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Usmle 2 rapid review

usmle ck step 2

AnswerQuestion
"Sawtooth" P waves Classic ECG finding in atrial flutter.
Angina is new, is worsening, or occurs at rest Definition of unstable angina.
ACEI Antihypertensive for a diabetic patient with proteinuria.
Hypotension, distant heart sounds, and JVD Beck's triad for cardiac tamponade.
β-blockers, digoxin, calcium channel blockers Drugs that slow AV node transmission.
Niacin Hypercholesterolemia treatment that → flushing and pruritus.
Anticoagulation, rate control, cardioversion Treatment for atrial fibrillation.
Immediate cardioversion Treatment for ventricular fibrillation.
Dressler's syndrome: fever, pericarditis, ↑ ESR Autoimmune complication occurring 2–4 weeks post-MI.
Treat existing heart failure and replace the tricuspid valve IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Echocardiogram (showing thickened left ventricular wall and outflow obstruction) Diagnostic test for hypertrophic cardiomyopathy.
Pulsus paradoxus (seen in cardiac tamponade) A fall in systolic BP of > 10 mmHg with inspiration.
Low-voltage, diffuse ST-segment elevation Classic ECG findings in pericarditis.
BP > 140/90 on three separate occasions two weeks apart Definition of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism Eight surgically correctable causes of hypertension.
Abdominal ultrasound and CT Evaluation of a pulsatile abdominal mass and bruit.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured Indications for surgical repair of abdominal aortic aneurysm.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin Treatment for acute coronary syndrome.
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states What is the metabolic syndrome?
Exercise stress treadmill with ECG Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.
Pharmacologic stress test (e.g., dobutamine echo) Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.
Angina, ST-segment changes on ECG, or ↓ BP Signs of active ischemia during stress testing.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves ECG findings suggesting MI.
Prinzmetal's angina A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
CHF, shock, and altered mental status Common symptoms associated with silent MIs.
V/Q scan The diagnostic test for pulmonary embolism.
Protamine An agent that reverses the effects of heparin.
PT The coagulation parameter affected by warfarin.
Hypertrophic cardiomyopathy A young patient with a family history of sudden death collapses and dies while exercising.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after Endocarditis prophylaxis regimens.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia The 6 P's of ischemia due to peripheral vascular disease.
Stasis, hypercoagulability, endothelial damage Virchow's triad.
OCPs The most common cause of hypertension in young women.
Excessive EtOH The most common cause of hypertension in young men.
Seborrheic keratosis "Stuck-on" appearance.
Psoriasis Red plaques with silvery-white scales and sharp margins.
Basal cell carcinoma The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
Impetigo Honey-crusted lesions.
Cellulitis A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
Pemphigus vulgaris + Nikolsky's sign.
Bullous pemphigoid - Nikolsky's sign.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Varicella zoster Dermatomal distribution.
Lichen planus Flat-topped papules.
Erythema multiforme Iris-like target lesions.
Contact dermatitis A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Pityriasis rosea Presents with a herald patch, Christmas-tree pattern.
Alopecia areata (autoimmune process) A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Pityriasis versicolor Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance.
Asymmetry, border irregularity, color variation, large diameter Four characteristics of a nevus suggestive of melanoma.
Actinic keratosis Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Lesions of 1° varicella "Dewdrop on a rose petal."
Seborrheic dermatitis. Treat with antifungals "Cradle cap."
Acne vulgaris Associated with Propionibacterium acnes and changes in androgen levels.
Herpes simplex A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Lichen sclerosus Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Squamous cell carcinoma Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Hashimoto's thyroiditis The most common cause of hypothyroidism.
High TSH, low T4, antimicrosomal antibodies Lab findings in Hashimoto's thyroiditis.
Graves' disease Exophthalmos, pretibial myxedema, and ↓ TSH.
Iatrogenic steroid administration. The second most common cause is Cushing's disease The most common cause of Cushing's syndrome.
Hypoparathyroidism A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.
Signs and symptoms of hypercalcemia "Stones, bones, groans, psychiatric overtones."
1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.
Pheochromocytoma A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
α-antagonists (phentolamine and phenoxybenzamine) Should α- or β-antagonists be used first in treating pheochromocytoma?
Nephrogenic diabetes insipidus (DI) A patient with a history of lithium use presents with copious amounts of dilute urine.
Administration of DDAVP ↓ serum osmolality and free water restriction Treatment of central DI.
SIADH due to stress A postoperative patient with significant pain presents with hyponatremia and normal volume status.
Metformin An antidiabetic agent associated with lactic acidosis.
1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
< 7.0 Goal hemoglobin A1c for a patient with DM.
Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+) Treatment of DKA.
They can mask symptoms of hypoglycemia Why are β-blockers contraindicated in diabetics?
Observational bias Bias introduced into a study when a clinician is aware of the patient's treatment type.
Lead-time bias Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Confounding variable If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.
Sensitivity The number of true positives divided by the number of patients with the disease is _____.
Out Sensitive tests have few false negatives and are used to rule _____ a disease.
Highly sensitive for TB PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Higher prevalence Chronic diseases such as SLE—higher prevalence or incidence?
Higher incidence Epidemics such as influenza—higher prevalence or incidence?
Prevalence Cross-sectional survey—incidence or prevalence?
Incidence and prevalence Cohort study—incidence or prevalence?
Neither Case-control study—incidence or prevalence?
High reliability, low validity Describe a test that consistently gives identical results, but the results are wrong.
Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR Difference between a cohort and a case-control study.
The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed Attributable risk?
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed Relative risk?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed Odds ratio?
1 ÷ (rate in untreated group − rate in treated group) Number needed to treat?
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer In which patients do you initiate colorectal cancer screening early?
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths The most common cancer in men and the most common cause of death from cancer in men.
68%, 95.5%, 99.7% The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Number of live births per 1000 population Birth rate?
Number of live births per 1000 women 15–44 years of age Fertility rate?
Number of deaths per 1000 population Mortality rate?
Number of deaths from birth to 28 days per 1000 live births Neonatal mortality?
Number of deaths from 28 days to one year per 1000 live births Postnatal mortality?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality) Infant mortality?
Number of deaths from 20 weeks' gestation to birth per 1000 total births Fetal mortality?
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births Perinatal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births Maternal mortality?
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity True or false: Once patients sign a statement giving consent, they must continue treatment.
No. Parental consent is not necessary for the medical treatment of pregnant minors A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Conflict of interest A doctor refers a patient for an MRI at a facility he/she owns.
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs) Involuntary psychiatric hospitalization can be undertaken for which three reasons?
False. Withdrawing and withholding life are the same from an ethical standpoint True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care When can a physician refuse to continue treating a patient on the grounds of futility?
Treat immediately. Consent is implied in emergency situations An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse Conditions in which confidentiality must be overridden.
When treatment noncompliance represents a serious danger to public health (e.g., active TB) Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
Treat because the disease represents an immediate threat to the child's life. Then seek a court order A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
A patient's family cannot require that a doctor withhold information from the patient A son asks that his mother not be told about her recently discovered cancer.
Emergent laparotomy to repair perforated viscus, likely stomach Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Diverticulosis The most likely cause of acute lower GI bleed in patients > 40 years old.
HIDA scan Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Acute pancreatitis Sentinel loop on AXR.
Fat, female, fertile, forty, flatulent Risk factors for cholelithiasis.
Murphy's sign, seen in acute cholecystitis Inspiratory arrest during palpation of the RUQ.
Campylobacter Identify key organisms causing diarrhea: ■ Most common organism
Clostridium difficile Identify key organisms causing diarrhea: ■ Recent antibiotic use
Giardia Identify key organisms causing diarrhea: ■ Camping
ETEC Identify key organisms causing diarrhea: ■ Traveler's diarrhea
S. aureus Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise
E. coli O157:H7 Identify key organisms causing diarrhea: ■ Uncooked hamburgers
Bacillus cereus Identify key organisms causing diarrhea: ■ Fried rice
Salmonella Identify key organisms causing diarrhea: ■ Poultry/eggs
Vibrio, HAV Identify key organisms causing diarrhea: ■ Raw seafood
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC) Identify key organisms causing diarrhea: ■ AIDS
Yersinia Identify key organisms causing diarrhea: ■ Pseudoappendicitis
Crohn's disease A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.
Ulcerative colitis Inflammatory disease of the colon with ↑ risk of colon cancer.
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis Extraintestinal manifestations of IBD.
5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations Medical treatment for IBD.
Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture Difference between Mallory-Weiss and Boerhaave tears.
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis Charcot's triad.
Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis Reynolds' pentad.
↓ protein intake, lactulose, neomycin Medical treatment for hepatic encephalopathy.
Establish the ABCs First step in the management of a patient with acute GI bleed.
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7 A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
HBV immunoglobulin Post-HBV exposure treatment.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline Classic causes of drug-induced hepatitis.
Biliary tract obstruction A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Femoral hernia Hernia with highest risk of incarceration—indirect, direct, or femoral?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time" A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia Four causes of microcytic anemia.
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Sulfonamides, antimalarial drugs, fava beans Precipitants of hemolytic crisis in patients with G6PD deficiency.
Factor V Leiden mutation The most common inherited cause of hypercoagulability.
Hereditary spherocytosis The most common inherited hemolytic anemia.
Osmotic fragility test Diagnostic test for hereditary spherocytosis.
Diamond-Blackfan anemia Pure RBC aplasia.
Fanconi's anemia Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV Medications and viruses that → aplastic anemia.
Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels How to distinguish polycythemia vera from 2° polycythemia.
Pentad of TTP—"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities Thrombotic thrombocytopenic purpura (TTP) pentad?
Anemia, thrombocytopenia, and acute renal failure HUS triad?
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs Treatment for TTP.
Usually resolves spontaneously; may require IVIG and/or corticosteroids Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓. Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?
von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?
Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?
Hodgkin's lymphoma Reed-Sternberg cells
Non-Hodgkin's lymphoma A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
Anemia of chronic disease Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
Iron deficiency anemia Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.
Chronic lymphocytic leukemia (CLL) An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Blast crisis (fever, bone pain, splenomegaly, pancytopenia) A late, life-threatening complication of chronic myelogenous leukemia (CML).
Acute myelogenous leukemia (AML) Auer rods on blood smear.
M3 AML subtype associated with DIC.
↓ Ca2+ , ↑ K− , ↑ phosphate, ↑ uric acid Electrolyte changes in tumor lysis syndrome.
Retinoic acid Treatment for AML M3.
CML A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy Heinz bodies?
Glanzmann's thrombasthenia An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
Parvovirus B19 Virus associated with aplastic anemia in patients with sickle cell anemia.
O2, analgesia, hydration, and, if severe, transfusion A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
Iron overload; use deferoxamine A significant cause of morbidity in thalassemia patients. Treatment?
Infection, cancer, and autoimmune disease The three most common causes of fever of unknown origin (FUO).
Fever, pharyngeal erythema, tonsillar exudate, lack of cough Four signs and symptoms of streptococcal pharyngitis.
Postinfectious glomerulonephritis A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.
Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella Asplenic patients are particularly susceptible to these organisms.
105 bacteria/mL The number of bacterial culture on a clean-catch specimen to diagnose a UTI.
Pregnant women. Treat this group aggressively because of potential complications Which healthy population is susceptible to UTIs?
Coccidioidomycosis. Amphotericin B A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
1° syphilis Nonpainful chancre.
Rubella A "blueberry muffin" rash is characteristic of what congenital infection?
Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin Meningitis in neonates. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin Meningitis in infants. Causes? Treatment?
Check for ↑ ICP; look for papilledema What should always be done prior to LP?
Bacterial meningitis CSF findings: ■ Low glucose, PMN predominance
Aseptic (viral) meningitis CSF findings: ■ Normal glucose, lymphocytic predominance
Subarachnoid hemorrhage (SAH) CSF findings: ■ Numerous RBCs in serial CSF samples
MS CSF findings: ■ ↑ gamma globulins
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms Findings in 3° syphilis.
Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis Characteristics of 2° Lyme disease.
Mycoplasma Cold agglutinins.
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin) Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones Risk factors for pyelonephritis.
7–10 days Neutropenic nadir postchemotherapy.
Lesion of 1° Lyme disease Erythema migrans.
Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots Classic physical findings for endocarditis.
Parvovirus B19 Aplastic crisis in sickle cell disease.
Taenia solium (cysticercosis) Ring-enhancing brain lesion on CT with seizures
Actinomyces israelii Name the organism: ■ Branching rods in oral infection.
Haemophilus ducreyi Name the organism: ■ Painful chancroid.
Pasteurella multocida Name the organism: ■ Dog or cat bite.
Sporothrix schenckii Name the organism: ■ Gardener.
Toxoplasma gondii Name the organism: ■ Pregnant women with pets.
Neisseria meningitidis Name the organism: ■ Meningitis in adults.
Streptococcus pneumoniae Name the organism: ■ Meningitis in elderly.
Klebsiella Name the organism: ■ Alcoholic with pneumonia.
Klebsiella Name the organism: ■ "Currant jelly" sputum.
Pseudomonas Name the organism: ■ Infection in burn victims.
Pseudomonas Name the organism: ■ Osteomyelitis from foot wound puncture.
Salmonella Name the organism: ■ Osteomyelitis in a sickle cell patient.
Legionella pneumonia A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
Lyme disease, Ixodes tick, doxycycline A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, and how did he get it? Treatment?
S. aureus or S. epidermidis. A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
All-compartment fasciotomy for suspected compartment syndrome A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
Spinal stenosis Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
MCP and PIP joints; DIP joints are spared Joints in the hand affected in rheumatoid arthritis.
Osteoarthritis Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteogenesis imperfecta Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Suspect ankylosing spondylitis. Check HLA-B27 Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Pseudogout Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
Polymyalgia rheumatica An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.
Osgood-Schlatter disease An active 13-year-old boy has anterior knee pain. Diagnosis?
Distal radius (Colles' fracture) Bone is fractured in fall on outstretched hand.
Avascular necrosis Complication of scaphoid fracture.
Wrist drop, loss of thumb abduction Signs suggesting radial nerve damage with humeral fracture.
Duchenne muscular dystrophy A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Slipped capital femoral epiphyses. AP and frog-leg lateral view An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Multiple myeloma The most common 1° malignant tumor of bone.
Cluster headache Unilateral, severe periorbital headache with tearing and conjunctival erythema.
β-blockers, Ca2+ channel blockers, TCAs Prophylactic treatment for migraine.
Prolactinoma. Dopamine agonists (e.g., bromocriptine) The most common pituitary tumor. Treatment?
Broca's aphasia. Frontal lobe, left MCA distribution A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?
Trauma; the second most common is berry aneurysm The most common cause of SAH.
Subdural hematoma—bridging veins torn A crescent-shaped hyperdensity on CT that does not cross the midline.
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Elevated ICP, RBCs, xanthochromia CSF findings with SAH.
Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count) Albuminocytologic dissociation.
Normal Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Lung, breast, skin (melanoma), kidney, GI tract The most common 1° sources of metastases to the brain.
Absence seizures May be seen in children who are accused of inattention in class and confused with ADHD.
Headache The most frequent presentation of intracranial neoplasm.
Infection, febrile seizures, trauma, idiopathic The most common cause of seizures in children (2–10 years).
Trauma, alcohol withdrawal, brain tumor The most common cause of seizures in young adults (18–35 years).
IV benzodiazepine First-line medication for status epilepticus.
Wernicke's encephalopathy due to a deficiency of thiamine Confusion, confabulation, ophthalmoplegia, ataxia.
Seventy percent if the stenosis is symptomatic What % lesion is an indication for carotid endarterectomy?
Alzheimer's and multi-infarct The most common causes of dementia.
ALS Combined UMN and LMN disorder.
Parkinson's disease Rigidity and stiffness with resting tremor and masked facies.
Levodopa/carbidopa The mainstay of Parkinson's therapy.
IVIG or plasmapheresis Treatment for Guillain-Barré syndrome.
Huntington's disease Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma.
Neurofibromatosis 1 Café-au-lait spots on skin.
Klüver-Bucy syndrome (amygdala) Hyperphagia, hypersexuality, hyperorality, and hyperdocility.
Edrophonium Administer to a symptomatic patient to diagnose myasthenia gravis.
Placental abruption and placenta previa 1° causes of third-trimester bleeding.
Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination Classic ultrasound and gross appearance of complete hydatidiform mole.
46,XX Chromosomal pattern of a complete mole.
Partial mole Molar pregnancy containing fetal tissue.
Continuous, painful vaginal bleeding Symptoms of placental abruption.
Self-limited, painless vaginal bleeding Symptoms of placenta previa.
Never When should a vaginal exam be performed with suspected placenta previa?
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides Antibiotics with teratogenic effects.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis Shortest AP diameter of the pelvis.
Betamethasone or dexamethasone × 48 hours Medication given to accelerate fetal lung maturity.
Uterine atony The most common cause of postpartum hemorrhage.
Uterine massage; if that fails, give oxytocin Treatment for postpartum hemorrhage.
IV penicillin or ampicillin Typical antibiotics for group B streptococcus (GBS) prophylaxis.
Sheehan's syndrome (postpartum pituitary necrosis) A patient fails to lactate after an emergency C-section with marked blood loss.
Inevitable abortion Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Threatened abortion Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
β-hCG; the most common cause of amenorrhea is pregnancy The first test to perform when a woman presents with amenorrhea.
Menometrorrhagia Term for heavy bleeding during and between menstrual periods.
Asherman's syndrome Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D
Weight loss and OCPs Therapy for polycystic ovarian syndrome.
Clomiphene citrate Medication used to induce ovulation.
Endometrial biopsy Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation Indications for medical treatment of ectopic pregnancy.
OCPs, danazol, GnRH agonists Medical options for endometriosis.
"Chocolate cysts," powder burns Laparoscopic findings in endometriosis.
Ampulla of the oviduct The most common location for an ectopic pregnancy.
Ultrasound How to diagnose and follow a leiomyoma.
Regresses after menopause Natural history of a leiomyoma.
Trichomonas vaginitis A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.
Oral or topical metronidazole Treatment for bacterial vaginosis.
Intraductal papilloma The most common cause of bloody nipple discharge.
OCP and barrier contraception Contraceptive methods that protect against PID.
Endometrial or estrogen receptor–  breast cancer Unopposed estrogen is contraindicated in which cancers?
Consider Fitz-Hugh–Curtis syndrome A patient presents with recent PID with RUQ pain.
Paget's disease Breast malignancy presenting as itching, burning, and erosion of the nipple.
CA-125 and transvaginal ultrasound Annual screening for women with a strong family history of ovarian cancer.
Kegel exercises, estrogen, pessaries for stress incontinence A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence. A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
↑ serum FSH Lab values suggestive of menopause.
Endometriosis The most common cause of female infertility.
Colposcopy and endocervical curettage Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
Lobular carcinoma in situ Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.
Neuroblastoma Nontender abdominal mass associated with elevated VMA and HVA.
Esophageal atresia with distal TEF (85%). Unable to pass NG tube The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity Not contraindications to vaccination.
Ophthalmologic exam, CT, and MRI Tests to rule out shaken baby syndrome.
CF or Hirschsprung's disease A neonate has meconium ileus.
Duodenal atresia Bilious emesis within hours after the first feeding.
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Selective IgA deficiency The most common 1° immunodeficiency.
Febrile seizures (roseola infantum) An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms Acute-phase treatment for Kawasaki disease.
Phototherapy (mild) or exchange transfusion (severe) Treatment for mild and severe unconjugated hyperbilirubinemia.
Reye's syndrome Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
Suspect retinoblastoma A child has loss of red light reflex. Diagnosis?
HBV, DTaP, Hib, IPV, PCV Vaccinations at a six-month well-child visit.
Precocious puberty Tanner stage 3 in a six-year-old female.
RSV bronchiolitis Infection of small airways with epidemics in winter and spring.
Surfactant deficiency Cause of neonatal RDS.
Chronic granulomatous disease What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.
Wiskott-Aldrich syndrome What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.
Bruton's X-linked agammaglobulinemia What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.
Intussusception A condition associated with red "currant-jelly" stools.
Coarctation of the aorta A congenital heart disease that cause 2° hypertension.
Amoxicillin × 10 days First-line treatment for otitis media.
Parainfluenza virus type 1 The most common pathogen causing croup.
Kwashiorkor (protein malnutrition) A homeless child is small for his age and has peeling skin and a swollen belly.
Lesch-Nyhan syndrome (purine salvage problem with Defect in an X-linked syndrome with mental retardation,
HGPRTase deficiency) gout, self-mutilation, and choreoathetosis.
Patent ductus arteriosus (PDA) A newborn female has continuous "machinery murmur."
SSRIs First-line pharmacotherapy for depression.
MAOIs Antidepressants associated with hypertensive crisis.
Patient on dopamine antagonist Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.
Conversion disorder A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Displacement Name the defense mechanism: ■ A mother who is angry at her husband yells at her child.
Reaction formation Name the defense mechanism: ■ A pedophile enters a monastery.
Isolation Name the defense mechanism: ■ A woman calmly describes a grisly murder.
Regression Name the defense mechanism: ■ A hospitalized 10-year-old begins to wet his bed.
Neuroleptic malignant syndrome Life-threatening muscle rigidity, fever, and rhabdomyolysis.
Anorexia Amenorrhea, bradycardia, and abnormal body image in a young female.
Panic disorder A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.
Agranulocytosis The most serious side effect of clozapine.
Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms) A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
Weight gain, type 2 DM, QT prolongation Key side effects of atypical antipsychotics.
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Neuroleptics Medication to avoid in patients with a history of alcohol withdrawal seizures.
Conduct disorder A 13-year-old male has a history of theft, vandalism, and violence toward family pets.
Rett's disorder A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.
Acute mania. Start a mood stabilizer (e.g., lithium) A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
Malingering After a minor fender bender, a man wears a neck brace and requests permanent disability.
Factitious disorder (Munchausen syndrome) A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Substance abuse A patient continues to use cocaine after being in jail, losing his job, and not paying child support.
Phencyclidine hydrochloride (PCP) intoxication A violent patient has vertical and horizontal nystagmus.
Depersonalization disorder A woman who was abused as a child frequently feels outside of or detached from her body.
Frotteurism (a paraphilia) A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine) A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Dissociative fugue A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
Stasis, endothelial injury and hypercoagulability (Virchow's triad) Risk factors for DVT.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6 Criteria for exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis Causes of exudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy Causes of transudative effusion.
Fatigue and impending respiratory failure Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Sarcoidosis Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.
Obstructive pulmonary disease (e.g., asthma) PFT showing ↓ FEV1/FVC.
Restrictive pulmonary disease PFT showing ↑ FEV1/FVC.
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help Honeycomb pattern on CXR. Diagnosis? Treatment?
Radiation Treatment for SVC syndrome.
Inhaled β-agonists and inhaled corticosteroids Treatment for mild, persistent asthma.
Hypoxia and hypocarbia Acid-base disorder in pulmonary embolism.
Squamous cell carcinoma Non–small cell lung cancer (NSCLC) associated with hypercalcemia.
Small cell lung cancer (SCLC) Lung cancer associated with SIADH.
SCLC Lung cancer highly related to cigarette exposure.
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Immediate needle thoracostomy Treatment of tension pneumothorax.
Age > 45–50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins Characteristics favoring carcinoma in an isolated pulmonary nodule.
ARDS Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
Mycobacterium tuberculosis ↑ risk of what infection with silicosis?
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch Causes of hypoxemia.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing Classic CXR findings for pulmonary edema.
Type I (distal) RTA Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type II (proximal) RTA RTA associated with abnormal HCO3 − and rickets.
Type IV (distal) RTA RTA associated with aldosterone defect.
Hypernatremia "Doughy skin."
Cirrhosis, CHF, nephritic syndrome Differential of hypervolemic hyponatremia.
Hypocalcemia Chvostek's and Trousseau's signs.
Malignancy and hyperparathyroidism The most common causes of hypercalcemia.
Hypokalemia T-wave flattening and U waves.
Hyperkalemia Peaked T waves and widened QRS.
IV hydration and loop diuretics (furosemide) First-line treatment for moderate hypercalcemia.
Prerenal Type of ARF in a patient with FeNa < 1%.
Nephrolithiasis A 49-year-old male presents with acute-onset flank pain and hematuria.
Calcium oxalate The most common type of nephrolithiasis.
Cerebral berry aneurysms (AD PCKD) A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Nephritic syndrome Hematuria, hypertension, and oliguria.
Nephrotic syndrome Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.
Membranous glomerulonephritis The most common form of nephritic syndrome.
IgA nephropathy (Berger's disease) The most common form of glomerulonephritis.
Alport's syndrome Glomerulonephritis with deafness.
Wegener's granulomatosis and Goodpasture's syndrome Glomerulonephritis with hemoptysis.
Glomerulonephritis/nephritic syndrome Presence of red cell casts in urine sediment.
Allergic interstitial nephritis Eosinophils in urine sediment.
Nephrotic syndrome Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Uremic syndrome seen in patients with renal failure Drowsiness, asterixis, nausea, and a pericardial friction rub.
Wait, surgical resection, radiation and/or androgen suppression A 55-year-old man is diagnosed with prostate cancer. Treatment options?
DI Low urine specific gravity in the presence of high serum osmolality.
Fluid restriction, demeclocycline Treatment of SIADH?
Renal cell carcinoma (RCC) Hematuria, flank pain, and palpable flank mass.
Choriocarcinoma Testicular cancer associated with β-hCG, AFP.
Seminoma—a type of germ cell tumor The most common type of testicular cancer.
Transitional cell carcinoma The most common histology of bladder cancer.
Central pontine myelinolysis Complication of overly rapid correction of hyponatremia.
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation Salicylate ingestion → in what type of acid-base disorder?
Respiratory alkalosis Acid-base disturbance commonly seen in pregnant women.
DM, SLE, and amyloidosis Three systemic diseases → nephrotic syndrome.
RCC or other erythropoietin-producing tumor; evaluate with CT scan Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP) A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?
Antipsychotics (neuroleptic malignant syndrome) Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies Side effects of corticosteroids.
Benzodiazepines Treatment for DTs.
N-acetylcysteine Treatment for acetaminophen overdose.
Naloxone Treatment for opioid overdose.
Flumazenil Treatment for benzodiazepine overdose.
Dantrolene or bromocriptine Treatment for neuroleptic malignant syndrome.
Nitroprusside Treatment for malignant hypertension.
Rate control, rhythm conversion, and anticoagulation Treatment of AF.
Rate control with carotid massasge or other vagal stimulation Treatment of supraventricular tachycardia (SVT).
INH, penicillamine, hydralazine, procainamide Causes of drug-induced SLE.
B12 deficiency Macrocytic, megaloblastic anemia with neurologic symptoms.
Folate deficiency Macrocytic, megaloblastic anemia without neurologic symptoms.
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Bladder rupture or urethral injury Blood in the urethral meatus or high-riding prostate.
Retrograde cystourethrogram Test to rule out urethral injury.
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus Radiographic evidence of aortic disruption or dissection.
Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography) Radiographic indications for surgery in patients with acute abdomen.
Pseudomonas The most common organism in burn-related infections.
Parkland formula Method of calculating fluid repletion in burn patients.
50 cc/hour Acceptable urine output in a trauma patient.
30 cc/hour Acceptable urine output in a stable patient.
Third-degree heart block Cannon "a" waves.
Hypotension and bradycardia Signs of neurogenic shock.
Hypertension, bradycardia, and abnormal respirations Signs of ↑ ICP (Cushing's triad).
Hypovolemic shock ↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).
Cardiogenic shock ↓ CO, ↑ PCWP, ↑ PVR.
Septic or anaphylactic shock ↑ CO, ↓ PCWP, ↓ PVR.
Fluids and antibiotics Treatment of septic shock.
Identify cause; pressors (e.g., dobutamine) Treatment of cardiogenic shock.
Identify cause; fluid and blood repletion Treatment of hypovolemic shock.
Diphenhydramine or epinephrine 1:1000 Treatment of anaphylactic shock.
Continuous positive airway pressure Supportive treatment for ARDS.
A patient with chest trauma who was previously stable suddenly dies Signs of air embolism.
AP chest, AP/lateral C-spine, AP pelvis Trauma series.
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