Step 2 Fam MED 1 6-4-16

ruhland1's version from 2016-06-19 18:34


Question Answer
herpetic whitlowherpes on fingers, typical of dental procedures
left side painhx of constip
rectal diastatfor anti-sz abortive (diazepam)
valporic acidhepatoxicity, monitor levels monthly, hyperammonemia
carbamazepineleukopenia, angranulocytosis
ER Migraine MedsIV toradol, phenergan, diphenhydramine
arcus senilishyperTG

Section 2

Question Answer
retrovirals for HIVPeriphreal Neuropathy
COPD smoking asthmaindic for pneumo 13/23 vax before 65
Asthma stepsSABA-> lo ICS-> LABA-> med ICS -> hi ICS -> oral steroid + omalizumab if ALL
paget von schroter dzthrombosis in subclavian vein that up unil UE claudication sx with use
less than 3mo acute signspersistent elevated tachypnea, retractions, nasal flaring, wont eat b/c cant breath, bluish hue-> possible sepsis workup
Inferior MINitrates contra ( II III aVf)
MI standard of care isMONA Morphine O2 Nitrates ASA
StrokeFAST Face Arm Speech Time
Osmolality serum275-300
Sz due to hypo Naanti Sz med wont work, use hypertonic saline first
med rulesno motrin until 6 mo, no tylenol until 3 mo

Section 3

Question Answer
LBP due to degen disk or OAPT, stretch, meloxicam, SI injxn
lateral epicondylitistennis elbow, pain with wrist extension, 1st RICE and elbow straps, then steroid injxn then srx
non-displaced olecranon frxecchymosis, dn ROM, need XR, put in posterior long arm splint in 30 degree flexion
Olecranon bursitistrx intact ROM, local swelling-> ice 24 hr then warm elevation NSAID
septic arthsrx irrigation, debride, IV abx
chadwick signblue cervix of early preg
get dexa scan and want to determine treatment planget FRAX score to determine risks
Goodells signof pregnancy is softening of vaginal portion of cervix
Ladins signof pregnancy is softening at junction between cervix and uterus
chronic ETOHmamillary body degeneration
MCC of amygdala dmgduring temporal lobectomy for epilepsy srx
putamenassoc with EPS sx
burkitt lymphomaadolescences, tx rituximab CD20 AB, binds B-cells (8:14) 8=B duh
AbciximabGP IIb/IIIa binder * dnpl8 agg, tx for ACS and PCTA
PCTAPercutaneous transluminal coronary angioplasty
Percutaneous transluminal coronary angioplastyThe use of a balloon-tipped catheter to enlarge a narrowed coronary artery.
busulfanalkylating agent for use in CML, or ablation of b marrow for stem cell TP pts
Imantinib9:22 philly chr bcr-abl tyr kin inh to tx CML and GI stromal, S/E is fluid retention
TraztuzamabMAB for HER-2(erb-B2) fir HER2+ breast cx, s/e is cardiotox

Section 4

Question Answer
HTN + evidence of prouria and CKDlinsoipril
BBindic with htn with CHF or pt's post MI, LOWER MORTALITY, contra in COPD/asthma
spironolactone and get gynecomastiause eplerenone
Trichomonasgreen, malodorous, get metronid for both pt and partner
garedenelladig for "clue cells" give flagyl to pt as it is not an STD
topical clotrimazoleKOH + psuedohyphae for candida albicans, do not have to tx partner
low ferritin, low Fe low transferrin saturationFE def anemia
sideroblastic anemiadue to lead, isoniazidm ETOH, lab up ferritin up Fe, normal transferrin sats, ringed sideroblast is dx use prussian blue staining
Anemia of chronic RFdn EPO have functional iron def meaning they have adequate ironstores, but cannot utilize that iron
serum ferritinacute phase reactant
phenerganacute dystonic reaction, some DA antagonism
b12 defdn RBC count, dn hgb up MCV
Alpha Thallup ferritin, normal TIBC, normal RDW, microcytic, target cells
alpha thall spectrum1 deletion asx, 4 deleltion hydrops fetalis
alpha thall histotarget cells
pediatric nose bleedvaseline, humidifier -> chemical cautery.

Section 5

Question Answer
Carpal tunnelwrist splint 2nd line NSAID 3rd steorid inj oral steroid 4th srx
Tertiary syphilistabes dorsalis and dilated thoracic aorta so up aortic regurg
reiters reactive arthseen few weeks after chlymidia
primary ITP1st givesteroids anti-Rh(D) RHOGAM 2nd IVIG, if persistent >6 mo splenec 3rd autologous hematopoietic stem cell TP if not responded to splenec
Neonatal resp distressimmaturity surfactant lecithin:sphingmyelin <2:1, do antenatal steroids weeks 25-35 in hi risk.
VWDvasopressin induces VWF release
lidocaineadd buffered solution(na bicarb) to dn burning and decrease time to activation because acidity increases time to activation.
Rh incompatibiltyoccurs when negative mom is exposed to positive fetal, * if father is negative it is unnecessary to give Rhogam.
szIV benzo 2 rounds ten min then fosphenytoin. if at 30 min start barb,midazolam,propofol
CDz flareIV corticosteroids
thiazidehyperCa, hyperNa, hypoK, hyperuricemia
loopslose calcium
statinto dn TG and LDL
fibrateto up HDL and dn TG

Section 6

Question Answer
Niacinto up HDL and dn LDL vs fibrate which is up HDL and dn TG
LDLif >160 after 12 wk exercise, do drugs
transpoisition of great arteriesgive PGE1 to keep PDA open, Coarc of Aorta is assoc finding
knee-chest positionto tx hypercyanotic episodes of ToF MOA: up SVR * up pulm circ and oxygenation
Rett syndinitial normal develop, exclusive female, starts around 2 yo, breath-holding speels hand wringing
Rett geneMECP2
Rett synd txsupportive for motor and communication
hemochromatosisHFE mutation, lab dn TIBC up serum Fe, up Cirr, up HCCx
NF-1chr 17 cafe au lait, optic glioma, lisch nodule
lisch nodulepigmented iris harmatoma
kernicterusdeposits in basal ganglia, sx hypertonia/sz/poor feeding and high pitched cry
coarc of aortaabsent femoral pulses, presents with cardiogenic shock w in 1st few weeks of life when PDA closes due to TOGA assoc, so give the PGE1 immmediately
clostridium perfringens gas gangreneclindamycin if penicillin is contra (all clostridium's are G+)
DaptomycinMRSA coverage
Oxacillinfor necrotizing fascitis of MRSA
strep pyrogenes and clost perfringens nec fascia infxnpenicillin is 1st line
intraductal papillomasolitary lesions in bloody or clear nipple discharge, small risk of DCIS
Lobular carcinoma insitunoninvasive lesion, bilateral
ductal carcinoma insitutypically unilateral, vs lobular which is bil

Section 7

Question Answer
pagets breastbloody discharge but scaly ulcerated lesion of nipple
cellulitis w MRSAclinda/bactrim/doxy
Cellulitisfloxacillin, naficillin, cefazolin
cellulits+ penicillin ALLclinda/vanco
any obstrutive lung diseaseincreased TLC (asthma, emphysema, cystic fib, chronic bronchitis)
obesityrestrictive lung dz * DN tlc
COBB anglescoliosis >75degree assess CVasc func, >50degrees assess resp func
raloxifeneexacerbates postmenopausual sx (hot flashes dry vagina), is a SERM, used in osteoporosis
Tamoxifeneincreases risk of endometrial cancer
raloxifeneanatgonist on breast and uterine tissue up post-menopausal symptoms
HF with LV dysfACEi reduce mort when begun shortly after MI (reduces pathological myocardial remodeling) also give BB to reduce re-hospitalization for CHF and future cardiac events.
digioxinindic significant systolic dysf, esp w A flutter with RVR
early preg + bleedthreatened, trend bHCG and U/S
verruca vulgarisaka common wart
anaphylaxisABC tx order priority
Chorionic Villous Sampling9-11 weeks to assess fetal karyotyping, risk of limb reduction
Aminocentesisat 15-20 weeks, for genetics
Premature Rupt of Memsudden gush of fluid, dx with fern/nitrazine tests
depo-shotneed preg test (-) two weeks no sex, 2nd (-) test to give
ulcerative colitis and RUQ px and jaudicethink primary sclerosing cholangitis
HLA-DR52aassoc with Primary Sclerosing cholangitis

Section 8

Question Answer
PSC dxMRCP or ERCP (stenosing/beading of bile ducts) "onion skinning"
PSC txursodeoxycholic acid, endoscopid dilation, stent, steroids, azthiroprine/methotrexate
liver central depressed scar w blood vesselsfocal nodular hyperplasia
granulomatous destruction of intrahepatic bile ductsassoc primary bili cirr
reyes syndliver microvesicular fatty change
bile w in neoplastic hepatocyteshepatocelluar carcinoma
recurrent perianal fistulathink CDz
fat and swellingddx venous insuff cause fat, liver disease, CHF nephrotic
think CHFget b-np
low protein and liver diseaseto point of CIRR * liver should be non-pxful
nitrazine testshows Rupt Of Mem b/c amniotic pH is more alkaline.
animal biteamox-clav (pasteruella multicida) AB AC
post-partum fever think postpartum endometritisIV clinda and gentamicin