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USMLE misc3

QuestionAnswer
tx of choreiform, unintentional mvmts in HD anti Dopa agents, ie haloperidol
what's tramadol opioid like pain med
w/u for dermamyositis/myositis once suspect dx get EMG, then mscl bx
what Hb types see w alpha thal difft types trait (2 loci):nothing abnl; HbH dz (3 loci): HbH and Hb barts; 4 loci: Hb Barts only (rapidly fatal/hydrops fetalis). All have nml HbF and HbA2 levels
what Hb chains in HbH? Hb Barts? HbA2? HbF? HbA? Which is nml? Which in which dz? HbH (a thal)=4 beta; Hb Barts (a thal)=4Hb beta; HbA (nml)=2 alpha 2 beta; HbA2 (b thal)=2alpha, 2 delta; HbF (b thal, SC)=2alpha, 2 delta
what Hb types in b thal major and minor both have incrsd HbF and HbA2
w/u for suspected pseudotumor cerebri need MRI or imaging first to r/o structural, then tap (both diagnostic and therapeutic). Tx includes acetazolamide
how does amio cause pul fibrosis? On BAL what see? phospholipid accum within lysosomes, see foamy changes in lamellar inclusions on BAL, aka foamy macrophages
describe acid-base status, Na, K, U_Cl and renin levels for 1ry hyperaldosteronism and diuretic use. How do you tell them apart Na is high, K low, Cl high, and U_Cl high w metabolic alk for both, but renin will be low in 1ry hyperladosteronism
how difft cauda equina and anterior spinal artery occlusion cauda equina will have sensory and motor loss (flaccid paralysis) and bowel/bladder compromise; anterior spinal will have motor, pain temp, bowel/bladder compromise, but NO SENSORY problems,
tx of vaginal candidiasis preferred: 1 dose oral flucanazole exc in preg women where give intravag imidazole creams 3-7d or nystatin tablets intravag
what TV should be for COPD? ARDS? Asthma? 5-7, 6, <8. nml 8-10ml/kg
describe effects of tamoxifen v raloxifen. SE both tamoxifen (prevent br ca): agonist endomet (vaginal bldg, atypia, if so d/c), antag at breast. Raloxifen (osteoporosis, also Br Ca prevent): estrogenic on bone, antagonist on breast and endometrium. SE incl hot flashes, thromboembolic, lowers LDL
what's goserelin, 3 similar drugs? GnRH agonist used in androgen R positive prostate cancer and endometrial lesions. Other GnRH agonist=Leuprolide, and other anti androgens inc bicalutamide and flutamide
you suspect acute angle glaucoma, what are the s/s what test next painful red eye, sudden halos/blurred vision, HA, pupil nonreactive, cornea cloudy/steamy. Tonometry is next (fundo exam is nml)
how does acyclovir work? Amph B? bactrim? inhibits DNA synthesis, alters cell mem permeability, inhibits folate syn
tx and prophyl for cluster HA? Migraines? Tension? cluster=acute tx 100% O2 then sumatriptan, prophyl ergots, verapamil. Migraine, tx abortive=triptans, prophyl b blocker, amitryptyline, valproate. Tension tx=NSAIDs abortive, can consider triptans, ergots. Relaxation, foods
key diffs bw Nocardia and Actinomyces Nocardia=grm+ wkly acid fast, obligate aerobe soil; in immunocomp (incl steroid) can cause PNA w nodules, cavitation (like TB), dissem brain abscess. Actin grm+ anaerobe, cervicofacial dz, sulfur granules, nml oral flora. Nocardia=sulfa/bactrim; Actin=PCN
describe lung exam consolidation v pl eff consolidation-egophany, dull percussion, incrsd fremitus, incsrd breath sounds w expiration (bronchial); pl eff-dull/flat percussion, decrs breath sounds, decrsd fremitus, may have consolidation findings just above effusion
when hydroxychloroquine used? Cyclophosphamide (other than cancer? malaria, RA (As dz modifier), SLE ie rash. Cyclo used SLE w renal involvement, and in cases when steroids don't work for myositis/dermatomyo, PAN, Wegeners
tx for otitis media in 3 yo? 7yo? If had 2 sets of ear infxns in last year? 10d amoxicillin <5yo or severe infxn; 5-7d >5yo if not severe (even no Abx reeavluate 48-72hr). Always f/u 48hrs make sure responding. Use amox even if mltpl infxns in past. Only augmentin or other Abx if prev h/o reptd OM resistant to amox.
lytic bone lesion most likely which 2 cancers? Blastic? lytic=lung, breast. Blastic=prostate, breast. Remember colon and GI cancers go to LN and liver
management of cystic breast lesion in young woman? If comes back? aspirate w cytology, if recurs can aspirate again but really should do excisional bx to exclude malignancy, even if young
when can radiaiton be used for skin cancer? What margins needed for basal cell (once bx confirms dx)? Melanoma? Mohs is for? SCC (Although my notes had said basal). 1-2mm for basal cell, 2cm for melanoma. Mohs can be used for basal cell or squamos.
key findings on eye exam for cavernous venosus thrombosis. MC bug retro-orbital HA, ptosis, chemosis, proptosis, CN palsies other than just III. MC S Aureus
how does eye exam on cluster HA look. Tx? miosis, drooping of one eye, nml visual acuity, unilateral HA behind orbits, conjunctival injxn, lacrimation. Give O2 first then sumatriptan
what Rx used for repeat allergic eyes? Acute tx (2)? ketotifen (combined anti His and mast, so mast prophyl). Anti His1 in acute=levaocabastin, emedastine
tx of SSS? S-J? TEN? SSS=IV oxacillin if diffuse involvement (remember this is kids<6), S-J=steroids+fluids, TEN=fluids, no steroids
what 2 dx studies used for dx of Guillan-Barre, which most specific CSF and nerve conduction. Nerve conduction is most specific
what's the RBC count, RDW, for thal and Fe defic anemia thal has nml Fe studies w NML RDW (All cells affected equally, same size), elevated RBC count (compensating). Fe defic anemia has HIGH RDW and LOW RBC count
contraindications for mefloquine? What can be used for malaria prophylaxis instead? cardiac conduction, neuropsych, sz. Use doxy
malaria prophyl for India? Brazil? Africa? S America? C America&Carribean? Areas where no Rx resistance India/Africa=mefloquine, S America=primaquine, Brazil=atovaquine/proguaril. C America&Carrbean=chloroquine. No resistance=chloroquine
2 cxns of orbital floor fx damage to V2 leading to anterior cheek numbness and maxillary teeth numbness, and entrapment of inferior rectus mscl
dx and management of orbital floor fx get CT and will see fx and fluid in maxillary sinus. Management conservative unless inferior rectus is trapped.
how stop excessive vaginal bleeding if pt stable? Unstable? stable=7d hi dose estrogen and progesterone. Unstable=IV estrogen [would need to transfuse if Hb less than 7-8 (or sympt w angina/CP/CNS sympt and <10)
SE sildanefil HA, flushing, dyspepsia, nasal congestion, changes in vision, diarrhea, dizziness, rash
which pts should get screened for celiac? 5 What's the screening and f/u testing? 2 other markers 1st degree relative w celiac, DMI, Downs, IgA defic, Hashimoto. Screen w tissue transglutaminase A and IgA levels, f/u w duo bx (note: anti endomysial and TTG are better than gliaden (lower sens/spec)
SE of tacrine? Donepezil? Galantamine&rivastagmine? these are all anticholesterinase for Alz. Donepezil preferred bc least SE. Tacrine has hepatotoxicity and other 2 have GI
what's ideas of reference? Ideas of influence reference=ppl on tv are talking directly to them, objects/things around them have special meaning to them. Influence=pt thinks being controlled by another person or forces
3 step tx for anaphylaxis epi, anti His, steroids (prevents late phase rxn)
rx for shivering chlorpromazine or diazepam
s/s of Shy drager syndrome orthostatic hypotension even though well hydrated, bladder dysfxn, Parkinsonian or Cb findings (ie stiff limbs)
OCPs used in tx for what dysfxnl uterine bleeding/anovulatory (or cyclic progestins), endometriosis, PCOS, dysmenorrhea, PMS (although SSRI preferred), fibrocystic breast dz. Not fibroids, adenomyosis,
what Abx can accutane (oral isoretinoin) NOT be given w? why? tetracycline, causes benign intracranial HTN
what's acitretin an oral retinoid used for psoriasis, esp pustular type (difft from oral isoretinoin)
Created by: ehstephns on 2011-02-01



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