Step 3 part 1 Flashcards
(152 cards)
1
Q
Tx for latent TB
A
9months isoniazid
2
Q
MI: Lateral wall defect of LV means which coronary a. is occluded:
A
Left circumflex coronary a.
3
Q
Recent trip to Africa
Periodic fevers, myalgias
Splenomegaly
thrombocytopenia
A
Malaria (plasmodium falciparum)
Ppx: antimicrobial
4
Q
Acute otitis bugs in kids: (3)
*if concurrent purulent conjunctivitis
Tx
A
Moraxella, strep.pneumo, non-typeable H. influenza.
(adenovirus less common cause-no purulent discharge)
*If concurrent purulent conjunctivitis: H. Influ
Tx: uncomplicated-10day course of amoxicillin
recurrent-amp/clavulanic acid (augmentin)
Myringotomy, tube placement if persistent >3mth or 3 and + occurrences in 6 mth
5
Q
Kartagener syndrome
A
autosomal recessive disorder, situs inversus, chronic sinusitis, airway disease bronchiectasis. Primary ciliary dyskinesia
6
Q
Common causes of recurrent or chronic sinusitis
A
Air pollution, second hand smoke, inadequately treated acute sinusitis, structural abnormalities, allergic rhinitis (seasonal allergies)
7
Q
vertigo, unilateral hearing loss, tinnitus
A
Meniere’s disease
8
Q
Presbycusis
A
Loss of hearing with aging,
9
Q
serous otitis media v.s suppurative otitis media v.s bacterial otitis externa vs. necrotizing otitis externa
A
- Serous otitis media: fluid in ear but not infected or inflammed, Exam= bulging tympanic membrane
- Suppurative otitis media: Infected fluid in middle ear, will drain purulent fluid tympanic membrane ruptures. Fever, cranky kids, No pain with manipulation of pinna. Staph Aureus.
- Bacterial otitis externa: Swimmer’s ear, pain with manipulation of pinna. Pseudomonas
- Necrotizing otitis externa: aggresive Pseudomonas infection affecting surrounding bone. Fever, pain, purulent drainage but usually elderly and diabetic and immunocompromised
10
Q
Acute otitis media risk factors in babies
A
Second hand smoke, no breastfeeding, pacifier use, day care,
11
Q
PPSV 23 vaccine (pneumococcal polysaccharide vaccine) is given to kids with___
A
cochlear implants, asplenia, cardiac disease, sickle cell anemia (kids at high risk of pneumococcal diseases). **if less than 2 years old PPSV 13 is better to mount immune response
12
Q
Tympanostomy for acute otitis media recommended for kids when
A
3 or + episodes in 6 months or 4+ episodes in 12mth, or high risk of speech and hearing impairment (craniofacial abnrmlaties kids or neurodevlpmtal disorders)
13
Q
dysphagia vs odynophagia
A
diffculty swallowing vs pain with swallowing
14
Q
Thyroglossal duct cysts
A
Common appearance of neck swelling that moves with protusion of tongue. 1/3rd appear after 20 yo. Thyroglossal duct connects tongue to thyroid. Ectopic tissue often only functional thyroid tissue so get imaging before considering cutting it out.
15
Q
chronic rhinitis:
- allergic
- non-allergic
A
AR appears at <20yo w/ watery eyes, sneezing, nasal congestion, watery rhinorrhea. Identifiable triggers. Normal or pale blue mucosa with polyps.
NAR appears >20yo w/ nasal blockage, rhinorrhea and post-nasal drip. Cant ID trigger. Nasal mucosa: nrml or boggy and erythematous. Tx: intranasal glucocorticoids or antihistamines
16
Q
otalgia
A
ear pain
17
Q
cleft lip +/- palate: repair at age___
A
3 mths of age, RUle of 10: 10lbs, 10 weeks of age, 10g of Hgb
Can be autosomal dominant or recessive or X linked
18
Q
Negative exercise stress test means…
A
<1% risk of cardiovascular events in the next year
19
Q
Factors associated with increased risk of CV event on exercise stress test: -Clinical variables v/s EKG variables
A
- Clinical variables: poor exercise capacity, angina at low workload, fall in SBP from baseline, chronotopic incompetence
- EKG variables: >1mm ST depression, ST depression at low workload, ST elevations without Q waves, Ventricular arrhythmias
20
Q
Bronchoprovocation testing for asthma. Positive and diagnostic findings are:
A
Fall in expiratory volume in 1 sec>10% =positive
if fall >15%=diagnostic
> 20% reduction in FEV1 with methacholine
21
Q
TCA overdose
list TCA:
A
amitriptyline, nortriptyline, trimipramine, desipramine. (SNRIs, antihistamine, anticholinergic activity)
Mental status change, seizures, respi depression
Anticholinergic effects: dry mouth, blurred vision, dilated pupils, flushing, hyperthermia, urinary retention
CV effect:sinus tachycardia, arrhythmias, hypotension–> cause most of the death in TCA overdose as it prolongs PR/QRS/QT interval–> V.tach, V.fib
Tx: Sodium bicarbonate, best tx for managing cardiotoxic effects: increases pH and neutralizes TCA (non ionized) making them less available to bind to rapid sodium channels and inhibit them. It also increases extracellular Na.
22
Q
mydriasis
A
dilated pupil
23
Q
refeeding syndrome is due to which electrolyte being low:
A
phosphate
As dextrose present in TPN is given it shifts Phosphate into cells causing hypophosphatemia–> seizures, rhambdomyolysis, arrhythmias, CHF
24
Q
obstructive vs. restrictive PFT
A
Obstructive: decreased FEV1 and decreased FEV1/FVC
Restrictive: decreased FEV1 and FVC but increased FEV1/FV, it will be > 80%
25
bacterial endocarditis ppx
High risk cardiac conditions: previous IE, prosthetic valve, structural valve abnormality in transplanted heart, unrepaired/repaired congenital heart disease
Indicated procedures: Dental, GU and GI if active infection, infected sin and muscle surgery, prosthetic cardiac material placement.
26
asthma or cystic fibrosis pt w/ recurrent exacerbation of fever, malaise, cough with brownish sputum, wheezing and bronchial obstruction
allergic bronchopulmonary aspergillosis: pt become hypersensitive to Aspergillus antigens w/ intense IgE and IgG immune responses.
aspergillus
-CT shows bronchiectasis
-eosinophilia
-positive skin test for Aspergillus
-elevated Apergillus specific and total IgE
tx: steroids and antifungal
27
DVT treatmt
Oral Xa factor inhibitor (rivaroxaban) for > or = to 3 months for pt with DVT or PE and no cancer. If malignancy LMWH has better outcome.
28
harsh holosystolic murmur in 4th left intercoastal space
Ventricular septal defect (enlarged RV, LA, LV, pulm arteries)
29
mid-systolic ejection murmur over the LSB
| wide and fixed splitting of S2
Atrial septal defect (enlarged RA, RV)
30
Hypertrophic cardiomyophathy murmur is
Harsh cresc-decresc systolic murmur at apex and L left sternal border
31
Beck triad
hypotension, JVD, decreased heart sounds
| Cardiac tamponade most spe finding is: Early diastolic collapse on echo
32
trastuzumab-related cardiotoxicity is irreversible or reversible
reversible
33
TIMI score:
assess mortality for patient with unstable angina or NSTEMI: 1pt each
-Age> or = to 65
-> or = 3 risks factor for CAD (Family history of CAD, hypertension, hypercholesterolemia, diabetes, or current smoker)
-Known CAD (= or >50% stenosis)
-Aspirin use in last 7 days
-Severe angina (2 or + episodes in 24hr)
-EKG ST changes greater or equal than 0.5mm
-positive cardiac enzymes
0-2 Low risk: stress test
3-7: coronary angiogram w/in 24h
Hemo unstable: immediate coronary angiogram
34
Aortic dissection tx
Adequate pain control (morphine), lowering SBP to 100-120; decreasing LV contractility to reduce aortic wall stress (beta blocker first line: esmolol/propranolol/labetalol, +/- Nitroprusside if SBP still >120), emergent surgical repair
**hydralazine (arterial vasodilator), nitroprusside (arterial and venous vasodilator) cause reflex sympathetic stimulation--> tachycardia, increased LV contractility and increased aortic wall shear stress which could increase propagation of aortic dissection
35
Kerley B lines represent:
interstitial edema
36
Maternal hyperglycemia can cause what on babies heart?
Poorly controlled glucose--> glycogen deposit on myocardium--> hypertrophy of heart w/ septum most often affected--> outflow tract obstruction
Condition resolves after birth!
37
Antecedent nasal congestion/discharge, cough
| Age <2yo now presenting with wheezing/crackles, respiratory distress
Bronchiolitis, caused by Respiratory Syncytial virus
Tx: respi isolation and supportive care or Palivizumab if Preterm, chronic lung disease or heart disease
-> associated with reccurent wheezing and reactive airway disease in up to 30% of kids
38
Number needed to treat NNT
| number of pts needed to be treated in order to prevent or cure one disease or medical condition
NNT: 1/ARR (absolute risk reduction)
| -ARR: risk of "something" in exposed/treated group - the risk in UNexposed/placebo/control group
39
Initial treatment for HCOM
Beta blockers best initial tx
Negative inotropes: also verapamil and dysopyramide
(slow HR for more filling of LV)
40
Wolf Parkinson White syndrome sx, tx
Wide QRS, delta waves
Kid becomes dizzy, dypsneic, passes out and recovers with not other sx
tx: procainamide, quinidine, ablation of pathway
Sudden cardiac death risk is low but increases in pt with episodes of tachyarrhytmias.
41
CHADS2VASc
```
CHF (1pt)
HTN (1pt)
Age>75yo (1pt)
Stroke or TSA (2pt)
Vascular disease (1pt)
Age 65 to 74yo (1pt)
Sex female (1pt)
```
42
First degree AV block
Prolonged PR interval
43
Second degree AV block
- Mobitz 1
- Mobitz 2
Mobitz 1: Wenckebach: PR progressively longer until QRS droppes
Mobitz 2: no PR prolongation, QRS dropped intermittently
44
third degree AV block
none of the P waves conduct to ventricle
45
Noncyanotic congenital heart defects
ASD, VSD, PDA
46
Cyanotic congenital heart defect
Truncus arteriosus, Transposition of great vessels, tricuspid atresia, Tetralogy of fallot: VSD, RVH, pulm stenosis, overriding aorta, total anomalous pulm venous return
47
Calcium channel blocker names and SE
amlopidine, nifedipine (dihydropyridine)> non-DHP CCB (verapamil, diltiazem)
SE: peripheral edema in 25% after 6mth of use
48
HTN prevention
- weight loss best non pharmalogical measure
- Dash diet next
- Exercise
- Low sodium diet
- Reduce alcohol intake
49
Severe aortic stenosis criteria:
- Aortic jet velocity
- Mean transvalvular pressure gradient
- Valve area
-Aortic jet velocity > or = 4.0m/sec
-Mean transvalvular pressure gradient> or = 40mmHg
-Valve area < or = to 1cm cubed
Valve replacement if onset of sx, EF<50% or getting cardiac surgery for other stuff (CABG)
50
Causes of acquired long QT syndrome
- Meds: Diuretics, antiemetics, antipsychotics, TCA, SSRI, antarrhythmics, antiangical , Antimicrobial
- Met disorder: HYPO K, Mg, Ca, starvation, hypothyroidism
- Bradyarrhythmias: Sinus node dysfxn, AV block
- Others: Hypothermia, MI, Intracranial disease, HIV
- -> Mg Sulphate tx
51
Brugada syndrome EKG findigns
pseudo-RBBB and persistent ST elevation of V1 to V2
- pt die from V.fib not exertional related
- ICD
- Quinidine, 1a
52
Marfan mutation in ___ gene
fibrillin gene
53
Hazard ration that are significant
HR>1 is significant
54
Sensitivity analysis
Repeating primary analysis calculations after modifying certain criterias or variable ranges. The goal is to determine whether such modifications affect the results initially obtained.
55
Common CNS infection in AIDS
Cryptococcus neoformans
56
rhomboid shape and positive birefringence under polarized light
Pseudogout. Calcium pyrophosphate dihydrate crystals, 50% of pt with hemochromatosis have these crystals. So does hyperparathyroidism, hypoparathyroidism. Tx: colchicine and NSAIDS
57
disease modifying anti-rheumatic drugs DMARDs
RA tx
-methotrexate, steroids than use infliximab or etanercept (anti-cytokine such these last 2 can reactive TB so screen with PPD skin test prior to giving)
58
Microcytic anemia
Lead poisoning, Thalassemia, sideroblastic anemia, iron deficiency
59
Sensitivity
TP/(TP+FN) Ability to detect disease
High sensitivity test: Screening test (catch them all, how many signals have to go off before pt deemed to have disease, good to catch as many even if negative to r/o disease)
60
Specificity
Ability to detect health TN/(TN+FP)
High specifity: disease confirmation
(ok well you might loose people that have the disease but you wont have a test + if someone doesn't have the disease)
61
Positive predictive value
When a test is +, the PPV measures how likely it is that pt has the disease. Depends on prevalance of disease and spe/sensi of test. The higher the prevalence the higher the PPV
TP/(TP+FP)
62
Negative predictive valure
When test -, NPV measures how likely it is that the pt is healthy (not with disease) TN/(TN+FN)
63
Attributable risk
number of cases attributable to one risk factor. put another way, the amount you would expect the incidence to decrease if a risk factor were removed .
AR: (Risk in exposed-in UNexposed)/risk in exposed
64
Relative risk
compares the disease risk in exposed population to disease risk in the unexposed population. Any RR value other than 1 is clinically significant. ONLY AFTER PROSPECTIVE or experimental study.
RR: risk in exposed group/risk in UNexposed group
65
Odds ratio
ONLY for retrospective studies. Compares odds of pt w/ disease having been exposed v.s odds of pt w/out disease got exposed
66
p<0.05
stat significant (less than 5% chance)
67
metoclopramide
Reglan: anti-emetic, dopamine antagonist (peripheral and central D2 blocker) SE: extrapyramidal symptoms: akathisia, dystonia, parkinson-like symptoms
68
neonatal hyperbilirubinemia
Mild: maximize brestfeeding every 2-3h
Moderate: Phototherapy, consider formular and IV fluids
Severe (bilirubin >20-25mg/dL): exchange transfusion in baby
69
likelihood ratio
the probability of a given test result occurring in a patient with a disorder compared to the probability of the same result occuring in a pt without the disorder. Calculated from spe/sensi not dependent on prevalence
Positive LR: Sensi / (1-spe)
Negative LR: (1-sensi)/spe
70
Confounding bias vs. Effect modification bias
Effect modification bias: an extraneous variable (effect modifier) changes the direction or strength of the effect an independent variable has on the dependent variable (outcome). ex: aspirin causes Reye syndrome in children and not in adults. Effect modifier: age
*Stratifying by the effect modifier will show different effect in each stratum*
Confounding bias: extraneous variable (confounder) obscures the association between exposure and outcome. *Stratification doesnt change anything*
71
Child, platelet count<100,000 w/ sudden onset of bleeding: petechiae/purpura, mucosal bleeding, internal hemorraghe . Recent viral infection, NO current systemic disease or other abnrml labs.
Immune thrombocytopenia due to autoimmune platelet-specific autoantibodies.
If mild tx: observation
If moderate/severe: IV immune globulin
(50% have remission after few years).
72
Multiple myeloma
Malignant clonal proliferation of plasma cells that produces monoclonal protein
CRAB
Calcium elevation
Renal insufficiency
Anemia (normolytic)
Bone Pain (lytic lesions, commonly low back)
Dx: serum or urine protein electrophoresis
> or = to 10% clonal plasma cells in bone marrow or soft tissue/bone plasmacytoma
(If untreated complication can be hyperviscosity syndrome, renal insufficiency, hyperCa, infection, thrombosis)
73
external validitiy in biostats means
generalizability
74
vitamin B6 is called
pyroxidine
75
SAAG
serum-ascites albumin gradient:
If > or = to 1.1 then portal HTN, think CHF, cirrhosis, alcoholic hepatitis
If < then 1.1 NOT portal HTN think peritoneal carcinoma, peritoneal TB, nephrotic syndrome, pancreatitis, serositis
76
Pernicious anemia: autoimmune destruction of
parietal cells or intrinsic factor (antibodies against those two)
on gastric endoscopy: antropy of body and fundus, glandular atrophy, intestinal metaplasia, inflammation (autoimmune metaplastic atrophic gastritis)
77
Diagnosis test for sickle cell disease
Hemoglobin electrophoresis
78
Most common inherited thrombophilia (repeat DVT/PE)
Factor V leiden
79
bug of osteomyelitis in sickle cell kid and abx tx
Salmonella, MRSA, Ceftriaxone and clinda
80
Acute chest syndrome in sickle cell ABX tx
Azithromycin (for mycoplasma pneumo) and ceftriaxone (for strep pneumo)
81
Polycythemia Vera has an elevated or decreased EPO, due to mutation of --- gene
Jak2 mutation, tyrosine kinase gene
Polycythemia vera has low EPO, bone marrow goes crazy and makes too much rbc
(Secondary polycythemia has high EPO usually 2/2 to chronic hypoxia/sleep apnea)
82
Drugs that induce pancreatitis
Thiazide diuretics and loop diuretics, ACE inhib, ARB
Autoimmune (mesalamine, corticosteroids)
Chronic pain (NSAIDS, acetaminophen, opiates)
Seizure (valproate, carbamazepine)
HIV (Lamivudine)
83
MELD (Model for End Stage Liver Disease)
Calculated based on sodium, creatinine, bilirubin, inr
Used for 90 day survival prognosis and prioritizing of liver transplantation.
Score of 10 or greater is bad.
84
Light criteria, exudate and transudate common causes
Exudate if:
-Pleural protein/serum protein> 0.5
-Pleural LDH/Serum LDH>0.6
-Pleural LDH> 2/3 upper limit of normal serum LDH
Pathophysiology of exudate: inflammation
Common causes: Infection, malignancy, CT disease, PE, pancreatitis, post-CABG
Transudate
Patho: Hydrostatic or oncotic pressure
Causes: Cirrhosis, nephrotic syndrome, heart failure, constrictive pericarditis
85
hematochezia w/ orthostatic hypotension (or hemodynamic instability) suggests bleeding at Upper or Lower GI?
Upper: large volume bleed
86
Primary biliary cholangitis
Symptoms: fatigue, pruritus, inflam. arthritis, RUQ pain, xanthelasmata, xanthomata
Dx: elevated ALkaline Phosphatase, +AMA, liver biopsy, antimitochondrial antibodies
Tx: Ursodeoxycholic acid, liver transplantation
Pathophysio: autoimmune disease, T cell attack on intrahepatic bil ducts--> fibrosis, obliteration of ducts--> cirrhosis
Screen them for osteoporosis and osteopenia
87
Elevated TSH and normal T4 get.... test
Antithyroid peroxidase measurement for hashimoto (hypothyroidism)
88
DEXA T score for osteoporosis and osteopenia
T -2.5 or lower is osteoporosis
| T-1 to -2.5 for osteopenia
89
hypertension + hypokalemia and test to order to confirm diagnosis
Conn's syndrome= primary hyperaldosteronism
| Test: plasma aldosterone to renin ratio (ratio> 30 is suggestive, need aldosterone level >15 too)
90
Statin should be initiated in pt of ages 40-75 with diabetes 1 or 2 who have LDL> or = to
LDL> or = to 70mg/dL
91
systemic sclerosis Limited (CREST) vs. diffuse
```
Limited:
C: Calcinosis of skin
R: Raynaud phenomenon
E: Esophageal dysmobility
S: Sclerodactyly
T: telectangia
Diffuse: Skin + lungs (pulm HTN and interstitial lung disease) + GI involvement
```
92
Jaundice due to breastfeeding failure vs. breast milk
Breastfeeding failure: first week of life due to subopitmal breastfeeding leading to decreased bilirubin elimination
Breast milk jaundice: age 3-5 days peaks at 2 weeks w/ adequate breastfeeding due to High levels of beta-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation (kernicterus from breast milk jaundice is very rare)
93
Predictors of acute pancreatitis severity are
BUN>20, BMI>30, Hematocrit>44% ( indicates hemoconcentration from third spacing losses, CRP>150
94
Patient at increased risk of colon cancer
First degree relative <60 yo with colon cancer OR greater/equal to 2 first degree relative with colon cancer or adenomatous polyps at any age
95
Treatment of DKA:
* Normal saline bolus over an hour
* Insulin drip
* IV with K if K low or normal
- > dont give bicarbonate (no benefit and might cause hypokalemia, metabolic alkalosis, cerebral edema)
* If glucose<200 but pt still has elevated anion gap then halve insulin drip and add dextrose infusion
* When transitioning to subQ insulin, continue insulin gtt fror 1-2h to allow subQ to take effect and prevent rebound ketoacidosis.
96
Amiodarone 3 different effects on the thyroid:
* 1) Amiodarone decreases peripheral conversion of T4 to T3 therefore pt has High T4, low T3 and normal or mildly elevated TSH. Most prominent in first 3 months and then improves, clinically euthyroid
* 2) High iodine content in amiodarone inhibits TH synthesis-> primary hypothyroidism
* 3)Amiodarone induced thyrotoxicosis, TSH is low.
97
non insulin hyperglycemic agent that cause hypoglycemia as side effect
Sulfonylurea (glyburide, glipizide, glimepiride), meglitinide (repaglinide, nateglinide) bc they increasei insulin secretion by pancreatic cells
98
anosmia, hypogonadotropic hypogonadism
Kallman syndrome
99
radioactive iodine uptake in subacute thyroiditis ( deQuervain's) is...
diminished bc thyroiditis causes release of stored TH not increase in TH production!
Also low uptake of iodine in painless/silent thyroiditis, postpartum thyroiditis, TH abuse
100
Treatment of subacute Thyroiditis
supportive (NSAIDS, betablocker)
101
Presentation of subacute thyroiditis
Likely postviral inflammatory process (after URI), fever, hyperthyroid symptoms, painful/tender goiter with diminished radioactive iodine uptake.
102
non insulin hyperglycemic agent that cause weight gain
Thiazolidinediones: Pioglitazone, rosiglitazone (increases insulin sensitivity in peripheral tissue by PPAR transcription regulator).
103
Symptoms of adrenal insufficiency ( Addison's disease), PE, labs
weight loss, abdominal pain, asthenia, amenorrhea, fatigue, poor appetite. PE: muscle tenderness, decreased axillary and pubic hair, **Increased pigmentation due to co-secretion of ACTH and melanocyte stimulating hormone
Labs: hyponatremia, hyperkalemia, mild hyperchloremic metabolic acidosis, hypoglycemia
Test: morning cortisol with ACTH if low cortisol but elevated ACTH= primary adrenal insufficiency
104
Tx for pustulopapular rosecea
topical metronidazole, if no pustules can treat with topical brimonidine *pt usually also have ocular symptoms
105
Erythema nodosum
painful and erythematous subcutneous nodules, located bilaterally in lower extremities
Associated with Sarcoidosis
106
Erythema nodosum + facial palsy + lymphadenopathy
| Dx, Tx
Sarcoidosis, Tx: steroids, Dx: biopsy of LN or parotid gland or lacrimal glands, salivary glands
107
Chronic urticaria
Recurrent episodic sx of wheals + pruritus >6 weeks. Ususally episodes last 24h. Self-resolves in 2-5 years. Triggers: many cold/hot due to mast cell activation.
40% have associated angioedema
Tx: second generation antihistamine (loratadine, cetirizine)
108
Cetirizine
second generation antihistamine
109
Severe seborrheic dermatitis is associated with
HIV and Parkinson's
110
Pyoderma gangrenosum is associated with
Necrotic deep ulcers. associated with Inflammatory bowel disease
111
Paget disease labs:
Elevated Alakaline phosphatase, nrml Ca
| Tx: bisphosphonates
112
Niacin deficiency
Pellegra: dementia, diarrhea, dermatitis (in sun exposed area +/- blisters), stomatitis, cheilosis
113
polymyositis and dermatomyositis dx test (antibodies)
ANA, anti-Jo 1, anti SRP
114
Polymyositis vs. Polymyalgia rheumatica
Polymyositis: weakness
Polymyalgia: pain and stiff, no weakness.
Both treated with steroids
115
Primary adrenal insufficiency vs. central adrenal insufficiency
Primary: High ACTH, subnormal increase in cortisol with ACTH stimulation
Central: Low ACTH, subnormal response to ACTH stimulation bc of adrenal atrophy from chronic ACTH deficiency
116
ulcerative colitis treatment
Mesalazine (mesalamine, 5 Aminosalicylic acid)
117
Treatment for trigeminal neuralgia
carbamazepine
118
Treatment of status epilepticus
- benzodiazepine: lorazepam, diazepam.
- if seizure persist: phenytoin (1b antiarrhythmic medication which causes hypotension and AVblock.) Fosphenytoin does not have these SE.
- if seizure persist: phenobarbital
119
Absence seizure treatment
ethosuximide
120
Anterior spinal artery infarction symptoms
Loss of motor functional below
Loss of pain and temperature
Intact sensation and proprioception
121
Brown Sequard syndrome symptoms
Loss of pain and temperature on contralateral side
| Lost of proprioception, vibration and motor on the ipsilateral side
122
Syringomyelia
Loss of pain and temperature bilaterally in arms, loss of reflexes and atrophy.
123
Benztropine, trihexylphenidyl
anticholinergic medication. Relieve tremor and rigidity in mild parkinsonism.
124
Amantadine
increase release of dopamine from substantia nigra
125
pramipexole, ropinirole
dopamine agonist. In severe parkinsonism.
126
LMN or UMN:
| weakness, wasting, fasciculations
LMN
127
LMN or UMN:
| weakness, spasticity, hyperreflexia, extensor plantar responses
UMN
128
Spina bifida clinical features and comorbidities
Tx at birth is surgery but pt can still have:
Neurogenic bladder/bowel
Motor/sensory dysfunction
Hydrocephalus
Scoliosis
*Elevated alpha-fetoprotein on maternal screening is suspicious for Neural tube defect
129
Cerebral palsy features
delayed motor milestones
hyperreflexia, hypertonia, sustained clonus
comorbid seizures, intellectual disability
*risk factor is prematurity, low birth weight
W/u: MRI (majority have abnormal findings such as periventricular leukomalacia, brain malformation, ischemia)
130
Mini mental status examination: score of ____ indicates dementia
<20
20-24 mild dementia
(its out of 30)
131
Tuberous sclerosis:
Cause
Clinical features: skin, neuro, CV, renal
MCC of death
Autosomal dominant
"Ash-leaf spots" hypopigmentation
Angiofibromas
Shagreen patches
Epilepsy, CNS lesions, cognitive disabilities, Autism, behavioral problems
Rhabdomyomas (regress in adult life), angiomyolipomas
*Most common cause of death is epilepsy and neuro impairment
132
bilateral cerebellopontine angle masses caused by proliferation of which cells:
Acoustic neuroma 2/2 to Schwann cells proliferations (Schwannomas)
133
Vertebrobasilar insufficiency
reduced blood flow in the base of the brain, usually 2/2 to thrombi, emboli or arterial dissection. Labyrinth and brainstem often affected: vertigo, dysarthria, diplopia, numbness. Risk factors: HTN, DM, smoking...
134
Pt with asthma or Cystic Fibrosis and recurrent infection and BROWNISH productive cough, fleeting infiltrates on Xray
Allergic bronchopulmonary aspergillus: Hypersensitivity disorder, exaggerated IgG and IgE response to aspergillus (noninvasive colonization in lungs)
Tx: glucocorticoid and intraconazole
135
Wallenberg syndrome
vertigo, nystagmus (horizontal and vertical), loss of pain and temp in ipsilateral face and CONtralateral body, bulbar muscle weakness (dysphagia, dysarthria, hoareseness, ipsilateral Horner's syndrome (miosis, ptosis, anhydrosis), hiccups
136
croup: What? Who? Tx?
Parainfluenza, <3 yo, barking cough, inspiratory stridor, hoarseness
Tx: humidified air, 1 dose of steroids (IM or oral) if you want to reduce stridor and corticosteroids+ nebulized epinephrine if moderate/severe croup or concern for upper airwary obstruction.
137
Wernicke's sx and Korsakoff's sx. + Korsakoff's MRI findings:
Wernicke: encephalopathy, oculomotor dysfunction, gai ataxia. Tx: thiamine.
Korsakoff: retrograde/anterograde amnesia, confabulation MRI: mammillary body atrophy (complication of chronic thiamine deficiency).
138
Tx for prolactinomas
dopamine receptor agonist , usually no surgery is required
139
Pineal gland tumor classically presents with ____ syndrome
Parinaud's syndrome: Loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus and ataxia
140
SE of carbamazepine
Bone marrow suppression: ex neutropenia
141
Which diuretic does not increase lithium levels:
CCB or loop diuretics
142
dermatitis herpetiformis presentation:
pruritic papules and vesicles on the extensor surface of elbows and knees as well as the buttock and back. Tx: gluten free diet
143
chronic pruritis rash with excoriation and lichenification is:
atopic dermatitis, often associated to asthma and allergies. Tx: oral antihistamines, skin hydration, avoidance of hot/dry environment, topical glucocorticoids: hydrocortisone, triamcinolone...
144
Acute cystitis and asymptomatic bacteriuremia treatment in pregnant woman
Cephalexin, amoxicillin-clavulanate, fosfomycin, nitrofurantoin (NOT bactrim as it can cause neural tube defects)
145
chlamydia treatment
azithromycin, doxycycline
146
Gonorrhea treatment
Ceftriaxone
147
Alzheimer medication treatement (3+1)
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Anticholinesterase inhibitor (donepezil, rivastigmine, galantamine)
Memantine
```
148
Antibiotic treatment in COPD exacerbation: inpatient vs. outpatient
Inpatient: Levofloxacin or Ceftriaxone
Outpatient: Bactrim or doxycycline
149
Hypertensive crisis tx drug:
Nitroprusside IV
150
Preeclampsia prevention in high risk pt
high risk: med hx of HTN, KD, DM, prior preeclampsia
| Tx: aspirin starting at 12 weeks gestation
151
Pregnant women w/epilepsys at increased risk for
preeclampsia, preterm labor, abruptio placenta,
152
autoimmune hepatitis antibodies (2)
anti smooth muscle antibodies and ANA antibodies
