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Step 2 CK First Aid Rapid Review

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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
Initially presents with a pruritic papule with regional lymphadenopathy; evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis.
Cold agglutinins.
Mycoplasma.
A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension.
Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
≤ 200 for P. jiroveci (with TMP-SMX); ≤ 50-100 for MAI (with clarithromycin/azithromycin).
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.
Neutropenic nadir postchemotherapy.
7-10 days.
Erythema migrans.
Lesion of 1° Lyme disease.
Classic physical findings for endocarditis.
Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots.
Aplastic crisis in sickle cell disease.
Parvovirus B19.
Ring-enhancing brain lesion on CT with seizures.
Taenia solium (cysticercosis).
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?
Legionella pneumonia.
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?
Lyme disease, Ixodes tick, doxycycline.
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis.
Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared.
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis.
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta.
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27.
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma.
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid.
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
Pseudogout.
An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.
Polymyalgia rheumatica.
An active 13-year-old boy has anterior knee pain. Diagnosis?
Osgood-Schlatter disease.
Bone is fractured in a fall on an outstretched hand.
Distal radius (Colles' fracture).
Complication of scaphoid fracture.
Avascular necrosis.
Signs suggesting radial nerve damage with humeral fracture.
Wrist drop, loss of thumb abduction.
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy.
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction.
An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphysis. AP and frog-leg lateral view.
The most common 1° malignant tumor of bone.
Multiple myeloma.
Unilateral, severe periorbital headache with tearing and conjunctival erythema.
Cluster headache.
Prophylactic treatment for migraine.
Antihypertensives, antidepressants, anticonvulsants.
The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g., bromocriptine).
A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?
Broca's aphasia. Frontal lobe, left MCA distribution.
The most common cause of SAH.
Trauma; the second most common is berry aneurysm.
A crescent-shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma—bridging veins torn.
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely source? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation.
CSF findings with SAH.
Elevated ICP, RBCs, xanthochromia.
Albuminocytologic dissociation.
Guillain-Barré syndrome (↑ protein in CSF without a significant ↑ in cell count).
Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathologic?
Normal.
The most common 1° sources of metastases to the brain.
Lung, breast, skin (melanoma), kidney, GI tract.
May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures.
The most frequent presentation of intracranial neoplasm.
Headache.
The most common cause of seizures in children (2-10 years).
Infection, febrile seizures, trauma, idiopathic.
The most common cause of seizures in young adults (18-35 years).
Trauma, alcohol withdrawal, brain tumor.
First-line medication for status epilepticus.
IV benzodiazepine.
Confusion, confabulation, ophthalmoplegia, ataxia.
Wernicke's encephalopathy due to a deficiency of thiamine.
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic.
The most common causes of dementia.
Alzheimer's and multi-infarct.
Combined UMN and LMN disorder.
ALS.
Rigidity and stiffness with resting tremor and masked facies.
Parkinson's disease.
The mainstay of Parkinson's therapy.
Levodopa/carbidopa.
Treatment for Guillain-Barré syndrome.
IVIG or plasmapheresis.
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
Huntington's disease.
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe.
Café au lait spots on skin.
Neurofibromatosis type 1.
Hyperphagia, hypersexuality, hyperorality, and hyperdocility.
Klüver-Bucy syndrome (amygdala).
May be administered to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium.
1° causes of third-trimester bleeding.
Placental abruption and placenta previa.
Classic ultrasound and gross appearance of complete hydatidiform mole.
Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination.
Chromosomal pattern of a complete mole.
46,XX.
Molar pregnancy containing fetal tissue.
Partial mole.
Symptoms of placental abruption.
Continuous, painful vaginal bleeding.
Symptoms of placenta previa.
Self-limited, painless vaginal bleeding.
When should a vaginal exam be performed with suspected placenta previa?
Never.
Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.
Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis.
Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone × 48 hours.
The most common cause of postpartum hemorrhage.
Uterine atony.
Treatment for postpartum hemorrhage.
Uterine massage; if that fails, give oxytocin.
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin.
A patient fails to lactate after an emergency C-section with marked blood loss.
Sheehan's syndrome (postpartum pituitary necrosis).
Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion.
Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
Threatened abortion.
Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma.
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube.
Not contraindications to vaccination.
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity.
Tests to rule out shaken baby syndrome.
Ophthalmologic exam, CT, and MRI.
A neonate has meconium ileus.
CF or Hirschsprung's disease.
Bilious emesis within hours after the first feeding.
Duodenal atresia.
A two-month-old baby presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy.
The most common 1° immunodeficiency.
Selective IgA deficiency.
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum).
Acute-phase treatment for Kawasaki disease.
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms.
Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe).
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
Reye's syndrome.
A child has loss of red light reflex. Diagnosis?
Suspect retinoblastoma.
Vaccinations at a six-month well-child visit.
HBV, DTaP, Hib, IPV, PCV.
Tanner stage 3 in a six-year-old girl.
Precocious puberty.
Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis.
Cause of neonatal RDS.
Surfactant deficiency.
A condition associated with red "currant-jelly" stools.
Intussusception.
A congenital heart disease that causes 2° hypertension.
Coarctation of the aorta.
First-line treatment for otitis media.
Amoxicillin × 10 days.
The most common pathogen causing croup.
Parainfluenza virus type 1.
A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition).
Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency).
A newborn girl has a continuous "machinery murmur."
Patent ductus arteriosus (PDA).
Risk factors for DVT.
Stasis, endothelial injury, and hypercoagulability (Virchow's triad).
Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6.
Causes of exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis.
Causes of transudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy.
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure.
Dyspnea, lateral hilar lymphadenopathy on CXR, noncaseating granulomas, ↑ ACE, and hypercalcemia.
Sarcoidosis.
PFTs showing ↓ FEV1/FVC.
Obstructive pulmonary disease (e.g., asthma).
PFTs showing ↑ FEV1/FVC.
Restrictive pulmonary disease.
Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.
Treatment for SVC syndrome.
Radiation.
Treatment for mild, persistent asthma.
Inhaled β-agonists and inhaled corticosteroids.
Treatment for COPD exacerbation.
O2, bronchodilators, antibiotics, corticosteroids with taper, smoking cessation.
Treatment for chronic COPD.
Smoking cessation, home O2, β-agonists, anticholinergics, systemic or inhaled corticosteroids, flu and pneumococcal vaccines.
Acid-base disorder in pulmonary embolism.
Hypoxia and hypocarbia (respiratory alkalosis).
Non-small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma.
Lung cancer associated with SIADH.
Small cell lung cancer (SCLC).
Lung cancer highly related to cigarette exposure.
SCLC.
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.
Treatment of tension pneumothorax.
Immediate needle thoracostomy.
Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins.
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS.
Sequelae of asbestos exposure.
Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass).
↑ risk of what infection with silicosis?
Mycobacterium tuberculosis.
Causes of hypoxemia.
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch.
Classic CXR findings for pulmonary edema.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing.
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA.
RTA associated with abnormal HCO3- and rickets.
Type II (proximal) RTA.
RTA associated with aldosterone defect.
Type IV (distal) RTA.
"Doughy" skin
Hypernatremia.
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephritic syndrome.
Chvostek's and Trousseau's signs.
Hypocalcemia.
The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism.
T-wave flattening and U waves.
Hypokalemia.
Peaked T waves and widened QRS.
Hyperkalemia.
First-line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide).
Type of ARF in a patient with FeNa < 1%.
Prerenal.
A 49-year-old man presents with acute-onset flank pain and hematuria.
Nephrolithiasis.
The most common type of nephrolithiasis.
Calcium oxalate.
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (autosomal-dominant PCKD).
Hematuria, hypertension, and oliguria.
Nephritic syndrome.
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema.
Nephrotic syndrome.
The most common form of nephritic syndrome.
Membranous glomerulonephritis.
The most common form of glomerulonephritis.
IgA nephropathy (Berger's disease).
Glomerulonephritis with deafness.
Alport's syndrome.
Glomerulonephritis with hemoptysis.
Wegener's granulomatosis and Goodpasture's syndrome.
Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome.
Eosinophils in urine sediment.
Allergic interstitial nephritis.
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome.
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure.
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
Wait, surgical resection, radiation and/or androgen suppression.
Low urine specific gravity in the presence of high serum osmolality.
Diabetes insipidus.
Treatment of SIADH?
Fluid restriction, demeclocycline.
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC).
Testicular cancer associated with β-hCG, AFP.
Choriocarcinoma.
The most common type of testicular cancer.
Seminoma, a type of germ cell tumor.
The most common histology of bladder cancer.
Transitional cell carcinoma.
Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis.
Salicylate ingestion occurs in what type of acid-base disorder?
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.
Acid-base disturbance commonly seen in pregnant women.
Respiratory alkalosis.
Three systemic diseases that lead to nephrotic syndrome.
DM, SLE, and amyloidosis.
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
RCC or other erythropoietin-producing tumor; evaluate with CT scan.
A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP).
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome).
Side effects of corticosteroids.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies.
Treatment for DTs.
Benzodiazepines.
Treatment for acetaminophen overdose.
N-acetylcysteine.
Treatment for opioid overdose.
Naloxone.
Treatment for benzodiazepine overdose.
Flumazenil.
Treatment for neuroleptic malignant syndrome and malignant hyperthermia.
Dantrolene.
Treatment for malignant hypertension.
Nitroprusside.
Treatment of atrial fibrillation.
Rate control, rhythm conversion, and anticoagulation.
Treatment of supraventricular tachycardia.
If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine.
Causes of drug-induced SLE.
INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine.
Macrocytic, megaloblastic anemia with neurologic symptoms.
B12 deficiency.
Macrocytic, megaloblastic anemia without neurologic symptoms.
Folate deficiency.
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant.
Blood in the urethral meatus or high-riding prostate.
Bladder rupture or urethral injury.
Test to rule out urethral injury.
Retrograde cystourethrogram.
Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus.
Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography).
The most common organism in burn-related infections.
Pseudomonas.
Method of calculating fluid repletion in burn patients.
Parkland formula.
Acceptable urine output in a trauma patient.
50 cc/hr.
Acceptable urine output in a stable patient.
30 cc/hr.
Cannon "a" waves.
Third-degree heart block.
Signs of neurogenic shock.
Hypotension and bradycardia.
Signs of ↑ ICP (Cushing's triad).
Hypertension, bradycardia, and abnormal respirations.
↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).
Hypovolemic shock.
↓ CO, ↑ PCWP, ↑ PVR.
Cardiogenic (or obstructive) shock.
↑ CO, ↓ PCWP, ↓ PVR.
Septic or anaphylactic shock.
Treatment of septic shock.
Fluids and antibiotics.
Treatment of cardiogenic shock.
Identify cause; pressors (e.g., dopamine).
Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion.
Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000.
Supportive treatment for ARDS.
Continuous positive airway pressure.
Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies.
Trauma series.
AP chest, AP/lateral C-spine, AP pelvis.