Carestandard Set 4

Front 1

CAP TOC

Back 1

levofloxacin
gatifloxacin
- not ciprofloxacin (poor streptococcal coverage)

Front 2

lumbar spinal stenosis physical findings (4) BPPV

Back 2

bilateral leg pain while walking
pain relief on sitting
posture-dependent
vertebral disc degeneration

Front 3

tx for uncomplicated sinusitis in children < 10

Back 3

Amoxicillin

Front 4

putamen hemorrhage (CEHHHS)
- % of hypertensive hemorrhages ?
- sx ?

Back 4

35%
coma
eyes deviated away side of lesion
hemiparesis
hemi-sensory loss
hh
stupor

Front 5

cerebellar hemorrhage (AFGOV)
- % of hypertensive hemorrhages ?
- sx ?

Back 5

16%
ataxia
facial weakness
gaze palsy
occipital headache
vomiting
- no hemiparesis
- if no decompression brainstem compression may cause stupor & coma

Front 6

pontine hemorrhage
- % of hypertensive hemorrhages ?

Back 6

5-12 %
decerebrate rigidity
deep coma & paraplegia w/in minutes
no horizontal eye movements
pupils pinpoint & reactive

Front 7

no focal neurologic signs
sudden, dramatic headache
usu caused by aneurysm & vascular malformations

Back 7

subarachnoid hemorrhage

Front 8

definition of hypoxemia

Back 8

PaO2 < 80

Front 9

the 4 categories of hypoxemia

Back 9

hypoventilation
low inspired O2
shunting
V/Q mismatch

Front 10

nl A-a gradient in a young person

Back 10

< 15

Front 11

elevated PaCO2
normal A-a gradient

Back 11

hypoventilation

Front 12

hypoxemia with:
normal PaCO2
normal A-a gradient

Back 12

low inspired O2

Front 13

normal PaCO2
elevated A-a gradient
does not correct with 100% inspired O2

Back 13

shunting

Front 14

normal PaCO2
elevated A-a gradient
does correct with 100% inspired O2

Back 14

V/Q mismatch

Front 15

A-a gradient eqn ?

Back 15

PAO2 - PaO2
(Alveolar - arteriolar or ABG)

Front 16

PAO2 (Alveolar eqn) ?

Back 16

PAO2 = FiO2(760-47) - PaCO2/.8
- never figured out the 47

Front 17

elevated A-a regardless of age ?
- causes ?

Back 17

> 30
shunting
V/Q mismatch

Front 18

causes of V/Q mismatch (2)

Back 18

PEmbolism
bronchial asthma exacerbation

Front 19

causes of shunting (3)

Back 19

pulmonary edema
pneumonia (expect fever)
vascular shunt

Front 20

Adult Treatment Panel 3 (ATP 3) guidelines for hypercholesterolemia depend only on:

Back 20

LDL cholesterol

Front 21

CAD or CAD risk equivalent LDL mgt.

Back 21

goal < 100 mg/dl
> 100 lifestyle mods
> 130 drug therapy starts

Front 22

2+ CAD risk factors

Back 22

goal < 130 mg/dl
> 130 mg/dl lifestyle mods
> 160 mg/dl drug therapy starts

Front 23

0-1 risk factors LDL objectives:

Back 23

goal < 160 mg/dl
> 160 mg/dl lifestyle mods
> 190 mg/dl drugs

Front 24

risk factors for CAD

Back 24

men > 45
women > 55
htn
cigarette smoking
HDL < 40
family hx premature CAD (male<55 female<65)
HDL >60 negates one risk factor

Front 25

CAD risk equivalents (ds that impart an equal risk for MI as having had a previous MI) "PADS-10"

Back 25

PAD
AAA
DM
Symptomatic carotid artery ds
10-yr risk of CAD of > 20%

Front 26

Cholesterol measurement screening tool of the USPSTF.

Back 26

total cholesterol

Front 27

measurement of 3 or more means
measurement of 2 means
categorical data and proportions

Back 27

ANOVA
two-sample t test
chi-square test

Front 28

Dilation of pulm artery proximal to PE clot and collapse of vessels distal to the clot on CXR.

Back 28

Westermark's sign
- pulmonary embolism

Front 29

Pulmonary infiltrates corresponding to areas of pulmonary infarction on CXR in cases of PE.

Back 29

Hampton's hump.

Front 30

MC finding on CXR in PE ?

Back 30

Normal CXR

Front 31

PE signs: (AEFHPTTW)
atelectasis
elevated D-dimer
fvr, cough, hemoptysis
Hampton's hump
pleural effusion
tachypnea
tachycardia
Westermark's sign

Back 31

PE pulmonary embolism

Front 32

blunting of costophrenic angles
easily seen on lateral CXR

Back 32

pleural effusion

Front 33

chronic inflammatory joint ds causes ACD. But chronic ________ joint ds does not.
So a pale elderly person with degenerative joint ds has iron deficiency, no ACD.

Back 33

degenerative

Front 34

MC anemia in the elderly ?

Back 34

IDA

Front 35

duodenal atresia

Back 35

vomiting in 1st 24-48hr (2 days)
Down syndrome
"double bubble" - dilated stomach & duodenum

Front 36

non-bilous projectile vomiting p feeding
palpable olive-shaped abd mass
hypochloremic met alk
confirm with US

Back 36

pyloric stenosis

Front 37

recurrent bilious vomiting
abdomen distended
dilated bowel with air-fluid levels

Back 37

malrotation or atresia

Front 38

MC cause of communicating hydrocephalus.

Back 38

SAH
- can be caused by intraventricular hemorrhage in a preme.

Front 39

cystic expansion of 4th ventricle

Back 39

Dandy-Walker anomaly
- non-communicating hydrocephalus

Front 40

protrusion of structures of posterior fossa through the foramen magnum

Back 40

Chiari malformation
- non-communicating hydrocephalus

Front 41

AVN diff. (ACGSS)

Back 41

alcoholism
corticosteroid therapy
Gaucher's ds
sickle cell ds
SLE

Front 42

arteries supplying femoral head which lie in the ligamentum teres.

Back 42

ascending arteries
foveal artery (becomes obliterated later in life & explains why kids rarely have AVN of the femoral head)

Front 43

AD - positive family hx
spherocytes with loss of central pallor
extra-vascular hemolysis = nl haptoglobin

Back 43

hereditary spherocytosis

Front 44

extra-vascular hemolysis
coomb's postitive
nl platelets & RBC counts

Back 44

autoimmune hemolytic anemia

Front 45

PNH (AIIPPR)

Back 45

acquired disorder of hematopoietic cells
intravascular hemolytic anemia ("characterized by")
incr reticulocytes & LDH, decr haptoglobin
pancytopenia
portal vein thrombosis or Budd Chiari syndrome
recurrent thrombosis in unusual sites

Front 46

PNH confirmation test.

Back 46

expression of GPI-anchored proteins CD55 & CD59 using moabs and flow cytometry

Front 47

best means to ID retroperitoneal hemm in hemodynamically unstable person with negative US and diagnostic peritoneal lavage.

Back 47

pelvic angiography

Front 48

Pt with chronic Hep C (or any chronic liver ds). Tx ?

Back 48

Hep A & Hep B vaccination.

Front 49

RTI used to tx HIV & chronic Hep B

Back 49

Lamivudine (3TC)

Front 50

chest cavity
partially acid-fast, G+, branching rod
hx of corticosteroids
dx ?
tx ?

Back 50

Nocardia
TMP-SMX

Front 51

monobactam
G- bacteria including Psuedomonas

Back 51

aztreonam

Front 52

Unlike Nocardia, Actinomyces is:

Back 52

anaerobic
cervicofacial ds & sinus tracts
demonstrates sulfur granules

Front 53

bilirubin in the urine results from:
mech ?

Back 53

conjugated (direct, bound to glucuronide) hyperbilirubinemia
95% of circulating bili is unconjugated
- highly soluble in water
- bound to albumin
- this complex can't get through the glomerulous

Front 54

this is great !!!!!!
95% of circulating bilirubin: (tell story)

Back 54

1. unconjugated to glucuronide
2. bound to albumin
3. it can't get through glomerulus so it does not appear in the urine !!!!

Front 55

presence of bilirubin in urine is indicative of:

Back 55

conjugated bilirubin

Front 56

benign condition caused by defective hepatic storage of conjugated bilirubin

Back 56

Rotor's syndrome

Front 57

ISH (nl to low diastolic bp) - mech:
tx:

Back 57

aterial wall rigidity
HCTZ

Front 58

ring-shaped scaly patches with central clearing on trunk
itching

Back 58

Tinea corporis

Front 59

Non-cardiogenic pulmonary edema is:
(PCWP would be low)

Back 59

ARDS

Front 60

ARDs dx:("ABIPP")

Back 60

acute dyspnea
bilateral infiltrates on CXR
inciting condition (bleed, trauma, toxic injury)
PCWP < 18
PaO2 / FiO2 < 200
(ABIPP)

Front 61

fetal hyperinsulinism antagonizes cortisol leading to delay in lung maturation

Back 61

Cause of RDS in infant of mother with DM
- However, prematurity is MC cx for RDS

Front 62

Most sensitive indicator of dehydration in the elderly ?

Back 62

BUN / Cr

Front 63

cause of decubitus ulcer due to pressure on a bony prominence for > 2 hr.

Back 63

ischemia

Front 64

hyperactive DTRs associated with:
- expect this in early post-op

Back 64

hypocalcemia

Front 65

prevent gout in chemo induction with:

Back 65

allopurinol
(allopurinol, probenicid, colchicine used to prevent gout)
(NSAIDs (indomethacin), steroids used during acute attacks)

Front 66

functional disorder of bile formation in 2nd & 3rd trimester
pruritis
increased bilirubin

Back 66

intrahepatic cholestasis of pregnancy

Front 67

cocaine intoxication - use:

Back 67

alpha-blockers
(phentolamine)

Front 68

juvenile with epistaxis, local mass, bony erosion

Back 68

angiofibroma until proven otherwise

Front 69

massive increases in AST & ALT
milder increases in bili & alk phos

Back 69

ischemic hepatic injury

Front 70

thalassemia trait

Back 70

microcytic anemia
mildly elevated reticulocytes
RDW, MCHC, TIBC are nl
does not respond to Fe therapy

Front 71

1 way to rule out Cardiac Tamponade

Back 71

Normal BP.
Usually CT exhibits hypotension.

Front 72

Diff for Kussmaul's sign (CMRRR)
- Think Jane Seymour with Kussmal's

Back 72

constrictive peridcarditis
massive PE
restrictive cardiomyopathy (think Hemochromatosis)
RV infarction
rarely pericardial tamponade

Front 73

lasts no more than 4 weeks

Back 73

acute stress disorder

Front 74

C. difficile vs. bowel ischemia

Back 74

C. diff requires 4-5 days.
Ischemic bowel occurs day after surgery.

Front 75

lacunar stroke mech ?
MC site ?
Sx ?

Back 75

small vessel hyalinosis
posterior internal capsule (corticospinal & corticobulbar fibers)
pure motor stroke

Front 76

schizophrenia + mood symptoms
- must be at least 2 wks when psychotic sx are present w/o mood sx
mood = major depression, bipolar or mixed

Back 76

schizoaffective disorder

Front 77

4th leading cause of cancer death in the US

Back 77

pancreatic cancer

Front 78

migratory thrombophlebitis
(Trousseaus's syndrome)
Diff ? (PLPSAC)

Back 78

24% pancreatic CA
20% lung CA
13% prostate CA
12% stomach CA
9% acute leukemia
5% colon CA

Front 79

All adults should get this booster every 10 years.

Back 79

Td (Tetanus & Diphtheria)

Front 80

MC primary malignancy of bone.

Back 80

Osteosarcoma

Front 81

Normal ESR
Elevated Alk Phos
Rare systemic manifestations

Back 81

Osteosarcoma

Front 82

Definition of RR ?
Null value of RR ?
RR > 1 ?
RR < 1 ?

Back 82

mortality (or incidence) in exposed /
mortality (or incidence) in unexposed
1.0 = no association between risk & ds, CI must not contain Null value.
Exposure associated with ds.
Exposure decreases disease.

Front 83

How do ACE inhibitors decrease the damage in diabetic nephropathy ?

Back 83

they reduce intraglomerular htn and decrease glomerular damage

Front 84

order of glomerular damage in DM:

Back 84

hyperfiltration causing intraglomerular htn
thickening of the BM (1st change that can be quantified)
mesangial expansion

Front 85

ECG changes in Ao dissection result from:

Back 85

damage to right coronary ostia
http://www.cvphysiology.com/Blood%20Flow/BF001.htm

Front 86

should be given in females aged 9-26
- 29 is too old !

Back 86

HPV vaccine

Front 87

elevated in 21 & 11-hydroxylase def.
decreased in 17-hydroxylase def.

Back 87

17-OH progesterone

Front 88

MC cx of hypercalcemia in ambulatory pts.

Back 88

primary hyperparathyroidism

Front 89

Ca levels in 2ndary hyperparathyroidism ?

Back 89

Nl to low.

Front 90

Nl PTH ?
Nl Phosphorus ?

Back 90

8-24 pg / ml
3.0-4.5 mg / dl

Front 91

increased Ca2+ abs in GI tract by
conversion of 25-hydroxyvitamin D to
1,25 dihydroxyvitamin D (calcitrol)

Back 91

sarcoidosis

Front 92

Due to ADH deficiency or resistance.

Back 92

DI

Front 93

Tx for nephrogenic DI ? "HINDI"
Tx for Li-induced nephrogenic DI ? "LIAM"
Tx for central DI ?
Tx for SIADH ?

Back 93

Indomethacin, HCTZ
amiloride
DDAVP (intranasal desmopressin acetate)
Demeclocycline (worsens effect of AVP or ADH on the DCT)

Front 94

Chronic fatigue syndrome requires how long ?

Back 94

6 months

Front 95

20-50 yrs expect
> 50 years expect

Back 95

fibromyalgia
polymyalgia rheumatica (incr ESR)

Front 96

narrow QRS with tachycardia, think:

Back 96

supraventricular tachycardia

Front 97

follicular occlusion tetrad

Back 97

suppurative hidradenitis (axilla, groin)
pilonidal ds (coccyx)
dissecting folliculitis of the scalp
acne conglobata

Front 98

Name the 4 tumors that don't metastasize to the brain.
Think PrEON.

Back 98

prostate cancer
esophageal cancer
oropharyngeal cancer
non-melanomatous skin cancer

Front 99

Idiopathic Osteonecrosis of the Femoral Head. Children 4-10 yo.

Back 99

Legg-Calve-Perthes disease

Front 100

long-term neuro sequelae of bacterial meningitis: (HLMSS)

Back 100

hearing loss
loss of cognitive fns (neuronal loss in the dentate gyrus of the hippocampus)
mental retardation
seizures
spasticity or paresis
http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/atlas/n1a7p4.html

Front 101

MC cause of atypical pneumonia.
Expect erythema multiforme.

Back 101

Mycoplasma pneumonia.

Front 102

Name the atypical pneumonias.

Back 102

Chlamydia
Coxiella
Legionella
Mycoplasma (expect erythema multiforme)
Influenza

Front 103

The 4 categories of asthma.

Back 103

intermittent
mild persistent
moderate persistent
severe persistent