usmleworld test6 step2
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- si/sx of optic glioma
- slowly progressive unilateral vision loss, decreased brightness sensation, exophthalmos
- what is the eye manifestation of tuberous sclerosis
- retinal hamartoma
- what are the tumors of MENI?
- Pituitary adenoma, pancreatic tumors (gastrinoma, VIPoma, glucagonoma), parathyroid adenomas
- what are the four syndromes of lacunar infarcts?
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1. pure motor hemiparesis
2. pure sensory stroke
3. ataxic-hemiparesis
4. dysarthria-clumsy hand syndrome - what causes pure hemiparesis-type lacunar infarcts?
- infarct in the posterior limb of the internal capsule,
- si/sx of pure hemiparesis lacunar infarct?
- unilateral motor deficit (face, arm, leg), no loss of vision or higher cortical function
- what causes a pure sensory lacunar infarct?
- infarct in the ventroposterolateral nucleus of the thalamus,
- si/sx of a pure sensory lacunar infarct?
- unilateral numbness, paresthesias, involving face, arm , leg
- what causes ataxia-hemiparesis lacunar infarcts?
- infarct in the posterior limb of the internal capsule
- si/sx of ataxia-hemiparesis lacunar infarcts?
- weakness that is more prominnent in the lower extremity, ipsilateral arma nd leg incoordination
- what causes dysarthria-clumsy hand syndrome?
- infarct in the basis pontis
- si/sx of dysarthria-clumsy hand syndrome?
- hand weakness, mild motor aphasia, NO sensory abnormalities
- three phases of hepatitis infection
- prodromal, icteric, convalescent
- si/sx of acute hepatitis A?
- nausea, vomiting, mild abdominal pain, aversion to smoking
- treatment of hepatitis A?
- supportive, give contact immunoglobulin
- what treatments improve survival in pts with chronic renal insufficiency?
- protein restriction and ACE inhibitors
- when should ACE inhibitors NOT be used in renal failure pts?
- when creatinine is over 3-3.5
- what is the hallmark finding in mitral stenosis?
- elevated left atrioventricular pressure gradient
- treatment of mediastinitis
- open debridement and abx
- how do you give viagra to pts on alpha blockers?
- make sure they take them greater than 4 hours apart
- what do you order if a pt has gouty attacks while on colchicine?
- 24 hours urine uric acid
- most common place for basal cell carcinoma
- lower eyelid margin
- what is the most common cause of asymptomatic elevation of alkaline phosphatase in the elderly?
- paget's disease, even with normal calcium and phosphorus
- absolute contraindication for bupropion?
- epilepsy
- what is a chalazion?
- tear gland of the eyelid becomes obstructed, a painfull swelling that progress to a non-painful rubbery lesion, may house a squamous cell cancer, so get histologic examination
- what are the phosphorus levels in hyperparathyroidism?
- low
- what are the phosphorus levels in multiple myeloma
- high
- define heat exhaustion
- volume and salt depletion from heat, may have vertigo, impaired judgement, nausea, vomiting, frontal headache
- best drug for acute hyperthyroidism
- beta blocker
- most common bug in nursing home pneumonia?
- strep pneumonia
- what are unmeasured cations in the blood?
- calcium, magnesium, phosphorus
- BP goal for diabetics?
- <130/80
- si/sx of HUS?
- recent diarrheal illness, fever, anemia, renal failure, thrombocytopenia, shistocytes, thrombocytopenia
- si/sx of mesenteric ischemia?
- food fear, weight loss, pain after eating, abdominal bruit,
- treatment of mono
- rest, avoidance of contact sports, steroids if there's upper airway obstruction, hemolytic anemia, or thrombocytopenia
- karyotype in Kallman's syndrome
- 46, XX or XY (normal)
- si/sx of Kallman's syndrome
- anosmia, hypogonadotropic hypogonadism, amenorrhea, absent secondary sexual characteristics, euchonoid stature
- what causes the si/sx of Kallman's syndrome?
- absence of GnRH
- how is routine diabetes screening done for pregnant women?
- it's done at 24-28 weeks, with a one hour 50gm glucola test as a screening test. If that's positive (>140), it's followed with a 3 hour, 100gm test which is positive if two or more values are elevated
- what is the best test to confirm GERD?
- 24 hours pH monitoring
- how do you treat migraines in pregnant pts?
- NOT triptans!!!! or NSAIDS!!! use tylenol
- in which pts are triptans contraindicated?
- pregnant pts, those with CAD, uncontrolled HTN, CVA
- which pts get chlamydial screening?
- sexually active women 25 years old or younger
- immediate management of chemical eye burns
- irrigation for at least 30 minutes with water, even if they're at home, irrigate before going to ER
- what is the most important predictor of mortality in TCA overdose pts?
- QRS prolongation
- what is the recommended screening test for lipid disorders?
- HDL and total cholesterol.
- what do you do for a suspected VSD
- if no pulmonary sx, all they need is EKG, echo, and surveillance, endocarditis prophylaxis, most close spontaneously