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STEP 2 Fam
USMLE step 2
| Term | Definition | ||
|---|---|---|---|
| Intussusception | - invagination of a proximal part of the bowel into a distal part - leads to mechanical obstruction and bowel ischemia. - vomitting - sudden screaming or crying caused by acute, cyclical abdominal pain. | - sausage-shaped mass in the RUQ on palpation - emptiness or retraction in the RLQ. - Children may pass stools with a currant jelly look in advanced stage. | |
| Pneumococcal conjugate vaccine 13 PCV13) | - protection against 13 subtypes of Streptococcus pneumoniae - currently recommended for all individuals ≥ 65 years with an immunocompromising condition | - followed by the pneumococcal polysaccharide vaccine 23 (PPSV23) at least 8 weeks later. | |
| All pregnant women should receive a single dose of Tdap between the 27th and 36th week of pregnancy. | Tdap vaccine protects the mother from puerperal tetanus | the neonate from pertussis, diphtheria, and neonatal tetanus ***live vaccines are contraindicated | |
| pertussis vaccine | - Children with a history of seizure disorder are at increased risk of having a seizure | the neurologic condition to be stable and well-controlled prior to DTaP administration | |
| Meningococcal conjugate MEN ACWY | - inactivated, - polysaccharide-conjugate vaccine - children at 11-12 and 16 years of age, - patients at risk for meningococcal infections (patients with asplenia or complement deficiencies). | Additional doses recommended for high-risk individuals - military recruits, | - first-year college students in residential dormitory housing if not already vaccinated at ≥ 16 years of age - asplenic, HIV pt, complement inhibitor use - history of travel to high-risk countries |
| Urge incontinence | Overactive bladder incontinence | - urine leakage preceded or accompanied by a strong urge to void. - Tenesmus | - caused by overactivity of the bladder detrusor muscle. - RX is conservative - bladder training and antimuscarinic agents (oxybutynin) |
| pt presents with loss of urine with physical stress such as coughing, sneezing, and laughing. | - stress incontinence | - involuntary leakage of urine, - follows activity associated with increased intra-abdominal pressure - (e.g., coughing, sneezing, standing up). | - caused by sphincteric resistance being overcome by bladder pressure - pelvic floor weakness, - intrinsic sphincter deficiency, etc. |
| urethral sling | - first-line surgical procedure for stress incontinence | - done if conservative therapy fails. | conservative therapy - pelvic floor muscle exercises (Kegel exercises), - lifestyle changes (e.g., weight loss, alcohol cessation), - use of continence pessaries |
| Metamorphopsia | - visual distortion in which straight lines appear wavy, . | - can be tested for using an Amsler grid. | - associated with certain ocular conditions - notably macular degeneration |
| The presence of soft drusen near the macula | - age-related macular degeneration (AMD). | - the most common cause of impaired vision in the elderly in developed countries. | - Cardiovascular diseases such as hypertension can increase the risk of AMD. |
| Dual-energy x-ray bone absorptiometry | - to diagnose osteoporosis. - for women over the age of 65. | - women under the age of 65 who are at an increased risk of osteoporosis, should also receive screening. | Risk factors for osteoporosis - family history of hip fracture, - excessive alcohol consumption, - smoking, - low BMI. |
| vitamin E deficiency. | Hemolytic anemia - deficiency results in increased fragility of erythrocytes - and membrane breakdown | Neurologic dysfunction - Demyelination of the posterior column and spinocerebellar tract → ↓ proprioception and vibration sensation; ataxia | - muscle weakness - acanthocytosis |
| Psychomotor agitation | A state of restlessness accompanied by purposeless movements - (e.g. tapping fingers, pacing). | seen in - alcohol withdrawal, - bipolar disorder, - generalized anxiety disorder, | - major depressive disorder, - post-traumatic stress disorder. |
| pt has insidious onset of memory loss, impairment in activities of daily life (he was found wandering the parking lot), . A mini-mental state examination score of 19/30 MRI finding of generalized cerebral atrophy. | Alzheimer disease | RX; acetylcholinesterase inhibitor. - donepezil, galantamine, or rivastigmine, - they promote increase of neurotransmitter acetylcholine, which is decreased in Alzheimer disease. | If this pt disease progresses to moderate-to-severe (≤ 18/30 MMSE), - memantine (an NMDA-receptor antagonist) is also indicated, - which may be given in addition to an acetylcholinesterase inhibitor. |
| Alzheimer disease | MRI - Ventriculomegaly and prominent cerebral sulci | ||
| Acetazolamide | - for idiopathic intracranial hypertension (IIH) | also be used to treat normal pressure hydrocephalus (NPH) - in pts who do not respond effectively to drainage of excess CSF via cerebral shunt | |
| Normal pressure hydrocephalus | - A form of hydrocephalus - lateral ventricles are expanded and the corona radiata is disrupted on imaging, - lumbar puncture does not reveal elevated CSF. | - urinary incontinence, - dementia, - changes in gait. | Removal of small amounts of CSF by lumbar puncture alleviates symptoms and supports the diagnosis. - rx; Acetazolamide if symptoms don't improve |
| Creutzfeldt-Jakob disease. | - human prion (misfolded protein) disease - EEG and CSF diagnostic | - Rapidly progressing mental decline - mutism - leads to death within 12 months. | myoclonus - brief, shock-like, involuntary twitch of muscle or groups caused by muscular contraction or inhibition |
| Chorea/ choreiform | - group of neurological disorders called dyskinesias. | - movements are continuous - involuntary, - rapid and abrupt, - irregular, - nonstereotyped, | - are not urge- or compulsion-driven. Most commonly involve: - shoulders, - hips, and face. - seen in Huntington disease |
| Personality changes, inappropriate behavior, and overeating (particularly of sweet foods) in a middle-aged adult with intact cognitive function | is highly suspicious for - frontotemporal dementia. | ||
| Temporal lobe degeneration | results in memory loss ; - (misplaced keys, leaving the stove on) | language deficits ; - (word-finding difficulties | Alzheimer disease |
| parietal lobe degeneration | results in spatial navigation problems (getting lost during walks outside), | Alzheimer disease | |
| Dysarthria | - A condition of impaired articulation - from motor dysfunction of the tongue, lips, or vocal cords. | Typical pathologic speech patterns; - slurring, - mumbling, - staccato pronunciation, | changes in speed and pitch - seen in Parkinson plus syndromes |
| Multiple system atrophy Shy-Drager syndrome | degeneration of ; - the substantia nigra, - striatum, - cerebellum, - inferior olivary nuclei, - or ventromedial columns of the spinal cord. | cerebellar symptoms ; - dysdiadochokinesia, - gait disturbances, - dysarthria | - motor abnormalities (tremor and rigidity), - autonomic dysfunction (orthostatic hypotension and incontinence), . |
| Multiple system atrophy Shy-Drager syndrome | belongs to the Parkinson-plus syndromes. - present with parkinsonism and a variety of additional features | Parkinson-plus syndromes should be considered if; - parkinsonism does not respond to levodopa treatment, - if dementia progresses rapidly, - if gait instability occurs early in the course of the disease. | |
| pt presents with asymmetrical resting tremor, rigidity, and reduced facial expression that was preceded by a likely history of an REM behavior sleep disorder | Parkinson disease. | ||
| Parkinson disease. | progressive depletion - of dopaminergic neurons in the basal ganglia, - particularly the substantia nigra. | - bradykinesia with resting tremor and/or rigidity. - Postural instability (late finding). | Neuropsychiatric and nonmotor manifestations; - cognitive dysfunction, - depression, - psychosis. |
| patient presents with the classic triad of urinary incontinence (wet), dementia (wacky), and gait abnormalities (wobbly), ). | - normal pressure hydrocephalus (NPH | -->compression of the periventricular white matter tracts. --> loss of central inhibition of the detrusor muscle, --->Urge incontinence | |
| Urge incontinence / Overactive bladder incontinence | - urine leakage that is preceded or accompanied by a strong urge to void. | - overactivity of the bladder detrusor muscle. | RX; conservative - bladder training and antimuscarinic agents. |
| Renal angiolipoma | - A benign renal tumor - arises from perivascular epithelioid cells | - consists of blood vessels, smooth muscle, - mature fat cells. - May be sporadic or associated with certain syndromes (e.g., tuberous sclerosis). | - large angiomyolipomas may present with hematuria, - retroperitoneal hemorrhage, - and impaired renal function. |
| Azoospermia | The absence of spermatozoa the ejaculate. | - seen in exogenous testosterone use, which inhibits the hypothalamic–pituitary–gonadal axis. | - Can also result from obstruction of the ejaculatory duct (e.g., in men with cystic fibrosis). |
| 5α-reductase deficiency | - decreased levels of dihydrotestosterone (DHT) - patient is karyotypically male (XY) | without DHT, masculinization of the external genitalia cannot occur. | - at adolescence; large volumes of testosterone produced by fully grown intraabdominal or inguinal testes ---> virilization of the female genitalia and the development of male secondary sexual characteristics |
| Neurofibromatosis type 1 | - mutation of NF1 tumor suppressor gene on chromosome 17. | - café-au-lait spots, - Lisch nodules (pigmented iris hamartomas), | - neurofibromas (benign peripheral nerve sheath tumors) - optic pathway gliomas |
| A child with inspiratory stridor at rest, chest wall retractions, and diminished air movement . radiograph demonstrates the classic Steeple sign (indicating tracheal narrowing) | - Laryngotracheitis, Laryngotracheobronchitis - inflammation of the larynx and trachea, - parainfluenza virus. | - small children six months to three years of age during winter months. | - hoarseness, - barking cough, - inspiratory stridor, - a steeple sign on x-ray. |
| RX for Croup | - epinephrine, | - oral/parenteral glucocorticoids (usually dexamethasone) | |
| A girl presents with progressive bilateral limb ataxia and weakness, loss of deep tendon reflexes, pallhypesthesia, dysarthria, and skeletal deformities,. | - Friedreich's ataxia (FA) | - Inverted feet, - hammer toes ( hyperextension of the metatarsophalangeal joints due to atrophy of the intrinsic muscles of the foot.) - kyphoscoliosis | |
| fragile X syndrome | Mitral valve prolapse (MVP) | - intellectual disability, - delayed language development, - long facies, large ears, | - macroorchidism, -hyperactivity. - hypermobility of their joints |
| First-line treatment of idiopathic central precocious puberty with elevated GnRH levels | GnRH agonists such as leuprolide or buserelin. | ||
| Sore throat and fever followed by a diffuse maculopapular rash, an erythematous tongue (strawberry tongue), and perioral pallor | scarlet fever. - Group A Streptococci (e.g., S. pyogenes | - erythematous, sandpaper-like rash. - RX ; penicillin | - complication ---Poststreptococcal glomerulonephritis - seen 10 - 30 days after initial infection |
| Poststreptococcal glomerulonephritis / Postinfectious glomerulonephritis | - post preceding infection - group A (beta-hemolytic) Streptococcus pyogenes | - caused by immune complex deposition - subsequent destruction of the glomeruli. - symptoms of nephritic syndrome (e.g., hypertension, edema, hematuria). | |
| low-grade fever, stuffy nose followed by a cough, signs of respiratory distress (tachypnea, nasal flaring, intercostal retractions, oxygen saturation of 92%) with expiratory wheezes in a child < 2 years old indicates? | severe bronchiolitis -Respiratory syncytial virus | RX; supportive. hospitalization is indicated in; - poorly feeding, - dehydrated, - respiratory distress. - signs of hypoxia (SaO2 of 92%) | -- monitor O2 status ---> supplemental oxygen, nebulized hypertonic saline. - If pt's SaO2 doesn't improve, CPAP / endotracheal intubation may be required. |
| parvovirus B19 in adults | - symmetric polyarthritis in the fingers, hands, knees, and ankles - while the rash can be absent. | RX is supportive, - analgesics and NSAIDs. | A short course of prednisone for parvovirus B19-associated arthritis. |
| Palivizumab | A monoclonal antibody against respiratory syncytial virus (RSV) F protein. | Used for RSV prophylaxis in high-risk infants < 2 years of age | (e.g., due to prematurity, heart and lung diseases, immunodeficiency). |
| a young pt presents with anterior knee pain that is worse with activity. is reproducible with extension against resistance. His x-ray shows a separated, sclerotic bone fragment cranial of the tibial tuberosity. | Osgood Schlatter disease. - due to inflammation and avascular necrosis. | Traction apophysitis of the tibial tubercle causes Osgood Schlatter disease, | RX; Mostly conservative (rest, ice, NSAIDs ) |
| Traction apophysitis | Irritation or inflammation of the apophysis, - the site on bone where a tendon inserts | (e.g., tibial tubercle inflammation | |
| young woman presents with hx of headaches, lightheadedness, and tinnitus with elevated blood pressure and concurrent cervical and abdominal bruits is suggestive of ? | fibromuscular dysplasia. | caused by stenosis of; - small and medium-sized arteries - result of proliferation of connective tissue and muscle fibers within the arterial vessel walls. | - ACE inhibitors.ARBS - Antiplatelet drugs (e.g., aspirin) for stroke prophylaxis is recommended in CFMD - Patients who are symptomatic: percutaneous transluminal angioplasty |
| Hypertension that is difficult to control, hypokalemia, and a significant increase in creatinine after adding an ACE inhibitor are suggestive of | renal artery stenosis. | - next best step in the management of this patient would be | duplex ultrasonography, - CT angiography, - or MR angiography with gadolinium contrast - to confirm the exact site of stenosis |
| Mitral stenosis (OPENING SNAP) | ---> elevated left atrial pressure ---> left atrial dilatation (resulting in atrial fibrillation) | --> increase in pulmonary arterial pressure to overcome the increased left heart pressure (pulmonary hypertension). | - pulmonary vascular remodeling --> increased pulmonary vascular resistance -->S2 split - right ventricular hypertrophy (as indicated by right axis deviation |
| patient presents with peripheral edema, anemia, increased creatinine and BUN, proteinuria, and hyperkalemia. . | - end-stage renal disease | - kidney biopsy findings; sclerosis in the capillary tufts and arterial hyalinosis | - microangiopathic anemia |
| Propranolol | - non-selective beta blocker | frequently used for migraine headache prophylaxis | |
| elderly patient has a wide pulse pressure with elevated systolic blood pressure and normal diastolic pressure. | decrease in arterial compliance secondary to reduced arterial elasticity and increased stiffness is a common occurrence in the elderly population (> 60 years). | ||
| DASH diet | diet rich in fruits, vegetables, whole grains, low-fat dairy foods | - also includes meat, fish, poultry, nuts and beans | |
| patient with hx of drug abuse presents with dyspnea, evidence of right-sided heart failure (peripheral edema, JVD, split S2), and pronounced central pulmonary arteries, all of which are strongly suggestive | pulmonary hypertension, - likely related to her history of drug use | Right heart catheterization Swan-Ganz catheter, Pulmonary artery catheterization | Diagnosis is made when the mean pulmonary artery pressure is ≥ 20 mm Hg at rest and underlying pulmonary and left heart conditions (e.g., valvular heart disease, systolic dysfunction, diastolic dysfunction) are excluded |
| iron deficiency anemia | Diagnostic - Iron studies | - decreased serum ferritin concentration, - decreased transferrin saturation, - increased total iron binding capacity | |
| Venous thrombosis | leading cause of mortality in PNH | Thrombosis occurs in atypical locations, such as hepatic veins (Budd-Chiari syndrome), portal veins, and cerebral veins (headaches, stroke) | free Hb released during hemolysis scavenges serum nitric oxide (a vasodilator) --activates endothelial lining of blood vessels, leading to vasoconstriction --> platelet aggregation --> venous thrombosis. |
| severely decreased hemoglobin with signs of hemolysis (jaundice, dark urine, ↑ reticulocytes, ↑ indirect bilirubin, ↑ LDH) | indicates hemolytic anemia. | ||
| Autoimmune hemolytic anemia | Hemolytic anemia in combination with circulating antibodies (positive direct Coombs test) | elevated erythropoietic activity -- nucleated RBCs -- polychromasia, | |
| Warm agglutinin disease Warm autoimmune hemolytic anemia | - caused by circulating IgG antibodies to erythrocytes | RX - glucocorticoids. - Refractory cases are treated with rituximab or splenectomy. | |
| Intravascular hemolysis | due to mechanical damage or complement fixation. | - decreased haptoglobin, - presence of schistocytes, | - urine hemosiderin/hemoglobin. (Dark urine) |
| The normal age of onset of puberty is | 9–14 years old in boys | and 8–13 years old in girls | |
| Salmonella typhi Rx | third-generation cephalosporin (e.g., ceftriaxone) / fluoroquinolone | ||
| management of Malignant hyperthermia | immediate discontinuation of volatile anesthetics | start dantrolene | Hyperventilation with 100% O2, and cooling measures (e.g., ice packs, cold IV fluid infusion, cold lavage) are also indicated. |
| pericardial knock is often heard on auscultation | constrictive pericarditis | high-pitched, early-diastolic sound that sounds like a premature S3. | |
| Increased levels of 17-hydroxyprogesterone | a physiological substrate for 21β-hydroxylase | confirms the diagnosis of 21β-hydroxylase enzyme deficiency | |
| Grade IV astrocytomas (glioblastomas) | highly malignant rapidly progressive brain tumors | nonspecific neurological symptoms such as - altered mental status - seizures - headaches - nausea that progress over days to weeks | |
| triglyceride levels exceed 1000 mg/dL /hypertriglyceridemia | can cause acute pancreatitis | ||
| Retrograde urethrography | test to assess for traumatic urethral injury in pts with gross hematuria & associated signs of a urethral injury | (e.g., blood at the urethral meatus, perineal hematoma) | |
| Retrograde cystography (or retrograde CT cystography) | used to diagnose bladder rupture | once urethral injury has been excluded (by retrograde urethrography / successful Foley catheter insertion) | |
| Prostate cancer | most common cause of osteoblastic bone metastases. | PSA is > | |
| elevated alkaline phosphatase, mixed hearing loss with normal serum calcium, PTH , & vit D levels | Paget disease of the bone. | Bisphosphonates | |
| Anterior uveitis | eye pain, redness, photophobia, | leukocytes in the anterior chamber of the eye. | rx; steroids |
| Primary hyperparathyroidism | > calcium < phosphate | gastrointestinal (nausea & vomiting) renal (nephrolithiasis) musculoskeletal (e.g, lower back pain) | psychiatric (depression, fatigue, anxiety, sleep disorders) and polyuria. |
| a medial popliteal mass disappears upon flexion of knee & during extension of the knee, the mass increases in size | popliteal cyst (Baker cyst). | Asymptomatic cysts do not require treatment. | rx for symptomatic; intra-articular injection of glucocorticoids Surgical resection for symptomatic cysts that persist |
| pt with CKD who missed dialysis has confusion, fatigue, & an increased risk of bleeding indicate | uremia. | increased risk of bleeding in uremia is due to platelet aggregation dysfunction | > bleeding time |
| cannabinoid hyperemesis syndrome (CHS) | cyclic episodes of colicky abdominal discomfort, nausea, and vomiting a patient with a hx of chronic cannabis us | ||
| Rx for traumatic / idiopathic facial paralysis. | corticosteroids | ||
| Seminoma | most common testicular germ cell tumor | almost exclusively occurs in adults | beta Hcg |
| erythroid colonies in epidural space on biopsy & widening of the diploic spaces in skull on imaging (with hair-on-end appearance) | extramedullary hematopoiesis. | Beta-thalassemia | |
| mass below the inguinal ligament | femoral hernia | painless groin swelling widened femoral ring | > risk in chronic cough weight |
| low albumin and low protein leads to | hypocalcemia | pt is often asymptomatic because unbound/ free Ca2+ is normal | |
| ECG findings of hypocalcemia | QT prolongation | ||
| maintenance fluid of choice in adults who are not eating | one - half normal saline with 5% dextrose | 10-20 MeQ of K+ is added | |
| first-line treatment for neuropathic pain (e.g., trigeminal neuralgia) | Carbamazepine | ||
| pt with incomitant hypertropia caused by weakness of a specific extraocular muscle | trochlear nerve damage | trochlear nerve innervates the superior oblique muscle (SOM), which is a depressor & intorter of the eye ball | one eye is deviated upwards (hypertropic) in comparison to the opposite eye. |
| pt has fever, malaise, tender abdomen with raised amylase & lipase, after an episode of acute pancreatitis that was previously treated | Pancreatic abscess | - walled-off collection of necrotic tissue - complex cystic fluid | |
| acute urinary tract obstruction (UTO) rx | Percutaneous nephrostomy -rapidly decompress renal collecting system, until a more definitive therapy for the renal stone can be performed | treat any UTI first | Once the UTI has been treated, shock wave lithotripsy / ureteroscopic removal of the stone to remove renal stones measuring more than 10 mm |
| multiple pseudofractures (Looser zones), bone pain & serum findings of low calcium, low phosphate, elevated PTH are highly suggestive of | osteomalacia | caused by vitamin D deficiency (most common) proximal tubular acidosis hypophosphatemia low oral calcium intake | |
| pt had a renal transplantation 8 months ago, has fatigue, weight loss, & hemoptysis in conjunction with a consolidated lung mass on x-ray, a parenchymal brain abscess on MRI, 7 weakly acid-fast, branching bacteria | nocardiosis. | TMP-SMX add amikacin in cases of brain abscess | |
| 1 hr old newborn with respiratory distress (e.g., tachypnea, cyanosis, hypoxemia). Symptoms improve with crying and worsens with feeding. | Bilateral choanal atresia | inability to pass a catheter through the nares. | oropharyngeal airway and orogastric tube should be placed temporarily to allow for breathing and feeding |
| C7 radiculopathy | ipsilateral pain or paresthesia of dorsal medial forearm up to the fingers II–IV & in palmar fingers II–IV | impaired function of triceps wrist flexor finger extensor muscles as well as a reduction in triceps reflex. | |
| hx of shoulder injury in a pt with progressive unilateral shoulder pain & stiffness who is otherwise physically active | adhesive capsulitis (frozen shoulder). | conservative measures; movement restriction NSAIDs physical therapy for shoulder range-of-motion exercises. | |
| Adolescent idiopathic scoliosis occurs in children 10–12 years of age | pain reduced mobility asymmetry of the shoulder blades, progressive respiratory compromise in severe scoliosis. | RX; - Cobb angle less than 20° managed with observation - between 20–29° can receive bracing, - angle 30–39° should receive bracing - angle > 40° referred for spinal fusion surgery | |
| edema, characteristic skin changes (hyperpigmentation, stasis dermatitis), and ulcers | Chronic venous insufficiency | ||
| a nonhealing ulcer in the setting of chronic venous insufficiency should raise suspicion for | Marjolin ulcer type of cutaneous squamous cell carcinoma (cSCC). | undergo a biopsy to rule out malignancy. | Rx; Wide surgical excision |
| Sudden onset unilateral conductive hearing loss, otalgia, and bleeding into the tympanic cavity during a flight suggest | middle ear barotrauma. | commonly develops during flights or while diving in patients with nasal congestion, | managed conservatively surgically if inner ear is involved |
| antibiotic for pts with human bites on the face, hands, tendons, or joints, that are deep, &/ the pt is immunocompromised | amoxicillin-clavulanate, 2nd or 3rd generation cephalosporin | ||
| Macrolides mainly affect | gram-positive cocci & intracellular pathogens such as mycoplasma, chlamydia, and legionella. |
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