USMLE III Flashcards
1
Q
Oropharyngeal dysphagia def
A
difficulty swallowing, cough, drooling, or aspiration
2
Q
Initial test oropharyngeal dysphagia
A
Nasopharyngeal laryngoscopy
3
Q
Symptoms lateral medullary infarct
A
Loss of pain/temp ipsilateral face and contralateral body; vestibular impairment; motor spared.
4
Q
Calculation of SAAG
A
Serum albumin minus ascites fluid albumin
5
Q
Conditions for SAAG >/= 1.1 g/dL
A
CHF, cirrhosis, and Etoh hepatitis
6
Q
conditions for SAAG < 1.1
A
peritoneal carcinomatosis, peritoneal TB, nephrotic syndrome, pancreatitis and serosis
7
Q
Main worries for TCA overdose
A
CNS, arrhythmias, and anticholinergic findings
8
Q
Treatment for TCA overdose
A
Worry about arrhythmias and treat with sodium bicarbonate
9
Q
Screening for renovascular HTN
A
MR angiography of renal arteries
10
Q
Etiology of constrictive pericarditis
A
viral, cardiac surgery, radiations, and TB
11
Q
Symptoms/findings for constrictive pericarditis
A
Calcifications heart border, increase jVD, edema, Knock, ascites, pulsus paradoxes
12
Q
Scoring system for severity of pancreatitis
A
APACHE II
13
Q
APACHE II most imports calculating info
A
BUN and Hematocrit (Pancreatitis severity)
14
Q
Red Flag back pain
A
> 50, weight loss, IV drugs, recent bacterial infection, night pain, hx malignancy
15
Q
Clinical features adenomyosis
A
dysmenorrhea, heavy bleeding, chronic pelvic pain, diffuse uterine enlargement (globular uterous)
16
Q
When iron supplementation for ESRD
A
HgB < 10.0, transferrin saturation =/< 30%, and ferritin = 500 ng/mL
17
Q
Most common causes of dilated cardiomyopathy
A
Idiopathic and Ischemic
18
Q
New unexplained case dilated cardiomyopathy what are next initial tests
A
Stress testing or coronary engiogram
19
Q
Routine prenatal screening at 24-28 weeks
A
Hgb/Hct, Antibody screen for Rd, 50 g 1-hr GTC
20
Q
Calculating odds ratio
A
ad/bc (see table in book)
21
Q
Type of studies odds ratio used in
A
Case control studies
22
Q
What is subclinical hypothyrodism
A
Elevated TSH but normal T4
23
Q
Subclinical hypothyrodism with only mild elevation in TSH
A
Antithyroid peroxidase antibody titer, if abnormal they may benefit from treatment
24
Q
Complications if subclinic hypothyroidism not treated
A
Recurrent miscarriages, severe preeclapsia, preterm birth, low birth weight, and placental abruption
25
What are the first trimester complications from elevated sugars
CHD, NTD, small left colon, spontaneous apportion
26
What are the 2nd and 3rd trimester complications from elevated sugars
Fetal hypoglycemia, polychythemia, organomegaly
27
Contraindication to Tdap
Anaphylaxis or encephalopathy, not minor illness, local irritation or immunocompromised
28
Initial test for polycythemia
Serum erythropoietin level
29
Ddx for polycythemia with low serum erythropoietin level
polycythemia vera
30
Ddx for polycythemia with high serum erythropoietin level
Chronic hypoxia or renal cell carcinoma (most common)
31
First test scrotal mass (no pain)
Scrotal ultrasound
32
Treatment of Tourette syndrome in children versus adults
Children: Second-gen antipsychotics (eg, resperidone, aripiprazole), tetrabenazine and habit reversal therapy
Adults: First-gen antipsychotics: Haloperidol and pimozide
33
Type of lung cancers that causes SIADH (normovolemic hyponatremia)
Small cell carcinoma of the lung
34
In a study what is external validity
"How generalized are the results of a study to other populations"?
35
In a study what is internal validity
"Are we observing/measuring what we think we are observing/measuring?"
36
In preventative medicine what is primary prevention
Action taken before a patient develops the disease
37
In preventative medicine what is secondary prevention
Action taken that attemps to halt the progression of a disease in its initial stage
38
In preventative medicine what is tertiary prevention
Limit impairment and disabilities
39
Type of test that evaluate the association between a quantitative dependent variable and the independent variables of interest while controlling for the effects of other factors?
Multiple linear regression
40
Initial biopsy site for possible metastatic cancer?
Biopsy the most easily obtainable side (eg supraclavicular lymph nodes)
41
Treatment for severe neonatal hyperbilirubinemia
Exchange transfusion (unresponsive to phototherapy or >25 mg/dL)
42
Suggestive symptoms of Legionnaires' disease
Confusion, ataxia, or diarrhea, hyonatremia
43
Treatment of Legionella pneumonia
Respiratory fluoroquinolone or newer macrolide (azithromycin)
44
Recurrent symptoms after treatment of H. pylori-associated ulcers
Repeat test for eradication of bacteria (urea breath testing and fecal antigen testing)
45
Consent in ER with patients that lack decision-making capacity
Implied consent - treat patient of what a reasonable person would expect
46
Concerning ddx for dialysis patient who just finished hemodialysis and now has developed dyspnea in the setting of iron replacement or other medications
ACS or anaphylaxis
47
CXR findings for malignant pleural mesothelioma
Pleural effusion, pleural thickening, calcifications or mass
48
How is malignant mesothelioma diagnosed
Thoracentesis with cytology, video-assisted thorascopic biopsy, or open thoracotomy
49
Manifestations of malignant mesothelioma
Pleura most commonly affected
Cough, dyspnea, chest pain, night sweats, weight loss
Pleural effusion is usually prominent
50
Hx abdominal pain with fat malabsorption; especially in setting of heavy alcohol use
suspicious for chronic pancreatitis
51
Diagnosis of chronic pancreatitis
magnetic resonance cholangiopancreatography (MRCP) or an abdominal CT
52
First line treatment of chronic pancreatitis
Pain management, stop vices, frequent small meals, pancreatic enzyme supplements
53
Non-controllable risk factors for colorectal cancer
family history, polyposis syndromes, inflammatory bowel disease, and African-American race
54
Preventable risk factors for colorectal cancer
alcohol intake, cigarette smoking, and obesity
55
Protective factors for colorectal cancer
high-fiber diet, regular NSAIDs, hormone replacement therapy, and regular exercise
56
Symptoms of overflow urinary incontinence
constant dribbling of urine, incomplete bladder emptying
57
Typical examination findings with overflow incontinence include
Neuropathy (decreased perineal sensation) and an increased post-residual urine volume (>150).
58
Reversible and non-reversible cardiotoxicity chemotherapy medications
Non-reversible: doxorubicin and cyclophosphamide
Reversible: Trastuzumab
59
Most likely condition with rapidly enlargement of the thyroid gland
Thyroid lymphoma
60
Symptoms of pituitary enlargement, hyperpigmentation, and visual field defects following bilateral adrenalectomy
Nelson's syndrome
61
Nelson's syndrome
Symptoms of pituitary enlargement, hyperpigmentation, and visual field defects following bilateral adrenalectomy
62
What interventions best help facilitate recovery for a patient with critical illness (eg., ICU, intubation)
Early PT for progressive mobilization
63
Order of therapy in management of heart failure
1. Angiotensin
2. Diuretic therapy, BB (EF <40% once euvolemic), spironolactone (EF < 35% with stable renal function & potassium), defibrillators for EF = 30%
3. Isosorbide dinitrate/hydralazine OR Digoxin if symptomatic with spironolactone
4. Transplant/Ventricular assist device evaluation
64
HF treatment with EF <40%
BB (EF <40% once euvolemic)
65
HF treatment with EF <35 with what exceptions
Spironolactone but need stable renal function and potassium
66
HF treatment with EF <30%
Defibrillators
67
Potential benefits of quitting smoking include
reduction in mortality (within 5 years), reduced risk of cardiac events, reduced risk of osteoporosis, and less decline in lung function over time
68
Older adults with new-onset of cognitive impairment (even significant) should be assessed for what other conditions outside of dementia
Pseudodementia (late-life depression), which may be reversible with treatment
69
Indications for diagnostic testing for pheochromocytoma
Episodic headaches, diaphoresis & tachycardia
Hyperadrenergic spells (eg, nonexertional palpitations, pallor)
Resistant hypertension or onset of hypertension at young age
70
Patient with episodic symptoms of headaches, diaphoresis, paroxysmal hypertension, and tachycardia should be tested for what
Pheochromocytoma specifically plasma free metanephrine
71
Antidepressant effects on manic patients (especially bipolar disorder)
Can induce mania. First step in managing emergent mania is to discontinue any antidepressants.
72
Persons needing antimicrobial prophylaxis following Neisseria meningitidis exposure:
People in same house, roomate, or intimate contact
Child care center workers
Direct exposure to respiratory or oral secretions
Seated next to for >/= 8 hours
73
Antimicrobial chemoprophylaxis for Neisseria meningitidis exposure
Rifampin (not if on oral contraceptives), ciprofloxacin, and ceftriaxone
74
In type I diabetic what is the most common reason for decreasing insulin requirements and what is first test(s)
Adrenal failure
| Cosyntropin stimulated cortisol levels
75
Most common emergency Orders CCS Cases (before physical exam)
```
Pulse oximetry
Oxygen
IV access
Normal Saline
Cardiac Monitor
BP Monitor
ECG
Ect
```
76
When do you perform a full physical exam on CCS
In clinic or non-acute setting
77
On CCS when do you assess location of patient
After physical exam. Decide if patient needs immediate transfer (eg., to ER)
Some initial test might later get you to transfer patient
78
Order of ordering test and meds
Labs then Imaging and then symptoms management
79
On CCS what orders need to be completed when admitting a patient.
```
Diet
Activity
IV access
IV fluids
Vitals (should be set)
```
80
On CCS monitoring
Check things during case
81
On CCS what to check at follow-up
Short exam and may consider follow-up testing
82
On CCS what are important things to complete/consider prior to surgery
```
Need surgery consult
NPO
IV access (fluids if needed)
PT/PTT
Type and cross match
ECG
Cefazolin
```
83
On CCS consults
Use if needed
84
At end of case you have two minutes to order
the final labs, treatment or counseling
85
On CCS case of meningitis what are big things not too miss
Antibiotics and lumbar puncture
86
Example of counseling
```
Stop smoking
Etoh
Safe sex
Contraception
Mediation side effects
```
87
When should a CT be completed in a patient with possible pancreatitis?
uncertain diagnosis of pancreatitis
Can diagnosis with serum lipase (or amylase) levels > 3 times upper limit of normal in the setting of characteristic symptoms and hx
88
What type of imaging with patient with pancreatitis but persistent abdominal pin and clinical deterioration
Abdominal CT scan with IV contrast looking for gas within pancreatic necrosis
89
What does kappa statistic represent
Represents the extent to which inter-rater agreement is an improvement on change agreement alone.
Inter-rater reliability
90
What follow-up test for patients with fracture following minor trauma
Dual-energy x-ray absorptiometry
91
Symptoms to watch for in patient with higher dose of metochlopramide?
Extrapyramidal effect
92
Drugs of choice of the immediate treatment of metoclopramide-induced acute dystonia
Diphenhydramine or benztropine
93
Order of treatment for peripheral artery disease
Risk factor management
Supervised exercise therapy
Cilostazol
Revascularization for persistent symptoms
94
What to test pprior to starting biologic medication (TNF inhibitors)
Screened for latent TB (opportunistic infections)
95
What is the most reliable method for verification of entotracheal tube placement
Capnography
96
Treatment for organophosphate poisoning
Atropine
97
Acquired methemoglobinemia recognition and causes
Large oxygen saturation gap (low pulse ox but normal PaO2)
Most common medications include topical anesthetics (eg, benzocaine), dapsone, and nitrates (in infants)
98
How to rule out a diagnosis using PPV/NPV/Sensitivity/Specificity
A negative result on a highly sensitive diagnostic test helps to rule out a diagnosis
99
Define likelihood ratio
Probability of a given test result occurring in a patient with a disorder compared to the probability of the same result occurring in a patient without the disorder
100
Highest increase risk for pelvic inflammatory disease
Multiple sexual partners
101
Most common pathogens in acute otitis media
Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis
102
What pathogen causes otitis-conjunctivitis syndrome (purulent conjunctivitis at same time as acute otitis media)
H. influenzae
103
Broad-spectrum antibiotics for PID
Cefoxitin plus doxycycline
104
Acoustic neuromas are from proliferation of what type of cells
Swhwann cells (schwannomas)
105
Cystitis in Pregnancy
7-day course of Augmentin OR fosfomycin
May use nitrofuratoin but not until 2/3 trimester
106
Patient >60 years old with cherry-red lesions and GI bleed
Angiodysplasia
107
Causes of angiodysplasia in colon
ESRD, von Willebrand disease and aortic stenosis
108
Oral contraceptives / pregnancy's effects on Thyroid
Estrogen stimulate hepatic synthesis of TBG, thus require higher dose of levothyroxine
109
Most effective nonpharmacologic intervention for decreasing blood pressure
Weight loss (6 per 10-kg loss)
110
Next step in patient with newly diagnosed medullary thyroid cancer
Serum calcitonin
Carcinoembyronic antigen
Neck ultrasound (regional mets)
Genetic testing for germline RET mutations
Evaluation for coexisting tumors (hyperparathyrodism, pheochromocytomas)
111
Medications that cause an increased risk of infantile hypertrophic pyloric stenosis
Azithromycin and erythromycin
112
Medications used for postexposure prophylaxis against pertussis
Azithromycin and erythromycin
113
DDx to think about in patient with meningo symptoms
Could be viral or bacterial, treatment based on history
114
Main features / findings of lactose intolerance
Diarrhea after lactose-containing meals
Increase stool osmotic gap
Decrease stool pH
+ Lactose hydrogen breath test
115
Main features / findings of chronic pancreatitis
Greasy stools
| Abdominal pain radiating to back
116
Main features / findings of celiac disease
Increase stool osmatic gap
Microcytic anemia, iron deficiency
Villous atrophy
117
Main features / findings of small intestinal bacterial overgrowth
Macrocytic anemia, B12 deficiency
| + Lactulose breath test
118
Calculate attributable risk percent (ARP)
Strokes
Smokers = 1:1000
Non-smokers = 0.5:1000
Measure of excess risk (stroke in smoker population)
(Risk in exposed - Risk in unexposed) / Risk in exposed
Or
(RR - 1) / RR
Answer 50%
119
Relative risk calculation
Population 1 = 1:1000
Population 2 = 0.5:1000
0.1/0.05 = 2
120
Calculate population attributable risk
Strokes
Smokers = 1:1000
Non-smokers = 0.5:1000
Risk within the population
(Risk in total population - Risk in unexposed) / Risk in total population
Risk in total population = (Risk in smokers)(Proportion of smoker) + (Risk in nonsmokers)(Proportion of nonsmokers) = 0.1 * 0.5 + 0.05*0.5) = 0.075%
PARP = (0.075 - 0.05) / 0.075 = 0.33 (33%)
121
How should traumatic amputation be transferred
Goal temp 33.8-50 F
Wrap in saline-moistended gauze and place in a sealed, bag and misssed with saline with 50/50 mixture of ice.
122
Diagnosis of narcolepsy
One of the following:
Cataplexy
Hypocretin-1 deficiency (CSF)
Sleep study showing rapid eye movement sleep latency <15 minutes
123
Treatment of narcolepsy
Modafinil
124
Medication to help treat cataplexy in narcolepsy
SNRI, SSRI, Tricyclic
125
Diagnostic tests for GI bleed
```
ESR
Sigmoidoscopy
Rectal biopsy (suspect UC)
CBC with differential
BMP
Stool ova and parasites
Stool for white cells
Stool culture
LFTs
PT/INR
PTT
```
126
Treatment of UC with mild proctitis
Topical therapy with 5-ASA compounds (mesalamine suppository)
127
Treatment of UC with moderate proctitis
Oral therapy with 5-ASA compounds (sulfasalazine, mesalamine, olsalazine)
Steroids are added when 5-ASA compounds faile to induce remission
Immunomodulators (azathioprine, 6-MP) for refractory cases
128
Management of UC with severe proctitis
```
Hospital with IV fluids and electrolytes
NPO, TPN
IV steroids
Consider BS antibiotics for fever, leukocytosis or sepsis
Surgery for refractory cases
```
129
Managing diarrhea/cramps/mood in UC with bleeding
Loperamide (avoid in severe proctitis)
Anticholinergic agents for abdominal cramps
Antidepressants/anxiolytics for associated mood disorders
130
Methotrexate versus laparoscopy for ectopic pregnancy
MTX for stable patient with B-Hcg < 5,000, tubal mass <3.5 cm, and no fetal cardiac activity.
131
How to interpret odds ratios
OR >1 means that exposure is associated with higher odds of outcome
OR <1 means that exposure is associated with lower odds of outcome
OR = 1 exposure has no effect on odds of outcome
132
What complication is most commonly associated with compartment syndrome
Acute renal failure
133
Features of ocular melanoma
small, densely pigmented lesion with irregular borders in the choroid, iris, ciliary body
134
Ocular melanoma management
diameter <10 mm, thickness <3 mm can manage with close follow-up as long as no eye pain or visual disturbances
If larger, treatment is radiotherapy
135
Clinical features of post-intensive care syndrome
Psychiatric: >50% with maro depression, PTSD
Neurocognitive: decrease attention/memory, executive function, and processing speed
Physical: >50% with decrease mobility and independence
136
Looking for what in urine when concerned about rhabdomyolysis
UA positive for blood but there is no RBC's/hpf
If RBCs are present then likely exercise induced hematuria
137
Bugs in pediatric septic arthritis
Age <3 months: Staph aureus, group B streptococcus, gram-negative bacilli
Age >3 months: Staph aureus, group A Streptococcus
138
Treatment of septic arthritis in a 4 month old
Joint drainage and debridement
| IV vancomycin
139
Treatment of septic arthritis in a 2 month patient
Joint drainage and debridement
| IV vancomycin and cefotaxime
140
When are renal/bladder ultrasounds or voiding cystourethrogam be completed in pediatric patients following an UTI
Renal ultrasound if <24 months
Cystourethrogram with abnormal ultrasound or recurrent infections
141
When should menigitis be suspected in pateints
nuchal rigidity
headache
bulging fontanelle
prolonged altered mental status
142
Next step when there is concern that a patient does not understand the consequences of refusing treatment
A formal assessment of decision-making capacity
143
Difference between Type I/II error
Type I: False Positive
Type II: False negative
144
DVT prophylaxis recommendations for stroke patient who did not receive thrombolytics and are still in the hospital
If only receiving aspirin therapy patient should also started on intermittent pneumatic compression and low dose heparin
145
Safe and effective treatment for severe bipolar mania during pregnancy
First generation antipsychotics (haloperidol) --> second gen antipsychotic --> Lithium (Ebstein anomaly)
Avoid carbamazepine and valproate
146
Overrepresented health issues in women who have sex with women
```
Cardiovascular disease
Type 2 diabetes mellitus
Obesity
Cervical cancer
Breast cancer
Ovarian cancer
Depression, anxiety
Intimate partner violence
Bacterial vaginosis
```
Most of these are increased due to this population having poor healthcare maintenance.
147
Resting period before returning to the previous step in gradual return-to-play protocol
24-hour rest period
148
Treatment for neonatal polycythemia
Adequate hydration
Correction of metabolic derangements (hypoglycemia)
Partial exchange transfusion
149
Pathogen and Presentation of impetigo
Staph aureus and Strep pyogenes
Papules and pustules with honey-crusted, adherent coating
Plus/minus pain or pruritus
150
Pathogen and Presentation of eczema herpeticum
HSV Type I
Painful vesicular rash
"Punched-out" erosions and hemorrhagic crusting
151
Pathogen and Presentation of molluscum contagiosm
Poxvirus
Skin-colered papules with central umbilication
152
Pathogen and Presentation of Tinea corporis
Trichophyton rubrum
Pruritic circular patch with central clearing
Raised, scaly border
153
Diagnostic tests for diarrhea
```
CBC with diff.
BMP
TSH
FOBT
ESR
Stool O&P
Stool WBC
Stool bact. culture
72-hour stool fat
PAP smear????
```
154
Therapy for irritable bowel syndrome
```
Lactose free diet
High fiber diet
Loperamide
Biofeedback
Reassurance
Relaxation exercise
Patient counseling
```
155
Diagnostic test in depressed pateint
CBC with diff
BMP
TSH
Vitamin B12
156
Diagnostic test UTI/Yeast infection
```
Vaginal pH
Wet mount
Gram stain, vagina
GC, culture
Chlamydia, culture
U/A
```
157
When should NIPPV be started in a COPD exacerbation
PCO2 >45 or pH <7.30
158
Outpatient antibiotics for COPD exacerbation
TMP-SMZ or doxycycline
159
Inpatient antibiotics for COPD exacerbation
levofloxacin, moxifloxacin, ceftriaxone, or cefotaxime
160
Therapy for COPD exacerbation
```
Bronchodilators
Steroids
Antibiotics
Counseling
Influenzae vaccine
Pneumococcal vaccine
```
161
When is a fine-needle aspiration completed following a mammogram
If it demonstrates a complex cyst or solid mass
No further work-up if simple cyst
162
Procedure to remove aspirated foreign body
Rigid bronchoscopy
163
Diagnostic test for foreign body aspiration
CXR-PA/lateral
X-ray neck
CBC
Rigid bronchoscopy
164
Indications for carotid endarterectomy (CEA)
symptomatic patient with 70%-99% within 14 days of last symptomatic event
165
Contraindications for carotid endarterectomy (CEA)
100% carotid stenosis
Previous stroke with persistent neurologic symptoms
Poor surgical candidate
166
Difference in pharmacotherapy for carotid stenosis and cardioembolic
Carotid stenosis: Aspirin and/or clopidogrel
Cardioembolic:
Heparin in TIA is controversial
warfarin, rivaroxaban, apixaban (not if GFR <30)
167
Empirical antibiotics for lower abdominal pain, cervical motion tenderness, or adenexal tenderness Inpatient versus outpatient)
Inpatient:
IV cefoxitin plu IV or PO doxycycline
```
Outpatient:
Ceftriaxone IM (one dose) plus doxycycline PO x 14 days
```
May add metronidazole for suspected BV, Trich, pelvic abscess or recent gynecologic instrumentations
168
Patient with bleeding and prolonged PTT with normal PT
```
Deficiency of:
factor VIII (Hemophilia A)
factor IX (Hemophilia B)
factor XI
Von Willebrand's disease
```
Acquired causes:
antiphospholipid syndrome
heparin use
169
Patient with bleeding and diagnosed with hemophilia
Purified monoclonal recombinant factor VIII (Hem A) or factor IX (Hem B)
Desmopressin and antibibrinolytic agens
170
Symptoms of suspected stable coronary artery diease
Elderly patients (eg >80) are more likely to experience anginal symptoms other than chest pain
Symptoms other than chest pain:
SOB
Lightheadedness
Fatigue
171
Time-to-event data in survival analysis where the event of interest is death
It accounts not only for the number of events in both groups, but also for the timing of the events throughout the follow-up period (eg all die at same time but on group has better life prior to death)
172
What are the most important predictors of prognosis in patients with COPD
FEV1 < 40%
| Age
173
Treatment of aspiration pneumonia (not aspiration pneumonitis)
Clindamycin or ampicillin-sulbactam or amoxicillin-clavulanate
174
Evaluation of a child >4 years old with primary nocturnal enuresis
Urinalysis (to exclude other causes)
| Voiding diary
175
Suggestive labs of platelet dysfunction
Increase bleeding time and normal PT/APTT
176
Treatment for bleeding patient with platelet dysfunction
desmopressin
177
Characteristic blood findings in thalassemia
```
microcytic, hypochromic anemia
mildly elevated ferritin
Normal RCDW
Normal Fe
Normal to mild decrease TIBC
```
178
Clinical features of stress-induced (takotsubo) cardiomyopathy
Chest pain mimicking myocardial infarction
Decompensated heart failure
Moderate troponin elevation
179
EKG findings in stress-induced (takotsubo) cardiomyopathy
ischemic changes in precordial leads without CA findings
180
Fitz-Hugh-Curtis syndrome
PID
RUQ pain with elevated transaminases
Fever
181
Main findings of acute sickle hepatic crisis
Triggered nausea and vomiting resulting in dehydration
| Anemia, elevated transaminases, and fever
182
What are the objective measurements of the MELD (Model for End-Stage Liver Disease):
Bilirubin
INR
Serum creatinine
Serum sodium levels
183
Need to closely monitor what in patients with Guillain-Barre syndrome
High risk of respiratory failure
| Frequent monitoring of tidal volume and negative inspiratory force
184
Main features of Guillain-Barre syndrome
Symmetric muscle weakness (lower legs first)
Paresthesia
Dysautonomia (eg, tachycardia, urinary retention)
Decreased or absent deep tendon reflexes
185
Treatment of Guillain-Barre syndrome
Plasma exchange or IV immunoglobulin
186
In diabetic neuropathy what are main senses testing to assess nerve damage
Pain, temperature, vibratory (tuning fork), and proprioception sense
187
Ddx with ST depression and elevated cardiac enzyems
NSTEMI
188
Ddx with ST depression and normal cardiac enzymes
unstable angina
189
In a patient with unstable angina what should be completed prior to starting Heparin
FOBT
190
Medications for patient in hospital for unstable angina
Metoprolol
Simvastatin
Eptifibatide
191
Important orders for hospital patient with unstable angina
```
NPO, bedrest, 12 lead ECG, urine output
Metoprolol
Simvastatin
Echocardiography
Cardiology consult, stat (cardiac catheterization)
Eptifibatide
Lipid panel, LFTs
```
192
Counseling for unstable angina
```
Smoking cessation
Limit alcohol
Exercise program
Medication compliance
Relaxation techniques
Diet, low sodium
Diet, low cholesterol
Follow-up at 2-6 weeks
```
193
What should be added prior to sending a patient with unstable angina for catheterization
GP IIB/IIIA (Eptifibatide)
194
Orders for patient with viral croup
```
CBC with diff, stat
Neck x-ray, stat
Humidified air
Dexamethasone, oral
Epinephrine, inhalation (moderate/severe)
```
195
Diagnostic test for patient that present for suspected asthma exacerbation
```
Peak flow (PEFR) q hr
ABG
ECG
CXR
CBC
BMP
```
196
Under what criteria should a asthma exacerbation be admitted to floor
Admit for PEFR (peak expiratory flow rate) <40% predicted at 4 hours
Consider admission for PEFR 40-70% at 4 hours
Discharge to home for PEFR >70% at 4 hours
197
Basic labs for clinic constipation patient
CBC
BMP
serum magnesium, phosphate, TSH, HgbA1c
FOBT
198
Preoperative antibiotics
Cefoxitin
ampicillin-sulbactam
cefazolin plus metronidazole
199
Diagnostic study for suspected appendicitis
Ultrasound then CT
200
Broad spectrum antibiotics for bacterial arthritis
ceftriaxone with IV vancomycin
201
Antibiotics with septic knee with gram stain showing gram-positive cocci
MRSA: IV vancomycin x 4-6 weeks
MSSA: IV cefazolin for 2 weeks than 2-4 more weeks of oral antibiotics
202
Antibiotics with septic knee with gram stain showing gram-negative bacilli
IV 3 generation cephalosporin (ceftriaxone x 14 days), then 14 days of oral antibiotics
203
Appropriate joint drainage for septic arthritis
Perform in all cases using closed needle aspiration
| If closed needle aspiration does not provide adequate drainage, then: Arthroscopy or open drainage (arthrotomy)
204
Initial labs in patient (pediatric or adult) with abnormal uterine bleeding
```
Urine pregnancy test
Serum TSH
Serum prolactin
CBC with diff
PT/INR
PTT
```
Consider biopsy (perimenopausal women), pelvic ultrasound (obese/PCOS), LFTs (liver disease)
205
What OCP to start on patient present with dysfunctional uterine bleeding
Hgb 10-12:
- Absence of active bleeding: Progestin-only OCPs
- Presence of active bleeding (combination OCPs, low progesterone, low estrogen)
Hgb < 10:
- Hormonal therapy: Combination OCPs with high estrogen if stable; IV estrogen if unstable
206
Treatment for idiopathic or viral pericarditis
NSAIDs while patient is symptomatic (steroids if resistant)
Colchicine for 3 months
Avoid NSAIDS (other than aspirin) in post-MI pericarditis
207
Diagnostic tests for suspected pericarditis
```
CBC/CMP
CXR
Troponin/CK-MB
ESR
Blood cultures
Echocardiography
```
208
Routine labs in ER trauma patient
```
CBC with diff
BMP
LFTs
Serum amylase/lipase
UA
ABG
PT/INR/PTT
Blood type and cross
Ethanol
Urine tox screen
Urine Hcg
12 lead ECG
Chest and Spin x-ray
Abdominal CT
Urine output
```
209
Monitoring for patient with traumatic event (MVA)
Serial exam
H&H q6 hours (bleeding)
Urine Output (Foley catheter)
210
In a trauma, under what circumstances is ultrasound (FAST exam) versus CT of abdomen
Unstable perform ultrasound
Stable CT
211
Diagnostic test in patient with suspected gout
```
CBC with diff
BMP
PT/IRN
PTT
ESR
Serum uric acid
X-ray of the foot/toes
Synovial fluid analysis
```
212
Initial therapy for gout including lifestyle changes
```
NSAIDs (indomethacin, naproxen)
Low protein diet
No alcohol
No Smoking
No aspirin
```
213
Management of PCP pneumonia
Bactrim
PO2 < 70 and/or A-a O2 > 35 add oral steroids
214
Early treatment for patient with HIV
Early HAART (Efavirenz/Tenofovir/Emtricitabine)
Azithromycin if CD4 <50 for MAC prophylaxis
215
Preop antibiotic
cefazolin
216
Preop antibiotics for bowel surgery
Ampicillin-sulbactam or piperacillin-tazobactam
217
Once Turner syndrome is confirmed what other screening that need to be completed.
```
Serum FSH and LH
UA
BMP, fasting glucose, serum TSH
Echocardiogram
renal and pelvic ultrasound
skeletal survey
Hearing test
```
218
Therapy for Turner syndrome
Growth hormone (height <5%) and anabolic steroids (oxandrolone)
Estrogen replacement (12-13 yr old)
Age >13 begin with combination estrogen and progestin until menopause
Vitamin D and calcium (osteoporosis)
Dietary and Psychiatry consult (IQ)
Ophthalmology consult
Ob/Gyn consult
Exercise
219
How long attempt non-pharmacologic treatment for BP until starting medications
6-12 months
220
Treatment for life altering menopausal symptoms
```
Oral estrogen (no uterus)
Estrogen AND Progesterone with intact uterus
```
221
Initial treatment of patient with suspected PE
High suspicion just start patient on heparin (LMWH or UFH)
When confirmed add warfarin until therapeutic
IVC filter for patient with contraindication to anticoagulation
thrombolytic therapy for hemodynamically unstable patients
