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STEP 2 CK Frequently Missed > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Next step in massive >600mL/24hr or >100/hr hemoptysis?

A

Secure airway (intubate), breathing, circulation, lay them so bleeding lung is in the dependent position (lateral position), then BRONCHOSCOPY, bcus it can localize bleeding, provide suctioning, and can be therapeutic (balloon tamponade, electrocautery).

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2
Q

How to nitrates exert their effect?

A

Direct vascular smooth muscle relaxation causing venous dilation and increase in peripheral venous capacitance. Anti ischemic effect –> venodilation and decrease in cardiac preload, decrease in LVED and ES volume. This leads to a reduction in left ventricular systolic wall stress which reflects afterload (pressure *Radius/Thickness) and decrease in myocardial oxygen demand.

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3
Q

Most common cause of MR in develped countries?

A

MVP which initially has mid systolic click and mid to late systolic murmur, but eventually has severe leaflet dysfunction and MR with holosystolic murmur. Though to be due to myxomatous degeneration of the mitral valve leaflets and chordae.

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4
Q

3-4 month old with hypoglycemia, seizures, lactic acidosis, hyperuricemia, hyperlipidemia, doll like face with round cheecks, short, proteuberant abdoment with hepatomegaly?

A

Glucose 6 phosphatase deficiency, type 1 glycogen storage disease, VOn Gierke

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5
Q

PEA or asystole manage with ..

A

CPR and vasopressors

No Defibrillation of synchronized CV

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6
Q

When to do defibrillation?

A

Vfib or pulseless VT

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7
Q

Thrombocytopenia, what to look for?

A

Chronic HIV infection, EBV, HCV

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8
Q

Cardiac tamponade causes?

A

Decreased left ventricular preload

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9
Q

Pathophys of high output HF?

A

2/2 trauma, iatrogenic, atherosclerosis, cancer, PDA, angiomas, pulm AVF, CNS AVF
Shunt a large amount of blood through the fistula decreases SVR, increases cardiac preload, and increases CO. See widened pulse pressure, strong peripheral arterial pulsation, systolic flow murmur,t tachy, flushed extremities.

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10
Q

Common drugs associated with photosensitivity

A

Tetracyclines (doxy), chlorpromazine, prochlorperazine, furosemide, HCTZ, amiodarone, promethazine, prioxicam

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11
Q

If left untreated hyperthyroidism can cause

A

Bone loss, osteoporosis 2/2 increased thyroid hormone increase osteoclastic bone resorption. Also high Ca++

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12
Q

Contraindication to raloxifene?

A

Hx Venous thrombosis
E Antagonist breast and endometrium, E agonist on bone
Adverse effects: Hot flashes, VTE, endometrial hyperplasia and carcinoma with tamoxifen

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13
Q

2 year old with 2 months of chronic oligoarthritis (more in the AM), daily fever for over 2 weeks, and rash, increased WBC/platelet, decreased RBC, increased ESR.. what is dx?

A

systemic Onset Juvenile idiopathic arthritis

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14
Q

Reyes syndrome what does liver look like?

A

Mircovesiculr fatty infiltration 2.2 ASA during flu or varicella

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15
Q

HTN IP brain hemorrhage that shows contralateral hemiparesis and sensory loss, and conjugate gaze TOWARD side of lesion, where is lesion?

A

Basal Ganglia, Putamen (involves internal capsule too)

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16
Q

HTN IP brain hemorrhage that shows contralateral hemiparesis and sensory loss, non reactive miotic pupils, upgase palsy, and gaze away from lesion, toward hemiparesis?

A

Thalamus

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17
Q

HTN IP brain hemorrhage with deep coma and total paralysis, pinpoint reactive pupils

A

Pons

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18
Q

Treatment BPD in patients with renal dysfunction?

A

Valproate bcus lithium nephrotoxic

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19
Q

What is ludwig angina?

A

Cellulitis of submandibular space, from dental infections that spread to root of the submylohyoid and then sublingual space.polymicrobial usually. Fever, chills, drooling, dysphagia, muffled boice. Crepitus. Tx IV abx.(amp-sulbactam, or clinda) and remove tooth.

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20
Q

What DM2 med can have losing weight as a side effect?

A

GLP1 receptor antagonist. Exenatide.

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21
Q

Flank pain, hematuria, palpable abdominal mass, scrotal varicoele (left sided)

A

RCC, abdominal CT

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22
Q

Treatment of asx prolactinoma <10mm?

A

No treatment

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23
Q

Treatment of prolactinoma <10mm and symptomatic OR >10mm

A
  • Dopamine agonist cabergoline or bromocriptin

- Resect if very large >3cm or it increases in size while on tx

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24
Q

Labs in Vit D deficiency

A

Low to normal Ca and Phos
Low 25-OH Vitamin D
High high Alk phos, High PTH

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25
Q

How do you manage Renal artery stenosis with HTN?

A

ARBs or ACEis

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26
Q

Euvolemic hyponatremia in HIV pt?

A

2/2 SIADH

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27
Q

Workup bilious vomiting in neonate:

A

1st Abdomina X ray

2nd Water soluble contrast enema

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28
Q

Labs in euthyorid sick syndrome:

A

Low T3, normal T4 and TSH

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29
Q

Chronic nonbloody diarrhea and weight loss after multiple abdominal surgeries, what type of diarrhea?

A

Secretory

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30
Q

Risks of succinylcholine in rapid sequence intubation?

A

Cardiac arrhythmia 2/2 efflux of K ions, causing hyperkalemia!
This is more likely with crush injury, burns, muscle atrophy, denervation. In these cases give non depolarizing NM blockers like vecuronium, rocuronim.

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31
Q

Contraindications to breastfeeding?

A 
Active untreated TB
Maternal HIV
Herpetic breast lesion
Active varicella
Chemo/Rad tx
Active substance abuse
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32
Q

What initial study of choice in hemodynamically stable people with suspected aortic dissection?

A

CT angiography

33
Q

What initial study of choice in hemodynamically UNstable people with suspected aortic dissection? (also renal insuff)

A

TEE

34
Q

What are the main substrates of gluconeogenesis?

A

Alanine –> pyruvate
Lactace –> pyruvate
Glutamine –> citric acid cycle
Glycerol 3 phosphate –> from adipose, to glucose

35
Q

Tx of euvolemic hyponateremia?

A 
Hyponatremia
Serum osm <275
Urine osm >100
Urine Na >40
TX. Fluid restriction + salt tables
3% Saline for severe hyponatremia
36
Q

Guy with hyperCa++ (11) and acute painful monoarthritis, sxs like fatigue, constipation, nephrolithiasis?

A

Pseudogout 2/2 hyperparathyroidsm (pseudogout also associated with hemochromatosis)

37
Q

Guy with HIV and CD4 <50, Mycobacterium avium vs CMV?

A

MA: Watery diarrhea, HIGH FEVER >102.2, weight loss
CMV: Frequent small volume diarrhea, hematochezia, abpain, low fever, weight loss
Dx colonoscopy

38
Q

Fanconi anemia

A

AR or XLR, predispo for cancer, 2/2 DNA repair
See: Aplastic anemia and progressive bone marrow failure, short stature, microcephaly, abnormal thumbs, hypogonadism, hypo/hyperpigmented areas, cafe au lait spots, large freckle, stravismus, low set ears, middle ear abnormalities.

39
Q

Most common coag d/o in Caucasians

A

Factor V leiden d/o, activated protein C resistance

40
Q

Measles vs rubella

A

Measles has higher fever 104F, cephalocaudal spread of rash over DAYS, and cervical adenopathy, no arthritis

41
Q

Northern european guy with megaloblastic anemia and atrophic glossitis, vitiligo, thyroid disease, neuro abnormalities

A

Pernicious anemia

42
Q

Prefered anticoagulation for those with pulm embolism and renal insufficiency? GFR<30

A

unfractioned heparin

43
Q

Fetal complications of preeclampsia

A

oligohydramnios and fetal growth restriction/small of GA due to chronic uteroplacental insuffiency

44
Q

Suspect meniscal injury? >3-4 weeks sxs and younger

A

MRI

45
Q

Tx polymyositis?

A

Steroids (prednisone) and methotrexate, azathrioprine.

46
Q

HIV + guy with floaters, blurred vision in right eye, photopsia, may cause blindness, increases risk of retinal detachement

A

CMV retinitis

47
Q

Tach Sachs

A 
B hexosaminidase A deficiency
AR
Jewish
2-6month onset
cherry red macula NO HSM
hyperreflexia
48
Q

Niemann Pick

A 
Sphingomyelinase deficiency 
AR
Jewish
2-6month onset
cherry red macula 
HSM
areflexia
49
Q

Gaucher

A 
glucocerebrosidase deficiency
anermia
thrombocytopenia
HSM
no loss of milestones
50
Q

Tx of acute cystitis in non pregos

A

Uncomplicated: Nitrofurantoin for 5 days (not if pyelon or Cr Cl <60), TMP/SULF 3 days, single dose Fosfomycin, FQ if above can’t be used. Urine culture if initial tx fails.
Complicated cystitis: FQ 5-14 days, amp/gentamicin for severe cases, obtain sample for urine culture prior to abx and adjust as needed

51
Q

Tx of pyelon in non pregos

A

Outpt: FQ Cipro,levo
Inpt: IV FQ, amiglycoside+amp obtain sample for urine culture prior to abx and adjust as needed

52
Q

Abx for UTI in pregnancy

A

Cefpodoxime, cephalexin, amox-clav, fosfomycin

53
Q

HTN, palpable abdominal masses, microhematuria

A

ADPKD
Berry aneurysm is a complication 5-10%
Can also have hepatic cysts, valvular heart disease, colonic diverticula, abdominal wall and inguinal hernia

54
Q

Tx CRAO

A

Ocular massage and high flow oxygen

55
Q

3 meds indicated in stable angina

A

BBlocker
Nitrates
ASA

56
Q

Meds that cause HyperKalemia

A

BBlocker, ACEi, ARB, Sprinolactone, Digitalis, Cyclosporine, Heparin, NSAIDs, Succinylcholine, Trimethoprine

57
Q

When to add prednisone to TMP-SMX for PCP?

A

If PaO2 <70, A-a >35 on room air, pulse ox <92%

58
Q

Asymptomatic proteinuria or nephrotic syndrome, cardiomyopathy with heart failure, hepatomegaly, mixed sensory and motor peripheral neuropathy or autonomic, visible organ elargement (macroglossia), bleeding diathesis, waxy thickening easy bruiseing

A

2nd Amyloidosis
Dx wtih abdominal fat pad aspiration Bx
Tx underlying condition, colchicine for prevention and treatment

59
Q

Respiratory distress, neurological dysfunction, petechial rash 24-72 hours following inciting event (femur fracture, orhto surgery, pancreatitis)

A

Fat embolism

60
Q

IE w/hx of pyelonephritis and recent cystoscopy

A

Think Enterococci

61
Q

Osteomalacia causes

A

Malabsorption (celiac sprue), bypass, chronic liver or kidney disease. 2/2 Calcium or phosphorus deficiency –> leads to defective mineralization of organic bone matrix. 2/2 severe vitamin D deficiency or renal tubular acidosis (proximal type 2). See elevated alk phos, PTH, low serum Ca, Phos, decreased 25OH

62
Q

Dullness to percussion and increased breath sounds increased tacticle fremitus think ..

A

Consolidation / PNA

63
Q

PPSV23

A

Polysaccharide vaccine, can not be presented to T cells, vaccine induces a relatively T cell independent B cell response that is less effective in young children and the elderly

64
Q

CHARGE syndrome

A 
Coloboma
Heart Defects
Atresia choanae
Retardation/growth/dev
GU anomalies
Ear abnormalties/deafness
65
Q

Someone with Primary biliary cholangitis is at risk for developing what?

A

Osteomalacia 2/2 vit D malabsorption and HCC

66
Q

How do you define arrest of active phase of labor? How do you manage?

A

No cervical change >4 hours with adequate contractions OR
no cervical change for >6hours with inadequate contractions
C section delivery

67
Q

What are considered adequate contractions?

A

> 200MVUs in 10 minutes

68
Q

What are MVU?

A 
#uterine contractions in 10 minutes x contraction strength
 (contraction strength = peak mmHG-baseline mmHG using Internal pressure catheter)
69
Q

Things that can cause methemoglobinemia

A

Exposure to oxidizing substances dapsone, nitrites, local/topical anesthetic
See Cyanosis, pulse ox sat 85% dark choco colored blood
Lab:>5% difference between ox sat pulse ox and ABG
normal PaO2
Tx methylene blue

70
Q

Pronator drift sign shows lesion where?

A

upper motor neuron or pyramidal tract disease affecting upper extremities

71
Q

Allergic rhinitis

A

Always bilateral
can last <30 min to perennial
Watery discharge
Ocular pruritis

72
Q

suspected DVT vs PE management

A

DVT - dx with compression US

PE - anticoagulate

73
Q

What is a positive bronchodilator response?

A

> 12% increase in FEV1 after bronchodilator

74
Q

<4 hours from ingestion of acetaminophen

A

Administer charcoal & check acetaminophen levels

75
Q

Type 4 RTA

A

Hyperkalemia non anion gap met acidosis commong with poorly controlled DM

76
Q

15 year old no menstruation, stage 4 breast dev and pubic hair, normal external female genetalia and axillary hair, vagina feels short no cervix or uterus, but does have ovraries…

A

Mullerian agenesis

77
Q

What cardiac conduction abnormality is common with dig tox?

A

Atrial tachycardia with AV block

78
Q

Spontaneous lobar hemorrhage in elderly 2/2

A

Amyloid angiopathy

79
Q

Fever, chest pain, hemoptysis, pulm nodules with halo sign, positive cultures, positive galactomannan beta D glucan, immunocomp or neutropenia

A

Invasive aspergillosis

tx vori +/- capsofungin

STEP 2 CK Frequently Missed (5 decks)

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