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USMLE xtra4

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-
what's tinidazole like metronidazole but newer w less SE. Used for bac vaginosis
tx Ca oxaloate stones, 1x? Reptd? 1x just hydration and observe, repeated Na restriction, nml Ca and thiazide…also low protein diet
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)
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
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
w/u for pneumaturia CT, will need to r/o cancer (sigmoidoscopy/colonoscopy)
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)
what's ropinerole a Dopa agonist like pramipexole, used in restless leg syndrome
tx for restless leg syndrome Dopa agonists, ie pramipexole, ropinerole, or levodopa
pt w contaminated wound--what tetanus prophyl do you give depending on vaccination status if incomplete: Td+TIG, if >5yrs since booster give Td
pt w clean wound--what tetanus prophyl do you give based on vaccine status if incomplete give Td, if >10y give Td
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)
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)
native valve endocarditis in otherwise healthy young man most likely 2/2 to? MVP, if immigrant could be 2/2 RHD
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
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
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.
empiric tx of neutropenic F cefepime (covers Pseudo+Staph), imipenem, AG+anti pseudo. Key to cover Pseudo. If don't respond add anti fungal
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)
features of serum sickness and cause F, urticaria, arhtritis, nephritis due to immune complex rxn to heterologous proteins (ie animal anti serum)
infxn in burn pts based on timing if <1wk=Staph Aureus, >1wk=Pseudo
screening for glaucoma if risk factors (AA, incrsd IOP, FMH, DM), screen q1yr >40yo, otherwise 40-60 q3-5y and >60 q1-2y
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)
tx Chl PNA 6wk-6mo erythro drops, need tx mom and her sex partner
tx PNA <2mo (other than Chl) IV amp+gent or amp+ceph and need full septic w/u
tx PNA 2mo-5yo and likely bugs S Pneu, H Flu, Staph, tx w ceftriax or cefurox, for out patient amox/augmentin
3 key s/s fibroids dysmenorrhea, menorrhagia, enlarged uterus
name some mature defense mech 4 altruism, humor, sublimation/channeling, suppression
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)
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)
use and SE of cyclosporin (remember used s/p transplant), viral infxns, lymphoma, renal toxic
SE of hydroxychloroquine GI, visual, G6PD
what Rx can help w sexual dysfxn assoc SSRI cyproheptadine (anti His)
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
components of medial medulla? Lateral medulla? medial: CN12, DC, CD; lateral: CN8-11, ?CN5, ST, Cb peduncle
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
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
how difft medial medullary from medial pontine syn medulla spares facial sensation and has ipsi tongue deviation; pons involves CN6
how difft lateral medullary from pons medulla has CN8-11
Created by: ehstephns



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