CME4LIFE PANCE BOARD REVIEW FLASHCARDS 2018
HIGH YIELD INFO FOR THE 2018 PANCE (750 cards)
1
Q
What nerve are we checking for with EOM with an orbital fracture?
A
Infra-orbital Nerve
2
Q
What kind of lesion represents herpes keratitis?
A
Dendritic
3
Q
Where is the tear from retinal detachment most common?
A
Superior temporal area
4
Q
What is classically described as a curtain being drawn over the eye from the top to the bottom?
A
Retinal Detachment
5
Q
What is the leading cause of irreversible central vision loss?
A
Macular degeneration
6
Q
How is the metamorphosis of macular degeneration best measured?
A
Amsler Grid
7
Q
What is the leading cause of blindness in the USA?
A
Diabetic retinopathy
8
Q
An impediment through what structure leads to glaucoma?
A
Canal of Schlemm
9
Q
Which kind of glaucoma is most common?
A
Open angle
10
Q
What is the main symptom of glaucoma?
A
Peripheral visual field loss
11
Q
What is periorbital cellulitis primarily associated with?
A
Sinusitis
12
Q
When is dacryostenosis most common and what is the treatment?
A
Newborns. Symptomatic treatment.
13
Q
What is involved with an internal hordeolum and what is the common pathogen?
A
Meibomian gland, S. Aureus
14
Q
What is the most common pathogens of bacterial conjunctivitis?
A
Strep pneumonia, S. Aureus and HFlu
15
Q
What two diseases are caused by Neisseria?
A
Gonorrhea and Meningitis
16
Q
What do we call a yellowish, fleshy conjunctival mass typically on the nasal side?
A
Pinguecula
17
Q
What are the main causes of papilledema?
A
Malignant HTN, Increased intracranial pressure and pseudotumor cerebri
18
Q
How will papilledema appear?
A
Disc swollen with margins blurred and obliteration of the vessels
19
Q
What are the two most common causes of transient vision loss?
A
Emboli (amaurosis fugax) or giant cell (temporal) arteritis
20
Q
What causes sudden vision loss?
A
Central retinal vein occlusion, optic neuropathy, papillitis or retrobulbar neuritis
21
Q
What is the most common cause of amblyopia?
A
Strabismus
22
Q
What is blue/cyanotic discoloration of the sclera associated with?
A
Osteogenesis imperfecta
23
Q
With a conduction hearing loss, how will the Webber test respond?
A
Lateralize to the affected ear
24
Q
With conductive hearing loss, how will the Rinne test respond?
A
Bone conduction greater then air conduction
25
What is the most common cause of sensorineural hearing loss and what kind of hearing is lost?
Presbycusis, high frequency
26
What are the four main features of Meniere's disease?
Vertigo, low range hearing loss, tinnitus and ear pressure
27
What drugs ototoxic agents lead to hearing loss?
Aminoglycosides, loops, and chemotherapy drugs (cisplastin)
28
What bugs most are most common in otitis media?
Strep, H.flu and M.Cat
29
What kind of nystagmus is associated with peripheral vertigo?
Horizontal with rotatory component.
30
What test is used to diagnosis BPPV?
Dix-Hallpike
31
True or False: Most cases of sinusitis resolves without antibiotics?
TRUE
32
What symptoms are suggestive of Group A beta hemolytic strep?
Centor's Criteria
33
What symptoms are NOT consistent with Group A beta hemolytic strep?
Corzya, hoarse voice or cough
34
What is the antibiotic of choice for Group A beta hemolytic strep if PCN allergic?
Erythromycin
35
What is the diagnosis consistent with sore throat, uvula deviation, drooling, and trismus?
Peritonsillar abscess
36
How will aphthous ulcers appear in the mouth?
Painful, round with yellowish-gray centers & red halos
37
What is the most common yeast in oral thrush?
Candidia albicans
38
What is the location of anterior nose bleeds?
Kiesselbach plexus
39
What is the triad called of nasal polyps, asthma and aspirin sensitivity?
Samter's triad
40
What is the most common cause of community acquired pneumonia (CAP)?
Strep pneumonia
41
What antibiotic is appropriate for outpatient treatment of community acquired pneumonia (CAP)?
Macrolide (not erythromycin) or doxycycline
42
Who is the pneumococcal polysaccharide vaccine recommended for?
Young and old, sick, sickle cell, smokers, no spleen and liver disease
43
What are two buzz words that go with Mycoplasma pneumoniae?
Bullous myringitis and cold agglutinins
44
What are two buzz words with pneumocystis jiroveci?
Elevated LDH and hyper-hypoxia
45
What is a buzz word for pneumococcal pneumonia? (aka streptococcus pneumonia)
Rust colored sputum
46
What is a buzz word for klebisella pneumonia?
ETOH abuse and current jelly sputum
47
What bug is most likely to cause pneumonia in a patient with ETOH abuse?
Klebsiella
48
What bug is most likely to cause pneumonia in a patient with COPD?
Haemophilus
49
What bug is most likely to cause pneumonia in a patient with cystic fibrosis?
Pseudomonas
50
What bug is most likely to cause pneumonia young adults?
Mycoplasma/chlamydia
51
What bug is most likely to cause pneumonia in a patient with exposure to aerosolized water?
Legionella
52
What bug is most likely to cause pneumonia in children less than 1 year old?
RSV
53
What bug is most likely to cause pneumonia in children less than 2 years old?
Parainfluenza
54
What is the most common hospital acquired infection?
UTI
55
What is the most likely pathogen for ICU acquired pneumonia?
Pseudomonas
56
What is the most common opportunistic infection in patients with HIV infection?
Pneumocystis jiroveci (formerly P. carinii)
57
What are the classic symptoms of TB?
Fever, night sweats, weight loss
58
What are Ghon complexes that represent healed infection?
Calcified primary focus in the lungs
59
What is the historical landmark of TB?
Caseating granuloma that is AKA necrotizing granuloma
60
What are the side effects of INH?
B6 deficiency, hepatitis, neuropathy
61
What are the side effects of rifampin?
Orange discoloration and hepatitis
62
What is NOT predictive of bacterial bronchitis?
Sputum color
63
What is the leading cause of cancer death?
Bronchogenic carcinoma
64
What radiographic finding is diagnostic for epiglottitis?
Thumbprint sign
65
What radiographic finding is diagnostic for croup?
Steeple sign
66
What is the most common cause of bronchogenic CA?
Adenocarcinoma
67
What is the treatment of choice for Non-small cell CA?
Surgery
68
What are the three components of asthma?
Obstruction of airflow, hyperreactivity and inflammation
69
What change in FEV1 after bronchodilation is supportive of the diagnosis of asthma?
10%
70
What is the most effective anti-inflammatory for chronic asthma?
Inhaled steroids
71
What is the most contributing cause of COPD?
Smoking
72
What deficiency leads to COPD?
Alpha 1 antitrypsin
73
What is the single most important intervention in COPD?
Stopping smoking
74
What is superior to B agonists in achieving bronchodilation?
Anticholinergics (ipratropium or tiotropium)
75
What therapy is the only therapy that may alter the course of COPD?
Supplemental oxygen
76
What are the main symptoms of cystic fibrosis?
Cough, excessive sputum, sinusitis, steatorrhea and ABD pain
77
What is the gold standard for identifying a pleural effusion?
Thoracentesis
78
What are the most common irritants used for pleurodesis?
Doxycycline and talc
79
What type of image reveals the presence of pneumothorax?
Expiratory CXR
80
What are the risk factors for DVT/PE?
Virchow's Triad: Damage, Stasis and hypercoaguable state
81
What are the most common hypercoaguable states?
High estrogen, cancer and genetics
82
What is the initial method for the diagnosis of PE?
Spiral CT
83
When is a negative D.Dimer helpful in ruling out PE?
With low pre-test probability
84
What is the definitive test for PE?
Pulmonary angiogram
85
What physical findings are suggestive of pulmonary HTN?
Systolic ejection click and splitting/accentuation S2
86
What causes pneumoconoises?
Coal dust, silicate or other inert dusts
87
What is used to relieve chronic alveolitis in silicosis?
Steroids
88
What CXR findings are seen in asbestosis?
Pleural based plaques
89
What is the number one complication of asbestosis?
Mesothelioma
90
What disease is a multiorgan disease of idiopathic cause characterized by noncaseating granulomatous inflammation in affected organs?
Sarcoidosis
91
What is the main presentation of an aspirated foreign body?
Choking, coughing or unexplained wheezing or hemoptysis
92
What is the most common cause of respiratory disease in a preterm infant?
Hyaline membrane disease
93
What can be used as prophylaxis or rescue in a patient with established hyaline membrane disease?
Exogenous surfactant
94
What is the most common cause of shock
Gram negative sepsis
95
What lab test can identify and monitor sepsis?
Lactate
96
How should urine output be monitored in a patient with shock?
Indwelling catheter with a urine output of 0.5mL/kg/hour
97
How long should it take to lower a patient with a HTN urgency?
Hours
98
How long should it take to lower a patient with HTN emergency?
1 hour
99
What are the findings of malignant HTN?
Papilledema, encephalopathy or renal failure
100
What is the most common symptom of HTN?
Headache
101
What is recommended as the initial agent for HTN?
Diuretic
102
What diuretic should be used in patients with renal disease?
Loop Diuretics
103
In which patients are B-blockers most effective?
Younger/Caucasian
104
What is the initial drug of choice in a diabetic patient with HTN?
ACE Inhibitors
105
What is the major side effect of an ACE Inhibitor?
Cough
106
What agent is preferred for HTN in blacks and elderly?
Calcium Channel Blocker
107
What medications are recommended for BP control in aortic dissection?
Nitroprusside and a B-blocker
108
What is the anti-HTN medication of choice in a pregnant patient?
Hydralazine
109
What are the cardiac signs of CHF?
Enlarged heart, diminished first heart sound and S3
110
What is the most useful image with CHF?
Echocardiogram
111
What two medications prolong life in a patient with CHF?
ACE Inhibitor and B-Blockers
112
When is an implantable cardio-defibrillator indicated in a patient with CHF?
EF\<35%
113
What is the most common cause of cardiovascular death and disability?
Atherosclerosis
114
What are the risk factors for arterial disease?
Smoking, Age (M \> 55 and F \> 65,) DM, Cholesterol, HTN and family history
115
Name the three kinds of angina
Stable (predictable,) unstable (unpredictable) and Prinzmetal
116
What is the most common presentation of unstable angina?
Resting chest pain
117
What is Levine sign?
Clenched fist and teeth to describe angina pain
118
How long does stable angina last?
Less than 3 minutes
119
What is the most sensitive clinical sign of angina on an EKG?
Horizontal or down sloping ST segment depression
120
What percent of patients with unstable angina will have a normal EKG?
25%
121
What is the most useful and cost effective noninvasive test for angina?
Exercise stress testing
122
What is the definitive diagnosis for angina?
Coronary angiogram
123
What is the primary pharmacotherapy for angina?
Sublingual nitroglycerine
124
What is the first line therapy for chronic angina?
B-Blockers
125
What medication prolongs exercise duration and time to angina?
Ranolazine
126
What disease encompass acute coronary syndrome?
Unstable angina, Non-STEMI and STEMI
127
What is our primary decision point for patient with chest pain?
EKG
128
What two acute coronary syndromes are treated the same?
Unstable and NSTEMI
129
What is the rhythm that most people die from?
V. Fib
130
When is an AMI most likely to present?
Early morning
131
What is Dressler's syndrome (post MI syndrome?)
Pericarditis, fever, leukocytosis, pericardial or pleural effusions
132
What is the EKG findings of a STEMI?
1 MM ST segment elevation in two contiguous leads
133
What EKG finding is highly suspicious for STEMI?
LBBB
134
What are the contraindications to a B-blocker?
Slow hearts, weak hearts (CHF) or bad pulmonary patients
135
When should aspirin or clopidogrel be used in a patient with a STEMI?
Immediately
136
Name the 4 cyanotic heart anomalies
Tetralogy of fallot, pulmonary atresia, hypoplastic left heart syndrome, and Transposition of the great vessels
137
Name the non-cyanotic heart anomalies
ASD, VSD, PDA, AV septal defect (seen in Down's syndrome) & Coarctation of aorta
138
What is the most common ASD?
Ostium Secundum
139
What is the most common congential heart anomaly?
VSD
140
How do we treat PDA pharmacologically?
Indomethacin
141
How do we keep the ductus arteriosus open?
IV prostaglandins E
142
What is the most common valvular disease?
Aortic Stenosis
143
What is the most common presentation of valvular heart disease?
Dyspnea on exertion/exercise intolerance
144
What is the definitive method to identify heart structure and functional abnormalities?
Echocardiogram or TEE
145
How is the murmur of Tetralogy of Fallot identified?
Crescendo/decrescendo holosystolic at left sternal border that radiates to back
146
What heart defect gives a machinery murmur?
PDA
147
How are all regurgitation murmurs identified?
Blowing and higher pitch
148
What valvular pathology has an Austin Flint murmur?
Aortic regurgitation
149
What is the most common arrhythmia?
A.Fib
150
What is the key principle of treating an unstable arrhythmia?
Synchronized cardioversion
151
What is the initial treatment for a symptomatic bradyarrhythmia?
Atropine
152
How do we define V.Tach?
Three or more PVCs in a row
153
What are the two most common causes of Torsades?
Hypokalemia and hypomagnesemia
154
Who is Brugada syndrome most often seen in?
Asian population
155
What are the drugs of choice for V.Tach?
LAP = Lidocaine, Amiodarone and Procainamide
156
How do we treat Torsades de pointes?
Magnesium
157
How do we treat most patients with sick sinus syndrome?
Pacer
158
What is the most common cardiomyopathy?
Dilated (95% of the cardiomyopathies)
159
What are the physical findings of a dilated cardiomyopathy?
S3, JVD and rales
160
What are the physical findings of a hypertrophic cardiomyopathy?
S4 gallop, Bisferiens carotid pulse, jugular venous pulsation with a prominent "a" wave.
161
What are the key presenting features of a pericarditis?
Pain relieved leaning forward and a friction rub
162
What are the most common bugs that cause infectious endocarditis?
Strep viridians, S. Aureus and enterococci
163
What is the most common bug that causes endocarditis in an IV drug user?
S. Aureus
164
What are the most common bugs that infect a heart valve if infection occurs less than 2 months after implantation?
Gram Negative and fungi
165
What are the four classic findings of endocarditis?
Roth spots, Splinter hemorrhages, Osler's nodes & Janeway Lesions
166
What is the drug of choice for endocarditis prophylaxis
Amoxicillin
167
What valve is most commonly affected in Rheumatic heart disease?
Mitral
168
Name the major criteria for rheumatic heart disease? (AKA Jones Criteria)
Carditis, erythema marginatum, Subcutaneous nodules, chorea, polyarthritis
169
What medication can provide symptoms relief with PVD?
Cilostazol
170
What is recommended to prevent travel associated DVT?
Frequent ambulation, leg exercises and compression hose
171
What are the key demographics of temporal arteritis?
Age greater than 50 and a history of polymyalgia rheumatic
172
What are the signs and symptoms of giant cell arteritis
Unilateral temporal HA, scalp tenderness, jaw claudication, elevated ESR
173
What is the most common cause of aortic aneurysms?
Atherosclerosis
174
Who is the classic patient with aortic dissection?
Elderly male smoker with COPD, CAD and renal insufficiency
175
What is the diagnostic test of choice for AAA?
Ultrasound
176
What is the diagnostic test of choice for thoracic aneurysms?
Aortagram
177
What is the best indicator for response to RBC loss?
Reticulocyte count
178
What conditions lead to an elevated INDIRECT bilirubin?
Hemolysis and Gilberts syndrome
179
What are the causes of a microcytic anemia?
Sideroblastic, Thalassemia, Iron deficiency and chronic disease
180
What is the most common sideroblastic anemia basophilic stippling?
Lead
181
What problem do patients with one alpha globin chain (Hgb H) have?
Stillbirth = hydrops fetalis
182
What is another name for B-Thalassemia major?
Cooley anemia
183
What do people with Hgb H disease need?
Folic acid
184
What is the most common form of anemia?
Iron deficiency
185
What is the hallmark or iron deficiency?
Pica
186
What are the most common causes of a macrocytic anemia?
B12 and folate deficiency
187
What is the most common cause of folate deficiency?
Diet
188
What cell findings are pathognomonic for folate deficiency?
Macro-ovalocytes, hypersegmented PMN cells and Howell-Jolly bodies
189
What is the most common cause of Pernicious anemia?
Lack of intrinsic factor
190
What test looks for antibodies on the RBC thus looking for hemolytic anemia?
Coombs
191
What stain looks for G6PD?
Heinz body
192
What daily/lifelong medication should be considered for all patients with sickle cell patients?
Hydroxyurea
193
What does atypical lymphocytes point towards?
EBV (mono)
194
What does Auer rods point to?
acute myeloid leukemia (AML)
195
What cells are pathognomonic for CLL ( chronic lymphocytic leukemia)?
Smudge cells
196
Which cells point towards Hodgkin's Disease?
Reed-Sternberg
197
What virus is seen in 50% of Hodgkin's?
EBV
198
What is a trigger for lymph node pain in Hodgkin's?
Pain after alcohol
199
Where is the pathology in Multiple Myeloma?
Plasma cells
200
What is the most common complaint of patients with multiple myeloma?
Bone pain (LBP,) infections and anemia
201
What is the hallmark of multiple myeloma?
Monoclonal spikes on serum electrophoresis and Bence-Jones protein
202
What is the most common congenital coagulopathy?
Von Willebrand disease
203
What is Christmas Disease?
Hemophilia B (Factor IX deficiency)
204
What is a modality for a patient with significant night time symptoms?
H2 blocker at night and a PPI in the day
205
What are common viral causes of esophagitis?
CMV and HSV
206
What are common causes of esophagitis in a patient with HIV?
Mycobacterium tuberculosis, EBV, Mycobacterium Avium Complex
207
How do we treat HSV esophagitis?
Acyclovir
208
How do we treat CMV esophagitis?
Ganciclovir
209
What is a key feature of Zenker's diverticulum?
Vomiting undigested food after several hours
210
What is the classic finding on barium swallow in a patient with Achalasia?
Parrot beak
211
What is the condition called that is caused by thrombosis of the portal vein that leads to esophageal varices?
Budd-Chiari syndrome
212
What three diseases does H. Pylori cause?
Peptic ulcers, gastric adenocarcinoma and gastric
213
What is the most common cause of PUD ( peptic ulcer disease)?
H. Pylori
214
What is the name of a gastrin secreting tumor that causes hypergastrinemia?
Zollinger-Ellison Syndrome
215
What is diagnostic of Zollinger-Ellison Syndrome?
Fasting Gastrin level greater than 150pg/mL
216
What is strongly associated with gastric adenocarcinoma?
H. Pylori
217
What is the supraclavicular lymphadenopathy of gastric adenocarcinoma called?
Virchow's node
218
What is the umbilical nodule of gastric adenocarcinoma called?
Sister Mary Joseph nodule
219
Which organism causes the most rapid onset of diarrhea?
S. Aureus
220
What denotes an inflammatory process in diarrhea?
WBC in stool
221
When should a colonoscopy be ordered in a patient with constipation?
Patients older than 50 with new onset constipation
222
What causes most small bowel obstructions?
Adhesions and hernias
223
What is the most common cause of a large bowel obstruction?
Tumor
224
What test distinguishes mal-digestion from mal-absorption?
D-xylose test
225
What is the most common genetic condition in the USA?
Celiac
226
What are the screen tests for Celiac disease?
IgA antiendomysial and anti-tissue transglutaminase
227
What is the age of onset of Crohn's disease?
25 y/o with M=F
228
What is possible curative in ulcerative colitis?
Surgery
229
What is the most common cause of chronic or recurrent ABD pain in the USA?
IBS
230
What is the most common cause of intussusception in a child and adult?
Child: viral infection and adult: neoplasm
231
What is the presentation of intussusception?
Colicky pain, current jelly stool and a sausage like mass
232
How do we both diagnose and treat intussusception in a child?
Barium or air enema
233
How do we diagnose intussusception in an adult?
CT
234
What test is avoided in diverticulitis?
Barium enema
235
What is the risk of inherited polyposis syndrome?
Near-100% risk of CA
236
What lab test is used to monitor colorectal CA?
Carcinoembryonic antigen (CEA)
237
What is the most common cause of appendicitis?
Fecalith
238
What is the most common emergency surgery?
Appendicitis
239
What is the initial symptom of appendicitis?
Periumbilical or epigastric pain
240
What are the most common causes of pancreatitis?
ETOH and cholelithiasis
241
What is the classic pain pattern of pancreatitis?
Epigastric pain radiating to back
242
What is bleeding into the flanks called?
Grey Turner sign
243
What is bleeding into the umbilical area called?
Cullen sign
244
What is a palpable gallbladder and jaundice called?
Courvoisier sign
245
What is the surgical resection of pancreatic cancer called?
Whipple procedure
246
What are the complications of choledocholithiasis?
Cholecystitis, pancreatitis and acute cholangitis
247
What is Charcot triad?
RUQ pain, jaundice and fever
248
What is Charcot's triad that also has an altered mental status and hypotension called?
Reynold's Pentad
249
What is primary sclerosing cholangitis associated with?
Ulcerative colitis
250
What is the most common presentation of primary sclerosing cholangitis?
Jaundice and pruritus
251
What is the only know treatment for primary sclerosing cholangitis?
Liver transplant
252
What represents ongoing hepatitis B infection?
Hepatitis B SURFACE antigen (HBsAg)
253
What represents immunity to hepatitis B?
Anti-HBs: Antibody against hepatitis B surface antigen
254
What medication is used for acetaminophen toxicity?
Acetlycysteine
255
What is the general cause of a liver abscess?
Entamoeba histolytica
256
Where is the liver a common source or metastases from?
Lung and breast
257
Which diseases cause an elevation of Alpha fetoprotein?
Hepatic carcinoma, hepatitis C and cirrhosis
258
What is the location of an indirect inguinal hernia?
Through internal inguinal ring
259
What is the location of a direct inguinal hernia?
Through the external ring at Hesselbach's triangle
260
What is the basic patient demographic for pyloric stenosis?
5 week old male
261
What is the radiographic finding of pyloric stenosis?
String sign
262
What is the disease caused by vitamin D deficiency?
Rickets
263
What is the disease caused by a lack of Thiamine?
Beriberi
264
What is another name for vitamin B6?
Pyridoxine
265
What is the problem with phenylketonuria?
Inability to metabolize phenylalanine
266
What is the treatment for phenylketonuria?
Low phenylalanine diet and tyrosine supplementation
267
Which renal function is most sensitive to dehydration?
BUN
268
How will the urine appear with intrinsic renal disease?
Casts (WBC, RBC, granular, epithelial) and protein
269
What is a new bio-marker for detecting acute kidney injury?
Cystatin C
270
What ultrasound finding indicates a chronic renal problem?
A small kidney less then 10cm
271
What are indications for dialysis?
Acidosis, electrolyte disorder, fluid overload, uremic complications
272
What are the most common causes of chronic kidney disease?
DM, HTN, glomerulonephritis, and polycystic kidney disease
273
What are three abnormal symptoms of renal failure?
Metallic taste, hiccups and pruritus
274
What is the gold standard for identifying renal disease?
GFR
275
What is the marker for kidney disease?
Proteinuria
276
What diagnostic test looks for recent strep infection and is helpful in evaluating post streptococcal glomerulonephritis?
ASO Titer
277
How do we define nephrotic syndrome?
Excretion of more than 3.5grams of protein (per 1.73m2) of body surface area
278
What are the manifestations of nephrotic syndrome?
Hypoalbuminemia, lipiduria, hypercholesterolemia and edema
279
What is a key finding in the urine for nephrotic syndrome?
Oval fat body in urine
280
What is the diagnostic method of choice for polycystic renal disease?
Ultrasound
281
What are 80% of kidney stones made up from?
Calcium
282
What stones are produced by infections?
Struvite stones
283
What is the modality of choice in identifying kidney stones?
CT scan Abd/pelvis without contrast
284
What are the 5 causes of Diabetes insipidus?
Inherited, lithium, hypokalemia, hypercalcemia or renal disease
285
What urine osmolality points to DI?
\<250 mOsm/kg
286
How is diabetes insipidus treated?
Intranasal desmopressin
287
What medication should be administered to patients with hyperkalemia and EKG changes?
Calcium gluconate
288
What are the EKG changes in hyperkalemia?
Peaking of T waves, QRS wide and flat P waves
289
What treatment is used to remove potassium from the body?
Sodium polystyrene sulfonate (Kayexalate)
290
Name the classic sign of hypocalcemia that is identified by tapping on the cheek?
Chvostek sign
291
Name the classic sign of hypocalcemia that is identified by tourniquet-ing off the arm with a BP cuff?
Trousseau sign
292
What is the suggested treatment for cystitis?
Fluoroquinolone or nitrofurantoin for 3-5 days
293
What medications will change your urine red/orange?
Phenazopyridine and Rifampin
294
What is the most common bug to cause pyelonephritis?
E.Coli
295
What is the recommended treatment for prostatitis?
Cipro 500mg BID, Levoquin 500mg daily for 2- 6 weeks or TMP-SMZ BID for 6 weeks
296
What is the bug in male patient with epididymitis less than 35 years old?
GC/Chlamydia
297
What is the bug in male patient with epididymitis older than 35 years old?
E.coli
298
What is a classic, yet unreliable sign in epididymitis?
Prehn's sign
299
What medication class is effective in treating urge incontinence?
Anticholinergic
300
What is the most common kind of prostate CA?
Adenocarcinoma
301
What is the most common renal cancer?
Adenocarcinoma
302
What is the classic triad for renal cancer?
Hematuria, flank pain and palpable mass
303
What is the most common solid renal tumor in children?
Wilms tumor (nephroblastoma)
304
What is the initial image testing to evaluate abdominal masses?
Ultrasound
305
What is the most common cancer in young men?
Testicular
306
What are the risk factors for testicular cancer?
Cryptorchidism or past testicular CA
307
What diagnostic markers are diagnostic for non-seminomatous germ cell testicular CA?
Alpha fetoprotein and B-human gonadotropin
308
What is it called when we can't retract the foreskin over the glans penis?
Phimosis
309
What leads to paraphimosis?
Frequent cauterizations without reducing the foreskin
310
What is a fibrous plaque causing penile curvature?
Peyronie's disease
311
What is the class of medications used for erectile dysfunction?
Phosphodiesterase 5 inhibitor
312
Which two scrotal masses trans-illuminate?
Hydrocele and Spermatocele
313
Which scrotal mass has a bag of worms presentation?
Variocele
314
How can the presentation of a varicocele be more pronounced?
Valsalva
315
What is the most common cause of secondary amenorrhea?
Pregnancy
316
What are the two most common causes of secondary amenorrhea in patients with normal estrogen?
Asherman syndrome and polycystic ovarian syndrome
317
What is another name for gonadal dysgenesis?
Turner's syndrome
318
What lab test is diagnostic for menopause?
FSH \> 30mIU/mL
319
What is the most common presentation of a leiomyomata (uterine fibroid)?
Vaginal bleeding
320
What is recommended in most cases of a leiomyomata?
Observation
321
What is the most common gynecological cancer?
Endometrial cancer (adenocarcinoma)
322
What is the cardinal symptom of endometrial cancer?
Vaginal bleeding
323
What patient population is most common in endometriosis?
Nulliparous 30 years old
324
What are the most common ovarian growths?
Cysts
325
What is the most common cause of androgen excess and hirsutism?
Polycystic ovarian syndrome
326
Bilateral enlarged cystic ovaries, amenorrhea and infertility are the key features of this disease?
Polycystic Ovarian Syndrome
327
How will the ultrasound appear in a patient with Polycystic ovarian syndrome?
Sting of pearls or oyster ovaries
328
How is infertility of polycystic ovarian syndrome treated?
Clomiphene
329
When is Cervical itraepithelial neoplasia (CIN) most common to occur?
Women in their 20s
330
When has the CDC recommend patients receive the HPV vaccine?
Boys and girls age 11-12. Three injections over 5 months.
331
What kind of cancer are women exposed to diethylstilbestrol (DES) at increased risk for?
Clear cell adenocarcinoma
332
What bug most commonly causes mastitis?
S. Aureus
333
What is the antibiotic of choice for mastitis?
Penicillinase resistance antibiotics (dicloxacillin)
334
What is the most frequent benign condition of the breast?
Fibrocystic Breast Disease
335
What benign breast lesion is more common in black woman?
Fibroadenoma
336
What is the most common cancer in woman and what kind is the most common?
Breast, Infiltrating ductal carcinoma
337
What ductal carcinoma presents with eczematous lesions of the nipple?
Paget disease
338
What is the best screen test for breast neoplasms?
Mammography
339
What is the most effective form of contraception?
Oral contraception
340
What is the black box warning for IM depo injections?
Osteoporosis: thus only to be used for 2 years
341
What is the most common cause of infertility?
Ovulatory disorders
342
What is the physical exam finding of pelvic inflammatory disease (PID)?
Chandelier sign
343
Where should the uterus be at 20 weeks of gestation?
Umbilicus
344
When should we hear fetal heart tones (FHT)?
10 weeks
345
What is bluish discoloration of the vagina and cervix called that is seen in pregnancy?
Chadwick sign
346
Where are most ectopic pregnancies located?
Fallopian tube
347
What is the most common cause of ectopic pregnancy?
Adhesions
348
What is the classic triad of ectopic pregnancy?
Unilateral ABD pain, amenorrhea and tenderness/mass on exam
349
What hCG level should show evidence of an IUP?
1,500 mU/mL
350
What patients should receive RhoGam with an abortion?
Rh-negative woman
351
How does a hydatiform mole present on ultrasound?
"grapelike vesicles "or a "snow storm pattern"
352
What is the most common cause of non-congenital malformation deaths in a neonate?
Preterm delivery
353
What is a major risk factor of premature rupture of membranes?
Infection
354
What test can confirm rupture or membranes and spilling of amniotic fluid?
Nitrazine paper and the fern test
355
What is administered to enhance fetal lung maturity if under 34 weeks gestation?
Betamethasone
356
What is the classic triad of preeclampsia?
HTN, edema and proteinuria
357
What is HELLP syndrome?
Hemolysis, elevated liver function and low platelets
358
What is the most common risk factor for pre-eclampsia?
Nulliparity
359
What is the first line medication to decrease the risk of seizure in mild pre- eclampsia?
magnesium sulfate (MGSO4)
360
What BP medication should be given to decrease the BP in a pregnant woman?
Hydralazine or labetalol
361
What is administered to Rh-negative Moms at 28 weeks?
Rho-Gam
362
What is the test to measure fetomaternal hemorrhage?
Kleihauer-Betke (KB) stain
363
What is the condition that develops if Rh-incompatibility leads to severe fetal anemia and death?
Fetal hydrops
364
What is the most common cause of third trimester bleeding and when does it occur?
Abruptio placenta, after 20 weeks
365
What is the major symptom in abruptio placenta?
Painful vaginal bleeding
366
What is contraindicated in a patient with placenta previa?
Digital exam
367
What is the key differentiating feature of placenta previa from abruption?
Previa is painless
368
At what time interval is the APGAR assessed?
1 and 5 minutes
369
What medication decreases blood loss by stimulating contractions?
Oxytocin
370
What is the leading indication for cesarean section?
Dystonia
371
When is endometritis most common?
After C-section or PROM for more than 24 hours before delivery
372
What is the first line treatment for endometritis?
Clindamycin + gentamycin
373
What is the most common arthopathy?
Osteoarthritis (OA)
374
What is osteoarthritis involving the DIP called?
Heberden nodes
375
What is osteoarthritis involving the PIP called?
Bouchard Nodules
376
What joint is usually spared in Rheumatoid Arthritis?
DIP
377
What labs are present in 90% of patients with Rheumatoid Arthritis?
RF and anti-cyclic citrullinated peptide
378
What is the frequent initial disease modifying antirheumatic drug (DMARDs) in RA?
Methotrexate
379
What is systemic RA called in a child?
Still disease
380
What is it called when a rash is brought out when scratching an area?
Koebner phenomenon
381
What is the most common joint pathogen in septic arthritis?
S. Aureus
382
What cancers met to bone?
Prostate, breast, lung and thyroid
383
What is the most common benign bone neoplasm?
Enchondroma
384
What is the most common primary sarcoma?
Chondrosarcoma
385
What is the most common primary malignant bone tumor?
Multiple myeloma
386
What is the age range and location of Ewing sarcoma?
5-25 and diaphysis of long bones/ribs
387
What is the age range and location of Osteosarcoma?
10-20 and in the metaphyseal area of long bones
388
What type of pain is most often associated with malignancy?
Night pain
389
What test is used to identify the specific abnormal globulin of multiple myeloma?
Protein electrophoresis
390
What are the modifiable risk factors of osteoporosis?
ETOH, smoking, low body weight, sedentary lifestyle, low calcium, low Vit D, and steroids
391
What is the first line treatment for osteoporosis?
Bisphosphonate
392
How is a Colles fracture described?
Dorsal displacement of distal radius
393
How is a Smith fracture described?
Volar displacement of distal radius
394
What orthopedic finding is a red flag for child abuse?
Multiple fractures in various stages of healing
395
What is the most common cause of facial pain?
TMJ
396
What is the most common condition affecting the cervical spine?
Spondylosis
397
What are the most painful conditions of the hand and wrist?
OA and RA
398
What is OA of the wrist from osteonecrosis of the lunate bone called?
Kienbock disease
399
What condition affects palmer aponeurosis causing painful nodules, pitting and contractures?
Dupuytren's disease
400
What is the most common mononeuropathy?
Carpal Tunnel Syndrome
401
What is it called when tapping on the volar aspect of wrist causes pain?
Tinel sign
402
What is it called when flexion of the wrist causes pain?
Phalen sing
403
What bug infects from a person's bite and how do you treat this bug?
Eikenella corrodens, Augmentin
404
What is the most common fracture of the wrist?
Colles Fracture
405
What is it called when there is a sprain of the ulnar collateral ligament?
Gamekeeper's thumb
406
What is the most common fracture of the elbow in the adults?
Radial head fracture
407
How is the diagnosis of radial head fracture usually diagnosis?
Posterior fat pad or "sail sign" of the anterior fat pad
408
What is the most common fracture of the carpal bones?
Scaphoid
409
What is tenosynovitis of the abductor pollicis and extensor pollicis brevis called?
De Quervains disease
410
What test is used to diagnosis de Quervains disease?
Finkelstein test
411
What is the most common cause of low back pain?
Prolapsed intervertebral disk
412
Where is the pain from sciatica felt?
Posterior leg to lateral malleolus
413
What pain is worse when walking and relieved by leaning forward?
Spinal stenosis
414
What exercises are helpful for low back pain?
McKenzie exercises
415
What is the most common location and presentation of scoliosis?
T7/T8 and to the right
416
What is juvenile kyphosis called?
Scheuermann's disease
417
What is TB of the spine called?
Pott's disease
418
What is the most common extrapulmonary location of TB?
Spine
419
What is a seronegative spondyloarthropathy that progresses to fusion called?
Ankylosing spondylosis
420
What lab test is positive in Ankylosing spondylitis and Reiter's syndrome?
HLA-B27
421
What is considered the best exercise for Ankylosing spondylitis?
Swimming
422
What is aseptic necrosis of the hips called in kids?
Legg-Calve-Perthes disease
423
What is the name of the XRAY used to diagnosis slipped capital femoral epiphysis?
Frog leg lateral pelvis
424
What part of the meniscus is most often injured?
Medial
425
What tests are helpful to diagnosis meniscal tears?
McMurray and Apley
426
What is the average age and sex of Osgood-Schlatter disease?
12 year old boy
427
What ligament is most common injured in the knee?
ACL
428
What test is most sensitive to diagnosis ACL tear?
Lachman's test
429
What is the most common sports related injury?
Ankle sprains
430
How can stability of the ankle be checked?
Anterior drawer test
431
What is another name for a bunion?
Hallux valgus
432
When is the pain of plantar fasciitis most common?
AM
433
What does PTH cause to happen in the body?
Calcium to rise
434
What is the most common cause of hypercalcemia in ambulatory patients?
Hyperparathyroidism
435
What is the most common cause of hypercalcemia in hospitalized patients?
Cancer
436
What is the most common pathological fracture site?
Jaw
437
What lab test confirms hyperparathyroidism?
Elevated PTH
438
What is a disorder of excessive systemic copper called?
Wilson's disease
439
What is Kayser-Fleischer rings?
Copper deposits in the eye from Wilson's disease
440
What is a congenital cause of hypocalcemia due to parathyroid hypoplasia, thymic hypoplasia and cardiac outflow track defect called?
DeGeorge Syndrome
441
What is the etiology of 80% of hyperthyroidism?
Graves
442
How are the reflexes in hyperthyroidism?
Brisk
443
What antibodies are positive in Graves?
Perioxidase and thyroglobulin antibodies
444
What medication is used to control the symptoms of hyperthyroidism?
B-Blocker like propranolol
445
What is the drug of choice for hyperthyroidism in a pregnant or lactating female?
PTU
446
What is the most common cause of hypothyroidism?
Hashimoto's
447
What two medications commonly cause hypothyroidism?
Lithium and Amiodarone
448
What is Sheehan's syndrome?
Necrosis of pituitary gland that occurs after childbirth
449
What are the two most common symptoms of hypothyroidism?
Weakness and course dry skin
450
What is the single best screen test for hypothyroidism?
TSH
451
What is the hallmark of Myxedema crisis?
Altered mental status
452
What is the most common cause of a painful thyroid?
de Quervain's
453
What is the treatment of choice for de Quervain's?
Aspirin
454
What is the most common cause of a sporadic goiter in kids and also the most common thyroid disease in the US?
Hashimoto's
455
What is the most common benign nodule of the thyroid?
Follicular Adenoma
456
What cell has eosinophil staining and malignant potential in the thyroid?
Hurtle Cell
457
Which thyroid nodules require surgery?
Cold hypo-functioning nodules
458
What is the most sensitive test to identify thyroid lesions?
Ultrasound
459
What thyroid CA is most common?
Papillary
460
What thyroid CA often metastasizes to lung/liver & brain/bone?
Follicular
461
What childhood exposure increases the risk of thyroid CA 25 times?
Radiation
462
What is the most common cause of large for gestational age infants?
Maternal diabetes
463
What are the most common serious presentations of heart disease in the infant?
Cyanosis, CHF & Diminished peripheral pulses
464
The passage of an infant's first stool is delayed more than 24 hours after birth, what do you suspect?
Hirschsprung disease
465
Chromosomal abnormalities and adrenal hyperplasia are most often associated with what finding on an infant?
Ambiguous genitalia
466
What are the most common causes of unconjugated hyperbilirubinemia in an infant?
Physiologic jaundice, Prematurity and breast-feeding jaundice
467
What is the classic and most efficient way of gauging sexual maturation in males and females?
Tanner stages
468
What is the most common neurodevelopmental disorder in children?
Attention-deficit hyperactivity disorder (ADHD)
469
What is the most common causes of speech and/or language delay in children?
Conductive hearing loss due to chronic middle ear effusion
470
What are the risk factors for the development of spina bifida (myelomeningocele)?
Insufficient folic acid during pregnancy and maternal use of valproate
471
Congenital heart disease is common in children with Trisomy 21 (Down syndrome); what is the most common?
Atrial septal defects
472
What vaccines should be avoided during pregnancy?
Live vaccines: MMR and varicella, and live attenuated influenza vaccine
473
If a child is immunocompromised, what vaccines should be avoided?
MMR & Varicella
474
What is a contraindication to giving the tetanus, diphtheria, pertussis (Tdap)/DtaP vaccine?
Chronic seizure disorder
475
A child presents to the ER with an overdose of acetaminophen, what is the specific antidote?
Acetylcysteine
476
Activated charcoal and physostigmine can be used to treat an overdose of what class of medications?
Antihistamines
477
What medication is used to treat iron overdose?
Desferoxamine
478
What is the current first-line treatment for most ingested poisons?
Activated charcoal
479
What is the most common innocent murmur of childhood?
Still's murmur
480
What is the treatment of Kawasaki disease?
IV immunoglobulin & high-dose ASA
481
What is the cause of erythema infectiosum, otherwise known as Fifth Disease?
Human parvovirus B19
482
A child presents with a red face, described as a "slapped cheek" appearance with a lacy, pink macular rash on the torso; what do you suspect?
Erythema infectiousum (Fifth disease, Slapped Cheek)
483
A child presents with fever x 4 days with an associated pink, macular rash. The child's mother informs you that the fever has resolved before the rash. What do you suspect?
Roseola
484
A maculopapular rash common on the face to extremities with associated Koplik spots in the mouth, are indicative of what viral exanthem?
Measles (Rubeola)
485
What is a common complication of the rubella virus?
Teratogenic (birth defects)
486
What is a common complication in geriatric patients following surgical admission to the hospital?
Delirium
487
What are two reasons to avoid NSAID's in the elderly population?
Risk of GI bleed & renal toxicity
488
What class of medication should be avoided in the elderly due to the potential for delirium and other anticholinergic effects?
Tricyclic antidepressants
489
True/False: Incontinence is a normal part of aging?
False: Incontinence is NOT a normal part of aging and new onset requires further investigation.
490
True/False: Impairment of cognition is not a normal part of aging.
TRUE
491
What are the drugs of choice for treating depression in the elderly?
SSRI's
492
When treating anxiety in the elderly, what classes of medication should be avoided?
Benzodiazepines and Antihistamines
493
How do you characterize senile psychosis?
Hallucinations and delusions
494
What are common drugs that can cause taste disturbances?
Anticholinergic agents, Digitalis & ACE inhibitors
495
When treating systolic hypertension in the elderly, what is considered class of medication is considered first line?
Thiazide diuretics
496
At what dose should HCTZ not be exceeded in elderly patients, as it may result in more side effects and not blood pressure control?
25 mg
497
What is a common presentation of aortic stenosis in the elderly?
Syncope, CHF & Fatigue
498
When should preoperative creatinine levels be obtained?
Patients older than 40 years
499
What is the best determinant of bleeding tendencies during surgery?
Coagulation response to minor trauma
500
In what patient populations are silent myocardial infarctions more commonly seen?
Elderly and diabetics
501
When is a pregnancy test indicated in the preoperative evaluation of a surgical patient?
All women of childbearing age
502
When evaluating a patients potential for risk of DVT, what has been the classic identifiers?
Virchow's Triad: stasis, intimal damage, and hypercoagulability
503
What is the preferred DVT prophylaxis for trauma patients or those with abdominal or pelvic cancer?
Lovenox (enoxaprin)
504
True/False: Does the dose of enoxaprin have to be adjusted in patients with renal impairment?
TRUE
505
When considering a potential cause of diarrhea in a patient receiving enteral feedings, what should always be ruled out?
Clostridium difficile
506
What is the leading cause of death between the ages of 1 and 44 years?
Unintentional and violence-related injuries
507
What is the leading cause of accidental death in the United States?
Motor vehicle accidents
508
What are the signs that characterize cardiac tamponade?
Beck's Triad: jugular venous distention, hypotension, and muffled heart sounds
509
How are most cases of penetrating chest traumas managed?
Tube thoracotomy
510
What is the test of choice for detecting intra-abdominal injury?
Focused Assessment with Sonography for Trauma (FAST) examination
511
True/False: The presence of a pulse distal to the site of vascular injury rules out significant vascular injury?
False:
512
When evaluating a head trauma patient, you appreciate rhinorrhea, otorrhea, ecchymosis of the lids (raccoon eyes), and ecchymosis behind the ears (Battle's sign), what do you suspect?
Basilar Skull Fracture
513
Injury to what artery is the usual cause of epidural hematomas?
Middle meningeal artery
514
When considering the mental status of a head injury patient, what is a common presentation of a patient with an epidural hematoma?
A brief period of unconsciousness is followed by a lucid interval.
515
What is the triad of signs indicative of brain herniation?
Coma, fixed and dilated pupils, and decerebrate posturing
516
What is the most common type of burn?
Scald burns
517
How are first degree burns characterized?
Erythema, tenderness and the absence of blisters
518
A burn victim presents with thin-walled, fluid-filled blisters, that are moist, blanche with pressure and are painful, what do you suspect?
Second-degree burn
519
What is the characteristic appearance of the skin following a third degree burn?
Dry, with a white, leathery or charred appearance, and without sensation
520
When estimating the percentage of burn, the palm of the victim's hand is roughly what percentage?
1%
521
What is the most commonly used topical burn ointment?
Sulfadiazine (Silvadene)
522
What is the most common complication associated with all burns?
Infection
523
When considering postoperative fever, what is the most likely cause within the first 24-48 hrs postoperatively?
Atelectasis (Wind)
524
What would you suspect the cause of a fever in a patient 48-72 hours after surgery?
UTI (Water)
525
What is the most common cause of postoperative fever after 72 hours and which is the common pathogen that causes this?
Wound infection, Staphylococcus aureus
526
What is the most common nosocomial acquired infection?
UTIs
527
What is the most effective approach to preventing pressure ulcers?
Frequent position changes, removal of moistures
528
In what patient populations is necrotizing fasciitis more commonly seen?
DM, alcoholics, and IV drug abusers
529
What is the most important complication of laparoscopic cholecystectomy?
Biliary injury
530
What is the most common complication of surgically repairing an inguinal hernia?
Recurrence of the hernia
531
What is the most common complication of open appendectomy?
Wound infection
532
What is the most common complication of laparoscopic appendectomy?
Intra-abdominal abscess
533
What is the most important preoperative evaluation performed by the surgical team?
History and physical exam
534
What is a common postoperative complication seen with the use of unfractionated heparin?
Hematoma
535
When considering the primary survey (ABC's) in a trauma patient, what is the most common indication for and preferred modality of intubation?
Altered mental status
536
Usually a self-limited disease, how long is the duration of pharyngitis?
3-4 days
537
The rash of erysipelas is typically confined to what area of the body?
Face
538
Thick, crusted, golden "honey" yellow lesions, best describes what?
Impetigo (Streptococcus pyoderma)
539
What is the most common cause of cellulitis in the United States?
Group A streptococci
540
True/False: When diagnosing acute rheumatic fever using the Jones criteria, the presence of two major criteria or one major and two minor criteria plus evidence of recent B-hemolytic streptococci (culture or ASO titer) makes the diagnosis?
TRUE
541
541. When using the Centor's criteria, what is the percentage of chance a sore throat is caused by group A B-hemolytic streptococcus is the cause when 3 out of 4 criteria are present?
40-60%
542
What should be avoided in infants due to increased risk of botulism?
Honey
543
A sudden onset of severe, frequent 'rice water diarrhea is suggestive of what?
Cholera
544
What is the incubation period of tetanus following a puncture wound?
5 days to 15 weeks
545
In patients with tetanus, hyperreflexia and muscle spasms develop most commonly in what areas?
Jaw and face
546
What should be given as part of the treatment of tetanus?
IM tetanus immunoglobin and PCN
547
Salmonella bacteremia is most commonly seen in what type of patients?
Immunosuppressed
548
True/False: When considering shigellosis, individuals who are HLA-B27 positive may mount a reactive arthritis because of temporary disaccharidase deficiency.
TRUE
549
What is the treatment of choice in shigellosis?
TMP-SMX
550
What two antibiotics are effective in the treatment of diphtheria?
PCN or erythromycin
551
What is the medication of choice in the treatment of pertussis?
Erythromycin
552
What is the vaccine of choice for adults in the prevention of pertussis?
Tdap
553
What is the most characteristic disease with EBV as the implicated cause?
Mononucleosis (the kissing disease')
554
Splenomegaly is present in what percentage of cases of EBV infection?
50%
555
Administration of what antibiotic increases the incidence of rash in patients with EBV infection?
Amoxicillin
556
Patients with mononucleosis with associated splenomegaly should be counseled against what?
Contact sports
557
How do you define Reyes syndrome?
Fatty liver with encephalopathy
558
Ingestion of what medication increases the incidence of Reyes syndrome in children with influenza A or varicella infection and what age does this peak?
Aspirin, 5-14 years
559
What two medications are no longer recommended as single therapy agents in the treatment of influenza because of resistance?
Amantadine and rimantadine
560
When is varicella-zoster the most contagious?
The day before the rash appears
561
What is the characteristic description of the lesions seen in varicella-zoster?
Lesions begin as erythematous macules and papules, form superficial vesicles ('dewdrops on rose petal'), and later crust over
562
Eruptions of zoster lesions on the tip of the nose (Hutchinson sign) indicates involvement of what cranial nerve and risks corneal involvement?
Trigeminal
563
How is AIDS defined by the CDC?
CD4 count below 200
564
When examining the eyes of an immunocompromised patient, you notice neovascularization and proliferative lesions, commonly referred to as 'pizza pie,' what do you suspect?
CMV retinitis
565
What is the most common form of pathogenic Candida species?
Candida albicans
566
What is the name of a dimorphic fungus found in soil infested with bird or bat droppings?
Histoplasma capsulatum
567
What is the name of an encapsulated, budding yeast found in soil contaminated with dried pigeon dung?
Cryptococcus neoformans
568
What test is helpful in the diagnosis of cryptococcal infection?
India ink stain
569
What is the treatment of choice for pneumocystis jiroveci pneumonia?
TMP-SMX
570
What is an alternative treatment to TMP-SMX in the treatment of pneumocystis jiroveci pneumonia?
Dapsone
571
What is the recommended treatment for hookworms?
Mebendazole twice per day for 3 days
572
What is the only host for Enterobius vermicularis?
Humans
573
What are the characteristic symptoms found in patients with pinworms?
Perianal pruritus, insomnia, weight loss, enuresis, and irritability
574
True/False: All members of a household of a patient with pinworms should be treated.
TRUE
575
In the treatment of pinworms, a single dose of albendazole, mebendazole, or pyrantel is given and then repeated when?
2-4 weeks later
576
In making the diagnosis of malaria, blood films are stained with what?
Giemsa or Wright stain
577
What is the drug of choice for both the prophylaxis and treatment of malaria?
Chloroquine
578
Primary syphilis is characterized by what?
Chancre: a painless ulcer with clean base and firm, indurated margins
579
Gummatous lesions involving the skin, bones and viscera are seen in what stage of syphilis?
Late (tertiary) syphilis
580
Hutchinson teeth are a common manifestation of infants not treated with what disease?
Congenital syphilis
581
In what disease states can the fluorescent treponemal antibody absorption test yield a false positive result?
Lyme disease, systemic lupus erythematous, malaria or leprosy
582
What is the treatment of choice for syphilis?
Benzathine penicillin G 2.4 million U IM in a single dose
583
In the treatment of syphilis, what can occur when there is massive destruction of spirochetes?
Jarisch-Herxheimer reaction (fever, toxic state)
584
Without treatment, gonorrhea can progress to involve what structures in males?
Prostate, epididymis, and periurethral glands
585
What is the treatment of choice for gonorrhea?
IM ceftriaxone or oral cefixime
586
Lymphogranuloma venereum starts with vesicular or ulcerative lesions which may spread to the lymph nodes causing what?
Inguinal buboes
587
What is the drug of choice in the treatment of chlamydia in pregnant women?
Erythromycin
588
Trichomoniasis is what type of organism?
Flagellated protozoan
589
What is the most common vector-borne disease in the United States?
Lyme disease
590
What is the drug of choice in patients with erythema migrans or a suspicion of Lyme disease based on clinical findings and a history of tick bite?
Doxycycline
591
What is transmitted by the wood tick?
Rickettsia
592
Treatment with what has been shown to hasten recovery in patients with Rocky Mountain spotted fever?
Doxycycline or chloramphenicol
593
Rubbing a lesion that causes urticarial flare is referred to as?
Darier's sign
594
Pinpoint bleeding after a scale is removed is referred to as?
Auspitz sign
595
Pushing a blister causing further separation of the dermis is referred to as?
Nikolsky's sign
596
A patch test demonstrates what?
Hypersensitivity reaction
597
Minor trauma leading to new lesions at the site of trauma is referred to as?
Koebner phenomenon
598
What test is used to identify dermatophyte infection?
Potassium hydroxide preparation (KOH prep)
599
Thickened skin with distinct borders, often resulting from excessive scratching or prolonged irritation is referred to as?
Lichenification
600
You are examining a child with diaper rash and you notice satellite lesions, what do you suspect?
Candida infection
601
Where is the rash of atopic dermatitis most commonly located?
Flexural surfaces, neck, eyelids, forehead, face and dorsum of the hands and feet
602
What is the mainstay of treatment of atopic dermatitis?
Topical corticosteroids
603
In the treatment of dandruff, shampoos with which two elements has been shown beneficial in acute flare ups?
Selenium and zinc
604
Describe the skin manifestations of lichenification.
Well-circumscribed plaques that are highly pruritic, which sets up a cycle of itch-scratch lesions
605
Round, salmon-colored, slightly raised, popular and macular lesions aligned in a "Christmas tree-like distribution", what do you suspect?
Pityriasis rosea
606
Pityriasis rosea is a self-limiting condition of what duration?
3-8 weeks
607
What is the cause of molluscum contagiosum?
Poxvirus
608
What are the 4 P's of lichen planus?
Purple, polygonal, pruritic, papule
609
Describe the lesion of lichen planus.
Flat-topped, shiny, violaceous papules with fine white lines on the surface (Wickham striae)
610
True/False: Koebner phenomenon is seen in lichen planus?
TRUE
611
All patients with lichen planus should be screened for what disease state?
Hepatitis C
612
In what climate is dyshidrotic eczematous dermatitis (dyshidrosis) seen?
Hot, humid weather
613
What is the basic pathology found in psoriasis?
Enhanced epidermal cell turnover
614
In psoriatic lesions, peeling away a scale produces specks of bleeding from the capillaries. What is this called?
Auspitz sign
615
In patients with psoriasis, scratching leads to more lesions. What is this referred to?
Koebner phenomenon
616
What is the most common variant of psoriasis?
Psoriasis vulgaris
617
Which form of psoriasis involves the entire skin surface?
Psoriatic erythroderma
618
Pemphigus vulgaris is more commonly seen in people of what decent?
Jewish or Mediterranean
619
In pemphigus vulgaris, there is lateral extension of the lesions when they are pushed. What is this referring to?
Nikolsky's sign
620
What are the hallmark lesions of acne?
Comedones
621
What are the topical preparations used in the treatment of mild acne?
Retinoids, azelaic acid, and salicylic acid
622
What is the drug of choice in the treatment of more serious or cystic acne?
Tetracycline's
623
True/False: Acne rosacea is a chronic acneiform disorder mainly affecting females between 30 and 50 years of age.
TRUE
624
What are typical triggers of acne rosacea?
Heat, alcohol, sun, or hot, spicy foods
625
What is characterized by the insidious onset of scattered, small papulopustules and sometimes nodules, in which comedones are absent and the face appears red or flushed?
Acne rosacea
626
What does the suffix "-phyma" mean?
Enlarged
627
What is the most common cause of folliculitis?
Staph aureus
628
What is the cause of folliculitis seen in hot tub users?
Pseudomonal folliculitis
629
What are three common causes of erythema multiforme?
1.Drugs (sulfonamides, phenytoin, barbiturates, PCN, allopurinol) 2. Infections (HSV, Mycoplasma) 3. Idiopathic: 50% of cases
630
What is the hallmark of erythema multiforme major?
Mucosal lesions that are painful and erode
631
What two conditions are mucocutaneous blistering reactions most often caused by a drug reaction?
Steven-Johnson syndrome and toxic erythema necrolysis (TEN)
632
Where should SJS/TEN patients with extensive necrolysis be care for?
Burn unit
633
What pathogen is the most common cause of furuncles?
Staph aureus
634
What is the first step in the treatment of furuncles and carbuncles?
Warm, moist compresses
635
When beginning broad spectrum antibiotic treatment for cellulitis, what three organisms should be covered?
Haemophilus influenza, Streptococcus and Staphylococcus
636
In patients who are allergic to penicillin, what is the most appropriate antibiotic alternative?
Erythromycin
637
What should patients taking griseofulvin be advised to avoid?
Alcohol
638
What is the cause of tinea versicolor?
Malassezia furfur
639
What is the characteristic feature of tinea versicolor?
Hypo- or hyperpigmented macules that do not tan in areas of overgrowth
640
What is the treatment of choice of tinea versicolor?
Selenium sulfide shampoo
641
What is the most common distribution seen in scabies?
Hands, wrists, web spaces
642
What is the most important spider bite that can puncture the skin in the United States?
Brown recluse (Loxosceles reclusa)
643
What three topical insecticides are considered the first line treatment of pediculosis (lice)?
Permethrin, pyrethrins, and malathion
644
What is the most common type of malignant melanoma?
Superficial spreading malignant melanoma
645
How is prognosis determined in melanoma patients?
Depth of the lesion (Breslow depth)
646
What are the two most common neoplasms of the skin?
Squamous and basal cell carcinomas
647
What is the typical presentation of squamous cell lesions?
Sharply demarcated, scaling, or hyperkeratotic macule, papule, or plaque
648
How are stage I decubitus ulcers characterized?
Non blanching erythema of intact skin
649
What is the most effective solutions in patients with new onset and smaller areas of hair loss?
Minoxidil
650
Alopecia areata may be seen in what four disease states?
Thyroiditis, pernicious anemia, systemic lupus erythematosus (SLE), Addison disease
651
What is a felon?
Subcutaneous infection of the pulp space of the nail
652
What is the most significant and treatable risk factor for stroke?
HTN
653
Strokes involving the anterior circulation are likely to produce what signs and symptoms?
Hemispheric: aphasia, apraxia, hemiparesis, hemisensory loss, and/or visual field defects
654
Strokes involving the posterior circulation are likely to produce what signs and symptoms?
Evidence of brain stem dysfunction: coma, drop attacks, vertigo, nausea, vomiting, and/or ataxia
655
What is the best imaging modality for differentiating ischemic from hemorrhagic stroke and is recommended during the acute phase?
Noncontrast CT
656
Thrombolytic therapy is found to be most effective in reducing the extent of deficit caused by a stroke if given within how long of symptoms onset?
3 hours
657
What is the indication for endarterectomy?
Greater than 70% stenosis of the common or internal carotid artery
658
What two disease processes are often associated with cerebral aneurysms?
Polycystic kidney disease and coarctation of the aorta
659
A patient presents to the ER with complaints of an unusually severe, generalized headache of sudden onset, stating "this is the worst headache I've had in my life." What do you suspect?
Subarachnoid hemorrhage
660
What is the treatment of status epilepticus?
IV diazepam or lorazepam until the seizure stops with a loading dose of phenytoin or fosphenytoin
661
What is the pathogenesis associated with multiple sclerosis?
Inflammation associated with multiple foci of demyelination in the CNS white matter
662
True/False: Age of onset for multiple sclerosis in 18-45 years and is more common in women than men.
TRUE
663
What are the two most common presenting symptoms of multiple sclerosis?
Sensory complaints in the limbs and vision loss (high correlation with optic neuritis)
664
What diagnostic test allows for visualization of white matter lesions in the CNS?
MRI with gadolinium
665
What is commonly found in the CSF of patients with multiple sclerosis?
Oligoclonal bands
666
What two medications have been shown to improve spasticity commonly seen with multiple sclerosis?
Baclofen and diazepam
667
What is the most common form of dementia?
Alzheimer disease
668
What class of medication may be used to delay the progression of Alzheimer disease and improve memory function?
Acetylcholinesterase inhibitors
669
What medication has been used in the treatment of moderate to severe Alzheimer disease?
memantine (Namenda)
670
What is a potential cause of frontotemporal dementia and what is this associated with?
Pick disease, Amyotrophic lateral sclerosis
671
What are common frontal lobe symptoms associated with frontotemporal dementia?
Behavioral symptoms (euphoria, apathy, disinhibition) and compulsive disorders.
672
What is the most common type of headache?
Tension headaches
673
What is the treatment of choice for cluster headaches?
Oxygen and/or injection of SC sumatriptan
674
What is the preferred therapy for prophylaxis of cluster headaches?
Verapamil
675
What medication is used in controlling benign essential tremors?
Propanolol
676
What are the essential clinical features that establish a diagnosis of Parkinson disease?
Resting tremor, bradykinesia, rigidity, and postural instability
677
When considering bradykinesia is patients with Parkinson disease, what is are common facial features?
Infrequent blinking and mask-like faces
678
When testing passive range of motion on a patient's suspected of having Parkinson disease, what would you expect to find?
Cogwheel rigidity
679
On what chromosome is the gene responsible for Huntington disease found?
Chromosome 4
680
What are the characteristic features seen in Huntington disease?
Progressive chorea and dementia
681
What is the most common initial manifestation seen with Tourette syndrome?
Phonic tics: grunts, barks, hisses, coughing or verbal utterances
682
What disease process is characterized by a chronic impairment of muscle tone, strength, coordination or movements?
Cerebral palsy
683
When do the symptoms of restless leg syndrome most commonly occur?
During periods of prolonged inactivity or rest
684
In addition to prescription medication management, a trial of what is now recommended in all patients with restless leg syndrome?
Iron (avoid in patients with iron overload)
685
On which side of the face is Bell palsy most common to occur?
Right side: 60% of cases
686
In what two patient populations is Bell palsy more prominent?
Pregnant women and diabetics
687
What cranial nerve supplies the muscles affected in Bell palsy?
CN VII
688
When does the facial weakness of Bell palsy peak?
About 21 days or less
689
What other disease processes lead to facial palsy that should be ruled out prior to the diagnosis of Bell palsy?
Stroke, tumors, Lyme disease, AIDS, sarcoidosis
690
What is the most common form of neuropathy diagnosed in the western hemisphere?
Diabetic neuropathy
691
What medication has recently been approved for the treatment of painful diabetic neuropathy?
duloxetine (Cymbalta): SNRI
692
What is the most common precipitant of Guillain-Barre syndrome (acute idiopathic polyneuropathy)
Campylobacter jejuni
693
Describe the pattern of weakness noted in patients with Guillain-Barre syndrome.
Symmetrical extremity weakness that begins distally and ascends
694
In what percentage of patients with Guillain-Barre syndrome are cranial nerves affected?
45-75%
695
What form of treatment has been shown to reduce the time required for recovery and may reduce the likelihood of residual neurologic deficits in patients with Guillain-Barre syndrome?
Plasmapheresis
696
In the treatment of Guillain-Barre syndrome, what form of treatment is preferred over plasmapheresis in adults with cardiovascular instability and in children?
IV immunoglobulin (IVIG)
697
Describe the characteristics of myasthenia gravis.
Muscle weakness and fatigability, which improves with rest
698
What is the mainstay of treatment for myasthenia gravis?
Cholinesterase inhibitors, such as pyridostigmine
699
What are the three primary causes of bacterial meningitis?
Streptococcus pneumonia, Neisseria meningitidis, and group B streptococci
700
What is the most common bacterial cause of meningitis in neonates younger than 1 month of age?
Group B Streptococcus
701
What clinical feature is characteristic of Neisseria meningitidis?
Petechial rash
702
Prompt lumbar puncture and CSF analysis are essential in making the diagnosis of bacterial meningitis. Prior to the lumbar puncture, what diagnostic test must be performed and why?
CT scan to rule out space-occupying lesion
703
Neonates with bacterial meningitis are commonly treated with what antibiotic regimen?
Ampicillin and cefotaxime
704
What is the treatment of choice for bacterial meningitis in immunocompetent children older than 3 months of age and adults younger than 55 years?
cefotaxime or ceftriaxone plus vancomycin
705
What two potential combinations are used in the treatment of bacterial meningitis in adults older than 55 years and those of any age with alcoholism or debilitating illness?
Ampicillin plus cefotaxime or ceftriaxone plus vancomycin
706
What is the combination of antibiotics given to hospital-acquired, post traumatic or post neurosurgery meningitis, or if the patient is immunocompromised?
Ampicillin plus ceftazidime plus vancomycin
707
What medication is recommended in adults with meningitis secondary to S. pneumonia and in children older than 1 month of age with meningitis secondary to Hib?
Dexamethasone
708
What is the treatment for suspected herpes viral meningitis?
Acyclovir
709
What are the presenting symptoms seen in patients with a brain abscess?
Vomiting, fever, altered mental status and focal neurologic signs
710
Lumbar puncture is contraindicated in patients with what type of presenting symptoms and signs?
Focal neurologic symptoms or focal neurologic signs as brain stem herniation may be precipitated
711
In patients who suffered head trauma, loss of conscious of what duration implies a worse prognosis?
2 minutes
712
What would you expect to find in a patient with central cord syndrome?
Lower motor neuron deficit and loss of pain and temperature with sparing of the posterior column functions
713
What are the most common primary intracranial neoplasms?
Gliomas
714
What are the most common sources of intracranial metastasis?
Lung, breast, kidney and GI tract cancer
715
What are the six major hormones produced by the anterior pituitary gland?
ACTH, THS, LH, GH, FSH, prolactin
716
What are the two hormones stored in the posterior pituitary gland?
ADH (vasopressin), oxytocin
717
What are the diagnostic criteria for prediabetes?
HbA1c (%): 5.7- 6.4, fasting glucose: 100-125 mg/dL, oral glucose tolerance test: 140-199 mg/dL
718
In patients with poor control of their metabolic syndrome with diet and exercise alone, what medication is recommended?
Metformin
719
In the United States, what is the leading cause of blindness in adults over 60 years of age?
Diabetic retinopathy
720
What is the most common complication of DM?
Neuropathy
721
What is the characteristic pattern of occurrence scene in diabetic neuropathy?
Peripheral symmetric polyneuropathy (stocking and glove distribution)
722
As a first line intervention, all diabetics should be counseled on what?
Diet
723
In patients with diabetes, what is used in the primary prevention in patients with increased cardiovascular risk?
Daily ASA (75-325 mg/d)
724
What is the most common first line agent in the treatment of DM?
metformin
725
Deficiency of what vitamin can be seen with prolonged use of metformin?
Vitamin B12
726
How often are ophthalmologic exams recommended in monitoring for diabetic retinopathy?
Annual
727
Elevated LDL levels increase the risk of what disease process?
CAD
728
Severe elevations of triglycerides can cause what disease process?
Pancreatitis
729
What is the recommended first line management in patients with hyperlipidemia?
Lifestyle modifications: diet and at least 30 minutes of daily exercise
730
What are common side effects seen with the use of statins (HMG-CoA inhibitors)?
Myalgia's and GI complaints
731
What is a common side effect seen with niacin and how can it be reduced?
Prostaglandin-induced flushing: reduce by taking ASA 30 minutes prior or a daily NSAID
732
What class of medications are the most potent for lowering triglyceride levels and raising HDL?
Fibric acid derivatives
733
What are potential complications from treatment with fibric acid derivatives?
Gallstones, hepatitis, myositis
734
What are common symptoms of hypercortisolism?
Obesity, HTN, thirst, polyuria
735
What are the characteristic features associated with hypercortisolism?
Buffalo hump, moon facies, supraclavicular pads
736
What are the most specific signs indicative of hypercortisolism?
Proximal muscle weakness and pigmented striae more than 1 cm wide
737
You suspect a patient of having hypercortisolism, what diagnostic tests would aid in your decision making?
Dexamethasone suppression test, 24-hr urine collection for free cortisol and creatinine
738
At what diagnostic threshold of plasma or serum ACTH would be suggestive of an adrenal tumor?
ACTH \< 20 pg/mL
739
What characteristic finding is only found in primary Addison disease?
Hyperpigmentation due to elevated ACTH
740
What signs and symptoms would you expect to see in a patient with Addison's crisis?
Hypotension, acute pain (abdomen, low back), vomiting, diarrhea, dehydration, altered mental status
741
What class of medications is considered first line in the treatment of mood disorders and how long should they be continued to determine efficacy?
SSRIs and 4-6 weeks
742
What are common side effects associated with lithium?
Weight gain, tremor, nausea, increased thirst and urination, drowsiness, hypothyroidism, arrhythmias, and seizures
743
Which personality disorder is characterized by a lifelong pattern of voluntary social withdrawal, and is often perceived as eccentric and reclusive?
Schizoid personality disorder
744
What class of medications is used to control hostility and brief psychotic episodes in patients with borderline personality disorder?
Antipsychotics
745
What is the most common mental disorder in the United States?
Phobias
746
What is a common lab finding in patients with eating disorders?
Hypochloremic hypokalemic metabolic alkalosis
747
What are the most commonly abused drugs?
Alcohol, nicotine, and caffeine
748
When would you expect withdrawal symptoms to present in a patient who abuses alcohol?
6-18 hours after cessation of alcohol
749
What medication is used in the reversal of any opioid?
Naloxone
750
You are evaluating a baby in the ER and notice retinal hemorrhages and hyphema, what do you suspect?
Shaken baby syndrome
