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Step 2 CK UW > 7/28/16 > Flashcards

7/28/16 Flashcards

1
Q

what is the normal RBC to WBC ratio in CSF?

A

1 WBC to each 500-1000 RBCs

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2
Q

loss of all function (flaccid paralysis) except for position and vibratory sensation below a spinal cord level, loss of deep tendon reflexes

A

anterior spinal artery occlusion

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3
Q

ddx: position and vibratory sensation are lost, motor pain and temperature intact

A

subacute combined degeneration of the cord (B12 deficiency or neurosyphilis)

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4
Q

loss of pain and temperature on one side and loss of position and vibratory sense on the other side below a spinal cord level

A

brown-sequard syndrome (unilateral hemisection of sp cd)

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5
Q

presentation of tuberous sclerosis

A

RETINAL LESIONS, NEUROLOGICAL ABNORMALITIES (seizures, mental retardation), SKIN (leathery plaques on trunk, hypopigmented patches, reddened facial nodules), RENAL ANGIOMYOLIPOMAS, cardiac rhabdomyomas

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6
Q

port-wine stain on the face, seizures

A

sturge-weber syndrome

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7
Q

tx of mild vs severe parkinson disease

A

mild: ANTICHOLINERGICS (benztropine, trihexyphenidyl), AMANTADINE (in older pts intolerant of anticholinergics)
severe: DOPAMINE AGONISTS (pramipexole, ropinirole), LEVODOPA/CARBIDOPA, COMT INHIBITORS (extend duration of levodopa/carbidopa), MAO INHIBITORS (slow progression of disease)

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8
Q

what are the important side effects of the anticholinergic medications given to mild parkinson disease pts?

A

benzytropine and trihecyphenidyl cause dry mouth, WORSENING of PROSTATE HYPERTROPHY, and constipation

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9
Q

what are the important side effects of the medications given to severe parkinson disease pts?

A

levodopa/carbidopa are associated with “ON/OFF” phenomena, where insufficient dopamine can cause BRADYKINESIA (off), or too much dopamine can cause DYSKINESIA (on)
MAO inhibitors can cause hypertensive crisis if taken with tyramine-rich foods

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10
Q

pt with parkinson syndrome symptoms PLUS autonomic problems such as orthostatic hypotension, impotence, incontinence, dry mouth, dry skin

A

multiple system atrophy (Shy-Drager syndrome)

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11
Q

tx for dyskinesia of huntington disease

A

tetrabenazine

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12
Q

what should you consider in a pt with multiple sclerosis on chronic suppressive medication has worsening neurological deficits and MRI shows new, multiple white matter hypodense lesions

A

NATALIZUMAB is associated with development of PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)

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13
Q

what are the best drugs to prevent relapse in multiple sclerosis?

A

glatiramer and beta-interferon

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14
Q

tx for amyotrophic lateral sclerosis (ALS)

A

RILUZOLE (prevent progression), BACLOFEN (for spasticity)

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15
Q

what nerve affected: wasting of hypothenar eminence, pain in 4th and 5th fingers

A

ulnar nerve

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16
Q

what nerve affected: wrist drop

A

radial nerve (saturday night palsy = pressure on inner, upper arm; crutches)

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17
Q

what nerve affected: pain/numbness in ankle and sole of foot that worsens with walking

A

Tibial nerve (Tarsal Tunnel syndrome)

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18
Q

what nerve affected: weak foot with decreased dorsiflexion and eversion

A

peroneal (high boots, pressure on back of knee)

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19
Q

tx for guillain barre syndrome

A

IVIG OR plasmapheresis (NOT STEROIDS and NOT BOTH)

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20
Q

pathogenesis of myasthenia gravis and presentation

A

autoantibodies against acetylcholine receptors at the neuromuscular junction, presents in YOUNG WOMEN OR OLD MEN with ptosis, difficulty chewing, slurred speech, diplopia, weakness of limb muscles EXACERBATED BY CONTINUOUS USE

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21
Q

what imaging should be done in pts with confirmed myasthenia gravis?

A

chest CT with contrast to look for thymoma

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22
Q

tx for myasthenia gravis

A

neostigmine or pyridostigmine (acetylcholinesterase inhibitors)

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23
Q

distinguishing features of myasthenia gravis vs lambert-eaton syndrome

A

myasthenia gravis sx WORSEN with repeated muscle stimulation, whereas lambert-eaton syndrome (small cell lung cancer antibodies against presynaptic calcium channels) causes weakness that IMPROVES with repeated stimulation

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24
Q

management of myasthenia gravis pts that are refractory to medications

A

under 60 = thymectomy

over 60 = prednisone

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25
Q

tx for acute myasthenic crisis

A

IVIG or plasmapheresis

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26
Q

tx for lewy body dementia

A

tx alzheimers and parkisons features with levodopa/carbidopa

27
Q

what is BRCA associated with?

A

THE BRCA BOP! Breast, Ovarian, and Pancreatic cancer

28
Q

what are the side effects of the ER/PR positive breast cancer drugs?

A 
tamoxifen: endometrial cancer, clots
aromatase inhibitors (anastrazole, letrozole, exemestane): osteoporosis (inhibit estrogen effect everywhere, even the good effects, like on bone density)
29
Q

how do you decide what medications to give to a ER/PR positive breast cancer pt?

A

aromatase inhibitors (anastrozole, letrozole, exemestane) are better for POSTmenopausal pts, whereas tamoxifen is better for PREmenopausal pts

30
Q

what is the tx for her2/neu positive breast cancer pts?

A

trastuzumab

31
Q

how is gleason grading used in prostate cancer?

A

measures aggressiveness of prostate cancer; range from 2-10, high score = get it out before it metastasizes!

32
Q

alpha fetoprotein is secreted only by ______ testicular cancers. _____ is up in all of them.

A

nonseminomatous; hCG

33
Q

tx of seminoma vs non-seminoma testicular cancers

A

seminoma: radiation for local disease and chemotherapy for widespread disease
non-seminoma: chemotherapy only

34
Q

management of low-grade or high-grade dysplasia on pap smear vs atypical squamous cells of undetermined significance (ASCUS)

A

low-grade or high-grade dysplasia = colposcopy

ASCUS = HPV testing; if HPV is positive, get colposcopy. if HPV is negative, repeat pap at 6 MONTHS

35
Q

what is an important risk factor for squamous cell cancer of the skin other than sunlight?

A

organ transplant pts, secondary to LONG-TERM USE OF IMMUNOSUPPRESSIVE DRUGS

36
Q

thick, scaly, crusty patches on sun-exposed skin

A

actinic keratosis (premalignant, must remove due to risk of squamous cell cancer)

37
Q

hyperpigmented lesions with “stuck-on” appearance

A

seborrheic keratoses (no premalignant potential)

38
Q

what agents are used in atopic dermatitis to help pts get off steroids?

A

tacrolimus and pimecrolimus (T cell-inhibiting agents; rarely associated with development of lymphoma)

39
Q

tx of extensive psoriasis

A

UV light, anti-TNF inhibitors (infliximab, etanercept, adalimumab)

40
Q

what class of medication is associated with pemphigus vulgaris?

A

ACE inhibitors

41
Q

what drugs are used to wean pts with pemphigus vulgaris off of steroids?

A

azathioprine, mycophenolate

42
Q

what is porphyria cutanea tarda and what diseases is it associated with?

A

blistering skin disease of sun-exposed areas; HEPATITIS C and HEMOCHROMATOSIS

43
Q

most accurate diagnostic test for porphyria cutanea tarda

A

increased uroporphyrins in a 24-hour urine collection

44
Q

if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a mild infection?

A

macrolides, clindamycin, doxycycline, or TMP/SMX

45
Q

if pt has penicillin allergy with anaphylaxis, what are the alternate medications for a severe infection?

A

vancomycin, linezolid

46
Q

tx for tinea in hair or nails

A

ORAL TERBINAFINE (itraconazole is close in efficacy)

47
Q

what is the tx for steven-johnsons syndrome or toxic epidermal necrolysis?

A

IVIG (NOT STEROIDS!)

48
Q

side effects of isotretinoin (vitamin A)

A

hyperlipidemia, pseudotumor cerebri, teratogen (get a pregnancy test)

49
Q

blood gas in aspirin overdose

A

respiratory alkalosis progressing to metabolic acidosis (both, not a compensation, pH should be alkalotic)

50
Q

cyanosis with normal pO2

A

methemoglobinemia

51
Q

most effective therapy for methemoglobinemia

A

methylene blue (decreases half-life of methemoglobin)

52
Q

tx for pt with nerve gas or organophosphate poisoning with ACTIVE sx

A

atropine (blocks effects of acetylcholine already increased in body)

53
Q

when is pralidoxime used?

A

organophosphate poisoning (reactivates acetylcholinesterase) without current threatening symptoms (i.e., respiratory arrest)

54
Q

yellow halos around objects, arrhythmias, nausea, vomiting, hyperkalemia

A

digoxin toxicity

55
Q

what are the sx of a black widow spider bite? what is the tx?

A

abdominal pain, muscle pain, hypocalcemia; tx with calcium and antivenin

56
Q

management of human cat dog bite with no suspicion for rabies

A

AMOX/CLAV

57
Q

what type of intracranial hematoma is associated with skull fracture?

A

epidural hematoma

58
Q

why is hyperventiatlion used in a brain bleed?

A

it decreases pCO2 which causes cerebral vasoconstriction, which decreases pressure. normally, cerebral circulation constricts when the pCO2 is low and dilates when pO2 is high

59
Q

what are the indications for stress ulcer prophylaxis with a PPI?

A

head trauma, burns, endotracheal intubation, coagulopathy with respiratory failure

60
Q

how to calculate volume replacement in burns

A

4 mL x %BSA burned x weight in kg. head is 9, arms are 9 each, legs are 18 each, chest and back are 18 each. one hand width is 1.

61
Q

painless proximal muscle weakness with normal ESR and CK

A

glucocorticoid-induced myopathy

62
Q

what is normal pH and glucose for pleural fluid?

A

pH = 7.2, glucose = 60

63
Q

what are the sx of acute intermittent porphyria?

A

5 P’s: Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs, alcohol, starvation

Step 2 CK UW (12 decks)

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