USMLE Other Flashcards
1
Q
Acute angle closure glaucoma / Symptoms and presentations
A
pain, diminished visual acuity, seeing halos around lights, a red eye, headache, and a dilated pupil.
2
Q
Alcoholic hepatitis
Maddrey’s Discriminant function score:
Treatment / how long?
A
modified Maddrey’s discriminant function score > 32 or hepatic encephalopathy should be considered for treatment with prednisolone 40 mg daily for four weeks followed by a taper.
3
Q
Alzheimer disease
A
Effects in daily living and instrumental activities of daily living; other language difficulties; or personality changes. MMSE scores of 19 to 24 suggest mild dementia, and scores of 10 to 19 suggest moderate dementia.
4
Q
When to order ankle radiographs
A
Ankle radiographs should be obtained only
- When patients are unable to bear weight
- Who have bony tenderness to palpation at the posterior edge of either the lateral or medial malleoli.
5
Q
Anti Depressant therapy / Therapy time periods
Remission
post remission therapy
A
The goal of treatment / remission within 6 to 12 weeks / continue treatment for 4 to 9 months thereafter.
Patients assessed 2-4 weeks after starting therapy for adherence and again at 6-8 weeks for response to therapy. Using a formal tool for severity assessment (such as the PHQ-9) helps quantify the nature of the response; patients are considered to have at least a partial response if a 50% or greater decrease in symptom score has occurred.
6
Q
Benign paroxysmal positional vertigo (BPPV).
A
- Otolith repositioning, commonly known as the Epley maneuver
- Tinnitus, ear pain, and hearing loss are absent, and nausea that is sufficiently severe or prolonged to cause vomiting is rare.
7
Q
Causes of rhinitis
- Non allergic
- Allergic
- Occupational
- Rhinitis medicamentosa
- Pregnancy
- Systemic Dz
- Medications
A
- Vasomotor and Gustatory
- Seasonal, perennia
- Animal handles, food processors
- Cocaine, regular nasal decongestants
- Unclear
- Hypothyroid, Wegeners, sarcoid
- Oral Contraceptives, sildenafil, Clonidine
8
Q
Central retinal artery occlusion / CRAO / Symptoms & presentation
A
visual acuity is markedly diminished in the affected eye to either finger counting or light perception. There is an afferent pupillary defect. On funduscopic examination, the retina appears pale, either segmentally or completely.
9
Q
Central vertigo
A
- Vertical nystagmus occurs immediately with the Dix-Hallpike maneuver.
- MRI with angiography of the brain.
- Prolonged (>1 min), and nonfatigable
- Due to ischemia or infarct in the brainstem or cerebellum.
10
Q
Child-Turcotte-Pugh class and postoperative mortality
A
Patients with CTP class / scores have postoperative mortality
A (0-6 points) 10%
class B (7-9 points) 30%
class C (≥10 points) 80%
11
Q
Dantrolene
A
Hyperthermia associate with neutroleptic syndrome
Tx: Neuroleptic malignant syndrome - Lorazepam and IVF
12
Q
Nonasthmatic eosinophilic bronchitis
A
patients with chronic, nonproductive cough without an apparent cause, including asthma; sputum examination for eosinophils is useful in establishing the diagnosis.
13
Q
Essential Mixed Cryoglobulinemia
Associated with what dz?
A
- Hep C
- palpable purpura
- Arthalgias
- Renal Dz (MPGN)
- purpuric skin lesions in LE progress to necrosis
14
Q
Fenofibrate
A
- Reducing serum triglyceride levels, with observed decreases of 20% to 50%.
15
Q
GAD Tx?
A
CBT or SSRI/SNRI
16
Q
Herbal meds
- Ginko Biloba
- Ginseng
- Saw Palmetto
- Black cohosh
What are they used for ?
What is thier side effect?
A
- Ginko Biloba : Memory enhan
- Ginseng: mental performance
- Saw Palmetto: BPH
- Black Cohosh: Post manopausal
All increase chance of bleeding
17
Q
Got Foot problems
- Charcot Joint
- Matatarsal stress fracture
- Morton’s neuroma
- Plantar fasciitis
A
- Progressive degenerative joint ds due to peripheral neuropathy / swelling, erythema and loss of sensation new the involved joint.
- In runners due to repetitive stress injury / after two weeks visible on Xray focal point tnederness near the metatarsal shaft.
- Interdigit nerve compression resulting in enlargement of planatal digital nerve - burning sensation and numbness usually between 3 and 4 metatarsals
- heel pain usually early mornings involves the plantar areas
18
Q
Guttate psoriasis
A
- Varieant of psoriasis that occurs 2-3 weeks after a streptococcal infection
- Sole palms usually spared
19
Q
Heavy menstrual bleeding - Treament outpatient
Severe/acute bleed
A
- Oral medroxyprogesterone acetate
- patient were orthostatic or dizzy from blood loss, intravenous estrogen would be appropriate. Parenteral conjugated estrogens are approximately 70% effective in stopping the bleeding entirely. Pulmonary embolism and venous thrombosis are complications of intravenous estrogen therapy.
20
Q
Hereditary Angioedema
- Clinical Features
- Screening
- Tx
A
Clinical Features
- Angioedema without any urticaria or pruritus > 12 hrs
Screening (1 week after ffp treatment)
- C4 levels (C1 substrate)
- C1 inhibitor antigenic levels
- C1 inhib. functional levels
Tx:
- 1st line:
- C1 inhibitor / icatibant (bradykinin) / Ecallantide
- FFP
Prophylaxis
- Angdrogens (Danazol)
21
Q
human papillomavirus vaccine
A
- Females between the ages of 11 and 26 years
- Males between the ages of 11 and 21 years.
22
Q
Hyperlipidemia in pregnancy
A
- Colesevelam / Bile acid sequestrants are the best option
- STatins / Ezetimibe catagory X
- Gemfibrozil category C
23
Q
IgG4 Related systemic dz
should be suspected in pt with the follwoing?
A
- Idiopathic pancreatitis
- Sclerosing cholangitis
- B/L salvary or lacrimal gland Enlargment
Dx
- IgG4 +ve plasma cells
- Peripheral eosinophilia
Tx
- Steriods
24
Q
Licorice
A
- Stomach ulcers
- Hyperkalemia/HtN
25
Likelihood Ratio
Positive
Negative
LR + = **Sensitivity / (1-specificity)**
LR - = **(1-Sensitivity)/ Specificity**
26
Malitonin
Used when corssing 4 time zones for sleep
27
Manage advanced cancer pain
1-3 Mild
4-6 Moderate
7-10 Severe
The World Health Organization analgesic ladder
* ASA, acetaminophen, or NSAIDs mild pain (1-3).
* oxycodone and acetaminophen (combo pills) Moderate pain (pain score 4-6) / daily cumulative acetaminophen dose (
* Severe pain (pain score 7-10) is mainly treated with opioids.
Adjunctive therapies (antidepressants, anticonvulsants, corticosteroids, muscle relaxants) can be used at all levels of the analgesic ladder.
28
Indications for specialized RBCs Treatments
* **W** **_A_**shed
* **_I_** RRADIATED
* **L** EUKOREDU**_C_**ED
**_I_**rradiated: **_Immune / BMT_**
* BMT reciepients
* Acquired or congenital cellular immunodef
* blood donated by first or second degree relative
**_L_**eukoredu**_C_**ed:
* _**C**hronically_ transfused pt
* _**C**MV_ seronegative at risk
* potenstial transplant pt
**_WA_**shed
* Ig**_A_** def
* Complement dependent autoimmune hemolytic
* Allergic reaction to RBC
29
Manage chronic fatigue syndrome
* Graded exercise programs
* Cognitive-behavioral therapy
* 6 months - least four of the following symptoms:
* subjective memory impairment
* sore throat
* tender lymph nodes
* muscle or joint pain
* headache
* unrefreshing sleep
* postexertional malaise lasting longer than 24 hours.
30
Medications for Bulimia vs Anorexia
**Bulimia** : SSRI
**Anorexia**: Olanzapine
Bupropion is CI in eating disorders
31
Medications for Rhinorrhea vs Chronic Sinusitis
Ipratropium nasal spray for rhinorrhea
Chronic Sinusitis \> 12 weeks NS Nasal spray
32
**_Metabolic syndrome:_**
Waist size
Dyslipidemia TAG
Dyslipidemia HDL
Blood pressure
Fasting glucose
At Least 3 of the following:
* Central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 35 inches(female)
* Dyslipidemia: TG ≥ 1.7 mmol/L (150 mg/dl)
* Dyslipidemia: HDL-C \< 40 mg/dL (male), \< 50 mg/dL (female)
* Blood pressure ≥ 130/85 mmHg
* Fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dl)
33
Mild cognitive impairment
have a single or few areas of cognitive impairment, and the Mini-Mental State Examination score is typically 24 or 25.
34
Modafinil (used for)
Causes wakfulness in pt with OSA and excessive daytime sleepiness
35
Nicotinic acid
* Reduce serum triglyceride level by 20% to 50%
* Decrease LDL cholesterol level by 5% to 25%
* Increase the HDL cholesterol level by 15% to 35%.
36
Nonhormonal therapy for hot flushes
post Manopausal
* Venlafaxine
* Paroxetine / fluoxetine or citalopram.
* Gabapentin and clonidine
37
OCD tx
CBT or SSRI/SNRI or both
38
Optic Neuritis
* associated with pain on eye movement
* Multiple Sclerosis
39
Hepatitis B vaccine is indicated
* Children and adolescents through age 18 years
* HIV+ve
* Recent sexually transmitted infections
* Sexually active but not monogamous
* Workers with occupational exposure to blood
* Illicit drug users
* DM who are younger than 60 years
* Persons with advanced chronic kidney disease who are approaching hemodialysis
40
When to expect Osteoarthritis
* Osteoarthritis of the knee can be diagnosed if knee pain is accompanied by at least three of the following features: Age greater than 50 years
* Stiffness lasting less than 30 minutes
* Crepitus, bony tenderness
* Bony enlargement
* No palpable warmth.
41
Panic DO tx
CBT or SSRI/SNRI or both
Short term Benzo for severe distress \< 2 weeks
42
Optic Neuropathy / Meds causing
Ethambutol
Sildenafil
Linezolid
Bevacizumab
Infliximab
Amiodarone
43
Patellofemoral pain syndrome
What age to expect and physical exam
most common cause of knee pain in patients younger than 45 years.
more common in women than in men and is characterized by anterior knee pain that is made worse with prolonged sitting and with going up and down stairs. The pain is reproduced by applying pressure to the patella with the knee in extension and moving the patella both medially and laterally (patellofemoral compression test).
44
Pemphigus Vulgaris
Pathology?
* Autoimmune vesiculobullous dz / blisters form due to loss of cohesion between epidermal cells
* Flaccid bulae that rupture easily
* **Nikolsky sign**
* Autoantibodies to Desmoglein
45
Clinical Predictors of increased preoperative cardiovascular risk
* Active Cardica conditions
* Clinical risk factors
Active Cardiac Conditions
* Unstable agina / recent MI
* Decompensated CHF
* Arrythmia (SVT \> 100, VTach, Brady)
* Severe valvular Dz (AS, MS)
Clinical Risk factors
* Ischemic CAD
* Compensated CHF
* CVA
* DM
* Renal insufficiency
46
Risk of perioperative pulmonary complications
* Chronic lung disease
* Older age
* Use of spinal or general anesthesia
* Surgery around the diaphragm
PFT's do not assess the risk
47
Central retinal vein occlusion
Symptoms and presentations
* Painless blurry vision due to reduced venous outflow
* Vascular edema in the eye
* Optic disc swelling, dilated and tortuous veins, flame-shaped retinal hemorrhages, and cotton-wool spots (“blood and thunder”).
48
pes anserine bursitis
Pain is typically located along the anteromedial aspect of proximal tibia distal to the joint line of the knee. Pain is worse with climbing steps and frequently worsens at night
49
Pneumococcal Polysaccharide Vaccination
Immunocompetent patients
* Chronic CVD (including hypertension)
* Asthma and COPD
* Diabetes mellitus
* Chronic liver disease (including cirrhosis)
* Alcoholism
* Cigarette smoking
* Cerebrospinal fluid leak
* Cochlear implant
* **_Single vaccination; single booster at age 65 y or 5 y after initial vaccination, whichever is later_**
Immunocompromised patientsc
* HIV infection
* Chronic kidney disease or nephrotic syndrome
* Malignancy (leukemia, lymphoma, generalized malignancy)
* Use of immunosuppressive treatment (corticosteroids, antirejection medication, radiation therapy)
* Multiple myeloma
* Congenital or acquired immunodeficiency
* **_Two doses separated by 5 y_**
Patients with aspleniac
* Functional asplenia (sickle cell disease, other hemoglobinopathies)
* Anatomic asplenia (congenital, surgical, others)
* **_Two doses separated by 5 y_**
50
Vaccinations
* Pneumoncoccal
* HPV
* MMR
* Meningococcal
* Hep A
* Hep B
**_Pneumococcal disease_**
* Inactivated
* Adults ≥65 y; adults 19-64 y with risk factors (see Table 8 )
**_Human papillomavirus_**
* Inactivated
* Females 11-26 y; males 11-21 y (permitted 21-26 y)
**_Measles, mumps, rubella_**
* Live, attenuated
* Adults born after 1957 without documented vaccination or immunity. One dose usually sufficient; second dose indicated in HCWs, international travelers, college students, and post-exposure.
**_Meningococcal disease_**
* Inactivated
* Adolescents; persons living in dormitories; persons with HIV or asplenia
**_Hepatitis A_**
* Inactivated
* Travelers to endemic areas, men who have sex with men, users of illicit drugs, persons with chronic liver disease.
**_Hepatitis B_**
* Inactivated
* Adults with increased risk of transmission, morbidity, or exposure (see Table 9 )
51
Pravastatin
Pravastatin is one of the preferred statins in patients who are being treated with multiple medications.
Female sex, small body frame, hypothyroidism, statin dosage, and treatment with multiple medications also influence the likelihood of developing statin-related myopathy.
52
Pregnancy Vaccination
1. Prior to pregnancy (month before)
2. Routine vaccines during pregnancy
3. Other vaccinations for special conditions
4. Postpartum
5. not recommended during pregnancy
1. Varicella / MMR
2. Tdap / inactive influenza
3. Other vaccinations
1. Hep B /A
2. Pneumonococcus 2/3 tri
3. H-influenza for asplenic pt
4. MMR / varicell / anti-D immune globulin for RhD-
5. HPV / MMR / Varicella / Small pox / live influenza nasal
53
BACK PAIN
* Bulging disc
* with neuro changes
* without neuro changes
_If no neurological changes_
* NSAIDS / short acting opiods or tramadol
* Muscle relaxants
* TCA if subacute 4-12 weeks or chronic \> 12 weeks of back pain
54
Pseudodementia
condition in which the cognitive impairment is secondary to depression. Treatment of the depression leads to improvement in cognition. Whereas this patient is frustrated with his condition, he is not depressed.
55
PTSD tx
CBT or SSRI/SNRI or both
56
PTSD
SSRI or SNRI plus Cognitive behavioral therapy
57
Rhinitis Medicamentosa
Over use of OTC nasal decongestants sprays / due to Tachyphylaxis and emotional lift / patients need to use more frequent / causes rebound vasodialation
Tx: Steriod Nasal spray / short term
58
ASC-US
Atypical Squamous Cells of Undetermined Significance
* Repeat pap 6-12 months
* Colposcopy
* HPV DNA testing
59
Rotator Cuff tears
Adhesive capsulitis
Rotator cuff impingement.
Rotator cuff tears are usually accompanied by weakness and loss of function. Examination findings include supraspinatus weakness, weakness with external rotation, and a positive drop-arm test.
Adhesive capsulitis is caused by thickening of the capsule surrounding the glenohumeral joint. Adhesive capsulitis presents with loss of both passive and active range of motion in multiple planes and patient reports of stiffness- typically slow in onset and is located near the insertion of the deltoid muscle.
pain in her shoulder that began after performing the repetitive overhead motion of painting, and her pain is most pronounced with abduction of her arm. On examination, her pain occurs between 60 and 120 degrees of abduction, which supports the diagnosis of rotator cuff tendinitis. She also has a positive Hawkins test, which has a high sensitivity (92%) but poor specificity (25%) for rotator cuff impingement.
60
Screening
HTN
Lipids
DM
Osteoprosis
AAA
HTV
HEP B
Chlamydia
Gonorrhea
Asymptomatic Bacteriuria
Breast Ca
Cervical Can
Colon Cancer
Hypertension : All adults /then Q2 yrs
Lipid disorders : men ≥35 years of age; high CVS risk. Women ≥45 with High CVS risk.
Diabetes mellitus: blood pressure \>135/80 mm Hg
Osteoporosis : Women ≥65 years of age; any other woman whose fracture risk
Abdominal aortic aneurysm: One-time screening in all men 65-75 years of age who have ever smoked
HIV infection: All persons at increased risk of HIV infection
Hepatitis B virus infection : All pregnant women at the first prenatal visit
Chlamydial infection : All women ≤24 years of age who are sexually active; all women \>24 years of age who are at increased risk of infection.
Gonorrhea :Sexually active women who are at increased risk of infection
Asymptomatic bacteriuria :Pregnant women at 12-16 weeks' gestation or at the first prenatal visit, whichever comes first.
Syphilis :High-risk persons and pregnant women
Breast cancer : Biennial screening mammography for average-risk women 50-74 years of age; initiation of screening between 40 and 49 years of age should be individualized.
Cervical cancer: Screen with Pap smear: initiate no sooner than 21 years of age; test every 3 years thereafter or, for women aged 30- 65 years who want to lengthen the duration of screening, every 5 years if combined with HPV testing. Screening is not indicated in women following hysterectomy and without previous high-risk Pap smears. Screening may be discontinued at age 65 years in non–high-risk women with no recent abnormal Pap smears.
Colon cancer: All adults 50-75 years of age (see MKSAP 16 Gastroenterology and Hepatology)
61
Sensitivity to
specificity to
High sensitivity is to Rule out will have high Negative pridictive value = **Sn**Out
High Specifiscity is to Rule in the Dz will have hight Positive predictive value = **Sp**IN
62
Side effects of commonly used drugs in elderly
1. Digoxin
2. Bnazo
3. Anticholenergics
4. Opiods
5. Antipsychotics
6. Insulin/Sulfonylureas
7. Flouroquinolones
1. N/V, cognitive impairement and heart block
2. Falls
3. Cognitive decline, confusion, hallucination, dizziness
4. contipation, sedation, confusion
5. increased mortality / community acquired pneumonia
6. Hypoglycemia
7. tendon inflammation and rupture
63
Skin changes that require HIV test
Severe psoriasis or severe seborrheic dermatitis
64
Skin conditions related to following dz
1. DM
2. HEP C
3. Iron Malabsorption
4. Pernicious Anemia / Autoimmune thyroid disease / Type 1
1. Acanthosis Nigricans
2. Lichen planus / Leukocytoclastic vasculaitis (due to cryo)
3. Dermatitis herpetiformis
4. Vitiligo (autoimmune dz)
65
Social Anxiety
CBT or SSRI/SNRI for Generalized form
Benzo for infrequent
66
Specific Phobia
CBT first line
SSRI/SNRI
Benzo when CBT not available
67
Srotonin Syndrome
* Common Drugs
* Symptoms
* Tx
Common Drugs
* TCA
* Linezolid
* 5 HT3
* Triptans
Symptoms
* Hyperthermia
* Agitations/tremor/hyperreflexia/akathisia
* Dry mucus / rigidity (clonus)
* Dilated pupils
Tx
* DC meds
* Sedation with benzodiazepines
* Supportive care
* Cyproheptadine (antidode)
* Intubation / ICU care
68
Sweet Syndrome
* Etiology
* Clinical features
* Tx
**Etiology**
* post infection / IBD / pregnancy
**Clinical features**
* Painful erythematous leasions / Febrile
* Netrophilic leukocytosis
* Neutrophilic infiltrate without vasculitis
**Tx**
* Topical and systemic corticosteriods
69
Tx: Acute Stress Disorder
* CBT (cognitive behavioral therapy)
* Short term Benzo for severe distress
70
tetanus and diphtheria (Td)
* Every 10 years
* All adults are recommended to receive a single tetanus, diphtheria, and acellular pertussis (Tdap) vaccination regardless of the interval since their last Td booster
71
Treat a depressive episode of bipolar disorder.
In patients with depressive symptoms, it is important to elucidate a history of hypomanic or manic episodes in order to identify bipolar disorder, which is treated with mood stabilizers rather than antidepressants.
72
Treatment for the following
1. Secondary Syphillis
2. Psoriasis
3. Generalized Vitiligo
4. Seborrheic dermatitis
5. Tinea Veriscolor infections
* Benzathine pcn
* Phototherapy and topical steriods
* Pphototherapy and topical steriods
* Topical Corticosteriods (2nd )
* Topical terbinafine
73
Tx rhinitis
Intranasal ipratropium: when it is triggered by smells or enviromental triggers such as cold
Oral and nasal decongestants: use about 3 days URI
Intransal corticosteriods better for vasomotor rhinitis / allergies
Leukotriene for allergic rhinitis
74
Types of Surgery
* High risk
* Intermediate Risk
* Low Risk
High risk
* Vascular Surgery
* Peripheral vascular surgery
Intermedicate risk
* CEA
* HEAD & Neck
* Intraperitoneal/thoracic surgery
* Orthopedic
* prostate
Low
* ambulatory / endoscopic surgery
* cataract
* breast surgery
75
Vaccination
* Influenza
* Td / Tdap
* Varicella
* Herpes Zoster
**_Influenza_**
* Live, attenuated or inactivated
* All adults
**_Tetanus, diphtheria, pertussis (Td, Tdap)_**
* Inactivated
* All adults. Booster every 10 y. One-time Tdap for all (see text)
**_Varicella_**
* Live, attenuated
* Persons born after 1980, HCWs, persons with ↑ risk of disseminated varicella without documented vaccination or immunity.
**_Herpes zoster_**
* Live, attenuated
* Adults ≥60 y
76
Vaccination
Tdap
Influ
Pneumo
**Influenza: **yearly
**Tdap:** Ones as a substitude for Td booster then Td Q10 yrs
**Pneumo**: 1 or 2 doses for high risk **if \> 65** once
77
Vertigo of peripheral origin
* Lasts less than 1 minute, has a latency of 2 to 40 seconds, and fatigues with time.
* The direction of peripheral nystagmus is not vertical but is horizontal with a rotational component.
78
Menopausal hot flushes hormone
therapy AE
* including coronary heart disease, stroke, invasive breast cancer, and venous thromboembolism.
* Specially \> 60 yrs old
79
Number needed to treat
Group Z =X %
Group Y =Y %
NNT= 1/ |X-Y|
80
patellofemoral syndrome
The pain is peripatellar and exacerbated by overuse (such as running), descending stairs, or prolonged sitting. On examination, pain and apprehension can often be elicited by applying pressure on the patella (the patellofemoral compression test).
81
β-blockers in the perioperative period
* trials showing both benefit and harm.
82
83
