due to HTN. Efferent vasoconstriction occurs due to increased renin activity due to mesangial proliferation.
Why does proteinuria develop in those with diabetic nephropathy?
Mesangial proliferation leads to stretching of the glomerulus which lets out protein through stretched fenestrations.
The increased efferent constriction in diabetic nephropathy leads to ______________.
ischemic damage
There are distal arteries from the efferent arteriole that perfuse the kidney. Constriction of the efferent arteriole leads to ischemic death.
List the negative and positive prognostic factors associated with schizophrenia.
•Positive:
- Positive symptoms
•Negative:
- Early onset
- Negative symptoms
- Family history
- Intrusive family
- Prodromal phase with slow onset
- No precipitant
Lack of placental delivery and increased vaginal bleeding are features of ______________.
retained placenta
Bleeding can be quite profuse (up to 500 mL!).
With psych questions, if they didn’t tell you about a symptom, it ___________.
isn’t there
This is really important. There are a lot of questions in which the person they’re describing seems depressed or anxious, but unless they tell you that the person endorsed the DSM-V criteria for those disorders then they don’t have them!
What disorder can resemble tophaceous gout?
Chronic bursitis
In chronic bursitis, repetitive use leads to fluid accumulation in the bursa. This is common on the elbow, particularly in those who work with their elbows on a surface (like carpenters). Chronic bursitis lesions will be softer and more fluctuant than gouty tophi. Also, there will not be a history of gout.
What is pulmonary cachexia?
A disorder in those with advanced COPD in which the increased respiratory drive leads to atrophy of the respiratory muscles
This is a diagnosis of exclusion, so it is important to rule out infection, malignancy, and adrenal insufficiency (in those taking high-dose steroids repeatedly).
Inadequate post-procedural compression can lead to what abnormality in those who have undergone femoral catheterizations?
- Hematoma
- Pseudoaneurysm
These can be distinguished from each other with physical exam: pseudoaneurysms will be pulsatile and have a bruit.
The UWorld first-line therapy for borderline personality disorder is _______________.
psychotherapy
Before surgery and steroid injection, you need to recommend these interventions in osteoarthritis: _______________.
NSAIDs, weight loss, moderate activity, and PT to strengthen the quadricep muscles
Review the causes and presentations of chalazia and sty.
- Chalazia: blocked meibomian tear glands (the glands along the eyelid) that is non-infected; this is a more chronic, less painful presentation of an eyelid swelling; typically rubbery swelling that is farther from the lid margin; treat with warm compresses
- Sty (hordeolum): S. aureus infection of a eyelash follicle
What is the technical name for a fetus that is < 10th percentile weight but otherwise completely normal?
Consitutionally small infant
This is just the small range of normal and does not predispose the child to any future morbidity.
True or false: needle aspiration is the next diagnostic step when you discover a suspicious cyst/mass on mamogram or US.
False
Core biopsy is the next step.
Needle aspiration can be done to exclude malignancy in simple cysts.
What is susceptibility bias?
A type of selection bias in which those who have a more severe presentation are susceptible to being selected for different treatments
This would be in an RCT without intention-to-treat analysis or in an observational trial.
True or false: Cushing syndrome from pituitary ACTH secretion leads to suppressed cortisol on low-dose dexamethasone suppression test.
False
Pituitary tumors are suppressed with HIGH-dose dexamethasone. This distinguishes them from ectopic ACTH production, which will not suppress on high-dose dex testing.
Open-angle glaucoma causes what kind of vision loss?
Peripheral vision loss
What is the diagnostic feature of open-angle glaucoma on fundoscopic exam?
Optic disc cupping
This is an increase in the cup:disc ratio, meaning the disc (the surrounding rim) will stay the same size, but the cup will increase to greater than half the disc diameter.
What CBC abnormality is often seen in babies born to diabetic mothers who have not treated their diabetes?
Polycythemia
The high levels of glucose lead to a hypermetabolic state in the developing fetuses, which in turn leads to hypoxemia from increased metabolic demand. The chronic hypoxemia leads to reactive erythrocytosis.
Both colonic pseud-obstruction and opiod ileus can occur after surgery. How can you differentiate the two?
Colonic-pseudo obstruction presents with more severe colonic dilation often with a normal-appearing distal rectum, whereas opioid ileus leads to milder dilation of the colon with symmetically dilation.
Explain the framework for declining patient requests for unnecessary procedures.
Explain the risks and benefits that are the reason why you’re declining the test/medicine in a nonjudgmental way. Instead of saying “this test is unnecessary,” explain why it is unnecessary (the high risks and low benefits).
Onycholysis is the _______________.
separation of the distal nail from the nail bed
These are the side effects of lithium:
- Tremor
- GI upset
- Nephrogenic DI
- _____________
hypothyroidism
Think of this if a person with well-controlled psychiatric symptoms presents with weight gain, fatigue, cognitive slowing, and constipation.
True or false: viral tenosynovitis commonly presents with mild fever.
False
Fever, leukocytosis, and elevated ESR are uncommon symptoms.
Recurrent watery diarrhea –particularly at night –in an elderly woman will classically show a ___________ infiltrate on colonic biopsy.
mononuclear
The best way to prevent genital herpes transmission is _______________.
consistent condom use
What migraine medicine can cause akathisisa?
Prochlorperazine
Describe MDS.
Myelodysplastic syndrome is a hematopoietic neoplasma that interferes with all bone marrow cell lines, leading to pancytopenia and dysplasia. Common smear signs are hyposegmented neutrophils and oval RBCs.
Which patients should be referred for valve replacement in aortic stenosis?
Any patients with symptoms
Recall that aortic stenosis has a long asymptomatic phase with a quick decline once symptoms start. Thus, any increased SOB, syncope, decreased exercise tolerance, or heart failure should be referred for aortic valve replacement.
True or false: progesterone implants (Nexplanon) is more effective than IUD.
False
I thought it was, but UWorld says IUD and implants are both >99% effective. IUD lasts longer, so in those with “busy schedules” –who may not want to come back for Nexplanons –choose IUD.
Review the birth control requirements for isotretinoin.
- Two negative pregnancy tests
- Two forms of contraception (barrier and pill)
- Monthly pregnancy tests while on the medication
Testicular torsion is caused by ____________.
failure of the tunica vaginalis to connect with the testes
When an older child acts out against the younger child –with, for instance, hitting the younger child or behavioral regression –the recommended treatment is ____________.
to have the parent spend more time with the older child
Those with chronic diarrhea are at increased risk for which type of kidney stone?
Uric acid
Loss of bicarbonate through the GI tract acidifies the urine, which predisposes to uric acid crystal formation.
When they ask you “what is the most likely reason an adolescent is doing X?” The answer is ____________.
their friends are doing it
What are phimosis and paraphimosis?
- Phimosis: foreskin stuck to the glans
- Paraphimosis: foreskin stuck around the base of the glans when retracted –an ischemic emergency that requires immediate reduction of the foreskin
If they say “this guy’s never had abdominal surgery” and then ask what kind of obstruction he has, the answer is most likely ___________.
not SBO due to adhesions but rather sigmoid volvulus, which can occur due to chronic constipation with resultant redundant colon
Discomfort during the rectal exam of a patient with bowel obstruction indicates ___________.
sigmoid pathology
A kid has limb ataxia following a viral illness. This is _____________.
acute cerebellar ataxia, a post-viral syndrome in which kids develop limb ataxia, usually one-sided, that resolves on its own
Cocaine withdrawal can last ___________.
weeks
If symptoms persist for longer than one month, though, this is abnormal and suggests something else.
What type of headache is often accompanied by decreased level of consciousness?
Subarachnoid hemorrhage
Weakening of the floor of the inguinal canal causes which type of hernia?
Direct
Indirect inguinal hernias are caused by laxity of the deep inguinal ring.
Genital warts are treatable with ______________.
trichloroacetic acid
Elevated LDH in a person with a mechanical valve may indicate _____________.
hemolysis from valve dysfunction
