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COMBANK Review 2

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jmanderson's version from 2017-06-09 18:02

Section

Question Answer
Tx for leg-calve paresthesis d/oBrace w/ partial wt bearing (surgery if fails)
Pathophysiology of lead poisoningProduction of ROS
Confirm dx of lead poisoningSerum free erythrocyte protoporphyrin
Tx lead poisoningChelation (succimer, dimercaptosuccinic acid)
Avoid what rx in WPWDigoxin, BBs, CCBs (d/t AV node blockage → SVT)
Megaloblastic anemia with high homocysteine and nL MMAFolate def
Malabsorption d/o assoc. with folate def.Celiac dz (impaired jejunal absorption)
Test of raising leg in uninvolved extremityWell SLR
GBS w/u includes what for mcc mortalityPFTs (to r/o resp muscle weakness)
Imaging of choice for Budd ChiariDoppler u/s
Mcc budd chiariHypercoagulability
Rx for budd chiariwarfarin
Dx- severe htn, palpitations, sudden onset ha, pallorphoechromocytoma
w/u for pheo dxserum metanephrine
Viscerosomatics for adrenal gland t10
Sudden painless vag bleed >28 wk gestationPlacenta previa (dx with u/s)
Episodic vertigo with tinnitus/hearing lossMeniere’s dz
DOC for tetanusHuman tetanus Ig (neutralizes toxin)
Dx- sob, syncope, angina, palpitations, in athletesHCM
HCM dx on echoLarge interventricular septum (LVH, large atri)
Doc for HCM with systolic murmurBBs to increase preload
vWD labs (plt, PT, PTT, bleeding time)nL plt, nL PT, high PTT, high bleeding time
Dx- detached personality, no interest in socializationschizoid
Personality d/o sees ghosts, can’t maintain relationshipsschizotypal
Abx empiric for neutropenic fever (2/2 chemo)Ceftazidime and vancomycin
If neutropenic fever lasts >5 days, add rxanti-fungal
Amenorrhea w/u orderBhcg, tsh, prl, progestin challenge, FSH/LH
Absent sucklin CST nerve and txCN XII, condylar decompression
Common rx of abuse in bulimicsLaxatives (bisacodyl, cascara, senna, fiber)
When d/c pt d/t narcotic abuse and no showProvide pt paperwork if requested
Initial stress test of choice for exertional CPExercise ecg
Gold standard image for atherosclerosisCoronary angiography
Image for pt with active CP and no ischemic changes on ecgMyocardial perfusion imaging
Systemic s/sx pt in 50-60 y/o, cervical LADHodgkin's lymphoma
MC type and mgmt for dx Hodgkin'sNodular sclerosing, excisional LN bx
Dyspneic infant, low apgars, patchy cxr, post-termMeconium aspiration (post-term mc RF)
Meconium asp is mc assoc. withPersistent pulmonary HTN
Best mgmt of conn’s syndrome neoplasmLap adrenalectomy
Infant days old with cardiogenic shock, s/sx of CHF, weak LE pulses- dx and txCoarctation of the aorta (s/p DA closure), tx with PGE1 (keep PDA open)
Hepatitis transmitted mainly via blood and IVDUHep C
Septic arthritis in IVDU initial abx Ceftriaxone (gonococcal) and vanc (MRSA)
Ambiguous genitalia, no uterus/ovaries, masses in inguinal canal, nL electrolytes5 alpha reductase def. (XY, elevated T, low DHT)
Image of choice for SAHNon contrast CT
MC vulvar caSquamous cell
Status epilepticus txBZD 1st line (2 dose), then try phenytoin
s/d mc assoc with migrainesSBS strain pattern cervical or upper T s/d
BPP measurement (out of 10)2 pts each- Fetal mvmt, tone, breathing mvmt, AFI (2x2 cm), NST
Rx for vertigo 2/2 viral labrynthtitis meclizine
Severe abd pain with benign PEMesenteric ischemia (a fib is RF)
DOC for opioid dependence in pregnancymethadone
What murmur- RHD, loud S1, opening snap, diastolic rumble at apexMitral stenosis
What position increases mitral stenosis murmurSquatting (inc venous return)
Dx- osteochondrosis at Achilles insertion in kidsSever’s dz
Scoliosis with cobb angle >50 deg, mgmt?Assess respiratory fxn
Tx of postmenopausal hot flashes estrogen
Tx for post menopausal hot flashes if h/o breast caSSRIs (E is contraindicated)
MCC aortic stenosisValve calcification
Fundal height at navel, what gestational age20
Recent diuretic rx, now unstable v/s, what ABG values?Metabolic alkalosis (increase HCO3)
Etoh intox on ABGMetabolic acidosis
Lung ca in non smoker, type and mgmtAdenocarcinoma, CT guided bx
Dx, complication, tx- pt with AMS, n/v taking Ca carbonate with PR prolonged and short QTMilk alkali syndrome (2/2 too much Ca carbonate), ARF is a complication, tx with IVF and furosemide (to excrete Ca)
IJ relative to common carotid artery and CNXIJV is lateral to common carotid and anterior to vagus
Central lines should end up in the...SVC
DES increases risk for what caVaginal ca
Addison’s labs (renin and aldosterone)High renin, low aldosterone
Addison’s electrolytes (Na, K, Ca, cortisol)hypoNa, hyperK, hyperCa, low cortisol
Landmarks for leg length discrepancyASIS and medial malleolus
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Question Answer
ABGs in COPDChronic resp acidosis with comp metabolic alkalosis
Rx for stable angina sx control that reduces CV eventsBBs (metoprolol)
Elderly pt on BZD had 2 day h/o psychosisDelerium (2/2 meds)
CST axis for sphenoid/occiput in lateral strain2 vertical axes
Dx, eval- pt with knee pain, wam fluid lesion in popliteal lesionBaker’s cyst, U/S
Alpha 1 antitrypsin def. complication and txcirrhosis/encephalopathy, lactulose
MC vector borne dz in north americaLyme
Dx- fever, RUQ pain, jaundice, HoTN, AMSAcute cholangitis
Test to confirm acute cholangitis dxERCP
CHF s/sx in alcoholic ptDilated CMP (weak systole) 2/2 thiamine def.
MC cardiomyopathy and MCCDilated CMP (systolic dysfxn), myocarditis mcc
Rx with s/e of seeing blue halossildenafil
Dx- pt feels inadequate, hypersensitive, fear of rejection, social inhibitionAvoidant personality d/o
Dx- avoid social situations d/t fear of humiliation, somatic sxSocial phobia
Wilson’s labs (ceruloplasmin, urinary Cu, plasma Cu)Low ceruloplasmin, increased urinary Cu, decreased plasma Cu
Tx for Wilson’sPenicillamine (chelation), low Cu diet, B6, Zn
Diet for wilson’sLow Cu (avoid shell fish, cocoa, nuts, mushrooms, organ meat)
F sexual assault victim, piece of evidence to takesperm
Acute and chronic tx of MSSteroids acute, IFN-beta chronic
Impaired pt drives home, doc lets him, he gets hurtBreach of duty (negligence causing direct harm)
Common RF for ectopic pregnancy in young ptPID
Tx of choice for non ruptured ectopic pregLaparoscopic surgery
Med $ org for pts aged, blind, disabled, low incomemedicaid
Med $ for >65 y/o with certain disabilities and ESRDMedicare
Empiric abx for bacterial meningitis neonatesampicillin, cefotaxime
Empiric abx for bacterial meningitis -children/teensceftriaxone, vancomyycin
Empiric abx for bacterial meningitis -adultsceftriaxone, vancomycin
Empiric abx for bacterial meningitis elderlyceftriaxone, vancomycin, ampicillin (S pneumo, N meningitidis, listeria)
Rx in acute NSTEMI to reduce morbidity/mortalityASA
Mgmt of De Quervain's if conservative NSAIDs and splint failCorticosteroid injection
Oral retinoid s/e’sSuicidal ideations, teratogen, high TG/chol/AST/ALT
Dx- elderly pt, fatigue, night sweats, diffuse painless LAD, splenomegaly, high WBCCLL
Blood smear for CLLSmudge cells (damaged small lymphocytes)
Dx- recent travel, flu sx, rose spots on abd, splenomegaly, bloody diarrheaSalmonella typhi (typhoid fever)
Test for achilles tendon ruptureThompson test (calf squeeze, no plantar flexion)
Cast type, position, and time for achilles tendon ruptureLong leg cast, plantarflexion, 6 wks
Mgmt of suspected SBO 2/2 adhesionsSupine and upright abd radiographs, NG suction, IVF
Tricuspid atresia assoc with what teratogenlithium
Subdural vs epidural hematomaSubdural- midline shift
Less symmetry in sphinx test meansExtended, backwards torsion (LoR or RoL)
Is FPR active or passiveIndirect, passive
Rifampin moaBacterial dependent DNA-dep RNA polymerase inhibitor
Budd chiari s/sx with CD55/59 def and dark urineParoxysmal nocturnal hemoglobinuria
Curative tx for PNHAllogeneic bone marrow transplant
QoL tx for PNHPrednisone, eculizumab
Diastolic murmurAortic regurg, mitral stenosis
Systolic murmurAortic stenosis, mitral regurg
Tx for aortic regurgHydralazine, catopril (decrease afterload)
Thoracic CS anterior txflex, STRA
Thoracic CS Posterior txextend, SARA
Widespread fluid blisters in kid with feverStaph scalded skin syndrome
Huntington’s inheritanceAD, CAG anticipation
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Question Answer
Tx for toxo meningitisPyrimethamine and sulfadiazine
HIV -PCP CD4 level for ppx, ppx abx, tx abxCD4<200, ppx TMP-SMX or dapsone, tx TMP-SMX or dapsone+TMP or primaquine+clinda or atovaquone
HIV -toxo CD4 level for ppx, ppx abx, tx abxCD4<100, ppx TMP-SMX or dapsone+pyrimethamine, tx TMP-SMX or pyrimethamine+clindamycin/sulfadiazine
Scientific name for lice, txPediculosis, pyrethrin
Herbal that may cause yellow skinCamelia sinensis (black/green tea)
African herb for libidoPanax ginseng
Dx test for GBSAlbuminocytologic dissociation
Best omt technique for otitis mediagalbreath
Greater wing of sphenoid during flexion and extensionInferior- flexion; superior - extension
Organism- F with dysuria, recurrent UTI, positive Lloyd’s, u/a with RBCs and WBCs and alkali pHProteus (staghorn calculi)
Debakey classification of dissecting aortaType I- involves all aorta; type II (A)- ascending; type III (B)- descending
Neonate F with bulging blue dome translucent membrane at vaginal introitusImperforate hymen
Study of choice for imperforate hymenPelvic u/s
How much proteinuria for mild and severe preeclampsiaMild- >300 mg/d; Severe- >5g/d
Gestational htn with trace proteinStill just gestational htn
Child with low plt, reoccuring infxn, lymphoblasts on BM smearALL
Acute abd distension, dilation of colon, electrolyte abn, no acute s/sxColonic pseudo-obstruction (ogilvie’s syndrome)
Carcinoid s/sx (flushing, diarrhea, 5-HIAA), where is neoplasmMets to liver
Occipitomastoid suture affects what foramenJugular foramen (CN 9, 10, 11)
What bones make occipitumoastoid suture (jugular foramen)Occiput and temporal
Salter harris fxr types1- btw ME; 2- M; 3- E; 4- “ME”; 5- compression
Pt with severe hypoK mgmtAdminister KCl, admit with cardiac monitor
How often to measure FHR in laborEvery 30 min 1st stage, every 15 min 2nd stage
Image of choice for renal artery stenosisDuplex u/s
Test for TOS with hyperabduction and external rotation of arm to dec radial pulseWright’s maneuver
b/l loss of vibratory sensation and b/l spastic paresis (legs before arms)Vit B12 def
Pt with atherosclerosis w/ wkness and decreased pain/temp (but spared proprioception)Beck’s syndrome (anterior spinal artery synd) -spares dorsal columns
Spastic and flaccid paralysisALS
Young F with b/l conductive hearing loss (BC > AC with Rinne) and +fam hx (AD)Otosclerosis (loss of stapedial reflex)
Mgmt of F with 3rd tri bleedingu/s
Greater wing of sphenoid is superior on LL torsion
Pathophysiology of vitiligoautoimmune
Pain out of proportion to exam (3 d/o)Mesenteric ischemia, necrotizing fasciitis, compartment syndrome
MC neurological sequelae of N. meningitidisHearing loss
Rx for premenopausal women w/ bleeding (2/2 hyperplasia of endometrium)Cyclic progestins
Young healthy f with HTN on OCPs, mgmtStop OCPs
Painless obstructive jaundice Pancreatic ca
Pt with liver dz and new ascites, best testAbd u/s with doppler flow (liver vasculature)
Surgeon removing ovary ca and sees mets in uterus, what to do abt consent?Just remove ovary, ask pt abt consent for uterus removal after surgery
Buproprion CI in pts with h/oSZ
What lung d/o is assoc with low DLCOEmphysema (low O2 exchange d/t alveolar damage)
Chronic bronchitis v emphysema on PFTDLCO (nL in chr bronchitis)
Multiple myeloma pt w/ s/sx of chf- dx/echoRestrictive CMP (dec. SV on echo)
most likely dx: New onset severe ha with fever, LP pendingViral meningitis
Pt with fear of public places after isolated panic attack occurred 1 mo agoagoraphobia
Initial tx of aortic regurgACEI or CCB (lower afterload)
Posterior CP for appendixR T11 TP
memorize