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309 Cards in this Set

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AZACYTIDINE

1/ RX 4 WHAT CONDITION?
2/ HOW IT WORKS?
3/ AE?
1/ (MDS) MYELODYSPLASTIC SYNDROME.
2/ INHIBITING METHYLATION OF DNA.
3/ MYELOSUPPRESSION , N & V.
1/ MOST COMMON CAUSE OF THROMBOPHILIA( HYPERCOAGULABILITY)
FACTOR V LEIDEN MUTATION. RESISTANCE OF FACTOR V TO INACTIVATION BY PROTEIN C.
PT COMES WITH THE SKIN NECROSIS AFTER WARFARIN TREATMENT. WHAT IS THE MOST LIKELY DX?
PROTEIN C DEFICIENCY. PROTEIN C IS A NATURAL VIT-K DEPENDENT ANTICOAGULANT.
aPTT DOES NOT RISE AFTER HEPARIN.?
ANTITHROMBIN 111 DEFICIENCY.
Sx OF PCP (PHENCYCLIDINE INTOXICATION?
mnemonic. RED DANES
R= Rage
E=Erythema (redness of the skin)
D=Dialated Pupil
D=Delusions.
A=Amnesia.
N=Nystagmus ** vertical**
E=Excitation & skin dryness.
OCP AND HTN
Pt taking OCP, and noted to have high blood pressure should discontinue the pills and have their blood pressure rechecked at a later date.
1) WHAT IS DDI?

4)DRUG
Didanosine,NUCLEOSIDE ANALOGUE OF ADENOSINE. (Reverse Transcriptase Inhibitor) Effective against HIV, Used with HAART.
)MECHANISM OF ACTION DDI?
Inhibit viral reverse transcriptase by competing with dATP.
3) COMMON SE OF DDI?
Diarrhea, N & V, rash, Abd pain,fever. 21%- 26% peripheral neuropathy.
Rarely observed serious SE of DDI?
Pancrititis and Optic neuritis.

Alcohol can exacerbate DDI toxicity.
Drugs interact with DDI?
Allopurinol.
Koilocytosis on Pap smear?
Human Papiloma virus.
Most common STD?
C. trachomatis. Rx Doxycicline or Azithromycin.
When should you intubate a patient.?
1) CO2 is >50mmHg or O2 is <50 mmHg +pH < 7.3 .

2) Pt become too tired (using accessory muscles.
MMR VACCINATION IS CI in Pt with ?
1) current moderate or severe febrile illness.
2)anaphylaxis to neomycin or gelatin.
3) severe immunodeficiency.
4) Thrombocytohenia after 1st dose of MMR.
5) Recent administration of Immunoglobulin.
6) Pregnancy.
MMR is not contra indicated?
1) pt with positive ppd.
2) breast feeding.
3) immunodeficient family member or houaehold contact.
4) asymptomatic hiv Pt.
5) Anaphalaxis to eggs.
In pt with thyroid cancer in remission, dose of levothyroxin ?
Is adjusted to supress the TSH below normal range. usually .1 to 0.3 uU/mL
ALCOHOLIC MAN, CONFUSION,CONFABULATION AND AGITATION. PARALYSIS OF EXTRAOCULAR MUSCLES AND GAIT ATAXIA, NYSTAGMUS?
WERNICKE'S ENCEPHALOPATHY CAUSED BY A DEFICIENCY OF THIAMINE.
Shy-Drager syndrome? (Also called multiple system atrophy with orthostatic hypotension.

Prognosis?
Parkinson diaease with orthostatic hypotension as the main finding.

Die within 7 to 10 years after the onset of symptoms. common couse of death due to respiratory problems.
What are those drugs?
Tolterodine
Oxybutynin
trospium,
darifenacin?

2. Rx for?
3 SE?
Muscarinic receptor antagonist.

2) Rx for over active bladder( urge incotinence)
3) Dry eyes, dry mouth, constipation.
GTT GastationaL transient thyrotoxicosis occur ?
During 8-11 wks of gestation. due to increase level of hCG,which has thyroid stimulating properties.
Chelation therapy for lead intoxication,blood level should be?
blood lead level should be > 44mg/dL
patient with ciliac sprue could get what type o CA?
Intestina T cell lymphoma.
Rx for lead level > 45 mg/dL?
IV INFUSION EDTA or ORAL DMSA(dimecaprol)
Rx for Alzheimers dementia.?
Acetylcholinesterase inhibitors.
1) Donepezil
2) Tacrine.
Best therapy for oral candidiasis?
Nystatin suspension or clotrimazole troches.
Drugs that could cause SIADH?
Carbamazepine, cyclophosphamide, SSRI.
Brainstem leasions usually involve?
Lesion of the thalamus and cortex usually associated with?
Sensory loss on one half of the face and contralateral half of the body.

Sensory loss one half of the face and same half of the body.
medial medullary syndrome?
due to occlusion of the vertibral artery or one of its branches.pt will show contralateral paralysis of the arm and leg. contrlateral loss of tactile and vibratery, position sense, tongue deviated to the injured side.
Wallenberg syndrome?
Lesion of the lateral medulla, ( due to occlusion of the PICA,BRANCH OF THE VERTEBRAL ARTERY)
ipsilateral Horner syndrom, loss of pain,temp of the face, weakness of the palate,pharynx and vocal cords and cerebella ataxia.Contralateral deficit in pain and temp in the limbs and torso.
Hypertrophic interventricular septum?
50% autosomal dominant.
lithium during pregnancy?
neonate might born with atrialized rt ventricle.
rapid and inexpensive toxcology screen for pt?
Urine immunoassay qualititave screen.
Rx for H pylori infection if pt is symtomatic?

If pt is allergic to penicillin?
if Sx recurs again?
PPI(pantoprazole), clarythromycin,amoxicillin for 2 wks.
use metronidazole instead of amoxy.

Add quadruple therapy with panto,bismuth,tetracycline and metronidazole.
older Women with difficulty to stand up from chair pt has heliotrope rash and gottron papules. what is the best initial Dx test? What is the most accurate test?
1) Aldolase and CPK
2) ELECTROMYOGRAM.
Aldolase is released from damaged skeletal muscles. ^ in inflammatory myopathies such as polymyositis, dermatomyositis.
Criteria for using corticosteroid on a pt infected with PCP?.
In addition to TMP-SMX, we should treat the pt with corticosteroid if the pt's alveolar to arterial gradient >35 mmHg or PaO2 (arterial oxyen tension is less than 70 mmHg.
Entacapone?
mechanism of action?
Rx?
COMT inhibitor.
prolong the effect of levodopa.
parkinson's disease.
pramipexole?
Rx?
Dopamine agonist.
parkinson's disease.
premalignant condition for SCC?
ACTINIC KERATOSIS.
Pt with rheumatoid arthritis who does not respond to methotrexate and prednisone. what is the next best step?
add infliximab.(anticytokine drug)
anticytokine drugs?

what screening you should do prior to adding this drug?
infliximab, etanercept.

screen for latent tb by doing ppd skin testing.
Phototherapy should start if unconjugated bilirubin is over?

exchang transfusion should start
over 15 mg/dl


If phototherapy has failed and unconjugated bilirubin over 20 mg/dl.
Ranson criteria at admission?
"GALAW"
G= BLOOD GLUCOSE > 10 mmol/l or > 200 mg /dl
A=AST > 250 IU/L
L= LDH > 350 IU/L
A= AGE > 55 Y/O
W= WBC > 16000 cells /mm3

This is applicable only to non gallestone pancreatitis. Gallestone pancreatitis parameter is G: 12.2 or >220 mg/dl.
A: >70 y/o
LDH> 400

AST> 250

WBC > 18000 cells/cumm3

If the score >3 severe pancreatitis is likely if < 3 severe panceatitis unlikely.
Ranson criteria at 48 hours.
" C HOBBS"
C= Serum Calcium < 2 mmol/l or < 8mg/dl
H= Hematocrit fall over 10%
O= PO2 < 60 mmHg
B=BUN increase 1.8 mmol/l or 5 mg/dl after IV hydration.
B= base deficit (negative base excess) > 4 mEq/L
S= sequstration of fluid over 6 litrers.
In gallestone pancreatitis. B should be > 5 mEq /L, S= should be > 4 L.
Alternative to Ranson criteria,to identify the severity of pancreatitis.
1) APACHEII SCORE.
2) Organ failure
3) Substantial pancreatic necrosis > 30% according to contrast enhanced CT (glandular necrosis)
Type of Methemoglobinemea?
1/ Acquired
2/ Hereditary.
Common drugs that cause methemoglobinemia?
1) Phenazopyridine( Pyridium) given for urinary tract pain. urin will turn in to orange color.
2) Benzocaine
3) Dapsone
Treatment for methemoglobinemia?
Methylene blue. Sodium nitrite induces methemoglobinemia.
Antidote for Diphenoxylate toxicity?
Naloxone(Narcan) . Diphenoxylate is a synthetic opiate.
SE of Ketamine.
salivation,^ bronchial secretion,^ intra cranial pressure, ^ intra occular pressure, nystagmus, random limb movement.vomiting.
Treatment for Colorado tick fever.
symptomatic ,Fever is a self limited, pt usually present with retro-orbital headache, and photophobia. recovery occurs within 3 wks.
1)Causative agent of Lyme disease.

2) treatment
1) Borrelia burgdorferi.

2) Doxycycline or tetracycline. Amoxy,Pennicillin, erythro given for pt's who cannot tolerate tetra.
1)Etiologic agent of Rocky mountain spotted fever.

2)Treatment.
1)Rickettsia rickettsii

2) Tetracycline and Chloramphenicol should be initiated.should not be delayed pending lab confirmation.
Best medication to give for a combative alcoholic pt to facilitate evaluation and allow monitoring his baseline mentation.
Halloperidol. Droperidol is more sedating and shorter duration of effect.

SE of Droperidol: QT prolongation, torsade de pointes
Cause of fever >101.9F associated with while receiving blood transfusion.

appropriate Mx?
1) Most often, due to antileukocyte or antplatelet antibodies.However when a febrile reaction occures,it could be due to 1st sign of hemolytic reaction.
Mx: Stop the transfusion and treat with crystaloid fluid.
d
Discribe functional impairment.
1) Spinal cord transection at C5?
2) C6?
3) C7?
4C8
1) C5:inability to shrug the shoulder and loss of sensation below the clavicle.
2) C6:inability to flexion at elbow and loss of thumb sensation.
3) C7:inability to extend at elbow and loss of index finger sensation.
4) C8: inability to flex fingers and loss of little finger sensation.
Antidote following chemical warfare agent Sarin?
Sarin considered as a Nerve agent. Tx involved decontamination, Atrophin,pralidoxime chloride and supportive care.
1) Good gas exchange have oxygen saturation?

2) Hypoxia is considered when the oxygen saturation falls below?

3) Things that could interfere with pulse oxymetry reading?
1) Between 97% and 100%
2) 95%
3) Hypotension,Hypothermia, Vasoactive drugs and Ambient light.
1) Another name given for Croup.
2) Croup peak incidence at what age?
3) Due to what organisms?
4)Dx
5)Rx
1) Laryngotracheobronchitis.
2)At age of 21 to 24 months. common < 3 years.
3) Parainfluensa V>Influenza > RSV >
4) Usually made on the basis of clinical findings, hoarse voice,barky cough and stridor-> respiratory distress. AP neck Xray-> Steeple sign.
5) Humidified air, Iv or IM steroids, nebulized racemic epinephrine.
1) In children,most common cause of priapism?
2) Priapism 2ry to sickle treated with.
3) treatment for priapism due to coporal injection therapy(phentalomine for impotence)
4) non reversible causes of priapism. Tx?
1) Sickle cell disease.
2) subcutanous terbutaline,hydration, exchange transfusion.
3) coporal aspiration of blood->irrigation with saline or alfa adrenergic agent(phenylephrine)
4) high spinal cord lesion,medication,tx ->sc terbutaline, coporal aspiration,phenylphrine instillation,heparin irrigation,if necessary shunt surgery.
Dx of acute otitis media-> most acurate physical finding.
lack of movement of the tympanic membrane with insufflation.
Pt with thyroid storm-> drugs that used to block the release of additional stored thyroid hormone?

2) Pt with a h/o iodine allergies, which drug can be used for thyroid storm?
3) Mx of thyroid storm
4) complication?
1) potassium iodide 5 drops po q6h or Lugol's solution 4-8 dropd po q6hr. Should administer 1hr after administration of propylthyouracil.
2) Lithium can be used in place of iodide.
3) proppylthyouracil or methimazole-> after 1hr-> potassium iodide,propranol if pt asthematic cardioselective agent atenalol or metoprolol.Hydrocortisone, acetaminophene.
4) CHF and pulmonary edema.
1)Another name for Schmidt's syndrome?
2) features of this Syndrome?
1) Autoimmune polyendocrine syndrome type2 ( APS-II).
2) a)Addison's disease.
b)Hypothyroidism.
c)Diabetes Mellitus type1.
less common. Hypogonadism and vitiligo. women>men
1)Diagnosis of PBC?
2) Associated other disorder?
1) ^ ALP, ^ GGT,^ serum bilirubin,^ Anti mitochondrial antibody 95%,^ anti nuclea and anti smooth muscle antibodies in 70% cases.^ed ALP in the abseence of ^ AMA, ANA,ASA, Serum Immunoglobulin and liver biopsy should be indicated.
2) Thyroid dysfunction: graves disease and hashimoto thyroiditis,, sjogren's syndrome, rheumatic disease, ulcerative colitis, thrombocytopenia, hemolytic anemia,celiac diaease, osteoporosis.
HONKC ?

2) HONKC causes?

3) serum glucose level^ in which one HONKC OR DKA?
1) HYPEROSMOTIC NON-KETOTIC COMA.
2) Usually precipitated by infection,MI,acute illness.
3) Serum glucose level ^ in HONKC>DKA. USUALLY OVER 600 mg/dl
1) drug of choice for immunocompromised pt with invasive aspergillosis?
Voriconazole.
1) Voriconazole mecahnism of action?

2)Adverse effects of Voriconazole?
1) inhibit microsomal cytochrome p450(CYP) enzymes.v biosynthesis of ergosterol.
2) ^ creatinine, distal renal tubular acidosis, hypokalemia, hepatotoxicity, prolong QT, transient visual disturbance.
Felty's syndrome defined by---?
Rheumatoid arthritis, splenomegaly ( causing anemia and thrombocytopenia), low white blood cell count.-> recurrent infection.effects less than 1% pt with rheumatoid arthritis.
Most common and most aggressive primary malignant brain tumor in humans?
Glioblastoma multiform.
Test to r/o ITP?
1) CBC
2)Examination of peripheral smear.
3)HIV Antibody testing.
4) Proviral DNA PCR Assay
5) CT (ABD, SPLEEN)

CONSULTING WITH HEMATOLOGIST.
Primary and 2ry causes of ITP?
1ry cause due to abnormal autoantibody (Ig G) bind to the platlet membrane.

2ry causes. due to HIV, collagen vascular disease ( SLE) , CLL, NHL,Drug induced (Heparin, quinin,quinidine,sulfonamide, H. Pylori infection,toxins(ethonol), Hep C, Herpes,TB and Hodgkin infection.
Rx for ITP?
1) Glucocorticoid (Oral Prednisone, Dexamethasone or IV Methylprednisolone.
2) IVIG
3) If pt is Rho (D)-positive, Rho(D) Immunoglobulin (Anti D can be used) however should not be used if pt Hemoglobin concentration less than 8 g/dl.
4) Treat H Pylori infection if positive.
5) If no improvement after 6 month-> can be used a course of immunosupprsssive therapy(rituximab,cyclosporine,azathyoprin) or Danazol-> still no improvement surgical or laporoscopic splenectomy. Prior to surgery > 2 years should be immunized with pneumococcal and meningiococcal vaccine. If elective surgery should be immunized with H influenza type b vaccine 2 wks before surgery.
1)Retrobulbar hemorrhage Clinical features?

2) Treatment for RH?
1) Decreased vision, orbital pain,diplopia, reduction of ocular motility, signs upon examination: proptosis, eyelid ecchymosisi,decrease visual
acuity,opthalmoplagia,increase
intraoccular pressure,fundoscopy-> pale optic disk and cherry red spot.
2) delay in surgery < 2hs could result in permanent visual loss.Rx include osmotic agent ( iv manitol) reduce vetrous body. Carbonic anhydrase inhibiters(acetazolamide) reduce intraoccular pressure, steroid therapy-> if no improvement in visual acuity in 30 min lateral canthotomy and inferior cantholysis.
A man after being involved in an altercation. c/o rt eye and facial pain, on examination sluggish rt pupil. decrease visual acuity, photophobia due to what condition?
Acute traumatic iritis.
1) Drug which rapidly counteracts the cardiac of hyperkalemia?
1)Calcium gluconate.

Definitive Rx for hyperkalemia -> stimulation renal excreation of potassium from body ( Furosemide) and gastrointestinal elimination with cation exchange resins.
slit lamp examination on pt with eye pain.

fluoreascein uptake

1) Dendritic pattern is due to.
2) Central circular abrasion due to.
3)multiple linear abrations due to.
4)multiple punctate uptake lesions due to
1) Herpes simplex keratitis. steroids are CI.
2) prolong contact lense use.Broad spectrum antibiatic that covers Gm -ve organism (Pseudomonas) should be used.
3) Due to Foreing Body.Lid eversion to remove offending agent.
4) Due to UV light or welding. Uncomplicated corneal abbration should be treated with mydriatic agent, antibiotic ointment and analgesics.
1)Hyphema definition?

2) Mx
1) collection of blood in the anterior chamber of the eye.
2) Elevation of the head,
Atrophin 1% drops.
intravenous mannitol if intraoccular pressure > 30 mmhg.
Narcotic pain medication. Acetazolamide should not be used in sickle cell disease patient it will reduce the ph of anterior chamber-> leads to sickling of the rbc-> block the trabecular outflow -> increase the eye pressure.
1)Acutely ill, 7y/o child present with fever 102.2F,headache, macularpapular rash on wrist,palm and lower leg. He complains of myalgia particularly in the lower extremity. Dx?
2) Rx?
1) Rocky mountain spotted fever.
2) Oral tetra or Chloramphenicol.
In this case as the child is <8y/o use chloramphenicol iv .
Difference between heat stroke and heat exhaustion.?
Heat stroke you see CNS dysfunctions.(irritability,bizzhare behavior,combativeness, halucinations,seizures and coma. usually temp > 104.9F.
1)What would you do if you see a patient with clotted external hemodialysis shunt.
Shuld not be irrigated patient end up with pulmonary embolism. Clot removal should be performed in the operating room by a vascular surgeon.
1) Bullous myringitis
a) causative organisms.
b) Rx
1) Viral and Mycoplasma pneumoniae.
2) Erythromycin.
Otitis externa. Rx
Irrigation and debridement.along with application of topical hydrocortizone-neomycine-polymyxin or acetic acid drops.
suppurative otitis media is caused by?
Strep pneumoniae, H. influenzae, Moraxella catarrhalis.
Post traumatic perichronditis usually caused by due to what organism?
Pseudomonas.
Furunculosis, Organism?
Stapylococcus.
Hemodynamically unstable pt with hypothermia. body temp < 90 F , Rx?
foley lavage with warm water,gastric lavage with warm water, peritonial lavage with warm water.cardiopulmonary bypass. Bair hugger circulating hot air blanket.
Conditions that increase the systolic murmur during valsalva maneuver?
Hypertrophic cardiomyopathy.

and Mitral valve prolapse.
ACE inhibitor indicated for what type of valvular lesion?
Aortic regurgitation,
Mitral regurgitation
VSD.
1) murmurs which (valvular lesions) get worse due to hand grip technique?

2) Murmurs which gets better due to hand grip?
1) AR,MR, VSD
( iF USED aMYL NITRATE IT HAS OPPOSIT EFFECT OF THE same murmurs mentioned here decrease the intensity of the murmur..
2) AS,HOCM,MVP.
1)Holosystolic murmur, both S1 and S2 obscured,murmur heard best at the apex and radiate to axilla.?

2) What is the most common complain of this patiet?
3) Best initial diagnostic test?

4) Best initial therapy

5) In what condition, surgery would be the best answer to this pt?
1)Mitral regurgitation.

2) Despnea on exertion.

3) TEE.
4) ACE inhibitors, ARB'S and nifidipine.
5)If ejection fraction drops <60% or left ventricular systolic diameter goes above 45mm.
1)Murmur: diastolic rumble after opening snap.
2) most common cause of this murmur?
3) What will happen to the murmur during expiration?
4) best initial therapy?
5) Sign and Sx present with this patient.
6) Best effective therapy?
MS
2) Rheumatic fever.
3) ^.
4) Diuretics.
5) Dysphagia, Horseness,Atrial fibrillation.
6) Baloon valvuloplasty. Best therapy for pregnant women.
1)Murmur: Diastolic decresendo murmur heard best at the left sternal border.
2) Common and rare causes of this murmur?
3) Best initial test?
4)Most accurate tes?
5) Best initial therapy?
6) When do you consider surgery as an option?
1) AR.
2) HTN, Rheumatic heart disease,endocarditis, cystic medial necrosis, Rare causes are Marfan syndrome, ankylosing spondylosis, syphillis, reactive arthritis(Reiter's syndrome.)
3) TEE.
4)Lt heart catheratization.
5) ACE, ARBs, Nifidipine, loop diuretics.
6) EF <55% OR late systolic diameter >55mm
1)S3 gallop is associated with?
1) Due to fluid overload ( CHF, mitral regurgation) can be normal in patient under the age of 30 years.
1)Holosystolic murmur at the Lt lower sternal border.
2) Best initial Dx testing.
VSD.
2) echocardiograph.
1) Causes of wide splitting of S2.( Delayed P2)
1) RBBB, , Pulmonic stenosis, Rt ventricular hypertrophy, Pulmonary Hypertension.
1) Paradoxical splitting of S2( A2 delayed) causes?
1) LBBB,,AS, LVH, HTN.
1) Fixed splitting of S2.
1) ASD.
1) Besides ischemia what are the other causes of Dialated cardiomyopathy?
1) Alcohol, Adriamycin, radiation, Chaga's disease. Rx: ACE inhibiter, beta blocker, spiranolactone.
1) Hypertrophic cardiomyopathy may present with ?
1) shortness of breath on exertion and S4 gallop.
Rx: for Hypertrophic cardiomyopathy.
beta blocker and diuretics.
Papillitis?
Painful inflammatory process that tends to effect unilateral central vision early in the course, with the total loss of vision late. Eg: multiple sclerosis.
1) Condyloma lata?

2) Condyloma acuminata?
1) Highly infectious lesion seen in patients with secondary syphilis. Usually present with large painless,fleshy,pearly gray pale lesions..

2) Genital warts caused by papilloma virus.
1) Chancroid?
1) Painful genital ulceration . Regional bubo formation often accompanies the ulcerated lesion. caused by H. ducreyi.
Antidote for Arsenic ?
Dimercaprol
1) Reflex sympathetic dystrophy?

2) Rx.
1) syndrome of pain,autonomic dysfunction,resticted motion,skin changes, which occur after trauma.pulse and capillary refill are normal.
2) Anti inflammatory, neuropathic pain medication( gabapentine,phenytoin),mobilization,physiotherapy.
Three organisms spread by aerosolized particles?
Vericella, measles, and TB.

MENINGIOCOCCAL MENINGITIS IS SPREAD BY RESPIRATORY DROPLETS.
ECG S1Q3T3 SEEN IN WHICH TYPE OF PATIENTS.
PULMONARY EMBOLISM.(ONLY A SMALL % OF PEOPLE WILL SHOW THIS ON ECG.Majority of pt with pulmonary embolism, ecg shows tachycardia with rt heart strain.In rt heart strain you see T inversion in V1,V2,V3.
Drug of choice for C difficile enterocolitis.
Metronidazole.
If you see a chronic renal failure pt with serum K-> 7.1 mEq/L and QRS interval 0.14msec, what is the DOC.
Intravenous calcium chloride.intravenous calcium stabilized the myocardium and works within 1 to 5 min. Sodium bicarbonate takes 10 to 15 min. IV glucose/insuline take upto 30 min.Kayexalate takes upto 1hr to become effective.( Calcium chloride act faster than calcium gluconate)
Does prolong sitting associated with hemorrhoid?

conditions likely to be associated with development of hemorrhoids?
no.

Chronic constipation, chronic liver disease,pregnancy,tumor of the descending colon.
T or F re: Cl diff colitis:

The more severe the presentation, less likely the diarrhea present.
True.
common drug causing Cl diff colitis.
Clindamycin and fluoroquinolone.
Infectivity period of VZV ?
48 hrs before onset of rash until all lesions are crusted over.
prevention strategies of tick borne infection?
Removing tick ASAP,
Wearing light colored clotheslong sleeved shirt, long pants tucked into socks.
applying DEET.
Treating yard with acaricide.
Which test should use to confirm the positive ELISA in Lyme disease.
western blot.
Best propylactic antibiotic for acute pancreatitis.
Imipenem monotherapy or Fluoroquinolone + metranidazole.
Mx for gallstone pancreatitis.
NPO, IV fluids, meperidine for pain, ERCP with papilotomy if the CBD is obstructed or if +ve evidence of cholangitis. If gallstone has passed, cholycystectomy once the pt is stable for surgery.
Pancriatic D cells produced what?
somatostatin.
causes of acute pancrititis.
GET SMASH'D
Gallstones
Ethanol
Trauma
Steroid
Mumps
Auto immune
Scropion bites
Hyperlipidemia
Drugs.
Middle aged man present with hepatitis, bronzing of the skin, diabetes mellitus, arthritis. ?

What is the Tx?
Hereditary Hemochromatosis. ( Autosomal recessive)

Dx made with ^ iron saturation 60% in male, 50% in female. and HFE gene.

Tx. Phlebotomy and deferoxamine, genetic counselling.
Middle aged women c/o itching. Xanthalsama may be fond on examination.?

What are the lab test?

Mx?
Primary biliary cirrhosis.

2) ^ Alk phosphatase level, bilirubin may be normal. ^ Ig M level in the blood, +ve(95%) AMA ( anti mitochondrial antibody). most accurate liver biopsy.

Mx: Ursodeoxycholic acid.
What disese you may be seen in patients who have.

Autoimmune disorder, chronic pancrititis,IBD( chrons and UC) and sarcoidosis?

TESTS?

Tx?
1) PSC (PRIMARY SCLEROSING CHOLANGITIS.

ERCP beading of the biliary system,
+ve ASMA ( Antismooth muscle Ab).

+ve ANCA.( ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY)

Tx: ursodeoxycholic acid ,cholestyramine for itcheness, fatsoluable vitamins,
1)Causes Serum to ascites albumin gradient > 1.1 g/dL ( serum ascite - albumin ascite).

Causes: Serum to ascite albumin gradient < 1.1 g/dL ?
cirrhosis, alcoholic hepatitis,massive hepatic metasisi,CHF, fatty liver disease,vascular occlusiosn, myxedema

2) peritoneal CA, peritoneal TB,Pancrititis,serositis,nephrotic syndrome,bowel obstruction/infarction/ perforation
Dermatitis herpetiformis associated with?

Sign and symptoms?

Dx?

Mx?
Celiac sprue.

2) malabsorption, chronic diarrhea, steatorrhea, wt loss.

3) small bowel biopsy most accurate. you see loss of villi.
antigliadin, antiendomyseal and antitissue transglutaminase antibodies (highly specific)

Gluten free diet.avoid weat,oat,rye and barley.
How to differentiate tropical sprue from celiac sprue?

Tx?
Presents in the same way as celiac disease. you find h/o pt being in the tropics, also antitissue transglutaminase antbody is negative.small bowel biopsy can show organism.

Tetra or TMP/SMX for 3 to 6 months.
Newborn child, you noticed a defect in the iris.
1) Diagnosis.

2) Additional screening we should do to this child?
1) Coloboma of the iris.

2) Should screen for CHARGE syndrome.
C-coloboma
H- Heart defects
A- Atresia of the nasal choanae.
G-growth
E-ear abnormalities.
Newborn, you noticed absence of iris.

1) Diagnosis?

2) What other condition associated with this disease.
3) Further management?
1) Aniridia
2) Wilms tumor
3) Screen for wilms tumor with Abd ULTRA SOUND every 3 months until age 8.
Cardiac abnormalities you may see in an infant of a diabetic mother. IODM?

Other abnormalities?

Lab abnormalities in IODM?
ASD, VSD, truncus arteriosus.

2) small left colon syndrome.alos ^ risk of developing diabetes and childhood obesity.

3) HYPOGLYCEMIA, HYPOCALCEMIA, HYPOMAGNESEMIA, HYPERBILURIBINEMIA, POLYCYTHEMIA.
Newborn with macrosomia, hx of birth trauma and cardiac abnormalities, best initial test?

Mx?
Blood glucose level.

2) treat with glucose and small frequent meals.
Newborn child with tachypnea, nasal grunting, intercostal retraction.
1) best initial Dx?

2) Other lab studies?

3) best initial treatment?

4) What would you do if no improvement with this treatmment?

5) most effective treatment for RDS.
1) CXR.
2) ABG, Bld culture, CBC, blood glucose, cranial ultrasound,

3) Oxygen keep SaO2 > 95%. and nasal CPAP
4) Evaluate the child for any cardiac abnormalities.
5) surfactant administration.
Newborn infant without any respiratory symptoms. present with chocking and gagging with the 1st feeding DX?

How do you confirm the Dx?

What other abnormalities we should look for?
TEF ( Tracheoesophageal fistula)

by placing the nasogastric tube. (nasogastric tube will coil in the chest.)

VACTERAL sndrome. Vertebral defect, anal atresia, cardiac abnormality, TEF, radial and renal anormalies, limb syndrome.
1) Causes for Meconium plug syndrome?

2) Causes for Maconium ileus?

3)best initial test for both?

4) Treatment for both?
1) Small left colon in IODM(infant of diabetic mother).
Hirschsprung disease.
Cystic fibrosis
Maternal drug abuse.

2) Cystic fibrosis.

3) Abd Xray.
4) Gastrografin enema.
1)Q: newborn with normal vaginal delivery w/o any compication.Upon her first feed she started vomiting gastric and billious material. on abd xray noticed double buble. Dx?

2)D/D FOR DOUBLE BUBLE SEEN ON xray?

3) Tx?
1)Duodenal atresia.

2) dudenal atresia, annular pancrease,malrotation and volvulus.

3) nasogastric decompression and surgical correction.
1)Common cause of NEC (necrotizing enterocolitis ) in newborn?

2)Initial Dx test?

3) Tx?
1) Due to premature delivery.

2) abdominal xray.( see pneumatosisi intestinalis is pathognomonic)

3) stop all feeds, decompress gut, broadspectrum antibiotics, evaluate for surgical resection.
If suspect left pneumothorax, trachea should be deviated to ?
opposite side( rt)
If collapse of the lung due to neoplasm, sputum plug or foreign body, trachea should deviate to the ?
same side.
When should you consider newborn Hyperbilirubinemia pathological?
1) When it appears 1st day of the delivery.
2) bilirubin rises > 5mg/dl/day
3) bilirubin rises > 12 mg/dl in term infant.
4 ) direct bilirubin over 2mg at any time.
5) Hyperbilirubinemia present after 2wks of life.
Pt w/ sore throat, fever,lymphadenopathy ,malaise and mild splenomagaly. What is the best initial test?

What is the most accurate test?
Monospot test. to diagnose(IM) Infectious mononucleosis.

IgM to EBV viral capsid antigen or Antibodies to EBV nuclear antigen in 3 to 4 wks.
40 y/o male present w/ headache,fever,confusion for 2 wks duration. What is the most important 2 test to order?
CSF analysis.

Herpes simplex PCR done on CSF.
Low value C peptide in Hypoglycemic pt indicate what?
Pt is abusing insulin.
High C peptide value indicate?
Endogenous insulin production e.g Insulinoma or using drugs such as sulfonylurea.
When a pt present with multiple hospital visit, unexplained hypoglycemia and high insulin level, what is the best test to order?
C-peptide level.
5 major criteria " Rheumatic fever"?

4 minor criteria. "acute rheumatic fever?
"C2 sea"
C- carditis,chorea, subcutanous nodule,erythema marginatum, arthritis.

"FEA PR"- Fever, high ESR, arthralgia, prolong PR IN ECG..

to diagnose have to have two major criteria or one major and two minor.also to confirm the dx need to do throat culture (prove the infection) or Anti streptolysin O titre.
Urinary 5HIAA (Hydroxyindoleacetic acid) is a best initial test for what condition?

Sign and sx you find in this pt with ^ 5HIAA?
Carcinoid syndrome.


cutanous flushing,diarrhoea, abdominal cramping,hypotension, tachycardia.
Risk factors or resistance to PCN include.
age > 60 years.
antibiotic previous 3 mos.
alcoholics,
immunosuppression,
multiple medicle comorbidities.
childcare or daycare exposure.
If resistace to PCN, what are the other drugs that could be resistant .
Erythro, Tetra, Ciprofloxocin.
Empiric Tx for Meningitis, if pt < 1month.

Empiric Tx for meningitis if pt 1 to 50 years old?

If over 50 y/o ?
Ampicillin + Cefotaxime

2) Ceftriaxone and Vancomycine+/- Dexamethosone.

3) In addition to above add Ampicillin to cover Listeria organism.
T/ F
If you suspect ACA stroke leg weakness is more than arm weakness.
True.
If MCA STROKE SUSPECT?
1) CONTRALATERAL ARM WEAKNESS, SENSORY LOSS, FACIAL PALSIES, APHASIA,receptive aphacia, partial loss of visual field.
In stroke patient what is the recommended blood pressure to have during reperfusion?

What is the time limit we should consider giving tpA to stroke pt. if it is not a hemorrhagic stroke.
Sys 185 mm Hg, Diastolic < 110

< 4.5 hrs.
SE OF SULFONYLUREA.
hypoglycemia, wt gain, teratogenic, SIADH,Sulfa allergies.Sulfanyluria considered as a first line oral hypoglycemic.
RU 486?

Recommended use?

SE:
4- MIFEPRESTONE.

2) < 7 WKS OF PREGNANCY.NON SURGICAL ABORTIFICANT.
3) Bleeding,Abd pain,diarrhea, fever. All women should undergo posttreatment exam around day 14.

3)
RU 486?

Recommended use?

SE:
4- MIFEPRESTONE.

2) < 7 WKS OF PREGNANCY.NON SURGICAL ABORTIFICANT.
3) Bleeding,Abd pain,diarrhea, fever. All women should undergo posttreatment exam around day 14.

3)
Physical examination findings you may see in a pt who has S1Q3T3 on EKG?
CLEAR LUNGS,NORMAL HEART.SWOLLEN LEGS AND TENDERNESS OF THE MEDIAL CALF. PULMONARY EMBOLISM.
T OR F

MVP IS ASSOCIATED WITH MITRAL REGURGITATION IN MOST CASES.
F

majority of pt has only have prolapse of the posterior valve. If both valves prolapse a/w mitral regurgitation.
T OR F

MVP IS ASSOCIATED WITH MITRAL REGURGITATION IN MOST CASES.
F

majority of pt has only have prolapse of the posterior valve. If both valves prolapse a/w mitral regurgitation.
In pt with MVP, palpitation is primarily due to what?

Sudden death in MVP pt due to ?
Due to premature ventricular contraction.Also can be caused by paroxismal ventricular tachycardia.

Malignant ventricular dysrythmia.
Classic presentation of pontine hemorrhage?
sudden onset of coma,quadriparasisi,pinpoint pupil,ataxic breathing. commonly occur in hypertensive pt.
Sinusitis, commonly associated with orbital cellulitis in children?

2) two sinuses you find at birth?

3) When do you find frontal and sphenoid sinus in children.
Ethmoid sinusitis.

2) Ethmoid and maxillary.

3) Around 6 to 7 years.
What is the immediate tx for Jellyfish attack?
Pouring vinegar to the area.
Common extra intestinal manifestation of UC AND crohns disease?
Arthritic eg: arthritis, ankylosing spondylitis, sacroilitis.

Ocular: episcleritis, uvitis.

Dermatologic. erythema nodosum, pyoderma gangrenosum.

Hepatobiliary: cholelithiasis,fatty liver, chronic active hepatitis, PSC,

Nephrolithiasis only seen in crohns disease as a result of hyperoxalurea,
Vaso-occlusive crisis usually occur in which pts?

Discribe the mechanism?
Sickle cell children.

2) Due to increased viscosity and microvascular obstruction resulting from irreversibly sickled rbc.pt typically present with pain in the back, abdomen and extremities.

in sequestration crisisi pt present with sudden onset of severe abdominal pain due to intrahepatic and intrasplenic sickling and obstruction. pt present with enlargment of liver and spleen.
Pt present with severe abd cramp,nausea witn no vomiting,frequent watery stools, 12 hrs after ingestion of improperly refrigerated poultry. what is the organism?

How to differentiate with Staph food poisoning?
Cl. perfringens.

Staph food poisoning usually occur after 6 hrs of ingestion. vomiting is very common.
Most common midfoot fracture?
Lisfranc fracture. (hyperextension of the forefoot on the mid foot, dorsal dislocation of the tarsometatarsal joint.
Acute contusion over the thigh (over 7 cm) due to trauma. pt c/o sever pain with flexion of the knee and walking. distal pulse normal.what is the best management?

Why we do this Mx?
immobilization,wrap the leg while keeping the knee in a flexed position as much as possible for 2 to 3 days.

Due to thigh contusion, pt might develop myositis ossificans.

In addition to the firm compressive bandage, it can be managed coservatively with bed rest, non wt bearing, ice pack and elevation.
T OR F

1) Central pontine myelinolysis is a complication of treatment of pts with profound life threatning hypernatremia

2) Signs and symptoms of central pontine myalinolysis?

3) other risks a/w the above condition.
1) F, It is due to the treatment of Hyponatremia.

2) Acute paralysis of all 4 limbs., dysarthria, dysphagia.confusion, delirium,

3) Alcoholism,liver disease, malnutrition.
T OR F.

Overly rapid correction of Hypernatremia can result in Central pontine myalinolysis.
1) F, Can result cerebral edema.
Difference between ADL and IADL?
1)activities of daily living. ( self care activities that person perform daily. eg. bathing,dressing, eating.

IADL, instrumental activity of daily living. Activities that are needed to live independantly, banking,taking medications, coocking.
Insulin therapy should be consided in a pt with type 2 DM ?
1) If initial A1c lever greater than 9
2) Diabetes is uncontrolled despite oral hypoglycemic therapy.
Hemorrhoid grade .

1
2
3
4
Hemorrhoid grade

1, may bleed but no protrusion.
2,protrude with defecation but reduce spontaneously.
3, protrude must be reduced by hand.
4, does not reduce.
Clinical manifestation of hypernatremia?
Altered mental status, intrcranial hemorrhage, seizure.
Abnormal(TOO LONG) PTT MAY BE DUE TO?
Disseminated intravascular coagulation (DIC)
Factor XII or Factor XI deficiency
Hemophilia A
Hemophilia B
Hypofibrinogenemia
Liver disease
Lupus anticoagulants
Malabsorption
Vitamin K deficiency
Von Willebrand's disease
^ PT(prothrombin time: time it takes for plasma of your blood to clot.11-13.5 second) may be due to ?
(prothrombin time: time it takes for plasma of your blood to clot.11-13.5 second)
The wrong dose of medication
Drinking alcohol
Taking certain over-the-counter medicines, vitamins, supplements, cold medicines, antibiotics, or other drugs
Eating a food that changes the way the blood thinning medication works in your body

Bile duct obstruction
Disseminated intravascular coagulation
Liver disease
Malabsorption
Vitamin K deficiency
Factor VII deficiency
Factor X deficiency
Factor II (prothrombin) deficiency
Factor V deficiency
Factor I (fibrinogen) deficiency
Common etiology of orbital cellulitis?

complication of orbital cellulitis.
1) Sinusitis.

2) Subperiosteal abscess, cavernous sinus thrombosis,vision loss.orbital cellulitis usually occur deep to the superficial conjunctiva therefore inflammation of conjunctiva does not occur (conjunctivitis)
Criteria for +ve Diagnostic peritoneal lavage?
Aspiration of blood > 5ml. or
100,000 / rbc/uL.
Pt with chronic back pain started using meperidine for pain. also he has a h/o depresion, presently taking SSRI. After pain medication, pt became confused, agitated,temp 102.2F, pupils dialated with rigid lower extremity. DOC?
Cyproheptadine also chlorpromazine,olanzapine can be given. Bromocriptin is not the answer.bromocriptine can only be given to NMS (neuroleptic malignant syndrome) bromocriptin is a dopamine agonist.
Can we give mefloquine to suspected malaria pt who is vomitting repeatedly?
No. because you dont get mefloquine iv. therefore the DOC is quinidine gluconate iv 10mg/kg over an hour followed by 0.02mg/kg for the rest of the 3 days until he can ingest oral medication.best medication quinine sulfate and doxycycline.
Most important lab test to evaluate pt with oliguria?
serum potassium. other important test, BUN, cretinine, urin osmolality and electrolytes.
Salter1 fracture??
Disruption of the tibial epiphyseal plate .
This drug benefit in pt undergoing percutanous coronary interventions?
GP 11b/111a inhibitor. it directly bind to platelet surface and interrupt platelet activation. eg. abciximab,eptifibatide,tirofiban.
1)Causes multifocal atrial tachycardia.

How to identify?

Mx?
1) Pt with decompensated chronic pulmonary disease( hypoxia and COPD), Theophyllin therapy,sometimes see in CHF and sepsis pt.Also seen in methylxanthene toxity.very rarely you see in digitalis toxicity.more common in the elderly.
2) 3or more P-waves of variable morphology and varying PR intervals.

3) treat the underline disorder. if COPD, give oxygen and bronchodialater. Rate may in some caseses be reduced by verapamil or diltiazem.In some pt Magnesium sulphate has been shown to reduce atrial ectopy.
Drug that could increase intracranial pressure?
Ketamine.
Child born to a mother with 2ry syphyllis ( RPR and FTA-abs are positive.What would you expect to see in a newborn baby?

What would you expect to see after 2 years time?

What is the clue to differentiate 2ry syphilis rash from othe rash?
1) rhagades,snuffles and neurosyphilis.

2) Hutchinson teeth, saber shins and saddle nose.

3) Palm and sole extension of the rash.
1) CSF Glucose level TB and fungal meningitis?

2) normal CSF protein?

3) CSF PROTEIN ^ over 100 mg/dl in what condition?
< 50 mg/dl.

20-45 mg/dl

3) Guillain-Barre syndrome.
20 d old girl brought to ped ward due to vomiting. child did not receive prenatal or antenatal care. on examination pt has poor tone, enlarge clitoris, fusion of labial fold.
Dx?

serum sodium?

serum potasium?

tx?
1) CAH

2) SERUM SODIUM IS LOW.

3) SERUM K IS HIGH.

4) ADMINISTER IV HYDROCORTISONE AND ADMIT TO PED ICU.
1) Causes for migratory arthritis?

2) Causes for nonmigratory arthritis?
1) Rheumatic fever,subacute bacterial endocarditis,HSP, cefaclor hypersensitivity,septicemia(Steph,Staph, Meningo, Gono), pulmonary infec (mycoplasma) and Lyme disease.

2) Juvenile rheumatoid arthritis, Reiters syndrome, SLE,
Elderly female comes to you due to palpitations. On examination you found out the pt has high blood pressure and diastolic decrescendo murmur is heard.
1. Where do you think the murmur best heard.
2 .what is the dx?
3.Intensity of murmure when pt handgrips and squatting.
4.Intensity of murmur when you do valsalva manuever.
5. This type of murmur is commenly due to what condition. what are the other 2ry causes?
1. murmur best heard lower left sternal border.It may radiates to the apex.
2. Dx-> AR
3. When hand grips ^ afterload therefore worsen AR. squatting ^ the preload therefore ^ the murmur (worsen).
4.valsalva decrease the preload -> reduse the murmur.
5. This type of murmur common due to HTN. Other causes . Rheumatic fever,endocarditis, ankylosing spondylitis,Reiter's syndrome, Marfan syndrome, Syphillis,Eshlers-Danlos syndrome
Antitopoisomerase 1 antibody?
another name for Anti-scl-70 antibodies.Seen mainly in patient with diffuse systemic sclerosis.
Anticentromereantibodies found in ?
limited systemic sclerosis( crest syndrome) Also can be seen in other autoimmune disorder (primary biliary cirrhosis)
Drugs that might give lupus like symtoms ( drug-induced lupus) ?
Procanamide, hydralazine, phenytoin,sulfonamide,penicillamine,isoniazid.
1)Best Tx for Onchomycosis?

2) Mechanism of action?

3) Common adverse effect.
1) Terbinafine. for finger nails has to use at least 6 wks. for toe nail at least for 12 wks.

2) interfere with the fungal cell wall synthesis. ( production of ergosterol)

3) Taste disturbance and Hepatotoxicity.
Two drugs that could increase serum digoxin level?
Quinidine and Amiodarone.
How long anticoagulation should continue after successful cardioversion?
4wks.
initial blood test to evaluate reversible A-fib?
Thyroid function test and serum electrolytes.
Can A-fib cause cardiomyopathy?
Yes. Inadequate rate control could lead to tachycardia mediated cardiomyopathy
Modifiable risk factor for A-fib?
1) Smoking
2)Alcohol in paroxysmal A-fib.
3)Avoid caffeine in paroxysmal A-fib.
4)pt should be screened for obstructive sleep apnea.
5) Medication may interfere.
Pt present with cocaine induced MI. Which drug should be avoided?
Avoid beta blocker,it might leads to unopposed alfa stimulation and ^ BP. options include:
Nicardipine
Verapamil

Also consider treatment with benzodiazapine in addition to above.
Pentolamine
Diltiazem
pt with preeclamsia BP 166/120.
What medication should be avoided to reduce BP?

Drugs we can use during pregnancy?
Nitropraside and ACE inhibitor shoud be avoided.

Labetolol
Hydralazine
nifidipine
Magnesium sulphate.
Pt present with high BP. he has taken sildenafil, yesterday. what drug should be avoided when treating for his high blood pressure.
Avoid nitroglycerine.can use labatolol,esmolol,clevedipine,nicardipine.
Dx of DM?
8hr fasting plasma glucose level > 126 mg/dl .
non fasting plasma glucose >200mg/dl in the presence of symptoms.
OGTT > 200 MG/DL AFTER 2 HRS.
N-acetylcysteine?

route of administration?

mechanism of action?
1) paracetamol poisoning.

2)oral and IV

3)acetylcysteine helps to increase glutathion in the body. glutathion helps to bind with toxic metabolite-> reduce damaging hepatocyte-> reduce liver failure.
Rumack-Mathew normogram?
Provides a means of determining whether the individual falls into the high risk catagories for developing hepatotoxicity based on serum acetaminophen levels.
RE: acetaminophen poisoning:

1)Poor prognosis is associated with?
2) Therapy with N-acetylcysteine is most effective if begin within howmany hours?
1) Elevated serum lactate level > 3.5 mmol/L.
2) within 8 hrs.
pt with celiac sprue are at increased risk for malignancies? T/F
T. yes small bowel cancer such as adenocarcinoma and lymphoma.
A)Pt with ulcerative colitis are risk of getting what type of cancer?
B) DOC for mild to moderate UC?
1) colon cancer
2) Cholangiocarcinoma due to PSC.
B) oral prednisone
Give 2 Rheumatic disorder that could predispose a pt to MI.
1) PAN
2) Kawasaki disease.
2 of the most common condition that may present as a CHF in neonates?
singn and sxs?
1) coarctation of the aorta.
2) VSD.
child present with diaphoresis during bottle feeding, also present with tachypnea and tachycardia.
Most common incomplete spinal cord injury after trauma?
Mechanism?
signs and sxs?
1) central cord syndrome.
2) forced hyperextension of the spinal cord. injury is common with degenerative arthritis.
3) mostly effect the central portion of the pyramidal and spinothalamic tracts. neurologic deficit(motor impairment) greater in the upper extremities than lower extremities.
27 wk pregnant pt present to you after falling from stairs. she has a conusion on her lt flank region. denies any abd pain,bleeding,n,v. what is the mx?
External tocodynemic monitoring for 4 hrs. If < 3 contactions /hr, pt can discharge. If 3 to 7pt should be monitored for 24 hrs.
Most common cause of treatment failure in organophosphate poisoning?
Failure to administer sufficient atropine to the pt. Atropine should be titrated to dry tracheobronchial secreation. should not rely on mydriasis. Should not be withheld in the presence of tachycardia.
Most sensitive diagnostic test for rhabdomyolysis is ?
Serum creatin kinase. five times greater than normal is diagnostic. serum myoglobin has short half life < 3hrs. therefore serum myoglobin is not suitable to dx rhabdo.
Adenosine 1) site of action

2) indication
1)site of action AV nod

2) terminate SVT due to reentry rhythm.
may be useful in diagnosing atrial flutter.
Adenosine 1) site of action

2) indication
1)site of action AV nod

2) terminate SVT due to reentry rhythm.
may be useful in diagnosing atrial flutter.
Adenosine 1) site of action

2) indication
1)site of action AV nod

2) terminate SVT due to reentry rhythm.
may be useful in diagnosing atrial flutter.
Common cause of death in a young child undergoing treatment for D ketoacidosis?
Cerebral edema. reason -> rapid fall blood glucose level-> excessive administration fluid-> failure to ^ serum sodium level-> use of bicarbonate
DOC for TCA induced seizure?

mechanism of action?
Phenobarbital and diazapam both can be used in TCA induced seizure.

TCA's are GABA antagonist. Diazapam and phenobarbital are GABA agonist.
Drug contra indicated in TCA induced cardiac toxicity?

Reason behind?
Procainamide.

Both inhibit sodium channels.
T or F
Most common cause of upper GI hemorrhage is esophageal varices.
F. common cause is peptic ulcer disease.
D/D of Hypercalcemia?
PAM P SHIT MD

P-> Parathyroidism
A-> Addisons disease
M-> Multiple myeloma

P-> Paget disease

S-> Sarcoidosis
H-> Hyperthyroidism
I-> Immobilization.
T->Thiazide diuretics
M->Milk alkali syndrome
D-> Vit D
12 d old bottle fed infant is brought to you due to poor appetite. on examination you notice mild jaundice. What is the most important diagnostic test ?

What are the causes of mild jaundice after 12 days.
1) Lumbar puncture.

2) Septicemia, hepatitis,congenital hemolytic anemia,conginatla atresia of bile duct, rubella, hypothyroidism, brest milk jaundice, (syphillis, toxo, cytomegalo virus)
T OR F
fat embolism most common after pelvic fracture.
F. most common after long bone fracture. fracture of the femur and tibia. the only therapy that is proven benefit is high dose of steroid therapy.
Most common organism cause life threatening infection in pt undergoing solid organ transplantation or bone marrow transplantation?
CMV.
^ Metanephrin and vanilylmandalic acid in 24 hr urine is due to ?
Pheochromocytoma.
cosyntropin stimulation test?
to dx adrenal insufficiency.
pt taking HCT and Beta blocker develop hypotension after administration of IV contrast. What is the initial treatment.

reason behind.
Glucagon 1mg IV.

reason as the pt on beta blocker epi may not helpful to increase his blood pressure. Diphenhydramine (H1 receptor antagonist) may reduce the bronchoconstriction,urticaria and improve the condition but does not help blood pressure due to vasodialation.
Pulse most likely to be associated with CHF due to lt ventricular dysfunction?
Alternating pulse.
pulsus you noticed in pericardial tamponade?
pulses paradox. reduce amplitude of the pulse during inspiration.
two blood test that could be abnormal in mesenteric ischemia.
wbc and serum lactic acid level.
Indication for emergency department cesarean delivery?
Maternal death and a 26 week old fetus.
Needle stick injury to a nurse. she has been vaccinated with Hep B vaccine previously. the pt is Hep B +ve. what should you do?
Draw Hep B surface antibody on the nurse. If titre is less than 10 mlU,she should receive Hep B vaccine (20ug IM ) and 2 doses of Hep B immunoglobulin,One ASAP and other one at 30 days.
Primary symptoms of Myxedem coma?
Sever end of the clinical spectrum of hypothyroidism. Pt may present with mental status changes,hypothermia,hypoglycemia,hypotension,hyponatremia,bradycardia and hypoventilation.
mnemonic for salter harris fracture.
I S-> same = transvers fx through the growth plate.
II A-> above= fx through the growth plate and metaphysisi, epiphysisi is sparing.
III L -> lower= fx is below the physis in the epiphysis.
IV T -> through = fx is through the meta,epi, and physis.
V, R-> rammed = the physisi has been crushed. type II occur in 75% of people.
Uremic encephalopathy?
mental status changes due to change in sodium and potassium ATPase activity leading to increase in brain calcium level. pt respond to increased dialysis.
WPW with wide complex tachycardia on ekg, what is the drug of choice.

What will happend if administer beta blocker, calcium channel blocker or adenosine to the pt.
Procainamide. if no improvement should undergo cardioversion.

Pt might develop ventricular fibrillation.
1)Fentanyl?

2) classic triad you see due to overdose of fentalyl?

3) DOC for fentanyl overdose?
4) Other signs and sx's you may see due to fentanyl overdose?
5) other drugs come under same catagory?
6) Are we able to detect fentanyl from urine toxicology .
1)Synthetic opioid that is hundred times more potent than morphine.
2) coma,miosis and respiratory depression.
3) nalaxone
4) lethargy,bradycardia,hyportension.
5) Heroin,morphin,clonidine.
6) no
1)3 diastolic murmurs?

Diastolic murmur that present with transient ischemic attack,fever. murmur change with bodily position.
aortic regurgitation,
mitral stenosis
Atrial myxoma.

2) Atrial myxoma.
How do you differentiate drug induced (furosemide) pancreatitis from gallstone pancreatits.
Drug induced pancreatitis usually do not cause elevation of liver chemistries (AST AND ALT).
5 y/o F ,samll size for her age, previously dx with asthma,rectal prolapse,sinusitis present with abn breath sound,purulant rhinorrhea. on examination you noticed digital clubbing.
1) most likely DX?
2) Initial test?
1)CF

2) CXR, sweat chloride test.
7 y/o boy with limping brought to you due to low grade fever. On examintion you find Hepatospleenomegally,petechiae.
1) most likely DX?
2) Initial test?
,
1) ALL
2) CBC with differential with platelet count.
RE: APSGN

1) two test to prove evidence of recent strep infection.

2) What wil happen to complement C3 and C4 in APSGN.
3) If C3 level does not normalize in 6-12 wk, what is the probable dx.
4)T or F
Antibiotic use during the initial phase of GABHS may prevent APSGN?
1)a. Antistreptolysin-O (ASO)

b.Antideoxyribonuclease B ( Anti DNaseB)
2) C3 level reduced. C4 normal.
3) Lupus nephritis.
4) F.
ELEVATED CA-19-9 ?
Pancreatic cancer.
Teriparatide?
Recombinant form of parathyroid hormone that stimulate bone formation.This drug will ^ bone mineral density better than many other drugs eg, estrogen, calcitonin, alandronate, raloxifen.
1)Three drugs reducing the serum uric acid level.?
2) best initial therapy for gout?
1)Allopurinol,probencid, sulfinpyrazone.all 3 drugs are used for prevention of gout.
2) NSAID if not responsive to NSAID, can use steroid. colchicine is useful in the 1st 24 hr of attack also when there is a contraindication to NSAID.
Best initial test for septic arthritis?

Best emperic therapy?
Arthrocentesis.> 50.000 white cells is consistent with infection.

Ceftriaxone and vancomycin IV
drugs which inhibit cytochrome P450 system?

pt who is on warfarin, what will happend to his INR? MECHANISM?
SSRI,cimetidine,fluoroquinolones,metronidozole,isoniazid,amiodorone,quinidine,erythromycine,cyclosporine,HIV protease inhibitors and azole anti fungals.

^INR. elimination of warfarin depend on the activity of cytochrome P450 in the liver.drugs which leads to reduction of P450 will lead to reduction of warfarin clearance.
memantine?

usage?

mechanism of action.
NMDA receptor antagonist.first drug aproved for the tx of alzheimer's disease.
1) 3 common abn you see in pt with nephrotic syndrome?
1) hypocalcemia (due to vit D deficiency)
low thyroxine level due to low thyroxine globulin level and hypochromic anemia due to transferin loss. nephrotic syndrome associated with protenuria,hypoalbumemia, hyperlipidemia.
commonly used 1st generation quinolone drug?

commonly used 2nd generation quinonone drug?

mechanism of action?
1)nalidixic acid.

2)ciprofloxacin
3) inhibit the bacterial DNA gyrase or topoisomerase 11 enzyme thereby inhibiting DNA replication and transcription.
80 y/o elderly pt with fever admitted to hospital. cxr,blood cultur and UFR done. empiric antibiotic ciprofloxacin started. after 36 hrs, blood came out Enterococcus fecalis positive.what is the best tx?
Discontinue cipro and start with gentamycin and ampicillin.
1)condition that increase Erythrocyte protoporphyrin in serum?
2) In iron defeciency anemia MCV , ferritin level AND hematocrit?
3) what increase in iron defeciency anemia.
1) Iron defeciency anemia, anemia of chronic disease, chronic lead poisoning.
2) decreases.
3) TIBC, transferrin, RDW(red blood cell distribution width)
NYHA classification of Class I angina?
NYHA classification of Class II angina?
NYHA classification of Class III angina?
NYHA classification of Class IV angina?
1) Angina does not appear when pt undertake ordinary physical activity.
2) Angina caused by simple ordinary activity.
3)Symptoms appear during less than ordinary activity.
4) Symptoms appear at rest.
Pt on metformin,quinidine,insuline,allopurinol , recently diagnosed with hypertension. What drug should be avoided to treat HTN.
HCTZ.

REASON.
Quinidine can prolong the QT intrrval-> torsade de pointes->ventricular fibrillation. Also HCTZ may decrease the effectivness of uricosuric agents,insulin, and sulfonyleureas.
Pt c/o chest tightness,sob,palpitation after exertion. EKG shows pulse rate 56/min, increased PR interval,ST elevation on V1 and V2.
1) Which coronary arteries are effected
2)Dx
1) On EKG increase PR interval = 1st degree heart block+ bradycardia-> therefore rt coronary artery effected.Also EKG shows ST elevation in V1 and V2-> therefore his Lt anterior decending coronary also effected.
2) MI
Pt present with chronic Ulcerative colitis that is refractory to medical managment and causes significant disability. What is the best therapy?
Proctocolectomy with ileal pouch-anal anastomosis.
Intravenous hypnotic drug used as an anesthetic agent,chemically related to LSD?
2)SE of this drug?
3)contraindications?
1) Ketamine
2) Bad dreams,-> can be prevented by pretreatment of benzodiazepine. HNT, ^ HR, ^ Cardiac output.
3) In pt with ^ ed intracranial pressure.
Best anesthetic agent in pt undergoing neurosurgery.?

Reason behind?
Thiopental.

decrease brain oxygen consumption.
Best IV anesthetic agent when cardiovascular stability is an issue?

SE of this drug?
Etomidate.

adrenocortical suppression,myoclonus, seizure.
IV anesthetic agent that never associated with malignant hyperthermia?

SE of this drug?
Propofol.

Hyportension, apnea.
Causes of prerenal azotemia?

BUN: Cr level in prerenal azotemia? Fractional excretion of Na?

Signs and symptoms?
azotemia = abnormally high level of nitrogen containing product(urea,creatinine) in the blood. prerenal azotemia caused bu decrease blood floor to the kidney. eg. CHF,hemorrhage,shock, volume depletion, renal artery stenosis.
2) BUN: Cr level > 20 in prerenal. normal < 15. Fractional excreation of Na is <1%.
3) confusion, oliguria,asterixis,decrease alertness,pale skin,tachycardia,dry mouth, hypotension,orthostatic hypotension.
pt with immunodeficiency c/o fever.CBC shows neutropenia. After blood culture, he was given empiric treatment,imipenem.After three days, pt not responded to antibiotics. What is the next drug we should use?
Mechanism of action?
What are the organism covered from this drug?

Any adverse effects?
1)Posaconozole.
2) Block ergosterol synthesis.
3)use to treat invasive infections caused by Candida, Aspergillus,mucor.Also recently found out drug is effective for Chagas disease
4) QT prolongation, Liver toxicity.
1)Most sensitive and specific test to to find out pancreatic exocrine dysfunction?
2) Gold standard functional test to diagnose chronic pancreatitis?
Other test that can be used?
1) measurment of fecal elastase test.value less than 200 ug/g indicate pancreatic insufficiency.
2) secretin stimulation test.
3) serum trypsinogen, CT abdomen,MRCP,ERCP.
T or F

Tumor lysisi syndrome typically charaterized by combination of hyperkalemia,hyperphospatemia,hypercalcemia,hyperurecemia,lactic acidosis.

Drugs we can use as a preventive measure(tumor lysis syndrome) prior to and during the treatment of Leukemias and lymphoma.
F

Hypocalcemia.

prophylactic oral/iv allopurinol-> inhibit uric acid production.
Adequate IV hydration.
Rasburicase(uricase) is an alternativ to allopurinol.It is a synthetic urate oxydase enzyme act by degrading uric acid.
If the pt does not respond hemodialysis should be started.
F pt c/o recent blue coloration of her hand after exposing to clod.
What is the best initial screening test to find out whether she will get any systemic disease in the future?
2) If the test is positive, what are the other test we can order?
3) If pt is hoping to get pregnant, what are the other test we should order?
1)ANA
2) basic lab work should be done first(CBC,urin analysis, etc) prior to ANA. If ANA +ve should order anti -Scl-70.
3) Anti SSA and Anti SSB. if positive infant migt get neonatal lupus(complete heart block,thrombocytopenia, rash)
Best test to confirm rheumatoid arthritis?
Ant-CCP (anti cyclic citrulinated peptide antibody) not only it confirms the dx but also may indicate pt at increased risk damage to his joints.
Type of malignancy that could be associated with dermatomyositis and polymyositis?
lung, pancreatic,GI tract, non-hodgkin lymphoma, ovarian.
1)Risk factor for gastric lymphoma?

Initial treatment for MALT lymphoma (mucosa associated lymphoid tissue).
1) Helicobactor pylori,long term immunosuppressant drug therapy, HIV infection.
2) Antibiotic treatment to eradicate H. pylori.
During annual checkup, pt informed his father died at the age of 46 due to colon cancer, His paternal aunt died due to endometrial cancer, his brother 38 y/o recently dx colon cancer. Pt appear to be at risk for what type of cancer?
HNPCC (Hereditary non polyposis colon cancer or Lynch syndrome. Autosomal dominant.
1)Leuprolide acetate (leuproline)?

2) clinicle use?
GnRH analog. Act on pitutary GnRH receptors-> reduce pulsatile secreation of LH FSH-> both estrodiol and testosterone.
2) Hormone-responsive cancer-> prostate,brease, also estrogen dependant condition endometriosis,IVF procedure, precocious puberty.
1)Leuprolide acetate (leuproline)?

2) clinicle use?
GnRH analog. Act on pitutary GnRH receptors-> reduce pulsatile secreation of LH FSH-> both estrodiol and testosterone.
2) Hormone-responsive cancer-> prostate,brease, also estrogen dependant condition endometriosis,IVF procedure, precocious puberty.
Most likely cause:

Pt with metastatic breast cancer,serum ca 16 mg/dl?
Ectopic production of parathyroid hormone-related protein.
Neutropenia definition?

Fever definition?

What test should be performed in neutrophenic cance pt?
ANC( ABSOLUTE NEUTROPHIL COUNT) < 500 cells/mm3

Single oral temp mesurment >or equal 38.3 c / (101 F) or sustained temp 38 c or 100.4F over one hour period.

CBC with differential count,platelet count,serum cretinine and BUN, serum electrolyte, hepatic tranaminase level, total billirubin.
What empiric antibiotic we should used in neutropenic cance pt with fever?
After admission IV antipsudomonal beta lactam agent, such as cefepime, a carbapenem (meropenam or imipenam-cilastin or piperacillin-tazobactem is recomended. Other antibiotic( amynoglycosides, fluoroquinolones or vancomycin may be added if pt has other complications such as pneumonia, hypotension or prior antibiotic resistant pt.,
What empiric antibiotic we should use in neutropenic cancer pt with fever?
After admission IV antipsudomonal beta lactam agent, such as cefepime, a carbapenem (meropenam or imipenam-cilastin or piperacillin-tazobactem is recomended. Other antibiotic( amynoglycosides, fluoroquinolones or vancomycin may be added if pt has other complications such as pneumonia, hypotension or prior antibiotic resistant pt.,
What empiric antibiotic we should used in neutrophenic cancer pt with fever?
After admission IV antipsudomonal beta lactam agent, such as cefepime, a carbapenem (meropenam or imipenam-cilastin or piperacillin-tazobactem is recomended. Other antibiotic( amynoglycosides, fluoroquinolones or vancomycin may be added if pt has other complications such as pneumonia, hypotension or prior antibiotic resistant pt.,
F pt c/o unilateral spontaneous bloody nipple discharge?

What is the next step?
1) Most likely intraductal papiloma.

2) Mamogram and surgical duct excision for definitive diagnosis.
Investigation of choice to diagnose Meckel'd diverticuli?
Pertechnate(99mTc) scan.
T or F
TIPS (Transjugular intrahepatic portal systemic shunt) is not an option after stabilizing the pt with liver failure and GI hemorrhage.
T OR F
TIPS usually connect portal vein to the splenic vein.
F

TIPS can be performed in the acute setting. Surgical shunt primarily reserve for stable patients with recurrent bleeding episodes. not performed in an acutely unstable patients.
2) F, TIPS connect hepatic vein to the portal vein.
When doing laser procedure, which inhaled anesthetic should not use?

Reason?
N2O (Nirous Oxide)

Combustible.
Anesthetic agent that does not cause malignant hyperthermia?

Common SE of this drug?
propofol

Hypotension, apnea.
MOA of Pyridostigmine or Neostigmine?

This drug is given for what condition?

SE of this drug?
Increase the acetylecholine at the neuromuscular junction by inhibiting its metabolism.

Myasthenia gravis.

Diarrhea,cramping,salivation and bronchorrhea.
Pt comes with diplopia and weakness. test we can order to r/o Myesthenia gravis?
1) Cholinesterase inhibitor test (Edrophonium test)
2)^ serum Antibodies against nicotinic Acetylcholin receptor.

Single Fiber EMG.deminish amplitude with repetitive stimulation.

CT or MRI to detect abnormal Thymus gland.
.
MOA hydroxyurea.

SE?

WHAT OTHER CONDITION WE CAN USE THIS?
1) It decrease the level of painful crisis by ^ the lever of fetal Hb. Also ^ amount of water in the red cells.
2) SE: Leukemia and myelosuppression with long term use.
3) Can be uses in pt with essential thrombocythemia. It reduces the cell count. Also can be used in polycythemia vera.
Signs and symptoms of Carcinoid syndrome?

Best initial test?
Episodic flushing of head and neck, hypotension, tachycardic, abdominal cramping and diarrhea, occational murmur due to serotonin exposure, vascular telangiactasia, wheezing.

Urinary (5-HIAA) LEVEL
Octriotide?

MOA?

If this treatment fails what is the next step?

Other conditions we can use octreotide?
Synthetic somatostatin used in acute variceal bleeding.
Potent inhibitor of growth hormone,glucagon and insulin.Decrease portal pressure and splanchnic blood floor.

If octreotide fails to controle bleeding we can do endoscopic band ligation.

Pt with acromegaly, diarrhea due to carcinoid syndrome, diarrhea due to vaso active peptide(Vipoma,)
two murmurs, worsen with valsalva?
MVP and Hypertrophic obstructive cardiomyopathy?
Acute dystonic reaction?

DOC for acute dystonic reaction
MOA not clearly understood. occurs due to antidopaminergic effect of some drugs. ( metochlopromide, and some antipsychotic drugs)

2) Diphenhydramine and benztropine.
Another name for Calcium pyrophosphate dihydrate deposition disease(CPPD).

Commonly seen CPPD in what type of pts.
1) Pseudogout-> Commonly effect the knee.Joint fluid analysis,you see positivly birefringence rhomboid shape ccrystals.

2) Commonly seen in pt with hemochromatosis, hyperparathyroididm and acromegaly.
Complication of Kawasaki's disease?

Treatment?
Coronary artery aneurysm and myocarditis.

IV immunoglobulin and asprin.
Positive ANA, positive Anti-Ro, and Anti-La ?

Signs and symptoms?
Sjogren syndrome.

Dry eyes, dry mouth, arthritis. may need water to swallow food,
Progression of MS can be slowed with?
Beta interferon and Glatirimer acetate.
MOA Donepezil, galantamine?
Anticholinesterase inhibitors. Act in the central nervous system to increase the level of acetylcholine. Used for Alzheimer's disease(best initial therapy)
1)RE: epidural Vs subdural hematoma. which one gives bleeding from arterial blood?

2)If you see blood forms the shape of a lens on CT?


3)If you see blood forms the shape of a crescent shape on CT?
1)Epidural hematoma.

2)Epidural hematoma.

3) Subdural hematoma.
1)Drug that can be used as and antidepressant and smoking cessation.

MOA?
SE AND CI?
1) Bupropion.

2)Inhibit the reuptake of Dopamine and norepinephrine.

3) seizure, HTN, insomnia, appetite suppresion. CI for those with seizure disorder and those using MAO.
Oseltamvir and Zanamvir ?

Indications?
Neuraminidase inhibitors. Can be used to treat Influenza A and B.Should be treated within 24 hrs of symptoms. They only shorten the duration of the illness.
Anti-mitochondrial antibody ?
Primary biliary cirrhosis.
Best initial test to diagnose Myeloma after found out lytic lesions on X ray?
2)Other common condition you can use the same test to diagnose?
SPEP ( serum protein electrophoresis)

MGUS( monoclonal gammopathy of unknown significance)
Treatment with pyrimethamine and sulfadiazine ?
Toxoplasmosis.
Initial test to DX acute pancreatitis?

Most acurate test to DX acute pancreatitis.
Serum Amylase and Lipase.

Abdominal CT scan.
2ry syphillis signs and sx?

Does VDRL/RPR decrease in response to Tx?
lympadenopathy,non-itchy rash on the palms of the hands and trunk. condyloma lata,alopecia.

2) Yes. FTA Ab test can remain positive life long.
Pt with osteomylitis (Staph) resistant to Oxacillin, what are the other drugs we can use?

Pt with osteomylitis (Staph), after ABST found to be sensitive to Oxacillin but he has an allargy to penicillin?
1)Vancomycin,Linezolid or daptomycin.

2) If he is an allergic to penicillin,we can use cephalosporin instead.
Best Tx :
1)Pt with onchomycosis of his great toe.
2) MOA and SE of thIS drug?
1)Terbinafin 12 wks for toe nail. 6 wks for finger nail.

2)Inhibit the production of ergosterol,which is necessary to make the fungal cell wall.
3) hepatotoxicity and bad taste.
Pt with liver failure and cirrhosis.
Which shunt is commonly used?
a) Mesocaval shunt.
b) Hepatorenal shunt.
Hepatorenal shunt.

mesocaval shunt conect SMV to IVC.
Recent liver transplant pt. What are the test you can do to find out transplanted liver is not functioning well.
1) Coagulopathy with INR > 2
^ PROTHROMBIN TIME
2)Hypoglycemia. liver unable to do gluconeogenesis.
3) elevated amonia and potassum level.
4) oliguria.
Best treatment for chronic achalasia cardia.
Esophagomyotomy ( Heller myotomy)
Two test which can be done to identify medullary thyroid cancer other than the biopsy?
T OR F
2)Medullary carcinoma originate from thyroid follicular cells.
1)^ serum calcitonin and CEA.

2) F . parafollicular cells(C cells) which produce serum calcitonin.
T OR F

Radioiodine treatment is the treatment of choice in medullary thyroid cancer.
F. extensive surgery is the only option if detected early. radioiodine has no role in medullary thyroid cancer.
Pt who has prolong PTT that does not correct with mixing study. What could be the reason?

2) What is the test to confirm this condition?
1) Antiphospholipid antibidies or lupus anticoagulant.

2) RVVT ( russel viper venom clotting time)
Pt comes with skin condition, Nikolsky's sign positive?

Treatment?
Pemphigus vulgaris.

Oral prednisolone. then taper to lowest dose. Immunosuppressive such as azathioprin,cyclophosphamide, methotrexate can be used in resistant cases.
If you suspect a pt with carcinoid syndrome, what is the best initial test you should order?

Pt with carcinoid syndrime symtoms occur due to?
Urinary hydroxyindileacetic acid test (5-HIAA).

Exposure to serotonin.