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Dedicated - Step 2 > Last Minute 2 > Flashcards

Last Minute 2 Flashcards

1
Q

Posterior hip dislocation vs Anterior hip dislocation vs. Hip fracture

A

Posterior: shortened, internally rotated
Anterior: lengthened, externally rotated
Fracture: shortened, externally rotated

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2
Q

Rx acute Meniere disease? Ongoing Rx?

A

Benzos, anticholinergics (scopolamine) and antihistamines (meclizine or dimenhydrinate)

Diuretics for ongoing

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3
Q

Cholinergic crisis?

A

SLUDG - excessive salivation, lacrimation, urination, defecation, GI activity, pinpoint pupils, decreased HR

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4
Q

Anticholinergic crisis?

A 
Blind as a bat
Hot as a hare
Mad as a hatter
Dry as a bone
Red as a beet
Dilated pupils
Increased HR
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5
Q

Sympathomimetics?

A 
HTN
Tachycardia
Anxiety
Dilated pupils
Diaphoresis
Possible AMS
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6
Q

Diagnose Cushing syndrome.

A
  1. 24-hour measurement of free urine cortisol (abnormally elevated) OR dexamethasone suppression test (cortisol not appropriately suppressed)
  2. ACTH (elevated in Cushing disease, decreased with adrenal adenoma)
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7
Q

Diagnose hypoadrenalism (Addison disease).

A
  1. ACTH stimulation test -> measure plasma cortisol, give ACTH, remeasure cortisol in 1 hour (should rise appropriately)
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8
Q

Dx central vs. nephrogenic DI

A

Give ADH and measure urine Osms

Central - UOsm increases

Nephrogenic - UOsm remains inappropriately dilute

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9
Q

Main cause of duodenal vs. gastric ulcer?

A

Duodenal - H. pylori

Gastric - NSAIDs

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10
Q

Ulcer that gets better with eating vs. worse?

A

Duodenal gets better with eating

Gastric gets worse or no change

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11
Q

Gold standard diagnostic study for PUD? Cheaper/less invasive?

A

Gold standard - endoscopy (if done, biopsy required for gastric ulcer)
Cheaper/less invasive - upper GI barium study

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12
Q

Best first imaging study for suspected gallbladder disease? Next step if uncertain?

A

U/A; HIDA

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13
Q

Remember that ___ can cause increased amylase and lipase levels.

A

Perforated bowel

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14
Q

Management of suspected cardiac tamponade?

A

If stable - echo first

If unstable - pericardiocentesis

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15
Q

Most common cause of immediate death after an automobile accident or a fall from a great height?

A

Aortic rupture

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16
Q

What are the 3 zones of the neck?

A

I - base of the neck from 2 cm above the clavicles to the level of the clavicles

II - midcervical region from 2 cm above the clavicle to the angle of the mandible

III - top of the neck fro m the angle of the mandible to the base of the skull

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17
Q

Management of Zone I and III injuries?

A

Arteriogram before OR UNLESS obvious bleeding or rapidly expanding hematoma

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18
Q

Management of Zone II injury?

A

OR right away

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19
Q

Buccal smear with absent Barr bodies

A

Turner syndrome

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20
Q

Work-up for secondary amenorrhea?

A
  1. R/o pregnancy
  2. Progesterone challenge (if normal, indicates sufficient estrogen)
  3. LH level (if high -> PCOS?) FSH level (if estrogen insufficient; if high -> premature ovarian failure, if normal -> MRI brain)
  4. Prl and TSH
  5. GnRH levels
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21
Q

Teardrop-shaped RBCs

A

Myelofibrosis

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22
Q

Acanthocytes (irregularly spiculated cells) and spur cells

A

Abetalipoproteinemia

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23
Q

Target cells

A

Thalassemia (Hgb C disease)

Liver disease

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24
Q

Echinocytes (burr cells)

A

Uremia

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25
Q

Classic cause of microcytic anemia with normal or elevated reticulocyte count?

A

Thalassemia/hemoglobinopathy (SCD)

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26
Q

4 causes of microcytic anemia with low reticulocyte count?

A

Iron deficiency
Lead poisoning
Sideroblastic anemia
Anemia of chronic disease )some)

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27
Q

3 causes of normocytic anemia with normal or elevated reticulocyte count?

A

Acute blood loss
Hemolytic
Medications

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28
Q

5 causes of normocytic anemia with low reticulocyte count?

A 
Cancer/dysplasia
Anemia of chronic disease (some cases)
Aplastic anemia/BM suppressing medications
Endocrine failure (thyroid, pituitary)
Renal failure
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29
Q

Rx thalassemia

A

Transfusions as needed

Iron chelation therapy to prevent secondary hemochromatosis

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30
Q

Dx G6P deficiency?

A

RBC enzyme assay (do not do immediately after hemolysis -> false negative possible)

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31
Q

Transfuse whole blood?

A

Rapid, massive blood loss or exchange transfusions (poisoning, TTP)

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32
Q

Packed RBCs?

A

Routine transfusions

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33
Q

Washed RBCs?

A

Free of traces of plasma, white cells, and platelets; good in IgA deficiency and for allergic/previously sensitized patients

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34
Q

Platelets?

A

Symptomatic thrombocytopenia (usually <10,000)

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35
Q

FFP?

A

Contains all clotting factors; used for bleeding diatheses when vitamin K will take too long or when it won’t work (liver failure)

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36
Q

Crytoprecipitate?

A

Contains fibrinogen and factor 8; use in hemophilia, VW disease, and DIC

37
Q

Genetic causes of clotting?

A

Factor V Leiden mutation (aka activated protein C resistance)
Prothrombin G20210A mutation
Hyperhomocysteinemia
Elevated factor 8
Protein C, protein S, or antithrombin III deficiencies

38
Q

Rx TTP?

A

Plasmapheresis; DO NOT GIVE PLATELETS

39
Q

List the 4 classic types of hypersensitivity reactions.

A
  1. Anaphylactic
  2. Cytotoxic (pre-formed IgG and IgM Ab that react with an antigen)
  3. Immune complex-mediated
  4. Cell-mediated/delayed
40
Q

What medication should be avoided in patients with nasal polyps?

A

Aspirin (can precipitate a severe asthma attack)

41
Q

AR disorder characterized by giant granules in neutrophils, infections, and often oculoncutaneous albinism; cause?

A

Chediak-Higashi; microtubule polymerization

42
Q

Recurrent infection with catalase-positive organisms; deficient nitroblue tetrazolium dye reduction by granulocytes

A

CGD

43
Q

Other medications used for PCP PPx when the patient is allergic to TMP-SMX?

A

Dapsone
Aerosolized pentamidine
Atovaquone

44
Q

MAC PPx?

A

Clarithromycin or azithromcyin; rifabutin is an alternative

45
Q

The risk of what type of blood cell cancer is increased in HIV?

A

Non-Hodgkin lymphoma

46
Q

Positive India ink?

A

Cryptococcus neoformans

47
Q

Main organism + empiric Rx - UTI

A

E. coli

TMP-SMX, nitrofurantoin, amoxicillin, FQs

48
Q

Main organism + empiric Rx - Bronchitis

A

Virus, H. influenzae, Moraxella

Usually no ABX benefit; consider macrolides or doxycycline

49
Q

Main organism + empiric Rx - pneumonia (classic)

A

S. pneumoniae, H. influenzae

3rd generation cephalosporin, azithromycin

50
Q

Main organism + empiric Rx - pneumonia (atypical)

A

Mycoplasma, Chlamydia spp.

Macrolide, doxycycline

51
Q

Main organism + empiric Rx - ostemyelitis

A

S. aureus, Salmonella

Oxacillin, cefazolin, vancomycin

52
Q

Main organism + empiric Rx - cellulitis

A

Strep, staph

Cephalexin or dicloxacillin
TMP-SMX, doxy, or clinda often used because of MRSA

53
Q

Main organism + empiric Rx - meningitis (neonate)

A

GBS, E. coli, Listeria

Ampicillin + AG (gentamicin) +/- cefotaxime (3rd gen ceph) if GN organism is suspected

54
Q

Main organism + empiric Rx - meningitis (child/adult)

A

S. pneumoniae, N. meningitidis

Cefotaxmie or ceftriaxone + vancomycin

55
Q

Main organism + empiric Rx - endocarditis (native valve)

A

Staph and Strep

Oxacillin, nafcillin, vancomycin if allergic to penicillin + AG

56
Q

Main organism + empiric Rx - endocarditis (prosthetic valve)

A

Numerous

Vanc + gent + cefepime or carbapenem

57
Q

Main organism + empiric Rx - sepsis

A

GN, strep, staph

3rd generation pencillin/cephalosporin + AG
or
Imipenem

58
Q

Main organism + empiric Rx - septic arthritis

A

S. aureus (Vanc)
GN bacilli (ceftazidime or cefriaxone)
Gonococci (ceftriaxone, cipro)

59
Q

Empiric ABX of choice + other choices - Strep A or B

A

Penicillin, cefazolin

Erythromycin

60
Q

Empiric ABX of choice + other choices - S. pneumoniae

A

3rd generation cephalosporin + vancomycin

FQ

61
Q

Empiric ABX of choice + other choices - enterococcus

A

Penicillin or ampicillin + AG

Vanc + AG

62
Q

Empiric ABX of choice + other choices - S. aureus

A

Methicillin, etc.

Vanc, TMP-SMX, doxy, clinda, linezolid (MRSA)

63
Q

Empiric ABX of choice + other choices - gonococcus

A

Ceftriaxone

Cefixime or high-dose azithro followed by test of cure in 1 week

64
Q

Empiric ABX of choice + other choices - meningococcus

A

Cefotaxime or ceftriaxone

Chloramphenicol or penicillin G if proven to be penicillin susceptible

65
Q

Empiric ABX of choice + other choices - Haemophilus

A

2nd or 3rd generation cephalosporin

Amoxicillin

66
Q

Empiric ABX of choice + other choices - Pseudomonas

A

Anti-pseudomonal pencillin (ticarcillin, piperacillin) +/- beta lactamase inhibitor (clavulanate, tazobactam)

Ceftazidime, cefepime, atrezonam, imipenem, cipro

67
Q

Empiric ABX of choice + other choices - Bacteroides

A

Metronidazole

Clinda

68
Q

Empiric ABX of choice + other choices - Mycoplasma

A

Erythro, azithro

Doxy

69
Q

Empiric ABX of choice + other choices - T. pallidum

A

Penicillin

Doxycycline

70
Q

Empiric ABX of choice + other choices - chlamydia

A

Doxy, azithro

Erythro, ofloxacin

71
Q

Empiric ABX of choice + other choices - Lyme

A

Cefuroxime, doxy, amox

Erythro

72
Q

Positive cold-agglutinin antibody titers in the setting of URI symptoms?

A

Mycoplasma pneumonia

73
Q

Mycoplasma vs. chlamydial pneumonia

A

Chlamydial has negative cold-agglutinin Ab titers

74
Q

Rx neurocysticercosis?

A

Albendazole or

praziquantel

75
Q

Rx Legionella

A

Azithro or levo

76
Q

How do you recognize rubella in children?

A

Milder than measles
Low-grade fever, malaise, tender swelling of the suboccipital and postauritcular nodes
Arthrlagias
After a 2-3 day prodrome, faint maculopapuler rash appears on fash and neck, spreads to trunk

77
Q

Rx RMSF (2/2 Rickettsia ricketsii)

A

Doxy

Chloramphenicol is a second choice

78
Q

Non-tender erythematous lesions on plasma and soles?

A

Janeway lesions

Endocarditis -> infectious symptoms, new-onset heart murmur, embolic phenomena, Osler nodes, Roth spots, septic shock

79
Q

Which types of bacterial meningitis require ABX prophylaxis in contacts?

A

N. meningitidis (rifampin, cipro, ceftriaxone, or azithro) and H. influenzae (rifampin)

80
Q

Rx diphtheria?

A

Antitoxin and either penicillin or erythro

81
Q

Rx pertussis?

A

Azithro or erythro

82
Q

TB Rx - exposed adult with negative PPD skin test

A

None

83
Q

TB Rx - exposed child < 5 y/o with negative PPD

A

INH for 3 months, then repeat PPD

84
Q

Prophylaxis for PPD conversion (negative to positive) with no active disease

A

INH for 9 months

85
Q

Distinguish between HUS and HSP in children.

A

HUS: preceding diarrhea, low RBC and platelet counts, hemolysis

HSP: preceding URI, normal RBC and platelet counts, may have rash, abdominal pain, arthritis, melena

86
Q

When are steroids given in GBS?

A

NEVER

87
Q

What causes an EMG study with no muscle activity at rest and decreased amplitude of muscle contraction upon stimulation?

A

Intrinsic muscle disease such as muscular dystrophies or inflammatory myopathies

88
Q

L upper quadrant anopsia?

A

R optic radiations in R temporal lobe

89
Q

L lower upper quadrant anopsia?

A

R optic radiations from parietal lobe

Dedicated - Step 2 (22 decks)

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