Step 2 Flashcards
Uworld and Notes (154 cards)
1
Q
Rule out persistent proteinuria in children by?
A
repeat urine dipstick on two separate occasions
2
Q
what is the major protein source in breast milk?
A
whey- more easily digested than casein in formula
3
Q
Anterior cerebral artery stroke
A
lower leg contralateral sensory and motor deficit, abulia (lack of will/.initiative), urinary incontinece, dyspraxia, emotional disturbances
4
Q
Risk factors for chorioamnionitis?
A
prolong rupture of membrane, pPROM, prolonged labor,, internal monitoring devices, repetitive vaginal exam, genital tract pathogen
5
Q
Why is there hypotension and tachycardia with acute pancreatitis?
A
local and systemic vascular endothelial injury causing intravascular loss and hypotension
6
Q
Most common cause of lower GI bleed in adults?
A
Diverticulosis
7
Q
Pneumocystic jirovecii treatment
A
TMP-SMX, Prednisone with low O2 sat
8
Q
ADR Amitryptiline
A
anticholinergic sx (muscarinic recept), lethargy (histamine recep), orthostatic hypotension (alpha adrenergic)
9
Q
Pregnancy lab test 24-28 weeks
A
Hgb/Hct, Antibody screen if RhD negative, 50g 1 hour GTT
10
Q
Normal age related sleep changes
A
decreased total sleep time, increased night time awakening, phase advancing (going to bed earlier and waking up earlier)
11
Q
Major Depressive Disorder mneumonic
A
Sleep (hyperinsomnia/insomnia) Interest (loss of interest) Guilt (worthlessness) Energy (lack of) Concentration (decreased) Appetite (incr or decr) Psychomotor agitation or retardation Suicidal ideation
Need 5/7
12
Q
Normal hematocrit
A
Male 41%-53%
Female 36%-46%
13
Q
Ruptured ovarian cyst
A
sudden onset unilateral pelvic pain
sometimes can cause hemoperitineum leading to guarding/shoulder pain/pleuritic chest pain
14
Q
Sx of hemoperitineum
A
diffuse/severe abd pain, shoulder pain, pleuritic chest pain, decreased hemoglobin and hematocrit, phrenic nerve irritation
15
Q
Motivational interviewing technique
A
ask Open ended questions
give Affirmations
be Receptive and Summarize main points
16
Q
Alcohol Abuse is considered to be
A
> 4 drinks a day in men or more than 3 drinks a day in women
>14 drinks a week
17
Q
1st line screen for aortic injury
A
CXR
see widening of the mediastinum, may see tracheal deviation or NG tube deviation
Vitals show tachycardia, anxiety, hypertension
18
Q
Concern for ___ with MVA and fall >10 feet
A
aortic injury
19
Q
What causes HELLP syndrome?
A
abnormal placentation leading to systemic inflammation that activates the coagulation cascade and complement. this causes increased platelet use and coagulation
increased platelets will cause MAHA because of shearing and will lead to increased indirect hyperbilirubinemia
20
Q
what is seen in HELLP syndrome
A
Hemolysis, elevated liver enzymes, low platelets
hypercoaguable state causes portal thrombi and hepatic necrosis-> RUQ pain
21
Q
tx for HELLP
A
deliver fetus >34 weeks or if maternal/fetal status bad, anti hypertensives, magnesium for seizure prophylaxis,
22
Q
Androgen insensitivity syndrome features
A
x linked mutation in androgen receptor-peripheral tissues insensitive to androgen
46 XY karyotype
phenotypically female
breast development, minimal pubic/axillary hair, external female genetalia, no uterus/cervix/upper2/3 of vag, cryptorchid testes
23
Q
management of androgen insensitivity syndrome
A
gender identity assignment/counseling
elective gonadectomy once past puberty
estrogen post gonadectectomy
24
Q
Treatment of Kawasaki Dz
A
aspirin and IVIG
25
Pharm: Aspirin
thromboxane A2 inhibitor causing antiplatelet effects
26
MEN 1
primary hyperparathyroidism, pituitary tumors, pancreatic tumors
hypercalcemia, prolactinoma/visual defects, gastrinomas
27
MEN2A
medullary thyroid cancer, pheocromocytoma, parathyroid hyperplasia
28
MEN2B
medullary thyroid cancer, pheochromocytoma, mucosal neuroma/marfanoid habitus
29
OSA features
daytime sleepiness, headaches, impotence, poor judgement, and depression
30
Tx of cyanide toxicity
sodium thiosulfate
31
Cyanide toxicity symptoms
Skin-Flushing to cyanosis
CNS- headache, AMS, seizure, coma
CV- arrythmia
Resp- tachypnea followed by resp depression and pulm edema
GI- abd pain n/v
renal- metabolic acidosis (from lactic acidosis), renal failure
32
Estrogen's effect on TBG
estrogen increases TBG which leads to more binding of T3 T4 and causes decreased availability to body. Body increases tsh
stimulates hypothyroidism
33
What changes do acute MR cause?
increased end diastolic LV pressure
34
What changes do chronic MR cause?
increased end diastolic LV pressure and increased atrial dilation
35
Familial Hypocalciuric Hypercalcemia
caused by mutation in calcium sensing receptor
asymp hypercalcemia with elevated or normal PTH and low urine calcium
urine calcium/creatinine clearance ratio <0.01 unlike in primary hyperparathyroidism where it is >0.02
36
What is a marjolin ulcer
squamous cell carcinoma in a burn wound
| usually more agressive if SCC is found in chronic wounds
37
pearly telangiectasic papule often with central ulceration
basal cell carcinoma
38
most common complication of supracondylar fracture
brachial artery or median nerve injury
39
most common cause of supracondylar fx
FOOSH
40
Other complications of supracondylar fx
brachial nerve injury, compartment syndrom, volkmann ischemic contracture, brachial artery injury
41
negatively birifringent- yellow when parallel, blue when perpendicular
monosodium urate crystals - gout
42
Most common cause of myocarditis in children
viral- cocksackie B or adenovirus
43
pathophys of viral myocarditis
myocyte necrosis and autoimmune inflammation caused by viral infecftion
44
Dx of viral myocarditis
CXR: pulm edema, cardiomegaly
EKG: sinus tach
Echo: decreased EF
Biopsy (gold standard): inflammation and necrosis
45
Tx viral myocarditis
inotropes, diuretics, IVIG
46
comorbidities of PCOS
diabetes, hypertension, NASH, endometrial hyperplasia/cancer, OSA
47
risks with oral contraceptives
hepatic adenoma, hypertension, stroke, MI, cervical cancer
48
benefits with oral contraceptives
decr risk of ovarian and endometrial ca, no pregnancy, menstrual regulation, hyperandrogenism treatment
49
post partum endometritis risk factors
c section, chorioamnionitis, GBS, prolonged rupture of membrane, operative vaginal delivery
50
what is postpartum endometritis?
infection of the decidua after birth. Most common cause of fever post delivery
Dx by fever, purulent/bad smell lochia and uterine tenderness
51
Tx post partum endometritis
broad spec abx- clindamycin and gentamicin until fever has been cleared for over 24 hours
52
Tx: borderline personality disorder
dialectical behavioral therapy + meds as adjunct( 2nd gen antipsychotic, mood stabilizers, antidepressent)
53
Distribution of mean median mode in positively skewed? negatively skewed?
```
Positive= mode>median>mean
Negative= mean
```
54
name of rash in lyme disease
erythema migrans
55
Def: primary amenorrhea
no period in girls >13 with no secondary sex characteristics
| no period in girls >15 with secondary characteristics
56
First step in dx primary amenorrhea
pelvic ultrasound to diagnose if it is an endocrine problem or anatomic problem
57
Clincal: Pagets disease of bone
skull: headache, hearing loss
long bones: fracture, arthritis, bowing
spine: radiculopathy, spinal stenosis
58
CT of hemorrhagic stroke
white hyperdense appearance in parenchyma on non contrast immediately
59
Etio: herpangina
cocksackie A
60
Age: herpangina
3-10 y
61
season: herpangina
summer fall
62
Clin: herpangina
fever, gray ulcers posterior oropharynx, pharyngitis
63
Tx: herpangina
supportive
64
Clin: herpetic gingivostomatitis
fever, pharyngitis, ulcers on anterior oropharynx
65
Nontender, firm, hyperpigmented nodule or nodules with dimpling in center and usually in lower extremity
dermatofibroma- caused by fibroblast proliferation
66
Sus: tracheobronchial rupture
subq emphysema, pneumomediastinum, pneumothorax post chest tube,
67
Clin: Lymphedema
early- swelling, pitting edema, soft skin
| late- stasis, non pitting edema, thick firm skin
68
Tx ichthyosis vulgaris
emollients, keratolytics, topical retinoids
69
Indications for PID hospitilization
abscess, perihepatitis, non compliance, pregnancy, can't tolerate oral meds, high fever/vomiting
70
Tx for PID inpatient
IV cefoxitin/cefotetan + doxy or IV gent+ clinda
71
How many months do you anticoagulate for provoked DVT
atleast 3 months
72
What type of heparin can be used in ESRD?
unfractionated heparin. LMWH (lovenox) is metabolized by the kidneys
73
Protein C and S both promote
anticoagulation.
with warfarin, these are inhibited first so the initial reaction is a lot of coagulation. why you need a heparin bridge
74
axillary nerve innervates
teres minor and deltoid
| sensory to skin overlying deltoid
75
Congenital rubella presents with
sensorineural hearing loss, PDA, leukoria from cataracts, blueberry rash
76
Rubella in adults presents with
macular papular rash spreading from head to toe, fever, arthralgia/arthritis
77
Tx of contact/allergic dermatitis
low- med stregnth steroid and removal of item
78
Indication for raloxifene use
post menopausal osteoporosis
79
Breast cancer risk factors
HRT, increased maternal age, nulliparity, alcohol, BRCA or cancer in first degree relative, white, increased age, early menarche or late menopause
80
When to start mamogram?
50 years
81
What is reproducability
the measure of random error
82
What is akathisia
inability to stay still
83
Acute dystonia?
muscle spasms and twisting
84
Mild intermittent asthma
<2 days/ week
<2 nights/ month
FEV1 >80%
PRN SABA
85
mild persistent asthma
>2/ week but only once per day
>2 night/ month
FEV>80%
SABA+ LD ICS
86
moderate persistent asthma
daily day symptoms
>1 night/week
SABA+low -mod ICS+ LABA (formeterol, salmetorol)
87
severe persistent asthma
frequent day and night symptoms
SABA+ HD ICS+ LABA+ PO steroid
88
Nasopharyngeal carcinoma presents with
nasal congestion with epixstasis, headaches, numbness/cranial nerve palsy, serous otitis media, cervical lymphadenopathy
89
Triad of disseminated gonorrhea
tenosynovitis, assym polyarthritis, vesiculopustular rash
90
criteria of massive hemoptysis
>600ml or >100 ml an hour- next step is to intubate
91
How to diagnose parkinsons
clincally
must have 2/3- rigidity, bradykinesia or tremors
92
Positioning for person with massive hemoptysis?
bleeding lung down- prevents blood from collecting in opposite lung
93
When should FFP be given?
INR >1.5 in patient with known coagulopathy
94
Tx for parkinson's disease
Amantadine, levodopa/carbidopa, dopamine agonist (ropinerol, pramipexole, bromocriptine), MAO B inhibitors (selegeline), COMT inhibitors (tolcapone), anticholinergics (in younder tremor only patients, benztropine)
95
Neurotransmitters disrupted in parkinsons
increased Ach, decreased dopamine
96
Neurotransmitters disrupted in Alzheimers
decreased Ach and norepinepherine
97
Neurotransmitters disrupted in MG
blocked Ach activity
98
What causes hyper iGM syndrome
```
abscence of CD40 ligand binding preventing class switching leading to elevated IgM
X linked
```
99
Complications of caustic esophageal injury
mediastinitis, esophageal perforation
100
preferred points of central vein
IJ (ultrasound guided)
| Subclavian (anatomic marking)
101
Ultrasound findings of benign breast mass
hyperechoic on US
102
Atomexatine
First line alternative for non stimulant ADHD drug
norepinephrine reuptake inhibitor (causes more norepi to be in the system)
103
Tx for asymptomatic endometriosis
none
104
intraoperative findings during laparoscopy of powder burn lesions, adhesions, nodules, chocolate cysts
endometriosis
105
Thiazide diuretics metabolic ADR
glucose intolerace- decrease release of insulin from pancreas and decrease insulin utilization
dose dependent and occur more with chlorthalidone but chlorthalidone is seen to reduce mortality
106
Distinguish between seminomatous and non seminoma germ cell tumors
seminoma- elevated BHCG, normal AFP
| nonseminoma- elevated bHCG and AFP
107
Differential for mediastinal mass
Teratoma, thymoma, terrible lymphoma and thyroid neoplasm
108
Neuroleptic malignant syndrome symptoms
after antipsychotic use
| delirium, confusion, rigidity, fever >40C, autonomic instability, elevated CK and leukocytosis
109
most common feature of malignant skin finding
color variation
110
cerebrospinal fluid for HSV meningitis
increased WBC- lymphocyte predominant, increased protein, normal glucose
111
acquired risk factors for VTE
immobilization, malignancy, surgery, medications
112
estrogen deficiency causes
vaginal atrophy, recurrent UTI, increased vaginal pH, dysuria and urge incontinency
113
Condyloma lata associated with
syphilis
114
condyloma acuminata associated with
HPV
115
Shy drager syndrome/ multple system atrophy is
parkinsonism with autonomic dysfunction and widespread neurologic signs
116
treatment for spontaneous subconjunctival hemorrhage
observe
117
Wernicke encephalopathy is caused by ____ and results in _____
caused by thiamine deficiency
causes confusion, ataxia, nystagmus
can be cause iatrogenically by giving glucose without thiamine
118
Treatment of bulemia
SSRI
| Doesn't help in anorexia
119
Pharm: Bupropriion
norepinepherine and dopamine reuptake inhibitor
Depression+smoking cessation
Not for people with eating disorders and seizures
120
Inpatient CAP Tx
Fluoroquinolone
| Beta lactam and macrolide
121
ICU CAP Tx
beta lactam and macrolide or betalactam and fluoroquinolone
122
Outpatient CAP Tx
macrolide or doxycycline
| Fluoroquinolone or beta lactam + macrolide for comorbidities
123
What should a non reactive stress test be followed up with?
biophysical profile or contraction stress test
124
acute adrenal insufficiency is characterized by
abdominal pain, hypotension, vomiting, and fever in patient with chronic steroid use, adrenal hemorrhage or infarction
125
Tx: tourettes
behavioral therapy
anti dopamine agents- tetrabenazine and antipsychotics
alpha 2 adrenergic receptor agonists
126
Uterus in adenomyosis
uniformly enlarged, tender, soft
127
ECG of ventricular aneurysm
persistent ST elevations and deep q waves 5 weeks to 3 months post MI
128
Tx of SCID
stem cell transplant
129
Tx myasthenia gravis
acetylcholineasterase inhibitor
| pyridostigmine
130
elevated AFP and bowel seen on US
gastroschisis
| AFP travels through the bowel into the amniotic fluid
131
Developing whistling after rhinoplasty is sus for
septal perforation due to a septal hematoma
132
pulsus paradoxus
decrease in SBP by >10 with inspiration
133
becks triad, important for
hypotension, jvd, distant heart sounds
| important for cardiac tamponade
134
____ is sus in child with joint pain, elevated ESR, CRP and WBC and fever
septic arthritis
| arthocentesis immediately
135
Laryngomalacia is caused by
floppy supraglottic structures that collapse during inspiration
136
Presentation of laryngomalacia
stridor when supine or feeding
| better when prone
137
Tx of laryngomalacia
resolves spontaneously by 18 months
138
magnesium toxicity tx
calcium gluconate
139
what class of drugs is use dependence most seen
```
antiarrythmics class 1 C
flecanide, propafenone, moricizine
```
140
latent TB treatment
isoniazid and pyrodoxine (Vit B6) for 9 months
141
what decreases risk of relapse in schizophrenic patients?
minimizing conflict and stress at home
142
Patients with septic shock usually have a (metablic/resp) (alkalosis/acidosis) due to build up of ___ because the body can't give oxygen efficiently
metabolic acidosis due to build up of lactic acid
143
____ should be suspected in young patients after a viral illness that present with heart failure, chest pain or arrythmias
dilated cardiomyopathy
144
restrictive cardiomyopathy is caused by
sarcoidosis, hemachromotosis, amyloidosis
145
most common adult brain tumor
astrocytoma/glioblastoma multiforme (grade IV)
146
types of child brain tumors
```
pilocytic astrocytoma
medulloblastoma
ependymoma
craniopharyngioma
pinealoma
```
147
CML associated with ___
BCR- ABL
| imatinib
148
With no signs of bone infection, patients with sickle cell are most likely infected with __________
strep pneumo
| encapsulated and SC patients usually have splenic dysfxn
149
Increasing cuttof point of a test will cause
increase in SP and decr in SN
| less people will test positive
150
Tx for acute dystonia
diphenhydramine
| anticholinergic benztropine
151
radial nerve injury causes
weakness in wrist and hand extensors and loss of sensation in dorsum of hand
152
most common cause of malignant pleural effusion
breast cancer
| lung cancer
153
resusitative fluids
crystalloids
| NS
154
unstable CGG on x chromosome is
fragile x syndrome
