Term
| What is the first line medication class for PTSD? |
|
Definition
|
|
Term
| What are some early and later stage findings with autism? |
|
Definition
Early: 50% of children are mute.
Later: difficulty with social interaction, eye contact, and defective imitation. |
|
|
Term
| What are the 2 types of anorexia nervosa? |
|
Definition
| Restriction and Binge/Purge (with or without the use of laxatives or diuretics). |
|
|
Term
| What are some PE signs and symptoms of anorexia? |
|
Definition
| Emaciated appearance, hypotension, bradycardia, lanugo, salivary gland hypertrophy, peripheral edema and dental enamel erosion. |
|
|
Term
| What are some commonly seen laboratory abnormalities seen with anorexia? |
|
Definition
Low K, Cl, zinc, estrogen and thyroid hormone levels.
High LFTs, HCO3, cholesterol and carotene. |
|
|
Term
| What are the 2 types of bulimia? |
|
Definition
| Purging and Non-purging (fasting and/or excessive exercising, without the use of laxatives or diuretics). |
|
|
Term
| What is the only approved medication for the treatment of bulimia? |
|
Definition
|
|
Term
| What are some PE findings associated with bulemia? |
|
Definition
| dehydrated appearance, enlarged parotid glands, dental erosion, oropharyngeal irritation and GI bleeding. |
|
|
Term
| What are the 2 required symptoms and time frame for diagnosis of depression? |
|
Definition
| Depressed mood and loss of interest/pleasure for at least a 2 week period of time. |
|
|
Term
| What lab value should be evaluated on any patient presenting with new onset depression? |
|
Definition
| Thyroid, up to 40% will have low T4 on evaluation. |
|
|
Term
|
Definition
| Chronic disorder that lasts for more than 2 years in which the depression is mild. (Some good days and some bad days) |
|
|
Term
| What is the difference between Bipolar I and II? |
|
Definition
I: mania and major depression.
II: hypomania and major depression. |
|
|
Term
|
Definition
| Chronic mild form of bipolar involving hypomania with mild depression. Basically a mild form of bipolar where they feel normal between episodes of highs and lows. |
|
|
Term
| What is the toxic level of lithium in the body? |
|
Definition
|
|
Term
| What are the signs of lithium toxicity? |
|
Definition
| N/V/D, dry mouth, blurred vision, rigidity, tremor, ataxia, seizures, nephrogenic diabetes insipidus, ventricular arrhythmias, delirium, coma and death can occur. |
|
|
Term
| Describe avoidant personality disorder. |
|
Definition
| Does not interact in social situation due to fear of not being liked and are obsessed with thoughts if people like them, making them feel socially inept and inferior. |
|
|
Term
| What is the most common clinical symptoms of a patient with borderline personality disorder? |
|
Definition
|
|
Term
| Describe borderline personality disorder. |
|
Definition
| Unstable relationships, self-image, control of anger and control over impulses. |
|
|
Term
| Describe and name the personality disorders are in Cluster A, B and C? |
|
Definition
A: Odd behavior (Paranoid, Schizoid and Schizotypal).
B: Dramatic or emotional behavior (Antisocial, Borderline, Histrionic and Narcissistic).
C: Anxious or fearful behavior (Avoidant, Dependent and OCD). |
|
|
Term
| Describe Histrionic personality disorder. |
|
Definition
| discontent when not the center of attention, inappropriately sexually seductive or provocative, exaggerated expressions, theatrical displays of emotion and self-dramatization, easily influenced by others and circumstances. |
|
|
Term
| Describe a narcissistic personality disorder. |
|
Definition
| Patient exhibits grandiosity (a feeling of being greater than what is reality), requires excessive admiration, and is critical of others who challenge them. They also lack empathy towards others. |
|
|
Term
| What is the differentiating characteristic between schizoid and schizophrenia? |
|
Definition
| Schizoid will not have a need or behavior that dangers or involves others, while schizophrenia does. |
|
|
Term
| Describe schizotypal personality disorder. |
|
Definition
| Condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior. Will have 5 or more of the following: Odd magical beliefs, odd thoughts/speech, odd behavior/appearance, inappropriate affect, loner, ideas of reference, perceptual disturbances, paranoia and anxious socially. |
|
|
Term
| Describe schizoid personality disorder. |
|
Definition
A psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation.
They appear "aloof" and detached, avoid social activities that involve emotional intimacy with other people and they do not want or enjoy close relationships, even with family members. |
|
|
Term
| Describe antisocial personality disorder. |
|
Definition
Disregard for, and frequent violations of, the rights of others involving unlawful behavior, lying, disregard for safety of self and others and lack of remorse.
*They are at least 18 with a history of conduct disorder before 15. |
|
|
Term
| What is the difference between schizophreniform and schizophrenia? |
|
Definition
| Schizophreniform describes symptoms of schizophrenia which have been present for less than 6 months, usually preceeding the diagnosis of schizophrenia. |
|
|
Term
| Describe some hallmark signs for schizophrenia. |
|
Definition
| Delusions, hallucinations (usually auditory), disorganized speech and thoughts and negative symptoms (deficits of normal function). |
|
|
Term
| What brain lesion sites are most commonly associated with psychosis? |
|
Definition
| Temporolimbic system, caudate nucleus and frontal lobes. |
|
|
Term
| Describe the general characteristics of a conversion disorder and a somatization disorder. |
|
Definition
Conversion: a person has blindness, paralysis or other nervous system disorder that cannot be explained.
Somatization: person has physical complaints where no physical problem can be found. |
|
|
Term
| Describe the progression of symptoms during alcohol withdrawal. |
|
Definition
6-8 hours after last drink: Autonomic hyperactivity (tachycardia, HTN, tremors, anxiety, agitation).
24 hours after last drink: hallucinations (auditory and/or visual).
1-3 days after last drink: global confusion. |
|
|
Term
| How does a patient with opiate withdrawal present? Treatment? |
|
Definition
Runny eyes/nose, tachycardia, hair on end, abdominal pains, N/V/D, insomnia, and pupillary dilation.
Tx: methadone and clonidine can blunt some of the side effects. |
|
|
Term
| Wild and abundant dreams may result from the withdrawal of what class of meds? |
|
Definition
|
|
Term
| Describe the components of the Axis I-V diagnostic system. |
|
Definition
I: psych disorders (ADHD, dementia, schizophrenia, somatic, identity, etc).
II: personality disorders (paranoid, borderline, antisocial dependent, etc) and mental retardation.
III: Physical medical problems/conditions that may contribute.
IV: Social and environmental factors.
V: Global assessment of function. |
|
|
Term
| What is neuroleptic malignant syndrome? |
|
Definition
| A life- threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase (CPK). |
|
|
Term
| What is Munchausen syndrome and Munchausen by proxy? |
|
Definition
Munchausen is a syndrome in which patients actually try to harm themselves to seek invasive medical procedures.
By proxy is when they do it to others, usually their children. |
|
|
Term
Define the following terms:
Perseveration
Nonsequiturs
Derailment
Tangential speech
Neologism
Verbigeration
Loosening of associations |
|
Definition
Perseveration: repetition of certain words or phrases.
Nonsequiturs: patient answers are unrelated to the questions asked.
Derailment: patient suddenly switches lines of thought.
Tangential speech: responses are on the correct subject matter but the responses are inappropriate to the questions asked.
Neologism: meaningless combinations of two or more words to invent a new word.
Verbigeration: the patient repeats words, especially at the end of thoughts, thoughts, thoughts.
Loosening of associations: word salad. |
|
|
Term
| Describe the physiology of Alzheimer's disease. What neurotransmitter is found to be reduced? |
|
Definition
Involves loss of nerve cells within the brain due to amyloid plaque formation and neurofibrillary tangles; develops structural obstruction within the brain leading to atrophy of the cerebral cortex and hippocampus.
Acetylcholine activity is reduced. |
|
|
Term
| What is the difference between the typical and atypical antipsychotic medications? |
|
Definition
| The atypicals treat positive and negative symptoms and the typicals just treat the positive symptoms. |
|
|
Term
| What are the 3 main immediate and 1 main delayed SEs of neuroleptic (antipsychotic) drugs? |
|
Definition
Immediate: Parkinsonism, acute dystonia and acute akathisia (restlessness).
Delayed: Tardive dyskinesia. |
|
|
Term
| Describe schizoaffective disorder. |
|
Definition
| Kind of like a combination between schizophrenia and bipolar disorder. |
|
|
Term
| What are the 2 main symptoms of a MDD? |
|
Definition
| Decreased mood and anhedonia (inability to experience pleasure). |
|
|
Term
| What are some of the SEs of TCAs? |
|
Definition
| Confusion, sedation, orthostatic hypotension and prolonged QRS complex. |
|
|
Term
| Name and describe the 2 main SE conditions that result from MAOI use. |
|
Definition
Serotonin syndrome: hyperthermia, sweating, nausea, diarrhea, muscle rigidity, increased reflexes and altered mental status.
Hypertensive crisis: occurs when ingested with foods rich in tyramine (wine and cheese). |
|
|
Term
| How can you differentiate between MDD and bereavement? |
|
Definition
| If symptoms have occurred for greater than 2 months it is considered MDD. |
|
|
Term
|
Definition
| Fear of being in situations where getting out would be very difficult should a panic attack arise, these patient have a history of panic attacks. |
|
|
Term
| First line therapy for OCD? |
|
Definition
| SSRIs with psychotherapy. |
|
|
Term
| Treatment options for PTSD? |
|
Definition
TCAs or SSRIs first line.
Try to avoid BZDs due to the correlation of PTSD and substance abuse. |
|
|
Term
| What is the difference between factitious disorder and malingering? |
|
Definition
| They both involve consciously faking symptoms but malingering is with the purpose of material gain (pain meds, work comp). |
|
|
Term
| Describe some of the signs and symptoms of PCP intoxication. |
|
Definition
| Intense psychosis, super human strength, violence, rhabdomyolysis and hyperthermia. |
|
|
Term
| Describe some of the signs and symptoms of LSD intoxication. |
|
Definition
| Sensation is enhanced. They describe being able to "hear colors and see sounds". |
|
|
Term
| Describe dissociative fugue. |
|
Definition
| Syndrome of sudden travel to another place, with inability to remember the past & confusion of present identity. |
|
|
Term
| Describe REM vs NREM sleep. |
|
Definition
Non-REM involves 4 stages with stages 3-4 being delta wave sleep and being the most difficult to awake from.
REM is the stage where dreaming occurs. |
|
|
Term
| What is the first line treatment for mild to moderate non-inflammatory acne? |
|
Definition
| Keratolytics (tretinoin, adapalene or salicylic acid) |
|
|
Term
| What is the first line treatment for mild-moderate inflammatory acne? |
|
Definition
| Topical tretinoin or adapalene AND topical benzoyl peroxide or clindamycin or erythromycin |
|
|
Term
| What is the treatment for severe nodulocystic acne? |
|
Definition
|
|
Term
| What is the treatment for moderate-severe noninflammatory, non-nodulocystic acne? |
|
Definition
| Topical retinoid (tretinoin or adapalene0 |
|
|
Term
| What is the treatment for moderate-severe inflammatory, non-nodulocystic acne? |
|
Definition
| Oral abx (tetra/mino/doxycycline) AND topical retinoin (tretinoin, adapalene). |
|
|
Term
| Describe the symptoms associated with allergic contact dermatitis. Tx? |
|
Definition
Sx: linear pruritic rash at the site of contact.
Tx: topical steroids and oral antihistamines and avoidance of irritant. |
|
|
Term
| Describe the age of onset for psoriasis. |
|
Definition
| Bimodal in the early 20s and mid 50s. |
|
|
Term
| What are the 2 most common organisms with impetigo? |
|
Definition
| S. aureus and Strep pyogenes |
|
|
Term
| Which antibiotic is used very commonly in superficial skin infections? |
|
Definition
|
|
Term
| Describe necrotizing fascitis. Tx? |
|
Definition
Infection along the muscle fascia planes which presents with severe pain, fever, leukocytosis and the patient will appear very ill. It is caused by either C perfringens or Strep pyogenes.
Tx: rapid and early surgical debridement and abx. |
|
|
Term
| Describe the cause and symptoms of scarlet fever. Tx? |
|
Definition
Caused by Strep pyogenes.
Sx include: "sunburn with goosebumps" rash, sandpaper skin, strawberry tongue, beefy red pharynx, Pastia's lines (axilla and groin rash), fever, sore throat and cervical LAD.
Tx: PCN. |
|
|
Term
| Describe some of the symptoms seen with Typhoid fever. |
|
Definition
| Sx: Rose spots (small pink papules on the trunk found in clusters of 1-2 dozen), high fever, bradycardia, myalgia, abdominal tenderness and splenomegaly. |
|
|
Term
| What 2 conditions can present with the classic fever-pulse dissociation? |
|
Definition
| High fever with relative bradycardia (typhoid fever and brucellosis) |
|
|
Term
| What is the treatment for chronic asymptomatic typhoid fever? |
|
Definition
| Cholecystectomy bc S. typhi lives in the gallbladder. |
|
|
Term
| Describe Erythrasma. Organism? |
|
Definition
| Irregular erythematous rash found along the major skin folds in diabetics caused by Corynebacterium. |
|
|
Term
| Describe the first and second line tx options for psoriasis. |
|
Definition
1st: Topical steroids
2nd: UV A light |
|
|
Term
| Describe eczema or atopic dermatitis. Tx? |
|
Definition
Intensely pruritic rash that is most common on the face in infants and the flexoral surfaces in children. Often presents with dry skin, erythema, vescicles, scaling and/or papules.
Tx: topical steroids and oral antihistamines. |
|
|
Term
| Describe Urticaria (Hives). Tx? |
|
Definition
Intensely pruritic condition characterized by transient wheals surrounded by erythema. Most are IgE (Type I) mediated due to mast cell degranulation and histamine release.
Tx: steroids, antihistamines epinephrine. |
|
|
Term
|
Definition
| Black-blue nodule present at birth, commonly mistaken for melanoma. |
|
|
Term
| Describe pityriasis rosea. TX? |
|
Definition
Erythematous pruritic maculopapular rash often preceded by a "herald patch" on trunk and can progress to a "christmas tree" formation on the back.
Tx: topical steroids, antihistamines, topical emollients. |
|
|
Term
| Describe the presenting symptoms and treatment for dermatomyositis and polymyositis. Tx for both? |
|
Definition
Dermatomyositis: Presents with heliotropic (reddish purple) patches on eyelids, erythema of the neck and shoulders (shawl sign), scaly patches over the dorsum of the PIP and MCP joints (Gottron sign) and widespread muscle weakness.
Polymyositis: Widespread muscle weakness.
Tx: high dose oral steroids. |
|
|
Term
| Describe seborrheic keratosis. Tx? |
|
Definition
Black or brown benign plaques which appear to be stuck on the skin surface, can be mistaken for melanoma.
Tx: cryotherapy, but usually too many to treat. |
|
|
Term
| Describe Kaposi's sarcoma. |
|
Definition
| Red-purple plaques or nodules on the skin & mucosa caused by HHV8, almost exclusively seen in AIDS patients. |
|
|
Term
| Describe Pemphigus Vulgaris. Tx? |
|
Definition
Rare autoimmune disorder that causes cutaneous bullae which slough off easily (Nikolsky's sign) leading to a high incidence of secondary infection.
It is often fatal if not treated w/ steroids. |
|
|
Term
| Describe bullous pemphigoid. |
|
Definition
| Much less severe case of pemphigus involving hard, tense bullae which do not rupture easily. Tx is still oral steroids bc it is autoimmune. |
|
|
Term
| Describe the treatment for mild and moderate cases of poison ivy contact dermatitis. |
|
Definition
Mild: topical steroids.
Severe: oral steroids.
Both also receive oral antihistamines for pruritis. |
|
|
Term
| Which chronic disorder with acute exacerbations is characterized by deep-seated vescicles located on the palms, soles and lateral aspects of the fingers and is intensely pruritic? Tx? |
|
Definition
Dyshidrotic eczema
Tx: potent topical steroids and oral antihistamines |
|
|
Term
| Describe the symptoms seen with lichen simplex chronicus. |
|
Definition
| Dry, leathery, lichenified patches of skin most commonly seen on the nape of the neck, wrists forearms and lower legs/perineal area. |
|
|
Term
| What type of infections and medications most commonly cause erythema multiforme? |
|
Definition
| HSV, mycoplasma, sulfonamides, NSAIDs, phenytoin, allopurinol, barbiturates and salicylates. |
|
|
Term
| What medication class is the treatment of choice for comedonal acne? |
|
Definition
| Topical retinoids (tretinoin, adapalene) |
|
|
Term
| Describe the treatment regimen for scabies. |
|
Definition
| Topical permethrin cream that is applied to the entire body from the neck down, is left on for 8 hours and then washed off. Repeat in 1 week. |
|
|
Term
| A patient with AIDS presents with a grayish-white "corduroy-like" plaque on the lateral borders of her tongue that does not scrape off, what is the diagnosis? |
|
Definition
| Oral hairy leukoplakia (EBV) |
|
|
Term
| Differentiate between erysipelas and cellulitis. |
|
Definition
| They are both red, hot, tender and caused by group A strep. Erysipelas is well demarcated with sharp, raised borders. |
|
|
Term
| : a special localized form of lichenification usually occurring in circumscribed plaques. |
|
Definition
|
|
Term
| :a chronic, pruritic, inflammatory dermatitis occurring in the form of coin-shaped plaques composed of grouped small papules and vesicles on an erythematous base, especially common on the lower legs of older males during winter months |
|
Definition
|
|
Term
| :an acute or chronic inflammatory dermatosis involving skin and/or mucous membranes, characterized by flat-topped, violaceous, shiny, pruritic papules on the skin and milky white papules(Wickham’s striae) in the mouth |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The most distinguishing characteristics for glomerulonephritis on UA are? |
|
Definition
| RBC casts, hematuria and mild proteinuria |
|
|
Term
| How long do Cluster headaches typically last? |
|
Definition
|
|
Term
| The patient education for Fosamax involves ____________. |
|
Definition
| taking it with a glass of water, not eating anything for 30 minutes and remaining upright. |
|
|
Term
| Most common type of colon cancer? Prostate? |
|
Definition
|
|
Term
| The most likely electrolyte abnormality to result from lisinopril use is__________. |
|
Definition
|
|
Term
| Furosemide can lead to which acid base disorder? |
|
Definition
|
|
Term
| Spironolactone can lead to which acid base disorder? |
|
Definition
|
|
Term
| What is the classic triad for Menieres? |
|
Definition
| Vertigo, tinnitus and hearing loss lasting several hours. |
|
|
Term
| What is the classic triad for normal pressure hydrocephalus? |
|
Definition
| Abnormal gait, memory loss and incontinence |
|
|
Term
| What is the most common fracture site in osteoporosis? |
|
Definition
|
|
Term
| Which antibodies are found in drug induced lupus and what is the most common drug to cause it? |
|
Definition
| Anti-histone and Procainamide |
|
|
Term
| Describe the differences between gout and psuedogout on crystal analysis. |
|
Definition
| Gout is yellow, needle shaped and negatively birefringent and psuedogout is blue, rhomboid shaped and positively birefringent. |
|
|
Term
| What is the first abnormality to occur with iron deficiency anemia? |
|
Definition
|
|
Term
| Describe the typical presentation of carcinoid syndrome. |
|
Definition
| Diarrhea, flushing, abdominal cramps and signs of serotonin induced right sided heart failure. |
|
|
Term
| What type of casts do you see on UA for diabetic nephropathy? |
|
Definition
|
|
Term
| What is the most common thyroid cancer? |
|
Definition
|
|
Term
| What electrolyte abnormality results from digoxin use? |
|
Definition
|
|
Term
| How do you distinguish Bell’s Palsy from an UMN Cn VII lesion (stroke)? |
|
Definition
| Bell’s palsy involves the entire side of the face with the lesion being on the ipsilateral side. Stroke will only involve the lower face and the patients will be able to lift their eyebrows symmetrically on both sides with the lesion occurring on the contralateral side of the affected side of the face. |
|
|
Term
| Describe the characteristics of diabetic retinopathy vs hypertensive retinopathy. |
|
Definition
Diabetic is characterized by microaneurysms, cotton wool spots, dot/blot hemorrhages and hard exudates.
Hypertensive is characterized by arteriolar constriction, AV nicking, copper and silver wiring, flame shaped hemorrhages, cotton wool spots, hard exudates and papilledema in severe cases. |
|
|
Term
| Describe the incidence of symptoms, nighttime awakenings, SABA use, and FEV1 for intermittent, mild persistent, moderate persistent and severe persistent asthma. |
|
Definition
Intermittent: 2 or less days/week of symptoms, 2 or less nighttime awakenings/month, 2 or less times/week SABA use and FEV1 > 80% predicted.
Mild persistent: 3-6 days/week of symptoms, 3-4x/month nighttime awakenings, 3-6x/day SABA use but only 1x/day and FEV1> 80% predicted.
Moderate persistent: daily symptoms but not all day, 5-27x/month nighttime awakenings, daily use of SABA and FEV1 between 60-80% predicted.
Severe persistent: symptoms are all day every day, nighttime awakenings are every night, SABA use is several times/day and the FEV1 is <60% predicted. |
|
|
Term
| Describe the treatment options for each stage of asthma. |
|
Definition
Intermittent: SABA PRN
Mild persistent: SABA PRN + low-dose inhaled corticosteroid
Moderate persistent: SABA PRN + (low-dose inhaled corticosteroid and LABA) or (medium dose inhaled corticosteroid)
Severe persistent: SABA PRN + medium/high dose inhaled corticosteroid + LABA |
|
|
Term
| What is the most common etiology for hemoptysis in adults? |
|
Definition
|
|
Term
| How can COPD be differentiated from asthma as far as FEV1 testing? |
|
Definition
| FEV1 will show almost complete reversibility with SABA in asthma but in COPD it will show some improvement but it will stay below 70% of the predicted value. |
|
|
Term
| What is the most common type of bronchogenic carcinoma? |
|
Definition
|
|
Term
| Describe where each of the 4 most common bronchogenic carcinomas are found in the lungs. |
|
Definition
| Adenocarcinoma is usually peripherally located, Squamous cell is usually centrally located, Small cell typically begins centrally and spreads, and large cell can be central or peripheral. |
|
|
Term
| What are the treatment options for Pulmonary HTN? |
|
Definition
| Supplemental oxygen, diuretics, hydralazine, CCBs (be careful in HF patients), phosphodiesterase inhibitors (sildenafil), endothelin receptor antagonists (bosentan) and/or prophylactic anticoagulation (due to risk for polycythemia if pulm HTN is due to chronic hypoxic conditions). |
|
|
Term
| Which organism is typically responsible for aspiration pneumonia in alcoholics? |
|
Definition
|
|
Term
| What are the 2 most common UE veins involved with DVTs? |
|
Definition
|
|
Term
| How does TB reactivation typically appear on CXR? |
|
Definition
| Apical or subapical (top of the lungs) cavitary infiltrations. |
|
|
Term
| Describe the treatment regimen for TB. |
|
Definition
| 6 month regimen of isoniazid, rifampin, pyrazinamide and ethambutol for the first 2 months and just isoniazid and rifampin for the last 4. |
|
|
Term
| Describe the hallmark CXR findings for Sarcoidosis. |
|
Definition
| Noncaseating granulomas with predominance for the upper lobes. Will also show hilar and paratracheal LAD. |
|
|
Term
| Describe some of the PE findings for a patient with Sarcoidosis. |
|
Definition
| Lung involvement (dyspnea, dry cough), nontender peripheral or cervical LAD, parotid gland enlargement, skin involvement (erythema nodosum, lupus pernio) and eye involvement (uveitis). |
|
|
Term
| What is the only pulmonary infiltrates the commonly affects the lower lobes? |
|
Definition
| Asbestosis and primary TB |
|
|
Term
| How can you differentiate between transudative and exudative pleural effusions? |
|
Definition
| Transudative are typically due to non-infectious or cancerous causes (CHF, cirrhosis, nephrotic syndrome) and they will have low pleural fluid protein and LDH concentration relative to the serum concentrations |
|
|
Term
| What are the most common causes of transudative and exudative pleural effusions? |
|
Definition
| Transudative is CHF and exudative is pneumonia. |
|
|
Term
| Describe the characteristics of Lofgren’s syndrome. |
|
Definition
| Hilar LAD, erythema nodosum, uveitis, fever, arthralgia and a good prognosis (>90% resolve within 2 years). |
|
|
Term
| What is the treatment for ARDS? |
|
Definition
| Low tidal volume, plateau-pressure-limited mechanical ventilation is the only therapy that has been shown to reduce mortality. |
|
|
Term
| What is the treatment for a pneumothorax? |
|
Definition
| Needle decompression at the MCL in the 2nd or 3rd ICS is temporary, definitive treatment requires tube thoracostomy. |
|
|
Term
| What is especially concerning about right sided (posterior/lateral) MI’s? Which meds should be used? |
|
Definition
| Nitroglycerine will decrease the preload so sublingual is ok but IV should not be used. Use Dobutamine or Dopamine instead |
|
|
Term
| Which coronary arteries are affected in Anterior, Inferior, Posterior and Lateral MIs? |
|
Definition
Anterior: LAD
Inferior: RCA
Posterior: RCA
Lateral: LCX |
|
|
Term
| Describe the progression of EKG findings with an acute MI |
|
Definition
| Peaked T waves, T wave inversion, ST elevation and then Q waves. |
|
|
Term
| Describe the stages of Pre-HTN, HTN1 and HTN2 according to the JNC VII. |
|
Definition
Pre-HTN is 120-139/80-89
HTN-1 is 140-159/90-99
HTN-2 is >160/100 |
|
|
Term
| What is the antihypertensive of choice during pregnancy? |
|
Definition
|
|
Term
| Describe the LVEF differences between systolic and diastolic CHF. Which kind is more common? |
|
Definition
| Systolic is more common and will have an EF < 40%. Diastolic will have an EF >40%. |
|
|
Term
| How do you treat an acute CHF exacerbation? |
|
Definition
| LMNOP (Lasix, Morphine, Nitrates, Oxygen and Positioning) |
|
|
Term
| Describe the differences between acute and subacute infective endocarditis as far as most common organism and typical patient. |
|
Definition
| Acute can develop in patients with normal or damaged hearts, it is most common among IV drug users and the MC organism is S. aureus. Subacute usually affects patients with already damaged hearts and the MC organism is Strep viridans. |
|
|
Term
| Describe the Duke criteria for infective endocarditis. |
|
Definition
Two major criteria, one major criteria with three minor or 5 minor criteria are needed for diagnosis.
Major criteria: Positive blood cultures and evidence of endocardial involvement on echo.
Minor criteria: predisposing heart condition, fever, Osler nodes, Janeway lesions, sunungual splinter hemorrhages, positive blood culture or echo that doesn’t meat major criteria. |
|
|
Term
| How is WPW seen on EKG? How is it treated and what drugs should be avoided? |
|
Definition
| Short PR interval and a falsely widened QRS duration due to a delta wave. It is treated with IV procainamide, electrical cardioversion or ablation if unstable. Do not use CCBs or digoxin because they work on the AV node and that is not where the problem is, it will slow AV conduction and can potentially worsen the condition. |
|
|
Term
| What is the treatment for chronic and acute atrial fibrillation? |
|
Definition
Chronic: Coumadin, rate control (BBs, CCBs or digoxin) and possible rhythm control (amiodarone). Cardioversion for unstable patients.
Acute: Coumadin and rate control (BBs, CCBs) plus cardioversion after 3-4 weeks of anticoagulation. |
|
|
Term
| What drug is given empirically for benign PACs or PVCs? |
|
Definition
|
|
Term
| Describe the differences in presentation between gastric and duodenal ulcers. |
|
Definition
| Gastric ulcers are not caused by acid hypersecretion, instead they are due to a decreased mucosal protection. Gastric ulcers typically get worse with food intake and duodenal ulcers typically get better with food intake. |
|
|
Term
| What is the treatment for outpatient and inpatient diverticulitis? |
|
Definition
| High fiber diet and oral antibiotics (Augmentin or Cipro+Flagyl), if not response to the oral antibiotics (IV Rocephin+Flagyl) or (IV Zosyn) can be used. |
|
|
Term
| What are the two most common causes of acute pancreatitis? |
|
Definition
| Alcoholism (MC) and gallstones |
|
|
Term
| Describe the differences in Crohn’s and UC in relation to presence of skip lesion, depth of inflammation, appearance on barium enema, risk for ascess/fissures/fistulas/granulomas and complications. |
|
Definition
| Crohn’s: skip lesions, transmural, “cobblestone” appearance on barium enema, increased risk for abscess/fissures/fistulas/granulomas and complications include malabsorption (B12, folate, ADEK) and nephrolithiasis/cholelithiasis. UC: no skip lesions, only mucosal/submucosal inflammation, “lead pipe” appearance on barium enema, no increased risk for abscess/fissures/fistulas/granulomas and complications include toxic megacolon and an increased risk for bowel cancer. |
|
|
Term
| What is the treatment for UC and Crohn’s Disease? |
|
Definition
| Mesalamine for mild disease, corticosteroids for moderate, azathioprine/6-MP/MTX for those unresponsive to corticosteroids and the Anti-TNF immune modulators are used as last line. Surgical removal of the involved area of the intestine is the next step. |
|
|
Term
| What are the transmission routes for Hep A, B and C? |
|
Definition
A: fecal-oral
B: blood, sex or vertical
C: almost always blood |
|
|
Term
| Describe what is meant by the presence of the Hep B markers (HBsAg, Anti-HBs antibodies, HBeAg and Anti-HBc IgM and IgG antibodies. |
|
Definition
HBsAg: first evidence of acute HepB infection, if present longer than 6 months it signifies chronic HepB with active replication.
Anti-HBs antibodies: Recovery from HepB or vaccination if HBsAg is not present.
HBeAg: acute HepB or chronic with active replication if present longer than 3 months.
Anti-HBc IgM: indicates acute infection and may be the only positive marker after HBsAg has cleared and anti-HBs has not been made.
Anti-HBc IgG: appears during acute hepatitis but persists indefinitely. |
|
|
Term
| How is Hepatitis C diagnosed? |
|
Definition
| The presence of Anti-HCV antibodies by RIBA that is confirmed with PCR amplification to detect HCV RNA in the serum. |
|
|
Term
| What is the treatment for HBV and HCV? |
|
Definition
HBV: Interferon or antivirals (lamivudine, adefovir, entecavir)
HCV: Interferon + ribavirin |
|
|
Term
| What is the most common composition of gallstones? How will they appear on x-ray? |
|
Definition
| They are cholesterol stones so they will be radiolucent. |
|
|
Term
| What is the cause of ascending cholangitis? What is Charcot’s triad and Reynold’s pentad? Treatment? |
|
Definition
| It is caused by a secondary bacterial infection of the obstructed common bile duct. It is a life threatening emergency. It is characterized by Charcot’s triad of: jaundice, RUQ pain and fever. Alterned mental status and hypotension can be added to make up Reynold’s pentad. Treatment is NPO, IV hydration, antibiotics and ERCP to decompress the biliary tree and remove obstructing stones. |
|
|
Term
| What is the source, symptoms and treatment for Giardiasis? |
|
Definition
| Source is contaminated water, symptoms include: explosive watery diarrhea, vomiting, fever, fatigue and abdominal cramps. Treatment is Flagyl. |
|
|
Term
| What is the source, symptoms and treatment for Enterobiasis? |
|
Definition
| Source is ingestion of pinworm eggs, symptoms are anal pruritis mainly. Treatment is Albendazole |
|
|
Term
| What is the source, symptoms and treatment for Trichinosis? |
|
Definition
| It is a hookworm infection caused by eating raw or undercooked pork. Symptoms include: GI distress, eye/retina swelling and bleeding, myalgia, arthralgia, edema, urticarial, etc. Treatment is Mebendazole or Albendazole. |
|
|
Term
| What is the most common bacterial cause of diarrhea? |
|
Definition
|
|
Term
| What is the source, symptoms and treatment for Campylobacter? |
|
Definition
| Acquired from drinking wilderness water sources. Symptoms include: diarrhea that can be watery or bloody and inflammatory changes that resemble IBD. Treatment is Cipro. |
|
|
Term
| How does acute pyelonephritis appear on UA? |
|
Definition
| It appears on UA as pyuria, bacteriuria, hematuria and WBC casts. |
|
|
Term
| What is the most common composition of kidney stones? Which kind is the only radiolucent stone? |
|
Definition
| Most common is calcium pyrophosphate. The only radiolucent stones are the uric acid stones. |
|
|
Term
| Describe the relationship between pH, pCO2 and HCO3 for all the acid base disorders. |
|
Definition
Metabolic acidosis: they are all down
Metabolic alkalosis: they are all up
Respiratory acidosis: pH is down and the other 2 are up
Respiratory alkalosis: pH is up and the other 2 are down |
|
|
Term
| Which is the most common type of incontinence in women, elderly and diabetics? |
|
Definition
| Women is stress, elderly is urge and diabetics is overflow. |
|
|
Term
| What is the most common tumor with bladder cancer? |
|
Definition
| Transitional cell carcinoma |
|
|
Term
| What is the most common cause of chronic renal failure? |
|
Definition
|
|
Term
| Describe the typical UA and serum findings with Nephrotic syndrome and nephritic syndrome. |
|
Definition
Nephrotic: Proteinuria >3.5g/day, lipiduria, fatty casts, hyperlipidemia and hypoalbuminemia.
Nephritic: Hematuria, RBC’s, WBC’s, RBC and granular casts and no lipid abnormalities. |
|
|
Term
| Two common medications that can induce nephrogenic diabetes insipidus include? |
|
Definition
| Lithium and amphotericin B |
|
|
Term
| Describe stages 0-5 for DM ulcers. |
|
Definition
O: skin is red
I: skin is broken down to the dermis
II: skin is broken down into the tendon but there is no osteomyelitis or abscess
III: skin is broken down into the tendon and there is osteomyelitis or abscess
IV: gangrene of the forefoot
V: gangrene of the entire foot |
|
|
Term
| Describe the scoring for the Glascow coma scale. |
|
Definition
Eyes (1-4): Does not open, opens to pain, opens to auditory, opens spontaneously.
Verbal (1-5): Makes no sound, incomprehensible sounds, utters inappropriate words, confused/disoriented, normal.
Motor (1-6): No movement, decerebrate posture, decorticate posture, flexion/withdrawal to pain, localizes pain, normal. |
|
|
Term
| A score of less than what on the GCS indicates a need for mechanical ventilation? |
|
Definition
|
|
Term
| Describe the Jones criteria for acute Rheumatic Fever. |
|
Definition
Major criteria: carditis, migratory polyarthritis, syndehams chorea, erythema marginatum and subQ nodules.
Minor criteria: fever, arthralgia, elevated acute phase reactants and prolonged PR interval.
Need 2 major or 1 major + 2 minor PLUS positive evidence of a strep infection. |
|
|
Term
| What is the most common valvular abnormality that is seen with acute rheumatic fever? |
|
Definition
|
|
Term
| What does CREST stand for in reference to limited scleroderma? |
|
Definition
| Calcinosis, Raynauds, Esophageal dysfunction, sclerodactyly and telangiectasias. |
|
|
Term
| Which antibodies are present for CREST (limited scleroderma) and diffuse scleroderma? |
|
Definition
| CREST is anti-centromere antibody and diffuse scleroderma is anti-SCL70. |
|
|
Term
| Describe the symptoms of polymyositis. Which antibodies are present? |
|
Definition
| Symptoms include: insidious, painless, proximal muscle weakness. If the skin is involved (malar or heliotrope rash) is it called dermatomyositis. Antibodies present include Anti-Jo1 and anti-Mi2. |
|
|
Term
| Which antibodies are present in Sjogren’s syndrome? |
|
Definition
| RF, ANA, anti-Ro and anti-La |
|
|
Term
| Describe the general characteristics of polyarteritis nodosa. |
|
Definition
| Small and medium vessel vasculitis that spares the lung and almost always involves the kidney, skin, abdomen and peripheral nerves. Kidney involvement leads to HTN, skin manifestations include: palpable purpura and livedo reticularis. Abdominal pain results due to mesenteric artery inflammation and peripheral nerve involvement leads to arthralgias and myalgias. |
|
|
Term
| What is the classic triad of Wegeners granulomatosis? Which antibody is found? |
|
Definition
| Triad: Upper and lower respiratory tract involvement with glomerulonephritis. C-ANCA is indicative of Wegeners. |
|
|
Term
| Describe the typical characteristics for an osteochondroma, enchondroma, Ewing’s sarcoma and osteosarcoma. |
|
Definition
Osteochondroma: MC benign bone tumor, most commonly found in the long bones especially near the knee or shoulder.
Enchondroma: benign bone tumor that arises from the cartilage of the long bones of the hands or feet.
Ewing’s sarcoma: highly malignant bone tumor that is commonly found in the femur, tibia, humerus or pelvis. It has a typical “onion skin” pattern of periosteal reaction.
Osteosarcoma: MC primary malignant bone tumor, it has a characteristic “sunburst” pattern of periosteal reaction. |
|
|
Term
| Describe the site of action for the class I-IV anti-arrythmics |
|
Definition
I: Block sodium channels
II: Beta blockers
III: Block potassium channels
IV: Block calcium channels |
|
|
Term
| Describe the symptoms for BPPV, Meniere’s disease, labyrinthitis and acute vestibular neuronitis. |
|
Definition
BPPV: vertigo lasting less than 30 seconds caused by specific head movements.
Meniere’s: vertigo, hearing loss and tinnitus lasting minutes to hours.
Labyrinthitis: hx of viral infection, vertigo that can last up to 72 hours, nausea, vomiting, hearing loss, tinnitus, ear fullness, otorrhea, and nystagmus.
AVN: hx of viral infection, severe vertigo with nausea, vomiting and nystagmus lasting 7-10 days. |
|
|
Term
| Describe the symptomatic differences between tension, cluster and migraine headaches. |
|
Definition
Tension: dull, nonpulsatile, bilateral, constricting pain. Minimal nausea/vomiting and a lack of aggravation to routine physical activity.
Cluster: severe, nonthrobbing pain localized to the unilateral periorbital or temporal areas with possible lacrimation and duration lasting minutes to as many as 3 hours.
Migraine: severe, unilateral, throbbing headache that is worsened with routine activity and lasts 4-72 hours. It has associated symptoms of visual disturbance, nausea, vomiting, light/noise sensitivity. |
|
|
Term
| What is the most common initial presentation for multiple sclerosis? Diagnostic test? Treatment? |
|
Definition
| The most common initial presentation is subtle changes in vision or abnormal eye movements with focal weakness and gait disorder. The symptoms are often transient. Diagnostic test is MRI. Treatment is steroids or IV immunoglobulins. |
|
|
Term
| Describe the characteristic symptoms with Neurofibromatosis. |
|
Definition
| Café au lait spots, multiple neurofibromas and Lisch nodules on the iris. |
|
|
Term
| What are the treatment options for myasthenia gravis? Diagnostic test? |
|
Definition
| Pyridostigmine is the maintain, corticosteroids, immunosuppressants and IV immunoglobulin are adjunctive therapies for more advanced disease. Thymectomy due to risk of thymoma is also done. Diagnostic test is the Tensilon test with a rapid response to edrophonium. |
|
|
Term
| Describe the symptoms seen with Amyotrophic lateral sclerosis. What is the diagnostic test of choice? |
|
Definition
| Progressive muscle weakness that spreads relentlessly causing leading to progressive disability and death within 3-5 years. The diagnostic test of choice is electromyography. Treatment is Rilutek (riluzole) and ventilator/nutritional support. |
|
|
Term
| What drug should be added to PO iron when response is poor? |
|
Definition
| Ascorbic acid (vitamin C) |
|
|
Term
| How is sickle cell anemia seen on peripheral blood smear? |
|
Definition
| Sickled cells, nucleated RBCs, Howell-Jolly bodies and target cells. |
|
|
Term
| How does aplastic anemia present on labs and what are the causes? Treatment? |
|
Definition
| Presents as pancytopenia and can be due to radiation, chemo, toxins, SLE or autoimmune suppression of hematopoiesis. Treatment is stem cell transplant. |
|
|
Term
| How do you treat anthrax? |
|
Definition
|
|
Term
| What is the causative organism and treatment of dysentery? |
|
Definition
| Shigella, Bactrim is treatment |
|
|
Term
| How do you treat a systemic fungal infection? |
|
Definition
|
|
Term
| Describe the cause/symptoms of G6PD deficiency and labs/peripheral smear. |
|
Definition
| It is due to an enzyme deficiency that causes the individual to not tolerate oxidative stress and results in hemolysis. Symptoms include: jaundice, dark urine, nausea, cataracts and splenomegaly. Labs show hemoglobinuria, elevated indirect bilirubin and high LDH. Peripheral smear shows Bite cells and Heinz bodies. |
|
|
Term
| Describe the common characteristics for ITP. Treatment? |
|
Definition
| Autoimmune IgG disorder that is often preceded by a viral URI. Treatment involves corticosteroids, platelet transfusions and possible splenectomy. It however, may resolve spontaneously. |
|
|
Term
| Describe the common characteristics for TTP. Treatment? |
|
Definition
| Rare, often fatal thrombocytopenia that can occur with preeclampsia or post-transplantation. It involves RBC hemolysis with schistocytosis that causes multiple small vessel occlusions in the kidney and CNS. Treatment involves plasma exchange, corticosteroids and anti-platelet agents. |
|
|
Term
| What finding on peripheral smear is indicative of AML? |
|
Definition
|
|
Term
| Describe the typical presentation and peripheral blood smear findings for Hodgkin’s lymphoma. Initial treatment? |
|
Definition
| Painless cervical, supraclavicular, and mediastinal LAD is the most common presentation. Fever, night sweats, weight loss and fatigue are also common presenting symptoms. Reed-Sternberg cells are seen on smear. Initial treatment is radiation for early disease and the 10 year survival exceeds 80%. |
|
|
Term
| Which leukemia has the Philadelphia chromosome [t(9;22)(q34;q11)] identified in more than 95% of cases? |
|
Definition
|
|
Term
| Describe the typical presentation for non-Hodgkin’s lymphoma. |
|
Definition
| Diffuse, painless LAD is the most common presenting form. If abdominal fullness is present then Burkitt’s lymphoma should be suspected. |
|
|
Term
| Describe the MOA action for the DM2 drugs/classes (Metformin, Sulfonylureas, Alpha Glucosidase Inhibitors, TZDs). |
|
Definition
Metformin: decreases hepatic glucose production, increases tissue sensitization to insulin and decreases intestinal absorption of insulin.
Sulfonylureas (glipizide, glyburide): stimulate the pancreas to release endogenous insulin.
Alpha-Glucosidase Inhibitors (acarbose, miglitol): blocks dietary absorption of glucose.
TZDs (actos, avandia): increases tissue sensitization to insulin |
|
|
Term
| What is the most common cause and top 3 for meningitis in adults? |
|
Definition
| Strep pneumo (MC), N. meningiditis, and H. flu. |
|
|
Term
| Describe stages (I-IV) for decubitus ulcers. |
|
Definition
I: erythematous skin
II: partial thickness skin loss with epidermis and possible dermis involvement.
III: full thickness skin loss With penetration to the fascia but not into it.
IV: extension into muscle, bone, tendon or joint capsule. |
|
|
Term
| Describe the differences between CHL and SNHL on Weber and Rinne tests. |
|
Definition
CHL will show Weber localizing to the affected ear and Rinne will show BC>AC.
SNHL will show Weber localizing to the good ear and Rinne will show AC>BC. |
|
|
Term
| Describe the organ involvement and cause of Goodpasture syndrome. |
|
Definition
| It involves glomerulonephritis and pulmonary hemorrhage due to autoimmune anti-GBM antibodies. |
|
|
Term
| What is the most common cancer of the colon, stomach, esophagus, liver, pancreas and from Barrett’s esophagus. |
|
Definition
Colorectal, gastric, pancreatic and Barrett’s: Adenocarcinoma
Esophagus: Squamous cell
Liver: Hepatocellular carcinoma |
|
|
Term
| Describe the neurotransmitter differences between Huntington’s and Parkinson’s diseases. What are the symptoms of Huntington’s? |
|
Definition
Parkinson’s has a decreased production of dopamine and Huntington’s has an increased production of dopamine.
Symptoms of Huntington’s include dementia and chorea. |
|
|
Term
| What is the Parkland formula for IV fluid replacement in burn patients? How is this fluid administered time frame wise |
|
Definition
Determines total amount of fluid replacement in first 24 hours.
Total BSA of burn(%) x weight(kg) x 4.
*The first half of this amount is delivered in the first 8 hours, and the remaining half is delivered in the remaining 16 hours. |
|
|
Term
| What are the absolute contraindications to thrombolytic use? |
|
Definition
Hx of intracranial bleeding
Any stroke in last 3 months
Closed head trauma within 3 months Suspected aortic dissection
Active bleeding diathesis
Uncontrolled high blood pressure (>180 systolic or >100 diastolic)
Known structural cerebral vascular lesion (AV malformation) |
|
|
Term
| Describe the stroke symptoms seen in an anterior cerebral artery stroke. |
|
Definition
| Contralateral hemiparesis worse in the leg |
|
|
Term
| Describe the stroke symptoms seen in a middle cerebral artery stroke. |
|
Definition
| Contarlateral hemiparesis worse in the arm and face, contalateral homonymous hemianopsia |
|
|
Term
| Describe the stroke symptoms seen in a posterior cerebral artery stroke. |
|
Definition
| Contalateral homonymous hemianopsia, unilateral cortical blindness, unilateral 3rd Cn palsy, and hemiballismus (uncontrolled, random, large-amplitude movements of the limbs). |
|
|
Term
| How do you treat BB or CCB OD? |
|
Definition
|
|
Term
| Initial treatment for trigeminal neuralgia? |
|
Definition
|
|
Term
| How do you manage a person with a laceration who has never had a tetanus shot or have had less than a primary series of 3 tetanus immunizations? |
|
Definition
| Tetanus immune globulin (TIG) and Td shots |
|
|
Term
| Are asystole or PEA shockable rhythms? How are they treated? |
|
Definition
| No, Give epinephrine or vasopressin plus atropine to get into a shockable rhythm (v tach or v fib). |
|
|
Term
| Which local anesthetic is most cardiotoxic? |
|
Definition
|
|
Term
| Describe the typical suture removal dates for sutures to the: face, scalp, trunk, extremities and joints. |
|
Definition
–Face: 3-5 days (replace with Steri Strips)
–Scalp: 7-10 days
–Trunk: 7-10 days
–Arms and legs: 10-14 days
–Joints: 14 days |
|
|
Term
| How do you treat hyperkalemia? |
|
Definition
| IV Calcium gluconate if emergency, insulin and D50, Kayexalate and Beta blockers also temporarily lower potassium. |
|
|
Term
| How do you treat hypercalcemia? |
|
Definition
| Hydration to dilute the serum and Loop diuretics to increase excretion. |
|
|
Term
| How can you treat v tach and v fib? |
|
Definition
| V tach can be treated with Amiodarone or Lidocaine IV if stable or unsynchronzed cardioversion if unstable. V fib is also unsynchronized cardioversion. |
|
|
Term
| What is the complication of correcting hyponatremia too quickly? Hypernatremia? |
|
Definition
Hypo: central pontine myelinolysis.
Hyper: cerebral edema. |
|
|
Term
| What are the causes of normal anion gap metabolic acidosis? |
|
Definition
HARDUPS:
Hyperalimentation
Acetazolamide
RTA
Diarrhea
Uretero-Pelvic shunt
Post-hypocapnia
Spirinolactone |
|
|
Term
| How do you determine how much crystalloid volume replacement to give? |
|
Definition
| 3 to 1 rule. Give 3 times the estimated blood loss. |
|
|
Term
| Which vessels are responsible for an epidural and subdural hematoma? |
|
Definition
Epi: middle miningeal artery
Sub: bridging veins |
|
|
Term
| Describe the symptoms seen with Brown-Sequard syndrome. |
|
Definition
| Due to hemisection of the spinal cord, causes ipsilateral loss of motor function and contralateral loss of pain and temperature sensation. |
|
|
Term
Describe the following C-spine fractures:
Jefferson
Hangman's
Clay Shoveler's |
|
Definition
Jefferson: C1 burst fracture due to axial loading.
Hangman's: anterior listhesis of C2 due to hyperextension injury.
Clay Shoveler's: disruption of the ligamentous structures without bony involvement, usually due to repetitive neck flexion. |
|
|
Term
| What organism causes pneumonia with a CXR that looks worse than expected and the patient also has a bullous myringitis? |
|
Definition
|
|
Term
| Describe the typical management of a patient with DKA. |
|
Definition
1. Fluid rescucitation and IV insulin (Regular is the only form available IV) to reverse shock and hyperglycemia/ketoacidosis.
2. Dextrose to prevent hypoglycemia and potassium once hyperkalemia is excluded. |
|
|
Term
| When should TIG be given? |
|
Definition
| If the patient is unsure of how many tetanus shots they have recived or if they know it is less than the series of 3 as a child and if the wound is anything other than a clean, minor wound. |
|
|
Term
| Above what BP should patients with stroke symptoms receive anti-HTN meds? What must the BP be to receive thrombolytics? |
|
Definition
Above 220/120 to receive HTN meds.
Must be below 185/110 for thrombolytics. |
|
|
Term
| What is the major value of the D-dimer assay? |
|
Definition
| It is extremely useful in its negative predictive value. If it is negative, the likelihood on a PE is very small, if it is positive they still may or may not have a PE. |
|
|
Term
| What 3 veins are responsible for 80% of DVTs? |
|
Definition
| Iliac, femoral and popliteal. |
|
|
Term
| Which pathogens typically cause bloody diarrhea? |
|
Definition
| Salmonella, Campylobacter, Shigella, EHEC, Entamoeba histolytica |
|
|
Term
| What are the main medications and classes used to treat acute angle glaucoma in the ER? |
|
Definition
| Topical acetazolamide (carbonic anhyhdrase inhibitor), timolol (beta blocker) and pilocarpine (miotic agent). Can also use osmotic agents (mannitol and glycerol). |
|
|
Term
| Describe the typical symptoms of anterior uveitis (iritis). |
|
Definition
| Pain, blurred vision, photophobia, circumcorneal redness (ciliary flush), anterior chamber WBCs and the affected pupil is smaller, irregular and minimally reactive. |
|
|
Term
| Describe the empiric treatment for suspected meningitis in someone younger and older than 50. |
|
Definition
Younger = Vanco + 3rd generation cephalosporin.
Older = Vanco, 3rd generation cephalosporin and ampicillin. |
|
|
Term
| What is the most common metabolic cause of seizure? |
|
Definition
|
|
Term
| What is the antibiotic of choice for anaerobic pneumonia? |
|
Definition
|
|
Term
| What is the antidote for iron poisoning? |
|
Definition
|
|
Term
| What is the antidote to anti-cholinergic toxicity? |
|
Definition
|
|
Term
| What is the antidote to cholinergic toxicity? |
|
Definition
|
|
Term
| What is the antidote to organophosphate or insecticide poisoning? |
|
Definition
|
|
Term
| What vaccination should children with sickle cell disease get due to their increased likelihood to get septic shock from this pathogen? |
|
Definition
|
|
Term
| What is the difference between a Mallory-Weiss tear and Boerhaave syndrome? |
|
Definition
| Mallory Weiss is just the mucosa and submucosa tear and Boerhaave involves the muscle layer as well, is worse. |
|
|
Term
| How does an organophosphate poisoning present? What are the killer B's of organophosphate OD? |
|
Definition
| SLUDGE: fluids are coming from everywhere (salivate, lacrimate, urinate, diarrhea, etc). Killer B's are bronchorrhea, bronchospasm and bradycardia. Tx is atropine which will dry out the lungs and increase HR. |
|
|
Term
| What happens with a TCA OD? |
|
Definition
| QRS is prolonged, seizure threshold is lowered, hypotension, sedation |
|
|
Term
| What should a chest tube be placed? |
|
Definition
| In the 4th intercostal space in the midaxillary line |
|
|
Term
| List the causes of high anion gap metabolic acidosis. |
|
Definition
| MUDPILES: Methanol, Uremia, DKA, Phenothiazines (Haldol), Isoniazid, Ethanol, Salicylates. |
|
|
Term
| First line drug treatment for VF or pulseless VT after defibrillation? |
|
Definition
| IV amiodarone or lidocaine after 360J biphasic shock. *Shock again after administration of medication. |
|
|
Term
| Treatment for PEA or Asystole? |
|
Definition
|
|
Term
|
Definition
| IV Amiodarone or lidocaine first line |
|
|
Term
| How do you calculate the anion gap and what is the normal range? |
|
Definition
AG = Na - (Cl + HCO3)
Normal is < 14 |
|
|
Term
| Describe the common vitamin deficiency in chronic alcoholics and describe what can result if it is untreated. |
|
Definition
| Thiamine deficiency can result in Wernicke's encephalopathy (confusion, ataxia, altered mental status) and eventually Korsakoff's syndrome (impaired memory with intact congition and psychosis). |
|
|
Term
| How may a PE present on EKG? |
|
Definition
S1Q3T3: S wave in lead I Q wave in lead III Inverted T wave in lead III
May also present with a new onset RBBB in the case of a massive PE. |
|
|
Term
| Which kind of head injury presents with a "lucid interval" in which they "talk and then die"? |
|
Definition
|
|
Term
| Describe where needle decompression is done on a patient with a tension pneumothorax. |
|
Definition
| 2nd intercostal space in the mid-clavicular line. |
|
|
Term
| How is rhabdomyolysis managed? |
|
Definition
| Maintain adequate hydration to maintain high urine output and alkalinizing the urine. |
|
|
Term
| How can you differentiate delirium from psychosis? |
|
Definition
Delirium is days to weeks, hallucinations are usually visual and delusions are transient.
Psychosis is years, hallucinations are usually auditory and delusions are sustained. |
|
|
Term
| What is the most common type of stroke? |
|
Definition
|
|
Term
| Which spinal nerve roots are responsible for the achilles, patellar, biceps and triceps reflexes? |
|
Definition
| Achilles: S1-2 patellar: L3-4 Biceps: C5-6 Triceps: C7-8 |
|
|
Term
| Treatment regimen for cluster headaches? |
|
Definition
| 100% oxygen, NSAIDs, Steroids |
|
|
Term
| What is the acute management for SAH or other intracranial hemorrhage? |
|
Definition
1. CCB to prevent cerebral vasospasm
2. Dexamethasone to prevent cerebral edema
3. Prevent hypo or hypertension
4. Phenytoin for seizure prophylaxis
5. Admit for observation |
|
|
Term
| Describe some of the PE signs of HOCM. |
|
Definition
| Rapid biphasic carotid pulse, S4 gallop, systolic ejection murmur heard best along the left sternal border which decreases with squatting and increases with valsalva, and paradoxical splitting of S2. |
|
|
Term
| Concerning HOCM, what manuever decreases its murmur and basically increases most other murmurs. |
|
Definition
|
|
Term
| Most common type of hernia? |
|
Definition
|
|
Term
| What lap results would lead you to suspect alcoholic hepatitis? |
|
Definition
| AST>ALT by a factor of 2 or more |
|
|
Term
| What is the cause and treatment for chancroid, LGV, syphilis and condyloma acuminata? |
|
Definition
Chancroid: H. ducreyi. Tx w/ Azithro 1g.
LGV: C. trachomatis. Tx w/ doxy x 3 weeks.
Syphilis: T. pallidum. Tx w/ penicillin G 2.4 million units IM.
Condyloma: HPV. Tx w/ Podofilox or Imiquimod, or cryo/TCA. |
|
|
Term
| What is the HELLP syndrome? |
|
Definition
Hemolytic anemia, Elevated Liver enzymes, and Low Platelets.
*It is a life threatening condition associated with pregnancy and preeclampsia in which delivery is indicated. |
|
|
Term
| Explain what is present in FFP and Cryoprecipitate and what they are used for. |
|
Definition
FFP: contains coagulation proteins and many clotting factors. Can be used to reverse coumadin toxicity rapidly.
Cryoprecipitate: contains factor VIII, fibrinogen and vWF. Can be used for hemophilia A, vWD and DIC. |
|
|
Term
| Which blood products should be used to treat massive hemorrhage, hemophilia A, vWD and excessive anticoagulation bleeding? |
|
Definition
Hemorrhage: packed RBCs and volume expanders.
HemoA: factor VIII concentrate or cryoprecipitate.
vWD: DDAVP, factor concentrates and then cryoprecipitate.
Excessive anticoagulation: FFP. |
|
|
Term
| What is it and what is the treatment for hyperemesis gravidarum? |
|
Definition
| Intractable N/V in the first trimester of pregnancy. Can be treated with metoclopramide (Reglan). |
|
|
Term
| Define threatened abortion, inevitable abortion, incomplete abortion, complete abortion and missed abortion. |
|
Definition
Threatened: abdominal pain/bleeding in the first 20 weeks.
Inevitable: bleeding with open os but no passage of fetal products yet.
Incomplete: in complete passage of fetal products.
Complete: complete passage of fetal products and placenta.
Missed: Uterine retention of dead fetal products. |
|
|
Term
| What is the treatment for premature labor? |
|
Definition
| Steroids to accelerate fetal lung maturity and tocolysis (magnesium sulfate, terbutaline and indomethacin). |
|
|
Term
| Describe the 4 stages of delivery. |
|
Definition
1: Begins with the onset of labor and ends with complete dilatation of the cervix (10cm).
Latent- effacement with minimal dilation.
Active- accelerated rate of cervical dilation.
2: starts with complete dilatation and ends with delivery of the baby.
3: starts with delivery of the baby and ends with delivery of the placenta.
4: starts with delivery of the placenta and ends with stabilization of the mother. |
|
|
Term
| Describe the typical S&S for: Measles (Rubeola), Rubella (German measles), Roseola infantum, Erythema infectiosum and Hand/Foot/Mouth Disease. |
|
Definition
Measles: erythematous maculopapular rash that erupts 5 days after prodromal symptoms of fever, Koplik spots (white spots on buccal mucosa), cough, coryza and conjunctivitis. The rash begins on the head and spreads downward.
Rubella: Maculopapular rash that begins on the face and then generalizes and will also have low grade fever and suboccipital LAD.
Roseola infantum: abrupt high fever with no physical symptoms, when the fever drops a rash appears on the trunk and spreads over the entire body lasting 24 hours.
Erythema infectiosum: classic "slapped cheek" appearance.
Hand/Foot/Mouth Disease: Vesicular rash on hands/feet with ulcerations in the mouth. |
|
|
Term
| Describe 1st-4th degree burns. |
|
Definition
1: superficial, epidermis only, mild to moderate erythema, heals without scar.
2: superficial partial thickness or deep partial thickness, blisters and very painful, some charring with deep. Heals with or without a scar.
3: Full thickness, pale, charred, painless, surgical skin graft necessary.
4: bone involvement, life threatening. |
|
|
Term
| Drug of choice for hypertensive encephalopathy? |
|
Definition
|
|
Term
| Injury to which nerve causes wrist drop? Foot drop? |
|
Definition
Wrist: radial.
Foot: Common peroneal. |
|
|
Term
| What condition presents with Marcus Gunn pupil, painless unilateral vision loss and cherry red spot on ophthalmic exam? |
|
Definition
|
|
Term
| What condition presents as an acute painless unilateral loss of vision with a blood and thunder fundus on ophthalmic exam? |
|
Definition
|
|
Term
| Organism found in human bites? Cat/dog? |
|
Definition
Human: Eikenella corrodens.
Dog/Cat: Pasturella multocida. |
|
|
Term
| Most common lung lobe for pneumonia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Appropriate initial treatment for someone having an acute inferior wall MI is? |
|
Definition
|
|
Term
| Medication of choice in treating acute WPW? |
|
Definition
|
|
Term
| When should men have a screening ultrasound to check for a AAA? |
|
Definition
| Between age 65 and 75 in men who have ever smoked. It is not recommended in men who have never smoked or women regardless or smoking status. |
|
|
Term
| When should routine screening begin for men and women for lipid disorders? What is they are at increased risk? |
|
Definition
Routine for men over 35 and women over 45.
20 years old if they are at increased risk. |
|
|
Term
| When should adults begin colorectal cancer screening? What should they have and at what intervals? |
|
Definition
Older than 50 years of age.
FOBT annually, sigmoidoscopy and barium enema every 3-5 years and colonoscopy every 10 years. |
|
|
Term
| What should be considered when COPD develops in pts younger than 45 especially without a history of smoking? |
|
Definition
| Alpha-1 antitrypsin deficiency |
|
|
Term
| Describe the timing of diarrhea after food ingestion with S. aureus, C. perfringens and E. coli. |
|
Definition
S. aureus = within 6 hours.
C. perfringens = 8-12 hours.
E. coli = 12-14 hours. |
|
|
Term
| What is the recommended daily dose of calcium and vitamin D for an average risk female over 50. |
|
Definition
1200mg calcium
400-800IU vitamin D |
|
|
Term
| When does the USPSTF recommend women to begin mammogram screenings for breast cancer and how often should they get them? |
|
Definition
Age 40 and every 1-2 years
*Some other societies advise starting after age 50 |
|
|
Term
| At what age should you begin PAP smears? At what age range is the Gardisil vaccine warranted? What are the 2 high-risk subtypes of HPV for cervical cancer? Warts? |
|
Definition
Begin at age 21.
Ages 9-26 should be given Gardisil.
Cancer = 16 and 18.
Warts = 6 and 11. |
|
|
Term
| At what age does the USPSTF recommend DXA scanning for osteoporosis? What levels correlate with osteopenia and osteoporosis? |
|
Definition
Screen after the age of 65.
Osteopenia = (-1 to -2.5)
Osteoporosis = (greater than or equal to -2.5) |
|
|
Term
What is the most common type of melanoma?
What is the most aggressive type of melanoma? |
|
Definition
Superficial spreading
Nodular melanoma |
|
|
Term
| What is the typical patient presentation with symptomatic hypercalcemia? |
|
Definition
"Stones, bones, psychic groans and abdominal moans"
Kidney stones, bone pain, poor concentration and abdominal pain. |
|
|
Term
| Describe how long acute, subacute and chronic sinusitis last. |
|
Definition
Acute: <4 weeks
Subacute: 4-12 weeks
Chronic: >12 weeks |
|
|
Term
| What is the most common bacterial cause of acute sinusitis? |
|
Definition
|
|
Term
| What are the 3 most common bacterial pathogens associated with OM? |
|
Definition
| S. pneumo, H. flu and M. cat |
|
|
Term
| Describe the NYHA Functional Classification of Angina classes I-IV. |
|
Definition
I: Angina with unusually strenuous activity
II: Angina with slightly strenuous or prolonged activity
III: Angina with ADLs
IV: Angina at rest |
|
|
Term
| What drugs should every patient with an acute MI receive initially? What else should they receive once stabilized but within 24 hours? What additional drug are they send home with? |
|
Definition
ASA, heparin and IV nitroglycerine until stabilized.
Once stabilized, give them a beta blocker and ACEI.
They are usually put on a statin once they are discharged. |
|
|
Term
| What is the LDL goal for any patient with a history of CAD or at high risk for future cardiac events? |
|
Definition
|
|
Term
| What 3 drug classes should be avoided in individuals with CKD? |
|
Definition
| NSAIDs, Aminoglycosides and iodine radiographic contrast material used in CT's. |
|
|
Term
| Which type of colonic polyp has the highest risk of becoming cancerous? |
|
Definition
|
|
Term
| What are the top 3 causes of CAP? |
|
Definition
| Strep pneumo, H. flu and M. cat |
|
|
Term
| When is S. aureus pneumonia common? |
|
Definition
| After influenza infection |
|
|
Term
| What Black Box warning to all anti-depressant medications carry? |
|
Definition
| They can increase the risk of suicidal thoughts or behaviors in children, adolescents and young adults, especially in the first months of treatment. |
|
|
Term
| What is the hallmark finding on PE for a young athlete with hypertrophic cardiomyopathy? |
|
Definition
| A systolic murmur that that decreases in intensity when lying down and increases with valsalva, which is in contrast to the common functional outflow systolic murmur heard in athletes that increases in intensity when lying down. |
|
|
Term
| Describe the typical presentation of a patient with Lewy Body Dementia. |
|
Definition
| Well formed hallucinations, vivid dreams, fluctuating levels of cognition, sleep disorder and frequent falls. |
|
|
Term
| In order to make the diagnosis of Metabolic Syndrome, 3 of the following 5 traits must be met... |
|
Definition
Waist circumference greater than 40" in men or 35" in women
Trigs > 150
HDL <40 in men and <50 in women
BP > 130/85
Fasting glucose >110 |
|
|
Term
| Which cholesterol class/drug has the greatest effect on raising HDL? |
|
Definition
|
|
Term
| What are the 5 factors that are used to determine LDL goal? What are the LDL goals that correspond to someone with (1 or< RF), (2 or> RFs) or a person with CHD/CHD risk equivalent? |
|
Definition
-Cigarette smoking
-HTN
-Low HDL
-Age over 45 for men and 55 for women
-Fam Hx of premature CHD
1 or less RF = Goal of <160
2 or more RF = Goal of <130
CHD/equivalent = Goal of <100 |
|
|
Term
| What is the most common pediatric fracture that is associated with abuse? |
|
Definition
| Displaced posterior rib fracture |
|
|
Term
| Describe a "Toddler's Fracture", which is commonly misdiagnosed as child abuse. |
|
Definition
| Distal tibia spiral fracture |
|
|
Term
| What is the MCC of bronchiolitis? Describe the pathophysiology behind it and the typical presentation. |
|
Definition
RSV.
Non-specific inflammation of the small airways that produces mucous, edema and cellular debris that result in a airway blockage and a decreased ability to clear secretions.
It is common in kids under 3 years old and they will present with symptoms of cough, dyspnea, wheezing, rhinits, nasal flaring and fever. |
|
|
Term
| What is the MCC of Croup? How will these patients typically present? |
|
Definition
MCC is parainfluenza virus.
They will present with a characteristic barking cough, hoarseness and stridor. |
|
|
Term
| What is the characteristic x-ray finding for croup and epiglottitis? |
|
Definition
Croup = Steeple sign
Epiglottitis = Thumb sign |
|
|
Term
| What is the MCC of a peritonsillar abscess? |
|
Definition
|
|
Term
| Which drug can be used for intermittent abdominal pain associated with IBS? What about persistent abdominal pain? |
|
Definition
Intermittent = Dicyclomine (antispasmotic anticholinergic)
Persistent = TCAs |
|
|
Term
| What cardiac complications are pts with Marfan's syndrome at risk for? |
|
Definition
| Aortic arch aneurysm and MVP |
|
|
Term
| What is the most common bacteria that causes infection after punching a person in the mouth and suffering a puncture to the hand? |
|
Definition
|
|
Term
| What is the single most important risk factor for stroke? |
|
Definition
|
|
Term
| What is the time frame to use thrombolytics in the treatment of an ischemic stroke? |
|
Definition
|
|
Term
| Describe the clinical presentation of PCP pneumonia. Classic x-ray finding? |
|
Definition
Nonproductive cough, fever, dyspnea that worsens over a few days to weeks, tachypnea and hypoxic.
Classic x-ray finding is bilateral interstitial infiltrate with a ground-glass appearance. |
|
|
Term
| How is HIV definitively diagnosed? |
|
Definition
| ELISA with confirmatory Western Blot |
|
|
Term
| How does an acute Hepatitis A infection appear on serologic markers? What about a past resolved one? |
|
Definition
Acute = anti-HAV IgM
Resolved = anti-HAV IgG without anti-HAV IgM |
|
|
Term
| What is the MCC of hepatocellular carcinoma worldwide? |
|
Definition
|
|
Term
| Which area of involvement is most common for ulcers overall? Which area for NSAID users? |
|
Definition
Overall is duodenal.
NSAID users is gastric. |
|
|
Term
| What is the preferred test for diagnosing H. pylori? What are the downsides of the other tests? What is the gold standard? |
|
Definition
Stool antigen testing is best.
Serologic testing for anti-H. pylori antibodies cannot distinguish an acute or resolved infection.
Urea breath test is expensive.
Gold standard is EGD with biopsy. |
|
|
Term
| Which antibiotics can be used in combination along with a PPI to treat H. pylori? |
|
Definition
| Metronidazole, tetracycline, clarithromycin, amoxicillin |
|
|
Term
| What is the DOC for treating galactorrhea? |
|
Definition
|
|
Term
| What are the 3 initial lab tests in the workup of menstrual irregularities? |
|
Definition
| Pregnancy, TSH and prolactin levels |
|
|
Term
| Which DM2 treatment class has the lowest risk of causing hypoglycemia? |
|
Definition
|
|
Term
| How do you reverse a prolonged PT? |
|
Definition
|
|
Term
| What are the first line treatment options for an essential tremor? |
|
Definition
| BBs or the anti-convulsant primidone |
|
|
Term
| Which condition is a result of loss of substantia nigra neurons with intra-cytoplasmic inclusions (Lewy bodies)? How will this present clinically? How is this treated? |
|
Definition
Parkinson's disease.
It will present with resting tremor, shuffling gait, bradykinesia, rigidity and postural instability.
Tx = Levodopa |
|
|
Term
| Which drugs are first line for treating Tourette's and other tic disorders? |
|
Definition
|
|
Term
| Furosemide can lead to which acid base disorder? |
|
Definition
|
|
Term
| Spironolactone can lead to which acid base disorder? |
|
Definition
|
|
Term
| What are the treatment options for oral candidiasis? |
|
Definition
| Nystatin or gentian violet |
|
|
Term
| What is the name of the test that will be positive in a corneal perforation? |
|
Definition
|
|
Term
| Which type of pneumonia are alcohol abusers at risk for? What about CF patients? What about young adults? What about air conditioning workers? |
|
Definition
alcohol abuse: Klebsiella pneumo
CF: pseudomonas
young adults/college setting: mycoplasma pneumo, Chlamydia pneumo
air conditioning: Legionella pneumo |
|
|
Term
| Decribe the treatment regimen for Latent and Active TB. |
|
Definition
Latent: INH x 9 months and Rifampin x 4 months.
Active: Rifampin/INH/Pyrazinamide/Ethambutol for 2 months and then Rifampin/INH for 4 months. |
|
|
Term
| What type of vaccine is the influenza shot vaccine? What about FluMist nasal spray? What type of allergy must these patients be checked for? |
|
Definition
Shot: Inactivated virus (killed).
Spray: Live attenuated.
Must be checked for egg allergy. |
|
|
Term
| Describe the severity of PAD based on the ABI. |
|
Definition
Mild: .90 - .71
Moderate: .70 - .41
Severe: < .40 |
|
|
Term
| What is the characteristic lab finding with menopause? |
|
Definition
|
|
Term
| Describe the length of acyclovir treatment for initial HSV episodes and recurrent. |
|
Definition
Initial: 7-10 days.
Recurrent: 5 days. |
|
|
Term
| What is the cause and treatment of Molluscum Contagiosum? |
|
Definition
Cause: poxvirus.
Tx: dessication, cryotherapy, currettage |
|
|
Term
| Describe Wernicke encephalitis and Korsakoff syndrome. |
|
Definition
Wernicke encephalitis: ataxia, confusion, and oculomotor palsy typically precipitated by administration of glucose without thiamine to a malnourished alcoholic.
Korsakoff: neuronal damage due to thiamine deficiency in alcohol abusers, hallmark finding is confabulation (pt fills in gaps in memory by fabricatingg things). |
|
|
Term
| Define at-risk drinking for men/women, alcohol abuse and alcohol dependence. |
|
Definition
At-risk men: 14 drinks/week or 4/occasion.
At-risk women: 7 drinks/week or 3/occasion.
Abuse: prevents people from fulfilling obligations, puts them in dangerous situations or results in legal/social problems withOUT evidence of dependence.
Dependence: evidence of dependence such as tolerance and withdrawal. |
|
|
Term
| Which condition is described as "dew drops on a rose petal"? |
|
Definition
|
|
Term
| What are the basic uses for Fish oils, Niacin, fibrates, statins and bile acid sequestrants? |
|
Definition
Fish oils: decrease trigs.
Niacin: increase HDL and decrease trigs.
Fibrates: increase HDL and decrease trigs.
Statins: Lower LDL.
Bile Acid: Lower LDL. |
|
|
Term
| How do you treat resting and intention/essential tremors? |
|
Definition
Resting: Benztropine.
Intention/Essential: Primidone or BBs. |
|
|
Term
| How do you diagnose Pernicious anemia? |
|
Definition
|
|
Term
| What is the cause of scurvy and beriberi? |
|
Definition
Scurvy: Vit C deficiency.
Beriberi: Vitamin B1 (Thiamine deficiency) |
|
|
Term
|
Definition
"VM BOY" (Very Mature BOY)
Varicella
MMR
BCG
Oral polio
Yellow fever |
|
|
Term
| Which insulins are rapid, short, intermediate and long acting? Describe the onset, peak and duration for each class. |
|
Definition
Rapid: lispro (Humalog). Short: regular (Humulin R, Novolin R) Intermediate: NPH, Lente (Humulin N, Novolin N). Long: Ultralente (Lantus).
Rapid: 15min, 1.5 hours, 4 hours.
Short: 45min, 2 hrs, 8 hours.
Intermediate: 3 hrs, 6 hours, 15 hours.
Long: 1.5 hrs, flat, 24 hours. |
|
|
Term
| When is spinal surgery indicated for scoliosis? |
|
Definition
|
|
Term
| Cyanotic congenital heart diseases (5 T’s and an H)? |
|
Definition
| Tetralogy of Fallot, Tricuspid Atresia, Transposition of Great Arteries, Truncus Arteriosus, Total Anomalous Pulmonary Venous Connection and Hypoplastic Left Heart Syndrome. |
|
|
Term
| “Boot-shaped” heart on CXR indicates? |
|
Definition
|
|
Term
| “Egg on a string” heart appearance on CXR indicates? |
|
Definition
| Transposition of great arteries |
|
|
Term
| “Snowman” heart appearance on CXR indicates? |
|
Definition
| Total anomalous pulmonary venous connection |
|
|
Term
| Innocent pediatric heart murmurs include? |
|
Definition
| Classic vibratory/Still’s murmur, Pulmonary ejection murmur, Pulmonary flow murmur of the newborn, Venous hum and Carotid bruit. |
|
|
Term
| Kawasaki Syndrome (CRASH) =? |
|
Definition
| (Conjunctivitis, Rash (truncal), Aneurysms of coronary arteries, Strawberry tongue, Hand/feet erythema and desquamation) |
|
|
Term
| Physiologic Genu Valgum (knock-knees) should correct itself between _____ years old. |
|
Definition
|
|
Term
| Screening test for Celiac disease? Gold Standard diagnostic test for Celiac disease? |
|
Definition
Screening: Stool fecal fat.
Gold standard: biopsy. |
|
|
Term
| Suboccipital LAD, maculopapular rash that begins on face and speads down and Forchheimer spots (reddish dots on soft palate), dx? |
|
Definition
|
|
Term
| 3 C’s (cough, coryza and conjunctivitis), Koplik’s spots (blue/white dots surrounded by red halos on the buccal mucosa) and maculopapular rash that begins at the hairline and spreads downward, dx? |
|
Definition
| Rubeola (Ordinary Measles) |
|
|
Term
| Exam shows fever with no source which is followed by rose-pink macules that begin on the trunk and spread rapidly to extremities, dx? |
|
Definition
| Roseola Infantum (Exanthum Subitum) |
|
|
Term
| Roseola Infantum is caused by? |
|
Definition
|
|
Term
| Describe the pediatric immunization schedule at... Birth: 1 month: 2 months: 4 months: 6 months: 12 months: 15 months: 4-6 years: |
|
Definition
Birth: Hep B
1 month: Hep B
2 months: Hep B, RV, DTP, Hib, PCV, IPV (H2 with 2 People Riding Dirty)
4 months: RV, DTP, Hib, PCV, IPV (H1 with 2 People Riding Dirty)
6 months: Hep B, RV, DTP, Hib, PCV, IPV (H2 with 2 People Riding Dirty)
12 months: Hep B, DTP, Hib, PCV, IPV, MMR, Varicella, Hep A (H3 with 2 People going to the DMV)
15 months: Hep B, DTP, Hib, PCV, IPV, MMR, Varicella, Hep A (same as 12 months)
4-6 years: DTP, IPV, MMR, Varicella (can i Please leave the DMV)
*Influenza is yearly after 6 months of age |
|
|
Term
| Describe each area of the APGAR score and describe scores 0-2 for each. |
|
Definition
| Appearance: 0-pale or blue 1-only blue extremities 2-all pink Pulse: 0-absent 1-under 100 2-over 100 Grimace: 0-none 1-grimace to stimulation 2-sneeze/cough with stimulation Activity: 0-limp 1-some flexion 2-spontaneous movement Respiration: 0-absent 1-gasping 2-crying |
|
|
Term
| Describe the typical dosing schedule for the HPV vaccine. |
|
Definition
| 3 doses at months 0, 2 and 6 between ages 9 and 26. |
|
|
Term
Describe the typical causes of:
Measles (Rubeola)
Rubella (German measles)
Roseola infantum
Erythema infectiosum
Hand/Foot/Mouth Disease |
|
Definition
Measles (Rubeola): Paramyxovirus
Rubella (German measles): Togavirus
Roseola infantum: HHV6
Erythema infectiosum: Parvovirus B19
Hand/Foot/Mouth Disease: Coxsackie A virus |
|
|
Term
| How do you treat Seborrhea in children? |
|
Definition
|
|
Term
| What is the initial therapy for urticaria in children? |
|
Definition
|
|
Term
| What is the most common congenital cardiac malformation? How are most of these treated? |
|
Definition
| VSD, most resolve spontaneously. |
|
|
Term
| What results from thiamine (B1), Niacin (B3), Vit C and Vit D deficiencies? |
|
Definition
| Thiamine: BeriBeri (loss of sensation/motor function in the feet) Niacin: Pellagra (diarrhea, dementia, dermatitis) Vit C: Scurvy (dry/rough skin, easy bruising/bleeding, poor dentition) Vit D: Rickets |
|
|
Term
| What is the preferred pharmacologic treatment for enuresis? |
|
Definition
|
|
Term
| spasticity, hyperreflexia, ataxia, invl mvmts, clonus, upgoing babinski, floppy/limp muscle tone describes which condition? |
|
Definition
|
|
Term
| Describe Reye's syndrome. |
|
Definition
| Potentially fatal disease that damages all organs but mainly the brain and liver and is associated with ASA consumption during a viral illness. |
|
|
Term
| What is the most common type of small vessel vasculitis in children? Describe the symptoms. |
|
Definition
| HSP, URI precedes the condition in 2/3 of patients, palpable purpura found on the legs, buttocks and elbows with polyarthritis/polyarthralgia, HTN can develop if the kidneys are involved. |
|
|
Term
| What is the difference between a chalazion and a hordeolum? |
|
Definition
|
|
Term
| What be included in the laboratory investigation of a child with congenital cararacts? |
|
Definition
| Cultures or serologic tests for toxoplasmosis, rubella, CMV, herpes simplex virus, and syphilis, as well as evaluation for metabolic errors |
|
|
Term
| What is the difference between esotropia, exotropia and amblyopia? |
|
Definition
Esotropia: eyes are crossed.
Exotropia: eyes are divergent.
Amblyopia: lazy eye. |
|
|
Term
| What are the TORCH infections? |
|
Definition
Toxoplasmosis
Other: (HepB, Coxsackie, Syphilis, Varicella, HIV, Parvovirus B19)
Rubella
CMV
Herpes |
|
|
Term
| How long should febrile seizures last? Is there usually a source of the fever? |
|
Definition
| They should last under 15 minutes without evidence of an infection. If they last more than 15 minutes it is most likely do to an infection and you need to work them up. |
|
|
Term
| What is the most common cause of mental retardation in males? |
|
Definition
|
|
Term
| What are some S&S of fetal alcohol syndrome? |
|
Definition
| mental and growth retardation, smooth filtrum of lip, microcephaly and ASD. |
|
|
Term
| By what age should infants double, triple and quadruple their birth weight? |
|
Definition
Double by 4-5 months
Triple by 1 year
Quadruple by 2 years |
|
|
Term
| Clinical features of upslanting palpebral fissures, brushfield spots (white/grey spots in the periphery of the iris), flat facial profile, small rounded ears, excess nuchal skin, joint hyperflexibility, fifth finger clinodactyly, a single transverse palmar (simian) crease, epicanthal folds, brachydactyly and wide spacing between the first and second ties describes which condition? |
|
Definition
|
|
Term
| What are the 2 potentially life threatening conditions that much be addressed with any DS baby? |
|
Definition
| Cardiac issues (endocardial cushion defect, VSD or ToF) and duodenal atresia |
|
|
Term
| Which chromosomal abnormality presents with rocker bottom feet, low set/malformed ears, microcephaly, micrognathia and cleft lip/palate? |
|
Definition
|
|
Term
| An infant with microcephaly, sloping forehead, missing a portion of its skin and hair on the scalp, polydactyly, and omphalocele most likely has? |
|
Definition
| Patau syndrome (Trisomy 13) |
|
|
Term
| An immunodeficiency characterized by fever, difficulty with feeding, atypical facies, cleft palate and holosystolic murmur is characteristic of which condition? |
|
Definition
|
|
Term
| Which condition is characterized by an immature for age adolescent male with long limbs, developmental delay, gynecomastia and hypogonadism? |
|
Definition
|
|
Term
| What deficiency is likely to result in an infant that is fed solely from goat's milk? |
|
Definition
|
|
Term
| Which vitamins do CF kids needs supplemented? |
|
Definition
| The fat soluble ones (ADEK) |
|
|
Term
| Which vaccination would be contraindicated in a patient with an anaphylactic reaction to Baker's yeast? |
|
Definition
|
|
Term
| Which vaccinations would be contraindicated in patients with anaphylactic reactions to neomycin or gelatin? |
|
Definition
| MMR, IPV (only neomycin), and varicella |
|
|
Term
| What is the major adverse event associated with DPT administration that would prevent further doses? Which component is responsible for this side effect? |
|
Definition
Encephalopathy within 7 days of administration.
Due to the pertussis component. |
|
|
Term
| Describe the ability of a baby to control their head/body at 1 month, 2 months, 3 months, 4 months, 6 months, and 9 months. |
|
Definition
1 months: hold head up and turns to side while prone.
2 months: lifts head to 45 degrees while prone.
3 months: lifts head to 90 degrees and supports self on forearms while prone.
4 months: raises head vertically while prone, sits with truncal support and rolls over.
6 months: lifts head while supine, sits with pelvic support.
9 months: sits alone with back straight. |
|
|
Term
| Describe the ability of a baby to walk at 9 months, 1 year, 15 months, 18 months, 2 years, 3 years, and 4 years of age. |
|
Definition
9 months: pulls to stand and creeps/crawls.
1 year: stands without help, walks with hand held.
15 months: walks alone, can walk backwards, crawls up stairs.
18 months: runs stiffly, walks downstairs assisted.
2 years: walks step-wise up and down stairs without help, jumps in place.
3 years: alternate feet up stairs.
4 years: hops, skips and alternates feet going down stairs. |
|
|
Term
| Describe the ability of a baby to visually fix on objects at 1 month, 2 months, 3 months, and 4 months. |
|
Definition
1 month: visually fixes and follows to midline.
2 months: tracks moving objects to 180 degrees.
3 months: tracks moving objects to 180 degrees.
4 months: enjoys looking around. |
|
|
Term
| Describe the ability of a baby to talk at 1 month, 2 months, 3 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years and 3 years of age. |
|
Definition
1 month: no talking.
2 months: coos.
3 months: coos.
4 months: laughs.
6 months: babbles.
9 months: mama, dada.
12 months: 2 words other than mama, dada.
15 months: 4-6 words.
18 months: says "no", 10 word vocabulary.
2 years: says "I" or "you", 50 word vocabulary.
3 years: 250 word vocab, 3-word phrases, knows pronouns. |
|
|
Term
| Which type of hypersensitivity reaction causes anaphylaxis? Which antibody mediates this? |
|
Definition
|
|
Term
| Diagnostic test for botulism intoxication or myasthenia gravis? |
|
Definition
|
|
Term
| MCC of diarrhea in children < 1 y/o? |
|
Definition
|
|
Term
| Cause of diarrhea assoc w/seizures? |
|
Definition
|
|
Term
| Red blood cell basophilic stippling occurs with which 2 conditions? |
|
Definition
| Thalassemia and lead poisoning |
|
|
Term
| What are some classic findings of shaken baby syndrome? |
|
Definition
| FTT, lethargy, seizures, retinal hemorrhages, subarachnoid hemorrhage/subdural hemorrhage. |
|
|
Term
| What is the treatment for whooping cough? |
|
Definition
|
|
Term
| ________ is given in high doses to pts w/kawasaki’s disease to prevent coronary aneurysms |
|
Definition
|
|
Term
| Fetal lung maturity is measured by ratio of lecithin to sphingomyelin (L/S) of what level and presence of what? |
|
Definition
| Ratio > 2, plus presence of phophatidyl glycerol = mature lungs |
|
|
Term
| Describe the rule of 9's for a peds. |
|
Definition
Head is 18%
Each arm is 9%
Front chest/abdomen is 18%
Back chest/abdomen is 18%
Each leg is 13.5%
Genitals are 1% |
|
|
Term
| MC fractured bone @ birth? |
|
Definition
|
|
Term
| Describe Tanner stages 1-5 for breasts, 1-5 for pubic hair development and 1-5 for penis development. |
|
Definition
| Breasts: 1. Nothing 2. Budding 3. Breast and areola grow. 4. Nipple and areola form separate mound, protruding from breast. 5. Areola rejoins breast contour. Pubic hair: 1. None 2. Straight and fine hair. 3. Hair coursens, darkens and spreads. 4. Hair looks like adults but is limited in area. 5. Inverted triangle pattern is established. Penis: 1. No change. 2. Testes enlarge. 3. Penis lengthens. 4. Penis thickens. 5. Complete. |
|
|
Term
| How do you initially manage cyanotic heart conditions in a newborn? |
|
Definition
| Give prostaglandins to maintain the PDA. |
|
|
Term
| What diagnostic tests should you order for post-strep glomerulonephritis? |
|
Definition
| anti-streptolysin (ASO), anti-DNase B and C3 levels (low). |
|
|
Term
| How does Berger's disease present? |
|
Definition
| recurrent painless hematuria that is usually preceded by an URI. |
|
|
Term
| How does Goodpasture syndrome usually present? |
|
Definition
| nephritis and pulmonary hemorrhages |
|
|
Term
| What are the only treatments shown to significantly improve symptoms of moderate-severe Croup? |
|
Definition
| Aerosolized epinephrine and steroids |
|
|
Term
| Initial treatment for mild Croup? |
|
Definition
|
|
Term
| What is the prophylactic medication that should be given to contacts of a kid with neiserria meningitis? |
|
Definition
|
|
Term
| What is the diagnosis for a newborn with a skull hemorrhage that crosses suture lines? Does not cross suture lines? |
|
Definition
Does = subgaleal hemorrhage.
Does not = cephalohematoma. |
|
|
Term
| Describe the S&S and causes for Erb's and Klumpke's palsies. |
|
Definition
Erb: upper brachial plexus injury (C5, C6) that presents with the "waiters tip" configuration. The arm hangs by the side in medial rotation with the forearm in extension and pronation.
Klumpke: lower brachial plexus injury (C8, T1) that presents as a "claw hand" with the forearm supinated with the wrist and fingers hyperextended. |
|
|
Term
| What are the treatments for scoliosis based on the degree of rotation? |
|
Definition
10-25 degrees = PT and monitor.
25-45 degrees = Brace and PT.
Over 45 degrees = Surgery and PT. |
|
|
Term
| What position relives SOB in ToF? |
|
Definition
|
|
Term
| Which condition will present with a newborn being cyanotic but then return to being pink when crying? |
|
Definition
| Choanal atresia bc infants are obligate nose breathers |
|
|
Term
| Describe what causes an S3 and S4 heart sound. |
|
Definition
| S3: ventricular gallop, heard in early diastole, seen in dilated CHF and is caused by the oscillation of blood back and forth between the walls of the ventricles initiated by inrushing blood from the atria. S4: atrial gallop, heard in late diastole, produced by the sound of blood being forced into a stiff/hypertrophic ventricle by the atria. This indicates an acute MI or restrictive CHF, it is always pathologic. |
|
|
Term
| Describe what happens to the heart with standing, squatting and valsalva in regards to the murmur of hypertrophic cardiomyopathy. |
|
Definition
Standing: decreases heart size, venous return and left ventricular filling so it will increase the loudness of hypertrophic cardiomyopathy since the outflow obstruction is increased by decreasing the preload.
Squatting: increases venous return and thus the preload so the murmur of hypertrophic cardiomyopathy is diminished.
Valsalva: Same as standing so it will increase murmur of HOCM. |
|
|
Term
| What is the difference between gastroschisis and an omphalocele? |
|
Definition
| You can actually see the bowel in a gastroschisis. |
|
|
Term
| What is the treatment of choice for mycoplasma pneumonia? |
|
Definition
|
|
Term
| Which drug can lead to grey baby syndrome? |
|
Definition
|
|
Term
| What serum level of bilirubin is jaundice noticeable? Toxic? |
|
Definition
Noticeable: Over 5
Toxic: Over 17 |
|
|
Term
| Which vaccine shouldn't someone get if they have an egg allergy? |
|
Definition
|
|
Term
| What is shoulder impingement syndrome? Describe the 3 main maneuvers to test for impingement syndrome. |
|
Definition
Repetitive impingement of the supraspinatus between the humoral head and the acromion resulting in chronic tendinitis and potentially a rotator cuff tear.
Neer - at maximal passive forward flexion the examiner applies a light pressure to further flex the shoulder and push the acromion and the humoral head together.
Hawkins - shoulder is at 90 degrees of flexion and the elbow is at 90 degrees of flexion and the examiner internally rotates the arm.
Empty beer can test - shoulder is held at 90 degrees forward flexion and 30 degrees adduction and internal rotation and resists downward pressure by the examiner. |
|
|
Term
| What must be ruled out with a proximal humerus fracture? How will this present? |
|
Definition
| Axillary nerve damage which will present with numbness to the lateral side of teh shoulder and possibly Deltoid weakness. |
|
|
Term
| Which muscles are the primary elbow flexors? Which nerve innervates these muscles? |
|
Definition
| Biceps and brachioradialis, innervated by the musculocutaneous nerve |
|
|
Term
| Which muscle is the primary extensor of the elbow? Which nerve innervates this muscle? |
|
Definition
| Triceps, innervated by the radial nerve |
|
|
Term
| What nerve is at risk of injury in a humeral shaft fracture? How will this present? |
|
Definition
| Radial nerve, the patient will not be able to extend their wrist or fingers (wrist drop). |
|
|
Term
| Describe the differences between golfer's and tennis elbow. |
|
Definition
Golfer's elbow involves the wrist flexors so they will have medial elbow pain.
Tennis elbow involves the wrist extensors so they will have lateral elbow pain. |
|
|
Term
| Describe the differences between a Monteggia and Galeazzi fracture and their treatments. |
|
Definition
Monteggia involves a fracture of the proximal ulna and a dislocation of the radial head.
Galleazzi involves a fracture of the distal radius and dislocation of the distal radio-ulnar joint.
A Monteggia is usually treated with ORIF and a Galeazzi can usually be manual reduction. |
|
|
Term
| Describe the differences between a Colles' fracture, Smith's fracture and Barton's fracture. |
|
Definition
Colles = Distal radius fracture (and 50% of the type a ulnar styloid process fracture) with dorsal (posterior) displacement of the distal fragment.
Smith's = intraarticular fracture of the palmar (volar or anterior) lip of the distal radius.
Barton's = intraarticular fracture of the dorsal (posterior) lip of the distal radius. |
|
|
Term
| Which nerve can be damaged with distal radial/ulnar fractures? How does this present? |
|
Definition
| The median nerve can be damaged which will present as paresthesia to the thumb, index and middle fingers. |
|
|
Term
| What splint should be used for a De Quervain's? |
|
Definition
|
|
Term
| Describe the difference between a Bennett's and a Rolando's fracture. |
|
Definition
Bennett's is a single intra-articular fracture at the base of the 1st metacarpal.
Rolando's is a comminuted intaarticular fracture at the base of the first metacarpal. |
|
|
Term
| Describe the mechanism of injury for a skiers thumb. |
|
Definition
| Forced abduction of the thumb injuring the ulnar collateral ligament with possible avulsion fracture of the 1st proximal phalanx. |
|
|
Term
| Describe the differences between a mallet/baseball finger and a jersey finger. Which one definitely requires surgery? |
|
Definition
Mallet/baseball = the DIP joint will bend but it will not straighten due to rupture of the extensor tendon.
jersey = the DIP joint will extend but it will not flex due to rupture or avulsion of the flexor digitorum profundus.
A Jersey finger always requires surgery to reattach the FDP tendon. |
|
|
Term
| Which nerve supplies the hamstring and quadriceps muscles? |
|
Definition
Hamstrings = sciatic nerve.
Quads = femoral nerve. |
|
|
Term
| Damage to which nerve results in a foot drop? |
|
Definition
|
|
Term
| Describe the sensory, motor and reflex responsible C5-C7 and L3-S2/3. |
|
Definition
C5: Deltoid sensation, deltoid motor, biceps reflex.
C6: thumb sensation, elbow/wrist flexion, brachioradialis reflex.
C7: middle fingers sensation, elbow/wrist extension, triceps reflex.
L3: medial upper thigh sensation, knee extension, patellar tendon reflex.
L4: below the knee across to the medial foot sensation, ankle dorsiflexion, patellar tendon reflex.
L5: big toe sensation, big toe extension, no reflex.
S1: lateral foot sensation, ankle plantarflexion, achilles tendon reflex.
S2-3: anus sensation, anal sphincter, no reflex. |
|
|
Term
| Describe Ortolani and Barlow signs for congenital hip dislocations. |
|
Definition
Ortolani: exert an upwards force with external rotation to reduce a dislocated hip.
Barlow: exert a downward force with internal rotation to try and dislocate the hip. |
|
|
Term
| Describe Spurling's test of spinal examination. What does this indicate? |
|
Definition
| Head is tilted towards the effected side and you push down to see if the symptoms are increased. Indicates cervical disc herniation. |
|
|
Term
|
Definition
| Used to test the vascular system. Find the radial pulse and then abduct and move the arm posterior, then rotate the head towards the affected side. If they pulse disappears, that is a positive test. |
|
|
Term
| What is the normal kyphotic curve range for thoracic vertebrae? What are some characteristics of kyphosis on x-ray? What are the treatments of kyphosis based on the angle? |
|
Definition
Nl = 20-49 degrees.
Characteristics = flattened discs, thickened anterior longitudinal ligament, wedged vertebral bodies and Risser's sign (calcification of the iliac crest).
Tx for 50-70 degrees = exercise and stretching with use of a back brace.
Tx for over 70 degrees = surgery. |
|
|
Term
| What is the action of the Rotator Cuff muscles? |
|
Definition
Supraspinatus = Abduction.
Infraspinatus = External rotation.
Teres minor = External rotation.
Subscapular = Internal rotation. |
|
|
Term
| What tests can be used to detect thoracic outlet syndrome? Describe them. |
|
Definition
Adson test - turn your head toward the symptomatic shoulder while you extend your arm, neck and shoulder slightly away from your body. While you inhale, your doctor will check for a pulse on the wrist of your extended arm. If your pulse is diminished or if your symptoms are reproduced during the maneuver, your doctor considers this a positive test result, which may indicate thoracic outlet syndrome.
Roos test - hold both elbows at shoulder height while pushing your shoulders back. You will then repeatedly open and close your hands for several minutes. If your symptoms are present after the test, or if you feel heaviness and fatigue in your shoulders, this can indicate the presence of thoracic outlet syndrome. Halstead test - In a seated position, palpate the radial pulse, and then pull traction on the patient’s arm downward while the patient extends their head backwards. A positive test is the reproduction of symptoms such as paresthesias which indicates thoracic outlet syndrome. |
|
|
Term
| What does a fat pad/sail sign usually indicate in adults? Children? |
|
Definition
| It will hide fractures on x-ray but it is usually indicative of a subtle radial head fracture in adults and a supracondylar fracture of the humerus in children. |
|
|
Term
| What nerves and nerve roots make up the Sciatic nerve? |
|
Definition
| The tibial and common fibular nerve (L4-S3). |
|
|
Term
| Which ankle ligament common tears with inversion injuries? Which is most commonly injured? |
|
Definition
Most commonly torn = Calcaneofibular ligament.
Most commonly injured = anterior talofibular ligament. |
|
|
Term
| Which ankle ligament is injured with an eversion ankle injury? |
|
Definition
|
|
Term
| With spinal stenosis, which positions typically aggravate and improve the symptoms? |
|
Definition
Lumbar extension usually aggravates.
Lumbar flexion usually improves. |
|
|
Term
| How will a soft tissue osteosarcoma appear different than a myositis ossificans on x-ray? |
|
Definition
ST osteosarcoma — heavy mineralization in central area
MO — zonal pattern of ossification, w/ mature dense ossification at periphery of lesion |
|
|
Term
| What is the most common bone for cancer to METS to? |
|
Definition
|
|
Term
| Which organisms are patients with sickle cell or IVD abuse at risk for with osteomyelitis? |
|
Definition
SS = Salmonella.
IVD = pseudomonas. |
|
|
Term
| What is the only area of the spine affected by RA? |
|
Definition
|
|
Term
| Which antibody is 99% specific for SLE? |
|
Definition
|
|
Term
| What are the 3 main causes of neuropathic arthritis? Where do each of them typically affect? |
|
Definition
Diabetic neuropathy - most commonly affects the feet.
Tabes dorsalis - neurosyphilis, commonly affects the LE and vertebrae.
Syringomyelia - damage to the spinal cord due to the formation of a fluid-filled area within the cord, affects the UE first. |
|
|
Term
| :a progressive degenerative condition that affects the metatarsal, tarsometatarsal and tarsal joints in the feet. It is associated with nerve damage (neuropathy) that decreases the ability to sense stimuli, including pain, and decreases muscular reflexes that control movement. As a result, the joints in the feet are subjected to repeated trauma and injury, causing progressive damage to the ligaments, cartilage, and bones. |
|
Definition
|
|
Term
How do you treat an acute gouty attack?
Prophylaxis? |
|
Definition
Acute = NSAIDs, corticosteroids or colchicine.
Prophylaxis = allopurinol (overproducers) or probenecid (underexcreters). |
|
|
Term
| How do you treat a scaphoid fracture? |
|
Definition
| Thumb spica splint for 12 weeks |
|
|
Term
| Describe a Boutonniere deformity. |
|
Definition
| Flexion of PIP and hyperextension of DIP due to rupture of extensor tendon at the PIP. |
|
|
Term
| Describe a Mallet finger. |
|
Definition
| DIP is in flexion and PIP stays in extension due to extensor tendon rupture at the DIP. |
|
|
Term
| What tests can be used to detect someone that may be faking back pain to get narcotics or bc of a workman's comp issue? |
|
Definition
Waddle's test and the Hoover test (Done during a straight leg raise to determine if a patient is really trying to lift their leg or if they are a malingerer.
If the opposite leg does not exert pressure back against your hand then they are not trying fully). |
|
|
Term
| What is the best view for a patellar fracture? |
|
Definition
|
|
Term
| What is a pilon fracture and what is the treatment? |
|
Definition
Comminuted fracture of the distal tibia.
Treatment is ORIF. |
|
|
Term
| Injury to which nerve would cause a winged scapula? |
|
Definition
| Long thoracic nerve (serratus anterior) |
|
|
Term
| The main concern with a patient taking long term NSAIDs is irreversible damage to which organ? |
|
Definition
|
|
Term
| Describe the typical complain of a patient with plantar fascitis. |
|
Definition
| The pain is located on the bottom of the foot and is usually more severe upon waking up in the morning and lessens with ambulation. |
|
|
Term
| Describe the typical presentation and treatment for patellofemoral syndrome. |
|
Definition
Vague anterior knee pain that is worsened with stair climbing or with gentle pressure to the patella.
Tx is PT to strengthen the quadriceps. |
|
|
Term
| Which fracture has the highest mortality rate? |
|
Definition
|
|
Term
| What is Kienbock's disease? |
|
Definition
|
|
Term
| *What is the treatment for a child with a positive Galeazzi sign (knees are not equal when flexed)? |
|
Definition
| It is indicative of developmental hip dysplasia and they should be placed in a Pavlik harness. |
|
|
Term
| Which nerve roots supply the biceps, triceps, brachioradialis, patellar and achilles reflexes? |
|
Definition
Biceps = C5
Brachioradialis = C6
Triceps = C7
Patellar = L3-4 but 4 if test
Achilles = S1 |
|
|
Term
| What is the treatment for isolated polymyalgia rheumatica? What if there is also symptoms of temporal arteritis? |
|
Definition
| Low dose steroids if isolated, otherwise high dose prednisone |
|
|
Term
| What is the most effective treatment to prevent bone erosion in RA? |
|
Definition
| DMARDs, the NSAIDs just provide symptomatic relief |
|
|
Term
| Which x-ray view is best for visualizing a SCFE? |
|
Definition
|
|
Term
| What is the MOA of bisphosphonates? |
|
Definition
| Inhibit bone resorption by inhibiting osteoclast function |
|
|
Term
| What is the name of the splint used for humeral fractures? |
|
Definition
|
|
Term
| What is the name of the brace used in tennis elbow? |
|
Definition
|
|
Term
| What is the name of the cast used to treat a boxer's fracture? |
|
Definition
|
|
Term
| Describe the typical color, clarity, WBC count and neutrophil percentage on joint aspiration analysis for osteoarthritis, SLE, Gout, Psuedogout, RA, and bacterial arthritis. |
|
Definition
OA: yellow, transparent, <2000 WBCs, <25% neutrophils.
SLE: yellow, translucent, <9000 WBCs, <25% neutrophils.
Gout: Yellow or white, translucent or opaque, 100-160k WBCs, 90% neutrophils.
Psuedogout: Yellow or white, translucent or opaque, 50-75k WBCs, 90% neutrophils.
RA: Yellow or purulent, translucent or opaque, 3-50k WBCs, 50-75% neutrophils.
Bacterial: Purulent, opaque, 50-300k WBCs, >90% neutrophils. |
|
|
Term
| What should you suspect if you see a strawberry cervix? |
|
Definition
|
|
Term
| Describe Negel’s Rule for EDC. |
|
Definition
| Add a week, subtract 3 months, add a year to DOC |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do LATE fetal decelerations imply? |
|
Definition
| Fetal blood supply compromise |
|
|
Term
| What is the classic triad of PCOS? |
|
Definition
| Hyperandrogenism, obesity, amenorrhea |
|
|
Term
| Lab value seen during onset of menopause? |
|
Definition
|
|
Term
| What is it called when you have a heavy period that lasts 7-10 days? |
|
Definition
|
|
Term
| What does Paget's disease of the breast look like? |
|
Definition
| Eczematous lesion of the nipple caused by large malignant cells |
|
|
Term
| What is the most common reason for labor arrest? |
|
Definition
| Cephalopelvic disproportion |
|
|
Term
| What is the classic triad of preeclampsia? |
|
Definition
| HTN, proteinuria and edema |
|
|
Term
| What is the most common reason for male infertility? |
|
Definition
| Low sperm count and motility |
|
|
Term
| What phase of the menstrual cycle is variable? |
|
Definition
| The follicular phase is variable so if there is menstrual cycle changes it is in the follicular phase. The luteal phase is a fixed 14 days. |
|
|
Term
| What days are the follicular phase, ovulation and the luteal phase in a 28 day cycle. |
|
Definition
| Follicular phase is days 1-14, Ovulation is day 14, Luteal phase is days 15-28. |
|
|
Term
| What is the function of FSH in the follicular phase? Describe the cycle of FSH throughout the menstrual cycle and the effects of other hormones. |
|
Definition
| It stimulates the follicles in the ovary to grow and produce estrogen. As estrogen increases it shuts off FSH and triggers LH release from the anterior pituitary. FSH is triggered again at the end of menses by the lack of estrogen. |
|
|
Term
| Which hormone stimulates the follicle to produce androgens (testosterone and androsteindione), which can be later converted to estrogen? |
|
Definition
|
|
Term
| What are the proliferative and secretory phases of the menstrual cycle? Describe the changes in the endometrium during each phase and what hormone influences those changes. |
|
Definition
Proliferative phase is aka the non-menstruating days of the follicular phase (typically days 7-14) and the secretory phase is aka the luteal phase.
The proliferative phase is influenced by estrogen and causes a rapid increase in the endometrium thickness. The secretory phase is influenced by progesterone and it stabilizes the newly thickened endometrium with an increased blood supply. |
|
|
Term
| :Prolonged (>7 d) or excessive (>80 mL daily) uterine bleeding occurring at regular intervals |
|
Definition
|
|
Term
| :Uterine bleeding occurring between cycles |
|
Definition
|
|
Term
| :Prolonged or excessive uterine bleeding occurring at irregular and more frequent than normal intervals |
|
Definition
|
|
Term
| :Uterine bleeding occurring at regular intervals of less than 21 days |
|
Definition
|
|
Term
| :Uterine bleeding occurring at intervals of 35 days to 6 months |
|
Definition
|
|
Term
| :characterized by severe uterine pain/cramps during menstruation characterized by pain that is so severe it limits normal activities, or requires medication such as NSAIDS. |
|
Definition
|
|
Term
| What are some ways to diagnose and treat endometriosis? What drug can be used if fertility is desired? |
|
Definition
Can diagnose with laparoscopy (and treat while in there with laser vaporization) and also treat with GnRH agonists (Lupron) bc it negative feedback inhibits the production of LH/FSH, Danazol (a synthetic androgen, inhibits ovulation), continuous oral contraceptives (lead to a lack of menses and shrinks endometrial tissue) and pregnancy. Surgical removal of endometriosis is reserved for severe cases.
* Best oral contraceptives for endometriosis are continuous because in women with endometriosis that get pregnancy they are sometimes spontaneously cured simply due to 9 months without menses, continuous oral contraceptives for an extended period of time can cure endometriosis much in the same way.
If fertility is desired you can use Clomid. |
|
|
Term
| What is the most common cause of infertility in women in the US? |
|
Definition
|
|
Term
| Should DepoProvera be used as a long term birth control method? |
|
Definition
| No, because it is associated with a significant loss of bone mineral density. It should only be used if other methods are inadequate. |
|
|
Term
| What is the most common type of ovarian cancer? What is the screening test for ovarian cancer? |
|
Definition
Serous cystadenocarcinoma.
There is no effective screening test but CA-125 can be used as a biomarker for ovarian cancer. |
|
|
Term
| What is the most common type of vaginal cancer? What is linked to clear cell carcinoma of the vagina? |
|
Definition
It is rare but the most common type is squamous cell carcinoma.
Clear cell carcinoma of the vagina is linked with DES exposure of her mother during pregnancy. |
|
|
Term
| Describe the differences between a triple screen and a quadruple screen. What is the benefit of the quad? What do these screens test for? Describe how each disease will present in these tests if positive. |
|
Definition
Triple = Checks AFP, Unonjugated Estriol (eu3) and B-hCg.
Quad = Adds Inhibin A to the test.
Inhibin A aids in the detection of Down syndrome.
They test for Down syndrome, Trisomy 18 and neural tube defects.
Downs = AFP, eu3 and Inhibin A will be low and B-hCg will be high.
Trisomy 18 = AFP, B-hCg and eu3 will be low.
Neural tube defect = AFP will be high. |
|
|
Term
| Describe the color of vaginal discharge during the first month after pregnancy. |
|
Definition
First 4 days = red (lochia rubra).
5 days-2 weeks = pale brown (lochia serosa).
After 2 weeks = yellowish white to normal (lochia alba) |
|
|
Term
| Describe some of the typical symptomatic differences between Abruptio placentae and Placenta previa. |
|
Definition
Abruptio is usually painFUL vaginal bleeding WITH contractions and a non-reassuring fetal HR in the 3rd trimester.
Previa is usually painLESS vaginal bleeding withOUT contractions and has a reassuring fetal HR and can present after coitus or in the 2nd or 3rd trimesters. |
|
|
Term
| What is the typical presentation of a Hydatiform mole? How does it appear on US? |
|
Definition
Abnormal vaginal bleeding, uterine size greater than dates, abnormally elevated B-hCG (>100,000).
US = "sack of grapes" or "snowstorm" appearance |
|
|
Term
| How do you treat a potential preterm labor? |
|
Definition
| Initial management is IV fluids, then corticosteroids between 24-34 weeks and tocolytics can be used after 34 weeks (terbutaline, nifedipine, mag sulfate) |
|
|
Term
| What are the first 2 treatment lines for uterine atony? |
|
Definition
| Massage is first and oxytocin is second |
|
|
Term
| What disease shows multinucleated giant cells on Tzanck smear? |
|
Definition
|
|
Term
| What is meant by ASCUS and CIN I-III? What is worse than these? |
|
Definition
ASCUS = benign inflammation
I = mild dysplasia
II = moderate dysplasia
III = severe dysplasia
Carcinoma in situ and then invasive cancer are the next steps. |
|
|
Term
| What is the difference between a cystocele and rectocele? |
|
Definition
Cystocele = anterior vaginal wall is prolapsed due to bladder.
Rectocele = posterior vaginal wall is prolapsed due to rectum. |
|
|
Term
| What are some of the characteristic differences between fibrocystic breasts and a breast fibroadenoma? |
|
Definition
Fibrocystic breasts are painful/tender and their size fluctuated with hormone levels.
Fibroadenomas occur in younger women (mc black) and are nontender. |
|
|
Term
| What is the most common breast cancer (80%)? |
|
Definition
| Infiltrating ductal carcinoma |
|
|
Term
| Do breast cancers that are hormone receptor positive have a better or worse prognosis? |
|
Definition
|
|
Term
| Describe the differences between frank, complete and single/double footling breech presentations. |
|
Definition
Frank = In a piked position w/ the butt first.
Complete = Sitting with hips and knees flexed.
Single/double = One or both legs are completely extended and present before the buttocks. |
|
|
Term
| What are the main HTN drugs that can be used in pregnancy? |
|
Definition
| Methyldopa, hydralazine and propranolol |
|
|
Term
| What will the FSH:LH ratio be with PCOS? |
|
Definition
|
|
Term
| Describe the two maneuvers that are used to correct a potential shoulder dystocia. |
|
Definition
McRoberts maneuver - maternal legs are hyperflexed onto maternal abdomen.
Woods maneuver - after McRoberts if unsuccessful, rotate fetal shoulders into oblique position |
|
|
Term
| When should RhoGAM be given to an Rh negative mother with a Rh positive child? |
|
Definition
| At 28 weeks and within 72 hours of delivery |
|
|
Term
| What are the guidelines to be considered a immature vs premature infant? |
|
Definition
Immature = delivered between 20-28 weeks.
Premature = delivered between 28-37 weeks. |
|
|
Term
| What are Chadwicks and Hegars signs? |
|
Definition
Chadwick = blue discoloration of the cervix.
Hegar = softening of the uterus at its junction with the cervix during the first trimester of pregnancy. |
|
|
Term
| Describe the gestational age when you palpate the top of the uterus at the pubic symphysis, umbilicus, and what you expect from 26 weeks on. |
|
Definition
PS = 12 weeks.
Umbilicus = 20 weeks.
From 26-34 the fundal height will correlate with the gestational age.
From 36-40 the fundal height may decrease as the baby drops |
|
|
Term
| What is the chemotherapeutic agent of choice to treat estrogen receptor positive and postmenopausal breast cancer? |
|
Definition
|
|
Term
| What can be given to women with a history of preterm labor to prevent future PTL? How often and when is it given? |
|
Definition
17a-hydroxyprogesterone caproate
It is given as a weekly injection from 16-36 weeks |
|
|
Term
| What is the typical method of early labor induction, late labor induction and other methods? |
|
Definition
Early = prostaglandin gel applied directl to the cervix.
Late = IV Pitocin
Others = manual rupturing of the membranes |
|
|
Term
| What is a Sertoli-Leydig cell tumor? |
|
Definition
| Ovarian tumor that secretes testosterone |
|
|
Term
| What are the ACOG recommendations for follow up after an ASCUS, CIN I, CIN II or CIN III PAP result? |
|
Definition
ASCUS: HPV test + repeat PAP in 6 and 12 months or do colposcopy
CIN I: Colposcopy
CIN II: Colposcopy or LEEP
CIN III: Colposcopy or LEEP |
|
|
Term
| What is Sheehan Syndrome? |
|
Definition
| Anterior pituitary insufficiency due to postpartum hemorrhage most commonly. |
|
|
Term
| Describe what is monitored with the tumor markers: BRCA-1, BRCA-2, Her-2/neu, p53 mutation, PSA, Ca 19-9, Ca125, CEA and AFP. |
|
Definition
BRCA1: breast, ovarian, prostate CA.
BRCA2: breast, ovarian CA.
Her-2/neu: aggressive breast CA.
p53: breast CA.
PSA: prostate CA.
Ca19-9: pancreatic CA.
Ca125: ovarian CA.
CEA: colorectal CA (used to monitor prognosis, treatment and recurrence, not diagnose).
AFP: hepatocellular carcinoma, testicular CA and ovarian CA. |
|
|
Term
Describe the peripheral smear findings with:
Folate deficiency
G6PD
Sickle cell anemia
Thallassemia
CLL
AML
Hodgkin Lymphoma
Burkitt's Lymphoma
Lead poisoning
TTP |
|
Definition
Folate deficiency: macroovalocytes, hypersegmented PMNs, Howell-Jolly bodies.
G6PD: Heinz bodies, bite cells.
Sickle cell anemia: sickled cells, Howell-Jolly bodies, anisocytosis, poikilocytosis.
Thallassemia: target cells, basophilic stippling.
CLL: smudge cells.
AML: auer rods.
Hodgkin Lymphoma: Reed Sternburg cells.
Burkitt's Lymphoma: starry-night appearance.
Lead poisoning: ringed sideroblasts, RBC stippling.
TTP: schistocytes. |
|
|
Term
| What are the lab and characteristic PE findings with Wilson's disease? |
|
Definition
| Decreased serum ceruloplasmin levels and Kayser-Fleisher rings on eye exam. |
|
|
Term
Describe the antibodies/blood markers found with:
Polymyositis
Drug-induced lupus
SLE
Sarcoidosis
Ankylosing spondylitis
Microscopic polyangitis
Mixed connective tissue disease
Diffuse scleroderma
Neonatal lupus
Rheumatoid arthritis
Sjogrens Syndrome
Wegener's granulomatosis
CREST |
|
Definition
Polymyositis: anti-Jo1, anti-Mi2
Drug-induced lupus: anti-histone
SLE: anti-dsDNA, anti-smith, anti-Ro, anti-La
Sarcoidosis: ACE
Ankylosing spondylitis: HLA-B27
Microscopic polyangitis: p-ANCA
Mixed connective tissue disease: anti-RNP
Diffuse scleroderma: anti-SCL70
Neonatal lupus: anti-SSA (Ro)
Rheumatoid arthritis: anti-CCP, RF
Sjogrens Syndrome: anti-SSA (Ro), anti-SSB (La)
Wegener's granulomatosis: c-ANCA
CREST: anti-centromere |
|
|
Term
| Describe hemolytic uremic syndrome. Tx? |
|
Definition
Usually in kids, often due to 0157:H7 E. coli. Characterized by ARF, bloody diarrhea, abdominal pain, seizures, fulminant thrombocytopenia and hemolytic anemia.
Tx: dialysis. |
|
|
Term
| Describe Heparin Induced Thrombocytopenia. |
|
Definition
| Up to 5% of patients receiving unfractionated heparin will develop this immunologic response in which platelets clump together and form emboli. |
|
|
Term
| What medication is used in sickle cell anemia to decrease the incidence of crisis? |
|
Definition
|
|
Term
What are the causes of the following rashes:
Erythema marginatum
Erythema migrans
Erythema nodosum
Erythema multiforme |
|
Definition
Erythema marginatum: rheumatic fever.
Erythema migrans: Lyme disease.
Erythema nodosum: Sarcoidosis, UC, Crohns.
Erythema multiforme: infection and medications (SJS). |
|
|
Term
| What is the typical presenting symptoms of a patient withM eckle's diverticulum? Describe the rule of 2's. |
|
Definition
Abdominal pain +/- bloody stools.
Rule of 2's: 2% (of the population). 2 feet (from the ileocecal valve). 2 inches (in length). 2% are symptomatic. 2 types of common ectopic tissue (gastric and pancreatic). 2 years is the most common age at clinical presentation. 2 times more boys are affected. |
|
|
Term
| What do nigri bodies on peripheral smear represent? |
|
Definition
|
|
Term
| Initial study of choice for new onset seizure? |
|
Definition
| CT head for evaluation of hemorrhage or space occupying lesion. EEG can be done later to classify and find focus. |
|
|
Term
| What condition involves occlusion of the peripheral arteries and veins, occurring in young smokers typically and presents with ulcerations of the digits and eventual gangrene? |
|
Definition
| Thromboangiitis obliterans (Buerger's disease) |
|
|
Term
| What is the major component of surfactant? |
|
Definition
| The lipid dipalmitoyl phosphatidylcholine. |
|
|
Term
| What is the most common pathogen to affect the brain in a patient with HIV? |
|
Definition
|
|
Term
| What additional immunizations do children with sickle cell need in addition to their normal childhood vaccines? |
|
Definition
| influenza, pneumococcal and meningococcal |
|
|
Term
| What is the preferred therapy for coagulopathy due to liver disease? |
|
Definition
|
|
Term
| What is the initial therapy for perennial and non-perennial allergies? |
|
Definition
| Perennial is antihistamines, non-oerennial is avoidance therapy. |
|
|
Term
| If you treat a boy in the ER with confirmed meningococcal meningitis, what prophylactic treatment do you need to take? |
|
Definition
|
|
Term
| What is the treatment regimen for toxoplasmosis infection in an AIDS patient? |
|
Definition
| pyrimethamine and sulfadiazine |
|
|
Term
| How will toxoplasmosis show up on MRI of the brain? |
|
Definition
| Ring enhancing lesions with mass effect |
|
|
Term
| What is the treatment regimen for cryptococcal brain infection in an AIDS patient? |
|
Definition
| amphoteracin B and flucytosine |
|
|
Term
| How can you differential toxoplasmosis vs cryptococcal meningitis infections in an AIDS patient with PE, labs and imaging? |
|
Definition
PE:
Toxoplasmosis presents with acute mental status change, hemiparesis, headache, and seizure.
Cryptococcus presents with headache (most common), changes in mental status or consciousness, meningismus, fever, and occasionally seizures.
Labs: cryptococcus will show decreased glucose and positive India Ink test on CSF analysis.
Imaging: toxoplasmosis will show ring enhancing lesions with mass effect and cryptococcus will be normal on brain MRI. |
|
|
Term
| How can you differentiate a Wilm's tumor from a neuroblastoma on PE? |
|
Definition
| Neuroblastoma's are malignant tumors of the adrenal glands and Wilm's tumors are malignant tumors of the kidney. The main PE difference between the two is that neuroblastomas cross the midline of the abdomen. |
|
|
Term
| What is the most common cause of a patient with a single episode of hemopytsis that is a chronic NSAID user? |
|
Definition
| Acute hemorrhagic gastritis |
|
|
Term
| Describe the pathophysiology of Renal Tubular Acidosis and how it can present. |
|
Definition
| It involves a tubular defect caused by impaired ability to trap and excrete acids in the distal tubule. Because of chronic acidosis, it can cause calcium wasting, hypercalciuria, nephrolithiasis, and nephrocalcinosis (renal calcification). Nephrocalcinosis can be detected) with a renal ultrasound. The urinalysis of a patient with RTA should typically have a pH>5.5, even in the setting of systemic acidosis. |
|
|
Term
| Describe what causes accumulation of aflotoxins and what this accumulation can result in. |
|
Definition
| Aflotoxins are produced by Aspergillus flavus. This is a mold that can be seen on peanuts and stored grains. Accumulation of this toxin can result in hepatocellular carcinoma. |
|
|
Term
| Describe the main difference between acute stress disorder and PTSD. |
|
Definition
| Acute lasts less than 4 weeks, PTSD lasts longer than 4 weeks. |
|
|
Term
| Describe the differences in the infective sites for the following dermatophytes: Trichophyton, Microsporum and Epidermophyton. |
|
Definition
Trichophyton: infects skin, hair and nails.
Microsporum: infects skin and hair but not nails.
Epidermophyton: infects skin and nails but not hair. |
|
|
Term
| A 60-year-old male presents with recently experienced episode of hemoptysis along with cough. Bronchoscopy reveals a mass lesion involving the left superior segmental bronchus. Cytological examination shows polygonal pink cells with dark angular nuclei. What would be your probable diagnosis? |
|
Definition
|
|
Term
| Wernicke's encephalopathy is caused by a deficiency in what? |
|
Definition
|
|
Term
| Describe Takayasu's arteritis. |
|
Definition
| An inflammatory and stenotic disease of medium and large sized arteries most likely in young Asian women between 15 and 30 years of age. Because of the predilection for aorticarch and its branches involvement, Takayasu's arteritis is often referred as the aortic arch syndrome or pulseless disease. The clinical course may be fulminant and hence the need for arteriography that shows the characteristic lesions with stenosis and post stenotic dilatations, aneurisms, and increased collateral circulation. The most frequent affected site is the subclavian artery manifestedas claudication and Raynaud's phenomena. Steroids are used for the treatment. |
|
|
Term
| An 8-year-old child is brought to you with acute fever. Parents notice redness of the skin in the neck area. The thyroid gland is extremely tender to palpation, what organism is most commonly responsible for acute bacterial thyroiditis? |
|
Definition
|
|
Term
| Is a hordeolum or chalazion infectious in nature? |
|
Definition
|
|
Term
| Describe what results from a Thiamine (Vit B1) deficiency. |
|
Definition
Beri Beri: A bilateral symmetric peripheral neuropathy beginning in the legs. # On examination, there may be decreased vibratory and position sensation in the toes. Ankle jerk and knee jerk reflexes may be absent.
# Wernicke-Korsakoff syndrome comprising of nystagmus, ophthalmoplegia, ataxia, memory loss, and confabulation. |
|
|
Term
| Describe what results from a Riboflavin or Vitamin B2 deficiency. |
|
Definition
| patients present with angular stomatitis and cheilosis. |
|
|
Term
| Describe Bowen's disease of the skin. |
|
Definition
| Bowen's disease is a form of squamous cell carcinoma. The lesions typically appear as small, about 1-3 cm in size, well demarcated, pink to red in color, slightly raised, scaly plaques that may resemble psoriasis or actinic keratosis. |
|
|
Term
| Describe the PE presentation of Tuberous xanthomas. |
|
Definition
| Tuberous xanthomas are flat-topped, yellow, firm nodules that are primarily located on the elbows and knees. |
|
|
Term
| Describe what is meant by person-centered therapy in psych medicine. |
|
Definition
| During the course of therapy you facilitate the client's self-exploration as to the feelings that are associated with the stress. You ask few questions, but allow the client to guide the therapeutic process. You will often briefly summarize what the client has said to let him know that you are listening, and to make sure that you are clear about what he has said. During the course of the therapy, the client becomes more trusting and comfortable and begins to reveal more and more about the conflicting or incongruent feelings that have led to his stress. The focus of the therapy is to create a positive relationship with the client, so that he feels comfortable enough to engage in the self-exploration process and return himself to a state of congruence. |
|
|
Term
| Describe the behavioral approach to psych therapy. |
|
Definition
| Behavioral therapy is very directive, and does not focus on what the client is thinking and feeling. The whole purpose of behavioral therapy is to identify negative behaviors and correct them with the use of therapist led exercises. |
|
|
Term
| Describe the psychoanalytic approach to psych therapy. |
|
Definition
| Psychoanalytic therapy places the therapist in a position of authority. The relationship is of little importance. The client comes with a problem and the therapist interprets the problem and provides solution. |
|
|
Term
| Describe the reality approach to psych therapy. |
|
Definition
| Realty therapy is also a very directive approach. More emphasis is placed on the client/therapist relationship in the beginning. Once the client becomes comfortable with the therapist, the therapist proceeds in teaching the client ways in which to gain control of his or her life. |
|
|
Term
| Describe the cognitive-behavioral approach to psych therapy. |
|
Definition
| Cognitive-behavioral therapists view therapy as a joint process between the client and therapist. Once again there is more focus on the relationship, and building rapport is an important part of the process. The therapist will then provide the client with exercises and gently lead them through an exploration of what the problem is. The therapist will help the client identify negative or ineffective cognitions, and assist the client in challenging current irrational thoughts. Eventually the therapist assists the client in replacing irrational thoughts with more rational ones. |
|
|
Term
| Describe the paraneoplastic syndromes associates with small cell carcinoma, Hodgkin's disease and Adenocarcinoma of the GI tract. |
|
Definition
| Small cell: SIADH and Lambert-Eaton Syndrome. Hodgkin: Nephrotic syndrome. Adeno: Acanthosis Nigricans. |
|
|
Term
| What is the course of action in treating a CHF exacerbation in a patient taking nitro, metoprolol ER, enalapril and ASA? |
|
Definition
| Stop the BB, administer Dobutamine, Lasix, nitro, oxygen and position the patient upright. |
|
|
Term
| The classic presentation of the patient with a history of malaise, weight loss and low-grade fever with the X-ray showing calcification around the cardiac outline suggests what condition> |
|
Definition
|
|
Term
| What is the difference between Rosascea and Acne Rosacea? |
|
Definition
| Rosacea is usually seen in older males and does not present with comedomes. Acne Rosacea is usually presents in younger females and will have comedomes. |
|
|
Term
| What is the management of acute post-operative paralytic ileus? |
|
Definition
| Intestinal intubation and continuous suction until the ileus resolves (usually less than 48 hours). |
|
|
Term
| What supplement has been shown in recent studies to help with ADHD? |
|
Definition
|
|
Term
| Describe the typical presentation of Herpetic gingivostomatitis. How is this differentiated from Herpangina? |
|
Definition
HG: Symptoms may appear abruptly, with high fever, drooling, fetid breath, and refusal to eat. The tongue, cheeks, and gingiva are most commonly affected, but the entire oral cavity may be involved. These areas can present with ulcers that are yellowish-gray in color, and the gingiva may be quite friable.
Herpangina is usually associated with a prodrome of fever, headache, and occasional emesis. Lesions are present as vesicles and ulcers, and are yellow-white in color. Each lesion is surrounded by an erythematous halo up to 10 mm in diameter. The lesions are most always found on the anterior tonsillar pillars, as well as the uvula, soft palate, and tonsils. The anterior mouth is rarely affected. |
|
|
Term
| What should be suspected in a patient with chest pain, normal EKG except for tachycardia, elevated ESR, leukocytosis and elevated Troponin I? |
|
Definition
|
|
Term
| What is the recommended post-exposure prophylaxis for rape victims? |
|
Definition
| Prophylactic treatment for G/C and Trichomonas should be given and optional HIV prophylaxis should be offered. |
|
|
Term
| What bacteria should be suspected in an individual who was handling animal products and developed a papule, vesicle and then necrotic ulcer? |
|
Definition
|
|
Term
| Describe the Weber and Rinne findings for SNHL and CHL. |
|
Definition
SNHL: lateralize to the good ear and AC>BC.
CHL: lateralize to the bad ear and BC>AC. |
|
|
Term
| Which classes of meds are known to be ototoxic? What type of hearing loss do these cause? |
|
Definition
Aminoglycosides (amikacin, gentamicin, neomycin, streptomycin, tobramycin)
Chemotherapy agents (cisplatin, vincristine)
Loop diuretics (furosemide, bumetanide)
ASA/NSAIDs
They cause SNHL. |
|
|
Term
| Estrogen and Progesterone in OCPs each act to suppress what from the anterior pituitary? |
|
Definition
Estrogen: suppresses FSH.
Progesterone: suppresses LH. |
|
|
Term
| Which insect has a characteristic violin pattern on its back? |
|
Definition
|
|
Term
| What are caviar lesions and are they problematic? |
|
Definition
| They are varicosities found under the tongue and are completely benign. |
|
|
Term
| Describe the prognosis of Guillan-Barre Syndrome. What are some of the treatment options? |
|
Definition
>80% will make a full recovery.
Tx: plasmapharesis and/or IVIG in addition to supportive care |
|
|
Term
| What is the gold standard test for aortic dissection? |
|
Definition
|
|
Term
| What is the main difference in presentation between vibrio cholera and vernificus? |
|
Definition
| They both present with profuse watery diarrhea and are associated with contaminated water and shellfish but vernificus usually has bullous skin lesions as well. |
|
|
Term
| What are the 3 most reliable predictors of drowning outcome? |
|
Definition
| Presence or absence of coma, pupillary response and blood glucose levels. |
|
|
Term
| Which medication should be administered in VF patients unresponsive to cardiopulmonary resuscitation (CPR), shock, and vasopressor therapy? |
|
Definition
|
|
Term
| How does candida albicans appear on gram stain? How can it be differentiated? |
|
Definition
It stains as a gram positive cocci.
It can be differentiated because it is substantially larger than bacteria and will be "germ tube" positive. |
|
|
Term
| The mechanism of sumatriptan in migraine involves which neurotransmitter? |
|
Definition
|
|
Term
| What is the clinical presentation of erosive gastritis? |
|
Definition
| Since erosive gastritis is a condition affecting the mucosa and not the deeper parts of the gastric wall, patients will not have complaints or findings of perforation or peritoneal irritation such as is found in peptic ulcer disease. The presentation is typically painless hematemesis and is seen is chronic alcohol users. |
|
|
Term
| What is the risk of malignancy with oral leukoplakia? |
|
Definition
| About 5% will turn into squamous cell carcinoma |
|
|
Term
| Define echolalia, paraphasia, alexia, agraphia and apraxia. |
|
Definition
Echolalia: persistent repetition of a heard word without knowing the meaning.
Paraphasia: substitution of a similar sounding word for another word.
Alexia: inability to read.
Agraphia: inability to write.
Apraxia: inability to execute purposeful movement. |
|
|
Term
| Describe the appearance of gout under light microscopy. |
|
Definition
| Negatively birefringent, needle-shaped crystals. |
|
|
Term
| Describe the appearance of pseudogout under light microscopy. |
|
Definition
| Positively birefringent, rhomboid-shaped crystals. |
|
|
Term
| Will Mycoplasma present with cold or warm antibodies on agglutinin testing for hemolytic anemia? Which antibody will be present with warm and cold? What condition most commonly causes the other? |
|
Definition
Mycoplasma pneumonia: Cold antibodies (IgM) - causes hemolytic anemia.
Autoimmune hemolytic anemia: Warm antibodies (IgG). |
|
|
Term
| What is the most common cause of bacterial meningitis in children? |
|
Definition
|
|
Term
| Describe the management of an acute hyphema. |
|
Definition
Acetazolamide(control IOP)
Elevation of head
Eye shield
Immediate ophthalmology referral
*NSAIDs are contraindicated due to increased risk of bleeding. |
|
|
Term
| Which type of colonic polyp has the highest risk of becoming malignant? |
|
Definition
|
|
Term
| What is the initial therapy for acute rheumatic fever? |
|
Definition
|
|
Term
| How may Flagyl and Vancomycin be administered in the treatment of C. diff? |
|
Definition
| Flagyl can be oral or IV, Vanco can only be oral bc the IV formulation does not lead to high enough concentration of the abx in the intestines. |
|
|
Term
| What test should you order and what will be the findings if you suspect acute chest syndrome in a sickle cell patient? Tx? |
|
Definition
CXR: will show pulmonary infiltrates, usually starting in the base of the lungs.
Tx: ventilation support and/or exchange transfusion. |
|
|
Term
| What test will be prolonged in hemophilia A and B? |
|
Definition
|
|
Term
| What test will be prolonged with thrombocytopenia? |
|
Definition
|
|
Term
| Describe the symptoms seen in seborrheic dermatitis. |
|
Definition
| Dry scales and erythema on the scalp, face, chest, back, abdomen, and/or body folds. There may be itching and secondary infection. |
|
|
Term
| How is RSV (bronchiolitis) best dignosed? |
|
Definition
| Immunofluorescence of nasal secretions |
|
|
Term
Describe the cause and symptoms for:
Acute intermittent porphyria and Porphyria cutanea tarda. |
|
Definition
AIP: Results from the decreased activity of porphobilinogen deaminase (PBGD). Sx include: abdominal pain, nausea, vomiting, tachycardia, and dark red urine.
PCT: It is caused by a decrease in the activity of uroporphyrinogen decarboxylase in the liver. Sx include: photosensitivity that results in blistering skin lesions on exposed areas that commonly scar. |
|
|
Term
| At what age can you start taking tetracycline? |
|
Definition
|
|
Term
| Describe Ortolani's and Barlow's tests. |
|
Definition
Ortolani: The maneuver is performed by abducting the infant’s hip in the supine position and assessing for a clunk, used to relocate a posterior dislocation.
Barlow: Maneuver performed by bringing the thighs towards the midline of the body, positive result is feeling the femoral head slip out of the socket postolaterally. |
|
|
Term
| With a congenital hip dislocation, how will the affected side present when the patient is in the supine position with their knees and hips bent at 90 degrees? |
|
Definition
| The affected side will appear shorter because the dislocation is posterior. |
|
|
Term
| Describe the differences between Gilbert's syndrome, Dubin-Johnson syndrome and Crigler-Najjar syndrome. |
|
Definition
Gilbert's syndrome: benign lifelong indirect bilirubinemia that requires no treatment. It is caused by an enzyme defect that slows the conjugation of indirect bilirubin.
Dubin-Johnson syndrome: benign lifelong mixed direct and indirect bilirubinemia that requires no treatment. It is caused by impaired transport of bilirubin from the liver into the biliary system, so it backs up in the liver.
Crigler-Najjar syndrome: Is similar to Gilbert's syndrome but they lack the enzyme to conjugate indirect bilirubin completely and present in the first few days of life with marked indirect bilirubinemia. If not treated they will develop kernicterus rapidly. Tx includes: phototherapy and plasmapharesis but the only curative treatment is a liver transplant. |
|
|
Term
| What is the treatment options for pathologic unconjugated, conjugated and breast milk jaundice? When is hyperbilirubinemia considered physiologic? |
|
Definition
Unconjugated: phototherapy, exchange transfusion, IVIG and hydration.
Conjugated: Treat the underlying cause.
Breast milk: temporary cessation, phototherapy, exchange transfusion and hydration.
Neonatal hyperbilirubinemia is considered physiologic between 2 days and 1 week of life. |
|
|
Term
| Describe the histologic/imaging differences between sarcoidosis, wegener's and TB. |
|
Definition
Sarcoidosis: noncaseating granulomas, bilateral hilar LAD and upper lobe infiltrates.
Wegeners: caseating granulomas, classic triad of upper and lower respiratory tract involvement and glomerulonephritis.
TB: primary involves the lower lobes, reactivation the upper lobes. Lesions described as cavitary in nature. |
|
|
Term
| Kidney stones greater than white size are unlikely to pass on their own? What is the initial therapy of choice for these? |
|
Definition
>5mm
Lithotripsy is the inital treatment of choice because it is not invasive like the other options. |
|
|
Term
| Which nerves cause wrist and foot drop? |
|
Definition
Wrist: radial.
Foot: peroneal. |
|
|
Term
| What are some factors that are considered protective against breast cancer? |
|
Definition
| Late menarche, early menopause, breast feeding, pregnancy. |
|
|
Term
| How long is a Baker Act valid? |
|
Definition
|
|
Term
| Describe what is meant be positive IgG and IgM hepatitis A or B antibodies. |
|
Definition
| IgG is indicative of a past infection, IgM is indicative of a current infection. |
|
|
Term
| What is the treatment course for small cell lung cancer? |
|
Definition
Radiation with chemotherapy.
*surgical resection is not an option bc it is assumed to have spread even without evidence of metastasis. |
|
|
Term
| At what CD4 count should you begin prophylactic treatment with Bactrim? |
|
Definition
|
|
Term
| A 19-year-old mother gives birth to an apparently healthy 8lb baby girl. During her first attempt at feeding, choking, coughing, and cyanosis occur. Historically, the mother had polyhydramnios during her pregnancy. Which diagnosis is most likely the explanation for the newborn’s distress? |
|
Definition
| Tracheoesophageal fistula |
|
|
Term
| Briefly describe the differences between synchronized and unsynchronized cardioversion and what conditions each is used for. |
|
Definition
Synchronized cardioversion is a LOW ENERGY SHOCK that uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. Synchronization avoids the delivery of a LOW ENERGY shock during cardiac repolarization (t-wave). If the shock occurs on the t-wave (during repolarization), there is a high likelihood that the shock can precipitate VF (Ventricular Fibrillation). The most common indications for synchronized cardioversion are unstable atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachycardias in unstable patients or those who persist despite medication attempts at cardioversion.
Unsynchronized cardioversion (defibrillation) is a HIGH ENERGY shock which is delivered as soon as the shock button is pushed on a defibrillator. Unsynchronized cardioversion (defibrillation) is used when there is no coordinated intrinsic electrical activity in the heart (pulseless VT/VF) or the defibrillator fails to synchronize in an unstable patient. |
|
|
Term
| What is the main purpose of synchronized cardioversion as far as when it delivers the shock and what it is trying to avoid? |
|
Definition
| It makes sure that the shock is not delivered on a T-wave (ventricular repolarization) because that could precipitate ventricular fibrillation. |
|
|
Term
| How can leads V1 and V6 be used to differentiate a RBBB vs a LBBB? |
|
Definition
LBBB will present on V1 as a wide complex negative deflecting S wave and may have a small positive deflecting R wave. On V6 it will show as the typical rabbit ears appearance with R' greater than R.
RBBB will appear as the typical rabbit ears appearance in V1 and R' will be much greater than R. In V6 you will see a regular complex QRS with slurring of the S wave. |
|
|
Term
| What is the most common type of ASD and where does it occur? |
|
Definition
| Ostium secundum, occurs in the center of the atrial septum. |
|
|
Term
| What maneuver can be used during a Tet spell (TOF)? Why does this work? |
|
Definition
| Squatting or knees to the chest position because it will increase pressure on the left side of the heart, decreasing the right to left shunt thus decreasing the amount of deoxygenated blood entering the systemic circulation. |
|
|
Term
| Describe class I-IV of the NYHA Classification for heart failure. |
|
Definition
Class I: no limitation is experienced in
any activities; there are no symptoms
from ordinary activities.
Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class III: marked limitation of any
activity; the patient is comfortable only at rest.
Class IV: any physical activity brings on discomfort and symptoms occur at rest. |
|
|
Term
Describe the following lung sounds and what they may be indicative of.
Crackles/Rales
Wheezes
Rhonchi |
|
Definition
Crackles/Rales: heard during inhalation, sound like the crackling made by a campfire or bubbling in course. May indicate pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis or pulmonary edema.
Wheezes: continuous whistling sound during inspiration or expiration, indicated obstructive lung condition (asthma, COPD, RAD).
Rhonchi: coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Can be inspiratory or expiratory. Usually found in obstructive lung conditions or severe bronchitis. |
|
|
Term
| What must be present to diagnose malignant HTN? |
|
Definition
|
|
Term
| What are the typical systolic and diastolic criteria to be considered hypotensive? |
|
Definition
| Under 90 systolic or under 60 diastolic |
|
|
Term
| What medication classes are patient typically sent home on after an MI? |
|
Definition
Antiplatelets (ASA or Plavix)
BBs (decrease mortality and morbidity)
ACEI (decrease mortality)
Statin (decrease mortality and morbidity) |
|
|
Term
| The U.S. Preventive Services Task Force recommends one time screening for AAA in what population? |
|
Definition
| Men aged 65-75 who have ever smoked. |
|
|
Term
| At what size of AAA is surgical repair warranted? |
|
Definition
|
|
Term
| What is the diagnostic gold standard for GCA? When would you use high vs low lose steroids? |
|
Definition
| Dx: temporal artery biopsy. Tx: IV high dose steroids if visual symptoms (methylprednisolone), oral low dose steroids if just headache (prednisone). |
|
|
Term
| Describe the murmur heard with aortic stenosis. |
|
Definition
| Harsh, systolic, crescendo-decrescendo murmur heard best at the RUSB with radiation to one or both carotids. |
|
|
Term
| Describe the murmur heard with aortic regurgitation (insufficiency). |
|
Definition
High pitched, diastolic, decrescendo murmur heard best at the LSB.
Also Austin-Flint murmur: low-pitched, mid-diastolic rumbling murmur best heard at the cardiac apex. |
|
|
Term
| Describe the murmur of mitral stenosis. |
|
Definition
| Low-pitched, rumbling diastolic murmur with an opening snap heard best at the apex. |
|
|
Term
| Describe the murmur of mitral regurgitation. |
|
Definition
| Pansystolic, high-pitched, blowing murmur that radiates to the axilla and is heard best at the apex. |
|
|
Term
| What is the most common valvular abnormality seen with acute rheumatic fever. |
|
Definition
|
|
Term
| Describe the murmur of mitral valve prolapse. |
|
Definition
| Mid-systolic click with possible late systolic crescendo-decrescendo murmur. |
|
|
Term
| What murmurs are affected by inspiration? |
|
Definition
| Right sided murmurs become louder. |
|
|
Term
| How does standing affect most murmurs? |
|
Definition
| It decreases most murmurs except MVP and hypertrophic cardiomyopathy. |
|
|
Term
| How does squatting affect most murmurs? |
|
Definition
| It increases most murmurs except MVP and Hypertrophic cardiomyopathy. |
|
|
Term
| How does valsalva affect most murmurs? |
|
Definition
| It diminished most murmurs except MVP and HOCM. |
|
|
Term
How do hand grip exercises affect the following murmurs?
AS, AR, MR, MS and HOCM. |
|
Definition
Decreased: AS and HOCM.
Increases: AR, MR, and MS. |
|
|
Term
| Describe the murmur of tricuspid stenosis. |
|
Definition
| Diastolic murmur with opening snap and widely split S1, heard best at the LSB or xiphoid. |
|
|
Term
| What is the MCC of tricuspid stenosis? |
|
Definition
|
|
Term
| Describe the murmur of tricuspid regurgitation. |
|
Definition
| Pansystolic murmur heard best over the LLSB, with S3 gallop. Often will have atrial fibrillation/flutter as well. |
|
|
Term
| Describe the murmur of pulmonic stenosis. |
|
Definition
| Crescendo-decrescendo systolic ejection murmur with ejection click, heard best at the LUSB. Will have a split S2. |
|
|
Term
| Describe the murmur of pulmonic regurgitation. |
|
Definition
| Low-pitched diastolic murmur heard best at the LSB at the 3rd or 4th intercostal space. May have a right sided S3 and S4. |
|
|
Term
| Describe the typical patient and organism responsible for acute and subacute bacterial endocarditis. How can you differentiate between the two on PE and history? |
|
Definition
Acute: S. aureus is most common, usually affects individuals with a hx of IV drug abuse or valvular dysfunction.
Subacute: Strep viridans is most common, usually affects normal hearts.
Acute will present more toxic in appearance and will have symptoms which have lasted less than 2 weeks. Subacute will present with more flu-like symptoms and will have symptoms that have lasted more than 2 weeks. |
|
|
Term
| What are the 2 most common etiological agents of acute pericarditis? What other conditions are commonly susceptible to acute pericarditis? Treatment? |
|
Definition
Viral - Coxsackie B and Echovirus.
Others: Inflammatory disorders (RA, SLE, Scleroderma, AS, Sarcoidosis, etc) and Dressler's syndrome (Post-MI pericarditis)
Treatment for all include the underlying cause and NSAIDs/steroids. |
|
|
Term
| What medications are considered anticoagulants? What is their utility? |
|
Definition
Anticoagulants: heparin, warfarin, "parins" (dalte-, enoxa-, tinza)
(Fragmin, Lovenox, Innohep) and others.
They decrease the clotting ability of blood, NOT dissolve existing clots. Used to prevent clots from forming or growing, used after PCI, DVT prophylaxis/treatment or stable PE treatment (heparin). |
|
|
Term
| What medications are considered antiplatelets? What is their utility? |
|
Definition
Aspirin
Plavix (clopidogrel)
Ticlid (ticlopidine)
Persantine (dipyradamole)
Aggrastat (
They prevent blood clots from forming by
preventing blood platelets from sticking
together. They are used in acute coronoary syndrome, as a preventive against clot/thrombus formation in those with a history of stroke/MI or in those at high risk and as DVT prophylaxis. |
|
|
Term
| Describe what is meant by the heart sounds S1 and S2. |
|
Definition
| The S1 sound which marks the approximate beginning of systole, and is created when the increase in intraventricular pressure during contraction exceeds the pressure within the atria, causing a sudden closing of the tricuspid and mitral, or AV valves. The ventricles continue to contract throughout systole, forcing blood through the aortic and pulmonary, or semilunar valves. At the end of systole, the ventricles begin to relax, the pressures within the heart become less than that in the aorta and pulmonary artery, and a brief back flow of blood causes the semilunar valves to snap shut, producing S2. |
|
|
Term
| Describe the normal splitting on S1 and S2. |
|
Definition
| Because the left side of the heart is under higher pressure, the mitral closes slightly before the tricuspid, which makes the normal S1 split. The pressure in the aorta is much higher than the pulmonary arteries so the aortic valve normally closes slightly before the pulmonic, making a normal S2 split. |
|
|
Term
| In a patient with tachycardia how can you distinguish S1 from S2 on auscultation? |
|
Definition
| Feel their carotid or radial pulse which auscultating, the sound that you hear when you feel the pulse will be S1, the sound after it goes away will be S2. |
|
|
Term
| Describe grades I-VI murmurs. |
|
Definition
I - Lowest intensity, difficult to hear even by expert listeners
II- Low intensity, but usually audible by all listeners
III - Medium intensity, easy to hear even by inexperienced listeners, but without a palpable thrill
IV - Medium intensity with a palpable thrill
V - Loud intensity with a palpable thrill. Audible even with the stethoscope placed on the chest with the edge of the diaphragm
VI - Loudest intensity with a palpable thrill. Audible even with the stethoscope raised above the chest. |
|
|
Term
| Describe an S4 and what conditions can cause an S4. |
|
Definition
S4 occurs in the late stage of diastole, just before the next S1. It is caused by the late contraction of the atria where the final 20% of blood is pushed into the ventricles, if the ventricle is stiff or non-compliant the pressure wave of this final 20% will cause an S4 heart sound against the ventricle. It is termed an "atrial gallop" due to its proximity to S1.
Causes:
Ventricular hypertrophy (longstanding HTN, aortic stenosis)
Overloading of the ventricle (CHF)
Fibrosis of the ventricle |
|
|
Term
| Describe an S3 and what conditions can cause an S3. |
|
Definition
S3 occurs in the early stage of diastole, just after S2. It occurs just after the mitral/tricuspid valves open if the amount of blood waiting to enter the ventricles is abnormally large. This initial rush of blood into the ventricle hits the wall of the ventricle and causes this early diastolic sound. It is termed a "ventricular gallop" due to its proximity to S2.
It can be seen with conditions such as:
Mitral regurgitation
Left ventricular MI
Dilated Cardiomyopathy |
|
|
Term
| What are the typical abnormal heart sounds (S3 vs S4) heard with aortic stenosis, aortic regurgitation, mitral regurgitation and mitral stenosis? |
|
Definition
AS: longstanding can lead to LVH which would cause an S4.
AR: can lead to an S3 due to LV dysfunction but is uncommon.
MR: S3 heart sound due to excess blood in the left atria.
MS: No S3 or S4 but may have a loud P2 due to pulmonary HTN. |
|
|
Term
| What type of cancer is most common with Barrett's esophagus? |
|
Definition
|
|
Term
| What is the preferred treatment for histoplasmosis and blastomycosis lung infections? |
|
Definition
| PO itraconazol (Sporanox) |
|
|
Term
| How is histoplasmosis transmitted? Typical sx? |
|
Definition
It is transmitted through inhlation exposure to infectious spores found in soil contaminated with bird or bat droppings. It is not communicable from person to person.
Typical sx: flu-like illness. |
|
|
Term
| Where are histoplasmosis and blastomycosis endemic in the North America? |
|
Definition
Histoplasmosis: Lower Ohio, Mississippi and Missouri River valleys.
Blastomycosis: Upper Mississippi River valley in northern USA and Canada. |
|
|
Term
Describe the differences between the following breast masses in terms of consistency, mobility and tenderness:
Adenofibroma
Cystic Changes
Cancer |
|
Definition
Adeno: usually firm, very mobile, usually nontender.
Cyst: soft or firm, mobile, often tender.
Cancer: Firm or hard, fixed to underlying tissue, usually nontender. |
|
|
Term
| What pathogen on microscopic examination yields enlarged cells with prominent intranuclear inclusions? |
|
Definition
|
|
Term
| At what level of HTN is medication recommended in pregnancy? Which medication is first line? Which medications can be used to control the BP with eclampsia? |
|
Definition
Diastolic over 100.
First line is Methyldopa, BBs can be used but can cause growth restrictions.
Eclampsia BP tx: IV hydralazine |
|
|
Term
| Describe the optimal diet/supplement intake of a patient with cystic fibrosis. |
|
Definition
| Fat soluble vitamin supplementation, pancreatic enzyme replacement, high protein and high calorie. |
|
|
Term
| What is the preferred treatment for ongoing esophageal varices without bleeding? Acute with bleeding? |
|
Definition
Ongoing without: Beta blockers.
Acute with: Endoscopic variceal ligation and IV octreotide. |
|
|
Term
| Which vaccines contain egg products in them and should be avoided in those with allergies to eggs? |
|
Definition
Influenza (highest content)
Yellow Fever
MMR (only C/I in those with anaphylactic reactions) |
|
|
Term
| Describe the mechanism of action for Coumadin. |
|
Definition
| Inhibits Vit K dependent coagulation pathway (factors II, VII, IX, X, and proteins C & S). |
|
|
Term
| What is Gaisböck's syndrome? |
|
Definition
| Apparent polycythemia which commonly affects middle aged men who smoke, drink and/or have HTN. |
|
|
Term
| Describe De Quervain's thyroiditis (aka subacute granulomatous thyroiditis or giant cell thyroiditis). |
|
Definition
| It is thought to be caused by a viral infection and frequently precedes an upper respiratory tract infection. Patients develop fever and moderate enlargement of the thyroid, which is also tender. One fourth of patients develop hyperthyroidism due to an increase in serum T4 levels. In severe diseases, hyperthyroidism is followed by hypothyroidism after a period of euthyroidism. However, patients completely recover after a month. |
|
|
Term
| Define specificity and sensitivity. How can you calculate each? |
|
Definition
Specificity is defined as the ability of a test to identify correctly those who do not have the disease, i.e the true negatives.
Sensitivity is the ability of a test to identify correctly all those who have the disease, i.e. the true positives.
Specificity: true negatives/(true negative + false positive) x 100.
Sensitivity: true positives/(true positive + false negative) x 100. |
|
|
Term
| What are the normal ranges for serum pO2, pCO2 and HCO3? |
|
Definition
pO2: 75-105mmHg
pCO2: 35-45mmHg
HCO3: 22-28mEq/L |
|
|
Term
| Describe the differences between Lambert-Eaton syndrome and Myasthenia Gravis. |
|
Definition
| They present similarly but LE syndrome will show improvement of the weakness with sustained activity and may occur as a para-neoplastic syndrome with small cell lung cancer. |
|
|
Term
| Which condition is characterized by the production of auto-antibodies against the glomerular basement membrane? How does this condition present? |
|
Definition
| Goodpasture's disease: typically presents as glomerulonephritis and pulmonary hemorrhage predominately affecting males with a bimodal age distribution between 20-30 and 60-70. |
|
|
Term
| What is a major PE difference between CRAO and CRVO? What pupil defect with they both have? |
|
Definition
CRAO will have the class cherry-red spot on the fovea. CRVO will have a blood and thunder fundus.
They will both have Marcus-Gunn pupil (APD) and present with sudden painLESS vision loss. |
|
|
Term
| What does a positive hydrogen breath test indicate? |
|
Definition
|
|
Term
| What is the most common etiologic cause of diarrhea in a patient with HIV? |
|
Definition
|
|
Term
| What is the most common etiology of enteritis in the US? |
|
Definition
|
|
Term
| What is the most common presenting symptom of children with previously undiagnosed SS disease? |
|
Definition
| Acute dactylitis: non-erythematous sausage shaped swelling of a digit that is very tender. |
|
|
Term
| What is the management of a healthcare worker with a history of BCG vaccine and a 14mm induration on PPD. |
|
Definition
|
|
Term
| What is the most common cause associated condition with acanthosis nigricans? What rarer condition can also cause it and should be considered? |
|
Definition
Most commonly associated with obesity or obesity-related diabetes.
People with cancers of the GI or GU tract can also develop acanthosis nigricans. |
|
|
Term
| What is the initial treatment of choice for tinea faciale, corporis, cruris or pedis? |
|
Definition
|
|
Term
| What is the initial treatment of choice for tinea capitis or widespread other tinea skin infections? |
|
Definition
| Oral antifungals (griseofulvin, terbinafine, itraconazole) |
|
|
Term
| Individuals with what condition should avoid consuming diet drinks that contain aspartame? |
|
Definition
|
|
Term
| What nutrient is commonly deficient in vegetarians? |
|
Definition
|
|
Term
Describe the MOA for the following diuretic classes:
Carbonic Anhydrase Inhibitors
Thiazides
Potassium-sparing
Loop: |
|
Definition
CAI: act on the PCT by inhibiting carbonate from being reabsorbed in the interstitium leading to increased sodium, bicarbonate, and water in the urine.
Thiazides: They inhibit sodium reabsorption in the distal tubule, thus keeping water in the urine.
Potassium-sparing: act as aldosterone receptor antagonists in the distal tubule causing more water and sodium to pass through the tubule.
Loop: inhibit the reabsorption of sodium in the thick ascending loop increasing sodium and water loss. |
|
|
Term
| What are the causative organisms for Chagas' disease and African Sleeping Sickness? |
|
Definition
Chagas: Trypanosoma cruzi.
ASS: Trypanosoma brucei. |
|
|
Term
| What is the typical presentation, lab findings and treatment for someone with amebic liver disease. |
|
Definition
Presentation: Abdominal pain, mild fever, anorexia, diarrhea and hepatomegaly.
Labs: leukocytosis and liver US will show abscess.
Tx: Oral Flagyl x 10 dyays |
|
|
Term
| What are the 2 triple drug therapies used for H. pylori? |
|
Definition
1. PPI + amox + clarithromycin
2. PPI + flagyl + clarithromycin
*Each are taken BID x 2 weeks |
|
|
Term
Describe the typical stroke symptoms seen with infarction of the following areas:
Cerebral cortex
Brain stem
Pons
Cerebellum |
|
Definition
Cerebral cortex: produce contralateral motor and sensory findings in the limbs and contralateral cranial nerve deficits (e.g. right arm and right facial paralysis).
Brain stem: results in "crossed findings" (e.g. ipsilateral facial weakness and contralateral arm weakness).
Pons: result in coma, miosis, gaze paresis, and altered respiratory patterns.
Cerebellum: produce nystagmus, dizziness, nausea and vomiting, and inability to stand or walk. |
|
|
Term
| What is the preferred treatment for a thrombosed external hemorrhoid? |
|
Definition
| Excision of the area under local anesthesia |
|
|
Term
Define the following mental coping mechanisms:
Displacement
Projection
Sublimation |
|
Definition
Displacement: a destructive reaction redirected at a target other than the direct cause of the emotion.
Projection: the perceiving of one's own emotions and thoughts as actually originating from within other people.
Sublimation: mechanism that seemingly converts the anxiety of tragedy and trauma into behaviors of a constructive or creative nature, such as drawing or painting. |
|
|
Term
Describe what is meant by the following HAV blood markers:
Anti-HAV IgG
Anti-HAV IgM |
|
Definition
Anti-HAV IgG: indicates previous infection or immunity.
Anti-HAV IgM: indicates acute infection |
|
|
Term
| According to the Duke database, what 3 factors would lead a patient to undergo CABG vs PCI? |
|
Definition
Proximal LAD lesion
Triple vessel disease
Double vessel disease with diabetes |
|
|
Term
| What 2 medications can be used to treat the claudication with peripheral artery disease? |
|
Definition
cilostazol (Pletal)
pentoxifylline (Trental) |
|
|
Term
| How can edema from varicose veins be differentiated from lymphedema? |
|
Definition
| The edema from varicose veins will resolve spontaneously after elevating her legs, the edema from lymphedema will not. |
|
|
Term
| What is the most common primary tumor to metastasize to the heart? |
|
Definition
|
|
Term
| Where is the likely occlusion in an individual with claudication symptoms in the buttock or thighs? How about their calves? |
|
Definition
Buttock/thigh: aortoiliac.
Calf: popliteal. |
|
|
Term
| Prominent U waves on EKG is indicative of what? |
|
Definition
|
|
Term
| What condition will cause a fixed split of S2? Fixed narrowing? |
|
Definition
Split: ASD.
Narrow: Increased pulmonary vascular resistance. |
|
|
Term
| What should be suspected in an individual complaining of heart palpitations and pre-syncopal episodes? |
|
Definition
|
|
Term
| In an individual with a history of an MI 3 years ago who presents with HTN uncontrolled on HCTZ only, which class of medication should be added next? |
|
Definition
|
|
Term
| Describe the differences in the plaques seen with lichen planus, pityriasis rosea, psoriasis and atopic dermatitis. |
|
Definition
Lichen planus: acute eruption involving the flexor surfaces. 5 P's (pruritic, planar, polyangular, purple papules).
Pityriasis: typically confined to the trunk, starts as a single plaque and spreads.
Psoriasis: silvery-white plaques typically involving the elbows, knees and scalp.
Atopic dermatitis: Will occur in an individual with a hx of allergic rhinitis, asthma and/or asthma. It is characterizes by dry skin, lichenification and plaque formation. |
|
|
Term
| What is the hallmark presentation of bullous pemphigoid? |
|
Definition
| Tense bullae overlying erythematous plaques usually on the lower abdomen, groin or flexural areas on the extremities in elderly patients. |
|
|
Term
| What is the typical presentation of dermatitis herpetiformis? |
|
Definition
| Chronic itchy rash made of bumps and blisters, seen commonly in those with Celiac sprue. |
|
|
Term
| If a patient being treated for acne begins to report symptoms of headache and blurred vision, what is the diagnosis and what medication were they most likely taking? |
|
Definition
| Pseudotumor cerebri, a known complication of minocycline and also Accutane. |
|
|
Term
| How does vit C deficiency (scurvy) present? |
|
Definition
| Lethargy, myalgias, petechiae around hair follicles, corkscrew hairs and gingival/GI bleeding. |
|
|
Term
| What condition is characterized by lichenification secondary to scratching? |
|
Definition
|
|
Term
| What is the typical presentation of a patient with a pontine hemorrhage? |
|
Definition
| Coma, pinpoint reactive pupils, quadriplegia and decerebrate posturing. |
|
|
Term
| What is the etiologic agent for cat-scratch fever? |
|
Definition
|
|
Term
| What is the most common pathogen from a cat bite? |
|
Definition
|
|
Term
| Injury to what spinal cord level will cause sensory deficit at the nipples? |
|
Definition
|
|
Term
| Describe the etiology of a subdural hematoma. |
|
Definition
| Due to rupture of the superficial bridging veins usually caused by rapid acceleration-deceleration injury to the head. |
|
|
Term
| Describe an epidural hematoma. |
|
Definition
| Usually the result of a skull fracture across the middle meningeal artery. It presents with the classic "lucid internval" in which they act normal but then deteriorate rapidly. |
|
|
Term
| Describe the typical H&P findings with anterior uveitis. |
|
Definition
| Ciliary flush, conjunctival injection, small irregular pupil on the affected side and is commonly seen with inflammatory conditions (RA, SLE, Reiter's, etc) |
|
|
Term
| Which class of medications is responsible for the most drug related deaths? |
|
Definition
|
|
Term
| What condition can be diagnosed by the presence of calcium oxalate crystals in the urine? |
|
Definition
| Ethylene glycol ingestion. |
|
|
Term
| Describe the typical bite of a black widow spider. |
|
Definition
| Pain begins as a pinprick sensation and then forms a target lesion and spreads quickly to involve the entire extremity. They will then develop muscle cramps/spasms in the large muscle groups involved. |
|
|
Term
| What is the initial diagnostic step in the workup of short stature? |
|
Definition
| Radiographs of the left hand/wrist to determine the bone age by comparing the growth plates with age norms. |
|
|
Term
| In the management of a symptomatic hypoglycemic patient, at what blood glucose levels should fluids and solids be given? |
|
Definition
| Below 60 should give fluids, above give solids. |
|
|
Term
| How may carbamazepine and lithium affect urine output as a SE? |
|
Definition
| Carbamazepine: can cause SIADH. Lithium: can cause nephrogenic DI. |
|
|
Term
| What is the most common ectopic ACTH secreting tumor to cause Cushing's syndrome? |
|
Definition
|
|
Term
| Describe the typical presentation of primary biliary cirrhosis. |
|
Definition
| Most commonly affects women over the age of 30, it is usually asymptomatic at the time of diagnosis and is detected on routine blood work. Patients will require a liver transplant. |
|
|
Term
| During which season is Rotavirus and Norwalk virus most common? |
|
Definition
|
|
Term
| What is the difference between an incarcerated and strangulated hernia? |
|
Definition
Incarcerated: the hernia is not reducible but the blood supply is not compromised.
Strangulated: the hernia is irreducible and the blood supply is compromised. |
|
|
Term
| What is the recommended colonoscopy follow up for an individual who had colorectal cancer removal during their present colonoscopy? |
|
Definition
| 3 years and if that is normal, 5 years for the next one. |
|
|
Term
| What causes Pellagra and what are the typical symptoms? |
|
Definition
| Caused by Niacin deficiency. Typical symptoms include the 3 Ds: dermatitis, diarrhea and dementia. |
|
|
Term
| Describe the typical presentation of an AIDS patient with cryptococcal meningitis. |
|
Definition
| Typically have a headache and fever only. They usually have normal mental status and less than 20% have meningismus. |
|
|
Term
| What is the appropriate management of a needle stick of a person who is HIV positive? |
|
Definition
| zidovudine and lamivudine for 4 weeks |
|
|
Term
| What monitoring parameter is used to detect efficacy of HIV antiviral therapy? |
|
Definition
|
|
Term
| What is the treatment course for an infant born to an HIV positive mom who is on antiretrovirals? |
|
Definition
| Continue the prophylaxis for the infant for the first 2 weeks of life. |
|
|
Term
| The drug of choice for TB prophylaxis is? |
|
Definition
| Isoniazid for 6-12 months |
|
|
Term
| What antibiotics would you NOT use to treat strep throat in an individual who also has mono? Why? |
|
Definition
| Do not use amoxicillin or ampicillin because they have been shown to cause a rash when the patient has mono as well as the strep throat. |
|
|
Term
| What is the appropriate treatment regimen for acute Clostridium tetani infection? |
|
Definition
| Tetanus immune globulin, tetanus toxoid and metronidazole |
|
|
Term
| Describe the MOA for class I-IV antiarrythmics. |
|
Definition
I: block sodium channels
II: beta blockers
III: block potassium channels
IV: block calcium channels |
|
|
Term
| What are the 2 main class 1A antiarrythmics? What are their indications? |
|
Definition
Procainamide and Quinidine.
They can be used in A fib/flutter and ventricular arrhythmias. |
|
|
Term
| Describe the toxicities associated with the class 1A antiarrhythmics. |
|
Definition
| Procainamide causes a lupus like syndrome and prolongs the QT interval. Quinidine prolonges the QT interval. |
|
|
Term
| What is the main class 1B antiarrhythmic? What is it used to treat? |
|
Definition
| Lidocaine, used in the treatment of V Fib or pulseless V tach. |
|
|
Term
| What is the common AE of all class 1 antiarrythmic drugs? |
|
Definition
| They all prolong the QT interval. |
|
|
Term
| What anti-arrhythmic class is Amiodarone? What are its indications? Common side effects? |
|
Definition
It is class III.
Indications: SVTs, Vtach, Vfib.
Common SEs: pulmonary toxicity, hepatotoxicity, hypo/hyperthyroidism and QT prolongation. |
|
|
Term
| Describe the differences in laboratory findings between Cushing's disease and syndrome. |
|
Definition
| The disease is due to excess ACTH production by the pituitary or ectopic foci, syndrome is due to excess endogenous intake so ACTH will be supressed. |
|
|
Term
| What is the dexamethasone suppression test used to diagnose? |
|
Definition
|
|
Term
| Describe the differences between primary and secondary adrenal insufficiency. |
|
Definition
Primary (Addison disease): ACTH is markedly elevated due to lack of response from the adrenal glands so cortisol will be low.
Secondary: ACTH is not produced from the pituitary so it will be low as well as cortisol levels. |
|
|
Term
| What diagnostic test is used to diagnose Addisons disease? |
|
Definition
| ACTH stimulation test (aka cosyntropin test) |
|
|
Term
| Describe the conditions seen with MEN1, MEN2a and MEN2b. |
|
Definition
| MEN1: Parathyroid adenomas, ZES and pituitary adenomas. MEN2a (Sipple syndrome): Medullary thyroid carcinoma, Pheochromocytoma and Parathyroid hyperplasia. MEN2b: Medullary thyroid carcinoma, Pheochromocytoma, Mucosal neuromas and Marfanoid habitus. |
|
|
Term
| What is the main AE seen with the chemotherapy drug, Bleomycin? |
|
Definition
|
|
Term
| What is the main AE seen with the chemotherapy drug, Vincristine? |
|
Definition
|
|
Term
| What is the main AE seen with the chemotherapy drug, Cyclophosphamide? |
|
Definition
|
|
Term
| What are the main AEs seen with the chemotherapy drug, Cisplatin? |
|
Definition
| Nephrotoxic, neurotoxic and ototoxic. |
|
|
Term
| What is the main AE seen with the chemotherapy drug, Doxorubicin? |
|
Definition
|
|
Term
| Describe when a PPD would be considered positive if it is greater than 5, 10 or 15mm of induation. |
|
Definition
5mm: if patient is immunosuppressed.
10mm: if patient is high risk due to occupation or socioeconomic factors.
15mm: no known risk factors. |
|
|
Term
| What is the preferred tetanus prophylaxis for a contaminated wound and an unknown tetanus vaccination status? |
|
Definition
|
|
Term
| When are breast MRIs the screening modality of choice? |
|
Definition
| If they have a prior hx of breast cancer or they are BRCA positive. |
|
|
Term
| A 2 year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears nontoxic with a respiratory rate of 42 breaths per minute. What is the suspected diagnosis and next step in the evaluation of this patient? |
|
Definition
| Foreign body aspiration, CXR. |
|
|
Term
| What medication is considered first line for absence seizures? |
|
Definition
|
|
Term
| What is the only anti-hyperglycemic therapy indicated for DKA following fluid resuscitation? |
|
Definition
| IV regular insulin is the only anti-hyperglycemic therapy indicated for DKA. |
|
|
Term
| Which condition manifests as difficulty swallowing, difficulty breathing, tender cervical LAD and a gray-tan pseudomembrane in the back of the pharynx? |
|
Definition
|
|
Term
| A lesion of the optic chiasm will produce what condition? |
|
Definition
|
|
Term
| What maneuvers are specific to enhancing the murmurs of aortic regurgitation and mitral stenosis? |
|
Definition
AR: sitting up and leaning forward.
MS: laying in the left lateral decubitus position. |
|
|
Term
| What laboratory test should be closely monitored in those taking long-term lithium treatment? |
|
Definition
| TSH, it can cause hypothyroidism. |
|
|
Term
| What is the suspected etiology in a patient with a history of diarrhea who presents to the ER with symptoms of Guillain-Barre syndrome? |
|
Definition
|
|
Term
| What is done during delivery of a baby by an HIV positive mom to prevent transmission to the baby? |
|
Definition
| C-section is performed prior to the onset of labor and rupture of membranes. |
|
|
Term
| What dietary recommendation can reduce the recurrence of nephrolithiasis? |
|
Definition
| Increase fluid intake x 2 |
|
|
Term
| How does pulmonary fibrosis appear on CXR? |
|
Definition
| Bilateral, patchy, ground-glass infiltrates. |
|
|
Term
| What antibiotics can be used in the prophylaxis of household contacts to a patient with bacterial meningitis? |
|
Definition
| Rifampin, cipro, levaquin, azithromycin and recephin |
|
|
Term
| What is the best long term treatment for MS? best for acute exacerbations? |
|
Definition
Long term is Interferon beta 1a thereapy (Avonex).
Acute exacerbation is with methylprednisolone. |
|
|
Term
| Describe the LDL goals based on number of risk factors. |
|
Definition
Under 160: 0-1 risk factors.
Under 130: 2+ risk factors.
Under 100: CHD or DM. |
|
|
Term
| What are the first and second line treatments for trigeminal neuralgia? |
|
Definition
First is carbamazepine.
Second is Stereotactic (Gamma knife) radiosurgery. |
|
|
Term
| What is steatorrhea indicative of? |
|
Definition
| Malabsorption syndromes such as celiac sprue |
|
|
Term
| What medication classes can be used to treat acute psychosis in schizophrenia? |
|
Definition
| BZDs or typical antipsychotics |
|
|
Term
| Describe the difference between Terry's nails and Beau's lines on nails. |
|
Definition
Terry: nail plate turns white with a distal band of reddish-brown, seen with liver disease.
Beau: transverse depressions of the nails and are usually bilateral and result from temporary disruption of proximal nail growth from systemic illness. |
|
|
Term
| How can spinal stenosis be differentiated from PAD? |
|
Definition
| The claudication resolves with rest for both but the distal pulses will be diminished with PAD. |
|
|
Term
| What is meant by "ideas of reference"? |
|
Definition
| It is part of an abnormal thought content seen with schizophrenia where they think people on television or in newspapers are always talking about you but they just do not use your name. |
|
|
Term
| What type of incontinence is oxybutynin (Ditropan) used to treat> |
|
Definition
|
|
Term
What test is performed in adults with new onset of nephrotic syndrome to determine the cause of the
proteinuria and to guide management decisions? |
|
Definition
|
|
Term
| Briefly describe the differences between type I-IV hypersensitivity reactions. |
|
Definition
I: anaphylaxis, IgE mediated.
II: cytotoxic, IgG and IgM mediated.
III: immune complex (rheumatologic conditions), mainly IgG.
IV: delayed hypersensitivity, due to T lymphocytes and/or macrophages. |
|
|
Term
| What type of hypersensitivity reaction is the tuberculin skin test? |
|
Definition
|
|
Term
| Is an S3 or S4 always pathologic? |
|
Definition
|
|
Term
| Describe when the pregnant uterus should be palpable at the level of the pubic symphysis, midway between the pubic symphysis and umbilicus and at the level of the umbilicus. |
|
Definition
8 weeks just palpable at the pubic symphysis.
16 weeks at midpoint between pubic symphysis and umbilicus.
20 weeks at umbilicus. |
|
|
Term
| Describe the difference between Argyll-Robertson, Adie's tonic and Marcus-Gunn pupils and what conditions cause them. |
|
Definition
ARP: bilateral small pupils which accommodate to near vision but do not react to light, seen commonly with neurosyphilis.
Adie's: Abnormally dilated pupil which does not respond to light, caused by viral or bacterial infection that damages the neurons in the ciliary ganglion.
Marcus-Gunn: Afferent pupilary defect characterized by apparent dilation of the affected eye during the swinging flashlight test, usually caused by a lesion of the optic nerve. |
|
|
Term
| What is indicative of a positive Congo Red Stain? |
|
Definition
|
|
Term
| Which composition of kidney stone is associated with an infectious cause? |
|
Definition
|
|
Term
| For which cause of HTN would ACEIs be contraindicated? |
|
Definition
|
|
Term
| Abnormal urinary protein excretion is defined as? |
|
Definition
|
|
Term
| Glucose will spill into the urine when the serum levels reach what threshold? |
|
Definition
|
|
Term
| A unilateral small kidney on US suggests what? |
|
Definition
| Renal artery stenosis - the kidney not receiving enough blood supply will atrophy |
|
|
Term
| Which organism is most likely to colonize an in-dwelling catheter? |
|
Definition
|
|
Term
| What is the most common cause of nephrotic syndrome in kids? |
|
Definition
|
|
Term
| What organism is responsible for hte majority of peritonitis in individuals undergoign peritoneal dialysis? |
|
Definition
|
|
Term
| What is the treatment for an asymptomatic carotid bruit? Symptomatic? When is surgery indicated? |
|
Definition
Asx: daily ASA.
Sx: coumadin.
When they go over 70% they become surgical candidates. |
|
|
Term
| Describe the differences between simple and complex partial seizures. |
|
Definition
| Both involve no loss of consciousness. Simple have no alteration in consciousness but complex have a preceeding sensory aura followed by an impairment in consciousness, but no LOC. |
|
|
Term
| What is the most appropriate initial treatment for a newly diagnosed MS patient? |
|
Definition
|
|
Term
| What medication can be used to reduce the size of uterine leiomyomatas or endometriosis? |
|
Definition
|
|
Term
| Most common pathogen for PID? |
|
Definition
|
|
Term
| What is the most common bone tumor in children? How does it appear on xray? |
|
Definition
| Osteochondroma, appears as pedunculated lesion that resembles a cartilaginous cap on a bony stalk. |
|
|
Term
| Describe Ramsay-Hunt Syndrome. |
|
Definition
| Caused by the Herpes-Varicella virus and it causes intense ear pain, vesicles on the pinna, and facial paralysis. |
|
|
Term
| How do many macrolides and statins interact? |
|
Definition
| The macrolides inhibit the CYP3A4 enzyme and thus decrease the excretion of statins. This leads to elevated blood levels and higher risk for myopathy and other SEs. |
|
|
Term
| What in a patients PMH would make the triptan group of meds contraindicated? |
|
Definition
| History of cerebrovascular disease bc they vasoconstrict the cerebrovasculature. |
|
|
Term
| What is the net MOA of the anti-Alzheimers medications Aricept and Exelon? |
|
Definition
| They inhibit acetylcholinesterase. |
|
|
Term
| Describe the symptoms seen with Herpangina. What is the causative agent? |
|
Definition
Caused by coxsackie virus.
Sx: high fever, vomiting, possible febrile seizures and anterior tonsillar pillar petechiae that become ulcers. |
|
|
Term
| What is the diagnostic test of choice for scabies? |
|
Definition
| Skin scraping with immersion oil |
|
|
Term
| What are the indications and most common side effect for electroconvulsive therapy? |
|
Definition
Indications: Severe depression, depression in pregnancy, refractory mania, neuroleptic malignant syndrome and catatonic schizophrenia.
SE: amnesia. |
|
|
Term
| What is the preferred initial treatment for a single isolated wart? What about large and painful warts? |
|
Definition
Single: liquid nitrogen.
Large/painful: 40% salicylic acid. |
|
|
Term
| What is the cause of bronchiolitis and croup? |
|
Definition
Bronchiolitis: RSV.
Croup: parainfluenza virus. |
|
|
Term
| Describe primary, secondary and tertiary prevention. |
|
Definition
Primary: preventing disease before it occurs.
Secondary: early detection of existing disease.
Tertiary: therapeutic procedures. |
|
|
Term
| Define incidence and prevalence. |
|
Definition
Incidence: new cases of a disease in a population.
Prevalence: existing number of cases of a disease in a population at a given time. |
|
|
Term
| What complication is seen in anorexia but not bulimia? |
|
Definition
|
|
Term
| Describe the most common SE or SEs of isoniazid and rifampin. |
|
Definition
Isoniazid: hepatotoxicity and peripheral neuropathy.
Rifampin: red-orange urine. |
|
|
Term
| What is the suggestive radiologic findings with chronic silicosis? |
|
Definition
| eggshell calcification of enlarged hilar lymph nodes |
|
|
Term
| What is the preferred treatment for apnea of the premature infant? |
|
Definition
| Methylxanthines (caffeine citrate) |
|
|
Term
| Describe the 3 stages of pertussis. |
|
Definition
1: catarrhal - infectious but no symptoms.
2: paroxysmal - marked by the onset of coughing.
3: convalescent - resolution. |
|
|
Term
| What is considered the first line treatment option for COPD? |
|
Definition
|
|
Term
| When are tocolytics and steroid supplementation recommended in a pregnancy with PROM or premature labor? |
|
Definition
|
|
Term
| What is the management of PROM before 32 weeks? After 32 weeks? |
|
Definition
Before 32 weeks: tocolytics, steroids, antibiotics (unless GABHS status is known).
After 32 weeks: antibiotics (unless GABHS status is known to be negative) |
|
|
Term
| What is the next step in the management of a pregnancy at 32 weeks where the mother has felt few metal movements in the past 20 hours? What is that test is reactive? What if that test is nonreactive? What if that test is also nonreactive? |
|
Definition
| Non-stress test, if that test is reactive, do NSTs weekly until delivery, if that is nonreactive, add vibroacoustic stimulation, if that is still nonreactive, do a biophysical profile. |
|
|
Term
| What are the 5 components of the biophysical profile during pregnancy? How is it scored? |
|
Definition
1: NST
2: US for movement
3: US for muscle tone
4: US for breathing
5: US for amniotic fluid level
It is scored on a scale of 0 or 2, with 2 being normal. A score of 8 or 10 is considered reassuring. |
|
|
Term
| Anti-mitochondrial antibodies are seen most commonly in which condition? What is the most common presenting presentation of this condition? |
|
Definition
Primary biliary cirrhosis (95%) among a few other autoimmune diseases.
It commonly presents in a middle aged female with pruritis or asymptomatic on routine labs. |
|
|
Term
| What is the preferrent treatment for symptomatic aortic stenosis? |
|
Definition
|
|
Term
| What is the typical presentation of an anterior cerebral artery occlusion? |
|
Definition
| Contralateral weakness worse in the lower extremities. |
|
|
Term
| What kind of tumor presents with a "soap bubble" appearance in the end of long bones on xray? |
|
Definition
|
|
Term
| An individual with COPD will develop signs of right sided heart failure through what mechanism? |
|
Definition
| Chronic hypoxia leads to constriction of the pulmonary arteries and pulmonary HTN. |
|
|
Term
| What disease has has a high correlation with women with PCOS? |
|
Definition
|
|
Term
| What are the potential uses of the medications, Clomid, Tamoxifen, Lupron. |
|
Definition
| Clomid: ovulation and spermatogenesis induction, endometriosis/PCOS who desire fertility. Tamoxifen: breast cancer treatment and prevention. Lupron: endometriosis, uterine fibroids, PCOS, prostate cancer. |
|
|
Term
| What is the major AE associated with tamoxifen? |
|
Definition
|
|
Term
| How long after an acute bipolar episode must a patient be asymptomatic to be considered for taper/discontinuation of lithium or valproic acid? |
|
Definition
|
|
Term
| What is the abx of choice after I&D of a peritonsillary or retropharyngeal abscess in a pediatric? |
|
Definition
| dicloxacillin bc it could be staph or strep. Amox or PCN would be ok for strep but not staph. |
|
|
Term
| Which medications/classes have shown to improve survival rates in patients with CHF? Which medications are used but only provide symptomatic relief? |
|
Definition
Decrease mortality: ACEI, ARB, BB, ASA and K sparing diuretics.
Only sx: Loop diuretics and digoxin. |
|
|
Term
| What are 2 common health complications seen with Turner's syndrome? |
|
Definition
| Cardiovascular abnormalities (CoA or aortic valve abnormalities) and osteoporosis. |
|
|
Term
| What is the most likely explanation for a chronic smoker with HTN, DM and OA who has decreased serum calcium, increased serum phosphate and increased serum PTH levels? |
|
Definition
| ESRD causing secondary hyperparathyroidism |
|
|
Term
|
Definition
| When women with a strong desire to become pregnant will begin to experience symptoms of pregnancy but will be negative at the office on testing. It is a form of conversion disorder. |
|
|
Term
| How does leprosy present in the early stages? |
|
Definition
| Usually as a insensate, hypopigmented plaque. |
|
|
Term
| What is a common complication of subclavian central venous catheter placement? |
|
Definition
|
|
Term
| How does primary open angle glaucoma usually present? |
|
Definition
| Gradual loss of peripheral vision to eventual tunnel vision. Common in those with DM. |
|
|
Term
| Describe the pleural values of protein, LDH and pH that would differentiate transudative vs exudative pleural effusions. |
|
Definition
| Transudating: pleural protein should be less than 50% of serum, pleural LDH should be less than 60% of serum and pleural pH should be greater than 7.3 |
|
|
Term
| What type of skin cancer is most likely to arise from non-healing or old wounds? |
|
Definition
|
|
Term
| Describe the tetanus prophylaxis for minor/clean wounds and severe/dirty wounds in individuals who are unimmunized, had their last shot more than 10 years ago and had their last shot within the past 10 years. |
|
Definition
Minor/clean: Td toxoid for unimmunized or more than 10 years, no treatment for less than 10 years.
Severe/dirty: Td and TIG for unimmunized and more than 10 years, Td if latest booster was more than 5 years ago. |
|
|
Term
| How do you treat a pregnant women with syphilis who is allergic to PCN? |
|
Definition
| PCN desenitization, cannot use macrolides bc they do not cross the placenta and you want to treat mom and baby. |
|
|
Term
| What condition is common among those with an occupational history of mining, shipbuilding, insulation or pipe work? What are the typical x-ray findings? What type of cancers does this condition make more likely in this patient? |
|
Definition
Asbestosis.
CXR findings include interstitial abnormalities of the lower lung fields consistent with pulmonary fibrosis, pleural plaques (mesothelioma) and solitary masses (bronchogenic carcinomas).
The most common cancer with asbestosis is bronchogenic carcinoma but the only known cause of mesothelioma is asbestosis. |
|
|
Term
| What medications can be used to treat malignant neuroleptic syndrome? |
|
Definition
| Dantrolene, amantadine or bromocriptine. |
|
|
Term
| What medication is typically used to treat any extrapyramidal symptoms associated with antipsychotic use? |
|
Definition
|
|
Term
| What is the most likely diagnosis in a pediatric patient with a rash with eosinophils found in the pustules? |
|
Definition
|
|
Term
| Most enzyme deficiency conditions are what type of inheritance? |
|
Definition
|
|
Term
| What does the herterophile antibody test used for? |
|
Definition
|
|
Term
| How does EHEC typically present? |
|
Definition
| Lower abdominal pain, diarrhea which progresses to bloody, and absence of fever. |
|
|
Term
| What is the predominant pathology behind Paget's disease of the bone? |
|
Definition
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Term
| Describe the ACLS protocol for pulseless VT or VF. |
|
Definition
1. Unsynchronized shock
2. CPR, (if still in VT/VF) then
3. Unsynchronized shock
4. CPR, (if still in VT/VF) then
5. IV epi or vasopressin
6. Unsynchronized shock
7. CPR, (if still in VT/VF) then
8. IV Amiodarone or Lidocaine |
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Term
| What is the classic triad for disseminated gonococcal infection? |
|
Definition
| Polyarthralgia, tenosynovitis and painless vesiculopustualar skin lesions. |
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|
Term
| What is the best way to prevent ARF following iv contrast dye administration? |
|
Definition
| IV fluid hydration prior to procedure |
|
|
Term
| Describe the common presentation of a fat embolism. |
|
Definition
| Patients with fractures of long bones develop respiratory distress, petechial rash, subconjunctival hemorrhage and the normal tachycardia/tachypnea/fever. |
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Term
| What is the management for stress, urge and overflow incontinence? |
|
Definition
Stress: Kegal exercises, pseudoephedrine and urethropexy for definitive treatment.
Urge: Kegal exercises, bladder training and oxybutynin.
Overflow: Bethanechol and alpha-blockers. |
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Term
| What is the most likely etiology of meningitis with a petechial rash? |
|
Definition
| N meningitidis (Meningococcus) |
|
|
Term
| What is the treatment for a infant with suspected chlamydia conjunctivitis? |
|
Definition
Oral Erythromycin.
Not topical bc you want to decrease risk for Chlamydia pneumonia |
|
|
Term
| How can you differentiate S. pneumo from PCP pneumonia in an HIV infected patient through PE and CXR? |
|
Definition
S. pneumo will have productive cough and lobar consolidation on CXR.
PCP will have nonproductive cough and bilateral diffuse infiltrates on CXR. |
|
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Term
| What is the appropriate managment of a 37 week pregnancy who is not in active labor and baby is in the frank breech position? |
|
Definition
| External cephalic version (must have prior arrangements for emergent C-section due to potential risk of fetal distress though) |
|
|
Term
| What is the preferred method of diagnosing an acute gouty attack? |
|
Definition
Synovial fluid analysis.
*serum uric acid levels are not sensitive for diagnosing acute gouty attacks |
|
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Term
| A patient undergoes a LEEP procedure for CIN II, what is her recommended follow up and when can she resume a normal follow up schedule? |
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Definition
| She should have a PAP with or without colposcopy every 6 months. If she has 3 consecutive negative samples, she can resume normal follow up intervals. |
|
|
Term
| Explain how you can differentiate primary vs secondary hyperparathyroidism. |
|
Definition
| Primary is usually due to a parathyroid adenoma and will have elevated PTH and serum calcium. Secondary is most commonly due to ESRD which leads to vitamin D deficiency so calcium is not absorbed. Secondary will have elevated PTH but low serum calcium levels. |
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|
Term
Describe the general findings with the following kidney diseases:
Minimal change disease
Berger's Disease
Goodpastures
Wegeners |
|
Definition
Minimal change: common among children, seen after viral illness and have characteristic foot-process effacement on electron microscopy.
Berger: IgA nephropathy, recurrent painless hematuria, also preceeded by a viral infection.
Goodpasture: anti-GBM antibodies cause pulmonary hemorrhage and glomerulonephritis, usually preceeded by a viral illness.
Wegener: triad of upper/lower respiratory involvement and glomerulonephritis. |
|
|
Term
| Name and describe the function of the cranial nerves. |
|
Definition
I - Olfactory: smell.
II - Optic: visual acuity.
III - Oculomotor: medial/inferior/superior rectus and inferior oblique.
IV - Trochlear: superior oblique.
V - Trigeminal: facial sensation.
VI - Abducens: lateral rectus.
VII - Facial: facial motor function.
VIII - Vestibulocochlear: balance and hearing.
IX - Glossopharyngeal: gag reflex, swallowing and phonation.
X - Vagus: gag reflex, swallowing and phonation.
XI - Accessory: SCM and trapezius motor.
XII - Hypoglossal: tongue motor function. |
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|
Term
| Describe the main differences between anorexia and bulimia. |
|
Definition
| Anorexia can be of the fasting or exercising (restriction) subtype or of the binge eating followed by laxative or vomiting (binge/purge) subtype. The main difference is that anorexia will have a weight that is below normal and bulimia will have a normal or slightly above normal BMI. If they binge/purge but are underweight then they are considered anorexic, not bulimic. |
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|
Term
| What type of surgery is likely to cause short bowel syndrome, afferent loop bacterial overgrowth and dumping syndrome? |
|
Definition
Short bowel: massive resection of bowel resulting in malabsorption diarrhea.
Bacterial overgrowth: any condition that creates an afferent loop such as a billroth I or II for a bleeding gastric ulcer.
Dumping: Seen after gastrectomy procedures where hypertonic gastric contents are emptied straight into the small intestine which causes a shift of fluid from the intravascular space into the small intestine. |
|
|
Term
| What is the serious SE of the chemotherapeutic agent, Methotrexate? |
|
Definition
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|
Term
| Describe the most common causes for dilated, restrictive and hypertrophic cardiomyopathies. |
|
Definition
Dilated: Idiopathic, HTN, ischemia, alcoholism, post viral-myocarditis.
Restrictive: Idiopathic, sarcoidosis, amyloidosis, hemochromatosis, radiation fibrosis.
Hypertrophic: Usually congenital. |
|
|
Term
| Describe the typical extra heart sounds heard with each of the cardiomyopathies. |
|
Definition
Dilated: S3 (possible S4).
Restrictive: S3 and S4.
Hypertrophic: S4 (possible S3). |
|
|
Term
| What is the best lab to draw for a patient who had an AMI 4 days prior and underwent PCI, who now presents with new onset chest pain? |
|
Definition
| CK-MB because troponins have not come down to baseline yet. |
|
|
Term
| What are some of the considerations to take into account when deciding between a bare metal or drug eluding stent? |
|
Definition
Bare: only requires Plavix for 1 month but has a higher risk for restenosis.
DES: requires Plavix for 1 year but has a lower risk for restenosis. |
|
|
Term
| What is the most common cause of aortic stenosis? Regurgitation? |
|
Definition
AS: Congenital bicuspid aortic valve.
AR: HTN. |
|
|
Term
| Describe some of the differences between mechanical and bioprosthetic heart valves. When would you use one over the other? |
|
Definition
Mechanical: last 20-30 years but require lifelong anticoagulation. Consider in patients younger than 65 or in those where anticoagulation is already indicated.
Bioprosthetic: Less durable but minimally thrombogenic. Consider in those older than 65, lifespan of less than 20 years or with contraindications to anticoagulation. |
|
|
Term
| What is the typical presentation of a patient with amyloidosis? |
|
Definition
Cardiac, renal and hepatic involvement.
Restrictive cardiomyopathy, nephrotic syndrome and easy bruising. |
|
|
Term
| Which murmurs need a workup on initial diagnosis? What is the typical next step? |
|
Definition
| Diastolic, continuous and loud systolic murmurs should always be evaluated with a TTE. |
|
|
Term
| What is the best medication to treat a hypertensive patient with stable angina? |
|
Definition
|
|
Term
| What is the main indication for a cardiac electrophysiologic study? |
|
Definition
| To determine the site/focus of an arrhythmia prior to ablation or resection. |
|
|
Term
| What arrhythmia is most specific for digitalis toxicity? |
|
Definition
| Atrial tachycardia with AV block |
|
|
Term
| What would you hear on auscultation of a patient who you suspect of TAA? |
|
Definition
| Possible aortic regurgitation so a diastolic murmur. |
|
|
Term
| What are some symptoms of a patient with MVP? |
|
Definition
| Chest pain lasting 5-10 seconds, anxiety, palpitations and/or hyperventilation. Usually asx though. |
|
|
Term
Describe the following complications seen after an AMI:
Rupture of ventricular septum
Papillary muscle rupture
Ventricular free wall rupture |
|
Definition
Rupture of ventricular septum: pansystolic murmur heard best at the LSB.
Papillary muscle rupture: pansystolic murmur heard best at the apex with radiation to the axilla.
Ventricular free wall rupture: pericardial tamponade and sudden death. |
|
|
Term
| How may thiazide diuretics affect a patients metabolic and lipid panels? |
|
Definition
Metabolic: increase glucose intolerance.
Lipid: increase LDL and trigs. |
|
|
Term
| What is the classic triad of Leriche syndrome? |
|
Definition
| bilateral leg claudication, impotence and symmetric lower extremity atrophy due to chronic arterial ischemia. |
|
|
Term
| What historical finding would lead you to suspect seizure as the etiology of a patient who experienced syncope? |
|
Definition
|
|
Term
| Describe the management of asymptomatic PACs. Symptomatic? |
|
Definition
Avoid precipitating factors (tobacco, alcohol, caffeine and stress).
If symptomatic, avoid those but also start a BB.
*PACs are completely benign, the BB is just used for symptom control. |
|
|
Term
| In what scenario would a BB be contraindicated in someone having an AMI? |
|
Definition
| If they have CHF symptoms as well. Must give IV Lasix first and get rid of the fluid. |
|
|
Term
Describe the conditions that present with the following pulses:
Bounding pulses
Pulsus paradoxus
Pulsus parvus and tardus |
|
Definition
Bounding pulses: AR.
Pulsus paradoxus: cardiac tamponade.
Pulsus parvus and tardus: AS. |
|
|
Term
| What is the first line treatment regimen for cocaine induced myocardial ischemia? |
|
Definition
|
|
Term
| What is the most common cause of HTN refractory to medical management? |
|
Definition
| Renal artery stenosis (especially in those with evidence of atherosclerotic disease) |
|
|
Term
| What is the preferred diagnostic test for aortic dissection? What is the first step in the management of these patients? |
|
Definition
TEE or CT with contrast.
First step is BP control with a BB if they are hypertensive. |
|
|
Term
| An acute MI may lead to what extra heart sound? |
|
Definition
| Myocardial ischemia may lead to diastolic dysfunction and a stiffened left ventricle which would produce an S4. |
|
|
Term
| What should be considered as a cause of lower leg edema in a patient with HTN with a normal cardiac, kidney, vascular and liver workup? |
|
Definition
| They may be taking amlodipine for their HTN, peripheral edema is a common SE. |
|
|
Term
| What are the 2 primary manifestations of Chagas disease? |
|
Definition
| Toxic megacolon and cardiac disease. |
|
|
Term
| What should be considered in an otherwise healthy young patient who develops sudden CHF? |
|
Definition
| Viral myocarditis caused by coxsackie virus |
|
|
Term
| What is the main mechanism of nitroglycerine that is responsible for its anti-anginal properties? |
|
Definition
Venous dilation leading to a decrease in the ventricular preload.
*It also dilated coronary vessels but that is not the primary reason. |
|
|
Term
| What is the most common cause of mitral regurgitation? |
|
Definition
|
|
Term
| Describe the typical prodrome of a vasovagal episode. |
|
Definition
| Lightheadedness, nausea, warmth, diaphoresis, pallor, weakness and blurred vision typically brought on by an emotional stressor or activities such as urination. |
|
|
Term
| What is the treatment for lone atrial fibrillation in a patient who has no discernible cause or risk factors? |
|
Definition
ASA only
(CHADS2 score of 0) |
|
|
Term
| Define the CHADS2 scoring system for A fib. |
|
Definition
CHF: 1
HTN: 1
Age over 75: 1
DM: 1
Prior Stroke: 2
Score of 0 can just have ASA.
1-2 can have ASA or coumadin.
Over 2 should get coumadin |
|
|
Term
| How does PSVT appear on EKG? |
|
Definition
| Regular, narrow QRS complex tachycardia without definite P waves. |
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