Step 2: Top 100 Secrets

Front 1

what is the #1 cause of preventable morbidity and mortality in the U.S.?

what can it cause?

Back 1

smoking

1. atherosclerosis
2. cancer
3. COPD

Front 2

what is the #2 cause of preventable morbidity and mortality in the U.S.?

Back 2

alcohol

Front 3

more than 50% of accidental and intentional deaths involve what drug?

Back 3

alcohol

Front 4

what is the number 1 cause of preventable mental retardation?

what else can it cause

Back 4

alcohol

fetal alcohol syndrome

cancer, cirrhosis, and potentially fatal in withdrawal

Front 5

in alcoholic hepatitis, the ratio of what enzymes is >= 2.0?

Back 5

AST : ALT

Front 6

what vitamin do you give reproductive age women to prevent neural tube defects?

Back 6

folate

Front 7

how do you tx pernicious anemia? what are possible sequalae of pernicious anemia?

Back 7

vitamin B12

neurologic deficits

Front 8

what drug can cause vitamin B6 (pyridoxine) deficiency?

Back 8

isoniazid

Front 9

tx alcoholics with what vitamin to avoid Korsakoff dementia?

Back 9

thiamine

Front 10

what type of encephalopathy can alcoholics get?

Back 10

Wernicke's

Front 11

what is the most common cause of anemia?

what can cause it?

Back 11

iron-deficiency anemia

- menstrual loss in reproductive age women
- CA in men and older women

Front 12

what vitamin is a known teratogen?

Back 12

vitamin A

Front 13

what group of pts shouldn't treat acne with isotretinoin? why?

Back 13

pregnant women; isotretinoin is a vitamin A analog

Front 14

name 4 complications of atherosclerosis

Back 14

1. MI
2. heart failure
3. stroke
4. gangrene

Front 15

what are the top 7 primary risk factors for atherosclerosis?

Back 15

1. age/sex
2. family history
3. cigarette smoking
4. HTN
5. DM
6. high LDL chol.
7. low HDL chol.

Front 16

diabetes can lead to atherosclerosis and its complications. name them

Back 16

1. retinopathy
2. nephropathy
3. peripheral vascular disease
4. peripheral neuropathy
5. increased incidence of infx

Front 17

severe HTN can lead to acute problems, or a hypertensive emergency. what are those problems? [name 6 out of the 12]

Back 17

1. HA
2. dizziness
3. blurry vision
4. papilledema
5. cerebral edema
6. altered MS
7. seizures
8. intracerebral hemorrhage (classically in the basal ganglia)
9. renal failure/azotemia
10. angina
11. MI
12. heart failure

Front 18

what part of the brain is classically affected in intracerebral hemorrhage due to severe HTN?

Back 18

basal ganglia

Front 19

certain lifestyle changes can improve the sx of mild cases of what diseases?

Back 19

1. HTN
2. hyperlipidemia
3. diabetes
4. GERD
5. insomnia
6. obesity
7. sleep apnea

Front 20

what lifestyle changes can help improve sx in mild cases of HTN, hyper-lipidemia, DM, GERD, insomnia, obesity, sleep apnea?

Back 20

1. diet
2. exercise
3. weight loss
4. cessation of alcohol/tabacco use
5. elevation of head of bed

Front 21

how do you analyzed ABG's?

Back 21

1. pH tells you primary event (acidosis vs. alkalosis)
2. CO2 and bicarb tell you cause (same direction as pH) and suggest compensation (opposite direction of pH)

Front 22

exogenous causes of hyponatremia?

Back 22

1. oxytocin
2. surgery
3. narcotics
4. inappropriate IV fluid administration
5. diuretics
6. antiepileptic meds

Front 23

EKG in hyperkalemia?

Back 23

tall, tented T waves

Front 24

EKG in hypokalemia?

Back 24

loss of T waves/T wave flattening and U waves

Front 25

EKG in hypocalcemia? hypercalcemia?

Back 25

QT prolongation

QT shortening in hypercalcemia

Front 26

what do you do in case of shock?

Back 26

1. give pt oxygen
2. start IV
3. monitor (pulse ox, EKG, vitals)
4. fluid bolus (1L of normal saline or Ringer's lactate) if no signs of CHF (bibasilar rales)

Front 27

Virchow's triad of DVT, with examples for each?

Back 27

1. endothelial damage (surgery, trauma)
2. venous stasis (immobilization, surgery, severe heart failure)
3. hypercoagulable state (malignancy, birth control pills, pregnancy, lupus anticoagulant, inherited deficiencies)

Front 28

therapy for CHF?

Back 28

diuretics (furosemide and ACE inhibitors) and beta blockers (stable pts) are mainstays of tx

screen for and address underlying atherosclerosis risk factors (smoking, hyperlipidemia)

Front 29

what is cor pulmonale?

Back 29

right-sided heart enlargement, hypertrophy, or failure due to primary lung disease (usually COPD)

Front 30

what is most common cause of left heart failure?

Back 30

right heart failure

Front 31

what are the 2 main issues in pts with atrial fibrillation?

Back 31

1. ventricular rate (slow it if needed)
2. atrial clot formation/embolic disease (consider anticoagulation)

Front 32

how do you treat ventricular fibrillation?

Back 32

immediate defibrillation

Front 33

how do you treat ventricular tachycardia?

Back 33

amiodarone or lidocaine if stable; else defibrillate

Front 34

how do you distinguish obstructive from restrictive lung disease?

Back 34

FEV1/FEV ratio

the FEV1 may be the same

Front 35

what are the 2 most common causes of esophageal CA?

Back 35

1. reflux -> Barrett metaplasia -> adenocarcinoma

2. smoking and alcohol abuse are 2nd most common causes (squamous cell CA)

Front 36

all gastric ulcers must be biopsied or followed to resolution to exclude what?

Back 36

malignancy

Front 37

what is the first step in distinguishing an upper from lower GI bleed?

Back 37

testing a nasogastric tube aspirate for blood; bright red blood via mouth or anus is fairly reliable as well for a nearby bleeding source

Front 38

what is the classic pt of irritable bowel syndrome?

Back 38

young female adult with chronic hx of alternating constipation and diarrhea

- IBD is one of most common GI complaints
- dx of exclusion with negative physical and basic exams

Front 39

Crohn's v. UC: place of origin?

Back 39

C's: distal ileum, proximal colon

UC: rectum

Front 40

Crohn's v. UC: thickness of pathology?

Back 40

C's: transmural

UC: mucosal/submucosal only

Front 41

Crohn's v. UC: progression?

Back 41

C's: irregular (skip lesions)

UC: proximal, continuous from rectum with NO skipped areas

Front 42

Crohn's v. UC: location?

Back 42

C's: from mouth to anus

UC: involves only colon; rarely extends to ileum

Front 43

Crohn's v. UC: bowel habit changes?

Back 43

C's: obstruction, abdominal pain

UC: bloody diarrhea

Front 44

Crohn's v. UC: classic lesions?

Back 44

C's: fistulas/abscesses, cobblestoning, string sign on barium X-ray

UC: pseudopolyps, lead-pipe colon on barium X-ray, toxic megacolon

Front 45

Crohn's v. UC: which presents with lead-pipe colon on barium X-ray and toxic megacolon?

Back 45

ulcerative colitis

Front 46

Crohn's v. UC: colon CA risk?

Back 46

C's: slightly increased

UC: markedly increased

Front 47

Crohn's v. UC: surgery?

Back 47

C's: NO, may make it worse

UC: YES, proctocolectomy with ileoanal anastomosis

Front 48

what 3 hepatitis viruses are transmitted parenterally, and can lead to chronic infx, cirrhosis, and hepatocellular carcinoma?

Back 48

hep B
hep C
hep D

Front 49

what is the most common known genetic disease in white people?

Back 49

hereditary hemochromatosis

Front 50

what are some sx of hereditary hemochromatosis?

Back 50

fatigue, impotence, and hepatomegaly

Front 51

how do you screen, test, and treat hereditary hemochromatosis?

Back 51

screen: transferrin saturation test (serum iron/TIBC) and ferretin level

confirm with genetic testing and liver biopsy

treat with phlebotomy

Front 52

sequelae of liver failure? (name 4 of 8)

Back 52

1. coagulopathy (that can't be fixed with vitamin K)
2. jaundice/hyperbilirubinemia
3. hypoalbuminemia
4. ascites
5. portal hypertension
6. hyperammonemia/encephalopathy
7. hypoglycemia
8. DIC

Front 53

main 2 reasons for pancreatitis?

Back 53

1. alcohol or gallstones

Front 54

how do pts with pancreatitis present? treatment?

Back 54

1. abdominal pain, n/v, elevated amylase and lipase

2. treat supportively and avoid morphine (causes sphincter of Oddi spasm) for pain control

Front 55

complications of pancreatitis?

Back 55

1. pseudocyst formation
2. infx/abscess
3. adult respiratory distress syndrome

Front 56

most common cause of jaundice/hyperbilirubinemia in neonates?

Back 56

physiologic (need only monitoring and follow-up labs)

Front 57

is jaundice present at birth pathologic?

Back 57

YES

Front 58

are Graves, Hashimoto, and Addison's disease 1* or 2* endocrine disorders?

Back 58

primary

Front 59

how do you differentiate primary and secondary endocrine disturbances?

Back 59

primary: gland malfunctions, but pituitary or another gland and CNS respond appropriately

secondary: the gland is, appropriately, doing what it is directed to do by other, malfunctioning, organs

Front 60

ACTH-secreting lung carcinoma, heart-failure induced hyperreninemia, renal-failure induced hyperparathyroidism are 1* or 2* endocrine disturbances?

Back 60

secondary

Front 61

side effects of corticosteroids

Back 61

1. weight gain
2. easy bruising
3. acne
4. hirsutism
5. emotional lability
6. depression
7. psychosis
8. menstrual changes
9. sexual dysfunction
10. insomnia
11. memory loss
12. buffalo hump
13. truncal and central obesity with wasting of extremities

Front 62

most common cause of arthritis (>=75% of cases)? do findings include hot, swollen joints?

Back 62

osteoarthritis

NO - few if any physical findings

Front 63

highest incidence cancer in men and women (top 3)?

Back 63

Men:
1. prostate
2. lung
3. colon

women:
1. breast
2. lung
3. colon

Front 64

highest mortality cancer in men and women (top 3)?

Back 64

men:
1. lung
2. prostate
3. colon

women:
1. lung
2. breast
3. colon

Front 65

sequelae of lung cancer?

Back 65

1. hemoptysis
2. Horner syndrome
3. superior vena cava syndrome
4. phrenic nerve involvement - diagphragmatic paralysis
5. hoarseness from recurrent laryngeal nerve involvement
6. parpaneoplastic syndromes (Cushing, SIADH, hypercalcemia, Eaton-Lambert syndrome)

Front 66

what is bitemporal hemianopsia? what causes bitemporal hemianopsia? what's the work-up?

Back 66

A. loss of peripheral vision in both eyes

B. space-occupying lesion pushing on the optic chiasm (classically a pituitary tumor) until proven otherwise

C. CT or MRI of brain

Front 67

what are the potential risks and side effects of estrogen therapy (eg. contraception, post-menopausal hormone replacement)?

Back 67

1. endometrial CA (possibly breast CA)
2. hepatic adenomas
3. glucose intolerance, diabetes
4. DVT
5. cholelithiasis
6. HTN
7. endometrial bleeding
8. depression
9. weight gain
10. nausea/vomiting
11. headache
12. weight gain
13. teratogenesis
14. aggravation of pre-existing fibroids (uterine leiomyomas)
15. migraines
16. epilepsy

Front 68

ABCD of a mole that should make you think of malignant transformation? work-up?

Back 68

Asymmetry
Borders (irregular)
Color (change, or multiple colors)
Diameter (the bigger, the more likely it is to be malignant)

biopsy moles, especially if they itch or bleed

Front 69

sequelae of streptococcal infection? can they be avoided?

Back 69

1. rheumatic fever
2. scarlet fever
3. poststreptococcal glomerulonephritis

only #1,2 can be prevented with abx

Front 70

young adult with recurrent, varied neuro symptoms and signs. probable diagnosis?

Back 70

multiple sclerosis, if nothing obvious is causing sx

Front 71

name 3 tests used to diagnose multiple sclerosis.

Back 71

1. MRI (most sensitive)
2. LP
3. evoked potentials

Front 72

in multiple sclerosis, what do you expect to find in the LP and evoked potentials?

Back 72

LP: elevated IgG oligoclonal bands and myelin basic protein levels; mild elevation in lymphs and protein

evoked potentials: slowed conduction through areas with damaged myelin

Front 73

what do you think about in the unconscious or delirious patient in the ED with no hx or signs of trauma?

Back 73

1. empirical tx for hypoglycemia with glucose
2. opioid o/d (naloxone)
3. thiamine deficiency (thiamine before glucose in suspected alcoholic)
4. alcohol, illicit drugs, prescription drugs
5. DKA
6. stroke
7. postictal state
8. subarachnoid hemorrhage

Front 74

bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: common ages?

Back 74

B: 0-18 mos

C: 1-2 yrs

E: 2-5 yrs

Front 75

bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: are they common?

Back 75

B,C: yes

E: no

Front 76

bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: common causes?

Back 76

B: RSV (75%+), Parainfluenza, Influenza

C: Parainfluenza (50-75%), Influenza

E: H. influenza, Staphylococcus spp., Streptococcus spp.

Front 77

signs & sx of bronchiolitis?

Back 77

- initial viral URI sx followed by tachypnea and expiratory wheezing

Front 78

signs & sx of croup?

Back 78

- initial viral URI sx follwed by 'barking' cough, hoarseness, and inspiratory stridor

Front 79

signs & sx of epiglottitis?

Back 79

- rapid progression to high fever, toxicity, drooling and respiratory distress

Front 80

bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: x-ray findings?

Back 80

B: hyperinflation

C: subglottic tracheal narrowing on frontal x-ray ('steeple sign')

E: swollen epiglottis on lateral neck x-ray ('thumb sign')

Front 81

bronchiolitis v. croup (acute laryngotracheitis) v. epiglottitis: treatment?

Back 81

B: humidified O2, bronchodilators, ribavarin (for high risk pts.)

C: humidified O2, bronchodilators

E: prepare to establish airway, abx (3rd gen. cephalosporin)

Front 82

delirium v. dementia: onset?

Back 82

delirium: acute and dramatic

dementia: chronic and insidious

Front 83

delirium v. dementia: common causes?

Back 83

delirium: illness, toxin, withdrawal

dementia: Alzheimer's, multi-infarct dementia, HIV/AIDS

Front 84

delirium v. dementia: attention and arousal level?

Back 84

delirium: poor attention, fluctuating arousal

dementia: unaffected attention, normal arousal

Front 85

delirium v. dementia: which is reversible?

Back 85

delirium is reversible

Front 86

rule out pregnancy when ordering teratogenic tests - give 3 examples of such tests.

Back 86

1. antiepileptic drugs
2. x-ray
3. CT scan

Front 87

how do you treat anaphylactic reactions?

Back 87

1. secure airway (if laryngeal edema prevents intubation, do a cricothyrotomy)
2. give subQ or IV epinephrine

Front 88

are antihistamines and corticosteroids useful for immediate, severe reactions involving the airway?

Back 88

NO! use sub Q or IV epinephrine

Front 89

how do you screen for colorectal CA?

Back 89

sigmoidoscopy or double contrast barium enema q5yrs after 50yo

stool guaiac/hemoccult annually after 50yo

Front 90

how do you screen for colon and prostate CA?

Back 90

digital rectal exam annually after 40yo

Front 91

how do you screen for cervical CA?

Back 91

pap smear 18-65yo (or before 18 if sexually active); after 2 normal exams 1yr apart, do q3yrs

Front 92

how do you screen for gynecologic CA?

Back 92

pelvic exam 20-40yo q3yrs, then annually after 40yo

Front 93

when do you do mammography in women?

Back 93

after 40yo, annually