PANCE I Flashcards
(415 cards)
1
Q
Barrett’s esophagus treatment
A
- Indefinite use of PPIs
- EGD surveillance due to predisposition of esophageal adenocarcinoma
2
Q
First diagnostic test for esophagitis
A
EGD
3
Q
Types of esophagitis (5)
A
- Reflux (MC)
- Infectious
- Eosinophilic
- Pill-induced
- Radiation
4
Q
EGD finding and tx for reflux esophagitis
A
- Mucosal breaks
- PPI
5
Q
MC causes of infectious esophagitis
A
- Candida; adherent white plaques
- Viral (CMV/HSV); MC in immunocompromised pts
6
Q
EGD finding for eosinophilic esophagitis
A
- Pt will have hx of atopy
- Stacked rings
7
Q
Drugs that MC cause pill-induced esophagitis, and treatment
A
- Bisphosphonates, iron supplements, NSAIDs
- Tx = PPI
8
Q
Risk factors for 2 types of esophageal CA
A
- SCC-smoking, ETOH, HPV
- Adeno-Barrett’s eso, smoking, obesity
9
Q
Definition of Zenker’s diverticulum and symptoms
A
- Outpouching of post laryngopharynx
- Regurgitation of undigested food or liquid into pharynx several hours after eating
10
Q
GI complaint in patient with scleroderma
A
- Decreased eso sphincter tone and peristalsis
- Predisposes pt to reflux esophagitis
11
Q
Findings on two diagnostics for achalasia
A
- Esophagram-dilation of esophagus and bird’s beak
- Esophageal manometry (confirmatory)-aperistalsis, no relaxation of LES
12
Q
Symptoms of infant with pyloric stenosis
A
- Post-prandial “projectile” vomiting
- Always hungry baby
- Palpable “olive shaped” mass in RUQ
13
Q
Image of choice and finding for pyloric stenosis
A
UGI; “string sign”
14
Q
MC association with gastroparesis, and treatment
A
- Patients with diabetic autonomic neuropathy
- Small frequent low-fat meals
- Prokinetic agent (Metoclopramide)
15
Q
Side effects of Metoclopramide (Reglan)
A
EPS/tardive dyskinesia
16
Q
Complications of PUD (3)
A
- Hemorrhage
- Gastric outlet obstruction
- Perforation
17
Q
Perforation on KUB shows
A
Free air under diaphragm
18
Q
Triple and quad therapy for H pylori
A
- PPI, Amoxicillin, Clarithromycin
- PPI, Bismuth, Metronidazole, Tetracycline
19
Q
Signs of metastatic spread in gastric adenocarcinoma
A
- Virchow’s node-L supraclavicular lymph node
- Sister Mary Joseph node-umbilical nodule
20
Q
Signs of and diagnostics for celiac disease
A
- Villous atrophy on endoscopy
- Tissue transglutaminase IgA
- Dermatitis herpetiformis, FTT in children
21
Q
2 main conditions that cause function constipation (MC)
A
- Chronic idiopathic constipation
- IBS-C
22
Q
3 groups of drugs and 2 supplements that cause med induced constipation
A
- Calcium supp
- Iron supp
- Opioids
- Antipsychotics
- Anticholinergics
23
Q
4 complications of constipation
A
- Hemorrhoids
- Anal fissures
- Fluid/electrolyte abnormalities from laxative abuse
- Fecal impaction –> obstruction
24
Q
Why do you have to be careful with Miralax (polyethylene glycol) and Milk of magnesia and mag citrate?
A
Mg-containing laxatives in patients with renal insufficiency; can cause hypermagnesemia
25
Type of diarrhea in Vibrio cholerae
"rice water" diarrhea
26
Clostridium perfringens exposure
- Home-canned goods
| - Enterotoxin
27
Staphylococcus aureus exposure
- Egg/potato salad
- Creamy foods
- Enterotoxin
28
Cryptosporidium is a serious disease in what group of patients?
Patients with AIDS
29
"Classic dysentery"
Shigella
30
EHEC complication
- Enterohemorrhagic E coli 0157:H7
- NO ABX
- HUS
31
Complication of Clostridioides difficile
Toxic megacolon
32
Main point about Yersinia enterocolitica
Mimics appendicitis (RLQ pain)
33
Entamoeba histolytica can cause
-Intraluminal and disseminated disease (hepatic abscesses)
34
Medications that can cause chronic diarrhea (7)
- Mg antacids
- Metformin
- Reglan
- Laxatives
- Abx
- PPI
- Colchicine
35
Difference between osmotic and secretory diarrhea
- Osmotic (like from lactose intolerance) causes diarrhea that decreases with fasting
- Secretory (like from neuroendocrine tumors) causes diarrhea that is unrelieved with fasting
36
Criteria for IBS
Rome IV criteria
37
Extra-intestinal manifestations of IBD (3)
- Arthralgias
- Erythema nodosum
- Uveitis
38
Main diagnostic tool for Crohn's
EGD, small bowel imaging
39
Curative treatment for UC
surgery
40
Crohn's disease
- Skip lesions
- Transmural
- Mouth to anus
- Granulomas on biopsy
- NSAIDs can worsen sxs
41
UC
- Colon only
- Mucosal layer only
- NSAIDs can worsen sxs
42
Complications of Crohn's disease (5)
- Fistulas (chronic complication of abscess)
- Fissures "passing glass"
- Perianal abscess
- Malabsorption
- Colon CA
43
Complications of UC (3)
- Toxic megacolon
- Colon CA
- Association with Primary Sclerosing Cholangitis
44
Most colorectal CA arise from
Adenomas (precancerous polyps)
45
"Pseudopolyps" (in colon) are associated with
IBD
46
Most common type of adenoma (colon polyp)
Tubular adenoma
47
What age to start colonoscopies
- 50y
- Begin screening at 40 or 10y younger than age at diagnosis of youngest relative affected and then every 5 years
- IBD-q 1-2y beginning 8-10 years after diagnosis
48
MC type of colorectal CA
Adenocarcinomas
49
CA marker for colorectal CA
CEA
50
Type of CA pts with Familial Adenomatous Polyposis (FAP) are risk of
Duodenal/Ampullary CA
| -Need routine EGD
51
Type of CA pts with HNPCC (Lynch Syndrome) are at risk of
Extracolonic malignancies
| -Endometrial MC
52
MC cause of intussusception, and ultrasound shows
Meckel's diverticulum
| -US shows "target sign"
53
Triad for intussusception
- Colicky abd pain
- Sausage-shaped and mass
- "Currant jelly" stools
54
Complications (4) of diverticulitis
- Abscess
- Perforation
- Obstruction
- Fistula
55
Sign of diverticular bleeding
- Painless hematochezia
| - Common cause of overt LGIB
56
- Pts at risk of acute mesenteric ischemia
- Main PE sign
- Diagnostic TOC
- Atherosclerotic disease, valvular heart disease
- Pain out of proportion to PE
- CTA with IV contrast
57
2 main risk factors of getting toxic megacolon
- Ulcerative colitis
| - C diff
58
Main difference between internal and external hemorrhoids
- Internal = painless
| - External = painful
59
2 risk factors of anal CA, and MC type
- Hx of HPV or HIV
| - Squamous cell
60
Spectrum of alcoholic liver disease
- Alcoholic steatosis (fatty liver)
- Hepatitis (inflammation)
- Cirrhosis
61
Difference between Non-alcoholic fatty liver dz (NAFLD) and non-alcoholic steatohepatitis (NASH)
- NAFLD-secondary to Metabolic Syndrome
| - NASH-fatty liver + inflammation
62
Main etiologies (3) of cirrhosis
- Alcoholic liver disease
- HBV
- HCV
63
3 signs of cirrhosis
- Jaundice
- Spider telangiectasis
- Palmar erythema
64
Complication of portal hypertension (from cirrhosis)
- Caput medusae
- Ascites
- Splenomegaly
- Encephalopathy (asterixis)
65
3 main risk factors of primary hepatocellular CA (HCC)
- Hepatitis B
- Hepatitis C
- Cirrhosis
66
CA marker for Primary hepatocellular CA
AFP
67
Hemachromatosis
- Disorder of iron metabolism; excess deposition
| - Bronze pigmentation of skin
68
Wilson's disease
- Accumulation of copper in liver
| - Kayser Fleischer rings in cornea
69
Ultrasound for pt with gallbladder CA shows
Porcelain gallbladder
70
Cholangiocarcinoma
- Association with primary sclerosis cholangitis (pts with UC)
- Jaundice, pruritus, Courvoisier sign
71
Primary Biliary Cholangitis
-Autoimmune destruction of intrahepatic bile ducts
| + antimitochondrial antibodies (AMA)
72
Primary Sclerosing Cholangitis
-Increased incidence in pts with UC
| + P ANCA
73
Gilbert Syndrome
- Inherited
- Deficiency in enzyme UGT that converts unconjugated bilirubin to conjugated in liver
- Unconj hyperbilirubinemia in absence of hemolysis
- Intermittent jaundice
74
When is pain worse in acute pancreatitis, and two signs
- Worse with lying supine, and relieved by sitting and leaning forward
- Cullen and Grey Turner's sign
75
Criteria for acute pancreatitis
Ranson criteria
76
ERCP shows what for chronic pancreatitis
"Chain of lakes"
77
MC spot for pancreatic CA
Ductal adenocarcinoma involving head of the pancreas
| -Courvoisier sign
78
Risk factors for pancreatic CA
Tobacco
Obesity
ETOH
79
CA marker for pancreatic CA
CA 19-9
80
MC hernia
indirect inguinal hernia
81
Lab value for Paget Disease, and treatment
- Elevated serum Alk Phos
| - Tx = Bisphosphonates and Calcitonin
82
PKU
- Inability to convert phenyl aline to tyrosine
| - Irreversible intellectual disability, seizures
83
Deficiency in Rickets
Ca, Vit D, and PO4
| -Delayed closure of fontanelles, bow legs
84
Thiamine deficiency sign (2)
(B1)
- Beriberi-motor/peripheral neuropathy
- Wernicke-Korsakoff syndrome-neurologic
85
Riboflavin and Pyridoxine deficiency signs (3)
B2, B6
- Cheilitis
- Angular stomatitis
- Glossitis
86
Niacin deficiency
B3
- Pellagra (3 D's)-dermatitis, dementia, diarrhea
- Cheilitis
- Angular stomatitis
- Glossitis
87
2 risk factors for getting Cobalamin deficiency
B12
- Post gastrectomy
- Pernicious anemia
88
Vitamin A deficiency (4)
- Night blindness
- Bitot spots (on conjunctiva)
- Poor wound healing
- Dry skin
89
Vitamin D deficiency (2)
- Rickets
| - Osteomalacia
90
Main clinical presentation of vesicoureteral reflex, and diagnostic test
- Recurrent UTIs
| - VCUG is gold standard
91
Bladder CA
- MC type
- Risk factors
- Clinical presentation
- Transitional cell carcinoma
- Smoking, Cyclophosphamide
- Painless hematuria, irritative voiding sxs
92
Main diagnostic TOC and tx for bladder CA
- Cystoscopy with bladder biopsy
| - TURBT, cystectomy
93
Main treatment for urge urinary incontinence
Oxybutynin (antichol/antimuscarinics)
94
Main treatment for overflow incontinence
-osins (5 alpha reductase inhibitors)
95
Main causes of nephrolithiasis and diagnostic TOC
- Calcium and uric acid
| - CT A/P without contrast
96
3 main risk factors for renal cell carcinoma
- Smoking
- Obesity
- Polycystic kidney disease
97
Prehn's sign
- Epididymitis/orchitis
| - Alleviation of pain with scrotal elevation
98
Testicular CA
- Painless, palpable mass
- Serum protein markers (beta HG, AFP, LDH)
- Radical orchiectomy
99
Hydrocele
- Painless enlargement of one side of the scrotum
| - Transillumination
100
Varicocele
- "Bag of worms"
| - Pain/heaviness
101
Prostatitis physical exam
- Perineal pain
- Dysuria, urgency, hematuria
- Boggy, tender prostate
102
Strongest risk factors (2) for developing active TB
- HIV
| - Immunosuppressive therapy
103
Main symptoms of active TB infection
- Fever, chills, night sweats
- Bad cough >3 weeks (looks like bad PNA)
- Weight loss
104
PE and CXR findings of active Tb
- Post-tussive rales
- Primary active infection-hilar adenopathy, middle lobe infiltrates, pleural effusions
- Reactivation-upper lobe infiltrates and cavitation
105
Biopsy for active TB shows
Necrotizing (caveating) granulomas
106
TB skin testing
-BCG vaccine can give false positive
>5mm in HIV +, immunosuppressed pts, contacts with active TB
>10mm in everyone else (like hospital workers)
>15mm in people with no risk factors for TB
107
Drug treatment for active TB
- 4 drug regimen for 2 months, then RIFxINH for 4-7 months
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
108
TB drug side effects (5)
- RIF-red orange excretions
- INH-hepatic toxicity, peripheral neuropathy (co administer with Vitamin B6/Pyridoxine)
- PZA-hepatic toxicity, hyperuricemia
- EMB-optic neuritis
- Strep-otoxicity, nephrotoxicity
109
Latent TB treatment
- Treat only after active TB is ruled out (with hx and normal CXR)
- INH and Rifapentine (RPT) once weekly for 12 weeks
110
What cells does HIV target?
T cells (particularly CD4 T cells/helper T cells); lymphocytes that enhance immune response
111
Early HIV infection
- 2-6 weeks after exposure
- Mono like or flu like illness
- HIGHLY INFECTIOUS
- Routine HIV Ab test will be negative
112
Signs/symptoms of early HIV infection
- Rash (upper trunk, neck, face)
- Mucocutaneous ulcers
- Mono/flu like illness
113
Definition of AIDS
-CD4 T cell count <200
OR
-HIV + and 1 of 27 AIDS defining diseases
114
CXR and treatment for Pneumocystis jiroveci PNA (PCP)
- MC opportunistic infection in pts with AIDS
- Severe hypoxemia
- CXR-perihilar infiltrates ("ground glass" appearance)
- Bactrim
115
CT and treatment for toxoplasmosis in AIDS patients
- Causes encephalitis
- CT shows multiple contrast enhancing lesions
- Sulfadiazine and Pyrimethamine
116
Main class of drugs for HIV treatment
Antiretroviral therapy (ART)
117
Organism for gonorrhea
("OO")
| -Gram negative diplococci
118
Treatment for conjunctivitis of the newborn (ophthalmia neonatorum)
-Topical erythromycin applied ASAP after delivery for gonococcal prophylaxis
119
Organism for syphilis
Treponema pallidum
120
Primary syphilis sign
Painless chancre
121
3 MC clinical presentations of secondary syphilis
- Non pruritic rash on palms and soles of feet (not contagious)
- Condyloma lata (warts that are highly contagious)
- Mucous patches
122
Diagnostic tests for syphilis
- Bacteria from chancre visible under dark field microscopy
- RPR or VDRL
- Confirm RPR with treponema antibody test (FTA-ABS)
123
Tertiary syphilis
Can damage heart, vessels, brain, nervous system
124
Tzanck smear for herpes infection
(HSV, VZV, CMV)
| -Multinucleated giant cells
125
Condyloma acuminata
HPV (genital warts)
126
Most important prognostic factor in diagnosing melanoma
Depth
127
Acral melanoma
- MC in African Americans
| - Worse prognosis
128
Lentigo maligna
- Broad and thin melanoma on sun damaged skin
- Not much color variation
- Very slow growing
- Mohs is tx
129
MC skin cancer in humans
-Basal cell carcinoma
130
Basal Cell Carcinoma
- Rodent ulcer (ulcerated papule with rolled border0
| - Friable
131
Actinic Keratosis
- Pre skin cancer
- Can transition to SCC
- "Rough, dry skin"; sandpaper
- Cryotherapy
132
Squamous cell carcinoma
- Keratotic (scaly) plaques or nodules
| - Biopsy and treat with Mohs/excision
133
Pityriasis rosea
- Herald patch
- Christmas tree pattern
- Human herpes virus 6/7
134
Molluscum contagiosum virus
Pox virus
135
Sebaceous hyperplasia
- Central del surrounding grape-like bumps
- Adults with oily skin
- Big sebaceous glands
136
Verrucae AKA
-HPV (warts)
137
Erythema migrans is associated with
Lyme disease from Borrelia burgdorferi
138
Lyme disease symptoms
- Headache
- Joint pain
- Fatigue
- Erythema migrans
139
Erythema nodosum
- Swollen, tender nodules on shins
- Usually young women
- Associated with OCPs, sarcoidosis, cocci, UC, strep
140
Erythema Multiforme
- Type IV hyperactivity response to trigger on palms and soles
- HSV/viral or drug etiology
- Target lesions on palms
141
Drugs that usually cause SJS/TEN
- Sulfa
- Anti convulsants (Carbamazepine, Phenytoin)
- PCNs
Lids and eyes typical
142
Bullous pemphigoid
- Autoimmune blistering disease
- Intact bullae
- Itchy
- Tx with oral steroids
143
Dyshidrotic eczema
- Itchy
| - Tapioca like vesicles along fingers
144
Seborrheic keratosis
- Waxy, stuck on appearance
- Benign
- Scaly plaques on scalp, torso, ankles
- Tx with liquid nitrogen
145
3 main causes of acanthuses nigricans
- Obesity
- DM
- Paraneoplastic
146
Lichen Planus
4 P's
- Pruritic
- Purple
- Polygonal
- Papules
-Wickham striae-white lines in mouth
147
What don't you want to give to a patient with psoriasis?
Corticosteroids
148
Vitiligo
- Autoimmune destruction of melanocytes
- Depigmented macules/patches
- Woods lamp to diagnose
149
Tinea versicolor
- Malassezia furfur
- Hypopigmented macule
- KOH shows spores and pseudohyphae
- Tx with selenium sulfide shampoo
150
Beefy red erosions, KOH shows spaghetti and meatballs
Candidiasis
151
Erythrasma
- Corynebacterium
- Dry, brown patches in axilla and web spaces
- Woods lamp shows coral red fluorescence
- Tx-topical Erythromycin/Clindamycin
152
Two main organisms for impetigo
- Staph
| - GAS (Strep pyogenes)
153
Erysipelas
- Group A strep infection
- Similar to cellulitis
- Not itchy, but painful
- Patient will feel ill and feverish
- Tx-PCN
154
Rosacea
- Complaints of acne and flushing in an adult patient
| - Foods, heat, alcohol can be triggers
155
Hidradenitis suppurativa
- Severe follicular dysfunction
| - Smelly, cystic, scarring acne in intertriginous zones
156
MC cause of primary amenorrhea
Turner Syndrome
157
2 MC cause of secondary amenorrhea
- Pregnancy
| - Asherman's syndrome (from previous instrumentation of the uterus)
158
PMS occurs during which part of the menstrual cycle
Second half (luteal)
159
PALM-COEiN (AUB)
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified
160
MC gyn CA
Endometrial CA
161
Risk factors for endometrial CA
- Obesity
- Hx breast or ovarian CA
- Lynch Syndrome
- Early menarche
- Late menopause
- Nulliparity
162
Definitive diagnosis for endometriosis
- Laparoscopy
| - Chocolate cysts (endometriomas) on ovaries
163
Medical treatment for uterine fibroids
- GnRH analogs (Depo)
- Hormonal contraceptives
- Fibroids will usually shrink once menopause hits
164
Benign adnexal mass (5)
-Thin walled
<3cm pre and <1cm postmenopausal (simple cysts)
-Hyperechoic nodule (teratoma)
-Network of linear pattern (hemorrhagic cyst)
-Homogenous echos (endometrioma)
165
MC type of ovarian cysts
Follicular, then corpus luteum
| -Both regress after 1-2 menstrual cycles
166
Rotterdam Criteria for PCOS
- Menstrual irregularities (oligo/amenorrhea)
- Polycystic ovaries
- Hyperandrogenism (hirsutisme, acne)
Causes infertility
167
Ultrasound for PCOS shows
String of pearls
168
CA marker for epithelial ovarian CA
CA 125
169
CA marker for germ cell ovarian CA
hCG, AFP, LDH
170
MC types of cervical CA
- Squamous cell-HPV 16
| - Adenocarcinoma-HPV 18
171
Top 3 etiologies for vaginitis
- Gardnerella vaginalis
- Candida albicans
- Trichomonas vaginalis
172
Amsel's Criteria
```
For bacterial vaginosis
-Homogenous, thin, grayish white discharge
-Vaginal pH >4.5
+ whiff test
-Clue cells
```
173
MC type of vaginal CA
- Squamous cell
- Metastasis from uterus, cerix and ovary is MC cause of invasive disease
- HPV has to be present
174
Nageles Rule
For expected date of confinement
| Add 7 days to LMP and subtract 3 months
175
Abnormal AFP in maternal serum screen
```
High = neural tube defects
Low = Down's syndrome
```
176
What has to be present to be able to give Methotrexate for ectopic pregnancy?
- HCG <5000
- No cardiac activity
- Sac <4cm
177
MC type of gestational trophoblastic disease
Hydatiform Mole
178
Clinical presentation of Hydatiform mole, and ultrasound finding
- Uterine size greater than dates
- Absent fetal heart tones
-"Snow storm" or "grape like clusters"
179
Abruptio placentae
- Abrupt painful vaginal bleeding
| - Contractions
180
Placenta previa
- Abnormal location of the placenta in comparison to the cervical os
- Painless bleeding after 20 weeks
- DON'T PERFORM CERVICA EXAM
181
HELLP Syndrome
For preeclampsia
Hemolysis
Elevated liver enzymes
Low platelet count
182
When to give Rhogam
1st dose at 28w
| 2nd dose within 72 hours of a Rh+ infant
183
MC type of breast CA
Infiltrating ductal carcinoma
| MC in upper outer quadrant
184
Definition hemoglobin and hematocrit
- Hemoglobin-molecule that binds and transports O2
| - Hematocrit-volume of packed RBCs
185
- Hypochromic, microcytic anemia etiologies
- Normochromic, normocytic
- Macrocytic
- IDA
- Thalassemia
- Sideroblastic
- Anemia of chronic disease
- Aplastic anemia
- Folate def
- Vit b12 def
- Hemolysis
186
Treatment for anemia of chronic disease
- Treat underlying disease
| - EPO can help (if renal failure, CA, inflammatory disorders)
187
Aplastic Anemia
- All cell lines are decreased
| - Most are idiopathic; others from drug exposure and viral illnesses (EBV, CMV, hepatitis)
188
Etiologies of vitamin B12 deficiency
- Pernicious anemia
- Vegan diet
- Gastric surgery
189
Pernicious anemia
- Deficiency of IF
| - Autoantibodies against the gastric parietal cells
190
Peripheral smear for vitamin B12 deficiency
- Hypersegmented neutrophils
- Anisocytosis
- Macro-ovalocytes
191
Intravascular vs extravascular hemolysis
- Intra-destruction of RBCs within the blood stream (transfusion reactions, microangiopathy)
- Extra-destruction of RBCs in the reticuloendothelial system, esp spleen (hereditary spherocytosis, sickle cell anemia, thalassemia)
192
Hemolysis lab
- Increase unconjugated bilirubin
- Increase LDH
- Decreased hemoglobin
193
Hereditary spherocytosis
- Splenectomy
| - Though splenectomy increases risk of infection from encapsulated organisms (like Pneumococcus)
194
Homozygous vs heterozygous sickle cell anemia
- Homo (Hb SS)-sickle cell disease
| - Hetero (Hb S + Hb A)-sickle cell trait
195
Main etiologies for acute bronchitis
- MC viral (influenza, adenovirus, rhinovirus)
| - Bacteria include Streptococcus pneumonia, H flu, M cat
196
CXR on acute bronchitis
Normal
197
Etiology on bronchiolitis
RSV
198
Main difference between influenza and URI
- Severity of presentation for influenza
| - Flu has abrupt onset of fever and chills
199
MC etiology for croup
Parainfluenza
200
Top 3 etiologies for hospital acquired PNA
- Pseudomonas
- Staph aureus
- Enterobacter
201
CXR findings for PNA
- Presence of an infiltrate is "gold standard" for diagnosing PNA
- Lobar PNA = Strep pneumonia, H influenza
- Interstitial PNA = atypical, viral, PCP
202
3 stages of pertussis
- Catarrhal-prodrome
- Paroxysmal-intense coughing with inspiratory whoop
- Convalescent-cough subsides
203
Treatment for pertussis
Erythromycin for 2 weeks
204
CXR for viral PNA
Diffuse or patchy infiltrates
205
Histoplasmosis
- Bird and bat droppings
| - Single or multiple patchy or nodular infiltrates in lower lung fields on CXR and hilarious adenopathy
206
Treatment for histoplasmosis
Amphotericin B
207
Clinical presentation of cocci
- Rash (erythema multiforme or erythema nodosum)
- HA, fever, arthralgias
- Fever, cough, etc
-Eosinophilia
208
Treatment of cocci
Fluconazole and Amphotericin B
209
CXR for HIV related PNA
Interstitial infiltrates
-Elevated LDH
210
3 types of non-small cell lung cancer, and location
- Adenocarcinoma (MC)-peripheral
- Squamous cell-central
- Large cell-peripheral
211
MC symptom for lung cancer
-Cough
212
MC cause of hemoptysis
Bronchitis (NOT lung CA)
213
MC cause of transudative pleural effusion
CHF
214
Location for small cell lung cancer
Central
215
Leukemia definition
Unrestrained proliferation of leukocytes and leukocyte precursors
216
Possible etiologies of Acute Lymphoblastic Leukemia (ALL)
- Most idiopathic
- Genetics-Down's, Klinefelter's
- Viruses
217
Clinical presentation of ALL
Child presents with fatigue
- Abrupt onset of fever
- Bone pain (limp)
218
Diagnostics for ALL
-CBC shows leukocytosis with decreased ANC
-Circulating lymphoblasts on blood smear
>20% blasts on bone marrow
219
Risk factors for AML
- Environmental exposures (pesticides, radiation)
| - Prior chemo
220
Diagnostics for AML
-WBC >50,000 with decreased ANC
-Platelets <100,000
-Myeloid blasts on smear
-Auer rods
>20% blasts on bone marrow
221
Tumor Lysis Syndrome
Intracellular products are released
- Hyperuricemia
- Hyperkalemia
- Hypocalcemia
- Hyperphos
- Acute renal failure
Tx-Allopurinol
222
Diagnostics for CLL
-Autoimmune hemolytic anemia
-Thrombocytopenia
-Smudge cells
>30% B cell lymphocytes
223
Diagnostics for CML
- WBC >150,000 (markedly elevated)
- Philadelphia chromosome
- Elevated uric acid
- Elevated LDH
- Increased serum vitamin B12
224
Hodgkin's Lymphoma
- B cell lymphoma
- Arises from single node
- Can have extra nodal involvement in spleen and liver
225
Risk factors for Hodgkin's lymphoma
- EBV
| - Smokers
226
Multiple Myeloma
Malignancy of the plasma cells
227
MC acquired coagulopathy
Vitamin K deficiency
- Warfarin
- Malnutrition/absorption
Prolonged PT and PTT
228
MC inherited bleeding disorder
Von Willebrand Disease
- Prolonged PTT
- Tx with Desmopressin
229
Lab findings with hemophilia A
- Increased PTT
| - Decreased factor VIII
230
ITP
- MC in children after viral infection
- Self limited autoimmune disorder
- Isolated thrombocytopenia with petechiae and purport
231
Decreased ADAMTS13
TTP
232
Etiologies for DIC
-Malignancies
-Obstetrics
-Sepsis
-Trauma
(MOST)
233
Labs for DIC
-Elevated PT and PTT
-Decreased fibrinogen and platelets
+ D Dimer
-Microangiopathic hemolytic anemia with schistocytes
234
MC genetic cause of VTE in women
Factor V Leiden Mutation
235
CO =
HR X SV
| Decrease in SV, increase in HR to compensate
236
Systolic HF =
HFrEF (LVEF <40%)
| -Chamber dilation
237
Diastolic dysfunction =
HFpEF
| -Hypertrophy with impaired relaxation
238
MC cause of heart failure
CAD
239
Left HF
- Decreased CO
| - Pulmonary congestion
240
Two main treatment goals for CHF
Vasodilate and diurese
241
Cardio specific BB (3)
Carvedilol
Bisoprolol
Metroprolol
242
Normal S1 and S2 heart sounds
S1-Closing of mitral/tricuspid valves during ventricular systole
S2-Closing of aortic/pulm valves during early diastole
243
S3 and S4
S3-suspect HFrEF; displaced PMI; immediately following S2
| S4-suspect HFpEF
244
Aortic stenosis murmur
- Harsh
- Crescendo-decrescendo
- Radiates to neck
245
Mitral stenosis murmur
- Low pitch rumble
- Opening snap after S2
- Mid late diastolic
- Heard in left lateral decubitus position
246
Mitral regurgitation murmur
- High pitched blowing murmur
| - Massive LAE
247
Murmur with rheumatic fever
Aortic stenosis
248
HCM murmur heard worse at... treatment
- Louder if patient stands or valsalvas
| - Tx-CCB (Verapamil), BB (Propranolol)
249
Murmurs on R side of heart increases with
inspiration
250
Aortic regurgitation murmur
- Austin flint murmur (functional MS murmur)
- Low diastolic
- Widened pulse pressure
251
Mitral valve prolapse
- Murmur heard louder with standing and valsalva
| - Mid late systolic click
252
MC cause of mitral stenosis
Rheumatic heart disease
| -Atrial fibrillation
253
Medication for stress echo
Dobutamine
254
Gold standard for diagnosing CAD
Coronary angiography
255
Medications (3) to decrease O2 demand in stable angina
- Nitrates (preload reduction)
- BB (decrease HR, BP, contractility)
- CCB (vasodilation, decrease BP, contractility)
256
Medications (2) to increase O2 supply
- Nitrates (preload reduction)
| - CCB (vasodilation, decrease BP, contractility)
257
Indications for CABG
- Left main stenosis
| - Triple vessel disease
258
Prinzmetal angina
- Ischemic symptoms secondary to vasospasm
- Younger patients
- Tx-nitrates, CCBs
259
EKG changes in ischemia
- Inverted T wave
| - Depressed ST segment
260
EKG changes in infarct
-Pathologic Q waves
261
STEMI on EKG locations
- Anterior-V1-4 (LAD)
- Lateral-Lead I, aVL, V5/6
- Interior-Lead II, III, aVF
- Posterior-Reciprocal changes in V1/2, tall R waves with ST depression
262
Dressler Syndrome with treatment
-1-2 weeks post MI
- Pericarditis
- Fever
- Leukocytosis
- Pericardial effusion
-ASA/NSAIDs for 3-4 weeks
263
Primary hyperaldosteronism
- Hypokalemia
| - Metabolic alkalosis
264
Triad for Cushing Syndrome
- Skin atrophy
- Striae
- Proximal mm weakness
265
Triad for pheochromocytoma
- HA
- Sweating
- Tachycardia
266
Difference between thiazide diuretics and loop diuretics
Thiazide causes hypercalcemia, and loops cause hypocalcemia
267
Difference between non-dihydropyridines and dihydropyridines (CCBs)?
- Non (Verapamil, Diltiazem)-more of a cardiac depressant
| - Dihy (Amlodipine, Nifedipine)-more selective as vasodilators
268
What two drug classes can cause hyperlipidemia?
- Atypical antipsychotics
| - Diuretics
269
High intensity statins (2) and low intensity statin (1)
```
High = Atorvastatin, Rosuvastatin
Low = Simvastatin
```
270
Statins:
Lipid effects
Side effects
-Decrease LDL
- Hepatotoxicity
- Myalgias
- Rhabdo
271
Fibrates (Gemfibrozil, Fenofibrate):
Lipid effects
Side effects
-Decrease TAGs
- Don't use with statins
- Hepatitis
- Myositis
272
Niacin lipid effects
- Increase HDL
| - Decrease TAGs
273
Resin (Cholestyramine):
Lipid effects
Side effects
- Only lipid med safe in pregnancy
- Decrease LDL
- May increase TAGs
-Don't use in its with hypertriglyceridemia
274
Difference between obstructive and restrictive lung disease (and FEV1/FVC ratio)
Obstructive = difficulty exhaling air; FEV1/FVC decreased
Restrictive = difficulty expanding; FEV1/FVC normal or high
275
SABA, LABA examples
```
SABA = Albuterol
LABA = Salmeterol
```
276
Inhaled corticosteroids examples
- Beclomethasone
- Fluticasone
- Budesonide
277
Leukotriene modifying drugs (for lungs) examples
Montelukast (Singulair)
278
Lung exam for chronic bronchitis and emphysema
```
CB = rhonchi, wheezing, prolonged expiration
Emphysema = distant BS, hyper resonance
```
279
Treatment for COPD
```
Oxygen
Inhaled bronchodilators (SABAs, LABAs)
Anticholinergics
-SAMAs-Ipratropium bromide (Atrovent)
-LAMAs-Tiotropium bromide (Spiriva)
```
280
3 treatments for acute exacerbation of COPD
- Systemic steroids
- Antibiotics
- Increase bronchodilator therapy (SABA +/- SAMA)
281
Main cause of bronchiectasis
-Cystic fibrosis
Leads to recurrent pulm infections
282
CXR findings for bronchiectasis
Tram tracks
283
CXR findings for idiopathic pulmonary fibrosis
- Reticular infiltrates
- Honeycombing
Patients are usually former smokers
284
Treatment for sarcoidosis
Steroids
285
What can asbestosis lead to?
- Bronchogenic carcinoma
- Malignant mesothelioma
Smoking increases risk of bronchogenic CA
286
Asbestosis CXR findings, jobs
- Thickened pleura
- Pleural plaques
Pipefitter
287
Silicosis CXR findings, job
- Numerous small round opacities
- Hilar node enlargement and calcification (eggshell)
Mining
288
Rotator cuff order
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
289
Eustachian tube dysfunction (with tympanogram results)
- Ear fullness
- Recurrent middle ear effusions
- Hearing loss
- Type C on tympanogram
290
MC cause of tympanic membrane perforation
Otitis media
291
Etiologies for chronic otitis media (2)
- Gram neg (Pseudomonas)
- Staph aureus
- Anaerobes
292
Tympanogram types
- Type A = normal
- Type B = restricted TM mobility ("everything else")
- Type C = negative middle ear pressure (Eustachian tube dysfunction)
293
Acute sensorineural hearing loss etiologies (4) and treatment
- Viral
- Autoimmune
- Drug induced ototoxicity
- Acoustic neuroma
-Oral steroids
294
Etiology and definition for vestibular neuritis
- Acute onset after URI
| - Spont vertigo lasting days without hearing loss
295
Etiology and definition for vestibular labyrinthitis
- Acute onset after URI
| - Vertigo lasting days with hearing loss
296
Gold standard for diagnosing acute sinusitis
CT of the sinuses
297
Smear for oral herpes simplex
Tzank Smear; shows multinucleated giant cells
298
Etiology for sialadenitis/parotitis
Staph aureus
299
Blepharitis definition
- Eyelid inflammation due to Meibomian gland dysfunction
- Chronic itching, burning
- No vision change
300
Presentation for orbital cellulitis
- Eyelid swelling and erythema
- Impaired and painful ocular movements
- Fever
301
Chemosis is a part of which etiology of conjunctivitis?
Allergic
302
Acute angle glaucoma definition and presentation
- Acute rise of IOP due to outflow obstruction
- Acute decreased vision
- Halos around lights
- Steamy cornea
- Mid dilated pupil
- Firm globe
303
Treatment for acute angle glaucoma
- BB, alpha 2 agonists oph drops
| - Oral/IV osmotic agents (Mannitol)
304
Definition open angle glaucome
-Chronic painless visual field loss (peripheral, then central)
305
Definition macular degeneration
- Metamorphopsia (wavy/ distorted vision)
| - Central scotoma (blind spot)
306
Dry vs wet macular degeneration
Dry: druse deposits, vision loss slow, one/both eyes
Wet: me-vascular degeneration, rapid vision distortion, loss of central vision, MC in one eye
307
Definition retinal detachment
- Floaters
- Photopsias (light flashes)
- Loss of vision
- Curtain-like
308
Central Retinal Artery Occlusion (CRAO)
- Embolic
- Acute, total, painless loss of vision (black as night)
- "cherry red spot"
309
Central Retinal Vein Occlusion (CRVO)
- Thrombotic
- Acute, variable, painless loss of vision
- "blood and thunder"
310
Painful monocular vision loss with central scotoma
Optic Neuritis
Associated with multiple sclerosis
311
Corneal light reflex abnormal in...
Strabismus
Cover-uncover test can reveal latent strabismus
312
Blowout fracture
- Blunt trauma with fracture of orbital floow
- Inability to look up
- Double vision common
313
What can ophthalmic drops cause?
Glaucoma and cataracts
314
Initial therapy for child <5 years with ADHD
Behavior
| -Ritalin only if needed
315
Which disorder can turn into ASPD?
Conduct disorder
316
Two medications used for pts with eating disorders
- Prozac for bulimia
| - Vyvanse for binge eating disorder
317
TCA used in treatment of OCD
Anafranil (Clomipramine)
318
First line med for PTSD
Paroxetine (Paxil)
319
Adjustment disorder definition
Psychological response to an identifiable stressor
320
How long do symptoms have to be present for definition of MDD?
At least 2 weeks
SIG-E-CAPS
321
How long do symptoms have to be present for definition of persistent depressive disorder?
2 years
322
Bipolar I definition
1 manic episode
323
Bipolar II definition
1 hypomanic episode and 1 MDD episode
| NO manic episode
324
Cluster A PD (3)
Paranoid
Schizoid
Schizotypal
325
Cluster B PD (4)
Antisocial
Borderline
Histrionic
Narcissistic
326
Cluster C PD (3)
Avoidant
Dependent
Obsessive compulsive
327
Borderline PD definition
- Pattern of unstable interpersonal relationships
- Unstable self image
- Unstable affects
- Poor impulse control
- Fear of abandonment
328
Brief psychotic disorder
- 1 day to 1 month
| - Full return to full level of functioning
329
Delusional disorder
- Non bizarre delusions for at least 1 month
| - Functioning not impaired
330
Schizophreniform disorder duration
1 month to 6 months
331
Schizophrenia duration
6 months +
332
Top 2 first generation antipsychotics
D2 receptor blockers
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
333
Top 2nd generation antipsychotics (7)
```
Aripiprazole (Ability)
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperisdone (Risperdal)
Ziprasidone (Geodon)
```
334
Two somatic disorders where patient intentionally produces symptoms
- Factitious disorder ("sick role")
| - Malingering (external gain)
335
Multiple complaints with multiple organ systems
Somatic symptom disorder
336
Most effective treatment for unintentional somatic symptom disorders
CBT
337
Diphtheria etiology
Corynebacterium diphtheria
338
Treatment for diphtheria
Abx-Erythromycin or Pen G
339
Infants <1 month are at risk of what if prescribed a macrolide?
Pyloric stenosis
340
3 main complications for measles (rubeola)
- Myocarditis
- PNA
- Encephalitis
341
Presentation for rubella
-Fever + maculopapular rash ("blueberry muffin rash"; head to toe progression
342
Complications (3) for rubella
- Deafness
- Cataracts
- Cardiac defects
Congenital rubella can be lethal, esp in first trimester
343
Dew drops on a rose petal
Varicella (chicken pox)
344
Pregnant women contracting erythema infectiosum
"Fifth disease"
| Miscarriage, hydrous fettles
345
Kawasaki disease presentation
```
Conjunctivitis (b/l)
Rash (morbilliform)
Adenopathy (cervical)
Strawberry tongue (red lips, fissuring)
Hands (swollen and red)
Fever not responsive to antipyretics
```
346
Treatment for Kawasaki disease
IVIG and high dose ASA
347
Complications for Kawasaki disease
- Coronary aneurysms
- Carditis
Patient needs echo
348
Criteria for acute rheumatic fever (5)
(Major criteria)
- Polyarthritis
- Carditis
- Syndenham chorea
- SQ nodules
- Erythema marginatum (on trunk/limbs)
349
Complication of acute rheumatic fever
-Rheumatic heart disease (affecting mitral valve; mitral stenosis)
350
Top two causes of bilious vomiting in children
- Malrotation
| - Congenital atresia
351
Top three causes of bloody vomit in children
- Maternal ingestion
- Esophageal varices
- FB
352
Finding on abd ultrasound for intussusception
Target sign
353
Difference between indirect and direct inguinal hernia
- Indirect-abd contents herniate through int inguinal ring into inguinal canal; lateral
- Direct-abd contents do not go through canal
354
Presentation for Hirschsprung disease
- Congenital ganglionic megacolon
- Failure to pass meconium in first 48 hours of life
- Ribbon like stools
355
Diagnostic test for Hirschsprung disease
Rectal biopsy
356
Presentation for botulism
- Descending weakness
| - Hypotonia, loss of DTRs
357
Treatment for botulism
-Botulism immune globulin
358
Hyaline membrane disease
- Neonatal RDS
- More common in <32 weeks gestation
- Deficiency of surfactant in immature lungs
359
MC cause of speech delay
Conductive hearing loss from a middle ear effusion
360
Four tests for rotator cuff
Drop arm (complete tear)
Empty can
Neer's impingement sign
Hawkin's
361
Two tests for biceps tendonitis
Yergason's
| Speed's
362
Test for adhesive capsulitis
Apley scratch test
363
Bankart lesion
Detachment of ant inferior labrum from glenoid rim
364
Hill Sachs lesion
Cortical depression of the posterolateral humeral head
365
Nerve consideration for anterior shoulder dislocation
Axillary nerve
| Decreased sensation lateral aspect of shoulder (mid deltoid) and decreased deltoid function
366
Nerve consideration for humeral shaft fracture
Radial nerve; wrist drop
367
Cubital tunnel
Compression of ulnar nerve
368
Number one symptom for compartment syndrome
Pain
369
Colles vs Smiths wrist fracture
```
Colles = dorsal displacement
Smiths = volar displacement
```
370
Jersey finger
Flexor tendon rupture; inability to flex DIP joint
371
Mallet finger
Rupture of extensor tendon (DIP); inability to extend DIP joint
372
Boutonniere vs swan neck deformity
Boutonniere = flexion of PIP joint, hyperextension at DIP
| Swan neck = hyperextension of PIP, flexion of DIP
373
Boxer's fracture
Neck of 5th metacarpal
374
Bennett's fracture
Fracture at the base of the 1st metacarpal
375
Classic patient with dupuytren's contracture
Male, Northern European, >40y, ETOH abuse
376
DTRs
```
Biceps-C5
Brachioradialis-C6
Triceps-C7
Knee-L4
Achilles-S1
```
377
Spinal stenosis presentation
Pain relief with leaning forward while standing; pain increases with walking
378
+ straight leg raise
Herniated nucleus pulposus
Majority occur at L4-L5 and L5-S1
379
Gold standard diagnosing pelvic fractures
CT scan
380
Presentation for hip fracture
- Will hold leg in external rotation/abduction
| - Leg will appear shorter
381
Hip dislocation
- Posterior MC
- Adduction and internally rotated
- Leg will appear shorter
382
Two tests for meniscus
McMurray's
| Apley's
383
ACL tear presentation
-Pop sensation with instability
-Hemarthrosis
+ Lachman's
384
What fracture is at high risk for compartment syndrome?
Tibial shaft fractures
385
Stress fracture of foot
Midshaft 3rd MT
386
Lisfranc fracture
Fracture/dislocation of 1st and 2nd TMT
387
Septic hip Kocher criteria
- Holds leg in flexion, abduction, ext rotation
- Walks with limp or refusal to bear weight
```
WBC >12,000
ESR >40
Fever >101.3
NWB
2/4
```
388
MC mechanism for proximal tibia fractures
Trampolines
389
Focal tenderness to tibial tubercle
Osgood-Schlatter's disease
390
Metastatic tumors to the bone
```
Pb KTL ("lead kettle")
Prostate
Breast
Kidney
Thyroid
Lung
```
391
MC benign tumor in bone
Unicameral bone cyst (simple bone cyst)
392
Blood filled cyst in the bone
Aneurysmal bone cyst
393
Osteoid osteoma
- Worsening pain at night
- NSAIDs relieve pain
- Benign bone tumor
394
Fixed mass near joints
Osteochondroma
395
MC malignant bone tumor in children
Osteosaroma
396
Complex regional pain syndrome etiology and presentation
- POOP to injury involving extremities, usually following an injury (months later)
- Tx-pain management, NSAIDs
397
LP on Guillain barre syndrome, treatment
Elevated CSF protein with normal WBCs
Tx-IVIG or plasmapheresis
398
Diagnostic and treatment for trigeminal neuralgia
- MRI to r/o multiple sclerosis
| - Tx-Carbamazepine (Tegretol)
399
Increase risk for Bell's palsy (4)
- Idiopathic
- Pregnancy
- DM
- HSV/zoster
400
Petechial rash with meningitis
Neisseria meningitidis
401
Bacterial meningitis LP results
- High opening pressure
- Very high WBC count
- Decreased glucose
- Increased protein
402
Etiologies and treatment for encephalitis
- MC viral
- Enteroviruses (coxsackie)
- West nile
- HSV
Tx with Acyclovir
403
Diagnostics for multiple sclerosis
```
MRI = periventricular white matter changes
CSF = oligoclonal IgG bandds
```
404
Tx for myasthenia gravis
AchE Inhibitor-Pyridostigmine
405
Essential tremor
Action tremor
| Tx-Propranolol
406
Tremor in Parkinson disease
Resting tremor
407
MC primary benign brain tumor
Meningioma
408
MC malignant brain tumor
- From metastases
| - MC malignant primary brain tumor = glioblastoma
409
Cushing's triad
Htn
Bradycardia
Irregular respirations
410
4 reversible causes of dementia
Hypothyroidism
Vitamin B12 def
Hydrocephalus
Neurosyphilis
411
Cognitive fluctuations, visual hallucinations, REM sleep behavior disorder
Dementia with Lewy bodies
412
MC cause of SAH
Berry aneurysm
413
Epidural hematomas MC involve
Middle meningeal artery
| Convex bleed on CT
414
Subdural hematomas MC involve
Bridging veins
415
Artery involved in ischemic strokes
MC form of stroke; middle cerebral artery
