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Step 2 CK > Week 1 Step 2 CK > Flashcards

Week 1 Step 2 CK Flashcards

1
Q

What is the screening guideline for PAP smear for immunocompromised individuals?

A

Start at age 21, or one year after sex and do yearly
If results are normal for 3 consecutive years, and move screening to every 2-3 years.
Never screen every 5 years in these patient

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2
Q

What is the screening guideline for prostate cancer?

A

Start a discussion at age 50 for anyone with life expectancy > 10 years, use PSA alone

High-risk should start around 40-45

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3
Q

When can you use the live poliovirus vaccine?

A

Never, it is associated with causing paralytic poliomyeltitis

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4
Q

How do you use prophylactic medications for malaria?

A

Chloroquine and Mefloquine require administration 2 weeks prior and 4 week post trip

Primaquine should be started 1-2 days prior and continued 7 days post exposure

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5
Q

What is neonatal screening of HBV?

A

Test for HBsAg at initial visit
Positives then get further testing at 26-28 weeks
Women with LFTs <2x ULN and whose HBV DNA is >2x 105 require antiviral therapy

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6
Q

What do you give a neonate born to HBV positive woman?

A

Give both the vaccine and Hep B immune globulin within 12 hours of delivery

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7
Q

How do you determine if a pregnancy is ectopic?

A

UPT + then do a transvaginal U/S, if empty then get hCG, if hCG >3500 repeat U/S, if <3500 repeat in 2 days

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8
Q

How do you manage triple-negative breast cancer?

A

Adjuvant chemo if tumor size >0.5 cm

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9
Q

What is included with breast-conserving therapy?

A

Always also give adjuvant radiotherapy

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10
Q

What are the genetic risk factors for type I Diabetes?

A

Most common MHC on 6p21 or HLA DR3 and DQ

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11
Q

What are diseases associated with Type I Diabetes Mellitus?

A 
Hypothyroidism
Celiac
Addisons
Autoimmune gastritis
pernicious anemia
Vitiligo
Myasthenia gravis
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12
Q

What are symptoms of inflammatory carcinoma of the breast?

A

Erythema
Breast tenderness
Failed antibiotic therapy for mastitis
Peau d’orange

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13
Q

What is treatment of inflammatory carcinoma of the breast?

A

The respond to neoadjuvant (pre-op) chemotherapy followed by modified radical mastectomy which is then followed by adjuvant radiation

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14
Q

What are the risk factors for developmental dysplasia of the hip?

A

Three F’s:
Female sex
Faany first: breech position regardless of cephalic version
Family history

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15
Q

What are the causes of pulmonary regurgitation?

A

Idiopathic, traumatic, or iatrogenic (caused by surgical repair of tetralogy)

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16
Q

What heart sounds are associated with tricuspid regurgitation?

A

Systolic thrill at left sternal border, right-sided S3 gallop from long-standing pulmonary regurgitation.
It is a diastolic murmur that gets louder with inspiration

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17
Q

How does handgrip maneuver affect the murmur of aortic stenosis?

A

It decreases because if increases afterload which decreases the pressure gradient across the valve

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18
Q

What would lead to you getting a head CT in a head injury patient?

A

Unconscious, GCS <13, seizure or incontinence, neurological deficits, s/s of skull fracture

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19
Q

What is the test of choice to diagnose osteomyelitis?

A

X-ray is symptoms >2 wks
Nuclear triphasic bone scan if hardware present
MRI if no hardware and patient is diabetic

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20
Q

What vaccines are safe during pregnancy?

A 
Inactive flu
Tdap - given at 27-36 wks
Hep A and B
Men
Rabies
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21
Q

When do you give the Tdap for pregnancy?

A

Given 27-36 weeks gestation

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22
Q

What are complications of chronic pancreatitis?

A

Pseuddocysts, ascites and pleural effusion, biliary obstruction, splenic vein thrombosis, cancer

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23
Q

Are splenic vein thromboses associated with esophageal or gastric varices?

A

Gastric varices

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24
Q

What is the management of parotid gland tumors?

A

Superficial parotidectomy for benign - no CN VII involved

Total parotidectomy for malignant tumors.

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25
Q

What areas have malaria resistant to chloroquine?

A

Not in Caribbean and West of Panama Canal

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26
Q

What are contraindications to mefloquine use?

A

Psychiatric conditions, Seizure disorders, cardiac conduction abnormalities

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27
Q

What are good first-line agents for acute bacterial prostatitis?

A

Fluoroquinolones like ciprofloxacin and TMP-SMX

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28
Q

How long is treatment for acute bacterial prostatitis?

A

Long-term treatment of at least 4 weeks

Negative urine culture at 7 days predicts full cure at completion of therapy

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29
Q

What is the initial treatment for thyrotoxicosis?

A

Propranolol is the best initial treatment

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30
Q

What is treatment for postpartum thyroiditis?

A

Symptomatic only as disease is self-limiting, this usually will include propranolol for management for hyperthyroidism symptoms

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31
Q

What is most common thyroid adenoma?

A

Follicular

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32
Q

What is most common thyroid cancer?

A

Papillary carcinoma

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33
Q

What is the order of tests for cushing syndrome?

A

First do 24-hour urinary cortisol to see if it is elevated or not
Then do high-dose dexamethasone suppression test to see if its an adrenal or other pathology
Then check ACTH level to see if lung vs. adrenal neoplasia

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34
Q

What differentiates 21-beta hydroxylase deficiency from 11-beta hydroxylase deficiency?

A

21 - Hypotension, hyponatremia, hyperkalemia, precocious puberty
11 - HTN, hypokalemia, precocious puberty

35
Q

What are signs and symptoms of cortisol deficiency (Addison’s)?

A

Hypotension, hyperpigmentation, androgen deficiency
Weakness, muscle cramps
Hyponatremia, hypoglycemia

36
Q

What is the best test for diagnosing cortisol deficiency?

A

Cosyntropin-stimulation test

37
Q

What medications can cause drug-induced lupus?

A

Hydralazine, procainamide, isoniazid, chlorpromazine, methyldopa

38
Q

What medication slows the rate of skin thickening in scleroderma?

A

D-penicillinamine has been shown to slow thickening and prevent organ involvement

39
Q

What rash is characteristic of dermatomyositis?

A 
Heliotropic rash (lilac colored over edematous eyelids)
Does affect the nasolabial folds unlike the malar rash of SLE
40
Q

What is treatment for severe HSP symptoms?

A

Corticosteroids

41
Q

What findings are consistent with nutcracker esophagus?

A

Hypertensive disorganized contractions interspersed with normal responses to swallowing
Characteristically you see corkscrew esophagus on barium swallow

42
Q

What is the treatment for nutcracker esophagus?

A

Use calcium channel blockers and nitrates as it is a hypertensive etiology

43
Q

What are indications for bariatric surgery?

A

Failure of previous methods
Motivated patient
Reasonable risk of surgery
BMI >40

44
Q

What type of gastric procedure should be performed for weight loss?

A

RNY bipass or Sleeve gastrectomy

Gastric banding is not effective in American populations

45
Q

What is the preferred method for assessing and treating foreign body aspiration in pediatric patients?

A

Rigid bronchoscopy is preferred and safer in pediatric populations

46
Q

What is the treatment for BPH?

A 
Alpha antagonist (tamsulosin) - improves urinary flow but does not decrease prostate size
5-alpha reductase inhibitor (finasteride) - Decreases prostate volume
47
Q

Do you treat asymptomatic bactiuria?

A

No

In pregnant patients only

48
Q

What is a nevus sebaceous?

A

It is a benign hamartoma usually present at birth

Well-demarcated, hairless, yellow/orange, oval plaque

49
Q

What is the treatment for nevus sebaceous?

A

Excise all biopsy proven lesions before adulthood

50
Q

What is the histopathology of nevus sebaceous?

A

Immature hair follicles are diagnostic

All elements of skin with predominance of sebaceous glands

51
Q

What are the complications of nevus sebaceous?

A

Hair around - indicated CNS involvement and should not be biopsied
In adulthood can develop into trichoblastoma or rarely basal cell carcinoma

52
Q

What is the best method for detection and diagnosis of prostate cancer?

A

Transurethral resection of prostate (TURP)

53
Q

What is the treatment for localized prostate cancer?

A

Radical prostatectomy (or robotic) is preferred in stable patients with localized disease

54
Q

Do you need to do a CT to diagnose a perianal abscess in Chron’s disease?

A

No you do not, only if the symptoms are unclear

55
Q

When do you begin screening for FAP patients?

A

Start around 10-12 years old

56
Q

What are the indications for drainage of pancreatic pseuddocyst?

A

Rapid enlargement, compression of surrounding structures, pain, signs of infection
You can observe if <5cm and no symptoms

57
Q

What testing should be performed on a pregnant woman with HSIL on PAP?

A

Colposcopy should be performed to confirm the diagnosis

58
Q

Hemochromatosis patients are at higher risk for what complication?

A

Bacterial infection with Vibrio vulnificus and Yersinia enterocolitica

59
Q

What vaginal infection presents with thick-white discharge, vaginal itching, and beefy red scaly plaques with small pustules?

A

Vulvovaginal candidiasis

60
Q

What is the gold standard of diagnosis in ischemic colitis?

A

Endoscopic visualization of shedding mucosa

61
Q

Does the FDA deal with ethics issues?

A

No they typically do not deal with them, so there is no need to report kickback schemes to the FDA

62
Q

How long can an undescended testicle take to descend?

A

If it has not descended by 4 months, it is unlikely to do so spontaneously and you should prepare for surgery before 2 years to preserve fertility

63
Q

What can be used to relieve esophageal spasm?

A

Nitroglllycerin

64
Q

What thrombolytic therapy should not be used if needed to be repeated in a while?

A

Streptokinase, it is antigenic and can cause allergic reactions on repeat administration, antibodies can last up to 7.5 years

65
Q

Do you use thrombolytics in NSTEMI?

A

No, they have not been shown to improve survival or outcomes

66
Q

What medical therapy is used for papillary muscle rupture following MI?

A

Afterload reduction agents, such as IV nitroprusside, which is the most effective at doing this

67
Q

What heart sound is most specific for CHF?

A

S3 gallop is most likely seen with CHF

68
Q

What are the findings in Right Axis Deviation?

A

Positive R wave in lead III, Negative deflection in lead I and aVL. Lead II is biphasic

69
Q

What are the most common heart conditions associated with carcinoid tumor/syndrome?

A

Pulmonary and Tricuspid Stenosis

70
Q

How does cardiac function change in pregnancy?

A

CO is increased by 30-50%

LVEDV is increased, but LVEDP is normal

71
Q

What is trepopnea?

A

Dyspnea in the left lateral decubititus position that usually improves when placed in the right lateral decubitis position
It is associated with atrial vegetation and atrial myxoma

72
Q

What is the most common cause of infectious pericarditis?

A

Most commonly caused by viruses like: coxsackie, Influenza, EBV, Adenovirus, HIV

73
Q

What is Brugada Syndrome?

A

Seen in Asian patients or young age.
Repeated episodes of syncope with pseudo right bundle branch block with and STE in V1 and V2
About half have irreducible ventricular arrhythmia

74
Q

What is the treatment for Brugada Syndrome?

A

Only treatment that decreases mortality is placement of an automated implantable cardiac defibrillator

75
Q

What is Jervell and Lange-Nielsen Syndrome?

A

AR disorder with mutation in K ion channels

Congenital long QT syndrome associated with bilateral sensorineural hearing loss

76
Q

What is Romano-Ward Syndrome?

A

AD long QT Syndrome

No hearing deficits

77
Q

What is Lown-Ganong-Levine syndrome?

A

Congenital syndrome with a accessory pathway connecting the bundle of His to the atria
Results in atrial pre-excitation and shortened PR intervals
No affect on ventricular rhythm so it has a normal QRS

78
Q

What type of patient typically has an Osborn Wave (convex hump at J-point)?

A

Hypothermic patient

79
Q

What is the treatment for hydronephrosis and pyelonephritis with an obstructing stone?

A

IV antibiotics and nephrostomy tube in the acute phase

80
Q

What are the symptoms of tinea versicolor?

A

Variable changes in skin pigmentation
Fine scale or flaky texture
Upper trunk and proximal extremities involved

81
Q

What is the diagnostic test for tinea versicolor?

A

KOH prep showing Spaghetti and Meatballs (short hyphae and round yeast)
Wood’s lamp showing yellow to yellow-green fluorescence

82
Q

What is the treatment for tinea versicolor?

A

Topical antifungals (azoles), Selenium sulfide, zinc pyrithione
Systemic therapy for recurrent or refractory - itraconazle, fluconazole
Prophylaxis with: Selenium sulfide or ketoconazole shampoo

83
Q

What is the initial treatment for HELLP syndrome?

A

Magnesium sulfate prophylaxis, then maternal stabilization otherwise, then take delivery. Delivery is currative

84
Q

What are contraindications for Spiral CT for PE?

A

Renal insufficiency and contrast allergy

Do a V/Q Scan in these patients

Step 2 CK (1 decks)

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