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Step 2 Hi yield 2 7-12-2016

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ruhland1's version from 2016-07-12 17:29

Section

Infectious Disease
Question Answer
Fever of ukn originthink infx, cx, or AI
Strep pharyngitisfever, pharyngeal edema, tonsillar exudate, no cough
Post strep complica that cannot be altered by tx of 1o infxnpostinfx glomerulonephritis
Asplenic bugsencapsulated (pneumococcus, meningococcus, haemoph influ, klebsiella)
UTI dx cultureneed gt 100,000bact/mL for dx
Pregnant womensuseptible to UTI
SW USA and F C night sweatcoccidiomycosis, Amphotericin B
blue berry muffinrubella
Meningitis neonateGBS, E Coli, Listera. Give Ampicillin and Gentamicin
Meningitis InfantPneumococcus, Meningococcus, HiB. Give Cefotaxime and Vanco
Prior to lumbar punctcheck for up ICP (papillledema)
Up gamma globulins in CSFMultiple Scler
Black eschar and region LADcutaneous anthrax. Give penicillin or cipro
3o syphtabes dorsalis, paresis, gumma, argyll robertson pupill, aortic root aneursym
2o lym diseasearthralgia, migratory polyarthopathies, bells palsy, myocarditis
Find + cold agglutininsmycoplasm
24 yo with candidal thrushwork up for HIV, tx with nystatin in liquid
Pyeloneph riskprenancy, vesicouretal reflux, anatomic d, indwelling cath, stones
Neutropenic nadir postchemo7-10 days
Erythema migranslesion of 1o lyme disease
P Carinii ppxlt 200 give TMP SMX
MAC ppxlt 50-100 give azt/clathiro
EndocardF, murmur, Osler nodes, splinter hemm, janeway lz, roth spots
Sickle cell disease aplastic crisisParvo B19
55 yo M , smoke and ETOH new Cx and flulike. G ram is negative silver stain shows G - rodslegionella pneumoina
Acute monoarticular joint pain, bilateral bells palsylyme disease, ixodes tick, doxycycline
Endocarditis after recieving heart valveS aure or S epidermidis
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Name the Bug
Question Answer
Branching rods in infxnActinomyces Israelli
PX ChancroidHaemoph Ducreyii
Dog Cat bitePasteurella Multocida (tx AB AC= animal bite amox clav)
Gardenersporothrix schenkii
Pregnant w petsToxoplasma
Menin in AdultsN Menin
Menin in ElderlyS Pneu
ETOH and pneumoniaklebsliella (currant jelly sputum)
Infxn in burn victimpseudo
Osteomyelitis from foot wound puncturepseudo
Osteomyel in sickel cellsalmonella
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Musculoskeletal
Question Answer
Px on passive mvmt, pallor, poikilo, pares, parylysis and pulselessnessfasciotomy for compartment synd
Back px worse with standing and better with bending forwardspinal stenosis
RAMCP and PIP joints, DIPs are spared
Joint px worse over day no sx w restOA
Kid mulitiple frx, no child abuseosteogenesis imperfecta
Hip and back px stidd with improves w activity worsens with restankolosing spondylitis check HLA-B27
Arthritis conjunctivits urethrities young menReitiers Reactive arthritis (bug are campylo shigella salmon chylmid and ureaplasma)
Gout chronic txallopurinol or probenecid
Rhomboig shapepsuedo gout
Old F with px and stiff shoulder hip, cannot lift arms above head, anemia and up ESRpolymyalgia rheumatic
13 yo M with ant knee pxosgood schlatter
FOOSH frxdistal radius
Distal radius fracure FOOSHcolles frx
Radial nerver dmg due to humeral frxwrist drop, dn thumb abduction
Born breech, assymettric skin folds hipdeveolpmental dysplasia hip, get a pavlik harnessto maintain abduction
11 yo fat M with sudden limpslipped capital femoral epiphyses. AP and frog-leg lateral view
MC 1o malig tumore of bonemultiple myeloma
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Neurology
Question Answer
Uni, periorbilital severe HA with red eyecluster
Ppx migraineBB, CCB, TCA
MC pituitary tmxprolactinoma, bromocrpitine tx unless obstructive sx then get srx (transphenoidal for large tmx, radiotherapy for nonresectable)
“Broken speech”broca apahsia, frontal lobe left middle cerebral artery distribution
MCC SAHtrx, 2nd is berry aneurysm (CT of SAH shows pooling of blood in sections of brain
Crescent shape does not cross midlinesubdural (briding veins torn) the dura mater prevents from crossing midline
Initial d mind with intervening lucid intervalepidural hematoma, middle meningeal artery, convex shape, neurosrx evacuation
SAH CSF findingsup ICP, RBC, xanthochromia (yellowing due to hemolyisis)
Albuminocytological dissocgullian barre (that means up protein in CSF with only modest up in cell count)
Cold water in right earfast phase nystygmus toward L Ear is NORMAL
1o meta to brainlung breast skin melanoma kidney and GI tract
Kid ADHD ddxabsence seizures
Older and new onset headachesthink intracranial neoplasm
MCC sz kid 2-10 yoinfxn, febrile sz, trauma, idiopathic
MCC of sz in young adultTrx, ETOH w drawl, brain tmx
Confusion, confabulation, opthalmoplegia, ataxiaWernicke’s Enceph 2/2 def of thiamine
Indic for carotid endarterectomygt 70% lt 99% and pt has sx
Parkinson mxlevodopa carbidopa
ALS txriluzole (anti glutamate toxic drug)
Guillian Barre syndrome txIVIG and plasmaphere
Kid port wine stain in V2 distb with retard sz and leptomeningeal angiomaSturge Weber syndrome. Tx sx. Possible srx resection of affected lobe
Hyperphagia, hypersexulaity, hyperorality, hyperdocilityKluver-Bucy (dn amyg) (like Gary Bucy)
Dx myasgravisedrophonium
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