Usmleworld Step2 Test8

Front 1

Treatment of irregular periods with cytology showing "complex hyperplasia without atypia"

Back 1

cyclic progestins, repeat biopsy after 3-6 months of treatment

Front 2

Treatment of irregular periods with cytology showing "complex hyperplasia with atypia"

Back 2

If she wants to preserve fertility, give her cyclic progestins (there's a lower response rate), if she doesn't want to preserve fertility, give her a hysterectomy.

Front 3

si/sx of analgesic nephropathy

Back 3

sterile pyuria (meaning WBCs and WBC casts without infection), polyuria, renal colic and hematuria can occur if papillary necrosis occurs, mild proteinuria, fatigue

Front 4

associations with chronic analgesic abuse

Back 4

premature aging, atherosclerotic disease, urinary tract cancer

Front 5

What's the defect that causes Bruton's agammaglobulinemia

Back 5

x-linked recessive defect in tyrosine kinase in B cells

Front 6

si/sx of Bruton's agammaglobulinemia

Back 6

male infant, asymptomatic till 6-9 months, when he gets recurrent pyogenic infections (strep pneumo, h flu). labs show low gammaglobulins, absent B cells on peripheral smear

Front 7

what is dacryocystitis?

Back 7

infection of tear duct, it occurs in infants and adults over 40, redness and pain in medial canthus region, usual bugs are staph or strep

Front 8

what is a hordeolum?

Back 8

abscess over upper or lower eyelid, it appears as a local red swelling

Front 9

what is a chalazion?

Back 9

chronic granulomatous inflammation of the meibomian gland, appears as a hard painless lid nodule

Front 10

PFT findings in pulmonary fibrosis?

Back 10

decreased diffusing capacity of CO, reduced total lung volume, reduced residual volume, reduced functional residual capacity, flow volumes are reduced but FEV1/FVC is normal-increased, increased A-a gradient

Front 11

treatment of abruptio placenta

Back 11

careful monitoring, large bore IV, foley catheter, available blood products, rapid vaginal delivery, only do C-section if there rapid deterioration of mother or fetus. If abruption is mild and stable, you could use Mag to tocolyze and

Front 12

Risk factors for abruptio placenta

Back 12

cocaine use, maternal htn, previos abruption, trauma, rapid decompression of polyhydramnios, short umbilical cord, tobacco use, folate deficiency

Front 13

best test of Addison's disease? Why?

Back 13

cosyntropin stimulation test, cosyntropin is an analogue of ACTH, and if it produces any increase in cortisol levels, Addison's can be ruled out

Front 14

what causes Addison's disease?

Back 14

destruction of adrenal cortex, usually by autoimmune causes, but can be because of infections (TB, viral, fungal)

Front 15

si/sx of addison's disease?

Back 15

weakness, fatigue, weight loss, hyperpigmentation, hypotension,

Front 16

si/sx of RMSF?

Back 16

fever, myalgia, HA, petechial rash, hypotension and shock later

Front 17

treatment of RMSF?

Back 17

doxycycline, start based on clinical suspicion, any delay can allow progression to shock,

Front 18

tx of beta blocker OD

Back 18

atropine, isoproterenol, then glucagon

Front 19

so your pt has syphilis, what test do you order?

Back 19

HIV elisa

Front 20

what is the dx for cape-like distribution of sensory loss and reflexes

Back 20

syringomyelia (it's called syringobulbia if it extends into the medulla oblongata)

Front 21

si/sx of subclavian vein thromosis

Back 21

presents after a couple of weeks of having a central line there, swelling in pallor of arm, pain,

Front 22

tx of subclavian vein central line thrombosis

Back 22

first remove the central line, apply heat and elevate arm, get ultrasound to document the thrombus, start anticoagulation

Front 23

which congenital heart disease is the most common to present with cyanosis in the first 24 hours of life?

Back 23

transposition of the great vessels

Front 24

immediate treatment of transposition of the great vessels?

Back 24

prostaglandins to keep that ductus open!

Front 25

best test for acute cholecystitis?

Back 25

HIDA scan

Front 26

what do you know about aneurysms of the descending thoracic aorta?

Back 26

second most common site of an aortic aneurysm, most pts also have an aneurysm in the abdominal aorta, due to atherosclerosis

Front 27

what do koplik's spots look like

Back 27

red spots with blue center, on buccal mucosa

Front 28

describe the course of a measles infection

Back 28

10 days after exposure, a prodrome starts (cough, coryza, conjunctivitis), then Koplik's spots appear, then the maculopapular rash appears on face then migrates down the body

Front 29

what metabolic abnormality does acetazolamide cause?

Back 29

metabolic acidosis (non anion gap), because it causes kidneys to waste bicarb

Front 30

what do you do if you suspect aortic rupture on chest x-ray?

Back 30

get a chest CT or echo

Front 31

treatment of acute hepatitis C

Back 31

interferon and ribavirin,

Front 32

si/sx of heroin withdrawal in an infant

Back 32

tremors, wakefulness, loose stools, high-pitched cry, poor feeding, tachypnea, vomiting, fever, sx within first 48 hours of life

Front 33

associations of acanthosis nigricans

Back 33

diabetes, abdominal malignancy (in older pts)

Front 34

what is the difference between incomplete abortion and inevitable abortion

Back 34

Both have dilated cervix and vaginal bleeidng. Incomplete abortion has only parts of the conceptus in the uterus, while the inevitable abortion contains the entire conceptus but without fetal heart activity

Front 35

define dysthymia

Back 35

depressed mood for most of the day for two years

Front 36

define unstable angina

Back 36

angina of sudden onset, onset at rest, post-infarct angina, a change in the character of stable angina

Front 37

treatment of unstable angina

Back 37

hospitalization with aspirin, heparin, nitroglycerin with non-emergent angiography once chest pain has resolved

Front 38

si/sx meniere's disease

Back 38

recurrent episodes of positional vertigo, sensorineural hearing loss, tinnitus

Front 39

si/sx of acoustic neuroma

Back 39

progressive, constant tinnitus and vertigo

Front 40

si/sx of paget's ds of nipple

Back 40

red, oozing, crusting lesion of the areola that doesn't respond to abx or steroids, on path--large malignant cells with halo areas invading the epidermis

Front 41

strongest indicator for future suicide

Back 41

previous suicide attempts

Front 42

vitamin deficiency assoc with dilantin

Back 42

folic acid