Medical 1.4

Question 1

On which side of the rib does the neurovascular bundle run?

Answer 1

Along inferior margin of rib

Hence when doing Thoracentesis, you should put the needle in just over the top of the rib

Question 2

Dental prophylaxis: which heart conditions do not require antimicrobial ppx for dental procedures?

Answer 2

• Bicuspid AV
• Acquired aortic/mitral valve disease (including MVP with regurgitation)
• HOCM with latent/resting obstruction

Question 3

Methemoglobinemia: pathogenesis?

Answer 3

Ferrous (Fe2+) iron in heme becomes oxidized to the Ferric (Fe3+) state. Ferric heme is unable to bind to oxygen.

Question 4

HIT: diagnostic criteria?

Answer 4

1) Thrombocytopenia
- 2 points: Platelet count fall >50 percent
- 1 point: Platelet count fall 30-50 percent

2) Timing of platelet fall:
- 2 points: Clear onset between days 5-10
- 1 point: Possible fall at 5-10 days but not clear

3) Thrombosis or other sequelae
- 2 points: Confirmed new thrombosis after IV unfractionated heparin
- 1 point: Progressive/recurrent thrombosis or suspected thrombosis

4) oTher causes for thrombocytopenia
- 2 points: none apparent
- 1 point: possible
- 0 points: definite

0-3 pts: low prob
4-5 pts: intermediate prob
6+ pts: high prob

Question 5

Spondylolysis

Answer 5

Fracture of pars interarticularis of vertebra

Question 6

Spondylolisthesis

Answer 6

Spondylolysis that is severe enough to allow the vertebral body to shift out of place

Question 7

Therapeutic Hypothermia: Inclusion Criteria?

Answer 7

• Witnessed VT/VF arrest
• < 15 min to onset of CPR and < 60 min to ROSC
• GCS < 8 post-resuscitation
• SBP > 90 (i.e. not in cardiogenic shock)

Question 8

Testicular cancer: most common?

Answer 8

Germ cell tumors

Question 9

Germ cell tumors: types?

Answer 9

1) Seminomas

2) Nonseminomatous germ cell tumors (NSGCTs): AKA everything else

Question 10

Testicular cancer: prognosis?

Answer 10

Excellent: 95% 5-year survival

Question 11

Testicular cancer: risk factors?

Answer 11

• Cryptorchidism (abdominal cryptorchidism > inguinal cryptorchidism)
• Testicular feminaztion syndromes

Question 12

Testicular cancer: clinical presentation?

Answer 12

Painless testicular mass

Question 13

Antimitochondrial antibodies

Answer 13

Primary biliary cirrhosis

Question 14

Rank-ligand inhibitor

Answer 14

Denusomab (Prolia)

Question 15

Summarize beta-blocker specificity

Answer 15

Non-selective (B1 = B2): Propranolol, Nadolol, Labetolol

B1-selective: Esmolol, Atenolol, Metoprolol (“BEAM” of beta blockers)

Alpha and Beta: Carvedilol, Labetalol

Question 16

Iliotibial band syndrome: symptoms?

Answer 16

Pain where iliotibial band crosses the lateral epicondyle of the femur (just lateral and superior to the knee joint)

Question 17

Iliotibial band syndrome: exam findings?

Answer 17

Positive Noble test

Noble test: We perform the Noble compression test with the patient in a lateral decubitus position and the examiner standing behind them [7,17,30]. The patient’s hip is in a neutral position or slightly flexed. The clinician uses their opposite hand to hold and palpate the top knee, which is the one being examined (ie, clinician’s left hand palpates patient’s right knee and vice versa). The examiner places their thumb on the posterior border of the ITB just proximal to the LFE, while the fingers of the same hand support the underside (ie, medial side) of the knee. Using the other hand, the examiner passively flexes the knee from zero (straight lower extremity) to approximately 60 degrees, while the thumb positioned on the ITB maintains moderate but steady pressure. If the maneuver reproduces the patient’s typical pain this is considered a positive test. Pain is typically most pronounced at approximately 30 degrees of knee flexion.

Question 18

Neoadjuvant Therapy

Answer 18

Treatment given before the main treatment, to shrink tumor burden and make it easier to remove

May include chemo, radiation, or hormone therapy

Question 19

Induction Therapy

Answer 19

First treatment given for a disease (or treatment that is generally agreed to be the best treatment for that condition)

Question 20

Intensification Therapy

Answer 20

Treatment given after cancer has disappeared following the initial therapy

Used to kill any cancer cells that may be left in the body. May include radiation therapy, stem cell transplant, etc

Also called Consolidation therapy

Question 21

“Break-bone Fever”

Answer 21

Dengue fever

So named because of the characteristic MSK pain it causes, especially in the lumbar spine

Question 22

Actinic Keratosis

Answer 22

Precursor to Squamous Cell Carcinoma

Sometimes considered to be “SCC in situ”

Question 23

Basal cell carcinoma: appearance?

Answer 23

• Waxy, translucent, or pearly

- Telangiectasias often present (a feature that contributes to easy bleeding)

Question 24

Basal cell carcinoma: common locations?

Answer 24

Head and Neck

Can often lead to cosmetic disfigurement

Question 25

Bowen disease

Answer 25

Superficial type of squamous cell carcinoma

Question 26

Keratoacanthoma

Answer 26

Skin cancer that originates in the Pilosebaceous glands (hair follicle/sebaceous gland) Characteristic central craterlike depression filled with keratin

Question 27

Describe the dose adjustments in converting regular Metoprolol to Metoprolol XL

Answer 27

When converting, use THE SAME total daily dose. Example 1: Metoprolol 25mg BID should be converted to Metoprolol XL 50mg daily Example 2: Metoprolol 25 XL BID converts to Metoprolol 25 (regular) BID

Question 28

Name as many types of Skin cancer as you can

Answer 28

- Squamous cell carcinoma - Basal cell - Melanoma - Keratoacanthoma

Question 29

Lhermitte's sign

Answer 29

Sensation of electric shock radiating down the spine or into the limbs after neck flexion

Question 30

Lhermitte’s sign: associated conditions?

Answer 30

- Multiple Sclerosis - Cervical disk disease (herniation) - Spinal cord tumor

Question 31

Ring-enhancing lesions: differential diagnosis?

Answer 31

Mnemonic MAGIC DR ``` M: metastases A: abscess G: glioma (GBM) I: infarct (subacute) C: contusion D: demyelination R: radiation necrosis ```

Question 32

List the bones of the hand (Carpal bones)

Answer 32

Mnemonic "Some Lovers Try Positions That They Can't Handle". Order: proximal row then distal row, both lateral to medial. ``` S: scaphoid L: lunate T: triquetrium P: pisiform T: trapezium T: trapezoid C: capate H: hamate ```

Question 33

Herceptin: AKA?

Answer 33

Traztuzumab

Question 34

Herceptin: Mechanism?

Answer 34

Human epidermal growth factor receptor-2 (HER-2) blocker

Question 35

Herceptin: adverse effects?

Answer 35

Cardiotoxicity: often manifested by asymptomatic decrease in LVEF Trastuzumab-related cardiotoxicity is most often manifested by an asymptomatic decrease in left ventricular ejection fraction (LVEF) and less often by clinical heart failure [1-3]. In contrast to cardiotoxicity from anthracyclines, trastuzumab-related cardiotoxicity does not appear to be related to cumulative dose. It is often reversible with treatment discontinuation, and rechallenge is often tolerated after recovery. In addition, cardiac biopsy specimens after trastuzumab exposure do not show significant myocyte destruction characteristic of anthracycline-induced dysfunction. These differences have led to the terms "Type I" and "Type II" chemotherapy-related cardiac dysfunction [4]. Type I, associated with the anthracyclines, results, at least to some degree, in myocyte destruction and clinical heart failure. Type II, a phenomenon that is not unique to trastuzumab, is more often associated with a loss of contractility (presumably a form of stunning or hibernation) that is less likely to be associated with myocyte death or clinical heart failure and is more likely to be reversible