USMLE Test 1 Flashcards
Review stuff
what is the greatest risk to a patient when giving them TPN
CLABSI
what is the most common infection associated with TPN
coagulase negative staph and klebsiella or pseudomonas
what is the risk with TPN after greater than 2 weeks
cholestasis
what would the ph, Po2, Pco2, and Hco3 be for ethylene glycol poisoning
low, normal, normal, bicarb is low
symptoms of ethylene glycol ingestion
flank pain, hematuria, oliguria, CN palsies, tetany- calcium oxalate crystals in the urine
symptoms of methanol ingestion
visual blurring, scotomoata, afferent pupillary defect, altered mentation
symptoms of isopropyl alcohol ingestion
CNS depresseion, disconjugate gaze, absent cilliary reflex, no increased anion gap or metabolic acidosis
what is a nonstress test and when is it reassuring
it is reactive and normal if during a 20 minute interveal the baseline is 110-160 there is moderate variability and there are >2 heart rate accelerations that peak >15 min over the baseline and last >15 seconds.
what does it mean if the Non stress test is reassuring
that means there is adequate fetal oxygenation and sufficient uteroplacemental fetal blood flow
what does a biophysical profile include
NST and ultrasound evaluation of amniotic fluid volume and of fetal tone, breathing, and general movements
what is a contraction stress test
administering oxytocin or using nipple stimulation until 3 contractions occur in 10 minutes and then observing the fetal heart tracing. This helps determine if the fetus is having a sleep cycle or hypoxia
what is vibroacoustic stimulation used for during preg
it can provoke fetal movement to determine if an NST is non-reactive due to deal sleep
lesion on food that progresses rapidly from a small erythematous macule to a larger non tender nodule with necrosis- what is the infection
ecthyma gangrenosum is from pseudomonas bacteria and it is from invastion through the media and adventitia of blood vessel
what type of infections are people who recently had chemo are more susceptible to– great negative or gram positive
gream negative
what is the medication associated with men with orthostatic hypotension
alpha blockers- tarazosin
patient had sore throat and dry cough with retrosternal chest pain radiating to the left arm- weakness, dizziness, and syncope- what is happening and loss of pulse during inspiration
this is pericardial terminate and there is pulses paradoxes from it because of the large decrease in the systolic blood pressure on inspiration. This pericardial tamponade can be from an acute myocarditits
what is the mot common cause of infectious myocarditis and pericardititsi
coxsackie virus
patient presents with fever, headache, seizures, confusion, stupor, over a few days- what is it
HSV encephalitits
what is the CSF for HSV encephalitits
lymphoctic pleocytosis, increased protein, increased RBC, and normal glucose. The eleavted RBC is from the hemorrhagic destruction of the frontotemporal lobes
when is the FEV1/FVC remaining normal or increased in the case of SOB
intersitisal lung disease or fibrosis- this has crackles as well. There is a decreased FEV1, FVC and TLC.
causes of interstitial lung disease
chronic dust eposure, drug toxicity, connective tissue disease. over 50 is most common, Usuallysmoking histroy
what is happening if the person has lower extremity pain with extension of the spin and spinal flexion resolves the pain- what test should you get to confirm
lumbar MRI for lumbar spinal stenosis
patient has hyper pigmentation, mediately mass what is being produced and what does it look like
it looks like Cushing and it is ectopic corticotropin
what kind of hormone is ACTH
polypeptide
what should you do if there is a prolonged act phase of labor and they are 7 minutes apart and the fetus is at -4
give oxytocin to augment
patient has a TIA from fib, what should you give to them asa medication to prevent continuation of this
rivaroxaban or heparin or warddarin.
what is specific for a TB pleural effusion
very high protein levels, lymphocytic leukocytosis, and low glucose levels,
patient has headaches, whose when leaving forward, one sided JVD, and facial swelling- what does the patient have and what should you do
probably lung cancer like small cell or lymphoma. May need to o endogenous stunting followed by radiation- palliative overall
what modifications can you do to prevent aspiration of food after stroke
raise the head of the bed
do NG tubes or PEGs reduce aspiration
no
what is sub epidermal bullae assoctied eith
bullous pemphigoid
MRI has multiple ring enahnging lesions at the grey white junction
metastatic cancer
when should folic acid supplementation be started for pregnancy
before pregnancy
when does the neural tube close
3-4 weeks
patient has progressive symmetric proximal muscle weakness and as what
polymyositits
what is the typical mark of myositits
Anti Jo1 and CK
what does tension pneumothorax do to venous return
it impedes venous return because the high intrathoracic pressure causes the right side of the heart to collapse
if a patient has UMN and LMN signs, what doe they have
ALS
what is preserved in ALS
sensation
pateint has starring spells, leg dragging, and confusion afterwards, what do they have
temporal lobe epilepsy
what is Todds paralysis
it is transient post seizure neurologic symptoms
what are the three things that are most common with gestational diabetes
respiratory distress syndrome, preterm delivery, fetal macrosomia
patient has pleuritic chest pain with pleural and pericardal effusion with an enlarged cardiac sillouette. This has elevated Creatinine, and is black what do why have
it is SLE
what are positive for SLE
antinuclear antibody, anti smooth muscle antibody, anti double stranded DNA, and antiphospholipid
what do you give for stable ventricular tachycardia
loading dose of IV amniodarone
what is adenosine used to treat
supraventricular tachycardia
person had a stricture that was dilated then has post-procedure neck pain, chest pain, and abdominal pain- what do they have
rupture and esophageal perforation
how do you confirm the diagnosis of esophageal perforation
need to do a contrast esophagram and or chest CT
what should you think if there are multiple calcifications on the pancreatic duct
chronic pancreatitis which are characteristic of chronic alocholics and they can have steatorrhea from it as well.
why would ABI values be elevated
calcifications with diabetes
patinet has weakness, leg cramps, that are persistent after the initiation of a thiazide diuretic, what is the primary issue. She also has HTN refractory to treatment. What is the disorder, what are the cramps from and what is the best screening and what is the treatment
primary hyperaldoseronism, should do CT, and spirolactone would help, they will have hypokalemia
severe hypercalcemia, localized pain, and increased phosphorus- what is it probably from
lung cancer, and this is from overproduction of 1,25 dihydroxyvitamin D, bone metals, and theis is hypercalcemia of malignancy
what is a very common side effect of roux-en-Y gastric bypasses?
gallstones
why are gallstones more common after gastric bypass
more common because they have gallstones from the weight loss. Prophylactic is ursodeoxycholic acid and is often administered for 6 months
what is a complication a few days after Roux en Y and presentation of it
anastomatic lead that is fever, tachycardia, tachypnea, and abdominal pain
patient has tonsillitis and proteinuria and dysmorphic red blood cells- what will be seen
red cell casts and dysmorphic red blood cells- usually ten or more days following
hypocalcemia and hyperphosphatemia in the setting of CKD. what is going on
secondary hyperparathyroidsim
what do you give for neurogenic bladder
cholinergic agents
what is used to treat urge incontince
muscarinic antagonists
systolic ejection murmur at the right upper sternal border that radiates to the carotids— what is it and why
aortic stenosis from degenerative calcification of the aortic valve leaflets
what counts indicated SBP
neutrophil over 250 and albumin grdient over 1.1.
what is the treatment for SBP
broad spectrum abx, which include third generation cephalosporins, and Fqs
patient with cirrhosis, confusion, and hepatic encephalpoathy- what is a common cause of high nitrogen states
GI bleeding can increase the nitrogen which would cause probelms
do you want to eat more or less protein during cirrhosis
low protein
what kind of becarb, Pco2 and ph is septic shock
metabolic acidosis, hyper metabolic state so there is a buildup of lactic acid from increased anaerobic metabolism.
patient with preceding URI t=hen heart failure
myocarditits
what commonly causes myocarditis
coxsackie B
eryhtematous plaques with silver scale and on the extensor surfaces
psoriasis
scaly puritic patches or plaques
cutaneous T cell lympoma
jaundice, weight loss, and abdominal discomfort-what is it
pancreatic cancer
child is vomiting blood, nausea, diarrhea and green diarrhea- have hypovolemic shock and lactic acidosis- what did the child consume
iron toxicity
what is a long term complication of iron ingestion from toxicity
bowel obstruction from scarring
what is acetominophen toxicity look like
nausea, vomiting, and heaptic toxcitiy, but not GI hemoorhage
back pain, subactue intermittent fevers with spinal and pulmonary disease- what is it
TB
TB usually hits what part of the lung
apices because higher oxygen tensions and slower lymph outflow and cavitary lesions
what other condition could cause atrial fib in an older adult
hyperthyroidism
acute pain and limited joint extension from twisting injury, slowly developing effusion, tenderness at thejoint line
it is a meniscal tear
in astrocytoma, what is the most important prognostic factor
these are graded by anaplasia
patient have multiple chain lymphadenopathy, splenomegatly, mild cytosine, and marked lymphocytic predominant leukocytosis- confirmed with what, and what is this and how is it treated
chronic lymphocytic anemia with smudge cells, and treated with rituximab and monoclonal antibody against CD20 expressed on B lymphocytes it is common first line therapy
patient is an IV drug user with fever and neurologic symptoms with infective endocarditis what do they have and what is the bug
viridans strep, staph aureus, and brain abscess.
what can confirm the diagnosis of brain abscess
gadolinium enhanced brain MRI
sickle cell kid with septic shock and bacteria what do they have
strep penumo
sickle cell with meningitits
stre prnumo
sickle cell with bacterimia
strep prnumo or hflu
osteomyelitits sickle cell
staph, or slamonella
pneumonia in sickle cell
strp pneumo
what alves do you have to do antibiotic prophylaxis for
prosthetic heart valve, previously history of endocardititss, structurally abnormal valve in a transplanted heart, certain congentital heart disease,
acute dystonia- how to treat
diphenhydramine
what is the most common type of ovarian cancer in o post menopausal women
epithelial ovarian carcinoma
what is the most common tumor type in younger ovarian cancer
dysgerminoma in adolescents
ovarian tumor with hyperestrogenism what is that
granolas cell tumor
what is Meigs sundrome
ascites and pleural effusion which is from ovarian fibroma and is benign
symptoms of SBO
severe colickly abdominal pain, vomiting, failure to pass flatus, stool, abdominal distention, and diffuse tenderness. Increased pain with hyperactive bowel sounds
what is the triad of acute cholecystitis
constant right upper quadrant or epigastric pain, fever, and leukocytosis. Guarding from peritoneal abdominal irritation. This is from a setting of cystic duct obstruction of the cystic duct by gallstones.
what are common risk factors of gallstones
obese, female, sex, older age, and pregnancy.
what are other risks of gallbladder
rapid weight loss, hemolytic anemia, hyperlipidemia, billiard stasis
what is the best treatment for PCOS trying to get pregnant
weight loss
what is the treatment for BPH
this is from repositioning and reposting the displaced otoliths and techniques like the Epley maneuver
mid-shaft break of the humerus disturbs what nerve
radial nerve
supracondylar fracture of the humerus
median nerve
medial epicondyle injury
ulnar nerve
palliative intervention for pancreatic adenocarcinoma
endoscopic stent placement to relieve the CBD obstruction. Less invasive and risky than surgery.
progressive large nonpainful unilateral pleural effusion with rapid weight loss- what is it
maligngat pleural effusion usually related to breast or lung cancer.
what is the pleural fluid like in malignant plueral effusion
high lactic dehydrogenase levels
sickle cell with anemia, leukocytosis, and signs of hemolysis, and has vaoocclusive pain on the thig
it is from microvascular occlusion from sickled disease. pain crisis on the top
atrial fibrillation treatment
rate control with beta blockers
wide fixed split S2- mid systolic ejection murmur
ASD more symptomatic in teen years
eosinohillic poop
probably parasites
intratubular cast formation with toxicity and neuphropathy
multiple myeloma
what is the gene and for fragile X and what is the mental effects
it is FMR1 gene on the X chromosome and they are autistic
delirum is treated with
haloperidol
VSD murmur
oxygen saturation and increased right sided heart pressures. and low CO
what would you see on cardiac catherrization for pulmonary embolism
low cardiac output, increased RAP, increased right ventricular pressure, elected pulmonary artery pressure
what bugs tend to cause septic arthritis
gram positive and staph aureus
why does a Meckles bleed
gastric mucosa erodes surrponding tissue
if fibrinogen is low then
it is being used up so DIC would be an issue
low pitched rumbling during diastole
rheumatic mitral stenosis
how often do you mammogram
every 2 years
what is the genetics behind hypertrophic cardiomyopathy
autosomal dominant genetic disorder of the cardiac sarcomere.
what should the first intervention be for an early pressure ulcer
it would relieve pressure on the heals from pressure ulcers like pillows
if there is a reaccumulation of pleural effusion after a thoracentisis what should be suspected
thoracentesis and it is difficulty breathing and hemodynamic instability right after the thoracentesis
when the cremasteric reflex is gone, what is going on and what is the diagnostic step
testicular torsion and doppler ultrasound
side effect of cisplatn
renal toxicity and hearing loss
edema, proteinuria, and hhypoalbuminuria, with african descent and HIV infection- what is the cause
focal segmental glomerulosclerosis
what nephritic syndrome is from hepatitis B and C
it is from membranoproliferazive glomerulonephritits
hypoxia, acute respiratory distress and tachymea and hype without blood and pleural effusion after MVA
blunt thoracic trauma
progression from absence seizure to myoclonic seizures and then generalized tonic clonic with urinary incontince- what kind is that
juvenile myoclonic epilepsy
Lennox Gestalt is
diagnosed in underu7 with lots of seizures of various types and mental retardation
what decreases the chest pain from reperfusion
venous dilation that decreased preload so oxygen demalnd will decrease
kid corckscrew gut in the gut with contrast
midgut volvuls
immunocompromised and over 50 are at risk for what type of meningitis besides neisseria and group B strep and hflu
listeria monocytogenes
what is the best thing after the first treatment of gout
alcohol cessation and weight loss are firstline
what is the parkinson in the brain pathology
decreased dopaminergic activity in the brain
pancoast tumors
horner syndromes, shoulder pain, and C8-T2 neurological involvement- weakness or atrophy of the intrinsic hand muscles, pain and prosthesis of 4th and 5th digits, medial arm, and forearm, supraclavicular lymph node enlargement
what is the murmur for AR
decrescendo diastolic murmur- this could be from aortic root dilation
GBS CSF
elevated protein count and normal leukocyte counts
what is the most common organism for the spinal abscess
staph aureus
what is most common with vesicles on the palate and tonsillar pillars
herpangina and coxsackie A virus
decreased SVR< decreased PCWP, and elevated mixed O2 saturation, cardiac index increases
districbutive or septic hock
myelodysplasitic syndrome
hematopeotic stem cell neoplasm with dysplasia and cytopenias, and granulates and hepatospendomegative and ovalocytosis
patient with high K should give what first
calcium gluconate
pheo management
sustained and intermittent hypertension controlled by alpha and beta adrenergic blackout and alpha needs to go first
chemo and now has a fever
neutropenia and then gets an infection
transient paranoid ideation and depersonilzation- and poor sense of self
borderline personality disorder
what endocrine thing can cause psychosis
hypothyroid
what makes DKA patients nauseous
fatty acid breakdown
what should be the first fluid for DKA
isotonic fluids with potassium supplementation
what cells are seen with CLL
smudge cells because of increased fragility
what is the most common infection of clabsi
coagulase negative strep
pregnant woman has normal ventilation and perfusion scan and pain on the other side of the chest
they need a ventilation perfusion scan. Pregnant women cannot use d dimer
what is another risk of spherocytosis
gallstones from hemolysis
weird dreams on HIV medication
efavirenz
what is urge incontinence and how do you fix it
detrusor overactivity and start with bladder training
what is the gold standard for diagnosing placenta previa
transabdominal ultrasound
blunt chest trauma and wide mediastinum and stable what should you do diagnostically
use a CT scan or a TEE
what should you do for a bartholin cyst
I/D
what is the other medication you cannot combine with a triptan and another migraine med
ergot derivatives because there is elevated bp
treatment of kawaskai
IVIG and aspirin
painless eye blurring, glair, halos around lights, and worsening distance vision- what is lost and what is there
cataracts and opacification and loss of the red reflex
what is often a complication of splenectomy
secondary thrombocytosis
what is common with urethritis and cystitis and sterile pyuria
it is treated chlamyydia
what is the medication that increased longterm CHF persons
Beta blockers
what endocrine disorder can lead to hyperprolactinemia
hypothyroidism
what are risk factors for carpal tunnel syndrome
obesity, diabetes, and hypothyroid, and third trimester
what is the best tocolytic for 32-34weeks gestation
nifedipine but it can cause flushing, headache, tachycardia, and palpiation
what medication should be given for someone with lipemia serum
familial dysbetaproteinemia- with alcohol can lead to chronic pancreatitis- use fenofibrate for it
when do you give steroids during preterm labor
<37 weeks who are at risk. also
at 32 weeks and preterm labor then what to do
penicillin for strep B, and magneusm sulfate and toxolysis
what nerve is compressed when the fifth and fourth fingers are numb
ulnar at the elbow
slapped cheek rash
parvo B19
rash on the chest a nd thorax
HHV6
how to trat raynaud
nifedipine
whatdo you see on urinalysis for rhabdo
false positive for blood
broad waxy casts are seen when
in heavy CKD
what is a child with chronic airway inflammation and hemotysis
CF
what cancer risk is decreased with OCP
ovarian cancer
what is the treatment for torsades
Magneusm
painless monocular vision loss
retinal atherosclerotic lesion
what is the best protection for cancer in kids from the sun
use of protective clothing
five days of fever, malaise, headache, and nonpruritic painless pigmented maculopapular rash over the palms and souls with the diffuse lymphadenopathy
syphillus
what is the mechanism of action of cdiff in the gut
toxin induced inflammation of the colonic mucosa
late systolic murmur following a click heard at the apex
MVP
eosinophils in the hepatic triads
allograft rejection
if there is increased induration of TB test with negative CXR what do you do
begin isoniazid and B6 therapy
relative the incidence of fractures was 10% of drug group X and 20% in the procedue group. Which of the following was most likelyy presented as the 50% reduction in fractures- what is the statistical test for it
relative risk reduction
what antibiotics should you use for prophylaxis on knee replacement
parenteral cefazolin
what does cefazolin cover
staph and strep and some negative coverage
what does organophosphate poisoning hit- receptor site
peripheral muscarinic receptors
what treats impetigo
topical mupirocin
what should be used for newborn with onset of fever
IV administration of ampicillin and gentamycin
what is primary hemophilia factor deficiency
factor VIII deficiency
what are the PFT for asthma
FEV1 decreased, FVC normal, and TLC increased
friable cervical ulcer that is bleeding and pregnant women is what
cervical cancer
what is DIP changes are for
degenerative joint disease
how do you prevent progression of CKD to failure in a child
restrict intake of phosphorus
what is high decibel hearing loss from
exposure to high decibel sound
what do you do for increased PPD skin test and negative CXR
isoniazid
what is ascariasis cause
round worm and GI and lung
what does enterobeous cause
pin worm
what does trichophytan cause
ring worm
