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INTERNAL MEDICINE ANSWERS
1) Myasthenia Gravis
2) Dis. Of NMJ, presents with weakness and fatigue. Ab to Ach receptors -> dec # of active/functional Ach receptors at postsynaptic membrane
3) Ach receptor Ab
4) Fatigued muscle weakness plus +Ach receptor Ab test
5) Edrophonium (Tensilon) test
6) EMG (decremental dec in muscle fiber content on repetitive nerve stimulation
7) Anticholinesterase (pyridostigmine)
8) Immunosuppressive tx with glucocorticoids
9) Azathioprine and steroid combo
10) Plasmapheresis and IVIG
11) Thymectomy
12) Gullian-Barre synd (Acute idiopathic polyneuropathy)
13) Acute severe polyradiculopathy w/autoimmune destruction of myelin. Body’s immune system attacks self antigens (molecular mimicry)
14) Pain, tingling dysthesia. Loss of large sensory fibers -> loss of reflexes and proprioception
15) Autoimmune instability (profuse sweating, postural hypotension, labile BP, cardiac dysrhythmia)
16) Approx 75%
17) LP (inc protein, no inc in cell count 48 hrs after sx)
18) EMG (demyelination of peripheral nerves)
19) IVIG or plasmapheresis (equally effective)
20) Sumatriptan PO, IN, SQ (serotonin agonist) contraindicated in CVD. Alternative tx: ergotamine
21) Px for migraine when >3x/mo. Tx: propanolol, timolol, valproic acid & {methylsergide (for 2-6 wks distended over 6mo, SE: valvular & retroperitoneal fibrosis)}
22) Opioid analgesics
23) Relaxation & NSAIDS, if refractory: musc relaxants
24) Predinisone, Li, ergotamine, methylsergide & verapamil
25) 100% oxygen, alternative: sumatriptan
26) Central vertigo a)gradual b)absent c)present d)pure, vertical, does not suppress w/fixation &multidirectional
27) Peripheral vertigo a)usually sudden b)present c)absent d)mixed,horizontal,suppress w/fixation,unidirectional
28) Tinitis, hearing loss, episodic vertigo (1-8 hr)
29) Syphilis & head trauma
30) Perilymphatic fistula
31) Meclizine. If severe: diazepam
32) Low salt diet & diuretic. If fails: surgical decompression
33) Meclizine. If severe: diazepam
34) Hypothyroidism, Vit B12 def, Hep/uremic encephalopathy, CNS vasculitis, Syphilis, Brain abscess, Brain tumor, Meds (anticholinergic), Sleep apnea, Trauma, Subdural hematoma, NPH, Depression
35) Progressive multifocal leukoencephalopathy, Alzheimer’s dis, Dementia w/ Lewy bodies, Frontotemporal degeneration (Pick’s dis), Vascular dementia multiinfarct, Binswanger dis), Creutzfeldt Jakob dis
36) Personality changes w/visuospatial sparing
37) Dementia & myoclonus (aggressive wks-mo)
38) Subcortical white matter (slow)
39) Donepezil. Others: anticholinesterase inhibitors (rivastigmine, tacrine); discontinue if no improvement in 3-6 mo
40) Multiple sclerosis
41) Inflammatory dis of CNS white matter, multifactorial (infections, diet, climatic), focal areas of demyelination
42) Infection, trauma, post pregnancy (2- 3 mo after)
43) Brain MRI (inc T2 density, dec T1 density) Gandolinium enhance lesions till 2-6 wks after exacerbation
44) Brain MRI
45) Brain MRI
46) CSF (mild pleocytosis <50 cells, inc IgG oligoclonal band 70-90%pts)
47) Disease modifying agents: IFN B1b, IFN B1a, glatiramer acetate
48) IFN B1b &mitoxantrone
49) Methotrexate, cyclophosphamide, IVIG or azithropine
50) No disease modifying tx approved yet
51) 3 days of intense IV steroids-> oral steroids (taper over 4 wks) If severe & steroid unresponsive: plasma exchange
52) baclofen
53) tizandine, diazepam
54) oxybutynin
55) bethanechol
56) amantadine or fluoxetine
57) sildenafil acetate
58) Neurologic synd from def of neurotransmitter dopamine as consequence of degenerative, vascular or inflammatory changes in basal ganglia
59) Supranuclear palsy
60) Olivopontocerebellar atrophy
61) Shy Dragger synd
62) Anticholinergic meds
63) Amantadine
64) Carbidopa/levodopa
65) Sustained rel form of carbidopa/levodopa adding dopamine agonist, selegiline or COMT inhibitors or restriction of protein meal to night
66) Selegiline
67) Surgery for who cant tolerate or respond adequately to medical tx. Procedures: pallidotomy & thalamotomy
68) Electroencephalogram
69) Secure ABC, tx reversible causes, lorazepam or diazepam (potentiate GABA recept)-> seizure-> phenytoin or fosphenytoin (inhibit Na+ dependent AP)-> seizure -> phenytoin/fosphenytoin -> seizure -> phenobarbitol -> seizure-> phenobarbitol -> seizure -> midazolam or propofol
70) If Pt has abnormal neurologic exam, presented w/ status epilepticus, has strong family hx of seizures, or has abnormal EEG
71) Valproic acid (inc availability of GABA). If not a choice, pick lamotrigine (dec glutamate release)
72) Ethosuximide. Valproic acid
73) Carbamazepine & phenytoin. Valproic acid & lamotrigine
74) Valproic acid
75) Diplopia, dizziness & ataxia
76) Gum hyperplasia, lymphadenopathy, hirusitism, rash
77) Sedation, ataxia, rash
78) Ataxia, tremor, hepatotoxicity, thrombocytopenia, GI irritation, hyponatremia
79) Diplopia, ataxia, rash, Steven-Johnson syndrome
80) Contralateral weakness & sensory loss in legs > upp ext. Urinary incontinence, confusion, beh disturbances
81) Contralateral hemiplegia, hemisensory loss, homonymous hemianopia w/ eyes towards cortical lesion. Dominant: aphasia. Nondominant: preserved speech, comprehension w/ confusion & apraxia w/ spatial & constructional deficit
82) Contralateral HH, visual hallucinations, agnosia. Weber synd (w/contralat hemiplegia), Benedikt synd (contralat ataxia or athetosis)
83) Locked in synd (paramedian br) quadrapresis w/ intact vertical eye movement. Wallenberg synd (ipsilat facial sensory loss, contralat body sensory loss, vertigo, ataxia, dysarthria, dysphagia, Horner synd)
84) Vertigo, Vomiting, nystagmus, ipsilat limb ataxia
85) Non contrast head CT
86) Non contrast head CT
87) Diffusion weighted MRI
88) Echo, carotid duplex, 24 hr holter, inherited coagulability
89) Tissue plasminogen activator (tPA)
90) Inc risk of recurrent stroke (A fib, basilar art thrombosis, stroke in evolution)
91) Aspirin
92) Add dipyridamole or clopidrogel
93) When occlusion >70% of arterial lumen & lesion is symptomatic
94) Thoracic cord (70%)level as spinal cord is narrowest at this point
95) MRI of spine. If contraindicated: CT myelogram
96) 84-94%
97) Surgical decompression
98) High dose dexamethasone immediately. For radiosensitive tumors: RT. For others: surgical decompression
99) Functional status at time of presentation (80% who are initially able to ambulate -> retain function later)
100) Arnold Chiari
101) Spinal cord trauma
102) Cervical cord level
103) Distal paresthesia & weakness of ext followed by spastic paresis & ataxia. Combined def of vibration & proprioception w/ pyramidal signs (plantar extension & hyperreflexia)
104) Acute onset of flaccid paralysis->evolves into spastic paresis over days-wks. Loss of pain & temp (w/ sparing of vibration & position sense as post column is supplied by post spinal art)
105) 5%
106) 8%
107) 60-70x
108) 75x
109) squamous cell CA & small cell CA of lung
110) large cell CA & adeno CA of lung
111) AdenoCA of lung. Often req thoracotomy w/pleural biopsy
112) Cough (74%) Wt loss (68%)
113) 80%
114) Bronchoscopy (90%) helps in staging
115) Needle aspiration biopsy (40-50%)
116) Granuloma
117) 90%
118) Wt loss >10%, bone pain or other extrathoracic mets, CNS sx (tx: RT or chemo), sup vena cava synd, hoarseness, contralat mediastinal adenopathy, split-lung test tidal vol <800ml, classification of MI w/in 3 mo, tumor invasion of trachea, esophagus, pericardium or chest wall
119) Chemo VP16 (etoposide & platinum)
120) Chemo & RT or CAP (cyclophosphamide, adriamycin, platinum)
121) Sclerose w/ tetracycline
122) For squamous lung CA: 30-35%. For large cell & adeno cell lung CA: 25%
123) Cessation of airflow >10 sec at least 10-15x/hr during sleep. Day time somnolence
124) Wt loss & CPAP (as floppy airway but adequate ventilation)
125) Acetazolamide, progesterone & supplemental O2
126) Polysomnography
127) Dec PaO2, N or inc PaCo2
128) N C.O. & capillary wedge press, inc pulm art press
129) Tx underlying dis, PEEP & permissive hypercapnea
130) 70%
131) Factor V leiden
132) >40 yrs w/hx of DVT or prior PE, pts w/ extensive pelvic or abd surg for malignant dis or maj orthopedic surg of lower limbs
133) S1 Q3 T3 (R axis deviation, deep S in lead 1, Q waves in lead 3, inverted T waves in lead 3) w/nonspecific RV strain pattern, sinus tachycardia
134) V/Q scan
135) Angiogram
136) Venogram
137) Pts w/ high probability V/Q scan & high or intermediate clinical suspicion for PE should be treated. Any pt w/ abn V/Q scan and +DVT by US should also be treated.
138) Continuous heparin (5 days) to prolong PTT to 1.5-2x N, Long term warfarin (on day 1 to inc PT 1.3-1.5x N; baseline for 6 mo)
139) Thrombolytic tx (tPA). If contraind: embolectomy
140) Interrupt IVC Greenfield filter
141) LMWH for 6 mo
142) Workers in mining, quarrying, tunneling, glass & pottery making, sand blasting
143) Asbestos exposure in mining, milling, foundry work, shipyard, asbestos application to pipes, brake linings, insulation and boilers
144) Coal dust exposure (amount), high rank (hardness of coal), high silica content of inhaled dust
145) Restrictive w/dec DLCO, hypoxemia w/inc PAO2-PaO2 gradient
146) Bronchiogenic CA (adeno or squamous cell)
147) Lung biopsy: barbell shaped asbestos fiber
148) In acute silicosis: lung failure in months
149) Yearly PPD (if >10mm: INH pox for 9 mo)
150) Diffuse or local pleural thickenings, pleural plaques & calcifications at diaphragm, pleural effusion common at lower lung fields
151) Nodules (1-10mm) seen thru out lungs (prominent in upp lobes), Rare egg shell calcifications, progressive dis (densities >10mm) in large masses
152) Small round densities in parenchyma (upp half of lung), progressive (densities from 1cm to entire lobe)
153) Inc levels of IgA, IgG, C3, ANA, Rf
154) Rheumatoid nodules in lung periphery in pt w/RA & coexisting pneumoconiosis (usually CWP)
155) Sarcoid synd: Erythema nodosum, arthritis, hilar adenopathy
156) F, parotid enlargement, uveitis & facial palsy
157) Hypercalcemia or hypercalciuria (inc circulation of vit D produced by macrophages), nonspecific inc in ACE (60%), abn in LFT (30%) w/90% symptomatic pt, skin anergy, PFT N or restrictive, uveitis & conjunctivitis (>25%)
158) Biopsy of suspected tissue (non-caseating granuloma)
159) 80% w/lung inv: stable or resolve spontaneously, 20% have progressive dis w/end organ compromise
160) Involvement of CNS, uveitis & hypercalcemia
161) Idiopathic pulmonary fibrosis. Seen in 5th decade, CT: ground glass app. PFT: restrictive. Tx: steroid +/- azathioprine. Px: response to steroids
162) Secondary to repeated pneumonic processes as TB, fungal, lung abscess, and pneumonia (focal bronchiectasis) or when defense mech of lungs are compromised as CF and immotile cilia synd (diffuse b)
163) High resolution chest CT
164) Bronchodilators, chest phys tx, postural drainage, rotating antibiotics (amox, TMP-SMX, amox, amox/clavulanic acid when sputum prod inc or mild sx)
165) If significant sx or pneumonia
166) Localized bronchiectasis w/adequate PFT or massive hemoptysis
167) 10-15%
168) 80-90%
169) PFT (dec FEV1/FVC & FEF 25-75%, inc RV & TLC,
DLCO dec in emphysema & N in chronic bronchitis)
170) Anticholinergic (ipratropium bromide; atrovent)
171) B2 agonist (albuterol, terbutaline, metaproterenol)
172) Home O2 tx & smoking cessation
173) PaO2 < 59mmHg
174) Empirically for acute exacerbation of COPD: cover H inf & pneumococcus
175) Systemic steroids (slowly taper w/in 2 wks)
176) Check FEV1 after bronchiodilator (If inc FEV1: better survival, If faster rate of decline of FEV1: worse px)
177) FEV1 < 25% predicted
178) FEV1 < 50%
179) Pneumococcus/5 yr, Influenza/yr
180) Salmeterol (12hr)
181) Anticholinergic (ipratropium bromide: takes 90 min to bronchodilate, has medium potency)
182) Bronchoscopy w/subsequent removal of mucous plugs
183) LDH effusion<200, LDH E/S<0.6, Protein E/S<0.5
184) <35 yr non-smoker w/calcified nodule (follow w/ CXR/3mo for 2 yr. Stop follow up if after 2 yr, there is no growth
185) >50 yr w/smoking hx & nodule->likely bronchiogenic CA so best dx procedure is open lung biopsy & removal of nodule at the same time
186) Keep Hb & C.O. near normal
187) PAO2 – PaO2 gradient= 150-1.25 x PCo2-PaO2 (In N young individual its 5-15 mmHg; increases w/hypoxemia except hypoventilation & increase altitude)
188) Combined chronic resp acidosis & metab acidosis
189) Chronic hypercapnia (chronic resp acidosis or metab acidosis) superimposed on acute resp acidosis
190) Acute resp acidosis
191) Chronic resp acidosis superimposed on metabolic alkalosis
192) Abd US & captopril renogram
193) Captopril renogram
194) Arteriogram
195) PC transluminal angioplasty
196) Inc aldosterone in urine & blood
197) If adenoma: surgical resection; If hyperplasia: spironolactone
198) If smooth walled w/ no debri in cyst: no further dx or tx; If cysts w/ irregular walls or debri inside cyst: aspirate (R/O malignancy)
199) Acid load test; give NH4Cl (should lower urine pH secondary to inc H+) but in type I, pH remains high. Serum HCO3-=10
200) PO HCO3- as HCO3- reabsorption still works. K+ replacement
201) Pts unable to absorb IV HCO3- load & have basic urine in presence of academia
202) K+ replacement, thiazide diuretics, very large amounts of HCO3-
203) High urine Na+ w/ PO salt restriction
204) Fludrocortisone
205) Peaked T waves, wide QRS, short QT or prolonged PR interval
206) CaCl, NaHCO3-, Glucose & insulin, diuretic, B agonist, Kayexalate (w/sorbitol), dialysis
207) Primary inability to reabsorb NaCl from loop of Henle-> High renin, high aldosterone, N BP
208) U wave, T wave flattening
209) Correct underlying dis, IV K+ max 10-20 mEq/hr, K+ PO 200-400 mg/point of K+ decrease gut regulates absorption, half N or NS
210) Isotonic IV fluids. For CDI: correct dis, give ADH. For NDI: correct dis, diuretics or NSAIDS
211) Urine Osmolality > Serum Osmolality w/U Na+>40
212) Mild: fluid restriction <1000ml/d; Mod: loop diuretic & NS; Severe: hypertonic saline; Chronic: Li & demeclocycline
213) Erythropoietin & transfusions
214) Vit D, phosphate binders (Amphojel), Ca rep
215) Restrict protein, K, PO4, Mg & give Vit D, CaCo3, DDAVP (for bleeding)
216) Hyperkalemia, acidosis, fluid OL, pericarditis, encephalopathy
217) After pharyngitis or strep skin infect-> smoky urine (hematuria, proteinuria) w/HTN & edema. Inc ASLO, AHT (antihyaluronidase) & dec C3
218) Plasmapheresis (remove circulating Ab) combined w/ steroids & cyclophosphamide
219) Membranoproliferative (immune deposits & dec complement)
220) None as self-limited. Sometimes steroids
221) Plasmapheresis & steroids
222) Plasma exchange
223) Non-specific tx. For refractory cases: steroids
224) Cytotoxics & steroids
225) Sterile pyuria, hematuria, flank pain, mild proteinuria, hx (need 1g/d for 1-3 yrs)
226) Naficillin/oxacillin, restoration of hypovolemic shock, removal of toxin
227) Isolation of fungus in sputum, pus, biopsy
228) Severe: prolonged amphotericin (8-12 wks); mild: itraconazole/ketoconazole (6-12 mo)
229) Visualize parasite in tissue & fluid (serology is the most common method used)
230) Contrast Head CT or MRI, pt is given 10-14 days of tx, then re-scan, if lesion shrinks->dx confirmed
231) Specific serology: biopsy of skin lesion. Doxycycline
232) CD4<350 or (on PCR-RNA) VL>55,000
233) CD4<200. TMP-SMZ (most effective), dapsone, atovaquone, aerolized pentamidine (breakthrough). Discontinue when antiretrovirals raise CD4>200 >6mo
234) CD4<50. Px: Azithromycin PO 1/wk or clarithromycin bid (rifabutin is an alternative) Dx: blood culture, bone marrow, liver, and other body tiss or fluids culture. Tx: clarithromycin & ethambutol
235) CD4<100. TMP/SMZ, dapsone/pyrimethamine
236) Amphotericin IV at least 10-14 days followed by fluconazole (life long)
237) Endomyocardial biopsy
238) Direct visualization (usually at surgery) of pale, dead muscle w/brownish, sweet smelling discharge
239) High dose pnc (24 million/d) or clindamycine (if pnc allergic), surgical debridment or amputation, hyperbaric oxygen
240) Head CT w/contrast
241) MRI
242) HSV
243) PCR for HSV has 98% sensitivity & >95% specificity
244) Staph aureus
245) Head CT
246) Promyelocytic leukemia (M3)
247) FFP & sometimes platelets, correct underlying dis
248) Desmopressin (DDAVP) pre-op for mild pts. Factor 8 for severe pts.
249) VWD
250) Abn Ristocetin platelet agg test, low vW factor (aka factor VIII), inc BT, maybe inc PTT
251) Pre-op DDAVP for mild pts, VWF replacement for severe cases
252) Superficial bleeding, thrombocytopenia, N spleen, Antiplatelet Ab (high sensitivity w/poor specificity), Bone marrow filled w/ megakaryocytes, N peripheral smear & creatinine (R/O HUS, TTP, DIC)
253) Initially prednisone (mostly). IF platelet<10,000-20,000 recur even w/ rep steroid course-> splenectomy. If platelet <10,000 & life threatening bleed-> IVIG or Rhogam initially. If no response to IVIG or steroids in life threatening condition-> platelet transfusion (very rare)
254) HIV, EBV, HTLV-1, H. pylori
255) Only 10-20%
256) Excisional lymph node biopsy
257) Radiation
258) Combination chemo; Initial CHOP (cyclophosphamide, hydroxy-adriamycin, oncovin (vincristine), prednisone)
259) Autologous bone marrow transplant
260) 80-90%
261) Combination chemo ABVD (adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine)
262) Lymphocyte predominant HL
263) Inc WBC (predominantly neutrophils), blasts absent or <5%, dec LAP, basophilia, association w/ polycythemia vera, inc B12
264) If <60 yrs w/ suitable donor->bone marrow transp (as 25%/yr convert to acute leukemia); If w/o donor-> IFA initially, if fails-> hydroxyurea (dec # of cells); specific tx: Gleevec (tyrosine kinase inhibitor)
265) Bone marrow biopsy: >30% blasts
266) Monoclonal Ab
267) Initially chemo-> 99.9% remission-> consolidate -> transplant; Initial chemo for AML: cytosine arabinoside & daunorubicin or idarubicin; Initial chemo for ALL: Daunorubicin, vincristine, prednisone & asparginase; Promyelocytic leukemia: Add Vit A derivative (ATRA); CNS px for ALL: intrathecal methotrexate
268) Thrombosis of hep veins (Budd Chiari)
269) RBC memb defect in PIG-A
270) Specific: Sugar water test, Ham test, decrease DAF (decay accelerating factor)
271) If severe blood loss: Fe rep; If severe for unclear reasons: steroids; For thrombosis: anticoagulation
272) AD loss of spectrin (splenomegaly, jaundice, anemia)
273) Sensitive: Osmotic fragility test, Inc MCHC, -ve Coombs test
274) Chronic folate rep; If more severe anemia: splenomegaly
275) Coombs test (smear will show spherocytosis)
276) Stage I: 1 lymphatic gp; Stage II: 2 lymphatic gp on same side of diaphragm; Stage III: lymphatic gp on both sides of diaphragm or inv of any extra lymphatic gp contiguous to primary nodal site; Stage IV: widespread dis w/ different extralymphatic sites as bone marrow or liver
277) Unknown cause. 1% of population>50 yrs & in 3% of those >70yrs
278) Inc monoclonal spike of SPEP (lower than MM), N creatinine, Ca, Hb, inc total protein, no lytic lesion, bone marrow: <5% plasma cells)
279) Blurry vision, confusion, mucosal bleeding
280) Bone marrow biopsy: >10% plasma cell
281) Pre-op chemo VAD (vincristine, adriamycin, dexamethasone). Young pts: autologous bone marrow transp; Older pts: melphalan & prednisone
282) Stage 0: lymphocytosis; Stage I: lymphadenopathy; Stage II: splenomegaly; Stage III: anemia; Stage IV: thrombocytopenia
283) Inc WBC (80-90% lymphocytes), CD19, smudge cells
284) None for stage 0-II if asx; If stage I-II w/sx: chemo; Initial tx: chlorambucil w/prednisone; if don’t work: fludarabine
285) CBC: pancytopenia; confirm w/bone marrow biopsy: hypoplastic fat filled w/no abn cells
286) When pt<50yr & healthy: allogenic bone marrow transp (cure 80-90%); if not possible: immunosuppresion (remission in 60-70% w/ anti thymocte globulin, cyclosporine & prednisone)
287) Philadelphia chromosome 9-22 (more specific)
288) Tc bone scan & MRI (equal sensitivity; MRI has better differentiation but is less readily available)
289) X-ray (periosteal elevation)
290) Bone biopsy & culture
291) Clinically & by performing Giemsa or Wright stain (Donovan bodies) or smear of lesion or punch biopsy
292) Doxycycline or TMP-SMZ; Alternative: erythromycin
293) Clinical exam, hx, high titers of complement fixing Ab (isolate Chlamydia from pus in buboes)
294) Doxycycline or erythromycin
295) Clinical, Gram stain initially w/culture to confirm; PCR useful
296) Azithromycin 1 dose or ceftriaxone IM 1 dose; Alternative: erythromycin for 7 days or ciprofloxacin for 3 days
297) Stool for WBC w/methylene blue
298) Fish that ingest organisms that produce histamine; Sx: rash, D, V, wheezing; Tx: antihistamine (diphenhydramine)
299) Lymph nodes (adenitis)
300) CXR
301) Culture
302) Pleural biopsy (75%), 3 negative AFB (>90%)
303) TB pericarditis, TB meningitis
304) CXR
305) Open lung biopsy
306) Specific serology antibody titers
307) Degree of hypoxia (pO2<70), O2 sat <94% on room air, RR>20-24 (N 10-14)
308) Signs of resp infect (cough & sputum) w/N CXR
309) Decongestants (PO pseudoephedrin or oxymetazole spray)
310) First steroids, if unresponsive: splenectomy
311) Mild: avoid cold; Severe: alkylating agents (chlorambucil or cyclophosphamide)
312) Hb electrophoresis
313) Quick screening test to dx evidence of trait (don’t distinguish b/w trait & dis)
314) Hemolysis, liver dis, myelodysplasia
315) Folate & B12 def
316) Simply dec B12 level
317) Hb electrophoresis; B thalasemia: Inc HbF & HbA2; Alpha thalasemia: N HbF & HbA2; chain B4: HbH (alpha thalasemia w/3/4 alpha genes deleted); Target cells, RDW N
318) Blood transfusion 1-2x/mo; For Fe OL: deferoxamine; splenectomy; for small # of pts: splenectomy
319) N serum ferritin, Inc transferein sat & serum Fe but dec TIBC; most specific: Prussian blue stain
320) Serum ferritin N or inc; dec serum Fe, TIBC & retic count
321) Bone marrow biopsy; serum ferritin<10ng/ml (poor sensitivity/good specificity)
322) To confirm dx of angina, to determine severity of dis, post MI evaluation
323) If regular treadmill is nondiagnostic, any pt w/ MVP, WPW, LBBB, young females (any pt w/acute ischemia changes of EKG: LVH, nonspecific ST), pts on quinidine, procainamide, digitalis
324) Unstable angina, AS, HOCM, severe COPD, acute CHF, acute ischemic changes on EKG, aortic dissection, severe uncontrolled HTN; If inability to exercise: Persantine or dobutamine stress test used in who can’t exercise.
325) Useful in pts who r poorly controlled w/meds, + conventional or + thallium test to determine need for revascularization, in general to determine who needs by pass, public safety issue w/sx of CAD goes directly to cath (airline pilot)
326) Initial goal to reduce LDH<100, HMG CoA reductase
327) Diet therapy
328) Drugs
329) Diet
330) Drugs
331) Recurrent or persistent myocardial ischemia, severe L or bivent fail w/ or w/o shock (inflation of balloon augments C.O. & perfusion thru coronary art)
332) Stress test after 5-7 days (should have submax 70% of target rate) or after 2-3 wks (max stress test 85% of target rate); If post-infarct angina or ischemia on stress test: angiography to determine need for angioplasty or by pass surg; Meds (B blocker & aspirin to all, ACE inhibitor if EF<40% or L vent dysfunct, lipid lowering agents to keep LDH<100, smoking cessation
333) N, V, gynecomastia, blurred vision, yellow halo around objects, arrhythmia (most common PAT w/ block but any kind possible)
334) Stop drug, K+ if needed, lidocaine & phenytoin, digibund for acute overdose
335) Morphine SO4, diuretics, dobutamine, sit pt upright, O2-PEEP, nitroglycerin, digoxin (if in A fib), IV ACE inhibitors
336) AS, VSD, MR (slight decrease)
337) HOCM, AS (inc or dec), VSD/MR (no change)
338) Body size (smaller body, worse effect so worse in kids), location of bite (worse on trunk & face), exercising after bite (spread venom thru lymphatics), depth (20-50% superficial)
339) Dry skin 1000x resistant than wet skin. In dry skin more heat is produced so more injury
340) Wet skin conducts electricity along nerves & blood vessels so produce inj far from contact
341) V fib (any arrhythmia possible)
342) Aystole (any arrhythmia possible)
343) 5-30%
344) cardiopulmonary resuscitation (tx arrhythmia & ABC), fluid rep (monitor w/ U/O), local wound care (debridment, fasciotomy & amputation)
345) <2 Gray/Sievert of exposure
346) >10 Gray/Sievert (1000 rad)
347) As little as 2-3 Gy (200-300 rad) depress lymphocyte count; long term leukemia is earliest, most common CA from radiation exposure
348) 2-3 Gy: temporary aspermatogenesis; 4-5 Gy: permanent sterility
349) Healthy person w/ fluid & elec depression, painful muscle contraction (last few min) w/ muscle tenderness, pt can sweat, no neurological abn, N body temp
350) Rest, PO rehydration & salt rep
351) More severe, weaker pt, slightly inc body temp, H/A, anxiety, still sweats, may need IV hydration
352) Cant sweat, high body temp, confusion, disorientation, N, blurred vision, seizures, hemoconcentration, inc BUN/creatinine, inc WBC, DIC, rhabdomyolysis, anuria, lactic acidosis
353) IV fluid rep & rapid cooling of body, put in cool env & spray w/water, fan to evaporate fluid; for shivering: chlorpromazine & diazepam
354) 24 hr pH monitoring
355) H2 blockers: 50%, PPI: 80%
356) Barium swallow
357) 65% effective; repeat tx every 2 yrs
358) Surgical myotomy (circular muscle is incised)
359) Antireflux tx, no effective tx
360) Corkscrew
361) Manometric study: non peristaltic uncoordinated contractions
362) Ca channel blockers & nitrates commonly used
363) Nutcracker esophagus; Manometry: high amplitude peristaltic contractions
364) Schatzki ring at squamo-columnar junction or proximal to LES
365) High risk of squamous cell CA
366) Barium swallow
367) Schatzki ring: pneumatic dilation of symptomatic lower esophageal ring; Plummer Vinson: surgery
368) 10-20%
369) If Barrett’s >8 cm + dysplasia & smoking hx
370) If no dysplasia: rep every 2-5 yr; If low grade dysplasia: rep every 3-6 mo; If high grade dysplasia: esophageal resection should be considered
371) 5% 5 yr survival (poor prognosis)
372) Surg for localized lesions (20% mortality from procedure), chemo w/ cisplatin + 5FU + radiation for metastatic disease
373) Halitosis, transfer dysphagia (difficulty initiating swallowing) & regurgitation of food several days after ingestion
374) Cricopharyngeal myotomy or diverticulotomy or both
375) EGD
376) Angiographic embolization or vasopressin is an option
377) Histologic antral biopsy
378) Serologic test that measure IgG (ELISA)
379) Initial: serology; follow up: urea breath test
380) Stomach: 30%; duodenum: 20%
381) 20%
382) Gastric emptying study (ingestion of radioisotope labeled food that shows delayed gastric emptying)
383) Metoclopramide
384) Basic: Sulfasalazine & steroids; for small bowel: 5 ASA; for fistula: metronidazole; surg: for complications only (as recurrences [50-75% over 5 yrs] at resection site)
385) Not just for complications, 20-30% require colectomy (curative)
386) Secretory D: 2[Na+K]=290 mOsm/L; Osmotic D: 2[Na+K]=>50 mOsm/L
387) Except giardia & cryptosporidia
388) Sudan stain; 48-72 hr stool collection for fat
389) Lactase def & vit B12 def (pernicious anemia)
390) D xylose test (If N: panc insuff, confirm w/trypsin level & secretin level; If abn: small bowel pathology, confirm w/ small bowel biopsy
391) TMP-SMX or tetracycline for 6 mo
392) Anti-endomysial & Anti-gliadin Ab
393) Intestinal lymphoma
394) Arthralgias & CNS sx (dementia, opthalmoplegia)
395) Small bowel biopsy: foamy macrophages on PAS stain
396) Antibiotics (TMP-SMX or tetracycline for 6mo- 1yr)
397) 50% in pts >50 yrs
398) Pt complain of LLQ colicky abd pain relieved by defecation
399) Colonoscopy or BE; if diverticular bleed: bleeding scan or angiography
400) CT scan (sigmoidoscopy & BE are hazardous in acute phase)
401) 24 hr urine for 5HIAA
402) surg, octreotide (somatostatin analog)
403) 100% risk of colon Ca, deletion in long arm of chromosome 5
404) Hereditary nonpolyposis synd, AD, CA hx in more than 3 or 3 first degree relative, seen in 2 generations, 1 family memb <50 yr, CA usually proximal in location, association w/ovarian and endometrial CA
405) Colonoscopy every 10 yr for pts>50 yrs of age (more sensitive that sigmoidoscopy + BE)
406) Surgery
407) Chemo w/ 5FU & leucovorin combine w/surgery
408) EGD tx: bipolar electrocoagulation, injection therapy, sclerotherapy & band ligation for varices, IV omerprazole (decreases peptic ulcer bleed recurrences so given before doing endoscopy)
409) Endoscopic ejection therapy
410) Inc uptake of technetium (Meckel scan)
411) Endoscopic tx: bipolar electrocoagulation, injection therapy; angiography, surgery
412) Lipase
413) Amylase
414) If >5 cm & persists >1 mo
415) Abd X-ray: calcifications in pancreas, dec trypsin level, most sensitive is secretin stimulation test (measures HCO3- in duodenum), N amylase & lipase
416) US: 90% sensitive
417) ERCP
418) Portal HTN caused by liver disease or right HF
419) Nephritic synd, TB, peritoneal carcinomatous
420) Gilbert dis (prevalent in 3-10% pop) AD or AR, jaundice waxes & wanes, bilirubin never >5mg/dl, no other abnormal lab findings, no tx required
421) Crigler Najjar synd, usually AR, unconjugated bilirubin: 20-40 mg/dl, infant w/ kernicterus
422) Benign, AR, secondary to defect in biliary excretion, liver histology: black pigments in hepatocytes
423) Ursodeoxycholic acid; in end stages: liver transp
424) 15%
425) Characteristic structuring, beading & irregularity of intra & extra hepatic bile ducts
426) 30%
427) Inc Fe, transferrin, ferritin; for confirmation: liver biopsy
428) Phlebotomy: weekly or biweekly; chelating agents like deferoxamine
429) 20%
430) Electrophoresis: absence of alpha antitrypsin; confirm w/ dec serum alpha trypsin
431) Viral Hep, acetaminophen & shock liver
432) 10%
433) 90%
434) Alpha interferon or lamivudine (6 mo-1yr)
435) Only 25%
436) PCR
437) Alpha interferon + ribavirin
438) Phenothiazine, metoclopramide, alpha methyl dopa, reserpine
439) Clinical, screening test (give 100mg of PO glucose, + if GH remains high >5ng/ml), measure IGF or SMF w/ disease activity, CT & MRI to localize tumor
440) One fourth (25%)
441) GH dec in two-third pts; partial tumor regression in 20-50%
442) 10-20% (rapid response to surgery)
443) 20% (slow resolution of disease
444) Cardiac failure
445) Emergency situation. Synd associated w/ acute hemorrhagic infarction of pre-existing pit adenoma & manifestations as severe H/A, N, or V & depression of consciousness
446) Large pit tumors, pit apoplexy, hypothalamic tumors (craniopharyngioma, meningioma, glioma), inflammatory dis (sarcoidosis, TB, syphilis, eosinophilic granuloma, autoimmune lymphocytic hypophysitis), vascular dis (Sheehan), infiltrative dis (hemochromatosis & amyloidosis)
447) GH def: insulin (0.1 microg/kg) induced hypoglycemia (<40mg/dl); ACTH def: insulin tolerance test (0.05-0.1 U/kg of reg insulin-> plasma cortisol >19microg/dl); decrease LH, FSH, estrogen, testosterone; TSH def: dec T4 & T3, N to dec TSH
448) Herniation of suprasellar subarachnoid space thru incomplete diaphragm sella (no bony erosions). Obese, multiparous females w/H/A; 30% have HTN; tx: reassurance
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| shakil8
Forum Newbie
Topics: 3
Posts: 12
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I saw the Answers. But I don't have the Questions. can any one, please send me the questions. I will appreciate it. My e-mail is Zaami2000@yahoo.com. Thank you
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| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
|
yeah....what the heck are these answers to?
___________________
"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson
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| bugsbunny
Forum Junior
Topics: 14
Posts: 54
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i thought i had selective blindness that i couldt see questions and could see only answers..do u mind telling us wat these anwers r for?....im scared already with all that stuff u wrote down..lol
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| VM
Forum Junior
Topics: 4
Posts: 65
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can we subpeona DR NO MORE LOSER to deliver the questions before we all go crazy for the questions? lol
VM
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| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
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Its a trap...USMLE is testing the intergrity of foreign docs. Who ever will try to remember or use these answers, will be prosecuted to the fullest extent of Murphy's Law :-)
___________________
"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson
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| no more a loser
Forum Guru
Topics: 140
Posts: 580
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sorry guys, I actually put both these topics together when i first posted this long time back. Here r the questions. I prepared these Q & A from kaplan int medicine and memorized them and I thought these were very very helpful in my step2 exam. Another note I just found out from oasis that I passed step 1 as well 
http://www.prep4usmle.com/community/topic5305.htm...
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| VM
Forum Junior
Topics: 4
Posts: 65
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Thank you Doc winner and Congratulations!
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| Rehoboth
Forum Newbie
Topics: 3
Posts: 30
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Those are good learning materials.That is so kind of you to share
Rehoboth
___________________
Let us encourage ourselves always :To men it might be impossible but with God all things are possible
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| dericanthony
Forum Newbie
Topics: 2
Posts: 28
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hi what are these answers for ?
please send them to me deric@india.com
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