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USMLE xtra2

QuestionAnswer
empiric tx for hospital aquired PNA ceftaz or cefotax, OR imipenem, OR piperacillin/tazobactam (Zosyn)--basically cover Pseudo
how is transferrin sat'n calculated, how difft bw Fe defic anemia and sideroblastic? Fe/TIBC, low in Fe defic anemia (since Fe low and TIBC high) and high in sideroblast (since Fe high and TIBC low); Fe and TIBC are both low in anemia of chronic dz
what test is specific for identifying CSF in fluid b2 transferrin
how do OCPs affect Fe studies incrs TIBC, don't cause microcytic anemia
lady being tx for breast cancer comes in w point back bone pain, how w/u radionucleide scan--most sensitive for early met
tx after HIV needle stick do HIV test of recipient, give 3 HIV Rx for 4 wks, rept HIV test at 6wks, 12wks, 6mos. Seroconversion if pt was adv AIDS 0.3% [AZT alone decrs 80%]
Abc MC cause S-J? AIHA? C Dif? PCN, cephlo, qunio; PCN, cephalo; clinda, amp, ceph
3 Rx to help PVD besides ASA and anti-plt cilostazol (PDE inhib), dipyridamole, pentoxifylline
what's loffler syndrome when round worm coughed up and reswallowed, see hemoptysis and cough
what's Osborn wave on EKG upward deflection after R wave, indicates hypothermia
which Ig affected in Wiskott Aldrich? Ataxia Telangiectasia? IgA defic? low IgM, high IgA&E; low IgA,M,E; IgA but 50% also IgE
low serum Na, pt dry and tachy, U Na>20, what's the difftl? Tx? renal losses causing hypotonic hypovol hypoNa, should be holding onto Na, causes: diuretic, ACEI, low aldosterone, ATN. Tx=NS (add loop if 110-120)
low serum Na, pt dry and tachy, U Na>10, what's the difftl? Tx? extrarenal losses causing hypotonic hypovol hypoNa, renal holding onto Na appropriately, causes are extrarenal losses, ie GI (N/V, diarrhea), 3rd spacing. Tx=NS (add loop if 110-120)
low serum Na, pt not dry or tachy or wet, what do next? Diffts? check serum osmol. If nml think hyperproteinemia or lipidemia, if high think high Glu or radiocontrast, if low think siADH, dpolydypsia, hypothyr
high serum Na, how create difftl, what are they low vol: renal (diuretic, glycosuria, RF), extrarenal (diarrhea); nml vol (DI, letting go too much water); high volume (steroids, hyperaldost)
pt is vol overloaded if serum Na high think? Low? high=steroids, hyperaldosterone, low=water retaining, ie CHF, nephrotic, liver disease ?RF?
which lytes affect QT? PR? T? PR&T: K or Mg; QT: Ca++ or Mg
MC SE ketamine visual and auditory hallucinations (10%), basically a sedative similar to propofol
Rx causes of AIHA (5) PCN, cephalo, sulfa, quinine, NSAIDs
what is Felty's syn RA, splenomegaly, low WBC. See late in RA dz, at risk for infxn
what are COX2 inhib, one way they are used celecoxib, rofecoxib, avoid some SE of NSAIDs so used for RA in ppl w advanced age and comorbidities (GI, renal, CNS/confusion)
tx for rash in SLE? Nephritis? Rash in Scleroderma? chloroquine, AZT or cyclophosphamide (or steroids). Rash in scleroderma=penicillamine
tx antiphospholipid during preg LMWH
what's Schober test? Schirmer? Schober=spine motility used in dx ankylosing spondylitis. Schirmer=decrsd tear production in Sjorgen
what's keratoderma blennorrhagica seen in reiters. vesicopustular, waxy lesion w yellow brown color often on palms and soles, but also scrotum, scalp and trunk. Can resemble psoriasis
what's yohimibine a naturally occuring alpha blocker, see as herb extract and OTC, used for erectile dyfxn but can't use if cardiac dz
what's colonoscopy screening for ppl nml risk and high risk if not high risk colonoscopy q10y (+ yearly fecal occult blood). If high risk start screen 40yo or 10y younger than youngest relative and rept q3-5. High risk=1st degree relative cancer <60 or mltpl relatives
contraindications for the trivalent flu vaccine asthma, COPD, chronic metabolic or CV dz, children on longterm ASA, h/o Guillan Barre
what 3 Rx can be used in HIT for anticoag lepirudin or argatroban (direct thrombin inhib, argatroban can be used if renal insuffic), danaparaoid (heparinoid)
what lipid profile suggests metabolic syn LDL>150 and HDL <40
what 2 rx can be given to prevent tumor lysis syndrome allopurinol or rasburicase (can give prophylactically to ppl high risk before starting tx)
what is max med tx for stable angina? If sympt what do next? nitrates, ASA, b blocker, CCB, and statin if lipid; if still sympt cath
Rx for diarrheal predominant IBS can tx sympt w loperamide, diphenoxylate. If those don't work can try alosetron (5HT antagonist). For constipation the 5HT agonist/antagonist=Tegaserod maleate
incrsd bili, blood in stools, dilated intra and extra hep ducts…what is it? How dx? Px? cancer of ampulla of vater, dx w endoscopy of duo (small and can miss on CT), px better than pancreatic
what's tacrolimus? Mech of action? What drug works similarly? anti immune drug often used s/p transplant, aka FK506, inhibits IL2. cyclosporine also inhibits IL2 (by inhibiting calcineurin)
key features of adrenoleukodystrophy peroxisome membrane gene, XL, 5-15yo; neuro: wknss, spasticity, then dementia, blindness; 1ry adrenal insuffic (usu appears first)
px factors of schizo pts better: good premorbid state, female, married, later age of onset, onset assoc w ppt events, positive sympt, FMH mood d/o, good inter-episode fxn, quick onset of sympt. worse: the opposite of the above + FMH of schizo
contraindications to probenecid 3? Colchicine? pt >60yo, poor renal fxn, renal stones. Colchicine=renal insuffic, cytopenia. Also should not be used in chronic management of tophaceous gout.
what's tamsulosin alpha blocker for BPH
what's tolterodine. What's 1 contraindication for use anti muscarinic for hypotonic bladder. Can't use in acute angle glaucoma
what are specifics for dx Wilsons if ceruloplasmin <20+ Kayser-Fleischer rings don't need bx, otherwise need bx showing >250ug/g Cu
what liver studies (incl s) suggest hemochromo? What gene test can confirm?
tx of Hemochromo phlebotomy wkly until ferritin <50, transferring <45%, then maintain w phlebotomy 500ml ~q2-4 (ea will remove 200-250mg Fe). Deferoxamine is for pts who can't tolerate or 2ry overload
what bugs are hemochromo at risk for Vibrio vulnificus and Yersinia entercolitica (Fe-loving bac)
what AFP level would suggest liver cancer >400ng/ml
what specific cancer does vinyl Cl put pt at risk for liver angiosarcoma
what Rx put at risk for cholestasis antipsych like phenothiazine (chlorpromazine, fluphanezine, chlorperazine), OCP, androgen
name 2 Rx assoc w acute pancreatitis sulfa and thiazide
tx for migratory thrombophlebitis heparin, (warfarin doesn't work), until cancer is addressed and then it goes away
hyperkeratosis of ears, cheeks, fingers assoc w what cancer? Named sign? acrokeratosis paraneoplastica, assoc w pharyngeal cancer Bazex syndrome
describe familial melanoma syn, gene, cxns aka dysp nevus syn, numerous atypical moles melanoma (superficial and nodular) ~100%, CKN2A, also risk pan cancer
describe BC nevus syn, gene, other charact and cxns AD, PTCH gene, get mltpl BCC from childhood, see frontal bossing, jaw cysts, CNS tumors
what's the pH, ABG for PE? COPD w bronchitis acute respir alk, high pH, low CO2, low pO2. COPD w bronchitis: respir acidosis w metabolic compensation (nml pH, high pCO2, low pO2)
bug and tx for meningitis in pt w CSF drain Staph Epi, use vanc
what's the diff bw acute stress d/o and adjustment d/o acute stress d/o is basically like PTSD but sympt <1mo and event <1mo ago (reliving a LIFE THREATENING event, etc). Adjustment d/o is <3mo after an event, trbl dealing w/ it
what’s the dosing for steroids for preterm babies 2x betamethasone 24 hr apart of 4x dexamethasone 12 hr apart
bug causing elephantiasis Wucherieria bancrofti (fiiariasis), causes non pitting lymphedema
what's phanolphthalein? Test related to dx? laxative, can cause secretory diarrhea. If causing diarrhea NaOH will turn stool red
what used to differentiate subtypes of Staph? Alpha hemo Strep? B hemo Strep? novobiocin, optochin, bacitracin
how difft Rotors and Dubin Johnson both defects in excretion, but Rotors has elevated urinary coproporphyrins and NO BLACK liver
which Ceph cover Pseudo? Which also covers Staph? What else does that drug cover? Ceftaz and Cefepime, Cefepime also covers Staph (and it covers Neisseria)
which PCN work ag MSSA oxacillin, dicloxacillin, or if combine amp or amox w sulbactam or clavulonate
which PCN work ag Pseudo? What else do they work ag? What abt Staph cvg? piperacillin, ticarcillin, carbenicillin. Also work ag E Coli, Proteus, Enterobacter, Serratia, Kleb, but only ag Staph if combine (ie piperacillin/tazobactam or ticarcillin/clavulonate)
what's the key SE of methicillin interstitial nephritis (so no longer in use)
which Abx for MSSA infxn: oxacillin or vanc? oxacillin (more efficacious)
which Abx for VRE imipenem
can Cipro be used for S Pneu PNA? no, doesn't cover S Pneu
which quinolones cover Pseudo only Cipro
which Abx covers anaerobes, gram - incl Pseudo, and staph. What are these best used in? Carbapenems (imipnem, meropenem). But best used in gram - infxn
compared metronidazole and clinda in cvg. What 2 other classes have equiv anaerobe cvg to metronidazole metronidazole is better for intrabd infxn bc covers Bacteroides and C Dif, Clinda is better for anaerobic strep in mouth. Carbapenems and the combined PCN agents (ie piperacillin/tazobactam, augmentin) have equivalent cvg
midclavicular fx puts what vessel at risk subclavian
CD3 is a marker for what cell type? CD19? T cells, B cells
what's modafinil a non-amphetamine stimulant used in narcolepsy
what stain used for hairy cell leuk? Tx? TRAP (tartrate resistant acid phosphatase) stain shows hairy projections. Tx=cladribine
name 6 nucleoside rev transcriptase inhib zidovudine (AZT), didanosine, zalcitabine, stavudine, lamivudine, abacavir
what are the SE of didanosine, zalcitabine, stavudine, lamivudine, didanosine&zalcitabine=pancreatitis, peripheral neuro; stavudine=peripheral neuropathy; lamivudine (3TC)=nothing
SE zidovudine leukopenia/anemia, GI
name some protease inhibitors, general SE end in -navir, ie Nelfinavir, indinavir, ritonavir, saquinavir. SE=hyperlipid, hyerglu, LFTs. GI also for nelfinavir, ritonavir, saquinavir.
SE indinavir a protease inhib w hyperlipid, hyperglu, LFTs, kidney stones, hyperbili
name 3 NNRTI efavirenz, nevirapine, delavirdine
SE efavirenz (NNRTI), neuro w somnolence, confusion or psych
SE nevirapine (NNRTI) rash
what's enfuvirtide a fusion inhibitor for tx of HIV. Used if viral replication continues despite other HAART
what's a standard starting HAART Rx combo AZT, lamivudine (3TC), nelfinavir
what SE see w a standard starting HAART Rx combo (AZT, lamivudine (3TC), nelfinavir) anemia, leukopenia, GI (AZT), and rash (lamivudine)
Created by: ehstephns on 2011-01-27



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