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MEDICINE
STEP 2 UWORLD
| Question | Answer |
|---|---|
| Leukemoid reaction vs CML: Which has a higher LAP level? | Leukemoid reaction |
| What are the differences in labs btw Leukemoid reaction and CML? | Leukemoid reaction has higher LAP, higher neutrophil precursors (bands), and lack of basophilia |
| Leukemoid reaction vs CML: Which has no basophilia? | Leukemoid reaction |
| What is the common triad of Gonorrhea? | Tenosynovitis, polyarthralgia, and pustular lesions + purulent infection. |
| (+) or (-) synovial fluids in gonorrhea infection? | Negative blood and synovial fluid cultures |
| What medications are often associated with the development of physiologic tremor? | SSRIs and ß-agonists |
| How is medically induced physiologic tremor often treated? | Improves with dose reduction or drug cessation |
| What conditions do you have a (+) non-treponemal and (-) treponemal serology? | Pregnancy, IVDU, liver disease, HIV, and autoimmune conditions |
| Non-treponemal test --> | VDRL |
| Treponemal test --> | FTA-ABS |
| How is "human error" in a hospital setting decreased? | Designing system and workflow process that anticipate and correct human error |
| What type of hearing loss is due to chronic and excessive noise exposure? | Sensorineural hearing loss |
| Noise-induced hearing loss is described as: | Sensorineural hearing loss due to irreversible death of hair cells in the cochlea |
| ACA stroke will demonstrate: | Contralateral motor and sensory deficits |
| Which part of the frontal lobe is affected possibly in a stroke leading to urinary incontinence? | Frontal micturition center |
| What test or imaging result is required for DX of CAP? | CXR showing lobar, interstitial, or cavitary infiltrate |
| What is the initial lab to be check in secondary hemochromatosis deposition in the pituitary gland? | Ferritin levels |
| What is the best treatment option for secondary hemochromatosis? | Phlebotomy |
| How is DX of Parvo B19 infection done? | Detection of anti-parvovirus B19 IgM |
| How is Parvo B19 infection clinically presented? | Symmetric arthritis of the hands, knees, and ankle joints |
| What is Capnography? | Measurement of CO2 concentration over time |
| What is the most reliable measurement to asses proper Endotracheal tube placement? | Capnography |
| What are signs of IMPROPER Endotracheal tube (ETT) placement? | 1. Positioning tube in esophagus/stomach or, 2. Prolonged cardiac arrest |
| Why are SCD patients are higher risk for delayed hemolytic transfusion reactions? | Due to alloimmunization from frequent transfusions |
| What is the best test to DX or detect a hemolytic reaction? | Direct (+) Coombs test |
| How long after transfusion in SCD is the delayed hemolytic transfusion reaction seen? | >24 hours |
| What is the treatment or management of post-op incisional pain without any signs of infection or wound dehiscence? | Observation and reassurance |
| How is Amaurosis fugax clinically described? | Painless, rapid and transient monocular vision loss |
| What is the colloquial terminology used to describe the vision loss in Amaurosis fugax? | Curtain descending over visual field |
| What is the MCC of Amaurosis fugax? | Ischemia due to atherosclerotic emboli form the ipsilateral carotid artery |
| How is Amaurosis fugax best diagnosed? | Duplex U/S of the neck (carotid artery) |
| What is the best management option for persistent AFIB in unstable patient? | Immediate synchronized cardioversion |
| What lab is unique in Spherocytosis? | Elevated (↑↑↑) Mean Corpuscular Hb concentration (MCHC) |
| What is a common GI complication of Hereditary Spherocytosis? | Acute cholecystitis --> pigment stones |
| Carotid atherosclerotic disease in asymptomatic patient is only treated surgically when? | Stenosis > 50% |
| What are features of Esophageal pain that differs from Angina? | 1. Pain duration is > 1 hour 2. Young patients at rest without cardiac risk factors |
| What is Telogen Effluvium? | Acute, non-inflammatory hair loss due to strong stress events (illness, pregnancy, psychiatric trauma) |
| What should urgently be obtained in order to diagnose possible gout? | Synovial fluid to cell count, gram stain, and culture |
| Which fatal condition is often associated with isolated CN palsies? | Subarachnoid hemorrhage |
| Which artery often involves the aneurysm in isolated CN III palsy in SAH? | Posterior Communicating artery |
| Which populations are at increased risk for extensive, widespread infection of tinea species? | DM, chronic glucocorticoid users, or HIV (immunocompromised) |
| Which virus reactivation is often associated with the development of Bell palsy? | HSV |
| How does HSV reactivation cause Bell palsy? | Inflammation, edema, and degeneration of myelin sheath of CN VII |
| What is the DX test for a brain tumor? | MRI of the brain |
| S/S of a brain tumor often worse at night or day? | Night |
| What is the cause of dermatofibroma? | Fibroblast proliferation |
| How is dermatofibroma often described? | Non-tender, firm, hyperpigmented nodule of <1cm with a central dimple when pinched |
| How does a negative fluid balance help the recovery in ARDS? | ↓↓ formation of pulmonary edema --> accelerate (↑) recovery |
| What should be closely monitored in patients with non-sustained V-TACH episodes? | Electrolyte imbalances |
| What is a common and severe complication of small cell lung cancer? | SIADH |
| Is SIADH associated with hyper- or hypo-natremia? | Hyponatremia |
| What is the best initial TX for SIADH? | Fluid restriction |
| What is the most common neoplasm to metastasize to the brain? | Lung cancer |
| What are the MRI findings of brain metastasizes? | Multiple, well-circumscribed lesions with vasogenic edema at the gray-white matter juntion |
| Headache, focal neurologic deficits + MRI with lesions around the gray-white junction + no pulmonary symptoms. Dx? | Brain metastasis from lung cancer |
| Shingles is due to: | Reactivation of VZV from dorsal root ganglion |
| Why is shingles often missed diagnosed in the first few days of its reactivation? | The pain may present BEFORE the rash, making it difficult to diagnose |
| Dermatome rash + painful rash | Shingles |
| What is the gold standard test to DX a hemorrhagic stroke? | Urgent non-contrast CT scan of the head |
| What is a clinical clue for a hemorrhagic stroke? | Focal hemiparesis that rapidly progress with S/S of ↑ ICP |
| What angiopathy is associated with Alzheimer's disease? | Cerebral Amyloid angiopathy |
| What is the pathogenesis of Cerebral Amyloid angiopathy in Alzheimer's disease? | ß-amyloid deposition in the wall so small/medium cerebral arteries --> ↑↑ vessel fragility |
| What is the MC manifestation of cerebral amyloid angiopathy in Alzheimer disease? | Spontaneous, lobar intracranial hemorrhage |
| What is another name for Calcific Uremic Arteriolopathy? | Calciphylaxis |
| What is Calciphylaxis? | Systemic arteriolar calcification and soft-tissue Calcium deposition with local ischemia and necrosis |
| What are the R/Fs for Calciphylaxis? | Hyperparathyroidism, hyperphosphatemia, and hypercalcemia |
| What is the best lab to identify diabetic nephropathy? | Persisting albuminuria (>30 mg/g) and/or ↓GFR |
| What condition correlates with diabetic nephropathy? | Diabetic retinopathy |
| In case albuminuria levels cannot be detected in DM pt, how else can DM nephropathy be diagnosed? | Presence of retinopathy |
| What are the most common infectious agents causative of esophagitis in immunocompromised patient? | Candida albincans (MC), HSV, and CMV |
| How is Candida-esophagitis treated? | PO fluconazole |
| What is the best clue for candida-esophagitis? | Oral thrush, which should be empirically treated with PO Fluconazole |
| What is the purpose of Euthyroid Sick syndrome? | Serves to minimize catabolism in severe illness, while the body gets adapted to the new stressor |
| What are the initial findings of ESS? | Low T3 and normal T4/TSH levels, but as disease progresses the T4 and TSH levels also ↓↓↓ |
| What thyroid condition may be related to a "protective mechanism" against new illness? | Euthyroid Sick syndrome |
| What are the main findings is Chronic Venous Insufficiency (CVI)? | Leg edema +/- varicose veins +/- medial skin ulceration (especially the inner ankle) |
| What is the initial TX for CVI? | Conservative including: 1. Frequent leg elevation 2. Exercise 3. Compression therapy |
| What is the TX protocol in any patient with a STEMI? | Emergency cardiac catheterization and PCI |
| What neurons are affected in Huntington's disease? | Degeneration of GABA-producing neurons in the caudate nucleus and putamen |
| What is Mixed Cryoglobulinemia syndrome? | Small-vessel vasculitis that cause palpable purpuara, glomerulonephritis, arthralgias and peripheral neuropathy |
| What labs are associated with Cryoglobulinemia syndrome? | Cryoglobulins, Rheumatoid factor (RF), HYPO-complementemia, |
| Which infection is highly associated with Mixed Cryoglobulinemia syndrome? | HCV infection |
| At age is Bullous pemphigoid most commonly presented? | Over 60 years old |
| Pruritic, tense bullae preceded by a prodrome of eczematous or urticarial rash in a patients 65 years old. DX? | Bullous pemphigoid |
| What is the first line of treatment for BP? | High potency topical corticosteroids |
| What is a common high potency corticosteroid used in treatment of Bullous Pemphigoid? | Clobetasol |
| What is the main adverse effect of ACE-inhibitors? | Chronic cough |
| What is ARP? | Excess risk in the exposed population that can be attributed to the risk factor |
| How is ARP calculated? | (RR-1) ------- RR |
| What classical hx findings of Antiphospholipid syndrome? | Recurrent thromboembolism and/or recurrent fetal loss |
| What antibodies are diagnostic for antiphospholipid syndrome? | 1. Anticardiolipin antibody 2. ß2-glycoprotein-1 antibody |
| How is the PTT affected in Lupus Anticoagulant syndrome? | Prolonged PTT that does NOT correct with 1:1 dilution with normal serum |
| What is the TX for Thalassemia minor? | No treatment required |
| What is the primary difference between primary hyperparathyroidism and Familial Hypocalciuric hypercalcemia? | Primary hyperparathyroidism has increased urinary Calcium excretion |
| What is the suspected DX in any person with bronchodilator-responsive airflow obstruction? | Asthma |
| What change in FEV1 or FVC indicates an bronchodilator-responsive airflow obstruction? | ↑ 12% or more |
| What is the initial response/workup in incidental finding of a solitary pulmonary nodule? | Compare with old images (2-3 years ago) and review any changes |
| What is the main reason for infections in the 1st month in liver transplant patients? | Bacterial infections |
| What is the main type of infection etiology in months 1-6 after a liver transplant? | Opportunistic infections |
| What are the most common reasons for developing osteopenia, osteoporosis, and bone fractures in RA pts? | Medication effect and cytokine release |
| What is the treatment/follow up for Euthyroid Sick syndrome? | No TX required but test should be repeated following recovery of illness |
| What muscle condition may be due to prolonged immobilization due to ingestion of CNS depressant in AKI patient? | Rhabdomyolysis |
| Does a person with psychosis is automatically considered not able to make a decision? | No, if the patient regardless of psychosis understands the risk/benefits, then they are autonomous |
| What labs should be check prior starting MTX? | Liver studies |
| What lab or test should be checked prior starting DMARCs and/or TNF-inhibitors? | TB status |
| What are the parameters in age and CD4+ count that cause HIV-associated neurodegeneration? | Patients over 50 years of age with a CD4+ count < 200/mm3 |
| What does a CHAD2DS2-Vasc score of 0 indicate? | Low thrombus risk --> no additional therapy |
| Which pulmonary condition is highly associated with E. nodosum? | Sarcoidosis |
| How is Erythema nodosum described? | Painful, red/violaceous, subcutaneous nodules |
| What is the main CXR finding in Sarcoidosis? | Bilateral Hilar adenopathy |
| What is the direct effect of Estrogen on T4-biding globulins? | Increase (↑↑) of TIBG |
| What is the most common population affected by Sarcoidosis? | Young adults and African Americans |
| What is the systolic BP standard deviation for HTN? | 20 mmHg above average |
| What is the diastolic BP standard deviation for HTN? | 10 mmHg above average |
| What is the initial HTN treatment for a person with 20/10 mmHg increase in BP? | 1-drug antihypertensive |
| What is the initial HTN treatment for a person with 2 standard deviation above normal BP? | 2-drug antihypertensives |
| What is the history clue for suspecting RAS? | Recurrent Flash pulmonary edema |
| What is the clinical presentation of Cervical Spondylitis myelopathy? | Progressive neck pain, gait disturbance, LMN signs mostly in arms, and UMN lesions in legs |
| What sign is (+) in Cervical Spondylitis myeolopathy? | Lhermitte sign |
| What is the Lhermitte sign? | Electric shock-like sensation down the spine with forward flexion of the neck |
| What are clues for MM DX? | Older population with fatigue, CONSTIPATION, and depression |
| What electrolyte imbalance is seen in Multiple Myeloma? | Hypercalcemia |
| What causes the hypercalcemia in MM? | Osteolytic bone destruction |
| What is the best diagnostic test in suspected pancreatic caner with jaundice? | Abdominal ultrasound |
| Where is the MC location of pancreatic CA with jaundice? | Head of pancreas |
| What is the best diagnostic test in patient suspected of pancreatic cancer but no jaundice? | Abdominal CT scan |
| Which the MC location for pancreatic CA in pt with no jaundice? | Body and tail of pancreas |
| What is a common sound of acute HF? | S3 |
| What is an S3? | Low-pitch extra heart sound heard in early diastole, just after S2 |
| What creates S3 sound? | Blood filing an enlarged ventricle during passive diastolic filling (splash) |
| What indicates a severe S3 sound? | Decompensated HF with reduced ejection fraction |
| What are ways to reduce preload in HF in order to improve symptoms? | 1. IV diuretics (furosemide) 2. IV nitroglycerin |
| What is a therapy used to reduced afterload in decompensated HF patient? | IV nitroprusside |
| What is the MCC of end-organ complication in advance AIDS? | CMV retinitis |
| What are some clinical findings or features of CMV retinitis? | Blurred vision, FLOATERS, and photopsia |
| What are severe complication of CMV retinitis? | Vision loss and retinal detachment |
| What is the best treatment option for CMV retinitis? | Valganciclovir |
| How is a migraine described clinically? | Episodic; severe, unilateral, throbbing headache associated with photophobia, phonophobia, N/V + aura |
| What is contraindicated in women with migraines? | OCPs |
| Why are OCPs contraindicated in women with severe migraines? | ↑↑↑ risk for ischemic stroke |
| What is the morphologic description of Nocardia? | Filamentous, aerobic, gram (+) bacteria that is partially fast-acid |
| What is the TX for Nocardia infection? | TMP-SMX |
| What is caused by Nocardia? | Pulmonary or disseminated disease (especially in immunocompromised hosts) |
| What type of esophageal condition may be induced by strong emotional stress? | Diffuse esophageal spasm |
| What is the best test to diagnose an Esophageal motility disorder? | Manometry |
| What is the best technique to diffuse or minimize Implicit bias? | Small group debriefings |
| What is typical of Vasovagal syncope? | Last only 1-2 minutes and is preceded by a trigger and prodrome |
| How is Vasovagal syncope different from Conversion disorder? | The loss of consciousness in vasovagal is only 1-2 mins and conversion disorder is >5 mins |
| How is Glucocorticoid-indued myopathy presented? | Painless proximal muscle weakness mostly in the legs |
| Which myopathy is never seen with weakness? | Polymyalgia rheumatica |
| Which myopathy is never seen with pain? | Glucocorticoid-induced myopathy |
| Which myopathies are always seen with ↑↑↑ ESR? | Polymyalgia rheumatica >> poly-/dermatomyositis |
| Which are the 3 myopathies with elevated creatine kinase? | Polymyositis/Dermatomyositis Statin-induced myopathy Hypothyroid myopathy |
| Atrophy + legs most affected. Suspected myopathy? | Glucocorticoid-induced myopathy |
| Clinical features of Polymyalgia rheumatica? | Stiff shoulders and hips with restricted motion; co-exits with GCA; rapid improvement with steroids |
| Which myopathy is seen with delayed DTRs? | Hypothyroid myopathy |
| Which medications are avoided in treating delirium in older patients? | Benzodiazepines |
| What is the possible adverse effect seen in older patients on benzodiazepines that differs from a young patient? | Paradoxical effect leading to ↑agitation |
| What is the best reversal for Warfarin-induced hemorrhaging? | Prothrombin Complex Concentrate (PCC) |
| What is used to reverse effects of Heparin overdose? | Protamine sulfate |
| What is the second line to reverse bleeding due to Warfarin overdose? | FFP |
| What are the most common PO direct Xa inhibitors? | Rivaroxaban and Apixaban |
| Direct Xa inhibitors have a similar efficacy to --> | Warfarin |
| What are becoming the preferred agents for acute Venous Thromboembolism? | Direct Xa inhibitors |
| What re the common GI infectious agents, most often seen in immunodeficiencies? | Salmonella, Campylobacter |
| What common fungal infections are seen in patients with immunodeficiencies? | Candida and PCP |
| How is the diagnosis for CVID made? | Quantitative measurement of immunoglobulin levels |
| What is the MC age range of CVID? | 20-45 years old |
| What type of anemia (micro-/normo-/mega-) is seen in normal pregnancy? | Microcytic anemia with normal iron studies |
| What is the NBSM in pregnant woman with microcytic anemia and normal Fe2+ profile? | Evaluation for Hemoglobinopathy |
| What test is used to diagnose hemoglobinopathy most commonly? | Hb electrophoresis |
| What causes the permanent bronchial dilation in bronchiectasis? | Recurrent cycles of infection and inflammation |
| What are the hallmaark clinical featurs of bronchiectasis? | Copious thick sputum production, episodic hemoptysis, and recurrent exacerbations with mucopurulent sputum. |
| What is the CXR finding of Bronchiectasis? | Tram-track sign |
| What is the best way to DX bronchiectasis? | High resolution CT scan of the chest |
| Brief (<1min) loss of consciousness + emotional trigger + vagal prodrome. DX? | Vasovagal syncope |
| What is the NBSM in patients with confirmed Vasovagal syncope? | No further workup is needed if there are no EKG findings |
| What are the 3 main categories of Syncope? | Reflex, Orthostatic, and Cardiac syncope |
| What are the 3 main causes of Reflex syncope? | Vasovagal, Situational and Carotid hypersensitivity |
| What are the association with Vasovagal syncope? | Trigger (MC emotional), and prodrome |
| What are the associations for Situational syncope? | Occurs with urination, defecations, swallow, or cough |
| What are conditions that ↑↑ risk of Carotid hypersensitivity syncope? | Advance age and Carotid atherosclerosis |
| What is the etiology of Carotid hypersensitivity-induced syncope? | Tactile stimuli of carotid sinus while standing |
| Which sinus, aortic or carotid, is affected in carotid hypersensitive syncope? | Carotid sinus |
| What are the 3 main etiologies for Orthostatic syncope? | Medications, Hypovolemia, and Autonomic dysfunction |
| What are common drugs that cause Orthostatic syncope? | Vasodilators (α1-blockes, and anti-hypertensives ß-blockers |
| What conditions are often associated with development of autonomic dysfunction leading to Orthostatic syncope? | DM and Parkinson |
| What re the 2 main etiologies for Cardiac syncope? | LV outflow obstruction and Conduction impairment |
| What are common EKG findings in Cardiac syncope due to a conduction impairment? | Sinus pauses, dropped QRS complexes, and often preceded by a fatigue or light-headedness |
| What are common causes of cardiac syncope due to LV outflow obstruction? | Cardiomyopathy or ischemic heart disease. |
| B-cell neoplasm associates with ↑↑ monoclonal IgM | Waldenstrom Macroglobulinemia |
| What are some consequences of having high levels of IgM in Waldenstrom Macroglobulinemia? | Hyper-viscocity syndrome, peripheral neuropathy, cryoglobulinemia, and/or renal inssuficiency |
| What is a gamma gap? | Difference between total serum protein and serum albumin |
| What is the normal gamma gap range? | 2.0-3.9 g/dL |
| What is a therapeutic risk factor for SLE complications? | Long-term glucocorticoid use |
| How is osteonecrosis in SLE often presented? | Pain in groin, thigh, or buttocks that worsens with activity |
| What is the best test and most sensitive for Osteonecrosis in SLE? | MRI |
| Hepatic abscess + travel to poor country + Hx of bloody diarrhea. DX? | Entamoeba histolytica ifection |
| What is the best test for E. histolytica infection? | Serum testing |
| Why is chlamydia often not treated in many patients? | It is most common asymptomatic |
| What are the treatment options for Chlamydia trachomatis? | 1-time dose of azithromycin or Doxycycline for 7 days |
| What is the most common cause of recent and recurrent reinfection of chlamydia? | Current partner was not treated as well |
Created by:
rakomi
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