Usmle Step 3 Notes - General Review

Front 1

Pyloric stenosis

Back 1

- Hypochloremic hypokalemic metabolic alkalosis

- Associated: erythromycin

Dx: U/S

Tx: correct electorlites

Front 2

Psoriasis gets worse with...

Back 2

gets worse with bblockers (MC), NSAIDs, anti-malarials, ACEi, Lithium

Front 3

Ovarian cyst + pregnancy

Back 3

remove in second trimester if >5cm

Front 4

HCTZ (mechanism, adverse)

Back 4

Adverse: hyperGLUC (glycemia, lipidemia, uricemia, calcemia), photosensitivity, rash.

Mechanism: inhibit NaCl in DCT

Front 5

Complicated kidney stone Tx

Back 5

Stent or percutaneous nephrostomy

Front 6

Gout + HTN Tx

Back 6

Tx: ARBs (eg. losartan)

Front 7

Gout + kidney disease/transplant Tx

Back 7

Tx: Intraarticular steroids

Front 8

Likelihood ratio

Back 8

- independant of prevalence

- asses the value of test, post-test probability

(+) LR = Sensitivity/1-Specificity (likelihood of disease with (+) results)

(-) LR = 1-Sensitivity/Specificity (likelihood of disease with (-) results)

- clinical significance of various results (when >2 results are positive)

Front 9

Hep B recheck for infants

Back 9

Between 9-15 months

Front 10

Exudate vs Transudate

Back 10

Exudate:

- protein > 0.5 of serum

- LDH > 0.6

- cancer, infection, TB, viral, PE, collagen disease

Transudate:

- protein < 0.5

- LDH < 0.6

- CHF, cirrhosis, PE, nephrotic, low albumin, atelectasis, dialysis

Front 11

C. Difficile (cause, Sx, Dx)

Back 11

Drugs that cause: Clindamycin, Fluoro., Cypro., Ceph., Penicillin.

Sx: watery diarrhea, leukocytosis

Dx: C diff toxin in stool, sigmoidoscopy

Front 12

C. Difficile Tx

Back 12

Mild:

- WBC < 15.000, creatinine <1.5x baseline

- give Metronidazole PO

Severe:

- if WBC > 15.000, creatinine > 1.5x baseline, albumin < 2.5

- give Vancomycin PO

- if ileus -> add Metro IV or rectal Vanco

- if WBC > 20.000, lactate > 2.2, megacolon/ileus

- do subtotal colectomy or diverting loop ileostomy with lavage

Recurrent:

- Metronidazole PO

- Pulsed Vancomycin

- Fidaxomycin + microbiota transplant

Front 13

Desmoid tumor (Sx, Tx, associated with)

Back 13

Fibromatosis of anterior abdominal wall in women

Sx: epigastric pain, benign, aggressive

Tx: Surgery

Associated: trauma, FAP, Gardner syndrome

Front 14

Dermatofibroma

Back 14

- on lower extremities, after trauma

- red nodule that umbilicates when squeezed.

Front 15

Strep Pharyngitis

Back 15

Centor criteria (need 2 or more for dx)

- tonsilar exudates

- tender cervical lymph nodes

- no cough

- fiver

if less than 2 - symptomatic treatment

Front 16

Strep Pharyngitis (Tx, complications)

Back 16

Tx: Penicillin or Amoxicillin

if Penicillin allergy - give Azythro./Clarithro or Cephalexin

Complication: Rheumatic fever

Front 17

Sydenham's chorea

Back 17

Purpusless involuntary movements

Tx: Penicillin

Late manifestation: acute rheumatic fever (reversible)

Front 18

ARDS

Back 18

Use high PEEP with low Tidal volume (6 ml/kg)

Severity=pO2/FiO2

Goal: PaO2 - 55-80 mmHg

O2 sat - 88-95%

Keep plateau pressure < 30 cmH2O

If PaO2 is low - increase PEEP

Front 19

Stratified analysis

Back 19

Control confounding bias

Front 20

Epidural abscess

Back 20

Sx: temperature, tender spine, high ESR

Dx: MRI

Tx: surgery/drainage if severe

if not severe - Vancomycin/Linezolid

Front 21

SBP

Back 21

> 250 neutrophils

Tx: lactulose + ceftriaxone/cefotaxime

Profilax: Norfloxacin, TMP/SMX lifelong

Front 22

Model of End-Stage Renal Disease

Back 22

= 3.8 bilirubin + 11.2 INR + 9.6 creatinine + 6.4

if <14 - TIPS

if >14 - no TIPS

MC cause: Diabetes, HTN

Front 23

Atopic Dermatitis

Back 23

Scaly rash (face, scalp), high IgE, winter

Tx: steroids, Tacrolimus

if severe - add antihistamines

if + impetigo - add Cephalexin, Mupirocin

if recalcitrant - UV light

Associated: asthma, allergic rhinitis, age <5 y/o

Front 24

Herbs - Gingko biloba

Back 24

Use: Memory enhancement

Side effect: Bleeding, seizure

Front 25

Herbs - Ginseng

Back 25

Use: Increase mental performance

Side effect: schizophrenia, headache, Steven-Johnson

Front 26

Herbs - Kava

Back 26

Use: Anxiety, insomnia

Side effect: liver damage

Front 27

Herbs - Aconite

Back 27

Use: Ianxiety

Side effect: cardiotoxic

Front 28

Herbs - Saw Palmetto

Back 28

Use: BPH

Side effect: increase bleeding risk

Front 29

Herbs - Black cohosh

Back 29

Use: postmenopausal symptoms

Side effect: liver damage, increase bleeding risk

Front 30

Herbs - St John's wort

Back 30

Use: depression, insomnia

Side effect: hypertensive crisis

Front 31

Herbs - Licorice

Back 31

Use: stomach ulcers, bronchitis

Side effect: hypertension, hypokalemia

Front 32

Herbs - Echinacea

Back 32

Use: cold and flu

Side effect: anaphylaxis

Front 33

Herbs - Ephedra

Back 33

Use: cold and flu, weight loss

Side effect: hypertension, arrhythmia, MI, stroke, seizure

Front 34

Cimetidine, TMP-SMX, Probenecid

Back 34

Decrease creatinine clearance

Front 35

Carotid dissection

Back 35

unilateral headache + Horner's

Dx: MRA, then cath angio

Tx: anticoagulate, surgery (angioplasty + stent)

Front 36

HAART drug - side effect

Back 36

Indinavir - nephropathy

Didanozine - pancreatitis

Abacavir - hypersensitivity

NRTIs - lactic acidosis

Nevirapine - liver failure

Zidovudine - anemia

Front 37

Most common steering wheel injury

Back 37

Aortic rupture

Front 38

Gonococcal infection

Back 38

Sx: Joint pain, tendonitis, petechial rash

Tx: Ceftriaxone, Cefotaxime, Ceftizoxime

Front 39

Ca Channel blockers - adverse effects

Back 39

Side effect:

Dihydropyridines: headache, flushing, peripheral edema

Diltiazem, Verapamil: decrease contractility, constipation

Front 40

Carpal tunnel syndrome

Back 40

Tx: splint, steroids, NSAIDs, occupational rehabilitation

Front 41

Actinic Keratosis

Back 41

is premalignant, leads to squamous cell carcinoma

Front 42

TMP, MTX, Phenytoin

Back 42

Cause anemia

Tx: Folinic acid (Leucovorin)

Front 43

Intention to treat

Back 43

Preserve randomization

Front 44

Bronchopulmonary Aspergilosis

Back 44

History of asthma or atopic disorder

Dx: first do skin reactivity test

serum antibody

IgE (is > 1000)

eosinophils (> 500)

lung infiltrates (upper lobe)

unilateral bronchiectasis

Tx: Oral steroids

if recurs - Itraconazole PO

Front 45

Afebrile pneumonia syndrome

Back 45

Neonate < 6 months old

Cause: Clamidia (staccato cough), CMV, RSV, adenovirus, ureaplasma, mycoplasma

Front 46

Antipseudomonal antibiotics

Back 46

fluoro., ceftazidime, piperacillin, ticarcillin, aminoglyc.

Front 47

Isotretinoin - adverse effects

Back 47

Adverse: increase TG (cause acute pancreatitis), myalgia, hyperostosis, pseudotumor cerebri, night vision abnormalities, bone marrow suppression, liver toxicity, mucocutaneous lesions.

Front 48

Lichen planus

Back 48

Sx: Pruritic, polygonal papules/plaques on flexors, buccal mucosa, genitalia (whitish lacy pattern).

Dx: clinical, skin biopsy.

Associated: Hep C

Tx: steroids

Front 49

Meralgia paresthetia

Back 49

Lateral femoral nerve entrapment.

Decreased sensation over anterior/lateral thigh.

Tx: weight loss, avoid tight garments

Front 50

Trichomonas + breast feeding

Back 50

Tx: Metronidazole 2g PO 1x.

No breast feeding for 12-24h.

Front 51

Parenteral feeding

Back 51

Max 30 kcal/day with 1g/kg protein.

- If malnurished -> 15 kcal/day

- If on TPN and becomes hypoglycemic - most likely its sepsis.

Front 52

Acute compartment syndrome

Back 52

Rhabdomyolysis, renal failure

Front 53

PCOS

Back 53

Tx: Weight loss is most effective in obese.

- if no help, then Clomiphene

Front 54

Precocious pseudo-puberty

Back 54

21-OH deficiency

Front 55

Diarrhea after cholecystectomy

Back 55

Tx: Cholestyramine

Front 56

Tourette

Back 56

Many jerky movements + 1 vocal tic

Tx: Risperidone, Flufenazine, then Clonidine, Tetrabenazine.

Associated: OCD

Front 57

HSV + pregnancy

Back 57

Antivirals from 36w.

If symptomatic at the time of delivery - do c-section

Front 58

OCD

Back 58

Tx: SSRIs, then use Clomipramine

Front 59

If seizure risk in history

Back 59

No Imipenem

Front 60

If Pulmonary Embolus

Back 60

hold antibiotics if fever, opacities in lungs

Front 61

Sarcoidosis Dx

Back 61

Do parotid gland biopsy

Front 62

Psoriasis exacerbation

Back 62

Tx: Metoprolol

Front 63

Varicocele

Back 63

Causes testicular atrophy.

Dx: abdominal CT

Front 64

Drug induced pancreatitis

Back 64

from Drugs: Furosemide, HCTZ, Sulfasalazine, 5ASA, AZT, Valproic acid, Didanozine, Pentamidine, Metornidazole, Tetrabenazine

Front 65

Hemorrhagic pancreatitis

Back 65

Fast dropping hematocrit, high WBC (>18.000), very low Calcium

Front 66

If high MCV + GI complaints

Back 66

Check anti-IF Ab.

Stomach has absent rugae in fundus (atrophic gastritis).

Front 67

Keloids

Back 67

Tx: intralesional steroids

Front 68

Scuba diving

Back 68

Decongestants before diving reduces barotrauma

Front 69

Rabies

Back 69

Sx: hydrophobia, aeorphobia, agitation, pharyngeal spasm