USMLE Step2 CK review
Terms
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- MC thyroid tumor
- Papillary ca.
- Tx for SIADH
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Acute: fluid restriction and hyptertonic saline slowly(for board purpose do not give hypertonic saline)
Chronic: demeclocycline - Tx for DI
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Central DI: DDAVP
Nephrogenic: Thiazide diuretics - What 2 proteins are used in Dx acromegly
- GH ang IGF-1(made in liver in response to GH)
- Dx: Def of GnRH-->no secondary sexual characteristics; a/w anosmia
- kallmann's syndrome
- Dx test for Conn's syndrome
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Measure plasma aldosterone to plasma renin activity ratio
a ratio > 20 = Conn's syndrome (hyperaldosteronism) -
1. Dx:
18-yo man w/ hemophilia A who was recently mugged (receiving multiple blows to head and abdomen) is now complaining of dizziness, abdominal pain, dark patches on his elbows and knees, and uncontrollable cravings for pizza and french fries -
Primary Adrenal Insufficiency
(Addison's Dz) - What drug causes macrocytic anemia and atypycal lymph?
- Phenytoin
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3. Dx:
Pheochromocytoma, retinal angioma, CNS hemangioblastomas, renal cell CA, pancreatic pseudocysts, ependymal cystenoma - Von Hippel-Lindau Dz
- DOC for hyperaldosteronism
- Spironolactone
- Dx test for Pheochromocytoma (seceret Epi and Norepi, --NE secreted by all extraadrenal tumors)
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24 hr urine: Elevated urine catecholamines and their metabolites urine Vanillylmandelic Acid
(VMA), metanepherine etc - Tx for Pheochromocytoma
- surgery (preoperative alpha and beta-blockade)
- In Tx for Pheochromocytoma, why is it necessary to block alpha before giving beta blocker?
- to prevent unopposed vasoconstriction
- Electrolyte and CBC abn in Addison's DZ?
- hyponatremia, hyperkalemia and eosinophilia
- 2 main etiologies of primary hyperaldosteronism and their respective Tx
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Adrenal adenoma(Conn's Sx)-->adrenolectomy;
bilateral hyperplasia-->spironolactone - 2 tests used to screen for Cushing's Syndrome
- overnight low dose DXM suppression test and 24-h urine free cortisol (not plasm cortisol)
- D/D b/t primary and secondary hyperaldosteronism
- renin increase in secondary
- Test used to localize the source of hypercortisolism?
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1. ACTH level: increase=ectopic/pituitary;decrease=adrenal)
2. high dose DXM suppression test: ACTH incresing in pituitary dz - Tx of DKA
- Fluids (add dextrose when glucose falls below 200mg/dl), insulin and potassium
- Main Tx of hyperosmolar hyperglycemic nonketotic coma-DM2?
- aggresive fluid replacement
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Tx for each of the following in DM:
1. Proliferative retinopathy
2. neuropathy -
1. Proliferative retinopathy: laser photocoagulation
2.neuropathy: Gabapentin and amitriptyline -
DM drug:
increase insulin secretion; may cause hypoglycemia - Sulfonylureas(e.g., glyburide, glipizide, glimepiride)
- DM drug: increase peripheral insulin responsiveness; may cause hepatotoxicity
- Thiazolidinediones(e.g., pioglitazone, rosiglitazone)
- decrease GI absorption of carbohydrates; may cause GI upset
- alpha-Glucosidase inhabitors(e.g., Acarbose)
- Name the complication of DM Mx: Nocturnal hypoglycemia causing elevated morning glucose secondary to release of counterregulatory hormones
- Somogyi effect (due to increase epi and glucogon)
- Name the complication of DM Mx: Abrupt early-morning hyperglycemia caused by reduced effectiveness of insulin
- Dawn phenomenon
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Name the islet tumor:
Secondary DM, necrolytic migratory erythema - Glucogonoma (alpha-cell tumor)
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Name the islet tumor:
a/w WDHA syndrome(Watery diarrhea, Hypokalemia and Achlorhydria) - VIPoma
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Name the islet tumor:
Clinically characterized by Whipple's triad - Insulinoma(beta-cell tumor)
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Dx:
9 y/o female with muscle cramps; PE: rounded face with flat nasal bridge, abn dentition, +Trousseau's sign and Chvostek's sign and shortened metacarpals - Albright hereditary osteodystrophy ( Pseudohypoparathyroidism)
- D/D b/t Testicular torsion and epididymis
- absense of flow on Doppler US in testicular torsion
- Worst px of all testicular tumors
- Choriocarcinoma-highly invasive, elevated beta-hCG
- Tx for Wegener's granulomatosis
- Cytotoxics and steroids
- Kidney dz a/w Hodgkin's lymphoma
- Minimal change dz
- Tx of Babesiosis (a/w hemolysis and splenectomy)
- Tx with 2 drups regimes: Quinine-clindamycin; Atovaquone-azithromycin
- 4 common findings in ADPKD
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1. cerebrovascular aneurysm
2. HTN
3.nephrolithiasis
4. Mitral valve prolapse - Initial Tx for kidney calculi?
- Hydration and analgesia
- MC surgical procedure for BPH
- transuretheral resection of the prostate(TRUP)
- 2 MC complications of prostatectomy
- impotence and incontinence
- 3 Tx options for mets of prostate ca?
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Androgen ablation:
1. Luteinizing hormone releasing hormone(LHRH) agonist(Leuprolide)
2. Antiandrogens(Fluamide)
3. Orchiectomy - 2 Medical options for BPH
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1. 5-alpha-reductase inhibitors(Finasteride)
2.alpha-receptor blocker(terazosin) - INdications for surgery in BPH
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symptomatic obstruction:
1. postvoid residual volume >100ml;
2. multiple bouts of gross hematuria;
3.recurrent UTIs -
Mx: 1.prevent aplastic crisis in sickle cell anemia
2. decrease the frequency of sickle cell crisis (Painful episode) -
1.Foliac Acid
2.hydroxyuria - D/d b/t 2 hemolytic anemia: 1. Sperocytosis 2.autoimmune
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1. Sperocytosis: FHx+, direct coombs test-
2.autoimmune:FHx-, direct coombs test+ - Anemia a/w hypothyroidism
- Macrocytic anemia
- Anemia a/w leukemias and lymphomas
- autoimmune hemolytic anemia
- Anemia a/w "fishmouth vertebrae" on radiograph
- Sickle cell anemia
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Anemia a/w:
SLE, CLL, drugs;+direct coomb's test (due to IgG autoantibodies) - Warm autoimmune hemolytic anemia
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Anemia a/w:
unconjugated bilirubinemia, increased urine urobilinogen, decrease hemoglobin, hemoglubinuria, decrease haptoglobin, hemosiderosis - hemolytic anemia
- Tx of vasooclusive sickle crisis
- O2 therapy, IV hydration, analgesia (ususally opioids)
- AD d/o, episodes of easy brusing, mucosal and GI bleeding
- von Willebrand's dz
- coagulation d/o a/w lyphomas, leukemias, HIV infection, and autoimmune dz
- ITP
- coagulation d/o a/w IgG antiplatelet Ab (+coombs)
- ITP
- ITP therapy
- 1st line Tx=oral steroids; 2nd line is IV immunoglubin(IVIG), splenectomy, or chemotherapy(commonly cyclophosphamide)
- Tx of TTP
- 1st line Tx = plasmapheresis or IV immunoglubin(IVIG); splenectomy for refactory cases (fatal if untreated)
- Tx for von Willebrand's dz
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mild dz: desmopressin;
Severe : Factor VIII concentration - 2 hemo d/o with Low leukocytic alkaline phosphatase
- CML; paroxysmal nocturnal hematuria
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Myeloproliferative d/o a/w:
Erythromelalgia( throobbing or burning of hands and feet) - Essreential thrombocytosis
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Myeloproliferative d/o a/w:
increase RBC mass and low/normal erythropoitin - polycythemia vera
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1.Hyperviscosity Syndrome in two Myeloproliferative d/o
2. Hyperviscosity Syndrome in plasma cell d/o -
1. polycythemia vera and Essreential thrombocytosis;
2. Waldenstrom macroglubinemia -
plasma d/o a/w:
Russel bodies and "plymphocytes" (plasmacytoid lymphocytes) - Waldenstrom macroglobulinemia
- Tx for polythemia vera
- Tx with ASA, phlebotomy, and/or hydroxyurea
- myeloproliferative d/o a/w : Basophilia
- polythemia vera
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myeloproliferative d/o a/w :
peripheral thromocytosis, bone marrow megakaryocytosis, and splenomegaly - essential thrombocytosis
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myeloproliferative d/o a/w :
widespread extremedullary hematopoesis with megakaryocytic proliferation in the bone marrow - Myelofibrosis with myeloid metaplasia
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1.Somogyi effect? Dx? Mx?
2.Down Phenomenon? Dx? Mx? -
1. 7AM gglucose high with 4AM glucose level low. caused by releasing stress hormone Mx: decrease insulin
2. 7am glucose high without 4 am hypoglycemia(glucose normal or high at 4AM). Caused by am GH secreation. Mx: increase insulin -
Dx: a: central cord syndrome; b:anterior cord syndrome; posterior cord syndrome?
Q: result from hyperextension injury and is charcterized by weakness that is more pronounced in upper extremities that in the lower extremities - Central cord syndrome
- Dx: complete motor paralysis and loss of sensation distal to the lesion.
- anterior cord syndrome. It ususally occurs secondary to the compression of the anterior cord.
- Mx: femoral shaft fractures
- closed intramedullary fixation of fracture
- Dx: commonly associated with burst fracture of the vertebra and is characterized by total loss of motor function below the level of lesion with loss of pain and temperature on both sids below the lesion and with intact proprioception
- Anterior cord syndrome