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Random COMLEX Step 2 BS > Random > Flashcards

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1
Q

Major side effect of minoxidil

A

Hypertrichosis (you hairy)

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2
Q

Paired cranial bones

A

Frontal, temporal, parietal

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3
Q

Midline cranial bones

A

Sphenoid, occiput, ethmoid, vomer

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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

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5
Q

Antibody associated with primary biliary cirrhosis

A

Anti-mitochondrial antibodies

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6
Q

Antibody associated primary sclerosing cholangitis

A

perinuclear antineutrophilic cytoplasmic antibodies (p-ANCA)

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7
Q

What fasting LDL would you consider going straight to statin therapy instead of lifestyle modifications?

A

> 190

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8
Q

Inheritance of otosclerosis

A

AD

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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

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10
Q

Counterstrain for ribs 3-6

A

Slight flexion, sidebend and rotate towards point

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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)

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12
Q

What do ulcers in CMV esophagitis look like on endoscopy

A

Linear, shallow

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13
Q

Infectious mononucleosis + amoxicillin leads to what?

A

Rash

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14
Q

What can you use to test for semen in the case of sexual assault

A

Wood’s lamp

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15
Q

Treatment of choice for hairy cell leukemia

A

Nucleoside analogs

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16
Q

All-trans retinoic acid is used to treat what malignancy?

A

Acute promyelocytic leukemia (APL)

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17
Q

Imatinib (gleevec) is best used to treat what?

A

CML (it’s a Philadelphia chromosome inhibitor)

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18
Q

Apgar categories

A

Appearance, pulse, grimace, activity, and respirations

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19
Q

Antidote for benzodiazepine overdose

A

IV flumazenil; competitive inhibitor of GABA receptors

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20
Q

Antidote for ethylene glycol ingestion

A

IV fomepizole or alcohol

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21
Q

Earliest EKG sign of hyperkalemia

A

Peaked T-waves

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22
Q

EKG changes when serum K is >6.5

A

P wave widens and flattens, PR interval lengthens, eventually P waves disappear

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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)

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24
Q

EKG changes when K >9

A

CARDIAC ARREST due to asystole, vfib or PEA with weird QRS morphology

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25
Q

Hypomagnesemia findings

A

Tremor, tetany, EKG changes (U wave, QT prolongation leading to torsades, ST segment depression

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26
Q

During labor, how often should you monitor fetal heart rate in a patient WITHOUT complications

A

Every 30 minutes for stage 1, then every 15 for stage 2

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27
Q

During labor, how often should you monitor fetal heart rate in a patient WITH complications

A

Every 15 minutes for stage 1, then every 5 minutes during stage 2

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28
Q

Goal for preprandial glucose in type-1 diabetics

A

90-130

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29
Q

Goal for postprandial glucose in type-1 diabetics

A

Less than 180

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30
Q

Blowing diastolic murmur at left sternal border with or without mid-diastolic rumble (Austin-Flint murmur)

A

Aortic regurgitation

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31
Q

Name some drugs contraindicated in pregnancy

A

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)

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32
Q

Describe the stages of decubitis ulcers

A

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.

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33
Q

Most common complication of interscalene nerve block?

A

Phrenic nerve block (runs down the anterior scale muscle)

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34
Q

First, second, third line agents in status epilepticus

A

Benzo’s first (lorazepem, midazolam), then anti-epileptic (phenytoin or fosphenytoin), then anesthesia (usually propofol)

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35
Q

Rare demyelinating disease associated with natalizumab

A

Progessive multifocal leukoencephalopathy (due to reactivation of JC polyoma virus)

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36
Q

Prenatal labs to get at first prenatal visit

A

CBC, Abo and Rh status, hepatitis B, syphillis, chlamydia, gonorrhea, HIV, urinalysis

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37
Q

Prenatal care at 24-28 weeks

A

Repeat Abo and Rh status, gestational diabetes screening, and hemoglobin and hct

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38
Q

Prenatal care at 28-36 weeks

A

Can repeat STD testing (Hep B, syphilis, chlamydia, gonorrhea, HIV), estimated fetal weight and fetal assessment in patients at risk, Group B strep testing

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39
Q

What weeks should group B strep testing be done in pregnant patients

A

35-37

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40
Q

Required Jones criteria for diagnosing acute rheumatic fever

A

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

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41
Q

anti-dsDNA antibodies are found in what disease

A

SLE

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42
Q

anti-Jo-1 antibodies are found in what diseases

A

Dermatomyositis and polymyositis

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43
Q

anti-Scl-70 or antitopoisomerase-1 antibodies are found in what disease

A

Scleroderma or CREST

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44
Q

anti-Ro/SSA antibodies are found in what disease

A

Sjogren’s syndrome

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45
Q

Guidelines for screening lung cancer

A

> 30 pack years smoking and ages 55-80 and are currently smoking or quit within the past 15 years

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46
Q

What is Felty’s syndrome

A

Rheumatoid arthritis + splenomegaly and granulocytopenia

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47
Q

Criteria for mild pre-eclampsia

A

> 140/90 BP + >300 mg protein in 24h urine sample

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48
Q

Criteria for severe pre-eclampsia

A

> 160/110 bp +>300 mg protein in 24h urine

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49
Q

Microscopic path findings in Waldenstrom’s macroglobulinemia

A

PAS stain IgM deposits around the nucleus in plasma cell

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50
Q

Organisms to consider treating in the presence of bronchiectasis

A

Pseudomonas, TB, haemophilus influenza, mycoplasma avium-intracellulare

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51
Q

When should you consider using benzos for treatment of delirium

A

Alcohol or sedative related withdrawal

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52
Q

What lab test should you order to screen for Zollinger-Ellison syndrome

A

Gastrin levels

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53
Q

When should you consider secretin stimulation test to diagnose Zollinger-Ellison syndrome

A

Equivocal gastrin levels

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54
Q

Lab tests to diagnose secondary amenorrhea

A

First bHCG, then thyroid studies, then prolactin

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55
Q

What do if you have a 25-29 year-old woman with low-grade squamous intraepithelial lesions

A

Colposcopy

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56
Q

How to manage women >30 with LSIL lesions

A

If HPV negative, repeat cytology/HPV testing in 1 year. If HPV +, colposcopy

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57
Q

Type of cardiomyopathy seen from alcoholism

A

Dilated cardiomyopathy due to thiamine deficiency (systolic heart failure)

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58
Q

Main characteristics of avoidant personality disorder

A

Feelings of inadequacy and hypersensitivity towards others

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59
Q

Main characteristics of social phobia

A

Intense fear of embarrassment or humiliation due to their actions.

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60
Q

First gen sulfonylureas (tolbutamide and chlorpropamide) may cause what type of effect when combined with alcohol?

A

Disulfiram-like effects

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61
Q

Lab values in primary biliary cirrhosis

A

Markedly elevated alkaline phosphotase and mildly elevated ALT and AST

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62
Q

Developmental milestones at age 3

A

Rides tricycle, copies circles, stacks 9 cubes, most of speech is intelligible, starts potty training at 3

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63
Q

Difference between complex region pain syndrome 1 and 2

A

2 is caused by a specific nerve lesion

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64
Q

Complex regional pain syndrome signs and symptoms

A

Pain, allodynia, hyperalgesia, mottled skin appearance, edema of area

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65
Q

When can kids begin toilet training and when are they usually done

A

Can begin at 18 months, usually done by 36-48 months

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66
Q

Treatment of choice for actinomyces israelii infections

A

Penicillin G

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67
Q

Tricuspid atresia is commonly due to what drug

A

Lithium

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68
Q

Tachypnea, cyanosis, muddy lookin blood

A

Methemoglobinemia

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69
Q

Some drugs that can cover spontaneous bacterial peritonitis

A

Gentamycin and cefotaxime

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70
Q

Should you decrease or increase steroids before a surgery in a patient chronically on steroids

A

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

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71
Q

Common compensatory pattern

A

OA left, cervicothoracic right, thoracolumbar, left, lumbosacral right.

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72
Q

High T4, low TSH, heterogenous uptake of radioactive iodine

A

Toxic multinodular goider

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73
Q

Best SCREENING test for Zollinger-Ellison and MOST ACCURATE test

A

Gastrin for screening, secretin stimulation test for most accurate

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74
Q

Yolk sac tumors secrete what

A

alpha-fetoprotein

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75
Q

Choriocarcinomas secrete what

A

b-HCG (b-H-Choriocarcinoma-g)

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76
Q

Leydig cell tumors cause what in guys

A

Feminization

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77
Q

Putz-Jagher and Carney’s syndrome are associated with what sex cord tumor

A

Sertoli Cell tumors

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78
Q

Missed abortion

A

Abortion before 20 weeks with retention of fetal products

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79
Q

What should you do if you are doing pelvic surgery and want to make sure you didn’t cut the ureters

A

Inject IV carmine indigo dye (you can see the blue dye during surgery if the ureters are damaged)

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80
Q

Disease modifying drug in dementia

A

Memantine: NMDA receptor antagonist reduces excitotoxicity and neuron death from excess NMDA exciatation

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81
Q

What should all women of childbearing age be taking as a supplement

A

Folic acid

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82
Q

Ophthalmologic findings in optic neuritis

A

Pale optic discs

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83
Q

Thompson test for achilles tendon rupture

A

Squeeze the gastroc muscle; foot should plantar flex, if it doesn’t test is positive for achilles tendon rupture

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84
Q

Three most common organisms causing necrotizing fasciitis

A

C. perfringens, S aureus, strep pyogenes

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85
Q

What should you use for empiric treatment of necrotizing fasciitis

A

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)

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86
Q

Morphology of Haemophilus influenza

A

Gram - Coccobacillus

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87
Q

Fiberoptic bronchoscopy can be used to biopsy what kind of lung lesions?

A

Centrally based lesions

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88
Q

What should you use to biopsy peripheral lung lesions

A

CT guided biopsy

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89
Q

Initial screening test for hyperthyroidism

A

TSH

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90
Q

Best preventative measure for coronary artery disease (medical)

A

Statins

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91
Q

Which is better, percutaneous coronary intervention or thrombolytics in MI?

A

PCI, do thrombolytics if PCI can’t be done within 90 minutes

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92
Q

What can you do for a patient with a PE with contraindications to heparin?

A

Embolectomy

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93
Q

Diabetic retinopathy is strongly predicted by what?

A

Urinary protein and BUN/creatinine ratio

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94
Q

What personality disorder is characterized by hypersexuality, needing to be the center of attention?

A

Histrionic

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95
Q

Do you need to test for H. pylori infections in patients with duodenal ulcers?

A

Nah, just start triple (or quadruple) therapy

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96
Q

Quadruple therapy for H. pylori infections

A

Esomeprazole, bismuth salycilate, metronidazole, tetracycline

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97
Q

Why give zinc in Wilson’s disease?

A

It decreases GI absorption of copper

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98
Q

Bloody diarrhea+fever+daycare=

A

Shigella

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99
Q

When in cranial flexion, what does the sacrum do?

A

Counternutation (base moves posterior)

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100
Q

Diameter changes in craniosacral flexion

A

AP diameter decreases, transverse diameter increases

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101
Q

When to consider revascularization therapy in PAD

A

When the patient gets symptoms at rest?

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102
Q

If afib has been occurring for >48 hours, what should you do?

A

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

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103
Q

If you are cardioverting afib, should you use electrical or medical cardioversion

A

Depends on provider preference mostly, though drug therapy is preferred for paroxysmal afib.

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104
Q

Blood pressure finding in patients with aortic regurg

A

Wide pulse pressure

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105
Q

How can you tell the difference between an incarcerated and strangulated hernia based on the patient’s clinical presentation?

A

Patients with a strangulated hernia will appear much sicker and have lactic acidosis, fever and chills, and electrolyte derangements due to necrotic bowel

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106
Q

When should P. jiroveci prophylaxis begin in AIDs patients

A

CD4 count less than 200

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107
Q

When should prophylaxis for Toxoplasmosis and MAC/cryptococcus/CMV (respectively) start for patients with HIV

A

CD4 count less than 100 and 50 respectively

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108
Q

What components make up the primary respiratory mechanism in craniosacrial motion

A

CNS+CSF+Dural membranes+sacrum

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109
Q

Normal cranial rhythmic impulse (CRI)

A

10-14 per minute

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110
Q

Things that decrease the CRI

A

Stress, depression, chronic fatigue or chronic infections

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111
Q

Things that increase the CRI

A

Exercise, fever, craniosacrial OMT

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112
Q

Keystone of craniosacrial motion

A

Sphenobasilar synchrondrosis

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113
Q

Motion of the paired bones in craniosacral flexion

A

External rotation

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114
Q

Motion of the paired bones in craniosacral extension

A

Internal rotation

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115
Q

Motion of sacral base in craniosacral extension

A

Nutation (nods forward)

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116
Q

Diameter changes in craniosacral extension

A

AP diameter increases, transverse diameter decreases

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117
Q

How is craniosacral torsion named

A

Whichever greater wing of the sphenoid is more superior

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118
Q

Axis that craniosacral torsions occur around

A

AP axis

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119
Q

Axes that craniosacral sidebending-rotation occurs around

A

One AP, two vertical parallel axes

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120
Q

Naming craniosacral sidebending-rotation

A

Named for side of convexity (or fullness)

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121
Q

Non-physiologic craniosacral strains

A

Lateral and vertical strains, SBS compression

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122
Q

Axes in craniosacral vertical strains

A

Two parallel transverse axes

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123
Q

Naming vertical strains

A

Motion of SBS

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124
Q

Finger placement in the vault hold

A

Index: greater wing of the sphenoid, middle finger-temporal bonde, ring finger-mastoid, little finger-squamous part of occiput

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125
Q

What kind of diuretic is contraindicated in someone with gout?

A

Thiazide

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126
Q

What is the only way to make a definitive diagnosis of adenomysosis?

A

Hysterectomy

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127
Q

How to treat papillary thyroid carcinomas?

A

Surgical resection followed by radioactive iodine and yearly ultrasounds to prevent recurrence

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128
Q

most common viral cause of dilated cardiomyopathy?

A

Parvovirus B19

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129
Q

Lab findings in Kawasaki’s

A

Thrombocytosis, lymphocytosis, elevated CRP and ferritin, anemia, abnormal liver enzymes

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130
Q

Antibodies in bullous pemphigoid

A

IgG antibodies to hemidesmisomes

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131
Q

Initial treatment for bullous pemphigoid

A

Topical corticosteroids; can try rituximab if this fails

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132
Q

Cryoprecipitate is given to what patient population in what circumstance

A

Pts with von Willebrand Disease who are experience active hemorrhage; it is rich in vWf

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133
Q

What test to use to confirm cryptococcal meningitis?

A

Lumbar puncture

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134
Q

Treatment of epidydimitis

A

Ceftriaxone+doxycycline

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135
Q

Treatment of bacterial meningitis in patients >60

A

Vancomycin(penicillinase resistant s. pneumos), ampicillin(listeria), certriaxone (neisseria, haemophilus, s. pneumo)

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136
Q

What is Chadwick’s sign?

A

Bluish discoloration of the cervix, early sign of pregnancy

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137
Q

Below what GFR is metformin contraindicated

A

Less than 30

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138
Q

Treatment of acute exacerbations of COPD

A

Albuterol, oral corticosteroids, antibiotics

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139
Q

How do you treat tumors within 5 cm of the anal verge?

A

Abdominal perineal resection with permanent colostomy

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140
Q

Type of hepatitis associated with high infant mortality

A

Hep E

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141
Q

Metabolic and electrolyte changes with hydrochlorothiazide use

A

Hypercalcemia, hyperuricemia, hyponatremia, hypokalemia, hyperlipidema

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142
Q

Rate of transmission of HIV after needle stick with needle carrying HIV + blood

A

0.3%

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143
Q

Contact dermatitis is what type of hypersentivity reaction

A

Type IV (delayed-type)

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144
Q

Type of drug contraindicated in Prinzmetal’s or variant angina

A

Propanolol (causes unopposed alpha stimulation which can actually worsen vasoconstriction)

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145
Q

Drugs used to treat Prinzmetal’s or variant angina

A

CCBs or nitrates

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146
Q

What antibiotic to use in hepatic encephalopathy and why

A

Neomycin, decreases ammonia production by bacteria in the colon

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147
Q

Breast cancer staging

A

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)

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148
Q

How long should you wait after continuing an MAOi to start an SSRI

A

14 days (want to avoid serotonin syndrome)

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149
Q

Single most specific and sensitive test for ANY form of myesthenia gravis?

A

Single nerve electromyography

150
Q

Treatment for ALS and mechanism of action

A

Riluzole (glutamate antagonist)

151
Q

Top 3 most common causes of fever of unknown origin

A
  1. Infections (30-40%)
  2. Neoplastic (20-30%)
  3. Collagen vascular disease (10-20%)
152
Q

Why do surgeons prefer transplanting left kidneys?

A

Longer vein makes it easier to surgerize

153
Q

Structures that drain to the right lymphatic duct

A

Right side of head and neck, right UE, heart and lungs. All the rest of the body drains to the left thoracic duct

154
Q

Classic EKG finding in hypothermia

A

Osborne (or prominent J-wave, an extra positive deflection between the end of the QRS complex and the T wave)

155
Q

Genetic abnormality responsible for early onset Alzheimer’s in down syndrome patients

A

Amyloid beta precursor protein

156
Q

How long should you anticoagulate someone who has new-onset afib that has been present for >48 hours before you cardiovert

A

3-4 weeks

157
Q

Most common place for prostate cancer to metastasize to

A

Bone

158
Q

Migraine treatment in pregnant ladies

A

Acetaminophen

159
Q

First-line agents in sleep onset insomnia

A

Sedative hypnotics (zolpidem, etc)

160
Q

Where does the dural membrane attach to the sacrum

A

Posterior superior portion of S2

161
Q

Most common EKG finding in hypercalcemia

A

Short QT interval

162
Q

Findings on EKG with variant angina

A

Transient ST elevation

163
Q

Diagnostic modality to confirm achilles tendon rupture

A

MRI

164
Q

Treatment of pelvic inflammatory disease

A

Azithromycin and doxycycline

165
Q

Sudden onset scrotal pain, elevation of scrotum, Absent cremaster reflex

A

Testicular torsion

166
Q

Virus that causes hand foot and mouth disease

A

Coxsackie A virus

167
Q

Explain Le Forte fractures I-III

A

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
Q

NMDA receptor encephalitis is commonly associated with what in women over 18?

A

Ovarian teratoma; it is a paraneoplastic encephalitis

169
Q

What common drug used in older men is contraindicated with nitrates?

A

Sildenafil (viagra)

170
Q

Most common lab abnormality with PE

A

Decreased PaO2

171
Q

How often should you screen a patient with family history of familial adenomatous polyposis?

A

Yearly with flexible sigmoidoscopy

172
Q

What should you do in a burn victim with visible signs of airway involvement before transport?

A

Intubate

173
Q

Do you need to do a serum pregnancy test if urine test is negative?

A

No, urine test is very sensitive

174
Q

Bence-Jones casts in urine indicate what?

A

Multiple myeloma

175
Q

Most effective therapy for nasal polyps

A

Intranasal steroids

176
Q

Drug used to cover erysipelas if the patient is penicillin allergic

A

erythromycin

177
Q

How often should you do DEXA scans after initial scan?

A

Every 1-2 years

178
Q

Treatment of choice for exhibitionism (showing your junk to strangers)

A

Medroxyprogesterone acetate

179
Q

Glasgow coma scale categories and scores

A

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
Q

What GSC necessitates intubation?

A

8 or less

181
Q

Diethystilbestrol (DES) is associated with what in women

A

Clear cell adenocarcinoma of the vagina

182
Q

CSF findings in Guillain-Barre

A

Normal glucose, large increase in protein, normal opening pressure, clear yellow appearance

183
Q

Treatment of hepatitis C

A

ribavirin and weekly interferon-alpha injections (remember, there is no hep c vaccine)

184
Q

Treatment for borderline personality disorder

A

dialectic behavioral therapy

185
Q

Radial head dysfunction after falling forward on an outstretched hand

A

Posterior (pronated) radial head

186
Q

What is HLA B27 associated with?

A

Psoriatic arthritis, reactive arthritis, ankylosing spondylitis

187
Q

Treatment of infantile (neonatal?) meningitis

A

Ampicillin and 3rd-gen cephalosporin or gentamycin

188
Q

Most common cause on conjunctivits in neonates

A

Chlamydia

189
Q

How do you treat complete molar pregnancy

A

Dilation and evacuation

190
Q

Level 1-Level 3 evidence; which is strongest?

A

Level 1 evidence is the strongest (randomized clinical trials) and 3 is the weakest (retrospective case series).

191
Q

Describe the 3 transverse sacral axes and what motions happen around them

A

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
Q

Histologic origin of Ewing Sarcoma tumors

A

Neural; considered a primitive neuroectodermal tumor of childhood (PNET)

193
Q

LDL goals in a patient with 2 CAD risk factors, and when should statin therapy be started

A

Less than 130, statins should be started if LDL is greater than 160

194
Q

Name some coronary artery disease risk factors

A

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
Q

What do if someone presents with facial palsy (Bell’s)

A

Glucocorticoids; only need to do MRI if symptoms are progressive or atypical

196
Q

If afib presents with greater than 48 hours of symptoms, what should you do?

A

Rate control with a beta blocker or CCB and anticoagulate

197
Q

Presentation of erythrasma

A

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
Q

Bacteria that causes erythrasma

A

Corynebacterium minitissimum

199
Q

Treatment of erythrasma

A

Topical clindamycin if local, or erythromycin if more widespread

200
Q

First imaging you should obtain when you are thinking of a small bowel obstruction

A

X-ray; looking for dilated bowel loops with air-fluid levels

201
Q

In patients with normal uterus and secondary sexual characteristics and primary amenorrhea, what steps should you take in diagnosis

A

First, measure serum FSH. If this is elevated, get a karyotyping. If FSH is low or normal

202
Q

When should you start doing pap smears to screen for cervical cancer?

A
  1. Don’t do earlier even if they are sexually active
203
Q

Appendix anterior and posterior chapman point

A

Tip of 12th rib anteriorly, transverse process of T11

204
Q

Adrenals anterior and posterior chapman point

A

2 inches superior and 1 inch lateral to umbilicus anterior, between the spinous process and transverse process of T11 and 12

205
Q

Kidneys anterior and posterior chapman point

A

1 inch superior and 1 inch lateral to umbilicus, between spinous process of T12 and L1

206
Q

Bladder anterior and posterior chapman point

A

Just 1; periumbilical

207
Q

Colon chapman point

A

Lateral thigh within the iliotibial band from the greater trochanter to just above the knee

208
Q

Anticholinergic syndrome signs and symptoms

A

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
Q

How do you treat anticholinergic syndrome

A

Physostigmine, reversible acetylcholinesterase inhibitor

210
Q

Antidote for beta-blocker overdose

A

atropine

211
Q

Signs and symptoms of ethylene glycol poisoning

A

Sweet breath, ataxia, hallucinations, seizures

212
Q

Signs of mercury poisoning

A

Tremor, renal insufficiency, mental status change, erythema of lips and cheeks, diarrhea, tachycardia, peripheral neuropathy, hyperhidrosis

213
Q

Mercury poisoning antidote

A

Dimercaprol, succimer, penicillamine

214
Q

Signs and symptoms of organophosphate poisoning

A

DUMBBELSS; DIarrhea, urination, miosis, bradycaria, bronchospasm, excitation (of muscles and CNS), lacrimation, sweating, and salivation

215
Q

Antidote for organophosphate poisoning

A

Atropine +pralidoxime (regenerates AChE)

216
Q

MOA of organophosphate poisoning

A

Irreversibly inhibits AChE

217
Q

Antidotes for cyanide poisoning

A

Amil nitrite and thiosulfate

218
Q

Possible treatment for pulmonary fibrosis

A

Azathioprine

219
Q

Most ACCURATE test to diagnose cholecystitis

A

HIDA

220
Q

If a kid is admitted to the ICU for diabetic ketoacidos, what must resolve before they leave the ICU

A

Normalization of the anion gap

221
Q

Treatment of lichen sclerosis

A

Topical corticosteroids

222
Q

Treatment of restless leg syndrome

A

Pramipexole (or dopamine agonists)

223
Q

Drug used to treat the dyskinesias in Huntingtons

A

Tetrabenazine

224
Q

What direction does the sacrum rotate if L5 is rotated left?

A

Right on the oblique axis (always rotates opposite)

225
Q

When should you start screening for colon cancer in someone who has Crohn’s or UC?

A

After 8-10 years of colonic involvement, with repeat colonoscopy every 1-2 years

226
Q

Pruritic papules in intertriginous areas, spread skin-skin (often via clothing), more common in close living quarters like dorms, barracks, prisons.

A

Scabies

227
Q

What do you see on a peripheral smear with someone who has lead poisoning

A

Basophilic stipling (degraded rRNA)

228
Q

What should all breastfeed babies get supplements of

A

VitD (400IU); iron is not needed until about 6 months of age

229
Q

Description of basal cell carcinoma

A

Waxy, pearly, may have telangiectasias

230
Q

Description of squamous cell carcinoma on skin

A

Shallow ulcer with heaped up edges; may be covered with plaque/scale/crust

231
Q

Patients with Crohn’s should be counceled to avoid what commonly prescribed anti-inflammatory

A

NSAIDs; they can precipitate flairs

232
Q

Atopy, asthma, allergies, dermatography are mediated by what?

A

IgE causing mast cells to release histamine; aka Type I hypersensitivity

233
Q

First line treatment for epistaxis

A

Firm pressure on the cartilaginous portion of the nose for up to 30 minutes

234
Q

Raloxifene may do what in menopausal women?

A

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
Q

Most common medications that cause acute interstitial nephritis (AIN)

A

NSAIDs and proton pump inhibitors; rifampin, penicillin, and cephalosporins have also been implications

236
Q

Classic triad of symptoms seen in AIN

A

Rash, fever, eosinophilia

237
Q

Treatment of AIN

A

Removal of offending drug if present, and corticosteroids

238
Q

What is Russel’s sign?

A

Calluses on the back of the hand, often seen in bulimia nervosa

239
Q

Drug that has the most benefit in bulimia nervosa

A

Fluoxetine (SSRI)

240
Q

Classic pentad in thrombotic thrombocytopenic purpure

A

Fever, renal disease, microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities

241
Q

Signs and symptoms of meconium aspiration

A

Decreased oxygenation, difficulty breathing, tachypnea, in term or POSTTERM infants

242
Q

What respiratory problem can meconium ileus lead to?

A

Persistent pulmonary hypertension

243
Q

Winter’s formula

A

(1.5*bicarb)+8+/-2

244
Q

The inferior glands of the parathyroid and the thyroid gland are derived from what embryonic structure

A

Third pharyngeal pouch

245
Q

Pancreatitis can be cause by what diabetes drug?

A

GLP-1 agonists (exenatide, liraglutide, -tide, tide, etc.)

246
Q

Where is the most common location to injure the ureter during a hysterectomy

A

Near the cardinal ligament

247
Q

Quad screen results for neural tube defects

A

Increased MSAFP, decreased estriol, decreased B-hCG

248
Q

Quad screen results for down syndrome

A

Decreased MSAFP, decreased estriol, increase B-hcg, increased inhibin-A

249
Q

Quad screen results for Edward syndrome (trisomy 18)

A

Everything is low

250
Q

Rapid acting insulins

A

that GAL sure is fast; glulisine, aspart, lispro

251
Q

Short acting insuling (longer acting than rapid?)

A

Normal

252
Q

Intermediate acting insulins

A

NPH

253
Q

Long acting insulins

A

Glargine, detemir

254
Q

Granulosa cell tumors produce what

A

Estrogen

255
Q

How to monitor someone with a history of granulosa cell tumor and unilateral salpingo-oophorectomy

A

Inhibin levels

256
Q

If you suspect pancreatic cancer, what should you do after a RUQ ultrasound?

A

CT

257
Q

Difference between iron-deficiency anemia and thalassemias in labs?

A

Iron deficiency will have increased RDW

258
Q

Red cell morphology in autoimmune hemolytic anemia

A

Spherocytes

259
Q

What should you do in a woman over 35 with atypical glandular cells on pap smear?

A

Colposcopy + endometrial biopsy; only need colposcopy under 35

260
Q

Signs and symptoms of Fabry

A

Pain, proteinuria, hypertension, angiokeratomas and corneal verticillata

261
Q

Signs and symptoms of Gauchers

A

Pancytopenia, hepatosplenomegaly, diffuse infiltrative pulmonary disease

262
Q

Inheritance of Fabry’s

A

X-linked

263
Q

Inheritance of Gaucher’s

A

Autosomal recessive

264
Q

Enzymatic deficiency in Fabry’s disease

A

Glucocerebrisadoasdease

265
Q

Signs and symptoms of Klinefelter’s

A

Tall stature, behavioral issues, gynecomastia, infertility

266
Q

Genetic’s in Klinefelter’s

A

XXY

267
Q

Screening exams to consider in diabetic patients

A

Yearly foot, eye, and microalbuminuria checks

268
Q

Before what date is considered preterm premature rupture of membranes

A

37 weeks

269
Q

If the mother or the fetus are not at risk in PPROM, how do you manage them?

A

Manage expectantly; maternal vital signs, pelvic exam, fetal monitoring, and ultrasound

270
Q

Is adrenal crisis due to sudden withdrawal of steroids considered primary or secondary adrenal insufficiency?

A

Secondary

271
Q

Big difference between endometriosis and adenomysosis?

A

Adenomyosis usually has menorrhagia

272
Q

Major side effect of ginko biloba

A

Anticoagulant properties (bleeding!)

273
Q

Side effects of St. John’s Wart

A

Placebo-like side effects; n/v, fatigue. Also interacts with CYP3A4

274
Q

Herbal supplement incorrectly believed to help with erectile dysfunction

A

Ginseng

275
Q

Most common location of breast cancer

A

Upper-outer quadrant

276
Q

Most common benign parotid gland tumor

A

Pleomorphic adenoma (Warthin’s tumor is next most common)

277
Q

Most common presentation of pleomorphic adenoma (parotid gland tumor)

A

Painless, slow growing pre-auricular mass

278
Q

Common presentation of wegener’s (or polyangitis with granulomatosis)

A

Mucosal ulcers, recurrent sinusitis, rapidly progressive renal failure

279
Q

Sex-cord tumor that causes virilization in females

A

Sertoli-Leydig cell tumors

280
Q

Name the sex cord tumors

A

Sertoli-Leydig, granulosa, gynandroblastoma, and steroid cell tumors

281
Q

Iron studies in thalassemia

A

High ferritin, low to normal TIBC

282
Q

Best initial treatment in someone suffering urethral trauma

A

Suprapubic catheter

283
Q

Tanner stage 1 female

A

No glandular breast tissue or pubic hair

284
Q

Tanner stage 2 female

A

Breast buds and small amount of pubic hair on labia majora

285
Q

Tanner stage 3 female

A

Breast becomes more elevated, but lacks a secondary mound; pubic hair becomes more coarse and curly

286
Q

Tanner stage 4 female

A

Increased breast size with secondary mound; pubic hair extends to pubis bet spares thighs

287
Q

Tanner stage 5 female

A

Breast size increases, loses secondary mound; pubic hair extends to inner thigh

288
Q

Antibody associated with mixed connective tissue disease

A

Anti-U1 ribonucleotide antibody

289
Q

Signs and symptoms of mixed connective tissue disease

A

Non-erosive arthritis, Raynaud’s, muscle involvement, sclerodactyly and esophageal hypomotility

290
Q

What is the most common cause of neonatal congenital heart block?

A

Anti-Ro/SSA antibodies passed from a mother with Sjogren’s to a fetus

291
Q

External appearance of the kidneys in SLE with renal involvement

A

Flea-bitten appearance

292
Q

Conservative treatment for small kidney stones

A

Fluids (PO), pain meds, straining urine (to catch the stones so you can figure out the type

293
Q

What should you do if you have a pregnant lady with high grade intraepithelial lesions?

A

Colposcopy

294
Q

Most common group of cancers causing testicular cancer

A

Germ cell tumors (~95%)

295
Q

Findings for seminoma

A

history of cryptorchidism, well-defined hypoechoic mass on US,

296
Q

Lab value findings in DIC

A

Increased PT and PTT, low fibrinogen, low platelets

297
Q

Coag factor findings in vWB disease

A

Normal PT, elevated PTT, increased bleeding time, normal platelet count

298
Q

Treatment of choice for chancroid (H. ducreyi)

A

Single PO dose of azithromycin

299
Q

Toxic-multinodular goiter is also known as what?

A

Plummer’s disease

300
Q

Palpitations, sweating, increased HR 2 weeks after giving birth

A

Thyrotoxicosis

301
Q

Risk factors for placenta previa

A

Previous CS, advanced maternal age, cocaine abuse, smoking

302
Q

Type of exam CONTRAindicated in placenta previa

A

Pelvic exam

303
Q

Treatment for IgA nephropathy

A

Corticosteroids + an ACEi/ARB

304
Q

Protracted dilation is what rate?

A

1.2 cm/hr

305
Q

Major side effect in bupropion

A

Lowers seizure threshold

306
Q

Most common childhood renal tumor

A

Wilm’s tumor

307
Q

Beckwith-Weideman syndrome

A

Wilm’s tumor+omphalacele+macroglossia

308
Q

WAGR syndrome

A

Wilm’s tumor + aniridia + genito-urinary abnormalities+retardation

309
Q

How to manage 21-24 year olds with LSIL

A

Repeat cytology in 12 months

310
Q

Treatment of lichen sclerosis

A

Topical steroids first, then tacrolimus (calcineurin inhibitor) if that fails

311
Q

What do if someone who is pregnant has HSIL

A

colposcopy

312
Q

Antibiotics that are associated with ototoxicity

A

Aminoglycosides (gentamicin, tobramycin, neomycin, kanamycin)

313
Q

Fanconi syndrome is a side effect of what antibiotic

A

Tetracyclines

314
Q

Treatment of candidal esophagitis

A

Oral fluconazole

315
Q

Most common long-term sequelae of bacterial meningitis

A

CN VIII deficits (hearing loss)

316
Q

Treatment of clostridium perfringens necrotizing fasciitis

A

Clindamycin

317
Q

Most appropriate treatment for an athlete with an ACL tear

A

Bracing with mobilization and PT prior to reconstruction

318
Q

Treatment of mitral valve prolapse

A

Echo and reassurance

319
Q

Type of renal dysfunction multiple myeloma causes

A

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
Q

What is recommended weight gain in pregnancy based on?

A

Pre-pregnancy BMI; 30 should gain 11-20 lbs

321
Q

What type of imaging should you get in a kid with osteosarcoma?

A

Chest CT to look for metastases

322
Q

Chorionic villus sampling done before 9-11 weeks may put fetus at risk of what?

A

Limb abnormalities

323
Q

Congenital hypothyroidism may lead to what if untreated?

A

Mental retardation

324
Q

Some disease you may have an increased risk of if you have Down Syndrome

A

ALL and Alzheimer’s

325
Q

Triad of B12 deficiency

A

Weakness, sore tongue, paresthesias

326
Q

MOA of succinylcholine

A

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
Q

What do in a nosebleed if direct pressure has failed?

A

Anterior packing

328
Q

Where should you never use silver nitrate in nosebleeds?

A

On the septum due to risk of perforation

329
Q

If someone has myxedema coma, what should you check before giving thyroxine?

A

Cortisol, they may have coexisting adrenal insufficiency

330
Q

Why do beta-blockers increase the murmur in HOCM?

A

Increase the preload by blocking the vasodilatory effects of B2 receptors

331
Q

What should you do in post-op, dirty, or large corneal abrasions?

A

Prophylaxis with trimethoprim-polymyxin B eyedrops

332
Q

Diagnosing HIV?

A

Screen with ELISA, confirm with western blot

333
Q

How to treat someone with untreated HIV + active hep B infection

A

Interferon alpha, antiviral (tenofovir) and nucleoside reverse transcriptase inhibitor (emtracitabine)

334
Q

Screening for gestational diabetes

A

Done at 24-28 weeks; 1 hour glucose tolerance test is abnormal if greater than 140, if abnormal, repeat with 3 hour test

335
Q

Hormone responsible for gestational diabetes

A

Human placental lactogen; it has anti-insulin properties and is similar to human growth hormone

336
Q

Indications for cryoprecipitate over FFP

A

If the patient is volume overloaded or if the fibrinogen is low

337
Q

Treatment of choice for Toxoplasmosis

A

Pyrimethamine and sulfadiazine

338
Q

First line treatment for P. jiroveci and toxoplasmosis with CD4+ count under 100

A

TMP-SMX (same prophylaxis for P. jiroveci when count is under 200)

339
Q

What agent used to treat uterine atony is contraindicated if the patient has high BP?

A

Methylergonovine because it can cause severe hypertension

340
Q

When to perform a C-section in a HIV+ mother delivering a baby

A

Low CD4 count (less than 350) or viral load greater than 1000

341
Q

Hepatitis virus transmitted mainly through blood

A

Hep C (B can be transmitted via blood, but also by sex and birth)

342
Q

What is protease is decreased in thrombotic thombocytopenic purpura?

A

ADAMST13, aka vWF-cleaving protease; it cleaves vWF and thus makes a more thombogenic environment

343
Q

If a breast cancer patient is HER2/neu +, what should additional treatment should they receive?

A

Trastuzamab

344
Q

BUN/Cr ratio in post-renal obstruction

A

Greater than 15

345
Q

BUN/Cr ratio in intrinsic renal obstruction

A

Less than 15

346
Q

First-line treatment for cocaine induced chest pain

A

Benzos

347
Q

OMT for fibromyalgia

A

Indirect techniques like counterstrain

348
Q

Explain difference between SIRS, sepsis, severe sepsis, septic shock

A

SIRS you know, sepsis=SIRS + source of infection, severe sepsis = sepsis+ organ dysfunction, septic shock=sepsis derived hypotension unresponsive to fluids

349
Q

4 bones that make up the pterion?

A

Junction of temporal, parietal, sphenoid and frontal bones

350
Q

Osteopathic techniques useful on sutures

A

V spread

351
Q

Occipital and temporal bones join to form what foramen?

A

Jugular foramen

352
Q

What CNs exit the jugular foramen

A

IX, X, XI

353
Q

Occipito-mastoid suture formed by what bones?

A

Occiput and temporal

354
Q

What Cobb angles of the back do you consider using a brace?

A

20-40

355
Q

When do you consider surgery in scoliosis

A

Cobb angle >45

356
Q

Managing scoliosis with cob angles less than 20 degrees

A

Serial radiographs to monitor for progression, exercises, PT, OMM

357
Q

Muscles affect rib 1

A

Anterior and middle scale

358
Q

Muscle affecting rib 2

A

Posterior scalene

359
Q

Muscle affecting ribs 3-5

A

Pec minor

360
Q

Muscles affecting ribs 6-9

A

Serratus anterior

361
Q

Muscle affecting ribs 10 and 11

A

Latissimus dorsi

362
Q

Muscle affecting rib 12

A

Quadratus lumborum

363
Q

When will you get respiratory compromise in scoliosis

A

Cobb angle greater than 50

364
Q

When will you get cardio compromise in scoliosis

A

Cobb angle greater than 75

365
Q

Post-isometric muscle energy is AKA…

A

Direct muscle energy

366
Q

Reciprocal muscle energy is AKA…

A

Indirect muscle energy

367
Q

Maximum amount a shoe-lift can provide in short leg syndrome

A

1/2 “ or less than 2 cm

368
Q

How to measure leg length

A

ASIS and medial malleolus

369
Q

First line treatment in osteoporosis

A

Biphosphonates (alendronate, risodrenate, zolidrenic acid, denusomab)

370
Q

Treatment of choice for right mainstem bronchus foreign-body aspiration

A

RIGID bronchoscopy (NOT flexible)

371
Q

If the L4 nerve root is being compressed by a herniated disk, WHICH disk is it?

A

L3 disk (not L4)

372
Q

Most common organism causing epiglottitis

A

Haemophilus influenza

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