Step 2 Ck World Practice 1

Front 1

Anion Gap Met Acidosis

Back 1

Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde/Phenformin
Iron/Isoniazid
Lactate
Ethylene Glycol
Salicylates

Front 2

Methanol toxicity

Back 2

- windshield cleaning solution
- anion gap met acidosis
- visual disturbances

Front 3

Ethylene Glycol toxicity

Back 3

- windshield cleaning solution
- anion gap met acidosis
- calcium oxalate --> renal tubular damage --> hematuria, flank pain

Front 4

Ecythema gangrenosum

Back 4

- Pseudomonas Aeruginosa
- round lesion, halo erythema, necrotic center (invasion blood vessels)
--> anti-pseudomonal penecillin

Front 5

Pseudomonas Aeruginosa

Back 5

"AERuginosa = AERobic"
Pnemonia - CF
Sepsis
External otitis - swimmers ear
UTI
Drug use
Diabetic osteomyelitis
hot tub folliculitis
- gram neg
- "grapelike odor"
Treatment = aminoglycoside + extended spectrum penicillin (piperacillin, ticarcillin)

Front 6

Viral pericarditis

Back 6

- retrosternal chest pain --> L arm & shoulder
--> Cardiac tamponade:
- impaired RA filling
- Pulsus paradoxus = decrease systolic BP on inspiration, "radial pulse disappears when inspiring"
- clear lungs, no blood back up

Front 7

HSV Encephalitis

Back 7

- EEG/MRI = temporal lobe abnormalities
- bizarre behavior
- CSF: increased WBCs, increased protein, increased RBCs, normal glucose
** RBCs b/c temporal lobe damage **
treatment = IV acyclovir

Front 8

Restrictive lung disease

Back 8

- decrease FEV1 & FVC
- FEV1/FVC = normal, slight increase
** normal FEV1/FVC = 80-120% predicted

Front 9

Lumbar spinal stenosis

Back 9

e.g osteoarthritis of spine
** Pseudoclaudication: lower extremity pain with walking/standing, worse walking downhill

Front 10

Paraneoplastic Cushings

Back 10

- ACTH = polypeptide hormone **
- small cell lung carcinoma
- cannot be surpressed by dexamethasone
** hyperpigmentation

Front 11

Exudative Pleural effusion

Back 11

- protein > 4g/dL
** TB = most common
- empyema
- malignancy
- RA
- esophageal rupture
- pancreatitis
- pulmonary infarction

Front 12

SVC Syndrome

Back 12

- headaches worse when leaning forward
- JVD, no peripheral edema
- facial, upper extremity swelling
- lung cancer, lymphoma
--> palliative radiation

Front 13

Aspiration Pneumonia

Back 13

- impaired consciousness
- trachial/NG tube
** impaired gag reflex -- post stroke or intubation
** CXR = consolidation post basal R lung

Front 14

Spontaneous Bacterial Peritonitis

Back 14

- assoc with cirrhosis (ascites- peritoneal fluid infected via intestinal wall leak)
- Diagnosis = ascitic fluid neutrophils > 250 neut./microL

Front 15

Bullous Pemphigoid

Back 15

- > 60 y/o
- flexor surfaces
- biopsy = subepidermal blister
--> topical/systemic corticosteroids

Front 16

Polymyositis

Back 16

- symmetric prox muscle weakness
- increased CPK & LDH

Front 17

CXR tension pneumothorax

Back 17

- thin white line de-marking lung parenchyma --> no pulmonary vasculature beyond line
- flattening ipsilateral hemidiaphragm

Front 18

Complex Partial Seizures

Back 18

- complex = LOC (vs. simple)
- partial = focal part of brain
- blank stare for several minutes, lip smacking, chewing
- postictal state, Ex. Todds paralysis: focal weakness, R or L, "leg dragging"
** MC= temporal lobe epilepsy
-

Front 19

Ventricular Tachycardia

Back 19

- assoc. w. CAD, MI, structural heart disease
- nonsustained = often asymptomatic
- sustained = palpitations, hypotension, angina, syncope
-> -> VF -> death :(
ECG: 3 or more consecutive PVCs, wide QRS in regular rapid rhythm, AV dissociation
Treatment = cardioversion, antiarrhythmics - amiodarone, lidocaine, procainamide

Front 20

Complications esophageal dilation

Back 20

** Esophageal rupture:
- chest pain, hematemesis, SOB
- L sided pleural effusion
- pneumomediastinum (mediastinitis --> sepsis, death)

Front 21

Conns syndrome

Back 21

primary hyperaldosteronism
- usually adrenocortical hyperplasia (unilat. adrenal adenoma)
- ** hypertension, headache, polyuria, muscle weakness
- tetany, paresthesias, peripheral edema
- high Na+, low K+, metabolic alkalosis, hypomagnesia
* increased aldosterone/plasma renin activity (>30)
- surgical resection
- bilat. --> Spironolactone (aldosterone antagonist)

Front 22

Gastric bypass - gallstone prophylaxis

Back 22

- previous history --> cholecystectomy
- ursodeoxycholic acid 6 months post

Front 23

Renal osteodystrophy

Back 23

** high phosphate low Ca++
- renal disfunction --> retained phosphate
- renal disfunction --> low vit D --> low Ca++
--> parathyroid hypertrophy = secondary hyperPT

Front 24

Somatic vs. Visceral pain

Back 24

Somatic = sharp, severe (ex. peritonitis and free air under diaphragm)
Visceral = general, hard to pinpoint (ex. bowel obstruction)

Front 25

Overflow incontinence

Back 25

- neurogenic bladder, detrusor underactivity (ex. diabetes)
- frequent small leaks, high post-void residual volume
- Treatment: timed voiding, indwelling/intermittent catheter, ** cholinergic agonists

Front 26

Urge incontinence - medication

Back 26

- detrusor instability
--> ** muscarinic antagonists
- intense urge to urinate

Front 27

Aortic stenosis- murmur

Back 27

- systolic
- R upper sternal border
- radiates to carotids

Front 28

Aortic stenosis - cause

Back 28

- elderly = calcification of valve leaflets
- young = bicuspid valve
- developing country = rheumatic fever

Front 29

Spontaneous bacterial peritonitis - treatment

Back 29

- broad spectrum antibiotics (not pericentesis)

Front 30

Prevention - esophageal varice hemmorhage

Back 30

- non-selective beta blockers: propranolol, nadolol
- other options: nitrates, band ligation, TIPS

Front 31

Menisceal tear

Back 31

- twisting motion
- not severe enough to prohibit normal activities
- knee swelling the following day
- "locking sensation"

Front 32

Astrocytomas

Back 32

- most common adult brain tumor
- diagnosis based on grade = atypia, vascularity, necrosis, mitosis
- glioblastoma multiforme = grade IV astrocytome

Front 33

CLL

Back 33

- 60-70 y/o
** painless lymphadenopathy
- smudge cells
- treatment = Rituximab = monoclonal AB CD20

Front 34

Tricuspid regurg

Back 34

- holosystolic
- L lower sternal border (e.g xiphoid process)

Front 35

Sickle cell -bacteremia

Back 35

** MCC = strep. pneumonia --> encapsulated organism

Front 36

treatment of EPS (anti-psychotics)

Back 36

anti-cholinergics: diphenhydramine, benztropine, trihexphenidyl

Front 37

Gallstone disease vs. pancreatic cancer

Back 37

Gallstone disease = pain after meals, biliary colic - short episodes pain
Pancreatic cancer = painless jaundice!! loss of appetite, vague symptoms

Front 38

Benign Paroxysmal Positional Vertigo (BPPV)

Back 38

** episodic dizziness while rolling over in bed
- b/c displacement otoliths
- Diagnosis = "Dix-Hallpike" = put head in certain positions look for nystagmus
** Treatment = reposition otoliths, e.g Epley maneuver (head positioning excersises)

Front 39

Atrial Fibrillation - approach

Back 39

ECG: loss P waves, irregularly irregular QRS
Treatment:
1. rate control: metoprolol, esmolol, dilitiazam, verapamil
2. rhythm control: cardioversion
3. prevention embolization: warfarin, aspirin

Front 40

Mobitz I (Wenkebach)

Back 40

- second degree AV block
- ECG: progressively longer PR until dropped P & QRS
- usually asymptomatic

Front 41

Mobitz II (Hay)

Back 41

- second degree AV block
- ECG: dropped QRS with normal PR interval
- more likely structural defect
- more likely to progress to heart failure

Front 42

ASD

Back 42

- L->R shunt
** wide fixed splitting S2
** increased flow across pulmonary valve --> systolic murmur L upper sternal border

Front 43

C. diff - treatment

Back 43

- Metronidazole, Vancomycin

Front 44

Alzheimers vs. Multi-infarct dementia

Back 44

Alzheimers = gradual
Multi-infarct = "step-wise", presence of risk factors

Front 45

Septic Shock - treatment

Back 45

** 1. IV fluids
2. vasopressors: dopamine, NE
- antibiotics

Front 46

Multiple Myeloma & renal failure

Back 46

** MCC = toxic effect of light chain casts --> renal tubular damage
- glomerular damage = less common = amyloidosis, monoclonal immunoglobulin deposition

Front 47

Fragile X

Back 47

- CGG repeats, FMR-1 gene
- more common males
- autistic like features
- seizures
- long ears
- big balls

Front 48

Acute delerium

Back 48

- increased risk with chronic dementia
- triggered by medical condition
- "sundowning" = worse with nightfall
- waxing and waning
** danger to self/others --> haloperidol (soft restraints = last resort)

Front 49

Evaluation LSIS/CIN I

Back 49

adolescents = pap smear 12 months
premenopause = colposcopy (targeted biopsy)
postmenopause = reflex HPV testing/colposcopy

Front 50

Cone biopsy vs. targeted biopsy

Back 50

cone biopsy: more dramatic --> entire transitional zone, endocervical canal, used for more aggressive lesions

Front 51

Vulvovaginal candidiasis

Back 51

- perineal itching and discharge
- dyspereunia
- increased incidence with sex
** vaginal pH = 4-4.5 (normal) --> elevated pH in bacterial or trichomonas
- KOH = pseudohyphae & budding

Front 52

alpha thalassemia minima

Back 52

- three alphas (missing one)
** no clinical or lab abnormalities - totally asymptomatic

Front 53

Thalassemia Minor

Back 53

- cis or trans mutation: (a,a) (-, -) or (a, -) (a, -)
- asymptomatic
- mild chronic anemia, microcytosis
* target cells

Front 54

Crossed paralysis

Back 54

- hemiparalysis with contralateral malfunctioning of cranial nerve

Front 55

which CNs originate in the pons?

Back 55

5, 6, 7
(Trigeminal, Abducens, Facial,)

(8 - vestibulocochlear = cerebellarpontine angle, lateral to 7)

Front 56

which CNs originate in the medulla?

Back 56

9, 10, 12
(glossopharyngeal, vagus, hypoglossal)

Front 57

where does CN 11 originate?

Back 57

- accessory
- cranial and spinal roots

Front 58

Initial workup - onset psychotic symptoms

Back 58

** urine toxicology --> rule out drugs
- head CT, CBC, thyroid, syphillis tests, metabolic panel

Front 59

Post MI VSD

Back 59

- 3-5 days post
- holosystolic murmur L sternal border
- hemodynamic instability
- Pulmonary artery cath.: RV more oxygenated than RA (normally should be equal)

Front 60

PE

Back 60

- chest pain, SOB, hemodynamically unstable
** clear lungs
- soft holosystolic murmur L sternal border b/c tricuspid regurg
Cardiac cath.:
- low CO (normal = 5L/min)
- elevated right heart P
- elevated P between pulmonary A and PCWP

Front 61

Pressure Heart Chambers: RA

Back 61

<5

Front 62

Pressure Heart Chambers: RV

Back 62

< 25/ <5

Front 63

Pressure Heart Chambers: LA

Back 63

< 12

Front 64

Pressure Heart Chambers: LV

Back 64

<130/10

Front 65

Pressure Heart: Aorta

Back 65

< 130/90

Front 66

Pressure Heart: PA

Back 66

<25/10

Front 67

Septic arthritis vs. RA flare up

Back 67

- septic more likely in joint affected by RA
- fever can happen in both (RA = mild)
- monoarthritis more likely septic

Front 68

when can pap smears be discontinued?

Back 68

> 65 y/o

Front 69

preventive health recommendations - women over 50

Back 69

** annual mammogram
- fasting lipid profile every 5 yrs
- sigmoidoscopy/colonoscopy every 5 yrs
- pap smears til 65

Front 70

Hypertrophic Cardiomyopathy - murmur

Back 70

- holosystolic L sternal border
- worse when standing (decreased preload)

Front 71

Pressure ulcers on heels

Back 71

** put heels on pillows
- if break in skin --> moist dressings
(massage contraindicated!)

Front 72

Hemothorax

Back 72

- assoc. w. thoracentesis
- decreased LV preload

Front 73

Cisplatin toxicity

Back 73

- nephrotoxicity
- tinnitus and hearing loss

Front 74

Focal segmental glomerulonephrosis

Back 74

** MCC idiopathic nephrotic syndrome in adults
- increased risk - african americans, obese, HIV, heroin
- nephrotic = >3.5 g protein/day, hypoalbuminemia, hyperlipidemia

Front 75

Juvenile Myoclonic Epilepsy

Back 75

- absence seizures (10 y/o) --> myoclonic seizures (15 y/o)
(myoclonic = jerking/twitching)
--> tonic-clonic seizures (16 y/o)
** seizures upon wakening
- worse with sleep deprivation
- genetic

Front 76

Role of nitrates in treating MI

Back 76

venodilation --> reduces ventricular preload --> decreases O2 demand
** reduces pain

Front 77

Midgut volvulus

Back 77

- bilious vomiting
** imagine = corkscrew shaped duodenum in R abdomen

Front 78

Listeria monocytes

Back 78

- meningitis > 60 y/o
- immunocompromised
** ampicillin

Front 79

Parkinsons

Back 79

- festinating gait
- cogwheel rigidity
- slow speech
- resting tremor
** loss dopaminergic neurons substantia nigra
- lewy bodies

Front 80

Pancoast tumor

Back 80

- pulmonary apex
- thoracic outlet syndrome
- horners syndrome
- SVC syndrome

Front 81

polyps vs. celiac

Back 81

- both may cause diarrhea but only celiacs will have significant malapsorption (e.x osteopenia from vit D deficiency)

Front 82

Aortic regurgitation murmur

Back 82

diastolic decrescendo L sternal border

Front 83

Guillanne Barre - CSF

Back 83

- normal WBCs, high protein = albumincytologic dissociation

Front 84

Pott disease vs. epidural abscess

Back 84

- Potts = insidious onset
- Epidural abscess = acute onset back pain and fever

Front 85

spinal epidural abscess

Back 85

- acute onset back pain and fever
- neurologic signs
- risk factors: diabetes, IV drugs, trauma
** usually staph. A --> broad spectrum antibiotics, e.g vancomycin