Step 2 Cs

Front 1

How do you diagnose hypertension?

Back 1

three separate measurements on three separate occasions >140/90mmHg
Except in pregnancy

Front 2

What is the first line of drugs for Stage 1 hypertension?

Back 2

Thiazides

Front 3

What is the pharmaceutical treatment for Stage 2 hypertension?

Back 3

thiazides + 1 other agent

Front 4

What is the BP of Stage 1 HTN?

Back 4

140-159/90-99

Front 5

What is the BP of Stage 2 HTN?

Back 5

160+/100+

Front 6

What is the first line of treatment once a diagnosis of HTN is made?

Back 6

3-4 months of lifestyle modifications

Front 7

What is the difference between nitroprusside and nitroglycerin?

Back 7

Nitroprusside: dilates arteries AND veins

Nitroglycerin: venodilator only

Front 8

What is the MCC of death among untreated HTN patients?

Back 8

coronary disease

Front 9

What percentage of cases of HTN are essential, primary or idiopathic?

Back 9

95%

Front 10

What are some of the clues in a question stem to secondary HTN?

Back 10

age of onset < 30 yrs or > 50 yrs

Front 11

What is the MCC of secondary HTN in women?

Back 11

Birth control pills

Front 12

What is the MCC of secondary HTN in a young man?

Back 12

Excessive alcohol intake or exotic conditions

Front 13

What are the 6 MCC of secondary HTN after alcohol and OCPs?

Back 13

1. Pheochromocytoma
2. PKD
3. Cushing Syndrome
4. Renovascular HTN
5. Conn's Syndrome
6. Coarctation of the aorta

Front 14

For the following cause of secondary HTN, list the hints/tests to order:

pheobdominal

Back 14

Test: urinary catecholamines (vanillymandelic acid, metanephrine)

hints: signs of "panic attacks"

Front 15

For the following cause of secondary HTN, list the hints/tests to order:

PKD

Back 15

Test: Abdominal U/S; elevated creatine, elevated BUN

Front 16

For the following cause of secondary HTN, list the hints/tests to order:

Cushing's Syndrome

Back 16

Dexamethasone suppression test or 24-hour urine cortisol

Front 17

For the following cause of secondary HTN, list the hints/tests to order:

Renovascular HTN

Back 17

MR or CT andiogram, U/S or ACE-I nuclear renal scan

If bruit on exam treat with angioplasty and stenting.

Front 18

Conn's Syndrome

Back 18

High aldosterone, low renin

Front 19

Coarct of the aorta:

Back 19

upper extremity HTN only
associated with Turner's Syndrome
rib notching on CXR

Front 20

What must the plasma fasting glucose be to diagnose DM?
Random glucose?

Back 20

Plasma fasting: 126
Random: 200

Front 21

What are the goals of treatment for DM postprandial and fasting?

Back 21

Postprandial <180-200

Fasting < 130

Front 22

What are the C peptide levels in a pt with excessive exogenous insulin intake? Insulinoma?

Back 22

Exogenous insulin: low C pepide
Insulinoma: high C peptide

Front 23

What three signs must be present to diagnose DKA?

Back 23

hyperglycemia, hyperketonemia, metabolic acidosis

Front 24

What is the treatment for DKA?

Back 24

fluids, IV regular insulin, potassium and phos replacement. DO NOT give bicarn unless pH < 7

Front 25

What is the MCC of DKA?

Back 25

Infection

Front 26

Which type of DM typically gets DKA?

Back 26

Type 1

Front 27

What is required to diagnose nonketotic hyperglycemic hyperosmolar state?

Back 27

hyperglycemia, hyperosmolarity with ketonemia

Front 28

What is the treatment for nonketotic hyperglycemia hyperosmolar state?

Back 28

Fluids, IV regular insulin, electrolyte replacement

Front 29

What are the long term complications of diabetes?

Back 29

Atherosclerosis
Retinopathy
Nephropathy
Infections
Neuropathy (gastroparesis, charcot's joints, impotence, cranial nerve palsies, silent MI)
Foot ulcers, infections, gangrene

Front 30

What is the only cure for Type 2 diabetes?

Back 30

diet changes, exercise and weight loss

Front 31

What is the Somogyi effect in regards to diabetes?

Back 31

If too much NPH or long-acting insulin is given at night, the 3 am glucose will be low --> body releases stress hormones causing the 7 am glucose to be high

treatment is to DECREASE insulin night before

Front 32

What is the dawn phenomenon, in regards to diabetes?

Back 32

hyperglycemia caused by normal early AM growth hormone secretion. 7AM glucose is high without 4 AM hypoglycemia

treatment is to INCREASE insulin

Front 33

What lab value is used to follow diabetes management compliance?

Back 33

hemoglobin A1c

Front 34

What is the HbA1c level ideal for compliance?

Back 34

< 7%

Front 35

How often should a fasting lipid profile be ordered?

Back 35

Every five years starting at 20 yo

Front 36

How can one compute the LDL from the lipid profile?

Back 36

LDL=total cholesterol - HDL - (tgs/5)

Front 37

What is the goal for total cholesterol?

Back 37

< 200

Front 38

What is the goal for triglycerides?

Back 38

< 150

Front 39

What disease is the most important cause of permanent disability and accounts for more hospital days than any other illness?

Back 39

atherosclerosis

Front 40

What are the 5 main risk factors for coronary heart disease?

Back 40

Age (men = 45 yo, women = 55)
Family hx of premature CHD
Current cigarette smoking (>10 cigarettes/day)
HTN
Low HDL

Front 41

What are the symptoms and pathophys of Wernicke's syndrome?

Back 41

opthalmoplegia, nystagmus, ataxia, confusion
acute and reversibe, can be fatal
thiamine deficiency
damage to mamillary bodies and thalamic nuclei

Front 42

What are the symptoms and pathophy of Korsakoff's Syndrome?

Back 42

anterograde amnesia and confabulation
chronic and irreversible
thiamine deficiency
damage to mamillary bodies and thalamic nuclei

Front 43

What are the symptoms of acute alcohol withdrawal? When do the symptoms begins?

Back 43

tremors, sweating, hyperreflexia, seizures

12-48 hours after last drink

Front 44

What are the symptoms of acute delirium tremens? When do the symptoms begins?

Back 44

confusion, poor sleep, autonomic lability (sweating, increased pulse and temp)

2-4 days after last drink

Front 45

What are the stigmata of chronic liver disease in alcoholics?

Back 45

varices, hemorrhoids, caput medusae, jaundice, ascites, spider angiomas, gynecomastia, asterixis, prolonged PT, hypoalbuminemia, anemia

Front 46

What is the MCC of preventable mental retardation?

Back 46

fetal alcohol syndrome

Front 47

What are the MCCs of respiratory acidosis?

Back 47

COPD, asthma, drugs that decrease resp drive, sleep apnea, OHS

Front 48

What are the MCCs of respiratory alkalosis?

Back 48

anxiety or hyperventilation, aspirin or salicylate OD

Front 49

What are the MCCs of Metabolic acidosis?

Back 49

ethanol, DKA, uremia, lactic acidosis (sepsis/shock), methanol/ethylene glycol poisoning, aspirin or salicylate, diarrhea, carbonic anhydrase inhibitors

Front 50

What are the MCCs of metabolic alkalosis?

Back 50

diuretics (except carbonic anhydrase inhibitors), vomiting, volume contraction, antacid abuse, hyperaldosteronism

Front 51

What are the two primary acid/base disturbances you see with aspirin or salicylate OD?

Back 51

respiratory alkalosis and metabolic acidosis

Front 52

Unless already immune, all patients with chronic liver disease should be immunized against which virus(es)?

Back 52

HAV/HBV
immunity is reflected by antibodies to hepatitis surface antigens

Front 53

Where do metastatic brain tumors usually develop?

Back 53

grey-white junction
can be solitary of multiple

Front 54

What cancer lends itself to metastatic brain tumors?

Back 54

non-small cell lung CA

Front 55

What is the preferred treatment for a solitary brain met?

Back 55

resection followed by radiation

Front 56

For a woman diagnosed with ASCUS/CIN-1, what is the next step in management

Back 56

Repeat pap in 12 months

57% of CIN-1 cases regress to normal

Front 57

What is the MC nerve injury in a midshaft humerus fx? What is the sign/symptom?

Back 57

Radial n.

wrist drop

Front 58

What is the initial procedure in pts < 50yo who present with BRBPR without risks of colon CA?

Back 58

anoscopy/proctoscopy

Front 59

Is joint disease with SLE deforming or non-deforming?

Back 59

non-deforming (compared to RA)

Front 60

What is the pathophys of leukoplakia?

Back 60

chronic irritation of the oral mucosa 2/2 smoking, EtOH, ill-fitting dentures

Front 61

Leukoplakia carries a risk of which CA?

Back 61

squamous cell CA

Front 62

What is the pathophys of HIT?

Back 62

antibodies to heparin and platelet factor IV --> Ab attaches to Fc region on platelets causing activation -->paradoxical thrombosis

Front 63

Decreasing platelet counts > 50% 5-10 days after starting heparin is suggestive of what condition?

Back 63

HIT

Front 64

What is the treatment for HIT?

Back 64

d/c heparin
administer thrombin-inhibitors (argatroban and lepirudin)

Front 65

Prolonged QRS complexes on ECG in an older patient with syncope is suggestive of what pathophys?

Back 65

bradyarrhythmia

Front 66

Prolonged QT on ECG is suggestive of which arrhythmia?

Back 66

Tachyarrhythmia

Front 67

Which common calcium channel blocker decreases the renal clearance of digoxin?

Back 67

verapamil

Front 68

What are the three diseases associated with MEN-II?

Back 68

Medullary CA of the thyroid (check calcitonin levels)
hyperparathyroidism
pheochromocytoma

Front 69

what is the pathophys of pharyngeoesophogeal (Zenker's) diverticulum?

Back 69

esophogeal dysmotility and incoordination between the UES and pharyngeal contraction

Front 70

What is the surgical treatment for Zenker's diverticuluum?

Back 70

excision and cricopharyngeal myotomy

Front 71

Asymetric breath sounds immediately after intubation is suggestive of what complication?

Back 71

R mainstem bronchus intubation

w/d tube

Front 72

Which neuromuscular blocking agent is safe in patients with renal and liver failure?

Back 72

Atracurium--metabolized in the plasma and hydrolyzed by serum esterases

Front 73

What is the main cause of orthostatic hypotension in the elderly?

Back 73

progressively decreasing baroreceptor sensitivity

Front 74

MCC of mitral regurg?

Back 74

Mitral prolapse

Front 75

What does the presence of hyponatremia tell you about a person's CHF?

Back 75

That it is severe
May also see hypo/hyper K from fluctuations in the renin-angiotensin-also system

Front 76

In a patient with high risk/suspicion for a DVT, what is your first step in management?

Back 76

compression U/S

Low risk: D-dimer

Front 77

What are the signs/symptoms of X-linked agammaglobulimenia (Bruton's)?

Back 77

1. recurrent respiratory tract infxns including AOM, PNA, sinusitis in male children
2. nl CD3-positive (Tcells) and low CD19-positive (B cells)

Front 78

What is the treatment for X-linked agammaglobulinemia?

Back 78

IVIG

Front 79

Infections in which neck space (e.g., submandibular, sublingual) have the highest risk of mediastinal involvement?

Back 79

Retropharyngeal

retropharyngeal abscesses can lead to acute necrotizing mediastinitis

Front 80

What is lead time bias?

Back 80

incorrect assumption or conclusion of prolonged apparent survival and better prognosis due to a new screening test

Front 81

Suspect which disease in a patient with unexplained anemia and thrombocytopenia with renal failure and neuro symptoms?

Back 81

thrombotic thromobocytopenic purpura-hemolytic uremic syndrome (TTP-HUS)

Treat with plasmaphoresis

Front 82

Patients with hyperlipidemia should be tested for which endocrine abnormality?

Back 82

hypothyroidism

Front 83

What is the strongest risk factor for aortic dissection?

Back 83

systemic HTN

Front 84

Treatment for tinea corporis(ringworm)?

Back 84

antifungal (e.g., terbinafine)

Front 85

In a hemodynamically stable patient, what is the best study to eval solid organ damage?

Back 85

CT

Front 86

A positive Trendelenburg sign is indicative of ____?

Back 86

Gluteal muscle weakness

Front 87

What type of polyp is more likely to progress to malignant cancer?

Back 87

Sessile, villous polyps (followed by tubulovillous and tubular)

Front 88

What is the normal amniotic fluid index?

Back 88

between 5 and 25

Front 89

What is the typical presentation of Sturge Weber syndrome?

Back 89

wine-colored nevus on face, seizures and exopthalamous; cerebral lesions are histologically similar to the facial lesion

Front 90

What is the pathophysiology of Sheehan's syndrome?

Back 90

ischemic necrosis of the pituitary gland

Front 91

Causes of osteonecrosis of the femoral head?

Back 91

corticosteroid use
EtOH
trauma
antiphospholipid syndrome

Front 92

Side effects of amiodarone?

Back 92

**Pulmonary fibrosis
hyper/hypothyroid
hepatotoxicity
corneal deposits
skin discoloration

Front 93

What heart drugs can WORSEN peripheral artery disease?

Back 93

B-blockers can vasoconstrict peripheral arteries

Front 94

Treatment for Enterobius vermicularis?

Back 94

albendazole or mebendazole

Front 95

Indications for surgery in pts with aortic stenosis?

Back 95

SAD
1. syncope
2. angina
3. dyspnea (from CHF)

Front 96

What is the treatment for uterine atony after supportive measures have been exhausted?

Back 96

Oxytocin to stimulate contractions

Atony is the MCC of postpartum hemorrhage

Front 97

MC testicular sex cord stromal tumors

Back 97

Leydig cell tumors

-all age groups
-increased testosterone and estrogen ->decrease LH/FSH

Front 98

What is the pathophys of polycythemia vera? What does the pt p/w?

Back 98

markedly increased RBC mass and total blood volume, hypercellular bone marrow, increased leukocyte alk phos, decreased EPO

p/w: old plethoric male with pruritis after bathing

Front 99

What is the postexposure prophylaxis for HBV?

Back 99

Hep B immune globulin and 3 shots of Hep B at set intervals

Front 100

What can you do to screen pts at high risk for ovarian cancer

Back 100

Annual CA125 and trans vaginal u/s; there are no sensitive or specific screening tests

Front 101

MCC of death in dialysis and renal transplant pts?

Back 101

cardiovascular dz

Front 102

Presentation of VZV/HSV retinitis?

Back 102

PAIN, keratitis, uveitis, peripheral pale lesions, central retinal necrosis

Common in HIV pts

Front 103

Presentation of CMV retinitis?

Back 103

PAINLESS, no keratitis or conjunctivitis

Common in HIV pts

Front 104

Drugs that impair the absorption of folic acid?

Back 104

Phenytoin
Methotrexate
Trimethoprim

Front 105

1st line agents for HTN in pregnancy?

Back 105

labetalol and/or methyldopa

d/c ACE-I and ARBs

Front 106

Cause of hypotension after an epidural?

Back 106

sympathetic fiber block --> vasodilation of lower extremities-->venous pooling

Front 107

Indications for surgical treatment for hyperparathyroidism?

Back 107

Age <50
worsening renal fnxn
Osteoporosis
Serum Ca> 1mg/dL over upper limit of nl

Front 108

Tx for uncomplicated pyelo?

Back 108

TMP/SMX orals (it's cheaper)

Front 109

Tx for legionella pneumonia?

Back 109

high dose erythromycin and azithromycin

Front 110

What is pulseless electrical activity? Treatment?

Back 110

presence of a discernible rhythm on cardiac monitoring in a pt who is clinically in cardiac arrest with no palpable pulses

Tx: immediate CPR including chest compressions

Front 111

Tx for anaerobic pneumonia (foul smelling sputum)

Back 111

Clinda

Front 112

Drugs that shift potassium intracellularly?

Back 112

Insulin and glucose
Sodium bicarb
B2 agonists - Albuterol

Front 113

Pancoast syndrome?

Back 113

neoplasm in the pulmonary apex (superior sulcus) compressed the inferior portion of the brachial plexus -->shoulder pain and ulnar distribution

Front 114

Presentation of molluscum contagiosum?

Back 114

dome-shaped lesions with central umbilication

caused by poxvirus

seen in AIDS

Front 115

What is the pathophys of pancytopenia in pts with SLE?

Back 115

autoantibodies to RBCs (Type II hypersensitivity)

Front 116

Treatment for Reiter syndrome/Reactive arthritis?

Back 116

NSAIDS

Front 117

Tx of HTN in pts with peripheral vascular dz?

Back 117

CaChannel blockers - Amlodipine (have peripheral vasodilating properties)

Front 118

Presentation and treatment for Actinomycosis?

Back 118

Gram pos branching
p/w infxn in cervicofacial, thoracic and abdominal region
fluid contains sulfur granules

Tx: PCN for 6-12 weeks

Front 119

What is the pathophys of A-fib in patients with mitral stenosis?

Back 119

Left atrial dilatation

Front 120

Signs/sx of nephritic syndrome?

Back 120

Dependent edema
HTN
Hematuria (dysmorphic RBCs or RBC casts)
Rash, low grade fevers

Front 121

First step in a pt with MI who develops a cold leg?

Back 121

ECHO to r/o thrombus in the L ventricle

Front 122

Any HIV pt with bloody diarrhea and nl stool exam should be screened for what infection?

Back 122

CMV colitis with colonoscopy

cytomegalic cells with inclusion bodies

Front 123

Inheritance, pathophys and presentation of Heriditary Telangectasias (Osler-Weber-Rendu)

Back 123

AD inheritance
Diffuse telangectasias and recurrent epistaxis
Pathophy: widespread AV malformations (if in lung -> shunt -> chronic hypoxemia -> reactive polycythemia)

Front 124

Signs and symptoms of CML?

Back 124

Age > 50 with fever, malaise, fatigue, anorexia
Bone marrow shows hypercellularity with prominent granulocytic hyperplasia
LOW leukocyte Alk Phos is CLASSIC

Front 125

What is the MCC of UTI in patients with alkaline urine?

Back 125

Proteus

Front 126

What d/o should always be considered in a pt with unexplained elevation of serum CK?

Back 126

hypothyroidism

Front 127

TX for ingestion of liquid alkalai?

Back 127

1. maintain airway
2. Upper GI endoscopy w/i 24 hrs to assess injury and dictate tx

Front 128

Presentation and treatment for aspirin sensitivity syndrome?

Back 128

persistent nasal blockage
episodes of bronchoconstriction
Tx: leukotriene inhibitors, topical cotricosteroids and aspirin desensitization therapy

Front 129

Signs and sx of Dubin-Johnson syndrome?

Back 129

conjugated hyperbilirubinemia with otherwise nl LFTs
increased levels of urinary coproporphyrin
benign, no tx

Front 130

What therapy has been proven to prolong survival and improve quality of life in COPD pts

Back 130

oxygen

Front 131

Tx for sickle cell pts with frequent, acute, painful episodes?

Back 131

Hydroxyurea (increases Hb F levels -> erythropoesis)

All SC pts get folic acid

Front 132

Varicoceles that fail to empty when pt is recumbant. Dx?

Back 132

Renal cell CA, get Abdominal CT

Front 133

What does the V/Q scan for PE show?

Back 133

Large perfusion defect without ventilation defect

Front 134

Mechanism of Wilson's Dz?

Back 134

Hepatolenticular degeneration

Front 135

TX for acute exacerbations of MS?

Back 135

Steroids

Front 136

Signs and tx for HSV keratitis?

Back 136

corneal vesicles and dendritic ulcers

Tx: antiviral therapy