Step 2 Prep

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Author:
matt.hoffman
ID:
14105
Filename:
Step 2 Prep
Updated:
2010-04-23 15:33:31
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USMLE Step
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Description:
Prep for step 2
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  1. Headache, Nausea, Vomitting, Possible seizures
    Low Na, Nl to H urine osmol
    • SIADH
    • treat with H2O restriction
  2. Glasgow coma scale
    • Eyes:
    • 1. Dont open
    • 2. Open to pain
    • 3. Open to voice
    • 4. Open spontaneously
    • Verbal
    • 1. No sound
    • 2. Incomprehensible
    • 3. Inappropriate
    • 4. Confused
    • 5. Normal
    • Muscle
    • 1. No movement
    • 2. Extention to pain
    • 3. Flexion to pain
    • 4. Withdrawal from pain
    • 5. Localizes pain
    • 6. Responds to commands
  3. Tachypnea, dyspnea, chest pain, hemoptysis, and hypotension
    post sx, immobilization, etc.
    What are the steps
    • 1. CT c contrast (V/Q scan if no contrast)
    • 2. Heparin or LMW hep
    • 3. bridge to coumadin for 3-6 months
  4. Signs of arterial insufficiency vs venous insufficiency
    • Location: A-toes, webs, lateral maleoulus; V-proximal to medial maleoulus
    • Wound: A-Deep, well defined borders; V-Shallow, irregular borders
    • Pain: A-Severe pain V-Mild pain
    • Temp: A-Cool to touch V-Nl skin temp
    • Appearance: A-Thin shiny skin V-Brownish discoloration
  5. Pupil size
    • 3-9 mm
    • 3-4 constricted
    • 6-9 dilated
  6. Type of crystals found and causes
    • Needle shaped, negative birefringent: Gout
    • Rhomboid shaped, + birefringent: Pseudogout (Ca oxalate)
    • Coffin lid shaped: Struvite (kidney stones)
  7. Causes of Carpel Tunnel Syn
    • 1. Hypothyroid (waste deposits)
    • 2. Amyloidosis (amyloid deposits)
    • 3. RA (inflammation)
    • 4. Pregnancy (fluid)
    • 5. Acromegaly (tendon growth)
  8. Patient treated for depression and eats cheese or meat. What is the concern
    If pt is on MAOI it can cause HTN crises
  9. Which ECG leads correspond to different locations on the heart (Anterior, Inferior, Lateral)
    • Lateral: I, R, L, V1, V5, V6
    • Inferior: II, III, F
    • Anterior: V2, V3, V4
  10. Obstruction of which Coronary Artery causes Anterior heart damage
    LAD
  11. Obstruction of which Coronary Arteries causes Lateral heart damage?
    L Circumflex or Lateral branch of LAD
  12. Obstruction of which Coronary Arteries causes Inferior heart damage?
    RCA or L Circumflex
  13. Adult pt with:
    hx of URI 1-3 days ago
    Oliguria, Azotemia (+ BUN and Cr), Hematuria
    HTN
    IgA nephropathy
  14. Pt with: Liver disease
    CNS disturbances (depression, tremor, paranoia, catatonia, drooling)
    decreased ceruloplasmin
    Kayser-Fleischer rings
    Wilsons Disease
  15. What are the protein, cell count, and glu levels in different CNS status changes
    • Viral: p++; c+; g nl
    • Bacterial: p+; c+; g-
    • Herpes: p nl; c+; g nl (RBC present)

    • Guilliane Barre: p+
    • MS: IgG+; Bands++
  16. Over 40 man with bone pain, headaches, (rarely) decreased hearing with abnormal x-ray
    What is the next step? Treatment?
    • Likely Pagets disease:
    • Check AlkPO4(++), Ca(nl), and Phosph(nl)
    • Rx: NSAIDs, Etidronate(Bisphosphonates) or Calcitonin
  17. Pt with malignancy in testicle. What markers indicate which type of cancer?
    • Placental AlkPO4: Seminoma
    • AFP + B hCG: Embryonal
    • B hCG: Choriocarcinoma
    • + Testosterone and + Estrogen: Leydig cell tumor
  18. When should a pt be placed for dialysis?
    • 1. Refractory Fluid Overload
    • 2. Refractory +K
    • 3. Uremic pericarditis
    • 4. Refractory Met Acidosis
    • 5. Cr > 8 (>6 c DM)
  19. Right Heart Cath nl values:
    • R Art Pressure: 4-6
    • Pul Art Pressure: 25/15
    • Wedge Pressure: 6-12
  20. Which organism causes basic urine and is nosocomial
    Proteus
  21. Requirements for Exudative Pleural Effusion
    • Pleural Protein/Serum Protein > 0.5
    • Pleural LDH/Serum LDH > 0.6
    • Pleural LDH > 2/3 upper limit of serum LDH
  22. Icterus, + indirect billi, other liver enzymes nl
    Crigler-Najjar Type I
  23. Severe Jaundice, Neuro impairment, ++ indirect bili, No response to phenobarbital, liver enzymes nl
    Crigler-Najjar Type II
  24. Malaise, fatigue, abd discomfort
    Icterus after stress, illness, fasting, etc.
    + indirect billi
    cell counts nl
    Gilberts syndrome
  25. Extraintestinal manifestations of Ulcerative Colitis
    • Sclerosing Cholangitis
    • Uveitis
    • Erythema Nodosum
    • Ankylosing Spondylitis
  26. Tumor markers for : Colon, Ovarian, Testicular, Breast, Uterus, Female reproductive tract, Pheochromocytoma
    • Colon: CEA
    • Ovarian: Ca-125
    • Testicular: AFP / HCG, +test + est, placental alk PO4
    • Breast: Est or Progest receptors, HER-2 / Neu
    • Uterus: Ca-125
    • Female Tract: AFP / HCG
    • Pheo: Milli / Vanilli
  27. Pt with - Leukocyte alk PO4 and + WBC
    CML
  28. Pt with weakness and fatigue, with possible arrhythmias
    ECG findings: tall peaked T waves, wide QRS, long PR, loss of waves, or sine wave pattern
    What is the next step and steps in treatment?
    • Check chemistries (++K) ECG signs are in order of increasing K
    • Steps: 1. protect heart with Ca Gluconate
    • 2. Insulin and Glu to push K into cells
    • 3. Na HCO3 also pushes K into cells
    • 4. Excrete K with Furosemide
  29. Stone types and causes in nephrolithiasis
    • Ca Oxalate: hypercalciuria (radiopaque, needle shaped)
    • Struvite: UTI (", pyramidal crystals)
    • Ca PO4: Hyperparathyroid (")
    • Uric Acid: Chronic adic/concentrated urine, chemo, gout, DM (RADIOLUCENT)
    • Cystine: Cystinuria, AA transport defects (radiopaque, hexagonal, +nitroprusside test)
  30. Pt comes in acute cardiac failure, reports having URI a week ago. Dx?
    Dilated Cardiomyopathy from acute viral endocarditis
  31. PNA with high fever, N/V/D, altered mental status
    No organism seen on gram stain. Next step?
    • Likely Legionella use urine antigen test to confirm
    • Start Rx with: Azithro or Levofloxacin
    • Use Charcoal agar to grow
  32. Aplastic Anemia, Thrombocytopenia, Macrocytic anemia, Congenital Abnormalities, Hypopigmented spots, Tumors
    Fanconis anemia
  33. WHen should D5W be used?
    Hypernatremia with nl or high volume
  34. When should D5 0.45 saline be used?
    mild hypernatremic hypovolemia
  35. What is a common complication of giant cell arteritis?
    Aortic Aneurysm

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