Step 2 Ck - General/uncategorized Info

Front 1

2 most common locations in the circle of Willis for an aneurysm

Back 1

ACommA and PCA

Front 2

Acute tx of Hypercalcemia

Back 2

IV fluids, THEN loop diuretic (but fluids first)

Front 3

Acid-base disorder caused by aspirin overdose:

Back 3

Mixed respiratory alkalosis and anion gap metabolic acidosis

Front 4

WBC count in Synovial fluid analysis of
-Normal Joint
-Osteoarthritis
-Inflammatory condition joint
-Septic arthritis

Back 4

Normal: 0-200/ml
-Osteoarthritis: 200 -- 2,000
-Inflammatory arthritis: 2,000 -- 50,000
-Septic arthritis: >50,000

Front 5

Other name for ACTH stimulation test (in diagnosing Addison's)

Back 5

Cosyntropin test

Front 6

Acid-base and electrolyte abnormalities in Addison's disease

Back 6

Non-anion gap metabolic acidosis with hyponatremia and hyperkalemia

(normally aldosterone causes reabsorption of Na+ and secretion of H+ & K+, so with addison's being a state of hypoaldosteronism you get the opposite, no Na reabsorbed and you keep all your H+ ions and K+

Front 7

Electrolyte abnormalities in Cushing's syndrome

Back 7

Hypernatremia and Hypokalemia (because corticosteroids have some mineralocorticoid activity)

*for explan of how aldosterone/mineralocorticoids cause electrolyte phys, see previous flashcard on Addison's)

Front 8

Scenarios/drugs that can result in Drug-induced Pancreatitis

Back 8

1. Pt on diuretics--thiazides, furosemide
2. Pt with IBD--sulfasalazine, 5-ASA
3. Pt on immunosuppressive agents--azothioprine, L-asparaginase
4. Pt w/ hx of seizures or bipolar--valproic acid
5. AIDS pt--didanosine, pentamidine
6. Pt on Antibiotics--metronidazole, tetracycline

Front 9

Prolactin production is inhibited by ____________, but stimulated by ____________ and ____________.

Back 9

Inhibited by dopamine.
Stimulated by Serotonin & Thyroid-releasing hormone

Front 10

Cancers that ↑ Erythropoeitin (& mnemonic)

Back 10

"Potentially Really High Hematuria"

P- Pheochromoytoma
R- Renal cell carcinoma
H- Hepatocellular carcinoma
H- Hemangioma

Front 11

HCM murmur increases when Preload ⬆ or ⬇?
And what maneuvers cause this increase in murmur intensity?

Back 11

⬇preload causes more murmur in HCM,
b/c this lessens the size of the ventricular cavity and causes increased outflow obstruction.

VALSALVA INCREASES INTENSITY of HCM murmur b/c it causes ⬇ PRELOAD.

Inspiration and Squatting, on the other hand, DECREASES INTENSITY of murmur b/c it ⬆ Preload

Also Handgrip can DECREASE intensity because ⬆ Afterload, helping to maintain ventricular volume

Front 12

Most consistent reversible risk factor for pancreatitis:

Back 12

Smoking

Front 13

The most beneficial therapy to reduce the progression of diabetic nephropathy in the presence of renal insufficiency/azoetemia is:

Back 13

Intensive BLOOD PRESSURE control--ACE inhibitors!
(to at least <130/80)

Front 14

Causes of Disseminated Intravascular Coagulation (DIC)

and Mnemonic

Back 14

"STOP Making Thrombi"

-Sepsis
-Trauma
-Obstetric complications
-Pancreatitis
-Malignancy (esp gastric, breast, lung)
-Transfusions

Front 15

Most common complication of Peptic Ulcer disease

Back 15

Hemorrhage

Front 16

Screening for colon cancer in pt's with Ulcerative Colitis

Back 16

8 years after dx, then every 1-2 years after

Front 17

Descriptive definitions of Osteomalacia vs Rickets vs Osteoporosis

Back 17

Osteomalacia and Rickets are both caused by Vitamin D deficiency, so both result in defective bone mineralization, but in kids it also has an effect on the growth plate cartilage, so...

Osteomalacia-defective mineralization of bone
Rickets-defective mineralization of bone and cartilage

Osteoporosis--normal bone mineralization, but low bone mass

Front 18

Windshield wiper fluid= what type of poisoning

Back 18

likely ethylene glycol (if renal colic/stones) or methanol (if visual disturb's)

Front 19

Supracondylar fracture can cause secondary injury to:

Back 19

Brachial artery
(which would result in loss of radial pulse, so check it!

Front 20

Child has seizure a day after getting DTap. Can he get the vaccine again (next dose)?

Back 20

The possible adverse rxn's to DTap are due to the pertussis component. If a CNS complication (like seizure, an encephalopathy, or an anaphylactic reaction occur within 7 days of its administration, then further admin of DTap is Contraindicated.

In these instances, DT should be substituted for DTaP
(ie still get diptheria and tetanus, just not the pertussis component).

Front 21

Causes of widened mediastinum on CXr

Back 21

-Aortic dissection
-Mediastinal tumors or mass
(germ cell, lymphoma, tumors of thymus)
-Mediastinitis
-Lymphadenoapthy
-anthrax
-Esophageal rupture
-Cardiac tamponade
-Pericardial effusion

Front 22

Which type of pain (somatic or visceral) is poorly-localized, constant, and dull?

Back 22

Visceral pain

vs somatic pain which is well-localized and more severe in intensity

Front 23

Potential dreaded complication of Compartment syndrome:

Back 23

Volkmann's ischemic Contracture
(the final sequelae of compt syndrome in which the dead muscle has been replaced with fibrous tissue)

Front 24

Vague painful confution seen as a sequela of infection or trauma which may be minor, characterized by pain, hyperesthesia, and tenderness

Back 24

Reflex sympathetic dystrophy

Front 25

True or False:
Tightening of glycemic control will improve erectile dysfunction.

Back 25

False, it has not been shown to improve ED.

It is treated with phosphodisterase inhibitors (sildinafil)

Front 26

Most common causes of Acute Otitis Media (in order)

Back 26

#1=Strep pneumo
#2=Hib
#3=Moraxella

Front 27

What is Salvage therapy?

Back 27

Treatment for a disease when standard therapy fails

(such as radiation therapy for PSA antigen recurrence after radical prostatectomy for prostate cancer)

Front 28

Wilson's disease is also called:

Back 28

Hepatolenticular degeneration

Front 29

Mgmt of a pt with a liver mass who has traveled in an endemic area

Back 29

-Evaluate for amoebic abscess with serologic testing for antibodies
-Empiric tx with Metronidazole

Front 30

The most significant risk factor for limb reduction defects associated with chorionic villus sampling:

Back 30

Gestational age of the fetus

(CVS before 10 WGA is associated with greater risk)

Front 31

Diagnostic criteria for Rheumatic Fever

Back 31

2 major or 1 major & 2 minor criteria

J♥NES criteria = Major criteria

Joints (polyarthritis, hot/swollen joints)
♥ (carditis, valve damage)
Nodules (subcutaneous)
Erythema marginatum (painless rash)
Sydenham chorea

Minor crit = PEACE

Previous Rheumatic fever
ECG w/ PR prolonged
Arthralgias
CRP & ESR elevated
Elevated temperatire

Front 32

Which baby milk (breast milk or formula) has an inadequate supply of Vit D

Back 32

Breast milk

so exclusively beast fed infants need Vit D sup

Front 33

3 things GERD predisposes patients

Back 33

Barrett's esophagus, Erosive Esophagitis, and Peptic Stricture formation

Front 34

Most sensitive test to diagnose
-Acute Disseminated/diffuse Pulmonary Histoplasmosis
-Chronic Disseminated Pulmonary Histoplasmosis

Back 34

-Acute: Antigen in the serum or urine

-Chronic: Fungal blood culture

*Blood cultures can take up to 6 weeks to become positive in accute diffuse pulm histo so not the most sensitive in acute cases!

Front 35

Most severe consequences of methanol intoxication (2)

Back 35

Vision loss and Coma

Front 36

Causes of Foot drops (4)

Back 36

#1=Peripheral neuropathy
-Trauma to the common peroneal nerve (common fibular nerve)
-Radiculopathy to any of the spinal roots that contribute to the common peroneal nerve (L4, L5, S1, S2)

Less commonly, can be congenital:Charcot-Marie-Tooth disease

Front 37

Only clotting factors not made by liver and hence not decreased in liver disease

Back 37

vWF and Factor VIII

Front 38

Causes of Dilated Cardiomyopathy:

Back 38

1- Chronic CAD or ischemia
2 - ALCOHOL
3 - Doxorubicin
4 - MYOCARDITIS
✴ Viruses--COXSACKIE, Parvovirus B19,
Enteroviruses, EBV, CMV, HHV-6
✴ Parasites--Trypanosoma cruzi (Chagas dz)
✴Bacteria
✴Fungi
✴ Drugs
5 - Pregnancy
6 - Hemochromatosis (usu restrictive CM)

Front 39

Hemochromatosis patient is at increased risk for:

Back 39

Hepatocellular carcinoma

Front 40

Patients with uncontrolled hypertension are at greatest risk for what complication:

Back 40

Myocardial infarction (CAD)

Front 41

Normal MMSE score is:

Back 41

27-30

Front 42

Cause of Isolated Systolic Hypertension:

(ie systolic BP is elevated, but diastolic is normal)

Back 42

Decreased elasticity of arterial walls (rigidity of arterial walls...As a person ages, the elastic properties of the arterial wall diminish and the arteries become more rigid)

Note: Aortic regurg/insufficiency also caused Isolated Systolic hypertension....but on exam there would be a diastolic murmur)

Front 43

Caused of Hypertension with elevations in both systolic and diastolic
(systolic and diastolic hypertension)

Back 43

Increased plasma renin activity (like in RAS)

Front 44

Which crosses suture lines: cephalohematoma or caput succedaneum?

Back 44

Caput suCCedaneum
(more C's than cephalohematoma-->
multiple C's = Crosses suture lines = Caput seCCedaneum)

cephalohematoma is subperiosteal hemorrhage and so is always limited to the surface on 1 bone)--presents few hours after birth and there is no discoloration of skin

Front 45

When should Abx be given to someone to prevent pulm complications

Back 45

Only if they have severe lung disease or evid of infection...in which case surgery should only be done if emergent, otherwise elective surgeries should be postponed until no signs of infection

Front 46

Typical/possible symptoms of Irritable Bowel Syndrome (IBS):

Back 46

abdominal pain, pain relief with bowel movements, looser and more frequent stools with the onset of pain, passage of mucous, a sense of incomplete emptying, or bloating

can also have extra intestinal...depression, sexual dysfunction, and urinary changes

Front 47

What drug class is contraindicated during a STEMI MI

Back 47

Dihydropiridine CCB's (ie nifedipine)

b/c they cause vasodilation which leads to reflex tachycardia which worsens the heart ischemia

non-dyhidropiridine CCBs like verapamil and diltiazem can be used for ongoing ischemic sx after beta blockers ave been administered, but they wont improve mortality

Front 48

-How can right heart failure/right ventricular infarction lead to hypotension?

-Why might a patient with a right ventricular infarct have a low heart rate in the face of hypotension?

Back 48

-Failure of the right ventricle leads o decreased preload, and therefore can result in decreased cardiac output and hypotension.

-that is suggestive of possible SA node ischemia (SA node is located in right ventricle)

Pt's with RV infarcts require a high preload to maintain their BP and therefore are treated with IV fluids. You must avoid drugs that reduce preload such as nitro and diuretics!

Front 49

Kid needs treatment for ALL (non-emergent). Parents are divorced and have joint custody. What do you do when...
-One parent says yes, one parent says no.
-Both parents object to treatment:

Back 49

-One says yes and other says no: Proceed with tx...if joint custody, only requires 1 parent to consent to treatment despite what the other says. If one parent has custody, then only what they say matters.

-If both parents object to a non-emergent treatment, you'd have to seek court approval before proceeding

-If therapy is emergent or child will die, then proceed without consent if obtaining it would delay treatment

Front 50

How come patients with Hemophilia can get recurrent episodes of joint pain/swelling?
What would the most likely cause of this joint pain be?

Back 50

Recurrent hemarthroses--can lead to a joint injury called "hemophilic arthropathy." Exact mech not known, Iron deposition and synovial thickening with fibrosis are characterisitic.

-Cuaued by Hemosiderin (an iron-storage complex) deposition and fibrosis

Front 51

Gold standard for evaluating the cervix for possible cervical incompetence

Back 51

Transvaginal Ultrasound

Front 52

What does the sodium level tell you about Heart Failure:

Back 52

🌟⬇Na = Severe Heart failure 🌟

The presence of HYPONAREMIA indicates the HEART FAILURE is SEVERE. Water retention and the associated reduction in the plasma Na concentration parallel the severity of heart dz; they reflect the degree of neurohumeral activation in pt's with heart failure.

⬇Na level is associated with ⬆Renin, Aldosterone, Vasopressin, and Norepinephrine.

As a result, a pt's survival is significantly reduced if the serum Na is < 137.

Mgmt included decreasing the intake of water to help control the electrolyte abnormalities.


Uworld qID 4190

Front 53

Both Autoimmune hemolytic anemia (AIHA) and Hereditary Spherocytosis typically show spherocytes without central pallor on peripheral smear.
So how do you differentiate the two.

Back 53

Hereditary Spherocytosis--strong family hx, (+) Osmotic fragility test, and (−) Coombs test,

AIHI-- (+) Direct Coombs test, negative fam hx, and (-) osm frag test

Front 54

Lab abnormalities that are an indication for thyroid function testing (4):

Back 54

-Hyperlipidemia
-Unexplained hyponatremia (hypothyroidism can cause inappropriate ADH secretion)
-High serum muscle enzymes (myopathy)
-Anemia--typically is normocytic, normochromic

Front 55

Causes of arthritis:

Back 55

◆ The biggies: Osteoarthritis, Rheumatoid arthritis, Gout, Pseudogout, Septic arthritis

◆ Lupus & other collagen vascular diseases (SLE-symmetric & nonerosive)
◇ Mixed Connective Tissue Disorder
◇ Sjogren syndrome
◇ Scleroderma
◆ Psoriatic arthritis (psoriasis)
◆ Ankylosing Spondylitis
◆ Inflammatory Bowel disease
◆ Reactive arthritis (post-infection)
◆ Lyme disease (mono- or oligo-arthritis/migratory, late stage)
◆ Hemophilia (Hemophilic arthropathy)
◆ Paget disease
◆ Hemochromatosis
◆ Wilson's disease
◆ Neuropathy (Charcot joint)
◆ Prior trauma

Others:
◇ Rheumatic fever (migratory arthritis/polyarthritis)
◇ Henoch-Schonlein Purpura (HSP) (polyarticular arthritis)
◇ Sarcoidosis
◇ Juvenile Idiopathic Arthritis
◇ Sickle cell disease (hip arthritis from avascular necrosis of the femoral head)

Front 56

Suspected prostatitis--most appropriate next step in mgmt:

Back 56

Culture of Mid-stream urine sample

Front 57

List the causes (many) of SIADH:

Back 57

- Any CNS disorder (stroke, hemorrhage, trauma, psychosis, infection)

- Pulmonary diseases--esp. Pneumonia (viral, bacterial, tuberculous)

- Tumor (small cell lung cancer)

- Drugs (carbamazepine, NSAIDs, opiates, many more--list in drug adverse reactions flashcards)

- Exogenous hormones (Vasopressin, Desmopressin-DDAVP, Oxytocin)

- Endocrine d/o (Hypopituitarism & Hypothyroidism)

-Symptomatic HIV infection

-post-surgical procedure...

Front 58

What type of nerve injury causes diabetic neuropathy?
nerve compression, ischemia, or inflammation

Back 58

Nerve Ischemia cuases the various neuropathies seen in Diabetes Mellitus.

various pathophys factors result from the accum of sugar products in the bloodstream and lead to a resultant increase in oxidative stress on the nerve cell and an increase in vasoconstriction leading to ischemia, which will promote nerve cell injury and death.

Front 59

______ and _______ are both signs of increased cardiac filling pressures (congestive heart failure)

Back 59

S3 and ⬆BNP

Front 60

_____________________ should be suspected in any patient with pancytopenia following drug intake, exposure to toxins, or viral infections.

Back 60

Acquired Aplastic Anemia

Front 61

Earliest renal abnormality in diabetes:

Back 61

Glomerular hyperfiltration (which creates intraglomerular hypertension leading to the further problems down the rd--glomerular BM thickening, and then mesangial expansion, and later nodular sclerosis

(this is why ACE inhibitors are so effective in diabetics, b/c of their ability to REDUCE THE INTRAGLOMERULAR HYPERTENSION)

Front 62

Osmotic diuresis occurs in patients with _______________, _____________, or _______________;
-And what will the urine and serum osmolalities be (normal, up, or down)

Back 62

Hyperglycemia, Glucosuria, or administration of mannitol

Both Serum & Urine Osmolality are ⬆,

but Urine Osm > Serum Osm

Front 63

Which is associated with oral blisters/bullae: Pemphigoid vulgaris or Bullous Pemphigoid?

Back 63

Pemphigoid vulgaris (these are also the ones that are more fragile with + Nikolfsky test

Front 64

After US is done to rule out GB dz in patient with jaundice and abdominal pain, what labs/imaging/or test is next?

Back 64

Abdominal CT

Abdom CT is a very sensitive and specific tool used in the dx of pancreatic cancer. Commonly, CT scan is effective in detecting bile and pancreatic duct dilitation, mass lesions w/in the pancreas, and indications of extrahepatic spread (eg. metastases or ascites)


(not amylase/lipase or Ca-19-9)

Front 65

1st step in mgmt of an infant/newborn with suspected congenital diaphragmatic hernia

Back 65

placement of an OROGASTRIC TUBE connected to continuous suction to prevent bowel distension causing further lung compression

Front 66

________________ (PE finding) can be used to differentiate between heart-related vs liver-related causes of lower extremity edema.

Back 66

Hepato-jugular reflex

Front 67

Diagnostic test for Pheochromocytoma

Back 67

24-hour fractionated urinary METANEPHRINES & CATECHOLAMINES

(NOT VMA, less sensitive)

Front 68

Best diagnostic test for Endobronchial Obstructive Lesions:

Back 68

Flexible Bronchoscopy

(but if asks for best next step in mgmt, it would be high resolution CT scan)

Front 69

Management of Elevated Lead level

Back 69

First, confirm with Venous Lead level (if first sample was capillary). Then, chelation if Lead level > 45. Otherwise close observation, recheck in 1 month, and remove from the hazardous environment.

Chelation therapy: Dimercaptosuccinic acid (DMSA), and if >70, then DMSA + EDTA (calcium disodium edetate)