Step 2 random 1 (11-2-15)

ruhland1's version from 2015-11-02 16:46

Section 1

Question Answer
Rheumatic FMitral Sten, GASp A SNAKE
BBfor asx htn/ A-fib
Aortic sten 2nd line txballoon valvoplasty (indic for pt with CHF, LV dysf, Aor Regurg, age
Salmonellacontaminated P-Nut btr, H2S +(black precip on mackonkey agar)
P AeruOtitis Externa
Shigellairrev nick of 60S ribosome, inhibit protein synth
EHECirrev nick of 60S ribosome, inhibit protein synth
Coynebacterium Diptheriaeexotoxin that inactivated elongation factor-2, dn pro synth up cell death
P Aeruexotoxin that inactivated elongation factor-2, dn pro synth up cell death
Vibrio Cholerabinds Gs * up cAMP * up sx
Bordetella pertussisinactivates Gi * up adenyl cyclase * up water loss into the trachea * up sx
Salmonellaoxidase negative rod
Salmonelladirect activation of immune response resulting in up cAMP
Shigellapropels self through actin polymerization
Leptospiraquestion mark shaped
Leptospiraspirochete in animal iurine
Leptospirajaundice and photophobia and biphasic sx
Listeriapropels self through actin polymerization
Listeriadeli meats, milk, chease
deli meats, milk, cheaseavoid if preg (listeria)
Salm Typhi vs Salm TyphimuriumS Typhirium bloody rrhea. S typhi bacteremia, rose spot skin lz, constipation
Salmonella usesflagella
Borrelia BurgG(-) spirochete

Section 2

Question Answer
Aortic Stenget echocardiogram
late peaking crescendo-decresendo and very soft S2 and carotid upstroke is weak/delayedA Sten
SADsx of A Sten (Syncope/SOB, Angina, Death)
Aortic Sten severitydoppler Echo
B- Natriuretic Peppredicts sx and prog of HF
A Sten 2nd line dxCardiac Cath (if TEE is inconclusve or does not match clinical picture)
valve replacement srxmust eval CAD prior (card cath)
A Sten on CXRpostenotic dilatation of ascending aorta +valve calcif
any suspected valve dzget echocardiogram
A sten causesover 70 is degen calificacation, under 70 is bicuspid aortic valve, 3rd MC is RFever
A Regurgup murmur with hand grip, up SVR * for back flow
M StenMC cause is RFever

Section 3

Question Answer
Right Seated flexion, R base and R ILA posterior, what is L5Rot R sacrum * L5 is Rot L * R Seated Flex therefore L oblique axis * SB right
Fryetteany vertebra is neutral if SB and Rot in opposite direction
both ILAs cannot spring testbilateral sacral flexion
bilateral sacral flexionpregnancy
R + seated, shallow left sacral sulcus and ILAL on L sacral torsion
R + seated, shallow R sacral sulcus and ILAR on Lsacral torsion
L + seated, shallow L sulcus and ILAL on R sacral torsion
bil sacral flexion/extseated flexion is always (-)
(makes a D)dextroscoliosis
(makes an C)levoscoliosis
dextroscoliosisconvex R
convex= bulging outwards
meningococcal menin1000s(PMN) cell count, up pressure, dn glc, up protein
fungal menin10-100s (lympho cell count), up pressure, dn glc, up pro
viral menin10-100s (lympho) cell count, slight up pressure, ud glc, ud protein
normal csf<5 cell, ud pressure, ud gls, ud protein

Section 4

Question Answer
INR if any risk of emboli (srx, dz....) get to 2-3
FFPcontains clotting factors 2/7/9/10 * can reverse warfarin
INR <2subtherapeutic * up risk emboli
C-peptideused to differentiate pancreas produced insulin from exogenous(lacks C-protein)
difficulty with blood glc control using oral hypoglycemics in T 2 diabeticsinitiate insulin
diabetic "honeymoon"period of T1DM "remission" a week after tx with insulin lasts a few months. During this time patiend need less insulin than waht will be eventually rq'd
DM screeningeye,urine microalbumin, monofilament test
"silent" isch/myo infarctCVasc dz in DM!

Section 5

Question Answer
seligilineMAOI-B for early PDz
refractory depressionbupropion
buproprionblock reuptake of NE and DA
avoid if hx of sz or eating d/obupropion
buspironefor Generalized Anx (non-benzo)
ClomimpramineQT prolongation fatality
serotonin syndromecyproheptidine antidote
Vareniclinebinds nicotinic and releases DA while blocking and binding consequent effects of smoked nicotine
varenicline s/eup depression and suicidal ideation
orthostatic hypotenisonTCA
hx of cardiotoxicity specifically avoidTCAs and Citalopram (both up QT prolong)
donepezilcholinesterase inhib for severe alzheimers

Section 6

Question Answer
straight line for ASIS to medial mallelousto measure leg length
R anterior inominate will make leg R leg appear longer if anatomically the same length
R posterior inominatewill make R leg appear shorter if anatomaically the same length
if R leg is anatomically shorter what is compensationR ant inom rot L post inom rot
unilateral hip replacementside with srx will become shorter but appear normal due to ipsilateral anterior inominate rotation and contralateral posterior inom rot
heel liftINITIALLY use 1.5mm(1/16th inch) increments on the shorter side for ELDERLY and 3.2mm(1/8'' inch) in YOUTH
heel liftincrementally until 1/2 to 3/4 of discrepancy is reached
find short leg shortly after srxentire discrepancy heel lift corrected at once

Section 7

Question Answer
non selective BBcontrainidacted in any angina becasuse can cause vasocon
indirect Alpha 1 agonistnonselective BB
intermittent episodes of severe chest pain and find nonspecific ST-elevations on EKGvariant/prinzmetals angina
prinzmetal anginatx is CCB/nitrates
unopposed alpha rec vasoconseen in non-selective BB

Section 8

Question Answer
dependant personalitypt stays with boyfriend despite him beating her
shy, low self confidence, intense fear of being disliked and avoid relationships due to fear of rejectionavoidant personality
inadequacy and hypersensitivity towards othersavoidant personality
excessively emotional and seek attention, sexual and superficial, lively and charming, easily jealous and dramatic if not receving desired attnhistrionic personality
unstable mood, impulsive, manipulativeborderline personality