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COMBANK Review 1

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jmanderson's version from 2017-06-08 00:38

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Question Answer
Dx test of choice for infective endocarditisTransesophageal echo (TEE)
Tx for H ducreyi penile lesionSingle dose azithromycin, 3x dose ceftriaxone 7d, or cipro bid 3d
DOC post-herpetic neuralgiaTCA (nortriptyline)
Tx crytpococcol meningitisAmphotericin B and flucytosine
Supination of foot → ?fibular head motionPosterior
Dec ROM with foot supination → ?s/d dxAnterior fibular head
Sensitivity eq. (prob test will be + in pt +dz)TP / TP + FN
PPV eq. (prob pt will be +dz with +test)TP / TP + FP
Specificity eq. (prob test will be - in pt -dz)TN / TN + FP
NPV eq. (prob pt will be -dz with -test)TN / TN + FN
OR eq. (odds exp -dz vs. odds exp +dz)(TP * TN) / (FP * FN)
Most sensitive PE test for ACL injuryLachman’s
RF for PPROM (<37 wk), including MCOligohydramnios (MC), infxn, bleeding, smoking
PPROM pt in ED, mgmt?Bedside u/s
Supraspinatous actionabduction
Infraspinatous actionExternal rotation
Teres minor actionExternal rotation
Subscapularis actionInternal rotation
Empty can test for whatSupraspinatous RC tear
Posterior costal tenderpoints assoc. withInhalation s/d (elevated ribs)
Anterior costal tenderpoints assoc withExhalation s/d (depressed ribs)
Pt at risk for ACS with T-wave inv at II, III, aVF - next step?EKG on R side to isolate spot of infarction
Pt with wk/fatigue, sore tongue, paresthesias, wt loss, constipation, anorexia, abd fullness, loss of proprioception (+ rhomberg), dx?Pernicious anemia (IF d/o of parietal cells, dec B12 absorption)
Mode of sickle cell inheritanceAutosomal recessive
Pt w/ diarrhea, urinary frequency, muscle cramps, low BP, lethargy, tremor, poor turgorhypoMg
HypoMg on EKGTorsades de pointes
hypoMg assoc. Electrolyte d/ohypoK (also ca, PTH)
Tumor marker for seminomabhcg
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Question Answer
DOC for impetigoDicloxacillin (beta-lactamase resistant abx)
MC blood ca in children, tdt+, immature lymphoblasts on BM bxAcute lymphoblastic leukemia (ALL)
Dx- dec pain/temp sense in arms/hands, intact vibration/proprioception, dec DTR/strength UE, inc UMN in LESyringomyelia (spinothalamic cross at ventral white commissure)
5 P’s of compartment syndromePain, paresthesia, pallor, pulselessness, paralysis
Delta P definition and level for fasciotomyDBP - compartment P; <30 → fasciotomy
Rx etoh w/d for sz ppxBZDs (chlordiazepoxide)
Infarction of 2nd metatarsal headFreiberg dz
Dx- coma/sz, s/p smoke exposure, metabolic acidosis, high lactic acid, almond breathCyanide poisoning
Rx cyanide poisoningAmyl nitrite and thiosulfate
Time of dep to dx MDD>2 wks
Electrolyte d/o - weak, low DTR, peaked T waves, wide QRShyperK
Electrolyte d/o - stones, bones, abd groans, psych overtoneshyperCa
Electrolyte d/o - confusion, lethargy, ha, sz, diffuse STEhypoNa
Metabolic d/o - mental obtundation, low DTR, coma, blurred vision, dehydrationhyperglycemia
Electrolyte d/o - tetany, hyper DTR, dysrhythmias, STD, u waves, QRS wideninghypoMg
IVDU with CP, nausea, bitter taste in mouth, CP 2nd ICS leftesophagitis
Pt with SLE has anemia, what lab values?Low Hb, how MCV, high ferritin, low TIBC and Fe (AKA anemia of chronic dz)
Labs in Fe def. vs. anemia of chr dzFe def. (TIBC high, ferritin/Fe low), anemia of chr dz (ferritin high, TIBC/Fe low)
BZD w/d, what tx in ED?Lorazepam
Abrupt ha, vomiting, amsSubarachnoid hemorrhage
Artery involved w/ occulomotor n paralysis?Posterior communicating
Artery involved w/ wallenberg syndrome (dec pain/temp of same side face, opposite side body)?PICA
Old pt, fever, sore throat, hoarsness, tripodding, worse with layingEpiglottitis (H flu MC)
Glucosuria in pregnancynL
Repetitive UE motion (screwdriver), reduced terminal extension, elbow painLateral epicondylitis
Moa dantrolene (for malignant hyperthermia)Ryanodine Ca channel blocker
MC eye injury s/p surgeryCorneal laceration
Dx and tx corneal lacerationSlit lamp; erythromycin ointment
DOC for AChE inh organophosphate pesticide poisoning?Atropine
DOC for p jiroveci pneumoniaTmp-smx (bactrim)
EMG results on myasthenia gravisDecreased amplitude of AP with repeated stimulation
Lambert eaton vs myasthenia gravis
Rx for sjogren syndromePilocarpine (muscarinic agonist)
Dandy walker vs arnold chiariDandy walker (enlargement of 4th ventricle, large posterior fossa); Arnold chiari (tonsiller herniation)
Hand Foot mouth mc virusCoxcackie A
Tx of DDH in < 6moPavlik harness
MCC hypoT4Hashimoto’s
Ab in Hashimoto’santi-TPO, anti thyroglobulin
Change in TSH with glucocorticoids Decrease
Protein that acts in thyroid + I- to make T3/4Thyroglobulin
DOC for cutaneous larval migransThiabendazole (2nd line - albendazole, ivermectin)
1st line mgmt for 3rd degree heart block (Ps and QRS indep.)Transcutaneous pacer pads
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Question Answer
DOC essential tremor (at rest and intention)Propranolol (BB)
DOC for RLS nightly tremorPramipexole (DA agonist)
DOC for dyskinesia of huntington’s Tetrabenazine (VMAT inhb, dec DA, 5HT, NE)
DOC for tardive dyskinesia (perioral tremor)d/c drug, start atypical antipsychotic (i.e., d/c chlorpromazine to start clozapine)
SNS for head/neck (i.e., otitis media)T1-4
Sudden dyspnea in tall, thin, smoker malesSpontaneous ptx
Dx ptxCxr, lung hyperresonance, u/l dec BS
Gold standard to dx kidney stonesSpiral CT w/o contrast
Next step with solitary lung nodule on cxrCompare to previous cxr
Epi dose for anaphylaxis, IM v. IVIM 1-1,000, IV 1-10,000
Term- surgeon removes ovarian mass w/o consentbattery
Term- homeless man deserves same care as those who payStandard of care
Term- hosp is partially responsible for pt suing surgeon for leaving sponge in bodyVicarious liability
Term- doc puts coma pt on ventilator contrary to pt’s living willbattery
Complex regional pain synd type 1 vs 2Type 2 has evidence of nerve damage
Complex regional pain synd type 1 stage- limb swollen/red/burn, diaph., sx near site (wks)1 (acute)
Complex regional pain synd type 1 stage- skin cool, diaphl, sudek’s atrophy of bone xr, pain throughout limb not just site (mo’s)2 (dystrophic)
Complex regional pain synd type 1 stage- skin pale/shiny, atrophy of mm and bone, pain constant even w/ tx (yrs)3 (atrophic)
Dx- continued pain out of proportion to injury, allodynia, jt stiff, edema, hair growth, vasospasmComplex regional pain syndrome
SNS levels for LET11-L2
Pediatric seatbelt recommendations <2 y/oBack seat, rear facing
Pediatric seatbelt recommendations 2-8 y/oBack seat, fwd facing
Pediatric seatbelt recommendations 8-12 y/oBack seat
Pediatric seatbelt recommendations >12 y/oFront seat
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Question Answer
Acute bruise/bleeds and drop in PLT s/p URIITP
Rx for ITPSteroids and/or IVIG (transfusion if unstable)
Rule of 3sT1-3- SPs and TPs same level; T4-6- SPs ½ below TPs; T7-9- SPs 1 below TPs; T10- same as T7-9; T11- same as T4-6; T12- same as T1-3
What TPs are felt at inferior angle of scapulaT8 (but T7 SPs)
Disease modifying Rx for dementiaMemantine (NMDA antagonist)
Rx for neutropenic fever in chemo ptsPseudomonal abx (ceftazadime, zosyn, meropenem, imipenem, cefepime)
Rx for persistent neutropenic fever Anti-fungal (amphotericin B)
Rx for candida esophagitisPO fluconazole
Body surface area rule for burns (rule of 9’s)Adults (9% head and each arm, 18% front, back, and legs); kids (9% each arm, 14% each leg, 18% head, front, and back)
Testicular ca causing feminization (gynecomastia, dec libido, ED)Leydig cell tumors (cells stimulated by LH to make androgens)
Testicular ca assoc. with peutz Jeghers (intestinal polyposis) and Carney’s synd (mucosal melanin spots)Sertoli cell tumors (stimulated by FSH for spermatogenesis)
1st line tx for migrainesSumatriptan (-triptans)
Ppx for migrainesBBs (also TCAs, divalproex, topiramate)
1st two Ags in acute hepatitis BHBsAg + HBeAg
1st Ig in acute hepatitis Banti-HBc (IgM)
Ag present in Hep B with high viral loadHBsAg
Ig in chronic Hep Banti-HBc (IgG)
Serology in window period of Hep Banti-HBc (IgM) only
Triple therapy for h pyloriPpi + 2 abx (pcn + macrolide), metronidazole if pcn allergy
Unstable WPW pt with irregularly irregular rhythm, dx/txA fib, cardioversion
Tx afib in stable WPW ptIV procainamide
Bleeding d/o with factor XI def.Hemophilia C
Factor VIII and IX def.Hemophilia A and B respectively
Rx and route to tx C diffPO metronidazole
Complication of N meningitidis with DIC and hemorrhagic necrosis of adrenalsWaterhouse-Friderichsen
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Question Answer
renal lab of waterhouse friderichsenElevated renin
Viscerosomatics for adrenalsT10-12
Ppx abx for PCP and toxo in HIV w/ CD4<200TMP-SMX (dapsone if sulfa allergy)
Ppx for MAC in HIVazithromycin
Ppx for TB in HIVINH
Child with abd pain, hematochezia, HSP, s/p URIIntussusception
Dx- teen w/ sore throat, fever, fatigue, exudates, LAD, palate petechiae, GAS and monospot -, rash after pcn (previously toler.)Mono (1st week has false negatives)
Lethal complication of monoSplenic rupture
Sudden dyspnea and mill wheel murmur s/p central lineVenous air embolism (O2, lateral decubitus)
Dx- Vertebrate more symmetrical in flexion Flexed dx (T7 FSxRx)
Innominate rotation occurs around what sacral axisInferior transverse axis
Tx for mercury poisoningChelation (succimer, dimercaprol, penicillamine)
SBO 2/2 gallstones dx/txGallstone ileus, surgical consult
NYHA CHF class- no limitation on activityI
NYHA CHF class- slight limitation on activity, comfortable at restII
NYHA CHF class- marked limitation of activity, less than ordinary activity causes sobIII
NYHA CHF class- unable to carry on activity w/o discomfortIV
Pt with n/v, jaundice, low ceruloplasmin, hemolytic anemia, liver dysfxn (ex, hepB)Wilson’s Dz (AR, copper secretion d/o, Kayser Fleischer rings)
Tx for Wilson’sChelators (penicillamine), low Cu diet (shellfish, chocolate, nuts, mushrooms, liver), vit B6 and Zn suppl
HHS pH, ketones, and beta-hydroxybutyratepH>7.3, nL ketones and beta-HB
DKA labspH<7.3, high ketones and b-HB
MDD s/sx in elderly (unique)Somatic complaints and dec activity
hyperCa on EKG Short QT interval
Mgmt- 17 y/o F w/ amenorrhea, nL mullerian structures, elevated FSHKaryotype (to r/o Turner syndr, etc.)
CP at rest w/ nL troponinUnstable angina
Transient random CP with STE, resolves in minPrinzmetal’s
CP w/ feeling of impending doomMI
Type of RTA in multiple myelomaType II (proximal, hypoK)
RTA type- met acid, UpH>5.5, low K, stonesType 1 (distal, dec H+ secretion)
RTA type- met acid, UpH<5.5, low K, no stonesType 2 (proximal, dec reabs of HCO3)
RTA type- met acid, UpH<5.5, high KType 3 (dec aldosterone, no cation exchange)
Dx- asian pt, sudden collapse/death, STE V1-3 w/ RBBB and terminal S wave on lateral leadBrugada syndrome
Dural attachmentsForamen magnum, C2, C3, S2
SBS is articulation of what 2 bonesSphenoid and occipital
Succinylcholine moaDepolarizing nmsk blocker w/ cellular K efflux
Succinylcholine electrolyte s/ehyperK
Severe preE dxbp>160/110, change in vision or AMS, >5g proteinuria
Kidney injury 2/2 trauma- dx and urine microATN, granular “muddy brown” casts
GFR to d/c metformin d/t renal clearance<30 mL/min
1st line mgmt + sleep study for osacpap
1st line tx for infant GERDFormula thickening, rice cereal
2nd and 3rd line tx for infant gerdAntacids, then H2RAs or PPIs
Electrolyte d/o in Addison’s hypoNa, hyperK
Why the electrolyte d/o in addison’sLow mineralocorticoids, low aldosterone, Na wasting, K reabsorption
Most accurate test to dx cholecystitisHIDA scan
Dx- fever, RUQ pain, jaundice, high AST/ALTAscending cholangitis
Imaging finding of ascending cholangitisDilated common bile duct (2/2 stone block)
UMN and LMN s/sx (mm atrophy, clonus, hyperDTR, dysphagia)ALS
Progressive LE dysfxn and low DTRLambert eoton
Dx- child with painless limp, dec internal rotation and adduction of hip, adhd, xr w/ misshapen growth plate and flat femoral headLegg calve perthes dz
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