COMbank Flashcards
(323 cards)
1
Q
when triaging patients in multi person injury accidents, First priority patients are color coded what?
A
Red, indicating they need immediate life saving treatment
2
Q
when triaging patients in multi person injury accidents, Second priority patients are color coded what?
A
Yellow to indicate that they require urgent medical care within 2-4 hours
3
Q
when triaging patients in multi person injury accidents, patients who appear to have minimal injuries such as the child are treated last, regardless of age. Third priority is color coded what?
A
green, they need medical treatment, but it can be safely delayed
4
Q
when triaging patients in multi person injury accidents, Patients that are deceased or have minimal chance of salvage are not treated. These patients are color coded what?
A
black
5
Q
Door to needle time for fibrinolytic therapy in STEMI when PCI not available needs to be less than how long
A
< 30 min
6
Q
This is an acquired benign dermatologic condition that appears suddenly as an itchy papular rash over the trunk. It is most commonly seen in men over the age of 50. The rash usually appears as small, red papules on the central back or mid-chest regions. It has been associated with sweating, sun exposure, heat, and ionizing radiation.
A
Grover disease (transient acantholytic dermatosis)
7
Q
What are histologic findings of Grover disease
A
focal acantholysis and dyskeratosis
8
Q
Describe the disease progression of Grover disease
A
- The disease is self-limiting; patient should be educated to avoid excessive sweating and sun exposure
- A topical steroid can be used for symptomatic relief
9
Q
Symptoms of this include hemorrhagic blisters, milia, scarring, dyspigmentation, and hypertrichosis localized to the dorsal hand and forearms
A
Porphyria cutanea tarda which results from deficiency of hepatic uroporphyrinogen decarboxylase, an enzyme involved in the metabolism of heme
10
Q
Specific antibody for pemphigus vulgaris
A
anti-desmoglein 3
11
Q
This is an autosomal dominant disease due to a mutation in ATP2C1, a calcium ATPase pump. It is characterized by the presence of vesicular lesions and crusting erythematous plaques over intertriginous areas including the genitals, inguinal area, sometimes extending onto the thigh, as well as the chest, neck, and axilla. Burning and pruritis accompany the eruption, as well as a MALODOROUS drainage that may occur from secondary bacterial infections
A
Familial benign pemphigus (Hailey-Hailey disease)
12
Q
Both ALS and syringomyelia can present with both UMN and LMN signs . . how do you tell difference?
A
ALS is a pure muscle disorder . . no sensory changes
-ALS also, almost always begins Asymmetrically
13
Q
What are common somatic findings associated with migraines.
A
Abnormal strain patterns at the SBS and cervical or upper thoracic spine dysfunction
14
Q
Osteoporosis may be diagnosed how?
A
when dual-energy x-ray absorptiometry scan results show a bone mineral density of 2.5 standard deviations or more below peak bone mass (T score ≤ -2.5), OR with history of a fragility fracture ***
15
Q
Patients with meconium aspiration syndrome (MAS), are at increased risk of developing persistent what?
A
pulmonary hypertension (PPH).
16
Q
All infants and toddlers should ride in a rear-facing car safety seat until what age?
A
2 years or have reached the manufacturer’s max limit
17
Q
All children 2 years or older should use what type of car riding safety?
A
Forward-Facing car safety seat with harness for as long as possible
18
Q
At what size and age should children be restrained in the rear seats always using lap and shoulder seat belts
A
-typically 4 feet 9 inches and are between 8 and 12 years of age
19
Q
All children younger than 13 years should be restrained where in a vehicle
A
rear seat
20
Q
All children who have reached the weight or height limit for their forward facing car safety seat should be seated in what? . . . Most 5 year olds will have outgrown a child safety seat but will not be tall enough to fit correctly in a lap and shoulder belt
A
A belt-positioning Booster seat until the vehicle seat belt fits properly
21
Q
Budd-Chiari syndrome, or hepatic venous outflow obstruction is most commonly caused by polycythemia vera . . what are he classic findings of polycythemia vera
A
- pruritis
- Blurry vision
- Erythromelalgia (burning in the hands and feet followed by a blue or red discoloration)
22
Q
What is the imaging modality of choice in diagnosing Budd-Chiari syndrome.
A
Doppler ultrasonography
23
Q
What does doppler US show in Budd-Chiari syndrome?
A
Positive findings include inability to visualize the junction of the major hepatic veins with the inferior vena cava, thickening or stenosis of the hepatic veins, or abnormal flow in the hepatic veins or inferior vena cava.
24
Q
Describe the use of venography in the diagnosis of Budd-Chiari syndrome
A
Venography is the gold standard for diagnosing Budd-Chiari syndrome. It is critical in assessing full extent of disease and optimal treatment. However, due to its invasiveness it can only be performed if other noninvasive tests are not diagnostic or negative with a strong clinical suspicion for disease.
25
Management of Budd-Chiari syndrome
Should attempt medical therapy (eg, anticoagulant and diuretic) before surgical intervention (stent)
26
Describe the management when IUD string cannot be seen
- US first to confirm position
| - Flat plate x-ray if position is not confirmed in uterus
27
This condition involves osteochondrosis of the second metatarsal head and is most frequently encountered in adolescents and young females.
Freiberg's infraction
28
This traction apophysitis at the insertion of the Achilles on the calcaneus and is most common during periods of rapid physical growth, e.g. puberty.
Sever's Disease
29
This condition involves a traction apophysitis at the INFERIOR POLE OF THE PATELLA. Osgood-Schlatter affects the tibial tuberosity rather than the inferior pole of the patella. As with other similar conditions, it is most frequently encountered during periods of rapid growth (e.g. puberty).
Sinding-Larsen-Johansson syndrome
30
Treatment of Sjogren
-Pilocarpine or cevimeline
31
Hemodialysis should be performed in patients with methanol poisoning who meet the following criteria
1) Ingestion of methanol volumes greater than 30 mL
2) Serum methanol levels of 20 mg/dL or greater
3) Development of visual changes
4) Lack of acidotic improvement despite multiple sodium bicarbonate infusions
32
Metformin cannot be used in patients with a GFR under what
30
33
This is characterized by a rigid thoracic kyphosis, vertebral wedging, and degenerative end plates. It is diagnosed by radiograph, and anterior wedging > 5 degrees must be seen in at least 3 adjacent vertenbrae.
Scheuermann kyphosis
34
What is best treatment for Scheuermann kyphosis in a mature adult
OMM and PT
35
What is the most common risk factor in ectopic pregnancy
PID
36
This is a mental disorder characterized by repeated regurgitation of chewed food. Food is regurgitated, swallowed or spit out. A patient must demonstrate this activity for at least one month. PE is remarkable for raw and chapped lips, bad breath, tooth decay, and weight loss. It is more common in infants or very young children
Rumination disorder
37
Describe the management of a polyp detected incidentally on annual screening colonoscopy
multiple biopsies or polypectomy
38
Oculomotor nerve palsy can occur with subarachnoid hemorrhage, most commonly when there is a ruptured aneurysm of what artery?
Posterior communicating artery
39
The anterior communicating artery is the most common site for aneurysm formation. What is it likely to compress leading to what symptoms?
- Optic chiasm
| - Bitemporal heteronymous hemianopsia
40
The most common cause of subarachnoid hemorrhage is a ruptured berry aneurysm. The definitive treatment to prevent rebleeding is what?
endovascular coiling
41
Pedal edema in Rocky mountain spotted fever?
common in children
42
Homocysteine in folated and B12 deficiency?
elevated in BOTH
43
Le Fort fractures are fractures of the midface and are broken into I, II, and III. Describe a Le Fort I fracture
- Involve only the maxilla at the level of the nasal fossa
- Classically this occurs from a direct facial blow
- placing the central incisors between a gloved index and thumb and then moving anterior-posterior, slight mobility will be observed
- No other mobility of the nasal bones or zygoma is present
44
Le Fort fractures are fractures of the midface and are broken into I, II, and III. Describe a Le Fort II fracture
- involves the maxilla, nasal bones, and the medial aspects of the orbits
- PE will reveal and unstable maxilla as in a Le Fort I, but will also have nasal bone mobility
- In severe, CSF rhinorrhea may be present
45
Le Fort fractures are fractures of the midface and are broken into I, II, and III. Describe a Le Fort III fracture
- Most serious and is complete craniofacial disjunction
- It involves the maxilla, zygoma, nasal bones, and can include bones of the cranial base
- So severe that often airway compromise occurs from facial hemorrhage
- PE will reveal an unstable entire midface moving the maxilla will result in "floating" of the face from the rest of the head.
- In addition, Trismus, malocclusion, and CSF rhinorrhea may all be present
46
If a patient in status epilepticus does not respond to lorazepam, then what should be administered?
Phenytoin
47
If a patient in status epilepticus does not respond to lorazepam and then also not to phenytoin, what do you give next?
phenobarbital, pentobarbital, midazolam, or propofol can be tried
48
First line treatment for CAP in an outpatient setting
Macrolide or tetracyclines
49
what is the gold standard for diagnosing acute cholecystitis
Hepatobiliary iminodiacetic acid scanning (HIDA)
50
Best screening test fo acute cholecystitis
Abdominal US
51
What finding on HIDA is suggestive of cholecystitis
- A radioactive tracer is injected into any accessible vein and allowed to circulate to the liver whee it will be excreted in bile
- A normal filling time for the gallbladder is 35-45 minutes
- Failure to fill or delayed filling is suggestive of cholecystitis
52
ERCP and MRCP can be used to confirm what
choledochlithiasis
53
Cobb angle between 10 and 20 degrees in skeletally immature patients can be managed how?
- home exercises
| - observation and serial radiographs every 6-12 months
54
Cobb angle between 20 and 45 degrees in skeletally immature patients can be managed how?
-bracing and serial monitoring
55
Cobb angle >45 degrees in skeletally immature patients can be managed how?
surgical fusion
56
Alport syndrome is a hereditary form of glomerulonephritis caused by a defect in what?
type IV collagen
57
Glomerular basement membrane splitting
alport syndrome
58
Spike and dome appearance . . . . what glomerular disease
- due to granular deposits of IgG and C3
| - Membranous nephropathy
59
Tram Track appearance of the basement membrane . . what glomerular disease
- due to subendothelial and mesangial deposits
| - Membranoproliferative nephropathy
60
After an ECG, patients with stable angina should have what tests?
- Transthoracic Echo or
| - radionuclide myocardial perfusion imaging (if can't exercise)
61
Cervical cytology revealing HSIL in pregnancy must be evaluated with what
colposcopy
62
Most accurate diagnostic test for mitral regurg
transESOPHAGEAL echo
63
Neonatal mass through abdominal wall that is edematous, dark in color, and typically appears to be covered by a gelatinous matrix of greenish material
Gastroschisis
64
what food recommendation reduces gout flares
Low-fat diary products and vegetables
65
What is the best medication with the least side effects used to manage acute presentation of gout
NSAIDs
66
Colchicine was the mainstay of treatment of acute gout flares in the past. However, it is rarely used because of its high side effect profile. Describe its MOA and side effects?
- decreases leukocyte motility (and thus inflammatory response)
- N/V
- Diarrhea
- Bone marrow suppression
- thrombocytopenia
67
Cardiac sympathetic fibers originating on the left primarily innervate what?
- Left side of heart
| - AV node
68
Cardiac sympathetic fibers originating on the right primarily innervate what?
- right side of heart
| - SA node
69
NMDAR encephalitis . . confirmed with detection of antibodies for the NMDA receptor (either in serum or CSF) . . in a young women it is associated with what?
- Ovarian teratoma
| - Get Pelvic US or CT
70
Describe what the double density sign in Mitral stenosis is?
- Seen as 2 densities near the right heart border
- Caused by enlargment of the left atrium and leading to a rightward displacement of the right wall of the left atrium such that it pushes into the adjacent right lung and may become superimposed or even pass beyond, the normal borders of the right atrium on chest x-ray
71
What is the most common cause of endocarditis, even in patients with a known history of GI malignancies such as colon cancer
Staph aureus is still most common
72
ALS is the most common progressive motor neuron disease. Dx is largely based on history, PE, and what studies?
EMG studies
73
The ulnar nerve can be entrapped at the wrist (Guyon's canal) or elbow (cubital tunnel). How do you distinguish?
-Cubital tunnel: No pain or trauma to elbow. decreased sensation to dorsum of hand
74
What is the first line treatment for newly diagnosed gestation diabetes?
- A trial of diet and exercise
| - If this alone does not adequately control serum glucose levels, then therapy with insulin should be initiated
75
Children with ADHD are at an increased risk of having what psychiatric diagnosis later?
Antisocial personality disorder
76
What is the method of detecting semen in a sexual assault case
Wood's UV light lamp
77
Most common site of vaginal trauma in sexual assault
Posterior forchette
78
Treatment of Bell's palsy
Glucocorticoids and eye care
79
Possible lab findings in Sarcoidosis
- Increased ACE secondary to being secreted from non-caseating granulomas
- Also secrete 1,25 vitamin D resulting in Hypercalemia and hypercalciuria
80
Mainstay therapy for sarcoidosis
Corticosteroids
81
Treatment of Granulomatosis with polyangiitis
Corticosteroids and oral cyclophosphamide
82
What acute transfusion reaction?
- Fever
- Hypotension
- Flank/back pain
- Decrease in Hbg
Acute hemolytic
83
What acute transfusion reaction?
- Bronchospasms
- Hypotension
- Angioedema
Anaphylaxis
| -Most common with IgA deficiency
84
What acute transfusion reaction?
- Fever
- No other symptoms
- Febrile non-hemolytic
- Dx of exclusion, cytokines released from WBC during storage stimulate fever
- Risk reduced with leukoreduced RBCs
85
What acute transfusion reaction?
- Fever
- Hypotension
- Sepsis secondary to bacterial transmission
| - More commonly occurs in platelet transfusions (stored at room temp)
86
What acute transfusion reaction?
- Respiratory distress
- No fever
- TACO (Transfusion associated circulatory overload)
| - Occurs with large numbers of transfusions or hx of heart failure
87
What acute transfusion reaction?
- Fever
- Respiratory distress
- Hypotension
- TRALI (Transfusion related acute lung injury)
- Occurs during or within 6 hours of transfusion
- Occurs when transfusion recipients' neutrophils in lungs are activated by transfused product
88
Describe the relationship between Hyperventilation syndrome (tachypnea and hyperpnea) and Calcium
- Respiratory alkalosis
- As C02 drops, hydrogen ions are released from their binding sites on albumin
- Now albumin can bind calcium leading to hypocalcemia
89
What levels are useful in diagnosing Congenital adrenal hyperplasia
17-hydroxyprogesterone
90
first line treatment for congenital adrenal hyperplasia?
Glucocorticoids
91
Fever of unknown origin is a term used to describe prolonged fevers of > 101 F with no established dx despite a thorough evaluation. What are leading causes
- collagen vascular disorders
- Infections
- Malignancies
92
What is the criteria for metabolic syndrome
- Abdominal obesity > 40 inches in men or > 35 inches in women
- Triglycerides > 150
- HDL < 40 in men and < 50 in women
- Blood pressure > 130/85 or on HTN meds
- Fasting glucose > 100 mg/dL
- Must have 3/5
93
Exercise induced bronchoconstriction frequently presents during athletic participation and/or exercise. Spirometry usually gives a normal result. What is the diagnostic test
Bronchial provocation testing
94
First 2 meds to give patient post MI with acute systolic heart failure
ACEI and beta blocker
95
The evidence for systolic heart failure shows mortality benefit for only what 3 beta blockers
- Metoprolol succinate
- Carvedilol
- Bisoprolol
96
Stages/time frame of alcohol withdrawal
1) 6-12 hours: tremor, tachycardia, HTN
2) 12-24 hours: seizures
3) 2-7 days: DTs
97
Hypotonia with hyperreflexia is an early feature of what disease that causes dementia
Huntington disease
98
is there a coorelation b/t alcohol and pancreatic cancer
no . . . smoking is tho
99
Another name for anterior spinal artery syndrome
Beck's syndrome
100
Acceptable blood pressure in patients 60 or older is what?
less than 150/90
101
Describe the colon cancer screening of a patient with a first degree relative with colon cancer
colonoscopy every 5 years beginning 10 years earlier than the age at which the relative was diagnosed or age 40 . . whichever is earlier
102
Uptake in Graves?
diffuse
103
This is otherwise known as toxic multinodular goiter. 2nd most common cause of hyperthyroid. A radioactive iodine thyroid scan and uptake tests shows patchy or localized uptake
Plummer's disease
104
This is defined as low serum thyrotropin (TSH) with normal thyroid hormone levels
Subclinical hyperthyroidism
105
Describe the Rai staging system in CLL
```
Stage 0: Lymphocytosis > 15,000
Stage 1: Lymphocytosis + lymphadenopathy
Stage 2: lymphocytosis + splenomegaly
Stage 3: lymphocytosis + anemia
Stage 4: lymphocytosis + thrombocytopenia
```
106
Giant cells with bilobar nuclei and eosinophilic nucleoli are also known as what?
associated with what dz?
- Reed-Sternberg cells
| - Hodgkin's disease
107
These are PAS staining IgM deposits around the nucleus and may be seen within plasma cells of marrow aspirates?
Associated with what dx?
- Dutcher bodies
| - Waldenstrom's macroglobulinemia
108
Plasma cells with a fried egg appearance
Multiple Myeloma
109
Suspect dermatomyositis in a patient with proximal muscle weakness that presents with skin manifestations over the knuckles (Gottron's papules) and eyes (heliotrope purple rash). What may also be seen in the subcutaneous fatty tissue?
calcifications
110
What is the preferred method to evaluate centrally located lung lesions?
Fiberoptic bronchoscopy
111
What is the preferred method for evaluation of peripheral lung lesions
CT-guided biospy
112
What is the most sensitive physical exam test for an acute ACL tear?
Lachman test
113
Why is anterior drawer test not the best test for assessing ACL integrity
Because the knee is in 90 degrees flexion, other soft tissue structures are stabilizing the knee
114
Progression of osteoarthritis treatment?
first: exercise and weight loss
second: acetaminophen
third: NSAIDS
you know the rest
115
A patient with a recent travel history, who presents with severe systemic flu-like symptoms, rose spots and splenomegaly is most likely presenting with what?
Typhoid fever caused by Salmonella typhi.
116
Vibrio parahemolyticus can cause similar symptoms as Salmonella typhi but is associated with the ingestion of what
seafood
117
What is Waddell's signs?
| What disorder does it signify?
Basically it's a bunch of ways to tell if a patient complaining of back pain is malingering
118
what sex cord testicular tumor is associated with Peutz-Jeghers and Carney's syndrome.
Sertoli cell
119
The inferior glands of the parathyroid are derived from the what pharyngeal pouch. This structure is also the embryologic origin of the thymus.
third
120
Describe the PT, PTT, and bleeding time in von Willebrand's disease
- Platelet counts and PT normal
- PTT will be prolonged due to the decreased level of factor VIII
- Bleeding time prolonged due to platelet defect
121
This test can measure the capacity of vWF to agglutinate platelets and is used in the diagnosis of VWD.
A ristocetin cofactor assay of the patient's plasma
122
What test evaluated for the presence of a completely ruptured achilles tendon?
Explain the text?
- Thompson test
- Patient prone with feet hanging over the end of table
- The affected calf is squeezed, if torn then no planarflexion
123
Describe the non-operative treatment for acute Achilles tendon rupture?
- immobilization in 20 degrees of plantarflexion for 2 weeks**
- Followed by functional bracing with limited dorsiflexion, protected weight bearing, and PT
124
Normal UA but elevated proteins on 24 hours protein:creatinine ratio?
- MM
| - if nephrotic syndrome then Albumin would be detected on dipstick UA
125
Lipids and nephrotic syndrome?
Hyperlipidemia
126
This involves tendinopathy of the pelvic stabilizers at the confluence of the rectus abdominis insertion, adductor origin, and pelvic floor at the pubic ramus
Athletic pubalgia
127
Another name for Milk-alkali syndrome
Burnett syndrome
128
What is SIRS criteria
- 2 or more of the following
- Fever > 38 C (100.4 F) or < 36 C (96.8)
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC > 12k or < 4 K or > 10% bandemia
129
This is defined as meeting SIRS criteria plus a suspected source of infection
Sepsis
130
This is an herbal supplement that is marketed for the treatment of dementia, memory impairment, and vascular disorders. Its effects are thought to be mediated by antioxidant properties and inhibition of binding of platelet activating factor. Current studies have not consistently shown benefit, and expert recommendations are to not used this in treatment or prevention of dementia. While it is generally considered safe, there have been multiple reports of SERIOUS BLEEDING in patients taking it. It should not be used in patients taking anticoagulants or perioperatively in patients at high risk for bleeding. Other adverse effects include GI discomfort, N/V/D, headache, dizziness, heart palpitations, and restlessness.
Ginkgo biloba
131
This is an herbal supplement commonly used to treat BPH. The mechanism of action is unclear, but proposed mechanisms include antiandrogen effets and relaxation of the lower urinary sphincter. Data regarding its efficacy are mixed, but the most recent meta-analysis in 2012 suggest no benefit compared with placebo. Adverse effects are rar and generally mild and include headache, nausea, and dizziness
Saw palmetto
132
This is an herbal supplement popularly believed to be an immunostimulator taken to improve overall immune function. The likely mechanism of action is increased synthesis of inflammatory cytokines, which has been demonstrated in in vitro studies. Recent studies have shown no benefit in the treatment of upper respiratory infections (URIs), but it may have a small benefit in preventing URIs. Reported adverse effects of it include nausea, dizziness, dyspnea, rash, dermatitis, pruritis, and hepatotoxicity. These tend to be infrequent, mild, and transient. It should not be taken by persons with progressive systemic and autoimmune disorders, connective tissue disorders, or related diseases. It should also not be used in combination with immunosuppressants or hepatotoxic drugs.
Echinacea goldenseal
133
This is known as Asian ginseng root, is an herbal supplement known for its aphrodisiac properties and is used in the treatment of sexual dysfunction, type 2 diabetes mellitus, and fatigue. Meta-analyses do not support the use of this for any of these, although there is a small trial from Korea supporting its use in treating erectile dysfunction. It is generally well tolerated, with the most common adverse effect being the inability to sleep. Other adverse effects can include nausea, diarrhea, euphoria, headaches, hypertension, epistaxis, and mastalgia.
Panax ginseng
134
This herbal substance is widely known for its role in the treatment for depression. Its mechanism is thought to be mediated by modulation of the neurotransmitters norepinephrine and serotonin. Data regarding its efficacy are mixed, with international trials showing benefit in the treatment of depression, and US trials showing no benefit compared with placebo. Studies do, however, support the use of it in the treatment of somatoform disorders. it has has been shown to cause multiple drug interactions mainly through induction of the cytochrome P450 enzyme CYP3A4. This results in the increased metabolism of P450-metabolized drugs, resulting in decreased concentration and clinical effect. Examples of these drugs include oral contraceptive pills (OCPs), antiretrovirals, and anticoagulants. Current guidelines recommend against the use of this in the treatment of depression given its unclear benefit and multiple drug interactions
St. John's wort
135
What is the most appropriate treatment to control ascites
Diuretics and dietary sodium restriction
136
Lymph node biopsy of Hodgkin's lymphoma shows what?
- Scattered neoplastic cells upon a background of inflammatory cells (lymphocytes, plasma cells, eosinophils, fibroblasts)
- The neoplastic cells, known as Reed sternberg cells, are large giant cells with a multinucleated or bilobed nucleus resembling owl's eyes
137
This is a disorder characterized by continued pain, allodynia, or hyperalgesia, usually of one of the extremities. Edema, vasomotor instability (temp changes in extremity), skin changes (mottled appearance), and decreased range of motion are all symptoms
Complex regional pain syndrome
138
How to discriminate between complex regional pain syndromes type I and II
- type I: Pain may migrate; any type of injury, no nerve lesion
- Type II: Pain does NOT migrate; Large injury that damaged a peripheral nerve
139
Most common allergy in spring?
Trees
140
Most common allergy in summer
Grasses
141
Most common allergy in Fall
Weeds (ragweed)
142
Most common allergy in Winter?
trees
143
If you see intracranial calcifications in a neonate think of either CMV or toxo. The key to differentiating the two is what?
- Understanding the mother's diet
- Toxo can spread via ingesting undercooked beef and pork
- CMV is not transmitted that way, and the exact etiology on how the mother gets infected is not fully understood
144
What are the indications for valve replacement in infective endocarditis?
- prosthetic valve endocarditis especially when associated with valve dysfunction or staph aureus or Gram-negative rod bacteremia
- Uncontrolled infection leading to conduction abnormalities, periannular suppuration, and fistula despite appropriate antibiotic tretment for at least 1 week
- Repeated systemic embolizations despite appropriate antibiotic treatment
- Severe valvular disease resulting in refractory CHF
145
Valve issue associated with Turner syndrome?
Bicuspid Aortic Valve . . . aortic stenosis at young age
146
Explain the effect of NSAIDs on renal plasma flow, GFR, and filtration fraction
- Constricts afferents
- decrease RPF
- decrease GFR
- NO change in filtration fraction
147
Explain the effect of ACEI's on renal plasma flow, GFR, and filtration fraction?
- No constriction of Efferent
- Increases RPF
- Decreases FF
148
Gold standard for diagnosing diverticulosis
Colonoscopy
149
Chapman point for prostate?
Posterior aspect of the IT band
150
Coagulation panel values for hemophilia A
- Normal platelet count
- Normal bleeding time
- Normal PT
- Increased PTT
151
This medical legal term states that empoyers are liable for negligence of their employees.
Vicarious liability
152
This medical legal term is defined as an intentional act on the part of the caregiver to fail to respect a patients advance directive
Battery
153
What is a potential life-threatening effect of aminoglycoside therapy?
Acute tubular necrosis leading to renal failure
154
Describe the presentations of Duodenal and gastric ulcers
- Duodenal ulcer disease causes nocturnal symptoms and is relieved with food consumption
- Gastric ulcers are more painful with food intake
155
What is the most accurate test in evaluation of peptic ulcer disease
EGD with biopsy
156
+ O'Briens test
Superior labral anterior to posterior tears . . SLAP
157
up to 80% of osteosarcomas with metastasize where?
lung . . get chest CT
158
Cheyne-Stokes respirations are seen in what?
| Describe them?
- CHF
| - Oscillating periods of apnea and hyperpnea
159
What OMM technique is effective for acute otitis media
Galbreath technique
160
This personality disorder are excessively emotional and seek attention. They are also sexually provacative and superficial
Histrionic
161
This is demonstrated by rubbing one's genitalia against a clothed woman who is not consenting and unaware of the event?
Frotteurism
162
This occurs when one reveals his/her genitals to unsuspecting people for "shock-value"
Exhibitionism
163
This describes the act of using inanimate objects for sexual pleasure
Fetishism
164
This occurs when one gets sexual pleasure from engaging in sexual activity with dead bodies
Necrophilia
165
This refers to individuals who gain pleasure from watching other people undress or engage in sexual activity
Voyeurism
166
Treatment of NMS
cooling blankets and dantrolene
167
Describe the treatment of insomnia when the problem is going to sleep . . sleep onset insomnia
-First line is sedative hypnotic zolpidem, zaleplon, and triazolam
168
describe the treatment of insomnia when the problem is staying asleep . . . sleep-maintenance insomnia
-hypnotic with a slower rate of elimination such as estazolam or flurazepam
169
What is the treatment of choice in opioid dependence in pregnancy
Methadone
170
This is a psychiatric disorder that occurs when patients purge in the ABSENCE of binge eating. These behaviors occur with the goal of manipulating weight or body shape
Purging disorder
171
Suspected vulvar lichen sclerosis. Get a punch biopsy to dx . . what does histology show
epidermis is thinned with loss of rete ridges and lymphocytes in the basal layer
172
First line medical therapy for lichen sclerosis
a potent topical corticosteroid
173
Can you get a score of 1 on a category of BPP?
no . . its 2 or 0 for each with 10 as highest
174
Treat acute exacerbations of Behcet syndrome with what?
oral prednisone
175
Describe how to manage an in place IUD in a pregnant patient
- should be removed if pregnancy is less than 12 weeks
| - Should remain in place if the pregnancy is over 12 weeks
176
vaginal pH in Gardnerella vaginosis
> 4.5
177
pH in candida vaginal discharge
4-4.5 . . lower than both BV and trich
178
pH in Trichomonas
5-6
179
These headaches are a common complication of epidural anesthesia that occurs from accidental puncture of the dural membrane. Pain is relieved with supine posture
Post dural puncture headache . . also known spinal headache . .
180
What is the most effective treatment for patients suffering from post-dural puncture headache
Epidural blood patches
181
Every female of childbearing age should take what supplement
folic acid
182
Describe the medial management of GERD in pregnancy after conservative lifestyle changes have been made
H2 receptor blockers are preferred because of the increased safety for the fetus
183
If uterine fibroids are suspected, obtain what labs/imaging?
- CBC to assess for anemia
| - Vaginal US to view pelvic anatomy
184
What meds are an option for the treatment of vasomotor symptoms of menopause in patients who are not candidates for estrogen therapy (ie. breast cancer)
SSRI/SNRI
185
What is the best test to assess fetal limb development and cardiac function, given its extensive ability to view the heart
Level II ***** ultrasound (targeted ultrasound)
186
First line therapy for endometriosis
OCPs
187
Always due what before a pelvic exam in third trimester bleeding?
an US to rule out placenta previa or abruption
| -A pelvic exam is contraindicated in placenta previa
188
Lichen sclerosis is a chronic, painful, pruritic disease that most commonly affects the vulva of post-menopausal women. It can lead to dyspareunia. The cause is unknown but most lesions appear spontaneously. First line treatment is a potent topical corticosterioid such as clobetasol. If this is not effective, What is second line?
-Topical calcineurin inhibitors, such as tacrolimus
189
is fetal tissue seen in a partial or a complete molar pregnancy
partial
190
What is necessary to evacuate the uterus following diagnosis of molar pregnancy?
Dilation and evacuation
191
What is safe to use in pregnant patients suffering from flare-ups of RA
Prednisone at low doses
192
Describe normal pregnancy changes
- vagina and cervix turn bluish . . referred to as "Chadwick's sign"
- Breast swelling and tenderness
- development of linea nigra from umbilicus to pubis
- telangiectasias and palmar erythema
- Goodell's sign is softening of the vaginal portion of the cervix
- Ladin's sign is softening at the junction of the cervix and uterus
193
Management of uterine prolapse
- Try pelvic muscle training first
- Can use pessary
- Topical estrogen is an important adjunct
194
What is the viral load cut off requiring C section in a HIV positive pregnant patient
1000
195
What hormones are most commonly implicated in the development of gestational DM
- Human placental lactogen
| - progesterone
196
This is a cause of secondary amenorrhea that occurs secondary to the presence of intrauterine adhesions, which usually follow infection or uterine surgery
Asherman's syndrome
197
Describe the use of body temp in evaluating for ovulation
- Basal body temp is approximately .5 F higher in luteal phase
- identifies ovulation retrospectively about 2-3 days
- The least fertile days are those after the basal body temp has been elevated for 3 days and before menstruation
198
What is the 24 hour protein cutoff for mild preeclampsia
300 ug
199
What is the gold standard for diagnosis of Endometriosis
- "powder burn" on laparoscopic imaging
| - Laparoscopic visualization with/without histological evaluation
200
Management of CIN 2 and 3
excision or ablation given the decreased risk of spontaneous ablation
201
Management of CIN 1
often regress spontaneously without further management
202
Describe the estimated weight gain during pregnancy based on pre pregnancy BMI
- BMI < 18.5 (underweight): 28-40 lbs
- BMI 18.5 - 24.9 (normal weight): 25 - 35 lbs
- BMI 25 - 29.9 (overweight): 15 - 25 lbs
- BMI 30 or more (obese): 11-20 lbs
203
Bulging anterior fontanelle is clue for what in neonate
Meningitis
204
What are the empiric drugs of choice for treatment of neonatal meningitis?
- Ampicillin and cefotaxime or
| - Ampicillin and gentamicin
205
Cutaneous larva migrans is an infections by the hookworm that lives in tropical areas and is found in the soil or sand. Infections occurs when bare skin comes in contact with larvae that penetrate the skin. Patients presents with pruritic, erythematous papules at the site of penetration which is then followed by a serpiginous, red to brown lesion that develops as the larvae migrate in the skin. What is treatment?
- Thiabendazole is preferred
| - Second line agents include albendazole and ivermectin
206
this presents in neonates as a bulging blue domed, translucent membrane at the level of the vaginal introitus and can lead to urinary obstruction.
Imperforate hymen
207
Time frame for physiologic jaundice
starts on the second to third day and usually resolves within one to two weeks
208
time frame for biliary atresia
1-3 months of age
209
This may present with cardiogenic shock in the first few weeks of life when the ductus arteriosus closes. Physical exam will reveal signs of CHF and likely weak lower extremity pulses compared to the upper extremities
Critical coarctation of the aorta
210
What are the fetal 2 cardiac anomalies classically associated with maternal lithium use
- Tricuspid atresia
| - Ebstein's anomaly
211
Patients with nephrotic syndrome are at increased risk of infection, particularly what kind?
- encapsulated such as strep pneumo
| - Patients should be vaccinated with 23-polyvalent pneumococcal vaccine (PPV23)
212
The major side effects of oral retinoids (maybe for acne) includes what?
- suicidal ideations
- teratogenicity
- Hypertriglyceridemia
- Hypercholesterolemia
- elevated liver enzymes
213
Both Chiari type 2 and Dandy-Walker malformation are congenital brain malformations involving the cerebellum. A key distinction is what?
- Dandy-Walker consists of partial, or even complete absence of the cerebellar vermis
- Chiari type 2 consists of herniation of the cerebellar tonsils, cerebellar vermis, and medulla
214
This is a ventral curvature of the penis. It is often associated with HYPOspadias, especially in more severe forms
Chordee
215
Bladder exstrophy is associated with what
EPIspadias
216
What 3 things is hypospadias associated with?
- Chordee
- Cryptorchidism
- Inguinal hernias
217
describe the developemental milestones of a 2 month old
- lift head from their chest when prone
- track to midline
- alert to sounds
- coo
- recognize parents and exhibit a social smile
218
development of 10 month old
- crawl
- pull selves up to stand
- immature pincer grasp
- wave bye bye
219
development of 4 month old
- roll front to back
- grasp a rattle
- orient to voice and laugh
220
development of 6 month old
- sit unassisted
- transfer objects
- babble
- exhibit stranger anxiety
221
development of 8 month old
- sit unassisted
- transfer object
- babble and exhibit stranger anxiety
222
development of 9 month old
- play interactive games
- crawl
- grasp objects with their thumb
- speak first words
223
Lead causes generation of what? . . .leading to toxicity
reactive oxygen species
224
What in the serum measures the effect of lead on hemoglobin synthesis?
- Free erythrocyte protoporphyrin
| - elevated indicates chronic lead exposure
225
The most common cause of death in children aged 1-4 is unintentional injury. More specifically, the most common unintentional injuries in order are what?
- drowning
- MVA
- homicide
- burn/fire
- suffocation
226
What OMM technique has been shown to improve breathing in patients suffering from asthma and viral pneumonia. This is thought to occur through normalization of sympathetic and parasympathetic innervation. Consider doing this on all patients with asthma
Rib raising
227
This is a physical examination sign. When the examiner writes a word on the skin of the patient it remains imprinted as erythematous wheals? Describe the pathophysiology
- Dermatographism
- occurs when a patient has urticaria, otherwise known as hives
- It is an IgE mediated reaction involving mast cells and histamine release
228
This condition involves osteonecrosis of the tarsal navicular; it presents frequently in childhood
Kohler's disease
229
This condition involves avascular necrosis and collapse of the lunate. It is frequently encountered in individuals who overuse the wrist through repetitive compressive loading
Kienbock's disease
230
This presents with developmental delay and hypertonia and is commonly associated with a complicated labor
Cerebral palsy
231
This provides information concerning malpractice payments, adverse licensure, withdrawal of clinical privileges, and other negative actions taken against individual health care practitioners
National Practitioner Data bank (NPDP)
232
This is to combat fraud and abuse in health insurance and health care delivery
Healthcare Integrity and Protection data bank (HIPDA)
233
This operates accreditation programs to subscriber hospitals and other health care organizations. A hospital that meets this accreditation is deemed to meet the Medicare Conditions of Participation (which is a requirement for Medicare)
Joint Commission
234
This is designed to improve health care quality and manages voluntary accreditation programs for individual physicians and medical groups
The National Committee for Quality Assurance (NCQA)
235
Recurrent layngeal nerve injury can occur during a thyrioidectomy causing hoarseness . . what muscle would be involved
posterior cricoarytenoid
236
Loss of range of motion as seen on a positive Apley's scratch test indicates what pathology
possible tear of rotator cuff
237
What is the most common cause of thyroid storm?
undertreated or undiagnosed Graves disease
238
First line treatment for thyroid storm
PTU . . shorter half life
239
What is the gold standard for the diagnosis of nephrolithiasis
spiral CT without contrast
240
Pathophys of migrane
Primary neuronal dysfunction with the trigeminovascular system as the main pathway
241
Triptans can be used to ABORT migraines. What can be used for prophylaxis?
- Beta blockers
- CCBs
- TCAs
- valproic acid
- SSRI
242
does a varicocele transilluminate?
no
243
Anticoagulation is recommended for how long in a patient with a VTE that was UNprovoked?
- indefinitely
| - If it were provoked then 3 months
244
for seated flexion test, the side of the dysfunction is on the side where the PSIS is in what position compared to the other at the end of forward bending
Superior
245
Long term remission in UC is initially maintained with what medication
Mesalamine or other 5-aminosalicylate derivatives
246
Allen's test is used to assess what
Adequacy of blood supply to the hand by the radial and ulnar arteries
-open and close fist and then make tight fist as physician occludes both radial and ulnar arteries . . assess release of one artery at a time
247
Viscerosomatic reflex for penis
T11-L2
248
Viscerosomatic reflex for prostate
T12-L2
249
Edrophonium tests are performed in what myasthenia gravis patients
- Those who have objective findings such as ptosis or ophthalmoparesis but have negative antibodies and electrodiagnostic tests
- AChR antibodies are foundi n about 85% of patients with systemic MG, but in only about 50% of those with ocular
250
What is Conn syndrome
Primary hyperaldosteronism
251
An adverse reaction to a vaccine would occur within how many days
7
252
All patients with neutropenic fever should receive an antibiotic that treats what immediately? Give examples?
- Pseudomonas
- Ceftazadime
- Pip/Tazo
- Meropenem
- Imipenem
- Cefipime
253
In neutropenic fever, if fever persists despite antibiotics, what would you do?
Add a broad spectrum anti-fungal agent like amphotericin B
254
In STEMI, rises in troponin occur how long after myocyte injury
2-4 hours
255
Why would a meningitis HA be worse with sitting?
flexes knees so pulls down on inflamed meninges
256
What bones make up Occipitomastoid suture
Occiput and temporal bone
257
What cranial opening is formed from the occiput and temporal bone
jugular foramen
258
What important nerve exits jugular foramen
Vagus
259
Where does CNIII exit
Superior orbital fissure
260
track of CN VII in cranium
- enters internal acoustic meatus
| - Exits through stylomastoid foramen
261
Where does CN IX exit
-Jugular foramen
262
where does CN XII exit
-hypoglossal canal
263
Dysfunction of hypoglossal nerve occurs more frequently with what cranial somatic dysfunction
- occipital condyles
| - especially prominent in infants after passing through the birth canal and results in suckling disorders
264
What OMM technique at hte occipitomastoid suture is performed to affect the vagus nerve to address the parasympathetic nervous system?
V spread
265
What nerves exit Jugular foramen?
- IX
- X
- XI
266
What CN travels through Foramen magnum?
| Describe its course
-The spinal accessory nerve that originates at C1-C6 spinal nerves comes through foramen magnum entering the cranium and exiting through the jugular foramen
267
Foramen ovale is within what cranial bone
Sphenoid
268
What travels through foramen ovale
-V3 . . . trigeminal third branch
269
what nerves through superior orbital fissure
- III
- IV
- V1
- and VI
270
What is a sting sign on radiograph?
- In Crohn disease, an inflammation penetrates the submucosa and muscularis layers, deep, knife-like linear clefts form the basis of "cobblestoning" and fissure of fistula formation
- Long areas of circumferential inflammation and fibrosis resulting in long segments of luminal narrowing
271
Describe the translocation in Burkitt lymphoma
- t(8;14) c-myc
- The c-myc oncogene is on chromosome 8 and is translated next to the heavy chain Ig gene on chromosome 14
- Treatment is rituximab
272
What is translocation for Mantel cell lymphoma
-t(11;14) bcl-1
273
What is translocation for follicular lymphoma
t(14;18) bcl-2
274
This drug is effective in prevention and treatmeng of osteoporosis especially with breast cancer hx
- Raloxifene
| - Contraindicated in VTE
275
This is a monoclonal antibody against RANKL that reduces osteoclastogenesis. It is an effective treatment for osteoporosis but is not first line
Denosumab
| -Patients with hypocalcemia and vitamin D deficiency should have these corrected prior to administration
276
Management of patient with postive PPD and negative chest x-ray
- Isoniazid for 9 months
| - Once the skin test is positive it should never be repeated because it will always remain positive
277
defrillation in PEA or Asystole?
NOOO . . . CPR and epi and
278
Counterstrain position for posterior thoracic tender points
Extend and sidebend AWAY
279
These are bony outgrowths around the DIPs and are associated with OA
Heberden's nodes
280
These are bony outgrowths around the PIP joints and are associated with either OA or RA
Bouchard's nodes
281
What is the drug of choice for endocarditis prophylaxis for dental procedures
Amoxicillin
282
Initial treatment of choice for nasal polyps
intranasal corticosteroid spray
283
This is a rare cause of restrictive cardiomyopathy that is a result of eosinophil degranulation, leading to cardiac necrosis and eventual fibrosis
Loffler endocarditis
284
This is a genetic disease charactrized by specific ECG findings and an increased risk of sudden death. The typical ECG finding is persistent ST elevation in the leads V1-V3, with a RBBB appearance with or without terminal S waves in the lateral leads
Brugada syndrome
285
Describe the Histological findings in Cruetzfeldt-Jakob disease?
- Convalescent clear vesicles are seen
- These small vacuoles give the brains a spongiform appearance.
- Neronal loss, proliferation of glial cells with no presence of inflammation is characteristic
286
Histopathology of Alzheimer's
- Senile plaques which are characterized by eosinophilia and amylod A beta deposition
- The hippocampus is primarily affected
- Neurofibrillary tangles which are intraneuonal aggregates of abnormally modified microtubule associated tau proteins are characteristic
287
What gross findings are seen on examination of a brain in huntingtons disease
- atrophy
| - Neuronal loss with protein aggregates are seen in the caudate and putamen
288
Pathological findings in Lewy body disease
- Atrophy of brain SPARING hippocampus
- Accumulation of round, eosinophilic intranuclear inclusion (Lewy bodies), in the substantia nigra
- Lewy bodies are result of abnormal alpha-synuclein
289
Neuroimaging in Vascular dementia
- Gross ischemic infarct, lacunar infarcts, and arteriosclerosis with minimal atrophy
- Leukoaraiosis is another term for white matter disease
290
What IV meds can be used in hypertensive emergencies
- Nitroprusside
- Nicardipine
- Clevidipine
- Labetalol
- Fenoldapam
291
Most common causes of Nec fasc
- Clostridium perfringens
- Staph aureus
- Strep pyogenes
292
Necrotizing fasciitis needs broad spectrum antibiotic coverage for Gram +, Gram -, and anaerobic. This includes what antibiotics
- Clindamycin
- Penecillin
- Vanc
293
Class ECG finding in Digoxin toxicity
ST depression with a concave morphology (hockey stick morphology)
294
direction of thrust in AA HVLA
rotatory . . . so through the barrier . . . NOT toward opposite eye
295
The first sign of diabetic nephropathy, also known as kimmelstiel-Wilson disease, is what
Proteinuria on UA
296
Advanced lyme disease can cause post viral cerebellar ataxia. . tested how
finger to nose test
297
TIBC/transferrin in iron deficiency anemia?
Increased
298
TIBC/transferrin in Thalassemia?
Normal
299
TIBC/transferrin in Anemia of Chronic disease?
Decreased
300
This condition affects a branch of the radial nerve and results in weakness with extension of the wrist, thumb and index finger as well as with forearm supination and grip strength
Posterior interosseous nerve compression syndrome
301
This is also known as surfer's knee and involves compression of the saphenous nerve, usually at Hunter's canal, caused by kneeling fro prolonged periods of time. Pain frequently presents along the medial and inferior aspect of the knee
Saphenous neuritis
302
What hepatitis Virus is the only one with DNA as genome and uses reverse transcriptase that is uses to make DNA from viral RNA in the cytoplasm
Hep B
303
This type of hepatitis is spread through blood and coats itself with low-density lipoproteins in order to infect hepatocytes . . no vaccination
Hep C
304
This type of hepatitis is spread through contaminated food and the fecal-oral route and is more common than other types in the US
Hep A
305
Bladder diverticula are typically asymptomatic, but may present with UTI and hematuria. They are most commonly caused by bladder outlet obstruction such as with BPH or neurogenic bladder. Complications include infection, stone formation, and malignancy. What is the most efficient and reliable method of detection
Voiding cystourethrography
306
Best test to assess injury of medial meniscus
McMurray
307
Describe the Bounce home test
-The patient is supine with his or her heel cupped in the physicians hand. The physician fully flexes the knee and then passively extends the knee. If the knee does not reach complete extension or has a rubbery or springy end feel, the knee movement may be blocked by a torn meniscus
308
What should be checked in conjunction with thyroid hormones in myxedema coma
Serum cortisol
309
Suspect this deficiency in homeless alcoholics demonstrating symptoms consistent with the triad of encephalopathy, ophthalmoplegia, and ataxia
Thiamine deficiency
310
What Hep B infection?
| -presence of antibodies to the core and surface antigens
previous infection
311
What Hep B infection?
- IgM antibodies to core
- HBs Ag
- HBe Ag
Acute active and transmissable
312
What Hep B infection?
| -Isolated antibodies to core
window period
313
What Hep B infection?
| antibodies to surface antigen but not core
successful vaccination
314
What is the most definitive management for foreign body extraction in the pediatric population
RIGID bronchoscopy
315
What is the most common neurologic deficit of untreated bacterial meningitis
Hearing loss
316
Treat black widow spider bite with what?
antivenom
317
Most cases of warfarin-induced skin necrosis occur within how long after beginning warfarin?
first week
318
Pasteurella multocida is a the most common cause of cellulitis occurring after a dog or cat bite . . describe its Gram stain and shape
Gram-negative bacillus
319
innominate rotations occurs around what sacral axis
inferior transverse
320
What is the best Screening test on physical exam (most sensitive) for carpal tunnel
Phalen's test
321
What is the single most common organism responsible for necrotizing fasciitis
Group A strep
322
Which way do you sidebend when performing Spurling test
towards side of symptoms
323
What insulin has the fastest action at 5-10 minutes so it should be taken prior to meals
Lispro
