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Misc COMLEX

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jmanderson's version from 2017-06-17 22:32

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Question Answer
dx: skin d/o, middle age, mucous membrane blisters, anti-desmoglein, intraepidermal (superficial), flaccid, nikolsky +, poor prognosispemphigus vulgaris
dx: skin d/o, elderly, no mucous membraine, anti-hemidesmosome, subepidermal (deep), tense/firm, nikolsky (-), good prognosisbullous pemphigoid
Ig for SLEANA, anti-dsDNA, anti-Sm, false + RPR
Ig for drug induced SLEantihistone
Ig for RARF, ANA, HLA-DR4
Ig for polymyositis and dermatomyositisANA, anti-Jo 1
Ig for ankylosing spondylitisHLA B27
Ig for sclerodermaanti-scl-70 ANA
Ig for CREST syndanti-centromere
Ig for mixed connective tissue dzanti-RNP ANA
Ig for Sjogren syndanti-Ro (anti-SSA), anti-La (anti-SSB)
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endocrine

Question Answer
mc thyroid capapillary
papillary ca cellscolumnar cells of gland
medullary thyroid ca cells and hormoneparafollicular C cells, calcitonin
most aggressive thyroid caanaplastic
thyroid ca a/w MEN IIa and IIbmedullary
medullary thyroid ca histoamyloid (congo red, apple green birifringence)
MEN with 3 Ps (parathyroid, pituitary, pancreas) and ?ZESMEN I (Wermer's)
MEN with 1 M and 2 Ps (medullary thyroid ca, parathyroid, pheo)MEN IIa (Sipple)
MEN with 2ms and 1 P (mucosal neuromas, medullary thyroid ca, pheo)MEN IIb
mutation in most MENIIa and IbRET proto-oncogene
BUN/Cr, FENa, and UNa for pre-renal dzBUN/Cr>20, FENa<1%, UNa<20 mEq/L
FENa>2% indicatesATN (drugs, toxins)
w/u order for cushing'slow dose dexamethasone sup test> 24 hr free cortisol> high dose dex sup test> ACTH levl
mcc cushing syndrome excess steroid admin
2nd mcc cushing syndromeexcess ACTH 2/2 pituitary adenoma
dx: cushing s/sx, low dose dexameth. supp test shows low cortisol in amextrinsic cause (excess steroid admin)
dx: cushing s/sx, low dose test w/o change in cortisol, 24 hr cortisol high, high dose suppression test with low cortisolpituitary adenoma
dx: cushing s/sx, low ACTH adrenal tumor
dx: cushing s/sx, high ACTnon adrenal ACTH tumor
msk complication of cushing s/sxAVN of hip
dx: adrenal insuf s/sx (hotn, fatigue, low Na, high K) with high ACTH addison dz
dx: adrenal insuf s/sx with low ACTH and dec cortisol with synth ACTHpituitary or hypoth cause
mcc CAH21 alpha hydroxylase def
CAH s/sx (ambiguous genitalia, low K, high Na) with HTN mcc11 beta hydroxylase def
CAH s/sx with decreased androgens17 alpha hydroxylase
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Oral hypoglycemic agents

Question Answer
Mechanism of action metforminunknown but decreases gluconeogenesis and increased glycolysis and increased peripheral glucose uptake and insulin sensitivity
Most serious side effect of metforminlactic acidosis
What are the sulfonyureasglimepiride, glipizide, glyburide
MOA of sulfonyureasclose K+ channel in B cell membrane causes cell to depolarize. Insulin release via increased calcium influx.
Clinical use of sulfonyureasrequire some islet function so useless in type I DM.
A/E of sulfonyureashypoglycemia
TZDSpioglitazone and rosiglitazone
MOA of TZDSincrease insulin sensitivity in peripheal tissue. Binds to PPAR gamma nuclear transcritpion regulator. increase GLUT 4 expression on adiopyocyte membranes
How long does it take to see the effects of TZDSdays to weeks.
what cytokine do TZDS regulateadiponectin
Who should not take TZDSCHF and severe liver disease
A/E of TZDSfluid retention with weight gain and edema
What are the GLP-1 analogsexenatide and liraglutide
What is the MOA of GLP-1 analogsincreases insulin, decreases glucagon release. Suppresses appetitie.
Incretin effect of GLP-1 analogsmimics actions of incretins by decreasing glucagon secretion increasing insulin secretion and delaying gastric emptying
Toxicity of GLP-1 agonistspossible increased risk of acute pancreatitis
What are the DPP-4 inhibitorslinagliptin, saxagliptin, sitagliptin
MOA of DPP-4 inhibitorsincreases insulin, decreases glucagon release. No weightloss, but oral unlike GLP-1 analogs
DPP-4 effect on incretinprolongs incretin action, which decreases glucagon secretion, increases glucose-dependent insulin secretion and delays gastric emptying
amylin analogpramlintide
MOA of pramlintidedecreases gastric empty; decreases glucagon
What are the SGLT-2 inhibitorscanagliflozin
MOA of canagliflozinblocks reabsorption of glucose in PCT. Requires kidney to work
Toxicity of canagliflozinglucosuria increased creatinine.
alpha glucoside inhibitorsacarbose, miglitol
MOA of alpha glucosidase inhibitorsinhibits intestinal brush-border alpha glucosidases. Delayed carbohydrate hydrolysis and glucose absorption. Decreases postprandial hyperglycemia.
Toxicity of alpha glucosidase inhibitorosmotic diarrhea
Patient with diabetes should take [ ] to slow or prevent nephropathyACEI or ARBS
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Quick associations oral hypoglycemic agents

Question Answer
lactic acidosismetformin
most common side effect is hypoglycemiasulfonyureas
Not safe in patients with CHFTZDS
Should not be used in patients with abnormal kidney functionmetformin, SGLT-2 inhibits, sulfonyureas
Possible non-insulin treatment for patients with organ failureDPP-4 inhibitors
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section

Question Answer
epidural hematoma artery damage (and skull hole)middle meningial artery (foramen spinosum of sphenoid)
subdural hematoma vessel damagecerebral bridging veins
type II heart block mobitz txtransvenous pacing
actinomyces causesoral abscess
rx actinomycespcn and drainage of abscess
marfan chr15
chf labs (bnp, ADH, Na, K)high bnp and ADH, low Na and K
rx malaria P ovale and P vivax (tertian fever cycle, latency, dormant liver hypnozoite)primaquine
1st line antimalarialschloroquine, primaquine, quinine
antimalarials for chlorquine-resistent P falciparum proguanil or mefloquine
test for heridetary spherocytosisosmotic fragility test
dx: jaundice, splenomegaly, normocytic hemolytic anemia, reticulocytosis, high MCHC, round rbc on periph smearheritary spherocytosis
dx/tx: dizzy, fatigue, s/p toxin ingestion (fava bean, ASA, sulfa, dapsone, quinine, quinidine, primaquine, nitrofurantoin), hemolytic anemia, heinz bodies (bites)G6PD def., avoid toxin +/- transfusion
cholles fxr radial head displacementposterior
smith fxr radial head displacementanterior
HTN w/ low HR is c/winc ICP (cushing phenomenon)
2 vv best for swan ganz cathleft subclavian, R IJV
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spinal cord

Question Answer
spastic and flaccid paralysis, corticospinal tract, ventral hornALS
flaccid paralysis, ventral hornpolio
impaired proprioception, pain, dorsal columnstabes dorsalis (tertiary syphilis)
b/l loss of pain/temp, b/l spastic paresis, b/l flaccid paralysis, corticospinal tract, spinothalamic tract, ventral horn, lateral gray matter (dorsal columns spared)anterior spinal artery synd
b/l loss of vibration and discrimination and b/l spastic paresis affecting legs > arms, dorsal columns, corticospinal tractB12 def
b/l loss of pain/temp, b/l flaccid paralysis, ventral horn, ventral white commissuresyringomyelia
ipsilateral loss of vibration, spastic paresis, flaccid paralysis, contralateral loss of pain/tempbrown-sequard
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section

Question Answer
contraction with approx of origin/insertion w/o change in tensionisotonic
contraction w/o approx of origin/insertion w/ inc in tensionisometric
contraction against resistance while forcing muscle to lengthenisolytic
contraction w/ approx of origin/insertion w/ tensionconcentric
contraction w/ muscle lengthening during contraction d/t external forceeccentric
rx c/i in prinzmetal'sBB
rx c/i in inferior minitrates
mc type of glaucoma open angle (gradual b/l inc IOP)
dx- gradual b/l dec vision peripheral to central, cupping of optic discopen angle glaucoma
dx- severe u/l eye pain, n/v, hard and dilated non reactive pupilclosed angle glaucoma
never induce ___ in closed angle glaucoma, will worsen condition pupil dilation
tx closed angle glaucomaacetazolamide, pilocarpine, laser iridotomy
mcc rapid vision loss in elderlymacular degeneration
a fib >2 d should get _________ before cardioversion TEE (r/o mural thrombus)
rx for neurogenic shockIVF, pressors, atropine for bradycardia
new severe CP w/ mild LVH on ecgaortic dissectioin
new severe CP w/ ST changes on ecgMI
A _________ or _________ is necessary for survival in transposition of great vesselsVSD or PDA
tetrology of fallot problemspulm stenosis, overriding aorta, vsd, rvh
high serum ___ is a/w 3x risk of atherosclerosis homocysteine
___ is an indication for cardiac cath to asses need for PTCA or CABGreversible MI
3 greatest risks of sudden cardiac death w/in hrs of MIVtach, Vfib, cardiogenic shock
greatest risk ventricular wall rupture is _________ days post-MI4-8
PVCs >_________ per min may progress to other ventricular arrhythmia3
mc sign of CHFS3
crescendo decrescendo systolic murmur radiatiing to carotids aortic stenosis
harsh holoystolic murmur radiating to axilla, widely split S2, midsystolic clickmitral regurg
diastolic decrescendo murmur at R 2nd ICS, late diastolic rumbleaortic regurg
opening snap after S2, diastolic rumble, loud S1, RHDmitral stenosis
squatting _________ sx in HOCMrelieves
mcc sudden death young athletesHOCM
mc CMPdilated (systolic dysfxn)
pericarditis vs MI on ecgpericarditis- diffuse STE and PR depression
most pericarditis is transudate or exudatetransudate
pericardial fluid w/ low protein, SG<1.012transudate
pericardial fluid w/ high protein, SG>1.012 exudate (w/u neoplasm,, fibrosis, tb)
if pericardial exudate, w/u forneoplasm, fibrotic d/o, TB
dx and tx: HoTN, distant heart sound, distended neck vv (beck triad)cardiac tamponade, urgent pericardiocentesis
RHD only in _% of untreated strep3%
SLE pt endocarditis s/sx w/o infxLibman-Sacks endocarditis
JONES for RHDjoints, heart, nodules, erythema marginatum, sydenham chorea (mitral valve mc)
ACEI is c/i in _____ d/t accelerated renal failure (2/2 hypoperfusion, low GFR)b/l renal a stenosis
HTN emergency tx shouldn't decrease DBP by >_________% in 1st 2 hr to avoid ischemia25%
___ closes PDA, _________ keeps PDA openindomethacin, PGE1
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section

Question Answer
abx for prostatitistmp/smx, std if active
mc non derm ca in menprostate
1st and 2nd mc ca death in menlung, prostate
supporting scrotum relieves pain in ___, but not ___epididymitis, testicular torsioin
___ ca is mc ca in men btw 15-35 y/otesticular
testicle ca with inc Estromal cell
testicle ca with inc bhcg or afpgerm cell (seminoma)
dx and genes: F, short stature, infertile, coarctation of aorta, neck webbingturner, 45XO
most pregnancies with _________ genotype end in spont abortion45XO
dx and genotype: M, testicular atrophy, tall, thin, gynecomastia, MRklinefelter, 47XXY
genotype: M, tall body, acne, MRXYY
genotype: F w/ inc MR and menstrual abnXXX
mcc congenital MR of both sexesdown's
mcc congenital MR malesfragile x
dx and chr: MR craniofacial abn, duodenal atresia, risk alzheimer, ALL, cardiac d/o, simian hand creasedown's. tri 21
dx and chr: MR, small mouth, rocker bottom feet, overlapping fingers, cardiac and GI d/o, die w/in a yr edward's, tri 18
dx and chr: cleft lip and palate, cardiac and cns d/o, MR, round nose, polydactyly, die w/in 1 yrpataue 's, tri 13
trisomies from nondisjxyn paternal or maternal?maternal
dx- quad screen high hcg, high inhibin A down's
dx- quad screen low hcg, low papp-a, low afp, low ue3tri 18 (edward)
dx- quad screen low hcg, low papp-a, nl afp, nl ue3tri 13 (patau)
high afp in preg meansNTD
low afp in preg meanstri 21 or 18
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GU

Question Answer
catalyst for HCO3 reabs at PCTcarbonic anhydrase
20% of RPF enters ___ and is filteredbowman's capsule
loops have direct pulm vasolation effect, good for ___ caused by fluid overloadpulm edema
diuretic for hyperCaloops
diuretic w/ s/e of HoK, hyperuricemia, hyperCahctz
diuretic for glaucoma, epilepsy, altitude sickness, met alkalosiscarbonic anhydrase inhibitor s(acetozolamide)
diuretic for inc ICP mannitol
mc site for kidney stone impactionutero vesicle jxn
mc kidney stone with recur UTI in womenstruvvite, mgnh4po4, staghorn (proteus, klebsiella, urease +)
only radiolucent kidney stoneuric acid
r/o ___ before admin cath in anuric ptobstruction of bladder or urethra
15% polycystic kidney dz pts get ___ SAH
RCC, Hepatocellular ca, pheo, and hemagioblastoma cause inc ___EPO
mcc ARFdrugs
CKD happens when >_________% renal parencyma is necrotic90%
order ___ in pts with severe hyperK, met acidosis, fluid overload, uremia, CKD w/ Cr>12 and BUN>100dialysis
FENa eq.Una/Sna / Ucr/Scr
RTA w/ UpH>5.3 and stonestype 1 (distal, impaired H secretion)
psuedohyperNa occurs with ___HLD
correct Na in hyperBG ptsadd 1.6 Na per 100 BG>100
electrolyte d/o- confusion, nausea, wk, dec LOC, from renal H2O ret, SIADH, hctz, hyperBG or high H2O intakeHoNa
electrolyte d/o- wk, n/v, arrhythmia (tall peaked t waves), paralysis/paresthesia, from met acid, aldosterone def, insulin def. renal failure, aldactonehyperK
eletrolyte d/o- fatigue, wk, arrhythmia (t wave flat, STD, u wave), HoReflexia, paralysis, from high insulin, loop/hctz, RTA I or II, conn, vomit/diarrheaHoK
pseudohyperK comes from ___, so confirm with ___RBC hemoylsis from blood draw, repeat draw with large needle
Ca d/o and QT intervalhigh Ca-> short QT, low Ca-> long QT
dx- hyperCa with fam hx, low urine Ca, no osteopenia, kidney stone, AMS familial hypocalciuric hyperCa
diuretic with s/e of hypeCa hctz
BPH occurs in _________ zone and prostate ca occurs in _________ zonecentral, peripheral
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