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STEP 2 FAM MED 1 6-18

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ruhland1's version from 2016-06-18 20:00

Section

Question Answer
deliriummust have an organic cause
MMSEalternative is clock hands at 8:20
alz dzeosinophilia and amyloid-A beta deposition
neurofib tanglesaltered aggregates of tau proteins (mainly in hippocampus)
Huntinton Auto Dom, CHR 4 (HUNT=4), memory loss is atypical, CAG
Transmissible Spongiform Encephalopathymisfolded prior, CJDz, death 1 yr
Prion dz histoconvalescent clear vesicles (ak vaculoes=sponge brain)
Prion dz tissueneuronal loss, prolif of glial cells W/O inflammation!
CADASILCerebral Auto DOM Arteriopathy with Subcortical infarcts and Leukopathy
Binswanger diseaseaka subcortical dementia (CVasc lz in deep-white matter of brain, dn mem, dn cog, Δ mood)
D= delta = change
leukoenceph=white matter... (not WBC in brain)
Donepizilcholinesterase inh to tx mild dementia, S/E brady b/c up cholinergic
Tacrinechloinesterase inh (hepatotox!)
galantinecholinesterase inh
carotid endartectomysx find TIA, monoc blind, focal def
carotid enartect indicwhen >70%
haloperidolactually an inverse agonist, up QT, only in long term use for schizo
carbidopas rolea peripheral decarboxylase inh that blocks L-dopa to dopa * can cross BBB
myxedema comastate of decompesated hypothyroid, give IV t4, also give steroids until hypothyroid 2/2 adrenal insuff is R/O
memantineNMDA anatag, MOA: up NMDA ag * up glutamate excitotox, combined with cholinesterase inh for severe dementia
omega 3lowers risk of develop demntia, but cannot tx ADz
SelegilineMAOI-B inh for parkinsons dz (up DA []), S/E is hypertensive crisis, up lb, anx, insomnia * contra in htn
Citalopramup QT * contra in hx of arryth
statindn atheroscler prog * dn isch stroke risk, dn MI, no benefit for Alz Dz
T1 DMcheck glc multiple times/day
lassitudeaka fatiuge
hypergly sxblurred vision, nausea, lassitude
isorbide dinitrate and see hypotn and near syncopesuspect sildenafil use
nitrate moaup cGMP * up NO
sildenifil MOAPDE-3 inh * dn cGMP breakdn * up NO
huntington MRIcaudate/putmaen atrophy/protein agg
memorize

Section 2

Question Answer
basal cell cxround pearly flesh w telangectasia
fibrous papulenormal looking shiny bump, benign
skin sq cell cxhx of non healing ulcer or abn growth in sun exposed area
sq cell cx sitesfloor of mouth, soft palate, anterior tonsillar pillar, and retromolar tigone, up inflx up crust.
PPD >5mm +AIDS/HIV, abn CXR, close contact with TB +, immunosupp
hep C, ETOH, hx of drug abuse10mm PPD
DM + and given diureticup risk of Hyperosmolar Hyperglycemic State
ddx DKA from HHSdoes pt suffer from T1 or 2 DM, not found in T1, adequate insulin production is needed for HHS to oocur in first place * no ketones and no acidosis
kussmaulvery sllow and deep resp of DKA
SIADHhypoNa, Urine Osmolalit >200, excess UNa (>30) b/c urine so conc
SIADH sx2/2 cerbral edema
Hyperosm HyperGly State txinitial is isotonic saline (lots of fluid quick)
when to use IV insulin in HHSwhen fluid resus'd
SIADH 1st linefluid restrict, functions to correct dn Na
Lactulosefor Hepenceph (helps trap NH3 in colon by feeding bact * up colon acidity * up NH3 to NH4+ conversion)
valporic acidhepatotox and hep enceph s/e
carbamzepineused in sz except petite mal, status epilep, myoclon sz
petite malvalpro/ethosux
myoclonic szvalpro
carbamzipine s/eaplastic anemia, 450 inducer, thrombocytopenia
p450 inducerABC PQR (Alcohol, Benzo, Barbs, Pheny, Quinidine, Rifampin)
HHS txIV isotonic saline, once HR and BP good * switch to half-normal saline, when glc <250 add dextrose to IVF
DKA and HHS hintsteps of tx (isotonic fluid resus -> insulin therapy -> correct e-)
Insulinfluid shift intracellular, why initially contra in DKA/HHS
C BIG K U DiCalcium gluconatem B-ag/Bicarb, Insulin, Glucose (up Na+/K+ ATPASE so K+ goes intracell), Kayexalte (for chronic use only!), Diurectic/Dialysis
IV Calciumcardiac stabilizer in hyperK
COPD pneumoniathink using AZT since dn resp inflx
acarbosediarrhea, farts, (alpha glucosidase inhibitor) * down poly and disach abs
TZD= "gliTaZONEs", up lb, up LDL
TZD fearliver tox
NetfirminGI upset, need good kidneys, worry of lactic acidosis
exenatideGLP-1 ag (incretin mimetic), weight loss by acting on hypothal(like victoza/liraglutide)
incretin mimetic thoughtsdn lb because its augemented pancrease response (up Insulin sec) body thinks it has more food than actually does, so no need to store fat in liver * dn NAFLD, reduces gluagon response "up fed-state thought" so dn hyper glc risk
memorize

Section 3

Question Answer
NEER's testimpingment syndrome (rot cuff tendon/m are impinged between distal clav/ humeral head, common in people who do alot of overhead work,
NEER how to doarm is fully pronated and placed in forced flexion.
+ NEER tx10cc of 1% lido into subaromial space
Adson testThoracic oulet stndrome, patient neck full extension and rotate head towards bad side, pt fully inhales, a reduction in radial pulse is diagnostic
Cross arm testnarrows acromioclavicular joint space, dx's OA or joint separation
yergason and speedbicep tendon
shoulder impigement syndrome+ NEER and supraspinatus always involed
supraspinatusdirectly superior to hurmeral head and inferior to anterior edge of acromion
rotator cuff dxMRI to confirm, initial get XR
u/s for rot cufffor subacromial injxn
blue halosviagra "the BLUE pill"
Androgen replacementup OSA (redirected fat distb), erythrocytosis (why men have higher Hgb), up risk CVASC
why up CVASC risk in androgensup Cardiac m hypertrophy, dyslipidemis, myocardial fibrosis, arrythmia, MI
prediabetestx like DM, also 5.7-6.4
memorize

Section 4

Question Answer
ulcersstage 1 and 2 heal spont, 3 and 4 need srx
ulcer stage 1not open wound, skin reddened/px
ulcer stage 2skin open, tender, shallow crater/blister w clear fluid
ulcer stage 3extends into subcut (see fat but not m/done/tendon)
ulcer stage 4see m/bone
osteomyelitisbug S Aureus 90% of time
osteomyelitiis blood seedkids tibula fibula, IVDU into vetrbal body
osteomyelitiis sickle cellsalmonella paratyphi
osteomyelitiis IVDUP.Aeru/S.Aure
foot puncture through ruuber footwearP Aeru
osteomyelitiis hip replacementS. Epid
osteomyelitiis chronic woundS Aure/Psuedo/Enterobact
Pott's dzosteomyelitiis in veterbrae 2/2 TB
osteomyelitiis neonateS Aurem, S Agalac, Ecoli
osteomyelitiis childrenStpah Strep Salmon
osteomyelitiis labup ESR up CRP up PMN up WBC
osteomyelitiis imageperiosteal elevation
osteomyelitiis gold dxMRI
osteomyelitiis alternative dxbone scan
bone scanuse radiotracer and look at hot areas "up uptake", MC is Tc-99
osteomyelitiis why do deep bone bxverify bug
osteomyelitiis txIV abx and debride
osteomyelitiis abxflox, MSSA = clinda + flox or oxacillin/naficillin, MRSA=vanco, G- bact = ceftriaxone/cipro
osteomyelitiis monitorESR trends effect of therapy
memorize

Section 5

Question Answer
Lichen Planuspruritic, flat top papular eruption with violaceous colorm polygonal shapm with overlying wickham straie
Wickem striaewhite fine lacelicke lines in lichen planus
Kaposia sarcomaskin, oral mucosa, red to purple maculesm papules and nodules
mycosis fungiodesMC cutaneous T-Cell lymphoma, pathophys id expansion of clone CD4, patch plaque and tumoral phase, fine scale red plaques, annular or serpiginous with central clearing
Sezary syndromewhen mycosis fungoides (T-cell lymphoma) affects entire body
psoraisiselbow, scalp, intergluteal cleft, joints affected
memorize

Section 6

Question Answer
AFIB w RVR chronic txwarfarin
Anticoag for Afibuse CHADS2 (CHF, HTN, AGE>75, DM, prior thromboemoblic event is 2 points)
CHADS2 scoreing>1 give ASA or Coumadin, 2 or more use coumadin to 2-3 INR
AFib and use warfarindo not need to bridge w heparin unless (valve prosthesis, mitral sten, hx of TIA/CVA)
heparinbinds Anti-thrombin III * up activty of ATII * dn thrombin (Factor II) and Factor Xa
Factor Xaendproduct of common coag pathway leading to FII(thrombin) formation and fibrin-crosslink
GPPIIB/IIIAon pl8, up activation * up pl8 agg
AbciximabGPPIIB/IIIA inh * dn pl8 ag
TirofibanGPPIIB/IIIA inh * dn pl8 ag
EptifibatideGPPIIB/IIIA inh * dn pl8 ag
FVIIextrinsic coag * means active by extrinsic forces (trauma), if activated converges at common pathway leading to thrombin formation and fibrin cross-link
ASAdn COX-1 * down arachidonic acid to TXA2 conversion * dn pl8 recruit/aggregation
carpal intial txnighttime splint 3 wk to keep wrist in neutral position as wrist flexion up sx
median n sxnumbness to 1st to 4th digit, thenar atrophy
carpal tunnel splint failssteroid injxn
memorize

Section 7

Question Answer
toxic multinodular goiterhyperthyroid sx
hyperthroid and I uptakehomogeneous= graves, heterotoxic multinodular goiter, focal is functioning adenoma, no uptake sugests thyroxicosis factitia
thyrotoxicosis factitiano RAD I uptake, pathophys due to ingestion of exogenous thyroid hormone
struma ovariiup hyperthyroid sx, RAD I- shows no thyroid uptake (contains functional thyroid tissue)
proptosisspecific for graves
thyroid d/o workup1st TSH then free T4, if T4 elevated get RAD I- uptake
Ovarian cx risk factorsfam hx, up number of ovulatory cycles (increased if nulliparous, late onset menopaus, OCP is protective b/c done # cycles)
Ovarian cx assocBRCA 1/2, HNPCC, Peutz-Jeghers, Turner
Ovarian cx germ cellMCCX (equiv to male seminoma)
Ovarian cx turner syndgermcell type (dysgeminoma)
Ovarian cx germ cell labsup HCG and LDH (dysgeminoma)
Ovarian cx yolk sacyoung girls, also seen in testes
Ovarian cx yolk sac tissueegg yolk tissue, histo Schiller-Duval bodies (resemble glomeruli/yolksac)
Ovarian cx yolk sack labup AFP
Ovarian cx teratomamature="dermoid cyst"
MC Ovarian benign tmxMature teratoma = dermoid cyst
Ovarian cx immature teratomavery malignant aggressive
teratoma findingsteeth, hair, struma ovarrii (functioning thyoid tissue)
Ovarian cx thecoma-fibromahisto spindle-shaped fibroblasts
Ovarian cx meig's syndrometriad of ovarian fibroma, ascites, R lung pleural effusion (thecoma fibroma)
Ovarian cx sertolic leydigvirilization
Ovarian cx granuloas theca cellhyperestinism 2/2 sec of estrogen, findings precoscious puberty and endometrial hyperplasia
Ovarian cx granuloas theca cell histoCall-Exner bodies (small follicles with EOS sec)
Ovarian cx surface derivedall CA-125 +, incluedew serous cystadenoma/serous cystadenocarcinoma, mucinous cystadoma, mucinous cystadenocx, brenner tmx, meta= to krukenberg/signet ring tmx
Ovarian cx serous cystadenomabilateral histo fallopian tube-like epithelium
Ovarian cx serous cytaadenocxbilateral psamommas bodies
Ovarian cx mucinous cystadenomahisto intestine/endocerix-like tissue
Ovarian cx mucinous cystaadenomacarcinomapsedomyoxma peritonie (shitload of intraperitoneal accumlation of muscus)
Ovarian cx meta to stomachkrukenberg/signet ring tmx
Ovarian cx findingsasx until late, ASCITES/bloating, signs of hormones
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Section 8

Question Answer
Level II ultra sound"targeted" assess fetal limb development and heart
Preg and LithiumEbtstein "apical displacenebt od tricuspid leaflets, leads to atrialilzation of R ventricle
CT scancontra in preg duh...
triple test2nd trim screen of AFP Estriol and BHCG
AFP dn Estriol dn BHCG dn Inhibin A dnEdward syndrome
AFP low Estriol low BHCG high Inhibin A highDown Syndrome
Quad ScreenAFP BHCG Estriol Inhibin A (used now instead of triple screen)
Level 1 ultra soundnon-targeted
memorize

Section 9

Question Answer
anaphylaixsHSN T1 - IgE mediated, do ABC, then EPI
tertbutalineselective B2 ag that is 2nd line in resp distress due to asthma/bronchospasm
Anaphylaxis and resp arrest msintubate -> albuterol, epi, diphenhyrda, steroids
NIPPVaka CPAP or BiPAP (temporary measures in RF) used in reversible causes of resp F (pulm edema, COPS, asthma)
T2-T7lung
T1-T5heart
T5-T9celiac artery area
Anterior radial headfalling back on supinated forearm, restricted pronation but can supinate
radial headgoes anterior in supination, posteior in pronation
falling forward with pronated forearmposterior radial head
rot cuffSITS (supra,infra,Teresminor, subscap)
empty cansupraspinatus tendon
Labral Tearpositive Obrien's
obriens testarm 90o flecion, 10o adduction, int rot, flex arm up toward ceiling against resistance, Irish like pouring out a can of bear and lifting it as it is being poured out.
OA shoulderdn sx with reast, down active and passive ROM and crepitus, XR bonysclerosis/joint space narrowing, osteophyte formation.
subacromial bursitispoor localized px around acromion, up px with overhead activities like combing hair, may show + neer if impingement syndrome is underlying cause of bursitis, UExt rength should be 5/5
memorize

Section 10

Question Answer
multiple myelomahyper Ca sx, abn UA protiens, multiple lytic lz in spine
multiple myeloma dx>10% clonal plasma cells in BM, need BM bx to rule in MM (GOLD standard)
Pagets bone basicsabn bone remodeling, peaks in 50s-60s
Paget bone presentationaching bone/joint pc, "buy larger hat", sensineural hearing loss (n entrapment)
Paget bone imagethickened bone (remodled corticesm coarsened trabeculae giving bone a blastic appearance), cotton woll spots on skull XR
Paget bone scanintensely hot in lytic and mixed phase
Paget bone CTthicker trabeculae, heterogeenous bone density
Paget Bone histoirregular broad trabeculae, disorganized cement lines, numerous lg osteoclasts with mulptiple nuclei per cell
Paget bone txobserve(OTC px med) -> bisphos is 1st line (inh clast) -> calcitonin 2nd line -> MTX 3rd line
paget bone srxhip and knee arthroplasty is severe joint, internal fixation for frx of long bones
Paget bone complicvertebral compression frx, hearing loss 2/2 entrap, 2ndary osteosarcoma, up Ca, up Stones, up spinal cord compression
Urine electrophoresis+ in MGUS and AL amyloidosis, also an important intial workup in suspected MM
MM is aclastic process, not a blastic one (* a bone scan for blastic activity may be (-))
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