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Step 2 CK Flashcards

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1
Q

Class EKG finding in atrial flutter

A

Sawtooth P waves

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2
Q

Definition of unstable angina

A

Angina is new or worsening with no increase in troponin level

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3
Q

Beck’s triad

A

Triad for cardiac tamponade:

  • Hypotension
  • Distant heart sounds
  • JVD
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4
Q

Drugs that slow heart rate

A

Beta blockers
Calcium channel blockers
Digoxin
Amiodarone

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5
Q

Hypercholesterolemia treatment that leads to flushing and pruritis

A

Niacin

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6
Q

HCM murmur

A

Systolic ejection murmur heard at lateral sternal border

Increases with decreased preload (aka Valsalva maneuver)

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7
Q

Aortic insufficiency murmur

A 
"Austin Flint murmur"
Diastolic, decrescendo, low-pitched
Blowing murmur
Best heard sitting up
Increased with increased afterload (handgrip maneuver)
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8
Q

Aortic stenosis murmur

A

A systolic crescendo-decrescendo murmur that radiates to the neck
Increases with increased preload (squatting maneuver)

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9
Q

Mitral regurgitation murmur

A

Holosystolic murmur
Radiates to the axilla
Increased with increased afterload (handgrip maneuver)

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10
Q

Mitral stenosis murmur

A

Diastolic, mid- to late, low-itched murmur with opening snap

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11
Q

Treatment for a fib and a flutter

A

Cardiovert if unstable

If stable/chronic, rate control with CCBs or beta blockers

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12
Q

Treatment for v fib

A

Cardiovert

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13
Q

What is Dressler syndrome? When does it occur?

A

Autoimmune reaction with fever, pericarditis and elevated ESR
2-4 weeks post-MI

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14
Q

What does is pulsus paradoxus? What does it represent?

A

Decrease in systolic BP of more than 10 mmHg with inspiration
Seen in cardiac tamponade

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15
Q

EKG findings in pericarditis

A

Low-voltage, diffuse ST-segment elevation

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16
Q

When should AAA be repaired surgically?

A

5.5+ cm

rapidly enlarging, symptomatic, or ruptured

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17
Q

How is ACS treated?

A 
ASA
heparin
clopidogrel
morphine
oxygen
sublingual nitroglycerin
IV beta blockers
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18
Q

Which coronary artery supplies the anterior wall?

A

LAD/diagonal

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19
Q

Which coronary artery supplies the inferior wall?

A

PAD

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20
Q

Which coronary artery supplies the posterior wall?

A

left circumflex/oblique, RCA/marginal

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21
Q

Which coronary artery supplies the septum?

A

LAD/diagonal

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22
Q

What is the antibioitic used for endocarditis prophylaxis?

A

Amoxicillin

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23
Q

What is Virchow’s triad?

A

Stasis
Hypercoagulability
Endothelial damage

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24
Q

What is the most common cause of hypertension in young men?

A

Excessive EtOH

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25
What does the "Figure 3" sign represent?
aortic coarctation
26
What does a water bottle-shaped heart represent?
Pericardial effusion | - look for pulsus paradoxus
27
What does a positive Nikolsky sign represent?
Pemphigus vulgaris
28
What does a negative Nikolsky sign represent?
Bullous pemphigoid
29
What does an irislike target lesion represent?
Erythema multiforme
30
Flat, often hypopigmented lesions on the chest and back | KOH prep has a spaghetti-and-meatballs appearance
Tinea (pityriasis) versicolor
31
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
32
Inflammation and epithelial thinning of the anogenital area, predominately in postmenopausal women
Lichen sclerosus
33
Exophytic nodules on the skin with scaling or ulceration; the second most common type of skin cancer
Squamous cell carcinoma
34
Signs and symptoms: Hypertension hypokalemia metabolic alkalosis
Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)
35
``` Signs and symptoms: tachycardia wild swings in BP headache diaphoresis altered mental status sense of panic ```
Pheochromocytoma
36
What is first line treatment of pheochromocytoma?
First: alpha-antagonists (phenoxybenzamine) Second: beta antagonists
37
Signs and symptoms: | patient with history of lithium use with copious amounts of dilute urine
Nephrogenic diabetes insipidus
38
How is central diabetes insipidus treated?
Administration of DDAVP and free-water restriction
39
Signs and symptoms: | post-op patient with significant pain presents with hyponatremia and normal volume status
SIADH due to stress
40
Which antidiabetic agent is associated with lactic acidosis?
Metformin
41
``` Signs and symptoms: weakness nausea vomiting weight loss new skin pigmentation hyponatremia hyperkalemia ```
Primary adrenal insufficiency (aka Addison disease) | Treat with glucocorticoids, mineralcorticoids, and IV fluids
42
signs and symptoms: bone pain hearing loss Increased alk phos
Paget disease
43
What does elevation in IGF-1 usually mean?
acromegaly
44
What does elevation in 17 hydroxyprogesterone usually mean?
21-hydroxylase deficiency (CAH)
45
What is the difference between a cohort and a case-control study?
Cohort divides groups by an exposure and looks for development of disease Case-control divides groups by a disease and assigns controls, and then goes back and looks for exposures
46
What is attributable risk?
The difference in risk in the exposed and unexposed groups (aka the risk that is attributable to the exposure)
47
What is relative risk?
Incidence in the exposed group divided by the incidence in the non-exposed group
48
Diagnostic modality used with ultrasonography is equivocal for cholecystitis
HIDA scan
49
Murphy sign
Inspiratory arrest during palpation of the RUQ | Seen in acute cholecystitis
50
What is the most common cause of small-bowel obstruction in patients with no history of abdominal surgery?
hernia
51
How is IBD treated?
5-ASA agents | Steroids during acute exacerbations
52
Charcot triad
RUQ pain jaundice fever and chills
53
Reynolds pentad
``` RUQ pain jaundice fever and chills (aka Charcot triad) shock mental status changes ```
54
Which drugs can cause hepatitis?
TB meds (INH, rifampin, pyrazinamide) acetaminophen tetracycline
55
Which hernia has the highest risk of incarceration?
femoral hernia
56
``` Signs and symptoms: Watery diarrhea Dehydration Muscle weakness Flushing ```
VIPoma | Treatment: replace fluids and electrolytes, may need to surgically resect tumor and/or use octreotide
57
Courvoisier sign
Palpable, nontender gallbladder | Sign of pancreatic cancer
58
Causes of microcytic anemia
Thalassemia Iron deficiency Anemia of chronic disease Sideroblastic anemia
59
What is the diagnostic test for hereditary spherocytosis?
Osmotic fragility test
60
What is a pure RBC aplasia?
Diamond-Blackfan anemia
61
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia
Fanconi anemia
62
What meds and viruses can cause aplastic anemia?
``` Chloramphenicol Sulfonamides Radiation HIV chemotherapeutic agents hepatitis parvovirus B19 EBV ```
63
What are the signs of thrombocytic thrombocytopenic purpura?
``` "FAT RN" fever anemia thrombocytopenia renal dysfunction neurologic abnormalities ```
64
How is TTP treated?
Emergent large-volume plasmapheresis Corticosteroids Antiplatelet drugs NOTE: platelet transfusion is contraindicated!
65
How is ITP treated?
Usually resolves spontaneously | May require IVIG and/or corticosteroids
66
What happens in DIC to fibrin, d-dimer, fibrinogen, platelets, and hematocrit?
``` Fibrin split products: increased d-dimer: increased platelets: decreased fibrinogen: decreased hematocrit: decreased NOTE: in DIC, Factor VIII is also low ```
67
What do Reed-Sternberg cells indicate?
Hodgkin lymphoma
68
What do Auer rods indicate?
AML, particularly M3 (which is also known as APL)
69
Which AML is associated with DIC? How is it treated?
AML M3 | Treated with retinoic acid
70
What are the electrolyte changes in tumor lysis syndrome?
Decreased calcium | Increased potassium, phosphate, and uric acid
71
``` Signs and symptoms: early satiety splenomegaly bleeding cytogenics with t(9;22) ```
CML
72
What is the most common predisposing factor for acute sinusitis?
Viral URI
73
To which organisms are asplenic patients particularly susceptible?
Encapsulated organisms: pneumoccocus, meningococcus, h flu, klebsiella
74
``` signs and symptoms: from California or Arizona fever malaise cough night sweats ```
Coccidioidomycosis | Treat with amphotericin B
75
What are the signs of tertiary syphilis?
``` Tabes dorsalis General paresis Gummas Argyll Robertson pupil aortitis aortic root aneurysm ```
76
What do cold agglutinins indicate?
Mycoplasma
77
When should you start prophylaxing for PCP?
less than 200 CD4 (treat with TMP-SMX)
78
When should you start prophylaxing for MAC?
less than 50-100 CD4 (treat with clarithromycin/azithromycin)
79
What are the kind of crystals in gout?
Needle-shaped, negatively birefringent crystals | Seen on joint fluid aspirate
80
What are the kind of crystals in pseudogout?
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate
81
``` Signs and symptoms: Elderly pain and stiffness of shoulders and hips anemia elevated ESR ```
Polymyalgia rheumatica
82
Which nerve can be damaged with humeral fracture?
Radial nerve
83
What are the signs suggestive of radial nerve damage?
Wrist drop | Loss of thumb abduction
84
How is prolactinoma treated?
Dopamine agonist (eg bromocriptine)
85
What kind of aphasia is "broken speech"? Which lobe? Which vascular distribution?
Broca aphasia Frontal lobe Left MCA distribution
86
What are the signs of Guillain-Barre on LP?
Albuminocytologic dissociation | Elevated protein in CSF without a significant increase in cell count
87
What is the normal reaction to water flushed into patient's ear?
Fast phase of nystagmus toward opposite side
88
When should carotid endarterectomy be performed?
70% lesion
89
How is Guillain Barre treated?
IVIG or plasmapheresis | Avoid steroids
90
``` Signs and symptoms: Port-wine stain in the V1 distribution Intellectual disability Seizures in childhood Ipsilateral leptomeningeal angioma ```
Sturge-Weber syndrome | Tx: symptomatic, possible focal cerebral resection of the affected lobe
91
``` Signs and symptoms: Hyperphagia Hypersexuality Hyperorality Hyperdocility ```
Kluver-Bucy syndrome (affects amygdala)
92
How is myasthenia gravis diagnosed?
Edrophonium
93
What is the chromosomal pattern of a complete mole?
46XX
94
Which antibiotics are teratogenic?
Tetracycline Fluoroquinolones Aminoglycosides Sulfonamides
95
How is urge incontinence treated?
Anticholinergics (oxybutynin) or beta adrenergics (metaproterenol)
96
How is stress incontinence treated?
Surgery Kegel exercises Estrogen Pessaries for stress incontinence
97
Which breast cancer type increases the future risk of invasive carcinoma in both breasts?
Lobular carcinoma in situ
98
What nontender abdominal mass is associated with elevation in vanillylmandelic acid (VMA) and homovanillic acid (HVA)?
Neuroblastoma
99
Signs and symptoms: | Bilious emesis within hours after the first feeding
Duodenal atresia
100
Which immunodeficiency is seen in boys with chronic respiratory infections? Nitroblue tetrazolium test is negative
Chronic granulomatous disease
101
Which immunodeficiency is seen in child with eczema, thrombocytopenia, and high levels of IgA?
Wiskott-Aldrich syndrome
102
Which immunodeficiency is seen in 4-month-old boy with life-threatening Pseudomonas infection?
Bruton's x-linked agammaglobulinemia
103
Signs and symptoms: Mental status changes Emesis Liver dysfunction after ASA intake
Reye syndrome
104
What cancer does retinoblastoma increase risk for?
Osteosarcoma
105
Which vaccinations are given at 6-month well-child visit?
HBV, DTaP, Hib, IPV, PCV, rotavirus
106
``` Signs and symptoms: Red "currant-jelly" stools Colicky abdominal pain Billous vomiting Sausage-shaped mass in the RUQ ```
Intussusception
107
What is the most common pathogen causing croup?
Parainfluenza virus type 1
108
Signs and symptoms: Obese boy Sudden onset of limp
Slipped capital femoral epiphysis | Dx with AP and frog-leg lateral radiographs
109
Signs and symptoms: Active boy Anterior knee pain
Osgood-Schlatter disease
110
What are the key side effects of atypical antipsychotics?
Weight gain Type 2 DM QT segment prolongation
111
How is acute dystonia treated?
Benztropine or | Diphenydramine
112
Which meds should be avoided in patients with PTSD?
Benzodiazepines (high addiction potential) - patients commonly have a hx of substance abuse
113
What are Light's criteria for exudative effusion?
Pleural/serum protein >0.5 | pleural/serum LDH >0.6
114
What are causes of exudative effusion?
Think of leaky capillaries: malignancy, TB, bacterial or viral infection, PE with infarct, and pancreatitis
115
What are causes of transudative effusion?
Think of intact capillaries: CHF, liver or kidney disease, and protein-losing enteropathy
116
What are the PFTs like in obstructive pulmonary disease?
Low FEV/FVC
117
What are the PFTs of restrictive pulmonary disease?
Increased FEV/FVC, low TLC
118
What does honeycomb pattern on chest radiograph indicate?
Diffuse interstitial pulmonary fibrosis | Treat with supportive care; antifibrotic agents may help
119
How is SVC syndrome treated?
Radiation
120
What is the acid-base disorder in PE?
Respiratory alkalosis with hypoxia and hypocarbia
121
Which non-small cell lung cancer is associated with hypercalcemia?
Squamous cell carcinoma
122
Which lung cancer is associated with Lambert Eaton syndrome?
Small cell lung cancer
123
Which non-small cell lung cancer is associated with SIADH?
Small cell lung cancer
124
Which lung cancers are highly related to cigarette exposure?
small cell lung cancer, squamous cell carcinoma
125
What are the classic chest radiographic findings for pulmonary edema?
``` Cardiomegaly Prominent pulmonary vessels Kerley B lines "bat's wing" appearance of hilar shadows Perivascular and peribronchial cuffing ```
126
Renal tubular acidosis associated with abnormal H+ secretion and nephrolithiasis
Type I (distal) RTA
127
Renal tubular acidosis associated with abnormal bicarb reabsorption and rickets
Type II (proximal) RTA
128
Renal tubular acidosis associated with low aldosterone state
Type IV (distal) RTA
129
T-wave flattening and U waves
hypokalemia
130
Peaked T-waves and widened QRS
hyperkalemia
131
How is hyperkalemia treated?
``` "C BIG K" calcium gluconate bicarb insulin glucose kayexalate ```
132
How should nephrolithiasis be diagnosed?
noncontrast CT
133
Signs and symptoms: nephritic syndrome 3 days after URI normal C3
IgA nephropathy (Berger disease)
134
Glomerulonephritis with hemoptysis
Granulomatosis with polyangiitis | Goodpasture syndrome
135
Eosinophils in urine sediment
Allergic interstitial nephritis
136
Which testicular cancer is associated with beta-hcg?
Choriocarcinoma
137
What is the complication of overly rapid correction of hyponatremia?
Central pontine myelinolysis
138
Which acid-base disturbance is commonly seen in pregnant women?
Respiratory alkalosis
139
Treatment for benzodiazepine overdose?
Flumazenil
140
Treatment for malignant hypertension?
Nitroprusside
141
Treatment of SVT
If stable, rate control with carotid massage or other vagal stimulation If unsuccessful, consider adenosine
142
Macrocytic, megaloblastic anemia with neurological symptoms
B12 deficiency
143
Macrocytic, megaloblastic anemia without neurological symptoms
Folate deficiency
144
What is the most common organism in burn-related infections?
Pseudomonas
145
How is fluid repletion in burn patients calculated?
Parkland formula: 24h fluids = 4 x kg x %BSA
146
What are the Cushing triad signs of ICP
hypertension bradycardia abnormal respirations
147
What is the CO, PCWP, and PVR for hypovolemic shock?
CO down PCWP down Increased PVR
148
What is the CO, PCWP, and PVR for cardiogenic shock?
CO down PCWP up PVR up
149
What is the CO, PCWP, and PVR for distributive shock?
CO up PCWP down PVR down
150
Which thyroid cancer is associated with increased calcitonin?
Medullary cancer
151
How does papillary thyroid cancer spread?
Lymphatics
152
How does follicular thyroid cancer spread?
Hematologic
153
How is acromegaly treated?
Octreotide or lanreotide (somatostatin analogues)
154
How is central diabetes insipidus treated?
DDAVP: desmopressin acetate, a synthetic analogue of ADH
155
How is nephrogenic diabetes insipidus treated?
Salt restriction and water intake; thiazide diuretics can be used to promote mild volume depletion and to stimulate increased water absorption
156
How is SIADH treated?
Restrict fluid Cautiously give hypertonic saline if patient is very symptomatic - must monitor in ICU to prevent central pontine myelinolysis Demeclocycline, an ADH receptor antagonist, can help normalize serum sodium
157
What is associated with MEN type I?
Gastrinomas (ZES), insulinomas, and VIPomas aka pancreatic islet cell tumors Parathyroid hyperplasia Pituitary adenomas MEN 1 affects "P" organs: pancreas, pituitary, parathyroid
158
What is associated with MEN type 2A?
``` 2 P's: parathyroid and pheo Medullary carcinoma of the thyroid Pheo or adrenal hyperplasia Parathryoid gland hyperplasia NOTE: due to mutations in the RET proto-oncogene ```
159
What is associated with MEN type 2B?
1 P: pheo Medullary carcinoma of the thyroid, pheo, oral and intestinal ganglioneuromatosis (mucosal neuromas), marfinoid habitus NOTE: due to mutations in the RET proto-oncogene
160
How can etiology of ascites be identified?
SAAG (serum-ascites albumin gradient): SAAG = serum albumin - ascites albumin 1.1+ indicates portal hypertension (right HF, budd-chiari, cirrohsis, splenic or portal vein thrombosis) less than 1.1 indicates nephrotic syndrome, TB, or malignancy (NOT portal hypertension)
161
What is Libman-Sacks endocarditis?
Noninfectious vegetations often seen on the mitral valve in association with SLE and APS
162
What is the biceps reflex?
C5 nerve root
163
What is the triceps reflex?
C7 nerve root
164
What is the patellar reflex?
L4 nerve root
165
What is the Achilles reflex?
S1 nerve root
166
Which med should not be given to someone with VWD?
aspirin
167
How can tumor lysis syndrome be prevented?
Patients should be well hydrated | Patients can be started on allopurinol or rasburicase if WBC are up
168
What's with hypocalcemia and blood transfusions?
Blood products often contain citrate, which binds to serum calcium, leading to hypocalcemia
169
Which electrolyte abnormality can cause prolonged QT?
hypocalcemia
170
Which blood cancer has t(9;22)?
CML | This is the BCR-ABL translocation
171
How is CML treated?
Imatinib (Gleevec)
172
Which blood cancer stains with TRAP?
Hairy Cell Leukemia
173
Which HIV med causes crazy dreams?
Efavirenz
174
Which HIV med can cause a hypersensitivity reaction?
Abacavir
175
Which tumor looks like a bunch of grapes coming out of the vagina?
sarcoma botryoides

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