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BOARDS STEP 2 STUDY MATERIAL > UWorld wrong questions part 1 (1st 200 qs) > Flashcards

UWorld wrong questions part 1 (1st 200 qs) Flashcards

1
Q

What vitamin deficiency accompanies carcinoid syndrome?

A

niacin (b/c 5-HT is made from tryptophan which also makes niacin)

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2
Q

4 diagnostic things to do with carcinoid syndrome

A

24 hr urine with 5-HIAA, CT/MRI abd/pel, metastasis scan, echo

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3
Q

proximal muscle weakness + weight loss, anxiety, tremor with movement, tachy = think…

A

hyperthyroidism

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4
Q

Causes of proximal muscle weakness

A

poly/dermatomyositis, hypo/hyperthyroidism, Cushing’s, Lambert-Eaton, myasthenia gravis, steroids

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5
Q

suspect MEN syndrome: what do you do to screen and treat?

A

screen: genetic testing
treat: total thyroidectomy

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6
Q

what drug decreases frequency of acute relapse in MS?(for relapsing-remitting)

A

IFN-beta

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7
Q

what drug should be given DURING acute flare of MS?

A

high dose steroids

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8
Q

what drugs treat progressive form of MS?(one with no remissions)

A

immunosuppressants: cyclosporine, methotrexate, mitoxantrone

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9
Q

1st step in diagnosing/managing MS? 2nd step?

A

MRI of brain w/ w/o gadolinium, showing demyelinated plaques (SECOND step = IgG on CSF)

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10
Q

Extrapyramidal side effect of restlessness = ? treat with?

A

Akathisia. Benzo

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11
Q

Extrapyramidal side effect of tremor, rigidity, slow movements = ? treat with?

A

Parkinsonism. no Tx.

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12
Q

Sudden sustained contraction of neck, mouth, tongue, eyes = ? Treat with?

A

Acute dystonia. Benztropine or diphendydramine

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13
Q

adrenal insufficiency signs + hyperpigmentation, increased K, decreased Na, decreased BP = ?

A

primary insufficiency (so decreased cortisol, increased ACTH, decreased aldosterone)

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14
Q

best preventative measure to do to reduce chances of peripheral neuropathy with diabetes?

A

blood pressure control

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15
Q

diff between VIPoma and carcinoid syndrome?

A

VIPoma tumor in pancreas, carcinoid tumor in SI. also decreased H, Cl, and K in VIPoma

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16
Q

increased T3, T4 and normal TSH = ?

A

resistance to thyroid hormones. have hypothyroidism signs

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17
Q

loss of pain/temp over ipsi face & C/L body, ipsi dysphasia/hoarseness(CN IX/X), vertigo, nystagmus, Horner’s = what disease, localized where in brain? Tx?

A 
Wallenberg syndrome (lateral medullary infarct). 
Tx: t-PA
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18
Q

Weakness of jaw, decreased sensation on face = what neuro area infarct?

A

Lateral pons infarct = more sensory issues. / medial pons = more motor issues

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19
Q

C/L arm/leg paralysis, tongue deviation toward lesion = what neuro area infarct?

A

Medial medullar infarct

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20
Q

Patient with Parkinsonism experiences: orthostatic hypotension + autonomic dysfunction (i.e. bladder probs, ED, cholinergic signs) + neuro signs? Tx?

A

Shy Drager syndrome (Multiple System Atrophy). / Tx: fludrocortisone, salt, alpha-adrenergic agonists, constrictive garments

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21
Q

child with autonomic dysfunction and orthostatic hypotension, think what aut dom disease?

A

Riley Day Syndrome (Ashkenazis_

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22
Q

brain death = what is still functioning?

A

spinal cord, so DTRs present. NO brainstem fxn (no HR, no breathing, etc)

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23
Q

intention tremor found with what disease?

A

alcoholism –> cerebellar degeneration

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24
Q

lab values in secondary hyperparathyroidism? (PTH?Ca?PO4?D?)

A

increased PTH, decreased Ca, increased phosphate, decreased vit D

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25
Q

increased Ca+2 labs; next 2 steps?

A

Repeat Ca, THEN measure PTH

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26
Q

if hypercalcemia + increased PTH, consider what?

A

primary and tertiary hyperpara, familial hypercalcemic hypocalcuria, lithium

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27
Q

if hypercalcemia + decreased PTH, consider what?

A

malignancy, vit D tox, gramulomas, HCTZ/theophylline, thyroxic, vit A tox, immobilization

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28
Q

3 steps to take in management when suspecting acromegaly?

A

IGF-1 –> oral glucose suppression —> MRI of brain (pituitary?)

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29
Q

where can median nerve entrapment occur?

A

wrist (loss of motor and sensory) > mid-forearm > elbow (sensory spared)

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30
Q

lacunar infarct will cause what Sx?

A

U/L motor impairment (b/c posterior limn of internal capsule); no sensory deficits

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31
Q

lesion of optic radiation causes

A

contralateral hononymous hemianopia

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32
Q

oculomotor nerve lesion causes

A

ptosis and eye looking down and out (unopposed IV and VI)

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33
Q

trochlear nerve lesion causes

A

vertical diploplia and extorsion of eye

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34
Q

lesion on medial lemniscus causes

A

decreased touch and vibration sensation

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35
Q

what withdrawal symptoms happen from abrupt discontinuation of benzos?

A

seizures

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36
Q

what is first line treatment for OCD?

A

SSRIs + clomipramine (TCA)

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37
Q

what med to treat anorexia with if no response to CBT?

A

olanzapine

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38
Q

Cushingoid Sx - steps in management?(4)

A

1st get 24 hr cortisol / low dose dexa sup test. 2nd get ACTH level. 3rd get imaging based on where it is(adrenal/head MRI?). 4th get IPSS/full body imaging/high dose dexa for ectopic source

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39
Q

Addison Sx - how to diagnose?

A

after cortissol levels, do Consyntropin stimulation test (analog of ACTH) - if no increase in cortisol it’s primary

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40
Q

Parkland burn formula - how much IVF to give?

A

4 mL x kg x %BSA, then give first 1/2 first 8 hrs, 2nd half next 16 hrs

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41
Q

When to admit burn patient inpatient and do IVF, escharotomy?

A

2nd degree with >10% BSA, 3rd degree with >2% BSA, or involving face/hands/genitalia/skin flexure areas

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42
Q

glucose suppression test used for what?

A

confirmatory diagnosis of acromegaly (after iGF-1, which is 1st step in management)

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43
Q

differences in Ca and PO4 with primary vs secondary hyperparathyroidism?

A

primary: increased Ca, decreased PO4. secondary: decreased Ca, increased PO4.

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44
Q

feel palpable thyroid nodule, what are next steps in management?

A

1st get TSH, T4, U/S. 2nd: if hypo or euthyroid, get FNA. If hyperthyroid, do radionucleotide iodine uptake scan. If hot treat hyper. If cold, FNA.

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45
Q

For diabetics, when to do a) physical exam w/ glucose, b) urine microalbumin, U/A, CMP c) lipid panel, d) ophtho visit e) what vaccines

A

a) 3-6 months dep on HbA1C, b) yearly, c) yearly d) yearly e) flu and pneumo

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46
Q

if you see microalbuminuria in DM patient, what next?

A

24 hour urine protein to look for nephrotic syndrome

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47
Q

what is neovascularization on fundo exam and how is it treated?

A

Proliferative DM retinopathy: treat with laser photocoag

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48
Q

J waves on EKG = ?

A

hypothermia (bump after QRS)

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49
Q

How to treat scorpion sting?

A

atropine (antichol), antivenin, phenobarbitol

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50
Q

How to treat brown recluse spider bite?

A

debridement, dapsone. if infection, oral erythromycin.

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51
Q

If dirty/punctured/crush wound, do what tetanus stuff?

A

Td if > 5 years since last dose and equal to or more than 3 prior immunizations, Td + tetanus Ig if less than 3 prior immunizations

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52
Q

Do not do exercise stress test if…

A

L BBB, LVH (do nuclear & pharm)

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53
Q

gold standard for CAD?

A

coronary angio (after 1st step: stress test shows ischemia, angina, or greater than 1 mm ST depression)

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54
Q

chlorpromazine, prochlorperazine, or metoclopramide are hat kinds of drugs, and can be used with NSAIDs or triptans for what?

A

antiemetics, for migraines

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55
Q

migraine PPx drug?

A

beta blocker

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56
Q

what antipschotic is associated with QT prolongation and thus you should do ECG?

A

ziprasidone

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57
Q

what second gen antipsychotic comes with hyperprolactinemia?

A

risperidone

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58
Q

antipsychotics with highest risk of weight gain/llipid/glucose increase?

A

olanzapine, clozapine

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59
Q

how to tell malignant hyperthermia from thyroid storm?

A

malig hyperthermia: muscle rigidity, hyperkalemia. thyroid storm: lid lag, arrythmmias, tremor, goiter. BOTH can occur after surgery.

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60
Q

How to treat thyroid storm?

A

PTU, iodine, beta blocker for Sx, glucocorticoids for creasing T4 to T3 conversion

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61
Q

B/L LE weakness, UMN signs, think

A

spinal cord compression (UMN = CNS), B/L = spinal cord and not brain

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62
Q

what is trihexyphenidyl?

A

anticholinergic, often used for Parkinson’s

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63
Q

essential tremor is what? how to treat?

A

worsens with activity (OPPOSITE of Parinsonian kind) Primidone + beta blocker. (2nd line = benzos, clozapine)

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64
Q

painless curtain over eye, CAD = what?

A

amaurosis fugax = loss of vision from emboli, shows stroke is coming. Do Duplex U/S of neck – most common site.

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65
Q

levodopa + carbidopa: s.e.

A

somnolence, confusion, hallucinations in order patients

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66
Q

amantadine: s.e.

A

ankle edema, livedo reticularis

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67
Q

apomorphine, bromocriptine, pramipexole, ropinirole: s.e. (Parkinsonian drugs)

A

somnolence, confusion, hypotension, hallucinations in older patients (these are dopamine agonists)

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68
Q

entacapone/tolcapone: type, s.e. (Parkinsonian drugs)

A

COMT inhibitor. Dyskinesia, hallucinations, confusion, N, hypotension

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69
Q

selegiline: type, s.e.

A

MAO-B inhibitor. insomnia, confusion

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70
Q

treatment for prolactinoma: 1st, then 2nd

A

capergoline>bromocriptine, then Sx if it fails

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71
Q

what is diagnostic of MS?

A

MRI brain (not LP- IgG bands, b/c this only exists in 90% of pts)

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72
Q

treatment for Paget’s disease?

A

bisphosphonates if symptomatic

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73
Q

Patient with HTN & hypokalemia, suspect hyperaldosteronism. 1st step in management? 2nd? 3rd?

A

1) aldosterone/renin ratio. (primary vs secondary)

2) if increased, do adrenal suppression tests (if +, then adrenal imaging)

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74
Q

Type of gait in Parkinsonism?

A

hypokinetic (slow, shuffling, narrow, immobile arms)

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75
Q

waddling gait is in what?

A

muscular dystrophy (weak gluteals)

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76
Q

spastic gait is in what?

A

UMN lesions or cerebral palsy

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77
Q

wide-based, high stepping gait is in what?

A

sensory ataxia (because loss of proprioception) – Romberg +. Wide is also in MSA, multiinfarct.

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78
Q

how to tell apart lacunar infarct vs MCA vs ACA?

A

lacunar: U/L motor impairment. MCA: C/L sensory & motor face, arm, leg, homonymous hemianopia, eye deviation twd infarct, aphasia/hemineglect. ACA: same as above but in LE only.

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79
Q

1st and final diagnosis of prinzmetal angina?

A

1st: stress test (ST elev during pain sx only). Final diagnosis: coronary arteriography showing NO stenosis

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80
Q

1st line treatment of prinzmetal angina?

A

CCB (NOT beta blocker)

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81
Q

when to do CABG?

A

> 50% stenosis in LAD, 3 vessel disease, or CAD + DM

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82
Q

when to do fibrinolysis?

A

STEMI, NOT unstable angina

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83
Q

what to give in a propanolol OD?

A

glucagon, Ca, insulin + dextrose

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84
Q

what is a diagnostic glucose level for DM?

A

random >200 + DM symptoms OR fasting >126 on two occasions

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85
Q

narrow QRS, HR >100, healthy young patient

A

paroxysmal SVT. This includes WPW & AV nodal reentry. [v. tachy = wide QRS!)

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86
Q

treatment for SVT

A

1st: carotid massage, valsalva. 2nd: IV amiodarone. 3rd: CCBs, BB. 4th: CV.

87
Q

hyperthyroidism can cause what heart problem?

A

a fib (no P, narrow QRS)

88
Q

How to treat a fib?

A

if 48 hrs, anticoag & TEE to check for thrombus. Then rate control (bb) or rhythm control (sotalol or amiodarone, aka K+ antiarrythmics)

89
Q

wide QRS, no p waves

A

PVCs. No Tx.

90
Q

slightly decreased T3, normal T4, normal TSH with person with acute illness = what?

A

sick euthyroid syndrome

91
Q

Myasthenia gravis: what is screening test, what is used to diagnose, and what is 3rd test?

A

Screening: Edrophonium. Diagnose: EMG & ACh-R Ab test. 3rd: CT scan of chest (to look for thymoma)

92
Q

What DM drug is best for weight loss?

A

GLP-1-R agonist, i.e exenatide

93
Q

loss of motor and sensory function in LE + loss of rectal tone/urinary retention, sensation at umbilicus intact= ?

A

acute spinal cord compression (do emergent MRI + surgery, IV glucocorticoids). [not cauda equina b/c this would have saddle anesthesia // not conus medullaris lesion b/c this wouldn’t have motor/sensory loss]

94
Q

how to tell apart ruptured aneurysm -> subarachnoid hemorrhage vs. a intracerebral hemorrhage?

A

subarachnoid wouldn’t have specific FNDs like hemiparesis; just headache and N/V.

95
Q

What symptoms compose Wernicke’s encephalopathy?

A

triad: encephalopathy, oculomotor dysfunction, and gait ataxia.

96
Q

What constitutes progression of Wernicke’s into Korsakoff’s syndrom?

A

once neuro Sx include amnesia, confabulation, and apathy

97
Q

when should you do parathyroidectomy for asymptomatic hypercalcemia?

A

Ca >1mg above, age

98
Q

burst fracture of the vertebrae + loss of motor fxn I/L with loss of pain/temp B/L

A

anterior cord synfrome

99
Q

I/L motor and proprioception loss, C/L pain loss

A

Brown Sequard Syndrome

100
Q

Positive straight leg raising test means…

A

acute disk prolapse

101
Q

burning pain and paralysis in UE, sparing of LE, from hyperextension of neck in elderly

A

central cord syndrome

102
Q

a) enlargement of cerebral ventricles in what psych disease? b) total brain volume increased where? c) decreased hippocampus where? d) decreased amygdala where?

A

a) schizophrenia b) autism c) PTSD d) panic disorder

103
Q

what drugs reduce mortality in CHF?

A

beta blockers, ACE inhibitors, and aldosterone antagonists (ie eplenerone)

104
Q

VSD murmur?

A

systolic

105
Q

murmur buzzwords – a) opening snap? b)bounding pulses/head bobbing?

A

a) MS b) AR

106
Q

late systolic murmur at apex?

A

MVP (MR would be holosystolic)

107
Q

valsalva maneuver makes what murmurs louder?

A

HCM, MVP (because it decreased preload?

108
Q

DCM vs HCM - what heart sounds?

A

DCM: S3. HCM: S4

109
Q

confirmatory diagnosis of RCM?

A

with biopsy

110
Q

Kussmaul sign vs pulsus paradoxus?

A

Kussmaul: JVD w/ inspiration, constrictive pericarditis. Pulsus paradoxus: decreased SBP w/ inspiration. with cardiac tamponade

111
Q

Screening and gold standard test for renal artery stenosis?

A

Screen: MRA. Gold: renal arteriogram

112
Q

1st line drug for HTN?(nonblacks)

A

thiazide diuretics (also CCB, ACE, or ARB)

113
Q

Diuretics - which increase K? decrease K? increase Ca? decrease Ca?

A

increase K: aldo-I, ACE-I. / Decrease K: loop, thiazides. / increase Ca: thiazides. / decrease Ca: loops.

114
Q

beta-1 selective BBs

A

atenolol, metoprolol (first half of alphabet)

115
Q

beta-1/alpha-1 BBs

A

labetalol, carvedilol (don’t end in Olol)

116
Q

beta blocker s.e.s

A

bronchoconstriction (so, contra. in asthma/COPD - esp propanolol b/c nonselective), decrease HDL, increase Tgs, mask hypoglycemia

117
Q

nifedipine, amlodipine, diltiazem, verapamil - diffs?

A

1st 2: dihydro (-DIPINE) CCBs. work at vasculature. HTN, prinzmetal angina, migraines, esoph. spasm.
2nd 2: nondihydro CCBs: work at heart. rate control for A. fib.

118
Q

hydralazine, minoxidil, nitroprusside - type? s.e.?

A

vasodilators. (only this nitrate = vaso AND venodilator), s.e.: reflex tachy, so use with BB

119
Q

Treatment BP goals for HTN

A

> 60 yrs with no CKD/DM:

120
Q

Black population w/o CKD - what HTN drugs to use?

A

thiazide diuretics or CCB

121
Q

what HTN drug is contraindicated in CHF?

A

nondihydro CCBs (diltiazem, verapamil); BBs during acute exacerbation

122
Q

best HTN drug for person with osteoporosis/post-menopausal?

A

thiazide (because increased Ca is effect)

123
Q

Drugs for HTN in pregnancy?

A

Hydralazine, Methyl-dopa, Labetalol, Nifedipine (HTNive mothers love nifedipine)

124
Q

diuretics: contraindicated in = ?

A

gout

125
Q

what treats both migraines and essential tremor?

A

BBs

126
Q

treatment for cardiogenic shock?

A

dobutamine (beta-1 effect) or dopamine, PTCA (MI), intraaortic balloon pump

127
Q

if decreased BP, how can you tell that this is shock and not someone’s baseline low BP?

A

urine output & mental status (end organ damage)

128
Q

treatment for septic shock:

A

Abx, IVF, norepinephrine (because causes vasocontriction without effecting heart)

129
Q

treatment for anaphylactic shock

A

Epi, diphenhyhdramine, maintain airway, IVF

130
Q

treatment for neurogenic

A

IVF, vasopressors, atropine if bradycardia

131
Q

PCWP of Swann-Ganz cath measures…? when is it high/low?

A

left atrial P. high in cardiogenic. low in everything else.

132
Q

In what kinds of shock is SVR low?

A

neurogenic, septic, anaphylactic

133
Q

what is best pressor for a) cardiogenic shock? b) septic shock? c) anaphylactic shock?

A

a) dobutamine b)NE or phenylephrine; vasopressin if resistant c) Epi

134
Q

causes of decreased iodine uptake:

A

subacute thyroiditis, levothyroxine OD, iodine-induced thyrotoxicosis, struma ovarii

135
Q

How to treat metastases?

A

one: surgical resection then stereotactic radiosurgery/whole brain radiation. multiple: straight to whole brain radiation. [[chemo best for small cell, lymphoma, choriocarc]]

136
Q

Treatment of restless leg synfrome?

A

pramipexole (dopamine agonist); 2nd line = gabapentin

137
Q

ulnar nerve compression most common at the…

A

elbow

138
Q

How to treat myasthenia CRISIS?

A

intubate, then steroids + plasmapheresis > IVIG

139
Q

When to use haloperidol vs benzos for agitation?

A

benzos for younger patients (ontraindicated in older), haloperidol for older

140
Q

Pseudotumor cerebri/benign intracranial HTN is treated with what? What is complication?

A

weight reduction and Acetazolamide (b/c it is a problem with impaired absorption of CSF by arachnoid villi). Blindness.

141
Q

what is true vertigo?

A

spinning sensation looking at things (as opposed to dizziness from lightheadedness, syncope)

142
Q

vertigo and nystagmus on lying back into supine position with head rotated = ? Indicates what? Cause?

A

Dix-Hallpike maneuver. Indicated benign paroxysmal positional vertigo (caused by semicircular canal dysfunction)

143
Q

a) Pronator drift indicated what? b) Romberg indicates what? c) rapid alternating movements test what?

A

a) UMN damage of UEs. b) proprioception loss (posterior column sensory). c) cerebellar dysfunction

144
Q

facial pain leading to headache, FNDs, ring enhancing lesion = ?

A

ethmoid sinusitis ==> brain abscess, usually with S viridians or anaerobes

145
Q

Cauda equina syndrome (spinal nerve roots) vs. conus medullaris syndrome (spinal cord termination) – differences?

A

Cauda equina: saddle anesthesia, U/L motor weakness, hyporeflexia.
Conus medullaris: perianal anesthesia, B/L motor weakness, hyperreflexia.

146
Q

decreased Ca, decreased PO4, increased PTH with IBD/Gi thing or after surgery – what is cause?

A

osteomalacia/vit D deficiency (b/c malabsorption). Will have bone pain and increased alk phos as well.

147
Q

“suicide attempt” in person with CAD and wheezing, hypotension, bradycardia, hypoglycemia, seizures, =?

A

beta blocker OD. give glucagon

148
Q

a tachy with AV block, think…

A

digitalis toxicity

149
Q

HTN in young adult patient, consider =? treat=?

A

aortic coarctation, so do B/L arm/leg BP measurements. treat with baloon angioplasty

150
Q

Mixed venous-oxygen saturation for types of shock= ?

A

will have opposite trend of SVR, so just remember that.

151
Q

What drugs cause widening of QRS with increased heart rate (“use dependence”)?

A

antiarhythmics

152
Q

murmur with Marfan syndrome? what does it sound like?

A

aortic dissection that leads to aortic regurgitation. Early diastolic murmur. [also, MVP!]

153
Q

pulsus parvus et tardus = ?

A

arterial pulse with decreased amplitude and delayed peak seen in aortic stenosis

154
Q

Renal artery stenosis: how to treat in young patient, and in old patient?

A

Young: angioplasty with stent. Old: ACE inhibitor

155
Q

Heart failure after chemo, think…

A

constrictive pericarditis (if with JVP/kussmaul’s, low voltage QRS on ECG, +HJ reflux, knock (mid-diastolic sound)

156
Q

difference between chronic and acute MR?

A

acute: usually from papillary muscle displacement after acute MI, leading to volume overload –> increased LAP, LVP. chronic: increased atrial SIZE

157
Q

How to diagnose and treat AAA?

A

DIag: abd U/S. Treat: BB; surgery if Stanford A type.OR diameter >5.5 in men, >5 in women, or increase >0.5 in 6 months

158
Q

How to treat PVD aka PAD?

A

cilostazol to decrease claudiation (if no HF), ASA, clopidogrel, statin. If fails, angioplasty or bypass graft.

159
Q

When do you do a Ankle-Brachial Index (ABI)?

A

To diagnose PVD AND to r/o PVD when checking varicose veins

160
Q

If you see BP 170/94, HR 52, RR 9 think…

A

increased intracranial P (this is Cushing’s triad). Look for papilledema and pupil asymmetry too

161
Q

What to do to Dx/Tx stab wound in zone I of neck? zone II? zone III?

A

zone I (below cricoid): EGD + full imaging. Zone II: surgical exploration. zone III (above mandible): 4 vessel CT angio.

162
Q

How to manage blunt abdominal trauma in patient with stable vitals?

A

ABCs, 2 large bore IVs, NG/Foley, and CT abdomen and pelvis

163
Q

How to manage blunt abd trauma and unstable vitals?

A

FAST (Focused Assessment with sonography for trauma). If (+) for blood in pelvis: emergent lap.
If (-) for blood: angiography + embolization –> if this is normal, CT abd.
. If FAST inconclusive: DPL (diagnostic peritoneal lavage).

164
Q

How to treat patient with pelvic fracture?

A

IVF +/- blood, FAST. If (+) blood, emergent lap. If no fluid but unstable, DPL. If no blood on DPL and unstable,, angio + embolization. (may be retroperitoneal hemorrhage).

165
Q

Pelvic fracture + DPL shows blood in pelvis. Next step?

A

emergent lap

166
Q

Pelvic fracture + DPL shows urine in pelvis. Next step?

A

urgent lap

167
Q

Pelvic fracture + DPL shows nothing + unstable. Next step?

A

angiography + embolization

168
Q

Blunt abd trauma + unstable vitals + FAST shows fluid in pelvis. Next step?

A

emergent lap

169
Q

Blunt abd trauma + unstable vitals + FAST shows no fluid in pelvis. Next step?

A

angiography + embolization

170
Q

Blunt abd trauma + unstable vitals + FAST inconclusive. Next step?

A

DPL

171
Q

Patient has a. fib with RVR, has chronic a fib. What is next step?

A

TEE (look for clots ) – BEFORE CV

172
Q

What to do for stable fracture? For unstable fracture?

A

Stable: immobilization. Unstable: int/ext fixation

173
Q

neurovascular injury + fracture = Tx?

A

fasciotomy (risk of compartment syndrome)

174
Q

When to perform C-section with trauma in pregnant patient?

A

fetuses > 24 weeks in distress, or mom with CV compromise.

175
Q

When can you D/C a pregnant patient who had trauma?

A
  • contractions >10 min, no vag bleeding (and if ANY bleeding, check Rh and give RHoGAM if Rh-), no abdominal pain, and normal fetal heart
176
Q

Smokers - what to test pre-op?

A

make sure they stopped smoking >2 months; PFTs if with myasthenia.

177
Q

Can give what for renal patients pre-op?

A

N-acetyl cysteine

178
Q

High pitched bowel sounds and air fluid levels on abd CT means what?

A

bowel obstruction (HANG IV: Hernias, Adhesions, Neoplasms, Gallstone ileus, Intussuseption, Volvulus)

179
Q

How to treat diverticulitis?

A

metronidazole + fluoroquinolone

180
Q

how to treat hemorrhage from GI perforation?

A

angio + embolization

181
Q

sudden onset intense abdominal pain in CAD patient, bloody diarrhea, but not much on physical exa; CT with bowel wall thickening + air within bowel wall (pneumatosis)= ? Tx?

A

Acute Mesenteric Ischemia (“GI MI”). Tx: NPO, broad Abx, NG decomp, angiogram, heparin. If embolus/thrombus caused it, do -ectomy/resection of necrotic bowel + revascularization and 2nd look lap 1-2 days later for stuff you missed.

182
Q

dull post-prandial epigastric pain in CAD patient, weight loss, abdominal bruit =? Tx?

A

Chronic Mesenteric Ischemia (“GI angina”). Tx: ypass, endartectomy, angioplasty + stenting

183
Q

anti donor T cell Abs are present in what type of transplant rejection?

A

Acute (6 days - 1 yr)

184
Q

s.e. of cyclosporine and tacrolimus (immunosupp)?

A

nephrotoxicity (tacro used for eczema)

185
Q

s.e. of azathioprine, muromonab, and mycophenolate (immunosupp)?

A

bone marrow supp, decreased WBCs

186
Q

do not use azathioprine with which drug?

A

allopurinol (both inhibit xanthine oxidase)

187
Q

s.e. of rapamycin(immunosupp)?

A

decreased platelets, increased lipids

188
Q

what drug for lupus caused decreased WBCs, lymphoma, and is a teratogen?

A

mycophenolate

189
Q

Hydroxycholorquine - what is it used for and what s.e. does it have?

A

lupus and RA (immunosuppressant). s.e. = visual disturbances.

190
Q

if someone has a pure motor stroke but CT head does not show anything, where is the stroke probably located?

A

deep lacunar infarct from the internal capsule

191
Q

difference between CMV and HSV/VZV retinitis?

A

CMV = painLESS & no conjunctivitis + fluffy/grandular/hemorrhagic lesions.
HSV: painFUL, conjunctivitis, keratitis, pale lesions + central necrosis of retina.

192
Q

MI + hypotension, ncreased JVP, and clear lung fields, think…

A

right ventricular infarct (inferior wall)

193
Q

migrating skin rash + DM + GI symptoms (inc diarrhea), think what tumor?

A

glucagonoma (skin rash = necrolytic migratory erythema)

194
Q

cold leg vs warm leg, what to think/do?

A 
cold = acute limb ischemia from arterial occlusion, often from emoblus/thrombus. Do echo to look for thrombus, anticoag + surg. 
warm = DVT = Do doppler.
195
Q

main differentiating factor between seizures and syncope?

A

post-ictal state in seizures

196
Q

s.e. of antithyroid drugs (thoinamides) a) methimazole b) PTU

A

a) agranulocytosis

b) hepatic failture

197
Q

how to tell apart aortic dissection and esophageal perforation?

A

esophageal perf will have high amylase & low pH, and think of it more with alcoholic (Boerhaave)

198
Q

How to diagnose and treat Mallory-Weiss; Boerhaave?

A

Mallory dx: EGD. tx: wait.

Booerhave dx: CT/contrast w/ Gastrografin. tx: Sx for thoracic perf, Abx for cercical perf.

199
Q

diabetic neuropathy causes what GU problems?

A

hypogonadism, neurogenic bladder with overflow incontinance (dribbling + high RV) – SEPARATE from diabetic NEPHROpathy

200
Q

lidocaine – type, use, risk?

A

class IB antiarrythmic. decreases v. fib chances. Increases risk of asystole.

201
Q

what is keratitis?

A

irritation of the cornea; often from contact lens, and if infected can cause redness and ulceration (acute glaucoma does not cause ulceration, just opacification). emergenc, needs broad spec Abx

202
Q

what is episcleritis?

A

inflammation/redness at corners of sclerae only (as name suggests!) - associated with autoimmune i.e. RA

203
Q

proteinuria, heart failure sx, hepatomegaly, neuropathy, bruising/bleeding, echo = thickened ventricle and normal size, ECG = low voltage, think =? Dx?

A

Amyloidosis. Dx: tissue biopsy i.e. from abd fat pad, bone marrow, etc

204
Q

how is central retinal artery occlusion treated?

A

**remember it presents with amaurosis fugax, painLESS loss of vision *** Tx: ocular massage to dislodge embolus, and high flow O2

205
Q

difference between closed and open angle glaucoma?

A

closed: acute, painful, red eye with fixed dilated pupil.
open: chronic, decreasing peripheral vision.

206
Q

MAIN s.e. to remember with CCBs like amlodipine? how to fix?

A

peripheral edema. Add ACE inhibitor or ARB.

207
Q

at what stenosis level should you do carotid endarterectomy?

A

70%+ in women, 50%+ in symptomatic men, 60%+ in asymptomatic men

208
Q

CHF Sx in young patient, think…

A

DCM, and if sick then secondary to viral myocarditis.(often Coxsackie B)

209
Q

young woman with acute pain on eye movement, color perception problems, sluggish pupillary response, central scotoma =?

A

optic neuritis. common with M.S.

210
Q

What is presbyopia? How to treat?

A

loss of elasticity in lens from old age; cannot focus on near object as well anymore. Get reading glasses.

211
Q

unstable vital signs

A

retroperitoneal hematoma. Dx: noncontrast CT abd and pelvis.
Tx: ICU, bed rest, IVF/blood (supportive)

212
Q

diff between viral and allergic conjunctivitis?

A

allergic: always B/L, shorter duration, itchy.
Viral: gritty/sandy, U/L or B/L, longe duration with URI sx.

213
Q

How to treat acute glaucoma?

A

mannitol, acetazolamide, timolol, or pilocarpine to decrease IOP. [do NOT use atropine, it can make it worse]

214
Q

How to treat A. fib in patients with WPW? What NOT to do?

A

Procainamide for rhythm control for stable patients; CV for unstable. DO NOT use beta blockers, CCBs(esp verapamil), digoxin, or adenosine because theyblock AV node, increasing conduction thru accessory pathway.

BOARDS STEP 2 STUDY MATERIAL (6 decks)

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