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Step 2 Hi Yield 1 7-12-2016

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ruhland1's version from 2016-07-12 16:36

Section

Cardiovasc
Question Answer
Unstable anginanew, worsening, or occurs at rest
DM + prouriaACEi
Becks triadhypotension, distant heart, JVD
Cardiac tamponadebecks triad also pulsus paradoxus
Slow AV node transmissionBB
Slow AV node transmissiondigioxin
Slow AV node transmissionCCB
Flushing and pruritusniacin
A Fib TxAnticoag, control rate, cardioversion
V fib tximmediate cardiovert
AI 2-4 wks post MIDressler synd
Dressler SyndFever Pericarditis up ESR
IVDU and holosystolic murmur at left sternal bordertreat HF and replace trisc valve
Hypertrophicardiomyopathydx is echo (LV wall thicken and outflow obstruction)
Pulsus paradoxusfall of systolic BP >10 with inspiration (seen in cardiac tamponade)
Pulsus paradoxus MOAup inspiration * down pulm venous return, but the pressure gradient between L and R V is great enough to not see this normally, in cardiac tamponade the pressure gradient between RV and LV becomes more equal due to pericardial sac pressure becoming greater than LV * RV pushes into LV due to reduced pressure in LV * down CO and any sort of physiologic reduction in venous return to LV is more significant, hence pulsus paradoxus) AKA up pressure down LV preload * up PP
Pericarditislow voltage, diffuse STE
Hypertensiongt 140/90 on 3x occasions 2 weeks apart
AAA indic for srx>5.5 in abdm >6 in thoracic cavity, or if grows gt 1 cm/yr
Surgically correctable cause of htnrenal artery stenosis
Surgically correctable cause of htncoarc of aorta
Surgically correctable cause of htnpheo (tx phenoxybenzamine)
Surgically correctable cause of htnconns (1o hyperaldosteronism)
Surgically correctable cause of htncushing
Surgically correctable cause of htnunilateral renal parenchyma disease
Surgically correctable cause of htnhyperthyroid
Surgically correctable cause of htnhyperparathyroid
Eval for pulastile abd mass and bruitabdominal u/s and CT
MI txMONA IV BB and heparin
Acute Coronary Syndrome txMONA and IV BB and heparin
Acute Coronary syndromeincludes STEMI, NSTEMI, unstable angina
Metabolic syndromeadominal obese, high TG, low HDL, htn, insulin resist, prothrombitic/inflx states
Metabolic syndrome waistmen gt 40, fem gt 35
Metabolic syndrome fasting TGmen gt 150, fem gt 150
Metabolic syndrome HDLmen lt 40 women lt 50
Metabolic syndrome bpboth gt 130/85
Metabolic syndrome fasting glcboth gt 110
Metabolic syndrome criterianeed 3 of 5 to define
Cardiac test 50 yo M w angina and can exerciseexercise stress treadmill with ecg
Cardiac test 65 yo F with LBBB and severe OA and unstable anginaPharmological stress (dobutamine)
LDL target in DMlt 70
Stress test isch signsangina, ST-seg changes, down BP
MI ekgSTE, flattened T waves, Q waves
Young STE at rest, enzymes udPrinzmetal
Silent MI sxCHF, shock, d mind
Dx for PEV/Q scan
Heparin antidoteprotamine
Warfarinup PT only
Young + hx + sudden deathhypertrophic CMP
Endocarditis ppx oral srxamoxicillin
Endocarditis ppx GI srxampicillin and gentamicin before, amoxicillin after
Endocarditis ppx GU srxampicillin and gentamicin before, amoxicillin after
Ischemia d/t PVDzpx, pallor, pulselessness, paralysis, parathesia, poikilothermia
Virchows TriadStasis, hypercoag, endothelial dmg (SHE mneomnic) for PE risk
MCC of htn young womenOCP
MCC of htn young maleexcessive ETOH
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Dermatology
Question Answer
Stuck onseborrheic keratosis
Red plaques with silvery white scales and sharp marginspsoriasis
MC skin cxbasal cell cx
Pearyl colored papule with translucent surface and telangebasal cell cx
Honey crustimpetigo
Febrile, hx DM with red swollen px lower extcellulitis
Positive nikolskypemphigus vulgarus
Negative Nikolskybullous pemphigoid
Obese dark velvety back of neckacanthosis nigracans, check fasting blood sugar
Flat topped papulelichen planus
Iris-like target lzerythema multiforme
Celiacsdermatitid herpatiformis
Herald patch the christmas treepityriasis rosea
KOH spaghetti and metballsmalezzia furfur and pityriasis versicolor
Premalig lz from sun that up risk sq cell cxactinic keratosis
Dewdrop on rose petallesion of 1o varicella
Cradle capseborrheic dermatitis
Cradle cap txantifungals
Inflx and epithelial thinnning in anogential area in postmenop womenlichen sclerosus
Exophytic nodules with varying scaling and ulcersq cell cx
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Endocrine
Question Answer
MCC of hypohashimoto
Hashimoto labup TSH dn T4 up antimicrosomal antibodies
Exoph, pretibial myxedma, dn TSHgraves
MCC cushing syndromeiatrogenic steroids
High PO4finding of hypoPTH
Headache, wk, polyruia, htn, tetany, up Na dn K up pH1o hyperaldo conns
Conns synd2/2 bilateral adrenal hyperplasia
Pheonever BB then alpha B, always alpha block then BB
Pheo txphentolamine and phenoxybenzamine (alpha antag)
Li and polyuriaNephrogenic Diabetes Inspidus
Central Diabetes insipid txDDAVP
Post op with hyponatremia and normal voSIADH 2/2 stress
Lactic acidosismetformin
Wk, N/V, new skin pigm, dn Na up K1o adrenal insuff (addisons)
Addisons txreplace glucocorticoids, mineralcorticoids, IVF
A1C goal for DM ptlt 7.0
DKA txSaline until stable them half saline and insulin
memorize

 

Epidemiology
Question Answer
Bias introduced into a study when a clinician is aware of pt tx typeobservation bias
Screening detects a disease earlier and * lengthens time of dx till deathlead-time bias
If you want to know if race affects mortality rate but most of the variation in mortality is predicted by socioeconomic status, * socioeconomic status isconfounding variable
Sensitivity(TP/TP+FN)
Role of sensitive testslow false negative * good at ruling out disease
Most ppl with TB will be PPD + meaningit is highly sensitive for TB
Cross sectional surveryprevalence
Cohort studyprevalence and incidence
Test with consistent results, but results are wronghigh reliability, low validity
Cohort vs case controlcohort cal RR and Odds ratio, case control calcs Odds ratio
Odds ratiolikelyhood of disease among indiviuals exposed to a risk factor compared to those who have not been exposed
Attributable risk incidence rate of a dz in exposed - IR of dz in unexposed (how much can we attribute the riskfactor to the incidence rate)
Relative riskthe incidence rate of a dz in a population exposed to a factor divided by the IR of those not exposed
NNTx1/(rate in unTx’d group - rate in Tx’d group)
Screen colorectal cx earlyhx of IBDz, FAP, HNPCC, 1o relatives with adenomatous polyps lt 60 yo or colorectal cx
Neonatal mortnumber of deaths from 0 to 28 days perr 1000 live births
Fetal mort20 weeks gest to birth
Perinatal mort20 weeks gest to one month of life
Maternal mortpregnancy to 90 days postpartum
memorize

 

Ethics
Question Answer
Parental consentnot nescessaey for pregnant minors
Psych admindanger to self or others or cannot do ADLs
Withdrawling vs withholding life sustaining caresame from ethical standpoint
Grounds of futility, physician can refuse to txwhen no rationale for tx, maximal intervention is failing, a given intervention has failed, tx will not achieve goals of care
Young trxconsent is implied in emergencies
When confidentiality must be overriddenreal threat of harm to 3rd parties, suicidal intentions, certain diseases, elder and child abuse
Involuntary isolationwhen treatment noncompliance represents serious danger to public health (active TB)
Kid has cxa patients family cannot require a doctor withod info from a pt
memorize

 

Gastrointestinal
Question Answer
Sudden severe diffuse abd px, peritonal signs AXR free air under diaphragmemergency laparotomy to repair perf’d viscus, likely stomach
MCC of acute LGI bleed in gt 40yodiveticulosis
Dx used when u/s is equivocol for cholecystitisHIDA
Senteniel loopacute pancreatitis (isolated distended loop of bowel adj to inflx
Diarrhea MC bugcampylbacter
Diarrhea recent abxC diff
Diarrhea campinggiardia
Travelesr diarrheaETEC
Diarrhea picnic mayoS aureus
Diarrhea hamburgerEHEC (O157 H7)
Diarrhea fried ricebacillus cereus
Diarrhea chicken/eggsalmonella
Diarrhea seafoodvibrio
Diarrhea seafoodHepatitis A Virus
Diarrhea AIDSIsospora
Diarrhea AIDSCryptosporidium
Diarrhea AIDSMAC
Anorectal fistuathink chronz
Diarrhea psuedoappendicitisyersinia
Up risk colon cxUC
IBDz findingsuveitis, ankolosing spondylyitis, pyoderma gangrenosum, erythem nodsum, 1o sclerosing cholangitis
IBDz tx5 ASA +/- sulfasaline and steroids in acute
Charcots triadRUQ pz, jaundice, F and chil in setting of ascending cholangitis
Reynalds pentadCharcot + shock and d mind, with suppurative ascending cholangitis
Acute GI bleeddo ABCs
4 yo oliguria, petechiae, jaundice following an illness that had bloody rrheaHUS 2/2 EHEC O157 H7
Post HBV exposure txHBV Ig
Drug induced hepatitisTB drugs and tertacycline and tylenol (TTT)
40 yo fat F up Alk P, up Bili, prur, dark urine, clay stoolsbili tract obstruct
Highest risk incarcerationfemoral hernia
Mx of suspected pancreatitisconfirm dx with elevated amylase and lipase, make pt NPO and give IVF, O2, analgesia, “tincture of time”
memorize

 

HEME ONC
Question Answer
Microcytic Anemia MCCTICS Thalassemia, Iron def, anemia of Chronic disesase, Sideroblastic anermia
Old male with hypochormic, microcytic anemia asxget fecal blood test and sigmoidscopy, must rule out colon cx
G6PD hemolytic crisis precipsulfonamide, antimalaria, fava beans
MC inherited up coagFactor 5 leiden mutation
MC inherited hemolytic anemiahereditary spherocytosis
Dx hereditary speheocytosisosmotic fragility test
Pure RBC aplasiadiamond black fan (thumb looks like a finger)
Anemia with absent radii and thungs, diffuse hyperpig, cafe au lait, micro ceph, and pancytopeniaFanconis
Cause aplastic anemiachloramphenicol, sulfonaimides, radiation, chemotherapy
Viruses that cause aplastic anemiaHIV, hepatitis, parvo B19, EBV
Ddx polycythemia vera from 2o polycythemiaboth up hct and RBC, polycythemia vera has normal O2 and low EPO ( PCV cells are hypersenstive to EPO so EPO is down from negative FB but is still strong d/t sensitivity)
TTPFAT RN Fever Anemia Thrombocytopenia Renal dysf Neuro abn
HUStriad RAT Renal failure Anemia Thrombocyotpenia (dn RBC and pl8 due to microangiopathic thrombosis and hemolysis)
TTP txplasmapher, steroids, antipl8 drugs
ITP in children txself resolve, may need IVIG and steroids
DICup fibrin split products, up d-dimer, dn pl8 dn fibrinogen dn hct
Boy with hemathrosis up PTT ud PT and BTHemophilia A or B
Hemophilia A txdesmopressin (up VWF * up FVIII half life), factor VIII supplement
Hemophilia B txfactor IX supplement
Ud pt ptt, up btvonwille brands, txx is desmo FFP or cryoprecip
Muliple myelomamonoclonal gammopathy, bence jones prouria, “punched out” lz
Mixed celluar infiltrate with eosinophilshodgkins
10 yo with B syptoms and anterior mediastinal massnon-hodgkins lymphoma
Microcytic anemia dn Fe serum, dn TIBC, ud or up ferritinanemia of chronic disease
Anemia of chronic disease pathosup inflx * down Fe for bugs to gobble up
80 yo fatiauge, LAD, S meg, isolated lymphocytosisCLL
CML watch forblast crisis (F, bone px, S meg, Pancyto), just full of cx pumping out blasts causes all of this
Heinz bodiesseen in thalessemia, G6PD and post spenectomy (are oxidized/denatured Hgb)
Auto Recessive, defect in GP IIbIIIa pl8 receptor and dn pl8 aggGlanzmann’s thrombasthenia
Thrombastheniaaka decreased pl8 func
Sickle cell crisisO2, analgesia, hydration, if severe * transfusion
Complication of thallesmia txFe overload, use deferoxamine
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