COMLEX II: STATISTICS EXAM 2024

Vault hold finger positioning - ANS Index: g wing of sphenoid Middle: preauricular part of temporal bone Ring: mastoid Little: squamous portion of occiput VSR for head and neck - ANS T1-T4 VSR for heart - ANS T1-T5 hypokalemia on EKG - ANS u wave that directly follows t wave, flat or inverted t waves treatment of patient from burning home without signs of airway compromise - ANS 100% oxygen via non-rebreather mask pancreatic adenocarcinoma symptoms - ANS succussion splash, weight loss, early satiety, new unexplained hyperglycemia Burn on head - ANS 9% Burn on chest or back - ANS 18% Burn on arms - ANS 18% total (9% each, anterior and posterior) Burn on legs - ANS 36% total (18% each) Burn on genitals - ANS 1% Parkland formula - ANS %TBSA x weight (kg) x 4 mL/kg 1/2 given in first 8 hours, rest given over 16 hours treatment for nosocomial pseudomonal (gram neg aerobic) PNA in ICU patient - ANS anti-pseudomonal B lactam combined with B lactamase inhibitor AND aminoglycoside ex. amikacin & pip-tazo cryoprecipitate - ANS factors VIII & XIII, fibrinogen, and vWF -use when indication for FFP present, but pt is volume overloaded or if fibrinogen deficient Whipple procedure - ANS head of pancreas, duodenum, GB, CBD; prox jejunum, distal stomach prenatal visit frequency - ANS every 4 weeks from weeks 0-28 every 2-3 weeks from weeks 28-36 every week until delivery CML - ANS sx: splenomegaly (epigastric pain & satiety) labs: leukocytosis, myeloblasts, basophilia, granulocytosis, neutrophils, bands, & segmented mature cells CLL - ANS most common after 50 y/o dx: lymphocytosis w/ predom mature small lymphocytes myelodysplastic syndrome - ANS dysplastic neutrophils, pancytopenia, hypercellular bone marrow Nocardia - ANS gram positive branching bacilli cause of hydrocele - ANS patent processus vaginalis sarcoidosis treatment - ANS corticosteroids ankylosing spondylitis imaging results - ANS squaring of L-spine vertebral bodies, complete fusion of vertebral column, diffuse sclerosis, syndesmophytes tx w/ NSAIDs & PT MEN 1 - ANS pituitary adenoma (vision changes), parathyroid hyperplasia (hyperCa), pancreatic islet cell tumor (gastrinoma) teratoma - ANS nonseminomatous germ cell tumor, heterogenous w/ calcifications and cystic areas, hyperechoic negative AFP, B-hCG, & estradiol yolk sac tumor (endodermal sinus) - ANS most common testicular malig in prepubertal males, painless testicular mass -incr AFP w/ negative B-hCG & estradiol anal fissure - ANS tear b/c recurrence passage of hard stools; severe pain w/ defecation tx w/ topical nitroglycerin hemorrhoid treatment - ANS fiber, fluids, & laxatives; NOT topical NTG hypospadias management - ANS NO CIRCUMCISION refer to urology (surgery at 6 mo-1 year of age) lab finding in upper GI bleed - ANS elevated aldosterone, BUN, BUN:creatinine ratio GGT elevation - ANS hepatobiliary disease only (hepatomegaly, jaundice) Granulomatosis with polyangiitis (Wegener) - ANS antiproteinase-3 (PR3-ANCA) and c-ANCA tx w/ steroids & cyclophosphamide Post-streptococcal glomerulonephritis - ANS 2 weeks after GABHS -oliguria, edema, HTN, smoky brown urine dx: decr C3, pos ASO, lumpy bumpy subepithelial IgG & C3 deposits Henoch-Schonlein Purpura - ANS decr C4, incr IgA, active urinary sediment vasospastic ulcer due to Raynaud - ANS dry, painful, no pulse, mottled toes exacerbated by B-blocker optic nerve injury - ANS unilat vision loss and relative afferent pupillary defect/Marcus Gunn pupil; dx w/ CT Orbit light in uninjured eye: b/l equal constriction light in injured eye: b/l dilation retinal artery occlusion - ANS Cherry spot on macula due to atherosclerotic emboli from I/L carotid artery order neck duplex U/S optic neuritis - ANS sudden vision loss & pain w/ EOMI -seen in MS dx w/ visual evoked potential testing treatment of asymptomatic newborn w/ unvaccinated symptomatic varicella mother - ANS give varicella-zoster immunoglobulin IF maternal infection within 5 days before to 2 days after delivery Management of NPH - ANS VP shunt communicating hydrocephalus w/ normal opening P H. pylori treatment - ANS Triple: clarithromycin, amox, & PPI x 14 d Quad: bismuth, metro, tetra, & PPI x 14 d ACTH independent Cushing's syndrome (decr ACTH) - ANS exogenous steroids & cortisol-producing adrenal adenoma ACTH DEPendent Cushing's (incr ACTH) - ANS pituitary adenoma (Cushing dz) & ectopic/paraneoplastic ACTH production (small cell lung cancer) Diagnosis when decreased cortisol after high dose dexamethasone? - ANS pituitary adenoma Diagnosis when no change in cortisol after high dose dexamethasone? - ANS adrenal adenoma (decr ACTH), ectopic ACTH Polyarteritis nodosa - ANS fever, abd pain, focal motor deficits, erythematous subcutaneous nodules, livedo reticularis, & mesenteric artery aneurysms associated w/ Hep B (dsDNA virus), Hep C, & hairy cell leukemia Nail condition seen in psoriasis - ANS onycholysis Dermatomyositis - ANS Anti-Mi-2 w/ incr CK & aldolase -interstitial lung dz initial tx w/ steroids 2nd line= methotrexate & azathioprine Lichen sclerosus on vulva - ANS postmenopausal w/ itchy vulvar white plaques & dyspareunia; no vagina sx biopsy= irregular epidermal acanthosis necrotizing fasciitis causes - ANS C perf, staph aureus, & strep pyogenes What to do if lorazepam is given for seizure and it continues after 3 minutes - ANS repeat lorazepam (if 2 doses don't work, pick from fosphenytoin, phenytoin, valproic acid, or levetiracetam) top of the basilar syndrome - ANS impaired consciousness and vertical gaze issue (preferred upward gaze) hyperthyroidism treatment in FIRST trimester - ANS PTU (methimazole in following trimesters) lice management - ANS 1st: check household members Then: send kid to school after starting tx, wash clothes used within 48 hours with hot water how to measure true leg length - ANS ASIS to medial malleolus (apparent is umbilicus to medial malleolus) treatment of asymptomatic primary ITP that has failed steroids and IV Ig - ANS splenectomy cardiogenic shock - ANS AMS, tachycardia, bibasilar rales, poor cap refill, cool, narrow pulse P, & decr UOP -decr CO & SVO2 -incr SVR, preload, & PCWP distributive shock - ANS high pulse P, hypotension, warm, good cap refill ex. anaphylaxis, sepsis, neurogenic -decr SVR & preload/PCWP -incr CO & high or nl SVO2 hypovolemic shock - ANS hypotension, tachy, cool -decr all except incr SVR low SVO2 obstructive shock - ANS in PE, pericardial tamponade, or aneurysm dissection -decr CO -incr preload, PCWP, and SVR -low or nl SVO2 seb derm in adults associated with - ANS HIV treatment for lithium-induced nephrogenic DI - ANS amiloride (inhibits epithelial sodium channels AKA ENaC) missed abortion - ANS death of fetus before 20 wks GA w/ complete POC retention & closed cervical os best long-term treatment for HOCM - ANS alcohol septal ablation large bowel obstruction - ANS dilated large intestine & signs of SBO MOST COMMON CAUSE IS NEOPLASM multiple system atrophy (Shy-Drager syndrome) - ANS parkinsonism & autonomic dysfunction -neuronal loss due to a-synuclein aggregation Familial dysautonomia (Riley Day syndrome) - ANS AR dz in Ashkenazis at birth with hypotonia, feeding diff, severe orthostatic hypotension, & no tears management of DDH after two weeks of life - ANS U/S (prior to then, just observe) Membranoproliferative glomerulonephritis - ANS splitting of BM seen in lupus, RA, Hep B & C, and bacterial endocarditis ultrasound dating in second trimester - ANS biparietal diameter, head & abd circumferences, and femur length *prior to 14 weeks, crown-rump length is used PCP overdose - ANS agitation, combative, violent, & reckless NYSTAGMUS sickle cell anemia inheritance - ANS autosomal recessive Anti-smooth muscle antibodies - ANS Autoimmune hepatitis Antimitochondrial antibodies (AMAs) - ANS primary biliary cirrhosis First step in epiglottitis? - ANS oropharyngeal intubation Pediculus humanus capitis (lice) - ANS dark mobile "translucent cement" specks; lymphadenopathy Drug that will decrease morbidity and mortality in acute ACS (including unstable angina & NSTEMI) - ANS antiplatelet drugs AKA Aspirin or clopidogrel as alternative battery - ANS intentional touching without permission ex. surgeon removes appendix b/c it looks suspicious during hernia repair Treatment of chancroid (Haemophilus ducreyi) - ANS one PO dose of azithromycin When do most children achieve complete urinary continence? - ANS 3 years old (36-48 months) (night time isn't until 5-7 years old) initial complication of zoster ophthalmicus - ANS neurotrophic keratopathy HELLP syndrome - ANS hemolysis, elevated liver enzymes, & low platelets RUQ pain, n/v, HA, malaise may or may not have HTN & proteinuria Acute fatty liver of pregnancy - ANS n/v, abd pain, malaise, dark urine, encephalopathy, & polydipsia/uria -prolonged PT and aPTT, severe hypoglycemia, & incr creatinine Exclusively breastfed babies need supplements of? - ANS Vitamin D (400 IU/day) Best test for vasovagal syncope where diagnosis is unclear? - ANS tilt table test Anti-centromere antibodies - ANS Scleroderma (CREST) In order to perform rib exhalation dysfunction HVLA.. ex. ribs 5-7 - ANS Put thenar eminence on superior aspect of posterior 5th rib angle & thrust down to make it move superiorly Q angle of 19 and patellofemoral pain syndrome w/ poor patellar tracking are due to - ANS genu valgum Cranial extension - ANS -sacral flexion (nutation) -fingers moving superiorly & index+pinky are approximating -sphenoid post & occiput ant around transverse axis Cranial flexion - ANS -sacral extension (counternutation: sacral base moves post around transverse axis) -fingers moving inferiorly & index+pinky are separating -sphenoid ant & occiput post around transverse axis graft vs host disease - ANS rash, abd cramps, diarrhea, & incr bili after recent stem cell transplant tx w/ methylprednisolone Treatment of pseudomonal septic arthritis in patient with anaphylactic penicillin allergy - ANS aztreonam posterior fibular head somatic dysfunction - ANS restricted dorsiflexion-> restricted anterior movement supination, plantarflexion, IR, and inversion "Post is IIPS" anterior fibular head somatic dysfunction - ANS pronation, dorsiflexion, ER, and eversion "ant is a ProDEE" Blastomycosis - ANS ulcers, nodules, and PNA North America (Mississippi & Ohio River) & Brazil Histoplasmosis - ANS fever, cough, and hilar adenopathy Mississippi & Ohio River Valley Paget-von Schrötter syndrome - ANS Subclavian vein compression by a cervical rib, soft tissue anomaly, or scar tissue after clavicle fracture-> thrombosis and arm swelling seen in throwing athletes, swimmers, & weightlifters AC joint injury - ANS pain w/ cross body adduction & Neer's organophosphate poisoning - ANS SLUDGE: Constricted Pupils, Muscle weakness, Bradycardia, Bronchospasm, Bronchorrhea, Seizures tx w/ atropine + pralidoxime Physostigmine (ACHe inhibitor) treats what? - ANS anticholinergic OD MLF connects what? - ANS CN III & CN VI so in INO, problem is btw C/L CN VI & I/L CN III (remember LR6 and SO4) Beckwith-Widemann syndrome - ANS omphalocele, hemihypertrophy, polyhydramnios, macroglossia+somnia, & hypoglycemia Ankle sprains most commonly occur in which position? - ANS supination (inversion, int rot, & plantarflexion) most stable ankle= tibiotalar dorsiflexion Renal tubular acidosis type 4 - ANS DM-> hyporenin hypoaldo acidic urine & hyperK Renal tubular acidosis type 1 - ANS Defective H+/K+ ATPase of the collecting tubules: inability to secrete H+ -hypoK & urine pH >5.5, risk of calcium phosphate kidney stones Renal tubular acidosis type 2 - ANS - Poor bicarb resorption - pH <5.5 & hypoK - Causes: fanconi syndrome (glucosuria, phosphaturia, aminoaciduria), acetazolamide - kid growth failure E coli - ANS aerobic, motile, lactose fermenting superior labral anterior to posterior tear - ANS deep shoulder pain with positive O'Brien's test (flex shoulder to 90 and then internal rotate) central disc herniation at L5-S1 symptoms - ANS difficulty with plantarflexion (walking on toes) and diminished Achilles reflex Gaucher disease (lysosomal glycolipid storage) - ANS AR; glucocerebrosidase 1 deficiency-> xs glucosylceramide -lethargy, recur PNA, splenomegaly, & pancytopenia, avascular necrosis Fabry disease (lysosomal storage) - ANS XR; a-galactosidase A deficiency-> xs glycosphingolipids -neuropathic pain, proteinuria, HTN, angiokeratomas, & corneal verticillata Tay-Sachs disease - ANS AR; HexA deficiency-> xs gangliosides -6 m/o with blindness, deaf, unable to swallow systematic review - ANS has rigorous inclusion & exclusion criteria, only synthesizes small subsection of published literature first step in management of septic patient with necrotizing fasciitis - ANS obtain blood cultures antibiotic for gram negative organism that causes myasthenic crisis and ATN - ANS aminoglycoside