USMLE misc3
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| tx of choreiform, unintentional mvmts in HD | anti Dopa agents, ie haloperidol
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| what's tramadol | opioid like pain med
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| w/u for dermamyositis/myositis | once suspect dx get EMG, then mscl bx
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| 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
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| 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
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| what Hb types in b thal major and minor | both have incrsd HbF and HbA2
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| w/u for suspected pseudotumor cerebri | need MRI or imaging first to r/o structural, then tap (both diagnostic and therapeutic). Tx includes acetazolamide
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| 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
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| 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
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| 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,
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| tx of vaginal candidiasis | preferred: 1 dose oral flucanazole exc in preg women where give intravag imidazole creams 3-7d or nystatin tablets intravag
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| what TV should be for COPD? ARDS? Asthma? | 5-7, 6, <8. nml 8-10ml/kg
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| 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
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| 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
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| 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)
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| how does acyclovir work? Amph B? bactrim? | inhibits DNA synthesis, alters cell mem permeability, inhibits folate syn
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| 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
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| 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
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| 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
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| 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
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| 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.
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| 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
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| 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
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| 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.
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| 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
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| 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
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| 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
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| 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
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| what 2 dx studies used for dx of Guillan-Barre, which most specific | CSF and nerve conduction. Nerve conduction is most specific
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| 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
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| contraindications for mefloquine? What can be used for malaria prophylaxis instead? | cardiac conduction, neuropsych, sz. Use doxy
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| 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
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| 2 cxns of orbital floor fx | damage to V2 leading to anterior cheek numbness and maxillary teeth numbness, and entrapment of inferior rectus mscl
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| 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.
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| 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)
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| SE sildanefil | HA, flushing, dyspepsia, nasal congestion, changes in vision, diarrhea, dizziness, rash
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| 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)
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| 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
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| 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
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| 3 step tx for anaphylaxis | epi, anti His, steroids (prevents late phase rxn)
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| rx for shivering | chlorpromazine or diazepam
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| s/s of Shy drager syndrome | orthostatic hypotension even though well hydrated, bladder dysfxn, Parkinsonian or Cb findings (ie stiff limbs)
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| 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,
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| what Abx can accutane (oral isoretinoin) NOT be given w? why? | tetracycline, causes benign intracranial HTN
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| what's acitretin | an oral retinoid used for psoriasis, esp pustular type (difft from oral isoretinoin)
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