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USMLE xtra2
| Question | Answer |
|---|---|
| empiric tx for hospital aquired PNA | ceftaz or cefotax, OR imipenem, OR piperacillin/tazobactam (Zosyn)--basically cover Pseudo |
| how is transferrin sat'n calculated, how difft bw Fe defic anemia and sideroblastic? | Fe/TIBC, low in Fe defic anemia (since Fe low and TIBC high) and high in sideroblast (since Fe high and TIBC low); Fe and TIBC are both low in anemia of chronic dz |
| what test is specific for identifying CSF in fluid | b2 transferrin |
| how do OCPs affect Fe studies | incrs TIBC, don't cause microcytic anemia |
| lady being tx for breast cancer comes in w point back bone pain, how w/u | radionucleide scan--most sensitive for early met |
| tx after HIV needle stick | do HIV test of recipient, give 3 HIV Rx for 4 wks, rept HIV test at 6wks, 12wks, 6mos. Seroconversion if pt was adv AIDS 0.3% [AZT alone decrs 80%] |
| Abc MC cause S-J? AIHA? C Dif? | PCN, cephlo, qunio; PCN, cephalo; clinda, amp, ceph |
| 3 Rx to help PVD besides ASA and anti-plt | cilostazol (PDE inhib), dipyridamole, pentoxifylline |
| what's loffler syndrome | when round worm coughed up and reswallowed, see hemoptysis and cough |
| what's Osborn wave on EKG | upward deflection after R wave, indicates hypothermia |
| which Ig affected in Wiskott Aldrich? Ataxia Telangiectasia? IgA defic? | low IgM, high IgA&E; low IgA,M,E; IgA but 50% also IgE |
| low serum Na, pt dry and tachy, U Na>20, what's the difftl? Tx? | renal losses causing hypotonic hypovol hypoNa, should be holding onto Na, causes: diuretic, ACEI, low aldosterone, ATN. Tx=NS (add loop if 110-120) |
| low serum Na, pt dry and tachy, U Na>10, what's the difftl? Tx? | extrarenal losses causing hypotonic hypovol hypoNa, renal holding onto Na appropriately, causes are extrarenal losses, ie GI (N/V, diarrhea), 3rd spacing. Tx=NS (add loop if 110-120) |
| low serum Na, pt not dry or tachy or wet, what do next? Diffts? | check serum osmol. If nml think hyperproteinemia or lipidemia, if high think high Glu or radiocontrast, if low think siADH, dpolydypsia, hypothyr |
| high serum Na, how create difftl, what are they | low vol: renal (diuretic, glycosuria, RF), extrarenal (diarrhea); nml vol (DI, letting go too much water); high volume (steroids, hyperaldost) |
| pt is vol overloaded if serum Na high think? Low? | high=steroids, hyperaldosterone, low=water retaining, ie CHF, nephrotic, liver disease ?RF? |
| which lytes affect QT? PR? T? | PR&T: K or Mg; QT: Ca++ or Mg |
| MC SE ketamine | visual and auditory hallucinations (10%), basically a sedative similar to propofol |
| Rx causes of AIHA (5) | PCN, cephalo, sulfa, quinine, NSAIDs |
| what is Felty's syn | RA, splenomegaly, low WBC. See late in RA dz, at risk for infxn |
| what are COX2 inhib, one way they are used | celecoxib, rofecoxib, avoid some SE of NSAIDs so used for RA in ppl w advanced age and comorbidities (GI, renal, CNS/confusion) |
| tx for rash in SLE? Nephritis? Rash in Scleroderma? | chloroquine, AZT or cyclophosphamide (or steroids). Rash in scleroderma=penicillamine |
| tx antiphospholipid during preg | LMWH |
| what's Schober test? Schirmer? | Schober=spine motility used in dx ankylosing spondylitis. Schirmer=decrsd tear production in Sjorgen |
| what's keratoderma blennorrhagica | seen in reiters. vesicopustular, waxy lesion w yellow brown color often on palms and soles, but also scrotum, scalp and trunk. Can resemble psoriasis |
| what's yohimibine | a naturally occuring alpha blocker, see as herb extract and OTC, used for erectile dyfxn but can't use if cardiac dz |
| what's colonoscopy screening for ppl nml risk and high risk | if not high risk colonoscopy q10y (+ yearly fecal occult blood). If high risk start screen 40yo or 10y younger than youngest relative and rept q3-5. High risk=1st degree relative cancer <60 or mltpl relatives |
| contraindications for the trivalent flu vaccine | asthma, COPD, chronic metabolic or CV dz, children on longterm ASA, h/o Guillan Barre |
| what 3 Rx can be used in HIT for anticoag | lepirudin or argatroban (direct thrombin inhib, argatroban can be used if renal insuffic), danaparaoid (heparinoid) |
| what lipid profile suggests metabolic syn | LDL>150 and HDL <40 |
| what 2 rx can be given to prevent tumor lysis syndrome | allopurinol or rasburicase (can give prophylactically to ppl high risk before starting tx) |
| what is max med tx for stable angina? If sympt what do next? | nitrates, ASA, b blocker, CCB, and statin if lipid; if still sympt cath |
| Rx for diarrheal predominant IBS | can tx sympt w loperamide, diphenoxylate. If those don't work can try alosetron (5HT antagonist). For constipation the 5HT agonist/antagonist=Tegaserod maleate |
| incrsd bili, blood in stools, dilated intra and extra hep ducts…what is it? How dx? Px? | cancer of ampulla of vater, dx w endoscopy of duo (small and can miss on CT), px better than pancreatic |
| what's tacrolimus? Mech of action? What drug works similarly? | anti immune drug often used s/p transplant, aka FK506, inhibits IL2. cyclosporine also inhibits IL2 (by inhibiting calcineurin) |
| key features of adrenoleukodystrophy | peroxisome membrane gene, XL, 5-15yo; neuro: wknss, spasticity, then dementia, blindness; 1ry adrenal insuffic (usu appears first) |
| px factors of schizo pts | better: good premorbid state, female, married, later age of onset, onset assoc w ppt events, positive sympt, FMH mood d/o, good inter-episode fxn, quick onset of sympt. worse: the opposite of the above + FMH of schizo |
| contraindications to probenecid 3? Colchicine? | pt >60yo, poor renal fxn, renal stones. Colchicine=renal insuffic, cytopenia. Also should not be used in chronic management of tophaceous gout. |
| what's tamsulosin | alpha blocker for BPH |
| what's tolterodine. What's 1 contraindication for use | anti muscarinic for hypotonic bladder. Can't use in acute angle glaucoma |
| what are specifics for dx Wilsons | if ceruloplasmin <20+ Kayser-Fleischer rings don't need bx, otherwise need bx showing >250ug/g Cu |
| what liver studies (incl | s) suggest hemochromo? What gene test can confirm? |
| tx of Hemochromo | phlebotomy wkly until ferritin <50, transferring <45%, then maintain w phlebotomy 500ml ~q2-4 (ea will remove 200-250mg Fe). Deferoxamine is for pts who can't tolerate or 2ry overload |
| what bugs are hemochromo at risk for | Vibrio vulnificus and Yersinia entercolitica (Fe-loving bac) |
| what AFP level would suggest liver cancer | >400ng/ml |
| what specific cancer does vinyl Cl put pt at risk for | liver angiosarcoma |
| what Rx put at risk for cholestasis | antipsych like phenothiazine (chlorpromazine, fluphanezine, chlorperazine), OCP, androgen |
| name 2 Rx assoc w acute pancreatitis | sulfa and thiazide |
| tx for migratory thrombophlebitis | heparin, (warfarin doesn't work), until cancer is addressed and then it goes away |
| hyperkeratosis of ears, cheeks, fingers assoc w what cancer? Named sign? | acrokeratosis paraneoplastica, assoc w pharyngeal cancer Bazex syndrome |
| describe familial melanoma syn, gene, cxns | aka dysp nevus syn, numerous atypical moles melanoma (superficial and nodular) ~100%, CKN2A, also risk pan cancer |
| describe BC nevus syn, gene, other charact and cxns | AD, PTCH gene, get mltpl BCC from childhood, see frontal bossing, jaw cysts, CNS tumors |
| what's the pH, ABG for PE? COPD w bronchitis | acute respir alk, high pH, low CO2, low pO2. COPD w bronchitis: respir acidosis w metabolic compensation (nml pH, high pCO2, low pO2) |
| bug and tx for meningitis in pt w CSF drain | Staph Epi, use vanc |
| what's the diff bw acute stress d/o and adjustment d/o | acute stress d/o is basically like PTSD but sympt <1mo and event <1mo ago (reliving a LIFE THREATENING event, etc). Adjustment d/o is <3mo after an event, trbl dealing w/ it |
| what’s the dosing for steroids for preterm babies | 2x betamethasone 24 hr apart of 4x dexamethasone 12 hr apart |
| bug causing elephantiasis | Wucherieria bancrofti (fiiariasis), causes non pitting lymphedema |
| what's phanolphthalein? Test related to dx? | laxative, can cause secretory diarrhea. If causing diarrhea NaOH will turn stool red |
| what used to differentiate subtypes of Staph? Alpha hemo Strep? B hemo Strep? | novobiocin, optochin, bacitracin |
| how difft Rotors and Dubin Johnson | both defects in excretion, but Rotors has elevated urinary coproporphyrins and NO BLACK liver |
| which Ceph cover Pseudo? Which also covers Staph? What else does that drug cover? | Ceftaz and Cefepime, Cefepime also covers Staph (and it covers Neisseria) |
| which PCN work ag MSSA | oxacillin, dicloxacillin, or if combine amp or amox w sulbactam or clavulonate |
| which PCN work ag Pseudo? What else do they work ag? What abt Staph cvg? | piperacillin, ticarcillin, carbenicillin. Also work ag E Coli, Proteus, Enterobacter, Serratia, Kleb, but only ag Staph if combine (ie piperacillin/tazobactam or ticarcillin/clavulonate) |
| what's the key SE of methicillin | interstitial nephritis (so no longer in use) |
| which Abx for MSSA infxn: oxacillin or vanc? | oxacillin (more efficacious) |
| which Abx for VRE | imipenem |
| can Cipro be used for S Pneu PNA? | no, doesn't cover S Pneu |
| which quinolones cover Pseudo | only Cipro |
| which Abx covers anaerobes, gram - incl Pseudo, and staph. What are these best used in? | Carbapenems (imipnem, meropenem). But best used in gram - infxn |
| compared metronidazole and clinda in cvg. What 2 other classes have equiv anaerobe cvg to metronidazole | metronidazole is better for intrabd infxn bc covers Bacteroides and C Dif, Clinda is better for anaerobic strep in mouth. Carbapenems and the combined PCN agents (ie piperacillin/tazobactam, augmentin) have equivalent cvg |
| midclavicular fx puts what vessel at risk | subclavian |
| CD3 is a marker for what cell type? CD19? | T cells, B cells |
| what's modafinil | a non-amphetamine stimulant used in narcolepsy |
| what stain used for hairy cell leuk? Tx? | TRAP (tartrate resistant acid phosphatase) stain shows hairy projections. Tx=cladribine |
| name 6 nucleoside rev transcriptase inhib | zidovudine (AZT), didanosine, zalcitabine, stavudine, lamivudine, abacavir |
| what are the SE of didanosine, zalcitabine, stavudine, lamivudine, | didanosine&zalcitabine=pancreatitis, peripheral neuro; stavudine=peripheral neuropathy; lamivudine (3TC)=nothing |
| SE zidovudine | leukopenia/anemia, GI |
| name some protease inhibitors, general SE | end in -navir, ie Nelfinavir, indinavir, ritonavir, saquinavir. SE=hyperlipid, hyerglu, LFTs. GI also for nelfinavir, ritonavir, saquinavir. |
| SE indinavir | a protease inhib w hyperlipid, hyperglu, LFTs, kidney stones, hyperbili |
| name 3 NNRTI | efavirenz, nevirapine, delavirdine |
| SE efavirenz | (NNRTI), neuro w somnolence, confusion or psych |
| SE nevirapine | (NNRTI) rash |
| what's enfuvirtide | a fusion inhibitor for tx of HIV. Used if viral replication continues despite other HAART |
| what's a standard starting HAART Rx combo | AZT, lamivudine (3TC), nelfinavir |
| what SE see w a standard starting HAART Rx combo (AZT, lamivudine (3TC), nelfinavir) | anemia, leukopenia, GI (AZT), and rash (lamivudine) |
Created by:
ehstephns
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