1 Flashcards
(545 cards)
1
Q
Keratitis: normal or abnormal pupillary response
-relationship to contact lense?
A
Keratitis: noramal (vs anterior uveitis abnormal)
-Contact lense -> suggest keratitis
2
Q
Contraceptive that is not affected by cyp450 inducers? (3 options)
A
- copper IUD
- Depo-provera (progesterone injection)
- Mirena IUD
3
Q
Contraceptive associated with weight gain?
A
Depo-provera (progesterone injection)
4
Q
What is oculogyric crisis and cause
A
acute dystonia reaction- involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles
this is extrapyramidal disorder, can be caused by parkinson’s, haloperidol, metoclopramide (פרמין), phenothiazines
5
Q
Marcus Gunn’s pupil
A
in optic neuritis- abnormal afferent defect- abnormal pupil constriction
6
Q
breast preserving surgery criterion
A
tumor <4cm
7
Q
Breast cancer markers- which drug is for ER+ive and which is for HER2+ive
A
tamoxifen - ER+ive
Herceptin- HER+ive
8
Q
Drug which is contraindicated in stage 4 CKD
A
Tetracycline (doxycycline)
9
Q
how to differentiate between vW disease and haemophilia?
A
type of bleeding. vW=platelet type, haemophilia= coagulation factor deficiency type
10
Q
Hiv + visual deterioration
- opthalmoscopy findings
A
Cmv retinitis
- hemmorhages and yellow areas (pizza appearance)
11
Q
Night blindness + tunnel vision
A
Retinitis pigmentosa
12
Q
Cherry red spot
A
CENTRAL Retinal a occlusion
13
Q
vasa previa vs placenta previa
A
rupture of membranes followed by painless bleeding -> vasa previa
14
Q
first line for heavy menstrual bleeding
A
mirena (lenovorgestrel)
15
Q
contraception in sickle cell disease
A
depo provera
16
Q
מורידות CYP
A
איזוניאזיד, אריתרומיצין, קלריתרומיצין, אמיודרון(פרוקור), סימטידין. ציפרו.
מיץ אשכוליות
איזה ארי, קליירוש, עמי-דורון. סמנט!
17
Q
מעלות CYP
A
ריפמפין, פניטואין, טגרטול (קרבמזפין?), st john’s wort. כנראה גם סולפנילאוראה
צוק מעל הים עם ריף. יש מכונית, פאן, פרחים (מהם מפיקים STJOHNS)
18
Q
which contraceptive is not affected by carbamazepine?
A
UKMEC1: depo-provera, IUD, IUS
UKMEC2: implants (nexplanon)
19
Q
What can enhance efficacy of levodopa/carbidopa in parkinson’s?
A
trihexyphenidyl (=benzhexol)
20
Q
how does kaposi sarcoma looks
A
look in keep
21
Q
side effect of cyclosporin
A
nephrotoxicity
22
Q
- presentaion, and
- management
of fibroid degeneration in pregnancy?
A
- low grade fever, pain, vomiting
- conservative: rest+analgesia
23
Q
what drug causes achilles tendinopathy?
A
quinolones- cipro
24
Q
sources of follate
A
dark green leaves, citrus fruits
25
pneumotorax: when to
- discharge
- aspirte
- midclavicular cannula
- drain
?
- non traumatic, up to 1cm air on CXR
- rim of 1-2cm
- following trauma
- >2cm air on CXR
26
young female with elevated liver enzymes and secondary amenorrhea
autoimmune hepatitis
27
when to do a kleinhauer test?
Any event of fetomaternal haemorrhage AFTER WEEK 20
28
routine antiD to Rh-ive mothers
28 & 34 weeks
29
most common pathogen that causes COPD exacerbation
hemophilus I > strep pneumonia, moraxella cataralis
30
which drug should not be prescribed together with beta blockers?
CCB
31
first line treatment for toenail fungus
oral terbinafine
- not for children
32
at what age should a child with undescended testis be referred to a surgeon?
3 months.
should be seen before age 6m
33
risk factors for endometrial cancer (4)
obesity (high estrogen levels like unopposed estrogen->proliferation)
nulliparity (proliferation)
late menopause (proliferation)
T2DM (high insulin and related to obesity)
34
What does Rigler sign, also known as the double-wall sign, indicate?
bowel perforation (caused by gas within the bowel's lumen and gas within the peritoneal cavity)
35
difference between bullos pemphigoid <-> pemphigus vulgaris
pemphigus vulgaris involves mucosa
36
when to suspect Buerge's disease (thromboangiitis obliterans)?
male + age40 + smoking
- extremiti ischemia, raynaud's phenomenon, superficial thrombophlebitis
37
treatment following ischemic stroke
14 days aspirin,
followed by long term clopidogrel
38
psoriasis 1st and 2nd line management
1st: topical steroids + vitD analogs (calcipotriol)
2nd: phototherapy, acitretin, methotrexate
39
risky pathogen following splenectomy (4)
pneumococcus
haemophilus
meningococcus
capnocytophaga canimorsus
40
Treatment for splenectomy:
- when & which vaccins BEFORE?
- which vaccinations AFTER a splenectomy?
- what antibiotic profilaxis AFTER splenectomy?
-
2 weeks before:
Hib
meningitis
Influenza
Pneumococcus
-
annual influenza,
5-y pneumoccocal
-
penicillin V for life. no specific guidelines2 years OR age 16
41
findings in neurofibromatosis 1 and 2?
1: cafe-au-lait spots
2: sensorimotor polyneuropathy
42
tuberous sclerosis main systems affected
skin & neurological
43
what is talipes equinovarus
club foot
44
finasteride side effects
ejaculation and libido disorders, gynecomastia
45
anaphylaxis doses of adrenaline by age
<6m: 150 mcg
6m-6y: 150mcg
6-12y: 300mcg
>12y: 500mcg
hydrocortisone: starts at 25mg and doubles each step up to 200mg
46
DM criteria
glucose: fasting >7mmol/l, random >11.1mmol/l
HbA1c >6.5% (48mmol/mol)
47
When to add a second drug in DM2?
HbA1c >7.5 (58mmol/mol)
48
anemia cuttoff in pregnancy?
- 1st trimester - 11
- trimester 2&3 - 10.5
- postpartum period - 10
49
symptoms of bell's palsy besides facial palsy (4, ear, eye&tongue)
- post auricular pain
- altered taaste
- dry eyes
- hyperacusis
50
Under what age a mark of UKMEC2 is given to:
- Depo-provera
- Mirena
- Depo: 18
- Mirena: 20
51
With what condition is dermatitis herpetiformis associated??
coeliac
(autoimmune thyroid disease is also associatedd with coeliac)
52
complications of coeliac
! t-cell lymphoma of small intestines (assoc. w/ enteropathy)
! osteomalacia (malabsorption)
! anemia (malabsorption)
! functional hyposplenism -> sometimes appropriate to administer pneumococcal vaccine
53
gestational DM criteria
fasting glucose >5.6 mmol/l
2h glucose >7.8
54
target for gestational DM:
fasting glucose <7 within 1-2 weeks
55
criterion for insulin therapy at diagnosis of gestational DM:
fasting glucose >7 at diagnosis
OR
fasting 6.9>glucose>6 with symptoms
56
what to do with pre-existing DM management in pregnancy?
- stop oral hypoglycemic agents
- KEEP metformin! can also use glibenclamide
- initiate insulin to target 5.3 of fasting glucose
- detailed US scan at 20w
57
is clostridium dificile gram positive or negative?
positive
58
characteristics of interstitial cystitis (bladder pain syndrome)
pain, worsening with bladder filling
frequency+urgency (similar to UTI)
HUNNER's ulcers seen in cystoscoopy in 10% (reddened mucosa, vessels radiating twards a central scar)
trt- pelvic floor relaxation, NSAIDS, oxybutynin&anti neuropathic pains
59
TX for hyperemesis gravidarum
first line:
Antihistamine: Promethasine(phenergan)/cyclisine
Second line:
Ondasterone, metoclopramide
60
Renal transplant + infection =
cmv
61
sle serology:
- Which test is the most specific?
- which is the most sensitive?
- the most specific is anti Smith, then anti dsDNA. Diagnostic = dsDNA. Both have specificity of >99%
- ANA in 95%
62
Side effects of Sublingual glyceryl trinitrate
hyPOtestion, headache, tachycardia
63
Hourseness and dysphagia
Laryngeal tb
64
Wich tbmedication is xontraindicated in pregnancy
Streptomycin
65
Gastroenteritis- when to retuen to work
48h since last episode
66
Gastroenteritis ABX
Campylobacter- clarithromycin
Salmonella. - cipro
67
Followup after hearing loss
Hearing test within 4 weeks
68
treatment for chicken pox
supportive.
VZIG for newborn with +-7 days of exposure pre-post-nataly
Acyclovir for exposure+sick ptns: pregnant+immunocompromised
69
what malignancies are associated with EBV
burkitt's
hodgekin
nasopharingeal
leiomyosarcoma
and oral hairy leukoplakia
70
antibodies in scleroderma
anti centromere- the most specific in LIMITED cutaneous disease
anti-scl-70- associated with DIFFUSE cutaneic systemic disease
ANA- in 90% of systemic sclerosis
RF- in 30%
71
the main dorsiflexer and inverter of the foot
tibialis anterior (innervated by L5
72
extra manifestations of sjorgen syndrome
- arthalgia and polyarthritis
- interstitial lung disease and bronchiolitis
73
CURB65
confusion
urea>7mmol/l
respiraation>30
BP<90/60
age>65
74
what indicates a corckscrew sign on barium test?
diffuse esophageal spasm
75
Drugs associated with erythema multiforme
Penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDS, oral contraceptives, nevirapine
76
drugs that cause nephrotic syndrome
gold
penicillamine
77
nephrotic syndrome:
top 4 causes in descending order
(in adults)
membranous nephropaty
minimal change disease
SLE
FSGN
78
what test should be performed before recommending compression therapy for pedal venous insufficiency?
Ankle-brachial index,
to exclude arterial insufficiency
79
critical management step in bells palsy
artificial tears and taping the eyelid of affected side
(prevents infections and drying)
80
what is the threshold HR to reduce 1 point in APGAR score?
100. if absent- reduce 2 points
81
How many points should be reduced from APGAR if grimace is seen as a response to irritation?
1
82
which testicular tumors have better prognosis, and what are the supporting markers?
seminomas have better prognosis (LDH).
non-seminomas are characterized by AFP, bHCG
83
what is Fitz-Hugh–Curtis syndrome
rare complication of PID involving liver capsule leading to adhesions and RUQ pain
84
prostate cancer treatment with goserelin (Gonadotropin-Releasing Hormone Agonist)-
what is the side effect and how to mitigate it?
- worse LUTS
- pretreat with anti androgen flutamide
85
gold standard for diagnosing psoas abcess
MRI
86
Normal BMI, and BMI for anorexia
18.5-25
mild anorexia: >17
moderate anorexia: 16-17
severe anorexia: 15-16
extreme anorexia:<15
87
when to refer URGENTLY an anorexia case
BMI<15
self harm
unstable clinically (e.g. bradycardia)
88
Chicken pox and zoster management in immunocompetant adults
Chicken pox: Acyclovir within 7 days, preferably 48 hours
Shingles: acyclovir best within72 hours
89
ABX for Lyme
Spirochete:
Doxycycline- 1st
Amoxicilin
Ceftriaxone
90
ABX for meningitis + penicilin allergy + ambulatory
Chloramphenicol
Otherwise- benzylpenicillin
91
ABX for meningitis + penicilin allergy + ambulatory
Chloramphenicol
92
Meningitis Tx for:
- listeria
- cryptococcus
- prophilaxis
- >60 yo
- amoxicilln OR ampi+genta
- amphoteticin b
- cipro 1st, OR rifampin
- ceftriaxone + amoxicillin
93
When CT befor LP (2+2)
Papiledema
Focal deficits
Altered mental state
Seizure
94
1st line Tx for anaphylaxis
IM adrenaline every 5 min
(hydrocort no longer routinely recommended)
95
H.Pylori strongest association?
duodenal ulcer
(GERD- no concensus,
atrophic gastritis & gastric adenoca. are also connected)
96
Neutropenic sepsis immediate Tx
- Tazo!
- NO routine GSCF
97
acahlasia vs esophageal adenoca.
solid & fluid intolerance (achalasia) VS progressive nature (ca)
98
migrane Tx::
- prevent
- acute
PREVENT
- bb (important! not in asthmatics)
topiramate
ACUTE
- triptan
99
who needs urgent gastroscopy?
dysphagia
OR
1. age>55+2. weight loss+ 3. either:
- dyspepeia
- reflux
- upper abdominal pain
100
urinary incontinence Tx
urge
bladder training
oxybutinin- 1st. avoid in frail old women
tolterodine
mirabegron- if SVT
stress
pelvic floor exercises
surgery
100
what are the 2 types of schistosoma?
- mansoni: affects intestines and causes hepatosplenomegaly
- hematobium: hematuria, obstractive uropathy, bladder calcifications (do xray or ct) which can cause scc later
100
Ameba Tx
Oral metronidazole
101
analgesia for acute pancreatitis
IM pethidine
morphine can cause spasm of the sphincter of oddi
102
1st line Tx for Alzheimer's
AChE inh: donepezil, galantamine, rivastigmine
2nd line: memantine- NMDA antagonist
102
breast cancer treatment for:
- HER+I've
- ER+ive
- HER+I've: Herceptin (trastuzumab)
- ER+ive: Tamoxifen for pre and peri-menopause adn MEN! (usually are ER+ive). Post menopause use aromatase inhibitors like anastrosole
103
"pencil in a cup" is characteristic of
psoriatic arthritis
104
OA vs RA: which doesn't involve DIP?
RA
105
routine follow-up for amiodarone
- thyroid function (x6 per month!)
- liver function (x6 per month!)
- CXR ONLY before initiation of while symptomatic
106
rett syndrome?
תסמונת רט rett- לאחר 6-18 חודשי התפתחות תקינה הילדות עוברות רגרסיה התפתחותית מתפתח מיקרוצפלי. %50 יפתחו פרכוסים. עד גיל שנתיים יש איבוד של כל תנועות הידיים המכוונות.
107
targets of heparin
LMWH
both activates antithrombinIII, which inhibits:
Heparin: F12,11,9,10+2(thrombin)
LMWH: F10
108
when PPI should be added to aspirin?
when SSRI is prescribed also
109
silhouetting diaphragm=
pleural effusion
110
what to do with cocp before surgery
ideally stop 4 weeks beforehand.
Start again at least 2 weeks afterwards, at next menstruation.
If not stopped- offer thrombophylaxis
111
preferred opioids for ckd stage 4
fentanyl and buprenorphine
112
side effect of methotrexate
pneumonitis
113
benefit of ICS in COPD
reduction of exacerbation frequency (not severity)
114
association of antibodies:
ANA
AMA
ASMA
ASCA
Myeloperoxidase
Anti centromere
Diffuse scleroderma
Anti-Ro
Anti-La
ANA: SLE, dermatomyositis!
AMA: anti-mitochondrial: PBC
ASMA: (smooth muscle) autoimmune hepatitis
ASCA: crohn's
Myeloperoxidase: Churg Strauss
Anti centromere: limited cutaneous systemic sclerosis
Diffuse scleroderma: Anti scl-70
Anti-Ro&Anti-La: Sjorgen
115
Brown-Sequard syndrome
injury to one side of the spinal chord:
- ipsilateral upper motor
- ipsilateral dorsal columns
- contralateral spinothalamic
116
herpes zoster ophthalmicus <> ramsay hunt
herpes zoster ophthalmicus: trigeminal N, mainly eye + tip of the nose (Hutchinson's sign)
ramsay hunt: Facial N. mainly ear, can be hard to close the eye > irritation
117
HRT following hysterectomy
estrogen alone!
DONT give progesterone
118
risks of progesterone
increased risk of breast cancer (risk returns to normal 5 years post cessation)
increased risk of venous thromboembolism (stroke, MI if >10 years after menopause)
REDUCED risk of endometrial cancer associated with estrogen
119
when to prescribe cyclical combined HRT
last menstruation <1y
120
When to prescribe lorivan, disulfiram, acamprosate, or chlordiazepoxide
lorivan- delirium tremens (confusion)
chlordiazepoxide- withdrawal
acamprosate- reduce craving for alcohol
disulfiram- produces harsh responses to alcohol
121
which testicular cancer is associated with late descending testis, and what marker supports that type?
seminoma, LDH
122
what drug is associated with atypical femur fractures
aledronate
123
when to start contraception postpartum
after 21 days.
DONT use COCP
124
what kind of headache is associated with visual disturbances, confusion and neck stiffness?
basilar type mignare
125
Which conditions are associated with seeing halos
Glaucoma (mainly closed angle)
Cataract
126
when to treat bronchiolitis with oxygen?
so2<92%
127
contraception + breast cancer
copper IUD
all hormonal contraceptions are UKMEC3-4
128
Salter Harris grading
Type I to V
see picture in keep
129
paraneoplastic secretions of:
Lung SCC
Lung lymphoma
Lung small cell
Sarcoid
Lung carcinoid
Lung SCC > PTHrP
Lung lymphoma > VitD
Lung small cell > SIADH
Lung small cell > ACTH
Sarcoid > VitD
Lung carcinoid > the most frequent site of ACTH secreting carcinoid
130
how long before IVF in couples with up to mild known reasons for mild infertility
2 years (not 1)
131
Cabergoline or bromocriptine for prolactinoma?
Cabergoline is more effective and safe.
Bromocriptine is good for NMS
132
what age social smile is expected in babies
6weeks (2months)
133
antidote for cyclic antidepressants
sodium bicarbonate
134
tricyclic poisoning presentation
anticholinergic presentation:
dry mouth
mydriasis
agitation
sinus tachycardia
blurred vision
QRS>100 is associated with seizures
QRS>160 is associated with ventricular arrhythmias
135
Following a human bite
PEP NOT recommended (very low risk for hiv), unless risk is high: biter is ivdu, hiv positive, or the bite is deep with blood
Check hiv 6 months later
ABX (also for animal bites):
co-amoxiclave
If penicillin allergy: metronidazole+doxycycline
136
Vaccines to avoid in hiv
BCG!
if cd4 is low>
Avoid also MMR and yellow fever
137
Vaccines based on toxoids
Diphteria
Tetanus
138
Tetanus prophilaxis after injury
1. Ig if a dirty wound + last booster >10y ago
2. Give full immunization (5 vaccines) if immunization history is unknown or incomplete. Booster if last booster was >10y ago.
If all vaccines are up to date > no need for ig even if the injury is high risk
139
First marker to become abnormal in HB
sAG surface antigen (not antibody)
140
Avoid sugar for ADHD?
no
141
promethazine pharmacologic category
Histamine H1 Antagonist
142
antiemetics for:
- metabolic (renal failure, poisoning)
- radiotherapy
-chemotherapy
- bowel obstraction
- delayed gastric emptying
- metabolic (renal failure, poisoning): haloperidol- 1st
- radiotherapy: ondasteron (zofran), haloperidol
-chemotherapy: ondasteron (zofran), metoclopramide (pramin)
- bowel obstraction: cyclizine, hyoscine butylbromide, octreotide
delayed gastric emptying: metoclopramide, domperidone
143
neonatal hemorrhage types (3)
- subgleal hemorrhage (subaponeurotic). serious. may present as shock
- cephalhematoma. beneath periost, respects sutures
- caput succedaneum
144
maneuvers for shoulder distocia
- McRoberts position: hyperflex mother's legs + suprapubic pressure. Try first!!
- Rubin's: press on the posterior shoulder
- Woodscrew: rotate the fetus 180 degrees
145
mikulicz's disease
lacrimal gland enlargement, parotid enlargement, dry mouth and eyes
146
treatment before PPCI
aspirin+parsugrel+IV heparin
perscribe parsugrel only if PCI is not performed
147
Lichen planus - treatment
topical clobetasone butyrate
148
vaccines given after age 12m
MMR, Varicella, HAV (hepatitisA)
149
first vaccine at age 1m
HBV
150
causes of dupuytren's contacture
Alcoholic liver
manual labour!!
phenytoin!!
family history
151
the most important criterion for liver transplantation (king's critetria)
ph<7.3
152
fetal alcohol syndrome
- facial abnormalities: small eye openings, low ears, sunken nasal bridge...
- IUGR
- neurodevelopmental: learnind disabilities, cognitive&behavioral problems
153
when to reassure patient with enuresis?
age <5y
age >5y & frequency <2/week
154
ABX that causes photosensitivity and sensitivity to sun
Doxycycline
Ciprofloxacin
155
systolic murmur + fixed splitting of S2 in 1yo
ASD
156
confusion+ pink mucosa
CO- poisoning
157
Medication that causes pancreatitis
Valproate!!
azathioprine
mesalazine
didanosine
furosemide!! bendroflumethiazide
pentamidine
steroids
158
how much time to observe an SSRI overdose
6h
159
first sign of puberty
males: testicular growth. volume >4ml (10-15years)
females: breast development (9-13)
160
puberty age
average girls 11 (delayed if no breast growth by 13, or no period by 15)
average boys 12 (delayed if no testicular growth by 14)
161
what is lochia
fresh bleeding after giving birth (vaginally or after surgery), with changing color before stopping
162
side effects of gentamycin
nephro&oto toxicity
163
What causes single (or multiple) ulcers on genitalia?
Chancroid= hemophilus ducreyi
Dx pcr swab! (Culture also possible)
Tx azythro/ceftriaxone im/cipro
164
Diagnosis test for genital ulcers
Hemophilus? Hsv?
Pcr swab 1st
Viral /bacterial culture
165
Leptospirosis (Weil's) features
Hx of water exposure
Red eyes (hemorrhage), than
Yellow eyes
Hx of water exposure
arthalgia
fever
166
Leptospirosis (Weil's) treatment
Doxycycline
AMPIcillin
167
Leptospirosis (Weil's) diagnosis test
1. Serology
2. pcr
3. Culture
168
Campilobacter treatment
Usually dont treat! Unless immunocompromised....
1st: Azythro/erythro/clarythro
2nd: Cipro
169
Campilobacter is gram ne/pos?
Gan negative bacillus
Like salmonela and shigela!
170
Campilobacter is gram ne/pos?
Gan negative bacillus
Like salmonela and shigela!
171
Salmonela treatment
Usually dont treat
Cipro
172
Hints and their meaning
Rice water diarrhea
Diarrhea after oysters
Rice water diarrhea- cholera
Diarrhea after oysters- vibriosis
173
Tx for brucella
doxycycline
174
who gets cerebral toxoplasmosis
HIV with CD4<100 cells
175
typical finding in cerebral toxoplasmosis
brain MRI shows ring enhancing lesions
176
Tx for cerebral toxoplasmosis
pyrimethamine + sulfadiazine
177
when ampicillin/amoxicillin can cause pruritic maculopapular rash
infectious mono EBV
178
infectious mono EBV recommendation on physical activity
do not play contact sport- risk for splenic rupture
179
emergency contraception timeframes
72h- levonorgestrel (delays ovulation)
120h (5d)- copper IUD (inhibits fertilization&implantation)
120h (5d)- ulipristal (delays ovulation)
180
when to use MRI for CVA
suspected in posterior fossa
181
how to prescribe folate for women at high risk for neural tube defects (e.g., diabetes! anti-epileptics)?
5mg until week 12
182
erythema nodosum treatment, when it stands alone
NSAIDS
oral prednisolone IF NO INFECTION
183
when Rouleaux fromation is seen?
Multiple myeloma
184
What&when are Howell–Jolly Bodies
clusters of DNA- small cytoplasmic inclusions that stain purple
appear in hyposplenism (e.g., after splenectomy)
185
decreased goblet cells are a characteristic of
UC ulcerative colitis
186
patau vs eduards
hands
patau: polydactyly
edward: clenched, index over 3rd, 5th over 4th
rocker bottom feet: both. edward more?
head
patau: microcephalus, microphthalmia
edward: microcephalus, micrognatia
special:
patau has cleft palat
edward has rocker buttom feet
187
Ankle brachial pressure index for refferal for vascular surgeon
<0.8
188
most common reason for revision of hip replacement
aseptic loosening
189
COCP effect on cancer: breast, ovary, cervix, endometrium
increased risk: breast, cervix
decreased risk: ovarian, endometrial
190
when to call the police
female mutilation in <18yo
191
necrotizin fasciitis Tx
clindamycin or benzylpenicillin
NOT flucloxacillin
192
ABX for HIV- profilaxis
co-trimazole if cd<200 = prevents PCP
azythromycin if cd<50 = prevents mycobacterium avium
193
Whipple's Tx
co-trimazole with/without preceded by IV penicillin
194
Whipple's characteristics on jejunal biopsy
- stunted villi
- macrophages with PAS granules
195
what is "saturday night palsy"
compression of RADIAL nerve (resting on medial arm)
wrist drop
parasthesia of dorsal 1+2 metacarpals in hand
196
when to stop COCP before surgery
4 weeks prior
197
age of precocious puberty
boys: 9yo
girls: 8yo
198
SSRI discontinuation symptoms
diarrhea
vomiting
abdominal pain
199
how to manage shock right at the beginning of laparoscopy
deflate the abdomen.
the cause is vagal response from inflated abdomen
200
thyroid disease mechanisms
hashimoto- HYPO- anti-TPO
graves- HYPER- stimulating anti-TSH antibodies
de-quervain- HYPER- viral thyroiditis
201
klumpke vs erb palsy:
- injury location
- presentation
- mechanism
- injury location
erb: upper brachial plexus
klumpke: lower brachial plexus
- presentation
erb: waiter's tip
klumpke: claw hand
- mechanism
erb: lateral traction of neck
klumpke: upward force on arm (climbing a tree)
202
cerebellar infract symptoms
contralateral sensory loss!
contralateral hemiplegia!
dysphagia!
homonimus hemianopia!
vertigo- inferior cerebellum
postural dysfunction- inferior cerebellum
NOT PRESENT:
limb parasthesia
diplopia
203
brain stem infract symptoms
CN3-6!!! 9!!
vertigo
ataxia
diplopia
slurred speach
facial numbness
decreased consciousness!!
204
diseases with association to brain aneurisms
PCOS
ehlers danlos
205
Equivalents to 10 mg PO morphine
Codein?
Diamorphine iv?
Morphin iv/im?
Oxycodon?
Tramadol?
fentanyl patch?
Codein m*10
Diamorphine iv m/3
Morphin iv/im m/2
Oxycodon m/2
Tramadol m*10
fentanyl patch: 25mcg = 90mg ORAL MO
206
TX for pcp
resprim
207
Function of deep peroneal nerve
dorsiflexion of heel
Extension of toes
Sensation between toes 1&2
208
Function of superficial peroneal nerve
eversion of foot
Anterolateral sensation
209
ways of administering antiepileptics
Midazolam
Diazepam
Midazolam- buccal administration
Diazepam- 10mg rectally
210
alport
מחלת כליה, אובדן שמיעה, עיניים (לנטיקונוס, קרטוקונוס, קטרקט...). הפגיעה היא בקולגן סוג 4.
211
Whats the effect of bendroflumethiazide on litium
increase toxicity by reducing elimination
212
when can a patient be discharged following appendectomy if all is ok
after 24h
213
differences in biopsy between celiac and whipple's
celiac: lymphocytosis (can cause Tcell lymphoma)
whipple's: macrophages containing PAS granules
214
when to avoid breastfeeding
HIV
can continue breastfeeding after immunization:
TB
HBV
CAN FEED REGULARLY
nipple candidiasis
breast abcess
HCV- if nipple is intact and not bleeding
mom on sertraline
215
which animals carry rabies in UK
bats
not canines (neither wild nor domestic)
216
staph aureus common infections (3)
osteomyelitis
breast abcess
Conjuctivitis
elderly patients with bilateral cavitations and recent Hx of influenza
217
Cellulitis Tx
flucloxacillin
then-
macrolides clarithromicin, erythromycin
doxycycline
clindamycin
218
fetal CMV infection- long term comlication
hearing loss
219
vestibular neuritis vs BPPV
vestibular neuritis- Hx of recent viral infection
lasts longer: hours to days
220
vestibular neuritis vs labyrinthitis
labyrinthitis: hearing loss, tinitus
221
obstetric cholestasis symptoms
reduced flow of bile
maternal pruritus
fetus incapable of dealing with bile acids
biles constrict placenta's vessels>
fetal anoxia or death
222
whats the difference between colle's and torus (buckle) fracture?
probbably- buckle is an incomplete fracture
223
early menopause vs premature ovarian failure
early menopause: 40-45yo
premature ovarian failure: <40yo
224
acute pancreatitis is known to precipitate ARDS!
oh yes!
225
methotrexate side effects
leukoencephalitis (necrotising demyelinating)
neurotoxicity
pneumonitis
226
ferrous sulphate or iron dextran?
iron dextran is given as injection, is painful, and can cause permanent skin discoloration
ferrous sulphate is PO
227
Argyll Robertson pupils vs Holmes-Adie pupil
Argyll Robertson:
bilateral small pupils that fail to constrict in response to bright light but exhibit constriction during near vision tasks, Argyll Robertson pupils are a diagnostic marker for tertiary syphilis
Holmes-Adie syndrome
larger than normal (dilated) and slow to react in response to direct light but reacts fast to accommodation
228
First linen Tx for croup
oral dexamethasone
NOT prednisolone
229
230
When to investigate and treat in cases of post pill amenorrhea
after 3 m
But wait 6 m before active treatment with clomiphen citrate
231
When to give IV fluids for burns & how much
for kids with >10% and adults with >15%:
Area of burn x weight x 4
Give half of the fluids in first 8 hours
232
mydriatic drops can cause acute angle closure glaucoma!
oh yes!
233
Pituitary macroadenoma VS craniopharyngioma as cause for visual disturbances
Pituitary macroadenoma- upper quadrant bitemporal hemianopia
craniopharyngioma- lower quadrant bitemporal hemianopia
234
sublingual nitroglycerin vs isosorbide dinitrate
sublingual nitroglycerin is usually prescribed for the relief of an existing pain, while isosorbide dinitrate is used to prevent attacks of pain over an extended period
235
236
which factor gets 2 points in Chad's vasc?
stroke/tia
Also age 65,75
237
anemia in CKD
evaluate iron stores before treating with ESA erythropoiesis-stimulating agents
238
gingivitis Tx
oral metronidazole or amoxicillin
chlorhexidine
simple analgesia
239
when to CT immediately (within 1h and not within 8h)
GCS<15 within 2h og injury
GCS<13 on initial assessment
open/depressed skull fracture
seizure
focal neurological deficit
>1 episodes of vomiting
240
presentation age of duchenne
2-3yo
241
Limb girdle muscular dystrophies presentation
proximal weakness (opposed to duchenne/becker)
typically at 8-15yo
242
indications for dantrolene and baclofen
dantrolene - malignant hyperthermia, muscle cramps in motor neuron disease
baclofen - spasticity (e.g.- MS)
243
MS spasticity Tx
baclofen and gabapentin - 1st line
244
indication for ABX in mastitis & which ABX?
infected nipple tissue
no improvement over 12-24h despite effective milk removal
positive milk culture
--> give flucloxacillin!
245
duodenal atresia vs pyloric stenosis
double bubble?
check potassium?
AB blood?
first boy?
mom had too?
pyloric stenosis- check potassium! perform US for thickend pylorus! olive maa! visual peristalsis!
ילד בכור, לאמא היה גם, סוג דם ab. טיפול בניתוח אבל לודא שהאלקטרוליטים מאוזנים קודם, אם לא- יעשה אפניאות אחרי הניתוח.
duodenal atresia- presentation in the first hours of life, choking, respiratory distress, feeding difficulty, frothing, DOUBLE BUBBLE
246
cause for diarrhea in HIV
cryptosporidium- the most frequent
mycobacterium avium
giardiasis
247
what do histompalmosis and mycobacterium cause
cough+flu-like
248
lyme diagnostic test without erytdema migrans
blood for ELISA
249
Which part of eye can be inflamed in ankylosing spondylitis
anterior uveitis
250
How many hours between troponins?
3, if first test was performed <3h from symptom onset
251
hydrocelle vs varicocele
hydrocelle- testis cannot be palpated. Fully transilluminates.
varicocele- bag of warms
252
Vaginal tear degrees
1 vaginal mucosa
2 perineal muscles
3 external anal sphincter
4 rectal mucosa
253
cow milk intolerance onset and types and diagnostic test
within 3 months
1. IgE mediated- within 2h from ingestion. Can be spotted with a skin prim test.
2. Non IgE- within hours or days. Best test is eliminate milk from diet
254
management of cow milk allergy
switch to hydrolized formula, and if not working- to amino acid formula
If breastfed- eliminate cow milk from mothers diet
255
best time to perform pap smear and routine frequency
mid cycle
if pregnant- 12w post delivery
25-49 every 3 years
50-64 every 5 years
256
Why do cxr before starting amiodarone?
can cause pulmonary fibrosis/pneumonitis
257
How to isolate a patient with tb
negative pressure room
258
Hemochromatosis VS hemosiderosis
Hemochromatosis is primary iron overload. Deposition in all hepatocytes. Hemosiderosis is secondary iron overload (consumption or frequent transfusion), deposition in kupffer cells
259
presentation of alcoholic cerebellar degeneration
After long term abuse
Ataxia
Vertigo with nystagmus
Tremor
More in the mornings
260
meralgia parasthetica mechanism
Compression of lateral cutaneous nerve of thigh= burning sensation
261
carcinoid markers
urine- serotonin metabolite 5-HIAA
blood- chromogranin A, NT-ProBNP
262
stages of AKI
1- increase of 0.3 or 50% in serum cr
2- increase X2
3- increase x3
263
drug that promotes gout
hydrochlorothiazide
264
PPH: creteria for minor, major haemorrhage
minor 500-1000ml
major >1000
265
first line analgesia for osteoartritis
TOPICAL ibuprofen
266
mean age (for majority of children) to achieve day+night urine continence
3-4 years
267
When to start urate lowering treatment
2-4 weeks after a flare of gout
BUT
If patient already on allopurinol - continue treatment
268
2 phases of metabolism
1 by cyp450, inactivation by oxidation, reduction, hydrolysis...
2 conjugation
268
zero order metabolism
linear correlation between concentration and time. Elimination is not influenced by concentration of the drug because the enzymatic process is saturated
Is seen with high dose aspirin, ethanol
269
When to perform cpr in a patient with DNACPR
if the event was not anticipated gived the disease
Choking
Hit by a bus
270
common vein injury in chronic subdural hematoma
cerebral vein
271
Pseudotumor cerebri (PTC) alternative name
idiopathic intracranial hypertension
272
which condition is associated with supravalvilar aortic stenosis
williams syndrome
273
bp in pregnancy
- falls in first half
- rising to pre-pregnancy level before term
274
causes of endocarditis
strep viridans
staph aureus (IVDU)
staph epidermidis (prosthetic valves)
275
postpartum depression management
take seriously to exclude psychosis or harmful potential
avoid fluoxetine
arrange urgent psychiatric assessment
276
Pathogen that causes staghorn calculus, and type of calculus
proteus mirabilis
Struvite
277
most common renal stone type
CALCIUM OXALATE
278
which renal stone is radio luscent
cysteine stone
279
how to treat renal stones
calcium- increase fluid intake, lower protein in diet, lower sodium, use thiazides
oxalate- cholestiramine, pyridoxine - reduce oxalate secretion,
uric acid stones- alkalinization with bicarbonate, allopurinol
280
rheumatic fever criteria
מג׳וריים- קרדיטיס, ארטריטיס (מונו, פולי, או ארתאלגיה’ מיגרטורית!!! ומערבת מפרקים גדולים), כוריאה, אריתמה מרגינטום, נודולים סאבקוטנאים
מינוריים- חום מעל 38.5, שקיעת דם מעל 30, crp מעל 3, pr מאורך. נוגדנים של antistreprolysine O הם יותר ספציפיים מאשר שקיעת דם
281
when to offer FIT (fecal immunochemical test)
adults with
abdominal mass,
change in bowel habit,
iron-deficiency anemia
282
treatment for open angle glaucoma
SLT (selective laser trabeculoplasty)
prostaglandin analogue- latanprost
283
treatment for closed angle glaucoma
pilocarpine
284
treatment for endocarditis
native valve- amoxi+genta
severe sepsis: vanco+genta
severe sepsis and suspected gram-neg: vanco+mero
prosthetic valve: vanco+genta+rifampicin
285
hormones in turner
high FSH, high LH, high/normal GnRH
286
how to assesss risk for fractures?
FRAX
QFracture
287
chikungunya presentation
severe arthalgia
288
does high BMI cause miscarriages?
oh yessss
289
Central retinal vein occlusion- fundoscopy
flamed shape hemorrhage
hard exudates
stormy sunset appearance
edema of optic disc?
290
Central retinal artery occlusion- fundoscopy
pale optic disc
cherry red spots on macula
291
exposure to VZV during pregnancy with negative antibodies
seek specialist advice!
292
antiemetic in parkinson's
PLABABLE- cyclizine
medrevision- levomepromazine (nozinan)
Also- domeperidone
292
NOONAN presentation
like turner for boys
cryptorchidism
increased bleeding
pectus excavatum
pulmonary stenosis
292
how to administer MO in MI?
IV
NOT PO
293
AFLP vs HELLP vs Autoimmune hepatitis, intrahepatic cholestasis of pregnancy
AFLP vs HELLP
both have deranged liver profile and low platelets.
ALFP- low glucose, vomiting, high amonia, jaundice
HELLP- hemolysis!
Autoimmune hepatitis
pruritus!, fatigue, myalgia, diarrhea, arthalgia
294
time window for trombolysis after CVA + preferred agent
4.5h
alteplase,
NOT streptokinase
295
ALS vs progressive muscular atrophy vs primary lateral sclerosis
ALS
upper+lower symptoms: fasciculation+atrophy AND increased tone+hyperreflexia
progressive muscular atrophy
early involvement of small hand&foot muscles,
no muscle spasticity
primary lateral sclerosis
predominately leg muscle weakness,
can be with hand clumsiness or speech dificulties
296
BPH Tx
alpha-1 antagonists
tamsulosin
5 alpha-reductase inhibitors
finasteride
297
anticoagulation after hip replacement w/o bleeding risk
use mechanical+pharmacological thrombus prevention:
stocking
dalteparin 6h post op up to 35d
298
triptan contraindications
IHD
299
antiarrhythmics to avoid in WPW
verapamil
digoxin
300
ureteral stone presentation
can also present with chronic dull pain!
301
bloody diarrhea in crohn or UC?
both, more in UC
302
duration and onset of baby blues
peak at 5th day, subsiides within 10 d
303
seborrheic dermatitis tx
topical ketoconazole- 1st line
topical steroids for severe cases
304
typical presentation of seborrheic dermatitis
peri-orbital +
nasolabial
305
peak incidence of seizures and delirium tremens following alcohol withdrawal
seizures- 36h
delirium tremens- 72h
306
syringomyelia
progressive weakness in the hands
cape-like loss of pain+temperature sensation
loss of temperature sensation in the hands
307
BP target w/ or w/o end organ damage
140/90
308
hiccups Tx
1st- metoclopramide- reduces gastric distension
intractable- chlorpromazine
309
stone obstruction and hydronephrosis management
percutaneous nephrostomy before nephrolythotomy
309
PPH management
manual pressure+empty bladder
SYNTOCINON IV>
ergometrine>
carboprost>
misoprostol rectally>
surgery
310
follic acid in pregnancy + T1DM
due to higher risk for neural tube defects give highr doses of 5mg instead of regular 400mcg of follate until week12 of gestation
311
vesicle size in bullous impetigo
1-2cm
312
bullous impetigo Tx
1st- hydrogen peroxide creame 1%
2nd- fusidic cid 2% OR mupirocin
widespread- flucloxacillin
313
rescue therapy for neuropathic pain when standard trt not working
tramadol
NOT CODEINe
314
bishop score- when to induce labor?
<6
score>8 is likely to proceed to successful vaginal birth
315
symptomatic relief in sinusitis
paracetamol
intranasal decongestant for up to 7d
warm nasal irrigation
warm face packs
if more thn 10d- high dose intranasal corticosteroids
NOT:
oral antihistmines
steam inhalation
316
femoral hernia location
lateral to pubic tubercle, below inguinal ligament
317
large&medium vessel vasculitis
large vessel vasculitis
takayasu
temporal a
medium vessel vasculitis
kawasaki
polyartritis nodosa
318
when to correct club foot
soon after birth
319
cause of DI
litium
320
where can crypt abscesses be seen
mostly UC
less crohn
321
Cryptococcus Tx
amphotericin + flucytosine
Fluconzole for mild cases
322
the most prevalent cause of infective exacerbation in copd
Hemophilus influenza
323
Minimum seizure free period for antiepileptics discontinuation
2y
324
shy drager=
multi system atrophy
325
diets for ibs, epilepsy
ibs- Fodmap
Epilepsy- ketogenic
326
when to use terlipressin
hepatorenal syndrome
Constricts splanchnic vessels
327
PAH 1st line management
endothelin receptor antagonists
328
mechanism of dorzolamine
reduce aqueous secretion by cilliary body
carbonic anhydras inhibitor
329
best test for contact dermatitis
skin PATCH test (not skin prick)
330
Muscle for first 20 deg of shoulder abduction
supraspinatus
331
hyperemesis gravidarum timing
week 6 to 20
Peak at 12
332
Nelson syndrome
enlargement of pituitary adenoma following bilateral adrenalectomy following cushing
333
cerebral, lacunar, brainstem infarcts
cerebral
contralateral sensory loss, hemiplegia, dysphasia, homonimus hemianopia
lacunar
ataxic hemiparesis, pure motor loss, pure sensory loss, dysarthria sensorymotor loss
brainstem
quadriplegia, loched-in syndrome, vertigo, diplopia
334
scarlet fever pathogen
strep pyogenes- GAS
334
otosclerosis characteristics
bilateral
age 20-40
autosomal dominant
harder to hear in quite places, easier in noisy places
more in females, accelerates in pregnancy
335
porphyria is
a rare hereditary disease in which there is abnormal metabolism of the blood pigment haemoglobin.
abdominal pain
neurological & psychiatric signs
336
lead poisoning
abdominal pain
blue lines on gums
neurological & psychiatric signs
337
aspirin in high risk for pre-eclampsia
75mg from week 12 to birth
338
GBS example
strep agalactiae
339
cardiac malformation in turner syndrome
bicuspid aortic valve
340
when to reinitiate contraception after birth?
21 days
341
whe it is contraindicated to use COCP after birth
week6
342
TX for acute otitis externa
topical abx and syteroids
343
acne rosacea tx
Topical metronidazole
Oral tetracycline if severe (ocular involvement for example)
344
Straight leg raise indicates-
Sciatic nerve pain
345
appropriate age for hearing- distraction testing
6-18 months
346
when to perform needle thoracocenthesis
only TENSION pneumothorax
347
urine:plasma osmolality as pre or intra renal marker
>1.5 = pre
<1.1 = intra
348
femur head fracture- dynamic hip screw or hemiarthroplasty?
if above intertrochanteric line- hemiarthroplasty due to poor blood supply.
if below intertrochanteric line- dynamic screw
349
autonomic neuropathy in diabetes- presentation
diarrhea
constipation
sweating
incontinence
350
mechanism: Insulin in pcos
increase insulin sensitivity in the body (periphey)
351
which antidepressant if patient takes Tamsulosin?
sari!
Because ssri interacts with cy2pd6 and increases levels of tamsulosin
352
Argyll Robertson syndrome
usually bilateral
Pupils react poorly To light but briskly to accomodation
353
Holmes adie syndrome
Unilateral
One big pupil which react poorly to light
Like Sherlock Holmes who looks through a magnifying glass with only one eye
354
Acute TX for acute angle closure glaucoma
IV acetazolamide
Drops: Timolol, prednisolone, pilocarpine
355
rabies tx
if vaccinated- 2 more shots+abx
If not- immunoglobulins+full course of vaccination
356
which contraception causes the longest delay in returning to fertility
progesterone injection depo provera
357
when to aim for >94% sat in copd
when baseline co2 is normal
358
shortest incubation for gastroenteritis
staph aureus
bacillus cereus
358
oral candidiasis Tx
nystatin/topical clotrimazole
if severe- oral fluconazole
359
stomach poisoning gastroenteritis due to reheated rice
bacillus cereus
360
pediatric fluid maitanance
אופן מתן הנוזלים למייטננס – לפי חוק ה- 100/50/20. ב-10 ק"ג ראשונם – לכל קילו 100cc ליום. מ-10-20 ק"ג – לכל קילו נותנים עוד 50cc ליום. o מעל 20 ק"ג – עוד 20cc לקילו ליום. את הנפח הכללי מחלקים ב-24 שעות וכך נקבע קצת ההזלפה.
361
how to take bisphosphonates
30 min before breakfast, with a lot of water > sit upright 30 min afterwards
362
markers for liver damage following acamol intoxication
PT!!!!!!!!!!!
also-
pH
encephalopathy
creatininte
(not ALT)
363
Which tumor sends cannonball metastasis
Renal adenocarcinoma
364
TX NMS
stop antipsychotics
IV fluid if AKI
Bromocriptine
Dantrolene
365
Drug that causes agranulocytosis
carbimazole
366
most effective for allergic rhinitis (hay fever)
intranasal corticosteroids
367
diazepam or midazolam for seizures?
midazolam,
as it is absorbed faster when taken intranasally or buccally, and not rectally like diazepam
if there is IV access, use lorazepam
368
how much time until a driver with epilepsy can drive again?
1y seuzure-free
368
which dm medications cause weight gain?
thiazolindiona- YES
meglitinides- possibly
DPP4-NO
GLP1- weight loss
acarbose- NO
SGLT2i- weight loss
369
to which allergy does aspirin allergy relate to?
allergy to sulfalazine
370
drug that causes cholestasis
gliclazide
371
calculate total fluid requirement in 24h following a burn
4*body weight(kg)*burn area(%)=total fluid requirement in 24h (ml) . give 50% over 8h, rest over 16h
372
which drug is contraindicated for use with a statin
macrolide
(clarithromycin)
373
pityriasis versicolor- TX
sun yeast- malassezia
Tx- topical antifungal like ketoconazole shampoo
374
pulsus paradoxus
Temponade- fall of more than 10 sbp during inspiration
375
pulsus alternans cause
severe LVEF impairment
376
Pulsus bisferiens
Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one.It is a sign of problems with the aorta, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis
377
at what age sexual relationship always triggers child protection measures?
<13y
the child is unable to consent
378
HIV infection rate following needle stick
0.3%
379
non proliferative diabetic retinopathy features
microaneurisms
dot and blot hemorrhages
hard exudates
cotton wool spots
venous beading
380
curlings ulcers
acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa
381
most common cause for PID
chlamidia>
gonorrhea
382
compications of gonorrhea
infertility
migratory arthritis
septic arthritis
endocarditid
fitz-hugh-curtis
dermatitis (maculopapular or vesicular)
383
ovarian cancer risk factors
early menarch/latemenopause
obesity
HRT
384
duke classification for CRC
stage A- confined to mucosa
B- invades bowel wall. B2- through serosa
C- lymph
C2- more than 4 nodes
D- distant metastases
385
Type 1 vs 2 respiratory failure
Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia. Type 2 respiratory failure occurs when the respiratory system cannot sufficiently remove carbon dioxide
386
uc Tx for mild-moderate
mesalazine
387
Severe malaria criteiria
high parasitemia >2%
Hypoglycemia
Severe anemia
Renal failure
Pulmonary edema
Metabolic acidosis
Abnormal bleeding
Multiple convulsions
seizures
Shock
388
malaria management
severe falciporum
Iv artesunate
If parasite count: Consider exchange transfusion
Non severe falciporum
PO artesunate combination therapy (ACT)
Non falciporum
PO ACT
P. Vivax and ovals: Add primaquine to address hypnosoites
389
malaria Tx to avoid in epilepsy
chloroquin
Mefloquine
Can use proguanil
390
anticoagulation mechanisms of
Aspirin
Clopidogrel
Enoxaparin
Aspirin- inhibits thromboxane production
Clopidogrel- inhibits adp receptor
Enoxaparin- activates antithrombin, which inhibits FX
391
most common cause of infective endocarditis
staph aureus
392
infective endocarditis- risks
previous infective endocarditis- strongest factor
rheumatic valve
IVDU
prosthetic valve
congenital defect
393
infective endocarditis- profilaxis
infection in patient with risk factors
NO NEED-
dental procedures
procedures in GI, GU, respiratory
394
infective endocarditis- empirical Tx
native valve- amoxicillin + gentamicin
if severe sepsis
vanco+meropenem
if prosthetic valve- vanco+genta+rifampicin
395
antiemetic for increased ICP
cyclizine
396
features specific for legionella
hyponatremia
lymphocytopenia
hypoalbuminemia
elevated liver enzymes
diagnosed with urinary antigen
397
when to consider miro instead of ssri
aspirin+ssri combination increases risk of bleeding
398
when to test PSA
6w after prostate biopsy
4w after UTI
1w after PR examination
48h after heavy exercise or ejaculation
399
parvo VS coxaki virus
parvo- slapped cheek
coxaki- foot&mouth
400
complications of tpn
mild cholestasis
Elevated liver enzymes
Refeeding
401
pathogen which cause erythema multiforme
hsv
Mycoplasma!!!
402
how to reduce risk for contrast nephropathy
ask patient to drink plenty
403
why not Hartman?
contains potassium
404
what skin condition is associated with celiac
dermatitis herpetiformis
405
gonorrhea tx
ceftriaxone 1g im
406
putz joggers syndrome extra intestinal presentation
Mucosal pigmentation
407
risk factors for placenta previa
assisted fertilization!!
c-section
multiparity
previous surgical termination
other gynecological surgeries
408
no need for o2 tx if saturation ok, also in MI or CVA!
oh yeh
409
test for detection of liver cirrhosis
transient elastography
410
can bisphosphonates be started with t-score lower than 2.5?
yup, if there was an osteopenic fracture
411
when to use SADPERSON score
to assess suicide risk
412
Which score assesses depression
PHQ-9
413
which cardiac pathology is associated with 3rd heart sound
dcm
414
with which rheumatologic condition is peripheral enthesitis associated?
ankylosing spondylitis
415
difference between ascending and descending loop of henle
descending- permeable to water, not solutes
Ascending- site for fusid
416
ABX prophylaxis for PROM
erythromycin for 10 days of until labor
417
red flags in pediatrics that warrant urgent refferal to pedriatrician
age<3m + temp>38
high pitch cry
418
when to consider immediate ABX for AOM
age <3m
bilateral OM
perforation
discharge from ear
419
what is varenicline
nicotinic receptor partial agonist
420
CN within cavernous sinus
III, IV, V1, VI
421
initially, administer saline or blood after blood loss
saline
wait for crossmatch for blood transfusion
422
minimum duration of symptoms for MDD
2w
423
when to stop contraceptives before surgery
4w
424
צום לפני ניתוח
6 שעות
נוזלים צלולים עד 2 שעות
425
cyanosis during feeding that improves when baby cries
choanal atresia
426
Which conditions are associated with pyoderma gangrenosum
rheumatoid arthritis
Hematological malignancies
Ibd
427
Provoked pe management duration
3months
428
most common cause of hepatocellular CA
Worldwide
In europe
Worldwide- hepatitis b
In europe- hepatitis c
429
bone of the mastoid
temporal bone
430
mammary duct ectasia vs periductal mastitis vs intraductal papilloma
mammary duct ectasia- perimenopause, inverted nipple, smoking
intraductal papilloma
age 35-55
bloody discharge (or serous)
near areola, no nipple changes
periductal mastitis- hot&tender, bloody (not "brown") discharge, can present as a lump
431
give before fibroid myomectomy
GNrH analogue
432
glycemic control following MI
immediately after MI- stop metformin & gliclazide and start insulin INFUSION
433
angioplasty+stent OR endarthrectomy
endarthrectomy if after stroke and carotid >75% stenosis
434
oral terbinafine VS topical ketoconazole
oral terbinafine- fungal infections of the foot, nails
topical ketoconazole- seborrheic dermatitis
435
bronchiectasis- what is the most important intervention for long term control of symptoms
postural drainage and physiotherapy
436
fibrates mechanism
Agonism of PPAR-alpha
437
mechanism of statins
inhibition of HMG-CoA reductase
438
when to avoid malaria prophylaxis
with psychiatric disorders
439
MoCA vs ACE
MoCA is similar to miniMental
ACE is comprehensive, to when there is a need to differentiate types of dementia
440
best diagnostic tool for osteomyelitis
MRI
441
polymyositis vs PMR
ESR>30 in PMR
442
add to careldopa
anticholinergic- benzhexol
DONT use ergotamine derived dopamine agonists- cabergoline
443
cause of cavernous sinus thrombosis
PLABABLE- infectious
444
most common congenital airway disorder
laryngomalacia
also most common cause of stridor in neonates
445
test to perform when asthma is suspected and no diagnosis in spirometry
FeNO + spirometry/bronchodilator reversibility test
446
higher risk in paracetamol overdose
anorexia
cyp450 INDUCERS (NOT inhibitors)
chronic alcoholism
HIV
447
how to wash inhaler spacer
1 per month
with soapy warm water+
rinse with warm water+
AIR dry (not with towel)
448
drugs for rapid tranquilization
lorazepam
olanzapine
haloperidol
449
until what age to treat premature ovarian failure?
HRT until age 51
450
when sexual intercourse is permitted after a vasectomy
20 weeks after the second sperm check
451
complicatio of vasectomy
1-14% chronic testicular pain
452
what is the next intensification step after SABA+low dose ICS
add LTRA!
NOT LABA
453
dermatomyositis antibody
ANA
454
BP target in pre eclampsia
150/80-100
455
cocp and htn
UKMEC3 if controlled htn
UKMEC4 if uncontrolled htn
456
drugs that cause drug induced sle
procainzmide
chlorpromazine
methyldopa
hydralazine
isoniazide
d-penicillamine
minocycline
UV light
EBV
457
disease associated with flamingo pink tympanic membrane
otosclerosis
458
disease associated with inflamed tympanic membrane with cartwheel apperance of vessels
acute suppurative otitis media
459
if smear is negative for HPV, when to do colposcopy?
only for moderate dyskaryosis.
mild DO NOT need to be colposcoped
460
induction of labor- means
IV syntocinon or amniotomy- for bishop>6
vaginal prostaglandin gel, misoprostol vaginal tablets- for bishop<6
DONT use oral prostaglandins
461
nex step after oral mesalazine did not achieve remission of UC
ADD prednisolone on top of the mesalazine
dont replace
462
drug that increases risk for VTE
tamoxifen
Quetiapine
463
HIV infection
cerebral toxoplasmosis cd<100
cd<200 = PCP
cd<50 = mycobacterium avium
CMV
464
presentation of protein c deficiency
vte
465
apla management in pregnancy
aspirin!
If possible- with heparin
466
normal grief duration
up to 1 year
467
fragile x
טיפש ומכוער. ראש גדול פנים גסות
fragile X- בנים. פיגור, קוים אוטיסטיים, אשכים גדולים, תווי פנים (פנים ארוכות, אפרכסות גדולות, לסת מרובעת ובולטת). פגמים ברקמת חיבור: MVP, סקוליוזיס, גמישות יתר. פרכוסים, דלקות אוזניים חוזרות.
468
prophylaxis of pre eclampsia when there is a risk
aspirin 75 from day 12 to birth
469
in a combined deficiency, administer first b12 or follate?
b before f
to avoid subacute combined degeneration of the cord
470
orlistat mechanism
pancreatic lipase inhibitor
471
which contraception has UKMEC1 in cases with migrane+aura
copper IUD
472
skin lesion that looks like a volcano or a crater
KA- keratoacanthoma
473
painless wedge shaped redness in the eye
episcleritis
474
How long is p4ophilactic hiv treatment after needlestick injury
4w
475
thrombolysis contraindications
stroke in last 3m
Intracranial neoplasm
Aortic dissection
Pregnancy
Severe htn
Active intracranial bleeding
Recent hemorrhage
Trauma
Trauma
Surgery
Bleeding disorder
476
Initial treatment in pre eclampsia
labetalol before magnesium
477
desmoid tumor vs dermoid cysts
desmoid tumor-
like sarcoma
usually involves tendons and ligaments
dermoid cysts
like teratoma
478
which antiepileptic is associated with peripheral neuropathy
phenytoin
479
which antiepileptic is most associated with weight gain
valproate- also increased appetite and nausea
480
treatment of acne rosacea
topical metronidazole
if severe- systemic oxytetracycline
481
pendred syndrome
goiter
deafness
482
where is situs inversus
Kartagener
483
Which drug causes corneal opacities
amiodaron
484
pneumonia in an alcoholic
Klebsiella pneumonia
485
1st cause of hirsutism
pcos
486
drug induced sle antibody
anti histone
487
abx for sinusitis
Phenoxymethylpenicillin
Co amoxiclav
Doxycycline if pen. allergy
488
Felty's syndrome
splenomegaly&neutropenia (can b pancytopenia) in a patient with rheumatic arthritis
489
cerebral malaria dx: Lp or blood film more important?
blood film!
490
When to cxr before surgery
not a routine
491
deliver with c section in repeated HSV infection?
no
only if primary infection
492
common side effect of metformin
GI problems- diarrhea
493
management- exposure to VZV during chemo
seek specialist advice!!
494
which drug interacts with methotrexate
trimethoprim - cause together hematological toxicity
495
most common feature of carbon monooxide poisoning
headache
496
organism associated with reactivation of HSV
S pneumonia
497
dog bite tx
co-amoxiclav
if allergy-
metronidazole + doxycycline
498
most common cause of croup
parainfluenza
499
duodenal atresia VS pyloric stenosis
both with double bubble
D.a. Is more dramatic in very early age
500
mcd prognosis
good, episodes of nephrotic syndrome may reccur
501
palivizumab?
prevents (not a treatment!) rsv in high risk children up to 2yo
Administer at => 2 sites
502
sbp prophylaxis
cipro
503
incidence rate of aura in migraine
25%
504
keratoderma blenorrhagica
see pics in keep
505
leaf spots?
tuberous sclerosis
506
who can be a chaperone
impartial observer- usually health professional
507
superficial thrombophlebitis of pregnancy tx
nsaids
508
vasopresin vs desmopressin for DI
desmopressin is better
509
tx of nephrogenic di
thiazide! yesyes!
help against hypernatremia and increased thirst
510
what is the threshold for bicarbonate administration after MI
HCO3<10
ph<7
511
how many days to stop warfarin before surgery
5
replace with clexane
512
abx that prolongs qt and inhibits cyp450
macrolides erythromycin
513
Cushing syndrome VS disease
disease= pituitary adenoma
514
best diagnostic test for Cushing
Overnight suppression or 24hour urinary cortisol?
overnight supression
515
what does high dose dexametjasone test checks?
Ectopic source rather than pituitary adenoma
516
location of absence seizure with lip smacking
temporal lobe
517
normal qt
males 430
Females 450
518
Relationship between metformin and gfr
dapt <45
Stop <30
519
organism behind seborrheic dermatitis
Malassezia furfur
520
globus pharyngis
sensation alone
Hard to swallow saliva
Swallowing food improves the symptomes
521
eczema tx
1st- topical emoliants
2nd- topical steroids
522
inability to visualize the retina
virtuous hemorrhage
523
plummer vinson syndrome
triad:
iron def anemia
dysphagia
glossitis
524
Communicating hydrocele incidence in neonates
3%
525
where can be saddlynose
Wegener's granulomatosis
526
BP targets for dm
w/o end organ damage- 140/90
w/ end organ damage- 130/80
527
leriche syndrome
claudication of button
Atrophy of legs
Impotence
528
inferior MI culprit
right coronary
529
Wallenberg VS weber syndrome
stroke syndromes:
Wallenberg
(lateral medullary) ataxia/CN injury + contralateral limb sensory loss
weber
CN3 injury + contralateral motor loss
530
Parkinson 1st line with motor symptoms
levodopa
531
most likely organism for pharingitis tonsilitis
strep pyogenes
532
Which organism associated with cold sores
strep pneumonia
533
Which organism associated with influenza
staph aureus
534
Tx of lower uti in pregnancy
Trimethoprim- preferably not in first trimester. If must give- add 5mg follate
1st: Nitrofurantoin- avoid near term. Can cause hemolysis
2nd: Cephalexin is safe
535
Enzyme inducer + contraception
Dont use nexplanon, cocp or pop
Can use dpo provera injectable!
Can use iud
