COMBANK review Flashcards
waveform capnography - what does a reading of a)
a) you’re giving poor quality CPR b) good CPR compressions. c) return of spontaneous circulation
how to tell apart cholelithiasis and PUD?
chole: dull discomfort, goes away after 1 hr. / PUD: should be ‘burning’, with dyspepsia (indigestion), sometimes hematemesis, and risk factors.
what is cubital tunnel syndrome?
ulnar nerve compression at elbow
fall on shoulder of athlete in contact sport(common), pain by pressing on distal clavicle, pain with cross body adduction and Neer’s test, what is this?
acromioclavicular joint injury
MSK injury with “empty can” testing, patient can’t abduct against resistance. What is this and how to confirm?
supraspinatus tendon rupture. MRI to confirm
what Ab’s are specific for drug-induced lupus?
anti-histone
what disease is an avascular necrosis of the femoral epiphysis in kids ages 4-10 with ADHD, cigs risk factors? What are main Sxs? Dx? Tx?
Legg-Calve-Parthes disease. Sx: painless limb with some knee/thigh pain, loss of internal rot/abduction. Dx: pelvic radiograph showing collapsed/flattened fem head. Tx: bracing w/ Petrie cast, crutches
what disease has femoral epiphysis break off into epiphysis and femur slide anteriorly? what patient pop is this in?
Slipped capital femoral epiphysis, found in obese AA boys ages 10-16
developmental displasia of hip shows what age group, what position of legs? Tx?
legs flexed and adducted in
how to treat lichen sclerosis?
topical steroids
how to Dx BPH? Next step?
physical exam and DRE. Next step: drugs (tamsulosin, finasteride)
diff between cohort and case control studies?
Cohort changes the risk factors (disease –> factor vs no factor) and can be retro or prospective;[RISKS=WHORE/HOR]/// case control changes the disease (disease vs no disease –>risks) so it is always retrospective [CASE=DISEASE]
what MSK back disease is relieved by flexing(sitting)? What is worse by flexing(straight leg raise +)?
better: spinal stenosis(old pt). Worse: herniated disc (young pt)
How is heart failure classified?
Class I-IV: Class I = no symptoms, CLass II = Sx with strenous activity; Class III = Sx with minimal activity (i.e. walking), Class IV = Sx at rest.
patient with rapid hepatomegaly, jaundice, asciites, abdominal pain, NO JVD, in healthy and often young patient, think what?
Budd-Chiari syndrome (hepatic vein thrombosis: often in hypercoaguable states)
Patient with PID gets acute RUQ pain made worse with breathing, coughing, and movement, think what? Dx?
Fitz-Hugh-Curtis syndrome. Diagnose with laparoscopy (see “violin strings” = adhesions). Tx: Abx for infection, lap lysis of adhesions.
How to diagnose Paroxysymal nocturnal hemoglobinuria? Tx?
flow cytometry: decreased CD 55 & 59. Tx: steroids or eculizumab
how to treat acute intermittent porphyria? Treat HUS?
porphyria: high dose glucose. HUS: plasmapheresis.
Pterion is made of what 4 bones?
temporal, parietal, sphenoid, and frontal
1 technique for cranial sutures?
V spread
how to treat Histoplasmosis?
amphotericin B
what is a) lung fungus that causes ulcerated/verrucous lesions on skin? Dx? b) what is lung fungus that causes arthralgias? Dx?
a) Blastomycosis. Histo/cultures. b) Coccoides. isolation of organism
diff between atelectasis and pleural effusion on CXR?
both have opacifications and occur early post-op but atelectasis shows deviation of trachea and mediastinum TOWARDS opacification, pleural effusion these deviate AWAY from opacification.
lactulose(for hepatic enceophalopathy): main s.e.
diarrhea, causing dehydration, decreased K+
What drug decreases intensity of HCM murmur and how?
beta blockers, by increasing preload
secondary amenorrhea in post-gyn-on patient, think what?
Asherman syndrome (intrauterine adhesions)
corneal vascularization and chelosis, think what vitamin deficiency?
riboflavin (B3) (chelosis = corners of mouth cracked)
MSK extremity meniscal tear - treatment?
RICE, NSAIDs, rest
what are hormone levels in Klinefelter syndrome?
increased GnRH, FSH, LH, and estrogen; increased/normal, then DECREASED testesterone after mid puberty
What is most likely cause of a TIA/stroke in a young healthy patient? How to Dx? What else will you see?
PFO. Dx with TEE. Will see R BBB on EKG too.
if you think carotid stenosis is the cause of stroke, what do you use to diagnose?
angiography
stress/injury triggering throbbing/burning MSK pain, skin changes, swelling, altered skin temperature = ? Dx?
Complex regional pain syndrome. Dx clinically THEN EMG to diff between type I and II. If (-), type I. If (+) for peripheral nerve injury, then type II.
How is stable angina diagnosed? Next step?
ST depression on STRESS EKG. Next you do stress echo (exercise, or if EKG abnormalities/can’t tolerate, do dobutamine)
1st line treatment of stable angina?
beta blockers for long term treatment (nitrates only provide SHORT TERM/acute relief)
a) rash with pain, erythema, warmth, pruritis with advancing defined & raised margins in child after URI = ? b) same rash with ill-defined margins and edema? c) rash with ruptured vesicles with dried serous material, NO pain/erythema/pruritis?
erysipelas (strep pyogenes). b) cellulitis c) impetigo (Staph, strep pyogenes)
Herpangina - caused by what microbe? tx?
coxsackie A virus. Fluids, pain control
GERD refractory to all medical treatment, consider what Dx?
sliding hiatal hernia (NOT paraesophageal), usually in obese
corkscrew esophagus means what?
diffuse esophageal spasm
diff between orbital cellulitis and periorbital cellulitis? Dx? Tx:
orbital: inflammation of the eyeball, with acute pain/redness/swelling, loss of vision, decreased EOMs. PERIORBITAL = of the eyeLID, so EOMs won’t be affected. Dx: CT or MRI. Tx: abscess drainage + Abx if present on imaging; if not, admit and IV vanco/cefotaxime
interscalene brachial plexus block with anesthesia, what is biggest risk?
phrenic nerve block resulting in SOB
herniated disc: how do you know L4 is affected? L5?
L4: weakness of ankle dorsiflexion. L5: weakness of extensor hallicus longus(big toe).
1st choice treatment for allergic rhinitis?
intranasal steroids (not diphenydramine)
flexing/extending finger that “catches”, or gets stuck, has a nodule at finger, what is this? Tx?
Trigger finger aka stenosing tenosynovitis, usually at A1 pulley. Tx with stretching and splinting; 2nd line: steroid injections; 3rd like: surgical release of A1 pulley
young woman with sudden monocular vision loss and pain w/ eye movement, plaque in MRI and increased signal in optic nerve, think what? Tx?
optic neuritis, a presenting Sx of M.S. Tx with high dose IV steroids (treats this acute attack)
how to treat muscle spasticity of M.S.?
baclofen
difference between spinal shock and neurogenic shock?
both have bradycardia, hypotension, warm extremities, flaccid;/ but spinal: absent bulbocavernosus reflex, neurogenic: present bulbocavernosus reflex
1st step in diagnosis of UGIB?
EGD (NOT CT or radiograph!!)
How to treat serotonin syndrome? NMS?
SS: cyproheptadine. NMS: bromocriptine (dop. agonist), dantrolene
what to do next after abnormal quad screen?
amniocentesis if 15-20weeks, chorionic villus if 10-12 wks
Positive Adson’s test, what will you say and what disease is this for?
decreased radial pulse upon head extension and rotation to ipsilateral side. For Thoracic outlet syndrome (compression of brachial plexus)
thickening of prevertebral tissues on lateral x-ray, whay is this?
retropharnygeal abscess
when should you undergo carotid endarterectomy?
when there is carotid stenosis 50-99% in male patients with symptoms, 60-99% without symptoms (also male)
what disease has decreased carbon monoxide diffusing capacity?
emphysema
what is hemophilia C? hemophilia D?
C: factor XI deficiency. D: factor XII deficiency
what is crypoprecipitate and what is it used to treat?
factor VIII, XIII, fibronectin, fibrinogen, and vWF. For hemophilia A
when do you use a) cyclosporine to treat Crohns? b) sulfasalazine? c) infliximab? d) steroids? e) azathioprine?
a) severe-to-refractory (immunosuppressant) b) 1st line mild to moderate exacerbation (aminosalicylate) c) severe-to-refractory (immunosuppressant) d) mild-to-moderate exacerbation e) severe-to-refractory (immunosuppressant)
two things you can treat Pseudomonas ear infection with?
ciprofloxacin or gentamicin ear drops
if in a fib >48 hrs, how long to be on warfarin before CV?
4 weeks
what is Neer’s impingement test and Hawkin’s test and what does it diagnose?
Neer’s: patients arm fwd flexed to sky while scapula is stabilized, pain =(+). Hawkin’: abducting arm to 90 degrees and internally rotating arm / subacromial bursitis.
WHat is Yergason’s test and Speed’s test and what does it diagnose?
Yerg: elbow flexed, supinate against resistance. Speed’s: patient flexes arm against resistance. Bicipital Tendonitis.
a) dysphagia to solids & liquids? b) dysphagia to solids then liquids? c) dysphagia to solids only? d) intermittent and acute dysphagia triggered by cold liquids?
a) Achalaisa b) adenocarcinoma c) Schastki ring d) DES
female with recurrent UTIs, new flank pain, pH>7, what is most likely pathogen?
Proteus (NOT e coli)
How to treat a) displaced fracture of scaphoid? b) nondisplaced fracture of scaphoid? c) displaced fracture of long bone?
a) open reduction internal fixation b) thumb spica cast c) closed reduction
how to treat Boxer’s fracture?
ulnar gutter splint
ADHD is associated with what 4 other mental illnesses?
antisocial/conduct disorder, ODD, bipolar, OCD
What is Spurling’s maneuver and what does it diagnose?
pain in 4th & 5th digits upon extending head and rotating it to side, then applying compressive downward force. Cervical Radiculopathy.
patient with glucose >1000, normal beta hydroxybutyrate/actetate/acetoacetate, think what? what is pH? bicarb? osmolarity?
Hyperosmolar hypergylcemic nonketotic state. pH>7.3 , bicarb >20 (NOT acidic!) osm >300.
first 4 steps of secondary amenorrhea protocol? 1st 3 steps of primary amenorrhea protocol?
secondary: b-hCG –> thyroid –> prolactin –> progestin challenge / primary: U/S–>FSH –>karyotype
long term PTN with someone in the ICU for awhile can cause what disease?
acalculous cholecystitis due to bile stasis
How often do you read fetal heart tracings monitor in 1st stage and second stage of labor in patient a) without complications? b) with complications?
a) 1st stage every 30 min, 2nd stage every 15 min. b) 1st stage every 15 min, 2nd stage every 5 min
what is the most common cause of viral myocarditis in DCM?
parvovirus B19
Whipple procedure takes out what 5 organs?
pancreatic head, duodenum, prox jejunum, distal stomach, gallbladder
1st line Tx for ADPKD?
ACE or ARB(-sartan)
anti-mitochondrial Ab is for what?
primary biliary cirrhosis
gold standard for diagnosing syphilis?
serologic testing with FTA-ABS (NOT darkfield microscopy!!)
When to treat syphillis with penicillin G desensitization vs not?
For any stage syphillis inc pregnant women, teriary syph. Use DOXYCYCLINE if allergic.
If pregnant patient has a) low BIshop score (0-4), what do you do during delivery? b) medium score (5-9)? c) high score (10+)?
a) induce with prostaglandins b) induce with oxytocin c) no intervention necessary: good
a) dysgerminomas - what tumor marker? b) granulosa cell tumor - what tumor marker? how to treat?
a) LDH b) inhibin. Treat with U/L SO if wants kids, TAH BSO if no kids
when should steroids be given in premature infant (what age)?
if
diff btwn preeclampsia and severe preeclampsia?
severe will have proteinuria >5g, sBP>160/110 on 2 occasions, urine
HSIL on cervical cytology, what is next step in regular patient? preg patient?
reg: cervical biopsy./ pregnant: colposcopy
Biophysical profile scores - numbers and what they mean?
assign 0-2 for 5 parameters. 0-4: worrisome, deliver. / 6: equivocal, usually deliver./ 8+: reassuring.
what do you use to treat hyperthyroidism in pregnancy?
PTU (NOT methimazole - teratogenic!)
what to do about an IUD if patient becomes pregnant with it?
12 wks along: leave it in.
when to do glucose challenge test in preg patient?
24-28 wks
blisters in sun-exposed areas, erosions, hyperpigmentation in patient who is smoker/alcoholic/hep C/uses estrogen, what is this? Tx?
porphyria cutanea tarda. Tx: cessation of risks, avoid sun, phlebotomy
Skin disease with autoantibodies against adhesion molecules (desmoglien 3); on Bx: separation of epidermal cells with intact BM (acantholysis)?
pemphigus vulgaris
sudden itchy papular rash on trunk of man >50, histo shows acanthosis and dyskeratosis
Grover disease (transient acantholytic dermatosis)
stress fracture in the back of an athlete, pain with extension = ? confirm diagnosis with what?
spondylolysis (pars interarticularis fracture). confirm with oblique lumbar x-rays and lumbar CT
descending (thoracic) aortic dissections - what is test to confirm diagnosis?
spiral CT angio of chest (TTE, TEE TAKE TOO LONG)
main risk factor for acne? Tx?
family history. topical retinoids for comedonal, topical then oral Abx for papular/pustular/nodular
headache, fever,arthralgias, conjunctival erythema, blanching erythematous rash on palms and soles then moves centrally after camping=? Tx?
Rocky Mountain Spotted Fever. Tx: doxycycline even in kids. chloramphenicol if allergic/pregnant.
infant
ampicillin (covers GBS and ampicillin), 3rd gen cephalosporin i.e. cefotaxime (covers E coli)
Patient with trouble eating/swallowinig, decreased sensations with poorly controlled DM, what is this? 1st step in diagnosis? Tx?
gastropariesis. Dx with gastric scintiography. Tx with erythromycin and metochlorpramide (motility agents)
what produces cold agglutinins in Mycoplasma pneumoniae? Tx?
autoantibodies against RBCs. Tx = macrolide (erythro or azithro)
what stains acid fast?
MYCOBACTERIUM (not mycoplasma)
risk of cardiac cath = ?
livedo reticularis (it can dislodge cholesterol plaques to migrate to the skin, causing a mottled appearance)
effects of MI: blockage in what coronary artery causes a) AV block? b) bradycardia
a) RCA (b/c ischemia to AV node b) RCA (b/c ischemia to SA node)
what percent occlusion of LCA must happen to get CABG?
50%
aching and stiffness in the neck, shoulders, and pelvis; no loss of muscle strength – what is this?
polymyalgia rheumatica
what 2 enzyme increases are SPECIFIC to dermatomyositis?
creatine kinase > aldolase. Others not as specific (ANA, LDH, anti-Jo-1 & anti-Mi-2)
patient comes in with chest pain, shows MI on EKG, what are next 2 steps?
O2 and ASA, then morphine & nitro (UNLESS RCA aka inferior MI!!!!!! no nitrates!)
Rai staging system for CLL - what traits with stage 0,I,II,&III?
0: lymphocytosis, I: lymphocytosis & lymphadenopathy, II: lymphocytosis & splenomegaly, IV: lymphocytosis & anemia.
on path, what kind of lymphoma/leukemia would the following mean: a) lacunar cells w/ collagen banding? b) giant cells with bilobar nuclei & eosinophilic nucleoli c) plasma cells w/ fried egg appearance?
a) nodular sclerosing Hodgkin’s lymphoma b) Hogkin’s lymphoma (RS cells) c) multiple myeloma
Leydig cell tumor causes what effects?
hyperestrogenism in males (gynecomastia, loss of libido, ED; precocious puberty if kid)
Sertoli cell tumor is associated with what diseases?
Peutz-Jeugers (intestinal polyposis) & Carney’s syndrome (mucosal melanin spots)
petechiae, gum bleeding, increased bruising, and increased bleeding time + decreased platelets, what is this?
ITP
how to treat endometrial hyperplasia?
cyclic progestins (NOT estrogen, b/c this unopposed growth is caused by estrogen in the 1st place), then biopsy 3-6 months later to check if progession into endometrial cancer
mesenteric edema - in Crohn’s or UC? cobblestoning - in Crohn’s or UC?
both in Crohn’s
monocular loss of vision for a few minutes then complete recovery, in patient with bruit in neck, what is this? initial Dx?
amaurosis fugax (usually from emboli from carotid artery). Dx: Duplex U/S of carotid arteries.
positive empty can test means what?
supraspinatus tear (prod with abduction)
aminoglycoside toxicity can lead to what problem?
sensorineural hearing loss (CN VIII)
B/L conductive hearing loss, fam Hx, loss of stapedial reflex, what is this?
otosclerosis
ear fullness, tinnitus, sensorineural hearing loss: what is this and treatment?
Meniere’s disease - tx with acetazolamide (CA inhibitor)
diarrheal bacteria that is lactose (-), H2S (+)? /// lactose(-), H2S(-)? /// lactose (+), H2S(-)
Salmonella./// Shigella./// E Coli.
WHAT TEST TO DO IF YOU SUSPECT PE?
initial AND best: spiral CT with contrast. VQ if renal issues // gold standard BUT invasive so only do if CT is inconclusive: pulmonary angiogram.
how do you tell exogenous intake hyperthyroidism from disease w/ hyperthyroidism?
both will have high T4 and low TSH, but exogenous will give low radioactive iodine uptake, and disease will give high radioactive iodine uptake.
what should be used to treat stable WPW? unstable?
Stable – antiarrythmics: procainamide, amiodarone. Unstable – carotid massage, Valsalva, adenosine, or CV.
avoid what drugs in WPW and why?
digoxin, beta blockers, and CCBs b/c they block AV node which WPW already has; may lead to supraventricular tachycardia
Inversion ankle sprain injuries (type I,II,III) - what gets injured and with what type?
I - anterior talofibular (ATF: “Always Tears First”) /
II - anterior talofibular & calcaneofibular (ATF, CF) /
III - anterior talofibular & calcaneofibular & posterior talofibular (ATF, CF, PTF)
how to treat a) sinus tachy? b) stable supraventricular tachy? c) nstable supraventricular tachy? d) pulseless v tachy?
a) fluids (b/c usually due to dehydration), b) adenosine c) synchronized CV d) defibrillation
what is the female athlete triad? Tx?
disordered eating, amenorrhea, decreased bone density(stress fractures). Tx with correcting nutritional deficiencies.
what 3 renal diseases do you treat with cyclophosphamide?
Wegener’s, Goodpasture, lupus
what do you treat IgA nephropathy with?
ACE-i AND steroids
what crosses suture lines in babies’ heads and leads to hemorrhagic shock? common cause?
subgaleal hemorrhage (meanwhile caput seccundum is self-resolving with no hemorrhage). Cause: vacuum assisted delivery.
Friedberg’s infarction? Sever’s disease?
Friedberg’s: osteochondritis of 2nd metatarsal head; common in adolescents. / Sever’s: traction of Achilles tendon
when to do myocardial perfusion imaging? (shows perfusion during resting vs stressed states)
patients showing cardiac wall abnormalities during an echo OR patients with active chest pain that show no abnormalities on EKG
how to treat ascending aortic dissections? descending aortic dissections?
ascending: immediate surgery /// descending: BP control with BBs/CCBs/nitrates
person who does a lot of overhead work; (+) Neer’s test (put affected hand on unaffected shoulder then flex forward –> pain), what is this indicative of?
shoulder impingement syndrome (chronic rotator cuff tendon injury)
fever, increased WBCs, and diffuse abdominal pain in patient with asciites is prob what? What are diagnostic values? what suggests malignancy?
SBP. diagnose with neutrophils >500, LDH >25. Malignancy = RBCs in peritoneum
1st line treatment for animal bites?
amoxicillin-clauvulonate (covers Pasteurella)
hypoxemia with person on vent after some other sickness/surgery, B/L interstitial infiltrates, pulm edema, worsening Sx, think what? what number defines it?
ARDS. /// PaO2/FiO2
what is best test for detecting obstructions/diverticula/stress incontinence/vesicourethral reflux/trauma in bladder, voiding cysturethrogram or IV pyelogram?
VCUG: injects dye and shows real-time patient urinating it out (IVP only shows ant and post, dye blocks rest)
increased voltage (R) on EKG means what?
hypertrophy in that area (so if in L sided leads, LVH)
runner with pain going up stairs/prolonged sitting with knees flexed, patella going laterally with extension on exam(J sign), what is this? weakness of what muscle involved? Tx?
“runner’s knee” aka patellofemoral pain syndrome. associated with weakness of vastus medialis. Tx: strengthen this muscle.
what do you use to diagnose urethral injury: KUB radiograph, cystoscopy, retrograde urethrogram, or IV pyelogram?
retrograde urethrogram (pyelogram is only for seeing K,U,B; KUB XR only good for stones; cystoscope NEVER inserted with urethral injury)
seizures: 1st line? if >5 min?
1st: benzos. If >5 min this is status epilepticus, do ABCs and intubate
diff btwn Addisonian crisis and diabetic ketoacidosis?
both have polydipsia, polyuria, weight loss but DM: fruity breath, confusionINCREASED HR not decreased; Addison’s: more GI sx, hyperpigmentation
what is a) low flow priapism and how to treat? b) high flow priapism?
a) usually from PDE5 inhibitors; painful erection. intracavernosal Phenylephrine –> oral pseudoephedrine/terbutaline –> needle aspiration/irrigation /// b) from trauma; painless erection
what imaging to due after hysterectomy to make sure ureters weren’t cut?
IV indigo carmine administration (since it’s blue it’ll be easy to spot if there’s a leak)
1st step in management of patient with signs of bacterial meningitis + confusion/focal neuro deficits?
Tx with ceftriaxone, vancomycin, & steroids (if old person add ampicillin for Listeria coverage) –> THEN CT (always treat 1st if LP is contraindicated due to FNDs!)
most common complication of intreated bac meningitis?
hearing loss > seizures
kid under 5 years has rapid rise in temperature after having URI/ear infection, then generalized seizure
febrile seizure. antipyretics and reassurance
when to order x-ray for ankle injury?
with pain/tenderness in malleolus, fibula, or inability to bear weight
suspect myasthenia gravis, what is the first thing to order?
ACh Antibody test –> if (+), confirmed. If (-), go on to the more expensive Tensilon test.
how to treat Raynaud’s?
CCBs
baby can hold head up in prone position at what age? Laugh? smile?
head: 2 months. / Laugh: 4 months. / Smile: 2 months
how to diagnose GERD definitively?
24 hr pH monitoring
what meds to avoid in myasthenia gravis?
clindamycin and aminoglycosides
untreated UTIs in pregnant women can lead to what?
preterm labor/2nd semester abortions
person with severe acute right sided headache, excruciating eye pain, N/V, blurry vision, red watery eye, non-reactive right pupil, what is this? What drug can cause it? Tx?
acute angle closure glaucoma. // Can be set off by anticholinergics i.e. tolterodine. // Tx: oral acetazolamide, topical timolol, and pilocarpine THEN laser iridotomy
diff between jersey finger and mallet finger?
jersey finger - torn flexor tendon, can’t flex, stuck in extension. Mallet finger - torn extensor tendon, can’t extend, DIP stuck in flexion.
what does cubital tunnel syndrome cause?
parasthesia in ulnar distribution
diff btwn polymyositis and polymyalgia rhematica?
polymyositis: proximal muscle weakness, while polymyalgia = proximal muscle pain/stiffness only
how to confirm diagnosis of hip dysplasia?
U/S of hip joints (b/c bones aren’t fully ossified at this age)
how to treat HSP?
supportive care
pneumothorax - what is 1st step in management
immediate thoracostomy (chest tube) if unstable, —- CXR if stable
when is spinal bracing needed for scoliosis? surgery?
bracing: 20 to 40 degrees. surgery if greater than 50 degrees
what treats hypersexual psych disorders i.e exhibitionism?
medroxyprogesterone acetate
flexing arms fwd while stabilizing scapula, what test is this? Abducting arm then internally rotating, what test is this? what Dz do they test for?
Neer’s, Hawkins. Subacromial bursitis.
Bicipital tendinitis elicited by…?
supination or flexion at ELBOW (Yergason’s, Speed tests)
staph scalded skin syndrome becomes toxic epidermal necrolysis when…
mucous membranes are involved
what are 4 kinds of patients that need prophylaxis before dental procedures? What is the PPx?
patients with Hx of IE, congenital heart defects, prosthetic valves, & Hx of cardiac transplantation. Amoxcillin best, if not ampicillin/penicillin 30 min before.
if patient has fever over 101 and low neutrophils, what is this? what to do?
neutropenic fever: emergency. Draw cultures then broad Abx (vanco, ceftazidime)
best test for ACL tears? how to perform?
Lachmann’s test (better than anterior drawer). Put knee in 30 degrees flexion, pull tibia anterior and posterior
preventative therapy for migraines?
beta blocker (better than topimarate, CCB. while triptans treat actual attacks)
how to treat Prinzmetal angina? what is contraindicated? when are sx usually?
Tx with nitrates, CCBs. BB contraindicated. Sx early in morning.
most commonly cause what?: a) IE b) rheumatic fever
a) regurg (all) b) mitral stenosis
where is pheochromocytoma tumor located?
adrenal medulla (on top of kidneys, T10-T11)
What do you do to diagnose acute otitis media?
tympanocentesis (most accurate test and gold standard), pneumatic otoscopy (most sensitive)
when to not prescibe an alpha blocker (-zosin) for BPH patient?
if they have orthostatin hypotension or low BP. Give finasteride instead.
Diagnostic test of choice for Legionella?
URINE Ag (think water and AC in Legionella = urine)
CXR showing the following indicates what diseases: a) B/L pleural effusions b) low set & flattened diaphragm c) decreased lung markings d) increased vascular markings e) blunting of costophrenic angle
a) CHF b) COPD c) COPD d) CHF e) pleural effusion
elderly or alcoholic/chronic illness aptient with bac meningitis, how to treat?
ampicillin(for Listeria), ceftriaxone(for most microbes), and vancomycin (for resistant)
stroke affecting MCA, what can happen to eye?
homonomous hemianopia (b/c MCA supplies optic radiations) of the same side as affected in body
pentad of TTP?
hemolytic anemia, thrombocytopenic purpura, neuro abnormalities, fever, renal disease.
diarrhea with blood + mucus, plus seizures, high fever – what microbe?
Shigella
suspect bacterial meningitis in neonate, what are next 3 steps in management?
blood cultures, empiric Abx (cefotaxime, ampicillin), urine culture
cerebellar hematoma - what to do? cerebral edema - what to do?
hematoma: IMMEDIATE surgical decompression (otherwise, midbrain herniation thru foramen magnum possible).————- Edema: mannitol & diuretics
treatment of tinea versicolor?
topical ketoconazole or SeSl shampoo
best med for patient having a) trouble falling asleep? b) having trouble staying asleep (not awakening throughout?
a) Zolpidem b) benzo
when to use 3% saline instead of NS for hyponatremia?
Na
patient with osteosarcoma should undergo what other test for metastases?
CT chest (b/c most common site for mets is lungs)
what test to order if chronic lead poisoning is suspected? Is (+) what test next?
serum free erythrocyte protoporphyrin: increased protoporyrin. If (+) do CBC with blood smear, kidney function tests.
Fanconi’s syndrome and photosensitivity is an s.e. from what antibiotic?
tetracyclines
kids sghould face backwards in carseat in backseat of car till what age?
2 years
stage I-IV breast cancer - how is it diagnosed at each level?
I: less than 2 cm. II: 2-5cm. III: in lymph nodes. IV” distant metastasis.
1st step in management of acute vasocclusive crisis of sickle cell patient?
IV morphine if in hospital, NSAIDS and opioids at home
initial and diagnostic test for sarcoidosis?
CXR for hilar lymphadenopathy and granulomas. (more specific than Ca, ACE, vit D serum markers)
what meds can reactivate latent TB?
etanercept and infliximab
best imaging modality for nepholithiasis?
abdominal CT WITHOUT contrast (NOT U/S, unless pregnant)
how to treat post-herpetic neuralgia?
nortriptyline (pregabaline 2nd line)
flea bitten kidney/inflammation/scarring macroscopically with endothelial and mesangial proliferation causing thickened capillaries looking like wire loop microscopically (diffuse proliferative glomerulonephritis), what is this?
SLE (lupus nephritis)
anti-Ro/La Ab’s crossing into placenta from mom can cause what problems in the fetus?
complete AV block. Born with bradycardia, canon A waves, murmurs/gallops
How to tell apart ventricular free wall rupture from septal rupture?
both have hypotension, but free wall rupture causes cardiac tamponade with absent pulses, interventricular causes L to R shunt with RV O2 much higher than RA O2, “step up”
when to start treatment with bisphosphonates (indications)?
osteoporosis, stress fractures, or osteopenia with greater than 3% risk of fracture in next 10 yrs
AIDS patient with CD4 less than 100, was interacting with birds, AMS, fever, headache, suspect what and do what?
Crypococcal meningitis; do MRI/CT to r/o mass lesion then LP (w/ India Ink) to confirm!!
How to tell apart HSV encephalitis from cryptococcal meningitis from toxoplasmosis?
HSV: will have seizures, weakness, psych sx. Cryptococcal: just meningitis-like. Toxo: flu-like, visual changes.
gold standard for removal of foreign body aspiration?
rigid bronchoscopy
what should be used along with lactulose for hep encephalopathy?
neomycin
what heart condition is adenosine usually used for?
paroxysmal ventricular tachycardia, after vagal maneuvers have been tried, if patient is stable (if they aren’t, CV)
If patient has lichen sclerosis and has used steroids to no avail, or needs more long-term treatment, what do you use?
calcineurin inhibitor, i.e. tacrolimus 0.1% ointment (doesn’t cause skin atrophy)
what is chordee & what is it associated with?
ventral curvature of penis, hypospadias
most common bacteria with hepatic abscess?
Klebsiella
how to treat Lyme disease, regular? Untreated and turned into disseminated (& how do you know it is?)?
Reg: oral doxy or amoxicillin. Disseminated: when CSF findings are abnormal+ neuro disease – IV ceftriaxone
immunocompromised patient – microbes behind: “linear, longitudinal & deep ulcers on esophagus” vs “well-circumscribed, ulcer appearing like an erupted volcano on esophagus”
1st is CMV, 2nd is HSV
1st and 2nd thing to order when suspecting SBO?
supine and upright abdominal radiographs, then CT
downward displacement & herniation of cerebellar tonsils + non communicating hydrocephalus, what is this? absence of cerebellar vermis + dilation of 4th ventricle, what is this.
- Arnold Chiari malformation I (II is withherniation of vermis). 2. Dandy Walker
1st step in diagnosis of placenta previa?
transvaginal U/S (DO NOT do pelvic exam before; can disrupt/dislodge placenta)
if BP = 154/58 and patient has murmur, think what?
aortic regurg (b/c this is widened pulse pressure)
a) patient who has hysterectomy for fibroids, how often is pap needed? b) in patients ages 20-29? c) in patients 30-65? d) 65+
a) never (b/c was benign disease) b) every 3 years (only do HPV testing if abnormal) c) every 3 years w cyto alone, or every 5 yrs cyto + HPV testing d) if no dysplasia, never
a) decreased glucocerebrosidase, pancytopenia, HSM, pulm? b) decreased galactocerebrosidase, neuro in kids? c) decreased galactosidase A, pain, proteinuria, HTN? d) decreased hexosamidase A, blind, deaf, can’t swallow? e) decreased sphingomyelinase, HSM, neuro?
a) Gaucher b) Krabbe c) Fabry d) Tay-Sachs e) Neimann-Pick
1st line treatment for NSTEMI?
LMW heparin, then antiplatelet (ASA, clopidogrel)
what can happen if you improperly dose warfarin?
skin necrosis
what tetanus vaccinations should be given if: a) adult greater than 10 yrs since last booster, know vaccin Hx with more than 3 b) ages 0-6, haven’t gotten main stuff yet? c) less than 3 doses/uncertain Hx? d) 5-10 yrs since previous dose, known vaccine Hx with more than 3 e) less than 5 yrs since previous, known vaccine Hx
a) Td or Tdap - ALL WOUNDS b) DTaP c) Td or Tdap for clean minor wound, Td/Tdap + Ig for dirty wound d) none if clean/minor, Td/Tdap if dirty e) NONE for ANY wounds
main s.e. with drugs: a) benztropine b) risperidone c) selegiline d) amantadine e) levodopa
a) anticholinergic b) Parkinson-like sx c) malignant HTN (b/c MAO-B inhibitor) d) livedo reticularis e) confusion, hallucinations
rapidly fungating and ulcerating lesion over scar tissue, what is this? Dx and Tx?
Marjolin’s ulcer (aggressive squamous cell carcinoma coming from area of chronic injury, esp burn wounds). Bx, then wide excision.
