STEP 2 FAM Med 2 6-18

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


Question Answer
Muscle energyput pt into what doesnt like have pt goes to what likes (position into restrictive barieer)
M gravisskele m wk with preseved sensation and DTR
Lambert Eatonimpaired ach release, AB attack volatge gated Ca++ ch,
Lambert eaton findingproximal m wk, hyporeflexia, D automnomics,
Lambert eaton presentationpt difficult getting out of bed, chairs climbing stairs
Lambert Eatonautonomic dysfunction is a unique finding, oropharyngeal motor sx are uncommon, extraoccular wk is uncommon
MG sx presentationgeneral wk, worse at end of day, this flux is hallmark for this,
MG ocularptosis, diplopliam internuclear opthalmopledia, vertical gaze paresis
MG bulbar sxfatigue in chewing, dysarthria, dysphagia, nasal speech
MG vs Lambertworse at end of day, vertical gaze, respiratory involve
ALS findingsslapping gait (audible foot drop when foot hits floor in gait), wrist drop, difficulty in dextrous movements, drooling, EOM are spared.
Basilar Artery thrombosisisch of pons, repitive unilateral jerk/twitch, syncope, D mind
MS classicsensory def, m wk, spasticity, loss bladder/bowel
spasticitylike muscles are contracted in one position * dn ROM, found in MS (defintionof relating to m spasm)
inter nuclear opthalompleagiafinding of MS of nystgymus or inability to adduct the eye while other eye is capable of abducting
MG electromyographydecremental response to repitive stim
MG pathophysAB against nicotinc rec
ALS electromyographyshows fibrillation/fasiciulation indicating denervation, + sharp waves

Section 1

Question Answer
Lambert Eaton electromyographylarge amplitude fround after maximal activation and significantly reduced amplitude in resting m
Lamber eaton classicproximal limb wk and hyporeflexia
Guillaian Barrre electromyographyslowing of motor conduction with dn amplitude, increased distal motor latencies in lower ext show neuro demyelination.
MG associated findingthymoma b/c the Ach rec AB will agonize thymic tissue
GBS bugCamplyo bacter
GBS assoc withhodgkin, lupus, CMV, HIV, post-op
MS raceNorthern europe 2/2 Vit D def (MS has relapsing/remitting symptoms)
approx 40% of pt with Lambert Eaton have ___ at dxsmall cell cx
small cell lung cx100% + presnence of voltage gated Ca ch AB
MG initial dxach rec AB test
MG confirm dxEMG studies
tensilon testask edrophonium test to confirm dx of MG
MG txACH esterase inh (pyridostigmine)
GBS txIVIG or plamaphersis given to non-ambulatory pt with dz who present w/in 4 weeks of onset
Interferon Bfor MS, start early
interferon B s/eflu like sx and liver dysf
Riluzoleslow progression of ALS (antag of gluatmate * down excitotox), only med shown to increase lifespan
chemical burnmassive irrigation before coming to ER

Section 2

Question Answer
scloioisisup restrictive lung DZ * up FEV1/TLC
Duchhene gaitwaddling and has tip toe walking
ducheene heartdilated CMP, up aarthy
restrictive CMPhemachromatosis, amylodiosis, sarcoid, doxo/danorubicin
gower's signuses arms to push one up from sitting found in duchene
duchene deathMC is restritive lung dz and resp failure 2/2 scoli m weak > and dilated CMP
duchene geneX-linked recessive (up in boys)
duchene pathophysdn dystrophin * up mechanical injury

Section 3

Question Answer
pemphigus vulgarisAI against desmoglein 3, sores originate in mouth, +acantholysis, anti-epidermal antibodies + via immunofluoresence
acantholysisbx show separation of epidermal cells with retention of an intact basement membrane
bullous pemphigoidAI at epidermal basement mem, old onset, on flexor surfaces and perineal, + anti BM antibodies
Familial benign pemphigus= hailey hailey disease
vesiular lz and crusting plaques, burning, pruritus, white bands on fingernailsfamilial benign pemphigus
Grover dztransient acantholytic dermatosis
transient ancantholytic dermatosisparoxysmal itchy papular rash on trunk, men over 50 yo, small red papules on central back and mid chest
grover disease histofocal acantholysis and dyskeratosis
crusting vesicles and eryth plaques on axilla and genitalia burning, pruritus and malodorous drainagefamilial benign pemphigus
old male chronic papular eruption of tens years, histo focal acantholytic dyskeratosisgrover's disease
bullous pemphigoidwidespread blister over flexor and perianal, immunofluoresence shows antibodies to basement membrane

Section 4

Question Answer
vicarious liabilityattending is responsible for stuff commited by resident
central line placement and "mill wheel" murmurvenous air embolism
venous air embolism txaspiration of catheter, 100% O2, placement of pt in left lateral position
Behcet syndromesores on genitals and mouth, uveitis, acute falre use prednisone, use immunosuppressants for long term (MTX,cyclosporine,cyclophosphamide)
patellofemoral pain syndrome+J-sign (patella tracks laterally during terminal knee extension. up theatre sign
teres minorpain with elbow in 90 degree flexion and external rot
hawkins testimpingement of supraspinatous
MENIIAmedullary thyroid cx, pheo, hyperPTH
MENIIBpheo, med thyroid cx, mucousal neuroma
polyuria, hypokalemia, refractory hypertensionthink hyperaldosteroneism
insulinomaanxiety, tachy, nausea, diaphoresis that resolves with eating
pheo txalpha blockade followed by beta blockade, if do Beta first then unopposed alpha blockade would lead to hypertensive crisis.
phenoxybenzaminealpha blocker

Section 5

Question Answer
Genu valgumdefined as Q-angle>17o
genu recurvatumpostural hyperextension of joint
Genu varumQ-angle <14 degree
oseltamivircan be used in outpatients prior to 48 hours since sx onset.
anemia of chronic dzlow serum FE, transferrin and normal to elevated ferritin
harsh systolic murmur in kid that gets worse with standing, anything that increases preload decreases intensity of the murmurHypretrpohic cardiomyopathy
ACL teara "pop" heard from a non-contact cutting movement with the foot planted and tibia externally rotated with a valgus force across the knee.
ACL tear txinitial bracing with mobilization and physical therapy prior to ACL reconstruction.
migraine pathophsyioneuronal irritability
migrainecan abort with triptans hours later.........
cluster headache100% oxygen
migraine preventativepropanolol is best initial option, esp if HTN is comorbid, others include ELAVIL, divalporex, topiramate
ziprasidoneup QT
DM mom, macrosomic babyup hypoparathyroidism
phenoxybenzamineirreversible alpha blocker, used in pheo, must do alpha blockade before B blockade to avoid unopposed alpha activity
battery in small intestineobserve blood and urine mercury levels, too far gone to remove.

Section 6

Question Answer
renal artery stenosisuse duplex u/s to dx, use statin to reduce further stenosis
unilateral renal a stensisACEi/arb for HTN
NSAIDavoid in hx of gastric ulcer/kidney dz
PFT is normal and asthma is still suspectedget a methacholine challenge (provokes bronchial constriction in asthmatics * confirming dx)
carpal tunnel gold dxEMG studies
NSAIDScontra in preg b/c can close fetus ductus arteriosus
hyperglycemia nonketotic comagive isotonic saline and following resusitation give insulin (to avoid threshold for shock)
Neer's testto help indicate rotator cuff pathology (dn abduction down internal rotation=think suprasinatus as is most common)
RLS sxcheck ferritinFetal
paroxysmal supravent tachy(due to AV node rentrant) vagal manuevers are 1st line.
SVT unstablecardiovert
SVTvagal dont work use adenosine.
A-Fibuse Diltiazem and Metoprolol

Section 7

Question Answer
Pb poisonneuro and GI complaints, abd px diarrhea enceph periph neuropathy and RF(Fanconi syndrome)
Pb poison txsuccimer or dimercaprol
Arsenicin pesticides,contaminated ground water (severe HA, abd px, diarrhea, delirium, breath smells like garlic, tx is succimer/dimercaprol
CN poison txamyl nitrite/thiosulfate.
Hg poisondiahreeha , dn vision, RF, tachy, HTN, hyperhidrosis
methylene bluefor methehemeglobinemia (reduces Fe3+ to 2+)
prinzmetal anginatransient ST-E, tx is ditilazem/nifedipine/amlodipine =(variant angina)
Gest DMscreened at 1 hr glc at 24-28 wks, if abn do a 3 hour glucose. (abn if >140 in 1 hour
venoferiron sucrose injection
dental procedure and pt has mitral valve prolapseno indication for ABX
indication for abx ppx for dental proceduresprosthetic valve, hx of infective endocarditis, congenital heart dz, hx of cardiac t/p, prior infxn endocarditis
ppx for endocarditisuse amoxiciliin 2g 30 min prior to the procedure (prevent S. Viridians)