Misc COMLEX Flashcards by Brianna Thiessen

Treatment for Toxoplasma gondii?

pyrimethamine and sulfadiazine

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Tx of achilles tendon rupture?

Long-leg cast with plantar flexion x 6 weeks

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ECG changes with hypomagnesemia?

U wave, prolonged QT –> torsades

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Most common ECG finding in PE?

Sinus Tach (S1Q3T3 is specific but ONLY seen in massive PEs)

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What is Scheuermann disease?

rigid thoracic kyphosis, vertebral wedging and degenerative endplates.

tx: bracing in pre-mature skeletal bones
OMT and PE in mature

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What are the salter harris classifications?

S: slipped (type I) (through the cartilage of the physis)
A: above physis (type II)
L: lower physis (type III)
T: through or transverse or together (above and below) (type IV)
R: ruined or rammed (type V)

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Tx of tinea versicolor?

Ketaconazole 2% cream or selenium sulfide 2.5% shampoo

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First line tx of cocaine induced CP?

Benzo (Do NOT give beta blockers!)

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LUQ pain and referred left shoulder pain? Cause?

Kehr sign

- Splenic rupture

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What is considered a positive TB test in patients who have AIDS, abnormal chest x-ray findings, have been in close contact with someone with active TB or immunosuppressed?

induration >5mm

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What is considered a positive TB test in a patient that is a IVDA, nursing home resident, prisoner, homeless, health care provider?

> 10mm

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When does primary CNS lymphoma occur in AIDS patients?

CD4

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Vitamin D deficiency that leads to defective bone mineralization and calcification of osteoid? (Pseudo fractures on x-rays)

Osteomalacia

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What is the target INR in a patient on warfarin for PE prophylaxis after a total hip replacement?

2-3

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Treatment for conjunctivitis in a neonate 5-14 days old?

Oral erythromycin (likely chlamydia)

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Neonate 2-5 days old with mucopurulent discharge and eyelid swelling? Tx?

Gonococcal.

IV or IM ceftriaxone or cefotaxime

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Difference between TEN and SJS?

SJS is 30% of the body

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Common cause of constrictive pericarditis outside of the US?

TB!

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What is the female athlete triad?

disordered eating, amenorrhea and low bone density (osteopenia/osteoporosis)
-problem: misperception of body image

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Transient, monocular loss of vision lasting a few minutes followed by a complete recovery? Next test?

amaurosis fugax

- duplex US of carotids (normally results from a retinal emboli dislodged from the carotid A)

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Best test to confirm ascending cholangitis?

ERCP

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Gene mutation associated with Rett Syndrome?

MeCP2

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What diagnosis is commonly found with hypospadias?

Chordee (a ventral curvature of the penis).

-Also commonly seen with cryptorchidism and inguinal hernias

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What is commonly found with epispadias?

bladder exstrophy

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Attachments of the dura mater?

cranium, foramen magnum, C2, C3, S2

Smooth, polylobulated breast mass that rapidly expands? Tx?

phyllodes tumor | -Wide local excision (whether it is benign or malignant)

What should be suspected in a patient that presents with liver failure without an obvious cause?

Budd-chiari syndrome

When the cranial bones move into external rotation and flexion, which way does the sacrum move?

counternutation

What do these radiographic findings indicate: pneumobilia, radio-opaque mass in the bowel and dilated bowel loops proximal to the bowel?

gallstone ileus

What is the most concerning lab result in an asthma exacerbation patient?

Normal or elevated pCO2 on ABG in the setting of increased work of breathing = cannot maintain adequate ventilation

Pathological finding in either type of IBD?

Neutrophilic cryptitis

What are the recommended vaccines for asplenic adults?

- Sequential PCV13 and PCV23 (and PPSV23 5 years later and at age 65) - HiB x1 - Meningococcal q5years - Influenza annually - HAV - HBV - Tdap then Td q10 years *should be given 14 days before or after surgery!*

Hemolytic anemia and thrombocytopenia?

Suspect TTP (thrombotic thrombocytopenia purpura)

Acute thyrotoxicosis with mild thyroid gland enlargement (nontender) and suppressed TSH with decreased radioiodine uptake?

Painless thyroiditis (silent thyroiditis)

Bilateral hip, thigh and buttock claudication, impotence and symmetric atrophy of the bilateral LE due to chronic ischemia?

-Leriche syndrome (aortoiliac occlusion)

What is cryoprecipitate? When is it used?

- contains factor VIII, fibrinogen, vWF, factor XIII | - can be used when FFP is needed but the patient is volume overloaded or if the fibrinogen is low (DIC)

Treatment of gallstone ileus?

Surgical laparotomy and enterolithotomy

What is the most SENSITIVE test for carpal tunnel?

Phalens

Best test for suspected gastroparesis?

Gastic scintography (measures gastric emptying)

Medication for gastroparesis?

Erythromycin or metoclopromide

Newborn cyanotic worse when feeding, better with crying?

Choanal atresia

Tx of Lyme in a kiddo

Amoxicillin or Cefuroxime

how do you diagnose disseminative histoplasmosis?

-Serum or urine antigen test

Tx of histoplasmosis?

Itraconazole (better than fluconazole)

What medications should be held for 48 hours prior to stress test?

Beta blocker, CCB, nitrates

SE of methotrexate?

hepatotoxicity. Monster LFTs q3 months

Causes of primary adrenal insufficiency?

TB, fungal infections, CMV

Neonate (

Midgut volvulus | -upper GI contrast study

Initial treatment of choice for SIADH?

fluid restriction

What are the components of a biophysical profile?

2 points for normal. 0 points for abnormal 1. 30 seconds of breathing 2. 3 body/limb movements 3. fetal tone (1 episode of extension --> flexion or opening --> closing of the hand) 4. reactive NST 5. Amniotic fluid volume (one pocket >2cm)

What is Light's criteria for an exudate?

- Fluid LDH/serum LDH >0.6 - fluid LDH >2/3 the upper limit of normal - Fluid protein/serum protein >0.5

Initial test in acromegaly?

IGF-1. | -then you can do a glucose suppression test.

Which medication is used in post-herpetic neuralgia?

Nortriptyline | 2nd line=pregabalin

What is a normal cranial rhythmic impulse (CRI)?

10-14 cycles/minute

Which medication is used for long-term remission in Crohn's?

Immunomodulators such a azathioprine and TNF-alpha inhibitors

How do you definitively diagnose cor pulmonale?

Right heart cath showing elevated pulmonary artery systolic pressure >25mmHg

Definition of fulminant hepatic failure? Tx?

- hepatic encephalopathy within 8 weeks of the onset of acute liver failure - TRANSPLANT!

Ovarian mass with thick separations, solid components and peritoneal fluid?

Epithelial ovarian cancer

Tx of impetigo?

- if limited skin involvement=topical antibiotics (mupirocin) - If extensive skin involvement=oral ABX (cefalexin, dicloxacillin, Clinda)

Tx of a duodenal hematoma 2/2 abdominal trauma?

-NG tube and parental nutrition x 1-2 weeks until the hematoma resolves

Pure sensory deficit from a stroke where?

Lacunar stroke of the thalamus | -Posterior cerebral artery

Preferred treatment for major depression in elderly who are not eating, drinking, are psychotic or actively suicidal?

-ECT

What is associated with angiodysplasia? What is this called?

- aortic stenosis | - Heyde's Syndrome

Goal for pre-prandial glucose? Post-prandial?

- Pre-prandial: 90-139 | - post-prandial:

Most common long term sequelae of bacterial meningitis?

-CN VIII deficits--> hearing loss

What is the most sensitive and specific test for ocular myasthenia gravis?

-single fiber EMG (ACh R Ab are only positive in 40-50% of cases)

Which androgen is produced by the adrenals?

DHEA-S

How can multiple myeloma cause hypokalemia?

- MM cause type II Renal tubule acidosis (decreased reabsorption of bicarbonate by the proximal tubule) - -> causes increase in sodium to the tubule --> increased aldosterone --> increased K+ excretion

1st line treatment of hyperemesis gravid arum?

Doxylamine/pyridoxine | H1 blocker and Vit B6

Most sensitive test for duchenne muscular dystrophy? (if normal, it can be ruled out)

What dietary changes can help decrease the incidence of gout?

-increase the consumption of low-fat diary products

Tx of delirium?

Antipsychotics (Haldol)

Most common bug in erysipelas?

S. pyogenies (gram + cocci in chains)

Which allele has an increased risk of developing Alzheimer's?

Apolipoprotein E4

Name for an osteochondral defect of the second metatarsal head?

Freiberg's infraction

What patient populations should get acyclovir for treatment of chickenpox?

- >12yo - history of chronic cutaneous or cardiopulmonary disorders - taking intermittent oral or inhaled steroids - taking chronic salicylates

How is chicken pox transmitted? Shingles?

- Chickenpox: aerosolized (coughing, sneezing, etc) | - Shingles: contact with open lesions

Appendix chapman points?

- anterior=tip of right 12th rib | - posterior=tip of Transverse process of T11

Posterior chapman point for adrenals?

between spinous process and transverse process at T11-T12

Posterior chapman point for kidneys?

between spinous process and transverse process at T12-L1

Medication to reduce morbidity and mortality in all ACS?

Aspirin

Next step if atypical glandular cells found on cervical cytology in a woman >35 yo?

Colposcopy and endometrial biopsy (cells come from either endocervix or endometrium) *If

If someone has a sulfa allergy, which medication would cover PCP and toxoplasmosis PPX in an AIDS patient?

Dapsone

Treatment of choice for disseminated Lyme with neurological sequela?

Ceftriaxone 2g IV x 14 days -if only facial nerve palsy and no abnormal CSF, can you PO Doxycycline

Most accurate test for ZES?

secretin stimulation test

RA, splenomegaly and granulocytopenia?

Felty's syndrome

Highest risk factor for strokes?

HTN