Usmle Step2 Ck

Front 1

how is a panic attack related to spasm?

Back 1

panic attack--> Hyperventilate --> increase pH --> increase ca++ bound to albumin ---> hypocalcemia ---> tetany-like symptoms.

Front 2

how do you treat hypercalcemia?

Back 2

1st give IV fluids. then furosemide.
phosphorus adminstration.
calcitonin.
bisphosphonate.
plicamycin or prednisone if 2/2 malignancy.
if hyperthyroidism-->surgery.

Front 3

Bupropion
2-moa?
3-se?
4-C.I.s?

Back 3

2- inhib reuptake of NE and Dopamine.
3- hypertension, insomnia & seizures.
4- C.I. eating disorders, seizures; MAOI

Front 4

HIT
-confirmatory test?

Back 4

+ platelet factor 4

Front 5

anagrelide
1- what is it? uses?
2- moa?
3- se?

Back 5

1- a platelet reducing agent, used in tx of thrombocytosis 2/2 myeloproliferative d/o.
2- phosphodiesterase inhib
3- headache, diarrhea.

Front 6

ITP in healthy person with no splenomeagaly.

tx?

Back 6

1st - steroids.

2nd - if thrombocytopenia is recurrent -> splectomy

Front 7

Life-threatening bleeding with ITP.

1st-line tx?

2nd-line tx?

Back 7

1st - IVIG

(its the fastest way to bring the platelet count up)

2nd - RhoGam + steroids

Front 8

Plasmapheresis is #1 Tx for what diseases?
(5)

Back 8

1-Guillan-Barre (equal in efficacy to IVIG)
2-GP (+ steroids)
3-MG
4-TTP
5-Waldenstrom's Macroglob (used to decrease hyperviscosity from hyper-IgM)

Front 9

VWD:
1- dx?
2- best initial tx?
3- moa?
4- se?

Back 9

1- abnormal ristocetin cofactor assay
2- DDAVP
3- releases subendothelial stores of VWF, F VIII
4- HTN, flushing, headache

Front 10

PNH
1-presentation?
2-screening test?
3-conformation?
4- tx?

Back 10

1- Abd pain 2ndry to hepatic vein thromosis
2- sucrose lysis test, hams test
3- flow cytometry for cd59
4- prednosone + danazol

Front 11

pregnant with increased msAFP

what do you do?

Back 11

AFP >7 -> u/s

AFP 2.5 - 7 -> repeat msAFP

Front 12

A-fib in a pt w/o risk factors (DM, HTN, previous stroke, nomal echo)

what is the tx?

Back 12

Aspirin.

Front 13

A febrile pt with pain in chest, back and thigh. He has anemia and elevated bilirubin, LDH and reticulocyte count.
other than fluids, pain meds and o2 what is the next step?

Back 13

ABX for fever--ceftriaxone, levofloxacin.
Hydroxyurea to prevent crisis.

Front 14

Colicky pain + bloody stools, 3mo - 3yo

Dx?

Back 14

Intussusception

Front 15

COPD now with cor pulmonale.

Single best therapy for this patient?

Back 15

Home O2 is the best tx for pulmonary hypertension.

Front 16

IFN-a
1- indications?
2- se?

Back 16

1- Hep B, Hep C, melanoma, cryoglobulinema

2- myalgia, flu like sx, thrombocytopenia, suicidal ideation

Front 17

Ribavarin:
1- use?
2- moa?
3- se?

Back 17

1- cryoglobulinemia, Hep C, RSV
2- purine neucleoside analog, inhibits viral RNA polymerase -> mRNA synthesis
3- anemia

Front 18

HBsAg+ > 6mos, HBeAg+

1-tx?
2-se?

Back 18

Lamivudine-->lactic acidosis

Adefovir---> Nephrotoxic

IFNa--> myalgia, thrombocytopenia, flu like sx, suicidal ideation

Front 19

Alcoholic with massive hemoptysis:

step-wise mgmt?

PPx?

Back 19

1st--> IVF + FFP + Blood
2nd--> Octreotide (decreases portal pressure)
3rd--> sclerotherapy or band-ligation
4th --> TIPS
PPx: propranolol

Front 20

Octreotide.

Uses? (4)

Back 20

Acute variceal bleed
Acromegaly
Diarrhea in carcinoid syndrome
Glucagonoma

Front 21

Hepatic encephalopathy:
1- w/u?
2- most effective tx?
3- moa?
4- se?

Back 21

1- r/o SBP, sepsis
2- Lactulose
3- Non-absorbable disaccharide, changes ammonia (NH3) to ammonium (NH4+), which is excreted
4- diarrhea, hypernatremia, hypokalemia

Front 22

Penicillamine:
1- use?
2- moa?
3- se?

Back 22

1- DOC for Wilson's; lead poisoning, arsenic & mercury poisoning; old drug for Rheum Arthr
2- Chelates Cu, Zn, Pb, Hg; decreases T-cell activity and Rheumatoid Factor
3- MCD/nephrotic syndrome, bone marrow supression

Front 23

Achalasia:
1- sx?
2- dx?
3- tx?
4- last step if tx fails?

Back 23

1- Dysphagia to solids & liquids
2- manometry -> failure of sphincter to relax
3- pneumatic dialation -> botulinum toxin injection
4- Heller myotomy (of LES)

Front 24

Cushing's syndrome:
1- dx (screening)?
2- tx if primary Cushing's?

Back 24

1- 24hr urine cortisol

2- surgery; if not surgical candidate -> ketoconazole

Front 25

Glanzman's thrombocytopenia:
1- what is it?
2- tx?

Back 25

1- missing glycoprotein IIb/IIIa

2- transfusion of platelets

Front 26

Bleeding, PT, PTT:
1- prolonged PT noral PTT.

2- prolonged PTT and normal PT

3-both PT & PTT Prolonged

Back 26

1- Factor 7 diff, vit K diff or use of warfarin.

2- no bleeding--> factor 12

mild bleeding--> factor 11 in azkanazi jews.

frequent bleeding--> factor 8 or factor 9. (hemophila)

3- DIC,liver dz or vit k diff.

Front 27

Hairy cell leukemia: pancytopenia + splenomegaly in 55yo
1-test?
2-tx?

Back 27

1- TRAP stain

2- cladribine.

Front 28

1-when is diarrhea tx with Abx?

2- what is the best empiric tx?

Back 28

1-when pt shows signs of sepsis (hypotension, bloody diarrhea and abd pain)

2- Ciprofloxacin (covers invasive pathogens, Campy, E. coli, Shigella, Salmonella)

Front 29

what kind of study can RR be calculated from?

Back 29

only prospective or experimental, NOT retrospective.
(COHORT studies)

compares dz risk in ppl exposed and not exposed.

Front 30

when do we use OR?

Back 30

used in RETROspective studies, as a measure to estimate relative risk.

Front 31

what can you do to decrease...
1-confounding?
2- selection bias?
3- observer bias?
4- ascertainment bias?

Back 31

1- Randomization
2- Representative sample, follow up
3- double-blind
4- strict protocol

Front 32

Lead-time Bias?

Back 32

when the difference is due to earlier detection, NOT improved treatment or prolonged survival

Front 33

Acyclovir:

1-use?

2-moa?

3-se?

Back 33

HSV1/2
Herpes Encephalitis
Varicella Zoster Virus
Shingles
Bell's Palsy

2- Inhibits thymidine kinase

3- nephrotoxicity. neurotoxicity.

Front 34

Rifazimin:

1-use?

2-moa?

3-se?

Back 34

1- ETEC

2- non-absorbed rifamycin

3- none.

Front 35

Daptomycin, Linezolid.

1-use?

2-moa?

3-se?

Back 35

1- Used to treat VRE.

2- linezolid inhibits protein synth
2- daptomycin disrupts cell membrane

3- linezolid causes thrombocytopenia.

Daptomycin causes elivation of CPK and LFT.

Front 36

Tigecycline:
1-use?

2-moa?

3-se?

Back 36

1- MRSA, VRE, Penicillin-resistant Pneumococcus.

2- inhibits protein synth

3- Hepatotoxic.

Front 37

Polymyxin and colistin:
1-use?

2-moa?

3-se?

Back 37

1- TOPICAL ABx for conjunctivitis, skin, MDR GNRs

2- disrupting phospholipids.

3- Nephrotoxic and neurotoxic.

Front 38

dog bite vs human bite?

1- organisms?
2- tx?

Back 38

dog bite:
1- Pasturella multocida
2- Capnocytophagia cani--
3- tetanus shot + ...

Human bite:
1- Eikenella corrodens
2- Unasyn/Augmentin (clinda and TMP/SMX if allergic)

Front 39

Man going to India:

1- PPx?

2- se?

Back 39

1- mefloquine or Atovoquone

Doxycycline--->if mefloquine resistance.

2- psychosis, seizures, arrythmias
Doxycycline-->photosensivity.

Front 40

myalgia, fever, cough, HA, arthralgias for 24-36hrs.
1-tx?
2-moa?
3-se?

Back 40

1- Oseltamivir, Zanamivir within 48 hrs or sx onset.

2- inhibit neuraminidase.

3- zanamivir may cause bronchospasm

Front 41

AIDS, CD4<50, retinal lession

1-dx?
2-tx?
3-se?

Back 41

1- CMV retinitis

2- Valganciclovir (PO), Ganciclovir (IV), foscarnet (IV)

3- Ganciclovir-- neutropenia
3- Foscarnet-- nephrotox, urethral ulcers, hypocalcemia
3- Valgancyclovir-- seizures, neutropenia

Front 42

Drotecogin:
1-use?

2-moa?

3-se?

Back 42

1-used to tx multiorgan dysfunction and high APACHE2

2- activated Protein C analog. fibrinolytic and anti-inflammatory properties.

3- Bleeding.

Front 43

Rocker bottom feet and micrognathia:
what is the dx?

Back 43

Edwards syndrome (trisomy 18)

Front 44

Klinefelters synd:

1- tx?

Back 44

1- testosterone -> improves 2ndry sex characteristics

Front 45

when do kids do:
1-hold up their head?
2-sit up without support?
3-stranger anxiety?
4- pincer grasp and crawl?
5- walk?say first word?
6- run?
7- 2word combination,

Back 45

1- 3mo
2- 6mo
3- 7mo
4- 9 mo
5- 12 mo
6- 18 mo
7- 2yrs

Front 46

sequence of
1- male puberty?

2- female puberty?

Back 46

1- testicular enlargement, adrenarche, penile enlargement, growth spurt

2- Thelarche, growth spurt, pubarche, menarche.

Front 47

pt has bat bite.
what is the next step?

Back 47

rabies immune globulin + rabies vaccine

Front 48

pt has dog bite.
what is the next best step?

Back 48

if dog is wild.. observe dog for 10 days.. if abnormal behaviour give rabies immune globulin and vaccine.

if dog is healthy...no rabies prophylaxixs

Front 49

pt stepped on a dirty nail. no vaccines since childhood. next best step?

Back 49

If vaccine <10yrs ago, toxoid
If vaccine >10yrs ago, toxoid + tetanus immune globulin

Give Td booster based on wound...
- If clean wound, give Td if >10 years ago
- If dirty wound, give Td if >5 years ago

Front 50

Pneumococcal vaccine:
1-use?
2-moa?
3-contraindications?

Back 50

1- >65yo, DM, COPD, HIV, Alcoholics, cochlear implants, functionally asplenic/SCA
1- Give 2nd dose 5 yrs later if given before 65yo or HIV+

2- capsular polysaccharide

3- none

Front 51

immunocompromised Pt develops aspergillus

tx?

se?

Back 51

#1 = Voriconazole
#2 = AmpB

Voriconazole - hepatotoxic, visual hallucinations

AmpB - nephrotoxic, type1 RTA

Front 52

Echinocandins: (caspofungin, micafungin)

1-use?
2-moa?
3-se?

Back 52

1- febrile neutropenia despite Vanc/Zosyn

candida infections (e.g., esophagitis)
aspergillus

2- block D-glucan synthesis

3- histamine realease (flushing, headache, urticaria)

Front 53

Posaconazole:
1-use?
2-moa?
3-se?

Back 53

1- candida, aspergillus, mucormycosis > cryptocococcus, histoplasmosis, coccidiomycosis

"Posa" is "Potent"

2- block ergosterol synthesis
3- hepatotoxicity, Prolongs QT

Front 54

+PPD, NEGATIVE CXR

1- next step?

2- se of tx?

Back 54

1- 9 months of INH ( + pyridoxine)

2- hepatotoxic, pyridoxine deficiency -> periph neuropathy

Front 55

+PPD, + CXR apical infiltrate, + AFB sputum

- next step?
- what is the tx?

Back 55

1- Pt has TB, nees airborne precautions; file report

2- RIPE x2 mo -> adjust pending sensitivities -> RI x4 mo

Front 56

1- TB pt receiving tx, now with blurry vision...next step?

2- TB pt receiving tx, now with loss of sensation on his fingers...next step?

3- TB pt receiving tx, now with Podagra...next step?

Back 56

1- stop ethambutol (optic neuritis)

2- give pyridoxine (due to INH)

3- hyperuricemia 2/2 pyrazinamide, but it must be given so do NOT stop drug

Front 57

HIV+, CD4 105, PaO2 64, dry cough and b/l intersitial infiltrates.

1- tx?
2- alternative tx?

Back 57

1- TMP/SMX + prednisone (b/c PaO2<70 or A-a >35)

2- Pentamidine (if allergic to TMP/SMX)

Front 58

Pt that has urethral discharge.

1- Chlam coverage?
2- GC coverage?

Back 58

1- azithromycin or doxycycline

2- ceftriaxone or ciprofloxacin

Front 59

Pregnant pt with cervicitis

tx?

Back 59

Pregnant women do not receive TCs or FQs.

Use azithromycin and ceftriaxone

Front 60

+ cervical motion tenderness

1- out-pt tx?
2- in-pt tx?
3- criteria for admission?

Back 60

1- levofloxacin + metronidazole x2wks
or
ceftriaxone + doxycycline x2wks

2- cefoxitin + doxycycline

3- tubo-ovarian abscess

Front 61

Protease inhibitors:

Common se?

Back 61

All can cause...
- hyperlipidemia
- hyperglycemia
- P-450 interx

Indinavir: kidney stones

Front 62

Dapsone:
1- uses?
2- moa?
3- se?

Back 62

1- PPx for Toxo or PCP when Pt is intolerant to TMP/SMX
1- Leprosy
1- bullous pemphigoid, lichen planus, dermatitis herpetiformis

2- sulfonamide...inhibits folic acid synthesis.

3- rash, hemolysis in G6PD def, Met-Hb, aplastic anemia

Front 63

fever, HA and photophobia. LP shows 1400 WBCs.

1- tx?
2- what do you add if neonate, elderly, asplenic or imm-compromised?

Back 63

1- ceftriaxone, vancomycin + steroids with 1st dose

2- ... +/- ampicillin (for Listeria)

Front 64

onychomycosis + hyphae on KOH prep

tx?
se?

Back 64

Terbinafine (PO)
6wks for fingers
12wks for toes.

se- hepatotoxic, taste disturbances

Front 65

Abx for...

1-inpatient CAP?

2-outpatient CAP?

Back 65

1- ceftriaxone + azithromycin or levofloxacin.

2- azithromycin or levofloxacin

Front 66

1' or 2' syphilis:

1- DOC tx?
2- alternative tx?
3- if pregnant and allergic to DOC?

Back 66

1- Benzathine penicillin IM

2- if allergic to penicillin -> doxycycline

3- desensitize to PCN, then give PCN (can't give TC in pregnancy!)

Front 67

Jarisch-Herxheimer rxn

tx?

Back 67

aspirin

Front 68

vaginal itch. pH 6.5. malodorous.

1- tx?
2- what if pt is pregnant?

Back 68

bacterial vaginosis.

1- metronidazole PO
2- metronidazole PO

Front 69

vaginal discharge. wet mount shows motile forms:

1- tx?
2- if pregnant pt?

Back 69

pt has trichomoniasis:

1- metronidazole PO
2- metronidazole PO

Front 70

HIV+ pregnant:

1- tx?
2- mode of delivery?
3- rx to avoid?
4- tx for baby?

Back 70

1- mom should receive 2 NRTIs and 1 PI

2- C/S if viral load >1000 copies.

3- Avoid Efavirenz (causes neural tube defects)

4- Baby should get AZT syrup for 6wks after delivery

Front 71

HIV+, esophageal candidiasis

1-tx?
2- it does not resolve?

Back 71

1- fluconazole
2- if it fails -> endoscopy to r/o other lessions (HSV or CMV esophagitis)

Front 72

HIV+, CD4 40, viral load 45,000.

tx?
ppx?

Back 72

1- HAART
2- PPx:
CD4 < 200 - PCP (TMP/SMX)
CD4 < 50 - MAI (Azithro), Toxo (TMP/SMX) ___?___

Front 73

3- se of zidovudine?
4- se of di-dianosine?
5- se of stavudine?
6- se of tenofovir?

Back 73

3- anemia
4- pancreatitis
5- pancreatitis
6- renal insufficiency and Fanconi's syndrome.

Front 74

a newborn pt has pneumonia:
1- most common cause?
2- tx?
3- what if chlamydia was the cause?

Back 74

1- GBS, E.coli, Listeria

2- Amp (listeria) + cefotaxime (NOT ceftriaxone b/c biliary slugging) or gentamycin

3- chlamydia takes about 4 weeks to cause PNA, "afebrile PNA with staccato cough", tx with oral erythromycin

Front 75

tx of endometritis?

Back 75

clindamycin + gentamycin

Front 76

tx of:
1- PMR?
2- Fibromyalgia?
3- polymyositis?

Back 76

1- low-dose steroids

2- TCA + physical therapy

3- high-dose steroids

Front 77

Pt with hemoptysis. CXR PA/LAT shows cavitary lesion with mass, LLD film shows mass moves inside cavity.

1- dx?
2- tx?

Back 77

1- Aspergilloma

2- voriconazole (DOC) > amphotericin B

-> if all fails, surgery

Front 78

A pt comes in to the OB clinic she has sudden FHR decelerations of 15beats/min which last for 24 secs:
1- dx
2- cause?
3- tx?

Back 78

1-Variable decelaration.

2- umbilical cord compression.

3- O2, change position of mother....if pattern presists then do scalp pH.

Front 79

tx of incontinence?
1- urge

2-over flow

3- stress

Back 79

1- tx with oxybutynin

2- tx with bethanachol + -zosin.

3-tx with kegels + urethropexy

Front 80

Name the tocolytic based on these SE:

1- resp dep, muscle weakness
2- tachycardia, hypotension, myocardial depression
3- hypokalemia, hypoglycemia
4- oligohydraminos, PDA closure

Back 80

Name the SE of these tocolytics:
1- Mg (toxicity treated with calcium gluconate)
2- CCB
3- terbutaline, ritodrine (B-agonists)
4- indomethacin

Front 81

what is the secretin stimulation test?

Findings in normal? in disease?

Back 81

First measure baseline gastrin --> then inject secretin -->

Normal: gastrin decreases (antacid effect)

Z-E Syn: gastrin increases

Front 82

Aortic Transsection:
1- what is the study of choice?
2- what if you see a + sign? next test?
3- what if you dont? next test?

Back 82

1- CXR (PA or AP)

2- + widened mediastinum--> CTA (aortogram)

3- - widened mediastinum ---> spiral CT or TEE

Front 83

Status epilepticus

tx steps?

Back 83

1st--> Lorazepam/Diazepam

2nd--> Phenytoin/Phospheytoin (load)

3rd--> midzolam/ Propofol

4th--> Phenobarbital (induce coma)

Front 84

MCC of...
A- AOM
B- sinusitis

common DOC to tx?

Back 84

A. Strep pneumo
B. H. flu (non-typeable)


amoxicillin

Front 85

Fetal scalp monitoring of fetal pH:

what are the indications for emergent delivery?

Back 85

pH > 7.25 expectant management

pH 7.2-7.25 repeat FSS

pH < 7.2 EMERGENT DELIVERY

Front 86

isolated diastolic dysfunction

tx?

Back 86

B-blocker

Front 87

Post-op FEVER
1- day 1
2- day 3
3- day 5
4- day 7
5- 2wks

Back 87

1- day1--> Atelectisis

2- day 3-->UTI

3- day 5-->Thrombophlebitis

4- day 7-->wound infection

5- 2wks-->deep abscess (subphrenic, pelvic)

Front 88

impetigo

tx?

Back 88

Oral erythromycin or topical mupirocin

Front 89

A pt has Multiple Sclerosis:

1- tx acutely?
2- to slow progression or remitting episodes?
3- tx of fatigue?
4- tx of urinary incontinance?
5- tx of urinary retention?
6- tx of spasticity?

Back 89

1- acute--> corticosteroids.

2- to decrease relapses--> Beta interferon or glatirimic acid.

3- tx of fatigue with Amantadine.

4- tx urinary incontinance with --> oxybutamine

5- tx urinary retention with bethanechol

6- tx spasticity with Baclofen

Front 90

TTE shows "speckled" echogenicity pattern

1- dx?

Back 90

1- Amyloidosis

Front 91

Difference between constrictive and restrictive cardiomyopathy?

Back 91

Restrictive: calcified pericardium, increased thickness of pericardium.

Constrictive: Thickness of myocardium is normal.

Front 92

1-what does electrical alternans make you think of?

2- what else would you see on EKG?

Back 92

1-pericardial tamponade.

2- sinus tach, low voltage QRS

Front 93

Molecular basis of Chvostek's sign?

What is Trousseau's sign (specifically)?

Back 93

decrease ionized calcium -> threshold potential is lowered -> depolarization

Trousseaus sign is when thumb adducts into palm when taking blood pressure.

Front 94

A pt comes in with chronic diarrhea and R sided abdominal pain for 2 months. He also has increase in hepatic enzymes:
1-dx?
2-tx - acute?
3-tx - chronic?

Back 94

1- Crohn's dz.

2- hydrocortisone

3- prednisone, AZA, MTX, infliximab, adalimumab

Front 95

Prolactinoma.

tx?

Back 95

Bromocryptine, Cabergolin

Front 96

DI:
1- tx of central DI?
2- tx of nephrogenic DI?

Back 96

1- intranasal DDAVP

2- Kidney transplant ____?

Front 97

Most likely bug in PNA in...
5-copd
7-silicosis
10- Bird droppings
11- <1yr age
12- 2-5yrs age

Back 97

5-H. influ
7-TB
10- chlamydia
11-RSV
12- Parainfluenza.

Front 98

How do you tx a kid with precocious puberty?

Rationale?

Back 98

GnRH agonist

Prevent closure of epiphyseal plate

Front 99

Common renal complication s/p small bowel resection?

Back 99

Ca-oxalate kidney stones

Front 100

Cabergoline, Bromocriptine, Ropinerole

1- what are they used for?
2- se ?

Back 100

1-Parkinsonism; Prolactinoma; Restless leg syndrome

2- N/V, orthostatic hypotension, hallucinations

Front 101

Amantadine:

1- use?
2- moa?
3- se?

Back 101

-Infuenza A within 48hrs of sx
-mild parkinson dz

2- inhibits replication of influenaza A and enhances Dopamine release.

3- confusion, nightmares, livedo reticularis.

Front 102

Pt with painful contracted muscles.

tx?
se?

Back 102

Baclofen

se--> dizziness

Front 103

Pt with fasiculations, muscle wasting, hyper-reflexia, weakness and up-going toes:
1- dx?
2-tx?
3- moa of tx?
4- se of tx?

Back 103

1-ALS

2-Riluzole
3- inhibits glutamate release
4- N/V, spasticity.

Front 104

Congenital toxoplasmosis

TRIAD?

Back 104

1- chorioretinitis
2- hydrocephalus
3- intra-cranial calcifications

Front 105

Congenital rubella

TRIAD?

Back 105

1- cataracts
2- cardiac (PDA)
3- S-N hearing loss

Front 106

hypercalcemia in metastatic dz?

tx?

Back 106

use bisphosphonate: Zoledronic acid

prefered over normal saline since it also protects bones

Front 107

5 day old with vomiting + bloody stool
RBC + Eosinophils in stool

Dx?

Back 107

milk protein intolerance

Front 108

4 wk old with abdominal distention + pain

dx?

Back 108

NEC

Front 109

3mo - 4yo with cough, inspiratory stridor

dx?
x-ray finding?
tx?

Back 109

croup (paraninflunza virus)

chest/neck XR: steeple sign

tx: moisture + racemic epinephrine

Front 110

2yo with high fever, hoarse/muffled voice, sitting with neck extended, drooling.

dx?
x-ray finding?
1st step in tx?
tx?

Back 110

Epiglotitis (H. influenza type B)

LAT neck XR: thumb print sign

next best step?--> secure airway

tx: CFTX after airway secured

Front 111

pt with adenexal and cervial motion tenderness.

inpatient tx?

outpatient tx?

Back 111

PID tx:

Inpatient: clindamycin + gentamycin

outpatient: ceftriaxone + doxycyline

Front 112

candidal vaginitis

pH?

tx?

Back 112

Candida has pH ~4.5

clotrimazole cream

Front 113

16mo with cough and wheezing in February

dx test?
tx?

Back 113

naso-pharyngeal viral swab

humidifier
bronchodialators / DuoNebs
racemic epi

Front 114

RSV prevention in susceptible babies

Back 114

palivizumab

(anti-protein F mab)

Front 115

indications for palivizumab

Back 115

1. Prematurity:
≤ 28 weeks gestation and < 12 months of age at the start of RSV season
29-32 weeks gestation and < 6 months of age at the start of RSV season
32-35 weeks gestation and < 3 months of age at the start of RSV season, if there is a risk factor (child care attendance or sibling younger than 5 years old)

2. Chronic lung disease of prematurity < 24 mo

3. Cyanotic congenital heart disease, pHTN or CHF < 24 mo

Front 116

most common extra-cranial cx of AOM?

Back 116

hearing loss.

Front 117

most common intracranial cx of AOM?

Back 117

meningitis.

Front 118

sinusitis

best dx test?

Back 118

CT of sinus shows air/fluid levels

Tx: Augmentin or 2G CSPN

Front 119

what are the cyanotic heart lesions?

Back 119

5Ts + P (pulmonic stenosis)

Front 120

Most common heart defect

Back 120

VSD

Front 121

wide fixed splitting of S2

Back 121

ASD

Front 122

murmur associated with prematurity and rubella

increased pulmonary markings

Back 122

PDA

Front 123

htn in upper exteremites, and hypotension in lower extermites.

next step in mgmt?

Back 123

CoA

next step: PGE2

Front 124

cyanotic infant , harsh holosystolic murmur, spasms, hypoxia, SINGLE HEART SOUND (S2)

what is the dx?
CXR findings?

Back 124

most common cyanotic heart dz

CXR: boot-shaped heart

Front 125

CXR finding: "egg on a string" ______?

Next step in mgmt:

Back 125

ToGV

Next step: PGE2

Front 126

best test for myocarditis?

Back 126

Endomyocardial bx

Front 127

happy baby, normal BMI, with continuous diarrhea

dx?
tx?

Back 127

chronic diarrhea of infancy

no tx

Front 128

What is Sandifer's syndrome?

Back 128

a baby with GERD and arch their back ______

Front 129

GERD

dx test of choice?

Back 129

24hr pH probe

Front 130

pyloric stenosis

dx test of choice?

Back 130

ABD U/S

Front 131

4 week old with vomiting

AXR: string sign

tx?

Back 131

pyloric stenosis

tx: correct electrolytes; pyloromyotomy

Front 132

newborn infant with LGIB

first test?

Back 132

Apt test: differentiates FHb and AHb

Front 133

13 yr old, fever, right wrist pain, ESR elevated, abdominal pain, anemia

dx?

Back 133

IBS (most likely Crohn's)

Front 134

bloody diarrhea, pseudopolyps and lead-pipe colon

what is the dx?

Back 134

ulcerative colits

Front 135

15 mo, cramps abd pain/tenderness that started 10 hrs ago

mc dx?
associated with what dx?

Back 135

intussusception (#1 ileo-colic)

associated with HSP

Front 136

colicky abd pain, with currant jelly stool and sausage-shaped mass in RUQ

next step in mgmt

Back 136

Air-contrast barium enema (dx and tx)

Front 137

painless bleeding in a 2yo
abdomen soft, NON tender.

dx test of choice?

Back 137

technecium scan (detects gastric mucosa)
("Meckel scan")

Front 138

8yo, combative, is hypoglycemic and hyperammonemic

had a seizure post-URI which was 2 weeks ago.

what is the cause?

Back 138

Reyes syndrome

encephalopathy with fatty liver

Front 139

2yo girl with recurrent UTIs, fever and vomiting

what is the dx?

dx test of choice?

Back 139

vesico-urethral reflux

voiding cystourethrogram and u/s of kidney and bladder.

Front 140

10yo boy with cola-colored urine, edema, sore throat 2 weeks ago.

dx test of choice?

Back 140

DNAase (proves previous infection with GAS) ______?

Front 141

7yo boy failed hearing test. Maternal uncle also has it and he has cataracts.

what is the dx?
what do you see on renal bx?

Back 141

Alports syndrome

Thickned GBM, atrophy and foam cells on renal bx

Front 142

3yo with bloody diarrhea and vomiting. He has decreased urination and appears pale and lethargic.

dx?
what cells do you see?

Back 142

HUS


helmet cells/schistocytes

Front 143

C3 in GN vs nephrotic syndrome?

Back 143

C3 low in GN

C3 normal in nephrotic syndrome

Front 144

most common cause of ATN?

Back 144

NSAIDs

Front 145

diff between omphalocele and gastrochisis?

Back 145

omphalocele: midline, intestine in sac, umbilical ring is absent

Gastrochisis: to the right, only bowel no sac, umbilical ring present.

Front 146

2yo with sudden onset of pain and distention, rectal bleeding, bird's beak sign on AXR

dx?
tx?

Back 146

dx: mid-gut volvulus

tx: surgery

Front 147

1 week old has rectal prolapse, has not passed stool.

next dx test?

Back 147

sweat cl test

Front 148

pt with unilateral , severe headaches for few days. associated w/ tearing on the eye

prophylaxis?
abortive tx?

Back 148

abort with 100% O2 and sumatriptan/ergotamine

PPx: lithum or prednisone for a few weeks

Front 149

subarachnoid hemorrhage

best inital tx?
best drug tx?
most important test to guide tx?

Back 149

best inital tx: control SBP < 160

Nimodipine CCB used to prevent vaso-spasm and stroke

cerebral angiogram needs to be done and surgical clipping to prevent rebleeding

Front 150

Myasthenia gravis

what is the best tx?
what if the tx does not work?
how is acute myesthenic crisis treated?

Back 150

pyridostigmine / neostigmine

if they dont work:

If > 60 yo prednisone/azithropine
If < 60 yo thymectomy

plasmapheresis or IVIg, steroids

Front 151

se of dopamine agonist?

Back 151

cabergoline, bromocriptine, ropinerorole, pramipexole, pergolide.

parkinsons, prolactinoma, restless leg syndrome

se: orthostatic hypotension

Front 152

DOC for painful muscle spasms in MS?

Back 152

Baclofen, Tizanadine

Front 153

what do you give to stop the progression of MS?

Back 153

INF beta or Glatirimer

Front 154

a pt has motor neuron dz, fasiculations and wasting and hyperfeflexia

dx?
tx?

Back 154

ALS

Riluzole (inhibits glutamate presynaptically)

Front 155

Lamotrigine

use?

se?

Back 155

AED, peripheral neuropathy, bipolar

Front 156

se of valproic acid?

Back 156

wt gain
tremor
hepatotoxicity

Front 157

se of carbamezepine?

Back 157

hyponatremia
neutropenia
lethargy

Front 158

se of phenytoin?

Back 158

Gingival hyperplasia
hirsuitism

Front 159

se of topiramate?

Back 159

glaucoma

Front 160

diabetic neuropathy

tx?

Back 160

pregabalin, gabapentin

Front 161

TCAs

uses?

se?

Back 161

USES:
Major depression, OCD, ADD, peripheral neruopathies, nocturnal enuresis, migraine headache ppx

SE:
anti-cholinergic, QT prolongation, arrhythmias, sz

Front 162

what are COMT inhibitors?

uses?

se?

Back 162

-capone

USES:
prevent degradation of levadopa, extend its duration in tx of parkinsons

SE:
orthostatic hypotension, dyskinesia, hepatic failure

Front 163

peripheral neuropathy?

Dx test of choice?

Back 163

Nerve conduction velocity: slowed

Front 164

what drugs decrease mortality in CHF

Back 164

ACEi/ARB, B-blockers, spironolactone

ICDs if EF < 40

Front 165

TRIAD: angina, DOE, boot-shaped heart

dx?

Back 165

Aortic stenosis

Front 166

developmental d/o with slow-developing back pain with palpable step-off

dx?

Back 166

spondy-lo-lis-thesis

Front 167

HUS

tx?

Back 167

supportive

cipro? __?__

plasmapheresis, dialysis or steroids can be tried

Front 168

6mo with symmetrical contractions of the neck, trunk and extremities

hypsarrhythmic pattern on EEG (chaotic high voltage, asynchronous)

abnormal head CT (brain lesions)

dx?

tx?

Back 168

Tuberous sclerosis

ACTH (IM)

Front 169

DOC for infantile spasms?

Back 169

vigabatrin

Front 170

coughing spells, post-tussive emesis
rectal prolapse and epistaxis

dx?

Back 170

whooping cough / bordetella pertussis

Front 171

Actinomyces

tx?

Back 171

penicillin

Front 172

premature infant, LBW, with new fever
vomiting and abd distention

dx?

Back 172

NEC

Front 173

very low platelets
normal pt and ptt
epistaxis, bruising and petechia

dx?

tx?

Back 173

ITP

steroids and if they fail do splenectomy

Front 174

TTP

tx?

Back 174

plasmapheresis

Front 175

what surgery do turners synd pts get prophylactically?

Back 175

bilateral gonadectomy due to higher incidence of gonadoblastoma

Front 176

lesch nyhan syndrome

tx?

Back 176

allopurinol, increase fluids

Front 177

DMD

screen?
confirm?
gold standard?

Back 177

serum ck level

bx of muscle

genetic studies

Front 178

eryethmatous vesicles on extensor surfaces

diarrhea

dx?

Back 178

Celiac disease

Front 179

cherry red spot + hepatosplenomegaly

dx?

Back 179

niemann-pick

sphingomyelinase deficiency

Front 180

what vitamin is indicated in pts with sickle cell anemia?

what is the best intervention to prevent vaso-occlusive crisis?

Back 180

folic acid- replenishes folic acid stores and aids in erythropoesis

hydroxyurea

Front 181

jaundice that appears in 2nd week of life
mostly unconjugated

dx?
tx?

Back 181

breast milk jaundice

stop breastfeeding for a few days

Front 182

jaundice that appears after 24hrs and disappears by 1 week

mostly unconjugated

dx?
tx?

Back 182

physiologic jaundice

resolves on its own

more common in premies and IODMs

Front 183

what is given to sickle cell pts with auto splenectomy?

Back 183

pneumococcal vaccine

penicillin

Front 184

pt has presistent oral thrush, lymphadenopathy and heptatosplenomegaly

dx?

Back 184

HIV

Front 185

supracondylar fracture

what artery is most commonly affected?

Back 185

Brachial Artery

Front 186

long-term MSK complicaton of Turners?

tx?

Back 186

osteoporosis (lack of estrogen)

tx with HRT

Front 187

horners syndrome + ipsilateral hand paralysis in infant

dx?

Back 187

klumpke paralysis

Front 188

macrosomia, macroglossia
omphalocele
hypoglycemia, hyper-insulinemia

dx?
increased risk of?

Back 188

Beckwith-wiedeman synd

wilm's tumor, hepatoblastoma, gonadoblastoma

Front 189

first step in the management of enuresis?

Back 189

UA

r/o infection, bleeding, structural defects

Front 190

Recurrent sinopulmonary infections, diarrhea

onset after 6 m.o.

dx?

Back 190

B-cell deficiency

Front 191

a 2 yr old with a tumor that arises form the neural crest cells

precursor cells to sympathetic chains

calcifications and hemmorage on ct and xray
dx?

Back 191

neuroblastoma

most commmon site abdomen

Front 192

kid with anemia, wheezing, rectal prolapse, jaundice, failure to thrive

dx?

tx?

Back 192

dx: CF

tx: high-calorie diet, Creon, ADEK

Front 193

DDx: cephalohematoma vs. caput succedaneum?

Back 193

cephalohematoma:
does NOT cross midline, due to sub-periosteal hemmorage

caput succedaneum:
DOES cross midline, due to scalp swelling

Front 194

Auto Dom disease w/...
hypermobility of joints
ectopia lentis
aortic root dilatation

dx?
defect?

Back 194

Marfans

fibrillin 1 gene

Front 195

tx of infant botulinum?

Back 195

supportive care

HUMAN-derived botulinum antitoxin

Front 196

most common cyanotic heart disease in the first 24 hrs of life?

first step?
treatment?


mc cynotic heart disease a few yrs after birth?

Back 196

ToGF

first step: PGE2

tx: Fontan


Tetralogy of Fallot

Front 197

most common cause of meningitis in:
neonate
1mo - 2 yrs
2-18 yrs
>18 yrs

Back 197

neonate: GBS
1mo - 2yrs: Strep pneumo
2-18: N. meningitidis
>18: Strep pneumo

Front 198

how do you limit the risk of pertussis transmission?

Back 198

Close contacts get erythromycin x14 days.

Front 199

marfanoid+
mental retardation+
thromboembolic events+
downward dislocation of lens

dx?
defect?
tx?

Back 199

Homocystinurea

cystathionine synthase deficiency

tx: vit b6 high dose

Front 200

CGD

diagnostic test?
tx?
what is curative?

Back 200

nitroblue tetrazolium test

bactrim + IFN-gamma

BMT

Front 201

premature infant, low reticulocyte count
everything else normal

dx?
tx?

Back 201

Anemia of prematurity

iron supplementation and periodic cbc

blood transfusion if needed

Front 202

first step in a patient that presents with torticollis?

Back 202

do cervical xrays to rule out fracture or dislocation

Front 203

what are the 2 conditions that you can give aspirin to a kid?

Back 203

Kawasaki's dz (IVIG + high-dose ASA)

JIA

Front 204

Tet of Fallot.

immediate tx?

definitive tx?

Back 204

o2, knee-to-chest position, IVF, morphine
propranolol

surgery

Front 205

a kid with fever, tender fluctuant anterior cervial mass

dx?
tx?

Back 205

Staph or Strep

Tx: dicloxacillin (MSSA and Strep)

Front 206

management of croup?

Back 206

1 humidified o2
2 if sats do not improve give racemic epinephrine
3 if that fails then go to intubation

Front 207

preterm infant, increased gastric residues
ground glass app of both lungs

dx?
tx?

Back 207

NEC

+/- pneumatosis intestinalis on XR/CT, port ven gas

NPO, NG/OG suction, O2
meperidine
surgery

Front 208

child with Rheumatic fever.

tx (consider all complications requiring tx)

Back 208

benzathine Pen G
anti-epileptics for chorea
salicylates for arthritis
codeine for pain

Front 209

kid with migraine

initial tx?

tx / prophylaxis?

Back 209

reassurance and APAP or NSAID

sumatriptan/ergotamine

Front 210

infant w/ midline abdominal mass + oliguria

dx?
next best step?
tx?

Back 210

posterior urethral valve obst

do VCUG

decompress bladder

Front 211

obese teenage boy with unilateral hip pain

dx?

Back 211

SCFE

Front 212

Erlenmeyer flask deformity of distal femur

what is the dx?

Back 212

gauchers

B-glucocerbrosidase deficiency

Front 213

umbilical hernia

when do you NOT operate?

Back 213

<1yo

Front 214

when do you do surgery in an umbilical hernia?

Back 214

>3yo (unlikely to resolve spont anymore)
>2cm
strangulated

Front 215

umbilical stump infection in a newborn that did not have sterile procedure

dx?

Back 215

tetanus

they will have spasm and hypertonicity

Front 216

pt unconcious --> then hemi paresis

dx?

Back 216

Todd's paralysis (post-ictal)

Front 217

macrocytic anemia + pure red cell aplasia
tri-phalangial thumbs

what is the dx?

what is pathophys?

Back 217

Diamond black fan synd

defective erythroid progenitor cells which results in apoptosis.

Front 218

kid with fever, pharyngitis, rash sparing peri-oral/nasolabial folds, red tongue

dx?
tx?

Back 218

Scarlet fever

Penicillin V

Front 219

what disease has the development of
...neurologic (ataxia and dysarthia)
...skeletal (scoliosis)
...cardiac dz (hypertorophy)
?

Back 219

Friedreich Ataxia (a spino-cerebellar ataxia)

Front 220

newborn rash: abdomen, evanescent with red halos

eosinophils in the skin

dx?
tx?

Back 220

Erythema toxicum neonatorum

no tx needed it resolves on its own

Front 221

Pertussis

tx?

Back 221

Erythromcyin for 14 days

Front 222

Abd wall defects in hypothyroidism and beckwith weideman syndrome?

Back 222

BWS- omphalocele

Hypothyroidism- umbilical hernia

Front 223

4mo with jerky movements
spots on trunk (hypopigmented)

best drug for infantile spasms?

Back 223

IM ACTH

Front 224

exclusively breast fed kids need what supplementation?

Back 224

Iron
Vitamin D

Front 225

a kid comes with fever
sub-occiptal and posterior auricular lymphadenopahty
rash that decends
what is the dx?

Back 225

Rubella

Front 226

post gastrectomy malabsorption

how do you tx it?

Back 226

smaller meals

if it presists then octreotide
if that fails then reconstructive surgery

Front 227

kid with swollen testicle that transilluminates?

Back 227

hydrocele.

observe till 1 yr of age.

if it presists -> surgery

Front 228

Abdominal pain radiating to the groin what is the best test to make a dx?

Back 228

Abdominal ct to look for renal colic

if pregnant you can do u/s

Front 229

if a pt came in complaining of burning in the upper extremities and this was due to hyper-extention of the neck.
what is the dx?

Back 229

central cord syndrome

Front 230

a kid 5-10 yrs age with pain in the hips
mri shows femoral head necrosis and recalcification
what is the dx?
tx?

Back 230

Legg calve perthes

surgery to pin the head of the femor and keep it in the acetablum

Front 231

a 3mo pt presents with a positive barlows and orotlani
what is the dx?
what is the means of dx?
what is the tx?

Back 231

Developmental dysplasia of hip

dx on u/s in pts less than 4 months

pavlik harness and spica cast

Front 232

2 long-acting anti-psychotics that are given to non-compliant pts?

Back 232

Fluphenazine and Haloperidol

Front 233

If a pt has panic disorder and missed a few doses and got seizures what was the drug?

Back 233

Alprazolam bc it is short acting benzodiazepine

Front 234

when a pt comes and tells you that he can not control himself . his aggressive impulses often lead to assault and are out of proportion to the stressor
what is the dx?
what is low?

Back 234

Intermittent explosive disorder

low 5-HIAA in their csf

Front 235

a kid comes with:
primary bone tumor
renal cell ca
dx?
tx?

Back 235

Tuberous Sclerosis


Sirolimus