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421 Cards in this Set
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Need for negative vs positive pressure isolation rooms.
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Negative - for highly infectious diseases that can be spread via resp droplets (Active TB, Smallpox etc..)
Positive - room for someone severely immune compromised. NOTE: Most cutaneous infections even such as anthrax do not need airway isolation |
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Pseudodementia
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Actually depression in elderly that presents with cognitive decline similar to dementia
NOTE: Bereavement in elderly can present with hallucinations and not be considered delirium |
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Sequence of events for newborn with cyanosis or breathing difficulties
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First 30-60 seconds- Warmth, stimulation and airway clearning
Next 30 seconds - Intubate or PPA Next 30 - if HR<60 CPR Next 30 - Still no improvement = epi |
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Hypopigmented spot on mentally slow child and EEG findings
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Ash-leaf spot assoc w/ tuberous sclerosis
EEG shows hyperarrythmias NOTE: wave form EEG w/ 3 Hz spikes assoc w/ absence seizures |
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Another name for pseudofractures and their significance and treatment
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Milkman's lines - assoc/ w osteomalacia, usually vit D deficient
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Risk factors for bladder CA
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Smoking, DIET HIGH IN FATS AND MEATS, shisto, ANILINE DYES, chronic cyclophosphamide
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Least sensitive tissues to radiation
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1. Bone
2. Brain 3. Muscle 4. Skin |
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Treatment options for ASC-US
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1. F/U with pap Q 6 months and colposcopy if abnormal
2. Reflex HPV testing - colp if abnormal, return to normal paps if normal 3. Immediate colposcopy |
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Best analysis for fluid masses
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1. Usually first step if US if not available and infection not suspected next is MRI
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Pneumonia that can present with flu-like symptoms and cause electrolyte abnormalities or ARF
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Legionella
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Megaloblastic anemia with neurologic symptoms must be caused by?
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Some involvement of Vit B12, either autoimmune gastritis or decreased absorbtion b/c of colitis
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Contraindications to succinylcholine use and why
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Liver failure - cant make pseudocholinesterase which degreads succin.
Hyperkalemia and sever CKD |
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Cohort study vs
Case-control vs clinical trial vs cross-sectional |
1. Those with a risk factor and what happens
2. Group with a disease vs a group w/o 3. Therapy vs placebo 4. Time's effect on outcomes |
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Patient presents with "worst headache of life" without mental status change but signs of papilledema think?
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Cerebral venous thrombosis (look for mention of OCP, HRT, or steroids as increase clot risks)
NOTE- If subhyaloid or vitreous hemm noted "Terson's syndrom" think intracranial hemm or some sort |
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Good questions for working up headaches
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1) Is the headache unilateral or bilateral? 2) Is there anything that makes the headache better or worse? 3) Are there any risk factors that would suggest one diagnosis over the other?
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Painful rash with advancing edges and sharply demarcated borders not in a dermatomal pattern (Red rash with orange peel resemblance)
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Erysipelas - must exclude cellulitis and Herpes zoster from differential.
NOTE- Risk factors will include impaired lymph drainage |
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Screening ages for the following:
Osteoporosis Colon CA Breast CA |
1.65
2. 50 3. 40 |
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Treatment of choice for otitis externa with and without TM invovement
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Wtihout - Topical gentamicin and polymixin B or Topical cipro
With - Topical Oxfloxacin |
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Degrees of asthma
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Mild Intermittent-
Asthma Attack < 2 times a week Nocturnal Attack < 2 times a month PRN short acting beta 2 agonist Mild Persistent Asthma Attack > 2 times/week Nocturnal Attack > 2 times/month Daily inhaled low dose corticosteroid OR Leukotriene Modifier + PRN short acting beta 2 agonist Moderate Persistent Asthma Attack daily Nocturnal Attack> once per week Daily inhaled high dose corticosteroid + long acting beta 2 agonist (Salmeterol) + PRN short acting beta 2 agonist +/- Theophylline Severe Persistent Continuous Asthma Symptoms Frequent Nocturnal Attacks (every or almost every night) Oral corticosteroid + high dose inhaled corticosteroid + long acting beta 2 agonist + PRN short acting beta 2 agonist |
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Rash that affects groin, axilla and hands and is worse after hot showers and at night, considered a STD
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Scabies (Sarcoptes scabiei) - look for the "s-shaped rash" with pruritic papules
NOTE - Rx is with 5% Permethrin cream from neck down and Rx close contacts as well |
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DeQuervain’s tenosynovitis involves which tendon
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Abductor pollicis longus
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Vaginal or reproductive mass in children always think what?
Which mass appears at the vaginal introitus as a cluster of cysts? |
Cancer/tumor
Sarcoma Botryoides - F/U with complete pelvic imaging should be next step |
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Condition in which free air is present in the abdominal wall, risk factors and treatment
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pneumatosis intestinalis - found in necrotizing enterocolitis most commonly found in premature newborns. Rx is NPO, with OG tube IV hydration and abx with TPN.
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Threatened vs inevitable abortion
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both have bleeding before 20 weeks but inevitable has cervical dilation. Rx is expectant management
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Imaging indications for falls or suspected fractures
1. X-Ray 2. CT 3. DEXA 4. MRI 5. Bone Scintigraphy |
1. Primary evaluation
2. If X-ray fails to show fx and it is clinically expected 3. Fragility fractures - radius, humerus, femur, vertebral. used to assess osteoporosis 4. Soft tissue injury 5. Bony conditions such as tumors or infection or metastasis |
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Treatment of a rectal tumor within what distance to anal verge requires resection with permanent colostomy
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5 cm
NOTE - Sigmoid or proximal rectal tumors can be resected with re-anastamosis |
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Two common causes of coma and hypoxiallactic acidosis during a house fire
Rx for each and how to differentiate |
1. Cyanide poisoning - normal appearing skin, bitter almond smell to breath. Rx with amyl nitrate then thiosulfate
2. CO poisoning - cherry red skin and severe headache. 100% O2 |
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Most likely diagnosis of visual changes in newly diagnosed HIV and Rx
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CMV retinitis - assoc with yellowish build up around macula with hemorrhage and exudates. Rx with ganciclovir of foscarnet
NOTE- usually only appears if CD4 < 50 |
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Most common form of aortic dissection according to debakey classification
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Type III - descending aorta only (risks are HTN and atherosclerosis)
NOTE - Type I involves both ascending and descending, Type II is ascending only |
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Stepwise work-up of secondary amenorrhea
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Pregnancy then thyroid then prolactin then progesterone challenge (If positive go to FSH/LH levels, if negative got to estrogen-progesterone challenge if that is negative think ashermans syndrome
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Rx of dystonic reactions
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Usually benztropine or diphenhydramine because of the cholinergic side effects of some anti-dopaminergic meds; Dystonic reactions include oculogyric crisis (fixed upward stare) torticollis, buccolingual crisis and trismus.
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Diagnosis of mild symptoms including headache chills, low grad fever s/p blood transfusion
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febrile transfusion reaction - usually mild without severe symptoms of a true ABO incompatibility and caused by antibodies to WBC's of donor blood
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Type of abdominal study indicated if perforation expected
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CT w/o contrast or follow through with gastrografin rather than barium. Won't irritate structures because it is water soluble
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Tissues involved in
1. MEN I 2. MEN IIa 3. MEN IIb or MEN III |
1. 3 p's (para, pancreas, pituitary) also known as wermer syndrome
2. Thyroid, pheo, and para, Also known as sipple syndrome 3. Thyroid pheo and mucosal neuromas |
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Typical radiographic finding of epiglottitis
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Thumb-print sign - infllammation around epiglottis appears as thumb print like image
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A patient with edema of the legs even at rest with ulcerations and hx of tobacco abuse think vs same patient but diabetes instead of tobacco
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1. Buerger disease aka Thromboangiitis obliterans
2. Venous stasis ulcers or Necrobiosis lipoidica |
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Complication of rapid administration of high doses of warfarin
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Rare but skin bullae and necrosis
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Most common electrolyte imbalance associated with ileus
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Hypokalemia
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Criteria for a patient to be considered brain dead
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1. Absent brain/brainstem function
2. Absent brainstem reflexes 3. Core body temp above 32 Celsius all without evidence of acute intoxication |
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A patient >35 yo with DUB and a thorough work-up needs?
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D&C or some sort of endometrial biopsy, if negative can possible be a candidate for endometrial ablation
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After conservative treatments which type of shoulder condition(s) get a subacromial steroid injection vs intra-articular injection
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Subacromial - used for signs of bursitis (nonspecific pain worsened with overhead activities)
Intra-articular - labral tears or osteoarthritis |
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Most common acid/base disturbance seen in sepsis
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Respiratory alkalosis secondary to hyperventilation
NOTE: Most common causes of non anion-gap acidosis include renal tubular acidosis and GI loss of bicarb |
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How do you calculate renal clearance and what is it's significance to GFR?
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Urine flow x Urine substance conc./ Plasma substance conc
Renal clearance > GFR indicates substance is being secreted Renal clearance < GFR indicates substance is being reabsorbed |
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Coag panel of DIC
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PT, PTT and bleeding times all prolonged with low platelets and elevated D-Dimer
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Which is more important for diagnosing osteoporosis Z-score or T-score
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T-score - compared to healthy 30 year old
Note: -1 to -2.5 osteopenic < -2.5 osteoporosis |
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4 components of the quad screen and their significance
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MSAFP, Estriol, Inhibin A, B-HCG
Downs syndrome - MSAFP and Estriol are decreased with increased Inhibin and HCG Edwards - all decreased |
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Best laboratory value for showing resolution of osteomyelitis or other infective processes and why
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CRP - more of an acute phase reactant so normalizes much faster than ESR or imaging techniques
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AFI's associated with oligohydraminos vs polyhydraminos
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AFI < 5 is oligo and associated with renal abnormalities and cord compression/hypoxia
AFI > 20 is poly and associated with esophageal atresias and cord prolapse |
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Spiking fevers with or without seizures that resolve in a few days in a 6-15 month old, often followed by a rash on the trunk that spreads to the arms and legs
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Roseola - HHV 6
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Most common cranial nerve causing a poor suck reflex vs colicky baby
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CN XII for poor suck reflex
CN X for colicky baby |
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Common SE's of methylphenidate and a less common seen SE but commonly tested
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Common - Loss of appetite/weight, headaches, abd pain, insomnia.
Less common - Muscle Tics |
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To reduce risks of osteoporosis use tamoxifen or raloxifene and why?
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Raloxifene because both are SERM's that reduce bone turnover but tamoxifen has an additional SE of increased risk of endometrial and uterine cancers but both reduce risk of breast cancer
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LDL value to start treatment for:
0-1 risk factors 2 or more risk factors Previous CAD or equivalent |
190 with goal <160
160 with goal < 130 100 with gaol < 70 |
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Age to start screening for diabetes without any risk factors?
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40
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Types of hearing loss, findings for each and examples of each
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1. Conductive - most common osteosclerosis either familial or from frequent ear infections; Bone conduction > than air conduction
2. Sensinerual - caused by drug toxicity, meniere's disease, etc..; Decreased overall hearing both bone and air |
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Kayser-Fleischer rings (Deposits in descemet's membrane, a portion of the cornea) also seen in which other disease
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Primary biliary cirrhosis
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Types of vaccines for each of the following
1. Smallpox 2. HiB 3. Dibtheria/Tetanus 4. Hep A |
1. Live
2. Conjugate 3. Toxoid 4. Killed |
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Preferred fluid resuscitation following burn injury any why
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Lactated ringers - less sodium and more physiologic balance of electrolytes. Also slightly higher pH helping to neutralize metabolic acidosis experienced by burn victims and DKA
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3 categories and scoring for each of GCS
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1. Eye opening 4 points(none, to pain, to speech, spontaneously)
2. Speech 5 points (none, incomprehensible, inappropriate, confused, oriented) 3. Motor 6 points (none, extension, flexion, withdraws, localizes, obeys commands) |
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Best treatment for intranasal polyps caused by chronic inflammation (i.e. allergies)
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1. Oral steroids
If fails polyp steroid injection if fails surg resection |
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Electrolyte and acid/base disturbance seen with chronic diarrhea
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hypokalemia and metabolic acidosis
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Types of hypersensitivities and examples of each
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Type 1 (immediate)- IgE mast cell mediated ; anaphylaxis
Type 2 - antibodies binding to receptors ; Graves, goodpasture, etc.. Type 3 - antibody-antigen complex depostion; SLE and post-strep glomerular disease Type 4 - cell mediated; MS, DM I, PPD test |
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types of kidney stones assoc w/:
1. +family history and acidic urine 2. recurrent UTI's 3. Hyperparathyroid or pseudogout |
1. cystine stones - poor transport of C.O.A.L amino acids
2. Struvite 3. Calcium oxalate |
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Typical EKG findings of Brugada syndrome and population often seen in
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ST elevations in V1-V3 with a RBBB with or without terminal S waves of lateral leads
Seen often in young men from Laos and thailand |
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Diagnostic criteria for each of the 4 classes of hypovolemic shock
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Type I - 10-15% loss or <800mL
Type II - 15-30% loss or 800-1500mL with clinical sx's (Tachycardia, etc...) Type III - 30-40% or 1500-2000mL with HR>120 Type IV- >40% or >2000mL with HR>140 |
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Generalized hematologic cancer symptoms without lymphadenopathy except for an enlarged spleen and cells stain with T.R.A.P.
Also treatment? |
Hairy cell leukemia
Treatment is usually observance as some never require treatment those that do receive nucleoside analogs NOTE; Treatment for CML with philadelphia chrom. is imatinib (Gleevec) and acute promyelocytic is ATRA (all trans retinoic acid) |
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Number one associated finding with primary sclerosing cholangitis
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HLA-DR52a (100% of cases)
NOTE: Ulcerative colitis is most common IBD seen with PSC but only 70% of cases |
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Recommended weight gains during pregnancy based on pre-pregnancy weights
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Underweight (BMI<20) - 35+lbs
Healthy (BMI 20-26) - 25-35lbs Overweight (BMI 27-30) 15-25lbs Obese (BMI >30) 11-20lbs |
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Advantages and disadvantages of chorionic villous sampling over amniocentesis and major fetal abnormality seen with CVS
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CVS can be done early 9-11 weeks vs amnio 15-20 weeks with equal diagnostic efficacy except for NTD's. Also carries a greater risk of fetal loss.
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What processes lead to a right shift on the oxygen binding curve and does this allow more or less oxygen to be delivered?
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Right - Altitude, acidosis, elevated temp increased 2,3-BPG (More oxygen)
Left - alkalosis, decreased temp, and blood transfusions (2,3-BPG deactivated at cold temps blood stored at) |
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The specific protein associated with alzheimers disease in patients with down syndrome
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Amyloid precursor protein,
NOTE: Tau protein (as well as APP, Presenellin 1 and 2 and ApoE) has involvement in normal AD but less so in trisomy 21 |
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Physical exam findings in an imperforate hymen vs. sarcoma botryoides
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Bulging yellow gray mass at level or just beyond vaginal introitous
Firm grape-like mass extruding beyond introitous NOTE: Best test to CONFIRM is ultrasound |
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S/P splenectomy recommended vaccinations and treatments
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Hib, Strep, meningococcus, influenza and lifelong prophylactic abx
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Common but less well known physical exam finding of patient with suspected ovarian tumor
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Ascites
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Rash name of targetoid lesions with a central blister pale edema and ring of erythema?
Most common causes? |
Erythema multiforme
HSV, URI, mycoplasma pneumonia NOTE- Rash usually itches or burns which can help distinguish it from some others |
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MOA by which democlocycline can help with SIADH
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antagonizes action of ADH at collecting duct
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Most common infection in a child that causes both bloody diarrhea and systemic manifestations such as high fever and poor appetite
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Shigella
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What is sicca syndrome?
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Sjogren's syndrome without the clinical manifestation of arthritis
NOTE: Still have antibodies to ribonucleoproteins (SS- La and Ro) |
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What is the parkland formula and what is it used for?
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(4 x weight in kg) x %BSA burned = total amount of fluid to be given to burn victim in 24 hours (Half given over first eight hours rest given over final 16 hours)
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How if rule of 9's different in children?
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Children's heads represent 18% of BSA instead of 9% and each leg has a little less than the normal 18%
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Most appropriate way to monitor fluid status of a burn victim and expected value
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Urine output should be 0.5mL/kg/hour
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Types of seizures and how to differentiate each from the other
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Generalized (either complete tonic-clonic or abscence in children)
Partial (Complex in which consciousness is altered for a certain amount of time or Simple with localized symptoms and no loss of consciousness) |
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Type of culture needed to grow candidial species
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Sabouraud's
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Most common beneficial result of gastric bypass surgery besides weight loss
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Reduction of insulin resistance with either reduction or removal of DM drug's
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Best prophylactic abx for travelers diarrhea
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fluroquinolone (Cipro or levofloxacin)
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Glomerulonephritis with low complement levels following an URI and associated diagnoses
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Cryoglobulanemia - associated with IV drug abuse and/or Hep C
NOTE: IgA nephorpathy can present similarly but complement levels will be normal |
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First and second line treatments for postherpetic neuralgia
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Lyrica (Pregabalin), lidocaine patches 5% or capsaicin creams. Second line treatment includes nortriptyline (also used for chronic treatment)
NOTE: Carbamazipine can also be used although the question prompt did not mention it as a treatment option |
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Treatment of paget's disease
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Usually just observe patients unless clinical sympotoms (e.g. nerve intrapment, fractures, bone pain) are worsening or disabling then first line is bisphosphonates
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What is syringomyelia, what are some clinical manifestation?
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Syringomyelia is a post-traumatic cystic degeneration of the spinal cord. Patients present with loss of pain and temperature sensation, flaccid paralysis, decreased DTRs and fasciculations. Can also lead to the development of Charcot-like joints in the upper extremities.
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Osteoporotic patient with fracture after low impact stresses think of what?
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Osteonecrosis of jaw, femur, etc.. from bisphosphonate use
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First line treatment for suspected venous air embolism
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Aspiration of catheter, place patient in left lateral recumbent position and place on 100% Oxygen
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Best confirmatory test for GERD in an infant?
Best treatment options |
24 hour esophageal pH monitoring
First try thickening of the formula, if fails and child has failure to thrive H2 antagonists are your next line followed lastly by a PPI |
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Best urologic imaging study to diagnosis trauma to urethera
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retrograde urethrogram
NOTE: Best treatment is uretheral rest with the placement of a suprapubic catheter. if surgery is needed it is delayed 5-7 days |
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Ways to distinguish fluid of pleural effusions
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A transudative effusion will have pH > 7.3
An exudative effusion will have LDH higher than normal |
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Effects of ASA toxicity
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Metabolic acidosis with increased lactate
Respiratory alkalosis, patients often complain of tinnitus. Increased heart rate and temp. |
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Cut-off for delivery for a patient with severe pre-eclampsia
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34 weeks
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First line treatment for both dymenorrhea and menorrhagia
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NSAIDs
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Enzyme deficient in each of the following:
Gaucher Tay-Sachs Krabbe Fabry Niemann-Pick |
Glucocerebrosidase
Hexosaminidase A Galactocerbrosidase Galactosidase Sphingomyelnase |
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Safest treatment for a pregnant woman with severe depression and suicidal ideation
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Electroshock therapy
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Large proteinuria and HTN after URI think of what?
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IgA vs Post strep vs cryoglobulenemia
Treatment is usually with ACE's or ARB's |
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Clinical manifestations of wipples disease
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Malabsorbtion syndrome with join pain. Less rarely seen is oculomasticatory myoarrythmia but is pathognomonic if present
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Most common abnormality in a patient that develops an anaphylactic reaction following a blood transfusion
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IgA Deficiency
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Aside from the typical cough conjuctivitis and coryza seen with measles what other symptom can become a serious complication
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Diarrhea is very common and can lead to lethal dehydration
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Histologic appearance of molluscum contagiousum
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Henderson-Paterson inclusion bodies, as well the epithelial cell will disperse easily with pressure unlike normal epithelial cells which stick together
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A patient with a chronic inflammatory condition like RA or SLE and large proteinuria with HTN think what?
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Nephrotic syndrome probably caused by amyloid deposition into the mesangium
Can be identified with congo red staining |
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How to differentiate HSV vs CMV esophagitis
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HSV - has volcano or deep lesions in oral mucosa
CMV - has larger shallower ulcer like lesions with substernal burning and odynophagia |
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Bones that join to form the pterion
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Temporal, frontal parietal and sphenoid
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Child with conjuctivitis, mucosal ulcers, extremity edema, systemic rash and cervical lymphadenopathy think of what and what is the treatment?
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Kawasaki Disease
ASA and IVIG |
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What is nafarelin?
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GnRH analong used to diminish FSH/LH stimulation and reduce symptoms of endometriosis
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Antidote to tPA toxicity
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Aminocaproic acid
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How do the lesions of erythema multiforme appear?
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Targetoid like lesions, less often to affect mucosal membranes
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acute stress disorder vs adjustment disorder
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Acute stress - occurs within one month of a serious stressor (death or serious injury) and patients have PTSD like symptoms
Adjustment - occurs within three months of a less severe stressor and patients have anxiety/depression that affect their life |
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Difference between diabetic foot infection and neuropathic ulcer
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Diabetic foot infection will be exquisitely tender whereas neuropathic ulcers have lost their pain sensation
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Most commonly damaged area of the vagina during sexual abuse
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posterior fourchette
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Dye used to view ureteres intra-operatively
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indigo carmine
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Respiratory distress in a child with OSA after surgical removal of tonsils and adenoids and extubation
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Negative pressure pulmonary edema - secondary to the removal of the obstruction the pressures in the lung rapidly drop and fluid exduates into the spaces
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ABG findings in a patient with a suspected PE
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Low CO2 high pH and low O2 all secondary to hyperventilation and a ventilation perfusion mismatch
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Dark papules on the dorsum of hands found with muscle weakness
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Dermatomyositis - Gottron papules are the name of the papules
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Most likely complication of nephrotic syndrome in a child with minimal change disease
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Thrombosis - unknown mechanism but the attack on the kidneys is also associated with an hypercoagulable state
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1st line treatment for menorrhagia and second line options
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1st - NSAID's
2nd - OCP's or if contraindicated can consider depot medroxyprogesterone |
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Most dangerous position for a DVT (highest chance of embolization)
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Common femoral (more proximal = more worrisome)
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Definition of neutropenic fever
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One single temp above 38.3 with an absolute neutrophil count less than 500
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Second line treatment for status epilepticus
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Phenytoin
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Top 4 most resistant tissues to radiation and top 4 most susceptible
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Resistant - Bone, brain muscle skin
Susceptible - Lymph, bone marrow, GI mucosa, germinal cells |
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Formula for proper fluid resuscitation based on weight
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4ml/kg/hr for first 10kg then 2ml for next 10 kg, then 1ml for every 1kg thereafter
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Drugs used to treat sleep-maintenance insomnia
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longer acting benzo's including estazolam and flurazepam
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Number one contraindication for starting a hypnotic insomnia agent such as zolpidem
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Alcohol abuse, interestingly OSA is not a contraindication like it is with benzo use
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When to administer Rhogam
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routinely at 28 weeks if mother negative and father positive or unknown. Any time earlier in pregnancy with suspected bleeding or invasive procedure such as amnio or CVS
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difference of medicare vs medicaid
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medicare is "caring" for anyone over 65, medicaid provides "aide" for anyone who can't afford proper insurance
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post rape best method of contraception
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placement of a copper IUD can be done up to 7 days post event and is still 99% effective
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Proteinuria with M proteins and a symptomatic patient
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Waldenstrom's macroglobulinemia - progression of MGUS but unlike MM there is no lytic bone lesions
NOTE: Does create a hyperviscous syndrome leading to raynauds, SOB and other symptoms Treatment is with plasmapheresis |
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Which normal treatment of an acute MI is contraindicated if the MI is thought to involve the right ventricle
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Nitrates or any other vasodilator because they decrease preload which the heart becomes dependent on as the right ventricles ability to pump decreases
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Large tender painful mass in the axilla or groin of a child think of what?
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Cat scratch disease caused by Gram negative bacillus Bartonella henselae. also known as bacillary angiomatosis
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First line treatment for Guillan-barre syndrome
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Plasmapheresis with second line being IVIG unless the patient is unstable and high clinical suspicion then go straight to IVIG
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Dermatographia represents which type of dermatitis and mediated how?
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Atopic dermatitis mediated by IgE and mast cells
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Anti-depressant known to cause orthostatic hypotension
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imipramine
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Difference between evisceration, enucleation and exenteration
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Evisceration - muscles and sclera remain
Enucleation - complete removal of eye but leave all remaining structures Exenteration - removal of eye, muscles and portion of orbit |
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Classic presentation of low grade fever with rash on the face that spreads to extremities and has POST-auricular lymphadenopathy in a child
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German measles or rubella
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Two causes of painless genital ulcers and how to differentiate
Main cause of painful genital ulcer |
Granuloma inguinale vs syphillis - granuloma has inguinal lymphandenopathy with beefy red granulated lesions but syphilis ulcers are smaller and less granulated
Haemophilus ducreyi has buboes that are painful and slough off |
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1st line, 2nd line and pcn resistant treatment of acute otitis media
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1 - amoxicillin
2. augmentin 3. Azithromycin |
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At how many weeks is it always appropriate to induce labor in a pre-eclamptic patient
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36 weeks
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Two best treatments for atopic dermatitis
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1. Corticosteroids - easiest and most cost-effective
2. Phototherapy with methoxsalen and UVA (PUVA) |
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The first step in amenorrhea regardless of whether it is primary or secondary
|
B-hcg
|
|
|
Worsening signs of hypoxia in a patient with ARDS or acute lung injury on ventilation
|
Most likely barotrauma from ventilation leading to tension pneumothorax. Need immediate needle decompression
|
|
|
Common presenting symptoms of lead toxicity in adults
|
abdominal pain, diarrhea, encephalopathy, peripheral neuropathy and renal failure (specifically fanconi's syndrome with urinalysis positive for bicarbonate, amino acids, phosphate and glucose.
|
|
|
SBO in a woman without a history of bowel surgeries or hernias
|
Most likely ovarian cancer usually of the mucinous epithelial type
|
|
|
Main difference between presentation of labrynthitis and vestibular neuritis
|
Labrynthitis affects your hearing but vestibular neuritis usually spares your hearing
|
|
|
What is acute stress disorder?
|
Presents just like PTSD with a feeling of the traumatic event being unreal with flashbacks, nightmares and a fear of that situation but resolves in 4 weeks or less
Different from an adjustment disorder which causes mood disturbances but the inciting event is less traumatic e.g. a move or failing grade |
|
|
Most common area of the bowel affected in newly diagnosed chron's
|
Terminal ileum
NOTE: Remember IBD is often associated with HLA-B27 and an increased risk of ankylosing spondylitis |
|
|
Most common ligament injured during an ankle sprain and common co-morbidity that must be ruled out
|
Anterior taleo-fibular ligament and often is proximal fibular head fracture observed on knee x-ray
|
|
|
Characteristic findings of benign cystic ovarian changes
|
Unilateral, <8 cm, cystic non-necrotic or hemorrhagic
|
|
|
Stain used to recognize malignant mesothelioma
|
Prussian blue
|
|
|
Most common causes of hyperaldosteronism
|
1. Bilateral hyperplasia
2. Functioning adenoma (Conn's) |
|
|
Bishop's score
|
Totatl of five categories each worth three prediciting likelihood of delivery
Score 5-9 use pitocin Score 0-4 use prostaglandins and/or pitocin Score 10 or > no help needed |
|
|
Nephritic in a young boy without any medical history vs a person with a recent URI
|
Alport Syndrome - hereditary usually presents between ages 5-20
IgA nephropathy or Berger syndrome NOTE: IgA nephropathy often treated with an ACE or ARB |
|
|
Most common cause of osteomyelitis in a patient with a recent puncture wound
|
Pseudomonas aeurgenosa
|
|
|
Common migraine combination used in hospitals
|
Prochlorperazine (D2 agonist), toradol and diphenhydramine (used to prevent or treat dystonic reactions)
|
|
|
Best management of hyperemesis gravidpardum
|
1st B-hcg to confirm pregnancy, then ultrasound to r/o molar pregnancy. Next treat with Vitamin B6 if resisitant to that use doxylamine
|
|
|
Lab findings of Klinefelters syndrome
|
Increased estradiol, FSH, LH and gonadotropin with decreased bone density
|
|
|
Inability to get pregnant in a woman with a history of PID or uterine manipulation
|
Uterine synechiae aka asherman's syndrome
|
|
|
Diseases associated with each of the following:
HLA-DR2 HLA-DR3 HLA-DR4 |
HLA-DR2 - MS
HLA-DR3 - DM HLA-DR4 - RA |
|
|
Tearing, congestion, smaller pupil and pain behind one eye
|
Cluster headaches
|
|
|
Common additional abnormality in a patient with adrenal failure secondary to TB
|
Hyponatremia, hyperkalemia, hypotension and hypoglycemia
|
|
|
Which of the following blood smear descriptions is consistent with Burkitt’s lymphoma?
|
Sheets of lymphocytes with interspersed macrophages (starry sky)
Treatment for burkitt’s lymphoma is rituximab 8,14 genetic translocation (c-myc) |
|
|
Smear findings in MM
|
either rouleaux or Plasma cells with a fried egg appearance.
I believe stain positive with PAS |
|
|
Filtration fraction formula
|
Plasma renal flow/GFR
NOTE: Filtration fraction unaffected by NSAIDS but decreased by ACE's |
|
|
Most common compulsion in OCD?
|
Repetitive hand washing
|
|
|
Common EKG finding in mitral stenosis
|
P wave notched with a 0.20 seconds duration in lead II
|
|
|
Which symptoms associated with schizophrenia predict a better outcome
|
The positive symptoms of this disease, including hallucinations and delusions, contribute to a positive prognosis. (More easily treated than negative symptoms)
|
|
|
What is fetal hydantoin syndrome?
|
Mental retardation and physical changes in a newborn of a mother who was on anti-convulsant therapy. Growth retardation, microcephaly, hypoplasia of the distal phalanx of the fingers and toes, nail hypoplasia, hirsutism, cleft-lip/palate, rib anomalies and occasionally cardiac and genito-urinary anomalies are classic physical exam findings
|
|
|
What is acanthosis nigricans associated with?
|
associated with hyperinsulinemia and insulin-resistance, such as diabetes, obesity, and polycystic ovarian syndrome. It can be a sign of underlying malignancy, and, in a non-obese patient, a work-up for GI adenocarcinoma is warranted.
|
|
|
What is the first step in ruptured esophageal varices
|
1st ligation via endoscopy, if not possible try balloon tamponade or octreotide
|
|
|
What is a cohort study?
|
Following two groups of people based on their exposure or lack thereof to a particular variable e.g. smoking, caffeine etc.. (analytical and observational) rather than analytical and experimental like a randomized clinical
|
|
|
Best study to evaluate for pyloric stenosis
|
Ultrasound
NOTE: associated with macrolide use |
|
|
How is the diagnosis of hodgkin's lymphoma best done
|
Excisional biopsy because of HD FNA is often inconclusive. Look for reed steinberg cells
|
|
|
Most common infection causing fitz-hugh-curtis
|
Chlamydia trachomatis
|
|
|
Recommended diet for a person with renal stones of any composition
|
Low protein and low pH help
BEWARE low calcium diets can actually worsen stones |
|
|
Gold standard for diagnosing aortic dissection
|
CT angiography
|
|
|
Smallpox is what type of vaccine?
Hep A, Polio and influenza? Measles, mumps, rubella? |
1. Live
2. Killed 3. Attenuated |
|
|
NYHA classes of CHF
|
Class I - no limitations to activity
Class II - normal physical activity e.g. mowing lawn leads to SOB Class III - normal daily activity leads to SOB e.g. climbing stairs but comfortable at rest Class IV - unable to perform any physical activity with signs of heart failure at rest |
|
|
Most common cause of post-menopausal bleeding
|
Endometrial atrophy although cancer must be ruled out
|
|
|
Define
Alpha Error (Type 1) Beta Error (type 2) Power Confidence Interval |
the null hypothesis is rejected even though it is true
the null hypothesis is not rejected even though it is false an estimation of the probability of finding a statistically significant association in a research study when one truly exists the estimated range of values which likely includes an unknown population parameter |
|
|
Most likely diagnosis of vaginal bleeding in a 5 day old newborn
|
Pseudomenses - normal finding in most cases because of the loss of circulating maternal estrogens
|
|
|
Common EKG finding of prinzmetal angina
|
Transient ST elevations
|
|
|
Conditions in which SBE prophylaxis is indicated
|
prosthetic heart valves, previous infective endocarditis, congenital heart disease, or valvular abnormalities after cardiac transplant
|
|
|
Three types of renal tubular acidosis, differentiation of each and treatment of each
|
Type I - lots of causes lead to a dysfunction in hydrogen ion channels, leads to hypokalemia and urine pH above 5.3. Treat with potassium citrate
Type II - problems with bicarb secretion leads to hypokalemia as well but pH below 5.3 still treat with potassium citrate Type IV - dysfunction on adrenalcorticoids. leads to hyperkalemia and hyponatremia, Treat with furosemide and proper steroids |
|
|
Most common physical exam findings of acute angle glaucoma
|
Blurry vision in a red watery eye with a mid-dilated and fixed pupil
NO change in optic cup to disc ratio will be appreciated because of the acute process |
|
|
What are Ranson's 48 hour criteria?
|
calcium <8.0mg/dL, Hct drop >10%, PaO2 <60mmHg, base excess >4mEq/L, BUN increase >5mg/dL and sequestered fluid >6L.
|
|
|
What occurs to the diffusion capacity of carbon monoxide (DLCO) in obstructive lung diseases?
|
Decreases
|
|
|
How do you differentiate between ITP and TTP?
|
Both can occur after an URI but TTP usually will present with neurologic symptoms, renal failure of hemolysis in addition to low platelets and bleeding.
|
|
|
Treatment options for prophylaxis after a dog or cat bite
|
1st line is augmentin then bactrim. If PCN or sulfa allergy next line therapy is doxy as long as child is over age 8.
|
|
|
What are some treatments to help lower ICP?
|
Hyperventilate (temporary reduction), Hypertonic saline, furosemide + mannitol, elevate head of bed 30 degrees, cooling patient only if febrile
|
|
|
Common physical exam finding of asperger's disease
|
repetitive whole body movements
|
|
|
Untreated UTI's in pregnancy lead to increased risk of
|
Preterm labor, second-trimester abortions, preeclampsia, maternal anemia and amnionitis.
|
|
|
What is Charles Bonnet syndrome?
|
visual hallucinations and is most common in elderly patients with greatly decreased vision due to cataracts and/or glaucoma. The hallucinations are known by the patient to not be real and are usually patterns or people, at times people of smaller size. Nearly all of these patients have no underlying mental disorder.
|
|
|
What is alice in wonderland syndrome?
|
a normal eye exam, a migraine (hallmark), and altered body image such as confusion about the size and shape of their body parts.
|
|
|
What is the diabetic honeymoon phase?
|
When a type I is diagnosed and started on insulin C-peptide levels may increase to normal for the first week or two (it is a false rise must continue therapy)
|
|
|
Cut-off for 1 hour glucose (50 grams) and follow up if failed and interpretation of follow up
|
140mg/dL. If higher than that, then need a 3 hour glucose (100 grams) and should be less than 180 at 1 hour, 155 at 2 hours and 140 at three hours if higher gestational diabetes is confirmed. Start with conservative treatments first
|
|
|
Most common bacteria causing necrotizing fasciitis
|
Group A strep
|
|
|
How do you calculate the serum-ascites albumin gradient and what does it mean?
|
Serum albumin - ascites albumin. A value >1.1 means the ascitic fluid is a transudate and caused by high pressure e.g. portal hypertension. If < 1.1 then it is an exudate maybe from protein loss like in nephrotic syndrome
|
|
|
Common injury associated with a distal radius fracture
|
Distal radio-ulnar joint dislocation
NOTE: This fracture is also known as a galeazzi fracture |
|
|
Common fracture from a fall on an out stretched hand and actual location of injury
|
Colles fracture - ulnar styloid injury with a distal radius fracture
|
|
|
Normal treatment for polymyositis
|
High dose steroids unless patient uncontrolled diabetic then use methotrexate or azathioprine
|
|
|
Which anti-depressant is used to treat tobacco
|
Buproprion not Buspirone
|
|
|
Any time you see a p-qrs discrepancy in a pattern of 2:1 or 3:1 think of
|
Mobitz II
|
|
|
Best initial treatment of suspected subacute thyroiditis
|
NSAIDs and supportive
|
|
|
Differential diagnosis for a person that has recently endured stress and now has hypertension, tachycardia, muscle weakness, and fever should include
|
Psych disorders, substance abuse, and hyperthyroidism which has been shown to be set off by stress
|
|
|
Lab findings of Wilson's disease include
|
Low ceruloplasmin, low to normal serum copper, high urinary and high liver copper
|
|
|
The most common infection with otitis externa including diabetics is?
|
Pseudomonas Aeruginosa
|
|
|
What HgbA1C is need to diagnose diabetes according to the ADA
|
> 6.5%
|
|
|
Hemophilia C and D are caused by deficiency in what
|
C - Factor XI
D - Factor XII |
|
|
What is found in cryoprecipitate
|
Factors VIII and XIII, vWF, fibrinogen and fibronectin
|
|
|
What is the treatment regimen recommended for neutropenic fever in a stable patient with solid tumor
|
Outpatient PO ciprofloxacin and amoxicillin/clavulanate
|
|
|
Treatment of cryptochordism
|
before 6 months wait, after 6 months orchiopexy after 12 months orchiectomy
|
|
|
Common nail findings in psoriasis
|
Onycholysis and pitting
|
|
|
REM sleep is mostly affected by which neurotransmitter
|
acethylcholine
|
|
|
Top cross allergy in hospitals
|
Morphine and other opioids including hydromorphone
|
|
|
Angiodysplasia of the colon has a known association with?
|
Aortic stenosis aka Heyde's syndrome
|
|
|
What is the most likely organism to cause septic arthritis in a replaced hip joint?
|
Staph epidermidis - any time there is artificial hardware, mesh, etc.. this is even more common than s. aureus
|
|
|
Orthostatic hypotension definition
|
Drop of systolic by at least 20 or diastolic by at least 10 within three minutes of standing
|
|
|
Stepwise supportive treatment for cirrhosis with ascites
|
1. sodium and water restriction
2. Spirinolactone 3. Furosemide 4. TIPS procedure 5. transplant |
|
|
ECG findings in acute pericarditis include
|
diffuse ST elevations but also PR depression in leads II and aVF
|
|
|
How long in the active phase of labor without changes before failure to progress can be called?
Latent phase? |
Active - 2 hours both
latent - 20 hours primi - 14 hours multip |
|
|
In hemophilias which times are prolonged
|
PTT only
|
|
|
Best current treatment for a child born with respiratory distress secondary to low surfactant
|
CPAP
|
|
|
Radon gas has been linked mostly to what
|
Lung cancer
|
|
|
AAA's greater than what size need to be monitored yearly
|
3 cm
NOTE: Number 1 predisposing factor for AAA is smoking even over HTN and atherosclerosis |
|
|
Treatments for each of the following bladder cancer stages
In Situ Superficial Large or recurrent Invasive without mets Invasive with mets |
-Intravesicular chemo
-Transuretheral resection w or w/o intravesicular chemo -Intravesicular chemo -Radical cystectomy w or w/o radiotherapy -IV or oral Chemo |
|
|
Hypervascular lesion of the liver with AV malformations
|
FNH
Treatment is observation only |
|
|
What is the medical management of acute aortic regurgitation
|
Vasodilator nitroprusside with vasoconstrictor dopamine
|
|
|
Common cause of nephrotic syndrome in people with HIV, IV drug use and obesity
vs. HBV syphilis malaria |
Focal segmental glomerulosclerosis
vs. membranous nephropathy |
|
|
Which antibiotic requires oxygen uptake into cells to be effective?
|
aminoglycosides
|
|
|
Most common compulsion of OCD
|
repetitive washing
|
|
|
What is the latest that an abortion can be managed medically?
|
7 weeks for mifepristone & oral/vaginal misoprostol or IM/oral methotrexate & oral/vaginal misoprostol
or 8 weeks for Vaginal/sublingual/buccal misoprostol can be used up to 56 days gestational age |
|
|
HNPCC is most likely found where in the colon?
|
Proximal colon
|
|
|
What is the management for MVP?
|
It is now recommended that all patients with suspected MVP receive an echo for risk stratification
|
|
|
EKG findings for a posterior wall MI
|
Prominent R waves with ST depression in V1 and V2 describes a posterior wall infarction
|
|
|
Know how each maneuver affects heart murmurs
|
Inspiration – increases right-sided murmurs.
Expiration – increases left-sided murmurs. Abrupt standing – decreases venous return because increased venous capacity, causes a reflex increase in heart rate. Valsalva – like standing causes a decrease in venous return. Squatting – increases venous return and therefore increased preload to the heart. Handgrip - increased venous return, but more importantly increase afterload. Decreases AS murmurs and increases MR. |
|
|
How often should fetal heart monitoring be used in the first and second stages of labor?
|
Every 30 minutes in the first stage and every 15 minutes in the second stage or 15 and 5 if the pregnancy has been complicated
|
|
|
Two important signs for immediate surgical intervention in an acute abdomen patient include
|
Rebound guarding and tenderness and increasing need for pain narcotics
|
|
|
Cardiologic findings in acute blood loss include?
|
Decreased cardiac output, decreased PCWP and increased peripheral vascular resistance
|
|
|
Recommended treatment time with coumadin prior to an elective cardioversion
|
3 weeks
|
|
|
Toxoplasmosis is most common during which trimester and most dangerous during which
|
Most common 3rd
Most dangerous 1st |
|
|
Most common US appearance of most common cause of RUQ pain
|
Calculi, hyperechoic shadowing, pericholecystic fluid and thickened gallbladder wall
|
|
|
1st step to reduce regurgitation in a young baby being bottle fed
|
Switch to a nipple with a smaller hole, they will get less air and vomit less
|
|
|
How much does UC increase your likelihood of developing cancer
|
10-20 times the risk starting 10 years after diagnosis
|
|
|
Common lipid altering drug that when combined with statins can increase risk of myalgias
|
Fibrates and niacin
|
|
|
Worry when correcting hypernatremia too quickly
|
Cerebral edema
|
|
|
Urinary casts with dysmorphic red blood cells is highly suggestive of what?
|
Glomuerular disease
|
|
|
What are the 8 major criteria of CHF?
|
Paroxysmal nocturnal dyspnea, Neck vein distention, Rales, Cardiomegaly, Acute pulmonary edema, Auscultation of an S3 gallop, Increased venous pressure, and a positive Hepatojugular reflux.
|
|
|
Besideds allopurinal what other simple medications can be given to reduce the amount of uric acid stones and how do they work?
|
Sodium bicarb and citrate alkalinize the urine
|
|
|
What does res ipsa loquitor mean?
|
The thing that speaks for itself, no need to prove negligence as it is very obvious e.g. an x-ray showing an instrument left in an abdomen
|
|
|
Calcium recommendations for teenage girls, adult women, and women over 50
|
1300mg/day, 1000mg/day, 1200mg/day
|
|
|
Objective findings in ARDS?
|
Ground-glass appearance on x-ray (pleural edema) and a PaO2/FiO2 ration of less than 200
|
|
|
Anti-hypertensives that are safe during pregnancy
|
Labetalol, hydralazine, methyldopa
|
|
|
Besides the normal GI disturbances what are more worrisome side effects of beta blockade?
|
erectile dysfunction, depression and dyslipidemia
|
|
|
What is the highest that physiologic jaundice should be and what is the most common reason for pathologic jaundice in the first 24 hours?
|
No more than 12mg/dL in the first 3 days of life or an increase more than 5mg/dL per day. Most common cause is ABO incompatibility
|
|
|
When must a newborn be seen in the office after discharge?
|
Within 72 hours
|
|
|
Best initial test for a probable fibroadenoma
|
FNA
|
|
|
Artery most often associated with posterior nose bleeds
|
Maxillary from shenopalantine
|
|
|
Causes of painful inguinal lymphadenopathy
|
H. Ducreyi and C. trachomatis type L1-4 differ by painful and painless chancre
|
|
|
Schizophrenia is related to what change in which neurotransmitter
|
Increased Dopamine
|
|
|
GI distress, blurry vision, arrythmia and heart block in a person with CHF
|
Digoxin toxicity made worse by hypokalemia and renal failure (increasing Cr)
|
|
|
Women above what age are required to get a mammogram and biopsy of any breast lesion?
|
45
|
|
|
What is amaurosis fugax and what is the most likely etiology?
|
Transient monocular loss of vision, Emboli from ipsilateral carotid
|
|
|
what is necrobiosis lipoidica?
|
usually painless vasculitis in diabetics that presents with shiny pigmented patch that enlarges over time
|
|
|
Is ITP more associated with and URI in children or adults?
|
Children
|
|
|
1st line treatment of suspected lyme's disease in women and children
|
oral amoxicillin
|
|
|
What is the work-up for ASCUS?
|
Either HPV testing or close follow-up with repeat PAP at 6 months then possibly colposcopy if no change
|
|
|
Bacterial sepsis is most likely associated with which transfusion product?
|
Platelets because they are stored at room temp
|
|
|
What is the best way to diagnose parkinson's disease?
|
Physical exam even more important than the history
|
|
|
What is the work-up for a missing string of an IUD?
|
First pregnancy test then use pap brush to try and tease the string down if not possible need ultrasound and possibly second form of contraception.
|
|
|
What should be suspected in an asthma patient who continues to worsen or is hard to wean from steroids?
|
Aspergilosis - causes a continued allergic response and worsening of asthma
|
|
|
What testicular size is reassuring that a pubescent teen has appropriate hormone levels?
|
Length of greater than 2.5cm
|
|
|
Anti-arrythmics that are not contraindicated in WPW include which classes?
|
Amiodarone and procainamide
|
|
|
First line treatment for Dressler syndrome?
|
NSAIDs, 2nd line is steroids
|
|
|
What is the cheapest way to assess kidney function in a diabetic?
|
Microalbumin: creatinine ratio, also happens to be the best way
|
|
|
What is a contraindication to the use of salmeterol or other long acting beta 2 agonist in the treatment of asthma?
|
Must be on an inhaled steroid as well or there is an increased risk for mortality
NOTE: Those not willing to use steroids or can't use should consider a leukotriene modifying drug |
|
|
What is true of all trauma patients brought in to the ER?
|
They must try and be stabilized before a transfer is considered.
|
|
|
What is probably the most important electrolyte to correct in a hospitalized chronic alcoholic?
|
Magnesium, helps to stabilize membranes. Increases threshold for seizures and decreases sedation needed
|
|
|
What caution must be used as people age and are on levothyroxine?
|
Often dosages need to be decreased because low albumin leads to less being protein bound
|
|
|
What is schuermann's kyphosis?
|
Structural anterior kyphosis with wedged vertebral bodies and schmorl nodules (disc herniations) not corrected with posture
|
|
|
Rai staging for CLL include?
|
Stage 0 - lymphocytosis
Stage I - + lymphadenopathy Stage II - + splenomegaly Stage III - + Anemia Stage IV - + Thrombocytopenia |
|
|
What is a common cause of continued pain months after a traumatic injury?
|
Complex regional pain syndrome caused by autonomic hyperreflexia
|
|
|
What deficiency is associated with bleeding and an abnormal ristocetin assay?
|
vWF deficiency - expect prolonged PTT secondary to unstable factor VIII
|
|
|
What is the medical treatment of urge incontinence vs overflow incontinence?
|
Urge - oxybutinin -anticholinergic
Overflow - bethanecol cholinergic agonist |
|
|
Progression of treatment for constipation
|
1st line is high fiber diets. next is a bulking agent such as psyllium with or without enemas.
|
|
|
What is the main vitamin deficient in breast milk?
|
Vitamin D must be supplemented
|
|
|
A young boy with developmental delay and hypertonia either spastic or dyskinetic think of what?
|
Cerebral palsy - often associated with a complicated delivery and/or neurologic insult in utero or during delivery
|
|
|
Hemodynamic changes in ARDS
|
PCWP <18 mmHg, PaO2/FiO2 ratio <200, and increased PVR (> 250 dynes*sec/cm5).
|
|
|
What is the first step in BPH with suspected urinary obstruction?
|
BMP and urinalysis and if available a PSA
Next steps include imaging such as ultrasound |
|
|
What is the imaging of choice for suspected megacolon
|
Barium enema
|
|
|
What is indicated for a patient that presents with unstable angina?
|
Admit to the hospital and start heparin or enoxaparin as well as a platelet inhibitor like clopidogrel
|
|
|
What is expected with wilm's tumor both comorbidities and prognosis?
|
It is a malignant tumor with an excellent prognosis if found early. B-W syndrome occurs with macroglossia, organomegaly and hypoglycemia
|
|
|
When do you use sedation in an emergent cardioversion?
|
If the patient is unstable but conscious and alert. If confused or unconscious go with synchronized cardioversion without sedation
|
|
|
Besides alcohol name some other risks for acute pancreatitis
|
OCP's with estrogen, diabetes, high triglycerides, sulfonamides, tetracyclines
|
|
|
What is first line treatment for uterine atony and what are some alternative treatments and their risk factors?
|
1st line - oxytocin
2nd line - methylgonovine but causes hypertension or caraboprost tromethamine but causes bronchoconstriction (no good in asthma patients) |
|
|
What are some tocolytics?
|
Terbutaline - Beta2 agonist often first line
Ritodrine - Beta2 agonist only FDA approved Nifedipine - Very popular Magnesium Sulfate - commonly used but evidence is lacking |
|
|
1st step in suspected developmental delay (no breasts or testicular enlargement by age 14)
|
X-ray to check bone age. If not revealing then go to checking hormone and thyroid levels
|
|
|
Most common form of anthrax vs most deadly and treatment
|
Common - cutaneous
Deadly - inhalation look for widened mediastinum and infiltrates Treatment - cipro or doxy plus additional abx but no longer PCN |
|
|
Treatment of adenocarcinoma vs squamous cell cancer of the anus
|
Adenocarcinoma - complete resection
Squamous - Chemotherapy and external beam radiation, if persists additional neoadjuvant chemo and resection |
|
|
Indications for tetanus toxoid +/- immunoglobulin
|
Toxoid for anyone under 7 or with a high risk wound that hasn't had one in 5 years. Add Ig for anyone over 60 or that hasn't had the full 3 series
|
|
|
Best two screening tests for SUSPECTED TB
|
Chest x-ray and sputum staining
|
|
|
In the ER setting of a multi-victim accident who gets treated first second last
|
First priority - most alert person with most serious injury or unstable vitals
Second - those with serious injuries or unstable vitals that are less aware Third - Mild injuries with stable vitals regardless of age (including babies) Last - those already dead or considered unsalvageable |
|
|
How long before surgery should OCP's with estrogen be stopped?
|
1 month
|
|
|
What is a less commonly known side effect of SSRI's especially paroxitine?
|
GI Bleed
|
|
|
What are the major duke criteria for endocarditis?
|
at least two separate positive blood cultures for a typical organism, persistent bacteremia with any organism, a single positive culture with Coxiella burnetti, evidence of endocardial involvement and a new heart murmur.
NOTE: Osler nodes and things like that are minor criteria |
|
|
What pulley is affected in trigger finger and what is the treatment progression?
|
A1 pulley (more common in diabetics) first stretching, splinting and NSAIDs, then steroid injection, lastly surgery
|
|
|
Difference between dandy-walker, arnold chiari I and arnold chiari II
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DW - lost of all or portion of brain stem and/or cerebellar vermis
Type I - Herniation of cerebellar tonsils Type II - Herniation of cerebellar vermis |
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2 leading causes of fever of unknown origin
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infection and cancer, then rheumatologic diseases, then auto-immune
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Abx coverage for fractures with <1cm laceration, 1-10cm, and >10cm
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<1cm - 1st gen cephalosporin
1-10cm - 1st gen ceph plus amino >10cm - as above plus PCN Clindamycin is the alternative for those allergic to ceph or PCN |
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1st line therapy for metastatic prostate cancer
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If localized to a region, like lower spine radiation therapy alone.
If widespread then chemo with platinum based |
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What is Mackler's triad?
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Chest pain, vomiting and subcutaneous emphysema. Less common findings in Boerhaave's syndrome but highly suggestive. More commonly see odynophagia, dyspnea, CP and tachypnea
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What are some causes and treatments of ogilivie's syndrome?
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Usually medications or electrolyte abnormalities. NG tube with IV fluids. Possible rectal tube or colonoscopy and if still not resolved neostigmine
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Treatment of nursemaid's elbow
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Supination with full flexion
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Which animal bites do not imply need for rabies vaccination and Ig?
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Small common rodents, e.g. squirrels rabbits guinea pigs etc..
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What is the differential and treatments in an alcoholic with encephalopathy?
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WK - have opthalmoplegia and ataxia. treat with thiamine 1st even if glucose low, glucose worsens the encephalopathy
Hepatic enceph - lactulose and neomycin Withdrawl - benzo's |
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What is isokinetic exercise?
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Same speed but varied resistance
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Recommended rate of breast exams
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If normal every 3 years until 40 then yearly
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Women with HIV should deliver how?
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Vaginally no better outcomes with section but should not breast feed
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Treatment for a slow or stable splenic bleed?
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Angioembolization if unsuccessful then open
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Conservative modality with the highest reduction in blood pressure?
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Weight reduction
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what type of study allows you to calculate absolute and relative risk?
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cross-sectional
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How is the Ann Arbor staging for hodgkin's lymphoma set-up
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I - single lymph node
II - either all above or all below diaphragm III - limited disease but is both above and below diaphragm IV- Disseminated Sub groups A = w/o symptoms B = with symptoms |
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What is the only current treatment for ALS and how long does it prolong life?
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Glutamate antagonist - riluzole
Usually prolongs life by 1 year |
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What is unique about the anthrax bacterium and how is it diagnosed?
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Polypeptide capsule
Confirmed using antibody testing Treatment is with cipro or doxy plus 1 or 2 additional abx |
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What should be in your DDX of delta waves?
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WPW and any other abnormality that leads to early ventricular excitation such as dilated cardiomyopathy especially concerning in alcoholics
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When can amniocentisis be done and who is it indicated in?
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All women with an abnormal triple screen or over age 35.
Usually done at 15-20 weeks. |
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First step of diagnosis after an abnormal alpha feto protein?
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Always do ultrasound first to r/o a dating error then amniocentesis
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Factor VIII deficiency levels and severity corresponding, treatment options
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<1% activity - severe
1-3 - moderate 5% or greater - mild Cryoprecipitate or VII replacement - half life is short so must be dosed BID but factor IX is Q day |
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What is the treatment for Schuermann's kyphosis?
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During growth back bracing and stretching. If past growth stage OMT and physical therapy unless curve >40 degrees or affecting physiology then surgery
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What often helps to delineate meningitis from a pyogenic brain abscess?
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Papilledema is present in abscess but not meningitis
Also look for recent dental work in elderly with confusion and fever |
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What are lewy bodies?
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Eosinophilic lesions of parkinsons
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Time frame for CVS vs amnio
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CVS 9-12 weeks
Amnio 15-20 weeks |
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How does succinylcholine work?
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Massive depolarization causing K efflux and then stays bound to receptors causing a competitive inhibition not a true refractory period
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What injuries most often occur with an inversion ankle sprain?
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1. Anterior talofibular
2. calcaneofibular 3. Posterior talofibular |
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a child should be able to lift their head from their chest when in a prone position, track to the midline, alert to sounds, coo, recongize their parents and exhibit a social smile at what age?
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2 months
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a child should be able to roll front to back, grasp a rattle, orient to voice and laugh at what age?
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4 months
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a child should be able to sit unassisted, transfer objects, babble and exhibit stranger anxiety at what age
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6 months
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a child should be able to play interactive games, crawl, grasp objects with their thumb, and speak their first words at what age
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9 months
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What new milestone occurs at age 10-11 months?
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Pull to stand, pincer grasp and wave bye bye
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What are the differences in cow's milk and human milk?
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Cows milk has more protein (too much for baby kidneys) and Vit K but human milk has more Vit C
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In an acutely ill person what oxygen saturation is recommended to start nasal oxygen?
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<94%
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What are the common causes of a wide split S2?
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1. RBBB
2. Pulmonic stenosis |
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What are common causes or paradoxical splitting?
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1. Aortic Stenosis
2. LBBB |
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What is the generic name for the drug for CML?
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Imatinib
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Main reason for birth control on isoretinoin?
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Greatly increases risk of spontaneous abortion. Also increases risk for other birth defects but less common than spontaneous abortion
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How is the biophysical profile scored?
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Either 0 (abnormal) or 2 (normal) points for each of 5 categories no score of 1. 8-10 is reassuring 6 equivocal and 4 or less bad
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What is the treatment of cocaine intoxication with cardiac involvement or unstable vitals?
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Cardiac enzymes and IV Benzo
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Some differentiating factors for rubella vs rubeola?
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Rubeola - classically has the 3 c's cough, coryza and conjuctivitis(not often in rubella)
Rubella - more likely to present with POSTERIOR cervical lymphadenopathy |
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Coverage of nosocomial pnuemonia or infection?
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Two abx for pseudomonas (Penem and aminoglyc.) plus broad gram positive resistant organisms (Vanco)
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Best treatment for simple aspiration pnuemonia
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Clindamycin
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Treatment of cystic fibrosis pneumonia?
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Pseudomonas (Penem and aminoglycoside)
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Nursing home resident with pneumonia and history of hospitlizations?
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Nosocomial coverage (Penem, aminoglyc, and vanco) plus atypical coverage (macrolide)
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IV Drug user with pneumonia
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Must cover anaerobes clindamycin and resistant gram positives vanco
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Treatment protocol of benign intracranial hypertension?
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1st acetazolamide (although CI in cirrhosis) next is steroids and if can't tolerate either of those optic sheath fenestration surgery
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Treatment of klinefelter's?
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Can use testosterone replacement which can help even with gonadal dysgenesis and infertility but CI in those with heart disease as well.
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What is the defect that leads to NTD?
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Lack of folic acid leads to dysfunction in the vertebral bones, often the lamina
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What is freidrich's ataxia?
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Progressive loss of dorsal columns and spinocerebellar tracts. Scoliosis and high arched feet are common along with the loss of proprioception and balance
Often associated with cardiomyopathy 90% of cases |
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How would you differentiate metastatic prostate cancer to spine from MM?
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Look for hypercalcemia, anemia and renal failure in MM.
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Most common location for a ureter to be damaged during female surgery?
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Cardinal ligament - very close to ureter
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A newborn who is irritable with a mild tremor and ruddy (reddish) skin?
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Polycythemia - Hct should be above 65% and males will also present with priapism
Treatment: Umbilical partial exchange |
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What are the following signs and what are they associated with?
DeMusset Corrigan Quincke Duroziez |
DeMusset - head bob with heart beat
Corrigan - Bounding pulses Quincke - Pulsating and elevated nail bed Duroziez - femoral artery bruit |
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Treatment of aortic regurgitation?
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CCB or ACEi until medical management fails
If acute then combination of nitrates and pressors (usually dopamine) |
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What are some signs of right ventricular infarct and what is the best initial treatment?
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JVD with kussmaul (Increases on inspiration), hypotension, and slow pulse as well as inferior lead ST elevation.
Initial treatment is to stabilize patient with IV Fluids, oxygen and aspirin (Important to increase pre-load) |
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Most likely diagnosis in a patient several weeks s/p MI with CHF like symptoms and ST elevation only in V1-V4 and best initial test
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Ventricular wall aneurysm - CXR
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What is porphyrea cutanea tarda associated with and which enzyme is deficient?
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Liver dysfunction caused by hepatitis B, alcoholism, estrogens, or smoking. Lack hepatic uroporphyrnogen decarboxylase
NOTE: Have skin blisters in sun exposed areas that leave hyperpigmentation behind |
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What is the clinical presentation of someone with familial benign pemphigus
|
Vesicular and crusting lesions with burning and pruritis around genitalia chest, neck axilla and back. longitudinal white bands on the fingernails are also common
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What is grover disease?
|
A benign skin condition of transient red papules with acantholytic dyskeratosis. Usually occurs after age 50 and in men.
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Commonly used anticholinergics used in the OR and reversal?
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Scopalomine, atropine, glyccopyrolate
Reversal with physostigmine |
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A young child with tremors, renal failure and erythematous cheeks or lips with hair or teeth loss?
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Mercury poisoning best treatment is demercaprol
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What are the recommendations for patient screening prior to elective surgery?
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An EKG for all patients with previous cardiac history all men over 40 and all women over 50.
CXR for all patients over 50 or hx of lung disease. |
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|
A key difference in clinical presentation of IgA nephropathy vs post-strep glomerulonephritis?
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IgA occurs during or days after URI, post-strep is usually a couple of weeks after
Treatment is usually conservative for both |
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What would the acid-base disorder be in a patient with a short acute exacerbation of asthma versus a prolonged exacerbation?
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Short flares usually have a respiratory alkalosis whereas prolonged flares the obstruction eventually leads to air trapping and a respiratory acidosis
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What is the most common acid-base disorder in salicylate toxicity vs the pathognomonic acid base disorder?
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Common - met acid with resp alk
Patho - mixed metabolic with resp alk |
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How to you calculate the odds of exposure with the disease vs odds of exposure without the disease?
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TP * TN / FP * FN
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Which right sided heart condition are each of these seen in?
Absent a waves Giant a waves Cannon a waves Giant CV waves |
1. A- fib
2. Tricuspid stenosis, Right heart failure 3. A flutter, premature atrial contractions, v-tach or v-fib (tricupsid valve closed) 4. Severe tricuspid regurgitation |
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Treatment of HIT
|
Switch to lepirudin, only transfuse platelets if active bleeding or below 10,000
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Treatment of a cephalohematoma?
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Conservative but must get CT or MRI to rule out significant birth trauma
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Herbal medication whose major side effect includes increased risk of bleeding especially in those already on thinners
|
Ginkgo biloba
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Herbal medication often used in depression with a relatively safe side effect profile?
|
St. John's Wort
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Herbal medication used to boost the immune system and its contraindications?
|
Echinacea - CI in auto-immune disorders and hx of hepatic disease
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Herbal medication used to boost sexuality, treat ED, and possibly help in DM?
|
Ginseng - biggest SE is insomnia
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What antibodies and/or antigens are present in the window phase of hep B infection?
|
Anti-HBc (IgM) only
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Which maneuvers cause the click of MVP to be closer to the first heart sound, which closer to the second and what is the initial treatment of MVP?
|
S1 - any that decrease preload valsalva, standing etc...
S2- any that increase preload squatting, hand grip etc.. Beta Blockers |
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|
Treatment progression of uterine atony?
|
Massage with oxytocin, then methylergonovine, PGF2 alpha, DandC, Exploratory lap, hyster
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4-5 days of high grade fever that resolve then days later a maculopapular rash breaks out on a child?
|
Roseola infantum - HHV - 6
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What is the diagnostic test for vWF deficiency?
|
Ristocetin co-factor assay
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|
A young baby > 6 months of age has encapsulated bacteremia?
|
Bruton's agammaglobulinemia
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|
What is chediak-higashi syndrome?
|
Defect in neutrophil chemotaxis resulting in neutrophils with giant granules and often associated with albinism.
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|
What is the deficiency in chronic granulomatous disease and what is the confirmatory test?
|
NADPH oxidase.
Nitroblue tetrazolium |
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|
Normal treatment of scoliosis?
|
Mild - Konstancin exercises and OMT
Moderate - Bracing and exercises, Severe - continued supportive unless resp compromise then surgery |
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|
What is the genetic defect in brugada syndrome and what are common EKG findings?
|
Defect in myocyte sodium channels.
ST elevation V1-V3 with RBBB |
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|
Common findings in an ACA infarct?
|
Speech perservation, disinhibition, gait apraxia, mood disturbances, contralateral weakness greatest in lower extremities, primitive reflexes (suck and grasp) return
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|
Common findings in a MCA infarct?
|
Contralateral weakness greatest in arms and face with hypesthesia and hemianopia, agnosia, aphasia if dominant and neglect if non-dominant
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|
Common findings in a PCA infarct?
|
Visual disturbances key with contralateral homonymous hemianopia being most common; may also have some memory impairment
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|
Common findings in a lenticulostriate infarct?
|
AKA lacunar infarct - common in those with HTN and DM. Usually has a simple motor or sensory component but commonly presents with ataxic hemiparesis
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|
Common findings in a vertobasilar infarct?
|
Variety of symptoms but will often present with some equilibrium disturbance, such as vertigo or nystagmus
|
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|
What is the common sign seen on abdominal radiograph in acute pancreatitis?
|
Sentinel loop or colon cut-off sign
|
|
|
What is Leriche's syndrome?
|
A subclass of peripheral artery disease that mainly affects the aortoiliac region with symptoms in lower extremities and pelvis common
|
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|
What are the typical waves seen on doppler flow and what do they represent?
|
Triphasic - normal flow
Biphasic - mild disease Monophasic - severe disease |
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|
What medications should be avoided in those with peripheral arterial disease?
|
Beta-blockers can cause unopposed beta2 constriction
|
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|
What is the inheritance pattern of HCM?
|
Autosomal dominant so very important to ask about family history
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|
Valsalva increases the murmur of HCM, how would you decrease it?
|
Any method that will increase pre-load and the classic medication that increases pre-load is a beta blocker
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|
What are some common clinical and EKG findings in dig toxicity? What is the treatment? Which electrolyte abnormality makes it worse which is a bad predictor of morbidity and mortality and which medications are CI?
|
Visual disturbances, palpitations, GI symptoms and mental status change. EKG findings include long PR, scooped ST segment with abnormal T waves. Hypokalemia worsens (increases risk of arrythmias), hyperkalemia is a bad sign and CCB's are CI (raise Dig levels further).
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|
What are each of the following signs associated with?
Sail String Lead pipe |
Sail - elbow fracture
String - chronic chrons Lead pipe - UC |
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|
What is now first line treatment for acute epiglotitis?
|
Ceftriaxone, becoming more resistant to penicillins
|
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|
What are the absolute CI to central line placement?
|
Adequate peripheral access and/or an uncooperative patient
|
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|
In order, what are the three top risk factors for developing AAA?
|
1. Atheroslerosis
2. Smoking 3. HTN |
|
|
How is asthma definitively diagnosed?
|
PFT's with a methacholine challenge
|
|
|
What is the proper management of wound dehisence?
|
Explore the wound to evaluate the fascia. Check for evisceration (surgical emergency). Fascial defects usually need surgery.
|
|
|
Best way to get tissue diagnose for suspected adenocarcinoma?
|
CT guided biopsy - because peripheral hard to get to with bronchoscopy
|
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|
Who is a PPD considered positive in with each of the following indurations?
5mm 10mm 15mm |
HIV, immunocompromised, close contact e.g. fluids with active TB
IV drug, prisoners, homeless, nursing home members All healthy people without risk |
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|
How to differentiate osteosarcoma from osteochondroma on xray
|
Osteosarcoma is more likely to have cortical thinning with a sunburst pattern or codman's triangle.
Chondroma will be a mass usually an incidental finding that is benign. |
|
|
If osteosarcoma is suspected on x-ray which additional tests are important to order?
|
1. CT of chest - most common place of distant mets
2. Bone scan - checks for other areas of tumor or bone mets |
|
|
What are the EKG findings of hypercalcemia?
|
Shortened QRS and prolonged PR interval
|
|
|
Indications for hemodialysis in a patient with methanol toxicity?
|
Ingestion of more than 30mL
Blood value > 20mg/dL Vision changes No change in acidosis despite multiple bicarb infusions |
|
|
What are the common innervations of the biceps femoris?
|
Dual innervation from the common peroneal (short head) and the tibial branch of sciatic (long head) both stem from L5-S2
|
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|
Which insulins have the longest and shortest duration of actions?
|
Longest - NPH 28 hours
Shortest - Lispro acts in 5-10 minutes with duration 2-4 hours |
|
|
What conditions is pheochromocytoma related to?
|
Men IIa - sipple syndrome
Men IIb- VHL Neurofibramatosis |
|
|
What are the five abnormal categories for metabolic syndrome and how many are necessary to diagnose?
|
1. Abd circumference men 40in. Women 35in
2. Triglycerides 3. HDL 4. Fasting glucose 5. HTN above 130/85 or on HTN med Three of the above criteria must be met |
