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Flashcards in STEP 2 CK USMLE incorrect Deck (169):
1

Severe isolated thrombocytopenia with normal hematocrit and WBC

Immune thrombocytopenia

2

Treatment for ITP if plts <30,000 OR bleeding

IVIg OR steroids

3

treatment for ITP >30,000 w/o bleeding

observe

4

Mild thrombocytopenia, giant platelets, bleeding out of proportion to thrombocytopenia

Bernard-Soulier syndrome (AR)

5

joint pain and tumors with chalky white appearance

Tophaceous gout

6

Characteristics or malignant renal cystic mass

-thick irregular wall
- multilocular
- multiple septae
- Contrast enhancement
- pain, hematuria or HTN

7

Dry cough, malaise for 2 mo and bilateral hilar adenopathy

Sarcoid

8

Treatment for HTN in pts with renal artery stenosis

ACEIs or ARBs
* if bilateral stenosis need careful monitoring

9

infective endocarditis with AV block

Perivalvular abscess

10

Murmur for tricuspid endocarditis

holosystolic murmur louder with inspiration.

11

pathophys of hepatorenal syndrome

cirrhosis->splanchnic arterial dilation->RAAS->renal vasoconstriction->decreased perfusion and GFR

12

first line treatment for erectile dysfunction

oral sildenafil

13

Most common complication of influenza

secondary bacterial pneumonia

younger: CA-MRSA

14

Medications that cause acute glaucoma

decongestants, antiemetics, anticholinergics (trihrxyphenidyl)

15

Tx for hemodynamically unstable SVT

Synchronized cardioversion

16

tx for hemodynamically stable SVT

IV amiodarone or IV procainamide

17

Age >50
BL pain and morning stiffness >1mo
involving: neck, shoulders, prox hip, constitutional
w/ elevated ESR

Polymyalgia rheumatica

18

Tx for poly myalgia rheumatica

Glucocorticoids

19

signs of early lyme disease

Erythema migrans, malaise, fatigue, arthralgia, meningitis, CN palsy, AV block

20

Antimitochondrial antibody

PSC

21

Anti- RNA pol III ab

Diffuse cutaneous scleroderma

22

Anticentromere ab

Limited cutaneous scleroderma

23

Diffuse cutaneous scleroderma characteristics

Scleroderma on trunk and UE
Prominent internal organ involvement: ILD, Myocardial ischemia, renal crisis
Anti-Scl-70 ab
Anti-RNA pol III ab

24

Cause of potassium shift into cell

-Beta-adrenergic agonist
- increased insulin
- alkalosis
- hematopoiesis

25

Drug therapy for recurrent nephrolithiasis

Thiazide
Urine alkalization (potassium citrate)
Allopurinol

26

Dietary changes to treat recurrent nephrolithiasis

>2L/day
low sodium and protein
nl ca intake
increase citrate
reduced oxalate diet (for ox stones)

27

consequences of nephrotic syndrome

Hypoalbuminemia
elevated liver protein and lipid synthesis->hyperlipidemia
Hypercoagulability
Edema
Hypovolemia

28

sx and labs ethylene glycol poisoning

Acute renal failure, envelope-shaped calcium oxalate crystals
gap met acid

29

signs of methanol intoxication

blindness
gap met acid

30

treatment of SIADH

Fluid restriction+/- salt tabs
Hypertonic (3%) saline for severe (confusion, seizures, coma)

31

Causes of SIADH

CNS disturbance (stroke, hemorrhage, trauma)
Medications (carbamazepine, SSRI, NSAIDs)
Lung disease (PNA)
Ectopic ADH secretion (SC lung cancer)
pain or nausea

32

Flank pain, hematuria, palpable renal mass, Left-sided scrotal varicoceles plus constitutional symptoms

RCC

33

middle ear effusion with no signs of acute infection in immunocompromised

Serous otitis media

34

Signs of serous otitis media

conductive hearing loss
dull, hypomobile TM

35

when to start treating Graves with antithyroid drugs alone

mild disease, small goiters, low TSH receptor Ab titers

Pregnant woman or Older pts

(sometimes just pretreatment due to risk for complications from RAI)

36

Pathogenesis of NAFLD

increased transport of FFA from adipose tissue to liver, decreased FFA ox in liver, or decreased clearance FFA

Related to insulin resistance--> increased peripheral lipolysis

37

Clinical presentation of thyroid storm

FEVER
tachycardia, HTN, CHF, fib
Agitation, delirium
Goiter, LID lag, tremor
N/v, d, jaundice

38

Treatment for acute adrenal insufficiency

fluids and IV dexa

39

signs of acute adrenal insufficiency

hypotension
tachycardia
Abd pain
vomiting
weakness

40

elevated free plasma metanephrines are a sign of...

pheochromocytoma

41

Imaging for gallstone pancreatitis

abd US

42

clinical: Cranial nerve VII palsy w/ lesion below pons

ipsilateral can't raise eyebrow or close eye, drooping mouth corner, no nasolabial fold

(decreased tearing, hyperacusis, loss of taste ant 2/3)

43

Most common paroxysmal supra ventricular tachycardia

Atrioventricular nodal reentrant tachycardia

44

Who gets AVNRT

young pts with normal hearts

45

Signs of AVNRT

PALPITATIONS
dizziness, SOB, CP

46

Cause of AVNRT

two conduction pathways in AV node (reentry mechanism)

47

Treatment for AVNRT

Vagal maneuvers to increase parasympathetic tone and slow AV node and increase refractory period

48

palpable purpura, proteinuria, hematuria, hx or IVDU, hepatosplenomegaly

Mixed cryoglobulinemia

(usually have underlying HCV)

49

Treatment for Ehrlichiosis

Doxycycline or minocycline

50

SE amiodarone

Pulm: CHRONIC interstitial pneumonitis

Cardiac: QT prolongation
Endocrine: thyroid
GI: transaminitis
Opitc: neuropathy

51

Signs of interstitial pneumonitis 2/2 amiodarone

dyspnea, nonproductive cough, new ground glass opacities on CXR

52

Diffuse telangiectasis, recurrent epistaxis, widespread AVM (mucous membranes), clubbing

Hereditary telangiectasia (Osler-Weber-Rendu syndrome)

(chronic hypoxemia and reactive polycythemia)

53

Clinical manifestations of amyloidosis

Renal (nephrotic)
Cardiac (restrictive cardiomyopathy, arrhythmia)
Heme (easy bruising, splenomegaly)
GI (hepatomegaly)
Neurologic (neuropathy)

54

Causes of restrictive cardiomyopathy

infiltrative Dz (sarcoid, amyloid, loftier syndrome)
Storage dz (hemochromatosis)
Endomycardial fibrosis
radiation

55

asthmatic symptoms, nasal and ocular sx, facial flushing

Aspirin exacerbated respiratory disease

pt with hx asthma or chronic rhinosinusitis with nasal polyposis

56

CYP450 inhibitors

APAP
Antibiotics
amiodarone
Cimetidine
cranberry juice
omeprazole
Thyroid hormone
SSRI

57

Effect of CYP450 inhibitors on warfarin

increased risk of bleeding

58

Treatment for fibromyalgia

aerobic exercise, good sleep hygiene, TCAs

59

Liver mass in patient on long-term oral contraception

Hepatic adenoma

60

Liver mass with anomalous arteries and arterial flow w/ central scar on imaging

Focal nodular hyperplasia

61

liver mass with elevated alpha-fetoprotein

Hepatocellular carcinoma

62

what is a concerning temp in cirrhosis?

>37.8

63

SBP clinical presentation

diffuse abdominal tenderness and/or mental status change
hypotension, hypothermia, paralytic ileum --> severe

64

SBP ascitic fluid

PMN>250
positive culture (GN)
protein <1
SAAG >1.1

65

HIV pt with fevers, headache worsening over 2 weeks, and signs of ICP

Cryptococcal meningitis

66

PPx for esophageal varices

nonselective beta blocker (propranolol, nadolol)

67

Treatment for actively bleeding esophageal varies

Octreotide

68

Test for lactose intolerance

Hydrogen breath test
Low stool pH
Increased stool osmotic gap

69

Elderly pt with hypercalcemia, normocytic anemia, renal insufficiency, and protein gap

Multiple myeloma

70

SE Levodopa/carbidopa

hallucinations, anxiety
n, arrhythmias, orthostatic hypotension

involuntary movements (5-10yrs)

71

ulnar compression most commonly happens at the...

elbow

72

episodic flushing and wheezing, diarrhea, valvular heart disease w/ tricuspid regurg

Carcinoid syndrome

73

Sx carcinoid syndrome

Episodic flushing and wheezing
diarrhea
valvular heart disease w/ tricuspid regurg.
Niacin deficiency(later)

74

Niacin deficiency

pellagra (diarrhea, dermatitis, dementia) also glossitis and angular stomatitis

75

Elevated alk phos in asymptomatic elderly patient

Paget disease of the bone

usually effects long bones, skull (HA, hearing loss) and spine

76

timing of fat embolism after trauma

12-24hrs

77

Sx fat embolism

Dyspnea
Neuro deficits (confusion, seizures, focal deficits)
Petechial rash

78

Signs of acute hypocalcemia

muscle cramps
chvostek and trousseau signs
Paresthesias
Hyperreflexia
Seizures

79

Sx hyperMg

hypOreflexia
paralysis
apnea
Cardiac arrest

80

Test for acute hep B

HBsAg and IgM Anti-HBc

81

Timing of post MI pericarditis

First few days

82

Timing of Dressler's syndrome

weeks post MI

83

Sx Dressler's syndrome

pericarditis
malaise
+/- fever
Elevated ESR

84

tx dressler's syndrome

NSAIDs

(or steroids)

85

Lab abnormalities with hypothyroid

hyperlipidemia, hyponatremia, elevated CK and transaminases

86

AST and ALT in alcoholic hepatitis

elevated
<300
AST: ALT >2

87

SE methotrexate

Macrocytic anemia and pancytopenia
Nausea
stomatitis
rash
hepatotoxicity
ILD
alopecia
fever

88

Intensely pruritus, migrating, reddish-brown tracks on lower extremity after walking on a beach

Cutaneous larva migrans

(hookworm larvae)

89

PFTs for restrictive lung disease

decreased lung volumes
Normal/elevated FEV1/FVC
decreased diffusion lung capacity
Decreased pulm compliance

90

What does pulmonary capillary wedge pressure indicate

left atrial pressure

91

pattern of central cord syndrome

post hyperextension of neck in elderly

weakness more pronounced in upper extremities than lower

92

what is amaurosis fugax

transient monocular blindness lasting seconds
2/2 embolus in ophthalmic artery

93

Signs of ICP

papilledema
enlarged blindspots
Headaches worse in the morning
Nausea/v
decreased consciousness

94

High TSH
High free T3 and T4

Secondary hyperthyroidism
(central--pituitary adenoma?)

95

Most common cause of CAP

S. pneumo

96

timing to diagnose chronic bronchitis

3 consecutive months of productive cough in 2 successive years

97

Causes of recurrent pneumonia in same region of lung

Local airway obstruction (extrinsic-neoplasm or adenopathy or intrinsic-bronchiectasis or FB)

Recurrent aspiration

98

cause of recurrent pneumonia in different regions of lung

Immunodeficiency
Sinopulmonary dz
Noninfectious (vasculitis, BOOP)

99

Signs of acute right heart strain

EKG with new RBBB or s1q3t3
bulging neck veins
Echo- dilated RV and decreased wall motion

100

Who needs low dose CT scan screening for lung cancer yearly?

55-80yo
30pk yr
quit <15y

101

categorization of high malignancy risk for solitary pulmonary nodule

Size: >2cm
Surface: Spiculated
Smoker: current
Cessation: <5yrs
Self (age): >60

102

Low malignancy risk factors for solitary pulmonary nodule

Size: <8mm
Surface: smooth
Smoker: never
Self (age): <45

103

Treatment for COPD

Muscarinic antagonist (ipratropium and tiotropium)

104

Features of OHS

daytime hypercarbia
Dyspnea
Polycythemia
Resp Acid
Pulm HTN
Cor pulmonale

105

Most sensitive lab value for hypovolemia

Decreased urine sodium

106

When can a patient with HIV not get varicella vaccine?

CD4<200

107

symptoms of phenochromocytoma

Paroxysmal
Pain (HA)
Pressure (HTN)
Palp (tachy)
Perspiration
Elevated BGL

108

Treatment for Paroxysmal supra ventricular tachycardias

Vagal maneuvers or IV adenosine

109

SE of phosphodiesterase-5 inhibitors

Hypotension (esp w alpha blockers and nitrates)
Blue discoloration of vision
Priapism
vision changes
Flushing
HA
Hearing loss

110

Diabetes medications that do not cause weight gain

Weight neutral: Metformin, DPP4 inhibitor

Weight loss: GLP-1 agonist

111

Causes of tachycardia-mediated cardiomyopathy

AF
A flutter
V tach
Incessant atrial tacky
AVNRT

112

Weight gain, proximal muscle weakness, HTN, hyperglycemia
anxiety
Hirsutism

Hypercortisolism (cushing syndrome)

113

Causes of cushing syndrome

Exogenous steroids
ACTH-producing putituary tumor
Ectopic ACTH production
Primary adrenal disease

114

Diagnosis of cushings disease

overnight low-dose dexamethasone suppression test
Late night salivary cortisol
24-hr urine free cortisol

115

Next step in eye exam if suspicious of intraocular foreign body after pen light

Fluorescein exam

116

signs of cardiac tamponade

hypotension
tachycardia
distended neck veins
pulsus paradoxus

117

Sx invasive aspergillosis

Fever, CP, hemoptysis

Pulm nodules with halo sign

118

Inpt (non-ICU) tx for CAP

FQs (levo or moxi)
OR
Beta-lactam + macrolide

119

Causes of bronchiectasis

Airway obs (cancer)
Rheum dz
Chronic or prior infection (aspergillosis, mycobacteria)
Immunodeficiency
Congenital

120

Dx bronchiectasis

HRCT

121

Pathogenesis of clubbing

Megacaryocytes get stuck in distal vasculature and produce VEGF and PDGF

122

Causes of clubbing

Intrathoracic neoplasms
Intrathoracic suppurative dz (abscess, empyema, CF, fungal)
Lung dz (ILD, Asbestosis, AVM)
Cyanotic congenital heart dz

123

When to do a CT for a PE?

After assessing if patient can get anticoagulant

if yes then treat before further workup

124

What tumor produces AFP and beta-hCG?

nonseminomatous germ cell tumors

(found in anterior mediastinum)

125

recurrent sinusitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria

granulomatosis with polyangiitis

126

Sx of GPA

upper resp: sinusitis/otitis, saddle nose deform
Lower resp: lung nodules/cavitations
Renal: RPGN
Skin: lived reticulais, non healing ulcers

127

Signs of respiratory failure in asthma exacerbation

elevated or normal PaCO2
Decreased breath sounds
Absent wheezing
AMS
Marked hypoxia w cyanosis

128

Lung dz after asbestosis exposure and smoking

Bronchogenic carcinoma

(bilateral pleural plaques)

129

Pleural plaques in pleural mesothelioma

unilateral with pleural effusion

130

Indication for long-term home O2 therapy

Resting: PaO2<55 or SaO2<88%RA

Corpulm, RHF, HCT>55%: PaO2<59 or SaO2<89%

131

Definition of pulm HTN

mean pulmonary arterial pressure > 25 rest or 30 w/ exercise

132

Class 1 pulm HTN

pulmonary artery HTN
Idiopathic, familial, drugs/toxins, associated conditions (HIV, shunts, connective tissue dz)

133

Clinical features of Pulm HTN

Dyspnea, weakness, fatigue
CP, hemoptysis, syncope, hoarseness

134

CXR findings pulm HTN

enlargement pulm arteries and enlargement of R ventricle

135

Class 2 Pulm HTN

Left heart Dz (LV dysfunction or valvular)

136

Class 3 pulm HTN

Lung dz and/or chronic hypoxia

COPD, OSA, etc

137

Class 4 pulm HTN

Chronic thromboembolic

138

Class 5 pulm HTN

misc:
Heme: chronic hemolytic anemia, splenectomy
Systemic: sarcoid, LAM, vasculitis
Metabolic: glycogen storage, thyroid
Other: obstruction

139

Myasthenia gravis S/S

muscle fatigue that worsens after use
ocular sx (ptosis, diplopia)
Bulbar dysfx
fatigue chewing, dysphagia, dysarthria

140

Associated disorder myasthenia gravis

thymoma, thymic hyperplasia

141

Tx myasthenia gravis

pyridostigmine

142

Most common cause of acquired angioedema

ACE inhibitor

143

Adverse effects of BB

bradycardia
AV block
Brohchoconstriction
Male sexual dysfunction

144

Treatment for hypovolemic hypernatremia

Sx: 0.9% saline (isotonic) then D5

ASx: D5

145

what does a positive direct coombs suggest in anemia

Autoimmune hemolytic anemia

Warm: + anti-IgG
Cold: + anti-IgM

146

Causes of cold AIHA

infections (mycoplasma pneumoniae)
lymphoproliferative disorders

147

Causes of warm AIHA

Drugs (penicillin)
Virals infx
Autoimmune
immunodeficiency
Lymophoproliferative (CLL)

148

Tx of warm AIHA

high-dose steroids

149

Acid base in OSA

Chronic resp acidosis with chronic metabolic alkalosis

150

SE trastuzumab

Cardiotoxicity

151

Tx of WPW afib

Procainamide

152

S/S arsenic poisoning

Acute: Garlic breath, v, d, QTc prolongation, pancytopenia

Chronic: Hypo/hyperpig, hyperkeratosis, stocking-glove neuropathy

153

fundiscopic findings with central retinal vein occlusion

Venous dilation, tortuosity.
Diffuse hemorrhages
cotton wool spots
Disk swelling

154

ARP=

(RR-1)/RR

155

Iron studies in iron deficiency

Iron low
Ferritin Low
Transferrin Low
TIBC HIGH

156

Iron studies in anemia of chronic disease

Iron Low
TIBC Low
Ferritin HIGH/nl
Transferrin Low/nl

157

Tx for botulism

supportive
Equine serum heptavalent antitoxin

158

Treatment for hyperosmolar hyperglycemic state

IV NS
IV insulin
Monitor K

159

Irregular menses, hirsutism, elevated T, acne

PCOS

160

Pathophysiology of zenker

Sphincter dysfunction and esophageal dysmotility

161

Where does giant cell tumor of bone appear

in the epiphyseal region of long bones (distal femur and proximal tibia)

162

Tetanus tx for pt who has clean or minor wound and has had 3 or more tetanus toxoid doses

Tdap if last dose was >10yrs
No TIG

163

When to give TIG for possible tetanus infection

Dirty or sever wounds in pts who have not has at least 3 doses of tetanus or who has unknown vaccine status

164

sounds of aortic stenosis

Mid to late peaking systolic murmur
soft S2
S4

165

Mid to late diastolic murmur at cardiac apex

mitral stenosis

also opening snap

166

Conditions with S3

chronic severe mitral regurg
chronic aortic regurg
HF

167

cause of arrhythmias w/in 10min of MI

immediate or phase 1a ventricular arrhythmia

Cause: reentrant

168

Cause of arrhythmia 10-60 min after MI

abnormal automacity

169

Most common cause of sudden cardiac arrest right after MI

Reentrant ventricular arrhythmias (e.g. V fib)