Questions and Answers USMLE
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131 terms
Terms | Definitions |
|---|---|
 Unstable angina | - rest angina with duraton over 20 min, new onset angina, or increasing angina - UA and NSTEMI MI are part of the continuum of acute coronary syndrome in which plaque rupture and coronary thrombosis compromise blood flow - NSTEMI and Unstable angina are treated with medical managment (antiplatelet therapy, nitro, b-blockers, and morphine) and considered for revascularization! |
| HOCM Diagnositc criterias | Septum: ventricular wall thickness ration over 1.3 - asymmetric setpal wall thickening in Echo! |
| Which antiarrhythmica shows these advere effects: Confusion, Slurred Speach, Tremor and personality changes | Lidocaine |
| Adverse effects b-blockers | associated with depression, sexual adverse effects, sleep disurbance |
| Adverse effects SSRI: | sexual disfuncion and anxiety, GI symptoms |
| adverse Effects ACEIs: | hyperkalemia, renal failure, dry cough* |
| Cardiac Tamponade history / signs: | - Chest pain, fatique, psypnea - Becks triad: hypotension, distant heart sounds, distended neck veins - usually due to trauma; but can as well be due to myocardial rupture, pericaritis, tumor, hypothyreosis, cancer, aortic dissection. |
| First step management HOCM | Betablockers CCB second line |
| Effect of therapeutic Mg? | Decreases ca influx and reduces early afterpolarizations, therapuetic in torsade de pointes |
| Empiric management of pulsless electrical activity | Atropin, ephedrin, bicarbonate! Bicarbonate because it can be due to severe acidosis.. |
| Common adverse effect of alpha1blockage? | Orthostatic hypotension |
| Triad od AbdomAA rupture? | Abdominal pain, pulsatile abd mass, hypotension. |
| Murmur in mitral valve prolaps? | Late systolic apical murmur preceeded by a click |
| Indication for sodium bicarbonate? | Qrs widening over 100msec, ventricular arrhythmias, and hypotension -increase in pH plus increase in extracellular sodium! |
| Cushings Triad: | hypertension, bradycardia, irregular respirations - is suggestive of increased intracranial pressure* |
| Candesartan | ARB |
| herald patch | - erythematous, round, and clears centrally with a peripheral scale - in pytiriasis rosea - may be confused with erythema mirgans |
| pytiriasis rosea: | - may come with prodrome, headache, malaise or sore throat - mostly asymptomatic - herald patch, trunk and proximal extremities |
| syphilis rash | - secundary - palms and soles |
| Contact dermatitis | type IV, eczematous rash with pruritic papules, and crusting |
| Erythema infectiosum | - typicall "slapped cheek" rash - edematous, erythematous, plaques - Parvovirus B19 |
| Impetigo | - Staphylococci, epidermal infection - typically face and neck or extremities - rash with vesicular, honey-colored crusting - can be intensely pruritic |
| acanthosis nigrans: | - hyperpigmentated, thickened plaques - axillae, back of the neck, or hands - associated with diabetes or insulin resistance |
| Lichen planus: | 5 p's: purlpe, polygonal, pruritic, planar papules and Wickham's striae= grey white lines or dots seen on the surface - autoimmune - may be associated with hep C infection or drug exposure (including B-blockers, penicillamine, ACEIs..) - usually self-limited - systemic steroids or UV therapy |
| classic: pretibial erythematous tender nodules in young woman | erythema nodosum - inflammation of subcutaneous fat - associated with strep pharyngitis, hypersensitivity reaction to drugs, IBD, sacroidosis, tuberculosis -associated with morbus crohn |
| Acyclovir therapy in herpes | effective if initiated within 72h of infection! - ?? |
| actinic ceratosis / seborrhoic keratosis DD: | - AK has a erythematous base, and is brighter than SK - risk of development of Scamous cell carcinoma from AK - but risk is rather small |
| Typical postmenopausal women, itching anogenital region, white, wrinkleled labia | Lichen sclerosis - treat with topical steroids |
| Candidiasis efflorescense: | white lesions, pruritic with sorrounding erythematous mucosa, may be edematous. |
| Kallmanns syndrome | -x linked -GnRH synthesis disorder - amenorrhoe and pubertas tarda - associated with anosmie and hyposmie, color blindness |
| Endocrine adverse effect of amiodaron | Hypothyreosis - due to inhibiting producion of T3 |
| Sings of hypocalciemia | Chvostek sing: twiching of facial nerve due to palpation Troussaus sign: induced carpal spasm |
| Effect of hypomagnesiemia | Can make hypocalciemia by decreasing producion of PTH and decrease sensitivity to the hormone |
| Symptomatic treatment of hyperprolaktinemia | Dopamin to suppress Prolactin |
| Diabetes in children history | Poliuria, polydipsia, no weight gain and increased food intake |
| HLA association in DM 1 | HLA DR-3 |
| De quervain thyrioditis | - subacute granulomatous thyrioditis! - inflammation causes destrucion of follikels with effect of hyperthyreosis as long as in storeage |
| MEN I | pancreatic tumors, hyperparathyroidism, pituary adenoma (Prolactinoma), can be associated with Zoellinger Ellison (ulcers due to gastrinoma) |
| MEN IIA: | medullary thyroid cancer, pheochromocytoma, hyperparathyroidism |
| MEN IIB: | medullary thyroid cancer, pheochromosytoma, mucusal neuromas |
| which oral antidiabetic can make lethargy, seizure like episodes? | Sulfonyureas due to severe hypoglykemia |
| Effect of Metformin? | inhibits hepatic gluconeogenesis, increases peripheral sensitivity to insulin |
| Effect of alpha- Glucosidase inhibitors? | decrease intestinal absorption of carbohydrates |
| Somogyi effect | reactive hyperglycemia following hypoglycemia - can be due to high insulin intake at night, with hyperglykemia in ther morning |
| Compare regular insuline / Neutral protamine Hagegendorn NPH Insuline | NPH Insulin has longer peak action and longer overall duration (8h/ 20h) than regular insulin |
| Condition due to exogenous high cortisol intake | - Cushing syndrome, low ACTH, low free urinary cortisol |
| Anion Gap: | Sodium - (Chloride plus bicarbonate) = 8-12 |
| Hyperchloremic acidosis: | In patients with a normal anion gap the drop in HCO3− is compensated for almost completely by an increase in Cl− to maintain electroneutrality* |
| Examples for high anion gap acidosis | Ketoacidosis, Lactatacidosis, Renal failure (causes high anion gap acidosis by decreased acid excretion and decreased HCO3− reabsorption. Accumulation of sulfates, phosphates, urate, and hippurate accounts for the high anion gap) |
| Exapmles for normal anion gap acidosis | = called hyperchloremic acidosis Diarrhea, renal tubular acidosis (due to loss of HCO3-), Addisons disease (mineralocorticoid deficiency) |
| Example for low anion gap | Hypoalbuminemia: as Albunin vaues as a Aniona (is neg charged), and loss of it leads to retention of other Anions such as Chloride or HCO3-, can also lead to Alkalosis* |
| Propylthiouracil PTU | thioamide drug used to treat hyperthyroidism (including Graves' disease) by decreasing the amount of thyroid hormone produced by the thyroid gland.[2] Its notable side effects include a risk of agranulocytosis. On 3 June 2009, the FDA published an alert "notifying healthcare professionals of the risk of serious liver injury, including liver failure and death, with the use of propylthiouracil."[3] As a result, propylthiouracil is no longer recommended in non-pregnant adults and in children as the front line antithyroid medication |
| Treatment Dequervain, subacute thyroiditis | NSAR like Ibuprofen |
| Lab findings in polycystic ovarian syndrome: | low FSH, high LH, high Estrogen |
| Metformin, advantage, adverse effects`? | - Does not lead to weight gain :-), can make weigh loss - can make lactate acidosis :-(*****, especially in patient with liver, renal failure, heart disease, - gastrointestinal upset :-( |
| First line treatment hyperprolactinemia, Prolactinoma? | Bromocriptine (a dopamine agonist) , can decrease prolactin secretion and size of tumor** |
| Effect of Rosaglitazone | is a thiazolidinedione and acts by increasing tissue insulin sensitivity |
| DM type 2 Dg: | finding on two seperate occasions of a fasting blood glucose level of 126 or higher (can be different) |
| First step managment in palpated nodule | TSH in serum |
| Managmant in nodule with low TSH? | radionucleide scan to determine wheter the nodule is hot or cold |
| Managment in nodule with normal TSH? | always fine needle aspiration* - if neg, make radionucleide scan |
| Secondary Hyperparathyroidism Cause, findings? | - caused by chronic renal disease - diminished ability to excrete phosphate leads to hyperphosphatemia. - excess phosphate binds to calcium causing hypocalcemia - Parathyroids reacts with hyperplasia - Lab shows: low calcium, high phosphate, elevated creatinine, high PTH |
| Secondary hypoadrenalism: History / DEF | - due to corticosteroid intake - may become unable to mount an appropriate response to ACTH - S: renal failure, hypotension, hyponatriemia |
| Secondary hypoadrenalism: Treatment: | restart steroids and gradually tapering off |
| a-Glucosidase inhibitors adverse effect common: | -reduce the amount of carbohydrates absorbed from the intestine -GI upset and flatulence |
| Managment of Papillary Thyroid-Ca in a Pregnant woman: | - until the second trimester hemithyroidektomy - in the third trimester wait and monitor* |
| IGF-1 / GH First Step: | always IGF-1 first because GH is secreted in a pulsatile manner and is difficult to measure. |
| Signs of hypocalcemia: | weakness, dry skin, patchy alopecia, circumoral numbness, paresthesias, Chvosteck sign, Troussaud sing, cataracts, myocardial dysfunction, osteomalazia and seizures |
| Hypomagnesiemia pathophysiology: | -reabsorbed in the loop of Henle - lack of magnesium inhibits PTH and causes Hypocalciemia and Hypoparathyroidism - magnesium closes potassium channels (K), thats why you cant keep the potassium if you havent enough magnesium - Release of calcium from the sarcoplasmic reticulum is inhibited by magnesium. Low levels of magnesium stimulate the release of calcium and thereby an intracellular level of calcium |
| Treatment of ketoacidosis: | - give insulin - give Potassium (K) (because Insulin thrives K from extra to intracellular) - monitor magnesium (because mg is needed to keep the potassium or use it )* |
| First-first Step managment in Peochromocytoma: | Give Prazosin= alpha adrenergic blocker to control hypertension** - later you can give Beta-blocker... whatever... |
| Di George Syndrome: | deletion of chromosome 22q11 - abnormal facies, cleft palate, - congenital heart defects (e.g fallots) - parathyroid hypoplasia with hypocalcemia - tetany, frequent infections with fungus or p. jirovecii - measure serum Ca2+!! |
| Carcinoid Syndrome: | - increased levels of urine 5-HIAA are a byproduct of serotonin metabolism - often affects the righ heart valves (right heart failure), murmur - Flushing of the skin, Diarrhea, Hypotension! |
| Neuroblastoma: | -tumors of the neural crest often occur in young children - associated with hirschsprungs disease and Neurofibromatosis - associated with elevated levels of urinary catecholamine levels = vanillylmandelic acid! |
| Nicain B3 Deficiency | pellagra: B3 think 3D - dermatitis, diarrhea, dementia |
| Budd-Chiari syndrome: Def and Therapy | - secondary hepatic vein thrombosis typically associated with hypercoagulabe states such as PCV or Malignancy - causing portal hypertension - spyder- web collaterals in US - RUQ pain, hepatomegaly and ascites - Therapy is thrombolysis followed by anticoagulation, and TIPS (shunt) |
| medial treatmend for portal hypertension? | B-blockers |
| Med treatment for hepatic encephalopathy? | Lactulose |
| M. Wilson | - copper acumulation in multiple organs (brain and liver) - Basal ganglina dysfuction and hemolytic anemia - liver cirrhosis with portal hypertension (needs upper endoscopy to look for varices) |
| Gastritis type B: | - antral-dominant (antrum) - chronic gastritis - use uf NSAR - Infection with H. pylorii |
| Gastritis type A: | - affects the fundus - autoimmune type - associated with Vit B12 Deficiency (intrinsic factor), pernizious anemia (Megaloblastic anemia) |
| H. Pylorii Gastritis Therapy? | Trippe Therapy: - Metronidazole and Clarithromycin - Bismuth - PPI |
| H. Pylorii Gastritis Diagnosis: | - positive H. pylorii antibody test - breath urea test - gastric biopsy and culture |
| chronic pancreatitis: | - atrophic calcificated pancreas - exocrine insufficiency lead to malabsorption and fatty stools and diarrhea, fould smelling - needs enzyme replacement |
| Schilling test: | radioative Vit B12 is given to measure the GI ability to absorb it - in Megaloblastic anemia such as pernizious anemia |
| Carcinoid tumors: rule of thrid | 1/3 metastazize, 1/3 accompagnied by second malignancy, 1/3 present with multiple carcinoid tumors - often in the appendix - often in the right heart |
| Plummer Vinsion syndrome: | Iron deficiency anemia and dysphagia due to upper esophageal webs, - idiopathic |
| Mallory-Weiss Syndrome: | oesophageal tear due to heavy vomiting** - cause of upper GI bleeding - endoscopic diagnosis |
| Achalasia: | - birds beak appearance in barium swollow - dysphagia of fluid and solid - non functioning oseophagus sphinkter |
| gastric MALT Lymphoma: | 95% of gastric MALT lypmhoma are associated with H. pylorii infection - majority of cases achieve remission with simple antibiotic eradication :-O |
| Hirschsprungs disease: | dilated proximal bowel, - delayed mekonium and abdominal distensio - pass mecoium after rectal stimulation |
| NEK: Treatmet | necrotyzing enterocolitis. very common in neborn - make bowel rest, stop feeding, nasogastric tube |
| Acute mesenteric ischemia: | - common in elderly with atherosclerothic disease - abdominal angina symptoms: few hours, postprandial - bloody diarrhea - bowel may become gangrenous with fluid and protein leaking trough the damaged mukosa causing shock and metabolic acidosis. |
| Schönlein-Hennoch Classic tetrad / signs: | - pruritic rash, arthralgias (aches and pain), abdominal pain, and glomerular renal involvement - common in children - asscociated with intussception (and other GI compl) |
| Intussception: | - invagination of the intestine: - nausea vomiting rectal bleeding - dance sign - associated with Schonlein-Hennooch |
| Hemochromatosis: signs: History | Dg of H. should be suspected when a patient presents with - diabetes, hepatomegaly, skin pigmentation, arthritis and hypogonadism |
| Which Colon polyps carry the highest risk of malignancy? | Villious Adenoma (large, broad based polyp) |
| Colon-CA Surgery / Indication for abdominoperineal resection? | - if the lesion is under 10cm from the anal verge, its not possible to preserve the anal sphinkter - resection of the rectum and anus with placement of permanent colostomy |
| Gram-negatice rods on gram stain | E. coli |
| Oesophagusspasms / Nutcracker O. / DD: | - both are characterized by odynophagia and dysphagia of solids and liquids - Globus feeling - Oesophagusspams: Nitro can releave symptoms, manometry shows uncoordinated contractions (can be treated with moytomy) - Nutcracker O. makes continous, cordinated contractions on manometry (can not be treated with myotomy), Nitro? |
| Crohns Disease complications: | small bowel obstruction is most common indication of surgery in Crohns |
| Achalasia: | - neuronal deficit to relaxate oesophagus sphinkter - Dysphagia of solid and liquids - birds peak on barium swallow - Treatement: pneumatic dilatation work in 80-90%, botox, anticholinergic agents, CCB |
| Hemochromatosis: compl / Diagnosis: | - coagulopathy, hepatocellular carcinoma, liver cirrhosis - Dg: is confirmed by Perls Prussian blue stain of liver biopsy |
| Acute pancreatitis: | -presents as acute epigastric pain, radiating to the back - often in alkis - nausea, emesis, fever - Dg: amylase,lipase, CT - Treatment: food restriction, fluid resuscitation |
| Meconium Ileus: | -nearly pathognomonic for cystic fibrosis - or less commonly volvulus - resulting in pancreatic insufficiency, which causes mekonium to become maculaginous and viscid, sticking to the walls. |
| Gallstone Illeus: | rare complication of cholelithiasis and occurs when a gallstone enters the bowel through a biliary-enteric fistula and creates an obstruction - DG: Rx, CT |
| Partia small bowel obstruction Treatment: | - nasogastric tube suction - intravenous hydration, correction of electrolytes - nothing to mouth |
| Complete small bowel obstruction: Signs / Treatment: | - present with vomiting, crampy abdominal pain with of without passage of feces or flatus since 12-24h Surgery is appropriate for: - complete small bowel obstruction - small bowel obstruction with vascular compromise such as necrotic bowel - or symptoms lasting at least 3 days without resolution! |
| Treatment of acute Mesenteric Ischemia: | - i.v. fluids, Heparin, Antibiotics - no Warfarin start!! - Exploratory laparatomy, with resection of nonviable bowel! |
| 2 year old Child, mucous, bloody diarrhea, normal emesis, abdomina pain ? | Intussusception mostly idiopathic, most common abdominal emergency in children under 2 years - cause mucosal bleeding with mucus (currant-jelly stools) - episodes typically last 15-20 min |
| Children under 2y bowel obstruction most common , second most common: | - 1. pylorusstenosis - 2. intussusception |
| Routine colonoscopy repeat time? | - normal each 10 y - if multiple large lesion removed return in 3 y |
| Watery, non bloody diarrhea with cramping in patients who reveive antibiotics think: ? | Pseudomembranous colitis and Clostridium difficile: - especially with cephalosporins, ampicillin / amoxicillin and clindamycin!! - kill normal bac flora - C. difficile has 2 toxins: 1 Enterotoxin A and a Cytotoxin B! - Treat with cease of antibiotic therpy or start Metronidazol or Vancomycin! |
| VACTERL | vertebral, anorectal, cardiovascular, tracheal, esophageal, renal and limp abnormalities - often occur with TEF (tracheoosesophageal fistula) and EA (esophageal atresia) |
| Hepatic Encaphalopathy Therapy: | - disturbed intellectual function, consciousness and neuromuscular function - Reduce protein consumption, give lactulose and metronidazole (spontan bak periton???) |
| 4 F's of Cholelithiasis: | Fat, Fourty, Female, Fertile |
| lactose intolerance | -common in Asians - short duration of watery diarrhea, flatulence after eating icecream or mikl - resolve after eg 1d |
| hairy cell leukemia | rare malignancy of B-lymphocytes - male predominance - presents with pancytopenia!! (hallmark) - fatique bruising infections - spleen shows hairy cell lymphocytes with cytoplasmatic projections |
| Why does Warfarin cause a hypercoagulable state the first 3 days of administration? | - 9, 10, 7, 2, C, S are Vit K dependent factors - due to a lower half-lives of C, S than the coagulation factors |
| HIT | - heparine induced thrombocytopenia - commonly occurs 4-10 day after initiation of unfractioned heparin - HIT is associated with thrombosis!!! due to platelet activation rather than bleeding - because platelet count is over 20'000 bleeding is rarely seen - presence of platelet antibodies which cause limb- and life-threatening thrombosis, in artheries too. - first intervention is immediate cessation of heparin! and initiation of a direct thrombin inhibitor. (Lepirudin) |
| Posttransplant lymphoproliferative disorder PTLD | - any patient who is chronically immunosuppressed is at risk to develop a lymphoproliferative malignancy!!! - cardiac transplant (4.6% risk), liver (3.0%), kidney (1.0%) - PTLDs generally occur in extranodal locations and may respond completely to reduction in immunosuppression - most PTLDs are related to EBV infection so Therapy with Acyclovir has shown to be able to resolute malignancy too |
| Brown / redish urine with gastrointestinal distress and neurological symptoms (seizures) following ingestion of alcohol or/ and barbiturate? | Acute intermittend porphyria: - severe autosomal dominant form of porphyria with results as a partial deficiency of porphobilinogen deaminsase activity - attacks can be triggered by stress, alcohol, premenstrual period, and consumption of drug who are CY P 450 iducers, like barbiturate |
| Cutaneous T-lymphocyte lymphoma CTCL | - mycosis fungoides, - makes Paultries abcess due to epidermal cluster of atypical lymphocytes - indolent - men, mid thirty - progress from: patch phase, plaque phase, cutaneous tumor, leonine facies - Sezary syndrome is mucosis fungoides with systemic illness, erythroderma and presece of atypical T-lymphocytes in blood! |
| Treatment of seminoma: | - Stage I and IIA orchidectomy and irration of the retroperitoneum - Stage IIB and III orchidectomy and radiation therapy |
| Courvoisiers sign : | palpable nontender gallbladder, result of common bile duct obstruction and compression by pancreatic adenocarcinoma at the head of the pancreas! |
| Hemophilia A and B, Factors involved, PT, aPTT? | - Hemophilia A: factor 8!! - Hemophilia B factor 9!! - Hemophilia C factor 11 - prolonged aPTT - PT, bleeding time, platelet count normal! - because are they are intrinsic cascade (8,9,10,11,12,5,2) |
| Infections post bone marrow transplant Day 7 ? | - fungal infections such as Candida and Aspergillus whats the dillio mann |
| Infections post bone marrow transplant Day 20-30 (1-3 weeks)? | bacterial infections - susceptible to aerobic bacteria found in the gut or the skin - Staph aureus (up to 3 weeks) - gram neg bacteriemia such as Escherischia coli, Pseudomonas, Klebsiella - Herpes simplex virus risk highest at 2 weeks following transplant (severe mucositis) |
| Euvoleme hyponatriemia with Lung cancer, wich type of lung cancer? | - SCLC! - a paraneoplastic syndrome in this kind of tumor with syndrome of innapropriate ADH secretion (SIADH) - diagnosis is set with: hyponatremia, urines osmolarity over 50-100, and urine sodium over 20 |
| Which type of lung cancer can make hypercacliemia? | Squamous cell carcinoma, due to paraneoplastic syndrome and PTHrP |
| Renal failure and Bence Jones Proteins? | Multiple Myeloma |
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