Comlex Bits 7-24-16

ruhland1's version from 2016-07-24 18:17

Section 1

Question Answer
fluoriderecommends supp at 6 mo if non-fluoridated
Prouriaif gt +1 protein
Antihtn for preeclampsiaif over 160/110
Mg sulfatefor severe preeclampsia, eclampsia, HELLP
Pre-eclampsia defnew onset htn and either prouria or end organ dysf after previously normotensive
Induction of laborrecommended at term for gest htn and mild preeclampsia
Inversion ankledn anterior talofibular ligament
Anterior drawer signgrades laxity of ATFL ankle sprain

Section 2

Question Answer
Ottawa rulesdetermine if ankle or foot x-rays are needed
Ankle xray indicboney tenderness at posterior edge of lateral malleolus, medialmalleolus of inability to bear weight on it
Foot x ray indicbony tenderness at base of 5th metatarsal, navicular, or cannot bear weight
Inversion sprain OMM findingseversion calcaneous, posterior fibular head, tibia ext rot, femur int rot
Amaurosis fugax/retinal artery occlusionseen in carotid plaquwes, srx is decompress retinal anterior chamber, digital globe massage, CO2 rebreathing
Edwards syndromerocker bottom, low set ears, look at kidneys, and heart

Section 3

Question Answer
Gonocoocal conjuncitivitis2-3 days after birth, eyrthromycin ointment
Chylmidia conjunctivitis5-23 days after birth, MCC
Haemophilus aegyptiusG- rod cause conjuntivitis purpuric fever and shock in kids
Comprehensive healthcare reform actobama care
Federal emergency relief actgave loans to states to operate relief programs
ASIS compression testindicates sacroiliac joint restriction on that side
Heat exhaustionlt 104F, malaise headache no coma/sz
Heat strokegt 104F, if exertional look out for DIC, AKI, Rhabdo, lactic acidosis, best dx is RECTAL temp
Heat stroke/exhaustion mxremove clothes, cold water ice immesion, goal is 100-102, avoid ASA tylenol, IVF not iced saline could strop heart, then get CPK and e- and EKG

Section 4

Question Answer
Botulismsorethroat and general weak, 0 DTR
Guillian barrelegs feeling heavy, hx of prior illness, dn DTR, symmetric ascending, lumbar puncture shows albumin cytologic dissasoc
Lyme dieseasefatigue, headache, migratory arthalgia, bulls eye lesion, Borerelia Burgdorfeir (doxycycline, or hi dose penicillin or ceftriacone if advanced)
-cycline antibioticsphotosensitivity
West nile virusheadache F meningigtis encephalitis
Right sidebending rotation strainright side feels more fuller and caudad
Superior vertical strainsphenoid is supeior to occiput
Lateral strainif R means sphenoid is shifted right, paralleogram head
Vault hold indexgreater wing of sphenoid
Vault hold thumbfrontal bone
Vault hold middle fingerperiauricular
Vault hold ring fingermastoid process
Vault hold little fingerocciput
Thomas testpsoas syndrome test (hip flexion contractures)
Treatthoracic dysf before rib dysf

Section 5

Question Answer
Obstructive lungFEV1 lt 80% is mild, less than 65% moderate, 50% severe
Restrictive lungTLC or FVC lt 80% mild, 65% moderate, 50% severe
Syphillis 2o rashtrunk palm and soles, are reddish brown papules and patches
SVTtradition antiarryhmics are contra in WPW
Stable SVTadenosine if regular
Unstable SVTcardiobert
Young male chest px and SOB after sneezesimple pneumothorax, listen to lung and get CXR
Cholelithiasisget RUQ u/s and then ERCP, only 20% gallstones radiopaque
PECARNhead trauma mx in kids, any palp skull frx, hematoma, LOC, severe mechanism of injury get a CT

Section 6

Question Answer
Hypocalcemiaup DTR, tetany, carpopedal spasm (trouseaus), recent thyroid srx
Hypocalcemia ekgQT prolong up torsades
Hypercalcemia ekgshortening QT, Osborn (Jwaves), possible VF
Osborn waveseen in HyperCa, hypothermia (J like appearance seen in V3-V4 in ST segment)
Parasympatheticsin cervical spine and sacral area
Oliguria and txing cx2/2 hyperuricemia
Tumor lysis syndromeup K up PO4 dn CA up Uric
Burkitt syndrometx is rituximab anti CD20
Normal pressure hydrocephalus1st CT/MRI then lumbarpunc
Paying for senior carerefer to local office of aging
MI sx and find Mitral regurg new2/2 ishemia papollary muscles
Short g- rods mistaken for cocciHiB
Intraparenchymal hemmdue to hypertension
Wrist jointaka radiocarpal joint
Hear tenderpointthink counterstrain
Poor MMSErule out hypothyroidism
Periarticular shoulder m atrophyOsteoarth
Septic shockIVF then IVabx then vasopressors (epi is 1st) if still hypotn if adequate resus
Marfarndissecting aoric aneuryms cause death (common is mitral valve prolapse and aortic regurg)

Section 6

Question Answer
BITEfor Inh / exh DYSF
Anterior radial head dysfunctionlikes anterior
Inflare vs outflare innominatelearn
Ashermanns syndromeup risk infertility, does not increase risk of ectopics
Milaria crystallinasweat rash (obstructed glands)
Swimmers itchaka schistome cercarial dermatitis, tx is hydroxyzine
Prostate displaced superiorly and blood in urethrabladder rupture
Suprapubic cystostomyacute urinary retention in which catherter cannot be passed, urethral trauma
Propoxyphenemild narcotic related to methadone
Non minor wound and not vaxgive tetanus toxoid and tetanus IVIG
Rubber soles puncturethink psuedo give piperacillin
G - coveragelevoflox
Cord like tractanalrecto fistula, assoc w chronsz
Anal fissureassoc with constip and chronz
Paralytic ileusNPO and NG tube, maybe give laculose, erythromycin
Ausc tinklingthink SBO
Somatostatincontrols flushing and diarrhea of carcinoid syndrome
Pilonidal cystat natal cleft of butt
Sebaceuous cysttreated with tetracycline and leaks cheesy material

Section 7

Postpartum fever differential
First day
Second day
Third day
Fourth day

Section 8

Question Answer
MSup sx when temperature is hot humid or theys got a fever
Piriformis counterstrainflex ipsi leg then abduct and ext rot L hip
CPRcardio pulmonary resus (tredelenberg position helps)
Couvelaire uterusabruptioplacenta causes bleeding to uterine myometrium forcing its way into the peritoneal cavity, up hypovolemic shock in neonate
Meconium aspirationup pneumothorax
MalariaHS meg, cyclic F shaking chills, hemolytic anemia smear has trophoozoites and schizonts in rbc
Varicocelespermatic v ligation
Kid sitting leaning forward w mouth open droolingepiglotitis, get lateral XR, do not examine throat unless anesthesiologist is present
Epiglotitis txendotrac tube, IV Ceftriaxone, chloramphenicol, ampicillin
Epiglotitis bugHiB if unvax, S. Pyogenes in vax
Steroids in cerebral edemareduced capillary permeability
Ulcer of buccal mucosa surrounded by a red haloaphthous ulcer
Frictional keratosiswhite patch of mouth, white line across length of cheek, linea alba
Uti and preguterus can block drainage, up stasis * up infxn
Prostate chapmanlateral thigh
Monteggia fracutureproximal third of ulna with dislocation of radial head
Todds paresisfocal wkness in part of body after sz
Apley compresion testflex knee, rotate tibia, to look for meniscus injury
Tender pointshelp dx fibromylagia, extremesly sensitive spots, occurs in specific symmetric locations
Trigger pointswhen pressure is applied it tiriggers pain to another part of the body, tiggerpoints are taut ,ropy bands of muscle fiber, can occur anywhere, the point itself may not be tender

Section 9

Question Answer
Scoliosislearn somatic dysfunc, like what spine is in…
Iron fortified foodsif breast feeding start at 6 mo
Compression of fourth ventriclereduce px,anxiety, dn SNS, facilitate extension of occiput, inhibit occipital flexion
Sphenopaletine ganglion releasesinusitis
Galbreath techniqueotitis media
Osgood schaltteroveruse injury showing fragmentation of tibial tubercle with overlying soft tissue swelling
Neonatal jaundiceonset is 3 to 5 days post nrith due to up indirect bili, breast feeding failure because inadqueate BM to excrete bili, breast milk can cause it because dn lipid processing occurs 4th to 7th day of life
Develop jaundice in 1st week of lifethink ABO incompatibility (hemolytic disease of newborn)
Otitis externapolymyxin-neomycin-hydrocortisone
Otitis mediaamoxicillin 10 days, if resist do augmentin
Tympanometrylearn about, flat tympanogram indicates perforated ™
Medulloblastomakid with occipital headache, ataxic gait, nystyg and paipilledema
TBupper lung lobes, erode into pulm artery or a rasmussens aneurysms resulting in massive hempytysis and death
Streptozotocintreat metastatic pancreatc cx
Laryngeal cxhoarseness, stridor, earache, dysphagia, risk factors are smokers, heavy alcohol, how to mx?
Orthostatic hypotensioncommon in parkinsons, induced by MAOI-b and Dopamine meds, phenytoin
Livedo reticularisthink antiphospholipid syndrome, spasm of dermal arterioles with capillary dilation
Lymphedema vs venous insufflymphedema is usually unil following srx LN romval, venous insuff has stasis dermatitis hyperpigmentation, CVI is due to venous reflux 2/2 incompetent valves
Adenomyosisup bleeding and menstrual px, up in multiple pregs
EndometrosisMCC of infertitlity, dx with lapscope with bx, tx is NSAIDS OCP progestin only pill, antiestrogen danazol (inhibits LH and FSH mid cycle surge), need laproscopic ablation or total abd hysterectomy with lysis of adhesions
Interstitial cystitisuse pentosan polysuflate for relief
Leuprolidefor tx of endometriosis, infertility

Section 10

Question Answer
Cholesteaomaseen in reccurent OM with perf, has foul ear smelling disch and a polypoid mass
OCD1st is SSRI then clomipramine and augment tx with AP
Lithiuminduces hypothyroid
Otitis media bugS pneumonia most common give amox 10 d, also Hib and Moraxella Catarrhalis give amox clav
Empyemaaka purulent pleuritis, devops after pneumonia
PSAthink normal is 0 to 4, yearly screening done in men whos PSA is 2.5 or higher
BPHup urine frequency cause up oressure on bladder
Quadratus lumborum spasmworking in forward bent position, complains of not being able to stand up, LBPx
Homans signcalf pain with forced dorsiflexion, DVT
PECXR is rapid, D-dimer is confirmatory, VQ scan if CXR is normal, if D dimer nefative do pulm angiography, do CT angio is CXR is abn
Massive PEacute PE with obstrutive shock SBP lt 90
Mastoiditisdue to untreated OM, give IV abx like ceftriacone
Bronchiolitischildren under 2 and RSV and winter
Cushing diseaseup hirsuit, supraclav fat pads, acne, up lb
MEN Iwermer syndrome
MEN IIsipple syndrome
Sacral inhibitiontreat diahrrhea and dysmennorrhea, dn PNS sx
Uti pregincrease risk of preterm labor
Scoliosis2 types structural, non reversible, and functional which is reversible and due to pain m spasm or sort leg syndrome
Kayexalateaka sodium polystyrene

Section 11

Question Answer
PTU and methimazoleprevents T4 to T3 conversion, takew WEEKS to be effective unless HI dose
Thyroid stormBB, PTU Iodine (blocks T3/4 release), hydrocortisone reduces T4 to T3 conversion
PTUfor 1st trim of preg, rest of time methimazole is prefrerred
Fever cough and diarrhea,esp in smokerrapid urinary antigen test for legionella
ALE for legionellaAzt Levoflox Erythro
Carotid endarterectomyright after srx are examined to r/o stroke
Preterm premature rupture of membranesrecent cocaine use
Nitrofurantoinfor preg UTI
Atrophic vaginitisup urethreal discomfort, feels like a UTI, give topical estrogen
Anxiety neurosisaka GAD
Diverticulitis1st do bowel rest IVF and ABX, srx is recommended after 2nd attack or 1st attack in a young diabetic or immunosupp pt
Tredelenburg testto determine valve competency in pt legs w varicose veins
Ober testto identify tightness of IT band
Phyloddes tumorquick growing in weeks, glistening white tumore with smoothly contoured leaf like areas separated by narrow epithelial lined spaces. Tx is wide excision
Inominate inflare METput in figure 4 position
Benzosup dry bouth and bad taste in mouth, up dil pupil
Pupils2-5mm is normal

Section 12

Question Answer
Due dateFDLMP + 7 days + 9 mo
UTInitrates turn to nitrates in bact infxn
Cluster HAfor hours, everyday same spot, lacrimation and runny nose
Polymenorrhealess than every 21 days, due to PCOS, perimenopause, exercise
Young homogenenous breast mass with posterior shadowingfibroadenoma is MCC breast tmx in women lt 30
Intraductal papillomaMCC of bloody disch in women lt 50
Rubeolais MEASLES, cough coryza conjunct, rash on face then goes downward
Varicellatear drop vesicles with red base, smal crops of tiny red papules
Meningocoocal meninkid w severe menin sx and petechiael rash
Prostatechapman lateral femur
B12 defblurred vision sore tonuge, ataxia, down dorsal columns, seen in vegatarians, jaundce
Hashimotofollows URI
Mitral valve prolapsemid systolic click
Pregancy cholecystitisdue to phenoemon of cholestasis of preg
DVTaka acute thrombophlebitis
StrabismusMCC of visual diffuiculties in baby, dn depth perception
Blockage of scleral venous sinusof Schlemms canal, causes glaucoma

Section 13

Question Answer
Premature infant and vision problemsretinopathy of prematureity due to O2 supplement
Intestinal malrotationabd dist, dn bowel sounds, up blood in stool
Intestinal pneumatosisgas cysts in bowel wall sign of necrotizing enterocolitits seen in premature
Isthmic spondylithesisone vertrbra slips forwards over vertebra below < due to defect of pars intterarticularis due to frx
Disabilitymust be unable to engage in substantial gainful activity
Cytogenic analysisfor chr abnomatieis
Fragile XCGG repeat in FMR1 gene on X chr
Wegener granulomatosissaddle nose, lung and kidney, C ANCA, granulomatosis with polyangitis, tx is steroids/MTX axithrioprine, cyclophosphamide, TMP SMX ppx for pneumonia
Give MTXprovide folate supplement
Cataplexyloss of all muscle tone with strong emoitional stimulus
Tactile fremitusincrease means up density or infamed tissue
Stroke hypothalamushyperthermia
Ecg with J wavehypothermia
Septic shockup hypothermia
FAPADom deltion of APC tsgene on CHR 5
Colonic polyps and CNS involveturcuot synd