Usmle Step 2Ck - Rapid Review

Front 1

Murmur: HOCM

Back 1

systolic ejection murmur heard along the lateral sternal border that increases with decrease preload (valsalva)

Front 2

Murmur: aortic insufficiency

Back 2

Austin flint murmur, a diastolic decresendo, low pitched, blowing murmur that is best heard sitting up; inc with inc afterload (handgrip maneuver)

Front 3

Murmur: AS

Back 3

A systolic crescendo/decrescendo, murmur that radiates to the neck; inc with inc preload (squatting maneuver)

Front 4

Murmur: MS

Back 4

A diastolic, mid to late low pitched murmur preceded by an opening snap

Front 5

Murmur: MR

Back 5

A holosystolic murmur that radiates to the axila; inc with inc afterload

Front 6

Eight surgically correctable causes of HTN

Back 6

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, conn's syndrome, cushing's syndrome, unilateral renal parenchymal disease, hyperthryoidism, hyperparathyroidism

Front 7

Metabolic syndrome

Back 7

Abd obesity, high trig, low HDL, HTN, insulin resistance, prothrombotic or proinflammatory state

Front 8

What is the appropriate test?

65F with LBBB and unstable angina.

Back 8

2. pharmacologic stress echo (b/c LBBB prevents EKG interpretation with ETT)

Front 9

Target LDL in a patient with DM

Back 9

<70

Front 10

Signs of active ischemia during stress testing

Back 10

Angina, ST segment changes on EKG, or dec BP

Front 11

Endocarditis prophylaxis regimens

oral surgery?

GI/GU surgery?

Back 11

oral surgery: amox for certain situations;

GI/GU procedures--not recommended

Front 12

Most common cause of HTN in young men

Back 12

excessive ETOH

Front 13

Derm: inflammation and epithelial thinning of the anogenital area, predominantly in post-menopausal women

Back 13

lichen sclerosis

Front 14

Hx: Pt complains of HA, weakness, and polyuria

Exam: HTN and tetany

Labs: hyperNa, hypoK, and metabolic alkalosis

Dx?

Back 14

Primary hyperaldo (due to Conn's syndrome or bilateral adrenal hyperplasia)

Front 15

The most likely cause of an acute GIB in a pt <40 yo.

Back 15

diverticulosis

Front 16

Key organism causing this diarrhea: raw seafood

Back 16

Vibrio parahaemolyticus, HAV

Front 17

Extra-GI manifestations of IBD

Back 17

PSC, uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodousm

Front 18

Medical tx for IBD acute exacerbations

Back 18

steroids

Front 19

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia

Back 19

fanconi's anemia

Front 20

Medications and viruses that leads to aplastic anemia.

Back 20

Chloramphenicol, sulfonamides, chemo
XRT
HIV, HBV/HCV, parvovirus B19, EBV

Front 21

TTP tx?

Back 21

#1 = Emergent plasmapharesis
steroids;
ASA/clopidogrel;

DO NOT GIVE PLT TRANSFUSION

Front 22

14 yo girl with prolonged bleeding time after dental surgery and with menses, normal PT, normal or elevated PTT, and elevated bleeding time.

Dx?
Tx?

Back 22

Dx: VWD

Tx: DDAVP, FFP, or cryo

Front 23

80 yo M p/w fatigue, LAD, splenomegaly.

Labs: isolated lymphocytosis.

Dx?

Back 23

CLL/SLL

Front 24

A late, life threatening complication of CML

Back 24

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

Front 25

TUMOR LYSIS Syndrome labs:

Decr: ?

Incr: ?

Back 25

DECR: Ca

INCR: K, Phos, uric acid, LDH

Front 26

A non-suppurative complication of strep infection that is NOT altered by tx of the primary infection?

...in contrast to...?

Back 26

postinfectious GN

(unlike Rheumatic Fever!)

Front 27

A pt from CA presents with subacute fevers, malaise, cough, and night sweats.

Dx?
Tx?

Back 27

coccidio-

amphotericin B

Front 28

Meningitis in infants.

MCCs?

Tx?

Back 28

pneumo, meningococcus, H flu.

cefotaxime (NOT ceftriaxone) and vanc

Front 29

Initially presents with a pruritic papule with regional LAD; evolves into a black eschar after 7-10 days.

Tx?

Back 29

cutaneous anthrax

PCN G or cipro

Front 30

At what CD4 count should you start MAC ppx?

Back 30

<50-100. azithro

Front 31

neutropenic nadir post chemo

Back 31

7-10 days

Front 32

Name the organism: meningoencephalitis in AIDS

Back 32

crypto

Front 33

A first-born female, born in breech position, now found to have asymmetric gluteal skin folds on newborn exam.

Dx?

Back 33

developmental dysplasia of the hip

Front 34

PPx for migraine

Back 34

B-blockers, CCBs;
antidepressants;
AEDs;
avoid caffeine, chocolate, red wine, precipitant foods

Front 35

The most common primary sources of mets to the brain

Back 35

lung, breast, skin (melanoma), kidney, GI tract

Front 36

Tx for guillan-barre

Back 36

IVIG or plasmapharesis.

AVOID steroids!

Front 37

chromosomal pattern of complete mole

Back 37

46, XX

Front 38

molar pregnancy containing fetal tissue

Back 38

partial mole

Front 39

When should vaginal exam be performed with suspected placental previa?

Back 39

never

Front 40

abx with teratogenic effects

Back 40

tetracyclne, fluoroquinolones, aminoglycosides, sulfonamides

Front 41

rx to accelarate fetal lung maturity?

timing?

Back 41

betamethasone or dexamethasone for 48 hrs

Front 42

tx for post partum hemorrhage? in order?

Back 42

uterine massage -> oxytocin -> hemabate?

Front 43

Abx for GBS PPx?

Back 43

IV PCN or Amp

Front 44

pt fails to lactate after emergency c/s with marked blood loss

Back 44

sheehans syndrome

Front 45

uterine bleeding at 18 wks

no products expelled

cervical os open

Back 45

inevitable abortion

Front 46

uterine bleeding at 18 weeks

no products expelled

cervical os closed

Back 46

threatened abortion

Front 47

A woman presents with amenorrhea.

First test?

Back 47

urine B-hCG

Front 48

Pt with amenorrhea; h/o a D&C

neg B-hCG
nl prolactin
no response to E/P challenge

Dx?

Back 48

Asherman's syndrome

Front 49

PCOS

tx?

Back 49

wt loss, OCPs, metformin

Front 50

female infertility.

rx to induce ovulation

Back 50

clomiphene

Front 51

55yo woman w/ post-menopausal bleeding

next step?

Back 51

endometrial bx

Front 52

indications for medical tx of ectopic pregnancy

Back 52

Pt is stable;
unruptured;
<3.5 cm at <6 wks GA

Front 53

medical option for endometriosis

Back 53

OCPs, danazol, GnRH agonist

Front 54

Best way to Dx and f/u leiomyomas?

Back 54

Pelvic U/S

Front 55

30yo woman with vaginal discharge, petechiae on upper vagina and cervix.

Dx?

Back 55

Trichomonas

Front 56

contraceptive methods that protect against PID

Back 56

OCPs!

... and barrier contraception

Front 57

unopposed estrogen tx

C.I.?

Back 57

endometrial CA

ER+ breast CA

Front 58

Annual screening for women with a strong family history of ovarian CA.

Back 58

CA-125 + transvaginal U/S

Front 59

30F has unpredictable urine leakage. Exam is nml.

Dx?
Medical options?

Back 59

Urge incontinence.

anticholinergics (oxybutynin)
B-agonists (metaproteronol)

Front 60

most common cause of female infertility

Back 60

endometriosis

Front 61

Breast cancer type that inc the future risk of invasive CA in both breasts

Back 61

lobular carcinoma in situ

Front 62

1yo with non-tender abd mass

elevated VMA and HVA

Back 62

neuroblastoma

Front 63

The most common type of tracheoesophageal fistula.

Sx?

Back 63

esophageal atresia with distal TEF (85%).

Unable to pass NG tube

Front 64

Name common scenarios that are NOT contraindications to vaccines.

Back 64

mild illness
low-grade fever
current abx
prematurity

Front 65

A neonate has meconium ileus

DDx?

Back 65

CF
Hirschsprungs's (failure to pass for 48 hrs)
Anal atresia

Front 66

Bilious emesis...
... within hours after first feeding
... at 3wks old

Back 66

...duodenal atresia
...MALRO

Front 67

2mo with non-bilious emesis.

Dx?

Next steps?

Back 67

pyloric stenosis

Correct metabolic abnormalities, then pyloromyotomy

Front 68

An infant has a high fever and rash as the fever breaks.

Dx?

Cx?

Back 68

roseola infantum

febrile sz

Front 69

A boy has chronic resp infx.
Nitroblue terazolium test is negative.

Dx?

Back 69

chronic granulomatous dz

Front 70

Child has prolonged bleeding time, high IgA, low IgM levels

Dx?

Back 70

wiskott-aldrich syndrome

Front 71

4mo boy has life-threatening Pseudomonal infxn.

Dx?

Back 71

Bruton's x-linked agammaglobulinemia

Front 72

tx for UNconjugated hyperbili...

...mild?

...severe?

Back 72

mild: phototherapy

severe: exchange transfusion

Front 73

Child tx at home by parents for a fever and viral illness, now with sudden-onset mental status changes, vomiting.

Labs: transaminitis

Back 73

Reye's syndrome

Front 74

A child has loss of red light reflex.

At risk for what OTHER cancers?

Back 74

Osteosarcoma

Front 75

3yo with bilious emesis, elongated mass in RUQ

Dx?

Back 75

intussuseption

Front 76

A congenital heart disease that causes secondary HTN.

What would you find on physical exam?

Back 76

CoA

Decr femoral pulses

Front 77

Key side effects of antipsychotics

Back 77

wt gain, type 2 DM, QT prolongation

Front 78

A young wt lifter receives IV haldol and complains of his eyes being deviated sideways.

Dx?
Tx?

Back 78

acute dystonia (oculogyric crisis)

Tx with benztropine or diphenhydramine

Front 79

Rx to avoid in pts with h/o DTs/EtOH withdrawal Sz?

Back 79

neuroleptics

Front 80

Rx to avoid in Pt with PTSD

Back 80

benzos (high addiction potential)

Front 81

Tx for SVC syndrome

Back 81

XRT

Front 82

Characteristics favoring CA in an isolated pulmonary nodule

Back 82

age >45-50; lesions new or larger in comparision to older films; abscense of calcification or irregular calcification; size >2cm; irregular margins

Front 83

CXR findings of pulmonary edema

Back 83

cardiomegaly
prominent pulmonary vessels/cephalization
kerley B lines
bat's wing of hilar shadows
perivascular and peribronchial cuffing

Front 84

"doughy" skin

Back 84

hypernatremia

Front 85

hypervolemic hyponatremia

DDx?

Back 85

Cirrhosis, CHF, nephrotic syndrome

Front 86

most common type of kidney stone

Back 86

calcium oxalate

Front 87

55yo man with prostate cancer.

Tx?

Back 87

wait

TURP

XRT and/or androgen suppresion

Front 88

class of rx that may cause...

muscle rigidity, hyperthermia, BP instability, renal failure

Back 88

neuroleptics

Front 89

steroids

SE?

Back 89

acute mania, osteoporosis, easy brusing, myopathies, peptic ulcers

Front 90

tx for NMS and malignant hyperthermia

Back 90

dantrolene

Front 91

tx for malignant HTN

Back 91

nitroprusside, hydralazine (unless INCR ICP), IV labetalol, nicardipine, fenoldopam

Front 92

causes of drug-induced SLE

Back 92

hydralazine, INH, penicillamine, procainamide

chlorpromazine, methyldopa, quinidine

Front 93

burn pt with cherry red, flushed skin, coma.
SaO2 nl, carboxyhemoglobin elevated.

Dx?
Tx?

Back 93

CO poisoning

100% hyperbaric O2

Front 94

high-riding prostate

Dx?

Back 94

bladder rupture or urethral injury

Front 95

radiographic evidence of aortic disruption or dissection

Back 95

wide mediastinum (>8cm)
loss of aortic knob
pleural cap
tracheal deviation to right
depression of left main stem bronchus

Front 96

Name 4 radiographic findings that should prompt emergent laparotomy in Pts with acute abd:

Back 96

free air, severe bowel distension (on AXR)
extravasation of contrast (on swallow/contrast study)
space-occupying lesion (on CT)
mesenteric occlusion (on CTA/angio)

Front 97

acceptable UOP in trauma pt

Back 97

50cc/hr (1cc/hr/kg)

Front 98

acceptable UOP in nml pts

Back 98

30cc/hr (0.5cc/hr/kg)

Front 99

dec CO, dec PCWP, inc PVR

Back 99

hypovolemic shock

Front 100

dec CO, inc PCWP, inc PVR

Back 100

cardiogenic shock

Front 101

inc CO, dec PCWP, dec PVR

Back 101

septic shock

Front 102

tx of cardiogenic shock

Back 102

MINIMIZE IVFs

* pressors (e.g., dopamine) *

Front 103

tx of anaphylactic schock

Back 103

diphenhydramine, EPI

IVFs

Front 104

supportive tx for ARDS

Back 104

cont positive airway pressure

Front 105

signs of cardiac tamponade

Back 105

JVD, hypotension, diminished heart sounds, clear lungs, pulsus paradoxus

Front 106

absent breath sounds, dullness to percussion, shock, flat neck veins

Back 106

massive hemothorax

Front 107

absent breath sounds, tracheal deviation, shock, distended neck veins

Back 107

tension PTX

Front 108

tx for blunt or prenetrating abd trauma in hemodynamically UNSTABLE pts

Back 108

immediate ex-lap

Front 109

bias introduced when screening detects a disease earlier and thus lengthens the time from dx to death

Back 109

lead time bias

Front 110

cohort study--incidence or prevalence

Back 110

both

Front 111

case control study--incidence or prevalence

Back 111

neither

Front 112

difference between a cohort and case control study

Back 112

Cohort studies can be used to calculate RR, incidence, prevalence.

Case-control studies can be used to calcuate an OR, which is an estimate of RR ASSUMING THAT the dz prevalnece is low.

Front 113

attributable risk?

Back 113

the DIFFERENCE in risk in the exposed and unexposed groups
(the risk that is attributable to the exposure)

Front 114

in which pts do you initiate colorectal cancer screening early?

Back 114

FAP/HNPCC

IBD (8yrs after onset of pan-colitis in UC)

first degree relatives with adenomatous polyps (<60yo) or colorectal CA

Front 115

how do you calculate birth rate

Back 115

# live births per 1000 population in one yaer

Front 116

how do you calculate mortality rate

Back 116

number of deaths per 1000 population in one year

Front 117

how do you calculate neonatal mortality rate

Back 117

number of eaths from births to 28 days per 1000 live births in one year