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Step 2 Ck > Step 2 CK part 2 > Flashcards

Step 2 CK part 2 Flashcards

1
Q

wernicke encephalopathy - w hat part of brain affected?

A

thalami

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2
Q

alcoholic cerebellar degeneration - what park of brain damaged?

A

purkinge cells of cerebellar vernis

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3
Q

3 drug regimens to use for uncomplicated cystitis

A
  1. nitrofurantoin x 5 days
  2. TMP-SMX x 3 days
  3. fosfomycin x1
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4
Q

contraindications to nitrofurantoin and TMP-SMX use in uncomplicated cystits?

A

nitro - avoid if suspected pyelonephritis or CrCl < 60

TMP-SMX - avoid if local resistance > 20%

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5
Q

what makes cystitis complicated?

A

preggo, DM, renal failure, UTobstruction, catheter, immunosuppressed, hospital acquired

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6
Q

tx for complicated cystitis

A

FQ x5-14d

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7
Q

pyelonephritis tx for outpatient and inpatient

A

outpatient - FQ

inpatient - IV abx: FQ or aminoglycoside +/- amp

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8
Q

3 encapsulated organisms most commonly present in ppl without spleen

A

pneumococcal
meningococal
H influ B

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9
Q

viagra:
official name/MOA
contraindicated if:

A

sildenafil
phosphodiesterase-5 inhibitor
contraindications = pt on nitrates or alpha blockers

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10
Q

schistocytes –
LDH?
haptoglobin?

A

ldh - incr

haptoglobin - decr

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11
Q

triad for trichenella

A

periorbital edema
myositis
eosinophilia

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12
Q

amyloidosis tx

A

colchicine

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13
Q

three antiphospholipid antibodies

A
  1. anticardiopilin
  2. anti-beta1 glycoprot
  3. lupus anticoagulant
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14
Q

atropine effect on eyes

A

mydriasis

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15
Q

what form of vitD do you take as supplement?

what is active form and how/where does it become active?

A

supplement- D3
active - 1,25-(OH)2D
via= 1-alpha-hydroxylation in kidney

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16
Q

salivary gland swelling and pain with meals

A

salivary gland stone

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17
Q

bilateral nontender submandibular gland swelling with salivary gland enlegrement

A

sialadenosis

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18
Q

triad for reactive arthritis
+ 2 other common findings

tx?

A

nongonococcal urethritis
asymmetric oligoarthritis
conjunctivitis
+2: mucocutaneous lesions, enthesitis

tx = NSAIDS

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19
Q

1 cause osteomyelitis in IVDU and SCD

A

s. aureus

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20
Q

tick bite with anemia and intravascular hemolysis (jaundice, dark urine, indirect hyperbilirubinemia)

A

babesosis

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21
Q

foodborne illnesses:

enterotoxin ingested

A

s. aureus and b.cereus

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22
Q

foodborne illnesses:

enterotoxin made in intestine

A

clostridium perfrinigens
ETEC
vibrio cholera

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23
Q

foodborne illnesses:

bacterial epithelial invasion

A

campylobacter jejuni
salmonella
listeria

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24
Q

central cord syndrome
how does it happen?
manifestations?

A

hyperextension injury in eldery person with pre-existing degenerative changes
weakness in UE > LE

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25
Q

anterior cord syndrome
loss of what?
preserved what?

A

loss - movement and P/T

preserved vib/proprio

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26
Q

brown-sequard

A

ipsi - weakness an dloss vib/proprio

contra - loss P/T

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27
Q

tx for anticholinergic overdose (atropine, diphenhysramine)

A

physostigmine

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28
Q

right vs left sided colon cancer presentations

A

right - anemia

left - obstruction

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29
Q

which cholesterol drug:

decreases LDL and TG

A

statin

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30
Q

statin SE

A

myositis and incr LFT

incr CK

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31
Q

which cholesterol drug:

increases HDL and decreased TG

A

fibrates

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32
Q

fibrate SE

A

myositis and incr LFT

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33
Q

which two cholesterol drugs:
decrease LDL only?
and what is the SE?

A

ezetimibe and bile acid resin

SE = diarrhea

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34
Q

which cholesterol drug:

incr HDL and decr LDL

A

niacin

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35
Q

niacin SE

A

flushing and itch

prevent with asa

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36
Q

vasospastic angina

preventatice and abortive tx

A

abortive - sublingual nitroglycerin

preventative - CCB (diltiazem)

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37
Q

causes of respiratory alkolosis

A 
CO2 < 36
HYPERVENT
tumor 
hypoexemia
atelectasis
PE
CHF
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38
Q

two most common heart problems in marfan syndrome

A

aortic dilation/regurg/dissection

MVP

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39
Q

S3 and S4 - what kind of gallops?

A

S3 - ventricular gallop

S4 - atrial gallop

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40
Q

myasthenia crisis tx

A

IVIG and plasmapharesis

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41
Q

what type of drug is atropine?

A

muscarinic receptor antagonists

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42
Q

type of bone lesions in multiple myeloma

A

osteolytic

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43
Q

MS acute attack tx

A

IC glucocorticoids –> plasma exchange

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44
Q

dypsnea, orthopnea, paroxysmal noctural dyspnea, hemoptysis.. what kind of heart problem?

A

mittral stenosis

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45
Q

chorioamnioitis:
what are diagnostic criteria?
(major plus 5)

A

maternal fever PLUS 1+

  1. fetal tachy (>1 60)
  2. matn tachy (>100)
  3. uterine fundal tenderness
  4. purulent amniotic fluid
  5. matn leukocytosis
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46
Q

criteria for premature rupture of membranes

A

+ ROM
+ term (>37 weeks)
(-) contractions

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47
Q

criteria for preterm premature rupture of membranes

A

+ ROM
(-) term
(-) contractions

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48
Q

preterm premature rupture of membranes management
< 34 weeks without infection
< 34 weeks with infection
34-37 weeks

A

<34w without infct = abx, roids
<34w with infct = abx, roids, deliver (add Mg if < 32w)
34-37 = abx, +/- roids, deliver

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49
Q

definition of arrest of active labor

A

no cervical change for 4 hours with adequate contractions
OR
no cervical change in 6 hours with inadequate contractions

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50
Q

tx for protraction vs arrest of active labor

A

protraction - oxytocin

arrest - c/s

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51
Q

preggo changes
CO? PV? SVR?
BP? HR? Hg?

A 
Co - incr
PV - incr
SVR - decr
BP - decr
HR - incr
Hg - decr
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52
Q

Protein/Cr ratio for preE

A

> 0.3

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53
Q

meaning of:

early, variable, and late decelerations

A

early - head compressin
variable - cord compression
late - uteroplacental insufficiency/ fetal hypoxia

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54
Q

timing of CVS and amnio

A

CVS - 10-13 weeks

amnio - 15-20 weeks

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55
Q

when to screen preggos for GDM?

A

24-28 weeks

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56
Q

name three DMd rugs that stimulate insulin secretion

A

sulfonureas
meglintie
incretin system

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57
Q

major side effects of sulfonureas (2)

A
  1. hypoglycemia

2. weight gain

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58
Q

what are the two drugs in the incretin system and their MOA?

A
  1. exentide: GLP1analog

2. sitagliptin : inhibits Dpp4

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59
Q

name two DM drugs that enhance insulin action

A

biguanide (metformin)

TZD (pioglitazone)

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60
Q

name 2 Dm drugs tha enhance glucose excretion

A

canagliflozin

acarbose

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61
Q

endometrial biopsy indications

A

AGE >45: AUB, postmen bleed
AGE <45: AUB + unopp estrogen, failed med mngmnt, lynch
AGE >35: atypical glanualr cells on pap test

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62
Q

adrenal insufficiency
primary?
central?

A

primary - decr cort, incr ACTH

central - decr cort, decr ACTH

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63
Q

level of bhcg when transvag u/s finds intrauterine pregnancy?

A

1500-2000

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64
Q

which vulvovaginitis infections have normal pH and elev pH?

A

normal - candida

>4.5 = BV and trich

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65
Q

Mg toxicity tx

A

IV calcium gluconate

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66
Q

fibrocystic changes vs fibroadenoma

A

fibrocystic changes -multiple nodules

fibroadenoma - solitary

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67
Q

fetal anemia heart tracing

A

sinusoidal

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68
Q

alternative tx for syphillis is pt allergic to pcn and its early syphillis

A

doxycycline

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69
Q

herpes dx?

A

pcr

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70
Q

granulosa cells secrete which two hormones?

A

aromatase and inhibin

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71
Q

arrest of second stage of labor criteria

A

no fetal descent after pushing for 3 hours (null) or 2 hours (multip)

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72
Q

baby with sniffles

A

congenital syphillis

73
Q

when to stop pap

A 
65 or hysterectomy 
PLUS
no h/o CIN2
AND
3 consecutive (-) pap
OR 
2 consecutive (-) cotesting
74
Q

acid base in preggos

A

respiratory alkalosis

75
Q

hemophillia blood levels

A

incr PTT only

76
Q

vWD blood levels

A

incr BT incr PTT

77
Q

preggo - asymptomatic bacturia tx

A

cephalexin (1st gen)
amox-clav
nitrofurantoin
fosfomycin

78
Q

PID tx
inpatient? (2 options)
outpatient?

A 
inpatient:
1. IV cefoxitin or cefotetan + oral doxy
2. IV gent/clinda
outpatient
1. IM ceftriaxone + oral doxy
79
Q

contraindications for:
methylergonovine?
carbaprost?

A

meth - htn - bc vasoconstriction

carba - asthma bc bronchoconstriction

80
Q

sheehan syndrome: what are FSH and LH levels?

A

both low

81
Q

preterm birth prevention
1. No h/o preterm –> first step?
if normal?
if short?

A

TVUS
norm - routine PNC
short - vag progesterone

82
Q

preterm birth prevention
2. h/o preterm –> first step?
if normal?
if short?

A

TVUS and progesterone shots
norm - serial TVUS till 24w
short - cervlage, serial TVUS till 24w

83
Q

adenomyosis uterus description

A

boggy
globular
tender

84
Q

overall increased risk breast cancer

A

bc increased lifetime estrogen exposure

85
Q

does having a baby increase or decrease lifetime estrogen exposure?

A

decreases

86
Q

three main systems involved in tissue invasive CMV dz

A

pulmonary
GI
liver

87
Q

what is the bloody HIV diarrhea?

A

CMV

88
Q

CMV tx

A

ganciclovir

89
Q

preterm labor
if <34 weeks?
if <32 weeks?

A

<34 toco + roids

<32 toco + roids + Mg

90
Q

erb-duchenne
which cranial nerves?
presentation?

A

C5,6,7

watiers tip

91
Q

Klumpke
which cranial nerves?
presentation?

A

C8, T1

claw hand

92
Q

which has impaired moro and bicpes reflex? (erb or klumpke?

A

erb

93
Q

which has horners? (erb or klumpke?

A

klumpke

94
Q

which has absent ability to grasp? (erb of klumpke?

A

klumpke

95
Q

subareolar, mobile, well-circumscribed, non tender breast mass
no fever
while breastfeeding

A

galactocele

96
Q

gold standard for definitive diagnosis of adenomyosis

A

histopathological exam of hysterectomy specimen

97
Q

what type of breast cancer shows microcalcifications on mammography?

A

DCIS

98
Q

PCOS - whats the deal with LH and FSH

A

they are imbalanced bc high estrone stimulates hypothalamus and = high frequency, short inteval GnRH. these pulses preferentially produce LH… lack LH surge = failure of follicle maturation

99
Q

AFP levels in downs, edwards, abd defect

A

downs and edwards - decr

abd defect - incr

100
Q

condyloma acuminata tx

A

trichloroacetic acid

101
Q

hidradenitis suppurtiva tx

A

doxycycline

102
Q

pyelonephritis in preggo tx

A

ceftriaxone

103
Q

lactational mastitis tx

A

dicloxacillin

104
Q

endometritis tx

A

amp + gent

+ clinda if c/s

105
Q

what causes theca lutein cysts?

A

ovarian hyperstimulation

GTD, twins, infertility tx

106
Q

two genetic abnormalities that cause primary ovarian insufficiency

A

turners and fragile X

107
Q

obesity is a risk factor for endometrial or cervical cancer?

A

endometrial

108
Q

cervical cancer risks

A

HPV/lotsa of rando sex
OCP
tobacco

109
Q

what drug induced ovulation for PCOS

A

clomiphene citrate

110
Q

HIV in preggos, what mode of delivery?

A

VL <1000 + HAARTS = vag

VL > 1000 or (-) HAART) = c/s + ziduvodine

111
Q

mom with HIV.. wha tto do with baby?

A

mom VL < 1000 - ziduvodine

mom VL >1000 - HAART

112
Q

what to do with ASCUS?

A

HPV testing

113
Q

three key findings of aromatase deficiency

A
  1. normal internal
  2. external virilization
  3. undetectable estrogen
114
Q

epithelial ovarian carcinoma mngmnt

A

ex lap

115
Q

describe BV discharge

A

white, grey and fishy

116
Q

1 and #2 most common posterior fossa tumors in kids

A 
#1 - astrocytomoa
#2 - medulloblastoma (worse prognosis)
117
Q

common symptoms of medulloblastoma in kiddos

A

truncal and gait instability

and obstructive hydrocephalus

118
Q

supratentorial tumor findings

A

incr ICP and seizures

119
Q

describe power, type 1 and type 2 error

A

power = prob of correctly rejecting null
type 1 = incorrectly reject null
type 2 = incorrectly accept null

120
Q

ARP formula

A

(RR-1)/RR

121
Q

NNT and NNH formula

A 
NNT = 1/ARR
NNH = 1/AR
122
Q

RR and OR formula

A 
RR = (a/a+b)/(c/c+d)
OR = (a/b)/(c/d)
123
Q

retrospective cohort description

A

compare dz incidence

124
Q

case control

A

compare risk factor frequency

125
Q

(+) LR and (-) LR formulas

A

(+) LR = SN/(1-SP)

(-) LR = (1-SN)/SP

126
Q

CI contains 1

A

cannot reject null for RR and OR

127
Q

CI contains 0

A

cannot reject null for means

128
Q

PPV and NPV formula

A 
PPV = a/(a+b)
NPV = d/(c+d)
129
Q

list 3 causes of hyperPTh

A
  1. adenoma: hi PTH hi Ca
  2. CKD: lo Ca hi PTH
  3. refrct CKD: hi hi PTH hi Ca
130
Q

list 3 causes of hypoPTH

A
  1. surgery: lo PTH lo Ca
  2. pseudo: hi PTH lo Ca
  3. pseudopseudo: norm PTH lo Ca
131
Q

best tx for emphysematous cholecystitis

A

ampicillin-sulbactam

132
Q

pancreatitis wtih ALT >150

A

gallstone pancreatitis

133
Q

three features of patellofemoral pain syndrome

A

pain worse with activty
pain worse with prolong sitting
crepitus with patella motion

134
Q

boundaries of anatomic snuff box

which artery?

A

extensor pollicus brevis
extensor pollicus longus
abductor pollicus longus
radial artery

135
Q

metoclopramine MOA and use in GI

A

dopamine antagonist

promotility (used for constipation/nausea)

136
Q

ondansetron MOA and use in GI

A

serotonin receptor antagonist
nausea
can contribute to constipation

137
Q

bowel sounds in emphysematous cholecystitis and why

A

decreased/absent

bc ileus

138
Q

patellar tendinitis - who gets it

A

athletes who jump or lots of forceful knee extension

139
Q 
axillary n
function  and fracture
A 
func - arm abduction, delt sens
fx - surgical neck humerus
140
Q

radial n

functino and fracture

A 
func - wrist exten, sup, dorsal hand/triceps
fx - midshaft humerus (wrist drop)
141
Q 
ulnar n
function and fracture
A 
func - finger flxn/abd/add and 4th5th finger
fx - medial epicondyle
142
Q

cause of ludwig angina

A

infected mandibular molar

143
Q

prosthetic joint infections
<3 mon
3-12 months
>12 months

A

<3 months - s.aureus
3-12 months - s epiderm
>12 months - s.aureus

144
Q

succinylcholine MOA

A

binds postsyn Ach receptors

= influx Na efflux K

145
Q

most common watershed areas for colonic ischemia

A 
splenic flexure (sma&amp;ima)
rectosigmoid junctino (sigmoid a and sup rectal a)
146
Q

which type of heparin good for ESRD? and which bad?

A

good - unfractionated hep

bad - LMWH hep and rivaroxaban

147
Q

abx before gi surgery

A

IV cefazolin

148
Q

fastest way to revere warfari

A

FFP

149
Q

hypovolemic shock – SVR?HR?EF?

A

all increased

150
Q

two drugs to help decrease etoh use

A

naltrexone (mu opiod antag)

acamprosate (glutamate modulator)

151
Q

contraindications for naltrexone and acamprosate

A

naltrexone - opiod depend or liver fialure

acamprosate - renal impariment

152
Q

mirtazipine se

A

incr appetite and incr sleepiness

153
Q

what to monitor if on lithium

A

kidney and thyroid

154
Q

bulemia tx

A

fluoxetine

155
Q

what kind of drug is benztropine

A

anticholinergic

156
Q

schizoaffective

A

mood with schizo and 2+ weeks delusions/hallucinations without moddd

157
Q

schizoid vs schizotypal vs avoidant

A

schizoid - like to be alone
schizotypal - weird, magicla
avoidant - avoid bc fear of criticism/rejection

158
Q

serotonin syndrome

A

tremor, myoclonus, hyperreflexia

159
Q

how long before starting MAOi should you stop fluoxetine?

A

5 weeks

160
Q

short acting BZ withdrawl

A

seizures if abrupt discontinuation

161
Q

person on PCP - how to calm down?

A

bz

162
Q

nightmare for nightterror

which occurs in REM and nonREM

A

nightmare - rem - remember

night terror - nonrem - dont remember

163
Q

three dopamine pathways and functions

A

mesolimbic - psychotic
nigostriatal - parkinsonism
tubuloinfundibular - prolactin

164
Q

piloerection, yawning, dilated pupils, hyperactive bowels

A

heroine withdrawl

165
Q

dont give haldol to seixure disorder

A

dont give haldol to seiizure disorder

166
Q

BP 1 monotherapy

A

lithium
valproate
quetiapine
lamotrigine

167
Q

if inadequate response to monotherapy for BP1 try –

A

lithium or valproate + second generation antipsychotic (quetiapine)

168
Q

important lab change with valproate

A

incr LFTs

169
Q

person with BP1 and kidney problems.. what should you use?

A

valproate

170
Q

displacement vs projection

A

displacemnt - transfer personal feeling to less threatening object/person(mad at dad but yell at dog)
projection - attribute one’s own feeling to others ( i am mad at joe, so youa re mad at joe)

171
Q

elderly sleep changes
sleep latency?
REM latency?
slow wave sleep?

A

sleep latency - incr
REM latency - decr
slow wave sleep - decr

172
Q

relaationship of antidep and bipolar

A

dont give antisepressant monotherapy to biipolar bc van induce mania

173
Q

acceptable tx for bipolar preggos

A

lamotrigine

174
Q

social anxiety tx?

A

SSRI, betablocker if performance type

175
Q

cortisol in MDD

A

incr

176
Q

acute bipolar depression tx

A

quetiapine, lurisdone, lamotrigine

177
Q

contraindications to
NSAIDs
Colchicine?

A

nsaids - on anticoagulants

colchcine - diarrhea, renal problems, old

178
Q

two ways to treat gout chronically

A
  1. overproduction - allopurinol

2. undersecretion - probenacid

Step 2 Ck (3 decks)

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