PANCE Flashcards
(173 cards)
1
Q
What are the 4 main causes of obstructive shock?
A
1) massive pulmonary embolism
2) Cardiac tamponade
3) Tension Pneumothorax
4) Aortic Dissection or stenosis
2
Q
What EKG finding is typical of pulmonary emobolism?
A
S1Q3T3
3
Q
What are the 4 types of distributive shock and which is most common?
A
1) Septic shock ( most common)
2) Anaphylactic shock
3) Neurogenic shock
4) Endocrine Shock
4
Q
What is the criteria for SIRs?
A
At least two of the following:
1) Fever >38 or hypothermia <36
2) pulse >90
3) RR >20 or PaCO2 <32
4) WBC >12,000 or <4,000
5
Q
What is the only kind of shock associated with increased CO?
A
Early (warm) septic shock
6
Q
What is the triad of symptoms associated with pheochromocytoma?
A
Palpitations, headache, and excessive sweating
7
Q
What thyroid antibodies are found in patients with Hashimotos?
A
Anti-thyroid peroxidase (TPOab) and antithyroglobulin
8
Q
What antibodies are found in Graves Disease?
A
TRab
9
Q
What is Charcots triad and what disease is it associated with?
A
Associated with Acute Cholangitis
1) Fever/Chills
2) RUQ pain
3) jaundice
10
Q
What is cullens sign and what disease is it associated with?
A
Associated with acute pancreatitis, periumbilical ecchymosis
11
Q
What is grey turner sign and what disease is it associated with?
A
Associated with acute pancreatitis, frank ecchymosis due to retroperitoneal bleeding from pancreatic necrosis
12
Q
What is the treatment for uncomplicated diverticulitis?
A
Outpatient treatment with Metronidazole and either Cipro or Levaquin
13
Q
What is it called when you have extreme colon dilation >6cm and signs of systemic toxicity?
A
Toxic megacolon
14
Q
When do you need to calculate anion gap?
A
Metabolic acidosis
15
Q
What is a normal anion gap?
A
8-12
16
Q
How do you calculate anion gap?
A
Na- (Cl+ HCO3)
17
Q
What are the causes of metabolic acidosis with increased anion gap?
A
MUDPILES Methanol Uremia DKA Propylene Glycol Iron/Isoniazid Lactic acidosis Ethylene Gycol Salicylate/starvation
18
Q
What drugs do you want to avoid is myasthenia gravis?
A
Fluoroquinolones, beta blockers, and hydroxychloroquine
**These can further reduce the effectiveness of neuromuscular transmission
19
Q
What two antibodies are present in myasthenia gravis?
A
Acetylcholine receptor antibodies and Muscle specific tyrosine kinase antibodies
20
Q
What is the first line medical management of myasthenia gravis?
A
Acetylcholinesterase inhibitors: Pyridostigmine and Neostigmine
21
Q
What is the test of choice to diagnose MS?
A
MRI with contrast
22
Q
What is the first line prophylactic medication for cluster headaches?
A
Verapamil
23
Q
What CSF finding is indicative of MS?
A
High IgG (oligoclonal bands)
24
Q
What is the most common etiology of acute mastitis
A
S. Aureus
25
What is the first line medical treatment for gynecomastia?
Tamoxifen: SERM that is an estrogen antagonist in the breast
26
What is the most common type of breast cancer?
Infiltrative ductal carcinoma
27
What is the best diagnostic test for cervical insufficiency?
Transvaginal US, insufficiency is present if cervical length is 25mm or less before 24 weeks
28
What serum test can you order in the first trimester to test for Down syndrome?
PAPP-A ( Serum pregnancy associated plasma protein A)
29
When should you order a nuchal translucency US for a pregnant patient?
10-13 weeks
30
What causes late decelerations on fetal heart rate monitoring?
Uteroplacental insuffiency
31
What causes variable decelerations on fetal heart rate monitoring?
Cord compression
32
What should the fundal height be at 20 weeks gestation?
At the umbilicus
33
When should you screen for gestational diabetes?
24-28 weeks
34
When should you screen for GBS in pregnancy?
36- 37 6/7 weeks
35
How should you treat GBS in pregnancy?
First line: IV Pen G
Second line: Ampicillin, ES penicillins
36
What pathogen causes TSS?
S. Aureus
37
What is the triad of Vasa Previa?
Rupture of membranes, painless vaginal bleeding, and fetal distress
38
What is Samters triad?
Asthma, chronic rhinosinusitis with nasal polyps, and sensitivity to aspirin
39
On brain biopsy, you see spindle cells concentrically arranged in a whorled pattern with Psammoma bodies. What kind of tumor should you be concerned for?
Meningioma
40
On brain biopsy, you see perivascular pseudo rossettes. What kind of tumor should you be concerned about?
Ependymoma
41
What is the most effective chemotherapy for CNS lymphoma?
Methotrexate
42
What is the first line choice of antibiotics for a UTI in children?
Cephalosporins
43
Red blood cell casts are diagnostic of what?
Glomerulonephritis
44
What is the classic tetrad of HSP?
Palpable purpura, arthralgia, abdominal pain, and renal disease
45
What is the DOC for giardia?
Metronidazole
46
Does giardia or amoebiasis cause bloody diarrhea?
Amobiasis, caused by E. Histolytica
47
What is the DOC for Amoebiasis?
Metronidazole
48
What should you think when you hear rice water stool?
Cholera
49
What is the DOC for absence seizures?
Ethosuximide
50
What is the DOC for status epilepticus?
Valium or Ativan
51
What is Charcots triad and what disease is it associated with?
Associated with acute ascending cholangitis: fever/chills, RUQ pain, and jaundice
52
What is the MOA of Thiazolidinediones?
Increase insulin sensitivity
53
What is the MOA of sulfonylureas?
Stimulate beta cell insulin release
54
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
55
What is the first line treatment for Minimal change disease?
Prednisone
56
What is the most common primary cause of Nephrotic syndrome in adults?
Membranous nephropathy
57
Is hematuria typical of nephrotic or nephritic syndrome?
Nephritic
58
You see “Maltese crosses” and oval fat bodies on urinalysis. What should you be concerned for?
Nephrotic syndrome
59
What is Hydronephrosis?
Urinary tract obstruction leading to dilation of the collecting system in one or both kidneys
60
What are the 3 primary causes of nephrotic syndrome?
Minimal change, membranous nephropathy, and focal segmental glomerulosclerosis
61
What are Gottrons papules? What is a heliotrope rash? What condition are both of these associated with?
Gottrons papules: Raised violaceous scaly patches typically on the PIP and MCP joints
Heliotrope rash: edema and blue/purple discoloration of the upper eyelids
Both associated with dermatomyositis
62
What two forms of malaria can be dormant?
P. Vivax and P. Ovale.
P. Falciparum and P. Malariae do not have dormant forms
63
What are the most common side effects of Chloroquine?
- Retinal and corneal toxicity
- Hemolysis (caution in G6PD deficient patients)
- QT Prolongation
64
What is the DOC for the radial cure of P. Vivax and P. Ovale?
Primaquine
65
What antibodies are a hallmark finding of drug induced lupus?
Anti-histone antibodies
66
What antibodies are positive in Sjögren’s syndrome?
ANA, Anti Ro, and Anti La
67
What is Takayasu arteritis?
Chronic large vessel vasculitis that affects the aorta and its primary branches, causing vessel ischemia, LE claudication, bruits, and asymmetric BP
68
What is the treatment for Kawasaki disease?
IVIG and aspirin
69
How is eosinophilic granulomatosis with polyangitis (Chung-Strauss) diagnosed?
Eosinophilia and P-ANCA positive is hallmark
70
What is Henoch-Schonlein purpura?
AKA IgA vasculitis, acute systemic IgA mediated small vessel vasculitis that occurs mostly in children
71
What is Polyarteritis Nodosa?
Systemic vasculitis primarily of medium sized vessels (commonly renal, CNS, and GI). Pulmonary vessels are not involved.
-Commonly associated with Chronic Hep B and C
72
What is the treatment for all stages of syphilis?
Penicillin
73
What is Jarisch-Herxheimer reaction?
An acute self limited febrile reaction that usually occurs within the first 24 hours after receiving therapy for a spirochete injection. Presents with fever, headache, myalgia, hypotension, worsening of rash
74
What is Argyll Robertson pupil?
Small, irregular pupil that constricts with accommodation but is not reactive to light
75
What is the bulls eye rash seen with Lyme disease called?
Erythema Migrans
76
What pathogen causes Amebiasis?
E. Histolytica
77
What is the most common cause of travelers diarrhea?
Enterotoxigenic E. Coli, from contaminated food and water
78
What is the recommended treatment for cholera?
First is rehydration and electrolyte replacement. Tetracyclines if needed to shorten disease course in patients who are severely ill .
79
What pathogen is the most common cause of death from seafood consumption in the US?
Vibrio Vulnificus
80
What are the 3 problems that V. Vulnificus can cause?
Gastroenteritis, necrotizing fasciitis, and cellulitis
81
What antibiotic most commonly causes C. Diff?
Clindamycin
82
How is Campylobacter enteritis treated?
- fluid and electrolyte replacement is mainstay
| - If severe disease, Macrolides
83
Why should you avoid antibiotics in patients with enterohemorrhagic E. Coli?
Increased incidence of HUS
84
Why shouldnt you treat a menopausal women with estrogen only?
Unopposed estrogen can lead to endometrial hyperplasia and endometrial cancer. Must give progestin with estrogen if they have an intact uterus.
85
What is the pharmacologic treatment for vulvovaginal atrophy?
- Ospemifene: SERM that is an estrogen agonist in the vagina and bone, and antagonist in the breast and uterus
- topic vaginal estrogens
86
What is adenomyosis? What is the only effective treatment?
When endometrial tissue grows within the myometrium
| -Total hysterectomy
87
What is the classic triad of endometriosis?
Premenstrual pelvic pain, dysmenorrhea, and dyspareunia
88
What is the most common gynecological malignancy in the US?
Endometrial cancer
**adenocarcinoma is most common type
89
What is the first line therapy for PMDD?
SSRIs (fluoxetine and sertraline)
90
What is Fitz Hugh- Curtis syndrome?
-Perihepatitis with hepatic fibrosis, scarring, and peritoneal surface of the anterior RUQ in the setting of PID
91
Buzzword: What should you think when you hear violin string adhesions?
Fitz Hugh-Curtis syndrome
92
What is the recommended treatment for bacterial vaginosis?
Metronidazole x7 days
** Partners do not need treatment
93
What is the recommended treatment for trichomoniasis?
Metronidazole 2g oral dose or 500mg BID x7 days
**partners need treatment
94
Patient presents with dyspnea, pulmonary edema, and rhonchi. What kind of heart failure should you be considering?
Left heart failure
95
What extra beat is commonly see with systolic heart failure?
S3 gallop
96
A patient presents with peripheral edema, JVD, and hepatic congestion. What kind of heart failure should you be considering?
Right sided heart failure ( most commonly caused by left sided heart failure)
97
What are the best two drugs for decreasing mortality in heart failure?
ACEI and Beta blockers
***discontinue beta blockers in decompensated HF!
98
What drug causes Grey Baby Syndrome?
Chloramphenicol
99
What is the treatment for Tetanus?
Metronidazole and IM tetanus immune globulin
100
What pathogen is the most common cause of traumatic gas gangrene?
Clostridium Perfringens
101
What antibiotics can be taken orally for MRSA coverage?
Doxycycline, Clindamycin, Bactrim, and Linezolid
102
What are the two main causes of Hypercalcemia?
Primary hyperparathyroidism and malignancy
103
What is the most common cause of hypocalcemia?
Hypoparathyroidism
104
What symptoms often arise from hypocalcemia?
- Increased muscular contractions, muscle cramps, bronchospasm
- Chvostek sign and Trousseaus sign
105
What is Chvostek sign?
Symptom of hypocalcemia, facial spasm with tapping of the facial nerve
106
What is the EKG finding associated with hypocalcemia?
Prolonged QT
107
What is the most common type fo pituitary adenoma?
Prolactinoma
108
What is the treatment for prolactinoma?
Dopamine agonists (Bromocriptine and Cabergoline)
***Dopamine inhibits prolactin release
109
What is metabolic syndrome?
A syndrome of multiple metabolic abnormalities that increase the risk for complications such as diabetes and cardiovascular resistance
110
What is the criteria for a diagnosis of metabolic syndrome?
Must have 3 of the 5:
- Decreased HDL
- Increased BP
- Increased fasting triglycerides
- Increased fasting blood sugar
- Increased abdominal obesity
111
What is the first line management for absence seizures?
Ethosuximide
112
Patient presents after a traumatic head injury. On exam, there are battle signs, raccoon eyes, and hemotympanum. What kind of skull fracture should you be concerned about?
Basilar skull fracture
113
What is the first line treatment for a panic attack?
Benzos
114
What is the first line treatment for Schizophrenia?
Atypical antipsychotics (Risperdal)
115
What is the female athlete triad?
Disordered eating, amenorrhea, and osteoporosis
116
What is indicative of scoliosis on XR?
Cobbs angle > 10 degrees
117
What is thoracic outlet syndrome?
Idiopathic compression of the brachial plexus, subclavian vein, or subclavian artery
118
What is Adson sign and what is it associated with?
- Associated with thoracic outlet syndrome
| - Loss of radial pulse when head is rotated to the affected side
119
What is the treatment if there is clinical suspicion of Cauda Equina
Dexamethasone 10mg IV x1 immediately, then get MRI with contrast
120
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What kind of drugs are the following:
Albuterol
Formoterol
Ipratropium bromide
Tiotropium Bromide
Advair
Symbicort
```
```
SABA
LABA
SAMA
LAMA
Fluticasone-Salmeterol
Budesonide-formoterol
```
121
What is the stepwise approach to COPD treatment?
- SABA or SAMA
- LAMA or LABA
- LAMA
- LAMA or LABA-LAMA
122
What is the treatment for uncomplicated vulvovaginal candidiasis?
Oral fluconazole
123
what is the treatment for Chlamydia?
Azithromycin 1gm PO or Doxycycline 100mg PO BID x 7 days
124
What is the treatment for Gonorrhea?
Ceftriaxone 250mg IM plus azithromycin 1gm PO single dose
125
What are the diseases caused by Thiamine deficiency?
Beriberi
| Wernicke-Korsakoff syndrome
126
What are the two types of Noninvasive (In Situ) Breast carcinomas?
Lobular (LCIS) and Ducati (DCIS)
127
Is DCIS or LCIS treated as malignant?
DCIS is because it has the potential to develop into invasive cancer. LCIS does not become invasive cancer if left untreated
128
What findings do you see in mammogram if there is DCIS?
Clustered pleomorphic calcifications
129
What are the two types of invasive breast carcinomas?
Infiltrating ducal carcinoma (IDC) and infiltrating lobular carcinoma (ILC)
130
What is Paget’s disease of the breast?
Rare condition associated with breast cancer that causes eczema like changes to the breast. Usually a sign of breast cancer behind the tissue)
131
What is familial adenomatous polyposis (FAP)?
An autosomal dominant gene mutation that results is >100 adenomatous polyps that begin to emerge around age 16.
**significant risk for CRC by age ~39 if left untreated. Prophylactic colectomy is typically recommended
132
When should you start CRC screening in patients with FAP?
Ages 10-12 and repeating every 1-2 years
133
What is Lynch syndrome?
- Hereditary NonPolyposis Colon Cancer (HNPCC)
- Autosomal dominant mutation that results in increased risk for CRC that usually emerges from 45-60 years.
- Multiple family members are affected
- ENDOMETRIAL CANCER commonly associated
134
What is the Amsterdam criteria?
Used to diagnose Lynch syndrome (3-2-1 Rule)
-Should be at least 3 affected relatives from two successive generations, and at least one should be diagnosed before age 50
135
Is a calcified or non-calcified SPN associated with malignancy?
Non-calcified
136
What study should you order for work up of an SPN?
Helical CT Chest without contrast with low dose radiation
137
What is Superior Vena Cava syndrome?
- Due to compression or direct invasion of the SVC (Commonly from cancer, NSCLC)
- Dyspnea, facial swelling, dilated neck veins
138
What are the contraindications to live vaccines?
Pregnancy and immunocompromised
139
Which vaccine is contraindicated if there is a histor of intussusception?
Rotavirus
140
How many doses is the IPV vaccine?
4
141
How many does is the DTaP?
5
142
Which vaccine is contraindicatied when the patient has an allergy to yeast?
Hep B
143
When is the Hep A vaccine administered?
Two doses separated by 6-18 months beginning between 12-23 months
144
When is MMR administered?
1st: 12-15 months
2nd: 4-6 years
Varicella is the same
145
How many doses is the PVC13 vaccine?
4, first administered at 2 months
146
How many doses is the H. Flu vaccine?
2 or 3, first administered at 2 months
147
What is the possible fatal condition that can occur years after a measles infection?
Subacute sclerosing panencephalitis: fatal degenerative disease of CNS that causes behavioral and intellectual deterioration and seizures
148
How do loop diuretics affect calcium and magnesium?
They increase calcium and magnesium excretion
149
How do thiazide diuretics affect calcium levels?
They increase calcium reabsorption
150
Why should you not give digoxin if a patient is taking thiazide or loop diuretics?
They drugs cause hypokalemia. Since digoxin compete with potassium for binding, hypokalemia can cause digoxin toxicity
151
What is the DOC for Lithium induced diabetes insipidus?
Amiloride (Potassium sparing diuretic)
152
How is muscarinic agonist toxicity treated?
Atropine (muscarinic antagonist) and albuterol to reverse bronchoconstriction
153
When is physostigmine used?
Atropine poisoning
154
What are the signs of organophosphate poisoning?
```
SLUDE
Salivation
Lacrimation
Urination
Defecation
Gastric Distress
Emesis
```
155
How is organophosphate poisoning treated?
Administer atropine until pupils dilate. Administer 2-Pam if less than 3-4 hours since exposure
156
What disorder is associated with an an ADAMTS13 deficiency?
TTP
157
What is the Pentad associated with TTP?
```
Thrombocytopenia
Microangiopathic hemolytic anemia
Neurologic symptoms
Fever
AKI
```
158
What is the initial treatment of choice for TTP?
Plasmapheresis
159
What is the DOC for partial seizures and trigeminal neuralgia?
Carbamazepine (tegretol)
160
What are the indications for lamotrigine (Lamictal)?
Partial seizures and bipolar disorder
161
What are the indications for valproic acid?
Absence and general tonic clinic seizures (mixed seizures)
- Bipolar
- Migraine prophylaxis
162
What is the use of Lurasidone (Latuda)?
Depression associated with bipolar disorder
163
What is the triad associated with chronic pancreatitis?
Calcifications, Steatorrhea, and DM
164
What is the renal threshold for plasma glucose and glucose starts to spill into the urine?
150-180
165
What kind of urine cast is common in normal urine?
Hyaline casts
166
What is the normal range for sodium?
135-145
167
What is the normal range for potassium?
3.5-5.0
168
What is commonly used for rapid correction fo hyperkalemia?
Calcium chloride (calcium directly antagonizes the effects of potassium at membrane potential)
169
What are tenofovir, entecavir, and lamivudine used to treat?
Hep B, Tenofovir is DOC
170
What is the recommended treatment for SBP?
Cefotaxime or ceftriaxone
171
What are the contraindications to statins?
Pregnancy and active hepatic disease
- Avoid P405 inhibitors (grapefruit, macrolides, verapamil)
- Avoid P450 activators (phenytoin, barbs, rifampin)
172
What are the indications to prophylactically treat for endocarditis?
1) Prosthetic valve
2) heart repair using prosthetic material
3) hx of endocarditis
4) CHD
173
What is Libman-Sacks endocarditis?
Non bacterial thrombotic endocarditisi is a non infectious endocarditis due to sterile platelet thrombi deposition on the affected valve, commonly affecting the mitral and aortic valves
-Seen with malignancy, SLE, rheumatic fever, etc
