Step 2 Ck - Classic Presentations

Front 1

Anion gap and Osmolar gap metabolic acidosis with rectangular, envelope-shaped crystals in urine.

Back 1

Ethylene glycol poisoning (anti-freeze)

(methanol and ethanol intox will cause anion, osmolar gap acidosis, too, but not the calcium oxalate crystals)

Front 2

Painful 3rd trimester bleeding with normal ultrasound

Back 2

Placental abruption

Front 3

Precocious puberty, Pigmentation (cafe au lait spots), and Polyostotic fibrous dysplasia (multiple bone defects)

Back 3

McCune-Albright syndrome

Front 4

Occipital headaches, ataxia, facial weakness, gaze palsy (deviation of the eyes to left or right side)

Back 4

Cerebellar hemorrhage

Front 5

Older patient with back pain, hypercalcemia, anemia, and renal failure

Back 5

Multiple Myeloma

Front 6

Sudden onset of eye pain, photophobia, and a mid-dilated pupil:

Back 6

Acute Glaucoma

Front 7

a

Back 7

a

Front 8

Exudative pleural effusion without evidence of infection

Back 8

Malignancy

(breast cancer and lung cancer are the most common causes of malignant pleural effusions)

Front 9

Young patient with a recent viral illness who presents with heart failure, chest pain, or arrhythmias:

Back 9

Myocarditis

(which can progress to dilated cardiomyopathy, but most patient will have a t least a partial recovery of myocardial function)

Front 10

Sickle cell patient with bacteremia/septic shock

Back 10

Streptococcus pneumoniae

(encapsulated organism, and SC kids are predisposed to splenic auto-infarction!!!)

Front 11

Sickle cell patient with diffuse musculoskeletal pain

Back 11

Microvascular occlusions
(vasoocclusive crisis)

Front 12

New mother will pain over lateral side of wrist

Back 12

De Quervain tenosynovitis

Front 13

HIV-patient with focal neurologic signs and multiple non-enhancing lesions in brain with no mass effect

Back 13

Progrssive Multifocal Leukoencephalopathy

(caused by JC virus)

(on MRI it would show as multiple demyelinating non-enhancing lesions, with no mass effect)

Front 14

Rapidly progressive skin lesions that develop into nontender nodules with central necrosis in an immunocompromised patients

Back 14

Pseudomonas aeruginosa bactermia--caused Ecthyma gangrenosum

Front 15

Thready pulses over radial arteries that disappear with deep inspiration

Back 15

Pulsus paradoxus

Front 16

Chest pain, signs of decreased cardiac output, and pulsus paradoxus following a viral infection

Back 16

Cardiac tamponade resulting from acute pericarditis

Front 17

Dizziness, hearing loss, and tinnitus

Back 17

Meniere's disease

Front 18

Back 18

Chronic Tophaceous Gout )gouty arthritis)

Tophi can ulcerate a drain a chalky white material

Front 19

Triad of findings in Disseminated Gonococcal infection (Gonococcemia)

Back 19

1-Polyarthralgias
2-Tenosynovitis
3-Vesiculopustular skin lesions (painless) (2 to 10)

Front 20

Lower abdominal pain that radiates to the thighs and back and begins a few hours prior to menses

Back 20

Primary dysmenorrhea, caused by INCREASED PROSTAGLANDINS

(release of PGs during the breakdown of the endometrium ie before the actual bleeding starts)

Front 21

Cyanotic infant with left axis deviation

Back 21

Tricuspid atresia

(90% assoc'd with VSDs, 30% w/ TGA)

Front 22

Pt from or ancestry of northern European ancestry with megaloblastic anemia, shiny tongue (atrophic glossitis), vitiligo, and thyroid disease, possibly with thrombocytopenia and/or leukopenia

Back 22

Pernicious anemia = most common cause of B12 deficiency in whites of northern European ancestry, and they frequently have tiger autoimmune diseases like thyroid disease and vitiligo

(usu neuro sx there, too, but not always)

Front 23

Macrocytic anemia in a sickle cell patient

Back 23

Folate deficiency

(b/c chronic hemolysis and bone marrow tries to make more RBC to compensate and uses up folate...so sickle cell patients should be on daily folate supplements)

*Note: if on hydroxyurea, this can also cause macrocytosis

Front 24

Sudden onset of photopsia (flashes of light) and floaters, with description of "a curtain coming down over my eyes"

Back 24

Retinal detachment

Front 25

Teenage girl with primary amenorrhea, fully-deveoped breasts, absent pubic and axillary hair, short/blind-ended vagina, no uterus on ultrasound

Back 25

Androgen Insensitivity Syndrome--karyotype would show 46 XY and labs would show elevated testosterone for a girl (but normal amount for a boy)

-Caused by defective androgen receptors resulting in androgen resistance in peripheral tissues

-Mullerian Inhibiting Factor is still present as it was produced by the testes (which are likely in the abdomen or inguinal canal) and that is why no uterus cuz MIF inhibits the formation of uterus, fallopian tibes, and upper part of vagina.

-No pubic or axillary hair because b/c ts production is dependent on testosterone, and its receptor are resistant/insensitive to testosterone.

Front 26

Female delivered baby 12 hours ago and now has temp of 100.4 and WBC 11,000, with shaking chills during and 10 min following delivery; uterus is found to be firm and nontender

Back 26

Normal postpartum presentation

In the immediate postpartum period, a low-grade fever, leukocytosis, and vag discharge are normal findings.

It would be worrisome if the lochia is foul-smelling or if the uterus is tender--then you'd be worried about endometritis.

Front 27

Smoker with whitish, localized plaques in oral mucosa with a granular texture and not removed by scraping

Back 27

Leukoplakia--> has a risk of transformation into squamous cell carcinoma

-A biopsy should be done to exclude cancer, but at this point the most likely cause of this lesion is leukoplakia

Front 28

Fall on an outstretched hand with tenderness in anatomic snuffbox

(if + displacement, then open reduction and internal fixation is required)

Back 28

Scaphoid fracture--risk of nonunion so wrist should be immobilized for 6-10 weeks

Front 29

HIV patient--pain with swallowing, has white plaques over pharynx, CD4 of 50, on TMP-SMX

Back 29

Candida Esophagitis--tx with fluconazole

Front 30

Back 30

Venous stasis ulcers, form chronic venous valvular insufficiency

typically present on lower leg, above the ankle

Front 31

Middle age patient with weight loss & jaundice

Back 31

Pancreatic cancer

--other signs and sx:
palpable, nontender gallbladder (Courvoisier sign),
-migratory thrombophlebitis (Trousseau syndrome),
-epigastric pain,

Front 32

Fever, and an erythematous area on body which is swollen, painful, hyperesthetic to touch, and has a sharp demarcation separating the red area from te normal skin...with local lymphadenopathy

Back 32

ERYSIPELAS = a superficial thrombophlebitis caused by Strep pyogenes

Front 33

Joint pain, splenomegaly, and neutropenia

Back 33

Felty's syndrome

(anemia and leukopenia often present as well)

(possible late consequence in rheumatoid arthritis)

Front 34

Painful oral and genital ulcers and erythema nodosum

Back 34

Behcet syndrome

also commonly uveitis/eye lesions, arthritis, or other skin lesions

Front 35

Alcoholic smoker with combination of elevated JVP, hepatomegaly, ascites, and lower extremity edema, without evidence of pulmonary congestion

Back 35

Isolated Right Heart Failure secondary to Cor Pulmonale from COPD

Other findings that may be present: right-sided S3, right ventricular heave, ascites

alcoholic part is there to throw off in thinking about liver issues from alcohol, but here there is hepatomegaly because of congestion whereas in alcohol cirrhosis there would be a small and firm fibrosed liver

Front 36

RUQ or epigastric pain in ICU patient with severe trauma/sepsis/etc

Back 36

Acalculous cholecystitis

emergent tx is percutanoeous cholecystostomy (perc drain) followed by cholecystectomy once patient stabilizes

Front 37

6 year old with rash, joint pain, abdominal pain, and hematuria

Back 37

Henoch-Schonlein Purpura

typically purpuric rash, but apparently the question can say a maculopapular rash
on lower extremities and btutocks usually

Front 38

Pt undergoes surgical repair of an AAA, then post-op he develops LLQ pain with bloody diarrhea. CT shows thickening of the rectosigmoid junction and colonoscopy shows ulecrations in that area but above and below it are normal

Back 38

Ischemic colitis

Bowel ischemia may complicate up to 7% of procedures on the aortoiliac vessels and most commonly affects the distal left colon
Common causes: loss of collateral circa, manip of vessels with the surg instruments, prolonged aortic clamping, and impaired blood flow thru the inferior mesenteric artery.

Front 39

After blunt trauma to the chest, if an x-ray shows a deviated mediastinum with a mass in the left lower chest, one should suspect:

Back 39

A diaphragmatic perforation with herniation of abdominal viscera

Dx with barium swallow or CT scan with oral contrast

Front 40

Elevated direct bilirubin and liver biopsy shows dark granular pigment in the hepatocytes

Back 40

Dubin-Johnson syndrome

(DJ likes rainbows!)

Front 41

Pt complains of blurred vision, cough, and shortness of breath, along with mild fevers and malaise. CXR shows bilateral reticulonodular infiltrates & hilar adenopathy.

Back 41

SARCOIDOSIS

◆ Most common complaints: cough, dyspnea, fever, wt loss.
◆ Lungs most freq involved organ system--CXR will show B/L hilar LAD &/or B/L reticulonodular infiltrates/opacities (ground glass appearance)
◆ Eyes--Anterior uveitis (silt-lamp shows leukocytes in ant chamber)
◆ Skin--Erythema nodosum
◆Joints--Arthritis

Front 42

PainFUL genital ulcer(s)

Back 42

"Holy Crap that hurts!"

Herpes & Chancroid

The others are painLESS--Granuloma inguinale, Lymphogranuloma venerum, & Syphilis ("Gross Lesions without Stress"...ie no pain)

Front 43

PainLESS genital ulcer(s)

Back 43

"Gross Lesions without Stress" (i.e. no stress=no pain)

Granuloma inguinale
Lymphogranuloma venerum
Syphilis

Syphilis vs Granuloma inguinale = no LAD in granuloma inguinale and it has beefy red base

Front 44

Erythematous papules with a central scale and a "sandpaper-like" texture on palpation

Back 44

Actinic keratoses

Front 45

2-hour old male LGA newborn, uncomplicated pregnancy, fine at birth but now 2 hours later--worsening cyanosis and respiratory distress, not relieved by oxygen. Has a normal S1 and a single & loud S2, with no murmur.

Back 45

Transposition of the Great Vessels

(the foramen ovale and ductus arteriosus begin to close after birth, so decreased mixing of oxygenated with non-oxygenated blood

Presents in first few hours of life

Give PGE1 IV immediately and then surgical correction

Front 46

ICU patient with low T3, normal T4, and normal TSH

Back 46

Sick euthyroid syndrome

any pt with acute severe illness can develop these abnormal labs which we call sick euthyroid syndrome (decreased peripheral conversion of T4 to T3 b/c under crazy stress, cytokines, etc)

Front 47

Newborn male with oliguria and a midline mass in lower abdomen

Back 47

Posterior Urethral valves

= most common cause of congenital urethral obstruction

the midline lower abdom mass likely represents a distended bladder

next step = VCUG to confirm dx

Front 48

Ipsilateral headache and ipsilateral Horner's syndrome

Back 48

Carotid artery dissection (sympathetic nerves travel along the carotid, can still have sweating if partial horners as sweat fibers only on ext carotid)