Step 3 - 03

Front 1

Antisocial disorder vs conduct disorder; what's the difference?

Back 1

Antisocial d/o must be >18yo; criminality in both.

Front 2

Substernal chest pain classically occurs at rest in early AM associated w STE (no cardiac enzyme elevations); dx? tx?

Back 2

Prinzmetal angina (d/t coronary artery vasospasm); Tx:Nifedipine (CCB),

Front 3

CHF: first line; HCTZ or loop diuretic, 2nd: ACEi or hydralazine; in pts with class III-IV CHF, what diuretic can be added to reduce mortality? What beta blocker can be added (other beta blockers contraindicated)?

Back 3

Spironolactone;
Carvedilol b/c arteriolar vasodilator.

Front 4

Lung mass and hypercalcemia; ML cancer?

Back 4

squamous cell carcinoma

Front 5

Lung mass and hyponatremia, ML cancer?

Back 5

Small cell lung carcinoma (d/t ADH production)

Front 6

Pts with 2nd or 3rd deg AV block after inferior MI (ST dep in II, III, avF); tx of AV block?

Back 6

Atropine (muscarinic antagonist); cardiac pacing if that fails

Front 7

Bleeding in a 4d old infant after circumcision; ML dx? Tx?

Back 7

Hemorrhagic dz of newborn; dec factors II, VII, IX, X; nml bleeding time factor V, VIII, plt. inc PT/PTT; Vit K

Front 8

What are 4 components of negligence (most common basis of malpractice suits)? All must be proven by plaintiff

Back 8

1.Duty; 2.breach of Duty; 3.Damages; 4.breach of duty leading to damages (cause)

Front 9

12:21 translocation; dx?

Back 9

ALL; good prognosis

Front 10

(9:22) translocation; dx?

Back 10

CML philadelphia translocation; gleevac

Front 11

(15:17) translocation; dx?

Back 11

acute promyelocytic AML; good prognosis; all-trans retinoic acid

Front 12

Before chemo for ALL, give IVF and allopurinol; helps prevent damage to what organ system?

Back 12

Kidneys; acute urate nephropathy due to destruction of tumor cells

Front 13

Contraindications to OCPs?

Back 13

Migraines w focal neuro sxs, h/o breast ca (protective for endometrial/ ovarian), smoker >20cigs + age>35, SBP>160, Liver dz,

Front 14

Older woman with urge incontinence and vaginal atrophy; tx for incontinence?

Back 14

Vaginal estrogen!

Front 15

Bilateral acoustic neuromas, posterior subcapsular lenticular opacities (cataracts); ML dx?

Back 15

NF-2

Front 16

Maintenance therapy for Crohn's dz?

Back 16

Mesalamine (5-ASA)

Front 17

75% O2 saturation correlates to paO2 of what?

Back 17

75% O2 sat = 40 mmHg paO2

Front 18

Risks of lithium therapy during pregnancy?

Back 18

cardiac abnormalities & goiter / hyperthyroidism

Front 19

What is struma ovarii?

Back 19

functional thyroid tissue in ovary (mature teratoma)

Front 20

What bipolar medication can lead to hypothyroidism? Especially when used with carbamazepine.

Back 20

Lithium

Front 21

Painless genital ulcerations; no LAD; dx?

Back 21

Granuloma inguinale (Calymmatobacterium granulomatis)

Front 22

Tender inguinal LAD; lymphogranuloma venereum; pathogen?

Back 22

chlamydia trachomatis (L1-3)

Front 23

Smudge cells on peripheral blood smear?

Back 23

CLL

Front 24

Confirm dx of CLL via flow cytometry; positive for what type of cells?

Back 24

clonal B lymphocytes; CD5, CD19, CD20, CD23

Front 25

How many measurements of elevated BP do you need to dx hypertension?

Back 25

3

Front 26

Blood pressure goals for pts with DM/CKD? for all others?

Back 26

130/80; 140/90

Front 27

At what BP above normal, should you start 2 BP meds instead of one?

Back 27

>20/10 above normal; >160/100, or >150/90 in pts w DM/CKD

Front 28

[insert HFM pic] Sore throat, oral lesions, skin lesions; dx? tx?

Back 28

hand-foot-mouth dz; Coxsackie; tx:analgesics, hydration

Front 29

Hemochromatosis; hepatomegaly, skin pigmentation, gonadal atrophy; endocrine d/o?

Back 29

"Bronze" diabetes

Front 30

Mild mental retardation in boy prior to age 11, should r/o what?

Back 30

Fragile X

Front 31

3mo old boy with Mod-Sev mental retardation, deafness, mutism; should r/o what?

Back 31

congenital hypothyroidism

Front 32

EPS sxs; which are MC after a few hours? few days?

tx?

Back 32

hours:acute torticollis (dystonia)
days: akathisia
months: parkinsonism
years: tardive dyskinesia

tx:antihistamines (benadryl) & anticholinergics (benztropine)

Front 33

Psych patient with hyperthermia, muscle rigidity, delirium, elevated BP, renal failure; most dangerous cause? tx?

Back 33

Neuroleptic Malignant syndrome; withdraw antipsychotic, bromocriptine (DA agonist) & dantrolene (prevents release of Ca from SR)

Front 34

PCP pna; tx?

Back 34

TMP-SMX, clindamycin, pentamidine, dapson

Front 35

Tx for idiopathic hirsutism?

Back 35

OCPs

Front 36

Newborn with SNHL, MC cardiac conduction abnormality?

Back 36

Long QT syndrome (risk of ventricular fibrillation); homozygous LTQ1

Front 37

Basophilic stippling; possible dx?

Back 37

lead exposure, thalassemia, and macrocytic anemias

Front 38

Pneumococcal vaccine; for >65 and?

Back 38

Anyone with chronic dz

Front 39

What asthma drugs in can cause WORSENING of sxs in a subset of pts?

Back 39

inhaled short- acting beta-agonist (e.g. albuterol) & long-acting agent salmeterol assoc w dec peak flows and inc risk of exacerbations of asthma in pts w arginine v glycine @16th position of beta adrenergic receptor protein

Front 40

If you suspect kidney stone in pt with flank pain, what is appropriate imaging study?

Back 40

CT abdomen (not kub nor u/s)

Front 41

TTP - fever, neuro issues, renal hematuria, low plt, large plt, helmet cells anemia; tx?

Back 41

plasmapheresis; do NOT transfuse plts

Front 42

In ITP, better to have early-onset or late-onset?

Back 42

early-onset better prognosis

Front 43

Rhinorrhea during common cold; give what med class to reduce severity of sxs?

Back 43

first gen antihistamines

Front 44

Most likely location of a gastric tumor?

Back 44

antral (nearest pylorus) lesser curvature - 40%; greater 12%

Front 45

To reach a dx of bipolar, you must have mania for at least __ days?

Back 45

7 days.

Front 46

Pt w hypervolemic hypotonic hyponatremia (Na=125) in pt w CHF and liver cirrhosis w ascites; tx?

Back 46

fluid < 1L/day AND salt restriction

Front 47

Acute glaucoma; tx?

Back 47

Acetazolamide

Front 48

Treatment for primary pulmonary hypertension: acute? chronic?

Back 48

acute:furosemide & diuretics
chronic:**CCB (dilt &nifedipine) AND warfarin

Front 49

What test is most predictive of survival in primary pulmonary hypertension?

Back 49

6-min walk test

Front 50

Patients with pulmonary hypertension are at high risk of developing what: Interstitial fibrosis? MI? Pulmonary thrombosis?

Back 50

Pulmonary thrombosis; interstitial fibrosis is a CAUSE of secondary pulmonary hypertension

Front 51

First step in evaluation of lower GI BRBPR with hemodynamic changes (after IVF given)?

Back 51

nasogastric lavage; if bile, then LGI bleed -> colonoscopy w/wo bowel prep (blood is cathartic). if blood then UGI bleed; if stomach contents, inconclusive.

Front 52

What hypertension medication can cause tinnitus?

Back 52

Loop diuretics (furosemide)

Front 53

tx small cell lung cancer?

Back 53

combination chemo + XRT