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Step 3 > Step 3 Q Bank q's > Flashcards

Step 3 Q Bank q's Flashcards

1
Q

Treatment of herpes zoster

A

acyclovir or valacyclovir x 7-10days, try to start within 72hrs of onset of rash

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2
Q

how is herpes zoster transmitted?

A

in the immunocompetent host, transmitted only via direct contact with the open lesions (in contrast to primary varicella aka chickenpox which is extremely contagious and transmitted through airborne droplets)

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3
Q

Preferred treatment for post herpetic neuralgia?

A
  1. Tricyclic antidepressants
  2. Topical Capsaicin cream
  3. Gabapentin
  4. Long Acting Oxycodone
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4
Q

Pathogenesis of idiopathic thrombocytopenia purpura?

A

platelet-specific autoantibodies, seen as sudden onset bleeding (petechiae, purport, epistaxis, and gingival bleeding), hx of infection

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5
Q

What are the three causes of failure to thrive?

A
  1. Inadequate calorie intake
  2. Inadequate calorie absorption
  3. Increased calorie requirements
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6
Q

When will you see low radioactive iodine uptake? 5 instances

A
  1. Silent thyroiditis
  2. Postpartum thyroiditis
  3. Surreptitious thyroid hormone abuse
  4. Iodine-induced thyroiditis
  5. subacute thyroiditis (de quervains)
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7
Q

treatment of choice for subacute thyroiditis

A

NSAIDs and beta blocker

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8
Q

genetic pathophys of MEN1

A

mutation of the tumor suppressive Menin1 gene

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9
Q

Characteristics of MEN1

A
  1. hyperParathyroidism
  2. ZES (gastrin-secreting Pancreatic tumor)
  3. Pituitary tumor (most common prolactinoma)
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10
Q

treatment of acne rosacea?

A

oral doxycycline

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11
Q

what is drug of choice for the immediate treatment of metoclopramide-induced acute dystonia?

A

IV diphenhydramine

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12
Q

Most common cause of acute renal failure in patients with cirrhosis?

A

hepatorenal syndrome (but must consider a diagnosis of exclusion)

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13
Q

treatment of choice for hepatorenal syndrome?

A

midodrine and octreotide + albumin

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14
Q

when should HIT be considered?

A

when platelet counts fall >50% from baseline 5-14 days after starting heparin

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15
Q

one major symptom of amiodarone?

A

causes thyroid dysfunction due to its high iodine content

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16
Q

two mechanisms by which amiodarone-induced-thyrotoxicosis may occur?

A
  1. Type 1: activation of grave’s disease

2. Type 2: destructive thyroiditis

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17
Q

positive antithyroid peroxidase antibodies

A

hashimoto’s thyroiditis

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18
Q

primary risk factor for the development of thyroid lymphoma?

A

preexisting hashimoto’s thyroiditis

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19
Q

major pathological feature of PSC

A

destruction of small and mid sized bile ducts

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20
Q

Antibodies seen in primary sclerosing cholangitis

A

antimitochondrial antibodies

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21
Q

antibodies seen in type I autoimmune hepatitis?

A

anti-smooth muscle antibodies

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22
Q

what can slow the progression of primary sclerosing cholangitis?

A

ursodeoxycholic acid (definitive treatment is w liver txp)

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23
Q

frequent complication of primary sclerosing cholangitis?

A

osteoporosis (due to decreased vitamin D absorbtion)

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24
Q

what are three EKG manifestations of severe hyperkalemia?

A
  1. Prolonged PR interval
  2. Widened QRS with sine wave pattern
  3. disappearance of p waves
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25
Q

what is the management of delivering babies w shoulder distocia?

A 
BECALM
Breath- don't push
Elevate legs into sharp hip flexion
Call for help
Apply suprapubic pressure
Large opening w episiotomy
Maneuvers: deliver posterior arm, corkscrew, all fours, lastly- push it back in and C section
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26
Q

SLE + renal involvement, what do you need?

A

renal biopsy! there are 5 types of renal involvement and they all have different treatments, thus need bx to know which type

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27
Q

what do you measure to monitor disease activity in SLE patients?

A

serum complement or levels of anti-dsDNA

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28
Q

most common cause of nec fasciitis in patients who are otherwise healthy?

A

group A strep

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29
Q

two different types of necrotizing fasciitis?

A

I: seen in patients with underlying diabetes and PVD, polymicrobial
II: individuals with no concurrent medical illness, hx of laceration/blunt trauma/surgery i.e. group A strep

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30
Q

Treatment of multiple sclerosis?

A

acute exacerbation = IV corticosteroids or oral but use IV in patients w optic neuritis
long term: beta interferon

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31
Q

Contraindications of breast feeding (6)

A
  1. Active TB
  2. Maternal HIV
  3. Herpetic breast lesions
  4. Varicella infection active
  5. Chemotherapy or ongoing radiation
  6. Active abuse of alcohol or drugs
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32
Q

fungus infection in patients with DKA

A

think mucormycosis caused by Zygomycetes

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33
Q

Definition of arrest of labor in first stage

A

> 6cm cervical dilation, ruptured membranes, and one of the following:

  • no cervical change in >4hrs despite adequate contractions OR
  • no cervical change for >6hrs with inadequate contractions
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34
Q

definition of adequate labor

A

> 200-250 MVU (montevideo units)

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35
Q

long term complication of RSV in kids?

A

up to 30% develop reactive airway disease

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36
Q

antibodies associated with Sjogren’s syndrome?

A

Anti-ro/SSA & Anti-La/SSB

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37
Q

what is the schemer test?

A

used to confirm the diagnosis of keratoconjunctivitis sick, filter paper is placed along the lower eyelid and wetting of the paper is measured after a defined period. too little = abnormal tear production
- used to rule in or out sjogrens syndrome

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38
Q

focal submandibular mass in a patient with sjogrens syndrome

A

concern for B cell non hodgkins lymphoma

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39
Q

how does sjogre’s disease lead to B cell lymphoma?

A

sjogrens results in polyclonal B cell activation and infiltration of the salivary glands, this can go awry and lead to B cell lymphoma

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40
Q

Most common cause of postpartum hemorrhage?

A

uterine atony

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41
Q

treatment of choice for uterine atony?

A

oxytocin and fundal massage, oxytocin is a uterotonic medication

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42
Q

what is HELLP syndrome?

A

hemolysis, elevated liver enzymes, and low platelet count

accounts for 20% of thrombocytopenia in pregnancy, ominous variant of preeclampsia

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43
Q

what is principal cause of infertility in patients with PCOS?

A

anovulation, weight loss can restore ovulation

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44
Q

definition of preeclampsia?

A

new onset hypertension (SBP>140 and/or DBP >90) at >20wks AND proteinuria or signs of end-organ damage

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45
Q

What are 6 severe features of preeclampsia?

A
  1. SBP >160 or DBP >110 on 2 occasions >4hrs apart
  2. Thrombocytopenia, plt 1.1 or doubling
  3. Elevated transaminases
  4. Pulmonary Edema
  5. New-onset visual or cerebral symptoms
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46
Q

what is the most troubling known complication of subchorionic hematoma?

A

spontaneous abortion

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47
Q

treatment of BV?

A
  • course of oral metronidazole or clindamycin
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48
Q

2 complications of bacterial vaginosis?

A
  1. Increased risk of preterm birth

2 Increased risk for acquisition of HIV, HSV2, G,C and trichomonas

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49
Q

Define: cohort study

A

a population is observed over time, grouped based on exposure to a particular factor and watched for a specific outcome, use RR

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50
Q

Define: case control study

A

retrospective study involving a group of people with a given disease and otherwise similar group of people without the disease who are compared for exposure to risk factors, use OR

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51
Q

when do you perform the triple marker screen/quad test?

A

between 15-20 weeks gestation

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52
Q

whats the difference between a quad screen and triple and whats included in them?

A

triple: AFP, estriol, b-HCG
Quad: adds inhibin-A, more sensitive to downs

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53
Q

how do you treat magnesium toxicity in moms treated for preeclampsia?

A

IV calcium gluconate

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54
Q

AFP is increased on triple marker test, what is it?

A

neural tube defect!

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55
Q

what do you see on triple marker test for trisomy 18?

A

decreased everything- AFP, estriol, b-HCG

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56
Q

what do you see on triple marker test for trisomy 21?

A

decreased AFP and estriol, increased b-HCG

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57
Q

whats all included in a biophysical profile? BPP

A 
Test the Baby, MAN!
Tone
Breathing
Movements
Amniotic fluid volume
Nonstress test
- give 2 for normal and 0 for abnormal
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58
Q

what is a negative test on the BPP? a positive?

A

negative = score 8-10, positive = score

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59
Q

what is a risk factor for chorioamnionitis?

A

Prolonged Rupture of Membranes

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60
Q

what is a risk factor for endometritis?

A

C section! and PROM

61
Q

is choir an indication for C section?

A

NO!

62
Q

what defect does Isotretinoin/etretinate cause in utero?

A

heart and great vessel defects, craniofacial dysmorphism and deafness

63
Q

which 4 antibiotics are teratogens and what do they cause?

A
  1. Tetracyclines: discoloration of deciduous teeth
  2. Quinolone: cartilage damage
  3. Sulfonamide late in pregnancy: kernicterus
  4. Streptomycin: CNVIII damage/ototoxicity
64
Q

what contrast material is a teratogen and what does it cause?

A

methylene blue- jejunal and ileal atresia

65
Q

what is the most common infection that causes IUGR?

A

CMV!

then toxoplasmosis

66
Q

definition of oligohydramnios?

A

amniotic fluid index

67
Q

definition of polyhydramnios?

A

AFI >25cm on US

68
Q

most common causes of third trimester bleeding? (2)

A

placental abruption and placenta previa

69
Q

what are maternal factors for indications for c section? 4

A
  1. Any prior c section
  2. Active genital herpes infection
  3. Cervical carcinoma
  4. Maternal trauma/demise
70
Q

Most common pathogens causing bacterial vaginosis?

A
  1. Gardnerella vaginalis
  2. Mycoplasma hominis
  3. Anaerobic bacteria
71
Q

treatment of BV?

A

metronidazole or clindamycin

72
Q

safest and most effective treatment for pregnant patients w bipolar mania?

A

haloperidol

73
Q

Positive family history of breast cancer includes what? 6

A
  1. 2x 1st degree relatives w breast ca
  2. 3 x 1st or 2nd degree relatives w breast ca
  3. 1st or 2nd degree relative w breast and ovarian ca
  4. 1st degree relative w bilateral breast ca
  5. breast ca in male relative
  6. ashkenazi jewish woman with any 1st or 2nd degree relative w breast or ovarian ca
74
Q

what is the most common cause of arrest of labor?

A

cephalopubic disproportion

75
Q

whats hornets syndrome?

A

anhydrosis, miosis, ptosis, enophthalmos

76
Q

drug of choice for chronic cluster headaches?

A

verapamil

77
Q

management of acute onset cluster headaches?

A

100% FiO2

78
Q

which 2 common vaccines have egg?

A

influenza and yellow fever

79
Q

how do you diagnose lyme disease?

A

initial ELISA and confirmatory with western blot

80
Q

when do you add IV ceftriaxone in treatment of lyme disease?

A

in setting of carditis or neurologic symptoms other than cranial nerve palsy

81
Q

what are the components of a CHADSVASc score?

A 
CHF (1)
HTN (1)
Age >75 (2)
DM (1)
Stroke/TIA (2)
Vascular dx (1)
Age 65-74 (1)
Sc: sex category, 1pt for female
82
Q

one major side effect of cyclosporin?

A

hyperuricemia: >50% of pts, decreases rate excretion from kidneys

83
Q

what do you see on aspiration of gouty joint?

A

negatively birefringent needle-shaped crystals

84
Q

treatment of gout in post renal txp patients?

A

intraarticular glucocorticoids

85
Q

most common cause of early death in acute stroke patients?

A

pulmonary embolism

86
Q

when do you do back blows versus abdominal thrusts on a choking patient?

A

1year = abdominal thrusts

87
Q

what is caisson’s disease?

A

decompression sickness!

88
Q

medical treatment of endometriosis?

A
  1. NSAIDs
  2. GnRH analogs
  3. danazol
  4. OCPs
89
Q

Indications for carotid endarterectomy?

A 
Men: 
Asx: >60%stenosis
Sx: 50-60% stenosis
Females:
70-99% stenosis
90
Q

dysfunctional uterine bleeding and anovulatory bleeding are treated with what?

A

OCPs or NSAIDs

91
Q

what is asherman’s syndrome?

A

endometrial adhesions likely 2/2 previous D&C, can be cause of amenorrhea

92
Q

what should b-HCG levels do during a normal pregnancy?

A

double every 2 days

93
Q

when can fetal heart motion be seen on US?

A

5-6weeks GA

94
Q

describe the rash in rocky mountain spotted fever

A

a petechial rash that begins on the ankles and wrists and spreads to the palms, soles, and then to central body

95
Q

what causes Rocky mountain spotted fever?

A

tick bite w gram neg organism Rickettsia rickettsii

96
Q

treatment of choice for RMSF?

A

doxycycline

97
Q

how do you diagnose spontaneous bacterial peritonitis?

A

find >250 neutrophils/mm3 in the ascitic fluid of a pt w cirrhosis or nephrotic syndrome

98
Q

antibodies seen in rheumatoid arthritis?

A

anti-CCP (cyclic citrullinated peptide) and rheumatoid factor (RF only positive in 70-80% of cases)

99
Q

how do you treat life threatening hemorrhage in patients on warfarin therapy?

A

FFP transfusion! vit k takes too long

100
Q

treatment of choice for latent TB?

A

isoniazid x9 months

101
Q

what is budd chiari syndrome?

A

hepatic vein thrombosis likely 2/2 thrombosis, usually affects young women

102
Q

treatment of choice for budd chiari?

A

thrombolytic therapy of the hepatic vein

103
Q

treatment of mild, moderate and severe lead poisoning in kids

A

Mild: nothing, repeat levels in 1 month
Moderate: DMSA
Severe: Dimercaprol + EDTA

104
Q

most common external manifestation of ADPKD?

A

hepatic cysts

105
Q

how do you screen family members of pts w ADPKD?

A

US of the abdomen

106
Q

which antipsychotics had the lowest incidence of drug-induced parkinsonism?

A

quetiapine and clozapine

107
Q

what antibodies are seen in dermatomyositis?

A 
Screening: +ANA
Anti-RNP
anti-Jo-1
anti-Ro
anti-La
anti-Mi2
108
Q

what two conditions is dermatomyositis associated with?

A

DM and malignancy, usually DM resolves once malignancy is treated

109
Q

which 4 drugs increase Thyroid Bonding Globulin? thus decreasing free T4 and requiring higher doses of thyroxine

A
  1. Estrogen
  2. Tamoxifen
  3. Raloxifene
  4. Methadone/heroin
110
Q

Which 4 drugs decrease Thyroid Binding Globulin and thus increase free T4 requiring a lower dose of thyroxine

A
  1. Androgrens
  2. Danazol
  3. Anabolic steroids
  4. glucocorticoids
111
Q

treatment of choice for dysfunctional uterine bleeding?

A

high dose estrogen followed by progestin

112
Q

what is herpes gestations? treatment?

A

autoimmune disease of pregnancy sowing as a rash around the umbilicus (PUPP spares the umbilicus)
treatment: corticosteroids

113
Q

first line contraception method in pts with sickle cell disease?

A

progestin-only methods, think Mirena IUD

114
Q

gold standard for treatment of endometritis?

A

clindamycin and gentamicin

115
Q

most important risk factor in the development of endometritis?

A

route of delivery

116
Q

Pts with klinefelter syndrome have a higher incidence of what type of cancer?

A

breast ca

117
Q

treatment for cryptorchidism?

A

aka undescended testes

orchiopexy before age 1, most undescended testes descend spontaneously during the first 6 months of life

118
Q

treatment of hyperthyroidism in pregnancy?

A

first trimester: switch to PTU (methimazole can cause scalp defects, TEFs, and channel atresia)
2nd and 3rd: switch back to methimazole bc PTU has risk of liver failure

119
Q

what is lurch syndrome?

A

Triad of

  1. lower extremity claudication
  2. absent or diminished femoral pulses
  3. Erectile dysfunction
120
Q

what are 3 red flags in developmental milestones?

A
  1. Persistent primitive reflexes by 6months
  2. Handedness before 1 year
  3. No pointing by 18 months
121
Q

which two childhood vaccines are live vaccines?

A

MMR and Varicella

122
Q

What are the TORCHeS infections?

A 
Toxoplasmosis
Other: HIV, parvovirus, listeria, TB, varicella
Rubella
CMV
Herpes
Syphilis
123
Q

Rubella infection in infants? presentation

A

“blueberry muffin” rash, cataracts, hearing loss, cardiac defects & PDA, encephalitis

124
Q

Toxoplasmosis infection in infants? presentation & tx

A

hydrocephalus, seizures, intracranial calcifications, ring enhancing lesions on head CT
tx: pyrimethamine

125
Q

treatment of CMV infections in babies?

A

ganciclovir

presentation: petechial rash, periventricular calcifications, microcephaly and chorioretinitis

126
Q

syphilis infection in infants? presentation and tx

A

maculopapular skin rash, lymphadenopathy, “snuffles”, osteitis
tx: penicillin

127
Q

jaundice in infants is NOT physiologic if it has what 3 features?

A
  1. occurs within the first 24 hrs of life
  2. severe or prolonged
  3. associated with a direct component
128
Q

What are the five known hereditary defects in bilirubin metabolism?

A
  1. Crigler Najjar type 1- absent UDP glucuronosyltransferase
  2. Crigler Najjar type 2- low levels of UDP GTA
  3. Gilberts- reduced activity of gluconyltransferase (conjugates bilirubin)
  4. Dubin Johnson- black liver, asx, defect in the ability of hepatocytes to secrete conjugated bilirubin into bile
  5. Rotor syndrome- like DJS but liver not pigmented, non-itching jaundice
129
Q

symptoms of kawasaki’s disease?

A 
CRASH and BURN
Conjunctivitis (bilat, nonpurulent)
Rash (truncal)
Adenopathy (LN>1cm)
Strawberry tongue
Hand/foot desquamation 
BURN (fever >5days)
130
Q

complications of kawasaki’s disease?

A

myocarditis/pericarditis

coronary artery aneurysm -> MI

131
Q

which types of VSD are least and most likely to close spontaneously?

A

least: membranous
most: muscular

132
Q

murmur of ASD?

A

wide and fixed split S2

133
Q

treatment of PDA?

A

indomethacin

134
Q

when shouldn’t you close a PDA?

A

in TGA! and in symptomatic TOF, give PGE

135
Q

4 components of tetralogy of fallot?

A 
PROVe
Pulmonary stenosis (RV outflow obstruction)
RVH
Overriding aorta
VSD
136
Q

what are tet spells?

A

squatting improves cyanosis when running and playing

137
Q

most common cause of bowel obstruction in first two years of life?

A

intussusception

138
Q

what is intussusception associated with?

A

Henoch Schonlein purpura and Cystic Fibrosis

139
Q

Classic triad of Henoch Schonlein purpura?

A
  1. Purpura
  2. Arthritis
  3. Abdominal Pain
140
Q

what are the contraindications to fibrinolysis w tPA? (6)

A
  1. Presence of active internal bleeding
  2. Bleeding diathesis (plt 33% of an arterial territory on CT
  3. Presence of intracranial hemorrhage on CT scan
  4. Intracranial surgery in last 3 mos
  5. BP >185/110mmHg
141
Q

screening test used for diabetic neuropathy?

A

tuning fork test

142
Q

first line treatments for diabetic neuropathy?

A
  1. Duloxetine (SNRI)
  2. Pregabalin/neurontin
  3. TCAs
143
Q

after administering tPA in a pt with CVA, what should blood pressure control be?

A

strictly 140/90

BP of 22/120 is okay in stroke pts who did NOT receive tPA

144
Q

First line tx for narcolepsy?

A

modafinil

145
Q

treatment for ALS?

A

riluzole: glutamate inhibitor, may prolong survival

146
Q

In a pt on heparin and warfarin who develops HIT, why do you stop warfarin as well?

A

increased risk of venous gangrene due to thrombocytopenia, wait until plot >150,000

147
Q

what is a case fatality rate?

A

the proportion of people with a particular condition who end up dying from the condition
diff from mortality rate which is the probability of dying from a particular disease in the general population

148
Q

how do you manage CIN 2 and 3?

A

excision or ablation of the transformation zone unless they are pregnant or are young and desire pregnancy

Step 3 (1 decks)

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