Usmle Step 2- Wrong Questions

Front 1

TPN Complications

Back 1

Most common- catheter tip infection.
Others: fluid overload, refeeding syndrome (hypokalemia, hypo Po4, hypo Mg) if too fast.

Front 2

Thyroid hormones and pregnancy

Back 2

Normal preg inscreases thyroid gland size, total T3 and T4, and TBG. Free T3 and T4 are w/in normal. TSH and TRH are often decreased.

Front 3

Do you keep synthroid levels the same? increase? or decrease? them if a patient becomes pregnant?

Back 3

Increase them.

Front 4

Describe the nonstress test in pregnancy

Back 4

Tests for fetal hypoxemia. Its "reactive" if 2+ accels of 15bpm above baseline that last for 15 secs over 20 min of observation.

Front 5

What is this lesion?

Back 5

Ecthyma gangenosum from P. aeruginosa. Rapid growing skin lesion that become nontender nodules w/ central nextrosis. Occurs in immunecompromised pts.
Tx= piperacillin w/ gentamicin

Front 6

Most common cause of infectious myocarditis and pericarditis

Back 6

Coxsackie virus

Front 7

Patients with chest pain, decreased cardiac output, and pulsus paradoxus following a viral infection probably have:

Back 7

cardiac tamponade secondary to acute pericarditis.

Front 8

Pulsus paradoxus:
definintion.
causes.

Back 8

bp inc with exhalation. dec with inhalation
on clinical examination, one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul sign). As is usual with inspiration, the heart rate is slightly increased,[2] due to decreased left ventricular output.

cardiac tamponade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease (e.g. asthma, COPD).

Front 9

Most common cause of infectious myocarditis and pericarditis

Back 9

Coxsackie virus

Front 10

Patients with chest pain, decreased cardiac output, and pulsus paradoxus following a viral infection probably have:

Back 10

cardiac tamponade secondary to acute pericarditis.

Front 11

Describe xanthochromia and its significance

Back 11

yellow discoloration of CSF secondary to degradation of elevated CSF RBCs.
Classic for HSV encephalitis.

Front 12

Describe HSV encephalitis

Back 12

Presentation: fever, HA, seizure, confusion, stupor over a few days.
Frontotemporal region affected thus temporal-based seizures, anosmia, gustatory hallucinations and bizzare/psychotic behavior.
CSF: lymphocytic pleocytosis, normal glucose and protein, and xanthochromia b/c hemorrhagic destruction of frontotemporal lobes.

Front 13

What is "normal" FEV/FVC ratio?

Back 13

80%-120%

Front 14

Describe pseudoclaudication

Back 14

lower extremity pain w/ walking and prolonged standing; particularyly evident with downhill walking.
Difference b/w claudication; pseudo is still bad with prolonged standing whereas claudication would improve.

Front 15

Describe paraneoplastic Cushing's

Back 15

ectopic ACTH production by small cell lung CA. Can't be suppressed with dexamethason, hyperpigmentation (MSH is breakdown product from ACTH), Other sx: truncal obesity, moon facies, buffalo hump, striae, htn, fatigue, glucose intol, osteopenia, weakness, easy bruising, edema, electrolyte probs.

Front 16

Complication of peritoneal dialysis

Back 16

Most common= Peritonitis.
fever, ab pain, rebound tenderness.
mc organism= staph epidermidis, and staph aureus.
NOTE: peritonitis from divertiulitis is often polymicrobial

Front 17

SBP: define,

Back 17

SBP- common complication of ascities; enteric org translocates from intestinal wall. Dx: >250 neutrophils in ascitic fluid.

Front 18

Bullous pemphigoid vs pemphigus vulgaris

Back 18

BP: autoimmune SUBepidermal blistering in flexural areas, pruiritis, >60 y.o., 1/3 have oral lesions
tx= topical/oral steriods
BV: autoimmune INTRAepidermal blistering. Oral cavity involvement ALMOST ALWAYS!
tx= corticosteriods. IvIG, etc.

Front 19

Most common intracranial tumors in adults

Back 19

Brain mets (mcc CA: lung, breast, renal)

Front 20

MRI findings w/ MS

Back 20

Ovoid plaques in periventricular region, corpus collosum and deep white matter.

Front 21

pt has this finding plus heliotrope rash, symmetric prox muscle weakness. What is treatment?

Back 21

Dx- dermatomyositis.
tx- high dose steroids then taper to low dose. Adjunct w/ azathoprine or MTX as needed.

Front 22

/absence seizures

Back 22

Usually occur in kids. i.e. child w/ multiple staring episodes per day. No post-ictal confusion

Front 23

Complex partial seizures

Back 23

Pts often stare blankly for several min and may do automatisms (lip smacking, chewing, etc.). POST-ICTAL CONFUSION or paralysis (Todd's paralysis) often occurs.

Front 24

SLE

Back 24

Migratory, polyarticular symmetric joint pain. (knees, hands often involved).
Photosensitivity, renal disease( proteinuria w/ normal creatinine in early stages).
Young female

Front 25

Adenosine

Back 25

Treats SVT

Front 26

Digoxin

Back 26

sometimes treats SVT

Front 27

Verapimil

Back 27

treats SVT, not effective for V tach

Front 28

Metroprolol

Back 28

treats SVT, not V tach

Front 29

Amiodarone

Back 29

treat stable V TACH!!!

Front 30

Mediastinitis

Back 30

complication from esophageal rupture from previous esophageal dilation procedures. Often gives left sided pleural effusion, pneumomediastinum, hemodyn instab and fever.
Dx with esophagram or chest CT

Front 31

Mallory weiss versus Boerhave

Back 31

MW- partial thickness
B- full thickness (can lead to mediastinitis)

Front 32

Assessment for PVD

Back 32

Ankle brachial index.

Front 33

Severe symptomatic hypercalcemia is most often caused by?

Back 33

Malignancy; hyper PTH can give increased Ca, but NOT AS HIGH AS MALIGNANCY

Front 34

Prevention of gallstones

Back 34

Ursodeoxycholic acid.

Front 35

What procedure gives VERY high risk of gallstones in the future?

Back 35

Gastric bypass.
if have symptomatic stones before surg then do cholexxystectomy. If not symptomatic give prophylactic ursodeoxycholic acid for 6 mos after surgery.

Front 36

ANA

Back 36

SLE

Front 37

anti-ds-DNA

Back 37

SLE

Front 38

Anti-smith

Back 38

SLE

Front 39

Anti-centromere Ab

Back 39

Scleroderma (Esp CREST syndrome)

Front 40

ANCA

Back 40

Small vessel vascultitis (ex. Wegener;s granulomatosis).

Front 41

anti-smooth muscle antibodies

Back 41

autoimmune hepatitis

Front 42

Anti-mitochondrial

Back 42

Primary biliary cirrhosis

Front 43

Prevention on variceal hemorrhage?

Back 43

Non-selective beta blockers (propranolol or nadolol).

Front 44

What is the effect of multiple myeloma on the kidneys?

Back 44

MC: renal tubular damage by the light chain casts.
Glom damage from amyloidosis or monoclonal Ig deposition also occurs less commonly.

Front 45

Fragile X- diagnosis

Back 45

Molecular analysis of # of CGG repeats in FMR-1 gene
Cell culture in folate deficient media.

Front 46

Fragile X- what is it?

Back 46

MOST COMMON INHERITED FORM OF MENTAL RETARDATION; Pts get seizures, elongated gace, large ears, enlarged testes.

Front 47

Treatment of delirium

Back 47

Haloperidol (i.e. antipsychotics)
NOTE: Benzos can worsen relirium unless the delirium is secondary to alcohol or benzo withdrawal.

Front 48

HPV screening

Back 48

Pap at three years past sexual intercourse or at age 21 (whichever first).

Front 49

Normal vaginal pH

Back 49

4-4.5;
BV= higher pH
Yeast= normal pH
Trich= higher pH

Front 50

Heterozygous alpha thalassemia

Back 50

(a, a,)(-,-) OR (a,-)(a,-)
Typicall asymptomatic; although can have mild fatigue, mild hypochromic anemia, severe microcytosis, target cells.

Front 51

Diagnostic test for carcinoid syndrome

Back 51

24 hr urine 5-HIAA

Front 52

Rosacea

Back 52

Middle age, episodic facial flushing to spicy food or alcohol, facial telangiectasias, pustules. Treatment- metronidazole (first line)

Front 53

Agitated patients

Back 53

If agitated and pose danger to themselves or others must give IM meds (loraz, haloperidol) and even physical restraints

Front 54

Workup of NEW onset psych symptoms

Back 54

head CT, CBC, TSH, syphilis screen, BMP, urine tox.

Front 55

Young patient with recent viral illness, heart failure, chest pain or arrhythmias.

Back 55

Suspect myocarditis.

Front 56

Iron poisoning

Back 56

GI HEMORRHAGE; bloody diarrhea, hematemesis. Severe poisoning=> metabolic acidosis, hepatotoxicity, bowel obstruction, or death.

Front 57

Patients with A-fib and weight loss should get what test?

Back 57

Thyroid! TSH, Free T4. Hyperthyroid can give weight loss and a fib.

Front 58

What is both diagnostic and therapeutic for SVT?

Back 58

Carotid sinus massage.

Front 59

New-onset seizures

Back 59

Think brain tumors; most common in adults are astrocytoma. The degree of anaplasia marks the prognosis.

Front 60

CD20

Back 60

CLL

Front 61

EGFR

Back 61

Colon cancer therapy

Front 62

IL-1

Back 62

RA treatment

Front 63

TNF-alpha

Back 63

RA, Chron's, inflamm diseases.

Front 64

BCR-ABL

Back 64

CML (tyrosine kinase)

Front 65

Focal neuro findings plus increased intracranial pressure, plus fever plus new murmur

Back 65

Brain abcess from endocarditis. Confirm with CT or MRI.

Front 66

Bacteremia in pts with sickle cell disease is most commonly caused by....

Back 66

strep pneumo (b/c its encapsulated and pts autoinfarct their spleen).

Front 67

Who needs prophylactic antibiotics for dental procedure?

Back 67

High risk conditions- prosthetic heart valves, history of IE, unrepaired CONGENITAL heart disease.
WHO DOES NOT: bicuspid aorta, acquired aortic valve disease, acquired mitral valve disease (including MVP w/ regurg).

Front 68

How to reverse EPS from haloperidol?

Back 68

Give diphenhydramine and anticholinergic meds (benztropine, or trihexyphenidyl).

Front 69

Where do the following get damaged with fractures?
Brachial artery
Median Nerve
Radial Nerve
Ulnar Nerve
Musculocutaneous Nerve

Back 69

1. midshaft frac of humurus (RARE!)
2. Supracondylar region of humerus
3. Middle portion humurus
4. Medial epicondyle
5. RARE; hypertrophy or entrapment b/w biceps.

Front 70

Exudative pleural effusion w/o evidence of infection

Back 70

Think MALIGNANCY!
MCC- lung or breast cancer. (lung is less likely if pt didn't smoke)

Front 71

A fib treatment

Back 71

Anticoagulation plus rate/rhythm control with B block or CCB.

Front 72

What causes a "step-wise" deterioration of cognitive functioning?

Back 72

Vascular dementia

Front 73

three risk factors for torsades de pointes

Back 73

long QT, hypokalemia, congenital deafness(!)

Front 74

Torsades tx

Back 74

correct hypokalemia, withdraw offending drugs. Give Mg initially and cardiovert if unstable.

Front 75

Dressler's syndrome

Back 75

PERICARDITIS: Autoimmune process occurring 2-10 weeks post-MI; Sx= fever, pericarditis, pleural effusion, leukocytosis, inc ESR.

Front 76

Back 76

Xanthoma- eruptive nocules in skin over tendons w/ hypercholesterolemia.

Front 77

Causes of secondary hypertension?

Back 77

CHAPS- Cushings, hyperaldosterone, Aortic coarc, Pheochromocytoma, Stenosis of renal artery.

Front 78

Antihypertensive with the following side effects: Headache, lupus like syndrome

Back 78

hydralazine

Front 79

Antihypertensive with the following side effects: orthostasis, facial hirsutism

Back 79

Minoxidil

Front 80

Antihypertensive with the following side effects: headache, flushing, peripheral edema

Back 80

dihydropyridines- i.e. nifedipine, felodipine, amlodipine.

Front 81

Antihypertensive with the following side effects: somnelence, orthostatic hypotension, impotence, rebound htn.

Back 81

methyldopa, clonidine (central acting adrenergic agonists- on alpha2--- they inhibit sympathetic nervous system via central a-2 adrenergic receptors).

Front 82

Causes of pulsus paradoxus

Back 82

Cardiac:
cardiac tamponade
pericardial effusion
pulmonary embolism
cardiogenic shock
Pulmonary:
tension pneumothorax
asthma
chronic obstructive pulmonary disease
Non-pulmonary and non-cardiac:
anaphylactic shock
superior vena cava obstruction

Front 83

Back 83

electrical alternans- cardiac tamponade

Front 84

Anemia with DIC is caused from

Back 84

Microangiopathic hemolytic anemia

Front 85

CSF findings with Guillian Barre

Back 85

albuminocytologic dissociation:
increasd protein but normal WBC.

Front 86

MCC of Guillian Barre

Back 86

Post-campylobacter.

Front 87

Electrolyte abnormalities with tumor lysis syndrome

Back 87

hypocalcemia, hyperphosphatemia, hyperkalemia, increased uric acid.
Also, nausea, vomiting, change bowel habits, dec urine output, acute renal insufficiency, seizure, tetany and/or arrhythmia.

Front 88

How to treat these types of meningitis:
1. Nocardia
2. Toxoplasmosis
3. listeria monocytogenes
4. cryptococcus
5. s. pneumo

Back 88

1. tmp-sulfa
2. pyrimethamine and sulfadiazine
3. ampicillin (added to cephalosporin)
4. amphotericin B or flucytosine
5. ceftriaxone + vanco if cef- resistant

Front 89

Myelodysplastic syndrome

Back 89

Ages 65+, macrocytic anemia, leukopenia, thrombocytopenia, and decreased segmentation of neutrophils (as opposed to b12 or folate deficiency).
Dx- via bone marrow biopsy.

Front 90

auer rods

Back 90

AML

Front 91

Heinz cells

Back 91

G6PD deficiency or thalasemmia

Front 92

Smudge cell

Back 92

CLL

Front 93

Spherocytosis leads to what?

Back 93

gallstones b/c chronic hemolysis

Front 94

入場

Back 94

입장
entrance, [관객 등의] admission, admittance. [enter + place]

Front 95

acid ingestion is a risk factor for what future GI abnormality?

Back 95

Gastric outlet obstruction

Front 96

Causes of primary adrenal insufficiency

Back 96

TB, fungal, CMV.

Front 97

What androgen hormone is elevated in pts with increased ADRENAL androgen secretion?

Back 97

DHEAS; the other androgens are also produced by the ovaries (i.e. are not specific to the adrenals)

Front 98

OCPs can lead to what liver problem in women?

Back 98

Hepatic adenoma- Complications include intra-tumor hemorrhage, malignant transformation.

Front 99

treatment of benign essential tremor?

Back 99

Betablocker- propranolol

Front 100

加害

Back 100

가해
assault, violence, wrong, wrongdoing [add + harm]

Front 101

防禦

Back 101

방어
defense, safeguard, protection [defend + protect]

Front 102

Complications of hepatitis C

Back 102

1. Cryoglobulinemia (membranoproliferative glomerularnephritis)
2. B-Cell lymphoma
3. Plasmacytoma
4. Auto-immune (Sjogren's, thyroiditis)
5. Lichen planus
6. Porphyria cutanea tarda
7. ITP

Front 103

Toxoplasmosis treatment/prevention?

Back 103

tx- sulfadiasine & pyrimethamine
prev- tmp-sulfa.

Front 104

Complication of infectious mono?

Back 104

Autoimmune hemolytic anemia (coombs positive) and thrombocytopenia.
And splenic rupture. (don't play contact sports)

Front 105

Side effect of succinylcholine?

Back 105

Hyperkalemia.

Front 106

Side effect of dihydropyridine calcium channel blockers (i.e. amlodipine)

Back 106

Peripheral edema

Front 107

Lenticular nuclear atrophy

Back 107

Wilson's disease

Front 108

Renal disease associated with Hep B

Back 108

Membranous glomerulonephritis

Front 109

Steroids effect on CBC

Back 109

erythrocytosis

Front 110

Initial treatment of acute mania (IN the manic episode!)

Back 110

Antipsychotic (haloperidol); and start lithium, but it'll take lithium 4 days+ to start working

Front 111

Mirtazepine

Back 111

TCA antidepressant, increases appetite.

Front 112

Asymptomatic increase of alkaline phoshatase

Back 112

Paget's disease

Front 113

Components of the fetal biophysical profile

Back 113

Fetal movement
Fetal tone
Fetal breathing
Amniotic fluid volume
Results of nonstress testing

Front 114

HLA DR3
HLA DR4

Back 114

Type I Diabetes

Front 115

smudge cells

Back 115

CLL

Front 116

Auer rods

Back 116

AML

Front 117

TRAP positive

Back 117

Hairy cell

Front 118

Gleevac (Imatinib) treats...

Back 118

CML

Front 119

Tumor lysis:
Calcium, Potassium, PO4, Uric acid

Back 119

DEC Ca++; all else high

Front 120

Normal ECG is upright in which axes?

Back 120

I and avF.

Front 121

Long QT can lead to?

Back 121

Torsades.

Front 122

What makes a Q wave significant?

Back 122

>1/3 QRS amplitude or >40ms.

Front 123

Q wave indicates?

Back 123

past MIs.

Front 124

Inverted T indicates?

Back 124

possible ischemia

Front 125

Management of A-Fibb?

Back 125

ABCD-
anticoag
b block for rate control
ccbs or cardiovert(?)
digoxin

Front 126

cannon A waves

Back 126

RA contraction against closed tricuspid

Front 127

A flutter treatment

Back 127

Rate and anticoag; cardiovert according to a fibb criterea (i.e. only if <48hrs without evidence of thrombi on echo; or after 4-6 weeks of anticoag.

Front 128

AVNRT treatment

Back 128

Carotid massage, valsalva, cold water on face (all dec AV node conduction by inc vagal tone). Give Adenosine if needed.
Cardiovert if hemo unstable

Front 129

PVC treatment

Back 129

B-blockers