Usmle Step2 Ck

Front 1

Treatment of Trigeminal Neuralgia?

Back 1

Carbamazapine

F/u cbc for agranulocytosis

Front 2

when do you treat for hypercholestrolemia?

Back 2

Start treatment when LDL is grater then 160
Dietary changes/lifestyle modification before that.

Front 3

what are the men syndromes? what are in each?

Back 3

Men 1= Gastrinoma,hyperparathyroidism pituitary tumors, pancreatic tumors
Men 2= medulary thyroid ca, pheochromocytoma
Men 3= Neuromas, marfanoid status

Front 4

Osteosarcoma
1- location?
2- key to dx?
3- age group?

Back 4

1- metaphysis
2- sunburst apearence, codmans triangle
3- 10-20 yrs

Front 5

Ewings Sarcoma
1- location?
2- key to dx?
3- age group?

Back 5

1- diaphysis
2- onion skinning, motheaten
3- <10 yrs age

Front 6

teen with pain in joints and all x-rays -ve what is the dx?

Back 6

Growing pains. Give tylenol

Front 7

chondroblastoma
1- location
2- age

Back 7

1- epiphysis
2- kids

Front 8

how do you treat hyponatremea?

Back 8

hypovolemic---> give normal saline.

euvolemic + hypervolemic---> water ristriction

Front 9

how do you treat hyper natremia?

Back 9

Normal saline till pt is hemodynamicaly stable then switch to 1/2 normal saline.

Front 10

what effect does pH have on K+ ?

Back 10

Acidosis= hyperkalemia

Alkalosis= hypokalemia

Front 11

how should you treat hypokalemia?

Back 11

give oral K+

monitor pt with EKG

Front 12

how should you treat hyperkalemia?

Back 12

1st get Ekg---to look for cardiotoxicity.
If grater then 6.5 then give calcium gluconate(cardio-protective).
then sodium bicarbonate.(Alkalosis-hypokalemia)
then glucose+insulin.(prevent hypoglycemia)
***beta2 agonist also drive K+ into cells

Front 13

how is a panic attack related to spasm?

Back 13

panic attack--> Hyper ventilate --> decreased co2 ---> increase pH --> increase ca++ bound to albumin ---> hypocalcemia ---> tetany like symptoms.

Front 14

how is hypocalcemia treated?

Back 14

ca++ supliments.

check mg levels if they do not increase after suplimentation.

Front 15

how do you treat hypercalcemia?

Back 15

1st give IV fluids. then furosemide.
phosphorus adminstration.
calcitonin.
bisphosphonate.(alandronate)
plicamycin or prednosone if due to malignancy.
if hyperthyroidism-->surgery.

***do not give thiazide they cause hypercalcemia.

Front 16

how do you determine fluid ressusitaion?

Back 16

Parkland formula
4ml/kg* kgs* %burn

remember 1/2 in first 8hrs and 1/2 in next 16hrs.

Front 17

what happens when you give glucose to a pt without giving thiamine?

Back 17

you may percipitate wernicke's encephalopathy

Front 18

what is wernickie, korsakov?

Back 18

wernickie= ataxia, opthalmoplegia, confusion.

Korsakoff= chronic psychosis, anterograde amnesia.Usually irreversible due to dammage to mammilary bodies

Front 19

Etoh withdrawal how is it treated?

Back 19

Inpatient with benzo. Dose tapered over days.

Front 20

treatment of Alcoholism?

Back 20

AA. Disulfiram is used in some pts.

***do not use disulfaram with pts on metronidazole or cephalosporins.

Front 21

Etoh + Pnemonia...what type?

Back 21

Aspiration Pnemonia.
Anaerobes, ecoli, strep, staff.

Front 22

tx of esophageal varacies?

Back 22

1--ABC's
2--fluids and blood if needed.
3--endoscopy
4--sclerotherapy/banding
5-- if recurrent bleeds then consider TIPS

Front 23

sildenafil
1- uses?
2- MOA?
3- se?

Back 23

1- erectile dysfunction
2- phosphodiesterase inhib
3- hypotension, headache, flushing.

Front 24

BPH
1- best initial tx?
2 most common se of tx?
3 if all meds fail?

Back 24

1- combination of 5alpha reductase inhib and peripheral alpha blockers.( finasteride/tamsulosin,prazosin)

2-dizziness, orthostatic hypotension

3- TURP

Front 25

Ezetimibe..what is it?
2-how does it work?

Back 25

used to tx hyperlipidemia.
-added to HMG-COA inhib (statin)if LDL is not controled
2- inhibits cholesterol absorbition @ brush border.

Front 26

tx of urge incontinence?
moa?
se?

Back 26

1- oxybutynin, solifenacin

2- muscarinic receptor antagonist w/ anticholinergic effect.

3- dry mouth-eyes & constipation.

Front 27

Varenicline
1- what is it for?
2- moa?
3- aka?

Back 27

Varenicline--
1- for smoking cessation
2- blocks nicotine from binding (partial agonist)
3-chantex

Front 28

Bupropion
1- what is it for?
2- moa?
3-se?

Back 28

1- Antidepressant, somking cessation
2- inhib reuptake of NE and Dopamine.
3- hypertension, insomnia & seizures.

***contraindicated in ppl with eating disorders and seizures and on MAOI....bc it supresses apitite and

Front 29

treatment of hepatic encephalopahty?

Back 29

deccrease amonia is key to tx.
1. Lactulose
2. Neomycin
3. Refaximin

Front 30

Argatroban, Lepirudin, Hirudin, Bivalirudin
1-what are they?
2-moa?
3-se?

Back 30

Thrombin inhibitors used as anticoagulants in pts with HIT.
2-inhibit thrombin
3-bleeding..therfore monitor activated PTT

Front 31

what is the key to HIT?

Back 31

pt on heparin with dropping platelet count.

+ve platelet factor4

Front 32

1-what tx is used to decrease frequency of painfull sickel cell crisis?
2-moa?
3-se?

Back 32

1- Hydroxyurea
2- increases amount of HbF and amount of H20 in RBC wich prevents sickeling
3-myelosuppression and leukemia

Front 33

Anagrelide
1- what is it?
2- moa?
3-se?

Back 33

anagrelide
1- platelet reducing agent. used in the tx of thromobocytosis 2ndry to myloproliferative disorders.
2- phosphodiesterase inhib
3- headache, diarrhea.

Front 34

ITP in healthy person, with no splenomeagaly. what is the tx?

Back 34

1st tx with steroids.

2nd if thromocytopenia is reccurent -->splectomy.

Front 35

Life threatning bleeding with ITP. tx?

Back 35

1st IVIG- its the fastest way to bring the platelet count up. Also rhogam in combination w/ steroids.

Front 36

what dz is plasmapheresis the best answer for?

Back 36

1-GBS(equal in efficacy to IVIG)
2-Good pastures syndrome (in combo with Steroids)
3-Myastehnia Gravis
4-TTP
5-Waldenstorms Macroglob...(used to decrease hyperviscosity from hyper IgM)

Front 37

vwb's dz
1-test?
2- best initial tx?
3-moa of tx?
4- se of tx?

Back 37

1-abnormal ristocetin cofactor assay
2- DDAVP--aka desmopressin
3-releases subendothelial stores of von willi factor and factor8.
4- HTN, flushing,headache.

Front 38

what is desmopressinm used to treat?

Back 38

1- von willibrands dz.
2- mild hemophillia.
3- central diabetes insipidus.

Front 39

tx of PE?

Back 39

1st Heparin and warfarin... continue heparin till warfarin is in theriputic range.
2nd warfarin for 6mo

Front 40

1- chronic a.fib tx?
2- how long is the tx?
3-how is it monitored

Back 40

1-warfarin and keep INR 2-3.
2-Warfarin given permanently
3-monitor with INR

Front 41

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

Back 41

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

Front 42

pregnant mother with increased AFP what do you do?

Back 42

if AFP >7 --->u/s.
if AFP <7 but >2.5---> reapeat meternal serum AFP.

Front 43

congenital adrenal hyperplasia
1- what is the most common cause?
2-confirm?
3- diff bw the different ones.

Back 43

1- 21-oH-lase diff
2-elevated 17 alpha hydroxyprogesterone
3- 21--->hypernatremia.HTN.
11--->hyponatreamia.

Front 44

what is the diff between formula milk and regular?

Back 44

Formula has more iron!!!

kids switched from fromula to regular may show they are anemic--->increase solid food.

Front 45

Afib in a pt w/o risk factors ( diabetes, HTN, previous stroke, nomal echo) what is the tx?

Back 45

Asprin.

giving warfarin in low risk pts ...bleeding risk may be more then thereputic benifit.

Front 46

pregnancy is a hypercoaulable state...so if a pregnant woman develops PE...
1-what is the tx?
2-moa?
3-se?

Back 46

1-Heparin throughout pregnancy.

2-potentiates effects of antithromibn 3

3-bleeding,HIT & longterm use can cause osteoporosis.

Front 47

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 47

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

Front 48

Dancers sign:
1-presintaion?
2-what is the dx?
3-what age group?

Back 48

1-currant jelly stool, painfull....remember merkels is painless.
2- Intussusception
3- 3mo to 3 yrs.

Front 49

In COPD...Which of the following treatments can be expected to have the greatest impact on his long-term survival?

( A ) Angiotensin-converting enzyme (ACE) inhibitors
( B ) Inhaled bronchodilators
( C ) Inhaled glucocorticoids
( D ) Chronic suppressive antibiotics
( E ) Home oxygen

Back 49

E. home O2 is best to decrease mortality in COPD.

Ace inhib decrease mortality in left vent dysfunction

Front 50

A COPD pt is being discharged. In addition to stopping methyprednisolone and restarting ipratropium, which one of the following is the most appropriate regimen for this patient?

( A ) Inhaled glucocorticoids
( B ) Prednisone, tapering over 2 weeks
( C ) Inhaled N-acetylcysteine
( D ) Inhaled albuterol

Back 50

B.Glucocorticoids play an important part of the inpatient management of patients with acute exacerbations of chronic obstructive pulmonary disease but should be tapered after first acute exacerbation.

Front 51

A pt whos has chronic bronchitis has an acute exacerbation. Which of the following organisms is likely to be present in the sputum of this patient?

( A ) Penicillin-sensitive pneumococcus
( B ) Beta-lactamase-negative Haemophilus influenzae
( C ) Beta-lactamase-negative Moraxella catarrhalis
( D ) Pseudomonas aeruginosa

Back 51

D. chronic bronchitis in a complicated patient at risk for drug-resistant or gram-negative bacterial infection.

Pseudomonas aeruginosa.

Front 52

pt with cor pulmonale due to chronic hypoxia leading to pulmonary hypertension. Which of the following is the single best therapy for this patient?

( A ) A calcium-channel blocker
( B ) Full-dose heparin
( C ) Intravenous methylprednisolone
( D ) Oxygen
( E ) Phlebotomy

Back 52

O2 is the best tx for pulmonary hypertension.

Front 53

A pt with exersice induced dyspnea has Oxygen saturation on room air is 88% at rest and decreases to 84% after walking for 1 minute. Other laboratory data are normal, except for a hematocrit of 54%.

Which of the following is the best oxygen therapy option for this patient?

( A ) Do not use oxygen
( B ) Use only at night when sleeping
( C ) Use continuously
( D ) Use only with exercise
( E ) Use only when short of breath

Back 53

c.
Criteria for prescribing long-term oxygen therapy include PaO2 < 55 mm Hg or SaO2 < 88% , and this patient meets these criteria. In addition, he has exertional desaturation, slight polycythemia, and signs of cor pulmonale with a right-sided S3 and peripheral edema.

Front 54

A 62-year-old woman arrives for a general medical evaluation because she seems to be “slowing down” this past year. She has smoked 1.5 packs of cigarettes a day for 40 years. She has a cough productive of white sputum each morning. She has no history of asthma or pneumonia. The physical examination shows a prolonged expiratory phase and scattered expiratory rhonchi on chest auscultation that clear with coughing. Spirometry gives the following results:

Forced vital capacity (FVC) 3.13 L (92% of expected)
Forced expiratory volume in 1 sec (FEV1) 1.08 L (40% of expected)
Ratio of FEV1 to FVC 0.35 (46% of expected)


Which of the following interventions is most likely to preserve the patient’s lung function over the next 5 years?

( A ) Inhaled β-adrenergic agonists
( B ) Inhaled cholinergic antagonist
( C ) Inhaled glucocorticoids
( D ) Pulmonary rehabilitation
( E ) Smoking cessation

Back 54

E.
Cigarette smokers with COPD who stop smoking and maintain smoking cessation have better lung function at the end of 5 years of follow-up evaluation than do smokers with COPD who continue to smoke.

inhaled β-adrenergic agonists, a mainstay in the long-term management of COPD, provide temporary improvement in lung function for many patients with COPD, but they do not alter long-term prognosis.

Front 55

Which one of the following statements regarding inhaled glucocorticoids is accurate?

( A ) Inhaled glucocorticoids are contraindicated during pregnancy.
( B ) Inhaled glucocorticoids are useful immediately before exercise in preventing exercise-induced bronchoconstriction.
( C ) Inhaled glucocorticoids are best taken twice a day.
( D ) Inhaled glucocorticoids are not associated with systemic absorption.

Back 55

All of the inhaled glucocorticoids are effective given twice a day, and patient adherence is much improved when the prescribed dosing is twice rather than four times a day. One inhaled glucocorticoid, budesonide, has been shown to be effective with once-daily dosing among persons with mild asthma.

Front 56

A 47-year-old man has exertional dyspnea. He does not smoke. He has no history of asthma or allergic diseases. He has only an occasional cough that is nonproductive. He has no history of heart disease. His brother, father, and two cousins all developed emphysema before 50 years of age. The physical examination findings are normal. Pulmonary function tests show moderate airflow obstruction without change after administration of a bronchodilator. Resting oxygen saturation measured with a pulse oximeter is 97%. The chest radiograph findings are normal.

Which of the following is the best study to confirm the diagnosis in this patient?

( A ) CT of the chest
( B ) Carbon monoxide diffusing capacity (DLco)
( C ) Exercise pulse oximetry
( D ) Measurement of α1-antitrypsin
( E ) Genetic testing of the patient and family members

Back 56

D.
Confirm diagnostic suspicion of α1-antitrypsin deficiency.


By far the most common inherited predisposition to the development of emphysema is a deficiency of the antiprotease protein, α1-antitrypsin (also called α1-protease inhibitor). The usual cause of α1-antitrypsin deficiency is production of an abnormal α1-antitrypsin protein that has impaired transport out of the liver with only very small amounts entering the blood. Measurement of the blood level of α1-antitrypsin is the most direct method to identify α1-antitrypsin deficiency

Front 57

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

Back 57

1- Interferon is used for:
Alpha-->Hep B, Hep C, melanoma, cryoglobulinema
beta--> MS.

2 inhibit viral replication

3- myalgia, flu like symptoms, thrombocytopena.

Front 58

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

Back 58

1- cryoglobulinemia, Hep C & RSV.
2-purine neucleoside that inhibits viral messenger RNA synthesis.

3- Anemia

Front 59

Hep B + pt has surface Ag for longer then 6mo & HbeAg+.
1-tx?--se?

Back 59

Lamivudine-->lactic acidosis

Adefovir---> Nephrotoxic

Interferon--> myalgia, arthralgia flu like sx.

Front 60

pt w/ epigastric pain found to be Hpyloi +ve on bx during endoscopy.

1-what is the best inital tx?

2- what is the next step if it inital tx fails?

Back 60

1- ppi( lansoprazole)+ 2 Abx ( amoxicillin, Clarithromycin)


2- ppi + Bismuth subsalicylate + 2 new Abx( tetracycline, metronidazole)

Front 61

pt w/ variceal bleed
first step in mangaement?

next?

Back 61

1st--> Iv fluids + FFP + Blood transfusion.

2nd-->
Octreotide-> decreases portal pressure. synthetic-somatostain)

3rd-->if octreotide does not control it use endoscopic band-ligation.

Front 62

Octreotide:
1- what is it used for?

Back 62

1-
Acute variceal bleed.
Acromegaly
Diarrhea in carcinoid synd
Glucagonoma.

Front 63

pt with Hepatitis + confusion:
1- dx?
2- most effective tx?
3- moa of tx?
4 se of tx?

Back 63

1- Hepatic encephalopathy

2-Lactulose.

3- Non-absorbable diaccharide, changes amonia (NH3) to ammonium (NH4)wich is readily excredted.

4- diarrhea, Hypernatremia & Hypokalemia.

Front 64

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

Back 64

penicillamine:
1- DOC for wilsons Dz
used in lead poisoning, severe rheumatoid arthritis, cystinuria, arsinic & mercury poisoning.

2- It is a penicillin derived chelating agent. Chelates Cu, Zn, lead, mercury & decreases T-cell activity and Rheumatoid Factor.

3- nephrotic synd, bone marrow supression

Front 65

so pt had esopheageal varaceal. was given fluids, ffp, blood T. Octreotide was tired..no change, endoscopic banding was tried no change... what do you do next?

2- most common se?

3- preventitive method?

Back 65

1- TIPS- Transvenous Intrahepatic Portosystemic Shunt.

2- Hepatic encephalopathy

3- Propranolol.

Front 66

pt has been on ppi, still presist to have epigastric pain from GERD.
1- next step?

Back 66

Nissen Findopilication. Its surgically placed narrowing of distal esopahagus

Front 67

Pt was constipated and was given a drug that caused torsade de pointes:

1- drug?
2- other se of drug?

Back 67

1- cisapride is a promotility drug that causes torsade de pontes
2- removed from the market for causing arrhythmias.

Front 68

Achalasia:
1- sx?
2- tx?
3- next step if tx fails?

Back 68

1-Dysphagia to solids & liquids. Narrowing of gastro-esopheageal sphinctor. Dx made by manomatry---> failure of sphinctor to relax.

2-->pneumatic dialation. Those that refuse pneumatic dialation---->botulinum toxin injection when ever they occur.

3- if pneumatic dialation and botulinium toxin fail then--->
Heller myotomy (surgery of lower esophageal sphincter )

Front 69

cushings synd:
1- screen?
2- tx?

Back 69

1- 24hr urine level of free cortisol



2-surgery, if not surgical candidate put them on ketoconazole.

Front 70

Glanzmans thrombocytopnea:
1- what is it?
2- tx?

Back 70

GT:
1- missing glycoprotein 2b3a

2- transusion of platlets.

Front 71

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

2- prolonged PTT and normal PT

3-both PT & PTT Prolonged

Back 71

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 72

Osteoporosis:
1-dx?
2-tx?

Back 72

1- Dexa scan
if T-score >2.5-->osteoporosis

if T-score is 1-2.5--> osteopenia.

2- Ca+ & vit D supliments. for osteoporosis add bisphosphonate. If at osteopnia stage add exersise program.

Front 73

Hairy cell leukemia: pancytopnea + splenomegaly in 55 yr pt.
1-test?
2-tx?

Back 73

1- Trap

2- cladribine.

Front 74

psych pt is combative and agitated about to harm self and others...
tx?

Back 74

haoperidol

Front 75

1-when is diarrhea tx with Abx?

2- what is the best empiric tx?

Back 75

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

2- Fluroquinolone such as ciprofloxacin. it covers invasive pathogens such as camylobacter and salmonella.

Front 76

1-formula for sensitivity?

2-formula for specificity?

3- PPV

4- NPV

Back 76

1- A/A+C

2- D/D+B

3- A/A+B

4- D/D+C

Front 77

FORMULA FOR :

1- odds ratio

2- relative risk

3- Attributable risk

Back 77

1- (A*D)/(B*C)

2- [A/(A+B)]/[C/(C+D)]

3- [A/(A+B)]- [C/(C+D)]

Front 78

what kind of study can relitive risk be calculated from?

Back 78

only prospective or experimental not retrospective.


compares dz risk in ppl exposed and not exposed.

Front 79

when do we use odds ratio?

Back 79

odds ratio is used in retrospective studies as a measure to estimate relative risk.

Front 80

stardard deviation
1--how much % of pop?
2--how much % of pop?
3--how much % of pop?

Back 80

1-
1SD=68%
2SD= 95%
3SD= 99.7%

Front 81

If you have extreme values which is most affected by it, mean median mode?

neg skew?
pos skew?

Back 81

mean is the most affected by extreme values.

-ve skew-->mean<median<mode.
+ve skew-->mean>median>mode.

Front 82

what controls?
1-confounding?
2- selection bias?
3- observers bias?
4- ascertainment bias?

Back 82

1-Randomization
2-Representitive sample & follow up
3-double blind
4- strict protocol.

Front 83

Type 1 error?
Type 2 error?

Back 83

Type 1 error: falsely rejecting null hypothesis.

Type 2 error: falsely accepting the null hypothesis.

Front 84

Lead time Bias?

Back 84

when the difference is due to earlier detection not due to improved treatment or prolonged survival.

Front 85

sildenafil, vardenafil:

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

Back 85

1- erectile dysfunction, pulmonary hypertension

2- inhibit phosphodiesterase and there by increase nitric oxide.

3- flushing, hypotension

Front 86

pt with bph

1- best tx?
2- moa of tx?
3- se of tx?
4 if meds fail next?

Back 86

1- 5-alpha reductase inhibitors finasteride.
alpha blockers also used prazocin

2- blocks production of dihydrotestostrone wich stimulate prostate growth.

3-orthostatic hypotenion, ...note tamsulosin has less se

4TURP--can cause retrograde ejaculation

Front 87

Ezetimibe

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

Back 87

1- to treat hyperlipidemia is added to HMG-coA red inhib.

2- ihibits absorption at brush border.

3- diarrhea.

Front 88

pt with urge incontinence:what is the best tx?

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

Back 88

best tx is oxybutynin, solifenacin.

2- muscarinic receptor antagonist.

3- dry mouth, dry eyes & constipation.

Front 89

Verenicline:

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

Back 89

1- smoking cessation

2- blocks nicotine from binding. nicotinic-ach partal agonist.

Front 90

Bupropion:


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

Back 90

1- antidepressant + smoking cessation.

2- inhibits re uptake of NE and dopamine

3- hypertension, insomnia, seizures, suppresses apatite.

Front 91

Acyclovir:

1-use?

2-moa?

3-se?

Back 91

1- HSV1/2
Herpes Encephalitis
Varicella Zoster Virus
Shingles
Bells Palsy

2- Inhibits thymidine kinase

3- nephrotoxicity. neurotoxicity.

Front 92

Rifazimin:

1-use?

2-moa?

3-se?

Back 92

1- Travelers diarrhea due to e.coli

2- nonabsorbed rifamycin

3- none.

Front 93

Daptomycin, Linezolid.

1-use?

2-moa?

3-se?

Back 93

1- Used to treat MRSA, streptococci, Vancomycin resistant enterococci.

Linazolid only oral abx for MRSA.

2-linazolid inhibits protein synth, daptomycin disrupts cell membrane.

3- linazolid causes thromobocytopnea.

Daptomycin causes elivation of CPK and LFT.

Front 94

Tigecycline:
1-use?

2-moa?

3-se?

Back 94

1- MRSA, Vancomycin resistant enterococci and Penicillin resistant pneumococcus.

2- inhibits protein synth

3- Hepatotoxic.

Front 95

Polymyxin and colistin:
1-use?

2-moa?

3-se?

Back 95

1- topically for conjunctivitis.
infections of skin
multi-drug resistant gram -ve bacilli

2- disrupting phospholipids.

3- Nephrotoxic and neurotoxic.

Front 96

dog bite vs human bite?

1- oranisim?

2- tx?

Back 96

dog bite-
1- pasturella Multocida
2- tetanus prophylaxix and local wound care

Human bite:
1- Eikenella corrodens
2- Amoxicillin/clavulanic acid.

penicillin/allergic pts are given clindamycin and bactrim.

Front 97

Man going to India:

1- Prophylaxes?

2- se?

Back 97

1- mefloquine or Atovoquone

Doxycycline--->is mefloquine resistance.

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

Front 98

Lyme Dz tx:
1- asymptomatic 30yr female.

2- 7 yr old with rash with central clearing after camping?

Back 98

1- Asymptomatic tick bite, <24hr contact, REASSURANCE.


2- AMOXICILLIN same efficacy as doxy but with out se.

Front 99

pt comes with myalgia,fever, cough, headache, arthralgia... for last 24/36hrs.
1-tx?
2-moa?
3-se?

Back 99

1- Oseltamivir, Zanamivir used to tx Infulenza A/B within 48 hrs or sx.

2- inhibit neuraminidase.

3- zanamivir may cause wheezing because its administered by inhalation.

Front 100

pt with aids has retinal lession and CD4 <50:

1-tx?

2-moa?

3-se?

Back 100

1- Cmv retnitis is tx with
Valganciclovir, Ganciclovir, foscarnet.
Valganciclovir is the only one used oraly.

2- interfears with viral replication

3- Ganciclovir---neutropenia

Foscarnet--nephrotox, urethral ulcars, hypocalcemia.

Valganciclovir-- seizures, neutropenia.

Front 101

Drtotecogin:
1-use?

2-moa?

3-se?

Back 101

1-Drotrecogin is used to tx multiorgan dysfunction and high APACHE2 score.

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

3- Bleeding.

Front 102

student gets stuck with needle:
1- next best step?

2- risk of transmission?

3-se?

Back 102

1- prophylactic regimins.

Zidovudine, Lamivudine & efavirenz. (2ppi+nri)

2-risk 1/300

3- n/v

Front 103

Rocker bottom feet and micrognathia:
what is the dx?

Back 103

Edwards synd(trisomy 18)

Front 104

Micro-opthalmia, Polydactaly,
mirocephaly, cleft lip/palate. what is the dx?

Back 104

platau synd (trisomy 13)

Front 105

most comon chromosomal abnormality?

Back 105

1 - DS
2- F x

Front 106

Lymphedema of hands+ shield shaped chest + widely spaced nipples+ webbed neck +low hair like. what is the dx?

Back 106

Turners synd (45xo)

They also have gonadal dysgenisis.

Front 107

Klienefelters synd:

1-gonads?
2- tx?

Back 107

1- xxy. hypogonadism. small phallus, testes and gynecomastia.

2- testostrone --> improves 2ndry characteristics.

Front 108

what are pradder valley, angelman synd?

from mom or dad?

Back 108

Angelman synd:
aka happy-puppet
Ataxic gait and tip toe walk
pts have severe retardation.
maternal imprinting.

pradder valley syndrome. Uncontrolable appitie. obease kid.

Front 109

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 109

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

Front 110

sequence of
1- male puberty?

2- femal puberty?

Back 110

1- testicular enlargement, penile enlargement, growth spurt and pubarche.

2- Thelarche, growth spurt, pubarche, menarche.

Front 111

pt has bat bite what is the next step?

Back 111

Prophylaxix with rabies immune globulin & rabies vaccine.

Front 112

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

Back 112

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

if dog is healthy...no rabies prophylaxixs

Front 113

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

Back 113

Prophylaxix for tetnus if >10yrs have passed. If vaccines given b4 then just give toxoid if not given give toxoid + tetanus immune globulin.

Give booster based on--->clean wounds protected for 10yrs dirty wounds for 5yrs.

Front 114

Influenza Vaccine:
1-use?
2-moa?
3-se?
4- contraindicated in?

Back 114

1- everyone >50yrs.
health care workers.
pregnant women.
copd,cirrhosis, hiv,diabetic pt.
Given yearly.
2- constructed with viral surface antigens ...inhibit replication
3- mild fever, myalgia and Guillain barre synd.
4- egg allergy pts
live intranasal vac should not be given to pregnant or immunocomprmized pt.

Front 115

Pneumococcal vaccine:
1-use?
2-moa?
3-se?
4-contraindication?

Back 115

1- Everyone >65ys
Alcoholics
ppl with cochlear implants.
pt with copd, hiv, diabeties

2- capsular polysaccharide from the surface of pneumococcus.

Given again in 5yrs to ppl whom it was given b4 65 or immunocompramised..

3-none.
4- none.

Front 116

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

Back 116

1- used for anerobic infections. like lung abscess, and aspiration pneumonia.

also usefull in tx Gram +ve (cellulitis, erysipeleas, impetigo, oral infections)

2- inhibits ribosome.

3- diarrhea from clostridium dificile.

Front 117

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

Back 117

1- used for Gram -ve anaerobic organisms in the abdomen.
c.diff colitis.
diverticulitis.
perforated abdominal organ.
pelvic infections.

Also used against
Giardia
Entamoeba histolitica
trichomonas


2- inhibits bacteral mitochondria

3- metallic taste & disulfarm rxn with alcohol. seizures are rare.

Front 118

pt that is immunocompramized develops aspirligilus. what is the tx?

se?

Back 118

Voriconazole is superior to amphotericin B

inhibits microsomal cytochorome p450.

Voriconazole is hepatotoxic. but note amphotericin b will raise the creatinine level and cause type1 RTA.

Front 119

Echinocandins: (caspofungin, micafungin)

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

Back 119

1- in pts with neutropenia who are still febrile after using bacterial abx.

candida infections
esophageal candidasis
aspergillus

2- block Dglucan

3- histamine realease.(flushing, headache, uticaria)

Front 120

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

Back 120

1- candida, aspirgillus, mucormycosis, cryptocococcus, histoplasmosis, coccidiomycosis.

2- block ergosterol synthesis
3- liver tox, qt prolongation

Front 121

1-pt with PPD >10mm but -ve xray. what is the next step?

2-se of tx?

Back 121

1- 9months of INH.

2- INH is hepatotoxic monitor LFT's.

Front 122

pt with +ve ppd, apical infiltrate on xray, sputum +ve for acid fast bicilli. what is the tx?

Back 122

1- Pt has TB nees resp isolation.

initial tx is INH, Rifampin, Pyrizinamice and ethambutal.
for 2 months....
INH and rifampin for 4 more months.

Front 123

1-A TB pt reciving tx for TB come with blury vision...next best step?

2-A TB pt reciving tx for TB comes with loss of sensation on his fingers..next step?

3- A TB pt reciving tx for TB comes with hyperuricemia ...next best step?

Back 123

1- stop ethambutol...it cause optic neuritis.

2- due to INH give Vit B6.

3- hyper-uricemia is due to pyrizinamide but must be given so do NOT stop drug.

Front 124

Pt with HIV, cd4 105, po2 64. pt has dry cough and bilateral intersitial infiltartes.

1- tx?
2-se?
3-alternative tx?
4when to use steroids?

Back 124

pt has pcp
1- tx is bactrim. milder cases of pcp w/o hypoxia can be tx with atovoquone.

2-rash. bone marrow sup. renal insuff.

3-If pt is allergic to bactrim give pentamide.

4- steroids added if po2<70 or A-a gradient >35.

Front 125

A pt that has urithral discharge. tx?

Back 125

tx for chlamydia and ghonorrhea.
single dose Azithromycin or doxycycline. for ghon use sefixime or ceftriaxone. Ciprofloxacin can aslo be used.

Front 126

A pregnant pt with cervicitis come in what is the tx?

Back 126

Pregnant women do not recive doxycycline and quinolones.

use azithromycin and ceftriaxone.

Front 127

female pt with cervical motion tendernes.

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

Back 127

1- out-pt PID consist of levofloxacin w/ metronidazole for 2wks.
or
ceftriaxone + doxycycline for 2wks.

2-inpatient tx of PID:
cefoxitin w/ doxycycline.

3- Intolerance of oral tx and presence of abscess.

Front 128

Protease inhibitors(avir):

1- use
2- moa?
3- se?

Back 128

1- Anti-retroviral tx

2- inhibit protease enzyme

3- All the protease inhibitors cause hyperlipidemia, hyperglycemia. Indinavir causes kidney stones.

Front 129

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

Back 129

1- PCP and toxo prophylaxix when pt is intolerant to bactrim.

Leprosy

Autoimmune disorders like bullous pemphigoid, Lichen planus and Dermmatitis herpetiformis.
2- sulfonamide antibiotic...inhibits folic acid synthesis.

3- se rash, hemolysis in G6PD pt, Methhemoglobinemia and aplastic anemia.

Front 130

pt has fever, headache and photophobia. LP shows 1400 wbc's.
1-tx?
2- moa?
3- when do you add ampicillin?

Back 130

1- Ceftriaxone, vancomycin and steroids.

2-inhibit bacterial cell wall synthesis

3- Add ampicillin if you suspect Listeria...in elderly, neonates, immunocompramized,asplenic pts.

Front 131

pt is sick taking abx...gets c.diff colitis.
1-next best step?
2-se?
3-if tx does not work?
4- if it re-occurs?

Back 131

1- metronidazole

2-disulfiram like rxn with etoh. metallic taste. peripheral neuropathy.
3- vancomycin
4-metronidazole again.

Front 132

pt comes in with murmmer you find out he is a iv drug user
1-valve?
2-tx?
3-se of tx?

Back 132

1- tricuspid regurg
2- draw blood for cultures and treat empiricaly with vancomycin and gentamycin.

3-Vancomycin causes red man syndrome. Gentamycin is nephrotoxic.

Front 133

pt with onchomycosis of toenail and fungal hyphe on KOH prep.what is the tx?

Back 133

Ter binafine.
6wks for fingers
12wks for toes.


se- hepatotoxic, taste disturbance.

Front 134

what is the tx for

1-inpatient pneumomia?

2-outpatient pneumonia?

Back 134

1 Inpatient pneumonia tx with ceftriaxone and azithromycin with fluroquinolone.

2-outpatient pneumonia is treated with macrolide such as azithromycin, clarithromycin.

if lung dz use fluroquinolones.... levofloxacin, gatifloxacin

Front 135

pt has ulcers, they are heaped up, indurated edges.
rpr -ve, darkfeild + for spirochetes.
1- tx?
2- alternative?
3-se?

Back 135

this pt has syphillis.
1- Benzathine penicillin IM is doc

2-if allergic to penicillin give Doxycycline.

3- Pen allergy, Jarisch Herxheimer rxn--->tx with asprin.

Front 136

pt has syphillis.
1- tx?
2- alternative?
3- what if she is pregnant and allergic to penicillin?

Back 136

1- benzathine pen IM
2- Doxycyline
3- de-sensitize to penicillin and then give penicillin.

Front 137

pt with vaginal itch. wet mount shows clue celss and ph of 6.5:

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

Back 137

pt has bacterial vaginosis.

1-metronidazole oral
2-metronidazloel oraly

Front 138

pt has vaginal discharge. wet mount shows motile forms:

1- tx?
2- if pregnant pt?

Back 138

pt has trichomoniasis:

1- metronidazole oraly
2- metronidazole oraly

Front 139

pt has HIV and is pregnant:

1- tx?
2- mode of dilivary?
3- meds to avoid?
4-tx for baby?

Back 139

1- she should recive 2 neucleoside reductase inhibitors and 1 protease inhibitor "avir".

2- c-section if viral load >1000 copies.

3- Avoid Efavirenz a non-neuclioside reverse transcriptase inhibitor---> it causes neural tube defects.

4- Baby should get AZT syrup for 6wks after delivary.

Front 140

Hiv pt with dysphagia, odynophagia
1-tx?
2- it does not resolve?

Back 140

pt has Aids and now developed esophageal candidiasis. This is esp true when cd4 is low.

1- tx with fluconazole
2- if it fails then do endoscopy to dx other lessions like herpes and cmv.

Front 141

pt has HIV with cd4 40 and viral load of 45000:
what would he need?

Back 141

1- pt needs Antiretroviral tx
2 NRTI's + (1 PI or Efavirenz).

with cd4 < 200 pcp prophalasis with bactrim

with cd4 <50 MAI prophalaxis with azithromycin.

Front 142

1-What are the se of NRTI's?
2-What are the se of PI's?
3- se of zidovudine?
4- se of Didanosise?
5- se of stavudine?
6- se of Tenofovir?

Back 142

1- all NRTI's cause lactic acidosis.

2- all PI's cause hyperlipidemia and hyperglycemia

3- anemia

4- pancreatitis
5- pancreatitis

6 renal insufficiency and Fanconi's syndrome.

Front 143

what are the se of aminoglycosides?
Gentamycin, tobramycin, amikacin

Back 143

Aminoglycosieds lead to ototoxicity and nephrotoxicity.

Front 144

pt on imipenem and Gentamicin for a Perforated peptic ulcer develops a seizure 3 days later explain?

Back 144

Gentamycin causes nephrotoxicicty there for increasing the dose of imipenem. Increased levels for imipeniem caused the seizure and increase creatinine levels.

Front 145

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

Back 145

1- most common cause Group B step, E.coli, Listeria.

2- tx with Amp (listeria) + cefotaxime or Aminoglycoside.

3-chlamydia takes about 4 weeks to cause pneumonia. Tx with oral erythromycin.

Front 146

tx of endometritis?

Back 146

clindamycin and gentamycin

Front 147

management of chf pt?

Back 147

1- give o2
2- lower preload (furosemide), nitrates, morphine.
3- if pt is still sob--> use + inotrope (dobutamine)

4- b4 discharge put pt on ACE-


***in severe cases use nitropruside and enalaprilat ICU setting.

Front 148

tx of:
1- polymyalgia Rheumatica?
2- Fibromyalgia?
3- polymyocitis?

Back 148

1-low dose prednosone

2- TCA and physical thearapy

3- high dose corticosteroids.

Front 149

what is the most common cause of a mobile cavity mass in the lungs,in a pt that presents with hemoptysis?

Back 149

Aspirigilosis

tx:voriconazole now prefered over amphotericin B

***note: steroids help in ABPA to decrease asthma exacerbation.

if all fails surgery to remove mass.

Front 150

A pt comes in to the OB clinic she has sudden 15 beats/min decrease in fetal heart reate, wich last for 24 secs:
1- dx
2- cause?
3- tx?

Back 150

1-Variable decelaration.

2- umbilical cord compression.

3- mask o2, change position of mother....if pattern presists then do scalp pH.

Front 151

tx of incontinence?
1- urge

2-over flow

3- stress

Back 151

1- urge incontinence is tx with oxybutynin

2- over flow incontinence is tx with bethanicol + alpha blocker.

3-stress incontinence is tx with kegel exercises + urethroprexy.

Front 152

the se are of wich tocolytic?

1- resp dep, muscle weakness.

2-tachycardia, hypotension, myocardial depression.

3- hypokalemia, hypoglycemia.

4- oligohydraminos , Pda closure

Back 152

1- mg toxicity treated with calcium gluconate

2- calcium channel blocker

3- beta agonist

4- indomethacin

Front 153

what is the secretin stimulation test?

Back 153

First meausure baseline gastrin level. Then inject secretin--->

In Normal pl...gastrin decreases (antacid effect)

In pts with ZE gastin increases

Front 154

Aortic Transsection:
1- what is the study of choice?
2- what if you see a widened mediastinum?
3- what if you dont see a widened midiastinum?

Back 154

1- the best inital test for dx of aortic transection is x-ray.

2- if there is a widened mediastinum--> perform Aortogram

3- if no widened mediastinum ---> perform spiral CT or TEE.

Front 155

a pt comes in he has been having recurrent seizures:
1-dx?
2-tx?

Back 155

1-status epilepticus

2-
1st--> Lorazepam/ Diazepam
2nd--> Phenytoin/ Phospheytoin
3rd--> Phenobarbital
4th--> midzolam/ Propofol

Front 156

what is the tx of status epilipticus?

Back 156

1- lorazepam, diazepam
2- phenytoin, phosphenytoin
3-phenobarbital
4-midzolam, propofol

Front 157

what is the mcc of
A- otitis
B- sinusitis
C- Bronchitis pneumomnia

Back 157

the mcc of ABC are
1 step pneumo
2 H. influ
3 N. Meningiditis

all treated with amoxicillin

Front 158

when do you diliver in fetal scalp monitoring?

Back 158

ph> 2.5 expectant management
ph7.2-7.25 repeat fss
ph < 7.2 diliver!!!!

Front 159

tx of isolated diastolic dysfunction?

Back 159

B-blocker

Front 160

FEVER post op

1- day 1
2- day 3
3- day 5
4- day 7
5- 2wks

Back 160

1- day1--> Atelectisis

2- day 3-->UTI

3- day 5-->Thrombophlebitis

4- day 7-->wound infection

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

Front 161

pt comes in has honey crusted lesion around mouth...he is dx with impetigo. what is the treatment ?

Back 161

Oral erythromycin or topical mupirocin

Front 162

pt comes in with ghonorrhea what is the treatment?

Back 162

ceftriaxone and single dose Azitromycin (or doxycycline 2times a week)

for ghonorrhea you treat for chalmidiya and ghonorrhea but the reverse is not true.

Front 163

1-what is mittelschmerz?

2- how do you tx it?

Back 163

1- Abdominal pain in a young female (mid menstural cycle pain) with benign clinical exam.

2- NSAIDS

Front 164

A pt comes in with HIV his CD4 is 150:
1- what prophalaxis do you give him?

2- what if he has a rash?

3- what if pt can not take PCP?

Back 164

1- bactrim if CD4 is< 200

2- Dapsone if there is a rash

3- Desensitize to Bactrim or give pentamide.

Front 165

tx in a pregnant woman in her 3rd trimester with HTN and proteinurea?

Back 165

This patient has pre-eclempsia, we dont want her to get seizures so we give her MGSO4

Front 166

A pt comes in with pneumonia, hyponatremia and diarrhea:

1-dx?
2-most specific test?
3-tx?

Back 166

1-Legionella Pneumonia

2-urine antibody antigen

3- erythromycin

Front 167

pt comes in he has suprapubic pain and cervical motion tenderness.
1- dx?
2-tx?

Back 167

1- PID.

2- mild PID--> single dose ceftriaxone IM + Azithromycin.

severe PID--> cefoxitin IV + Doxycycline.

Front 168

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 168

MS:

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 169

pt comes in with some chest pain.. on echo there is speckled pattern:
1- dx?
2-what kind of cardiomyopathy?

Back 169

1- Amyloidosis

2- ristrictive cardiaomyopathy.

Front 170

Difference between constrictive and ristrictive cardiomyopathy?

Back 170

Ristrictive:

X-ray shows calcified pericardium and increase thickness of pericardium.

Constrictive: Thickness of myocardium is normal.

Front 171

1-what does electrical altereans make you think of?

2- what else would you see?

Back 171

1-pericardial tamponade.

2- sinus tach, hypotension, low voltage QRS,

Front 172

1st step in the workup of micorcytic anemia?

Back 172

serum feritin,

increased in anemia of chronic disease

decreased in iron diff

normal in thalasemia

Front 173

pt twiches when you tap on the facial nerve:
dx?
tests?

Back 173

Tetany due to decrease in ionized calcium. Threshold potential is lowered, so muscle/nerve are partially depolarized: i.e. Chvosteks sign.

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

Front 174

Flank mass in a child mcc?

Back 174

Wilms tumor, associated with aniridia and hemihypertrophy in the AD type of Wilms

Front 175

Patient with viral myocarditis develops hypotension, neck vein distention, a drop in blood pressure on inspiration, and muffled heart sounds. Explain?

Back 175

Pericardial effusion from coxsackie myocarditis. Biopsy of heart would show a lymphocytic infiltrate with destruction of muscle.

Front 176

An alcoholic pt with bleeding, what is the mcc?

Back 176

Mallory weiss tear, there is a tear in the mucosa of cardia.

Front 177

what are the water shed zones in the abdomen?

Back 177

splenic flexture, rectosigmoid junction.

"Thumbprint sign"

Front 178

pt comes in with Gerd
whats the next step?

Back 178

1st do barium to R/o zenkers diveritculum

then do endoscopy...if -ve then do 24hr pH monitoring.

Front 179

pt comes in with diarrhea and dermatitis and on u/a hes found to have 5HIAA:
1-dx?
2-most comon site?

Back 179

1-carcinoid .

2- If carcinoid then most common site is apendix, if carcinoid syndrome then most comon site is smallbowel.

Front 180

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

Back 180

1-chrons dz.

2-steroids, 5-ASA

Front 181

Pt comes in with hyperthyroidism..
1-tx?
2-se of tx?

Back 181

1- PTU

2-agronulocytois

Front 182

A pt comes with a prolactinoma... what is the tx?

Back 182

Bromocryptine, Cabergolin

Front 183

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

Back 183

1- intranasal DDAVP

2- Kidney transplant

Front 184

what is the difference between osteomalasia and Padgets dz?

Back 184

Osteomalasia: defective miniralization

Padgets: defective remodeling

Front 185

what is the tx of BPH?

Back 185

Tamsulosin

Front 186

A pt has a pancratic tumor that produces large amounts of insulin:
what type of cells are responsible?

Back 186

beta cells produce insulin

alpha celss produce glucagon

delta produce somatostatin

Front 187

when they mention pneumonia and:
1-etoh
2-college student
3-cf
4-immigrant
5-copd
6-TB with cavity
7-silicosis
8-A/c and coolers
9-Hiv
10- Bird droppings
11- <1yr age
12- 2-5yrs age

Back 187

1-klebsiella
2-mycoplasma
3-pseudomonas
4-TB
5-H. influ
6-Asperigillus
7-TB
8-Legionella
9-Pcp
10- chlamydia
11-RSV
12- Parainfluenza.

Front 188

A pt that comes in with cirrhosis because of many yrs of Etoh consumption. what is he at risk for?

Back 188

cirrhosis--> Hepatic Adenoma -->Hepatocelluar ca

Front 189

How do you tx a kid with precoccious puberty?

Back 189

Gnrh agonist-->it prevents closure of epiphyseal plate

Front 190

A pt comes in with chrons dz and undergoes surgical resection.. what complication should we watch out for?>

Back 190

Chrons dz affects sm bowel. so sm bowel resection causes oxalate kidney stones.

Front 191

what age is a hydrocele normal till?

Back 191

1 yr

Front 192

what is CA19-9 a marker for?

Back 192

Pancreatic CA

Front 193

Dopamine Agonist

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

Back 193

1- Cabergoline, Bromocriptine, Ropinerole

2-Parkinsons dz, Prolactinoma, Restless leg syndrome.

3- N/V, orthostatic hypotension, hallucinations

Front 194

Amantadine:

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

Back 194

1- Amantidine is used for:
Acute Infuenza A within 48hrs of symptoms....inferior to OSELTAMIVIR
mild parkinson dz

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

3- confusion, nightmares, livedo reticularis.

Front 195

Pt comes in with painful contracted muscles:
tx?

Back 195

Beclofen, gaba analog.

se--> dizziness

Front 196

A pt comes in with fasiculations, muscle waisting, hyper-reflexia, weakness and up going toes:
1- dx?
2-tx?
3- moa of tx?
4- se of tx?

Back 196

1-ALS

2-Riluzole

3- inhibits glutamate release

4- N/V, spasticity.

Front 197

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

Back 197

1- seizure disorder, Peripheral neuropathy, mood disorders(bipolar)

2- inactivates Na+ chanels

3- steven's johnson syndrome

Front 198

where does prostate cancer grow?

Back 198

Periphral area of prostate

Front 199

where does BPH happen?

Back 199

central area of prostate

Front 200

what do you see in cf?

Back 200

1- impaired cl transport
2-increased sweat cl
3 thick viscous secretions
4-KADE difficiency
5- Miconium illus

Front 201

Toxo triad?

Back 201

1-chorioretnitis
2- hydro-cephalus
3- intra-cranial calcifications

Front 202

Rubella triad

Back 202

1-cataracts (see)
2- cardiac (PDA) (heart)
3-sensironural hearing loss (hear)

Front 203

treatment of hypercalcemia in metastatic dz?

Back 203

use bisphosphonate: Zoledronic acid

its prefered over normal saline since it also protects bones

Front 204

what is the dx?
5 day old with vomiting + bloody stool
Rbc + Eosinophils in stool

Back 204

milk protein intolerance

Front 205

painless malina in 2 yr old
what is the dx?

Back 205

meckels Diverticulum

Front 206

infant with abdominal distention + pain
pneumotosis intercoli
dx?

Back 206

Necortizing enterocolitis

Front 207

barky cough with inspiratory stridor
3months-5 yrs child
what is the dx?

Back 207

croup( paraninflunza virus)

look for steeple sign
tx: moisture +racemic epinephrine

Front 208

2 yr with high fever
hoarse/muffled voice, (hot potato)
pt in tripod position( neck extended)
drooling

what is the dx?

Back 208

Epiglotitis( H. influenza type B)

look for thumb print sign
next best step???--> secure airway
tx: 3rd gen cef after airway secured!

Front 209

pt comes with adenexal and cervial motion tenderness. she is dx with pid: what is the inpatient tx?
what is the outpatient tx?

Back 209

PID tx:
Inpatient; clindamycin +Gentamycin

outpatient: ceftriaxone + doxycyline

Front 210

candidal vaginitis tx?

Back 210

clotrimazole cream

remember candida has ph ~4.5

Front 211

gardenella and trichamonas vag tx?

Back 211

metronidazole

Front 212

how do you folllow the progression of asthma?

Back 212

blood gases ...as asthma gets worse the pco2 starts to rise and ph starts to drop.

initialy low pco2 bc of hyperventilating

Front 213

most common cause of hmatochezia in elderly

Back 213

diverticulosis

Front 214

acute attack

Back 214

bronco dialator(b2 agaonist)
o2
and steroids

Front 215

mild intermitent
attacks less than 2x / week
tx?

Back 215

short acting b2 agonist only when sxs

Front 216

mild presistant
attacks more than 2x/ week

tx?

Back 216

daily meds
chromolin
inhaled corticosteroids

b2 agonist on attack

Front 217

sever/ moderate presistant
more frequent sxs than 2x/week

Back 217

inhaled corticosteroids

use long acting b2 agonist
short acting b2 agonist only when sxs

leukotrine antagonist

Front 218

exerscise induced asthma

Back 218

b2 agonist prior to exercise

Front 219

acute asthma attack

what is the tx?

Back 219

bronco dialator(b2 agaonist)
o2
and steroids

Front 220

mild intermitent
attacks less than 2x / week
tx?

Back 220

short acting b2 agonist only when sxs

Front 221

mild presistant
attacks more than 2x/ week

tx?

Back 221

daily meds
chromolin
inhaled corticosteroids

b2 agonist on attack

Front 222

sever/ moderate presistant
more frequent sxs than 2x/week

what is the tx?

Back 222

inhaled corticosteroids

use long acting b2 agonist
short acting b2 agonist only when sxs

leukotrine antagonist

Front 223

exerscise induced asthma
what is the tx?

Back 223

b2 agonist prior to exercise

Front 224

bronchiolitis:(RSV)
Ratteling chough,
what is the age?
when?
dx?
tx?

Back 224

< 2yr age children
winter
best test is a naso-phrangial wash
TX: humidifier
bronchodialators can be tried
racemic epi

Front 225

rsv in premature baby what do you give?

Back 225

palimusinab (mono clonal ab)

Front 226

3 yr old , reccurent cough
bulky stool, nasal polyps,rectal prolapse,clubbing.
what is the dx?

Back 226

cystic fibrosis.
chromosome 7

Front 227

abnormal cl transport,
elevated salt content in sweat
meconium illus in child
malabsorbtion + faliure to thrive
tx?

Back 227

cf

tx: aggresive abx , bronchodialators, pancreatic enzymes, replace vitamins,

Front 228

what is the best test to dx cf?

what vitamins are missing in cf pt?

Back 228

sweat cl test.

kade.

Front 229

mc complication of meningitis?

Back 229

otitis media

Front 230

otitis media:
most common complaint?

Back 230

ear ache is the mc complaint.,
do pneumatic otoscopy to see bulging ear drum and decreased movement of tympanic membrane
fever, decreased hearing

Front 231

otitis media mcc?
tx:?

Back 231

mcc is s.pneumo

1) ammoxicillin doc

2) if still fever ammoxicilin + clavulenic acid

Front 232

most common complication of otitis media?

Back 232

hearing loss.

Front 233

most common intracranial complication of om?

Back 233

meningitis.

Front 234

repeted wetting of ear canal,
pain with manipulation of auricle,
dx?
mmc?
tx?

Back 234

otitis media

pseudomonas

topical : neomycin, polymyxin B

Front 235

new born cynotic at birth, red when cries.
can not pass ng catheter tube
dx?
tx?

Back 235

babies are obligate breathers.
dx: choanal atresia

tx: establish airway, surgery.

Front 236

purulent nasal discharge
headache/ tooth ache
dx?

Back 236

dx: sinusitus dx clinicaly confirmed with ct of sinus shows air/fluid levels

tx: ammoxiclin + clavulanate or
2nd gen cephalo

Front 237

systolic murmer 2/6
musical murmder
dx?
tx?

Back 237

innocent murmur

no tx

Front 238

murmer that goes away when jugular vein is pressed apon

Back 238

venous humm

Front 239

what are the cynotic heart lessions?

Back 239

5t's + p
Trunkus A,
Tet of falot,
Transposition,
Tricuspid A,
Total anomolous pulomonary venous return,
Pulmonic sten.

Front 240

harsh pancystolic murmur,

Back 240

VSD

mc heart defect

Front 241

what is the best test to order if you suspect a congenital heart dz?

Back 241

Echo

Front 242

a murmur with wide fixed splitting of s2 what is the murmur?
(physiologic splitting)

Back 242

ASD

Front 243

murmur associated with prematurity
and rubella.
machinery murmur
increased pulmonary markings
what is the murmur?

Back 243

pda

Front 244

to close pda?

Back 244

preterm: indomethacin

term : surgical closure

Front 245

mc cardiac anomaly in trisomy 21?

Back 245

Endocardial cushion defect

Front 246

htn in upper exteremites, and hypotension in lower extermites.

associated with truners syndrome

Back 246

co-arctation of aorta: (has ductal tissue)
make sure after upper limb bp is done lower limb bp is done.
next step in management: PGE2

Front 247

rib notching, found in?
tx?

Back 247

Co Aorta

Von recklinhousens dz

tx: surgical correction

Front 248

cynotic infant , harsh holosystolic murmur, hypoxic spasams
(tet spells)
SINGLE HEART SOUND(s2)
what is the dx?
what does it consist of?
chat is seen on cxr?

Back 248

Tet of Falot:
PROVE
pulm sten, rvh, over riding of aorta, vsd

most common congenital heart dz
Boot shaped heart on cxr

Front 249

mc cynotic dz in the first 24 hrs of life?

Back 249

Transposition of
GV

Front 250

TET spells: what is the tx:

Back 250

knee to chest....to increase systemic vas resistance.

Front 251

EGG on a string on cxr, what is the dx?

Back 251

tansposition of gv

keep ductus open. with pge 2

Front 252

what is the best test for myocarditis?

Back 252

Endomyocardial bx

Front 253

ACUTE HR

Back 253

PENICILLIN, SALISILATES, STEROIDS

Front 254

JONES CRITERIA

Back 254

j JOINTS, O CARDITIS, N NODULES, E ERYTHEMA S SYNDHANHAM CHOREA.

Front 255

FEVER, BI CUSPID VALVE, DENTAL WORK

DX?

Back 255

ENDOCARDITIS

Front 256

MCC OF ENDOCARDITIS?

Back 256

S. VIRDANS

Front 257

OSLERS NODES, JANEWAY LEASONS, SPLINTER HEMMORAGES, ROTHS SPOTS.
DX?

Back 257

ENDOCARDITIS.

Front 258

GERD tx?

Back 258

life style mod
h2 blockers
proton pump
Nissen fundoplication (surgery)

Front 259

mc cause of diarriea in infants?

Back 259

Rota virus

Front 260

a happy baby, normal bmi, with continous diarrhea,
dx?
tx?

Back 260

chronic diarrhea of infancy

no tx

Front 261

Travelers diarrhea caused by?

Back 261

Enterotoxogenic E.coli

Front 262

HUS caused by?

Back 262

Enterohemorragic E.coli

Front 263

prior abx use caused c. diff. what is the best test?

Back 263

stool for c. diff toxin

Tx: metronidazlole, vancomycin

Front 264

un cooked poultry, trutles. raw eggs.diarrhea what is the cause?

Back 264

salmonella

tx: tx prolongs carrier state so do not tx.
organism hides in Gall baldder

Front 265

chronic diarrhea in HIV pt?

Back 265

criptosporidium

Front 266

how do you tx peptic ulcer dz?

Back 266

do not do life style changes

1) triple therapy with (H2 blocker, PPI, abx{metronidazlole, amoxicillin, bismuth})

Front 267

how do you dx hishsprungs dx?

sx?

Back 267

bx

Abdominal distention, no stool palpated on rectal vault.

Front 268

bilious vomiting , double bubble in newborn with down syndrome. dx?

Back 268

Duodenal atresia

Front 269

what is sandefers syndrome?

Back 269

a baby with GE reflux and arch their back to

Front 270

for GERD what is the best test to dx?

Back 270

ph probe

Front 271

4 week old boy ,NON - bilious vomitus,
projectile vomiting, olive shaped mass in abdomen, peristalitic wave seen on abdomen.
waht is the dx?
what is the labs?

Back 271

Pyloric Stenosis

(hypo-kalemic, hypo-cholremic
met alkalosis)

Front 272

what do you do to dx pyloric stenosis?

Back 272

the best test for dx of pyloric stenosis is abd u/s

Front 273

a 4 week old with non bilious vomiting with string sign ino xray, what is the dx?

tx?

Back 273

pyloric stenosis

tx: correct electrolytes and surgery

Front 274

A newborn infant is passing blood from her vagina,best test for swallowed maternal blood?

Back 274

Apt test: differentiates fetal hgb from adult hgb

Front 275

13 yr old, fever, right wrist pain, esr elevated, abdominal pain,anemia, what is the dx?

Back 275

IBS

more likely chrons due to extra intestinal manifestations

Front 276

a teen with abdominal pain, string sign, skip lessions, fistula formation,
how do you dx?
tx?

Back 276

endoscopy with bx best way to dx chrons

tx: steroids, salicylates, azothiopine, tnf alpha, tacrolimus,

surgery if meds fail,

Front 277

cobble stoning , transmural lessions
dx?

Back 277

chrons

Front 278

mucosal lession, bloody diarrhea, with pseudoployps and lead pipe colon

what is the dx?

Back 278

ulcerateive colits

Front 279

15 mo old child, cramps abd pain/tenderness that started 10 hrs ago,
mc dx?
associated with what dx?

Back 279

intuseception
usually ilio-colic

associated with henoch schiolin purpura, rota virus vaccine.

Front 280

colicky abd pain, with current jelly stool and sausage shaped mass felt in abdomen, what is the best way to make a dx?
what is seen?

Back 280

Barium enema is the best test to dx and tx

coil spring sign seen

Front 281

painless bleeding in a 2 yr old. abdomen soft NON tender. what is the dx?

best test to dx is?

Back 281

meckels diverticulum

reminant of omphalomesinteric duct

order a technecium scan (detects gastric mucosa)

Front 282

what is the rule of 2's?

Back 282

2% of infants
2 yrs age
2 types of tissue(gastric/ pancreatic)
2 cm in size
2 feet from illio cecal valve

Front 283

8 yr old kid, combative,is hypoglycemic and has hyperamonia. he had a seizure post upper resp tract infection which was 2 weeks ago. what is the cause?

Back 283

Ryes syndrome, caused by asprin given to kids.

encephalopathy with fatty liver

Front 284

how do you tx esophageal varicies in portal htn?

Back 284

octreotide.

Front 285

how do you tx esopheageal spasams?
how do dx it?

Back 285

ca channel blockers

esophageal manometry

Front 286

a 2 yr old girl with recurrent uti, fever and vomiting. what is the dx?

what test do you do?

Back 286

vesico-urethral reflux

voiding cystourethrogram and u/s of kidney and bladder.

Front 287

10 yr old boy with cola colored urine, and edema of extremities, sore throat 2 weeks ago.
dx?
cause?
what is the best test to dx?

Back 287

Glomerulo Nephritis

post streptococal GN( hematurea/ edema/ HTN)

DNAase( proves previous infection with grop A strep)

Front 288

7 yr old boy failed hearing test, renal problems (microscopic hematurea), uncle also has it (X Dom) and he has cataracts. what is the dx?
what do you see on renal bx?

Back 288

Alports syndrome

Thickned BM with atrophy and foam cells on renal BX

Front 289

3 yr old with bloody diarrhea, and vomiting. he has decreased urination and appears pale and lethargic.
dx?
cause?
what cells do you see?

Back 289

HUS

E.coli 057.17 under cooked meat

Helmet cells

Front 290

what are the signs of HUS?

tx?

Back 290

H hemololyis( hemolytic anemia)
U uremia
T thrombocytopnea
S syndrome

tx: supportive.

Front 291

3 yr old with edema,protein urea, hypo albuminemia, hyperlipidemia, lipid urea.
dx?
most common cause?
tx?
what is the pt at risk for?

Back 291

nephrotic syndrome

minimal change dz

diuretics, steroids,

Spontaneous bacterial peritonitis

Front 292

c3 in GN vs nephrotic syndrome?

Back 292

C3 low in GN

C3 normal in nephrotic syndrome

Front 293

best test to dx uti?

what is emperic tx?

Back 293

urine culture

based on u/a waiting for u/c

Front 294

most common cause of ATN?

Back 294

Nsaids.

Front 295

what is the mcc of chronic RF?

Back 295

number 1 cause : DM

number 2 cause: HTN

Front 296

a pt finds out he has hepititis B how should he be tx?

Back 296

Interferon alpha 2a/b
or
Lamivudine

Front 297

a pt finds out she has hep c how should she be tx?

Back 297

Interferon alpha 2a/b
or
Ribavarin

Front 298

what is the diff between omphalocele and gastrochisis?

Back 298

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

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

Front 299

a 2 yr old presents with sudden onset of pain and distention, rectal bleeding and birds beak sign on abd xray.
dx?
tx?

Back 299

dx: Mid gut volvulus

tx: surgery

Front 300

a premature baby presents with air in bowel, fever, rectal bleed
dx?
tx?

Back 300

Necrotizing enterocolitis

NPO and surgery if needed

Front 301

a 1 week old has rectal prolapse, and has not passed stool.
dx?
what is the best test?

Back 301

CF (meconium illius)

the best test is sweat cl test

Front 302

difference between mallory weiss tears and boorhave tears?

how is the dx made?

Back 302

mallory weiss: superfical tears that stop on their own

Boorhave tears full thickness tears and require immediate surgical repair.

dx made by endoscopy

Front 303

pt with unilateral , severe headaches for few days. associated w/ tearing on the eye
dx?
tx to abort?
prophylaxis?

Back 303

cluster headache

abort with 100% oxygen and sumatriptan/ ergotamine

prophylaxed with lithum or prednisone for few weeks

Front 304

79 yr man with bilateral symetrical atrophy on ct and increased frogetfulness
dx?
tx?

Back 304

alzheimers

tx: donepezil, galantamine, rivastigmine
( all ach esterase inhibitors)

Front 305

assending parylsis with emg and nerve studies abnormal:
dx:
tx:

Back 305

Gullian Barre Syd

tx: plasmapheresis or iv immunoglobulins.

Front 306

a pt has continous seizures and lorazepam was given and it didnt break the seizure:
dx?
next best step?

Back 306

status epilepitcus

next best step phenytoin or fosphynetoin

if phynetoin or phosphynetoin do not work give phenobarbital and if that fails general anesthesia with midazolam, propofol.

Front 307

what are vecuronium and succinylcholine:
what do they do?

Back 307

they are neuro-muscular blocking agents used to stop muscle contractions

Front 308

sub arachnoid hemorrahge
best inital tx?
best drug tx?
most important test to guide tx?

Back 308

best inital tx: control bp to systolic < 160

Nimodipine ca channel blocker used to prevent vaso spasm and stroke

cerebral angiogram needs to be done and surgical cliping to prevent rebleeding.

Front 309

a pt has myasthenia gravis and has lab work done and we find ab to ach receptor.
what is the best tx?
what if the tx does not work?
how is acute myesthenic crisis treated?

Back 309

pridostigmine / neostigmine

if they dont work give prednisone/azithropine if over 60 yrs or thymectomy if under 60 yrs.

plasmapheresis or iv immunoglobulin

Front 310

what are dopamine agonist ?
what are they used for?
se of dopamine agonist?

Back 310

cabergoline, bromocriptine, ropinerorole, pramipexole, pergolide.

parkinsons, prolactinoma, restless leg syndrome

se: orthostatic hypotension

Front 311

what is the doc for restless leg syndrome and prolactinoma?

Back 311

dopamine agonist:

cabergoline, bromocriptine, pergolide....

Front 312

what do you use amantidine?

Back 312

pt with acute inf A with parkinsons


amantidine tx both

Front 313

what med is given to patient with ms and has painfull contracted muscles(muscle spasms)

Back 313

Beclofen and Tizanadine

Front 314

what do you give to stop the progression of ms?

Back 314

INF beta or Glatirimer

Front 315

a pt has motor neuron dz, fasiculations and wasting and hyperfeflexia
dx?
tx?

Back 315

ALS

Riluzole( inhibits glutamate presnyptically)

Front 316

Lamotrigine

use?

se?

Back 316

lamotrigine is used in seizure disorder, peripheral neuropathy and mood disorders (bipolar)

causes Steven Johnson syndrome

Front 317

A pt has sharp pain on face near mouth with progresses to ear and then resolves and recurres:
dx:
tx:

Back 317

Trigeminal neuralgia

tx: carbamazepine if it fails then phenytoin

Front 318

se of valproic acid?

Back 318

wt gain
tremor
hepatotoxicity

Front 319

se of carbamezepine?

Back 319

hyponatremia
neutropenia
lethargy

Front 320

se of phenytoin?

Back 320

Gingival hyperplasia
hirsuitism

Front 321

se of lamotrigine

Back 321

steven jhonson syndrom

Front 322

se of topiramate?

Back 322

glaucoma

Front 323

diabetic pt comes with tingling in extermities
dx?
tx?

Back 323

Peripheral neuropathy

tx: gabapentin or pergabalin


tca can also be used but causes dry mouth and urinary retention

Front 324

what are tca's?
use ?
se?

Back 324

Amitriptyline, imipramine, nortriptyline, desipramine

use:
Major depression, ocd, phobia, anxiety, ADD, peripheral neruopathies, NOCTURNAL ENURESIS, migraine headace prophylaxis.

se: anti-cholinergic effects and Q-T prolongation, arrythmias and seizures.

Front 325

what are comt inhibitors?
what is the use?
se?

Back 325

comt inhibitors are tolcapone and entacapone
use: prevent degredation of levadopa and extend its duration in tx of parkinsons

se: orthostatic hypotension, dyskinesia and hepatic failure.

Front 326

tx of absance seizures?

Back 326

Ethosuximide

Front 327

what is werding hoffman dz?

tx?

Back 327

autosomal recessive
degeneration of anterior horns in spinal chord and brainstem.

Infant hypotonic at birth

tx: supportive

Front 328

what test proves presence of peripheral neuropathy?

Back 328

Nerve conduction velocity: slowed

Front 329

what is the tx of hypertensive emergency?

Back 329

1- Nitroprusside iv
2- Nitroglycerin
3- Hydralazine

Front 330

what drugs decrease mortality in chf pts?

Back 330

ace inhib, b-blockers, spirinolactone

Front 331

what drug decreases sxs of chf but not mortality, use in fluid retention pts?

Back 331

loop diuretics

Front 332

what drug decreases sxs of chf by improving contractility?

Back 332

digitalis

Front 333

the triad of angina, exertional dyspnea and boot shaped heart . what is the dx?

Back 333

Aortic stenosis

Front 334

in what cardiomyopathy are the sxs releved by squatting?

Back 334

hypertorophic cardiomyopathy

Front 335

drooling dysphagia and hot potato voice
dx?
1st step?

Back 335

epiglottitis by h influ

nasotracheal intubation

Front 336

stridor, barking cough,
dx?
tx?

Back 336

parainfluenza croup


tx: corticosteroids or nebulized epi

Front 337

high fever, drooling with unilateral tonsillar swelling with uvular deviation
dx?

Back 337

peritonsillar abscess

clue : uvular deveation

Front 338

pale pt with, bloody diarrhea, , lethergy , and hyotensive 16 yr old pt

dx?
compliation?

Back 338

HUS

renal failure due to increase in creatinine

Front 339

talus is in equinus and varus position. foot clubbing. tx?

Back 339

strech, manupulation and serial casting

Front 340

treatment of anemia of prematurity?

Back 340

iron supplimentation

via fortified milk formula or ferrous salts

Front 341

wide based gait
myocarditis and inversion of t-wave
abnormality of tocopherol
trinucleotide repeate

dx?
next step?

Back 341

fredreich ataxia


genetic counseling if future pregnancies desired

Front 342

child pulling on ear, fever, bulging of tympanic membrane

Back 342

otitis media

ammoxicillin if it fails then
ammox-clavulanic acid

or im ceftriaxone

Front 343

kids with hearing imparement have what that add, adhd , selective mutism and oppositional defiant kids dont?

Back 343

hearing imparement leads to poor language and development and social skills

Front 344

laryngotracheobronchitis
hoarseness
barking cough
what does the x ray show?

Back 344

subglottic narrowing

treat w. corticosteroids or epi

Front 345

laryngotracheobronchitis
< 3 yrs age
hoarseness
barking cough
what does the x ray show?

Back 345

subglottic narrowing

treat w. corticosteroids or epi

Front 346

high fever
stridor and drooling
thickened aryepiglottic folds
what do you see on xray?

Back 346

thumb print sign
swollen epiglottis

do intubation

Front 347

developmental disorder with forward slip of vertebrae

slow developing back pain with plpable step off

what is the dx?

Back 347

spondy-lo-lis-thesis

Front 348

a child with bloody diarrhea
thrombocytopnea
and renal failure (increase creat)

dx?

Back 348

HUS

tx: supportive , plasmapheresis , dialasis or steroids can be tried

Front 349

a 6month old kid with symmetrical contractions of the neck trunk and extermities (INFANTILE SPASMS)

hypsarrhythmic pattern on eeg--chaotic high voltage asynchronous.

hypopigmented lessions ( Ashleaf spots)

Cortical tubers on CT

dx?
tx?

Back 349

Tuberous sclerosis

ACTH intra muscular

Front 350

drug of choice for infantile spasms?


best medication for a tuberous sclerosis pts seizure?

Back 350

vigabatrin


Acth Im

Front 351

highly contagious cough
coughing spells
rectal prlapse and epistaxis

dx?

Back 351

whooping cough by bordetella pertusssis

Front 352

tx of actinomycis

Back 352

penicillin

Front 353

what do you do in a newborn?

Back 353

1- suction airway secretions
2- dry + warm (thermoreg underdeveloped)
3-early preventitive meassures
(gonococcal opthalmia prevention and vit k)

Front 354

sickle cell pt with parvo virus b19 infection, very low reticulosites,
dx?
tx?

Back 354

aplastic anemia

blood transfusion

Front 355

tx of minimal change dx?

Back 355

steroids

Front 356

kid with inability to release hand after handshake

atrophy of hypothenar
baldness
eminences
upper lip is inverted v
dx?
tx?

Back 356

dx: myotonic muscular dystrophy

remember its AD

tx supportive and genitic counceling

Front 357

new born with fever, premature
low birth wt, vomiting and abd distention and pneumatosis intestinalis

dx?

Back 357

necrotizing enterocolits

Front 358

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

dx?

tx?

Back 358

ITP

steroids and if they fail do splenectomy

Front 359

thrombocytopnea
microangiopathic hemolic anemia
change in mental status
fever
renal failure

dx?
tx?

Back 359

TTP

plasmapheresis

Front 360

a seizure in a kid 6mo to 6yrs that last few mins and is tonic clonic
fever with no neurologic deficit

dx?
tx?

Back 360

febrile seizure

antipyretics

Front 361

what surgery do turners synd pts get prophylacticly?

Back 361

bilateral gonadectomy due to higher incidence of gonadoblastoma

Front 362

lesch nyhan syndrome
self mutilation
hgprt diff
uric acid excess
tx?

Back 362

alpurinol to reduce uric acid

increase fluids

Front 363

duchine muscular dystrophy

screen?
confirm?
gold standard?

Back 363

serum ck level

bx of muscle

genetic studies

Front 364

erythmatous vesicles on extensor surface

gluten senstive
malabsorbtion
dx?

Back 364

kwashiorkor

remove gluten from diet

Front 365

what cells are seen in a pt with sickle cell and functional spleen?

Back 365

howell jo9lly bodies

Front 366

positive coombs test
dx?

positive osmotic fragility test?
dx?

Back 366

Autoimmune hemolyitic anemia

hereditary pherocytosis

Front 367

cherry red spot + hepatosplenomegaly

dx?

Back 367

nemanpick

diff in sphingomylenase

Front 368

abscent palmer crease
rocker bottom feet
overlapping fingers
dx?

Back 368

edwards trisomy 18

Front 369

fever > 5 days
mucus mem changes
cutanious chantes
lymphadenopahty
rash

dx?
tx?
complication?

Back 369

kawasaki dz

high dose asprin and IVIG

coronary artery anurysm f/u with echocardiography

Front 370

what vitimin is indicated in pts with sickle cell anemia?

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

Back 370

folic acid-- replenishes folic acid stores and aids in erythropoesis

hydroxyurea increases hb F and there for prevents sickeling

Front 371

w- decreased igM
A- increased igA
T- thromocytopnea
E- Ecezema
R - recurrent infections

dx?

Back 371

wiskott aldrich sndrome

Front 372

jaundice in 2nd week of life
un-conjugated bilirubin
stops if brestfeeding is stopped

dx?
tx?

Back 372

breast milk jaundice

phototherapy

Front 373

jaundice that appears after 24hrs and disappears by 1 week
mostly unconjugated

dx?
tx?

Back 373

physiologic jaundice

resolves on its own

note: more commong in preterm and diabetic mothers

Front 374

treatment of anaphylaxis due to food alergy?

Back 374

sub cutaneous epi injection

Front 375

what is given to sickle cell pts with auto splenctomy?

Back 375

pneumococcal vaccinethat is a conjugated capsular polysaccharide.

and penicillin

Front 376

a pt has presistent oral thrush, lymphadenopathy and heptatosplenomegaly
what is the dx?
how do you screen ?
how do you conferm?

Back 376

HIV

screen with elisa

confirm with western blot

Front 377

how do you treat enuresis?

Back 377

imepramine or desmopressin

Front 378

in a supracondylar fracture what artery is most commenly affected?

Back 378

Brachial Artery

Front 379

long term complicaton of turners syndrome?

Back 379

osteoporosis due to lack of estrogen due to streak gonads


tx with estrogen replacement therapy

Front 380

horners syndrome + ipsilateral hand paralysis in infant

dx?

Back 380

klumpke paralysis

Front 381

macrosomia
macroglossia
omphalocele
hypoglycemia
hyper-insulinemia
dx?
increased risk of?

Back 381

Beckwith wiedmann synd


willms tumor, hepatoblastoma and gonadoblastoma.

Front 382

what is the first step in the management of enuresis?

Back 382

UA

try to rule out infection, bleeding and structural defects

Front 383

giardia due to lack of igA and recurrent sinopulmonary infections due to encapsulated organisms

after 6 months

dx?

Back 383

Bcell deficiency

Front 384

tx of henoch schonlein purpura?

Back 384

steroids and monitor Renal function

Front 385

palpable purpura on butocks, scrotal swelling, hematurea post upper resp tract infection.
dx?
tx?

Back 385

HSP

steroids and monitor Renal function

Front 386

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 386

neuroblastoma

most commmon site abdomen

Front 387

sxs of cf?

tx of CF?

Back 387

anemia, steatorrhea, wheezing, recurrent infections, rectal prolapse , jaundice, failure to thrive

tx:high calorie diet

replace pancreatic enzymes
fat soluble vitamins

Front 388

difference between cephal hematoma and caput seccedaneum?

Back 388

cephalohematoma does not cross the midline, due to sub periosteal hemmorage

caput seccandenum due to scalp swelling, crosses midline

Front 389

hearing loss
blue sclera
recurrent fractures
+ family hx
dx?
defect?

Back 389

Osteogenisis Imperfecta

Collegen 1

Front 390

AD
arachnodactyly
hypermobility of joints
ectopia lentis
aortic root dilatation
dx?
defect?

Back 390

Marfans

fibrillin 1 gene

Front 391

reccurent sinusitis
bronchiectasis
drextrocardia
dx?
dysfxn?

Back 391

kartagners syndrome

defect in dynein and therefore impared cilial function

Front 392

reccurent sinusitis
bronchiectasis
drextrocardia
dx?
dysfxn?

Back 392

kartagners syndrome

defect in dynein and therefore impared cilial function

Front 393

tx of infant botulinum?

Back 393

tx of infant botulenum is supportive care
HUMAN derived botulinum antitoxin should be administered

Front 394

blue grey lesion on the back of a hispanic kid

flat and do not fade into the skin
dx?
cause?
tx?

Back 394

mongolian spot

migration of melanocytes from neural crest to epidermis

tx: reassurance it will disappear in the next few yrs

Front 395

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 395

Transposition of GV
first step give PGE2 to keep pda open

tx: surgery


Tetralogy of Fallot

Front 396

most common cause of meningitis in:
new born
one month to 2 yrs
2-18 yrs
>18 yrs

Back 396

new born:Group B strep

one month - 2yrs: strep pneumo

2-18 - N. Meningitidis

>18 step pneumo

Front 397

how do you limit the risk of pertussis infection?

Back 397

all house hold contact will get erythromycin for 14 days.

Front 398

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

dx?
defect?
tx?

Back 398

Homocystinurea

cystathionine synthase diff

tx: vit b6 high dose

Front 399

CGD
diagnostic test?

tx?

what is curative

Back 399

nitroblue tetrazolium

bactrim+gama interferon

bone marrow transplant is curative

Front 400

premature infant
with low reticulocyte count and
everything else normal

dx?
tx?

Back 400

Anemia of prematurity

iron supplementation and periodic cbc and blood transfusion if needed

Front 401

obease kid what do you check for?

what if that test is elevated?

Back 401

screen for total cholesterol level

if grater then 200 then order a fasting lipid profile

Front 402

what is the next step in a patient that presents with torticollis?

Back 402

do cervical xrays to rule out fracture or dislocation

Front 403

Adrenal hemmorage
vasomotor collapse
skin rash

dx?

Back 403

water house frederichsen synd

Front 404

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

Back 404

kawasaki's dz
ivig and high dose asprin

juvinille rheumatoid arthritis

Front 405

what is the immediate tx of tof?

definitive tx?

Back 405

o2
place child in a knee chest postion
iv fluids
morphine
propranolol

surgery

Front 406

a kid with fever, and neck swelling
tender neck lump noticed
tender fluctuant anterior cervial mass
organism?
tx?

Back 406

mcc : staff or strp


tx: due to mrsa and beta lactamase risistance give dicloxacillin

Front 407

a kid <3
imparements in interaction and communication
stereotypical behaviors
delayed language development
dx?

Back 407

Autism

they also lack social smile and stranger anxiety

Front 408

management of croup?

Back 408

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

Front 409

preterm infant
increased gastric residues
ground glass app of both lungs
dx?
tx?

Back 409

necrotizing enterocolitis

you also see air in the bowel if lucky on ct
npo, o2, ng suction,
meperidine,
surgery

Front 410

what is the criteria for RF?

tx?

Back 410

poly arthritis
carditis
chorea
subcutaneous nodules
erythema marginatum

Benzathine penicillin G

Front 411

a child with fever , sore throat, pericarditis, erythema marginatum, arthrits , chorea and subcutaneous nodules. what is the tx?

Back 411

RF

tx benathane Pen G
anti-epileptics for chorea
salicylates for arthrits
codeine for pain

Front 412

a child with fever , sore throat, pericarditis, erythema marginatum, arthrits , chorea and subcutaneous nodules. what is the tx?

what is the causeitive organism?

Back 412

RF

tx benathane Pen G
anti-epileptics for chorea
salicylates for arthrits
codeine for pain

groupA strep

Front 413

kid with n/v and sensitivity to light and noise
photophobia
flash of light seen(aura)
dx?
initial tx?
tx / prophylaxis?

Back 413

migraine

reassurance and tylenol or nsaid

sumatriptan/ergotamine

Front 414

oligurea with midline mass in lower abd
dx?
next best step?
tx?

Back 414

posterior urethral valve obst

do VCUG

decompress bladder

Front 415

prominent jaw, long ears, large testicles and mr
in kid
dx?

Back 415

fragile x

Front 416

meduloblastoma where does it effect?

Back 416

infratentorial tumor

cerebellar vermis

Front 417

what is the tx of SCFE in a obease teenager with hip pain?

Back 417

surgery

Front 418

wrinkled paper appearance and erlenmeyer flask deformity of distal femur

what is the dx?

Back 418

gauchers

beta glucosidase diff

Front 419

umbilical hernia when do you not opperate?

Back 419

when its less that 1 yr age.. beyond that surgery

Front 420

when do you do surgery in an umbilical hernia?

Back 420

age 3
grater than 2cm
stangulated

Front 421

umbilical stump infection in a newborn that did not have sterile procedure what infection will they have?

Back 421

tetnus

they will have spasm and hypertonicity

Front 422

what if you had a pt they were unconcious and have hemi paresis
dx?

Back 422

Todds paralysis usualy due to seizure

Front 423

macrocytic anemia + pure red cell aplasia
tri phalangial thumbs
what is the dx?

what is the presentation?

Back 423

Diamond black fan synd

defective erythroid progenitor cells which results in apoptosis.

Front 424

a kid characterized by fever and pharyngitis and sandpaper like rash, strawberry tongue.
dx?
tx?

Back 424

Scarlet fever

Penicillin V

Front 425

if you have a kid with white eye reflex, what is the next stage in magnagement?

Back 425

referral to an ophthalmologist

Front 426

recurrent upper resp tract infections
bilateral nasal polyps
what must be ruled out?

Back 426

cystic fibrosis

Front 427

a kid with AD disease
blue sclerae
multiple fractures
limb deformity
intrauterine growth retardation
what is the dx?
what is the defect?

Back 427

the dx is osteogenisis Imperfecta

defect:defect in type 1 collagen

Front 428

the deficiency of what vitamin can cause megaloblastic anemia
glossitis
and neural tube defects
???

Back 428

Folic acid

Front 429

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

Back 429

Friedreich Ataxia

Front 430

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

Back 430

Friedreich Ataxia
it is a spino-cerebellar ataxia

Front 431

what is nurse maids elbow and how is it treated?;

Back 431

subluxed radial head

rotating the hand and forearm to a supinated position with pressure over the radial head usually reduces the annular ligament with audible click

Front 432

what dz has rash on abdomen that is evanescent with red haloes

and has eosinophils in the skin ??

Back 432

Erythema toxicum

no tx needed it resolves on its own

Front 433

a premature kid with central cynosis
nasal flaring and grunting
nasal o2 does not improve cynosis
fine reticular granularity in lower lobes
dx?]
tx?

Back 433

hyaline membrane disease

mechanical ventilation and surfactant administration(alprostadil)

Front 434

a kid has loud inspiratory sound while coughing

flue like sxs
dx?
tx?

Back 434

Bordetella pertussis

Erythromcyin for 14 days

Front 435

a kid who becomes cynotic and sob when feeding but becomes pink when he cries

dx?
first step in management?

Back 435

choanal atresia

place an oral airway and lavage feeding

repair obst with surgery

Front 436

what is the difference between hypothyroidism and beckwith weiderman syndrome?

Back 436

BWS- omphalocele

Hypothyroidism- umbilical hernia

Front 437

first feeding causes choking and inbility to pass catheter into the stomach?

Back 437

Tracheoesophageal Fistula

Front 438

a 4 month withjerky movements
ash leaf spots on trunk(hypopigmented)
cortical tubers
what is the best drug avalible for infantile spasms?

Back 438

IM ACTH

Front 439

exclusively breast fed kids need what suplimentation?

Back 439

Iron

thats why we give iron fortified milk

given even more so if premature

Front 440

a kid has delayed relaxation of hand, temporal wasting and upper lip (inverted v)
dx?

Back 440

Myotonic muscular dystorphy

Front 441

boy with lid retraction and paralysis of upward and downward gaze and poor pupillary reaction to light...what is the dx?

Back 441

Parinauds syndrome


pinealoma

Front 442

what is the first step in management of a infant with suspected congenital diaphragmatic hernia?

Back 442

placement of an orogastric tube this alows bowel compression and sucction and allows the lung to expand

Front 443

what is the next step in a kid with septic joint?

Back 443

immediate drainage

even a 4 hr delay can lead to avascular necorsis of femoral head

Front 444

HSP is a IgA mediated vasculits of small vessels
you see arthralgia
rash in lower extermities
renal disease
what is the immunoglobulin associated with it?
what condition is associated with it?

Back 444

IgA mediated Vasculits

intusuception

Front 445

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

Back 445

Rubella

Front 446

a pt comes with becks triad
hypotension
elevated jvp
muffled heart sounds
dx?
tx?

Back 446

pericardial tamponade

Pericardiocynthesis

insert a bore needle and releve blood and send pt to OR for pericardial window

Front 447

a kid with an injury to shoulder and tore his rotator cuff. what will they not be able to do ?
what are the muscles of the rotator cuff?

Back 447

they will not be able to lower the arm smoothly from 90 degree positon

supr/infra spinatous, teres minor and subscapularis.

Front 448

how do you manage a duodenal hematoma ?

Back 448

ng suction and give parenteral nutrition

Front 449

post gastrectomy if some one has malabsorbtion how do you tx it?

Back 449

smaller meals

if it presists then octreotide
if that fails then reconstructive surgery

Front 450

how do you manage a kid that comes in with collection of fluid in the tunica vaginalis and when looked at with a light it transilluminates?

Back 450

observe till 1 yr of age and if it still precists then surgery

Front 451

if there is hypotension and pneumothorax what is the first thing you do?

Back 451

the first thing you do is you insert a chest tube..
the hypotension may be due to the pneumothorax.

Front 452

the ct of a pt that just got into a car accident shows numerous min punctate hemorrages with blurring of the grey white interface. what is the dx?

Back 452

diffuse axonal injury

Front 453

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

Back 453

Abdominal ct to look for renal colic

Front 454

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

Back 454

Abdominal ct to look for renal colic

if pregnant you can do u/s

Front 455

if the pt needs fluids and there is no way to get the IV in then the next step for kids?
adults?

Back 455

for kids interosseous membrane cannulation


for adults saphenous vein cutdown

Front 456

a pt presents with pluretic chest pain, tachypnea dyspnea and hemoptysis
what is the dx?
how do you dx?
tx?

Back 456

Pulmonary Embolus
spiral ct
Heparin

Front 457

how do you treat a hair line fracture found in a athelete due to running?

Back 457

rest
analgesisa
hard soled shoe

Front 458

if a pt has an injury and he was given iv fluids and it did not raise his bp then suspect abdominal injury.
what is the next step in management?

Back 458

Emergent exploratory laprotomy is indicated

Front 459

a pt who is hemodynamicaly unsable and had a u/s in wich the FAST showed blood what is the next step?

Back 459

Laprotomy

Front 460

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 460

central cord syndrome

Front 461

a pt with loss of motor fxn below the lession and a loss of pain and temprature on both sides below the lesion. what is the dx?

Back 461

Anterior cord syndrome

Front 462

what are the sxs of cauda equina syndrome?

Back 462

paraplegia and sensory loss
urinary and fecal incontinence

Front 463

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

Back 463

Legg calve perhesis

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

Front 464

whip lash leading to cape like injury?

Back 464

syringomylea

Front 465

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

Back 465

Developmental dysplasia of hip

dx on u/s in pts less than 4 months

pavlik harness and spica cast

Front 466

a pt comes with meniscal injury what is the next thing you do?

Back 466

mri and arthroscopy

Front 467

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

Back 467

Fluphenazine and Haloperidol

Front 468

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

Back 468

Alprazolam bc it is short acting benzodiazepine that when stopped has withdrawal sxs of genralized tonic clonic seizures

Front 469

Name 2 conditions that you treat a pt against their will?

Back 469

Meningits and TB.

you treat a pt against their will if there is potential for harming others if they were not treated.

Front 470

what is the inital step in management of anorexia nervosa?

Back 470

hospitilization

correction of electrolyte abnormalities.

Front 471

a pts comes to you and says hes having flashbacks.
dx?
tx?
what should you avoid?

Back 471

PTSD

Paroxetine

avoid benzodiazapines like lorazepam because they are associated with substance abuse.

Front 472

a pt has stage fright and comes to see you about it what is the tx of choice?
what if he was having stage fright what would be the tx of choice?

Back 472

the prevention and maintenance of social phobia is assertive training ( cognitive behavioral psychotherapy) and SSRI (paroxitine)

if the pt was having an attack of stage fright now we give him beta blockers to help with peripheral sxs of anxiety.

Front 473

a young female that meets the criteria of anorexia nervosa but has normal menses. what is the dx?

Back 473

Eating disorder not otherwise specified.

Front 474

what is the bulimia?

Back 474

binge eating with fellings of guilt and disgust and compensatory behaviour( vomit, laxitive)

Front 475

what is anorexia nervosa?

Back 475

1) body wt 15% below normal
2) amenorrhea for 3 months
3) distortion of body image
4) fear of wt gain.


Emaciation and lanugo.

Front 476

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 476

Intermittent explosive disorder

low 5-HIAA in their csf

Front 477

how is catatonia treated?

Back 477

loazepam (benzo's are the most benifical and if they fail ECT)

Front 478

alzheimers dementia what are the sxs?

Back 478

Apraxia- difficulty with activities
Aphasia- diff with language
agnosia- diff with recognizing objects
and disturbed executive fxning.

Front 479

what is the triad of normal pressure hydrocephalus?

Back 479

wet/ wacky/ wobbly

urinary incont
dementia
aataxia

Front 480

antidepresants:
a) dep meds cause sexual side effects what do you switch to?

b) dep pt complains of insomnia what drug is good?

Back 480

a) bupropion has the least sexual se

b) tarazodone is useful in pts with insomnia.

Front 481

a kid comes with hypo-pigmented lessions(ashen leaf spots
primary bone tumor
rhabdomyoma
and renal cell ca
what is the dx?
tx?

Back 481

Tuberous Sclerosis


Sircolimus

Front 482

a kid comes with precoccous puberty
periosteal fibrosis
cafe au lait
dx?

Back 482

mcunne albright syndrome

Front 483

a pt with lower extremity weakness esp on walking or standing
better with sitting and leaning forward
dx?
tx?

Back 483

spinal stenosis

physical therapy

Front 484

saddle anasthesia
dx?
tx?

Back 484

cauda equina syndrom

physical therapy

Front 485

peri anus anesthesia
dx?

Back 485

connus medularis compression

Front 486

what does the choroid plexus need to make csf?

Back 486

Carbonic Anhydrase
and vit A

Front 487

psammoma bodies
seen in what conditions?

Back 487

papillary ca of thyroid

seminoma of ovary

meningioma

mesothilioma