Random Flashcards
1
Q
Major side effect of minoxidil
A
Hypertrichosis (you hairy)
2
Q
Paired cranial bones
A
Frontal, temporal, parietal
3
Q
Midline cranial bones
A
Sphenoid, occiput, ethmoid, vomer
4
Q
Sinusoidal pattern on fetal heart tracing means what and how do you treat it?
A
Fetal anemia and compromise, and you treat with emergent c-section
5
Q
Antibody associated with primary biliary cirrhosis
A
Anti-mitochondrial antibodies
6
Q
Antibody associated primary sclerosing cholangitis
A
perinuclear antineutrophilic cytoplasmic antibodies (p-ANCA)
7
Q
What fasting LDL would you consider going straight to statin therapy instead of lifestyle modifications?
A
> 190
8
Q
Inheritance of otosclerosis
A
AD
9
Q
Difference between spinal shock and neurogenic shock
A
Spinal shock is a temporary “stunning” of the spinal cord above T6 that causes hypotension, bradycardia, etc due to loss of sympathetic innervation (often due to trauma). Neurogenic shock is permanent damage above T6. Can be differentiated by the bulbocavernosus reflex
10
Q
Counterstrain for ribs 3-6
A
Slight flexion, sidebend and rotate towards point
11
Q
Dose of folate for a pregnant woman with a history of neural tube defects
A
4mg a day (0.4 mg is ok for women without a history of NTD)
12
Q
What do ulcers in CMV esophagitis look like on endoscopy
A
Linear, shallow
13
Q
Infectious mononucleosis + amoxicillin leads to what?
A
Rash
14
Q
What can you use to test for semen in the case of sexual assault
A
Wood’s lamp
15
Q
Treatment of choice for hairy cell leukemia
A
Nucleoside analogs
16
Q
All-trans retinoic acid is used to treat what malignancy?
A
Acute promyelocytic leukemia (APL)
17
Q
Imatinib (gleevec) is best used to treat what?
A
CML (it’s a Philadelphia chromosome inhibitor)
18
Q
Apgar categories
A
Appearance, pulse, grimace, activity, and respirations
19
Q
Antidote for benzodiazepine overdose
A
IV flumazenil; competitive inhibitor of GABA receptors
20
Q
Antidote for ethylene glycol ingestion
A
IV fomepizole or alcohol
21
Q
Earliest EKG sign of hyperkalemia
A
Peaked T-waves
22
Q
EKG changes when serum K is >6.5
A
P wave widens and flattens, PR interval lengthens, eventually P waves disappear
23
Q
EKG changes when serum K>7
A
Prolonged QRS interval with bizarre QRS morphology, high-grade AV block with slow junctional and ventricular escape rhythms, any kind of conduction block sinus bradycardia or slow AF, SINE WAVE rhythm (pre-terminal rhythm)
24
Q
EKG changes when K >9
A
CARDIAC ARREST due to asystole, vfib or PEA with weird QRS morphology
25
Hypomagnesemia findings
Tremor, tetany, EKG changes (U wave, QT prolongation leading to torsades, ST segment depression
26
During labor, how often should you monitor fetal heart rate in a patient WITHOUT complications
Every 30 minutes for stage 1, then every 15 for stage 2
27
During labor, how often should you monitor fetal heart rate in a patient WITH complications
Every 15 minutes for stage 1, then every 5 minutes during stage 2
28
Goal for preprandial glucose in type-1 diabetics
90-130
29
Goal for postprandial glucose in type-1 diabetics
Less than 180
30
Blowing diastolic murmur at left sternal border with or without mid-diastolic rumble (Austin-Flint murmur)
Aortic regurgitation
31
Name some drugs contraindicated in pregnancy
Valproic acid, ACEi, alcohol, androgens, carbamezepine, cocaine, DES, lead, lithium, methotrexate, organic mercury, aminoglycosides, tetracycline, phenytoin, warfarin (I know that lead probably isn't ever really indicated, but this was in a explanation from Combank)
32
Describe the stages of decubitis ulcers
Stage 1: no ulcer, just erythema, Stage 2: ulceration through dermis or fluid filled blister, Stage 3: ulceration into subcutaneous fat, but no muscle, bone, tendon visible, Stage 4: full thickness ulceration exposing muscle, bone, or tendon.
33
Most common complication of interscalene nerve block?
Phrenic nerve block (runs down the anterior scale muscle)
34
First, second, third line agents in status epilepticus
Benzo's first (lorazepem, midazolam), then anti-epileptic (phenytoin or fosphenytoin), then anesthesia (usually propofol)
35
Rare demyelinating disease associated with natalizumab
Progessive multifocal leukoencephalopathy (due to reactivation of JC polyoma virus)
36
Prenatal labs to get at first prenatal visit
CBC, Abo and Rh status, hepatitis B, syphillis, chlamydia, gonorrhea, HIV, urinalysis
37
Prenatal care at 24-28 weeks
Repeat Abo and Rh status, gestational diabetes screening, and hemoglobin and hct
38
Prenatal care at 28-36 weeks
Can repeat STD testing (Hep B, syphilis, chlamydia, gonorrhea, HIV), estimated fetal weight and fetal assessment in patients at risk, Group B strep testing
39
What weeks should group B strep testing be done in pregnant patients
35-37
40
Required Jones criteria for diagnosing acute rheumatic fever
1 required criteria (evidence of preceding group A strep infection) and then; 2 major, 0 minor criteria or 1 major and 2 minor criteria
Major criteria: Joints (polyarthritis), heart (carditis), nodules (subQ), erythema marginatum, sydenham's chorea
Minor criteria: Fever, elevate CRP and ESR, arthralgia, prolonged PR interval
41
anti-dsDNA antibodies are found in what disease
SLE
42
anti-Jo-1 antibodies are found in what diseases
Dermatomyositis and polymyositis
43
anti-Scl-70 or antitopoisomerase-1 antibodies are found in what disease
Scleroderma or CREST
44
anti-Ro/SSA antibodies are found in what disease
Sjogren's syndrome
45
Guidelines for screening lung cancer
>30 pack years smoking and ages 55-80 and are currently smoking or quit within the past 15 years
46
What is Felty's syndrome
Rheumatoid arthritis + splenomegaly and granulocytopenia
47
Criteria for mild pre-eclampsia
>140/90 BP + >300 mg protein in 24h urine sample
48
Criteria for severe pre-eclampsia
>160/110 bp +>300 mg protein in 24h urine
49
Microscopic path findings in Waldenstrom's macroglobulinemia
PAS stain IgM deposits around the nucleus in plasma cell
50
Organisms to consider treating in the presence of bronchiectasis
Pseudomonas, TB, haemophilus influenza, mycoplasma avium-intracellulare
51
When should you consider using benzos for treatment of delirium
Alcohol or sedative related withdrawal
52
What lab test should you order to screen for Zollinger-Ellison syndrome
Gastrin levels
53
When should you consider secretin stimulation test to diagnose Zollinger-Ellison syndrome
Equivocal gastrin levels
54
Lab tests to diagnose secondary amenorrhea
First bHCG, then thyroid studies, then prolactin
55
What do if you have a 25-29 year-old woman with low-grade squamous intraepithelial lesions
Colposcopy
56
How to manage women >30 with LSIL lesions
If HPV negative, repeat cytology/HPV testing in 1 year. If HPV +, colposcopy
57
Type of cardiomyopathy seen from alcoholism
Dilated cardiomyopathy due to thiamine deficiency (systolic heart failure)
58
Main characteristics of avoidant personality disorder
Feelings of inadequacy and hypersensitivity towards others
59
Main characteristics of social phobia
Intense fear of embarrassment or humiliation due to their actions.
60
First gen sulfonylureas (tolbutamide and chlorpropamide) may cause what type of effect when combined with alcohol?
Disulfiram-like effects
61
Lab values in primary biliary cirrhosis
Markedly elevated alkaline phosphotase and mildly elevated ALT and AST
62
Developmental milestones at age 3
Rides tricycle, copies circles, stacks 9 cubes, most of speech is intelligible, starts potty training at 3
63
Difference between complex region pain syndrome 1 and 2
2 is caused by a specific nerve lesion
64
Complex regional pain syndrome signs and symptoms
Pain, allodynia, hyperalgesia, mottled skin appearance, edema of area
65
When can kids begin toilet training and when are they usually done
Can begin at 18 months, usually done by 36-48 months
66
Treatment of choice for actinomyces israelii infections
Penicillin G
67
Tricuspid atresia is commonly due to what drug
Lithium
68
Tachypnea, cyanosis, muddy lookin blood
Methemoglobinemia
69
Some drugs that can cover spontaneous bacterial peritonitis
Gentamycin and cefotaxime
70
Should you decrease or increase steroids before a surgery in a patient chronically on steroids
Increase (stress dose); due to suppression of natural steroid production, and surgery would normally cause increased production of steroids. Therefore, you need to give more so you avoid adrenal insufficiency
71
Common compensatory pattern
OA left, cervicothoracic right, thoracolumbar, left, lumbosacral right.
72
High T4, low TSH, heterogenous uptake of radioactive iodine
Toxic multinodular goider
73
Best SCREENING test for Zollinger-Ellison and MOST ACCURATE test
Gastrin for screening, secretin stimulation test for most accurate
74
Yolk sac tumors secrete what
alpha-fetoprotein
75
Choriocarcinomas secrete what
b-HCG (b-H-Choriocarcinoma-g)
76
Leydig cell tumors cause what in guys
Feminization
77
Putz-Jagher and Carney's syndrome are associated with what sex cord tumor
Sertoli Cell tumors
78
Missed abortion
Abortion before 20 weeks with retention of fetal products
79
What should you do if you are doing pelvic surgery and want to make sure you didn't cut the ureters
Inject IV carmine indigo dye (you can see the blue dye during surgery if the ureters are damaged)
80
Disease modifying drug in dementia
Memantine: NMDA receptor antagonist reduces excitotoxicity and neuron death from excess NMDA exciatation
81
What should all women of childbearing age be taking as a supplement
Folic acid
82
Ophthalmologic findings in optic neuritis
Pale optic discs
83
Thompson test for achilles tendon rupture
Squeeze the gastroc muscle; foot should plantar flex, if it doesn't test is positive for achilles tendon rupture
84
Three most common organisms causing necrotizing fasciitis
C. perfringens, S aureus, strep pyogenes
85
What should you use for empiric treatment of necrotizing fasciitis
Clindamycin (anaerobe coverage), imipenem(imipenem, merepenem, ertapenem) or beta lactam+lactamase inhibitor (piperacillin-tazobactam, ampicillin-sulbactam, or ticarcillin-clavulanate), and something to cover MRSA (vancomycin, linezolid, daptomycin)
86
Morphology of Haemophilus influenza
Gram - Coccobacillus
87
Fiberoptic bronchoscopy can be used to biopsy what kind of lung lesions?
Centrally based lesions
88
What should you use to biopsy peripheral lung lesions
CT guided biopsy
89
Initial screening test for hyperthyroidism
TSH
90
Best preventative measure for coronary artery disease (medical)
Statins
91
Which is better, percutaneous coronary intervention or thrombolytics in MI?
PCI, do thrombolytics if PCI can't be done within 90 minutes
92
What can you do for a patient with a PE with contraindications to heparin?
Embolectomy
93
Diabetic retinopathy is strongly predicted by what?
Urinary protein and BUN/creatinine ratio
94
What personality disorder is characterized by hypersexuality, needing to be the center of attention?
Histrionic
95
Do you need to test for H. pylori infections in patients with duodenal ulcers?
Nah, just start triple (or quadruple) therapy
96
Quadruple therapy for H. pylori infections
Esomeprazole, bismuth salycilate, metronidazole, tetracycline
97
Why give zinc in Wilson's disease?
It decreases GI absorption of copper
98
Bloody diarrhea+fever+daycare=
Shigella
99
When in cranial flexion, what does the sacrum do?
Counternutation (base moves posterior)
100
Diameter changes in craniosacral flexion
AP diameter decreases, transverse diameter increases
101
When to consider revascularization therapy in PAD
When the patient gets symptoms at rest?
102
If afib has been occurring for >48 hours, what should you do?
Either anticoagulate for 3 weeks before attempting to cardiovert or do a TEE to look for an atrial thrombus. Should also anticoagulate for 4 weeks after
103
If you are cardioverting afib, should you use electrical or medical cardioversion
Depends on provider preference mostly, though drug therapy is preferred for paroxysmal afib.
104
Blood pressure finding in patients with aortic regurg
Wide pulse pressure
105
How can you tell the difference between an incarcerated and strangulated hernia based on the patient's clinical presentation?
Patients with a strangulated hernia will appear much sicker and have lactic acidosis, fever and chills, and electrolyte derangements due to necrotic bowel
106
When should P. jiroveci prophylaxis begin in AIDs patients
CD4 count less than 200
107
When should prophylaxis for Toxoplasmosis and MAC/cryptococcus/CMV (respectively) start for patients with HIV
CD4 count less than 100 and 50 respectively
108
What components make up the primary respiratory mechanism in craniosacrial motion
CNS+CSF+Dural membranes+sacrum
109
Normal cranial rhythmic impulse (CRI)
10-14 per minute
110
Things that decrease the CRI
Stress, depression, chronic fatigue or chronic infections
111
Things that increase the CRI
Exercise, fever, craniosacrial OMT
112
Keystone of craniosacrial motion
Sphenobasilar synchrondrosis
113
Motion of the paired bones in craniosacral flexion
External rotation
114
Motion of the paired bones in craniosacral extension
Internal rotation
115
Motion of sacral base in craniosacral extension
Nutation (nods forward)
116
Diameter changes in craniosacral extension
AP diameter increases, transverse diameter decreases
117
How is craniosacral torsion named
Whichever greater wing of the sphenoid is more superior
118
Axis that craniosacral torsions occur around
AP axis
119
Axes that craniosacral sidebending-rotation occurs around
One AP, two vertical parallel axes
120
Naming craniosacral sidebending-rotation
Named for side of convexity (or fullness)
121
Non-physiologic craniosacral strains
Lateral and vertical strains, SBS compression
122
Axes in craniosacral vertical strains
Two parallel transverse axes
123
Naming vertical strains
Motion of SBS
124
Finger placement in the vault hold
Index: greater wing of the sphenoid, middle finger-temporal bonde, ring finger-mastoid, little finger-squamous part of occiput
125
What kind of diuretic is contraindicated in someone with gout?
Thiazide
126
What is the only way to make a definitive diagnosis of adenomysosis?
Hysterectomy
127
How to treat papillary thyroid carcinomas?
Surgical resection followed by radioactive iodine and yearly ultrasounds to prevent recurrence
128
most common viral cause of dilated cardiomyopathy?
Parvovirus B19
129
Lab findings in Kawasaki's
Thrombocytosis, lymphocytosis, elevated CRP and ferritin, anemia, abnormal liver enzymes
130
Antibodies in bullous pemphigoid
IgG antibodies to hemidesmisomes
131
Initial treatment for bullous pemphigoid
Topical corticosteroids; can try rituximab if this fails
132
Cryoprecipitate is given to what patient population in what circumstance
Pts with von Willebrand Disease who are experience active hemorrhage; it is rich in vWf
133
What test to use to confirm cryptococcal meningitis?
Lumbar puncture
134
Treatment of epidydimitis
Ceftriaxone+doxycycline
135
Treatment of bacterial meningitis in patients >60
Vancomycin(penicillinase resistant s. pneumos), ampicillin(listeria), certriaxone (neisseria, haemophilus, s. pneumo)
136
What is Chadwick's sign?
Bluish discoloration of the cervix, early sign of pregnancy
137
Below what GFR is metformin contraindicated
Less than 30
138
Treatment of acute exacerbations of COPD
Albuterol, oral corticosteroids, antibiotics
139
How do you treat tumors within 5 cm of the anal verge?
Abdominal perineal resection with permanent colostomy
140
Type of hepatitis associated with high infant mortality
Hep E
141
Metabolic and electrolyte changes with hydrochlorothiazide use
Hypercalcemia, hyperuricemia, hyponatremia, hypokalemia, hyperlipidema
142
Rate of transmission of HIV after needle stick with needle carrying HIV + blood
0.3%
143
Contact dermatitis is what type of hypersentivity reaction
Type IV (delayed-type)
144
Type of drug contraindicated in Prinzmetal's or variant angina
Propanolol (causes unopposed alpha stimulation which can actually worsen vasoconstriction)
145
Drugs used to treat Prinzmetal's or variant angina
CCBs or nitrates
146
What antibiotic to use in hepatic encephalopathy and why
Neomycin, decreases ammonia production by bacteria in the colon
147
Breast cancer staging
Uses the TNM staging system (Tumor, node, metastasis)
T=tumor size; T0=no primary tumor, Tis=in situ, T1=2cm or less, T2=2-5cm, T3=>5cm, T4 direct extension to chest wall or skin
N=nodal involvement: N0=no nodal involvement, N1=ipsilateral axillary nodes (levels I, II), N2=ipsilateral axillary node involvement with nodes being fixed or matted, N3=beyond axillary lymph nodes
M=metastasis; no metastasis (M0) or metastasis (M1)
148
How long should you wait after continuing an MAOi to start an SSRI
14 days (want to avoid serotonin syndrome)
149
Single most specific and sensitive test for ANY form of myesthenia gravis?
Single nerve electromyography
150
Treatment for ALS and mechanism of action
Riluzole (glutamate antagonist)
151
Top 3 most common causes of fever of unknown origin
1. Infections (30-40%)
2. Neoplastic (20-30%)
3. Collagen vascular disease (10-20%)
152
Why do surgeons prefer transplanting left kidneys?
Longer vein makes it easier to surgerize
153
Structures that drain to the right lymphatic duct
Right side of head and neck, right UE, heart and lungs. All the rest of the body drains to the left thoracic duct
154
Classic EKG finding in hypothermia
Osborne (or prominent J-wave, an extra positive deflection between the end of the QRS complex and the T wave)
155
Genetic abnormality responsible for early onset Alzheimer's in down syndrome patients
Amyloid beta precursor protein
156
How long should you anticoagulate someone who has new-onset afib that has been present for >48 hours before you cardiovert
3-4 weeks
157
Most common place for prostate cancer to metastasize to
Bone
158
Migraine treatment in pregnant ladies
Acetaminophen
159
First-line agents in sleep onset insomnia
Sedative hypnotics (zolpidem, etc)
160
Where does the dural membrane attach to the sacrum
Posterior superior portion of S2
161
Most common EKG finding in hypercalcemia
Short QT interval
162
Findings on EKG with variant angina
Transient ST elevation
163
Diagnostic modality to confirm achilles tendon rupture
MRI
164
Treatment of pelvic inflammatory disease
Azithromycin and doxycycline
165
Sudden onset scrotal pain, elevation of scrotum, Absent cremaster reflex
Testicular torsion
166
Virus that causes hand foot and mouth disease
Coxsackie A virus
167
Explain Le Forte fractures I-III
Le Forte I: Horizontal maxillary fracture, separating teeth from upper face; fracture passes through alveolar ridge, lateral nose, and inferior wall of maxillary sinus
Le Forte II: Pyramidal fracture with teeth being the base of the pyramid and the nasofrontal suture at the apex; fracture passes through posterior alveolar ridge, lateral wall of maxillary sinuses, inferior orbital rim and nasal bones
Le Forte III: craniofacial disjunction; fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch
168
NMDA receptor encephalitis is commonly associated with what in women over 18?
Ovarian teratoma; it is a paraneoplastic encephalitis
169
What common drug used in older men is contraindicated with nitrates?
Sildenafil (viagra)
170
Most common lab abnormality with PE
Decreased PaO2
171
How often should you screen a patient with family history of familial adenomatous polyposis?
Yearly with flexible sigmoidoscopy
172
What should you do in a burn victim with visible signs of airway involvement before transport?
Intubate
173
Do you need to do a serum pregnancy test if urine test is negative?
No, urine test is very sensitive
174
Bence-Jones casts in urine indicate what?
Multiple myeloma
175
Most effective therapy for nasal polyps
Intranasal steroids
176
Drug used to cover erysipelas if the patient is penicillin allergic
erythromycin
177
How often should you do DEXA scans after initial scan?
Every 1-2 years
178
Treatment of choice for exhibitionism (showing your junk to strangers)
Medroxyprogesterone acetate
179
Glasgow coma scale categories and scores
Eye response: 1 doesn't open, 2 opens to pain, 3 opens to voice, 4 opens spontaneously
Verbal response: 1 no response, 2 incomprehensible sounds, 3 inappropriate words, 4 confused, 5 oriented
Motor response: 1 no motor response, 2 extension to pain (decerebrate response), 3 abdominal flexion to pain (decorticate response). 4 flexion/withdrawal to pain, 5 localizes pain, 6 follows commands
180
What GSC necessitates intubation?
8 or less
181
Diethystilbestrol (DES) is associated with what in women
Clear cell adenocarcinoma of the vagina
182
CSF findings in Guillain-Barre
Normal glucose, large increase in protein, normal opening pressure, clear yellow appearance
183
Treatment of hepatitis C
ribavirin and weekly interferon-alpha injections (remember, there is no hep c vaccine)
184
Treatment for borderline personality disorder
dialectic behavioral therapy
185
Radial head dysfunction after falling forward on an outstretched hand
Posterior (pronated) radial head
186
What is HLA B27 associated with?
Psoriatic arthritis, reactive arthritis, ankylosing spondylitis
187
Treatment of infantile (neonatal?) meningitis
Ampicillin and 3rd-gen cephalosporin or gentamycin
188
Most common cause on conjunctivits in neonates
Chlamydia
189
How do you treat complete molar pregnancy
Dilation and evacuation
190
Level 1-Level 3 evidence; which is strongest?
Level 1 evidence is the strongest (randomized clinical trials) and 3 is the weakest (retrospective case series).
191
Describe the 3 transverse sacral axes and what motions happen around them
Superior, inferior, and middle. Craniosacral motion and respiratory motion occurs about the superior axis. Postural motion occurs about the middle axis. Innominate rotation (and thus walking motion) occurs around the inferior axis
192
Histologic origin of Ewing Sarcoma tumors
Neural; considered a primitive neuroectodermal tumor of childhood (PNET)
193
LDL goals in a patient with 2 CAD risk factors, and when should statin therapy be started
Less than 130, statins should be started if LDL is greater than 160
194
Name some coronary artery disease risk factors
Diabetes, smoking, hypertension, HDL less than 40, age (more than 45 in males, more than 55 in females), early CAD in first degree relatives (less than 55 in males and less than 65 in females)
195
What do if someone presents with facial palsy (Bell's)
Glucocorticoids; only need to do MRI if symptoms are progressive or atypical
196
If afib presents with greater than 48 hours of symptoms, what should you do?
Rate control with a beta blocker or CCB and anticoagulate
197
Presentation of erythrasma
Scaly brown plaques in intertriginous, axillary, groin, inframammary areas that may be itchy. Diabetics and immunocompromised people are at risk. Woods lamp shows coral red fluorescence. Doesn't grow on KOH prep
198
Bacteria that causes erythrasma
Corynebacterium minitissimum
199
Treatment of erythrasma
Topical clindamycin if local, or erythromycin if more widespread
200
First imaging you should obtain when you are thinking of a small bowel obstruction
X-ray; looking for dilated bowel loops with air-fluid levels
201
In patients with normal uterus and secondary sexual characteristics and primary amenorrhea, what steps should you take in diagnosis
First, measure serum FSH. If this is elevated, get a karyotyping. If FSH is low or normal
202
When should you start doing pap smears to screen for cervical cancer?
21. Don't do earlier even if they are sexually active
203
Appendix anterior and posterior chapman point
Tip of 12th rib anteriorly, transverse process of T11
204
Adrenals anterior and posterior chapman point
2 inches superior and 1 inch lateral to umbilicus anterior, between the spinous process and transverse process of T11 and 12
205
Kidneys anterior and posterior chapman point
1 inch superior and 1 inch lateral to umbilicus, between spinous process of T12 and L1
206
Bladder anterior and posterior chapman point
Just 1; periumbilical
207
Colon chapman point
Lateral thigh within the iliotibial band from the greater trochanter to just above the knee
208
Anticholinergic syndrome signs and symptoms
Flushing, dry skin and mucous membranes, urinary retention, mydriasis, altered mental status (red as a beat, dry as a bone, blind as a bat, mad as a hatter, hot as a hair)
209
How do you treat anticholinergic syndrome
Physostigmine, reversible acetylcholinesterase inhibitor
210
Antidote for beta-blocker overdose
atropine
211
Signs and symptoms of ethylene glycol poisoning
Sweet breath, ataxia, hallucinations, seizures
212
Signs of mercury poisoning
Tremor, renal insufficiency, mental status change, erythema of lips and cheeks, diarrhea, tachycardia, peripheral neuropathy, hyperhidrosis
213
Mercury poisoning antidote
Dimercaprol, succimer, penicillamine
214
Signs and symptoms of organophosphate poisoning
DUMBBELSS; DIarrhea, urination, miosis, bradycaria, bronchospasm, excitation (of muscles and CNS), lacrimation, sweating, and salivation
215
Antidote for organophosphate poisoning
Atropine +pralidoxime (regenerates AChE)
216
MOA of organophosphate poisoning
Irreversibly inhibits AChE
217
Antidotes for cyanide poisoning
Amil nitrite and thiosulfate
218
Possible treatment for pulmonary fibrosis
Azathioprine
219
Most ACCURATE test to diagnose cholecystitis
HIDA
220
If a kid is admitted to the ICU for diabetic ketoacidos, what must resolve before they leave the ICU
Normalization of the anion gap
221
Treatment of lichen sclerosis
Topical corticosteroids
222
Treatment of restless leg syndrome
Pramipexole (or dopamine agonists)
223
Drug used to treat the dyskinesias in Huntingtons
Tetrabenazine
224
What direction does the sacrum rotate if L5 is rotated left?
Right on the oblique axis (always rotates opposite)
225
When should you start screening for colon cancer in someone who has Crohn's or UC?
After 8-10 years of colonic involvement, with repeat colonoscopy every 1-2 years
226
Pruritic papules in intertriginous areas, spread skin-skin (often via clothing), more common in close living quarters like dorms, barracks, prisons.
Scabies
227
What do you see on a peripheral smear with someone who has lead poisoning
Basophilic stipling (degraded rRNA)
228
What should all breastfeed babies get supplements of
VitD (400IU); iron is not needed until about 6 months of age
229
Description of basal cell carcinoma
Waxy, pearly, may have telangiectasias
230
Description of squamous cell carcinoma on skin
Shallow ulcer with heaped up edges; may be covered with plaque/scale/crust
231
Patients with Crohn's should be counceled to avoid what commonly prescribed anti-inflammatory
NSAIDs; they can precipitate flairs
232
Atopy, asthma, allergies, dermatography are mediated by what?
IgE causing mast cells to release histamine; aka Type I hypersensitivity
233
First line treatment for epistaxis
Firm pressure on the cartilaginous portion of the nose for up to 30 minutes
234
Raloxifene may do what in menopausal women?
Exacerbate hot flashes; it is a SERM, but is antagonistic towards breast and endometrial tissue and therefore does NOT increase the risk for these cancers
235
Most common medications that cause acute interstitial nephritis (AIN)
NSAIDs and proton pump inhibitors; rifampin, penicillin, and cephalosporins have also been implications
236
Classic triad of symptoms seen in AIN
Rash, fever, eosinophilia
237
Treatment of AIN
Removal of offending drug if present, and corticosteroids
238
What is Russel's sign?
Calluses on the back of the hand, often seen in bulimia nervosa
239
Drug that has the most benefit in bulimia nervosa
Fluoxetine (SSRI)
240
Classic pentad in thrombotic thrombocytopenic purpure
Fever, renal disease, microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities
241
Signs and symptoms of meconium aspiration
Decreased oxygenation, difficulty breathing, tachypnea, in term or POSTTERM infants
242
What respiratory problem can meconium ileus lead to?
Persistent pulmonary hypertension
243
Winter's formula
(1.5*bicarb)+8+/-2
244
The inferior glands of the parathyroid and the thyroid gland are derived from what embryonic structure
Third pharyngeal pouch
245
Pancreatitis can be cause by what diabetes drug?
GLP-1 agonists (exenatide, liraglutide, -tide, tide, etc.)
246
Where is the most common location to injure the ureter during a hysterectomy
Near the cardinal ligament
247
Quad screen results for neural tube defects
Increased MSAFP, decreased estriol, decreased B-hCG
248
Quad screen results for down syndrome
Decreased MSAFP, decreased estriol, increase B-hcg, increased inhibin-A
249
Quad screen results for Edward syndrome (trisomy 18)
Everything is low
250
Rapid acting insulins
that GAL sure is fast; glulisine, aspart, lispro
251
Short acting insuling (longer acting than rapid?)
Normal
252
Intermediate acting insulins
NPH
253
Long acting insulins
Glargine, detemir
254
Granulosa cell tumors produce what
Estrogen
255
How to monitor someone with a history of granulosa cell tumor and unilateral salpingo-oophorectomy
Inhibin levels
256
If you suspect pancreatic cancer, what should you do after a RUQ ultrasound?
CT
257
Difference between iron-deficiency anemia and thalassemias in labs?
Iron deficiency will have increased RDW
258
Red cell morphology in autoimmune hemolytic anemia
Spherocytes
259
What should you do in a woman over 35 with atypical glandular cells on pap smear?
Colposcopy + endometrial biopsy; only need colposcopy under 35
260
Signs and symptoms of Fabry
Pain, proteinuria, hypertension, angiokeratomas and corneal verticillata
261
Signs and symptoms of Gauchers
Pancytopenia, hepatosplenomegaly, diffuse infiltrative pulmonary disease
262
Inheritance of Fabry's
X-linked
263
Inheritance of Gaucher's
Autosomal recessive
264
Enzymatic deficiency in Fabry's disease
Glucocerebrisadoasdease
265
Signs and symptoms of Klinefelter's
Tall stature, behavioral issues, gynecomastia, infertility
266
Genetic's in Klinefelter's
XXY
267
Screening exams to consider in diabetic patients
Yearly foot, eye, and microalbuminuria checks
268
Before what date is considered preterm premature rupture of membranes
37 weeks
269
If the mother or the fetus are not at risk in PPROM, how do you manage them?
Manage expectantly; maternal vital signs, pelvic exam, fetal monitoring, and ultrasound
270
Is adrenal crisis due to sudden withdrawal of steroids considered primary or secondary adrenal insufficiency?
Secondary
271
Big difference between endometriosis and adenomysosis?
Adenomyosis usually has menorrhagia
272
Major side effect of ginko biloba
Anticoagulant properties (bleeding!)
273
Side effects of St. John's Wart
Placebo-like side effects; n/v, fatigue. Also interacts with CYP3A4
274
Herbal supplement incorrectly believed to help with erectile dysfunction
Ginseng
275
Most common location of breast cancer
Upper-outer quadrant
276
Most common benign parotid gland tumor
Pleomorphic adenoma (Warthin's tumor is next most common)
277
Most common presentation of pleomorphic adenoma (parotid gland tumor)
Painless, slow growing pre-auricular mass
278
Common presentation of wegener's (or polyangitis with granulomatosis)
Mucosal ulcers, recurrent sinusitis, rapidly progressive renal failure
279
Sex-cord tumor that causes virilization in females
Sertoli-Leydig cell tumors
280
Name the sex cord tumors
Sertoli-Leydig, granulosa, gynandroblastoma, and steroid cell tumors
281
Iron studies in thalassemia
High ferritin, low to normal TIBC
282
Best initial treatment in someone suffering urethral trauma
Suprapubic catheter
283
Tanner stage 1 female
No glandular breast tissue or pubic hair
284
Tanner stage 2 female
Breast buds and small amount of pubic hair on labia majora
285
Tanner stage 3 female
Breast becomes more elevated, but lacks a secondary mound; pubic hair becomes more coarse and curly
286
Tanner stage 4 female
Increased breast size with secondary mound; pubic hair extends to pubis bet spares thighs
287
Tanner stage 5 female
Breast size increases, loses secondary mound; pubic hair extends to inner thigh
288
Antibody associated with mixed connective tissue disease
Anti-U1 ribonucleotide antibody
289
Signs and symptoms of mixed connective tissue disease
Non-erosive arthritis, Raynaud's, muscle involvement, sclerodactyly and esophageal hypomotility
290
What is the most common cause of neonatal congenital heart block?
Anti-Ro/SSA antibodies passed from a mother with Sjogren's to a fetus
291
External appearance of the kidneys in SLE with renal involvement
Flea-bitten appearance
292
Conservative treatment for small kidney stones
Fluids (PO), pain meds, straining urine (to catch the stones so you can figure out the type
293
What should you do if you have a pregnant lady with high grade intraepithelial lesions?
Colposcopy
294
Most common group of cancers causing testicular cancer
Germ cell tumors (~95%)
295
Findings for seminoma
history of cryptorchidism, well-defined hypoechoic mass on US,
296
Lab value findings in DIC
Increased PT and PTT, low fibrinogen, low platelets
297
Coag factor findings in vWB disease
Normal PT, elevated PTT, increased bleeding time, normal platelet count
298
Treatment of choice for chancroid (H. ducreyi)
Single PO dose of azithromycin
299
Toxic-multinodular goiter is also known as what?
Plummer's disease
300
Palpitations, sweating, increased HR 2 weeks after giving birth
Thyrotoxicosis
301
Risk factors for placenta previa
Previous CS, advanced maternal age, cocaine abuse, smoking
302
Type of exam CONTRAindicated in placenta previa
Pelvic exam
303
Treatment for IgA nephropathy
Corticosteroids + an ACEi/ARB
304
Protracted dilation is what rate?
1.2 cm/hr
305
Major side effect in bupropion
Lowers seizure threshold
306
Most common childhood renal tumor
Wilm's tumor
307
Beckwith-Weideman syndrome
Wilm's tumor+omphalacele+macroglossia
308
WAGR syndrome
Wilm's tumor + aniridia + genito-urinary abnormalities+retardation
309
How to manage 21-24 year olds with LSIL
Repeat cytology in 12 months
310
Treatment of lichen sclerosis
Topical steroids first, then tacrolimus (calcineurin inhibitor) if that fails
311
What do if someone who is pregnant has HSIL
colposcopy
312
Antibiotics that are associated with ototoxicity
Aminoglycosides (gentamicin, tobramycin, neomycin, kanamycin)
313
Fanconi syndrome is a side effect of what antibiotic
Tetracyclines
314
Treatment of candidal esophagitis
Oral fluconazole
315
Most common long-term sequelae of bacterial meningitis
CN VIII deficits (hearing loss)
316
Treatment of clostridium perfringens necrotizing fasciitis
Clindamycin
317
Most appropriate treatment for an athlete with an ACL tear
Bracing with mobilization and PT prior to reconstruction
318
Treatment of mitral valve prolapse
Echo and reassurance
319
Type of renal dysfunction multiple myeloma causes
Type II RTA (bicarb is not reabsorbed, leading to a metabolic acidosis; will stimulate aldosterone release leading to increased reabsorption of sodium and excretion of K)
320
What is recommended weight gain in pregnancy based on?
Pre-pregnancy BMI; 30 should gain 11-20 lbs
321
What type of imaging should you get in a kid with osteosarcoma?
Chest CT to look for metastases
322
Chorionic villus sampling done before 9-11 weeks may put fetus at risk of what?
Limb abnormalities
323
Congenital hypothyroidism may lead to what if untreated?
Mental retardation
324
Some disease you may have an increased risk of if you have Down Syndrome
ALL and Alzheimer's
325
Triad of B12 deficiency
Weakness, sore tongue, paresthesias
326
MOA of succinylcholine
Depolarizing blocker with 2 agents; phase 1 is a primarily paralytic stage and keeps the membrane potential just above threshold so it's always depolarized, phase 2 is non-depolarizing where ACh is always blocked. Rapid, biphasic, and has no refractory period. Also cause cellular potassium efflux, so is contraindicated in patients with hyperkalemia or conditions that cause it.
327
What do in a nosebleed if direct pressure has failed?
Anterior packing
328
Where should you never use silver nitrate in nosebleeds?
On the septum due to risk of perforation
329
If someone has myxedema coma, what should you check before giving thyroxine?
Cortisol, they may have coexisting adrenal insufficiency
330
Why do beta-blockers increase the murmur in HOCM?
Increase the preload by blocking the vasodilatory effects of B2 receptors
331
What should you do in post-op, dirty, or large corneal abrasions?
Prophylaxis with trimethoprim-polymyxin B eyedrops
332
Diagnosing HIV?
Screen with ELISA, confirm with western blot
333
How to treat someone with untreated HIV + active hep B infection
Interferon alpha, antiviral (tenofovir) and nucleoside reverse transcriptase inhibitor (emtracitabine)
334
Screening for gestational diabetes
Done at 24-28 weeks; 1 hour glucose tolerance test is abnormal if greater than 140, if abnormal, repeat with 3 hour test
335
Hormone responsible for gestational diabetes
Human placental lactogen; it has anti-insulin properties and is similar to human growth hormone
336
Indications for cryoprecipitate over FFP
If the patient is volume overloaded or if the fibrinogen is low
337
Treatment of choice for Toxoplasmosis
Pyrimethamine and sulfadiazine
338
First line treatment for P. jiroveci and toxoplasmosis with CD4+ count under 100
TMP-SMX (same prophylaxis for P. jiroveci when count is under 200)
339
What agent used to treat uterine atony is contraindicated if the patient has high BP?
Methylergonovine because it can cause severe hypertension
340
When to perform a C-section in a HIV+ mother delivering a baby
Low CD4 count (less than 350) or viral load greater than 1000
341
Hepatitis virus transmitted mainly through blood
Hep C (B can be transmitted via blood, but also by sex and birth)
342
What is protease is decreased in thrombotic thombocytopenic purpura?
ADAMST13, aka vWF-cleaving protease; it cleaves vWF and thus makes a more thombogenic environment
343
If a breast cancer patient is HER2/neu +, what should additional treatment should they receive?
Trastuzamab
344
BUN/Cr ratio in post-renal obstruction
Greater than 15
345
BUN/Cr ratio in intrinsic renal obstruction
Less than 15
346
First-line treatment for cocaine induced chest pain
Benzos
347
OMT for fibromyalgia
Indirect techniques like counterstrain
348
Explain difference between SIRS, sepsis, severe sepsis, septic shock
SIRS you know, sepsis=SIRS + source of infection, severe sepsis = sepsis+ organ dysfunction, septic shock=sepsis derived hypotension unresponsive to fluids
349
4 bones that make up the pterion?
Junction of temporal, parietal, sphenoid and frontal bones
350
Osteopathic techniques useful on sutures
V spread
351
Occipital and temporal bones join to form what foramen?
Jugular foramen
352
What CNs exit the jugular foramen
IX, X, XI
353
Occipito-mastoid suture formed by what bones?
Occiput and temporal
354
What Cobb angles of the back do you consider using a brace?
20-40
355
When do you consider surgery in scoliosis
Cobb angle >45
356
Managing scoliosis with cob angles less than 20 degrees
Serial radiographs to monitor for progression, exercises, PT, OMM
357
Muscles affect rib 1
Anterior and middle scale
358
Muscle affecting rib 2
Posterior scalene
359
Muscle affecting ribs 3-5
Pec minor
360
Muscles affecting ribs 6-9
Serratus anterior
361
Muscle affecting ribs 10 and 11
Latissimus dorsi
362
Muscle affecting rib 12
Quadratus lumborum
363
When will you get respiratory compromise in scoliosis
Cobb angle greater than 50
364
When will you get cardio compromise in scoliosis
Cobb angle greater than 75
365
Post-isometric muscle energy is AKA...
Direct muscle energy
366
Reciprocal muscle energy is AKA...
Indirect muscle energy
367
Maximum amount a shoe-lift can provide in short leg syndrome
1/2 " or less than 2 cm
368
How to measure leg length
ASIS and medial malleolus
369
First line treatment in osteoporosis
Biphosphonates (alendronate, risodrenate, zolidrenic acid, denusomab)
370
Treatment of choice for right mainstem bronchus foreign-body aspiration
RIGID bronchoscopy (NOT flexible)
371
If the L4 nerve root is being compressed by a herniated disk, WHICH disk is it?
L3 disk (not L4)
372
Most common organism causing epiglottitis
Haemophilus influenza
