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Flashcards in Random Subject Review Part I Deck (235):
1

complication of LP in patient with elevated intracranial presure

uncal herniation

2

diagnosis: child presents to ER with altered mental status, hypoglycemia, and lesions suggestive of chickenpox

rye's syndrome (hepatoencephalopathy)

3

symptoms of basilar artery stroke

cranial nerve deficits, altered mental status/coma, contralateral full body weakness and decreased sensation, vertigo

4

TCA overdose signs and management

anticholingeric symptoms, cardiac and CNS toxicity

treat cardiac with sodium bicarb, and CNS with benzos

5

treatment for lithium induced nephrogenic diabetes insipidus

HCTZ and amiloride (binds lithium stimulated sodium channels)

6

treatment of acute dystonia

anticholinergics (benadryl, benztropine)

7

treatment of tardive dyskinesia

discontinue typical antipsychotic, switch to atypical antipsychotic

8

EEG pattern seen in absence seizures

3 cycle/second spike and wave pattern

9

typical complaint of patient with retinal detachment

sudden painless onset of flashing lights, floaters, and shade coming down over vision unilaterally

10

treatment for benign paroxysmal positional vertigo

epply maneuver to reposition otoliths

11

todd's paralysis

post-ictal hemiparesis < 24 hours

12

drugs combined with SSRIs known for causing serotonin syndrome

SSRIs, SNRIs, MAOIs, levadopa, mepiridine, lithium, amphetamines, cocaine, ecstasy, LSD, st. john's wort

13

most common cause of sensorineural hearing loss

prebycusis (progressive symmetric high-frequency loss of the elderly)

14

most common cause of conductive hearing loss

otosclerosis

15

most common complication of recurrent otitis media

hearing loss

16

medications used in ADHD

stimulants, TCAs, buproprion, alpha-2 agonists (clonidine)

17

medications used in tourette's

fluphenazine, pimizide, tetrabenazine

18

most worrisome side effect of ADHD drug atomoxetine

increased suicidal ideation, hepatotoxicity

19

diagnosis: patient presents with hearing loss and vertigo, grayish-white "pearly" TM lesion apparent on PE

cholesteatoma

20

symptoms of basilar skull fracture

raccoon eyes (orbital fracture)
battle sign (bruising over mastoid process)
blood behind tympanic membrane
CSF coming out of nose or ears

21

diagnosis and next step: chest trauma, hypotension, JVD, and distant heart sounds

cardiac tamponade
pericardiocentesis

22

diagnosis and next step: chest trauma, JVD, hypotension, and respiratory distress

tension pneumothorax
needle decompression and chest tube placement

23

how to evaluate neck trauma

neck zone 1: CT angiogram
neck zone 2: surgical exploration
neck zone 3: CT angiogram and triple endoscopy

24

how to manage elevated ICP

elevated head of bed
lidocaine prior to intubation
mannitol
hyperventilation
decompressive surgery

25

next step: pelvic fracture, DPL shows blood in pelvis

emergent laparotomy

26

next step: pelvic fracture, DPL shows urine in pelvis

urgent laparotomy (bladder injury)

27

next step: pelvic fracture, DPL shows nothing but there is hemodynamic instability

suspect retroperitoneal hematoma, angiography with possible embolization

28

next step: blunt abdominal trauma, unstable vital signs, FAST shows fluid in pelvis

emergent laparotomy (assume it is blood)

29

next step: blunt abdominal trauma, unstable vital signs, FAST shows no fluid in pelvis

retroperitoneal hematoma, angiogram with possible embolization

30

next step: blunt abdominal trauma, unstable vital signs, FAST inconclusive

perform DPL

31

empiric treatment for brain abscess

antibiotics, needle aspiration, corticosteroids

32

treatment for cluster headaches

100% oxygen
triptans and ergotamines

33

when are triptans contraindicated for headaches

pregnancy, CAD, prinzmetal's angina
(cause vasoconstriction)

34

side effects of theophylline overdose

seizures, excessive muscle contraction, hyperthermia, hypotension, cardiac tachyarrhythmias

35

ST elevation in multiple arteries

acute pericarditis

36

diagnosis: cardiac cath shows equal pressure in all chambers

constrictive pericarditis

37

antidote for methanol

fomepazole
2nd line: alcohol

38

antiode for ethylene glycol

fomepazole
2nd line: alcohol

39

antiode for arsenic

dimercaperol, succimer, or penicillamine

40

burn patient fluid replacement

lactate ringers
4 mL/kg x % burn area + maintenance fluids
1/2 first 8 hours
1/2 next 16 hours

41

treatment for neuroleptic malignant syndrome

discontinue offending medication
IV fluids and dantrolene (stops muscle contraction)
2nd line: bromocriptine or amantidine

42

paget's disease lab abnormalities

elevated alkaline phosphatase

43

osteomalacia/rickets lab abnormalities

vitamin D deficiency
decreased calcium
increased PTH
increased or normal alkaline phosphatase

44

osteoperosis lab abnormalities

all values normal

45

osteopetrosis lab abnormalities

all values normal

46

pseudohypoparathyroidism lab abnormalities

decreased calcium
increased phosphate
increased PTH
(defective receptors)

47

diagnosis: hypertension, depression, kidney stones

hyperparathyroidism

48

complications arising from using vasopressors in shock

ischemia and necrosis of distal extremities
mesenteric ischemia and renal failure

49

most effective intervention for reducing blood pressure

weight loss

50

preferred initial antihypertensive in a patient with no comorbidities

HCTZ or chlorthalidone

51

first-line hypertensive for diabetics

ACE-inhibitor

52

first-line hypertensive for CHF patients

ACE-inhibitor
beta-blocker and spironolactone

53

first-line hypertensive for BPH

alpha-blocker

54

first-line hypertensive for LVH

ACE-inhibitor
(considered pre-CHF)

55

first-line hypertensive for hyperthyroidism

non-selective beta-blocker

56

first-line hypertensive for osteoporosis

HCTZ

57

first-line hypertensive for benign essential tremor

beta-blocker

58

first-line hypertensive for post-menopausal female

HCTZ

59

first-line hypertensive for migraines

beta-blocker

60

most likely cause of secondary HTN with proteinuria

renal disease

61

most likely cause of secondary HTN with hypokalemia

hyperaldosteronism

62

most likely cause of secondary HTN with tachycardia, diarrhea, and heat intolerance

hyperthyroidism

63

most likely cause of secondary HTN with hyperkalemia

renal artery stenosis and renal failure

64

most likely cause of secondary HTN with episodic sweating, tachycardia

pheochromocytoma

65

antihypertensive side effect profile: first dose orthostatic hypotension

alpha-blocker

66

antihypertensive side effect profile: hypertrichosis

minoxidil

67

antihypertensive side effect profile: dry mouth, sedation, rebound HTN

clonidine
(must be dosed every three hours)

68

antihypertensive side effect profile: bradycardia, impotence, asthma exacerbation

non-selective beta-blocker

69

antihypertensive side effect profile: reflex tachycardia

vasodilators

70

antihypertensive side effect profile: cough

ACE-inhibitor

71

antihypertensive side effect profile: sulfa allergy

HCTZ, loop diuretics

72

antihypertensive side effect profile: angioedema

ACE-inhibitor or less likely ARB

73

antihypertensive side effect profile: drug-induced lupus

hydralazine
(anti-histone antibodies)

74

antihypertensive side effect profile: cyanide toxicity

nitroprusside

75

vasodilating effects of nitroglycerin and dihyropyridine calcium channel blockers

venodilators

76

vasodilating effects of nitroprusside

arteriodilators and venodilators

77

JONES criteria for rheumatic heart disease

J - joint polyarthritis
O - pancarditis
N - nodules
E - erythema nodosum
S - syndenham's chorea

78

major DUKE criteria for endocarditis

serial positive blood cultures
presence of vegetations or cardiac abscess on ECHO
new onset valvular regurgitation
blood culture positive for Coxiella

79

minor DUKE criteria for endocarditis

predisposing heat condition or IV drug use
fever > 38C
vascular phenomenon (septic emboli, infarc, mycotic aneruysm, intracranial hemorrhage, janeway lesions)
immunologic phenomenon (glomerulonephritis, osler's nodes, roth spots, positive rheumatoid factor)
positive cultures not meeting requirements for major criteria or serologic evidence of infection without positive culture

80

most common nephritic syndrome

membranous glomerulonephritis

81

endocarditis prophylaxis for oral surgery

amoxicillin before and after the procedure

82

endocarditis prophylaxis for GI/GU surgery

amipicillin + gentamicin before and amoxicillin after the procedure

83

treatment for mild unconjugated hyperbilirubinemia

UV therapy

84

when is the greatest risk for post-op MIs

first 48 hours

85

pressor causes vasoconstriction with bradycardia

phenylephrine

86

high dose pressor that maximizes alpha-1 constriction

epinephrine

87

when to stop warfarin prior to surgery

3-4 days

88

when to stop aspirin prior to surgery

5-7 days

89

treatment for DIC

FFP and possibly platelets

90

preferred placement of swan-ganz catheter

right IJ or left subclavian

91

protective measures for kidney with IV contract

n-acetylcysteine
IV fluids
sodium bicarbonate

92

treatment for cluster headaches

100% oxygen
triptans, ergotamines

93

antihypertensive contraindicated in bilateral renal artery stenosis

ACE-inhibitors
(unilateral okay)

94

antihypertensive contraindicated in advanced renal failure

ACE-inhibitors if they have hyperkalemia, otherwise okay
no potassium-sparing diuretics

95

antihypertensive contraindicated in gout

HCTZ

96

heart defect seen in chromosome 22q11 deletions

truncus arteriosus, tetralogy of fallot

97

heart defect seen in down syndrome

endocardial cushion defects

98

heart defect seen in congenital rubella

PDA, pulmonary artery stenosis

99

heart defect seen in turner's syndrome

coarctation of the aorta

100

heart defect seen in marfan's syndrome

aortic regurgitation

101

medication combination used in treatment of TB meningitis

RIPE drugs

102

features of a patient presenting with pericarditis

pleuritic chest pain, dyspnea, fever, cough
pain worse in supine position, pulsus paradoxus

103

classic ECG appearance in atrial flutter

saw-tooth pattern 2:1 or 3:1 P wave to QRS complex

104

60 year old obese patient with dirty, velvety patches on back of neck

acanthosis nigricans
fingerstick glucose and assess for visceral malignancies

105

most common cause of hypothyroidism

hashimoto's thyroiditis

106

type of bias introduced when screening detects a dsiease earlier and thus lengthens the time from diagnosis to death

lead-time bias

107

exceptions to the requirement of informed consent

unable to give consent (mentally disabled)
emergency decisions
patients who waive the right for informed consent

108

palpable flank mass, hematuria, and U/S showing bilateral enlarged kidneys with cysts, what brain anomaly is associated

berry aneurysm

109

four main causes of microcytic anemia

iron deficiency anemia
thalassemia
anemia of chronic disease
lead poisoning

110

US region where lyme disease is endemic

northeast US

111

hand joints affected in rheumatoid arthritis

MCP and PIP

112

xerostomia + parotid enlargement + xerophthalmia + anti-La antibodies

sjogren's syndrome

113

most common cause of seizures in young adults

trauma, alcohol withdrawal, brain tumors

114

most common cause of non-obstetric postpartum death

thromboembolic disease

115

immunodeficiency presenting with eczema, thrombocytopenia, and high levels of IgA

wiskott-aldrich syndrome

116

defense mechanism displayed when a woman calmly describes a gory murder in great detail

isolation

117

treatment for mild, persistent asthma

low-dose inhaled corticosteroid

118

EKG with peaked T waves and widened QRS

hyperkalemia

119

treatment for iron overdose

deferroxamine

120

imaging study used to diagnose DVT

compressive venous U/S

121

radiographic study used to diagnose injury to the urethra

retrograde cystourethrogram

122

drug of choice for trigeminal neuralgia

carbamazepine

123

treatment for normal pressure hydrocephalus

VP shunt

124

treatment for normal pseudotumor cerebri

weight loss. acetazolamide
if refractory, consider serial LPs

125

treatment for guillain-barre syndrome

endotracheal intubation
plasmapheresis or IVIG (not both)

126

somogyi effect v. dawn phenomenon

somogyi: 3am glucose low
dawn: insufficient NPH insulin, 3am glucose high

127

when does chronic COPD qualify for home O2

pulse ox < 88%
pulmonary HTN, peripheral edema, or polycythemia

128

method used to calculate fluid repletion in burn victims

4 mL/kg x %burn
first half in 8 hours
second half in next 16 hours

129

salicylate ingestion results in what type of acid-base disorder

respiratory alkalosis
metabolic acidosis

130

medication commonly used to induce ovulation

clomiphene citrate
second life: pulsatile leuprolide

131

psychiatric condition when personal travels a long distance and takes a new name and has no memory of prior life

dissociative fugue

132

congenital infection may present with a "blueberry-muffin" rash

rubella

133

breast cancer that increases future risk of invasive carcinoma in both breasts

LCIS

134

classic symptoms of placenta previa

painless bleeding

135

anterior knee pain in active 14-year-old boy

oshgood-schlotter disease

136

rhomboid-shaped, positively birefringent crystals in joint space

pseudogout

137

oral infection with branching rods

actinomyces

138

next step in evaluation of patient with two consecutive pap smears with ASCUS

colposcopy with ECC

139

45-year-old obese female with pruritis, clay-colored stools, dark urine, elevated alkaline phosphate and elevated bilirubin

biliary tract obstruction

140

infection causing diarrhea and pseudoappendicitis

yersinia

141

most likely cause of acute lower GI bleed in patients older than 40

diverticulosis

142

most common underlying cause of pathologic fractures in elderly thin women

osteoporosis

143

causative agent in pityriasis versicolor

malassia furur

144

chest pain in young patient with angina at rest, T-segment elevation, normal cardiac enzymes

prinzmetals angina

145

hypercholesterolemia medication causing flushing and pruritis

niacin

146

target lesions with red center, pale zone, and dark outer ring appearing on palms and soles with a prodrome of malaise and myalgias

erythema multiforme

147

what percentage of the population falls within 1SD, 2SD, and 3SD

1 standard deviation: 68%
2 standard deviations: 95%
3 standard deviations: 99.7%

148

equation for odds ratio

AD/BC

149

equation for relative risk

A/(A+B) / C/(C+D)

150

when is odds ratio a good approximation of relative risk

when disease is very rare

151

what does it mean when relative risk is equal to one

no association

152

what to do when parents refuse life-saving treatment for a child in an emergent situation

perform therapy and go to ethics board after

153

patient is emergently intubated after MVA, after family brings a signed DNR stating what she did not wish to be intubated, what do you do

extubate

154

patient tells you she does not want to know the results of her lung biopsy but her family is begging you to tell them, what do you do

withhold information

155

study shows that taking 325 mg of aspirin has no effect on ischemic cardiac events, what type of error is this

type II error

156

treatment for acute mesenteric ischemia

broad spectrum antibiotics, NG tube decompression, diagnose with angiogram, heparin to anticoagulate, reduce arterial vasospasm with papaverine, embolectomy, resection of necrotic bowel

157

when is rifampin prophylaxis indicated for bacterial meningitis

close contacts of neisseria or haeomphilus

158

treatment for acromegaly

transsphenoidal surgical resection, external beam therapy, or ocreotide
last choice: cabergoline dopamine agonist

159

COPD patient comes to ER with tachycardia and hypotension, begins to have seizures, what is the most likely etiology

theophylline intoxication

160

ACLS treatment for asystole

transcutaneous pacing
CPR, alternative epinephrine and atropine
cannot give more than 1mg IV atropine x 3 doses
do not shock these patients

161

treatment for febrile seizures

evaporative cooling

162

empiric treatment for pneumonia in a 2-month old

macrolide +/- cefotaxime

163

empiric treatment for pneumonia in a 2-year old

amoxicillin or ampicillin

164

autoimmune complication occurs 2-4 weeks after an MI

dressler's syndrome (autoimmune pericarditis)

165

name given to stress-related hair loss and what is the treatment

tilogen effluveum, just reassure, should go away with stress

166

most common cause of cushing's syndrome

exogenous steroid use
second most common is pituitary tumor

167

most likely cause of galactorrhea, impotence, and decreased libido in a patient with a history of schizophrenia

medication (dopamine antagonist)

168

ethical problem if doctor refers patient for MRI at a facility he owns

conflict of interest

169

two most common foodborne bacterial GI tract infections in the US

salmonella and campylobacter

170

diagnostic test for hereditary spherocytosis

osmotic fragility test

171

bullous skin disease with negative nikolsky sign

bullous pemphigoid

172

white plaques on tongue and back of throat that can be scraped off with a tongue depressor

candida albicans, screen for HIV

173

young male with hip and back pain along with stiffness that improves with activity and worsens with rest

ankylosing spondilitis

174

cold water is flushed into a patients ear and fast phase of nystagmus is towards the opposite side

normal

175

findings expected in post-term pregnancy > 42 weeks

oligohydramnios, passage of meconium in utero, dry peeling skin, mature placenta with calcifications

176

annual screening recommended for women with strong family history of ovarian cancer

CA-125 and transvaginal U/S

177

defense mechanism used by pedophile who enters a monastery

reaction formation

178

causes of exudative pleural effusion

pneumonia, malignancy, tuberculosis, pulmonary emboli, pancreatitis

179

eosinophilic casts found in urine

acute interstitial nephritis (drug-induced)

180

side effects of corticosteroids

hyperglycemia, hypertension, emotional lability, insomnia, cataracts, osteoporosis, thin skin, cushingoid features

181

classic findings of henoch-schonlein purpura

abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs

182

ranson's criteria for pancreatitis

hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L

183

entamoeba histolytica diarrhea treatment

metronidazole

184

giardia lamblia treatment

metronidazole

185

salmonella treatment

fluoroquinolone/TMP-SMX only in severe case (increases carrier state)

186

shigella treatment

fluoroquinolone/TMP-SMX only in severe case

187

campylobacter treatment

erythromycin

188

vasculitis with weak pulses in upper extremities

takayasu's arteritis (pulseless disease)

189

vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis

wegener's granulomatosis

190

vasculitis with necrotizing immune complex inflammation of visceral and renal vessels

polyarteritis nodosa

191

vasculitis of young male smokers

buerger's disease

192

vasculitis of young asian women

takayasu's arteritis

193

vasculitis of young asthmatics

cherg-strauss

194

vasculitis of infants and young children involving coronary arteries

kawasaki disease

195

most common vasculitis

giant cell arteritis (temporal arteritis)

196

vasculitis associated with hepatitis B infection

polyarteritis nodosa

197

vasculitis where occlusion of ophthalmic artery can lead to blindness

giant cell arteritis

198

vasculitis with perforation of nasal septum

wegener's granulomatosis

199

vasculitis with unilateral headache and jaw claudication

giant cell arteritis

200

lipid lowering agent that causes facial flushing

niacin

201

lipid lowering agent that causes elevated LFTs and myositis

statins and fibrates

202

lipid lowering agent that causes GI discomfort and bad taste

cholestyramine

203

lipid lowering agent that causes best effect on HDL

niacin

204

lipid lowering agent that causes best effect on triglycerides and VLDL

fibrates

205

lipid lowering agent that causes best effect on LDL and cholesterol

statins

206

lipid lowering agent that binds c. diff toxin

cholestyramine

207

drug known for causing elevated prolactin levels

dopamine antagonists, verapamil, methyl-dopa

208

classic findings of henoch-schonlein purpura

abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs

209

ranson's criteria for pancreatitis

hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L

210

entamoeba histolytica diarrhea treatment

metronidazole

211

giardia lamblia treatment

metronidazole

212

salmonella treatment

fluoroquinolone/TMP-SMX only in severe case (increases carrier state)

213

shigella treatment

fluoroquinolone/TMP-SMX only in severe case

214

campylobacter treatment

erythromycin

215

vasculitis with weak pulses in upper extremities

takayasu's arteritis (pulseless disease)

216

vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis

wegener's granulomatosis

217

vasculitis with necrotizing immune complex inflammation of visceral and renal vessels

polyarteritis nodosa

218

vasculitis of young male smokers

buerger's disease

219

vasculitis of young asian women

takayasu's arteritis

220

vasculitis of young asthmatics

cherg-strauss

221

vasculitis of infants and young children involving coronary arteries

kawasaki disease

222

most common vasculitis

giant cell arteritis (temporal arteritis)

223

vasculitis associated with hepatitis B infection

polyarteritis nodosa

224

vasculitis where occlusion of ophthalmic artery can lead to blindness

giant cell arteritis

225

vasculitis with perforation of nasal septum

wegener's granulomatosis

226

vasculitis with unilateral headache and jaw claudication

giant cell arteritis

227

lipid lowering agent that causes facial flushing

niacin

228

lipid lowering agent that causes elevated LFTs and myositis

statins and fibrates

229

lipid lowering agent that causes GI discomfort and bad taste

cholestyramine

230

lipid lowering agent that causes best effect on HDL

niacin

231

lipid lowering agent that causes best effect on triglycerides and VLDL

fibrates

232

lipid lowering agent that causes best effect on LDL and cholesterol

statins

233

lipid lowering agent that binds c. diff toxin

cholestyramine

234

drug known for causing elevated prolactin levels

dopamine antagonists, verapamil, methyl-dopa

235

how to differentiate between microcytic anemia of iron deficiency and thalassemia

iron deficiency: high RDW > 20% and low reticulocyte count

thalassemia: normal RDW and high reticulocyte count