Usmleworld Test4 Step2

Front 1

si/sx of a scaphoid fracture

Back 1

pain with wrist movement, history of falling on a outstretched hand, pain in anatomical snuff box

Front 2

management of suspected scaphoid fracture

Back 2

immobilization in a long arm cast--even if x-ray is negative. Make sure to get repeat x-rays every 2 weeks

Front 3

risk factors for cervical cancer

Back 3

multiple sex partners, early age of first coitus, smoking, high parity, low SES

Front 4

why does ammonia cause encephalopathy?

Back 4

it causes an increase in GABA inhibitory transmission

Front 5

precipitating factors for hepatic encephalopathy

Back 5

GI bleed, hypovolemia, metabolic acidosis, hyperkalemia, hypoxia, sedative use, infection, hepatic vascular occlusion

Front 6

how does lactulose work?

Back 6

it acidifies colonic contents, which converts absorbable ammonia into ammonium, which is not-absorbable (creates an ionic trap)

Front 7

what are treatment options for hepatic encephalopathy if lactulose doesn't work?

Back 7

sodium benzoate, ornithine aspartate, reduce protein intake (don't stop it though!)

Front 8

What is a TIPS procedure?

Back 8

bridge between hepatic vein and intrahepatic segment of portal vein

Front 9

what does TIPS treat?

Back 9

variceal bleeding, ascites, NOT hepatic encephalopathy

Front 10

best test to confirm intrauterine fetal demise

Back 10

ultrasound

Front 11

what is an important blood test to order after you confirm that pt has intrauterine fetal demise?

Back 11

coagulation studies (DIC is common!)

Front 12

si/sx of herpes encephalitis

Back 12

bizarre behavior, gustatory hallucinations, fever, impaired mental status, meningeal signs are frequently absent, non-specific CSF (may be grossly bloody)

Front 13

what test do you want to confirm HSV encephalitis

Back 13

CSF HSV PCR

Front 14

common causes of altered mental status in the elderly

Back 14

electrolyte imbalances, stroke, MI, infections

Front 15

what is the first line drug for HTN in the general population

Back 15

HCTZ or beta blocker

Front 16

what is the first line drug for HTN in diabetics`

Back 16

ACE inhibitors

Front 17

si/sx of HCOM?

Back 17

exertional dyspnea, syncope, chest pain

Front 18

what increases and decreases the murmur of HOCM?

Back 18

increases with Valsalva, decreases with leg elevation

Front 19

what does the murmur of HOCM sound like?

Back 19

harsh, diamond shaped murmur, best heard at left lower sternal border

Front 20

finding of HOCM on ech?

Back 20

interventricular septal hypertrophy, systolic anteriro motion of the mitral valve

Front 21

mechanism of methotrexate

Back 21

inhibits dihydrofolate reductase

Front 22

si/sx of vitreous hemorrhage

Back 22

sudden loss of vision, appearance of floaters

Front 23

causes of vitreous hemorrhage

Back 23

diabetic retinopathy

Front 24

five types of melanoma

Back 24

1. superficial sclerosing
2. lentigo maligna
3. acral lentiginous
4. amelanotic
5. nodular

Front 25

describe superficial spreading melanoma

Back 25

most common type, on legs in females, trunk in males, irregular brown lesion, slightly elevated

Front 26

describe nodular melanoma

Back 26

dome shaped black or purple lesion, bleeds easily

Front 27

describe acral lentiginous melanoma

Back 27

lest common type of melanoma, on palms and soles of african american pts, beneath nail plate

Front 28

si/sx of coarctation

Back 28

Headaches, leg muscle fatigue, mild continuous murmur heard all over chest (because of collaterals)

Front 29

first test to get in suspected PE

Back 29

V/Q scanning

Front 30

what if a V/Q scan is indeterminate in a pt with suspected PE?

Back 30

Get venous doppler ultrasound

Front 31

when do you order pulmonary angiogram in suspected PE?

Back 31

If you have high suspicion but indeterminate V/Q, ultrasound and/or CT angiogram

Front 32

si/sx of atrial myxoma

Back 32

looks like mitral stenosis without opening snap, exertional dyspnea, fatigue weight loss

Front 33

drug of choice for increasing HDL

Back 33

fibrates, not nicotinic acid because of side effects

Front 34

CSF findings in MS

Back 34

normal protein, oligoclonal bands, usually an increase in IGG

Front 35

CSF findings in Guillain-Barre

Back 35

albumino-cytologic dissociation

Front 36

CD4 counds in AIDS pts with CMV?`

Back 36

less than 50

Front 37

si/sx of CMV retinitis

Back 37

yellow-white patches of retinal opacification

Front 38

si/sx of toxoplasmosis of the retina

Back 38

necrosis of the retina, fluffy white lesions, most pts also have toxoplasmosis encephalitis

Front 39

most common cause of septic arthritis

Back 39

staph aureus

Front 40

WBC of synovial fluid in septic arthritis?

Back 40

>50,000, may often be greater than 100,000

Front 41

what is a reversible ischemic neurologic deficit

Back 41

neuro sx that lasts longer than 24 hours but resolves within one week

Front 42

lab findings in tumor lysis syndrome

Back 42

hyperphosphatemia, hyperkalemia, hyperuricemia, LOW calcium because it binds with phosphate

Front 43

tumors most often assoc with tumor lysis syndrome

Back 43

Burkitt's, the leukemias

Front 44

what do you do if you suspect SBP?

Back 44

diagnostic pericentesis

Front 45

bacterial species assoc with struvite stones

Back 45

proteus, klebsiella because they split urea forming nitrogen, which alkalinizes the urine

Front 46

three types of diabetic retinopathy

Back 46

1. simple--microaneurysms, hemorrhages, edema
2. pre-prolierative--cotton wool spots
3. proliferative--newly formed vessels

Front 47

what drugs can cause hypothermia

Back 47

phenothiazines, alcohol, benzos, any CNS depressant, opiates

Front 48

if you suspect hyperaldosteronism, what test should you get?

Back 48

aldosterone/renin ratio

Front 49

where does the ulnar nerve usually get entrapped?

Back 49

at the elbow

Front 50

what is the goal LDL?

Back 50

less than 100

Front 51

si/sx of vitamin D deficient rickets?

Back 51

craniotabes, rachitic rosary, enlarged wrists and ankles,

Front 52

what lab test confirms vitamin d deficiency

Back 52

calcefidiol

Front 53

si/sx of intertrochanteric fracture of hip

Back 53

leg is externally rotated and shortened

Front 54

management of hip fracture

Back 54

internal fixation with early mobilization

Front 55

si/sx of zinc deficiency

Back 55

alopecia, diarrhea, mental changes, maculopapular rash around eyes and mouth

Front 56

causes of zinc deficiency

Back 56

TPN, chronic diarrhea, inflammatory bowel disease

Front 57

classic presentation of choriocarcinoma

Back 57

hemoptysis, SOB, CP, post-partum female

Front 58

what test should you get if you suspect choriocarcinoma?

Back 58

quantitative hCG

Front 59

define an open fracture

Back 59

any fracture with a wound associated with it (NOT necessarily bone sticking out of it)

Front 60

management of open fractures

Back 60

stabilization with delayed primary closure

Front 61

what should you be worried about in pts with urinary voiding symptoms and negative urine culture?

Back 61

bladder cancer

Front 62

what tests should you get to rule out bladder cancer

Back 62

urine cytology and cystoscopy

Front 63

define childhood disintegrative disorder

Back 63

child has normal development for at least two years, then starts losing milestones, may have autistic features

Front 64

define autism

Back 64

impairments in communication and socialization, sx must be present before age three (often present very early), stereotypes, repetitive activity, poor eye contact

Front 65

define asperger syndrome

Back 65

like autism, but children have normal cognitive and language development, but still have repetitive movements

Front 66

define ADHS

Back 66

sx have to be present before age 7, inattention, hyperactivity, poor attention span, impulsiveness

Front 67

what tests do you get if ectopic pregnancy is suspected?

Back 67

transvaginal ultrasound and quantitative hCG

Front 68

si/sx of PCP overdose

Back 68

vertical nystagmus (only durg of abuse that causes this), hallucinations, sweating, HTN, hyperthermia

Front 69

what lab test should you get in every pt with suspected depression

Back 69

TSH

Front 70

what is the acid/base derangement in a pt with hepatic encephalopathy?

Back 70

metabolic alkalosis

Front 71

what supplement should all pts with sickle cell be on?

Back 71

folic acid