USMLE xtra4
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| if completed abortion, but no US prev, what need do? | wkly HCG to make sure goes to 0 (and that it wasn't ectopic). Don't need that if IUP was documented. Also give RhoGAM if Rh-
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| what's tinidazole | like metronidazole but newer w less SE. Used for bac vaginosis
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| tx Ca oxaloate stones, 1x? Reptd? | 1x just hydration and observe, repeated Na restriction, nml Ca and thiazide…also low protein diet
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| tx for polycythemia? (incl age and other risk factors) | phlebotomy to <45% men, 42% Hct women, ASA. If CV risk factors, h/o thromboemb, or >70 add hydroxyurea (INF only for refractory to Rx or refractory pruritus)
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| small, dehydrated child presents w HCO3 30, Na of 130 and K of 3.2. also perioral tingling, what's the dx? What's the metabolic state | Bartter syndrome, metabolic alk, they lose Na, K, and Ca and look like they are on a loop diuretic
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| what are the main features of Bloom syndrome? Mechanism? Cxns? | rash after exposure to sun, café au lait or telangiectasia, immune defic, hypo gonad, skeletal abnlties, chromosomal breakage syndrome, leuk and other malignancies
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| w/u for pneumaturia | CT, will need to r/o cancer (sigmoidoscopy/colonoscopy)
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| pt takes phenylcypromine w wine, what to watch for | tyramine HTN crises. Watch BP. Won't affect kidney, liver, hi F, or rhabdo, etc. See also w phenelzine (another MAOI)
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| what's ropinerole | a Dopa agonist like pramipexole, used in restless leg syndrome
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| tx for restless leg syndrome | Dopa agonists, ie pramipexole, ropinerole, or levodopa
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| pt w contaminated wound--what tetanus prophyl do you give depending on vaccination status | if incomplete: Td+TIG, if >5yrs since booster give Td
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| pt w clean wound--what tetanus prophyl do you give based on vaccine status | if incomplete give Td, if >10y give Td
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| w/u for jaundice w wgt loss, no signs biliary dz | think pancreatic cancer, usu start w abd US, then CT scan if the US was non diagnostic (or Kaplan says just do the CT) (ERCP is invasive)
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| tx impetigo | topical mupirocin or erythro (usu Staph or S Pyo and can get GN afterwards, but don't need oral tx if just skin)
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| native valve endocarditis in otherwise healthy young man most likely 2/2 to? | MVP, if immigrant could be 2/2 RHD
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| what's zanamivir, how is it used? What are 3 related rx? | a neuroaminidase inhib tx flu A&B, not for prevention. Oseltamivir=neuro for prevention&tx flu A&B, amantadine, rimantadine prevent&tx flu A
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| 2 key differences preseptal cellulitis and orbital cellulitis | proptosis and decrsd visual acuity indicate orbital cellulitis. Both have pain on mvmt…also if limited mvmt
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| 3 key diffs cavernous sinus thrombosis v orbital cellulitis | involvement of *CNIII (ptosis), *bilateral, *undo often shows papilledema and dilated veins, and early visual problems. Also see periorbital edema, proptosis and chemosis similar to orbital cellulitis.
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| empiric tx of neutropenic F | cefepime (covers Pseudo+Staph), imipenem, AG+anti pseudo. Key to cover Pseudo. If don't respond add anti fungal
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| 2Rx for aortic regurg. What avoid? | nifedipine/CCB and ACEI. Don't use b blockers bc decrsd HR incrses diastole and more regurg (so if CHF 2/2 MR they shouldn't be on a b blocker)
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| features of serum sickness and cause | F, urticaria, arhtritis, nephritis due to immune complex rxn to heterologous proteins (ie animal anti serum)
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| infxn in burn pts based on timing | if <1wk=Staph Aureus, >1wk=Pseudo
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| screening for glaucoma | if risk factors (AA, incrsd IOP, FMH, DM), screen q1yr >40yo, otherwise 40-60 q3-5y and >60 q1-2y
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| rules for fever in young children and when need to admit to hospital/w/u | <1mo if temp 38C/100.4 need admitted w full septic w/u and cover prophylactic Abx for GBS, E Coli, Listeria. When 1-3mo less likely to have serious infxn if WBC 5-15K, potl d/c home awaiting cx if f/u24h. <2mo include Listeria covg.>3mo temp=102 (39C)
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| tx Chl PNA 6wk-6mo | erythro drops, need tx mom and her sex partner
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| tx PNA <2mo (other than Chl) | IV amp+gent or amp+ceph and need full septic w/u
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| tx PNA 2mo-5yo and likely bugs | S Pneu, H Flu, Staph, tx w ceftriax or cefurox, for out patient amox/augmentin
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| 3 key s/s fibroids | dysmenorrhea, menorrhagia, enlarged uterus
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| name some mature defense mech 4 | altruism, humor, sublimation/channeling, suppression
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| name some immature defense mech 4 | RAPiD acting out, denial, regression, projection (attributing objectional thgts to other, acusing wife of having affair when he wants to)
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| name some neurotic defense mech 7 | DRICIRD controlling, displacement, dissociation/repression (unconscious), rationalization, intellectualization, isolation of effect (describing event w/o feeling), reaction formation (doing opposite of the bad impulse)
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| use and SE of cyclosporin | (remember used s/p transplant), viral infxns, lymphoma, renal toxic
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| SE of hydroxychloroquine | GI, visual, G6PD
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| what Rx can help w sexual dysfxn assoc SSRI | cyproheptadine (anti His)
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| clinical features of medial pons lesion? Lateral? And what supplies the 2 regions | medial (branches of basilar a): contra hemiparalysis/anesthesia +/- face; lateral (a inferior Cb a): CN5 ipsi face, contra pain/temp, CB ataxia
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| components of medial medulla? Lateral medulla? | medial: CN12, DC, CD; lateral: CN8-11, ?CN5, ST, Cb peduncle
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| clinical features of medial medulla lesion? Lateral? And what supplies the 2 regions | medial (vertebral a/a spinal a): contra hemiparesis/anesthesia, ipsi tongue, INTACT FACE sensation; lateral (Wallenberg syn, P infr Cb a): ipsi Horner, pain temp ipsi face/contra body, Cb ataxia, palate/pharynx/vocal cords, CN8 nystag/vertigo
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| how difft medial from lateral pons/medulla syn? | medial involve CS and DC tracts, while lateral involve ST, Cb peduncles …also differences in CN nerves involved
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| how difft medial medullary from medial pontine syn | medulla spares facial sensation and has ipsi tongue deviation; pons involves CN6
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| how difft lateral medullary from pons | medulla has CN8-11
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