USMLE misc xtra
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| what's methacholine, how is it used? | parasymp testing for asthma
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| what's ranibizumab | VEGF Ab used for proliferative/exudative macular degeneration
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| what's flutamide | anti androgen
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| SE isoretinoin | teratogen, transient incrsd chol, TGA, LFTs and maybe depression
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| what's anti DNAse B titer? | assay for S Pyo (most sensitive and specific v ASO)
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| what's orlistat? SE | a lipase inhibitor derived from a Strep bac lipstatin that is used for wgt loss, SE=mostly GI w steatorrhea, malabsorb of vit K, D, A, E (ie night blindness, etc)
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| what's dong quai used for? SE? | can prolong INR. Often taken by women w fatigue, recovering from illness, low vitality and has been used for reducing sm mscl spasms
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| what's GIngko used for? SE? | used for Alz and multi-infarct dementia inhibits plt activating factor and can cause hemorrhage. Be very careful if on anticoag, bldg problems, or around surgery
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| what's St. John's worti used for? SE? | can decrs dig. Some data to support its use in tx of depression w/o suicidal ideation.
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| name 2 5 alpha reductase? When are they indicated? | finasteride and dutasteride; severe BPH when prostate >40g of BPH unresponsive to monotherapy w alpha-adrenergics
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| what goserelin? What is it nmlly given w? | LHRH agonist for prostate cancer; usu given w an anti-androgen like bicalutamide bc can have flare of LH in first 2-3wks tx
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| what's ifosfamide? SE? | an alkylating agent used in cancers, watch for hemorrhagic cystitis (like cyclophosphamide)
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| what's topirimate? Key SE | sz med, closed angle glaucoma
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| what's rituximab? Use? | anti CD20, used for lymphomas (CD20 is expressed on most B cells, but progenitor B and plasma cells don't express)
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| what's erlotinib, gefitinib? Use? | EVRF inihibitors for NSLC, pan cancer and other cancers
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| what's efalizumab? Use? | anti CD11 used for severe psoriasis by preventing lymphocytes from migrating to skin
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| which TCA least likely to give orthostatic hypotension? Most anti chol? Least antichol? | nortriptyline; amitriptyline most antichol, desipramine least anti Chol and least sedating
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| which SSRI least sedating | Paxil
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| what's chloriadzepoxide? How is it useful | long acting benzo, good for tx of benzo addiction
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| what's hydroxyzine? How is it used? | anti His, anti chol, mild sedative, bronchodil. Premed for anesthesia and used pruritic. Causes drowsiness and dry mouth
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| what's zolpidem? Aka? How is it used? What else can be used like that 2? | Ambien, sleep aid (mostly helps getting to sleep). Similar to benzos, and flumanezil can even be used for reversal. Also insomnia: short acting benzo triazolam or temazepam, trazodone,
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| EPS SE in anti psych are due to which receptor | D2 (same that cocaine works on)
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| what can be used for opiate dependence | naltroxene (also EtOH), long acting so helps w cravings
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| most effective tx of ankylosing spondylitis 2 | anti TNFA (etanercept, infliximab) most effective
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| management of pul nodule | high probab (smoker, >35, spiculated) should be removed, if >1cm either PET or bx, if <1cm serial CT q 3 mos for 2 yrs
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| how tell if spider bite was brown recluse? Tx? | ulcerated, necrotic center w halo of erythe. Give dapsone
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| how tell black widow? s/s? tx? | red hour glass on belly, will develop N/V and mscl cramps, give Ca++ gluconate
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| pigmented macrophages on colonoscopy in someone asympt, what is it? | melanosis coli, due to laxative abuse
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| order of w/u for dysphagia | first Ba swallow, then EGD, then motility
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| what's Waterhouse Friderichson syn | fulminant adrenal failure s/p meningoccoccemia, see purpuric/petichael lesions all over flank and sudden vasomotor collapse, very high mortality
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| classic 4 features of HSP | arthritis, abd pain, hematuria, rash
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| what's the diff bw thgt d/o and delusion | thgt d/o is how the sentences are put together, ie the form of speech, delusion=the content of the speech
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| how difft substance abuse and tolerance | if evidence of tolerance or wdrawal its dependence
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| tx preg mom w toxo, baby? | 1st tri=spiramycin, 2nd=pyrimethamine, sulfonamide; baby=p&s + steroids for retinitis
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| dx of congenital toxo | IgM best (or cx)
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| dx congenital CMV | culture or PCR
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| tx of baby who's mom got varicella | VZIG if mom got rash 5d before-2d after
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| if need to trach child what size use? When use cuffed ET? | use cuffed ET tube >8yo. Tube size=(age in years +16)/4
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| Rx contraindications BF other than anti-neoplastics 6 | ergots, iodides/mercurials, atropine, Li, chloramphenicol, cyclosporine, also no nicotine, EtOH
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| Relative Rx contraindications BF | neuroleptics, sedatives, tranquilizers, metronidazole, tetracylcine, sulfonamides, steroids
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| Dz contraindications BF 5 | Untreated TB, syph, HIV, varicella, and herpes if active lesions on breast
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| goat's milk needs supplement w what | folate
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| risks assoc w cow whole milk | incrsd renal solute load, Fe defic anemia, intolerance for whole milk proteins
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| describe Bardet-Biedl, inheritence | AR: MR, retinitis pigmentosa (rod-cone dystrophy leading to night blindness), polydactyly, obesity, hypogenitalism
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| describe Laurence-Moon, inheritence | AR: MR, retinitis pigmentosa (rod-cone dystrophy leading to night blindness), spastic paraplegia, hypogonad, MR **difft from Bardet Biedl in HAS paraplegia, NO polydactyly or obesity
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| maintenance fluid for <1yo, 1-3yo, >3 | <1yo: d5 1/4NS; 1-3yo: D5 1/3 NS; >3yo D5 1/2 NS
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| name FEV1/FVC and %variability for mild intermitt asthma, mild persistent, moderate, severe | mild intermittent: >80%, <20; mild persist: >80%, 20-30%; moderate: 60-80, 30%; severe: <60%, >30%
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| name cut offs for sympt of mild intermittent asthma? Mild persistent? Tx for ea? | mild intermitt: <2x/wk day sympt, <2x/mo night sympt; tx=b2 PRN; mild persistent: >2x/wk day sympt, >2x/mo night sympt;tx=add steroid inhalor or cromolyn
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| name cut offs for sympt of moderate asthma? severe? Tx for ea? | mod: daily sympt, >1x/wk night sympt; tx=add long acting b2; severe: continuous day sympt, freq night sympt; tx=add oral steroid or leukotriene
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| criteria for Kawasaki | F>102 for 5d and 4 of: bilat conjunctivitis, oropharyngeal (MC red, cracked, swollen lips), cervical LAD, rash, extremity (edema/eryth, later peeling around nail beds) and can't be explained by another dz
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| tx for Kawasaki | Phase I (1-2wks): high dose IVIG and ASA; Phase 2 (wks-mos) low ASA
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| how freq and when do cor aneurysms occur in Kawasaki | 20%, 7-14d
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| what's the signif of peripheral/rim ANA staining? Nucleolar? Speckled? Diffuse? Centromere? | peripheral/rim=SLE, centromere=CREST, nucleolar=systemic sclerosis, the rest are nonspecific
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| besides RF and ANA, what other Ab can be + in RA | anti-CCP (cyclic citrullinated protein), aka ACPA
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| anti Ro and La are aka | SSA, SSB
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| how is ANA helpful for dx CT dz | sensitive for SLE, so if - you can rule that out…otherwise not very helpful bc not specific (ie in scleroderma, sjorgens, polymyo/dermomyo, RA
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| which Ab most specific for Sjorgens | anti La (bc only 15% SLE, whereas anti Ro is in 40% SLE)
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| SE hydroxochloroquine | visual loss, need eye checks q6mo
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| tx of SLE besides flares | cytotoxics like cyclophosphamide, AZT for GN (also mycophenolate?), hydroxychloroquine for cutaneous, articular
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| ARF after starting an ACEI--think what? | renal artery stenosis--get an MRA
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| marker for auto immune hep? Tx? | anti smooth mscl, (often also ANA+), tx w prednisone
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| rules on car seats | birth rear facing, 1 yr and 20lbs car seat faces fwd; 4yr OR 40lbs booster seat; 7yo seat belt
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| rules on concusions for kids | I=confusion, sit out 20min. II=confusion, amnesia, return to contact sports 1 wk. III=LOC, amnesia, confusion, return 1 mo
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| What OD? Drowsy, slurred speech, ataxia, nystagmus | benzos/barbs
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| what OD assoc w grinding teeth (bruxism) | ecstasy (MDMA); incrsd BP, HR, sweating. Euphoria, feel peaceful empathy, closeness to ppl. Also SOB, arrhythmia
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| What OD? N, dilated pupils, sweating, chills, tactile halluc. Tx? | cocaine…also see suspiciousness….ie if look like manic episode + dilate pupils; benzos for agitation/sz, if psychosis or severe agitation use haloperidol; control HTN w labetolol
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| What OD? Rhinorrhea, dilated pupils, N/V, abd pain, insomnia | benzo withdrawal, also have yawning, lacrimation, pilorection…can give anti chol
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| how is demerol dfft from other opiates | dilates pupils and more likely to cause sz in OD
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| restless, mscl rigidity, rotatory nystag--what OD? Tx? | PCP. Also see impulsiveness, violence, don't feel pain, highly assoc w violence. Tx=acidify urine w acorbic acid or cranberry juice, benzos
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| which OD more likely to have visual halluc, other sympt? Tx? | LSD, also see dilated pupils sweating. Tx=none
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| which vaccines have egg? Streptomycin/neomycin | eggs=MMR, flu, yellow F. Streptomycin/neomycin=IPV, MMR
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| contraindication dtap | severe CNS problem <7d, anaphylaxis, unstable encephalopathy.
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| when hospitalize for occult bacteremia 3mo-3yo | doesn't appear well, fever, OR bld cx + for H Flu or Mening
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| tx pertussis (excl contact prophyl) | supportive, erythro decrses communicability but not length. If <6mo or comorbidiites should hospitalize
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| tx contacts of pertussis | 14d of erythro. Children <7 w delayed immuniz get vaccine, if 3rd dtap was 6mo or 4th was 3yo should get booster
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| child develops measles, what do for preventing spread? MC cxn? | child needs be in isolation until 5d after rash; those exposed can get IgG within 6d. MC cxn=otitis
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| name 3 types of influenza, which cause epidemics. Tx and which can be used in. | A,B cause epidemics. C=sporadic. Tx=amantadine and rimantadine for severe Flu A if within 48hrs (doesn't work on flu B)
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| describe Ig subclass defic in Brutons, what can mimic | all are low; transient hypogammaglobulinemia of infancy can mimic
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| what is IgA defic assoc w | SLE, RA and incrsd cancer
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| what's Apert syndrome? Alport (genetics, defect, bx, sympt) | cranial deformities, fusion of finger and toes, VSD [don't confuse w Alport XL Col IV defic w GN, hearing loss, ocular, skin bx shows foam cells]
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| moon-like facies, choreoathetosis, drooling, irreg eye mvmts incl nystagmus; describe dz, inheritance, 3 cxns | Ataxia Teliangectesia, AR Chrom 11 ATM gene problem DNA repair; see telangiectasias on eyes and skin (appear 3-6yo), look for ataxia starting after starting to walk, confined to wheelchair by 12yo; chronic sinopul; at risk NHL, leuk, gastric carcinoma
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| what's periventricular leukomalacia? Assoc w? | hypoxic-isch episodes, the germinal matrix/ependymal choroid plexus hasn't matured and is very vascularized. Can cause pyramidal/spastic paralysis
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| 2 types of cerebral palsy, MC, features | pyramidal/spastic(75%): constipat, poor grwth/fdg, 2/2 IVH, hypoxic-ischemic/periventricular leukomalacia. Extrapyr/dsykinetic incl ataxic, choeroathetoid, dystonic; 2/2 damage BG ie kernicterus, the mvmts worse during stress and disappear during sleep
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| what's a hordeolum? Chalazion? | Stye=hordeolum=staph infxn of ciliary follicle/glands. Just use warm compress; Chalazion=chronic lipogranuloma from sxns of glands, usu regress
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| when do first teeth appear? How many by 1yo? 2yo? | usu 6-8mo, 1 yo ~6 teeth, 2yo ~12
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| tx of otitis media? If doesn't resolve? Why might it not have resolved | amoxicillin, if F or ear pain persists 72hrs it’s a treatment failure, switch to high dose augmentin or cephalo [MC bugs are S Pneu, nontypable H Flu, Moraxella and H Flu has b lactamase]
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| cause of bullous myringitis | (bullae on TM), usu Mycoplas PNA
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| what's cholesteatoma? Tx? | cxn of OM. squamos epithelium in TM that can spread and destroy temporal bones, etc, need surgical removal
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| when should do w effusion of ear but no sympt? What's this called? | OM w effusion (ie persistent fluid, but not many sympt). TM retracted and poorly mobile. Should tx (Abx, decongestants, myringotomy/ventilation tubes) if hearing loss or if persists 3mos
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| describe Kaartagener's syndrome, inherit | AR dysmotile cilia, recurrent sinusitis, bronchiectasis, dextrocardia
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| MC site for foreign body <1yo, >1yo? If stridor its where? | <1yo larynx; >1yo trachea/bronchus, esp R main stem. Stridor=pharynx
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| how does expiratory CXR help for foreign body? Dx and tx of foreign body aspiration? | will show overaeration if object is obstructing. But definitive dx is rigid bronchoscope--and that's how to take it out
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| bone pain worst at night relieved by ASA, what is it? Type of tissue, XR appearance, common location and tx? | osteoid osteoma, radiolucent nidus + osteosclerosis (“bone sclerosis”). Usu at metaphysis of long bones. Consists of haphazardly arranged bone trabeculae separated by fibrovascular tissue. Tx: resection.
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| what's porphyria cutanea tarda? Seen in? tx? | >40yo EtOH women on OCPs. blisters/erosions in sun exposed areas, heal w scarring, hyperpigment. Hyperpigment & hypertrichosis in DM or hepatic hemosiderosis upper cheeks. Ppt: estrogen, EtOH, Fe, hexachlorobenzene (fungal). Tx: chloroquine or phlebotomy
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| what's erythropoietic protoporphyria, tx? | burning pain, erythema and swelling minutes after exposure to sun. tx: beta carotene
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| what's acute intermittent porphyria, how present? Tx? | abnl heme production, acute abd pain and brown urine, ie after EtOH and barbs. Tx: hematin
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| at what level is acetominophen toxic? Fe? | acetominophen: 100mg/kg; Fe: 30mg/kg
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| what's palivizumab? When is it given | RSV Abs for high risk RSV, incl <2yo w CLD or premie, but not CHD. Given Oct-May q month
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| when hospitalize RSV pt | O2 <92%, RR>60, PO2<60; premie <34wks, <3mo, cardiopul dz, immunodefic, dehydration/apnea/poor feeding, parent not reliable
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| tx for hospitalized RSV pt | O2, humidifer, try albuterol, ribavirin if impending respir failure, immunodefic, CHD, neuromuscular dz, bronchopul dyspl, **NO STEROIDS
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| calculation A-a gradient | 150-(1.25xPCO2)-PaO2 (nml 5-15)
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| what color are gram - on gram stain? Gram +? | gram neg=red!!!! Gram + = Blue!!!
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| what's Kasabach-Merritt syn? | low plts. Rapidly enlarging cavernous hemangioma consuming plts
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| when tx Salmonella diarrhea | if tx will prolong the carrier state, so only <3mo, toxic, dissem or S Typhi
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| describe presentation neuroblastoma | blueberry muffin (subQ lesions), HTN, dancing eyes and dancing feet (chaotic eye mvmts, myoclonus, ataxia). Can also have raccoon’s eyes w periorbital hemorrh, exopthalmos, asympt abd mass, Horners, persistent cough, SVC syn, bone pain
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| describe grading for reflux | I=ureter, II=upper collecting/renal pelvis w/o dilation, III=into calyves w ureter dilation or blunting of calyceal fornices, IV=grossly dilated ureter w moderate dilation pelvis, V=massive reflux w gross dilation/tortuousity of ureter, pelvis, calyces
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| how assess renal scarring in kids | technetium labelled DMSA scan
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| when assessing for reflux using VCUG, what other tests? | check upper GU w renal US, IVP or renal scintogram, check for renal scarring (tech labelled DMSA), if scarring get serum Cr level, UA to check for infxn
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| indications for surgery for reflux | grades III, IV; renal scarring; breakthrough UTI while on Abx
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| when to test reflux VCUG | UTI any children <5yo, any girls 2 UTI, any boy w UTI, children w febrile UTI
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| what's enthesopathy | aka enthesitis, inflamm at sites of tendon insertion, seen in seronegative spondyloarthropathies (PAIR)
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| why would someone N/V have low Na? | bc they haven't been eating but having water
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| describe 2 MC lacunar stroke, their sympt and where the lesion is | pure motor (MC)=PL or genu of internal capsule, causing hemiparesis of one side, no ataxia signs; pure sensory=numbness, pain, tingling contra body; also ataxic hemiparesis if ALIC, clumsy hand dysarthia, and last mixed sensory motor if thal and IC
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| eqn of serum osmol | 2xNa* +BUN/2.8 + glu/18 + blood EtOH/4.6; *some also put K here
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| how tx lead of difft levels | 10-14: rept 3mos (eval sources, edu); <19 rept 2mos&Dept of Health; <45 rept 1mo; 70: tx w succimer; >70 if no encephalopathy EDTA +DMSA or BAL, if encephalopathy EDTA + BAL
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