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USMLE misc xtra

what's methacholine, how is it used? parasymp testing for asthma
what's ranibizumab VEGF Ab used for proliferative/exudative macular degeneration
what's flutamide anti androgen
SE isoretinoin teratogen, transient incrsd chol, TGA, LFTs and maybe depression
what's anti DNAse B titer? assay for S Pyo (most sensitive and specific v ASO)
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)
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
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
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.
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
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
what's ifosfamide? SE? an alkylating agent used in cancers, watch for hemorrhagic cystitis (like cyclophosphamide)
what's topirimate? Key SE sz med, closed angle glaucoma
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)
what's erlotinib, gefitinib? Use? EVRF inihibitors for NSLC, pan cancer and other cancers
what's efalizumab? Use? anti CD11 used for severe psoriasis by preventing lymphocytes from migrating to skin
which TCA least likely to give orthostatic hypotension? Most anti chol? Least antichol? nortriptyline; amitriptyline most antichol, desipramine least anti Chol and least sedating
which SSRI least sedating Paxil
what's chloriadzepoxide? How is it useful long acting benzo, good for tx of benzo addiction
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
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,
EPS SE in anti psych are due to which receptor D2 (same that cocaine works on)
what can be used for opiate dependence naltroxene (also EtOH), long acting so helps w cravings
most effective tx of ankylosing spondylitis 2 anti TNFA (etanercept, infliximab) most effective
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
how tell if spider bite was brown recluse? Tx? ulcerated, necrotic center w halo of erythe. Give dapsone
how tell black widow? s/s? tx? red hour glass on belly, will develop N/V and mscl cramps, give Ca++ gluconate
pigmented macrophages on colonoscopy in someone asympt, what is it? melanosis coli, due to laxative abuse
order of w/u for dysphagia first Ba swallow, then EGD, then motility
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
classic 4 features of HSP arthritis, abd pain, hematuria, rash
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
how difft substance abuse and tolerance if evidence of tolerance or wdrawal its dependence
tx preg mom w toxo, baby? 1st tri=spiramycin, 2nd=pyrimethamine, sulfonamide; baby=p&s + steroids for retinitis
dx of congenital toxo IgM best (or cx)
dx congenital CMV culture or PCR
tx of baby who's mom got varicella VZIG if mom got rash 5d before-2d after
if need to trach child what size use? When use cuffed ET? use cuffed ET tube >8yo. Tube size=(age in years +16)/4
Rx contraindications BF other than anti-neoplastics 6 ergots, iodides/mercurials, atropine, Li, chloramphenicol, cyclosporine, also no nicotine, EtOH
Relative Rx contraindications BF neuroleptics, sedatives, tranquilizers, metronidazole, tetracylcine, sulfonamides, steroids
Dz contraindications BF 5 Untreated TB, syph, HIV, varicella, and herpes if active lesions on breast
goat's milk needs supplement w what folate
risks assoc w cow whole milk incrsd renal solute load, Fe defic anemia, intolerance for whole milk proteins
describe Bardet-Biedl, inheritence AR: MR, retinitis pigmentosa (rod-cone dystrophy leading to night blindness), polydactyly, obesity, hypogenitalism
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
maintenance fluid for <1yo, 1-3yo, >3 <1yo: d5 1/4NS; 1-3yo: D5 1/3 NS; >3yo D5 1/2 NS
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%
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
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
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
tx for Kawasaki Phase I (1-2wks): high dose IVIG and ASA; Phase 2 (wks-mos) low ASA
how freq and when do cor aneurysms occur in Kawasaki 20%, 7-14d
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
besides RF and ANA, what other Ab can be + in RA anti-CCP (cyclic citrullinated protein), aka ACPA
anti Ro and La are aka SSA, SSB
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
which Ab most specific for Sjorgens anti La (bc only 15% SLE, whereas anti Ro is in 40% SLE)
SE hydroxochloroquine visual loss, need eye checks q6mo
tx of SLE besides flares cytotoxics like cyclophosphamide, AZT for GN (also mycophenolate?), hydroxychloroquine for cutaneous, articular
ARF after starting an ACEI--think what? renal artery stenosis--get an MRA
marker for auto immune hep? Tx? anti smooth mscl, (often also ANA+), tx w prednisone
rules on car seats birth rear facing, 1 yr and 20lbs car seat faces fwd; 4yr OR 40lbs booster seat; 7yo seat belt
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
What OD? Drowsy, slurred speech, ataxia, nystagmus benzos/barbs
what OD assoc w grinding teeth (bruxism) ecstasy (MDMA); incrsd BP, HR, sweating. Euphoria, feel peaceful empathy, closeness to ppl. Also SOB, arrhythmia
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
What OD? Rhinorrhea, dilated pupils, N/V, abd pain, insomnia benzo withdrawal, also have yawning, lacrimation, pilorection…can give anti chol
how is demerol dfft from other opiates dilates pupils and more likely to cause sz in OD
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
which OD more likely to have visual halluc, other sympt? Tx? LSD, also see dilated pupils sweating. Tx=none
which vaccines have egg? Streptomycin/neomycin eggs=MMR, flu, yellow F. Streptomycin/neomycin=IPV, MMR
contraindication dtap severe CNS problem <7d, anaphylaxis, unstable encephalopathy.
when hospitalize for occult bacteremia 3mo-3yo doesn't appear well, fever, OR bld cx + for H Flu or Mening
tx pertussis (excl contact prophyl) supportive, erythro decrses communicability but not length. If <6mo or comorbidiites should hospitalize
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
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
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)
describe Ig subclass defic in Brutons, what can mimic all are low; transient hypogammaglobulinemia of infancy can mimic
what is IgA defic assoc w SLE, RA and incrsd cancer
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]
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
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
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
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
when do first teeth appear? How many by 1yo? 2yo? usu 6-8mo, 1 yo ~6 teeth, 2yo ~12
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]
cause of bullous myringitis (bullae on TM), usu Mycoplas PNA
what's cholesteatoma? Tx? cxn of OM. squamos epithelium in TM that can spread and destroy temporal bones, etc, need surgical removal
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
describe Kaartagener's syndrome, inherit AR dysmotile cilia, recurrent sinusitis, bronchiectasis, dextrocardia
MC site for foreign body <1yo, >1yo? If stridor its where? <1yo larynx; >1yo trachea/bronchus, esp R main stem. Stridor=pharynx
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
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.
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
what's erythropoietic protoporphyria, tx? burning pain, erythema and swelling minutes after exposure to sun. tx: beta carotene
what's acute intermittent porphyria, how present? Tx? abnl heme production, acute abd pain and brown urine, ie after EtOH and barbs. Tx: hematin
at what level is acetominophen toxic? Fe? acetominophen: 100mg/kg; Fe: 30mg/kg
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
when hospitalize RSV pt O2 <92%, RR>60, PO2<60; premie <34wks, <3mo, cardiopul dz, immunodefic, dehydration/apnea/poor feeding, parent not reliable
tx for hospitalized RSV pt O2, humidifer, try albuterol, ribavirin if impending respir failure, immunodefic, CHD, neuromuscular dz, bronchopul dyspl, **NO STEROIDS
calculation A-a gradient 150-(1.25xPCO2)-PaO2 (nml 5-15)
what color are gram - on gram stain? Gram +? gram neg=red!!!! Gram + = Blue!!!
what's Kasabach-Merritt syn? low plts. Rapidly enlarging cavernous hemangioma consuming plts
when tx Salmonella diarrhea if tx will prolong the carrier state, so only <3mo, toxic, dissem or S Typhi
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
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
how assess renal scarring in kids technetium labelled DMSA scan
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
indications for surgery for reflux grades III, IV; renal scarring; breakthrough UTI while on Abx
when to test reflux VCUG UTI any children <5yo, any girls 2 UTI, any boy w UTI, children w febrile UTI
what's enthesopathy aka enthesitis, inflamm at sites of tendon insertion, seen in seronegative spondyloarthropathies (PAIR)
why would someone N/V have low Na? bc they haven't been eating but having water
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
eqn of serum osmol 2xNa* +BUN/2.8 + glu/18 + blood EtOH/4.6; *some also put K here
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
Created by: ehstephns



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