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COMLEX LEVEL2 > True learn missed > Flashcards

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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
treatment of dermatitis herpetiformis
dapsone and avoidance of gluten
26
imaging for scabies
mineral oil preperation of skin scraping
27
A positive sphix test means what
sacrum is backwards/extended
28
what does a positive lumbosacral spring test indicate (decreased spring at the lumbosacral junction)
sacrum is extended or backwards
29
description of a phyllodes tumor and treatment
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
30
diagnosis of diabetes (3 criteria)
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
31
metformin is contraindicated in what instance
if GFR <30 of severe BUN/CR abnormalities
32
in patients with a hemoglobin A1C greater than 10 what is the first line treatment
INSULIN, diet modification, weight loss, and exercise
33
social smile develops when
3 months
34
sitting up without support develops when
6 months
35
raking grasp develops when
6 months (transfers objects between hands)
36
when do babies develop a pincer grasp and can crawl?
9 months
37
when can babies walk and throw objects, with separation anxiety
1 year
38
patients with severe burns greater than 20% should have what monitored?
urine output (along fluid resuscitation)
39
what is the parkland formula for burns?
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
complications of receiving too much fluid in burn victims
pulmonary edema, compartment syndrome, swelling of the arms and legs
41
which lung cancer has a poor prognosis, metastasizes easily, but has a great response to chemotherapy
small cell lung cancer (associated with smoking) dx: squamous cell poor response to radiation/chemo, treat with excision , can also present with hypercalcemia
42
the diagnosis of pancreatitis requires 2 out of the 3
epigastric pain amylase or lipase 3X upper limit and imaging ( if the first 2 are present IMAGING IS NOT NECESSARY TO START TREATMENT)
43
treatment of pancreatitis
IV hydration, NPO , antiemetics and analgesics
44
scoring for morality in pancreatitis
Ranson score >3 APACHE score > 8
45
howell-jolly bodies are seen in what pathology
sickle cell disease they are inclusions of nuclear chromatin remnants due to autosplenectomy
46
patellofemoral syndrome symptoms
pain going up and down stairs crepitius on ROM pain with flexion and with sitting for a long time
47
meniscal tear symptoms
knee pain, locking and clicking of the knee joint
48
clinical trials compare what?
therapeutic benefit of a treatment and placebo or of 2 or more treatments
49
open label trial
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
post herpetic neuralgia
persistence of pain at the initial site of herpes zoster after resolution of the rash risk is increased with advanced age
51
employers are NOT allowed to require genetic testing as a prerequisite of employment, this is a violation of what act
The genetic information Nondiscrimination act of 2008 (GINA) tell the patient this is a violation
52
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
doctrine of double effect
53
euthanasia vs. physician assisted suicide
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
TCAS effect on the heart
block fast sodium channels which can cause QRS widening and a prolonged QT interval
55
how to combat QRS widening in TCA overdose
administer sodium bicarbonate to prevent sodium channel blockade
56
how to stabalize cardiac membrane in the setting of hyperkalemia
calcium gluconate "peaked T waves, wide QRS"
57
if there is suspected bacterial meningitis what do you do
1. lumbar puncture 2. antibiotics >50 ampicillin, vancomycin, and ceftriaxone and steroids
58
acute epididymitis symptoms
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
MCC of epididymitis in <35 and >35
<35: Chlamydia and Gonorrhea - treatment is with oral doxy and IM ceftriazone >35 E. Coli- treatment is with oral levofloxacin for 10 days
60
what medication can cause epididymitis
amiodarone
61
what are the dysfunction of fryettes first principle of vertebral motion?
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
Small bowel obstrucution initial imaging
supine and upright abdominal radiographs (X-rays)
63
What is klienfelter syndrome
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
what is the workup for klienfelters syndrome
total testosterone, LH and FSH
65
what is idopathic endolymphatic hydrops
meniners disease (vertigo, hearing loss, and tinnitus) increased pressure in the inner ear
66
viral labyrnitis
tinnitus and hearing loss following a virus that is self limited and resolves with time
67
when accepting gifts in general esp from a pharmacetical rep what is accepted
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
ascending tracts responsible for
sensation
69
niopsy in primary sclerosing cholangitis shows what
periductal sclerosis (aka onion skinning) associated with HLA-DR52a and Ulcerative cholitis
70
primary biliary cirrhosis biopsy shows
granulomatous destruction of the intrahepatic bile ducts
71
central depressed scar containing blood vessles in the liver
focal nodular hyperplasia
72
treatment of asystole or pulseless electrical activity
epinephrine and CPR (rounds) CPR at a rate of 100-120/min chest pulse and ryhtmn every 2 minutes
73
when is defibrillation used?
ventricular fibrilation of pulseless ventricular tachycardia
74
shockable ryhtmns
Vtach, Vfib
75
nonshockable rhythmns
PEA, asystole
76
reversible causes of cardiac arrest
5H's 5T's hypovolemia, hypoxia, hydrogen ions, hypo/hyperkalemia, hypothermia tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or cardiac)
77
treatment of wide complex tachcardia
amiodarone
78
treatment of narrow complex tachycardia
vagal, adenosine unstable: synchronized cardioversion
79
treatment of bradycardia
atropine if stable unstable: transcutaneous pacing

COMLEX LEVEL2 (19 decks)

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