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Step 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is triple therapy for H pylori? What is quadruple therapy?

A

PPI
Clarithomycin
Amox or Metronizazole (if penn allergy)
Quad Therapy = bismuth + tetra instead of clarithro

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2
Q

What are the three situations in which hep B capsule antigen is positive and nothing else?

A
  1. Window period: IgM and liver enzymes elevated
  2. Distant Hep B infection: IgM and livers normal
  3. Chronic Hep B infection: IgM normal, HBV DNA is positive, possible abnormal livers
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3
Q

What are the INR levels for which warfarin changes/vit K are needed if there are no bleeding episodes?

A

<5: Hold for 1-2 days, restart when in range
5-9: Hold, give low dose K 1-2.5mg oral
>9: Hold, give high dose K 2.5-5mg oral

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4
Q

What is the threshold for bronchodilator challenge in asthma?

A

12% increase in FEV1

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5
Q

What is the empiric antibiotic choice for PID?

A

Cefoxitin + doxy IV +/- ceftriaxone

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6
Q

What is the predisposing condition to Mallory-Weiss tears?

A

Hiatal hernia

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7
Q

How is H pylori eradication confirmed?

A

Either Urea breath test or fecal antigen test

4 weeks after therapy is complete

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8
Q

What are Light’s criteria?

A

Trandudate:
protein fluid/serum <0.5
LDH ratio <0.6 or less than 2/3 normal serum limit

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9
Q

What is the first and second line treatment for pleural effusion related to liver cirrhosis?

A

First line: diuretics and Na restriction

Second line: TIPS

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10
Q

What cancers are associated with FAP?
What gene is sequenced for diagnosis?
By what age do 95% of them have cancer?

A

Duodenal and Gastric
APC is sequenced
45 years old

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11
Q

What are the options for N. meningitis exposure prophylaxis?

A
  1. Rifampin 600mg PO BID x 2 days
  2. Ceftriaxone 250mg single dose
  3. Cipro 500mg single dose
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12
Q

What are the Centor criteria for strep pharyngitis?

How is it scored?

A 
Cough
Lymphadenopathy
Fever
Tonsillar exudates
If less than 3, likely viral
If 2, needs further testing
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13
Q

How should recurrent C diff be treated?

A

Repeat metronidazole first

Vanco only for severe or resistant cases

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14
Q

What are the electrolyte abnormalities for Addison’s disease?

A

Hypo NA
Hypo CL
Hyper K
Possibly low glucose

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15
Q

When is the GTT done in pregnancy?

A

50g at 28 weeks
Again at 35-37 weeks
Unless age>25years, obesity, history of DM, spontaneous abortions, previous macrosomic infant

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16
Q

What is the check-up schedule for pregnancy?

A

Every 4 weeks until 28
Every 2 weeks until 36
Every week after that

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17
Q

What are the standard prenatal vitamins?

A

Folate
Iron
Prenatal vitamins
Prenatal counselling

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18
Q

What are the prenatal tests for pregancy?

A

CBC with diff
Atypical antiboy
Blood type and RH
Basic metabolic panel

Rubella antibodies
RPR
HIV
Chlamydia culture
Hep B surface antigen

Urinanalysis
Urine culture
Pap smear

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19
Q

Hydrophobia: Won’t drink because of throat spasms?

A

Rabies

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20
Q

What is the most common complication of cat-scratch fever? What are the less common ones?

A

Most: Suppuration of lymph nodes
Less: Hepatosplenomegaly, encephalopathy, vision loss from neuroretinitis

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21
Q

What is viral failure in HIV treatment?

What is the expected rate of drop in viral copies on the first HAART cycle?

A

Unable to get <200 copies in 6 months
<5000 in 4 weeks
<500 in 16 weeks
<50 in 24 weeks

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22
Q

What is preferred PEP for HIV?

A

Tenofivir: NRTI
Emtricitabine: NRTI
Raltegravir: Integrase inhibitor

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23
Q

What is the rate of conversion from acute to chronic Hep B?

A

Infants: 90%
Children: 20-50%
Adults: <5%

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24
Q

What are the target glucose levels for gestational diabetes?

What is the treatment if diet isn’t enough?

A

Fasting <95
1h post prand <140
2h post prand <120
Treat with insulin, meformin or glyburide

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25
Q

What are the major side effects of metformin?

What is its relationship with IVP dye?

A

GI Upset
LACTIC ACIDOSIS
Decreased B12 absorption
IVPD interacts with it, increases risk of acidosis
Hold it on the day of, restart 2 days after normal renal function documented

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26
Q

Red-coloured papules with central depression that look like molluscum?

A

Cutaneous cryptococcus

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27
Q 
What are the "buzzword terms" for 
senile gait
spastic paraperetic gait
cerebellar ataxic gait
LMN gait?
A

Senile: walking on ice, cautious
Spastic: scissoring, no knee flexion
Cerebellar: drunken sailor, jerky, irregular
LMN: high stepping, toes touch first

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28
Q

When does physiologic jaundice occur?

A

24h AFTER birth

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29
Q

What are the causes of SAAG >1.1

A 
CHF
Portal hypertension
Budd-Chiari
Cirrhosis
Alcoholic hepatitis
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30
Q

What are the criteria of end organ damage in MM?

A 
CRAB
hyperCalcemia
Renal failure
normocytic Anemia
Bone pain
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31
Q

First and second line drugs for restless leg?

A

Dopamine agonist: pramipexole

Benzos or gabapentin

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32
Q

What is the most common cause of sudden cardiac arrest in young people?

A

Anomalous coronary artery

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33
Q

What are the side effects of pentamidine?

What is it used for?

A

K can be hypo or hyper
Glucose hypo or hyper
Ca HYPO
Used for PCP in HIV, leshmaniasis

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34
Q

Drug for remitting/recurring MS?

A

beta-interferon/ glatiramir

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35
Q

What needs to be ruled out before diagnosing dementia?

A

Hypothyroid
B12 deficiency
Depression

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36
Q

What part of the brain is affected in Wernicke-Korsakoff?

What can cause it acutely?

A

Mammillary bodies

Giving glucose before thiamine

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37
Q

What are the choices of laxitive for kids?

A
  1. Milk of magnesia (osmotic)
  2. Bisacodyl suppositories (as a rescue)
    Castor oil causes fat vitamin deficiency and aspiration
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38
Q

What is the antidote to sulfonylurea, glyburide, or meglintide overdose?

A

Dextroes, then octreotide

Octreo is somatostatin analog prevents insulin release

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39
Q

Isolated gastric varicies =?

A

Splenic vein thrombosis secondary to chronic pancreatitis

40
Q

What are the common drugs that can cause pancreatitis?

A

Loop and thiazide diuretics
Tetracycline and metronidazole
Valproic acid
5-ASA and sulfasalazine

41
Q

What is pyleophlebitis?

A

Infection of the portal veins usually secondary to peritonitis

42
Q

Difference between scleroderma and achlasia?

A

Sclero has no LES tone
Achalasia has increased LES tone
Both have no peristaltic waves

43
Q

What are the two causes of major BRBPR bleeding and their signs?

A

Diverticulosis = pain

Angiodysplasia/vascular ectasia = aortic stenosis, endstage renal disease

44
Q

What antibiotics are associated with hypertrophic pyloric stenosis?

A

Erythromycin (for pertussis)

Macrolides

45
Q

What are the three predictors of liver disease severity?

A

1: INR
2. Creatinine
3. Serum bilirubin

46
Q

How is a prolactinoma treated What are their at risk for?

A

1st) Dopanine agonist: Bromocryptine/Cabergoline
2nd) Surgery if neuro symptoms
At risk for osteoporosis secondary to hypogonadism

47
Q

What complications does tight sugar control prevent?

A

MICROvascular ones: Nephropathy, retinopathy

48
Q

What is the endpoint in treating KDA?

A

normal anion gap

May need to add dextrose +/- K to insulin infusion

49
Q

When is lamivudine used?

A

Hep B infection with high PT/PTT or immunosuppressed

50
Q

What are the differences between measles and rubella?
What is the other name for measles?
What is roseola?

A

Both have head first rash
Measles has higher fever and ill-looking
Measles = rubeola
Roseola = truncal rash spreading to extremities

51
Q

Reddish-brown papule with sharp borders and jelly-like consistency?

A

Cutaneous TB

52
Q

Fever, joint pains, petichial bruising with Hx of travel?

What is the most serious consequence?

A

Dengue fever

Can result in shock/cardio collapse

53
Q

When is an implantable defibrillator indicated in CHF?
When is a biventricular pacemaker the answer?
What does it do?

A

EF <35%
Use biventricular if QRS is also >120ms
Forces both ventricles to contract at same time. Wide QRS means they’re not

54
Q

What are the target goals of statin therapy in ACS cs diabetes?
What are the criteria for statin therapy?

A

ACS: LDL<100
DM: LDL <70
Criteria: LDL>190, known vascular disease, age 40-75 with DM, or calculated 10 year risk >7.5%

55
Q

When do you use hydroxychloroquine vs methotrexate vs cyclophosphamide in SLE?

A

Hydroxy: for arthalgia, serositis, cutaneous symptoms
Metho: if other organs are affected
Cyclo: only for serious problems like nephritis, vasculitis or CNS involvement

56
Q

What antibiotics are associated with C Diff?

A

Clinda
Fluoroquinolones
Cephalosporins
Enhanced penicillins

57
Q

What is the immunization schedule for newborns with Hep B?

A

At birth, 3 months and 6 months

Check serology at 9 months

58
Q

What is the murmur of pulmonary stenosis?

A

Systolic crescendo/decrecendo at left upper sternal border

59
Q

What is the murmur of mitral valve prolapse?

A

Mid-systolic click with end-systolic murmur

60
Q

What is pseudohypoparathyroidism?
What is pseudopseudo?
What distinguishes any PTH problem from Vit D deficiency?

A

Pseudo = end organ resistance to PTH
Pseudopseudo = normal Ca and Phos, but short MC 4+5, round facies
Vit D has low Ca AND low Phos

61
Q

What are the grades of pregnancy safety in drugs?

A

A - Safe: human and animal studies
B - Likely safe: animal, but no human, or human studies safe
C - Only if benefits outweight risks: Risky in animals, no human, or no studies at all
D - Only in severe circumstances: Fetal risk in human or post-market studies
E - Unsafe: Fetal risk in human studies

62
Q

In hypovolemia, cardiac shock and septic shock, what measurements are high amongst cardiac output, wedge pressure and SVR?

A

Hypovolemia: SVR is high
Cardiac: Wedge and SVR is high
Septic: CO is high

63
Q

What is the treatment for lead poisoning?

A

45-70ug/dL: Succimer, DMSA PO

>70: dimercapterol +EDTA IV

64
Q

What is the management of ARDS?

A

High PEEP
Proning
Low tidal volumes (6ml/kg)
Diuretics, maybe dobutamine

65
Q

What ratio indicates ARDS?

A

PO2 / FIO2 <200

66
Q

What tests are ordered after pleurocentesis?

A 
Gram stain and culture
Fluid and serum protein
Glucose
Acid-fast stain 
Fluid and serum LDH
Cell count w/diff
Triglycerides
pH
67
Q

What are the treatments for pulmonary hypertension?

A
  1. Bosentan - endothelin inhibitor prevents growth of pulmonary vasculature
  2. Epoptostenol/trepostinil: PG analogs dilate pulmonary vasculature
  3. CCB: weak
  4. Sildenafil
68
Q

What are the signs of pulmonary hypertension?

A

Loud P2 (second part of S2)
Tricuspid regurg: holosystolic but at LEFT sternal border
Right ventricular heave
Raynaud’s phenomenon

69
Q

What exposures are linked to beryliosis?

A

electronics
ceramics
Fluorescent light bulbs

70
Q

What is criteria for home O2?

A

PO2<55 or O2sat <88%

71
Q

What should be ordered for an asthma or COPD exacerbation?

A
  1. Inhaled bronchodilator
  2. IV prednisone
  3. Inhaled ipatropium
  4. O2
  5. Mg
72
Q

What should be ordered for all SOB?

A
  1. O2
  2. Continuous O2 sat
  3. CXR
  4. ABG
  5. Peak expiratory flow meter
73
Q

What are the other long-acting options for asthma control?

A
  1. cromolyn/nedocromil for hay fever
  2. Montelukast for atopic disease
  3. Tiatropium/ipotropium for COPD
  4. Omalizumab for high IgE when cromolyn fails
74
Q

Which murmurs get softer with squatting or leg elevation?

A

Mitral valve prolapse

Hypertrophic cardiomyopathy

75
Q

Which herbals are associated with liver toxicity?

A

Kava kava

Black cohosh

76
Q

What are the management additions for non-acute asthma management?

A
  1. Inhaled dilator: albuterol
  2. Inhaled steroid
  3. Long acting B-agonist: salmeterol/formeterol
  4. Oral steroids last resort
77
Q

What is the time line of complications post MI?

A 
Reinfarct: 0-2 days
Pericarditis: 1-4 days
Ventricular septal rupture: 0-7 days
Free wall rupture: 0-14 days
Papillary rupture: 2-14 days

Postinfarct angina: 0-1 months
Pericarditis: 0-3 months
Left ventricular aneurysm: 5 days to 3 months

78
Q

What two infections is ribavirin used for?

A

Hep C and RSV ONLY

79
Q

How are influenza, pertussis and N. meningitis transmitted?

A

Droplet

80
Q

How are varicella, TB and measles transmitted?

A

Airborne

81
Q

What are the tell tale signs of chlamydia pneumo in neonates?

A

Staccato cough
Hyperinflated lungs
History of conjunctivitis
Sometimes NO FEVER

82
Q

What are the symptoms for a respiroatory fungal infection?

A

Fever
Pulmonary: cough and chest pain
Sinus: headache and nose bleed

83
Q

What antibiotics are used for neonatal sepsis? For which suspected organisms?

A

<28 days: Amp + Gent or cefotaxime for E. coli and GBS

>28 days: Ceftriaxone or cefotaxime +/- vanco for Strep pneuo and N. Meningitis

84
Q

When cephaosporins can be used vs pseudomonas?

A

Cefepime

Ceftaxidime

85
Q

What are the CSF signs of crypto meningitis?

A
  1. High lymphocytes but low leuks <50
  2. High protein, low glucose
  3. Really high open pressure 250-300mmHg
86
Q

What is the treatment for acute pericariditis post-MI?

A

ASA high dose

87
Q

What causes edema in CCB use? What can make it better?

A

Preferential dilation of arteries creates relative venous insufficiency
ACEI can make better

88
Q

How does licorice cause HTN?

A

Blocks 11-beta hydroxysteroid reductase

Cortisol can’t become cortisone and acts on mineralocorticoid receptors

89
Q

What arrhythmia can occur with inferior MI? Which leads? How to treat?

A

Sinus brady
II, III, avF
Atropine

90
Q

What is the medical treatment for aortic dissection?

A

Beta-blockers first

Nitroprusside only if BP>100-120 after blockers

91
Q

What screen should happen with a Dx of bicuspid aortic valve?

A

Thoracic aortic aneurym from dilation of root

92
Q

What produces broad and notched P waves?

A

Mitral stenosis secondary to rheumatic fever

93
Q

What is an atrialized right ventricle called? What causes it?

A

Ebstein’s anomaly

Caused by lithium in pregnancy

94
Q

What are the time limits for PCI for STEMI?

A

Within 12 hours of onset
90 minutes on door entry
120 minutes on door if non-PCI hospital

95
Q

What are 3 coronary heart disease equivalents?

A

Non-coronary athlerosclerosis
Diabetes
Chronic renal failure

96
Q

When is human vs equine anti-botulism toxin given?

A

Human: Infantile flaccid paralysis from spores to avoid hypersensitivity of equine
Equine: Flaccid paralysis from non-spore food

97
Q

What are the symptoms of digoxin toxicity? What drugs should be looked for?

A

Nausea, anxiety, visual disturbance, confusion

Look for verapamil, amiodarine and quinidine

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