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COMBANK Review 7

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jmanderson's version from 2017-06-17 17:35

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Question Answer
dx: HIV pt CD4<50, fatigue, fever, diarrhea, cervical LADMAC
bug: water/bloody diarrhea, peanut butter, GNR, lactose (-), macconkey agar, H2Snon-typhi salmonella
salmonella diarrhea moahost immune response to upregulate cAMP
bug: watery/bloody diarrhea, daycare/mental inst, GNR, lactose (-), no H2S, propels through actin polymerizationshigella dysenteriae
shigella and EHEC diarrhea moadirectly invades colon, produces 60S protein-synthesis inhib toxin
bug: watery diarrhea, gm(-), lactose (+), traveler'sE coli
aafp rec for WCC in baby in hosp <48 hrs 1st wcc w/in 48 hr
dx: kid with unexplained fever 5 days and CRASH (conjunctivitis, rash, adenopathy [cervical LAD], strawberry toungue, hand desquamation)kawasaki d/o
labs in kawasaki d/o (wbc, crp, esr, plt)high wbc, crp, esr, and plt
rx for kawasaki d/ohigh dose ASA and IVIG
nyha class chf with s/sx on strenous activity (running)type II
a/e of vacc occurs w/in ___ days7 days
dx: painless nodule near MCP that causes locking of digitstrigger finger
tx trigger finger- conservative, interm, and invasivestretch/splint > steroid injxn > surg release A1 pulley
cranial s/d: index fingers move inferior and 5th fingers move superiorsuperior vertical strain
dx: most likely cause of jaundice and kernicterus in baby <1 day oldABO incompatibility (non-physiologic)
total bili shouldn't rise great than ___ in 1st 24 hr of life5 mg/dL
1st line for epitaxispressure on high cartilage part of nose
2nd line for epistaxisanterior packing, silver nitrate cauterization, topical vasoconstrictors
mgmt: HELLP synd <32 wk gestbetamethasone with expectant mgmt
mgmt: HELLP synd >32 wklabor induction, plan vag delivery
ion involved in malignant hyperthermiaCa (2/2 depol agents win Ca channel defect pts)
MET for psoas s/dhip flex against resistence
dx: ptt works construction in SW usa, pna s/sx, fever, arthralgias, erythema nodosumcoccidioidomycosis
dx: mycosis from bat/bird poop in OH, MI, MS river valleyhisto
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Question Answer
pt on long term steroids, advise for surgeryincrease dose (body usually naturally increases steroids after surg)
MI drug that is c/i in RV infarct (II, III, aVF)nitrates (give IVF instead to maintain perf)
dx: pt 2d s/p THA on BB, metformin, and mithimazole now with high fever, tachycardia, and AMSthyroid storm (too much T3), note pt meds
dx: old pt with anemia, low TIBC, high ESRanemia of chr dz
age: baby smiles, coos, lifts head when prone2 mo
age: baby rolls front to back, grasps rattle, orients to voice/laugh4 mo
age: baby sits unassisted, transfers objects, babbles, stranger anxiety6 mo
age: baby crawls, pulls themselves up, immature pincer, waves10 mo
age: baby plays interactive games, crawl, grasp objects w/ thumb, 1st words9 mo
established RF for acnefam hx
rx for acne pt who failed benzoyl peroxidetopical retinoids
radiation less than ___ is negligible risk to fetus50 mGy (5 rads)
mc Zink fascial pattern (oa, ct, tl, ls)L, R, L, R
anti htn drug with s/e of increased hair growthminoxidil
vacc rec for copd ptspneumo and flu
mgmt for HSPsupportive care with close f/u
midshaft humerus fxr nerve damageradial
1st line mgmt for uretheral injury s/p blunt traumasuprapubic cath
mc bact for endocarditis in IVDUstaph aureus
mc valve in bacterial endocarditis of IVDUtricuspid
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Question Answer
tx of carpal tunnel in pregnancywrist spints
asbestosis stainprussian blue
mcc mesotheliomaasbestos exposure
mc lung ca in asbestos exposurebronchogenic ca
temporal arteritis race mcnorthern euopean
mc hernia as GERD refractory to med tx sliding hiatal hernia
upper GI hernia a/w risk for strangulation, tx w/ emergent surgparaesophageal hernia
rx sliding hiatal herniareflux ctrl
+ drop arm testsupraspinatous tear
tx advanced Lymes (neuro and joint s/sx)IV ceftriaxone
bacteria causing neonatal conjunctivitisneisseria gonorrheae
dx: s/p surg, sob, cxr with opacified hemithorax with deviated trachea to white outatelectasis
CP for pancreasbtw rib 7-8 on R
triple therapy h pylori (1st line)ppi, macrolide, pcn
quad therapy h pylorippi, metronidazole, fluorquinolone, bismuth subsalicylate
w/u for pt with panic attacks and reoccuring htn with ha (esp- pmhx medullary ca)24 hr catecholamines (r/o pheo)
rx for pheo block alpha (phonoxybenzamine) before beta (BB)
murmur: wide spit fixed S2, asx or chf, assoc with down's or fetal alcoholASD
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Question Answer
law org. that helps ppl from losing insurance after losing jobCOBRA
oblique sacral axis engaged during stance phaseside of the standing leg
neg. spring test for sacral s/d meansfwd torsion or b/l flexion
most sensitive eval for pancreatitisCT scan (calacifications)
rx for MI pt s/p cath with a fibASA, clopidogrel, hep bridge to warfarin
standard of care in pt after percutaneous coronary interventiondual anti-plt rx (ASA, clopidogrel)
tx CVA pt with HTN emergencyIV labetalol BP<185, admin tPA
tx PP endometritis (PP fever with tender fundus)IV clindamyciin and gentamycin
right elbow adduction restriction s/d of elbow and wristabducted ulna, adducted wrist (ulnar deviation)
HVLA to wrist with right elbow adduction restrictionradial deviation
mc valvular heart dz caused by rheumatic heart dzmitral stenosis
murmur: mid-diastolic rumble with opening snap at apexmitral stenosis
vasalva maneuver in aortic stenosis vs HOCM murmurdecrease aortic stenosis, increase HOCM murmur
WAGR syndromewilms tumor, aniridia, GU abn (cryptorchidism), retardation
dx: wilm's tumor, macrosomia, macroglossia, hemihyperplasia, organomegaly, HoBGbeckwith-wiedemann synd
MET for L1-5 NRrSlpt lay on on L side, ask pt put legs down
DMD inheritenceX recessive
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Question Answer
dx: child w/ developmental delay and hypertoniacerebral palsy
mc RF for cerebral palsycomplicated labor (premature, PreE)
uterine tonic agent c/i in htn ptsmethylergonovine
mcc PP hemorrhageuterine atony
1st line rx for uterine atonyoxytocin
uterine tonic agent c/i in asthma ptscarboprost tromethamine (PG-F2a analogue)
bug: pt w/ recent travel, diarrhea, spiking fevers, salmon colored papules on trunk, bradycardia, organomegaly, AMSsalmonella typhi (typhoid fever)
bug: child in day care with high fever and bloody diarrheashigella
bug: watery diarrhea and dehydration in infants, rec vacc at 2, 4, and 6 morotavirus
only effective rx for ALSriluzole (glutamate antagonist)
translocation in burkitt lymphomat(8;14) c-myc
translocation in cml tx w/ imatinibt(9;22) bcr/abl
translocation in mantle cell lymphomat(11;14) bcl-1
translocation in follicular lymphomat(14;18) bcl-2
rhythm ctrl in post-MI pts (even if copd)BBs (metoprolol)
3 chf rx that decrease mortality ACEI, BB, spirnolactone
fht late decels meanuteroplacental insufficiency
fht var decels meancord compression
fht early decels mean head compression
best image cauda equinaMRI
1st line tx cauda equinasteroids, if fail -> surg
dx: poorly controlled asthmatic with wheezing more prom u/l with CT showing bronchiectasis and mucous pluggingaspergillosis
anterior innominate, stretch what musclesquads
posterior innominate stretch what muscleshammies
non randomized, non controlled studies are level _________ evidence3
RCT study is level _________ evidence1
left MCA CVA has what ocular findingright homonymous hemianopsia
what 4 bones make pterionfrontal, parietal, temporal, sphenoid
2 diuretics used together in CHFloops and thiazides
fluid overload in chemo pt, likely causeCHF 2/2 doxorubicin
thiazides include HCTZ and ___chlorthalidone
gest age u/s in 1st tri best withcrown rump length
gest age u/s in 2nd tri best withbiparietal diamter, abd circ, femur length
DOC for trigeminal neuralgiacarbamazepine
dx: episodes of intense facial pain, electric shocks, when eating, brushing teeth, breezetrigeminal neuralgia
dx and tx: herald patch rash from chest to trunk, christmas tree pattern, s/p viral URIpityriasis rosea, reassurance
DOC in CHF exacerbationloops (furosemide)
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Question Answer
mgmt: pt gets pregnant<12 wk with IUDmanual removal
mgmt: pt gets pregnant>12 wk with IUDleave IUD
mcc painless lower GI bleed in adultdiverticulosis
gold standard test for diverticulosiscolonoscopy
DOC for animal bites (pasteurella)amoxicillin-clavulanate
dx test and tx for suspected prinzmetal'scoronary angio, tx w/ nitrates and CCBs
image for biceps tendon ruptureMRI elbow
dx: kid crying, neck pain, not eating, dysphagia, fever, swelling posterior pharynx, lateral neck xr with thick pre-vertebral tissueretropharyngeal abscess
mgmt: retropharyngeal abscessIV abx, IVF, OR for drainage
+ yergason (resisted supination forearm)biceps tendonitis
+ speed's (resisted extension of forearm and flexion shoulder)biceps tendonitis
SIRS + infxnsepsis
sepsis + organ damagesevere sepsis
sepsis + HoTNseptic shock
innominate inflair a/w what s/danterior rotation innominate
mgmt: stones, bones, groans, psych overtonesprathyroidectomy
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Question Answer
ppd + for pt on prolonged steroids>5mm
mgmt: ppd + with -cxr9 mo INH
mc ca on skin with chronic draining sinu tract 2/2 osteomyelitissq cell ca
dx: pt w/ HoT4 and macrocytic anemia with pancytopeniapernicous anemia
most accurate test for pernicious anemiaserum B12 assay
rx that will worsen muscular rigidity in parkinsonian dementia ptsDA antagonists (haldol)
CP for GB6th ICS right midclavicular
rx for scabies on hands and genitals5% permethrin from neck down and tx contacts
CO, PVR, and PCWP in anaphylactic (distributive) shockhigh CO, low PVR, low PCWP
CO, PVR, and PCWP in hypovolemic shocklow CO, high PVR, low PCWP
CO, PVR, and PCWP in cardiogenic/obstructive shocklow CO, high PVR, var PCWP
after starting thyroid rx, recheck TSH/T4 at ___ months2
dx: HIV pt with upper GI s/sx, endoxcopy with long shallow ulcerations with inclusion bodiesCMV esophagitis
DOC CMV esophagitisganciclovir
dx: pregn F with fetal death (absent fhr on u/s) and complete retention of products of conceptionmissed abortion
dx: pregn F with bleeding and dilation of cx, but no expulsion of products of conceptioninevitable abortion
fxr name: base of the thumb to intra-articular MCP spaceBennet's fxr
fxr name: 5th metacarpal neck boxer fxr
fxr name: distal radius, less common than colles, fall on flexed wrist, anterior radial displacementsmith fxr
fxr name: distal radias +/- ulna, FOOSH injury, posterior radial displacementcolles fxr
mgmt: cx cytology with HSIL in pregnant Fcolposcopy
rx for long term Crohn's remissionimmunomodulators (azothioprine, TNF-alpha inh.)
rx for acute Crohn's flairesteroids
mgmt: internal hemorrhoid that prolapses but is reduciblerubber band ligation
mgmt: asx internal hemorrhoidsitz bath, high fiber
mgmt: internal hemorrhoid, prolapses, irreducible, severe sxsurgery
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Question Answer
breast ca stage <2cm w/o LNstage I
breast ca stage <2cm w/ 1-3 LN stage II
breast ca stage w/ axillary LADIII
breast ca stage w/ metsIV
mgmt: brain dead pt w/o living will (DNR/DNI)remove from ventilator
4 mcc of fever of unknown origin chr infxn, malignancy, collagen vascular d/o, granulomatous d/o
elderly parkinson dementia pt begins having AMS, what rx caused itbenztropine (anticholinergics - beers list)
d/o with antimitochondrial Absprimary biliary cirrhosis
dx: woman in 40-50s with fatigue, itching, nl bili, high alk phosphprimary biliary cirrhoisis
dx: fatigue, jaundice, pruritis, RUQ pain, p-anca, a/w IBDprimary sclerosing cholangitis
earliest sign of pregnancy on cx examchadwick's sign (bluish discoloration of cx and vagina)
colon ca screen in pt with 1st deg rel w/ CRCcolonoscopy 10 yr before 1st deg rel age of dx, every 5 years
mgmt: unstable pt with s/sx spontaneous ptxchest tube or thoracostomy (don't wait for cxr)
mgmt: battery in esophagusremove immediately
mgmt: battery in small bowelobservation and observe urine mercury
mgmt: suspect malignant melanomaexcisional bx
common cause of oligohydramnios (AFI<5)renal anomalies
dx: wt lifter, shoulder pain, + active compression (O'brian's) test in GH jointsuperior labral tear, anterior to posterior (SLAP)
Give Td or Tdap in dirty wound pt if it has been great than _________ years5
dx: kid hit chest over bike handle bars, sob, pain w/ inspiration, crunches on heart sounds, radioopacity in pericardial sac on cxrpneumopericardium
initial mgmt for acute pericarditisNSAIDs
dx: microangiopathic hemolytic anemia (schistocytes), thrombocytopenic purpura (low plt, bruis), neuro s/sx (sz, hemiplegia), fever, renal dz TTP
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