Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
330 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
PFT finding in obstructive lung disease.
|
FEV1/FVC is less than normal (which is 0.75-0.8)
|
|
|
|
PFT finding in restrictive lung disease.
|
FEV1/FVC is normal or close to normal.
|
|
|
|
Three types of sleep apnea and their differences
|
Obstructive: Restricts inspiratory airflow.
Central: Lack of signal from resp. center, no drive to breathe. Mixed: Combination of above. |
|
|
|
Most common cause of pneumonia
|
S. pneumoniae
|
|
|
|
Clinical features of typical pneumonia
|
Short prodrome, high fever, occurs in people over 40, typically lobar on CXR
|
|
|
|
Clinical features for atypical pneumonia
|
Longer prodrome (more than 3 days), low fever (less than 102), occurs in ppl younger than 40, CXR shows diffuse, multilobar involvement
|
|
|
|
Pneumonia in college student, cold agglutinins
|
Mycoplasma
|
|
|
|
Pneumonia in an alcoholic, currant jelly sputum
|
Klebsiella
|
|
|
|
Pneumonia in CF patient: most likely bug
|
Pseudomonas
|
|
|
|
Pneumonia in AIDS or HIV pt
|
Pneumocystis carinii or CMV
|
|
|
|
Wheezing in child less than 1 year old
|
RSV
|
|
|
|
Pulmonary hypertension CXR findings
|
Enlarged cardiac silhouette with bulging anterior cardiac border
|
|
|
|
Tx of mild intermittent asthma
|
No daily drugs required. Rescue beta-agonist inhaler. Systemic corticosteroids for exacerbations.
|
|
|
|
Tx of mild persistent asthma.
|
Low-dose inhaled corticosteroids and rescue beta-agonist inhaler. Alternative: Mast cell stabilizer, leukotriene modifiers, or theophylline, and rescue beta-agonist inhaler
|
|
|
|
Tx of moderate persistant asthma
|
Medium-dose inhaled corticosteroids and long acting beta-agonist, and rescue beta-agonist inhaler.
Alternative: Add leukotriene modifier or theophylline. |
|
|
|
Emphysema in a young person with minimal smoke exposure may indicate...
|
alpha-1-antitrypsin deficiency
|
|
|
|
Pneumothorax clinical presentation
|
Acute onset dyspnea and chest pain, diminished breath sounds, diminished tactile fremitus, increased resonance on percussion.
|
|
|
|
Type of pleural effusion that results from CHF, cirrhosis, and nephrotic syndrome
|
Transudative
|
|
|
|
Type of pleural effusion that results from inflammatory processes such as TB, pneumonia, carcinoma, infarction, trauma, rheumatic disorders
|
Exudative
|
|
|
|
Diagnosis of pleural effusion: imaging study
|
anteroposterior CXR shows blunting of the costophrenic angel, shows effusions up to 300ml. Lateral decubitus XR may show smaller fluid amounts.
|
|
|
|
Most common tumor originating in the mediastinum
|
Thymoma
|
|
|
|
Three compartments of mediastinum
|
Anterior, middle, posterior
|
|
|
|
Anterior mediastinal tumors include:
|
thymoma, teratoma, thyroid lesions, lymphoma
|
|
|
|
Middle mediastinal tumors include:
|
lymphadenopathy, pulmonary artery enlargement, great vessel aneurysm, developmental cyst, diaphragmatic hernia
|
|
|
|
Posterior mediastinal tumors include:
|
Neurogenic or diaphragmatic tumors
|
|
|
|
Risk factors for pulmonary embolism
|
cancer, OCPs, smoking, immobility, post-op, MI, CHF, obesity, orthopedic injury of pelvis, hips, or lower extremities.
|
Don't forget risk factors BESIDES Virchow's triad.
|
|
|
Pulmonary embolism presentation
|
Tachypnea, pleuritic chest pain, dyspnea, anxiety. Massive PE may have right ventricular failure and systemic hypotension.
|
|
|
|
Virchow's triad
|
Venous stasis, hypercoagulable state, venous endothelial injury. Predisposes to venous thrombus/PE.
|
|
|
|
Therapeutic mainstay for interstitial lung disease
|
Corticosteroids
|
|
|
|
Presence of a chronic productive cough for 3 months in each of 2 consecutive years, with other causes of cough excluded, is most likely..
|
Chronic bronchitis
|
|
|
|
Forced vital capacity is:
|
a measurement of the volume of airflow expired with the patient blowing as hard and fast as possible.
|
|
|
|
Causes of restrictive lung disease (Acronym PAINT)
|
Pleural (fibrosis, effusions, pneumothorax, empyema)
Alveolar (edema, hemorrhage, pus) Interstitial lung dz (inflammatory- sarcoid, or idiopathic) Neuromuscular (myasthenia) Thoracic wall (kyphoscoliosis, obesity, ascites, ankylosing spondylitis) |
|
|
|
CXR diagnosis of interstitial lung disease
|
Reticular, nodular, or ground-glass pattern. Honeycomb pattern if severe.
|
|
|
|
Features of sarcoidosis (Acronym GRUELING)
|
Granulomas
R-thritis (arthritis) Uveitis Erythema nodosum Lymphadenopathy Interstitial fibrosis Negative TB test Gammaglobulinemia |
|
|
|
Reversible airway obstruction secondary to bronchial hyperreactivity, airway inflammation, mucus plugging, and smooth muscle hypertrophy
|
Asthma
|
|
|
|
Terminal airway destruction and dilation that may be due to smoking or alpha-1-antitrypsin deficiency
|
Emphysema
|
|
|
|
Emphysema (pink puffer) clinical features
|
dyspnea, pursed lip breathing, thin, wasted appearance, minimal cough, decreased breath sounds
|
|
|
|
Productive cough, cyanosis, mild dyspnea, overweight, peripheral edema, rhonchi, barrel chest, use of accessory resp. muscles, JVD, end-respiratory wheezing, muffled breath sounds
|
Chronic bronchitis
|
|
|
|
COPD treatment
|
Smoking cessation, pneumococcal and flu vaccines, systemic or inhaled corticosteroids, oxygen, inhaled beta-agonists and anticholinergics
|
|
|
|
Pleural effusion that is due to increased pulmonary capillary wedge pressure or decreased oncotic pressure
|
Transudate
|
|
|
|
Pleural effusion that is due to increased pleural vascular permeability
|
Exudate
|
|
|
|
Left axis deviation ECG finding
|
Upright QRS in lead I and downward QRS in lead aVF
|
|
|
|
Right axis deviation ECG finding
|
Downward QRS in lead I and upright QRS in lead aVF
|
|
|
|
AV block ECG finding
|
PR interval greater than 200 msec, or P with no QRS following
|
|
|
|
Left bundle branch block ECG finding
|
QRS duration >120msec, no R wave in V1, and wide tall R waves in I, V5, and V6
|
|
|
|
RBBB ECG finding
|
QRS >120msec, wide R wave in V1, QRS pattern with wide S wave in I, V5, and V6
|
|
|
|
Atrial fibrillation management (Acronym ABCD)
|
Anticoagulate
Beta-blockers Cardioversion Calcium channel blockers Digoxin |
|
|
|
Most common cardiomyopathy
|
Dilated cardiomyopathy
|
|
|
|
Dilated cardiomyopathy CXR finding
|
Enlarged balloon like heart, pulmonary congestion
|
|
|
|
Dilated cardiomyopathy clinical findings
|
Gradual development of CHF, S3 gallop.
May have cardiomegaly, and tricuspid and mitral regurge |
|
|
|
Atrial fibrillation etiology (Acronym PIRATES)
|
Pulmonary disease
Ischemia Rheumatic heart disease Anemia, Atrial myxoma Thyrotoxicosis EtOH Sepsis |
|
|
|
Physical exam finding in atrial fibrillation
|
Pulse is irregularly irregular
|
|
|
|
2nd degree AV block (Mobitz I/Wenckebach) etiology
|
Drugs: digoxin, beta-blockers, or CCBs
Increased vagal tone (which is caused by inferior MI, sleep apnea, hypothyroid, among others) |
|
|
|
ECG shows wavy baseline without discernible P waves, with variable and irregular QRS response
|
Atrial fibrillation
|
|
|
|
ECG shows regular rhythm, but sawtooth appearance of P waves
|
Atrial flutter
|
|
|
|
ECG shows early wide QRS not preceded by P wave, followed by a compensatory pause.
|
PVC
|
|
|
|
ECG shows 3 or more consecutive PVCs, wide QRS complexes in a regular rapid rhythm
|
Ventricular tachycardia
|
|
|
|
Treatment for V-tach
|
Cardioversion, antiarrhythmics (amiodarone, lidocaine, procainamide)
|
|
|
|
Treatment for dilated cardiomyopathy
|
D/C EtOH, treat CHF (diuretics, ACEIs, beta-blockers)
If ejection fraction is less than 35%, consider implantable cardiac defibrillator. |
|
|
|
Physical exam findings for hypertrophic cardiomyopathy
|
Sustained apical impulse, S4 gallop, systolic ejection crescendo-decrescendo murmur that gets louder with Valsava maneuver
|
|
|
|
Most common cause of sudden death in young, healthy athletes in the U.S.
|
Hypertrophic cardiomyopathy
|
|
|
|
Treatment for hypertrophic cardiomyopathy
|
Beta-blockers initially for symptomatic relief, CCBs for 2nd line tx. Refer to cardiologist for surgical options.
Avoid intense athletic training. |
|
|
|
Beta blockers: common side effects
|
bradycardia, fatigue, sexual dysfunction
|
|
|
|
beta blockers: contraindications/cautions
|
sinus bradycardia, cardiogenic shock, use caution in diabetes, asthma, COPD, PVD. Do not discontinue abruptly.
|
|
|
|
Dihydropyridine CCBs (e.g. amlodipine (Norvasc)): Contraindications/cautions
|
hepatic dysfunction, hypotension
|
|
|
|
Non-dihydropyridine CCBs (e.g. verapamil, diltiazem): contraindications/cautions
|
sick sinus syndrome, 2nd or 3rd degree heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, renal/hepatic dysfunction
|
|
|
|
ACEIs contraindications/cautions
|
renal artery stenosis, hx of angioedema
|
|
|
|
ACEIs adverse effects
|
cough, angioedema, hyperkalemia, leukopenia, loss of taste
|
5 most common.
|
|
|
ARBs adverse effects
|
hyperkalemia, cough, URI
|
|
|
|
alpha/beta adrenergic blockers (e.g. labetalol, carvedilol) are used for:
|
CHF, HTN
|
|
|
|
Centrally acting antiadrenergic agents: examples
|
Clonidine (Catapres), Methyldopa (Aldomet)
|
|
|
|
Nitroglycerin contraindications/cautions
|
severe anemia, closed angle glaucoma, postural hypotension, early MI, head trauma or cerebral hemorrhage
|
|
|
|
Causes of right sided heart failure
|
Pulmonary disease, pulmonary HTN, rt ventricular infarction, mitral stenosis, left sided HF
|
|
|
|
Causes of left sided heart failure
|
MI with lt ventricular infarction, systemic HTN, cardiomyopathy, endocarditis, aortic valve dz and mitral regurge
|
|
|
|
left sided heart failure results in _______ congestion.
|
pulmonary
|
|
|
|
right sided heart failure results in ________ congestion
|
systemic venous
|
|
|
|
Systolic heart failure involves...
|
Decreased cardiac contractility and ejection fraction
|
|
|
|
Diastolic heart failure involves...
|
Poor ventricular compliance and relaxation, impaired ventricular filling.
|
|
|
|
Causes of heart failure
|
MI, afib, infection, shock/trauma, thyroid disease, PE, excess salt, medication noncompliance, beta blockers, NSAIDs
|
|
|
|
Physical findings of heart failure
|
JVD, tachypnea, bibasilar crackles, wheezing, S3 gallop, split S2, ascites, cyanosis, peripheral edema
|
|
|
|
CXR findings in CHF
|
Cardiomegaly, right or bilateral pleural effusions, Kerley's B lines, increased pulmonary vascular markings and pulmonary cephalization, interstitial edema, butterfly pattern of pulmonary edema
|
|
|
|
Laboratory findings in CHF
|
elevated BNP, respiratory alkalosis, increased BUN/Cr, dilutional hyponatremia, elevated liver enzymes, proteinuria
|
|
|
|
Mainstay of therapy for CHF
|
ACEIs
|
|
|
|
Drug therapy for CHF
|
ACEIs, loop diuretics, digoxin in systolic failure, beta blockers (low dose, increase slowly), vasodilators (hydralazine, oral nitrates, IV NTG)
|
|
|
|
Diastolic BP >140, fundoscopic changes (hemorrhage, exudates, papilledema), confusion, stupor
|
hypertensive crisis (aka malignant hypertension)
|
|
|
|
Complications of HTN
|
retinopathy, coronary artery disease, CHF, PVD, nephropathy, TIA/CVA
|
Don't forget what it does to the vascular system.
|
|
|
Fundoscopic findings in HTN
|
A-V nicking, copper wiring of arterioles, hemorrhages, exudates, papilledema
|
|
|
|
Nonpharmacologic management of HTN
|
salt restriction (2.4g Na/day), weight reduction, decrease alcohol, smoking cessation, aerobics, stress reduction (relaxation exercises)
|
|
|
|
Prinzmetal angina
|
Chest pain at rest with ST segment elevation
|
|
|
|
Levine's sign
|
Pt describes chest pain using clenched fist over his/her sternum
|
|
|
|
Gold standard study to evaluate CAD
|
cardiac cath with angiography
|
|
|
|
Pericarditis: clinical features
|
sharp retrosternal CP w/radiation to back & shoulder, intensifies with inspiration & lying supine, relieved by sitting up and leaning forward. odynophagia, anorexia, anxiety, myalgia.
|
|
|
|
dyspnea, tachycardia, cyanosis, JVD, hypotension, pulsus paradoxus, muffled heart tones may indicate..
|
pericardial tamponade
|
|
|
|
constrictive pericarditis PE
|
asymptomatic early. dyspnea, fatigue, JVD, peripheral edema, hepatomegaly, ascites
|
|
|
|
pericarditis ECG findings
|
acute phase with concave-up ST elevation in precordial leads, esp with absence of reciprocal ST depression seen in AMI. Intermediate phase ST segment returns to baseline, T waves invert. Late phase may have normal ECG.
|
|
|
|
Cardiac tamponade ECG findings
|
electrical alternans
|
|
|
|
pericardial effusion diagnostic study
|
echo
|
|
|
|
Uncomplicated acute pericarditis: treatment
|
ASA, NSAIDs, or prednisone; analgesics; rest; observe for signs of tamponade; treat underlying etiology
|
|
|
|
Cardiac tamponade: treatment
|
Immediate pericardiocentesis. If recurrent, refer to cardiothoracic surgeon.
|
|
|
|
Aortic stenosis murmur
|
mid-systolic ejection murmur best heard at the 2nd right intercostal space
|
|
|
|
Early decrescendo high-freq blowing diastolic murmur best heard at lt sternal border/3rd and 4th ICS; accentuated by having pt sit up, lean forward, hold breath after deep expiration, or by squatting.
|
Aortic regurge
|
|
|
|
Mitral stenosis most common etiology
|
Rheumatic fever
|
|
|
|
Mitral stenosis murmur
|
early to mid diastolic low pitch rumble murmur best heard at apex in left lateral decubitus position. May also have presystolic murmur.
|
|
|
|
Mitral regurge murmur
|
high frequency blowing holosystolic murmur best heard at apex with radiation to axilla in chronic cases. Can be accentuated by squatting. May be decrescendo if acute.
|
|
|
|
Mitral valve prolapse murmur
|
late-systolic murmur best heard at apex, increases in intensity with standing and handgrip.
|
|
|
|
CHF in newborn may indicate...
|
pulmonary stenosis
|
|
|
|
Harsh mid-systolic crescendo-decrescendo murmur loudest at left upper sternal border with radiation to neck, increased with inspiration.
|
Pulmonic stenosis
|
|
|
|
Pulmonic stenosis etiology
|
Usually congenital, may be associated with rubella.
|
|
|
|
Aortic aneurysm most common etiology
|
atherosclerosis
|
|
|
|
Most aortic aneurysms are located...
|
in abdominal aorta just below level of renal arteries
|
|
|
|
Complications of aortic aneurysm
|
Rupture, thromboembolism, distal ischemia
|
|
|
|
AAA Management
|
If <4cm and asymptomatic, watch and follow with serial U/S. If >4cm, surgical referral for elective surgery.
|
|
|
|
Aortic dissection most common etiology
|
HTN
|
|
|
|
Aortic dissection clinical features
|
Sudden onset tearing severe anterior chest pain with radiation to interscapular region.
|
|
|
|
Aortic dissection CXR findings
|
Widening of superior mediastinum, displacement of trachea, left pleural effusion, enlargement of aortic knob.
|
|
|
|
Aortic dissection gold standard diagnostic study
|
Aortic angiogram
|
|
|
|
Rheumatic fever etiology
|
GABHS pharyngitis
|
|
|
|
Jones' Criteria for diagnosis of rheumatic fever
|
Documented preceding GABHS infection (throat cx, rapid strep test, elevated aso titer) with 2 major and 2 minor manifestations.
|
|
|
|
Jones' criteria: major manifestations of RF
|
Carditis, polyarthritis, chorea (late finding), erythema marginatum, subcutaneous nodules
|
|
|
|
Jones' criteria: minor manifestations of RF
|
arthralgia, fever (101-104), prolonged PR interval, elevated acute phase reactants (ESR, C-RP)
|
|
|
|
Common amount of time elapsed between pharyngitis episode and rheumatic fever
|
1-3 weeks
|
|
|
|
Most common cause of acute bacterial endocarditis
|
Staph aureus
|
|
|
|
Most common cause of SBE
|
Strep viridans
|
|
|
|
Acute bacterial endocarditis etiology
|
S. aureus; Group A, B, C, and G strep; H. flu; S. pneumo; N. gonorrhea; enterococcus
|
|
|
|
SBE etiology
|
S. viridans; S. fecalis (enterococci); S. aureus; HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
|
|
|
|
IV drug abuse endocarditis organisms
|
S. aureus (MRSA); P. aeruginosa; enterococcus; candida
|
|
|
|
Endocarditis that is caused by virulent organisms and has an aggressive course
|
Acute bacterial endocarditis
|
|
|
|
Endocarditis that occurs in pts with preexisting valvular heart disease and has a slower course.
|
SBE
|
|
|
|
Classic triad of endocarditis
|
fever, heart murmur, positive blood culture.
|
|
|
|
Endocarditis physical findings
|
Murmurs; Fever; conjunctival hemorrhage; petechiae on LE or oropharynx; splinter hemorrhages; Osler's nodes; Janeway's lesions; Roth's spots on fundoscopy
|
|
|
|
Tests besides ECG to diagnose MI
|
Serial CK-MBs, troponin I or T, or myoglobin every 8 hours x 3. Elevated LDH, AST
|
|
|
|
MI Treatment
|
Admit to ICU. Early thrombolysis if less than 6 hrs from onset if pt meets strict criteria, otherwise PTCA or CABG. If symptomatic V-tach or V-fib, use lidocaine or amiodarone. Maintain O2 sat >90%. Control pain with morphine. NTG. Beta blockers for life. ASA, ACEIs, statins.
|
|
|
|
Who should receive endocarditis prophylaxis?
|
People with known valvular heart disease or prosthetic valves.
|
|
|
|
Protocols for endocarditis prophylaxis
|
Amoxicillin before and after oral surgery, or clindamycin or azithromycin in pts with PCN allergy. For GI or GU procedures, use ampicillin plus gent before the procedure and amoxicillin after; vanc if PCN allergy.
|
|
|
|
Most important side effect of heparin
|
Thrombocytopenia on day 3 to day 7 of heparin administration. D/C immediately if platelet count falls.
|
|
|
|
1. Heparin is monitored with...
2. Warfarin is monitored with... |
1. PTT.
2. PT |
|
|
|
Drug used to reverse the effects of heparin and LMWH.
|
Protamine
|
|
|
|
Warfarin reversal
|
Fresh frozen plasma (immediate effect) and/or Vitamin K (takes a few days)
|
|
|
|
Aspirin reversal
|
Platelet transfusions
|
|
|
|
How does hemophilia A or B affect coagulation tests?
|
Prolongs PTT. Hemophilia A will also have low levels of factor 8; hemophilia B will have low levels of factor 9
|
|
|
|
How does vWF deficiency affect coagulation tests?
|
Prolongs bleeding time and PTT. Normal factor 8 and 9, normal PT.
(autosomal dominant so look for family history) |
|
|
|
How does DIC affect coagulation tests?
|
Prolongs PT, PTT, and bleeding time. Positive D-dimer or FDPs. Associated with postpartum, infection, and malignancy. Schistocytes and fragmented cells on peripheral smear.
|
|
|
|
How does liver disease affect coagulation tests?
|
Prolongs PT. PTT may be normal or prolonged, and all factors but 8 are low.
|
|
|
|
How does Vitamin K deficiency affect coagulation studies?
|
Prolongs PT, slightly prolongs PTT. Normal bleeding time.
|
|
|
|
Right ventricular enlargement, hypertrophy, and failure due to primary lung disease.
|
Cor pulmonale
|
|
|
|
Common causes of cor pulmonale
|
COPD, PE, primary pulmonary HTN (young female age 20-40 with no other risk factors), sleep apnea
|
|
|
|
Signs and symptoms of cor pulmonale
|
tachypnea, cyanosis, clubbing, parasternal heave, loud P2, right sided S4, in addition to signs of pulmonary disease.
|
|
|
|
Wolff-Parkinson-White syndrome treatment
|
Procainamide, quinidine. AVOID digoxin and verapamil
|
|
|
|
Endocrine disease suggested when pt presents with sinus tachycardia or atrial fibrillation?
|
Hyperthyroidism. Screen with TSH.
|
|
|
|
Classic presentation of Wolff-Parkinson-White syndrome
|
Child becomes dizzy or dyspneic or passes out after playing, then recovers with no other symptoms. ECG will show delta wave.
|
|
|
|
Most common cyanotic congenital heart defect
|
Tetralogy of Fallot
|
|
|
|
Most common congenital heart defect.
|
Ventricular septal defect. Characterized by holosystolic murmur next to sternum.
|
|
|
|
Name that congenital heart defect! Upper extremity HTN only; radiofemoral delay; systolic murmur over mid-upper back; rib notching on x-ray; associated with Turner syndrome
|
Coarctation of the Aorta
|
|
|
|
Major risk factors for coronary artery disease
|
Age (Men > 45, women > 55 or with premature menopause and no ERT)
Family hx premature MI Smoking (>10/day) HTN (>140/90) Low HDL (<40mg/dl) High LDL (based on risk factors - if no risk, should be below 160. if high risk, should be below 70) |
|
|
|
First line therapy for hypercholesterolemia, after lifestyle modifications
|
HMG CoA reductase inhibitors (statins)
|
|
|
|
Rare but serious side effects to watch for with statins
|
Liver and muscle damage
|
|
|
|
2nd line therapy for tx of hypercholesterolemia.
|
Niacin and bile acid binding resins (cholestyramine)
|
|
|
|
What raises HDL?
|
Moderate alcohol consumption, exercise, estrogens
|
|
|
|
Lifestyle modifications for HTN
|
Diet: low salt, low fat, low calorie
Reduced smoking Reduced alcohol intake Weight loss Exercise |
|
|
|
5 classes of drugs considered 1st line therapy for HTN
|
ACEIs/ARBs
Beta Blockers CCBs Diuretics (thiazide) |
AABBCCD
|
|
|
In diabetics, ACEIs are protective against _____ and _____
|
Nephropathy and neuropathy
|
|
|
|
Pregnant women with HTN should be treated with...
|
Labetalol, hydralazine, or alpha-methyldopa
|
|
|
|
The number 1 modifiable risk factor for stroke
|
HTN
|
|
|
|
Which 3 tests should be ordered for every patient with a diagnosis of HTN, and why?
|
ECG: determine if the heart has been affected (LVH)
BMP: Look for 2ndary cause UA: Look for 2ndary cause or kidney damage |
|
|
|
How is endocarditis diagnosed and treated?
|
Diagnosed by blood cultures. Empiric treatment with broad-spectrum IV antibiotics such as 3rd gen cephalosporin or PCN plus an aminoglycoside until C&S results return.
|
|
|
|
Corticosteroid nasal spray will provide symptomatic relief in patients with allergic rhinitis in approximately how much time?
|
1-2 weeks
|
|
|
|
How can oral lichen planus be differentiated from oral candidiasis?
|
Oral lichen planus cannot be rubbed off, and oral candidiasis can be removed, leaving erythema.
|
|
|
|
Primary feature differentiating Meniere's disease from vestibular neuronitis.
|
Hearing loss
|
|
|
|
Most common cause of acute pharyngotonsillitis in a young child.
|
Rhinovirus
|
|
|
|
Chalky patch on the TM in a patient with recurrent OM is most likely...
|
Tympanosclerosis
|
|
|
|
Most common bacterial causes of acute sinusitis in a 6 year old.
|
H. flu and S. pneumo
|
|
|
|
Small child with 2 day history of painful ulcerative lesions on the buccal mucosa with a high fever. Most likely cause?
|
Herpetic gingivostomatitis
|
|
|
|
Small child with unilateral purulent odorous rhinorrhea, most likely cause?
|
Nasal foreign body
|
|
|
|
Most likely organism in a swimmer with ear pain that is increased with manipulation of the tragus or pinna
|
Pseudomonas aeruginosa
|
|
|
|
Pathology in the cochlea will cause which type of hearing loss?
|
Sensorineural
|
|
|
|
First choice of antibiotic in a child with acute OM
|
Amoxicillin
|
|
|
|
Acute tonsillitis and splenomegaly is suggestive of...
|
Epstein-Barr virus (infectious mononucleosis)
|
|
|
|
Vertigo, hearing loss, and tinnitus
|
Meniere's disease
|
|
|
|
Child with fever, arthralgia, rash on cheeks with "slapped cheek" appearance
|
Erythema infectiosum
|
|
|
|
Treatment of GABHS pharyngitis in a patient with PCN allergy
|
Erythromycin
|
|
|
|
What is Koebner's phenomena?
|
Linear lesions caused by allergic contact dermatitis
|
|
|
|
"target" lesions on hands and feet is suggestive of...
|
erythema multiforme
|
|
|
|
Purplish dermal plaque in a patient with HIV
|
Kaposi's sarcoma
|
|
|
|
Sudden painless loss of vision in one eye
|
Retinal artery occlusion
|
|
|
|
Vitiligo may indicate what disease?
|
Hypothyroidism
|
|
|
|
Raised papule on a chronic sun-exposed area with telangiectasias and a pearlescent border
|
Basal cell carcinoma
|
|
|
|
Small child who has had a high fever for several days develops an erythematous maculopapular rash on the trunk as the fever subsides.
|
Roseola
|
|
|
|
Child develops expanding erythematous rash associated with arthralgias, myalgias, headache, fatigue.
|
Lyme disease
|
|
|
|
Small child with lymphadenopathy followed by an erythematous maculopapular rash that begins on the face
|
Rubella
|
|
|
|
Staph toxin-mediated painful, tender, diffuse erythema followed by desquamation. Occurs mostly in babies.
|
Staph Scalded Skin Syndrome
|
|
|
|
Discrete, solid, skin-colored papules with central umbilication
|
Molluscum contagiosum
|
|
|
|
Sharply demarcated, tender, elevated, erythematous rash on face associated with fever
|
Erysipelas
|
|
|
|
Petechial lesions, fever, tachycardia, shock
|
Meningococcemia
|
|
|
|
Age group most likely to have testicular cancer.
|
15-35
|
|
|
|
Best initial test for someone presenting with signs of BPH
|
DRE
|
|
|
|
Inability to replace the foreskin over the glans penis in an uncircumcised male.
|
Paraphimosis
|
|
|
|
Middle aged male with signs of BPH. On DRE, the prostate is enlarged, nodular, nontender.
|
Prostate cancer
|
|
|
|
Sexually active heterosexual male with clear urethral discharge, dysuria, painful testicle
|
Chlamydia
|
|
|
|
Tumor associated with elevated alpha-fetoprotein AND beta HCG
|
embryonal carcinoma
|
|
|
|
Most likely site for prostate metastasis
|
Bone
|
|
|
|
False-negative rate of a screening PSA
|
20-25%
|
|
|
|
Initial diagnostic study for painless lump in testicle in a male 15-35 years of age
|
Ultrasound
|
|
|
|
Most likely type of testicular cancer in a young male (20s)
|
Choriocarcinoma
|
|
|
|
Infant with white reflex on fundoscopy
|
Retinoblastoma
|
|
|
|
Child with high fever, sore throat, drooling, sitting in tripod position
|
Epiglottitis
|
|
|
|
Dendritic ulcer on the cornea most likely indicates...
|
Viral keratitis
|
|
|
|
Cerumen impaction causes which type of hearing loss?
|
Conductive
|
|
|
|
Petechial rash that begins on wrist and ankles
|
Rocky Mountain Spotted Fever
|
|
|
|
Small child with high fever for several days, conjunctivitis, pharyngeal erythema, swollen lips that are cracked and fissured, rash on hands and feet
|
Kawasaki's disease
|
|
|
|
Treatment of choice for rocky mountain spotted fever
|
Doxycycline 100mg po BID x 10 days
|
|
|
|
Causative organism in Lyme disease
|
Borrelia burgdorferi
|
|
|
|
Name that STD: Gram stain of penile discharge reveals gram-neg intracellular diplococci
|
Gonorrhea
|
|
|
|
Anatomical portion of the prostate that becomes hyperplastic with BPH
|
transition zone
|
|
|
|
Primary symptom of bladder cancer
|
painless hematuria
|
|
|
|
Painless lesion on the penis
|
chancre
|
|
|
|
Minimal change disease presents as (nephrotic/nephritic) syndrome
|
Nephrotic
|
|
|
|
Poststrep glomerulonephritis presents as (nephrotic/nephritic) syndrome
|
Nephritic
|
|
|
|
Inability to retract the foreskin from the glans penis due to inflammation or infection
|
Phimosis
|
|
|
|
Most helpful test to differentiate testicular torsion from epididymitis
|
Nuclear medicine scan
|
|
|
|
Patients with Meniere's disease should limit their intake of _____
|
salt
|
|
|
|
leading cause of vision loss in Caucasians
|
Macular degeneration
|
|
|
|
Leading cause of vision loss in African Americans
|
Glaucoma
|
|
|
|
Normal pressure encephalopathy: 3 signs
|
ataxia, incontinence, dementia
|
Acronym: AID
|
|
|
itchy rash associated with asthma and allergic rhinitis
|
atopic dermatitis
|
|
|
|
Contact dermatitis therapy
|
Burrow's solution dressings for weeping vesicobullous eruptions. High potency topical steroids. Severe cases get a tapering course of oral steroids. Newer therapy includes topical anti-inflammatories such as tacrolimus
|
|
|
|
Recurrent episodes of pruritis of lateral fingers, palms, or soles with tapioca-like vesicles followed by papules, fissures, scaling, and lichenification
|
Dyshidrotic eczema (hand eczema)
|
|
|
|
lichen planus description "five p's"
|
pruritic purple (violaceous) planar (flat) polygonal papules. Usually seen on the wrists, lumbar area, shins, and penis
|
|
|
|
a single oval/round scaly patch resembling tinea corporis followed in days to weeks by crops of smaller lesions on the trunk and proximal extremities "Christmas tree" pattern
|
pityriasis rosea
|
|
|
|
Upper respiratory infection prodrome for 1-14 days followed by widespread vesicles and bullae on purpuric targetoid macules with severe mucous membrane involvement
|
Stevens-Johnson Syndrome
|
|
|
|
Stevens Johnsons syndrome is actually relatively benign as long as it doesn't progress into what?
|
Toxic epidermal necrolysis. Characterized by diffuse painful erythematous skin and epidermal shearing from friction (Nikolsky's sign)
|
|
|
|
Painful or painless bite by this spider is followed by generalize abdominal, back, and leg pain, possibly spreading within minutes to hours to include the entire torso and legs with severe abdominal pain. Subsides in 2-3 days.
|
What is a black widow?
|
|
|
|
A bite from this spider causes a reaction ranging from mild urticaria to full-thickness skin necrosis, followed in several hours by central bulla with surrounding gray to purple discoloration surrounded by erythema.
(Classic "red, white, and blue" sign) |
What is a brown recluse?
|
|
|
|
Verrucous "cauliflower" papules and plaques in the anogenital region
|
condyloma acuminata, caused by HPV. (genital warts)
|
|
|
|
True or False: Molluscum contagiosum will resolve without treatment
|
True, unless the patient is infected with HIV.
|
|
|
|
What is the rule of nines to estimate extent of a burn?
|
Each leg is 18%, each arm is 9%, front of trunk is 18%, back of trunk is 18%, the head is 9%.
|
|
|
|
Type of hearing loss resulting in decreased volume for low tones and vowels
|
Conductive
|
|
|
|
Type of hearing loss in which bone conduction is normal and air conduction is abnormal.
|
Conductive.
|
|
|
|
Type of hearing loss in which the tuning fork during the Weber test is heard more loudly in the affected ear.
|
Conductive
|
|
|
|
Type of hearing loss involving difficulty perceiving high tones
|
Sensorineural
|
|
|
|
Type of hearing loss in which air conduction is worse than bone conduction
|
Mixed
|
|
|
|
First line therapy for acute otitis media
|
amoxicillin
|
|
|
|
Hallmark of 1st degree heart block
|
PR interval >0.20 seconds
|
|
|
|
Main treatment goal for patients with hypoxic OR hypercapnic respiratory failure
|
Maintain partial pressure of oxygen in arterial blood levels
|
|
|
|
Common side effects of clonidine
|
sedation, fatigue, dry mouth
|
|
|
|
Most appropriate treatment for a patient with temporal arteritis
|
High dose long term steroids
|
|
|
|
Thrombolytic therapy in MI should be used within how many hours of the onset of chest pain?
|
12
|
|
|
|
True or false: Corticosteroids are only minimally effective in the treatment of emphysema
|
True: Only 20-30% of patients with COPD improve on chronic oral steroids
|
|
|
|
AAAs greater than ___ cm should be referred for surgical eval for consideration of elective repair to prevent rupture.
|
4 cm
|
|
|
|
Most common etiology of pulmonic stenosis
|
Congenital
|
|
|
|
Current recommendation for endocarditis prophylaxis before a dental procedure in patients with valvular heart disease
|
Amoxicillin 2g 1hr before procedure
|
|
|
|
An infant evaluated with failure to thrive is found to have a continuous machine murmur. Most likely diagnosis?
|
Patent Ductus Arteriosis
|
|
|
|
What signs are seen in hypertensive retinopathy but not on diabetic retinopathy?
|
AV nicking, copper and silver wiring, papilledema
|
|
|
|
Unilateral headache, visual changes, jaw claudication in an older woman
|
Temporal arteritis
|
|
|
|
2 most effective agents for lowering triglycerides and raising HDL
|
fibric acid derivatives (like gemfibrozil) and nicotinic acid
|
|
|
|
Effective medication for symptomatic mitral valve prolapse
|
Beta blockers
|
|
|
|
Barking "seal like" cough is what illness?
|
Laryngotracheitis (Croup)
|
|
|
|
Major caution with chemotherapy drug Doxorubicin?
|
Cardiotoxicity. Monitor for signs of cardiomegaly!
|
|
|
|
What anti-anginal agents are contraindicated in patients with closed-angle glaucoma?
|
Nitrates
|
|
|
|
CHF causes which type of pleural effusion?
|
Transudative
|
|
|
|
Best treatment for torsades de pointes
|
Magnesium sulfate
|
|
|
|
Obstructive pulmonary disease PFT findings
|
Decreased FEV1/FVC and maximal midexpiratory flow rate, high residual volume, and increased RV/total
|
|
|
|
Heart failure with a normal left ventricular ejection fraction is probably which type?
|
Diastolic
|
|
|
|
What anti-anginal medication requires drug-free periods of 8-12 hours to avoid tolerance effect?
|
long-acting nitroglycerin like isosorbide dinitrate
|
|
|
|
Heart murmur that is accentuated by sitting up, leaning forward, and holding breath after deep expiration
|
Aortic regurge
|
|
|
|
Common adverse effect of amlodipine?
|
Edema.
|
|
|
|
Medication used to prevent further eclamptic seizures?
|
Magnesium sulfate
|
|
|
|
ECG shows an irregularly irregular ventricular rhythm with no discernible p waves
|
Atrial fibrillation
|
|
|
|
Antihypertensive drug that inhibits the reabsorption of sodium and chloride
|
Loop diuretics (furosemide)
|
|
|
|
What, if any, symptoms can delineate patients with hypoxic respiratory failure between those with hypercapnic-hypoxic respiratory failure?
|
None! Check the ABGs.
|
|
|
|
The most important initial treatment for patients with diffuse parenchymal lung disease?
|
Stop exposure to pulmonary irritants
|
|
|
|
Hypoxic respiratory failure will have what CXR finding?
|
"white" lung or "white out"
|
|
|
|
What is the pattern of genetic transmission of cystic fibrosis?
|
Autosomal recessive
|
|
|
|
Otherwise health tall, thin cigarette smoker presents with dyspnea and pleuritic chest pain, is in mild distress.
|
Spontaneous pneumothorax
|
|
|
|
Anti-arrhythmic agent that prolongs repolarization and is used in atrial or ventricular arrhythmias?
|
Amiodarone.
|
|
|
|
Henoch-Schonlein purpura has what effect on coag studies?
|
None - normal clotting parameters. It is purpura due to vasculitis rather than a bleeding disorder.
|
|
|
|
Persistent fever following treatment for bacterial pneumonia is suggestive of...
|
empyema
|
|
|
|
Most common causative organism for laryngotracheitis (croup)?
|
Parainfluenza
|
|
|
|
ST segment elevation, leukocytosis, elevated ESR, and pericardial effusion on CXR
|
Pericarditis
|
|
|
|
What class of anti-arrhythmics is verapamil?
|
Class IV
|
|
|
|
2 intrathoracic complications of pneumonia
|
Empyema and lung abscess
|
|
|
|
Asthma medication that inhibits inflammation, edema, and bronchoconstriction.
|
Leukotriene modifiers
|
|
|
|
Removal of pleural fluid during pleurocentesis should not exceed ___mls at one time.
Why is this? |
1500 mls. To prevent possibility of pulmonary edema in the reexpanded lung.
|
|
|
|
Development of hypertension with proteinuria, edema, and other organ disturbances induced by pregnancy in the 2nd half of gestation
|
Preeclampsia
|
|
|
|
Dyspnea, substernal chest pain triggered by exertion, exertional dyspnea, and syncope.
|
pulmonary hypertension
|
|
|
|
RVH, ventricular septal defect, infundibular pulmonary stenosis, and an aorta overriding the VSD.
|
Tetralogy of Fallot
|
|
|
|
What clinical sign differentiates between arterial and venous disease?
|
Pulses. Absence of pulses correlates with arterial disease.
|
|
|
|
Sudden onset severe hypertension refractory to treatment, with an abdominal bruit.
|
Secondary hypertension due to renal artery stenosis.
|
|
|
|
Pleural fluid with high protein content, associated with inflammation or malignancy
|
Exudative
|
|
|
|
Most serious complication of pertussis
|
Bronchopneumonia from superinfection
|
|
|
|
Name the only beta blocker approved for use in CHF
|
Carvedilol
|
|
|
|
Which type of heart failure is caused by hyperthyroidism and anemia, high output or low output?
|
High output
|
|
|
|
A patient comes into the ED with SOB, hives, and hypotension. First medication to give?
|
Epinephrine. Hives and hypotension should signal the practitioner to begin therapy for anaphylactic reaction.
|
|
|
|
This congenital heart defect is more common in females than males, in preterm infants weighing less than 1500g. Produces a left-to-right shunt. PE shows a prominent apical pulse and a loud, harsh continuous murmur at the 2nd left interspace.
|
Patent ductus arteriosus
|
|
|
|
Mechanism of action of penicillins and cephalosporins
|
Inhibit bacterial cell wall synthesis
|
|
|
|
CXR shows cephalization of pulmonary vascular markings. Likely cause?
|
CHF
|
|
|
|
Most common pathogen of bronchiolitis
|
Respiratory syncytial virus (RSV)
|
|
|
|
CXR finding in hypoxic respiratory failure
|
"white" lungs
|
|
|
|
Most common serious consequence of untreated giant cell arteritis?
|
Blindness
|
|
|
|
Common adverse effects of systemic corticosteroids
|
Weight gain, increased appetite, blurry vision, hyperglycemia, and slow healing of cuts and bruises.
|
|
|
|
Therapeutic mainstay for interstitial lung disease
|
Corticosteroid therapy
|
|
|
|
What is the appropriate management for a patient with asymptomatic 2nd degree heart block, type II, with a heart rate of 40?
|
Permanent pacemaker
|
|
|
|
Patent ductus arteriosus: cyanotic or acyanotic?
|
Acyanotic.
|
|
|
|
Tetrallogy of Fallot: cyanotic or acyanotic?
|
Cyanotic
|
|
|
|
Treatment for hypertrophic cardiomyopathy.
|
Beta blockers
|
|
|
|
Angina, syncope, systolic murmur heard best at 2nd right interspace that radiates to the carotids. Also narrow pulse pressure and delayed carotid upstroke.
|
Aortic stenosis
|
|
|
|
What are the dermatologic findings of secondary syphilis?
|
Patchy hair loss, diffuse erythematous maculopapular rash, and condylomata lata
|
|
|
|
What is the dermatologic finding of primary syphilis?
|
A papule at the site of inoculation that evolves into a painless ulceration with raised borders
|
|
|
|
What are the dermatologic findings of tertiary syphilis?
|
Plaques, nodules, and gumma
|
|
|
|
What type of shock: Decreased cardiac output (CO), decreased pulmonary capillary wedge pressure (PCWP), increased peripheral vascular resistance (PVR)
|
Hypovolemic shock
|
|
|
|
Type of shock: Decreased CO, increased PCWP, increased PVR
|
Cardiogenic shock
|
|
|
|
Type of shock: Increased CO, decreased PCWP, decreased PVR
|
Septic or anaphylactic shock
|
|
|
|
Signs of neurogenic shock
|
Hypotension and bradycardia after trauma to the spinal column
|
|
|
|
Signs of increased intracranial pressure (Cushing's triad)
|
Hypertension, bradycardia, abnormal respirations
|
|
|
|
Treatment of septic shock
|
Fluid and antibiotics
|
|
|
|
Treatment of cardiogenic shock
|
Identify cause. Give pressors (dopamine)
|
|
|
|
Treatment of hypovolemic shock
|
Identify cause. Fluids and blood repletion
|
|
|
|
Treatment of anaphylactic shock
|
Diphenhydramine (Benadryl) or epinephrine 1:1000
|
|
|
|
Supportive treatment for ARDS
|
Continuous positive airway pressure
|
|
|
|
Signs of air embolism
|
A patient with chest trauma who was previously stable and suddenly dies.
|
|
|
|
Trauma radiographic series should include...
|
AP chest, AP/lateral C-spine, AP pelvis
|
|
|
|
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
|
Fatigue or impending respiratory failure
|
|
|
|
Treatment for SVC syndrome
|
Radiation
|
|
|
|
What is the acid-base disorder in pulmonary embolism?
|
respiratory alkalosis (hypoxia and hypercarbia)
|
|
|
|
What NSCLC is associated with hypercalcemia?
|
Squamous cell carcinoma
|
|
|
|
What type of lung cancer is associated with SIADH?
|
SCLC
|
|
|
|
What type of lung cancer is highly associated with cigarette exposure?
|
SCLC
|
|
|
|
What is the treatment for tension pneumothorax?
|
Immediate needle thoracostomy
|
|
|
|
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure. Diagnosis?
|
ARDS
|
|
|
|
Silicosis increases the risk of what pulmonary infection?
|
TB
|
|
|
|
What are the classic CXR findings for pulmonary edema
|
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's wing" appearance of hilar shadows, and perivascular and peribronchial cuffing
|
|
