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COMLEX LEVEL2 > True learn missed > Flashcards

True learn missed Flashcards

1
Q

Alpha-1 antitrypsin deficiency causes what?

A

Emphysema and Liver Failure (genetic disease that presents in adult hood)

this is a hereditary disease (family members will have history of it) , alpha-1 antitrypsin cannot leave the liver leading to liver failure and therefore cannot exert its protectional effects on the lung tissue (protects lungs from proteases)

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2
Q

Bicipital tendonitis presents with pain located where

pain is exacerbated with what movements?

A

over the anterior shoulder worst at the bicipital groove

exacerbated with supinator or flexion

tx: conservative–> glucorticoid–>surgery

speed and yeargon tests are positive

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3
Q

subacromial bursitis pain is located where?

A

it is often poorly localized but pain can be around the acromion and is worse with overhead activities

pain can awaken you up at night

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4
Q

what are the treatment regimine options for latent TB (positive ppd but negative CXR)

A

Isoniazid for 9 months (pregnancy)

Isoniazid + rifapentine for 3 months (not in pregnancy)

Rifampin for 4 months (if isoniazid isnt tolerated)

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5
Q

Positive PPD <5mm

A

HIV patients with close contact to a person with active contagious disease

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6
Q

PPD >5mm

A

HIV, abnormal CXR, immunosuppressed patients on steroids, chemotherapy organ transplantation, TNF alpha, close contact with someone with active TB

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7
Q

PPD >10

A

children less than 4 years old
healthcare workers
Hep C, IV drug use, dialysis, diabetes, underweight
foreigner with high TB incidence (MEXICO)

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8
Q

PPD >15

A

health individuals older than 4 years old

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9
Q

What class of medications are recommended for initial treatment for fluid management in congestive heart failure- name the drugs in this class (4)

A

Loop diuretics

  1. bumetanide
  2. furosemide
  3. ethacrynic acid
  4. torsemide
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10
Q

Electrolyte abnormalities from loop diuretics

A

hypokalemia, hypomagnesemia, metabolic alkalosis

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11
Q

what are the electrolyte abnormalities from thiazide diuretics?

A

hypokalemia, hypomagnesemia, metabolic alkalosis

(inhibits Na/Cl in the distal tubule)

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12
Q

Acetazolamide indications and electrolyte derangments

A

glaucoma, mountain sickness, pseduotumor cerebri

metabolic acidosis and hypokalemia

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13
Q

Amiloride MOA and electrolyte derangments

A

inhibits ENaCs in the late distal tubule and collecting duct

hyperkalemia , decreased blood pressure

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14
Q

Why do people with COPD have increased hemoglobin and hematocrit

A

because hypoxia from a lung disease increases erythropoietin secretion and stimulates erythropoiesis

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15
Q

when should supplemental oxygen be given to patients with COPD?

A

when PaO2 <55mmHg or resting oxygen saturation is <88%

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16
Q

people with cor pulmonale, pulmonary hypertension, and hematocrit greater than what should be put on supplemental oxygen

A

55%

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17
Q

what are the two treatments that are shown to reduce mortality in patients with COPD?

A

smoking cessation and supplemental oxygen therapy

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18
Q

epiglottis sign on X-Ray

A

thumbprint sign (softened voice/hot potato voice)

seen on lateral X-ray- differentiate from retropharyngeal abscess

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19
Q

Lead pipe sign is seen in what pathology

A

ulcerative colitis (the colon loses its haustra)

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20
Q

steeple sign is found in?

A

Laryngotracheal broncitis (croup)

-tracheal narrowing

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21
Q

string sign is seen in

A

chrons disease (inflammation and fibrosis)

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22
Q

What is an alternative to steroid treatment in asthma for a patient who DOES NOT want to take a steroid

A

a leukotriene receptor antagonists aka montelukast

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23
Q

salmeterol is what class

A

long acting beta agonist (always given in conjunction with an inhaled glucocorticoid because monotherapy is linked to increased mortality)

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24
Q

workup for dermatitis herpetiformis

A

direct immunofluorescence, and serologic testing for any of the following

antigliadin
anti tissue transglutaminase 2 (preferred)
anti endomysium antibodies

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25
Q

treatment of dermatitis herpetiformis

A

dapsone and avoidance of gluten

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26
Q

imaging for scabies

A

mineral oil preperation of skin scraping

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27
Q

A positive sphix test means what

A

sacrum is backwards/extended

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28
Q

what does a positive lumbosacral spring test indicate (decreased spring at the lumbosacral junction)

A

sacrum is extended or backwards

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29
Q

description of a phyllodes tumor and treatment

A

description: large fast growing solid hypoechoic well circumscribed mass that may present with cystic areas (overlying can be taut and shiny with visible veins)

treatment: wide local excision

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30
Q

diagnosis of diabetes (3 criteria)

A

hemoglobin A1c > 6.5%

fasting glucose > 126 on 2 seperate occasions

2 hours plasma glucose test >200 in asymptomatic patient

random blood glucose > 200 in symptomatic patient

oral hypoglycemic medications should be given if the HbA1c is well above the 6.5% threshold

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31
Q

metformin is contraindicated in what instance

A

if GFR <30 of severe BUN/CR abnormalities

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32
Q

in patients with a hemoglobin A1C greater than 10 what is the first line treatment

A

INSULIN, diet modification, weight loss, and exercise

33
Q

social smile develops when

A

3 months

34
Q

sitting up without support develops when

A

6 months

35
Q

raking grasp develops when

A

6 months (transfers objects between hands)

36
Q

when do babies develop a pincer grasp and can crawl?

A

9 months

37
Q

when can babies walk and throw objects, with separation anxiety

A

1 year

38
Q

patients with severe burns greater than 20% should have what monitored?

A

urine output (along fluid resuscitation)

39
Q

what is the parkland formula for burns?

A

4ml X % BSA burned = total amount given in the first 24 hours

administer half in the first 8 hours and the remaining half in the next 16 hours

40
Q

complications of receiving too much fluid in burn victims

A

pulmonary edema, compartment syndrome, swelling of the arms and legs

41
Q

which lung cancer has a poor prognosis, metastasizes easily, but has a great response to chemotherapy

A

small cell lung cancer
(associated with smoking)

dx: squamous cell poor response to radiation/chemo, treat with excision , can also present with hypercalcemia

42
Q

the diagnosis of pancreatitis requires 2 out of the 3

A

epigastric pain

amylase or lipase 3X upper limit

and imaging ( if the first 2 are present IMAGING IS NOT NECESSARY TO START TREATMENT)

43
Q

treatment of pancreatitis

A

IV hydration, NPO , antiemetics and analgesics

44
Q

scoring for morality in pancreatitis

A

Ranson score >3

APACHE score > 8

45
Q

howell-jolly bodies are seen in what pathology

A

sickle cell disease

they are inclusions of nuclear chromatin remnants due to autosplenectomy

46
Q

patellofemoral syndrome symptoms

A

pain going up and down stairs

crepitius on ROM

pain with flexion and with sitting for a long time

47
Q

meniscal tear symptoms

A

knee pain, locking and clicking of the knee joint

48
Q

clinical trials compare what?

A

therapeutic benefit of a treatment and placebo or of 2 or more treatments

49
Q

open label trial

A

RCTs that have more bias than double blinded RCTs in which both the subjects and investigators are aware of treatment assignments

one group goes to treatment group second group goes to placebo or standardized treatment

50
Q

post herpetic neuralgia

A

persistence of pain at the initial site of herpes zoster after resolution of the rash

risk is increased with advanced age

51
Q

employers are NOT allowed to require genetic testing as a prerequisite of employment, this is a violation of what act

A

The genetic information Nondiscrimination act of 2008 (GINA)

tell the patient this is a violation

52
Q

What states it is ehtical for a physician to provide palliative therapy to relieve pain and sufffering even if treatment may hasten/cause death in said patient if the purpose is to relieve suffering and medications are titrated for that purpose

A

doctrine of double effect

53
Q

euthanasia vs. physician assisted suicide

A

euthanasia- physician adminsters drug that kills patient with the goal to kill patient (illegal)

physician assisted suicde- physician prescribes drug that patient then self adminsters to end their own life (legal in oregon, washington and montana)

54
Q

TCAS effect on the heart

A

block fast sodium channels which can cause QRS widening and a prolonged QT interval

55
Q

how to combat QRS widening in TCA overdose

A

administer sodium bicarbonate to prevent sodium channel blockade

56
Q

how to stabalize cardiac membrane in the setting of hyperkalemia

A

calcium gluconate

“peaked T waves, wide QRS”

57
Q

if there is suspected bacterial meningitis what do you do

A
  1. lumbar puncture
  2. antibiotics >50 ampicillin, vancomycin, and ceftriaxone and steroids
58
Q

acute epididymitis symptoms

A

untilateral scrotal pain
tenderness, swelling, relieve of pain with scrotal elevation known as phren sign, urinary frequency, localized tenderness along the posterior aspect of the testicle

59
Q

MCC of epididymitis in <35 and >35

A

<35: Chlamydia and Gonorrhea - treatment is with oral doxy and IM ceftriazone

> 35 E. Coli- treatment is with oral levofloxacin for 10 days

60
Q

what medication can cause epididymitis

A

amiodarone

61
Q

what are the dysfunction of fryettes first principle of vertebral motion?

A

dysfunction includes more than 1 vertebrae

there is a neutral curve and rotation and side bending are in opposite directions

veterbral rotation and translation are to the same side (translation induces opposite side sidebending)

62
Q

Small bowel obstrucution initial imaging

A

supine and upright abdominal radiographs (X-rays)

63
Q

What is klienfelter syndrome

A

testicular atrophy/fibrosis leading to hypergonadotrophic hypogonadism

increased FSH and LH

decreased testosterone

gynecomastia, long arms and legs, small testes, and intellectual disabilities. 47XXY

(high estradiol as well)

64
Q

what is the workup for klienfelters syndrome

A

total testosterone, LH and FSH

65
Q

what is idopathic endolymphatic hydrops

A

meniners disease (vertigo, hearing loss, and tinnitus)

increased pressure in the inner ear

66
Q

viral labyrnitis

A

tinnitus and hearing loss following a virus that is self limited and resolves with time

67
Q

when accepting gifts in general esp from a pharmacetical rep what is accepted

A

you can accept gifts that will benefit patients (medical supplies, medical textbook, smart phone app) not any that will not benefit the patient ( sporting tickets, dinner)

68
Q

ascending tracts responsible for

A

sensation

69
Q

niopsy in primary sclerosing cholangitis shows what

A

periductal sclerosis (aka onion skinning)

associated with HLA-DR52a and Ulcerative cholitis

70
Q

primary biliary cirrhosis biopsy shows

A

granulomatous destruction of the intrahepatic bile ducts

71
Q

central depressed scar containing blood vessles in the liver

A

focal nodular hyperplasia

72
Q

treatment of asystole or pulseless electrical activity

A

epinephrine and CPR (rounds)

CPR at a rate of 100-120/min
chest pulse and ryhtmn every 2 minutes

73
Q

when is defibrillation used?

A

ventricular fibrilation of pulseless ventricular tachycardia

74
Q

shockable ryhtmns

A

Vtach, Vfib

75
Q

nonshockable rhythmns

A

PEA, asystole

76
Q

reversible causes of cardiac arrest

A

5H’s
5T’s

hypovolemia, hypoxia, hydrogen ions, hypo/hyperkalemia, hypothermia

tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or cardiac)

77
Q

treatment of wide complex tachcardia

A

amiodarone

78
Q

treatment of narrow complex tachycardia

A

vagal, adenosine

unstable: synchronized cardioversion

79
Q

treatment of bradycardia

A

atropine if stable

unstable: transcutaneous pacing

COMLEX LEVEL2 (19 decks)

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