Step 2 Fam med 1 (10-28-15)

ruhland1's version from 2016-06-19 19:29

Section 1

Question Answer
preg initial urine screen11wk
fasting blood glc preg24-28wk
GBS preg35 wk
asx bacturia screen12-16 wk
R2 ant ICSMyocard, esph
esph, thyroid, bronchiR2 ant ICS
middle of sternumpylorus chapman
C2 articular pillarsposteior chapm for pharynx tongue larnxy sinus arms
t1-t4head and neck
b/t clavicle and 1st rib ant chapman for sinus
hep A post exp ppx <12moivig
hep A post exp ppx >12moivig + vax

Section 2

Question Answer
triglyceride normal<150
high triglycerideup pancreatitis
high triglyceride tx (>500)fibrates
fish oillower TG 50% but up LDL
Eztimibeimpairs dietary bili abs with out affecting TG abs
niacindn LDL, up HDL, dn TG by 15%
niacin mustliver function test
high triglyceride tx (<500)statin
1st line to reduce cvasc riskstatin

Section 3

Question Answer
furosamideup gout
up hyperuricemialoop diuretics (furos,ethycrinic acid)
block sodium potassium chloride transporter and ascending LOHloop diuretic
urate reducing hypertensivelisnosopril
MC atypical pneumoniaMycoplasma Pneu
tx mycop pneumacrolides azt/erythromycin
somatizationmultiple physical complaints before 30 yo
somatization mxfrequent scheduled visits>>> than psych eval!
erectile dysf upssri, BB, CCB, alpha B, finasteride, TCA, digioxin, antihist
lifestlye mod and PDE-5 fails now?vacuum assist device

Section 4

Question Answer
dn PMN count,F,fatigue,young child, dn weight, pallor, petechiae, gone pain, LAD, HS-MegAcute Lymphoblastic Leukemia
kid with up WBC but down PMNALL classic
I and aVfdetermine axis
II III and aVfinferior leads
amantidineno longer used in influ ppx, anti glutamte for parkinsons down shaking
oseltamavirneuramindase inhibitor for pt who present less than 48 hours

Section 5

Question Answer
.12-.20PR int
RRAIHIrate rhythm axis interval hypertrophy ishcemia (ST-E/ST-D T wave inversion)
heart necbig q (long after infarct)
long QT>.45 think hypokalemia,
>QT .500up risk torsades
RBBBRSR low ear left tall ear right vs LBBB tall ear left and short ear right on V1
PQ>0.200AV block
RRAIHI and look atP wave, QRS wave, ST wave morphology
Oseltamavir vs ZanamvirOsel is oral, Zana is IV
Zanamavir indicseriously ill or osel resist
mx acute influagressive hydartion is 1st step

Section 6

Question Answer
LAIV 4(non preg age 2-50yo)Live Attenuated Influenza Vax (2 flu A 2 flu B)
IIV3inactivated intramusc vax (2 flu A 1 flu B)
IIV3 foregg allergy, vs using LAIV 4
PPSV23pneumococcal polysach vac 23 indic for >65yo
PPSV23 indic 2ndage 19-64 yo with cormorbid
Tdtetanus/dipth has booster every 10 yr
YF-VAXyellow fever (made of egg, used for travelers)
liver bxfor causes of hepatitis
LFTsuspicion of ETOHism after CAGE
Liver U/Seval for Cirrhosis
ETOH defthiamine and folate
LDL>160 and <190initiate lifestyle mods and recheck in 6 mo
when is HDL cardioprotective>60
total cholesterol goal<200
LDL > 190initiate statin
10 year CV risk <5%lifestlye mods
10 year CV risk >5%statin therapy

Section 7

Question Answer
clue cellsstippled epithelial cells in bac vaginosis (gardenella)
gardenellathin gray disch, KOH whiff, pH<4.5
why no ETOH in metronidazoleinhibits acetaldehyd dehydrogense * dn processing
milkdecreases Fe absorption
tenderness above superior pole of patellarectus femoris rupture
thompson testlack of flexion when calf squezzed = ruptured achilles (Klay Thompson the Basket ball player cant jump so...)
ACL tear gradesI slight II partial III complete
twisting injury with knee extended and externnaly rotatedacute patella dislocation
acute patella dislocationlarge hemarthrosis, medial sided tender, up patellar translation, patellar apprehension
popliteus muscleinternally rotate tibia and unlock knee during flexion
popliteus tendinitis txactivity modifacation, stretching, NSAID, ice
galactorrheause prolactin level in initial step to cofirm prolactinoma
able to make personal health care decisions for the incompetentspouse>parent>next of kin>default surrogate
leg pain after use, pale cool extermity, decreased distal pulsesperiphreal artery occlusion
>3cm difference in calf circumfence, palpable cordsDVT
DVT signHoman (tender calf with dorsiflexion) (Deep in that Ho)
DVT dxduplex U/S, suspicion with + Homan (Deep in that Ho)
wafarin initiationheparin bridging until INR 2-3
ribaroxabanfactor Xa inhibitor
fondaparinuxfactor Xa inhibitor

Section 8

Question Answer
aneurysm monitoring<5.5cm
U/S every 2 years3-4.0cm aneurysm
U/S every 6-12 mo4.0-5.4
single most important intervention in patients with non-surgical aortic aneurysmssmoking stop
aneurysm srx>5.5CM
young male, unil, periorbital =, same time every daycluster HA
cluster HAuse hi-flow oxygen> sumitriptan
metoclopramideDA antag (mig abort) opposite to loperamide (think of opioids the same as DA-ags). Think of DA as initiating reward system in conjuction with SNS (find food) state. U need less reward system in a rest and digest state. So DA ag means slowing of GI tract and DA antag increases GI tract action.
prochlorperazine (think pera- in haloperadol)DA antag (mig abort) dn DA so down brain reward/sns/motivation/activity system. Migraines are induced by increased bflow of increased brain activity
sumitriptan5-HT rec ag (mig abort), causes vasoconstriction so less inflamtory mediator leaking out,
non-classic migraine HAw o aura
MC form of chronic recurring HAtension HA
bandlike or viselike pressure, nonthrobingtension HA
tension HANSAID = abort

Section 9

Question Answer
hemoptysis, night sweat, F and weight lossTB
dyspnes, pleuritic chest pain cough and hemoptysisPE
acute F shaking chill, cough productive,thick,purulent suptum, up HR up RRCAP
CAPcxr lobar consolidation
A-CAPMyco P> Chyl P> legionella > influ A/B
minimal consolidation and rather, diffuse reticulonodular infiltartesA-CAP finding
HA, malaise, lo F, DRY CoughA-CAP finding
up RR HR, rales S4PE
causes of miscarriagesadvance maternal age, hx of previous miscarriage and smoking, also active infxn of PID