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USMLE Step 3 > Step 3 > Flashcards

Step 3 Flashcards

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1
Q

What is triple therapy for H pylori? What is quadruple therapy?

A

PPI
Clarithomycin
Amox or Metronizazole (if penn allergy)
Quad Therapy = bismuth + tetra instead of clarithro

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2
Q

What are the three situations in which hep B capsule antigen is positive and nothing else?

A
  1. Window period: IgM and liver enzymes elevated
  2. Distant Hep B infection: IgM and livers normal
  3. Chronic Hep B infection: IgM normal, HBV DNA is positive, possible abnormal livers
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3
Q

What are the INR levels for which warfarin changes/vit K are needed if there are no bleeding episodes?

A

<5: Hold for 1-2 days, restart when in range
5-9: Hold, give low dose K 1-2.5mg oral
>9: Hold, give high dose K 2.5-5mg oral

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4
Q

What is the threshold for bronchodilator challenge in asthma?

A

12% increase in FEV1

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5
Q

What is the empiric antibiotic choice for PID?

A

Cefoxitin + doxy IV +/- ceftriaxone

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6
Q

What is the predisposing condition to Mallory-Weiss tears?

A

Hiatal hernia

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7
Q

How is H pylori eradication confirmed?

A

Either Urea breath test or fecal antigen test

4 weeks after therapy is complete

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8
Q

What are Light’s criteria?

A

Trandudate:
protein fluid/serum <0.5
LDH ratio <0.6 or less than 2/3 normal serum limit

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9
Q

What is the first and second line treatment for pleural effusion related to liver cirrhosis?

A

First line: diuretics and Na restriction

Second line: TIPS

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10
Q

What cancers are associated with FAP?
What gene is sequenced for diagnosis?
By what age do 95% of them have cancer?

A

Duodenal and Gastric
APC is sequenced
45 years old

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11
Q

What are the options for N. meningitis exposure prophylaxis?

A
  1. Rifampin 600mg PO BID x 2 days
  2. Ceftriaxone 250mg single dose
  3. Cipro 500mg single dose
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12
Q

What are the Centor criteria for strep pharyngitis?

How is it scored?

A 
Cough
Lymphadenopathy
Fever
Tonsillar exudates
If less than 3, likely viral
If 2, needs further testing
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13
Q

How should recurrent C diff be treated?

A

Repeat metronidazole first

Vanco only for severe or resistant cases

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14
Q

What are the electrolyte abnormalities for Addison’s disease?

A

Hypo NA
Hypo CL
Hyper K
Possibly low glucose

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15
Q

When is the GTT done in pregnancy?

A

50g at 28 weeks
Again at 35-37 weeks
Unless age>25years, obesity, history of DM, spontaneous abortions, previous macrosomic infant

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16
Q

What is the check-up schedule for pregnancy?

A

Every 4 weeks until 28
Every 2 weeks until 36
Every week after that

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17
Q

What are the standard prenatal vitamins?

A

Folate
Iron
Prenatal vitamins
Prenatal counselling

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18
Q

What are the prenatal tests for pregancy?

A

CBC with diff
Atypical antiboy
Blood type and RH
Basic metabolic panel

Rubella antibodies
RPR
HIV
Chlamydia culture
Hep B surface antigen

Urinanalysis
Urine culture
Pap smear

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19
Q

Hydrophobia: Won’t drink because of throat spasms?

A

Rabies

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20
Q

What is the most common complication of cat-scratch fever? What are the less common ones?

A

Most: Suppuration of lymph nodes
Less: Hepatosplenomegaly, encephalopathy, vision loss from neuroretinitis

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21
Q

What is viral failure in HIV treatment?

What is the expected rate of drop in viral copies on the first HAART cycle?

A

Unable to get <200 copies in 6 months
<5000 in 4 weeks
<500 in 16 weeks
<50 in 24 weeks

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22
Q

What is preferred PEP for HIV?

A

Tenofivir: NRTI
Emtricitabine: NRTI
Raltegravir: Integrase inhibitor

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23
Q

What is the rate of conversion from acute to chronic Hep B?

A

Infants: 90%
Children: 20-50%
Adults: <5%

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24
Q

What are the target glucose levels for gestational diabetes?

What is the treatment if diet isn’t enough?

A

Fasting <95
1h post prand <140
2h post prand <120
Treat with insulin, meformin or glyburide

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25
What are the major side effects of metformin? | What is its relationship with IVP dye?
GI Upset LACTIC ACIDOSIS Decreased B12 absorption IVPD interacts with it, increases risk of acidosis Hold it on the day of, restart 2 days after normal renal function documented
26
Red-coloured papules with central depression that look like molluscum?
Cutaneous cryptococcus
27
``` What are the "buzzword terms" for senile gait spastic paraperetic gait cerebellar ataxic gait LMN gait? ```
Senile: walking on ice, cautious Spastic: scissoring, no knee flexion Cerebellar: drunken sailor, jerky, irregular LMN: high stepping, toes touch first
28
When does physiologic jaundice occur?
24h AFTER birth
29
What are the causes of SAAG >1.1
``` CHF Portal hypertension Budd-Chiari Cirrhosis Alcoholic hepatitis ```
30
What are the criteria of end organ damage in MM?
``` CRAB hyperCalcemia Renal failure normocytic Anemia Bone pain ```
31
First and second line drugs for restless leg?
Dopamine agonist: pramipexole | Benzos or gabapentin
32
What is the most common cause of sudden cardiac arrest in young people?
Anomalous coronary artery
33
What are the side effects of pentamidine? | What is it used for?
K can be hypo or hyper Glucose hypo or hyper Ca HYPO Used for PCP in HIV, leshmaniasis
34
Drug for remitting/recurring MS?
beta-interferon/ glatiramir
35
What needs to be ruled out before diagnosing dementia?
Hypothyroid B12 deficiency Depression
36
What part of the brain is affected in Wernicke-Korsakoff? | What can cause it acutely?
Mammillary bodies | Giving glucose before thiamine
37
What are the choices of laxitive for kids?
1. Milk of magnesia (osmotic) 2. Bisacodyl suppositories (as a rescue) Castor oil causes fat vitamin deficiency and aspiration
38
What is the antidote to sulfonylurea, glyburide, or meglintide overdose?
Dextroes, then octreotide | Octreo is somatostatin analog prevents insulin release
39
Isolated gastric varicies =?
Splenic vein thrombosis secondary to chronic pancreatitis
40
What are the common drugs that can cause pancreatitis?
Loop and thiazide diuretics Tetracycline and metronidazole Valproic acid 5-ASA and sulfasalazine
41
What is pyleophlebitis?
Infection of the portal veins usually secondary to peritonitis
42
Difference between scleroderma and achlasia?
Sclero has no LES tone Achalasia has increased LES tone Both have no peristaltic waves
43
What are the two causes of major BRBPR bleeding and their signs?
Diverticulosis = pain | Angiodysplasia/vascular ectasia = aortic stenosis, endstage renal disease
44
What antibiotics are associated with hypertrophic pyloric stenosis?
Erythromycin (for pertussis) | Macrolides
45
What are the three predictors of liver disease severity?
1: INR 2. Creatinine 3. Serum bilirubin
46
How is a prolactinoma treated What are their at risk for?
1st) Dopanine agonist: Bromocryptine/Cabergoline 2nd) Surgery if neuro symptoms At risk for osteoporosis secondary to hypogonadism
47
What complications does tight sugar control prevent?
MICROvascular ones: Nephropathy, retinopathy
48
What is the endpoint in treating KDA?
normal anion gap | May need to add dextrose +/- K to insulin infusion
49
When is lamivudine used?
Hep B infection with high PT/PTT or immunosuppressed
50
What are the differences between measles and rubella? What is the other name for measles? What is roseola?
Both have head first rash Measles has higher fever and ill-looking Measles = rubeola Roseola = truncal rash spreading to extremities
51
Reddish-brown papule with sharp borders and jelly-like consistency?
Cutaneous TB
52
Fever, joint pains, petichial bruising with Hx of travel? | What is the most serious consequence?
Dengue fever | Can result in shock/cardio collapse
53
When is an implantable defibrillator indicated in CHF? When is a biventricular pacemaker the answer? What does it do?
EF <35% Use biventricular if QRS is also >120ms Forces both ventricles to contract at same time. Wide QRS means they're not
54
What are the target goals of statin therapy in ACS cs diabetes? What are the criteria for statin therapy?
ACS: LDL<100 DM: LDL <70 Criteria: LDL>190, known vascular disease, age 40-75 with DM, or calculated 10 year risk >7.5%
55
When do you use hydroxychloroquine vs methotrexate vs cyclophosphamide in SLE?
Hydroxy: for arthalgia, serositis, cutaneous symptoms Metho: if other organs are affected Cyclo: only for serious problems like nephritis, vasculitis or CNS involvement
56
What antibiotics are associated with C Diff?
Clinda Fluoroquinolones Cephalosporins Enhanced penicillins
57
What is the immunization schedule for newborns with Hep B?
At birth, 3 months and 6 months | Check serology at 9 months
58
What is the murmur of pulmonary stenosis?
Systolic crescendo/decrecendo at left upper sternal border
59
What is the murmur of mitral valve prolapse?
Mid-systolic click with end-systolic murmur
60
What is pseudohypoparathyroidism? What is pseudopseudo? What distinguishes any PTH problem from Vit D deficiency?
Pseudo = end organ resistance to PTH Pseudopseudo = normal Ca and Phos, but short MC 4+5, round facies Vit D has low Ca AND low Phos
61
What are the grades of pregnancy safety in drugs?
A - Safe: human and animal studies B - Likely safe: animal, but no human, or human studies safe C - Only if benefits outweight risks: Risky in animals, no human, or no studies at all D - Only in severe circumstances: Fetal risk in human or post-market studies E - Unsafe: Fetal risk in human studies
62
In hypovolemia, cardiac shock and septic shock, what measurements are high amongst cardiac output, wedge pressure and SVR?
Hypovolemia: SVR is high Cardiac: Wedge and SVR is high Septic: CO is high
63
What is the treatment for lead poisoning?
45-70ug/dL: Succimer, DMSA PO | >70: dimercapterol +EDTA IV
64
What is the management of ARDS?
High PEEP Proning Low tidal volumes (6ml/kg) Diuretics, maybe dobutamine
65
What ratio indicates ARDS?
PO2 / FIO2 <200
66
What tests are ordered after pleurocentesis?
``` Gram stain and culture Fluid and serum protein Glucose Acid-fast stain Fluid and serum LDH Cell count w/diff Triglycerides pH ```
67
What are the treatments for pulmonary hypertension?
1. Bosentan - endothelin inhibitor prevents growth of pulmonary vasculature 2. Epoptostenol/trepostinil: PG analogs dilate pulmonary vasculature 3. CCB: weak 4. Sildenafil
68
What are the signs of pulmonary hypertension?
Loud P2 (second part of S2) Tricuspid regurg: holosystolic but at LEFT sternal border Right ventricular heave Raynaud's phenomenon
69
What exposures are linked to beryliosis?
electronics ceramics Fluorescent light bulbs
70
What is criteria for home O2?
PO2<55 or O2sat <88%
71
What should be ordered for an asthma or COPD exacerbation?
1. Inhaled bronchodilator 2. IV prednisone 3. Inhaled ipatropium 4. O2 5. Mg
72
What should be ordered for all SOB?
1. O2 2. Continuous O2 sat 3. CXR 4. ABG 5. Peak expiratory flow meter
73
What are the other long-acting options for asthma control?
1. cromolyn/nedocromil for hay fever 2. Montelukast for atopic disease 3. Tiatropium/ipotropium for COPD 4. Omalizumab for high IgE when cromolyn fails
74
Which murmurs get softer with squatting or leg elevation?
Mitral valve prolapse | Hypertrophic cardiomyopathy
75
Which herbals are associated with liver toxicity?
Kava kava | Black cohosh
76
What are the management additions for non-acute asthma management?
1. Inhaled dilator: albuterol 2. Inhaled steroid 3. Long acting B-agonist: salmeterol/formeterol 4. Oral steroids last resort
77
What is the time line of complications post MI?
``` Reinfarct: 0-2 days Pericarditis: 1-4 days Ventricular septal rupture: 0-7 days Free wall rupture: 0-14 days Papillary rupture: 2-14 days ``` Postinfarct angina: 0-1 months Pericarditis: 0-3 months Left ventricular aneurysm: 5 days to 3 months
78
What two infections is ribavirin used for?
Hep C and RSV ONLY
79
How are influenza, pertussis and N. meningitis transmitted?
Droplet
80
How are varicella, TB and measles transmitted?
Airborne
81
What are the tell tale signs of chlamydia pneumo in neonates?
Staccato cough Hyperinflated lungs History of conjunctivitis Sometimes NO FEVER
82
What are the symptoms for a respiroatory fungal infection?
Fever Pulmonary: cough and chest pain Sinus: headache and nose bleed
83
What antibiotics are used for neonatal sepsis? For which suspected organisms?
<28 days: Amp + Gent or cefotaxime for E. coli and GBS | >28 days: Ceftriaxone or cefotaxime +/- vanco for Strep pneuo and N. Meningitis
84
When cephaosporins can be used vs pseudomonas?
Cefepime | Ceftaxidime
85
What are the CSF signs of crypto meningitis?
1. High lymphocytes but low leuks <50 2. High protein, low glucose 3. Really high open pressure 250-300mmHg
86
What is the treatment for acute pericariditis post-MI?
ASA high dose
87
What causes edema in CCB use? What can make it better?
Preferential dilation of arteries creates relative venous insufficiency ACEI can make better
88
How does licorice cause HTN?
Blocks 11-beta hydroxysteroid reductase | Cortisol can't become cortisone and acts on mineralocorticoid receptors
89
What arrhythmia can occur with inferior MI? Which leads? How to treat?
Sinus brady II, III, avF Atropine
90
What is the medical treatment for aortic dissection?
Beta-blockers first | Nitroprusside only if BP>100-120 after blockers
91
What screen should happen with a Dx of bicuspid aortic valve?
Thoracic aortic aneurym from dilation of root
92
What produces broad and notched P waves?
Mitral stenosis secondary to rheumatic fever
93
What is an atrialized right ventricle called? What causes it?
Ebstein's anomaly | Caused by lithium in pregnancy
94
What are the time limits for PCI for STEMI?
Within 12 hours of onset 90 minutes on door entry 120 minutes on door if non-PCI hospital
95
What are 3 coronary heart disease equivalents?
Non-coronary athlerosclerosis Diabetes Chronic renal failure
96
When is human vs equine anti-botulism toxin given?
Human: Infantile flaccid paralysis from spores to avoid hypersensitivity of equine Equine: Flaccid paralysis from non-spore food
97
What are the symptoms of digoxin toxicity? What drugs should be looked for?
Nausea, anxiety, visual disturbance, confusion | Look for verapamil, amiodarine and quinidine

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