Combank Flashcards
(128 cards)
1
Q
What is the indication for prophylactic antibiotic coverage in dental procedures?
A
If dental procedure involves manipulation of gingival tissue: prior infective endocarditis prosthetic heart valves unrepaired cyanotic heart defects palliative shunts/conduits
2
Q
What is the prophylactic dose for dental procedures?
A
oral amoxicillin 2g given 30 min before procedure
3
Q
Name all the features of Down’s syndrome?
A
Microcephaly flattening of the occiput upward slant of eyes with epicanthal folds, single palmar crease large protruting tongue Brushfield spots broad stocky neck small feet/hands low set ears congenital heart defects GI malformations hip dysplasia cataraccts risk of obesity hypothyroidism leukemia hearing loss mitral valve prolapse Alzheimer's atlantoaxial subluxation strabismus
4
Q
What is the treatment for diverticulitis? refractory cases?
A
Ciprofloxacin and metronidazole
sigmoid colectomy with colocolonic anastamosis with proximal loop ileostomy can be done.
5
Q
Whats the drug of choice for shigellosis?
A
trimethoprim sulfamethoxazole
6
Q
what is a pyogenic granuloma?
A
an area of capillary proliferation that develops in the skin usually secondary to trauma.
First it looks like an erythematous papule that evolves to be blood engorged.
common in pregnancy.
7
Q
in pregnancy, where are pyogenic granulomas found? what is it then called?
A
in the gingiva
called an epulis
8
Q
> 6 cafe o lait spots
A
neurofibromatosis I
9
Q
pseudohypertrophy of calves
A
duchenne muscular dystrophy
10
Q
severe muscle wasting below the knees. autosomal dominant peroneal muscular atrophy causing foot drop and stocking glove decrease in vibration/pain/temperature and DTR in lower extremities.
A
charcot marie tooth dz
11
Q
macular cherry red spot
A
tay sachs and neiman pick dz
12
Q
sphingolipidosis associated with osteoporosis. deficiency of a lysosymal enzym B-glucocerebrosidase. Accumulation of sphingolipids in liver, spleen, and bone marroe
A
gauchers
13
Q
How can you tell the difference between pt with subclavian steal syndrome and carotid artery stenosis?
A
subclavian steal - steals blood from vertebral artery bc not enough blood going through subclavian. sx: arm claudication, syncope, vertigo, nausea, confusion and supraclavicular bruits
carotid artery stenosis can cause amourosis fugax, TIA, or CVA
14
Q
what neurotransmitter is affected with OCD?
A
seritonin
15
Q
what NT is associated with Parkinsons
A
dopamine too little
16
Q
what NT is associated with panic disorder
A
GABA depletion
17
Q
what NT is psychosis associated with?
A
too much dopamine
18
Q
what NT is associated with schizophrenia:/
A
low glutamate
19
Q
what NT is associated with alzheimer’s ?
A
low acetylcholine
20
Q
How do you perform a bilateral escharotomy of the chest?
A
bilateral incisions that extend from the clavicles to the costal margins following the axillary line.
21
Q
what is the mcc of 1st trimester loss of fetus? 2nd trimester?
A
1st - chromosomal abnormalities
2nd - incompetent cervix
22
Q
Describe a cluster headache
A
severe unilateral orbital, retroorbital or temporal pain
usually at nigh
ipsilateral concunctival injection
rhinorrhea/lacrimation, eyelid edema, nasal congestion.
pts become active and agitated during attack - pacing.
last 30 min-2h and may occur up to 8 times per
occur in clusters for 1 year, remission can occur lasting months/years. remissions increase with age.
23
Q
when does migraine incidence peak?
A
third decade - may get worse but generally occurrence and severity decrease with age.
24
Q
what is todd’s paralysis?
A
after seizure, there is hemiparesis of 5 min-24 hours aka post-ictal hemiparesis
25
pt with blurred vision, ipsilateral forehead headache, rainbow halos, eye pain, hazy cornea and conjunctival injection. dx?
closed angle glaucoma
26
who is at higher risk for closed angle glaucoma?
those with hyperopia (long sightedness and small eyeballs)
27
what is the eclipse test?
shallow anterior chamber raising the risk for closed angle glaucoma
28
How do Timolol, pilocarpine and iridotomy help treat narrow angle glaucoma?
timolol - beta blocker causing miosis by blocking sympathetic control of iris and decrease aqueous humor production
pilocarpine muscarinic cholinergic agonist aka parasympathetic agonist which contricts eye and gives more room to drain
iridotomy ensures good drainage
29
Fever, ha, diarrhea that progresses to severe hypotension and desquamating rash on the soles and palms on her period.dx? tx?
toxic shock syndrome bc of staph aureus secondary to tampon use
30
what is the movement disorder associated with huntington's disease?
athetosis - snake like movements
31
Other than IVF, what else can be given to manage hypercalcemia?
furosemide and calcitonin
32
What are the lab findings and sx of a pt with hepatic steatosis in pregnancy?
ruq pain, jaundice, n/v, prolonged pt/ptt, hi bilirubin, high ast/alt.
must deliver asap because it can develop into hepatic encephalopathy.
33
What is the common first symptom of anyone with a new lung ca?
cough
34
what are the 3 sx of SVC syndrome?
facial and neck edema
cyanosis
dilation of the veins in the face/neck
35
Describe where the nerve roots in the lumbar spine come out.
beneath the same number vertebral body but above the same number disc.
so to damage L4, the L3 disc needs to be herniated.
36
```
What moa are the following:
Jimson weed
foxglove
poinson mushrooms
tobacco plant
```
Jimson weed - anticholinergic agent causes sympathetic overdrive. It contains atropine
foxglove - digitalis
poinson mushrooms - liver failure
tobacco plant - nicotine is a ganglionic agonist which causes diarrhea, salivation, sweating and tachy
37
How is total cholesterol calculated?
HDL + LDL + TG/5 = total cholesterol
38
At what TG levels should you finally prescribe a fibric acid?
TG > 150
39
What is top of the ddx in any pt >50 with iron deficiency anemia?
get colonoscopy to r/o colon cancer.
40
CD8 deficiency results in susceptibility to what infections?
fungal, parasitic and viral infections.
41
what dificiency would predispose patients to dissemination of infection?
membrane attack complex deficiency
| C5-9 is MAC
42
what 2 diseases are eggshell calcifications seen in?
Silicosis and Sarcoidosis (rare)
43
if pt has silicosis, to what infectious agent is he more vulnerable?
tuberculosis
44
Neonate (1-30d) has bilious vomiting , abdominal distension and pain and GI bleed. double bubble sign on abdominal xray
midgut volvulus
45
When is a V/Q scan "readable" in a pt in the hospital?
only if the xray on admission was clear... otherwise, can't read for PE
46
What are the risk factors for developmental dysplasia of the hip? si/sx? followup?
risk factors: female, breech (footling), positive family history, firstborn
sx: uneven inguinal folds, +ortalani and barlow
f/u: ultrasound of hip joints and f/u peds ortho.
47
Why must you be cautious when switching between phenelzine and ssri? how long must you wait?
danger of seritonin syndrome with maoI and SSRI combo.
wait atleast 14 days.
48
Whats the difference between seritonin syndrome/neuroleptic malignant syndrome/malignant hyperthermia
too much seritonin - tx with supportive/benzos/seritonin antagonist
caused by antipsychotics - give dantrolene
caused by anesthetics- give dantrolene.
49
what nerve and muscle control extension of the big toe?
extensor hallucis longus innervated by the deep fibular nerve which branches off the common fibular nerve from the sciatic nerve,
50
what nerve innervates the gluteus medius and TFL?
superior gluteal nerve.
51
At what radiation level do fetuses risk tertogenic exposure? how much does one xray have?
>0.05 Gy = risk
xray = 0.0014mGy risk
abd CT = 8mGy
pelvic ct = 25mGy
52
When is a grahm patch indicated?
for perforated ulcers
53
What kind of peptic ulcers carry 10% risk of malignancy
gastric...
duodenal have low risk.
54
What is triple therapy for PUD?
amoxicillin, clarithromycin and omeprezole for 10-14 days.
55
What does the DCLO measure?
diffusing capacity of the lungs for carbon monoxide. Reflects the properties of the alveolar-capillary membrane specicifically how easy oxygen moves from the inhaled air to the rbcs.
ie. lowered in emphysema bc damage to alveoli.
56
What is the diagnostic modality of choice and the tx of choice for pyloric stenosis?
ultrasound
myotomy
57
What is the WBC cut off for septic arthritis vs. gout?
>50,000 wbc is septic arthritis
58
what is the most sensitive and specific antibody for RA?
anti-cyclic citrullinated peptide
59
Eating what food has shown to decrease gout flares?
increase gout flares?
low fat dairy products decrease
meats, wine, high fructose beverages, certain meds like thiazides and some leafy veggies have purines.
60
Paroxysmal nocturnal hemoglobinuria results from a defective gene for what? What complement deficiency does it cause? why does hemolysis occur at night? Whats the tx to cure? To manage?
phosphatidylinositol class A (PIG-A)
complement CD55 and CD59
hemolysis due to hypoventillation causing mild increase in pCO2 and acidosis.
allogenic bone marrow transplant to cure. prednisone
61
What are the top 5 causes of death in persons age 15-24?
accidental >homocidals > suicidal > cancer> heart disease.
62
urethral opening on the ventral side of penis.dx associated with?
If dosal side opening? what other congenital abnormality is this often associated with? treatment for both?
hypospadias
cordee (ventral curve of penis)
epispadias
bladder extrophy
surgical
63
Pt with weakness, sore tongue, parasthesias. Loss of 10-15 lbs, constipation, anorexia, abd fullness, unsteady gait. Often other authoimmune diseases too... .Dx? confirmatory test?
pernicious anemia
supplement with B12
confirm with intrinsic factor antibodies because they are more specific than parietal cell antibodies.
64
Bilobed nuclei of neutrophils seen in conjunction to a mutation in the lamina B receptor gene. --> terminal neutrophil differentiation. dx?
pelger-huet anomoly
Presentation: polydactyly, short metacarpls, short stature, and/or hyperkyphosis
65
What is the acute vs. chronis treatment of multiple sclerosis?
acute: high dose IV corticosteroids
chronic: interferon B
66
What is the diagnostic test for zollinger ellison syndrome? confirmatory test? imaging modality that is the most sensitive?
diagnostic is the fasting serum gastrin level obtained on 3 seperate occasions. If >1000 in the absence of achlohydria it is diagnostic of gastrinoma
If results are unequivocal, administer secretin test - bolus administered after an overnight fast and gastrin levels are then determined. should be cray elevated.
somatostatin receptor scintigraphy (SRS)
67
What are the features of Type II (wermer's), IIa (sipple's) and IIb(III)?
wermer: pituitary, parathyroid, pancreatoma (ie. Z-E in pancreas)
sipple: pheochromoccytoma, medullary thyroid ca, parathyroid hyperplasia
IIb: pheochromocytoma, medullary thyroid ca, mucocutaneous neuromas esp of the GI tract
68
Immediate treatment for gastrinoma? unresectable tx?
esomeprazole
ocreotide
69
What is the underlying pathophysiology on migraine headaches?
neuronal irritability with release of neurotransmitters (seritonin, dopamine, glutamate, calcitonin, sodium, K, etc.) Release is also what causes aura.
vascular theory has fallen out of favor.
70
How do you tell apart primary sclerosing cholangitis and primary biliary cirrhosis?
Both present with jaundice, pruritis and high alk phos levels.
PCS is extrahepatic and associated with men and UC
PBC is autoimmune, associated with females +ANA and anti-mitochondrial antibodies.
71
What supplement is reccomended in all women of child bearing age?
folic acid 0.4mg/day
| even if pt on ocps
72
What is the treatment of cellulitis in the following situations?
outpatient mild dz:
penicillin allergy:
MRSA:
severe dz:
outpatient mild dz: cephalexin or dicloxacillin
penicillin allergy: erythromycin, clarithromycin, or clindamycin
MRSA:clindamycin, TMP-SMX or doxycycline
severe dz: IV meds like oxacillin, nadcillin or cefazolin
73
What is the treatment for svt in the stable patient? unstable pt?
stable: carotid massage, adenosine if fails
unstable: IV access if possible and synchronized cardioversion. use sedation if possible, but if not, just cardiovert.
74
If pt is having a seizure for 30 min or greater and is not responding to the first iv dose of lorazepam, what to do next? after that?
give another round of iv lorazepam/diazepam.
if sz still continuing after 10 min, give second line fosphenytoin.
If that still doesn't work, give midazolam, propofol or phenobarbital
75
What is the appropriate initial step in management of a venous air embolism?
aspiration of catheter, 100% oxygen and placement of the pt in the left lateral position.
76
where are the firm attachment points of the dura?
C2 (axis), C3, foramen magnum and S2
77
what is the most definitive way to diagnose osteomyelitis? treatment?
bisopy the bone lesion and obtain cultures
could also oder esr and crp to evaluate for systemic inflammation.
treat with IV antibiotics (usually pip/tazo or vanco) and then surgical irrigation/debreidment (if chronic or severe, followed by 4-6 weeks of antibiotics)
78
What is the most common organism in the development of acne vulgaris? 1st line tx? 2nd line?
propionibacterium
1st line is benzoyl peroxide
2nd is topical retinoid
79
What GI problem might a poorly controlled diabetic have? how do you diagnose it?
tx?
Gastroparesis
dx with gastric scintography
tx with erythromycin or metoclopramide.
80
Pt with ITP (recent flu, now bleeding gums). what is the effect on megakaryocytes?
increased
81
How is thyroid storm related to Grave's disease? First line tx? 2nd line? why?
undertreated hyperthyroid can result in thyroid storm
first line is PTU, second is Methimazole.
Methimazole is longer half life, and it does not affect conversion of T4 into active T3. Methimazole is used for maintainenece for hyperthyoid bc of reasonable dose, but for active issue, PTU preferred.
82
What should be given 1 hour after thioamide administration for thyroid storm pts?
iodine to stop new hormone production.
83
Partial or even complete absence of the part of the brain located between the 2 cerebellar hemispheres (cerebellar vermis)
sx: slower motor dev, skull enlargement, increased ICP, lack of muscle coord and jerky movements.
Dandy walker malformation
84
What ist he difference between type I and II arnold chiari malformation?
I- is downward herniation of cerebellar tonsils
II - downward herniation of the cerebellar vermis
85
fluid filled cavity called ____ forms in the spinal card and leads to cord enlargement and degeneration of the spinal cord tracts.
syrinx
syringomyelia
86
What are the findings of RTA I and what autoimmune dz is it associated with? cancer?
Distal tubule can't secrete hydrogen ions in the form of NH4 so urine pH is high >5.5
a/w srogren's syndrome and multiple myeloma
87
What is the correct dilation for intramuscular epinephrine? IV?
1:1000
IV 1:10000
88
Why are ceftriaxone + vancomycin used to treat a patient with septic arthritis?
What's the gold standard for diagnosis for septic arthritis?
Ceftriaxone covers gonococcal infection
Vancomycin covers for MRSA
joint fluid aspirate - allows us to figure out sensitivities
89
What is a common infection of the eye seen in patients that do not clean their contact lenses properly?
Acanthamoeba
90
What are patients who have hemochromatosis at risk for developing, such that regular monitoring of ____ should be done?
hepatocellular carcinoma,
screen with AFP levels.
91
Define agoraphobia vs panic disorder
fear of public places - typically onset in the 3rd or 4th decade of life, more common in women.
generally agoraphobic have panic attacks but are afraid to be out in public in general
panic disorder, panic to a specif place or situation and attacks are recurrent.
92
What psych drug is good for pts who have depression and want to quit smoking?
what are the side effects?
Buproprion
insomnia, seizures, sweating, weight loss and decreased appetitie. (contraindicated in pts with seizures)
93
Walk through the metabolism of vitamin D from skin.
Vit D in skin --> UV light turns it into Previtamin D3 in skin --> vitamin D pinding protien carries previtamin D3 to the liver --> metabolized into 25-hydroxyvitamin D --> active vitamin D (calcitrol) in the kidney
The last step is regulated by 1-alpha hydroxylase which is upregulated by parathyroid hormone (PTH)
94
How does serum calcium affect active vitamin D?
low serum calcium means PTH will get upregulated causing increase in 1-alpha hydroxylase increasing vitamin D
95
What A1c is diagnostic for diabetes?
ADA goal?
first line intervention?
first line tx?
>6.5
96
What 4 categories do conduct diorders fall into?
| difference between conduct vs. opositional defiant disorder
1) aggression toward people/animals
2) destruction of property w/o agression toward people/animals
3) deceitfulness
4) serious violations of rules
ODD is recurrent patterns of negative disobidient behavior toward authority figures for atleast 6 months. Present at home, may not be present in public.
97
What vitamins are deficient in breast milk and when should supplementation of things begin?
A D K B1 B2 and B12
Newborns who exclusively breast feed need vit D 400 IU
Vit A can start at 4 mo
Iron has increased bioavailability for the first 6 months so after 6 mo, start supplementation.
98
Pt with otitis media and aphasia.. OM complication?
what are other OM complications?
temporal abscess
```
labrynthitis
lanbyrinthine fistula
mastoiditis
temporal abscess
petrositis
meningitis
otic hydrocephalus
simoid sinue thrombosis
encephalocele
```
99
What treatment should the following recieve?
hormone receptor positive
hormone receptor negative
her2/neu positive
tamoxifen
chemo
trastuzumab
100
What is the main ddx for n/v and very elevated transaminases?
Acute fulminant hepatitis
causes: viral hepatitis, acetaminophen toxicity, budd-chiari syndrome, autoimmune hepatitis...also other autoimmune diseases such as hashimoto's thyroiditis and DM I
101
Pt with coffee ground emesis and melena.
Initial treatment?
curative measure?
Pt with upper GI bleed
IVF, NGT, and give PPI
transfuse RBCS only if Hb is less than 7
then, once stable, do endoscopy to figure out where bleed is and cauterize.
102
Wilson's disease.. what are the levels of ceruloplamin ___ and urinary copper ____
treatment?
counseling?
decreased ceruloplasmin and increased urinary copper.
penicullamine or other copper chelators such as trientene.
avoid foods high in copper ie. shellfish, cocoa, nuts and mushrooms.
103
Pt c/o sensation changes at the dorsum of the foot. what nerve is affected?
superficial peroneal nerve (can happen in compression neuropathy)
104
What is the 1st and 2nd line treatment for post herpetic neuralgia?
Nortyptyline - 1st
Pregabalin - 2nd
105
Why are cerebellar hematomas a medical emergency? management?What's the first sign of brain herniation?
Cerebellar hematoma can lead to midbrain herniation through the foramen magnum.
Do immediate surgery
1st sign is respiratory depression
106
What are the most common #1 and #2 childhood bone tumors and what differentiates them histologically?
Osteosarcoma
Ewing's sarcoma
Histologically - ewings is of neural differentiation.
107
What causes ITP in children vs adults most often? Sx?
Tx for stable chronic ITP?
Bone marrow biopsy would show?
children - follows URI
Adults - chronic condition often due to anti-platelet antibody production
Sx: epistaxis, gingival bleeding and menorrhagia..+ elevated PT and petechiae.
Tx: IVIG and corticosteroids
BMB: increased megakaryocytes.
108
What imaging is best for a suspected kidney stone in a pt with hx of kidney stones vs. no hx of kidney stones?
if hx present, do KUB
| If no hx present, do CT scan of abdomen/pelvis.
109
What are the chances of passing following kidney stones?
| 8mm
8 mm = 20% chance of passing
110
What is the most common type of leukemia in elderly males? Peripheral smear findings? Staging system used for CLL?
CLL
Small, normal lymphocytes with smudge cells
Rei staging system
111
What is the rei staging system?
```
Stage 0 - lymphocytes >1500
1 = lymphs + lymphadenopathy
2=lymphs +splenomegaly
3 =lymphs + anemia
4 = lymphs + thrombocytopenia
```
112
What is the risk of HIV transmission with a needle stick? Mucus membrane exposure?
0.3%
| and 0.09%
113
Lichen sclerosus atrophicus (LSA) can progress to what cancer?
1st line tx? 2nd line?
Squamous cell carcinoma
1st - corticosteroids like clobetasol
2nd - calcineurin inhibitor like tacrolimus
114
Lateralization of Weber test on top of head to the right indicates what?
ipsilateral conductive loss and contralateral sensoneurial loss
115
A negative rinne when bone conduction is heard longer than air conduction is indicative of what?
conductive hearing loss.
116
Is mild fever or concalescence from illness a contraindication to give vaccines in any age?
NO.
117
When is sick euthyroid syndrome seen?
Seen in severe illness of non-thyroid origin. Typically it manifests no thyroid related symptomology
118
What is the initial and ultimate management/cure for priapism?
initial - ice packs to perineum, and ice water enemas along with terbutaline injection (b-agonist)
almost always curative - corporeal aspiration with butterfly needle and vasoconstrictor injection.
119
What is the current screening guidelines for lead screening?
Children should be tested at 12 and 24 months. If medicaid elidible, test at 6,12 and 24 mos. If identified as high risk with questionaire or if they start having neuro sx, test immediately.
120
When are clindamycin vs metronidazole preferred?
anaerobic infections above the diaphragm = clindamycin
anaerobic infections below the diaphragm = metronidazole
121
Drug for late stage African sleeping sickness?
Melarsoprol
122
ST elevation in leads AVL and V1 would indicate an infarct where? what vessel?
high lateral MI involving the proximal circumflex branch of the left coronary artery.
123
posterior left ventricle infarct would show what EKG findings?
tall R waves in leads V1 and V2
involves posterior descending artery
124
What EKG findings would be seen in an anterior septal left ventricle infarct?
V1 and V2 ST Elevations
distal left anterior descending branch of the left coronary artery.
125
What ekg findings are seen with a lateral apical left ventricle infarct?
V5 and V6 ST elevation
| vessel involved is the distal circumflex branch of the LAD
126
What ekg findings are seen with a anterior left ventricle infarct?
ST elevations in V1-V4
involves the proximal left anterior descending branch of the left coronary artery.
127
What is ambylopia and why does it occur
It is decrease in visual acuity and it occurs secondary to strabismus - eyes are not on the same visual axis and they do not fix on an object together . Usually strabismus is congenital and if it isn't fixed by age 5, vision loss is permanent.
128
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