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COMLEX LEVEL2 > CSSA Missed > Flashcards

CSSA Missed Flashcards

1
Q

When are blood transfusions warranted in a sickle cell patient

A

for severe sickle cell crises with evidence of organ damage, anemia.

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2
Q

What is the initial management for someone with a sickle cell crisis (severe pain in backs, shoulders, shins, dactylitis)

A

Intravenous fluids administration

oxygen and pain control

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3
Q

Denial defense mechanism vs Rationalization

A

denial: the mind unconsciously placing reality out side of awareness (due to painful reality)

rationalization: when patients justify an unacceptable action or feeling using logic

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4
Q

in a ischemic stroke how do you treat

A

get a CT to rule out hemorrhagic stroke

if patient was at their neurological baseline less than 4.5 hours before presentation you can treat with alteplase

if patient was at their neurological baseline > 4.5 hours before presentation you treat with aspirin

if its been less than 34 hours you can also do mechanical thrombectomy if the thrombus is visualized on imaging and is proximal

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5
Q

bells palsy symptoms

A

unilateral facial paralysis caused by lyme disease, or herpes (inflammation of CN 7)

includes forehead dysfunction

loss of taste on the anterior two thirds of the tongue and decreased lacrimation

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6
Q

diagnosis of bells palsy

A

CLINICAL can get EMG if it is unclear

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7
Q

treatment of bell palsy

A

oral glucocorticoids, antiviral if severe and supportive care to prevent corneal abrasion

(LMN involvement)

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8
Q

if a patient with a diabetic ulcer know has vertebral osteomyelitis via hematogenous spread how do you diagnose?

A

MRI of the spine

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9
Q

symptoms of vertebral osteomyelitis

A

back pain, fever, malaise, point tenderness over affected vertebral body

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10
Q

Osteosarcoma imaging

A

X-ray - first
MRI- next for planning
Bone biopsy- diagnosis

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11
Q

septic arthritis presentation

A

acute fever, joint pain, swelling and erythema

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12
Q

laxative abuse can cause what electrolyte deficiency (diarrhea)

A

hypokalemia

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13
Q

hypokalemia symptoms

A

muscle weakness, parathesias, hyporeflexia , long QT syndrfome, torsades

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14
Q

vomiting

A

hypomagnesium, hypochloremia

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15
Q

if a patient who has cirrhosis, heart failure, or end stage renal disease is admitted to the hospital but not hypotensive should they receive fluids?

A

No (dont want to volume overload them)

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16
Q

initial fluid resuscitation in sepsis is what

A

isotonic crystalloid solutions like 0.9% or lactated ringer

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17
Q

annual hyperlipidemia testing

A

asymptomatic men over 35

asymptomatic women over 40-45

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18
Q

Asthma exacerbation findings and treatment

A

bronchospasm leading to wheezing, dry cough, dyspnea, prolonged expiration, accessory muscle use , tachycardia, chest X-ray can show hyperinflation

common trigger is a viral upper respiratory infection

treatment: Short acting B agonist, systemic corticosteroids, oxygen

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19
Q

Obstructive Sleep apnea heart findings

A

Loud S2- pulmonary artery hypertension

increased sympathetic and pulmonary blood pressure

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20
Q

fetal loss after 20 weeks is most commonly caused by?

A

chromosomal abnormalities (number 1) uteroplacental insufficiency, maternal medical disease

do autopsy to find out

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21
Q

in a patient with previous stillbirth (loss at >20 weeks) what should you do during subsequent pregnancies

A

ultrasounds, rule out medical conditions, amniotic fluid volume

later than 32 weeks you should undergo weekly nonstress testing in the third trimester starting at 32 weeks gestation

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22
Q

CMV colitis presentation

A

intracellular inclusion bodies

can be treated with ganiciclovir

more common in immunocompromised with UC, solid organ transplant, aids

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23
Q

What can CMV/Human herpes virus 5 cause

A

Colitis, retinis ,esophagitis, encephalitis, pneumonia

CREEP

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24
Q

acute flares of ulcerative colitis are treated with?

A

hydrocortisone

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25
Q

serum and urine derangements in excessive vomiting

A

metabolic alkalosis (direct loss of chloride and protons in vomit)

increased bicarb, increased PH

decreased potassium, decreased, decreased chloride

low urine sodium and chloride

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26
Q

Diarrhea electrolyte losses

A

direct loss of bicarb in poop

hyperchloremic metabolic acidosis

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27
Q

patients with newly diagnosed Afib should undergo what testing

A

evaluation for reversible causes

TSH levels, high alcohol intake stimulant abuse. echocardiography, electrolyte levels, need for anticoagulation to decrease stroke risk with CHADS_VASc score

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28
Q

treatment off AFIB

A

rate control with B blocker or nondihydropyridine calcium channel blockers

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29
Q

when do you use a 24-hour ambulatory ECG monitor

A

to evaluate reported patient reported palpitations, presyncope, syncope and unexplained falls in a patient with an unrevealing office exam

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30
Q

chrons can cause intestinal obstruction (SBO) from

A

fibrotic strictures or inflammation

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31
Q

complications of chrons

A

enterocutaenous fistulas (air in pee) , uveitis, bowel perforation, intraabdominal abcesses, intraabdominal fistulas

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32
Q

diagnosis of chrons

A

imaging and biopsy

*elevated ESR and Crp

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33
Q

what is a rare complication that can affect children born to mothers with lupus or sjogrens syndrome

A

Complete AV block (heart block in general)

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34
Q

ASD is common in what neonates

A

fetal alcohol syndrome, down syndrome, trisomy 13

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35
Q

VSD is common in what neonates

A

down syndrome, thymic aplasia (Di Georges), Turner syndrome and tetrology of fallot

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36
Q

persistent depressive disorder (dysthymia)

A

3 depressive symptoms that have endures for >2 years

depressed mood on more days than not that leads to impaired social and occupational functioning (interpersonal friction)

tx: antidepressant + psychotherapy

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37
Q

substance induced mood disorder

A

mood disturbance that develops within a month of intoxication with or withdrawal from a substance

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38
Q

lumbar spinal stenosis

A

narrowing of the spinal canal that compresses lumbar nerve

it can cause neurogenic claudication (pain when walking), back pain that radiates to the legs, numbness or weakness

worse with hip extension better with hip flexion (lean forward on cart)

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39
Q

MCC of lumbar spinal stenosis

A

degenerative joint disease

osteophytosis

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40
Q

diagnosis of lumbar spinal stenosis and treatment

A

MRI

tx: NSAIDS, PT, surgery

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41
Q

lumbar degenerative joint disease

A

degenerative changes to the facet joints, can lead to spondylolithesis which is a common cause of sponal stenosis

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42
Q

what is spondylolsthesis

A

displacement of a vertebral body

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43
Q

lumbar disc herniation

A

dislocation of the nucleus pulposus that presents with back pain, parathesias, weakness in the lower extremities

pain improves with EXTENSION and WORSENS WITH FLEXION

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44
Q

SMA vs Duchenne muscular dystrophy

A

SMA: autosomal recessive mutation in SMN gene that presents with hypotonia and areflexia , proximal muscle weakness of both arms and less, wheechair dependent, scoliosis or kumbar hyperlordosis , waddling gait (respiratory weakness in other types)

Duchenne- X linked recessive mutation in dystrophin that presents with promximal muscle weakness, hyperlordosis, calf psuedohypertropy and gower sign

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45
Q

Pterygium

A

a benign growth of conjunctival tissue in the eye that is caused by ultraviolet light, hot and dry climates, dust and wind.

tx: wear sunglasses, topical lubrication or surgery

can present with irregular astigmatism myopia (near sightedness) irritation, redness, blurry vision

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46
Q

septic arthritis diagnosis and treatment

A

arthrocentesis first

empiric vancomycin +/- penicillin or cephalosporin

pain, swelling, erythema, fever, chills (hematogenous spread)

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47
Q

cardiac tamponade signs

A

becks triad: hypotension, distended jugular veins, distant heart sounds

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48
Q

renal cell carcinoma (adenocarcinoma) symptoms

A

large blood clots through urine, microscopic hematuria, flank pain, weight loss, fever

paraneoplastic syndromes: hypercalcemia (pthrp) polycythemia

bony metastasis with lytic lesions (back and bone pain)

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49
Q

causes of cardiogenic shock

A

Mi, valve dysfunction, heart failure, AV block, arrhythmia

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50
Q

1 pound of weight loss drops your blood pressure how much

A

1mmHg

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51
Q

best interventions to decrease blood pressure

A

weight loss, salt restriction - mediteterranean diet

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52
Q

cholesterol emboli dermatologic manifestations

A

petichiae, livedo reticularis, blue toe syndrome

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53
Q

labs in cholesterol emboli (multiple cholesterol emboli syndrome)

A

increased creatinine, leukocytosis and eosinophilia

(supportive treatment)

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54
Q

colorfectal cancer most commonly occurs where

A

rectosigmoid region

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55
Q

descending and rectosigmoid cancers appear

A

obstructive, they are more likely to be infiltrative and obstruct the large bowel

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56
Q

ascending colon lesions are more likely to be?

A

exophytic masses that bleed and cause iron deficiency anemia

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57
Q

after you diagnose colon cancer with colonoscopy what is next

A

CT imaging of the abdomen and pelvis to look for extend of disease

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58
Q

vertical transmission of HIV is low in their viral loads are less than?

A

1000 (can have vaginal delivery)

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59
Q

what is contraindicated in a intrapartum in a mom with HIV (testing)

A

placement of a fetal scalp electrode (invasive monitoring techniques)

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60
Q

what is the most common type of breast cancer

A

invasive ductal carcinoma

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61
Q

what are the indications for genetic testing for BRCA

A

personal history of breast cancer younger than 45 years old, personal or family history of ovarian cancer or male breast cancer

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62
Q

protective factors for ovarian cancer

A

breastfeeding, multiple pregnancies, long term oral contraceptives, bilateral oophorectomy

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63
Q

what should you do if there has been causing injection of drain cleaner (alkali ingestion)

A

emergent endoscopy (esophagoscopy)

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64
Q

phase 1 clinical trials

A

small healthy individuals are given therapy to determine if intervention is safe in healthy indivudals

safety, toxicity, and pharmacological properties are assessed

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65
Q

phase 2 clinical trials

A

small group of diseased population are tested to see if the intervention works and correct dosing

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66
Q

phase 3 clinical trials

A

compaires efficacy of the intervention to standard care or placebo in a large number of patients

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67
Q

phase 4 clinical trials

A

post marketing surveillance after drug has been approved for use in humans

long term safety profile

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68
Q

oral gingivo stomatitis

A

primary HSV infection where there are extremely painful vesicles in the orpopharynx on a erythematous base and cervical lymphadenopathy

dx: scrape the unroofed vesicle and test with PCR

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69
Q

Leishmaninasis

A

bite from a sandfly causes a papule at the site which can increase and coalecse into a ulcer/wart with eschar

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70
Q

what is the most common type of Supraventricular tachycardia in a structually normal heart

A

AV nodal reetrant tachycardia it is stimulated by alcohol, caffiene, exertion or stress..

palpitations with regular rhytmn and abrupt onset and termination

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71
Q

hypertrophic cardiomyopathy murmur

A

HARSH, SYSTOLIC Crescendo-decrescedno at the left lower sternal border

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72
Q

aspiration risk can be diminished with whaat?

A

thickened feeds/liquids, swallowing evaluation and language pathologist

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73
Q

what increases the risk of air embolisms

A

sitting upright, hypovoloemia, inhalation during instrumentation

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74
Q

treatment of air embolism (position)

A

left lateral decubitus and trendelenberg (confines the air in the right ventricular apex and reduces embolization)

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75
Q

symptoms of air embolism

A

acute SOB, tachypnea, tachyarrhythmia, cough, hypoxia, chest pain

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76
Q

pleural effusions can be secondary to

A

reactive to an adjacent pneumonia

if it is asymptomatic and small no other imaging is warranted

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77
Q

treatment of achlasia

A

pneumatic dilation or botox injection

decreased relaxation of the LES (reflux, dysphagia to liquids and solids) - feels like things get stuck in chest, mild heart burn

esophageal spasm is different and presents with chest pain and dysphagia during swallowing)

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78
Q

acute pancreatitis is most commonly caused by

A

gallstones and heavy alcohol consumption

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79
Q

gallstones form in the setting of

A

lithogenic bile

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80
Q

postpartum thyroiditis (decreased thyroid uptake)

A

autoimmune thyroiditis within 1 year of pregnancy

hyperthyroid –> hypothyroid –> euthyroid

hyperthryoid symptoms treat with : metroprolol or propranolol
hypothyroid symptoms treat with levothyroxine

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81
Q

post hoc analysis bias

A

when statisical analysis are conducted after data has alreadfy been collected and seen by investigators (got results and then ran the results of a subgroup)

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82
Q

first line treatment of oral candidiasis

A

flucanazole (oropharyngeal)

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83
Q

treatment of MS

A

acute: glucocorticoids

chronic: interferon beta therapy, monoclonal antibodies

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84
Q

highest risk factors for stroke

A

modifiable: hypertension, hyperlipidemia

nonmodifiable: age

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85
Q

apt test

A

differentiates between maternal and fetal blood

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86
Q

painless bleeding in the 3rd trimester

A

placenta previa

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87
Q

diagnoses of placenta previa

A

pelvic ultrasound

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88
Q

medication overuse headaches

A

headaches secondary to overuse of symptomatic headache medication in patients with pre-existing headache disorder

opids, coffee, nsaids, acetampinophen, triptans, etc. - discontinue!!!

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89
Q

diagnosis of aortic dissection/ traumatic dissection of aorta

A

CT angiography is the gold stanfdard

x-ray will show widened mediastinum

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90
Q

imaging for PE

A

spiral CT scan

CT angiography is gold standard

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91
Q

potassium and sodium levels in cirrhosis

A

hyponatermia (increase ADH)

hypokalemia

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92
Q

when is the Tdap vaccine administered in pregnancy

A

27-36 weeks

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93
Q

complex regional pain syndrome 1 vs 2

A

1: continued pain out of proportion from a reflex sympathetic dystrophy: patients will have edema, muscle spasm, increased hair growth, sensivity to light touch , livedo reticularis

2: associated nerve injury, decreased hair growth, brittle nails, thickened joints, muscle atrophy, cracked skin , osteoporosis , burning pain, allodynia, hyperalgesia

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94
Q

heart failure class 2

A

slight limitation of physical activity (SOB with moderate exertion

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95
Q

heart failure class 1

A

no SOB, no limitation on physical activity

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96
Q

heart failure class 3

A

SOB with minimal exertion and marked limitation of physical activity (sob when moving one chair to another, walking short distance, doing chores around the house)

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97
Q

heart failure class 4

A

SOB at rest, can do the physical activity at all

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98
Q

muscle energy for T1-4 what is the lever
muscle energy for T5-12 what is the lever

A

t1-t4- head

t5-t12- trunk

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99
Q

where are the TP for T1-T3

A

at the level of the corresponding spinous process

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100
Q

where are the TP for 4-T6

A

located 1/2 of a segment above corresponding spinous process ( T4 TP is halfway between T3 and T4)

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101
Q

where are the TP for T7-T9

A

located one segment above the corresponding spinous process. (T8 TP is located at the level of T7 spinous process)

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102
Q

T10 TP location

T 11 TP location

T12 TP location

A

TP 10- same rule as 7-9 (at the level above)

TP 9 - same as rule 4-6 ( 1/2 between T8 and T9 spinous process)

T12- same as T1-T3 (at the level of T12)

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103
Q

rapid correction of hyponatermia can cause osmotic demyelination syndrome and it can be combated with?

A

administration of desmopressin at the same time

at the same time as 3% hypertonic saline

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103
Q

patients taking nitrates should avoid _ due to the risk of hypotension

A

phosphodiesterase inhibitors (tadalafil)

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104
Q

what are the 6 muscle energy techniques

A

crossed extensor reflex

isolytic lengthening

joint mobilization

oculocephalogyric reflex

post isometric relaxation

reiprocal inhibition

respiratory assistance

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Perfectly
105
Q

what is crossed extensor reflex muscle energy

A

when you use muscle force on the opposite side of the targeted muscle to relax the targeted muscle - used for extremities

right triceps dysfuction: patient is asked to contract the left triceps

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106
Q

what is joint immobilization muscle energy

A

this is when muscle force is used to restore a joints range of motion

anterior innominate SD: contract hamstring to get the innominate to posterior rotate

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107
Q

what is oculocephalogyric reflex

A

this is when the patient uses specific eye movements to engage the cervical and upper thoracic spine to relax (patient looks toward or away from the restriction)

good for acute cervical injuries

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108
Q

what is reciprocal inhibition muscle energy

A

when the antagonist muscle is contracted and this sends a signal through the reciprocal reflex arc forcing the agonist to relax

hypertonic bicep: contract tricep (antagonist)

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109
Q

what is respiratory assitance muscle energy

A

when the patient uses breathing to restore normal motion and it only sued for inhalation somatic dysfunction

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110
Q

what helps to identify the presence of a STEMI when a patient has a new or old bundle branch block

A

Sgarbrossa Criteria

> 3 then emergent cardiac catherterization is warranted

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111
Q

cervical radiculopathy test

A

Spurling test (foraminal compression) Extension and rotation of the neck toward the affected side

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112
Q

bennett fracture

A

fracture at the base of the first metacarpal (thumb) with intraarticular extension into the carpometacarpal joint space

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113
Q

gamekeeper thumb fracture

A

avulsion fracture off of the bae of fthe proximal phalanx of the thumb with associated injury to the ulnar collateral ligament

caused by forced abduction and hyperextension of the thumb

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114
Q

jones fracture

A

stress fracture at the base of the proximal third of the 5th metatarsal

115
Q

boxer fracture

A

fracture of the 4th and or 5th metacarpal bone (from a closed fist)

116
Q

flexion and extension occur around what axis and in what plane

A

around a transverse axis and within a sagital plane

117
Q

rotation occurs around what axis in what plane

A

around a vertical axis in a transverse plane

118
Q

what are the risk factors for epithelial ovarian cancer

A

increased cycles of ovulation (nulliparity, early menarche, late menopause >50 years old)

endometriosis

family history of ovarain cancer at any age

BRCA mutations

lynch syndrome

Asbestos

119
Q

protective factors for ovarian cancer

A

OCP’s

multiparity
breastfeeding

bilateral salpingo-oophorectomy

tubal ligation

hysterectomy

120
Q

does a pap test with atypical squamous cells of undetermined signifigance indicate cancer

A

no, reactive chances, if HPV testing is normal you can continue with routine screening

121
Q

symptoms of severe endometriosis

A

extrauterine adhesions from inflammation can cause cervical motion tenderness and a laterally displaced cervix (dyspaurenia, dysmenorrhea, INFERTILITY)

(endometritis causes intraunterine adhesions) ***

122
Q

management for femur neck fracture

A

weight bearing pain–> surgery (open reduction/internal fixation)

123
Q

retropharyngeal abcess is worse with what motion

A

extension

124
Q

what are risk factors for preeclampsia

A

prior preeclampsia

CKD

chronic hypertension

diabetes mellitus

multiple gestations

autoimmune diseases

125
Q

in twin therapies what medicine should you start

A

low dose aspirin betwen 12-28 weeks (preferabily before 16)

start in all high risk patients

126
Q

progesterone therapy is offered to pregnant patients with a history of?

A

prior spontaneous preterm delivery

or a short cervix

127
Q

indomethacin in pregnancy

A

a tocolytic used in patients in preterm labor <32 weeks to delay labor

128
Q

what testing should be done at the first prenatal visit in high risk patients for preeclampsia

A

24 hour urine collection for total protein

129
Q

a capnography with a flat line indicates what

A

the sensor is not detecting CO2

  • esophageal or stomach intubation (common in uncuffed endotracheal tubes)
  • cardiac arrest
130
Q

a shark fin capnography is caused by

A

bronchospasm

*decreased alpha angle and phase 2 waveform)

131
Q

symptoms of neonatal abstinence syndrome

A

irriability, tremors, sneezing, sweating, yawning, loose stools

(fetal growth resitriction)

132
Q

treatment of neonatal abstinence syndrome

A

mild- supportive care

moderate/severse- opiod replacement (metadone, morphine)

133
Q

central retinal vein occlusion signs

A

painless vision loss for a susbtantial amount of time

swelling of optic disx, retinal hemorrhages, dilated and tortuous veins, cotton wool spots

134
Q

care of an amputated part to increase chances of replantaiton sucess

A

gental removal of gross contamination with salien irrigation

wrap in sterile saline mositened fauze, seal in plastic bag, then place bag in a container of ice

135
Q

otitis media with effusion signs and treatment

A

middle ear fluid without tympanic membrane inflammation (bulging/erythema) there will be air fluid levels with poor TM mobility (TM translucent and gray )

treatment is observation for speech delay and hearing loss > 3 months it is chronic and you need tubes

136
Q

chronic suppurative otitis media symptoms and treatment

A

> 6 weeks of purulent ear drainage, caused by preceeding acute otitis media or cholestoma

treat with ototopical fluroquinolones

(caused by staph aureus and psudomonas)

137
Q

oral hairy leukoplakia is caused by what and is associated with what infection

A

caused by EBV, associated with HIV (immunodeficient)

138
Q

aspirin exacerbated respiratory disease (AERD)

A

asthma

bronchospasm with ingestion of aspirin or NSAIDS

nasal polyposis (anosmia, nasal discharge)

139
Q

Breast Galactocele

what is it?

what does it look like

imaging

treatment

A

benign milk retention cysts that occurs a few weeks to months after cessation of breastfeeding

soft mobile nontender subareolar mass that can be as large as 5cm

ultrasound, aspiration confirms diagnosis and is curative

nonsymptomatic galactoceles can be managed with well fitting bra, ice packs

140
Q

breast abcess presentation

A

fever, tender, fluctuant breast mass with erythema

141
Q

fat necrosis presentation

A

can be a nontender breast mass following trauma and echymosis overlaying it

142
Q

fibroadenomas

A

benign mobile nontender breast mass in adolescents and young women

it increases in response to estrogen and involutes in postmenopausal women

143
Q

fibrocytic breast disease presentation

A

diffuse bilateral breast changes

144
Q

intraductal papilloma presentation

A

single nontender mass near the nipple

it is small <1cm

soild and irregularly shaped most often has bloody nipple discharge

145
Q

arteriovenous fistula of the femoral vessels presentation

A

palpable thrill and distal ischemia after percutaenous coronary inferventions

can lead to high output heart failure

146
Q

epidermoid cyst

A

a discrete nodule in the skin that is a result of epidermal keratin lodges in the dermis

147
Q

signs of bowel obstruction

A

hyperactive bowel sounds, abdominal distention, vomiting

148
Q

loud secound heart sound (pulmonic component)

A

pulmonary hypertension

149
Q

labs in primary vs. secondary adrenal insufficiency

A

primary: low cortisol, low aldosterone, high ACTH

secondary: low ACTH, Low corticol, normal aldosterone

150
Q

in primary adrenal insuffficiency is renin high or low

A

high (low aldosterone stimulates RAAS system)

151
Q

risk factors for functional hypothalamic amenorrhea

A

decreased GnRH leads to decerased FSH, LH and estrogen (non withdrawal bleeding )

  1. significant weifght loss
  2. strenuous excercise,
  3. illness/stress
152
Q

biliary leakage

A

complication from laparoscopic cholestectomy

incomplete clipping of the cystic duct or intraoperative bile duct leads to leakage fof bile into the abdominal cavity

abdominal pain, fever, RUQ pain, peritoneal signs, leukocytosis, elevated liver function tests and bilirubin

153
Q

pharmacotherapy options for

anorexia nervosa

bulimia nervosa

binge eating disorder

A

AN: olanzapine (if CBT and nutritional rehabilitation fails)

BN: SSRI

Binge eating: SSRI or Lisadexamfetamine

154
Q

Severe cancer related pain options

A
  1. NSAIDS + adjuvant therapy
  2. short acting opiods +/- step one (4 hour intervals)
  3. long acting opiods (extended release) +/- step one and two
155
Q

treatment of intertrigo

A

topical nystatin or micaonazole

(caused by candida)

156
Q

key features of congential toxoplasmosis (3)

A

chorioretinitis

hydrocephalus

diffuse intracranial calcifications

157
Q

key features of congential syphillis

A

rhinorrhea, skeletal anomalies

desquamating rash on palms and soles

158
Q

key features of congenital rubella

A

cataracts, heart defects (PDA), sensorineural hearing loss

159
Q

key features of congenital CMV

A

periventricular calcifications, microcephaly, sensorineural hearing loss, petichiae

160
Q

key features of congenital herpes simplex virus

A

vesicular/ulcerative rash

161
Q

treatment of minor sunburn

A

no blisters or dehydration (severe)

supportive care with cool compresses, calamine lotion, aloe vera, oral pain medications (NSAIDS)

if severe you need to hospitalize and give fluids and wound care

162
Q

in gout cholchicine and glucocorticoids are preferred when

A

when a patient is on an anticoaglant or has heart failure

163
Q

contraindications to cholchicine

A

severe renal failure, the elderly

164
Q

treatment of ocular rosacea

A

topical antibiotics like metronidazole or erythromycin, ocular lubricants, and lid scrubs

165
Q

Urgency incontinence

A

sense of needing to go to the bathroom and then immediate loss of urine

involuntary detrusor contractions (overactive bladder) - leave work meetings, urinating every hour

nocturia!!

TX: bladder training (resist voiding for long durations), pelvic floor therapy +/- antimuscarinics (oxybutarnin, tolerodine)

166
Q

Overflow incontinence

A

decreased detrusor activity (peripheral neuropathy, blockage of the urethra- fibroids)

increased intravesicular pressure leads to leakage and an increased postvoid residual volume

167
Q

stress incontinence

A

urethral hypermobility that causes urine leakage when there is increased abdominal pressure (cough, bear down)

168
Q

signs of acute liver failure (diagnostic)- no underlying liver disease present (no cirrhosis)

A
  1. elevated aminotransferases
  2. sighs of hepatic encephalopathy (confusion, asterixies, smnolence)
  3. synthetic liver dysfunction (prolonged PT with INR >1.5)
169
Q

alkaline phosphatase in wilsons disease

A

really low

170
Q

where is the most common site of intracerebral hemorrhage

A

basal ganglia which is right above the uncus and can cause an uncal herniation

171
Q

uncal herniation signs

A

fixed and dilated pupil on the same side (ipsilateral)

contralateral decerebrate posturing

comatose state

172
Q

describe uncal herniation

A

the medial temporal lobe is displaced under the tentorium cerebelli (can be caused by basal ganglia hemorrhage)

173
Q

Cerebral tonsillar herniation describe it

A

the cerebellum pushes through the foramen magnum and causes neck tilt, flaccid paralysis, coma, blood pressure instability, respiratory arrest

174
Q

midbrain stroke signs

A

ipsilateral fixed and dilated pupil and contralateral hemiparesis

175
Q

opccipital cortex signs

A

cortical blindness (bilateral)
homonymous hemianopia (unilateral)

176
Q

treatment of mycoplasma pneumoniae

A

azithromycin or respiratory fluoroqionolone

177
Q

first line for dental and skin infections

A

clindamycin

178
Q

narcoplepsy is associated with

A

decreased REM latency

cateplexy
low hypocretin 1
sleep hallucinations

179
Q

wiskott aldrich syndrome is a defect in

A

cytoskeletal defect in platelets and leukocytes

triad: microthrombocytopenia, recurrent infections, eczema

tx: stem cell transplant (X-linked recessive)

180
Q

allergic bronchopulmonary aspergillosis

A

hypersensitivity reaction to aspergillus that occurs in patients with asthma or cystic fibrosis

symptoms of uncontrolled asthma, recurrent pulmonary infiltrates and central bronchiestasis

eosionophilia, IgE testing

TX: oral corticosteroid and itraconazole

181
Q

permanent destruction and dilation of airways

A

bronchiectasis

182
Q

permenant enlargement of the airspaces distal to the terminal bronchioles

A

emphysema

183
Q

Tx of pagets disease

A

bisphosphsonates

184
Q

Failure modes and effect analysis what is it and what are the steps

A

a prospective systematic assessment for error prevention in new processes (identify issues before they occur)

  1. Team formation
  2. define goals and processes
  3. process mapping with flowchart outlining the process
  4. identify where failure could occur
  5. analyze risks at each step with a hazard analysis
  6. idenftify ways to correct these risks
  7. implement plan
185
Q

Five whys approach

A

used in root cause analysis to figure out why an error occurred

186
Q

dementia with lewy bodies deposition

A

alpha synuclein deposits in the brainstem (substantia nigra), limbic system and neocortical structures

dementia, visual hallucinations, fluctuating cognition, parkonsism and postural insability.

187
Q

what actions suggest a lesion in the cerebellar hemisphere

A

limb ataxia, dysmetria, dysdiadochkinesia

188
Q

startle clonus is seen in

A

prion related dementias like creuztfeldt jakob disease

189
Q

GBS prophylaxis what week

A

36-38 or if there is premature rupture of membranes

190
Q

Papillary muscle rupture/dysfunction

A

occurs 3-5 days after MI

inolves the RCA, causes pulmonary edema, new soft systolic murmur, mitral regurgitation on ECHO, hypotension and shock

190
Q

interventricular septum rupture

A

3-5 days after MI in the RCA or LAD

chest pain, new hash holosystolic murmur with thrill

ECHO will show left to right ventricular shunt

190
Q

free wall rupture

A

5 days - 2 weeks after MI

involves the LAD

chest pain, distant heart sounds, shock, cardiac arrect

ECHO will show pericardial effusion with tamponade

191
Q

left ventricular aneyrusm

A

months after MI

involves the LAD

can cause heart failure, angina, ventricular arrythmias, mitral regurgitation,

mural thrombus –>stroke, mesenteric ischemia, or acute limb ischemia

192
Q

left ventricular aneurysm ECG findings

A

persistent ST segment elevation, deep Q waves

193
Q

signs of anal cancer

A

anal bleeding, pain, anal mass or ulcerated lesions with non tender lymphadenopathy

194
Q

chanroid

A

painful ulcer with gray yellow exudate and severe suppurative lymphadenitis

195
Q

lymphogranuloma venerum

A

genital ulcer –> Lymphadenitis (supprative)–> fibrosis and strictures of the anogenital tract

196
Q

maternal and fetal complications of maternal pyelonephritis

A

fetal: preterm labor, fetal tachycardia

maternal: acute respiratory distress syndrome (crackles, hypoxia, dyspnea, infiltrates on X-ray)

TX: IV antibiotics

197
Q

acute mastoiditis

A

complication of acute otitis media that causes fever, ear pain, and inflammation of the mastoid air cells

displaces the ear

inflammation directly behind the ear

Tx: IV antibiotics and surgical drainage

198
Q

what is elevated in antiphopholipid syndrome

A

partial thromboplastin time (PTT)

anti beta 2 glycoprotein, anticardiolipin

199
Q

Beta 2 microglobulin is elevated in?

A

lymphoproliferative disorders like multiple myeloma

200
Q

cervical cancer signs

A

post coital bleeding

lower uterine segment mass that extends laterally

pelvic/back pain

hydronephrosis

**colposcopy

201
Q

obstruction of appendix lumen

A

pancreatitis

(N/V, anorexia, diffuse abdominal pain then RLQ pain, leukocytosis)

202
Q

cardiomyocyte replacement by fibrous tissue

A

chemotherapy induced cardiotoxcitty- antrhcyclines (dilated cardiomyopathy)

203
Q

cardiomyocyte hypertrophy and disarray

A

hypertrophic cardiomyopathy

204
Q

myocardial stunnning

A

trastuzumab cardiotoxicity

or

stress induced cardiomyopathy

205
Q

when do children start to understand the concept of death

A

> 6

206
Q

listeria

A

gram positive rod (found in unpasturized milk products, raw meats and veggies)

207
Q

femoral artery psuedoaneurysm

A

after cardiac catherization

contained hematoma that causes a bulging pulsatile mass and a systolic bruit

a hematoma would have a mass but no bruit

208
Q

femoral artery AV fistula

A

after cardiac catheterization

localized swelling, continuous bruit with a palpable thrill (no mass)

209
Q

CATCH 22 for digeorge syndrome

A

C- cardiac outflow tract anomalies

A- anomalous face

T- thymic hypoplasia (decreased T cell immunity)–> cellular immune deficiency

C- cleft palate

H- hypoparathyroidism

22q.11.2 deletion

210
Q

pes anserinus pain syndrome

A

pain at the medial aspect of the knee just distal to the joint line

exacerbated when there is pressure from the contralateral knee

211
Q

intial treatment of knee OA

A

weight loss, quad strenthening, low impact aerobic excercise, simple anagelsics

212
Q

occlusion of meibomian gland

A

chalazian (painless)

213
Q

inflammatory nodule arising from an eyelash follicle

A

hordeolum (painful)- stye

214
Q

acute infection of the lacrimal sac

A

dacrocystitis- sudden onset pain, red at the medial canthal region +/- discharge

215
Q

hyperemesis gravidarum

workoup

A

severe N/V in pregnancy, can cause dehydration, hypoglycemia, ketonuria, electrolyte abnormality, >5% weight loss

more common in molar pregnancies and twin pregnancies

workup with pelvic ultrasound

216
Q

maternal hyperglycemia in the first trimester vs second and third trimester

A

1st trimester: congenital heart disease, NTP, small left colon syndrome, spontaneous abortion

second and third: fetal hypoglycemia and hyperinsulinemia, polycythemia, organomegaly, macrosomia, hypertrophic cardiomyopathy

217
Q

treatment of DVT in pregnancy

A

low molecular weight heparin (continue for 3 months, and befoer stopping repeat ultrasound to see if thrombus is still there)

218
Q
A
219
Q

when would you use an IVC filter for DVT

A

if there is a high risk of bleeding from anticoagulation like recent surgery or hemorrhage

220
Q

DRESS syndrome

A

drug reaction following allopurinol and antileptics 2-8 weeks after starting drug

D- drug
R- reaction rash with a morbilliform eruption, facial edema
E: eosionophilia
SS: systemic symptoms- fever malainse, diffuse lymphadenopathy, liver, kidney or lung involvement

TX: stop drug

221
Q

diagnosis of colonic psuedo-obstruction (ogilvie syndrome)

A

abdominal CT

colonic dilation but no obstruction

222
Q

treatment of plasmodium falciparum vs vivax

A

malaria causes episodic fevers, cills, flus like symptoms

falciparum- chloroquine for erythrocyte phase

vivax has a dormant hypozoite hepatic form that can cause symptoms after the intial infection- treat with chloroquine and PRIMAQUIE for hepatic phase

223
Q

diagnosis of coarctation of the aorta

A

echo is diagnostic

CXR would show rib notching of the 3-8th rib

ECG would show left ventricular hypertrophy

224
Q

what lab should be monitored in chronic lithium therapy

A

TSH

**can cause hypothyroidism

225
Q

what are the best ways to prevent infecting your partner with genital herpes

A

not having sex ever, any kind of sex (viral shedding can occur even with no symptoms)

wearing a condom every time you have sex if you do

and have the infected person take daily antiviral therapy

226
Q

what migraine meds are antiemetics and dopamine antagonists that can cause extrapyramidal symptoms like akathsia, cogwheel rigidity and parkinsonism

A

prochlorperazine, metoclopramide, promethazie

227
Q

myelodysplastic syndrome

what is it, risk factors, manifestations, diagnosis, treatment

A

a hematopietic stem cell neoplasm that is increased in older people or people who have had chemotherapy or radiation- may transform to acute leukemia

manifestations: macrocytic anemia, leukopenia, thrombocytopenia

diagnosis: dysplastic red and white cells and hypercellular bone marrow (reduced seegmentation)

**need bone marrow biopsy

treatment: trnasfusions for cytopenias, chemotherapy, stem cell transplantation

228
Q

myelofibrosis

A

pancytopenia + massive splenomegaly

acelluar bone marrow- dry tap

229
Q

hairy cell leukemia

A

chronic B cell lymphoproliferative disorder

+ pancytopenia + splenomegaly + hairy cytoplasmic projections on blood smear

230
Q

hepatic encephalopthy treatment

A

lactuloase, riffaxamin (nonabsorbable antibiotic), fluids

TIPS can make Hepatic encephalopathy WORSE

231
Q

diagnosis of leigonella and treatment

A

diagnosis: urine antigen and respiratory culture

tx: levofloxacin or azithromycin

232
Q

treatment of severe aortic stenosis <1cm

A

valve replacement

233
Q

imaging for submucosal fibroids

A

sonohysterofgraphy (transvaginal ultrasound that infuses saline into the uterine cavity)

234
Q

uric acid kidney stones precipitate in what conditions

A

acidic <5.5, hyperconcentrated urine (chronic diarrhea, dehydration)

tx: urine alkalinization with postassium bicarb or citrate

235
Q

why are calcium oxalate stones common in crohns disease , gastric bypass, or small bowel resection

A

intestinal oxalate absorption is increased

236
Q

treatment of waldenstron macroglobulenemia

A

plasma exchange

237
Q

acute pulmonary embolism can cause syncope how (3 ways)

A

right ventricular dysfunction

cardiac arrhytmia

vasovagal response

238
Q

signs of sigmoid volvulus

A

inverted U shape, no haustra, no air in rectum

common from constipation

(SBO common from abdominal surgery/adhesions)

239
Q

acute cerebellar ataxia

A

nystagmus, staggering gait, intention tremor after a viral illness in children

240
Q

tranverse myelitis

A

post infectious weakness and flaccidity and parathesias below the lesion of the spinal cord affected

241
Q

thyroid hormone changes in pregnancy

A

total T4 increased
Free T4 unchanged or a little increased

TSH decreases

HCG stimulates thyroid hormone production in the first trimester

Estrogen stimulates TBG (binds thyroid hormone)

HCG suppresses TSH

242
Q

inguinal hernias

A

indirect: originate above the inguinal ligament lateral to the inferior epigastric vessels, through the deep inguinal ring into the inguinal canal - patent processus vaginalis- in scrotum

direct: above the inguinal ligament medial to the inferior epigastric vessels into hesselbachs triangle through the superficial ring- not in scrotum- weakening of tranversalis fascia

243
Q

femoral hernia

A

more common in women

inferior to inguinal ligament , protrudes through femoral ring into the femoral canal due to a widened femoral ring

244
Q

treatment of anogenital warts in pregnancy (HPV 6 and 11)

A

trichloroacetic acid

*fleshy/pink pedunculated/sessile growths that can increase in size during pregnancy

**imiquimod and pdophyllin are contraindicated in pregnancy

245
Q

perinatal HPV transmission can cause?

A

juvenile onset respiratory papillomatosis

condyloma on the childs larync/vocal cords that causes strifdor, chronic hoarseness or caugh

246
Q

Paroxysmal nocturnal hemoglobinuria

A

Intravascular and extravascular hemolysis that results from a acquired genetic affect of PIGA and decreased CD55 and CD59 on the surface

hemolysis, cytopenias, hypercoagulability (budd chiari)

high LDH and bilirubin, low haptoglobin

common in 3rd decade of life

DX: flow cytometry

247
Q

features of intravascular hemolysis

A

anemia, elevated bilirubin, low haptoglobin and elevated lactate dehydrogenase

248
Q

Acute intermittent porphyria

A

abdominal pain, dark/brown urine

porphyrins/porphyrin precurors in urine

autosomal dominant

249
Q

G6PD deficiency

A

episodes of hemolytic anemia following oxidative triggers like infection, nitrofurantoin, TMP-SMX, fava beans

most commonly in black men and is X-linked

heinz bodies and bite cells

250
Q

hereditary spherocytosis

A

autosomal dominant disorder in scaffolding proteins in RBC (ankryin, spectrin)

chronic hemolysis, splenomegaly, spherocytes

251
Q

iron deficiency anemia can be associated with

A

reactice thrombocytosis

252
Q

lead poisining can be from a house built before when

A

1978

253
Q

cervical insufficiency

A

painless cervical dilation that can lead to second trimester preganancy loss (can have prolapsing membranes)

caused by collagen defects, uterine abnormalities, cervical conization, obstertric injury

tx: cerclage placement

254
Q

acute lymphoblastic leukemia

A

common in boys 2-5

overgrowth of leukemic cells causes the production of other cells lines to down

bruising, petechiae, mucosal bleeding, impaired platelet production, lymphadenopathy (firm and nontender), hepatosplenomegaly

greater than 2 cytopenias, >20% blasts

255
Q

treatment of peripheral artery disease (intermittent claudication)

A

Statin + Aspirin

supervised graded excercise program

smoking cessation

aggressive diabetes control

revascularization if there is life threatnening limb complications like nonhealing ulcer, failure to respond to the options above

256
Q

risk factors for endometrial cancer

A

EXCESS ESTROGEN

obestiy, chronic anovulation

nulliparity

early menarche, late menopause

tamoxxifen use

257
Q

trigeminal neuralgia pathophysiology

A

compression of the trigeminal nerve root as it enters the pons leading to demyelination and atrophy of the nerve

**treat with carbamezapine

258
Q

bells palsy pathophysiology

A

inflammation and edema ofd the facial nerve (VII) that leads to unilateral facial paralysis

259
Q

vulvodynia

A

dysparuenia due to shard burning pain on the vulvar vestibule has a positive Q-tip test

vestibular erythema, vaginal tissue narrowing or clitoral tissue shrinkage

260
Q

first generation H1 antihistamines can cause urinary retention how

A

causes detrusor hypocontractility

due to the anticholinergic affects it results in impaired detrusor muscle contraction

261
Q

examples of first generation H1 antihistamines

A

diphenhydramine, chlorpheniramine, hydroxyzine

262
Q

chorioid plexus papilloma

A

rare benign brain tumor that is within the ventricles

it produces CSF and causes hydrocephalus , increased ICP, developmental delay, headaches

Diagnosis: MRI

tx: resection, recurrence is rare

263
Q

ependymomas

A

tumor in the fourth ventricle that can block CSF flow through the ventricular system

264
Q

CSF is reabsorbed from the subarachnoid space by

A

arachnoid granulations

265
Q

pre renal AKI in the setting of acute heart failure exacerbation is most likely due to what

A

cardiorenal syndrome

266
Q

how does cardiorenal syndrome occur

A

the failing heart causes decerased renal perfusion and activation of the RAAS

the backpressure from the heart not having foward flow increases central venous pressure and renal venous pressure which causes the GFR to decrease

267
Q

how to IV diuretics work in cardiorenal syndrome

A

they reduces central venous pressure and renal venous pressure to improve cardac output and increase GFR and improve AKI

decreases renal arterioles constriction (afferent)

267
Q

ACE inhibitors on the glomerulus

A

dilate efferent arterioles

268
Q

management in post streptococcal glomerulonephritis

A

loop diuretics fist

then antihypertensives- preffered CCB

269
Q

Trisomy 18

labs

MSAFP, B HCG, Estriol, Inhibib A

A

MSAFP: decreased
B hcg: decreased
Estriol: decreased
Inhibin A: normal

270
Q

labs in neural tube defect

A

MSAFP: increased
B hcg: normal
Estriol: normal
Inhibin A: normal

270
Q

labs in trisomy 21

A

MSAFP: decreased
B hcg: increased
Estriol: decreased
Inhibin A: increased

confirm with amniocentesis: limb defects, stillbirth risks

271
Q

epidural location

A

L4 (below spinal cord termination) into epidural space

272
Q

where is the epidural space

A

between the ligamentum flavum and dura

273
Q

epidural blocks what pain fibers

A

T10-L1

and S2-S4

also sympathetic nerve fibers

274
Q

epidural effects on blocking sympathetic nerve fibers

A

vasodilation, venous pooling, decreased venous return to the heart, decreased cardiac output

hypotension, compensatory tachycardia

lower extremity weakness

tx: place patient in left later decubitus position , IV fluids, vasopressor

275
Q

high spinal anesthesia

A

when anesthesia travels up to the spinal cord and brainstem which depresses of cervical spinal cord and brainstem

occurs with intrathecal injection of anesthetic overdose

hypotension, bradycardia and complete motor blockade (weakness)

276
Q

leakage of cerebral spinal fluid during epidural

A

puncture dura, leak out

postural headaches (headache worse when sitting up and improved when laying down)

277
Q

workup for glomerular hematuria in children

A

rbc casts, proteinuria, cola/dark urine, hypertension, edema

  1. complement levels
  2. other antibodies
  3. CBC and creatinine
  4. renal biopsy
277
Q

what antibiotic can you give to preoperitively to avoid endometritis

A

cefazolin. 30 minutes before C-section

278
Q

what is used to treat endometritis

A

gentamicin and clindamycin

279
Q

post expsoure prophylaxis to chicken pox

A

immunocompetent >1 –> varicella vaccine preferably within 5 days

immunocompentent (pregnant women, HIV, neonates born to mother with active varicella)–> varicella IVIG

<1 no prophylacis

280
Q

hyperthyroidism if left untreated can cause

A

bone loss/fractures

COMLEX LEVEL2 (19 decks)

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