FULLY RANDOMIZED PART II Flashcards
1
Q
Jeopardy style: At only 2% of the US population, this group makes up 63% of new HIV infections in the US.
A
MSM
2
Q
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. The last criteria is that the headache is not better accounted for by another diagnosis.
A
Free card.
3
Q
T-cell to T-cell transfer is a far more effective way for HIV to spread throughout a body than spreading through the blood. Briefly describe why this mode of transfer is likely responsible for most CD4 T-cell death.
A
Most CD4 T-cells are at rest and stop the productionof HIV at the chain elongation phase of reverse transcription. Incomplete viral DNA activates enzymes in the cell that lead to pyroptosis.
4
Q
In terms of classifying the severity of bulimia, how many episodes per week is considered moderate?
A
Four to seven
5
Q
Bacteria makes up 30% of the dry weight of fecal matter and helps synthesize which vitamins?
A
Vitamins B and K
6
Q
True or false: if left untreated, all Gardner’s Syndrome patients will develop colon cancer by age 35-40.
A
True.
7
Q
Which medications are the agents of choice to relieve bronchospasm?
A
Adrenergic agonists (beta 2 specifically).
8
Q
What mechanoreceptors can help modify respiration? Which of these is involved in the matching of blood and O2-rich lung areas?
A
Stretch receptors in chest wall and airways (cause expiration if overinflation), irritant receptors in airways (cough), and J receptors (in lung periphery; these make the match between blood and lung).
9
Q
Chest pain is not one of the common signs of most lung conditions. Which three of the conditions discussed do feature chest pain?
A
Sarcoidosis, tuberculosis, and histoplasmosis (chronic pulmonary).
10
Q
The pain of postherpetic neuralgia is ___________ (unilateral/bilateral), sharp/stabbing, and affects which branch(es) of the trigeminal nerve?
A
V1*
11
Q
How does toxoplasmosis get from your cat into you?
A
Organism appears in cat feces and gets lodged in muscles of animals that root around in the dirt (pigs, sheep; can also appear on fruits and veggies). Eating the undercooked meat or unwashed fruits/veggies gets the organism into our bodies.
12
Q
Wilson disease can present with liver, brain, and ocular symptoms. Name the brain symptoms.
A
Dysarthria, gait abnormalities/ataxia, dystonia, tremor, Parkinsonism, drooling.
13
Q
Prevention of migraines can be done with a calcium channel blocker like _________ .
A
Verpamil
14
Q
What three disorders make up Cluster A personality disorders?
A
Paranoid, schizoid, and schizotypal
15
Q
How would you treat a mild to moderate acute migraine?
A
NSAIDs or acetominophen
16
Q
Which headaches discussed in class are more common in women?
A
MigrainesTrigeminal neuralgiaParoxysmal hemicranias*Tension-typeBasilar migrainesHemiplegic migrainesRetinal migrainesSinus headachesGCA headache
17
Q
Protective measures against mosquitoes is very similar to those against ticks. What additional things could you do to protect against mosquitoes?
A
Don’t go outside at dawn and dusk (this is when they most commonly feed) and drain any standing water (this is where they lay their eggs).
18
Q
In Bipolar I and II, how does a hypomanic episode differ from a manic episode?
A
The features are similar, but not severe enough to cause marked social or occupational impairment, for at least 4 days.
19
Q
What features contribute to the lung’s immune response?
A
Lymph system is involved (enters at the hilum), cilia in the bronchi help get mucous and foreign substances out, cough reflex, mucous (to trap the foreign particles), and phagocytosis (if we can’t get the foreign particle out).
20
Q
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed brief psychotic disorder?
A
More than a day, but less than a month
21
Q
What are the symptoms of IIH?
A
Headache is the major one; can also get transient visual obscurations, pulsatile tinnitus, and diplopia (particularly CN VI)
22
Q
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do frequent headaches occur?
A
Between 1-14 days per month on average
23
Q
What treatments are used for the neurological symptoms of late Lyme disease?
A
IV ceftriaxone for 14-28 days
24
Q
What 7-minute test is the most widely used cognitive test for dementia? What does the shorter version of this test involve?
A
The Mini-Mental State Examination (MMSE), which involves testing the patient’s presence of mind and ability to follow instructions. The shorter version of the test involves having the patient repeat three words, draw a picture of a clock, and then repeat those same three words back to you from memory.
25
Comparing Crohn's Disease and Ulcerative Colitis, which features remitting inflammation that is discontinuous?
Crohn's Disease
26
Which two of the STIs discussed in class are in the top two of most commonly reported notifiable diseases?
Chlamydia is #1, gonorrhea is #2
27
In which two situations would you use intravenous immunoglobulin for MG?
During a myasthenic crisis or prior to a thymectomy.
28
What are the symptoms of cholecystitis?
Severe pain in upper right abdomen, tenderness over abdomen, N&V, fever.
29
What are the three most commonly abused drugs in the US?
Alcohol, tobacco, and marijuana.
30
Besides triptan treatment for acute migraines, you can use a triptan/NSAID combo, or dihydroergotamine.
Free card.
31
True or false: there is no specific treatment for scleroderma esophagus, besides getting the patient on pronton pump inhibitors to help with the GERD.
True. You can also use endoscopy to monitor for esophageal cancer.
32
Which class of drugs for Parkinson's disease are good for patients with tremor?
Anticholinergic drugs.
33
How is acute pancreatitis diagnosed?
2-3 times elevated serum lipase/amylase, and/or characteristic findings on imaging.
34
_________________ is a treatment for achalasia that involves cutting the muscles of the LES.
Heller myotomy
35
Comparing subdural vs epidural hematomas, which has a lenticular shape on a CT scan?
Epidural
36
What tests can be run to help diagnose HCV?
HCV antibody test, HCV RNA assay, and other liver tests.
37
It is estimated that only 50% of individuals get recommended screening for STIs. What is the screening recommendation for men?
Annual syphilis/chlamydia/gonorrhea/HIV screening if:-Sexually active gay, bisexual, or other MSMIf multiple/anonymous partners, screen every 3-6 months.If illicit drug user (or if partner is), screen even more frequently.
38
What surgery is used to treat Crohn's disease?
Resection (typically of the ileus)
39
What causes the cadiovascular symptoms of tertiary syphilis?
Damage caused by immune process causes cellular debris to be released into the blood. Antibodies known as reagin tag a cardiolipin-cholesterol-phospholipid antigen made from the debris. The immune system targets these antigens and causes inflammation and even more damage to heart tissue.
40
Sarcoidosis is a multisystem disorder. Which three system are most affected?
Pulmonary (95%), dermatologic, and ocular (20%).
41
Three types of laboratory tests were discussed in class for diagnosis of chlamydia. Which is recommended by the CDC? Briefly describe this test.
NAAT is CDC recommended. Sample required is vaginal swabs for women and urine for men. Gonorrhea will usually be concurrently tested for.
42
What is the treatment for adults and children over 45 kg for ocular gonorrhea?
Ceftriaxone 1 g in one IM dose plus Azithromycin
43
What is the active form of the toxoplasmosis parasite called? Where in the body does it lodge before reverting to its dormant form (due to immune system)?
Tachyzoites are the active form which lodge in muscles, myocardium, brain, and eyes. Bradyzoites are the dormant form.
44
What type of migraine subtype is associated with unilateral weakness during the headache?
Hemiplegic migraine
45
Jeopardy style: Parkinson's disease features depletion of this neurotransmitter from the basal ganglia.
What is dopamine?
46
Give a one-sentence description of a clonic seizure.
Muscle spasms with or without impaired consciousness.
47
What are the ocular clinical findings associated with IIH?
Papilledema is the major one; also visual field loss.
48
Though the definitive diagnosis for toxocariasis is tissue biopsy, this is not often done. What other test is done, and which form of the disease is it more useful for?
ELISA; it is more useful for VLM than OLM since there aren't many antibodies in the eye.
49
What is the advantage of inhalation powders over typical inhalers?
You don't have to have "hand-breath" coordination.
50
What is the typical transmission of Hepatitis D?
Percutaneous, intrafamily
51
Which drugs are anti-epileptic drugs for focal seizures?
Carbamazepine, phenytoin, phenobarbital, gabapentin.
52
What tests are used to diagnose sleep apnea? Which is the gold standard?
Sleepiness questionnaires and nocturnal polysomnography (measure eye movements, chest wall, electromyogram, electroencephalogram, electrocardiogram, oximetry, and nasal/oral air flow during sleep. Nocturnal polysomnography is the gold standard.
53
What are the signs and symptoms of a sinus headache?
Nasal congestion*Purulent nasal discharge*Tooth painFacial painPressure worse when bending over
54
Of the bipolar, depressive, and anxiety disorders mentioned in class, which have their onset in childhood or early adolescence?
Depressive Mood Dysregulation Disorder, selective mutism, specific phobia, and social anxiety.
55
Diagnosis for a diverticula is based on what?
Clinical history and CT or ultrasound
56
True or false: with ulcerative colitis, medical therapy has 70% success rate for remission.
True.
57
Comparing migraine with aura to migraine without aura, which requires at least two attacks for diagnosis?
Migraine with aura
58
Prophylaxis of tension headaches is done through stress avoidance. Use of which antidepressant can also be considered?
Amitriptyline*
59
____________ is characterized by the presence of fibrosis and regenerative nodules in the liver.
Cirrhosis
60
True or false: worldwide, gastric cancer is the 2nd most common cancer and the 4th leading cause of cancer death.
False; worldwide, it is the 4th most common cancer and the 2nd leading cause of cancer death.
61
If you could choose two words to describe the typical chronic bronchitis patient, what would they be? What do these two words imply about the condition?
Blue bloater--blue due to lack of oxygen, bloater because they don't have enough oxygen, so their physical activity is limited (also bloater due to edema from right sided heart failure).
62
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used to confirm eradication of H. Pylori after 6 weeks of therapy?
Stool antigen test.
63
The Sabin-Feldman dye test is the gold standard for toxoplasmosis. Does staining indicate a positive or negative test?
Staining indicates a negative test--organism must be intact for staining to occur. It patient has antibodies, organism will not be intact.
64
What surgery is used to treat ulcerative colitis?
Colectomy with ileal pouch-anal anastomosis
65
True or false: ketoacidosis is more common in type II diabetes than type I.
False; it is more common in type I, and when the patient has missed a dose of insulin.
66
Comparing sigmoidoscopy and colonoscopy, which evaluates the entire colon?
Colonoscopy
67
Gardner's Syndrome is a subtype of familial adenomatous polyposis (FAP) that eventually leads to colorectal cancer if left untreated. Gardner's Syndrome can be cause by what sort of inheritance patterns in which mutated genes?
Autosomal dominant in APC gene (90%) or autosomal recessive in MYH gene (8%)
68
What surgical options might be considered for a patient with IIH?
Optic nerve sheath fenestration, CSF shunting.
69
Sinus headaches are considered acute under _____ weeks, and chronic if more than _____ weeks.
Acute: less than 4 weeks; chronic: more than 12 weeks
70
In terms of diet and eating habits for a person with dysphagia, which of the following recommendations is incorrect? Eat in an uprightposition; eat small bites; eat slowly; don't talk while eating; check inside of cheek for pocketed food after eating; turn head up when swallowing; remain in upright position for 30-45 minutes after eating.
Turning head up when swallowing is incorrect; it is recommended that the patient turn their head down when swallowing.
71
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used for definitive diagnosis?
Endoscopy
72
Acquired toxoplasmosis can feature flu-like symptoms. What makes these flu-like symptoms stand out?
They can last for a month
73
What is the hallmark of myasthenia gravis?
Fluctuating weakness of skeletal muscles.
74
True or false: in order to diagnose Bipolar I, a patient must experience a manic episode and a major depressive episode at least once in a lifetime.
False; they only need the manic episode in order to meet the criteria.
75
If resolution of a Bell's Palsy begins within 21 days, full recovery is likely. There is a poorer prognosis if the symptoms last more than 4 months.
Free card.
76
_________________ is a way to treat achalasia that involved placing a baloon at the LES to stretch the area.
Pneumatic dilation
77
Which medication for asthma is given as a subcutaneous injection? How does it work?
Omalizumab is a monoclonal antibody that binds to IgE and decreases its action. It decreases attacks experienced by patients, but has a risk of anaphylaxis.
78
In late neurosyphilis, symptoms can be motor-based or sensory-based. Which sensory symptoms are possible?
Acronym OD LUAUOptic atrophyDecreased peripheral reflexesLightning pains in extremetiesUnusual gaitArgyll-Robertson pupilUrinary and fecal incontinence
79
What are the symptoms of HAV?
Dark urine, pale stools, jaundice, pruritis
80
What is the most common cause of bacterial meningitis?
Strep. Pneumoniae
81
Narcotics bind to pain receptors and reduce pain and induce euphoria. Which narcotics were asterisked in the presentation?
Morphine, heroin, codeine, and methadone.
82
Pneumoconiosis is an umbrella term for which conditions discussed in class?
Asbestosis, black lung, and silicosis.
83
The proposed mechanism of IIH involves decreased outflow of CSF via?
Venous stenosis and/or venous sinus thrombosis
84
What are some of the symptoms of seizures?
Blackout followed by confusion, drooling/frothing at the mouth, loss of bladder/bowel control, teeth clenching, muscle spasms, unusual smells/tastes/feelings, etc.
85
What are the atypical symptoms of GERD?
Hoarseness, chronic laryngitis and sore throat, globus sensation, otitis media, dental erosion, non-cardiac chest pain, aspiration pneumonia, and asthma
86
The spectrum of schizophrenia has several sub-categories, based on how long they symptoms last. How long do the symptoms have to last for the condition to be termed schizophreniform disorder?
More than a month, but less than 6 months.
87
What is the function of bile?
Detoxification, cellular recycling, breakdown and absorption of fat soluble vitamins.
88
What is the treatment for children under 45 kg for ocular gonorrhea?
Ceftriaxone 25-50 mg/kg in one IM or IV dose (don't exceed 125 mg)
89
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is that the headache must last how long?
30 minutes to seven days
90
What ocular signs might occur in a patient with early Lyme disease?
Follicular conjunctivitis, episcleritis, perioribital edema
91
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form usually occurs 10-20 years after the initial onset?
SPMS
92
Does Hepatitis A have a chronic form?
No.
93
True or false: in an acute Hepatitis A infection, 70% of adults are symptomatic.
True.
94
What are some of the roles of the liver?
Glucose homeostasis, fat/protein/hormone/bilirubin/drug metabolism, bile formation, plasma protein production, clotting factor production, blood detoxification.
95
What are the signs and symptoms of acute pancreatitis?
Acute, severe epigastric pain often radiating to the back, N&V, tenderness on palpation, obstructive jaundice, fever, tachypnea, hypoxemia, hypotension, panniculitis.
96
How many days after birth does congenital gonorrhea cause conjunctivitis? How does this compare with conjunctivitis due to congenital chlamydia?
Gonorrhea: 2-5 daysChlamydia: 1-2 weeks
97
What is the mechanism of action of the anti-fungal medications for histoplasmosis? What are the important side effects of these drugs?
Drugs bind to cell membrane and disrupts metabolic activity, but can be toxic to human cells. Important toxic effects are renal and liver toxicity.
98
CD4 cell count provides information on the overall immune function of an HIV+ patient. What level indicates an increased risk for opportunistic infections?
Less than 200 cells/mm3
99
Which type of hepatitis is the most common cause of chronic liver disease and indications for liver transplantation?
HCV
100
What is the treatment for a viral sinus headache?
Observation, NSAIDs, saline irrigation, degongestants.
101
Serological testing for syphilis falls into the category of non-treponemal and treponemal. Categorize each of the following bullet points according to which type of test it pertains to.-Less expensive-Targets reagin-Cannot be used to check success of treatment-Qualitative and quantitative-Most common test is FTA-ABS-More expensive-Qualitative only-Targets antibody against T. pallidum-Can be used to check success of treatment-Most common tests are VDRL and RPR
Non-treponemal-Less expensive-Targets reagin-Qualitative and quantitative-Can be used to check success of treatment-Most common tests are VDRL and RPRTreponemal-More expensive-Targets antibody against T. pallidum-Qualitative only-Cannot be used to check success of treatment-Most common test is FTA-ABS
102
One possible cause for hypoglycemia is if the patient skips a meal. What level of blood sugar may indicate hypoglycemia?
Less than 70 mg/dL
103
What percentage of Hepatitis C cases are chronic?
85%
104
Although a good history and x-ray exams can help with identifying histoplasmosis, what test is definitive? What other tests are available?
Isolation by culturing (which takes several weeks) is the definitive test.Can also use antigen detection (enzyme immunoassay through urine* or serum) and antibody tests (only proves exposure).
105
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is there must be at least two of which four characteristics?
Bilateral*Pressing/tightning* (nonpulsating)Mild/moderate intensity*Not aggravated by routine physical activity*
106
There are different types of delusional disorder. Briefly describe the jealous subtype.
Belief that their spouse or lover is unfaithful.
107
Treatment of syphilis is considered successful after 6 months if....
...the dilution of a non-treponemal test has decreased by a factor of 4 (i.e., from 1/64 to 1/16, or from 1/32 to 1/8)
108
What system is activated by all addictive drugs?
Mesolimbic dopamine system.
109
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do endocrine cells secrete?
Depends on the type. G cells secrete gastrin; D cells secrete somatostatin
110
What are some of the long term effects of bulimia?
Tooth decay, osteoporosis, electrolyte imbalance, swollen salivary glands, hypotension, low body temperature.
111
In Barret's esophagus, ____________ (squamous/columnar) epithelium is replaced by __________ (squamous/columnar) epithelium.
Squamous epithelium is replaced by columnar epithelium.
112
What class of medications are the single most important factor for increased lifespan of a patient with cystic fibrosis?
Inhaled antibiotics such as tobramycin (TOBI).
113
A patient has ALS and is exhibiting difficulty swallowing. What type of dysphagia are they most likely to have, oropharyngeal or esophageal?
Oropharyngeal.
114
Gonorrhea is asymptomatic early on in 10% of men and 50% of women, and is often concurrent with other STIs.
Free card.
115
True or false: lab tests are very useful for diagnosis of hepatocellular carcinoma.
False; they are non-specific. Ultrasound is used on screenings.
116
Patients with cirrhosis are 40 times more likely to develop that other condition?
Hepatocellular carcinoma.
117
True or false: for every case of Lyme disease reported, the CDC estimates that there is another case, unreported.
False; CDC estimates that there are 10 cases of Lyme for every one reported.
118
Wheat, barley, and rye are high in content of _______ and ______, which resists digestive processes in patients with celiac disease.
Glutamine and proline*
119
What supplements can be given for the malnutrition of alcoholism?
IV thiamine, folate, and multivitamin (banana bag)
120
Over the counter acute therapy for migraines involves NSAIDs or acetominophen, or Excedrin (combination of acetominophen, caffeine, and aspirin). True or false: a large single dose is more e
True.
121
Carotid endarterectomy is surgical treatment that involves removal of the plaque. What two criteria must be met in order to consider this procedure for a patient?
70-99% lumen occlusion and 5+ year life expectancy
122
What laboratory testing can be done for celiac disease?
IgA anti-tissue transglutaminase (anti-tTGA) and HLA-DQ2 allele
123
Guidelines for starting ART are rated based on the recommendations and the evidence. What is the scale for rating evidence?
I=Data from randomized controlled trialII=Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomesIII = Expert Opinion
124
What is the name of the protein produced in the liver that transports unconjugated bilirubin to the liver? Is a test for this protein a good indicator of acute damage? Why or why not?
Albumin. Testing for serum albumin may give an idea of the level of liver function; however, it has a half life of 15-20 days, so it is not a good indicator for acute damage or disease.
125
In which gender is secondary syphilis more likely, and why?
Females; the ulcers that occur in primary syphilis are more likely to be noticed by men, which means men are more likely to be treated for primary syphilis than are women.
126
What are the two latent TB treatment methods discussed in class? Which of these is the preferred treatment for HIV+ and young children?
Isoniazid (INH) 5 mg/kg po qd for 9 months.ORING 15 mg/kg rounded up to nearest 50 or 100 mg plus rifapentine (300-900 mg based on weight) 12 once weekly doses.The INH only treatment is the preferred for HIV+ and young children.
127
Holding an ice pack over the ptotic eye of a patient with MG should ___________ (improve/worsen) the ptosis.
Improve
128
Colorectal cancer is the second leading cause of cancer mortality among men and women combined. What are the risk factors for colorectal cancer?
Family history of colorectal cancer or polyps, IBD, older age, history of smoking, high fat/low fiber diet, sedentary lifestyle
129
Describe the treatment for inclusion conjunctivitis.
If over 8 years old OR above 45 kg-Azithromycin 1 g po single dose OR-Doxy 100 mg po bid for 1 weekIf under 8 years old AND below 45 kg-Erythromycin or ethylsuccinate solution 50 mg/kg/d (divided into 4 doses) po for 2 weeks
130
Comparing subdural vs epidural hematomas, which is located between the dura and the arachnoid?
Subdural
131
The primary anti-reflux barrier for the esophagus is the LES. What two main patterns of dysfunction can cause GERD?
Hypotensive LES; transient LES relaxation (can be predisposed by hiatal hernia)
132
Peripheral and central chemoreceptors both affect the respiratory rate. Which has the greater effect, and which blood gas is the major modifier of its actions?
Central have the most effect (85%). Central receptors are mainly influenced by blood CO2 levels. Higher CO2 levels or increased acidity trigger a reflex to increasing the breathing rate and depth.
133
What are the adverse effects of pyrimethamine?
Rash, asplastic anemia, anorexia, dry mouth, plus non-specific.
134
The diagnostic criteria for a migraine without aura includes a headache with at least two of which characteristics?
Unilateral location, pulsating quality, moderate or severe pain, aggravation caused by routine physical activity (or headache causing avoidance or routine physical activity).
135
Name the features of Korsakoff syndrome.
Damage to thalamus and hypothalamus, inability to form new memories, memory loss, confabulation, hallucinations.
136
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which can switch sides?
Cluster headaches
137
In terms of partial/focal seizures, which involves impairment of consciousness, and which does not?
Complex imapirs consciousness, simple does not.
138
What surgical options are available for trigeminal neuralgia?
Microvascular decompression (move the artery or vein away from the nerve), or lesion the trigeminal nerve.
139
True or false: histologic confirmation is needed for diagnosis of pancreatic cancer.
True.
140
What percent of seronegative (for autoantibodies against AChR) patients with generalized MG have autoantibodies against the receptor tyrosine kinase?
35-55%
141
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do chronic headaches occur?
More than 15 days per month on average
142
What is considered a normal respiratory rate for an adult?
12-19 cycles per minute
143
True or false: thunderclap headaches recur regularly and can be unilateral or bilateral.
False; they can indeed be unilateral or bilateral, but they do NOT recur regularly.
144
True or false: traumatic brain injuries are the leading cause of death in the US for people up to the age of 45.
True.
145
True or false: the symptoms of MS are separated in time and space and are usually followed by partial or complete remission.
True.
146
Comparing migraine with aura to migraine without aura, which requires at least five attacks for diagnosis?
Migraine without aura.
147
What percentage of patients with Zollinger-Ellison Syndrome have Multiple Endocrine Neoplasia type 1?
20-25%
148
What substance causes the psychoactive properties of cannabis?
delta-9-tetrahydrocannabinol (THC)
149
What is the name for the set of criteria used to determine if a case qualifies as IIH?
Modified Dandy criteria
150
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what protease inhibitors do, as well as any specific points made during class about this class of medication.
They inhibit protease, keeping it from activating new copies of viral enzymes.
151
Comparing sigmoidoscopy and colonoscopy, which is more suitable for screenings if combined with fecal occult blood testing (FOBT)?
Sigmoidoscopy
152
True or false: the normal volume of CSF is between 60-150ml, and the body produces about 250ml a day.
False; there is indeed 60-150ml of CSF, but the body produces 500ml per day
153
What is the name of the syndrome that can occur from vitamin B1 deficiency, often found in people with alcoholism?
Wernicke-Korsakoff Syndrome
154
True or false: MS is thought to decrease lifespan by 15 years.
False; it is thought to decrease lifespan by 7 years.
155
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What iatrogenic causes are possible?
Surgery, radiation
156
Late disseminated Lyme disease occurs after 4 months on average. What symptoms occur in this stage?
Lyme arthritis (in 60% of patients)Chronic neurologic (in 5%)-Encephalopathy, low grade CNS inflammation, paresthesias, "stocking glove" pattern shooting pain
157
If a liver nodule is found on ultrasound, how big would the nodule be in order to evaluate with imaging and possible biopsy, rather than just following the patient?
More than 1 cm
158
How is the severity of COPD evaluated?
Questionnaires and spirometry/FEV1 tests.
159
Sleep apnea is due to the collapse of the upper airway during sleep. The patient will thrash, snort, and gasp in their sleep and reopen the airway. What factors contribute to this condition?
Obesity, thick necks, small/receded jaw, increased soft palate and tongue, heavy drinking, history of asthma.
160
Why does jaundice cause pale stools and dark urine?
Bilirubin is normally responsible for the dark color of feces. If there is an obstruction that keeps the bilirubin from getting into the bile, it will spill over into the serum and be filtered by the kidneys. Low bilirubin in the bile leads to pale stools, high bilirubin in the serum leads to dark urine.
161
What are the risk factors for pancreatic cancer?
Hereditary chronic pancreatitis, hereditary breast cancer, smoking, diabetes, pancreatic cysts, high BMI, low physical activity.
162
What clinical manifestations can occur in a patient with chronic bronchitis, apart from the cough?
Wheezing, crackles, tachycardia, and polycythemia.
163
Define: vital capacity
The volume of air that includes everything from the expiratory reserve volume through the inspiratory reserve volume. (VC = IRV + TV + ERV)
164
Which headaches discussed in class are more common in men?
Cluster headaches*SUNCT*
165
True or false: the cortical spreading depression theory (CSD) states that nociceptor threshold is increased, and the magnitude of their response is increased as well.
False; the threshold is decreased (easier to feel pain), and the magnitude is increased
166
What drug is used in the diagnosis of MG? What class of drug is this, and what is its antidote?
Edrophonium; class is acetylcholinesterase inhibitor; atropine is the antidote.
167
Epilepsy prognosis is fairly good if controlled with medications. Children with epilepsy have a 3-4x increased risk of death. Sudden, unexplained death in epilepsy (SUDEP) occurs in 2-18% of patients with epilepsy.
Free card.
168
What are the symptoms of steatosis?
Usually asymptomatic
169
What are the adverse effects of rifapentine?
Reddened secretions, N&V, fever.
170
Although the ocular symptoms of West Nile Fever occur less commonly, they generally last longer than the non-ocular symptoms (2-3 weeks compared to about 1 week). What ocular signs/symptoms are there?
Conjunctivitis, photophobia, eye pain, floaters, vasculitis. May notice a linear pattern on the retina due to choroiditis.
171
What are some of the symptoms in a patient with a brain tumor?
N&V, seizures, focal weakness, headache, changes in personality, visual changes.
172
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat dependent disorder?
Psychotherapy
173
There should be a chain of command established in case of an emergency in your office. Who should be the coordinator?
The doctor (you)
174
Which anti-epileptic medication is associated with myopic shift and angle closure? For bonus points, which other condition can this drug be used for?
Topiramate; can also be used for idiopathic intracranial hypertension.
175
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form is progressive from the onset and involves minimal relapses?
PPMS
176
Triptans are used to treat acute migraines and are agonists of __________.
Serotonin
177
What does alair bronchial thermoplasty involve?
A catheter is worked into the airways, which are heated to decrease their thickness and hyperresponsiveness.
178
True or false: patients with COPD should get their vaccinations
True; flu vaccine in particular has been shown to reduce morbidity and mortality.
179
About how many people in the U.S. are infected with histoplasmosis? How many new infections are there each year?
50 million currently infected; 200,000 new cases each year.
180
What factors can help in determining when to do CT imaging for a TBI?
Less than 15 Glasgow scoreVomitingOver age 65Amnesia for more than 30 minutesSeizuresAnticoagulant useAlcohol use
181
True or false: most people with toxocariasis need to undergo treatment for the symptoms.
False; most individuals do not have symptoms and do not require treatment.
182
Comparing subdural vs epidural hematomas, which has a lunar shape on a CT scan?
Subdural
183
Compare and contrast the age of the typical patient with Creutzfeldt-Jakob disease and variant CJD.
CJD: 65 yearsvCJD: 29 years
184
What is the term for inability to swallow?
Aphagia
185
What are some fungal causes of aspectic meningitis?
Hisoplasm, candida
186
Retinal migraine (aka ocular or ophthalmic migraine*) is thought to involve which arteries?
Central retinal and ophthalmic
187
What are the symptoms of colorectal cancer?
Constipation, small-caliber stool, fecal impaction or obstructive symptoms, pain/bloating, acute or chronic GI bleed, bowel obsturction.
188
Hallucinogens create distortions in a person's perception of their surroundings. Which hallucinogens were asterisked in the presentation?
Cannabis and LSD.
189
True or false: in most cases, acute pancreatitis is mild and does not require therapy.
True.
190
A prodrome to a migraine occurs between 24-48 hours prior to the headache and involves what types of findings?
Depression, irritability, food cravings, neck stiffness, yawning, fatigue, difficulty concentrating, aversion to light, sounds, smells.
191
True or false: Hepatitis A is typically self-limited
True.
192
What ocular signs might occur in a patient with late Lyme disease?
Pupil abnormalities, CN palsies of III, IV, VI, pars planitis, choroiditis, granulomatous anterior uveitis, and unilateral or bilateral disc edema.
193
Treatment for cholecystitis includes likely hospitalization, antibiotics and/or pain medication, possible cholecystectomy, and what else?
Fasting (to lessen contractions of the gallbladder.
194
What are some of the urgent signs of diabetic ketoacidosis?
Constant fatigue, dry or flushed skin, N&V or abdominal pain, difficulty breathing, fruity odor on breath, confusion or difficulty paying attention.
195
What is the average age of onset of multiple sclerosis?
20-35 years
196
What are the screening recommendations for patients with a first degree relative with Gardner's Syndrome??
Sigmoidoscopy every 1-2 years beginning at age 12; genetic counseling after age 10-12
197
What non-pharmaceutical options are available for a patient with chronic bronchitis?
Respiratory dialysis with the Hemolung respiratory assist system.
198
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). In which form is the gender predilection equal?
PPMS
199
Though the incidence of syphilis decreased steadily in the latter half of the 20th century, there was a dramatic rise from 1986-1990. What caused this increase?
HIV, birth control pills, drug culture
200
If a patient with severe emphysema were to sit in your waiting room, how might he position himself?
This would be a thin patient that might breathe with pursed lips (helps increase pressure to keep airways from collapsing), and they might put their hands on their legs and lean forward slightly ("tripod") to get help from the accessory muscles for respiration.
201
There are different types of delusional disorder. Briefly describe the eromanic subtype.
Belief that someone is in love with them.
202
What are some systemic conditions that are associated with IIH?
Sleep apnea, polycystic ovary syndrome, coagulation disorders, anemia, lupus
203
What sorts of lifestyle changes can a patient with GERD make to ease the symptoms?
Weight loss, elevate bed slightly, avoid reclining within 2-3 hours of eating, eat small meals, stop smoking, and avoid foods and drinks that trigger the GERD.
204
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form involves acute attacks followed by remission to normal or near-normal?
RRMS
205
In terms of classifying weight severity in anorexia, what BMI is considered severe?
15-15.99 kg/m2
206
True or false: most HAV-infected individuals exerpience full recovery within 2 months.
False; most experience recovery within 6 months.
207
____________ product hormones like insulin and glucagon, and release them into the blood stream.
Islets of Langerhans
208
There are a few stages to syncope: prodromal, loss of consciousness, and post-syncopal. Name a few of the features of the prodromal stage.
Pale skin, lightheadedness, tunnel vision, nausea, feeling of warmth, cold clammy sweat, and blurred vision.
209
Which vitamin supplement would you add to either of the treatment for latent TB?
B6 (pyridoxine)
210
What is the most common cause of sinus headaches?
Viral infection
211
Treponema pallidum can enter intact mucous membranes.
Free card.
212
TST results are made by measuring the induration of the resulting reaction, not the redness. In which individuals would an induration of 15 mm be considered posittive?
Anybody.
213
How long does it take for inhaled cocaine vapor to reach the brain? How long is its effect?
Reaches brain instantaneously, lasts 5-10 minutes
214
Panic disorder is characterized by recurrent, unexpected panic attacks, followed by at least one month of persistent concern for another panic attack and/or significant maladaptive change in behavior.
Free card.
215
What clinical findings might a patient with bacterial meningitis have?
Fever, HA/altered mental status, and nuchal rigidity
216
Gallstones are diagnosed with transabdominal ultrasonography and can be treated with cholecystectomy (surgical removal of gall bladder), bile acid pill, or extracorporeal shock wave lithotripsy. What are some indications for cholecystectomy?
Large stones (more than 2.5 cm), hemolytic anemia, or organ transplant in an immune compromised patient.
217
True or false: sleep apnea is found in up to 1/4 of individuals over 20 years of age
False; it is found in up to 1/4 of males over 20 years of age.
218
What two receptors are needed for HIV to invade a host cell?
CD4 and CCR5
219
True or false: we as optometrists are less concerned about congenital toxoplasmosis because only 20% of children develop ocular complications later in life.
False; we are very concerned about it because 80% of children with congenital toxoplasmosis go on to develop ocular complications later in life.
220
What are some of the symptoms of a cardiovascular accident or a transient ischemic attack?
Sudden onset of: Numbness or weakness or face/arm/leg, especially on one side of bodyConfusion, trouble speaking or understandingTrouble seeing or blurred vision in one or both eyesTrouble walking, dizziness, loss of balance or coordinationSevere headache with no cause
221
There are five classes of HIV medications (plus pharmacokinetic enhancers). Describe what pharmacokinetic enhacners do.
They increase the amount of medication in the blood, and prevent the breakdown of protease inhibitors by the body.
222
What is the treatment for adults for non-ocular gonorrhea?
Ceftriaxone 250 mg in one IM dose plus Azithromycin 1 g PO single dose (or Doxy 100 mg po q12h for 7 days)
223
Which headaches discussed in class are typically in younger patients (under age 50)?
Migraines (30-39)*Basilar migraines (7-20)Hemiplegic migraines (12-17)Retinal migraines (under 40)Recurrent painful ophthalmoplegic neuropathyCluster headaches (27-37)Paroxysmal hemicranias (34-41)SUNCT (48)Sinus headache is from 45-75.
224
What is the term for pain on swallowing?
Odynophagia
225
Central sleep apnea is not considered an obstructive respiratory condition. What is a common cause of central sleep apnea? Briefly describe the mechanism of the apnea.
Heart failure is a common cause of central sleep apnea. Cheyne-Stokes respiration occurs: the central receptors will sense a decrease in the levels of blood oxygen and trigger an increase in respiration rate. The newly oxygenated blood takes time to get to the receptors, by which point the patient is experiencing hyperpnea and the blood is over-oxygenated. The receptors then tell the respiration rate to slow, leading to eventual apnea through the same type of process.
226
What are some of the triggers for cluster headaches?
Alcohol, smoking, hypoxia
227
There are a few different forms of multiple sclerosis: clinically isolated syndrome (CIS), relapsing-remissing (RRMS), secondary-progressive (SPMS), and primary progressive (PPMS). Which form is the most common?
RRMS
228
Bell's Palsy is thought to be related to which viral organisms?
Herpes simplex or herpes zoster.
229
Diagnosis of Wilson Disease is based on clinical manifestations (evidenced by a liver biopsy or the psychiatric symptoms or ocular manifestations) and lab testing. What lab tests could you do?
Serum ceruloplasmin low (less than 200 mg/L; transports copper)Serum copper low (less than 65 mcg/L; deposits in tissues, doesn't stay in blood)24 hour urinary copper excretion (more than 100 mcg).
230
Comparing psychotherapy, sociotherapy, and pharmacotherapy, which is best to treat borderline disorder?
Psychotherapy or sociotherapy
231
True or false: anticholinergics for asthma treatment are off-label.
True.
232
What is an optometrist's rule in the care of a patient with sarcoidosis?
The patient needs to have a baseline eye exam within the 1st year (including SLEx, DFE, GAT, and 10-2 VF). They need to have an annual exam thereafter (sooner if visual disturbance). And after 5 years of hydroxychloroquine use, they need to have a DFE and 10-2 VF and if possible a SD-OCT (spectral domain OCT) or mfERG (multifocal electroretinography), or FAF (fluorescein autofluorescence).
233
How many breaths per minute is considered bradypnea? Tachypnea?
10 or less is bradypnea, 20 or greater is tachypnea.
234
Chronic immunomodulators for MG include azathioprine, mycophenolate, cyclosporine, tacrolimus, and prednisone. What kind of dose would you use with prednisone, and why?
Low dose (no more than 1.0 mg/kg), since high dose steroids can make MG worse.
235
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which medications tend to predispose to GERD?
Diazepam, estrogens, progesterone, anticholinergics, and TCAs (tricyclic antidepressants?)
236
You can use EIA or IFA in terms of serological testing for toxoplasmosis. Which antibody do you look for first?
Usually IgG and then IgM (this is backwards from tests for other conditions--because IgG appears so quickly with toxoplasmosis, look for it first, then you can look for IgM to decide if the infection is acute)
237
Which condition is the most common occupational disease in the world?
Silicosis
238
MS attacks in a patient are typically reduced during what life event?
Pregnancy.
239
If your patient tested positive for WNV on a screening test, what confirmatory tests could you run?
Plaque reduction neutralization test (take live WNV, add to a sample of the patient's serum--positive if no growth, negative if growth) -- this is the gold standard to differentiate WNV from St. Louis encephalitis virusRT-PCR (detects viral RNA--positive confirmed the infection, negative does not rule out the infection)
240
Syphilis is hard to diagnose partly because of the fact that the disease has episodes of activity and periods of latency. About how long is the average incubation period (time from initial infection to symptoms)?
3 weeks
241
What sorts of conditions might cause two-tiered testing for Lyme disease to give false positives?
Autoimmune diseases, mono, malaria, syphilis, etc.
242
There are four classic stages to syphilis. What are the signs/symptoms of primary syphilis?
Regional lymphadenopathy (caused by immune response in the location of first exposure), and chancre (due to local infiltration of PMNs, also in the area of first exposure)
243
Oral therapy for MS is the most convenient, but is less effective than infusion and injection therapies. What drug is the most commonly used oral MS drug?
Dimethyl fumarate (Tecfidera)
244
Peptic ulcer disease is a mucosal defect in the stomach or small intestine. What symptoms arer associated with this condition? What symptoms would be cause for alarm?
Typical symptoms: epigastric pain with gnawing, dull, or "hunger like" sensation Alarm symptoms: possibly indicate a bleed and include melena (black, tarry stool), hematemesis (vomiting blood), guaiac-positive stool (blood in stool but not visible), anemia.
245
True or false: achalasia is mostly idiopathic, though 2-5% of cases are familial with autosomal dominant mode of inheritance.
False; most cases are indeed idiopathic; but in the 2-5%, the mode of inheritance is autosomal recessive.
246
How would you treat a patient with HEV?
Supportive care, since HEV is self-limiting.
247
Three types of laboratory tests were discussed in class for diagnosis of chlamydia. Which is used for detecting ocular infection? Briefly describe this test.
Direct fluorescent antibody (DFA): take a sample from the patient, add fluorescein-tagged antibodies from the lab, and see if there is fluorescence.Warning: if you're planning on doing this test on a patient, don't do it right after putting fluorescein in their eye.
248
In which portion of the small intestine does protein digestion and absorption occur?
Jejunum
249
Comparing Crohn's Disease and Ulcerative Colitis, which does not include the ileum?
Ulcerative Colitis
250
If you performed a lumbar puncture on a patient with bacterial meningitis, what might you find?
Elevated opening pressure, elevated WBCs
251
True or false: both CJD and vCJD commonly have a periodic sharp wave complex (PSWC) on an EEG
False; CJD does indeed have this finding, but in vCJD, it is rare and occurs later in the disease.
252
True or false: the unilateral weakness of hemiplegic migraines can switch sides during an attack.
True.
253
Define: expiratory reserve volume
The extra volume of air that can be forcefully expelled from the lungs
254
Syphilis incidence peaked in 1946, then had a huge decrease by 1956 due to what treatment?
Penicillin
255
True or false: in Hepatitis B, the incidence of chronic infections increases with age.
False; it decreases with age (from 90% neonatal to less than 1% in adults)
256
What percent of patients with generalized MG have autoantibodies against the acetylcholine receptor?
80-90%
257
What drugs are antiplatelets that can be used for reducing risk of a stroke?
Aspirin, aggrenox, clopidogrel, ticlopidine
258
In late neurosyphilis, symptoms can be motor-based or sensory-based. Which motor symptoms are possible?
Acronym PARESISPersonality disturbancesAffect abnormalitiesReflex hyperactivityEye abnormalitySensorium changesIntellectual impairmentSlurred speech
259
True or false: in Lewy Body dementia, memory is affected sooner than in Alzheimer's.
False; it is affected later.
260
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What ESR level may indicate GCA? How would you calculate ESR for a patient?
ESR over 50 mm/h may indicate GCA; for males, ESR = (age in years)/2; for females it's (age in years+10)/2
261
True or false: the most common symptoms of dependence in the use of cannabis are withdrawal, tolerance, continued use despite health problems, and lots of time spent obtaining or recovering from the effects of cannabis.
True.
262
Test is the definitive diagnosis for cirrhosis?
Liver biopsy
263
There are different types of delusional disorder. Briefly describe the somatic subtype.
Belief that something is wrong with their body in some way (parasites in body, bugs on skin)
264
What do you do if your patient experiences a stroke?
Call 911 and mark the time the stroke started. A tissue plasminogen activator should be administered within no more than 4.5 hours (but only for an ischemic stroke).
265
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What joint manifestations are there?
Ankylosing spondylitis and peripheral arthritis
266
True or false: some patients with IBS have en exaggerated colon motility response to meal ingestion.
True.
267
True or false: HDV requires co-infection with HBV for replication.
True.
268
If a patient experiences syncope, what would be a few reasons to call 911?
Irregular heartbeat, chest pain or SOB, more than one episode a month, no response to ammonia inhalant, or if the fainting occurred due to head turning.
269
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do surface mucus cells secrete?
Mucus and bicarbonate
270
90-100% of heavy drinkers have hepative steatosis, which is accumulation of ________ in the liver.
Fat.
271
What effect does the parasympathetic nervous system have on the lungs?
Bronchial smooth muscle constriction and stimulation of mucous glands.
272
Comparing Crohn's Disease and Ulcerative Colitis, in which is GI bleeding more prominent?
Ulcerative Colitis
273
What can cause false positives in serological testing for toxoplasmosis? False negatives?
False positives: RF/ANAFalse negatives: decreased immune response
274
Is there a vaccine for Hepatitis D?
No, but the Hepatitis B vaccine helps protect against HDV
275
What factors are important to good lung function?
Good blood flow, good ventilation, high lung surface area, and a match between where the air is in the lungs and which capillaries are carrying the blood.
276
What do you do if your patient has some of the symptoms of hypoglycemia?
Ask if they skipped a meal and do glucometry. Give them some juice or soda, or a lollipop. If they're unconscious, call 911 and apply something sugary (syrup, honey) to the oral mucosa.
277
___________ is when gallstones are lodged in the common bile duct and can be imaged with intraoperative cholangiography.
Choledocholithiasis.
278
The three types of clinical syndromes caused by chlamydia trachomatis are local, complications and sequelae. What are the findings of complications for men, women, and children?
Men: reactive arthritis, epididymitisWomen: endometritis, salpingitis, perihepatitis, reactive arthritisChildren: chronic lung disease
279
If untreated, secondary syphilis lasts for about 4-8 weeks before the patient becomes symptom-free and enters the latent period, which consists of an early period and a late period. Classify each of the following bullet points as "early" or "late" according to which portion of the latent period it pertains to.-Patient still sexually infectious-Organism can be passed by mother to fetus-Within one year of infection (or relapse)-Not considered sexually infectious-Relapse is rare-More than one year after infection (or relapse)-25% of these patients relapse to secondary
-Patient still sexually infectious: early-Organism can be passed by mother to fetus: early AND late-Within one year of infection (or relapse): early-Not considered sexually infectious: late-Relapse is rare: late-More than one year after infection (or rela
280
STDs are a major cause of infertility in women in the US. Which STD discussed in class is the main concern for female infertility?
Chlamydia.
281
What is the drug of choice for chorea in Huntington's disease?
Tetrabenzaine
282
There are a few different treatments for active TB. Which one was discussed in class?
INH + rifampin + pyrazinamide + ethambutol + pyridoxine qd for 8 weeks, followed by INH + rifampin + pyridoxine 2x per week for another 18 weeks with direct observation therapy.
283
Weight loss is one of the main treatment options for IIH. What pharmacologic options are available?
Carbonic anhydrase inhibitor (acetazolamide), topiramate (also used for epilepsy and associated with a myopic shift and angle closure), furosemide or methazolamide (diuretics)
284
Comparing tension headaches to migraines, which is not typically associated with nausea or vomiting?
Tension
285
Syphilis can cause stillbirth or miscarriage. What are the chances of syphilis transmitting to the fetus if the mother is in the primary or secondary stage? Early latent? Late latent?
Primary/secondary: 100%Early latent: 40%Late latent: 10%
286
What is the most common cause of the release of proteolytic enzymes in emphysema?
Cigarette smoke.
287
What types of pharmaceutical agents can be used to try and treat achalasia?
Sublingual nitroglycerin, calcium channel blockers, phosphodiesterase inhibitors, and anticholinergics.
288
What are the two common symptoms of lung disease?
Dyspnea (SOB) and chronic cough (phlegm and blood)
289
Which of the depressive disorders is more common in males? In females?
Males: disruptive mood dysregulation disorder. Females: major depressive disorder
290
During alcohol withdrawal, many symptoms can occur (anxiety, irritability, insomnia, tremor, tachycardia, hypertension, hyperthermia, N&V, seizures, hallucinations, etc). What type of medication can reduce the tachycardia and hypertension?
Beta blocker.
291
What are the disadvantages of non-treponemal serological testing for syphilis?
Possibly insensitive in very early or very late stages, must be followed by treponemal testing due to non-specificity, false negatives if testing too soon (not enough reagin) or if very high reagin levels (too many antibodies and they may clump up and not respond to the test very well)
292
Late manifestations of WNV occur months to more than a year after the diagnosis of WNV. What percentage of patients infected with WNV will develop late manifestations? List some of the manifestations.
About 50%; symptoms include fatigue/malaise/weakness (in 49% of these patients), memory problems, HA, depression (in 24%), and new tremor (in 20%).
293
Is there a vaccine for Hepatitis C?
No
294
What percentage of patients with Hepatitis D have a Hepatitis B superinfection?
More than 90%
295
Which blood gas can be used to determine if a respiratory acidosis is acute or chronic?
Bicarbonate: in an acute problem, it will be high. In a chronic problem, it will be normal or near normal.
296
What is the typical transmission of Hepatitis C?
Percutaneous (especially drug use)
297
Name both the spirochete which causes Lyme disease, as well as the organism that is its vector.
Borrelia burgdorferi is the spirochete, and the black legged tick (ixodes scapularis; in the east) and deer tick (ixodes pacificus; in the west) are the vector.
298
Give a one-sentence description of a myoclonic seizure.
Sudden, brief muscle contractions lasting 1-2 seconds, without impaired consciousness.
299
Which drug for migraines is preferred for anti-emesis?
Metoclopramide*
