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Step 2/Level 2 > Misc COMLEX > Flashcards

Misc COMLEX Flashcards

1
Q

Treatment for Toxoplasma gondii?

A

pyrimethamine and sulfadiazine

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2
Q

Tx of achilles tendon rupture?

A

Long-leg cast with plantar flexion x 6 weeks

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3
Q

ECG changes with hypomagnesemia?

A

U wave, prolonged QT –> torsades

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4
Q

Most common ECG finding in PE?

A

Sinus Tach (S1Q3T3 is specific but ONLY seen in massive PEs)

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5
Q

What is Scheuermann disease?

A

rigid thoracic kyphosis, vertebral wedging and degenerative endplates.

  • tx: bracing in pre-mature skeletal bones
  • OMT and PE in mature
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6
Q

What are the salter harris classifications?

A

S: slipped (type I) (through the cartilage of the physis)
A: above physis (type II)
L: lower physis (type III)
T: through or transverse or together (above and below) (type IV)
R: ruined or rammed (type V)

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7
Q

Tx of tinea versicolor?

A

Ketaconazole 2% cream or selenium sulfide 2.5% shampoo

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8
Q

First line tx of cocaine induced CP?

A

Benzo (Do NOT give beta blockers!)

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9
Q

LUQ pain and referred left shoulder pain? Cause?

A
  • Kehr sign

- Splenic rupture

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10
Q

What is considered a positive TB test in patients who have AIDS, abnormal chest x-ray findings, have been in close contact with someone with active TB or immunosuppressed?

A

induration >5mm

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11
Q

What is considered a positive TB test in a patient that is a IVDA, nursing home resident, prisoner, homeless, health care provider?

A

> 10mm

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12
Q

When does primary CNS lymphoma occur in AIDS patients?

A

CD4

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13
Q

Vitamin D deficiency that leads to defective bone mineralization and calcification of osteoid? (Pseudo fractures on x-rays)

A

Osteomalacia

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14
Q

What is the target INR in a patient on warfarin for PE prophylaxis after a total hip replacement?

A

2-3

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15
Q

Treatment for conjunctivitis in a neonate 5-14 days old?

A

Oral erythromycin (likely chlamydia)

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16
Q

Neonate 2-5 days old with mucopurulent discharge and eyelid swelling? Tx?

A

Gonococcal.

IV or IM ceftriaxone or cefotaxime

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17
Q

Difference between TEN and SJS?

A

SJS is 30% of the body

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18
Q

Common cause of constrictive pericarditis outside of the US?

A

TB!

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19
Q

What is the female athlete triad?

A

disordered eating, amenorrhea and low bone density (osteopenia/osteoporosis)
-problem: misperception of body image

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20
Q

Transient, monocular loss of vision lasting a few minutes followed by a complete recovery? Next test?

A
  • amaurosis fugax

- duplex US of carotids (normally results from a retinal emboli dislodged from the carotid A)

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21
Q

Best test to confirm ascending cholangitis?

A

ERCP

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22
Q

Gene mutation associated with Rett Syndrome?

A

MeCP2

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23
Q

What diagnosis is commonly found with hypospadias?

A

Chordee (a ventral curvature of the penis).

-Also commonly seen with cryptorchidism and inguinal hernias

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24
Q

What is commonly found with epispadias?

A

bladder exstrophy

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25
Q

Attachments of the dura mater?

A

cranium, foramen magnum, C2, C3, S2

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26
Q

Smooth, polylobulated breast mass that rapidly expands? Tx?

A

phyllodes tumor

-Wide local excision (whether it is benign or malignant)

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27
Q

What should be suspected in a patient that presents with liver failure without an obvious cause?

A

Budd-chiari syndrome

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28
Q

When the cranial bones move into external rotation and flexion, which way does the sacrum move?

A

counternutation

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29
Q

What do these radiographic findings indicate: pneumobilia, radio-opaque mass in the bowel and dilated bowel loops proximal to the bowel?

A

gallstone ileus

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30
Q

What is the most concerning lab result in an asthma exacerbation patient?

A

Normal or elevated pCO2 on ABG in the setting of increased work of breathing = cannot maintain adequate ventilation

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31
Q

Pathological finding in either type of IBD?

A

Neutrophilic cryptitis

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32
Q

What are the recommended vaccines for asplenic adults?

A
  • Sequential PCV13 and PCV23 (and PPSV23 5 years later and at age 65)
  • HiB x1
  • Meningococcal q5years
  • Influenza annually
  • HAV
  • HBV
  • Tdap then Td q10 years

should be given 14 days before or after surgery!

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33
Q

Hemolytic anemia and thrombocytopenia?

A

Suspect TTP (thrombotic thrombocytopenia purpura)

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34
Q

Acute thyrotoxicosis with mild thyroid gland enlargement (nontender) and suppressed TSH with decreased radioiodine uptake?

A

Painless thyroiditis (silent thyroiditis)

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35
Q

Bilateral hip, thigh and buttock claudication, impotence and symmetric atrophy of the bilateral LE due to chronic ischemia?

A

-Leriche syndrome (aortoiliac occlusion)

36
Q

What is cryoprecipitate? When is it used?

A
  • contains factor VIII, fibrinogen, vWF, factor XIII

- can be used when FFP is needed but the patient is volume overloaded or if the fibrinogen is low (DIC)

37
Q

Treatment of gallstone ileus?

A

Surgical laparotomy and enterolithotomy

38
Q

What is the most SENSITIVE test for carpal tunnel?

39
Q

Best test for suspected gastroparesis?

A

Gastic scintography (measures gastric emptying)

40
Q

Medication for gastroparesis?

A

Erythromycin or metoclopromide

41
Q

Newborn cyanotic worse when feeding, better with crying?

A

Choanal atresia

42
Q

Tx of Lyme in a kiddo

A

Amoxicillin or Cefuroxime

43
Q

how do you diagnose disseminative histoplasmosis?

A

-Serum or urine antigen test

44
Q

Tx of histoplasmosis?

A

Itraconazole (better than fluconazole)

45
Q

What medications should be held for 48 hours prior to stress test?

A

Beta blocker, CCB, nitrates

46
Q

SE of methotrexate?

A

hepatotoxicity. Monster LFTs q3 months

47
Q

Causes of primary adrenal insufficiency?

A

TB, fungal infections, CMV

48
Q

Neonate (

A

Midgut volvulus

-upper GI contrast study

49
Q

Initial treatment of choice for SIADH?

A

fluid restriction

50
Q

What are the components of a biophysical profile?

A

2 points for normal. 0 points for abnormal

  1. 30 seconds of breathing
  2. 3 body/limb movements
  3. fetal tone (1 episode of extension –> flexion or opening –> closing of the hand)
  4. reactive NST
  5. Amniotic fluid volume (one pocket >2cm)
51
Q

What is Light’s criteria for an exudate?

A
  • Fluid LDH/serum LDH >0.6
  • fluid LDH >2/3 the upper limit of normal
  • Fluid protein/serum protein >0.5
52
Q

Initial test in acromegaly?

A

IGF-1.

-then you can do a glucose suppression test.

53
Q

Which medication is used in post-herpetic neuralgia?

A

Nortriptyline

2nd line=pregabalin

54
Q

What is a normal cranial rhythmic impulse (CRI)?

A

10-14 cycles/minute

55
Q

Which medication is used for long-term remission in Crohn’s?

A

Immunomodulators such a azathioprine and TNF-alpha inhibitors

56
Q

How do you definitively diagnose cor pulmonale?

A

Right heart cath showing elevated pulmonary artery systolic pressure >25mmHg

57
Q

Definition of fulminant hepatic failure? Tx?

A
  • hepatic encephalopathy within 8 weeks of the onset of acute liver failure
  • TRANSPLANT!
58
Q

Ovarian mass with thick separations, solid components and peritoneal fluid?

A

Epithelial ovarian cancer

59
Q

Tx of impetigo?

A
  • if limited skin involvement=topical antibiotics (mupirocin)
  • If extensive skin involvement=oral ABX (cefalexin, dicloxacillin, Clinda)
60
Q

Tx of a duodenal hematoma 2/2 abdominal trauma?

A

-NG tube and parental nutrition x 1-2 weeks until the hematoma resolves

61
Q

Pure sensory deficit from a stroke where?

A

Lacunar stroke of the thalamus

-Posterior cerebral artery

62
Q

Preferred treatment for major depression in elderly who are not eating, drinking, are psychotic or actively suicidal?

63
Q

What is associated with angiodysplasia? What is this called?

A
  • aortic stenosis

- Heyde’s Syndrome

64
Q

Goal for pre-prandial glucose? Post-prandial?

A
  • Pre-prandial: 90-139

- post-prandial:

65
Q

Most common long term sequelae of bacterial meningitis?

A

-CN VIII deficits–> hearing loss

66
Q

What is the most sensitive and specific test for ocular myasthenia gravis?

A

-single fiber EMG (ACh R Ab are only positive in 40-50% of cases)

67
Q

Which androgen is produced by the adrenals?

68
Q

How can multiple myeloma cause hypokalemia?

A
  • MM cause type II Renal tubule acidosis (decreased reabsorption of bicarbonate by the proximal tubule)
  • -> causes increase in sodium to the tubule –> increased aldosterone –> increased K+ excretion
69
Q

1st line treatment of hyperemesis gravid arum?

A

Doxylamine/pyridoxine

H1 blocker and Vit B6

70
Q

Most sensitive test for duchenne muscular dystrophy? (if normal, it can be ruled out)

71
Q

What dietary changes can help decrease the incidence of gout?

A

-increase the consumption of low-fat diary products

72
Q

Tx of delirium?

A

Antipsychotics (Haldol)

73
Q

Most common bug in erysipelas?

A

S. pyogenies (gram + cocci in chains)

74
Q

Which allele has an increased risk of developing Alzheimer’s?

A

Apolipoprotein E4

75
Q

Name for an osteochondral defect of the second metatarsal head?

A

Freiberg’s infraction

76
Q

What patient populations should get acyclovir for treatment of chickenpox?

A
  • > 12yo
  • history of chronic cutaneous or cardiopulmonary disorders
  • taking intermittent oral or inhaled steroids
  • taking chronic salicylates
77
Q

How is chicken pox transmitted? Shingles?

A
  • Chickenpox: aerosolized (coughing, sneezing, etc)

- Shingles: contact with open lesions

78
Q

Appendix chapman points?

A
  • anterior=tip of right 12th rib

- posterior=tip of Transverse process of T11

79
Q

Posterior chapman point for adrenals?

A

between spinous process and transverse process at T11-T12

80
Q

Posterior chapman point for kidneys?

A

between spinous process and transverse process at T12-L1

81
Q

Medication to reduce morbidity and mortality in all ACS?

82
Q

Next step if atypical glandular cells found on cervical cytology in a woman >35 yo?

A

Colposcopy and endometrial biopsy (cells come from either endocervix or endometrium)

*If

83
Q

If someone has a sulfa allergy, which medication would cover PCP and toxoplasmosis PPX in an AIDS patient?

84
Q

Treatment of choice for disseminated Lyme with neurological sequela?

A

Ceftriaxone 2g IV x 14 days

-if only facial nerve palsy and no abnormal CSF, can you PO Doxycycline

85
Q

Most accurate test for ZES?

A

secretin stimulation test

86
Q

RA, splenomegaly and granulocytopenia?

A

Felty’s syndrome

87
Q

Highest risk factor for strokes?

Step 2/Level 2 (18 decks)

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