Step 2 CK part 2 Flashcards
(178 cards)
1
Q
wernicke encephalopathy - w hat part of brain affected?
A
thalami
2
Q
alcoholic cerebellar degeneration - what park of brain damaged?
A
purkinge cells of cerebellar vernis
3
Q
3 drug regimens to use for uncomplicated cystitis
A
- nitrofurantoin x 5 days
- TMP-SMX x 3 days
- fosfomycin x1
4
Q
contraindications to nitrofurantoin and TMP-SMX use in uncomplicated cystits?
A
nitro - avoid if suspected pyelonephritis or CrCl < 60
TMP-SMX - avoid if local resistance > 20%
5
Q
what makes cystitis complicated?
A
preggo, DM, renal failure, UTobstruction, catheter, immunosuppressed, hospital acquired
6
Q
tx for complicated cystitis
A
FQ x5-14d
7
Q
pyelonephritis tx for outpatient and inpatient
A
outpatient - FQ
inpatient - IV abx: FQ or aminoglycoside +/- amp
8
Q
3 encapsulated organisms most commonly present in ppl without spleen
A
pneumococcal
meningococal
H influ B
9
Q
viagra:
official name/MOA
contraindicated if:
A
sildenafil
phosphodiesterase-5 inhibitor
contraindications = pt on nitrates or alpha blockers
10
Q
schistocytes –
LDH?
haptoglobin?
A
ldh - incr
haptoglobin - decr
11
Q
triad for trichenella
A
periorbital edema
myositis
eosinophilia
12
Q
amyloidosis tx
A
colchicine
13
Q
three antiphospholipid antibodies
A
- anticardiopilin
- anti-beta1 glycoprot
- lupus anticoagulant
14
Q
atropine effect on eyes
A
mydriasis
15
Q
what form of vitD do you take as supplement?
what is active form and how/where does it become active?
A
supplement- D3
active - 1,25-(OH)2D
via= 1-alpha-hydroxylation in kidney
16
Q
salivary gland swelling and pain with meals
A
salivary gland stone
17
Q
bilateral nontender submandibular gland swelling with salivary gland enlegrement
A
sialadenosis
18
Q
triad for reactive arthritis
+ 2 other common findings
tx?
A
nongonococcal urethritis
asymmetric oligoarthritis
conjunctivitis
+2: mucocutaneous lesions, enthesitis
tx = NSAIDS
19
Q
1 cause osteomyelitis in IVDU and SCD
A
s. aureus
20
Q
tick bite with anemia and intravascular hemolysis (jaundice, dark urine, indirect hyperbilirubinemia)
A
babesosis
21
Q
foodborne illnesses:
enterotoxin ingested
A
s. aureus and b.cereus
22
Q
foodborne illnesses:
enterotoxin made in intestine
A
clostridium perfrinigens
ETEC
vibrio cholera
23
Q
foodborne illnesses:
bacterial epithelial invasion
A
campylobacter jejuni
salmonella
listeria
24
Q
central cord syndrome
how does it happen?
manifestations?
A
hyperextension injury in eldery person with pre-existing degenerative changes
weakness in UE > LE
25
anterior cord syndrome
loss of what?
preserved what?
loss - movement and P/T
| preserved vib/proprio
26
brown-sequard
ipsi - weakness an dloss vib/proprio
| contra - loss P/T
27
tx for anticholinergic overdose (atropine, diphenhysramine)
physostigmine
28
right vs left sided colon cancer presentations
right - anemia
| left - obstruction
29
which cholesterol drug:
| decreases LDL and TG
statin
30
statin SE
myositis and incr LFT
| incr CK
31
which cholesterol drug:
| increases HDL and decreased TG
fibrates
32
fibrate SE
myositis and incr LFT
33
which two cholesterol drugs:
decrease LDL only?
and what is the SE?
ezetimibe and bile acid resin
| SE = diarrhea
34
which cholesterol drug:
| incr HDL and decr LDL
niacin
35
niacin SE
flushing and itch
| prevent with asa
36
vasospastic angina
| preventatice and abortive tx
abortive - sublingual nitroglycerin
| preventative - CCB (diltiazem)
37
causes of respiratory alkolosis
```
CO2 < 36
HYPERVENT
tumor
hypoexemia
atelectasis
PE
CHF
```
38
two most common heart problems in marfan syndrome
aortic dilation/regurg/dissection
| MVP
39
S3 and S4 - what kind of gallops?
S3 - ventricular gallop
| S4 - atrial gallop
40
myasthenia crisis tx
IVIG and plasmapharesis
41
what type of drug is atropine?
muscarinic receptor antagonists
42
type of bone lesions in multiple myeloma
osteolytic
43
MS acute attack tx
IC glucocorticoids --> plasma exchange
44
dypsnea, orthopnea, paroxysmal noctural dyspnea, hemoptysis.. what kind of heart problem?
mittral stenosis
45
chorioamnioitis:
what are diagnostic criteria?
(major plus 5)
maternal fever PLUS 1+
1. fetal tachy (>1 60)
2. matn tachy (>100)
3. uterine fundal tenderness
4. purulent amniotic fluid
5. matn leukocytosis
46
criteria for premature rupture of membranes
+ ROM
+ term (>37 weeks)
(-) contractions
47
criteria for preterm premature rupture of membranes
+ ROM
(-) term
(-) contractions
48
preterm premature rupture of membranes management
< 34 weeks without infection
< 34 weeks with infection
34-37 weeks
<34w without infct = abx, roids
<34w with infct = abx, roids, deliver (add Mg if < 32w)
34-37 = abx, +/- roids, deliver
49
definition of arrest of active labor
no cervical change for 4 hours with adequate contractions
OR
no cervical change in 6 hours with inadequate contractions
50
tx for protraction vs arrest of active labor
protraction - oxytocin
| arrest - c/s
51
preggo changes
CO? PV? SVR?
BP? HR? Hg?
```
Co - incr
PV - incr
SVR - decr
BP - decr
HR - incr
Hg - decr
```
52
Protein/Cr ratio for preE
>0.3
53
meaning of:
| early, variable, and late decelerations
early - head compressin
variable - cord compression
late - uteroplacental insufficiency/ fetal hypoxia
54
timing of CVS and amnio
CVS - 10-13 weeks
| amnio - 15-20 weeks
55
when to screen preggos for GDM?
24-28 weeks
56
name three DMd rugs that stimulate insulin secretion
sulfonureas
meglintie
incretin system
57
major side effects of sulfonureas (2)
1. hypoglycemia
| 2. weight gain
58
what are the two drugs in the incretin system and their MOA?
1. exentide: GLP1analog
| 2. sitagliptin : inhibits Dpp4
59
name two DM drugs that enhance insulin action
biguanide (metformin)
| TZD (pioglitazone)
60
name 2 Dm drugs tha enhance glucose excretion
canagliflozin
| acarbose
61
endometrial biopsy indications
AGE >45: AUB, postmen bleed
AGE <45: AUB + unopp estrogen, failed med mngmnt, lynch
AGE >35: atypical glanualr cells on pap test
62
adrenal insufficiency
primary?
central?
primary - decr cort, incr ACTH
| central - decr cort, decr ACTH
63
level of bhcg when transvag u/s finds intrauterine pregnancy?
1500-2000
64
which vulvovaginitis infections have normal pH and elev pH?
normal - candida
| >4.5 = BV and trich
65
Mg toxicity tx
IV calcium gluconate
66
fibrocystic changes vs fibroadenoma
fibrocystic changes -multiple nodules
| fibroadenoma - solitary
67
fetal anemia heart tracing
sinusoidal
68
alternative tx for syphillis is pt allergic to pcn and its early syphillis
doxycycline
69
herpes dx?
pcr
70
granulosa cells secrete which two hormones?
aromatase and inhibin
71
arrest of second stage of labor criteria
no fetal descent after pushing for 3 hours (null) or 2 hours (multip)
72
baby with sniffles
congenital syphillis
73
when to stop pap
```
65 or hysterectomy
PLUS
no h/o CIN2
AND
3 consecutive (-) pap
OR
2 consecutive (-) cotesting
```
74
acid base in preggos
respiratory alkalosis
75
hemophillia blood levels
incr PTT only
76
vWD blood levels
incr BT incr PTT
77
preggo - asymptomatic bacturia tx
cephalexin (1st gen)
amox-clav
nitrofurantoin
fosfomycin
78
PID tx
inpatient? (2 options)
outpatient?
```
inpatient:
1. IV cefoxitin or cefotetan + oral doxy
2. IV gent/clinda
outpatient
1. IM ceftriaxone + oral doxy
```
79
contraindications for:
methylergonovine?
carbaprost?
meth - htn - bc vasoconstriction
| carba - asthma bc bronchoconstriction
80
sheehan syndrome: what are FSH and LH levels?
both low
81
preterm birth prevention
1. No h/o preterm --> first step?
if normal?
if short?
TVUS
norm - routine PNC
short - vag progesterone
82
preterm birth prevention
2. h/o preterm --> first step?
if normal?
if short?
TVUS and progesterone shots
norm - serial TVUS till 24w
short - cervlage, serial TVUS till 24w
83
adenomyosis uterus description
boggy
globular
tender
84
overall increased risk breast cancer
bc increased lifetime estrogen exposure
85
does having a baby increase or decrease lifetime estrogen exposure?
decreases
86
three main systems involved in tissue invasive CMV dz
pulmonary
GI
liver
87
what is the bloody HIV diarrhea?
CMV
88
CMV tx
ganciclovir
89
preterm labor
if <34 weeks?
if <32 weeks?
<34 toco + roids
| <32 toco + roids + Mg
90
erb-duchenne
which cranial nerves?
presentation?
C5,6,7
| watiers tip
91
Klumpke
which cranial nerves?
presentation?
C8, T1
| claw hand
92
which has impaired moro and bicpes reflex? (erb or klumpke?
erb
93
which has horners? (erb or klumpke?
klumpke
94
which has absent ability to grasp? (erb of klumpke?
klumpke
95
subareolar, mobile, well-circumscribed, non tender breast mass
no fever
while breastfeeding
galactocele
96
gold standard for definitive diagnosis of adenomyosis
histopathological exam of hysterectomy specimen
97
what type of breast cancer shows microcalcifications on mammography?
DCIS
98
PCOS - whats the deal with LH and FSH
they are imbalanced bc high estrone stimulates hypothalamus and = high frequency, short inteval GnRH. these pulses preferentially produce LH... lack LH surge = failure of follicle maturation
99
AFP levels in downs, edwards, abd defect
downs and edwards - decr
| abd defect - incr
100
condyloma acuminata tx
trichloroacetic acid
101
hidradenitis suppurtiva tx
doxycycline
102
pyelonephritis in preggo tx
ceftriaxone
103
lactational mastitis tx
dicloxacillin
104
endometritis tx
amp + gent
| + clinda if c/s
105
what causes theca lutein cysts?
ovarian hyperstimulation
| GTD, twins, infertility tx
106
two genetic abnormalities that cause primary ovarian insufficiency
turners and fragile X
107
obesity is a risk factor for endometrial or cervical cancer?
endometrial
108
cervical cancer risks
HPV/lotsa of rando sex
OCP
tobacco
109
what drug induced ovulation for PCOS
clomiphene citrate
110
HIV in preggos, what mode of delivery?
VL <1000 + HAARTS = vag
| VL > 1000 or (-) HAART) = c/s + ziduvodine
111
mom with HIV.. wha tto do with baby?
mom VL < 1000 - ziduvodine
| mom VL >1000 - HAART
112
what to do with ASCUS?
HPV testing
113
three key findings of aromatase deficiency
1. normal internal
2. external virilization
3. undetectable estrogen
114
epithelial ovarian carcinoma mngmnt
ex lap
115
describe BV discharge
white, grey and fishy
116
#1 and #2 most common posterior fossa tumors in kids
```
#1 - astrocytomoa
#2 - medulloblastoma (worse prognosis)
```
117
common symptoms of medulloblastoma in kiddos
truncal and gait instability
| and obstructive hydrocephalus
118
supratentorial tumor findings
incr ICP and seizures
119
describe power, type 1 and type 2 error
power = prob of correctly rejecting null
type 1 = incorrectly reject null
type 2 = incorrectly accept null
120
ARP formula
(RR-1)/RR
121
NNT and NNH formula
```
NNT = 1/ARR
NNH = 1/AR
```
122
RR and OR formula
```
RR = (a/a+b)/(c/c+d)
OR = (a/b)/(c/d)
```
123
retrospective cohort description
compare dz incidence
124
case control
compare risk factor frequency
125
(+) LR and (-) LR formulas
(+) LR = SN/(1-SP)
| (-) LR = (1-SN)/SP
126
CI contains 1
cannot reject null for RR and OR
127
CI contains 0
cannot reject null for means
128
PPV and NPV formula
```
PPV = a/(a+b)
NPV = d/(c+d)
```
129
list 3 causes of hyperPTh
1. adenoma: hi PTH hi Ca
2. CKD: lo Ca hi PTH
3. refrct CKD: hi hi PTH hi Ca
130
list 3 causes of hypoPTH
1. surgery: lo PTH lo Ca
2. pseudo: hi PTH lo Ca
3. pseudopseudo: norm PTH lo Ca
131
best tx for emphysematous cholecystitis
ampicillin-sulbactam
132
pancreatitis wtih ALT >150
gallstone pancreatitis
133
three features of patellofemoral pain syndrome
pain worse with activty
pain worse with prolong sitting
crepitus with patella motion
134
boundaries of anatomic snuff box
| which artery?
extensor pollicus brevis
extensor pollicus longus
abductor pollicus longus
radial artery
135
metoclopramine MOA and use in GI
dopamine antagonist
| promotility (used for constipation/nausea)
136
ondansetron MOA and use in GI
serotonin receptor antagonist
nausea
can contribute to constipation
137
bowel sounds in emphysematous cholecystitis and why
decreased/absent
| bc ileus
138
patellar tendinitis - who gets it
athletes who jump or lots of forceful knee extension
139
```
axillary n
function and fracture
```
```
func - arm abduction, delt sens
fx - surgical neck humerus
```
140
radial n
| functino and fracture
```
func - wrist exten, sup, dorsal hand/triceps
fx - midshaft humerus (wrist drop)
```
141
```
ulnar n
function and fracture
```
```
func - finger flxn/abd/add and 4th5th finger
fx - medial epicondyle
```
142
cause of ludwig angina
infected mandibular molar
143
prosthetic joint infections
<3 mon
3-12 months
>12 months
<3 months - s.aureus
3-12 months - s epiderm
>12 months - s.aureus
144
succinylcholine MOA
binds postsyn Ach receptors
| = influx Na efflux K
145
most common watershed areas for colonic ischemia
```
splenic flexure (sma&ima)
rectosigmoid junctino (sigmoid a and sup rectal a)
```
146
which type of heparin good for ESRD? and which bad?
good - unfractionated hep
| bad - LMWH hep and rivaroxaban
147
abx before gi surgery
IV cefazolin
148
fastest way to revere warfari
FFP
149
hypovolemic shock -- SVR?HR?EF?
all increased
150
two drugs to help decrease etoh use
naltrexone (mu opiod antag)
| acamprosate (glutamate modulator)
151
contraindications for naltrexone and acamprosate
naltrexone - opiod depend or liver fialure
| acamprosate - renal impariment
152
mirtazipine se
incr appetite and incr sleepiness
153
what to monitor if on lithium
kidney and thyroid
154
bulemia tx
fluoxetine
155
what kind of drug is benztropine
anticholinergic
156
schizoaffective
mood with schizo and 2+ weeks delusions/hallucinations without moddd
157
schizoid vs schizotypal vs avoidant
schizoid - like to be alone
schizotypal - weird, magicla
avoidant - avoid bc fear of criticism/rejection
158
serotonin syndrome
tremor, myoclonus, hyperreflexia
159
how long before starting MAOi should you stop fluoxetine?
5 weeks
160
short acting BZ withdrawl
seizures if abrupt discontinuation
161
person on PCP - how to calm down?
bz
162
nightmare for nightterror
| which occurs in REM and nonREM
nightmare - rem - remember
| night terror - nonrem - dont remember
163
three dopamine pathways and functions
mesolimbic - psychotic
nigostriatal - parkinsonism
tubuloinfundibular - prolactin
164
piloerection, yawning, dilated pupils, hyperactive bowels
heroine withdrawl
165
dont give haldol to seixure disorder
dont give haldol to seiizure disorder
166
BP 1 monotherapy
lithium
valproate
quetiapine
lamotrigine
167
if inadequate response to monotherapy for BP1 try --
lithium or valproate + second generation antipsychotic (quetiapine)
168
important lab change with valproate
incr LFTs
169
person with BP1 and kidney problems.. what should you use?
valproate
170
displacement vs projection
displacemnt - transfer personal feeling to less threatening object/person(mad at dad but yell at dog)
projection - attribute one's own feeling to others ( i am mad at joe, so youa re mad at joe)
171
elderly sleep changes
sleep latency?
REM latency?
slow wave sleep?
sleep latency - incr
REM latency - decr
slow wave sleep - decr
172
relaationship of antidep and bipolar
dont give antisepressant monotherapy to biipolar bc van induce mania
173
acceptable tx for bipolar preggos
lamotrigine
174
social anxiety tx?
SSRI, betablocker if performance type
175
cortisol in MDD
incr
176
acute bipolar depression tx
quetiapine, lurisdone, lamotrigine
177
contraindications to
NSAIDs
Colchicine?
nsaids - on anticoagulants
| colchcine - diarrhea, renal problems, old
178
two ways to treat gout chronically
1. overproduction - allopurinol
| 2. undersecretion - probenacid
