Step 2 CK First Aid Rapid Review

346 terms by m_s_c

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Classic ECG finding in atrial flutter.

"Sawtooth" P waves.

Definition of unstable angina.

Angina is new, is worsening, or occurs at rest.

Antihypertensive for a diabetic patient with proteinuria.

ACEI.

Beck's triad for cardiac tamponade.

Hypotension, distant heart sounds, and JVD.

Drugs that slow AV node transmission.

β-blockers, digoxin, calcium channel blockers.

Hypercholesterolemia treatment that leads to flushing and pruritus.

Niacin.

Murmur—hypertrophic obstructive cardiomyopathy (HOCM).

Systolic ejection murmur heard along the lateral sternal border that ↑ with Valsalva maneuver and standing.

Murmur—aortic insufficiency.

Diastolic, decrescendo, high-pitched, blowing murmur that is best heard sitting up; ↑ with ↓ preload (handgrip maneuver).

Murmur—aortic stenosis.

Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ preload (Valsalva maneuver).

Murmur—mitral regurgitation.

Holosystolic murmur that radiates to the axillae or carotids.

Murmur—mitral stenosis.

Diastolic, mid- to late, low-pitched murmur.

Treatment for atrial fibrillation and atrial flutter.

If unstable, cardiovert. If stable or chronic, rate control with calcium channel blockers or β-blockers.

Treatment for ventricular fibrillation.

Immediate cardioversion.

Autoimmune complication occurring 2-4 weeks post-MI.

Dressler's syndrome: fever, pericarditis, ↑ ESR.

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

Treat existing heart failure and replace the tricuspid valve.

Diagnostic test for hypertrophic cardiomyopathy.

Echocardiogram (showing thickened left ventricular wall and outflow obstruction).

A fall in systolic BP of > 10 mmHg with inspiration.

Pulsus paradoxus (seen in cardiac tamponade).

Classic ECG findings in pericarditis.

Low-voltage, diffuse ST-segment elevation.

Definition of hypertension.

BP > 140/90 on three separate occasions two weeks apart.

Eight surgically correctable causes of hypertension.

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.

Evaluation of a pulsatile abdominal mass and bruit.

Abdominal ultrasound and CT.

Indications for surgical repair of abdominal aortic aneurysm.

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured.

Treatment for acute coronary syndrome.

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin.

What is metabolic syndrome?

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.

Target LDL in a patient with diabetes.

< 70.

Signs of active ischemia during stress testing.

Angina, ST-segment changes on ECG, or ↓ BP.

ECG findings suggesting MI.

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves.

Coronary territories in MI.

Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal).

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

Prinzmetal's angina.

Common symptoms associated with silent Mls.

CHF, shock, and altered mental status.

The diagnostic test for pulmonary embolism.

V/Q scan.

An agent that reverses the effects of heparin.

Protamine.

The coagulation parameter affected by warfarin.

PT.

A young patient with a family history of sudden death collapses and dies while exercising.

Hypertrophic cardiomyopathy.

Endocarditis prophylaxis regimens.

Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after.

The 6 P's of ischemia due to peripheral vascular disease.

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia.

Virchow's triad.

Stasis, hypercoagulability, endothelial damage.

The most common cause of hypertension in young women. The most common cause of hypertension in young men.

OCPs. Excessive EtOH.

"Stuck-on" appearance.

Seborrheic keratosis.

Red plaques with silvery-white scales and sharp margins.

Psoriasis.

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

Basal cell carcinoma.

Honey-crusted lesions.

Impetigo.

A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

Cellulitis.

Pos Nikolsky's sign.

Pemphigus vulgaris.

Neg Nikolsky's sign.

Bullous pemphigoid.

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

Acanthosis nigricans. Check fasting blood glucose to rule out diabetes.

Dermatomal distribution.

Varicella zoster.

Flat-topped papules.

Lichen planus.

Iris-like target lesions.

Erythema multiforme.

A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

Contact dermatitis.

Presents with a herald patch, Christmas-tree pattern.

Pityriasis rosea.

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

Alopecia areata (an autoimmune process).

Pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-meatballs" appearance.

Pityriasis versicolor.

Four characteristics of a nevus suggestive of melanoma.

Asymmetry, border irregularity, color variation, and large diameter.

A premalignant lesion from sun exposure that can lead to squamous cell carcinoma.

Actinic keratosis.

"Dewdrops on a rose petal."

Lesions of 1° varicella.

"Cradle cap."

Seborrheic dermatitis. Treat with antifungals.

Associated with Propionibacterium acnes and changes in androgen levels.

Acne vulgaris.

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

Herpes simplex.

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

Lichen sclerosus.

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

Squamous cell carcinoma.

The most common cause of hypothyroidism.

Hashimoto's thyroiditis.

Lab findings in Hashimoto's thyroiditis.

High TSH, low T4, antimicrosomal antibodies.

Exophthalmos, pretibial myxedema, and ↓ TSH.

Graves' disease.

The most common cause of Cushing's syndrome.

Iatrogenic corticosteroid administration. The second most common cause is Cushing's disease.

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

Hypoparathyroidism.

"Stones, bones, groans, psychiatric overtones."

Signs and symptoms of hypercalcemia.

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis.

1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia).

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

Pheochromocytoma.

Should α- or β-antagonists be used first in treating pheochromocytoma?

α-antagonists (phentolamine and phenoxybenzamine).

A patient with a history of lithium use presents with copious amounts of dilute urine.

Nephrogenic diabetes insipidus (DI).

Treatment of central DI.

Administration of DDAVP ↓ serum osmolality and free water restriction.

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

SIADH due to stress.

An antidiabetic agent associated with lactic acidosis.

Metformin.

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids.

Goal HbA1c for a patient with DM.

< 7.0.

Treatment of DKA.

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+).

Why are β-blockers contraindicated in diabetics?

They can mask symptoms of hypoglycemia.

A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

Emergent laparotomy to repair perforated viscus.

The most likely cause of acute lower GI bleed in patients > 40 years of age.

Diverticulosis.

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

HIDA scan.

Risk factors for cholelithiasis.

Fat, female, fertile, forty, flatulent.

Inspiratory arrest during palpation of the RUQ.

Murphy's sign, seen in acute cholecystitis.

The most common cause of SBO in patients with no history of abdominal surgery.

Hernia.

The most common cause of SBO in patients with a history of abdominal surgery.

Adhesions.

A 25-year-old Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

Crohn's disease.

Inflammatory disease of the colon with ↑ risk of colon cancer.

Ulcerative colitis (greater risk than Crohn's).

Extraintestinal manifestations of IBD.

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis.

Medical treatment for IBD.

5-ASA agents and steroids during acute exacerbations.

Difference between Mallory-Weiss and Boerhaave tears.

Mallory-Weiss—superficial tear in the esophageal mucosa; Boerhaave—full-thickness esophageal rupture.

Charcot's triad.

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis.

Reynolds' pentad.

Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis.

Medical treatment for hepatic encephalopathy.

↓ protein intake, lactulose, rifaximin.

First step in the management of a patient with an acute GI bleed.

Establish the ABCs.

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Hemolytic-uremic syndrome (HUS) due to E. coli O157: H7.

Post-HBV exposure treatment.

HBV immunoglobulin.

Classic causes of drug-induced hepatitis.

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.

A 40-year-old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Biliary tract obstruction.

Hernia with highest risk of incarceration—indirect, direct, or femoral?

Femoral hernia.

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?

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and "tincture of time."

Four causes of microcytic anemia.

TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia.

An elderly man with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer.

Precipitants of hemolytic crisis in patients with G6PD deficiency.

Sulfonamides, antimalarial drugs, fava beans.

The most common inherited cause of hypercoagulability.

Factor V Leiden mutation.

The most common inherited bleeding disorder.

von Willebrand's disease.

The most common inherited hemolytic anemia.

Hereditary spherocytosis.

Diagnostic test for hereditary spherocytosis.

Osmotic fragility test.

Pure RBC aplasia.

Diamond-Blackfan anemia.

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café au lait spots, microcephaly, and pancytopenia.

Fanconi's anemia.

Medications and viruses that lead to aplastic anemia.

Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV.

How to distinguish polycythemia vera from 2° polycythemia.

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels.

Thrombotic thrombocytopenic purpura (TTP) pentad?

"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities.

HUS triad?

Anemia, thrombocytopenia, and acute renal failure.

Treatment for TTP.

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs.

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

Usually resolves spontaneously; may require IVIG and/or corticosteroids.

Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.

Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements.

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?

von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate.

A 60-year-old African-American man presents with bone pain. Workup for multiple myeloma might reveal?

Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones.

Reed-Sternberg cells.

Hodgkin's lymphoma.

A 10-year-old boy presents with fever, weight loss, and night sweats. Exam shows an anterior mediastinal mass. Suspected diagnosis?

Non-Hodgkin's lymphoma.

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

Anemia of chronic disease.

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

Iron deficiency anemia.

An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?

Chronic lymphocytic leukemia (CLL).

The lymphoma equivalent of CLL.

Small lymphocytic lymphoma.

A late, life-threatening complication of chronic myelogenous leukemia (CML).

Blast crisis (fever, bone pain, splenomegaly, pancytopenia).

Auer rods on blood smear.

Acute myelogenous leukemia (AML).

AML subtype associated with DIC.

M3.

Electrolyte changes in tumor lysis syndrome.

↓ Ca2+, ↑ K+, ↑ phosphate, ↑ uric acid.

Treatment for AML M3.

Retinoic acid.

A 50-year-old man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

CML.

Heinz bodies?

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy.

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

Glanzmann's thrombasthenia.

Virus associated with aplastic anemia in patients with sickle cell anemia.

Parvovirus B19.

A 25-year-old African-American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

O2, analgesia, hydration, and, if severe, transfusion.

A significant cause of morbidity in thalassemia patients. Treatment?

Iron overload; use deferoxamine.

The three most common causes of fever of unknown origin (FUO).

Infection, cancer, and autoimmune disease.

Four signs and symptoms of streptococcal pharyngitis.

Fever, pharyngeal erythema, tonsillar exudate, lack of cough.

A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.

Postinfectious glomerulonephritis.

Asplenic patients are particularly susceptible to these organisms.

Encapsulated organisms—pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella.

The number of bacteria on a clean-catch specimen to diagnose a UTI.

10^5 bacteria/mL.

Which healthy population is susceptible to UTIs?

Pregnant women. Treat this group aggressively because of potential complications.

A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?

Coccidioidomycosis. Amphotericin B.

Nonpainful chancre.

1° syphilis.

A "blueberry muffin" rash is characteristic of what congenital infection?

Rubella.

Meningitis in neonates. Causes? Treatment?

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin.

Meningitis in infants. Causes? Treatment?

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin.

What should always be done prior to LP?

Check for ↑ ICP; look for papilledema.

CSF: Low glucose, PMN predominance Normal glucose, lymphocytic predominance Numerous RBCs in serial CSF samples ↑ gamma globulins

Bacterial meningitis Aseptic (viral) meningitis Subarachnoid hemorrhage (SAH) MS

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