Carestandard Set 5

Front 1

fremitus def ?
- where is it most intense ?
- what increases fremitus ?
- what decreases fremitus ?
- when is there no fremitus ?

Back 1

palpable vibrations in body
- 2RICS and interscapular region, which are closest to bronchial bifurcation.
- areas of consolidation (pneumonia)
- pleural effusion or bronchial obstruction
- PTX

Front 2

arises from metanephros

Back 2

Wilm's turmor

Front 3

constitutes response to fluid resucitation ?

Back 3

SBP > 100

Front 4

VWF cleaving protease:
deficient or Ab against in ?
Tx ?

Back 4

ADAMTS-13
TTP-HUS
Plasma Exchange !

Front 5

proximal myopathy in lung Ca where ?

Back 5

mm membrane

Front 6

Recovery in TTP-HUS indicated by:

Back 6

LDH & Platelet normalization

Front 7

TTP-HUS findings:

Back 7

MAHA (microangiopathic h. a.)
or just hemolytic anemia
neurological sx
renal failure
thrombocytopenia

Front 8

MC cause of papillary necrosis ?

Back 8

analgesic overuse

Front 9

10% of dialysis pts due to:
- anemia (pallor) due to chronic renal failure
- hematuria
- htn (ex 160/100)
- intermittent flank pain
- multiple renal cysts
- nephrolithiasis (20%)
- nocturia 2-3x / night
- palpable kidneys
- renal CA not increased
- UTIs

Back 9

APKD (AHHIMNNPRU)

Front 10

cardiogenic shock tx ?

Back 10

bolus PCWP to 15-20 mmHG
if still hypotensive:
- add inotropic agents

Front 11

obstructs venous return to right heart

Back 11

tension PTX

Front 12

pseudotumor cerebri (tx)
also called benign / idiopathic intracranial htn

Back 12

MRI to rule out mass lesion
Lumbar puncture to demonstrate increased CSF presure

Front 13

size of benign lymph nodes ?

Back 13

< 1 cm in diameter

Front 14

1st line for streptococcal pharyngitis

Back 14

erythromycin
binds 23S rRNA of 50S ribo subunit
bactiostatic
URI, pn, STD, G+ cocci, MLCN
GI discomfort, acute cholestatic hepatitis, EOSINOPHILIA, skin rash, increases concentration of theophyllines, oral anticoagulants.

Front 15

pneumoperitoneum on upright radiograph under the diaphragm - what next ?

Back 15

emergent surgery

Front 16

peak incidence of intussusception ?
most common location ?
common finding ?

Back 16

8 months
ileocolic junction
currant jelly stools

Front 17

kill first, investigate later

Back 17

testicular cancer
- remove testis after hard mass + US suggest CA

Front 18

Chronic Hep C pt w/ nl AST/ALT but with PCR for HCV RNA.

Back 18

Reassurance & LFT F/U.
- not even interferon or anti-viral drugs

Front 19

70 yo with bright red bleeding into toilet. MC cause ?

Back 19

diverticulosis
- hemorrhoids rarely cause massive lower GI bleeding and are easily ID'd on PE.

Front 20

chronic occult blood loss

Back 20

colon CA

Front 21

abd pain out of proportion to physical findings

Back 21

acute mesenteric thrombosis
thrombus - forms in vessel & does not move
embolus - forms in vessel then moves

Front 22

peptic ulcer ds hemorrhage could be detected with:

Back 22

NG tube suction

Front 23

sudden severe pain in lower extremity:
slow, progressive arterial narrowing and pain in lower extremity - expect bilateral pulse loss:

Back 23

arterial embolism
arterial thrombosis

Front 24

pain and edema in lower extremity accompanied by warmth to touch - pain
is usu dull and aching vs. severe pain from an arterial origin.

Back 24

DVT (venous thrombosis)

Front 25

MC cause of pancreatitis ?
- how to confirm ?

Back 25

choledocolithiasis
- confirm w/ RUQ US in a pt w/ pancreatitis

Front 26

GERD leads to: (ABEP)
How long for development of adenocarcinoma in GERD ?

Back 26

Adenocarcinoma, Barrett's, Erosive esophagitis, Peptic stricture
> 20 years

Front 27

esophageal motility disorders (2)
- describe the physical findings

Back 27

achalasia
- decreased peristaltic waves
- increased LES tone (can't relax)
scleroderma
- decreased persistaltic wave
- decreases LES tone
- remember food "sticking" in her throat

Front 28

Ao arch vessels encircle trachea and/or esophagus.

Back 28

vascular rings

Front 29

What if my husband and I have both sickle trait ?

Back 29

select embryos w/o the mutation for in vitro fertilization

Front 30

warm Abs against RBC
MC age group ?
cause ?

Back 30

positive Coomb's test - autoimmune
2-12 yo
preceded by infection, usu URI

Front 31

these improve prognosis in CRF
- what's the big caveat ?

Back 31

ACE inhibitors
Protein restriction
Caveat: in Cr >3.0 ACE inhibitors worsen CRF

Front 32

embryonal CA marker, GIT & lungs
seminoma
choriocarcinoma

Back 32

AFP
PLAP (placental alk phos)
beta-HCG

Front 33

decreased visual acuity
sluggish afferent response to light
changes in color perception

Back 33

optic neuritis

Front 34

cytotoxin assay in the stool to test for:

Back 34

Clostridium difficile diarrhea

Front 35

MC cause of Afib ?
Describe Afib on EKG (3)

Back 35

HTN
1. absent P waves
2. irregularly irregular
3. narrow QRS

Front 36

Lidocaine
Adenosine
Carotid Massage
Diltiazem
which of these provides rate control ?

Back 36

Diltiazem

Front 37

hemodynamically stable Afib > 48 hr tx?
hemodynamically stable Afib < 48 hr tx?
hemodynamically unstable afib tx?

Back 37

rate control + anticoagulation first then cardioversion later
electrical or pharm cardioversion
immediate cardioversion

Front 38

type Ib antiarrhythmic used in Vtac
- ischemic myocardium is the target,
which are centers of abnormal automaticity. Compare to type Ia which target areas of normal automaticity.

Back 38

lidocaine (but amiodarone is first line)

Front 39

carotid massage & adenosine used for:

Back 39

SVT
- adenosine is only for dx

Front 40

IgM (expect hyperviscosity)
IgA or IgG (no hyperviscosity)

Back 40

Waldenstrom's macroglobulinemia
MM

Front 41

pregnancy test before starting:

Back 41

sumatriptan

Front 42

dopamine antagonist medication most commonly associated with NMS

Back 42

haloperidol

Front 43

begins w/in 2 weeks of initiation of precipitating drug
mortality 10-20%

Back 43

NMS

Front 44

widened mediastinum DDX (AAEMMS)

Back 44

anthrax exposure
Ao dissection
esophageal rupture
mediastinal hemorrhage
mediastinal mass
SVC syndrome (dyspnea, facial swelling)

Front 45

ADP inhibitors indicated in unstable angina (UA), NSTEMI & post PCI.
PCI = percutaneous coronary intervention

Back 45

clopidogrel (preferred)
ticlopidine

Front 46

periorbital edema
myositis
eosinophilia

Back 46

trichinellosis

Front 47

MC drug-induced CRF is analgesic nephropathy. Pathology ?
% of end-stage renal ds?
How much drug required ?

Back 47

papillary necrosis
tubulointerstitial nephritis
3-5%
2-3kg or 4.4-6.6 LBs

Front 48

Granular "muddy brown" casts
acute renal failure
(usu ischemic or nephrotoxic)

Back 48

acute tubular necrosis

Front 49

edema
hematuria (RBC casts)
htn
proteinuria

Back 49

glomerulonephritis
caused by: NIM
(nephritic syndromes, ischemia, malignant hypertension)

Front 50

premature aging
atherosclerotic vascular ds
urinary tract cancer

Back 50

analgesic abuse (esp. combined as in aspirin + naproxen)

Front 51

initial eval in delirium ?

Back 51

electrolytes + urinalysis

Front 52

initial test in acute pancreatitis to determine etiology in a non-drinker (that is, to find stones)

Back 52

US for gallstones
abdominal CT to confirm pancreatitis

Front 53

SIRS diagnostic criteria
- need only 2 to have SIRS
SIRS due to infection is Sepsis

Back 53

fever or hypothermia
tachypnea
tachycardia
leukocytosis, leukopenia or bandemia

Front 54

acanthosis nigricans think:
describe:

Back 54

DM in younger pts, GI malignancy in eldery
symmetrical
hyperpigmented
velvety plaques
axilla, groin, neck

Front 55

hyposthenuria

Back 55

impairment in kidney's ability to concentrate urine in sickle ds or sickle trait

Front 56

child with macrocytic anemia
low reticulocyte count
congenital anomalies
(triphalangeal thumbs)
etiology ?

Back 56

Diamond-Blackfan anemia (MLCT)
- defect of erythroid progenitor cells resulting in increased apoptosis

Front 57

no hypersegmentation of the nucleus in neutrophils, as occurs in megaloblastic anemia

Back 57

Diamond-Blackfan anemia
(congenital hypoplastic anemia)

Front 58

Wiskott-Aldrich syndrome (EHTX)
Etiology:

Back 58

eczema
hypogammaglobulinemia
thrombocytopenia
X-linked
Etiology: US Answer - It's on another card, I think.

Front 59

absent thumbs
autosomal recessive
cafe-au-lait spots
horseshoe kidney
micro-cephaly & thalmia
progressive pancytopenia & macrocytosis

Back 59

Fanconi's syndrome (AACHMP)

Front 60

accounts for 25% of LV end-diastolic volume

Back 60

atrial kick

Front 61

CD4<40 prophylaxis for MAC
Tx for MAC

Back 61

Azithromycin
Clarithromycin + ethambutol

Front 62

hypertriglyceridemia definition:
hypercholesterolemia definition:
optimal HDL:

Back 62

150 mg / dl
200 mg / dl
> 40 mg / dl

Front 63

How is pulsus paradoxus measured ?

Back 63

variation in systolic p. during expiration & inspiration
- 1st read systolic during expiration
- 2nd read systolic during exp / insp.
- 3rd if difference > 10 mm Hg this is PP

Front 64

Pulsus Paradoxus DDX: (AACCCPPST)

Back 64

anaphylactic shock
asthma
cardiac tamponade
cardiogenic shock
COPD
pericardial effusion
pulmonary embolism
SVC obstruction
tension PTX

Front 65

Obstruction of fluid drainage via lymphatic channels:
Inflammatory accumulation:

Back 65

transudate
exudate

Front 66

Relieved by sitting up and leaning forward and exacerbated by lying down.

Back 66

pericardial pain

Front 67

Beck triad of pericardial tamponade (JHM)

Back 67

JVD
hypotension
muffled heart sounds

Front 68

decorticate posturing ("mummy baby")
GCS score :
disinhibtion of:
fascilitaiton of:

Back 68

GCS = 3
red nucleus
rubrospinal tract (flexor motor neurons)

Front 69

decerebrate posturing (extension)
GCS score:
brain stem damage to:

Back 69

GSC = 2
red nucleus

Front 70

what caues transition from decorticate
to decerebrate posturing ?
mech:
Note: The GCS for decerebrate posturing extension is 2, for decorticate GCS is 3, so this represents worsening of the condition.

Back 70

uncal herniation (transtentorial)
or tonsillar herniation
mech: activation of gamma motor neurons (A small nerve originating in the anterior horns of the spinal cord that transmits impulses through type A gamma fibers to intrafusal fibers of the muscle spindle for muscle control.)

Front 71

Vaccination at birth

Back 71

Hep B

Front 72

Vaccinations at 2 months: (HHIRTDAPP)

Back 72

Hep B
Hib
IPV
Rota
Tetanus
Diphtheria
Acellular Pertussis
Pneumococcal

Front 73

Minimum weight for first vaccination:

Back 73

2 kg (5lb 4oz)

Front 74

think bradycardia

Back 74

prolonged QRS

Front 75

think tachycardia

Back 75

prolonged QT

Front 76

free of ds when study begins:

Back 76

cohort
(retrospective or prospective)

Front 77

water bottle heart

Back 77

pericardial effusion

Front 78

stop AAA progression:

Back 78

stop smoking

Front 79

think hyponatremia in this type stroke:
mech:

Back 79

subarachnoid hemorrhage
mech: incr vasopression cx H20 retention
atrial / brain natriuretic peptide causes Na wasting

Front 80

Lactase deficiency best test >

Back 80

positive hydrogen breath test

Front 81

how to cool a person in heat stroke ?

Back 81

evaporative cooling

Front 82

MC complication in PUD ?

Back 82

hemorrhage

Front 83

after cytoscopy, expect which bug in sepsis ?

Back 83

enterococcal bacteremia

Front 84

R/O pneumonia:

Back 84

lungs CTA

Front 85

when will drug fever develop ?

Back 85

1 - 2 weeks after administration

Front 86

caused by inhaled anesthetics
acidosis
fever
rhabdomyolysis
tachycardia

Back 86

malignant hyperthermia (AFRT)

Front 87

MC thyroid nodule:
2nd MC thyroid nodule:

Back 87

colloid
follicular adenoma

Front 88

increased LDH
increased total protein
think neoplasm, TB

Back 88

exudative parapneumonic effusion

Front 89

decreased LDH in the effusion
decreased total protein effusion
- type of effusion ?

Back 89

transudative parapneumonic effusion

Front 90

WBCs in parapneumonic effusion:
Neutrophils in parapneumonic eff:

Back 90

TB, neoplasm
infection

Front 91

syncope due to autonomic dysfunction or drugs is associated with:

Back 91

postural change

Front 92

febrile seizures in children expected above what temperature ?

Back 92

39C (102.2F)

Front 93

microcytic, hypochromic anemia
decreased reticulocytes
increased RDW

Back 93

Fe-deficiency anemia

Front 94

how to destinguish thalassemia from Fe-deficiency anemia ?

Back 94

Thalassemia has nl RDW

Front 95

Normal RDW ?

Back 95

20%
- 21% is probably for Fe-def anemia

Front 96

work up for back pain:

Back 96

R/O CES
- nl anal reflex, bowel & bladder
R/I Disc Herniation
- straight leg raise

Front 97

Disc Herniation Tx:

Back 97

NSAIDS, early mobilization
- neither exercise nor bed rest helps
- but recall the stupid Kaplan question included two days of bed rest ...

Front 98

Name the 3 parapneumonic effusions:
How best determine need for chest tube?

Back 98

1. uncomplicated effusion
2. complicated
3. empyema
Pleural fluid pH

Front 99

Pleura fluid pH < 7.2 is dx for:

Back 99

empyema

Front 100

What does LDH do ?
From where does energy come ?
When does this happen ?
Why is LDH increased in hemolysis ?

Back 100

converts pyruvate to lactate
NADH to NAD+
decreased O2
It is in the RBC !!!