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COMLEX LEVEL2 > True learn missed part 2 > Flashcards

True learn missed part 2 Flashcards

1
Q

What are the common manifestations of Antiphospholipid syndrome? (5)

A

Thrombosis, Pregnancy loss, thrombocytopenia, and nonbacterial vegetative endocarditis. Livido reticularis

PELTT (pregnancy loss, endocarditis, livedo reticularis thrombosis, thrombocytopenia)

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2
Q

What are the antibodies associated with Antiphospholipid syndrome

A

Anticardiolipin

Anti beta 2 glycoprotein

Lupus anticoagulant

(can be associated with SLE)

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3
Q

What are the common central venous catheters sites

A

internal jugular vein

subclavian vein

femoral vein

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4
Q

complications with central venous catheter insertion

A

nosocomial blood stream infections (you can combat this with practicing proper insertion technique, maintain occlusive dressings, and removing any unnecessary lines)

hematoma, pneumothorax, infection

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5
Q

where is the internal jugular vein in comparison to the carotid artery

A

the IJV is in the carotid sheath lateral to the carotid artery

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6
Q

what are the contents of the carotid sheath (vascular compartment of the neck in the deep cervical space)

A

internal jugular vein
common carotid artery
vagus nerve

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7
Q

where is the vagus nerve in comparison to the carotid artery ?

A

posterior to the carotid artery

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8
Q

what is the normal distribution rule

A

68% - 1 standard deviation outside of the mean (34% on each side of the mean)

95% - 2 standard deviations outside the mean (47.5 on each side of the mean)

99.7 %- 3 standard deviations outside the mean (49.85 on each side of the mean)

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9
Q

MCC of LEMS myasthenic syndrome

A

paraneoplastic syndrome from Small cell lung cancer

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10
Q

Antibodies associated with LEMS syndrome

Antibodies associated with Myasthenia gravis

A

LEMAS: voltage gated calcium channels antibodies

MG: acetylcholin receptor antibodies

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11
Q

Does LEMS or MG have autonomic dysfunction like dry mouth, erectile dysfunction?

A

LEMS!

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12
Q

Muscle weakness in LEMS VS MG

A

MG: begins with eye weakness (diplopia) , worsens with excercise and worsens throughout the day , progresses to proximal muscle weakness and bulbar weakness (slurred speech, dysphagia)

LEMS: begins with procimal limb weakness (rising from chair, going up stairs), improves with excercise, and improves throughout the day

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13
Q

Reflexes in MG vs LEMS

A

MG: normal

LEMS: decreased or absent

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14
Q

Does MG or LEMS respond to cholinesterase inhibitors

A

MG

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15
Q

Treatment of MG vs LEMS

A

MG: cholinesterase inhibitors (pyridostigmine) , +/- immunosuppressants

LEMS: treatment of underlying lung malignancy if it is paraneoplastic syndrome
, if it is idiopathic treat with amifampridine

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16
Q

diseases associated with MG

A

thymoma, thymic hyperplasia

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17
Q

Antibodies in Miller-fisher syndrome

A

Anti- GQ1b antibodies

(this is a variant of Guillan Barre syndrome that presents with areflexia, opthalmoglegia and ataxia)

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18
Q

dermatomyositis and polymyositis are associated with what paraneoplastic syndrome

A

adenocarcinoma

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19
Q

symptoms of polymyositis/dermatomyositis

A

muscle fiber injury that causes symmetric proximal muscle weakness, polyarthritis, dysphagia, skin findings (gottron papules)

increased CK

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20
Q

antibodies for dermatomyositis/polymyositis

A

Anti- Jo1, Anti- Mi2

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21
Q

cushing syndrome is associated with paraneoplastic syndrome and what are the symptoms

A

small cell lung cancer (ectopic ACTH production)

proximal muscle weakness and atrophy, weight gain, HTN, striae, hyperglycemia

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22
Q

Most common location for osteosarcomas and most common site of metastasis

A

location: metaphysis of long bones

mets: lungs

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23
Q

Treatment of Osteosarcoma (most common primary tumor in teenagers)

A

chemotherapy and limb salvage surgery

(osteosarcomas are radioresistant)

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24
Q

Ewing sarcoma treatment

A

radiation and chemotherapy (onion skinning)

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25
Q

which bone tumor pain is relieved by NSAIDS

A

osteoid osteoma (tumor has high burden off prostaglandins)

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26
Q

Where should the urinary drainage bag be placed in order to avoid risk of UTI

A

at the foot of the bed

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27
Q

lung adenocarcinoma location, symptoms and cell presentation on histology

A

location: periphery of the lung (most common lung cancer, especially in non smokers and women)

symptoms: diminished breath sounds, hemoptysis, chronic cough

histo: glandular formation with mucin production

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28
Q

can you prescribe opiods to a friend who is also a patient

A

yes if there is a need for it and additional tests have been completed

if you cant come to an agreement you can refer them to another provider

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29
Q

if a patient does not want HIV testing even though it is clear that they have aids defining illnesses can they refuse testing?

A

Yes, just document in their records that they refused testing

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30
Q

when do you screen for HIV in pregnancy

A

once per pregnancy

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31
Q

what are the CDC guidlines for screening for HIV

A

onces between the ages of 13 and 64

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32
Q

what is the first line treatment of juvenile myoclonic epilepsy?

A

Valproic Acid

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33
Q

what conditions is valproid acid frequently used to treat?

A

absence seizures, bipolar disorder, juvenile myoclonic epilpsy, tonic clonic seiszures, migraine prophylaxis

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34
Q

side effects of valproic acid

A

hepatotoxicity, pancreatitis, NTD (teratogenic), tremor and weight gain

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35
Q

Uses for topiramate and side effects

A

migraine prophylaxis, partial seizures, tonic clonic seizures

SE: glaucoma, nephrolithiasis , weightloss

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36
Q

phenytoin uses and side effects

A

uses: partial seizures, tonic clonic seizures

SE: CYP P450 inducer, enlarged gums, folate deficiency, hirsutism, skin discoloration, teratogenesis (fetal hydantoin syndrome)

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37
Q

phenobarbital is used in what types of seizures

A

seizures in neonates

side effects: cardiorespiratory depression, CYP450 induction

38
Q

Levetiracetam use and side effects

A

juvenile myoclonic epilepsy, partial seizures, tonic clonic seizures

SE: behavioral changes, suidical thought, corrdiation problems

39
Q

Lamotrigene uses and SE

A

uses: absence sizures, juvenile myoclonic epilepsy, partial seziures, tonic clonic seizures

SE: steven johnson syndrome, hemaphagocytic lymphohistocytosis

40
Q

ethosuximide uses and SE

A

first line treatment of absence seizures

SE: pruiritis, and gi upset

41
Q

carbamezapine uses and SE

A

first line for trigeminal neuralgia and partial seizures

SE: agranulocytosis, aplastic anemia, cyp 450 inducer, hepatotoxicity, SIADH, teratogenesis

42
Q

What drugs are commonly known to cause pulmonary fibrosis (6)

A

amiodarone, bleomycin, bulsulfan, carmustine, methotrexate, nitrofurantoin

BAB CMN

43
Q

drugs that commonly cause pancreatitis

A

Azathioprine, corticosteroids, didanosine, diuretics, valproic acid

“DAD’s CV’

44
Q

actions of the hamstrings

A

knee flexion and hip extension

45
Q

tight hamstring muscles lead to what type of innominate rotation

A

posterior innominate rotation

46
Q

parts of the hamstring muscle (3)

A

biceps femoris
semimembranosus
semindinosus

47
Q

single blinded studies

double blinded studies

triple blinded studies

A

single blinded studies: patient OR clinican is unware of intervention recieved

double blinded studies: patient AND clinican is unware of intervention being received

triple blinded studies: patient, clinicians and individual assessing the outcomes are all blinded to the intervention being received

48
Q

AFIB is stable is treated with CCB or Beta blocker but if unstable treated with cardioversion what is considered unstable

A

systolic blood pressure <90, chest pain, SOB, confusion

49
Q

treatment of chanchroid (papule–pustule–ulcer)

A

oral azithromycin (preferred)

OR

ceftriaxone, erythromycin or ciprofloxacin

50
Q

risk factors for hypomagnesemia

A

chronic PPI use, alcoholism, DM, chronic diarrhea and malnutrition

51
Q

what electrolyte disturbances are often seen with hypomagnesemia?

A

hypokalemia (most important)

hypocalcemia

hypoparathyroidism (low magnesium impairs PTH release from the parathyroid glands in response to low calcium)

(low potassium, low calcium)

52
Q

symptoms of low magnesium

A

weakness, muscle twitching, muscle cramps

53
Q

Central hypothyroidism vs Primary hypothyroidism

A

Central: low T4 and Low or low normal TSH, due to a lesion in the pituitary (2) or hypothalamus (4)

Primary: Low T4 and high TSH due to a lesion in the thyroid the most common cause is autoimmune destruction of the thyroid gland (hashimotos)

54
Q

what is a helpful way to decrease burnout and improve physician well being and the ability to cope with fried and emotional distresses caused by caring for ill and/or dying patients

A

interdisciplinary debriefing sessions that discuss psychosocial aspects of patients care

mindfulness training

wellness campaigns

55
Q

sjogren syndrome is associated with increased risk of developing what?

A

non-Hodgkins lymphoma (5-10% increase)!!!!

vasculitis, cytopenias

56
Q

sjogren syndrome antibodies

A

anti-Ro, anti- La , ANA and RF

57
Q

what is the most effective way to decrease medication errors during transitions of care

A

involving pharmacists in the discharge med rec process

having more than 1 person do a med reconcilliation review

58
Q

squamous cell carcinoma of the lungs can secrete what leading to hypercalcemia, what are the lab values

A

parathryoid hormone related peptide which will decrease parathyroid levels (hypoparathyroidism)

59
Q

which hepatitis is partly double stranded DNA that encodes a reverse transcriptase (uses reverse transcriptase to replicate)

A

Hep B

60
Q

which hepatitis is a flavivirus with a positive sense RNA genome

A

hepatitis C

61
Q

ST segment elevation in V1-V3 with ST depression in II, III, aVF are indicative of

A

acute anteroseptal infarction with reciprocal changes

62
Q

old infarcts are seen as?

A

Q qaves in V1-V3

63
Q

inferior infarct shows ST elevation in?

A

leads II, II and AVF

with ST depression in leads 1 and aVL

**avoid nitroglycerin

64
Q

pericarditis on ECG

A

diffsue ST segment elevation, low voltage and PR depression in leads II, and PR elevation in aVR

**treat with NSAIDS, aspirin or cholchicine

65
Q

pulmonary embolism symptoms

A

acute onset dyspnea, pleuritis chest pain

66
Q

exam of pulmonary embolism

A

hypoxia, tachypnea, tachycardia, can have a pleural EFFUSION with decreased breath sounds and dullness to percussion

+/- signs of DVT,

67
Q

ECG pattern of pulmonary embolism

A

sinus tachycardia, S1Q3T3

68
Q

a person with ALS has respiratory dysfunction what should you do

A
  1. noninvasive positive pressure ventilation first- has been shown to improve survivial and quality of life
  2. intubate and mechanically ventilate
69
Q

Idiopathic thrombocytic pupura

A

this is an isolated thrombocytopenia that can be caused by a recent URI or medications patients are well appearing and may have petechiae or brusing thats IT!!!!

treatment is with : steroids or IVIG

if platelet count is < 30,000 then you treat, if there is bleeding you can give platelet transfusion as well

refractory cases: splenectomy

70
Q

Spontaneous pneumomediastinum

A

crepitus from coughing paroxysms (asthma, respiratory infection) usually in a thin boy

chest pain, SOB and cough, palpation of crepitus along the neck and chest wall can have hmman sign on crunching sound over the heart and chest on ausculation

DX: CXR

TX: supportive care if there is no evidence of a pneumothorax

71
Q

normal TSH, normal T3, increased T4, increased TBG

A

euthyroid hyperthryoxinemia

(no symptoms)

72
Q

low TSH, normal T4, normal T3

A

subclinical hyperthyroidism

(asymptomatic)

73
Q

what two tendons are inflamed in de quervain tenosynovitis

A

abductor pollicus longus and extensor pollicis brevis

74
Q

Eye response grades in the glascow glaucoma scale

A
  1. no eye opening (1 point)
  2. eyes open to pain (2 points)
  3. eye open to voice (3 points)
  4. eyes open spontaenously (4 points)
75
Q

verbal response glascow score

A
  1. no verbal response (1 point)
  2. incomprehensible sounds (2 points)
  3. inappropriate words (3 points)
  4. confused (4 points)
  5. Oriented (5 points)
76
Q

motor response scores in glascow coma scale

A
  1. no motor response (1 point)
  2. extension to pain (2 points)
  3. abdominal flexion to pain (3 points)
  4. flexion/withdrawal (4 points)
  5. can tell you where his pain is (5 points)
  6. obeys commands (6 points)

anything lower than 8 on the glascow coma scale means you need to intubate

77
Q

methemglobenemia what is it and how is it treated

A

an oxidized form of hemoglobin that causes iron to be in the ferric Fe3+ state and decreases oxygen delivery to tissues leading to cyanosis, dyspnea, confusion, chocolate colored blood , but a normal PaO2

can be caused by a cytochrome b5 reductase deficiency or drugs like nitroprusside, nitroglycerin, anesthetics (benzocaine)

tx: methyelene blue which is a synthetic blue dye (gives electron to methylated hemoglobin)

78
Q

methylene blue should be avoided in patients with what deficiency

A

G6PD

  • it can precipitate hemolysis in these patients
79
Q

antibodies for autoimmune hepatitis that is most specific

A

anti-smooth muscle antibodies

80
Q

what antibodies in primary biliary cholangitis

A

anti-mitochondrial antibodies

81
Q

Acute mesenteric ischmia from arterial embolism presents in the setting of?

A

atrial fibrillation

(can be from athersclerosis, embolic sourfce, hypercoaguable states, vasculitis)

82
Q

diagnosis of Acute mesenteric ischemia

A

CT angiography is preferred

alternativesL MRF angiography, color doppler, ultrasound

83
Q

cryptococcous infections are treated with?

A

amphotericin B

84
Q

management of spontaneous bacterial peritonitis

A

DIAGNOSTIC PARACENTESIS THEN ANTIBIOTICS

SAAG> 1.1, >250 PMNs

85
Q

treatment of status epilepticus

A

IV lorazepam, if given 2 doses and patients is in respiratory distress (30 breaths per minute) preform rapid sequence intubation before administering another does of lorazepam

CHECK ABCs (address these before anything else)

refractory cases put in a phenobarbital coma

86
Q

lead poisoning interferes with?

A

erythrocyte cell membrane integrity

irritability, wrist drop, anemia, trouble concentrating, lead lines, basophilic stippling

87
Q

Acute intermittent porphyria

A

presents in adolescents with a deficiency in the enzyme porphobilinogen deaminase

symptoms: abdominal pain, constipation, and extremity weakness, neurovisceral symptoms

88
Q

alternative options for PCP other than TMP-SMX

A

dapsone

atovaquone

dapsone + pyrimethamine + leucovorin

aerosolized pentamidine

**discontinue TMP-SMX if there is development of steven johnson syndrome, toxic epidermal necrolysis, neutropenia, renal failure

89
Q

le fort II fractures involve what

A

maxilla, nasal bones and medial aspects of the orbits

nasal bone and maxilla mobility

(incorrect teeth placement)

+/- rhinorrhea

90
Q

le fort I fracutre involves what

A

maxilla at the nasal fossa

only movement of the maxilla

91
Q

le fort fracture III involves

A

maxilla, nasal bones, and zygoma

unstable entire midface “floating of the face from the head

CSF, rhinorrhea, maloclusion, trismus (lock jaw)

92
Q

herpes zoster ophthalmicus initial and late complications (v1 distribution)

A

acute keratitis initially showing a psuedodendritic pattern

uveitis (irregular shaped pupil) and cataracts or glaucoma

blindness later on

tx: oral antivirals are the mainstay of treatment, but topical antivirals can be used as well

COMLEX LEVEL2 (19 decks)

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