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Week 1 Step 2 CK Flashcards

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1
Q

What is the screening guideline for PAP smear for immunocompromised individuals?

A

Start at age 21, or one year after sex and do yearly
If results are normal for 3 consecutive years, and move screening to every 2-3 years.
Never screen every 5 years in these patient

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2
Q

What is the screening guideline for prostate cancer?

A

Start a discussion at age 50 for anyone with life expectancy > 10 years, use PSA alone

High-risk should start around 40-45

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3
Q

When can you use the live poliovirus vaccine?

A

Never, it is associated with causing paralytic poliomyeltitis

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4
Q

How do you use prophylactic medications for malaria?

A

Chloroquine and Mefloquine require administration 2 weeks prior and 4 week post trip

Primaquine should be started 1-2 days prior and continued 7 days post exposure

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5
Q

What is neonatal screening of HBV?

A

Test for HBsAg at initial visit
Positives then get further testing at 26-28 weeks
Women with LFTs <2x ULN and whose HBV DNA is >2x 105 require antiviral therapy

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6
Q

What do you give a neonate born to HBV positive woman?

A

Give both the vaccine and Hep B immune globulin within 12 hours of delivery

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7
Q

How do you determine if a pregnancy is ectopic?

A

UPT + then do a transvaginal U/S, if empty then get hCG, if hCG >3500 repeat U/S, if <3500 repeat in 2 days

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8
Q

How do you manage triple-negative breast cancer?

A

Adjuvant chemo if tumor size >0.5 cm

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9
Q

What is included with breast-conserving therapy?

A

Always also give adjuvant radiotherapy

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10
Q

What are the genetic risk factors for type I Diabetes?

A

Most common MHC on 6p21 or HLA DR3 and DQ

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11
Q

What are diseases associated with Type I Diabetes Mellitus?

A 
Hypothyroidism
Celiac
Addisons
Autoimmune gastritis
pernicious anemia
Vitiligo
Myasthenia gravis
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12
Q

What are symptoms of inflammatory carcinoma of the breast?

A

Erythema
Breast tenderness
Failed antibiotic therapy for mastitis
Peau d’orange

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13
Q

What is treatment of inflammatory carcinoma of the breast?

A

The respond to neoadjuvant (pre-op) chemotherapy followed by modified radical mastectomy which is then followed by adjuvant radiation

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14
Q

What are the risk factors for developmental dysplasia of the hip?

A

Three F’s:
Female sex
Faany first: breech position regardless of cephalic version
Family history

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15
Q

What are the causes of pulmonary regurgitation?

A

Idiopathic, traumatic, or iatrogenic (caused by surgical repair of tetralogy)

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16
Q

What heart sounds are associated with tricuspid regurgitation?

A

Systolic thrill at left sternal border, right-sided S3 gallop from long-standing pulmonary regurgitation.
It is a diastolic murmur that gets louder with inspiration

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17
Q

How does handgrip maneuver affect the murmur of aortic stenosis?

A

It decreases because if increases afterload which decreases the pressure gradient across the valve

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18
Q

What would lead to you getting a head CT in a head injury patient?

A

Unconscious, GCS <13, seizure or incontinence, neurological deficits, s/s of skull fracture

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19
Q

What is the test of choice to diagnose osteomyelitis?

A

X-ray is symptoms >2 wks
Nuclear triphasic bone scan if hardware present
MRI if no hardware and patient is diabetic

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20
Q

What vaccines are safe during pregnancy?

A 
Inactive flu
Tdap - given at 27-36 wks
Hep A and B
Men
Rabies
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21
Q

When do you give the Tdap for pregnancy?

A

Given 27-36 weeks gestation

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22
Q

What are complications of chronic pancreatitis?

A

Pseuddocysts, ascites and pleural effusion, biliary obstruction, splenic vein thrombosis, cancer

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23
Q

Are splenic vein thromboses associated with esophageal or gastric varices?

A

Gastric varices

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24
Q

What is the management of parotid gland tumors?

A

Superficial parotidectomy for benign - no CN VII involved

Total parotidectomy for malignant tumors.

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25
What areas have malaria resistant to chloroquine?
Not in Caribbean and West of Panama Canal
26
What are contraindications to mefloquine use?
Psychiatric conditions, Seizure disorders, cardiac conduction abnormalities
27
What are good first-line agents for acute bacterial prostatitis?
Fluoroquinolones like ciprofloxacin and TMP-SMX
28
How long is treatment for acute bacterial prostatitis?
Long-term treatment of at least 4 weeks | Negative urine culture at 7 days predicts full cure at completion of therapy
29
What is the initial treatment for thyrotoxicosis?
Propranolol is the best initial treatment
30
What is treatment for postpartum thyroiditis?
Symptomatic only as disease is self-limiting, this usually will include propranolol for management for hyperthyroidism symptoms
31
What is most common thyroid adenoma?
Follicular
32
What is most common thyroid cancer?
Papillary carcinoma
33
What is the order of tests for cushing syndrome?
First do 24-hour urinary cortisol to see if it is elevated or not Then do high-dose dexamethasone suppression test to see if its an adrenal or other pathology Then check ACTH level to see if lung vs. adrenal neoplasia
34
What differentiates 21-beta hydroxylase deficiency from 11-beta hydroxylase deficiency?
21 - Hypotension, hyponatremia, hyperkalemia, precocious puberty 11 - HTN, hypokalemia, precocious puberty
35
What are signs and symptoms of cortisol deficiency (Addison's)?
Hypotension, hyperpigmentation, androgen deficiency Weakness, muscle cramps Hyponatremia, hypoglycemia
36
What is the best test for diagnosing cortisol deficiency?
Cosyntropin-stimulation test
37
What medications can cause drug-induced lupus?
Hydralazine, procainamide, isoniazid, chlorpromazine, methyldopa
38
What medication slows the rate of skin thickening in scleroderma?
D-penicillinamine has been shown to slow thickening and prevent organ involvement
39
What rash is characteristic of dermatomyositis?
``` Heliotropic rash (lilac colored over edematous eyelids) Does affect the nasolabial folds unlike the malar rash of SLE ```
40
What is treatment for severe HSP symptoms?
Corticosteroids
41
What findings are consistent with nutcracker esophagus?
Hypertensive disorganized contractions interspersed with normal responses to swallowing Characteristically you see corkscrew esophagus on barium swallow
42
What is the treatment for nutcracker esophagus?
Use calcium channel blockers and nitrates as it is a hypertensive etiology
43
What are indications for bariatric surgery?
Failure of previous methods Motivated patient Reasonable risk of surgery BMI >40
44
What type of gastric procedure should be performed for weight loss?
RNY bipass or Sleeve gastrectomy | Gastric banding is not effective in American populations
45
What is the preferred method for assessing and treating foreign body aspiration in pediatric patients?
Rigid bronchoscopy is preferred and safer in pediatric populations
46
What is the treatment for BPH?
``` Alpha antagonist (tamsulosin) - improves urinary flow but does not decrease prostate size 5-alpha reductase inhibitor (finasteride) - Decreases prostate volume ```
47
Do you treat asymptomatic bactiuria?
No | In pregnant patients only
48
What is a nevus sebaceous?
It is a benign hamartoma usually present at birth | Well-demarcated, hairless, yellow/orange, oval plaque
49
What is the treatment for nevus sebaceous?
Excise all biopsy proven lesions before adulthood
50
What is the histopathology of nevus sebaceous?
Immature hair follicles are diagnostic | All elements of skin with predominance of sebaceous glands
51
What are the complications of nevus sebaceous?
Hair around - indicated CNS involvement and should not be biopsied In adulthood can develop into trichoblastoma or rarely basal cell carcinoma
52
What is the best method for detection and diagnosis of prostate cancer?
Transurethral resection of prostate (TURP)
53
What is the treatment for localized prostate cancer?
Radical prostatectomy (or robotic) is preferred in stable patients with localized disease
54
Do you need to do a CT to diagnose a perianal abscess in Chron's disease?
No you do not, only if the symptoms are unclear
55
When do you begin screening for FAP patients?
Start around 10-12 years old
56
What are the indications for drainage of pancreatic pseuddocyst?
Rapid enlargement, compression of surrounding structures, pain, signs of infection You can observe if <5cm and no symptoms
57
What testing should be performed on a pregnant woman with HSIL on PAP?
Colposcopy should be performed to confirm the diagnosis
58
Hemochromatosis patients are at higher risk for what complication?
Bacterial infection with Vibrio vulnificus and Yersinia enterocolitica
59
What vaginal infection presents with thick-white discharge, vaginal itching, and beefy red scaly plaques with small pustules?
Vulvovaginal candidiasis
60
What is the gold standard of diagnosis in ischemic colitis?
Endoscopic visualization of shedding mucosa
61
Does the FDA deal with ethics issues?
No they typically do not deal with them, so there is no need to report kickback schemes to the FDA
62
How long can an undescended testicle take to descend?
If it has not descended by 4 months, it is unlikely to do so spontaneously and you should prepare for surgery before 2 years to preserve fertility
63
What can be used to relieve esophageal spasm?
Nitroglllycerin
64
What thrombolytic therapy should not be used if needed to be repeated in a while?
Streptokinase, it is antigenic and can cause allergic reactions on repeat administration, antibodies can last up to 7.5 years
65
Do you use thrombolytics in NSTEMI?
No, they have not been shown to improve survival or outcomes
66
What medical therapy is used for papillary muscle rupture following MI?
Afterload reduction agents, such as IV nitroprusside, which is the most effective at doing this
67
What heart sound is most specific for CHF?
S3 gallop is most likely seen with CHF
68
What are the findings in Right Axis Deviation?
Positive R wave in lead III, Negative deflection in lead I and aVL. Lead II is biphasic
69
What are the most common heart conditions associated with carcinoid tumor/syndrome?
Pulmonary and Tricuspid Stenosis
70
How does cardiac function change in pregnancy?
CO is increased by 30-50% | LVEDV is increased, but LVEDP is normal
71
What is trepopnea?
Dyspnea in the left lateral decubititus position that usually improves when placed in the right lateral decubitis position It is associated with atrial vegetation and atrial myxoma
72
What is the most common cause of infectious pericarditis?
Most commonly caused by viruses like: coxsackie, Influenza, EBV, Adenovirus, HIV
73
What is Brugada Syndrome?
Seen in Asian patients or young age. Repeated episodes of syncope with pseudo right bundle branch block with and STE in V1 and V2 About half have irreducible ventricular arrhythmia
74
What is the treatment for Brugada Syndrome?
Only treatment that decreases mortality is placement of an automated implantable cardiac defibrillator
75
What is Jervell and Lange-Nielsen Syndrome?
AR disorder with mutation in K ion channels | Congenital long QT syndrome associated with bilateral sensorineural hearing loss
76
What is Romano-Ward Syndrome?
AD long QT Syndrome | No hearing deficits
77
What is Lown-Ganong-Levine syndrome?
Congenital syndrome with a accessory pathway connecting the bundle of His to the atria Results in atrial pre-excitation and shortened PR intervals No affect on ventricular rhythm so it has a normal QRS
78
What type of patient typically has an Osborn Wave (convex hump at J-point)?
Hypothermic patient
79
What is the treatment for hydronephrosis and pyelonephritis with an obstructing stone?
IV antibiotics and nephrostomy tube in the acute phase
80
What are the symptoms of tinea versicolor?
Variable changes in skin pigmentation Fine scale or flaky texture Upper trunk and proximal extremities involved
81
What is the diagnostic test for tinea versicolor?
KOH prep showing Spaghetti and Meatballs (short hyphae and round yeast) Wood's lamp showing yellow to yellow-green fluorescence
82
What is the treatment for tinea versicolor?
Topical antifungals (azoles), Selenium sulfide, zinc pyrithione Systemic therapy for recurrent or refractory - itraconazle, fluconazole Prophylaxis with: Selenium sulfide or ketoconazole shampoo
83
What is the initial treatment for HELLP syndrome?
Magnesium sulfate prophylaxis, then maternal stabilization otherwise, then take delivery. Delivery is currative
84
What are contraindications for Spiral CT for PE?
Renal insufficiency and contrast allergy | Do a V/Q Scan in these patients

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