Step 2 6-10-16

ruhland1's version from 2016-06-10 15:08


Question Answer
Internal Jug Vein in carotid sheathis lateral to common carotid artery and anterior to the vagus nerve
correct poistion of central Internal jug cathsuperior vena cava
struvite stoneradioopaque and have "coffin lid" crystals, need srx for removal
bugs of struviteproteus, klebsiella, serratia, staph sapro which are UREASE +, MC is proteus mirabalis
calcium oxalte"envelope"/"dumbbell" crystals, tx IVF and analgesia, no interventiion if <5mm
uric stoneradio lucent, rhomboid appearance, tx is alkinization of urine
aged 21-29pap every 3 years do HPV testing if cytology is abn
aged 30-65do cytology every 3 years or co-testing with cytology and HPV every 5 years
hysterectomycan stop papsmears if benign disease ie. no hx of CIN 2 or 3 w/in past 20 years
recurrent ca po4 stonedue to thiazide diuretics, b/c dn uric acid sec * up kindey/urine pH
living willapplies to terminal conditions only, does not include V-fib in young patient
advance directivesa living will to do not resus/inrube when tx is FUTILE
competencydetermined from a judge, not a physician
4 Dduty derelicition(negligence or deviation from standard of care) damages, direct cause
timololBB for glaucoma
travoprostfor glaumoa up aqueous fluid outflow (PG open things up)
post cholesectomyup SBO 2/2 gallstone ileus
Etanercepta TNF-Alpha inhibitor to tx RA, psoriatic arthritis, plaque psoriasis and ankylosing spondylitis
methotrexaterheumatoid arthritis
OADIP (heberden) PIP ( Bouchard)
RAUlnar deviation
singulairmonteleukast sodium
hypokalemia and non-responsive to replacementcheck Mg
Triad of Allergic rhinitisfluticasone, loratidaine, monteleukast
ER migraine cocktailtoradol, phenergan, bennadryl
phenergantardive dyskinesia, Qt prolong
BB for asthmaatenolol
triamtereneK sparing diuretic used in combo with thiazide
HCTZup Na up Ca up Uric dn K
RAgoose neck, ulnar deviation, Z-deformity of thumb

Section 2

Question Answer
resistant hypertnfailed with 3 drugs (1 including HCTZ)
Ottawa ankle rulesGet ankle X-ray if malleloar pain and tenderness at.... tip of lateral malleolus posterior tip OR medial malleolus posterior tip OR base of 5th metatarsal OR navicular
grade I ankle sprainbegin early ROM exercises and PT
alk phos range40-120
ectopic pregabd pain, vaginal spotting, ammenorrhea, palpation of mass
periumbilical then to RUQappendicitis
PIDzlower abd px with adnexal tenderness, + vag disch, hallmark=chandilier sign, up risk 10x ectopic
work up ectopicget b-HCG to confirm presence of preg and get a quantitative of it
PIDz bugN Gonn Chly Tracho
PIDz labwbc >10k temp >38 (bug is Chyl and Gonn and Tracho) tx is Cefotixin and Doxy
PIDz txFlox with Metronidiazole
Most common risk factor of ectopicPelvic inflx dz
pleural effusionfever cough dyspnes and chest pain
pleural effusion pxexplerual friction rub, tactile fremitus, dn breath sounds, CXR shows radiopacity in involved area.
PIDz txcefoxitin and doxycycline 14 days (abx for Chyl / gonn)
pleural effusion txthoracentesis
chest tubeto remove air(pneumo)/fluid(eff)/pus(empyema)
thoracotomyincision made along the 5th or 6th rib
selenium sulfidedandruff
mirabegronfor overactive bladder (A-1 antag and B-3 ag which relaxes prostate smooth m)
prazosinalpha 1 antag for nightmares 2/2 PTSD
Zestoreticlinosinopril and HCTZ
zidovudineto prevent vertical transmission of HIV, a NRTI
post-herpatic neuralgiapregabalin is 2nd line, oxycodone is 4th line
antiviral use in HIVcan cause risk of virus mutation and resistance
TSSvanco or clinda + naficillin
SIADHgive salt pills to up Na+
Guillian Barredyesthesias of the fingers and lower extremity muscle wk 2-4wks following GI and URI infxn, have low threshold for intubation
young visual complaint and isolated m wkthink MS
Myas Gravisimproved sx w rest
polymyositisbil proximal m wk with ambulation. tx is steroids
raynaudstx CCB
Guillian barregive IVIG and plasmapheresis (anti-ganglioside antibodies)
post camplylobacter jejuniguilian barre
lumbar puncture in gullian barre showscytological dissociation

Section 3

Question Answer
ovarian cx 1st signbloating
acromioclav joint arthinsert the needle superior to anterolateral edge of the aromion, angled perpindicularly to the junction of the acromion and distal clavicle
subacromial bursitisins needle inferior to the posterolateral edge of the acromion. directing it anteriorly with approc 30o of ceph angulation
glenohumeral jointins needle inf to the posterolateral edge of the acromion, directing it medially and aiming for the ant coracoid processs
lateral epicondylatisinsert the slightly angled needle approx 1 cm distal to the lateral epicondyle into the common extensor tendon.
meckel's diverticulumtwo feet from ileocecal valve, 2 inches long, 2 % pt develop complications, M to F 2:1
meckels dx99m technetium scan
visceromatic for head and neckt1-T4
viscerosomatic levelsT1-L2 SNS inn
laparoscopy or laparotomy-scopy is diagnostic only, so do -otomy in emergent cases
unstable and abdominal traumaget colloid fluids, head to OR for laporotomy
vault hold index fingergreater wing of sphenoid
vault hold middlefingerperiauricular portion of temporal bone
vault hold ringfingermastoid proceess
vault hold little fingersquamous portuion of occipital bone
aortic regurgiationhear at pulmonic listening poste. hiitched decresendo diastolic murmur and wide pulse pressure
emtaladoesnt cover pregnancy
acute aortic regurgcatopril and hydralazine are afterload reducers
ACEidn RAAS (dn AT1 to AT2)
epidural hemtaomamiddle meningeal artery
epidural hematomacentral herniation
cingulate herniationsubfalcine herniation
cingulate herniationpressure on falx cerebri, isch of anterior cerebral artery
central herniationdownward transtentorial, compresses CNVI, so diplolia looking towards nose
uncaltriad of 1.blown, fixed, ptosis "down and out"2. ipsilateral hemiplegia 3. coma
wrist px ddxcarpal, arthritis, tendonitis, trx, tenosynovitis, RA, Gonoccoal infxn, SLE, fractured scaphoid, DeQuervains, ganglion cyst
young wrist pxtrauma, dequervains, frx scaphoid,ganglion cyst, colles frx
collesdistal radial frx, pt would hold wrist in extension
T-scorecompares bonde density between age groups
hydralazine and captoprilvasodilators used in acute aortic regurg (afterload reducers)
papillary thyroid carcinomachemotherapy used after srx removal and thyroid suppression and yearly thyroid U/S
hyper PTH80% due to adenoma
up CAstones, bones, groans(GI px), psychiatric overtones
K is 2.3admit pt and continuos cardiac monitoring to watch for arryth
bisphosphate and hyperPTHinhibit clast, indic in pt with osteopenia/porosis, up bone mineral density, dn Ca, for non-srx candidates
parathyroidectomyindic in parathyroid cx (vs adenoma which is PTHectomy)
when to give Vit D in hyperPTH<20

Section 4

Question Answer
endometriosishallmark is px /cramp 1-2 day prior to each period, up dyspareunia if endometriosis is in the cul de sac
adenomyosisendometrial tisue invades myometrium, had dysmenorrhea and menorraghia due to anatomics and increased number of gland tissue
acute salpingitisdiffuse lower abd pain with purulent disch
salpingitiscauses perihepatic inflx leading to fitz hugh curtis "violin string"
fetal tachy>160 for >10 min
fetal brady< 110 for > 10 min
fetal brady thinkcogenital heart block
fetal tachy thinkmaternal fever
fetal acceleration15bpm above base for 15 sec, suggests good
early decelerationsdn HR due to uterine contraction due to up ICP * up vagal stim
Biophysical profileread on medbullet
variable decelumbilical cord compression, cord is compressed at random times so decelerations are random
variable decel txshift maternal position, amnioinfusion is refractory
late decelerationsdue to uteroplacental insuff, like variable but patterned because follows insufficiency that is exacerbated by uterine contractions, need intervention in repititive late decelerations
coumadinfor A fib with RVR long term
CHADS2for CVA 1 point for CHF, HTN, Age>75, DM, 2 points for stroke or prior embolic event
CHADS2 score >1give ASA or coumadin
Chads2 score >2coundamin with INR 2-3
heparin MOAbinds AT III * up AT III inactivation of Thrombin and Factor Xa
Factor 2= thrombin
Tirofiban and EtifibatideGPIIb/IIIa inh
ASAblocks conversion of arachidonic
extrinsic coagFactor 7 called extrinsic because actived by external trauma

Section 5

Question Answer
Triangluar Fibricatilage Complex tearulnar side pain
cut open flexor retinaculumrefractory tx
scaphoid frx non-displacelong spica cast thumb 6 weeks, then short none until union in radiograph
scaphoid frx displacedOpen-reduction internal fixation.
dysdiadochokinesiainability to perform rapid alternating movements, cerebellar d/o
HPOAC omep amox clathiro
RAinitial tx in MTX
SLEinitial is hydroxychlorquine
hydroxychlorquine moaup pH lysosome * altered cell secretion * dn chemotaxis, phagocytosis, and H2O2
gold saltsuncommon for RA, oral or injxn
Duchene MDhas to push self up with arms, up mental retard, big calfs, dystrophin gene mutation, up scoliosis
Scoliosisup restrictive lung dz
restrictive lung diseaseup FEV1/TLC
obs lung dzdn FEV1/TLC
primary dilated cardiomyopathy, up supravent arrythmiafound in Duchhene
restrictive Cardiomyopathyhemochromo, amylois, sarcoid, doxo/danorubicin
NSAIDscategory B in preg * dont use if there are other alternatives
corticosteroidcategory C in preg
tension type HAuse elavil if fall-risk vs flexiril
cobb defined scoliosis10o
fomepizolecompetivtive inh alcohol dehydrogenase, used in tx of ethylene glycol and methanol
acute ethanol ingestionIVF dextrose and thiamine
Glasgow recommend intubmax 10 min 3, but pt dependaent
polymyositispositive anti-jo-1
aldolasetest isolated for myositis

Section 6

Question Answer
high FSHindicated primary ovarian failure, b/c dn feedback, need to r/o turner if 1o ammenorrhea
ammenorrheainitial lab prolactin and thyrotropin (TSH)
TSH= thyrotropin
hyperprolactinup Ammenorhea
alpha thalltarget cells
extravascular rbc destruction and splenomegalydx warm (igG) AI hemolytic anemia
suggests AI hemolytic anemiaspherocytes
spherocytesspectrin, ankyrin cytoskele defect
M-CHATautism screen
sarcoidNCGranuloma fever wheeze derm, parotid gland enlarge dn CN VII, iritis, uveitis hilar LAD, dx LN bx for NCG, ACE, up Vit D * up Ca
sarcoid dermLExt panniculitis, lupus pernio, violaceous rash on face
Sarcoid Stage 0nml CXR
Sarcoid Stage IBIL hilar LAD
Sarcoid Stage IIBil hilar LAD + infiltrate
Sarcoid Stage IIIinfiltrates alone
Sarcoid Stage IVfibrosis
Sarcoid best non-steroidazithiroprine
infliximab TNF-Alpha inhfor use in sarcoid
lung TP indicFVC <50% or FEV1 <40%
Catscartchsolitary paplue and regional LAD, resolves in 2 mo
Cryptogenic Organizing Pnuemoniaboth alv and bronchiolar inflx, infiltrates in lower lober
lymphomaB symtoms, + reed-sternberg
EBVup risk lymphoma
LN bx in lymphomalymphocyte prolif
dequervainsinflx of abductor pollicus longus tendon, and extensor pollicis longus not brevis
wirst pain and paresthesias in the 4th and 5th fingersulnar tunnel syndome (guyon's canal)
initiating Hep C treatmentget a psychiatric eval
Pegylated Interferon Aused in Hep C and B treatment
doxorubicinmust get an echo before initiating
get before initiating TNF-Alpha inhibitorsPPD
adalimumabTNF-A inh
InflixamabTNF-A inh
Hep C txpegylated Interferon-alpha and ribavirin
ribavirintreatment for Hep C
Hep B txB-ITE (Interferon Alpha, tenofovir, emtricitabine)
tenofovirHep B tx
emtricitabineHep B tx
interferon Bused in MS
Lamivudine and AdeofovirHBV tx regimen
pegylated interferon Aneeds to be combined with ribavirn for HCV tx

Section 7

Question Answer
cyanosis + crying + low O2 sat= tet spell
tet spelldo knee to chest, causes a drop in SVR and up R to L shunt
Pastuerella MulitocidaG (-) bacillus
N Menin, N. GonnG (-) cocci
Moraxxella CataarhalisG (-) cocci
ClostridiumG + bacilli
CorynebacteriumG + bacilli causes diptheria
listeriaG + bacilli
MycobacteriumG + bacilli
Staph and StrepG + cocci
leptospiraspirochete, Penicillin, question mark shaped, dx dark field microscopy, etio animal urine (lepto "leaps to" humans)
leptospirosisflu sx, abd px, conjunctivitis, photophobia
Weil's dzsevere leptospirosis, hemorrhage, liver and kidney dmg
dog cate biteamox/clac (augmentin)
moraxella catarrhalisG - cooci,pnuemonia in COPD/immunocomp, tx is TMP-SMX or Amox Clav
hot tub folliculitis pseudomonasciproflox
cyroprecipto be used when FFP is indicated but large transfusion volume is needed (like DIC)
hemophillia Agive Factor VIII
encopresisinvoluntary pooping
hemophilia Bgive Factor IX
PTT time<35 sec
Prothrombin time12-14 sec
chronic floxtendon rupture
tmp-smxMRSA growth
hirdaradenitis suppuritivaboils in intertriginous, (acne inversa), chrominc minocycline, I and D when needed.
patellofemoral syndmobic and PT, moviegoer's knee, patellar chondromalacia, do patellar apprehension test
intuussusceptionterminal ileum, mcc of intestinal obstruction in kids, red-currant jelly stools
chlorthalidonelike HCTZ
SIGECAPSSleep Interest Guilt Energy Concentration Apetitie Pychomotor, Suicide
SSnore loud
OObservered (you stop breathing)
PPressure (being treated for HTN
BBMI >35
AAge> 50
NNeck > 16in
GGender = Male
STOPBANG0-2 low risk, 3-4 intermediate, 5-8 High