Step 3 Q Bank q's Flashcards
(148 cards)
1
Q
Treatment of herpes zoster
A
acyclovir or valacyclovir x 7-10days, try to start within 72hrs of onset of rash
2
Q
how is herpes zoster transmitted?
A
in the immunocompetent host, transmitted only via direct contact with the open lesions (in contrast to primary varicella aka chickenpox which is extremely contagious and transmitted through airborne droplets)
3
Q
Preferred treatment for post herpetic neuralgia?
A
- Tricyclic antidepressants
- Topical Capsaicin cream
- Gabapentin
- Long Acting Oxycodone
4
Q
Pathogenesis of idiopathic thrombocytopenia purpura?
A
platelet-specific autoantibodies, seen as sudden onset bleeding (petechiae, purport, epistaxis, and gingival bleeding), hx of infection
5
Q
What are the three causes of failure to thrive?
A
- Inadequate calorie intake
- Inadequate calorie absorption
- Increased calorie requirements
6
Q
When will you see low radioactive iodine uptake? 5 instances
A
- Silent thyroiditis
- Postpartum thyroiditis
- Surreptitious thyroid hormone abuse
- Iodine-induced thyroiditis
- subacute thyroiditis (de quervains)
7
Q
treatment of choice for subacute thyroiditis
A
NSAIDs and beta blocker
8
Q
genetic pathophys of MEN1
A
mutation of the tumor suppressive Menin1 gene
9
Q
Characteristics of MEN1
A
- hyperParathyroidism
- ZES (gastrin-secreting Pancreatic tumor)
- Pituitary tumor (most common prolactinoma)
10
Q
treatment of acne rosacea?
A
oral doxycycline
11
Q
what is drug of choice for the immediate treatment of metoclopramide-induced acute dystonia?
A
IV diphenhydramine
12
Q
Most common cause of acute renal failure in patients with cirrhosis?
A
hepatorenal syndrome (but must consider a diagnosis of exclusion)
13
Q
treatment of choice for hepatorenal syndrome?
A
midodrine and octreotide + albumin
14
Q
when should HIT be considered?
A
when platelet counts fall >50% from baseline 5-14 days after starting heparin
15
Q
one major symptom of amiodarone?
A
causes thyroid dysfunction due to its high iodine content
16
Q
two mechanisms by which amiodarone-induced-thyrotoxicosis may occur?
A
- Type 1: activation of grave’s disease
2. Type 2: destructive thyroiditis
17
Q
positive antithyroid peroxidase antibodies
A
hashimoto’s thyroiditis
18
Q
primary risk factor for the development of thyroid lymphoma?
A
preexisting hashimoto’s thyroiditis
19
Q
major pathological feature of PSC
A
destruction of small and mid sized bile ducts
20
Q
Antibodies seen in primary sclerosing cholangitis
A
antimitochondrial antibodies
21
Q
antibodies seen in type I autoimmune hepatitis?
A
anti-smooth muscle antibodies
22
Q
what can slow the progression of primary sclerosing cholangitis?
A
ursodeoxycholic acid (definitive treatment is w liver txp)
23
Q
frequent complication of primary sclerosing cholangitis?
A
osteoporosis (due to decreased vitamin D absorbtion)
24
Q
what are three EKG manifestations of severe hyperkalemia?
A
- Prolonged PR interval
- Widened QRS with sine wave pattern
- disappearance of p waves
25
what is the management of delivering babies w shoulder distocia?
```
BECALM
Breath- don't push
Elevate legs into sharp hip flexion
Call for help
Apply suprapubic pressure
Large opening w episiotomy
Maneuvers: deliver posterior arm, corkscrew, all fours, lastly- push it back in and C section
```
26
SLE + renal involvement, what do you need?
renal biopsy! there are 5 types of renal involvement and they all have different treatments, thus need bx to know which type
27
what do you measure to monitor disease activity in SLE patients?
serum complement or levels of anti-dsDNA
28
most common cause of nec fasciitis in patients who are otherwise healthy?
group A strep
29
two different types of necrotizing fasciitis?
I: seen in patients with underlying diabetes and PVD, polymicrobial
II: individuals with no concurrent medical illness, hx of laceration/blunt trauma/surgery i.e. group A strep
30
Treatment of multiple sclerosis?
acute exacerbation = IV corticosteroids or oral but use IV in patients w optic neuritis
long term: beta interferon
31
Contraindications of breast feeding (6)
1. Active TB
2. Maternal HIV
3. Herpetic breast lesions
4. Varicella infection active
5. Chemotherapy or ongoing radiation
6. Active abuse of alcohol or drugs
32
fungus infection in patients with DKA
think mucormycosis caused by Zygomycetes
33
Definition of arrest of labor in first stage
>6cm cervical dilation, ruptured membranes, and one of the following:
- no cervical change in >4hrs despite adequate contractions OR
- no cervical change for >6hrs with inadequate contractions
34
definition of adequate labor
>200-250 MVU (montevideo units)
35
long term complication of RSV in kids?
up to 30% develop reactive airway disease
36
antibodies associated with Sjogren's syndrome?
Anti-ro/SSA & Anti-La/SSB
37
what is the schemer test?
used to confirm the diagnosis of keratoconjunctivitis sick, filter paper is placed along the lower eyelid and wetting of the paper is measured after a defined period. too little = abnormal tear production
- used to rule in or out sjogrens syndrome
38
focal submandibular mass in a patient with sjogrens syndrome
concern for B cell non hodgkins lymphoma
39
how does sjogre's disease lead to B cell lymphoma?
sjogrens results in polyclonal B cell activation and infiltration of the salivary glands, this can go awry and lead to B cell lymphoma
40
Most common cause of postpartum hemorrhage?
uterine atony
41
treatment of choice for uterine atony?
oxytocin and fundal massage, oxytocin is a uterotonic medication
42
what is HELLP syndrome?
hemolysis, elevated liver enzymes, and low platelet count
| accounts for 20% of thrombocytopenia in pregnancy, ominous variant of preeclampsia
43
what is principal cause of infertility in patients with PCOS?
anovulation, weight loss can restore ovulation
44
definition of preeclampsia?
new onset hypertension (SBP>140 and/or DBP >90) at >20wks AND proteinuria or signs of end-organ damage
45
What are 6 severe features of preeclampsia?
1. SBP >160 or DBP >110 on 2 occasions >4hrs apart
2. Thrombocytopenia, plt 1.1 or doubling
4. Elevated transaminases
5. Pulmonary Edema
6. New-onset visual or cerebral symptoms
46
what is the most troubling known complication of subchorionic hematoma?
spontaneous abortion
47
treatment of BV?
- course of oral metronidazole or clindamycin
48
2 complications of bacterial vaginosis?
1. Increased risk of preterm birth
| 2 Increased risk for acquisition of HIV, HSV2, G,C and trichomonas
49
Define: cohort study
a population is observed over time, grouped based on exposure to a particular factor and watched for a specific outcome, use RR
50
Define: case control study
retrospective study involving a group of people with a given disease and otherwise similar group of people without the disease who are compared for exposure to risk factors, use OR
51
when do you perform the triple marker screen/quad test?
between 15-20 weeks gestation
52
whats the difference between a quad screen and triple and whats included in them?
triple: AFP, estriol, b-HCG
Quad: adds inhibin-A, more sensitive to downs
53
how do you treat magnesium toxicity in moms treated for preeclampsia?
IV calcium gluconate
54
AFP is increased on triple marker test, what is it?
neural tube defect!
55
what do you see on triple marker test for trisomy 18?
decreased everything- AFP, estriol, b-HCG
56
what do you see on triple marker test for trisomy 21?
decreased AFP and estriol, increased b-HCG
57
whats all included in a biophysical profile? BPP
```
Test the Baby, MAN!
Tone
Breathing
Movements
Amniotic fluid volume
Nonstress test
- give 2 for normal and 0 for abnormal
```
58
what is a negative test on the BPP? a positive?
negative = score 8-10, positive = score
59
what is a risk factor for chorioamnionitis?
Prolonged Rupture of Membranes
60
what is a risk factor for endometritis?
C section! and PROM
61
is choir an indication for C section?
NO!
62
what defect does Isotretinoin/etretinate cause in utero?
heart and great vessel defects, craniofacial dysmorphism and deafness
63
which 4 antibiotics are teratogens and what do they cause?
1. Tetracyclines: discoloration of deciduous teeth
2. Quinolone: cartilage damage
3. Sulfonamide late in pregnancy: kernicterus
4. Streptomycin: CNVIII damage/ototoxicity
64
what contrast material is a teratogen and what does it cause?
methylene blue- jejunal and ileal atresia
65
what is the most common infection that causes IUGR?
CMV!
| then toxoplasmosis
66
definition of oligohydramnios?
amniotic fluid index
67
definition of polyhydramnios?
AFI >25cm on US
68
most common causes of third trimester bleeding? (2)
placental abruption and placenta previa
69
what are maternal factors for indications for c section? 4
1. Any prior c section
2. Active genital herpes infection
3. Cervical carcinoma
4. Maternal trauma/demise
70
Most common pathogens causing bacterial vaginosis?
1. Gardnerella vaginalis
2. Mycoplasma hominis
3. Anaerobic bacteria
71
treatment of BV?
metronidazole or clindamycin
72
safest and most effective treatment for pregnant patients w bipolar mania?
haloperidol
73
Positive family history of breast cancer includes what? 6
1. 2x 1st degree relatives w breast ca
2. 3 x 1st or 2nd degree relatives w breast ca
3. 1st or 2nd degree relative w breast and ovarian ca
4. 1st degree relative w bilateral breast ca
5. breast ca in male relative
6. ashkenazi jewish woman with any 1st or 2nd degree relative w breast or ovarian ca
74
what is the most common cause of arrest of labor?
cephalopubic disproportion
75
whats hornets syndrome?
anhydrosis, miosis, ptosis, enophthalmos
76
drug of choice for chronic cluster headaches?
verapamil
77
management of acute onset cluster headaches?
100% FiO2
78
which 2 common vaccines have egg?
influenza and yellow fever
79
how do you diagnose lyme disease?
initial ELISA and confirmatory with western blot
80
when do you add IV ceftriaxone in treatment of lyme disease?
in setting of carditis or neurologic symptoms other than cranial nerve palsy
81
what are the components of a CHADSVASc score?
```
CHF (1)
HTN (1)
Age >75 (2)
DM (1)
Stroke/TIA (2)
Vascular dx (1)
Age 65-74 (1)
Sc: sex category, 1pt for female
```
82
one major side effect of cyclosporin?
hyperuricemia: >50% of pts, decreases rate excretion from kidneys
83
what do you see on aspiration of gouty joint?
negatively birefringent needle-shaped crystals
84
treatment of gout in post renal txp patients?
intraarticular glucocorticoids
85
most common cause of early death in acute stroke patients?
pulmonary embolism
86
when do you do back blows versus abdominal thrusts on a choking patient?
1year = abdominal thrusts
87
what is caisson's disease?
decompression sickness!
88
medical treatment of endometriosis?
1. NSAIDs
2. GnRH analogs
3. danazol
4. OCPs
89
Indications for carotid endarterectomy?
```
Men:
Asx: >60%stenosis
Sx: 50-60% stenosis
Females:
70-99% stenosis
```
90
dysfunctional uterine bleeding and anovulatory bleeding are treated with what?
OCPs or NSAIDs
91
what is asherman's syndrome?
endometrial adhesions likely 2/2 previous D&C, can be cause of amenorrhea
92
what should b-HCG levels do during a normal pregnancy?
double every 2 days
93
when can fetal heart motion be seen on US?
5-6weeks GA
94
describe the rash in rocky mountain spotted fever
a petechial rash that begins on the ankles and wrists and spreads to the palms, soles, and then to central body
95
what causes Rocky mountain spotted fever?
tick bite w gram neg organism Rickettsia rickettsii
96
treatment of choice for RMSF?
doxycycline
97
how do you diagnose spontaneous bacterial peritonitis?
find >250 neutrophils/mm3 in the ascitic fluid of a pt w cirrhosis or nephrotic syndrome
98
antibodies seen in rheumatoid arthritis?
anti-CCP (cyclic citrullinated peptide) and rheumatoid factor (RF only positive in 70-80% of cases)
99
how do you treat life threatening hemorrhage in patients on warfarin therapy?
FFP transfusion! vit k takes too long
100
treatment of choice for latent TB?
isoniazid x9 months
101
what is budd chiari syndrome?
hepatic vein thrombosis likely 2/2 thrombosis, usually affects young women
102
treatment of choice for budd chiari?
thrombolytic therapy of the hepatic vein
103
treatment of mild, moderate and severe lead poisoning in kids
Mild: nothing, repeat levels in 1 month
Moderate: DMSA
Severe: Dimercaprol + EDTA
104
most common external manifestation of ADPKD?
hepatic cysts
105
how do you screen family members of pts w ADPKD?
US of the abdomen
106
which antipsychotics had the lowest incidence of drug-induced parkinsonism?
quetiapine and clozapine
107
what antibodies are seen in dermatomyositis?
```
Screening: +ANA
Anti-RNP
anti-Jo-1
anti-Ro
anti-La
anti-Mi2
```
108
what two conditions is dermatomyositis associated with?
DM and malignancy, usually DM resolves once malignancy is treated
109
which 4 drugs increase Thyroid Bonding Globulin? thus decreasing free T4 and requiring higher doses of thyroxine
1. Estrogen
2. Tamoxifen
3. Raloxifene
4. Methadone/heroin
110
Which 4 drugs decrease Thyroid Binding Globulin and thus increase free T4 requiring a lower dose of thyroxine
1. Androgrens
2. Danazol
3. Anabolic steroids
4. glucocorticoids
111
treatment of choice for dysfunctional uterine bleeding?
high dose estrogen followed by progestin
112
what is herpes gestations? treatment?
autoimmune disease of pregnancy sowing as a rash around the umbilicus (PUPP spares the umbilicus)
treatment: corticosteroids
113
first line contraception method in pts with sickle cell disease?
progestin-only methods, think Mirena IUD
114
gold standard for treatment of endometritis?
clindamycin and gentamicin
115
most important risk factor in the development of endometritis?
route of delivery
116
Pts with klinefelter syndrome have a higher incidence of what type of cancer?
breast ca
117
treatment for cryptorchidism?
aka undescended testes
| orchiopexy before age 1, most undescended testes descend spontaneously during the first 6 months of life
118
treatment of hyperthyroidism in pregnancy?
first trimester: switch to PTU (methimazole can cause scalp defects, TEFs, and channel atresia)
2nd and 3rd: switch back to methimazole bc PTU has risk of liver failure
119
what is lurch syndrome?
Triad of
1. lower extremity claudication
2. absent or diminished femoral pulses
3. Erectile dysfunction
120
what are 3 red flags in developmental milestones?
1. Persistent primitive reflexes by 6months
2. Handedness before 1 year
3. No pointing by 18 months
121
which two childhood vaccines are live vaccines?
MMR and Varicella
122
What are the TORCHeS infections?
```
Toxoplasmosis
Other: HIV, parvovirus, listeria, TB, varicella
Rubella
CMV
Herpes
Syphilis
```
123
Rubella infection in infants? presentation
"blueberry muffin" rash, cataracts, hearing loss, cardiac defects & PDA, encephalitis
124
Toxoplasmosis infection in infants? presentation & tx
hydrocephalus, seizures, intracranial calcifications, ring enhancing lesions on head CT
tx: pyrimethamine
125
treatment of CMV infections in babies?
ganciclovir
| presentation: petechial rash, periventricular calcifications, microcephaly and chorioretinitis
126
syphilis infection in infants? presentation and tx
maculopapular skin rash, lymphadenopathy, "snuffles", osteitis
tx: penicillin
127
jaundice in infants is NOT physiologic if it has what 3 features?
1. occurs within the first 24 hrs of life
2. severe or prolonged
3. associated with a direct component
128
What are the five known hereditary defects in bilirubin metabolism?
1. Crigler Najjar type 1- absent UDP glucuronosyltransferase
2. Crigler Najjar type 2- low levels of UDP GTA
3. Gilberts- reduced activity of gluconyltransferase (conjugates bilirubin)
4. Dubin Johnson- black liver, asx, defect in the ability of hepatocytes to secrete conjugated bilirubin into bile
5. Rotor syndrome- like DJS but liver not pigmented, non-itching jaundice
129
symptoms of kawasaki's disease?
```
CRASH and BURN
Conjunctivitis (bilat, nonpurulent)
Rash (truncal)
Adenopathy (LN>1cm)
Strawberry tongue
Hand/foot desquamation
BURN (fever >5days)
```
130
complications of kawasaki's disease?
myocarditis/pericarditis
| coronary artery aneurysm -> MI
131
which types of VSD are least and most likely to close spontaneously?
least: membranous
most: muscular
132
murmur of ASD?
wide and fixed split S2
133
treatment of PDA?
indomethacin
134
when shouldn't you close a PDA?
in TGA! and in symptomatic TOF, give PGE
135
4 components of tetralogy of fallot?
```
PROVe
Pulmonary stenosis (RV outflow obstruction)
RVH
Overriding aorta
VSD
```
136
what are tet spells?
squatting improves cyanosis when running and playing
137
most common cause of bowel obstruction in first two years of life?
intussusception
138
what is intussusception associated with?
Henoch Schonlein purpura and Cystic Fibrosis
139
Classic triad of Henoch Schonlein purpura?
1. Purpura
2. Arthritis
3. Abdominal Pain
140
what are the contraindications to fibrinolysis w tPA? (6)
1. Presence of active internal bleeding
2. Bleeding diathesis (plt 33% of an arterial territory on CT
4. Presence of intracranial hemorrhage on CT scan
5. Intracranial surgery in last 3 mos
6. BP >185/110mmHg
141
screening test used for diabetic neuropathy?
tuning fork test
142
first line treatments for diabetic neuropathy?
1. Duloxetine (SNRI)
2. Pregabalin/neurontin
3. TCAs
143
after administering tPA in a pt with CVA, what should blood pressure control be?
strictly 140/90
| BP of 22/120 is okay in stroke pts who did NOT receive tPA
144
First line tx for narcolepsy?
modafinil
145
treatment for ALS?
riluzole: glutamate inhibitor, may prolong survival
146
In a pt on heparin and warfarin who develops HIT, why do you stop warfarin as well?
increased risk of venous gangrene due to thrombocytopenia, wait until plot >150,000
147
what is a case fatality rate?
the proportion of people with a particular condition who end up dying from the condition
diff from mortality rate which is the probability of dying from a particular disease in the general population
148
how do you manage CIN 2 and 3?
excision or ablation of the transformation zone unless they are pregnant or are young and desire pregnancy
