Pance Practice Exam 1 pearls Flashcards
(123 cards)
1
Q
neonatal hydrocele- mgmt
A
expectant
2
Q
Common drugs that cause tinnitus
A
aminoglycoside abx, ACE inhibitors, benzos, bismuth, CCBs, plavix, NSAIDs, valproate
3
Q
Amantadine treats
A
influenza (used to), parkinsons
4
Q
Primary causes of tooth loss in elderly
A
periodontal disease
5
Q
Hyperextension injury of thumb- name, PE findings, tx
A
Gamekeepers’ thumb (UCL injury). PE findings- MCP joint tenderness localized to ulnar side of joint with swelling. Weak pincer grip between thumb and 2nd finger.
Tx for partial tear is thumb spica
Tx for full tear is surgery
6
Q
Herniated disc at L5- S1- symptoms
L4-L5
A
S1- Pain- Post calf, little toe, sensory probs in lat foot, difficulty with plantar flexion. Abnormal ankle reflex.
L4-L5 (L5 root)- Pain in anterior tibia and big toe, sensory probs in medial foot, weakness on big toe extension. Abnormal biceps femoralis.
7
Q
Drugs that cause nipple discharge
A
1st gen antipsychotics (Chlorpromazine, haloperidol), 2nd gen (Risperidone), Tricyclics, metoclopramide
8
Q
Severe STI or TOA in pregnancy- 1st line management
A
treatment with IV abx- likely cephalosporin
9
Q
Non-Hodgkins lymphoma presenting symptom
A
painless lymphadenopathy
10
Q
Treatment for acute EtOH intoxication in child
A
Depends on severity- mainly watching and waiting with support for hypoglycemia, hypothermia, bradycardia, hypotension, or resp depression. No ipicac or activated charcoal.
11
Q
Dermoid cyst
A
intraovarian benign neoplasm
12
Q
How to manage Afib…
A
If less than 48 hours old and unstable, WPW, or new MI- cardiovert
If less than 48 hours old and stable- rate control (use CCBs like diltiazem or verapamil…or BB if only option)
If greater than 48 hours old and stable- just anticoagulate
13
Q
First thing to do for native valve endocarditis seen on echo
A
get blood cx
14
Q
Naegle’s rule
A
Start with 1st day of LMP, add 1 year, subtract 3 months, add 7 days.
15
Q
calculate rate on EKG
A
per large box in between QRS’s- 300, 150, 100, 75, 60, 50
For brady rates you count the R waves in a 10 second strip (50 big boxes 5 per second)
and multiply by 6
16
Q
most common causes of bacterial rhinosinusitis
A
- Strep pneumo
- H infl.
- Moraxella
17
Q
Cryptorchidism- sequela
A
Increased risk of testicular cancer
18
Q
1st line diagnostic test for suspected pulm HTN
A
Echocardiogram
19
Q
Skin lesion on sun exposed area with telangiectasias
A
basal cell carcinoma
20
Q
Old alcoholics get what kind of pneumonia?
A
Klebsiella
21
Q
Inferior MI looks like. What’s contraindicated?
A
ST elevations in II, III and AvF. Nitro is CI.
22
Q
What is aldendronate (Fosamax)? What are its side effects?
A
A bisphosphinate used in treatment tor prevention of osteoporosis.
Hypocalcemia, headache, low phosphate, GI, MSK pain.
23
Q
Someone with symptomatic decompensated heart failure has sx refractory to furosemide, what now?
A
If someone does not respond to a loop, add a second diuretic, like chlorothiazide or spironalactone. If that doesn’t work, try ultrafiltration.
24
Q
Cromolyn sodium mechanism
A
mast cell stabiliazer
25
Reynaud's treatment
CCB-of dihydropyridine type (nifedipine, amlodipiine)
26
empiric abx treatment with spiderbite
Dicloxacillin, cephalexin, clinda. Amox will work too.
27
Electrolyte abnormalities associated with vomiting/NG suction
metabolic alkylosis, hypokalemia. Acid load is lost through NG tube causing alkylosis.
Overall loss of acid load in ECF causes efflux of H+ from cell to maintain plasma pH. Reflex is in influx of K+ into the cell reducing plasma K concentration (hypokalemia).
Alkylosis=lo K
28
Most sensitive and specific symptoms of GAS pharyngitis?
Most sensitive is anterior cervical lymphadenopathy (if you're not counting sore throat, duh).
Most specific is palatine petechiae (95%), followed by exudates (pharyngeal>tonsillar)
29
How do you work up/treat hirsutism?
PCOS is most common cause- associated with mood disorder, menstrual dysfunction and no viralization.
If viralization (clitoromegaly, balding) occur, then consider ovarian hyperthicosis (like PCOS for postmenopausal women) or androgen secreting tumor (adrenal or ovarian)
Adrenal tumor- high testosterone and DHEA
Ovarian tumor- high testosterone and normal DHEA.
1st line treatment for PCOS is a combined oral contraceptive. You can add spironalactone as second line.
30
A diffuse petechial rash on trunk and arms with fever/general sx is concerning for what?
N. Meningitidis bloodstream infection.
31
Where do verapamil and diltiazem work?
CCBs that work in the AV node (no vasodilation)
32
Who gets thiazides first for primary HTN?
Olds (reduced dose), african americans, people with NO hx of MI, gout, DM, asthma, hypercholesterolemia.
33
Who gets a CCB as first line for HTN?
Asthmatics, African Americans (if thiazide not an option), patients with peripheral vascular disease, hypercholesterolemia (or ACE), pts with ischemic heart disease (w/ BBs)
34
Who gets an ACEi as 1st line for HTN?
Diabetics, hypercholesterolemia (with CCB), CHF (with diuretics)
35
Who gets a beta-blocker as first line for HTN?
pts with ischemic heart disease, and young people with "hyperdynamic circulation".
AVOID BBs in asthma, diabetes, african americans, pts with peripheral vascular disease,
36
Presents as a rash on trunk, hands, and soles in a person of reproductive age.
Syphillis
37
Most important predisposing factor for aortic dissection (not common)?
connective tissue disease (Marfan, Ehlers-Danlos).
38
most common cause of tear duct infection?
S. aureus
39
Glucagon mechanism
activity is entirely in liver:
1. Inhibits glycolysis
2. Activates glycogenolysis
3. Activates gluconeogenesis
Insulin inhibits glucagon but glucagon does not inhibit insulin.
40
DDx for acanthosis nigricans
1. DM2 (obese)
2. Cushings/ Addison's
3. Paraneoplastic syndrome (weight loss in older adult), usually caused by gastric cancer, hepatocellular carcinoma, adenocarcinoma of lung, ovary, ednometrium, kidneys, pancreas, bladder, breast.
41
What do you do when a pt with ectopic fails methotrexate?
depends on the risk of rupture. If the ectopic is stable and HCG is rising, you can repeat methotrexate.
If there are signs of rupture (increased peritoneal fluid) then laparoscopy with salpingectomy or salpingostomy must be performed.
42
Most important prognostic factor in melanoma lesion examined by biopsy.
Depth of lesion
43
honey-colored crust/erythema after rupture of vesicles. Rash on face and arms of 4 yo. Disease, etiology, tx
Impetigo- S. Aureus
Tx is erythromycin or augmentin
44
purpura, petechiae, diarrhea, low urine output after drinking unpasteurized product. What is the name of the renal dysfunction.
hemolytic uremic syndrome caused by infectious STEC (EHEC). usually in kids, young adults.
45
30s M with Neck mass, lymphadenopathy, splenomegaly with xray showing a mediastinal mass. What's the Dx?
Hodgkin lymphoma. It's associated with EBV infection which is why it presents similarly to mono
46
Leg is shortened, adducted, internally rotated
Posterior hip dislocation (MVC)
47
Leg is shortened, externally rotated
femoral neck fx
48
Leg is flexed, abducted, externally rotated
Anterior hip dislocation (Rare)
49
Lady in high heels with foot pain over 3rd metarsal head
Morton Neuroma
50
Systemic scleroderma will be positive for which autoantibody?
anti-Scl70
51
CREST syndrome- what is it, how do you diagnose and treat?
cutaneous scleroderma (limited). Stands for Calcinosis, Reynaud's, Esophageal dysmotility, sclerodactyly, and telangiectasia.
Dx with positive anti-centromere antibody.
Tx with CCB for reynauds, D-penicillamine for skin, Cyclophosphamide, methotrexate.
52
Most commonly dislocated carpal bone is...
lunate (moon on wrist).
53
Risk factors for hip dysplasia in newborn:
1. Breech presentation
2. Female sex
3. Primagravida
54
What direction does a herniated (or "ruptured") disc herniate?
Posterolaterally- this is where the nerve root is.
55
Young girl (child) with fatigue, ab pain, low- fever and rash. Rash begins on feet and spreads starting as small petechiae and wheals and progressing to palpable purpura. Labs are normal. Pt has viral gastroenteritis recently. What is it? How would it show on UA? Why should you check?
Henoch-Schonlein purpura (HSP)- purpura in "waist-down" distribution with antecedant viral illness. Check urine for hematuria as ESRD occurs in 1% of cases?
56
Looks like cauda equina syndrome but there is no injury, just spontaneous lower extremity weakness. Sensation is intact except for pain and temp. Reflexes lost. Dx is...
Anterior spinal artery occlusion.
57
PE difference between polymyalgia rheumatica and polymyositis?
Polymyalgia rheumatica will have a normal neuro exam. Polymyositis would cause muscle weakness on exam.
58
what happens if you stop steroids abruptly after long-term therapy
Steroids cause pituitary-adrenal suppression. Abrupt cessation causes an addison's-like picture of hypotension, hypoglycemia, and hyponatremia.
59
First line, second, and third lines for RA
1. Methotrexate
2. NSAIDs
3. Steroids
60
Guy passes out drunk on a park bench in weird position. Comes to ER with horrible forearm pain. What is it?
Compartment syndrome
61
Lab findings in septic arthritis:
WBC count >50,000 in joint aspirate. Note that cultures are usually NEGATIVE.
62
A kid with joint pain that is worse at night and when he/she first wakes up. Typically follows a viral illness. Initially xrays will be normal but eventually will show cartilage destruction. Elevated ESR. What is the DX? Tx? Prognosis?
this is Oligoarticular juvenile rheumatoid arthritis. Tx
Mild-moderate with nondisabling symptoms- NSAIDs
If inadequate response to NSAIDs give glucocorticoids
Biologics are important for long term management - Anakinra, tocilizumab, canakinumab etc. Typically try NSAIDS, then biologics, then add steroids if needed.
63
Ostioid osteoma vs ewing sarcoma vs. osteosarcoma
Affect same age groups! Osteoid osteoma causes atrophy and or shortening of affected limb, XR will show radiolucent nidus with reactijve sclerotic bone around it. OO is benign.
Ewing sarcoma will have "onion-skin" appearance and will present with fever and leukocytosis. Malignant.
Osteosarcoma is malignant.It produces bony and soft tissue deatruction with "sunburst" appearance and periosteal elevation forming an analge with bone cortex. Should also present with weight loss.
64
Most common deficit in carpal tunnel on PE
inability to flex digits 2 and 3 at MCPs
65
"foot drop" is caused by damage to which nerve?
Deep peroneal nerve.
66
What type of spinal cord injury will cause upper but not lower extremity deficits? MEchanism of injury?
Central cord syndrome (not anterior or posterior)- typically mechanism is hyperextension of neck (eg whiplash)
67
Kid or teen with persistant knee pain and normal knee exam. Cannot internally rotate leg with hip in flexion.
SCFE- slipped capital femoral epiphysis
68
What pathologic change would you see in an OA joint being replaced in surgery?
small fractures in cartilage.
69
What other physical exam findings would you expect in septic arthritis
Fever and necrotic papules on the extremities.
70
What drugs do you give a pt who has had an MI?
Beta blocker, aspirin, statin, ACEi for HTN
71
Which antiepileptic causes coarsened facial skin, osteomalacia, and gingival hyperplasia?
phenytoin
72
Fundascopic changes with HTN? Atherosclerosis?
Low AV ratio, venous distension, yellow hard exudates, hemorrhages, microaneurysms.
Atherosclerosis is suggested by "silver" or "copper" wiring
73
30 M presents with numbness and tingling in fingers and hands and feet. He has ABG suggesting respiratory alkalosis (high pH, low CO2), what is the disease?
Pulmonary embolism
74
What do you do with a pt who gets hypokalemic from HCTZ?
Depends on how bad. For mild disease add a K-sparing diuretic or K supplement. Note that once steady state is reached, no further measurement of serum K is required.
75
Which anemia can present with high RBC count?
If I had to guess I'd say hemolysis. All others impair production.
76
Girst visual defect in glaucoma?
peripheral vision loss
77
How do you manage pulmonary embolism in a pt with a bleeding disorder?
Heparin. Should also have an IVF filter if recurrent (PLUS anticoagulant)
78
Most common sequela of bacterial meningitis?
Hearing loss. Monitor in kids.
79
Tx for post herpetic neuralgia?
Pregabalin, gabapentin, tricyclic antidepressants, Tegretol (carbamazepine)
80
How to manage the airway in a pt with burns covering 70% of face?
Intubation
81
31 african american female presents with worsening malaise, dyspnea, low-fever for four weeks. She recently had iritis (anterior uveitis). On PE there are red nodules over lower legs, hepatomegaly. Bilateral hilar adenopathy on CXR. Likely dx?
Sarcoidosis (not lymphoma)
82
Most common physical exam finding in tuberculosis
Most common is a low fever
83
33 yo female at 35 weeks EGA has constant pelvic pain and a small amount of dark red vaginal bleeding after sex. BP is low 80/50) with tachycardia. Firm, tender uterus. Dx?
```
Abruptio placenta (placental abbruption)
Note: placenta previa presents with painless vaginal bleeding.
```
Management depends on mom's clinical status. Typically you want to deliver at 36 weeks, or 34-36
84
What ab pathology likely presents with increased bowel sounds?
Obstruction
85
Pathology of age-related hearing loss
Name is presbycusis. Sensorineural loss of high-frequency sounds first.
86
Optic neuritis is strongly associated with what disease?
MS
87
What's the first test you would order on a painless, firm scrotal mass?
Ultrasound for test. cancer. If not good, get MRI, AFP, beta-HCG
88
Woman in her 50s with pain and reduced passive and active ROM in her non-dominant shoulder. What's the diagnosis?
Adhesive capsulitis. Affects women in their 50s in the non-dominant shoulder.
89
What drug is incompatible with IV contrast?
Metformin
90
Where do nosebleeds originate most of the time?
anterior nasal SEPTUM (Kiesellbach's plexus)
91
Electrolyte imbalance in alcoholics...which are they? Which causes muscle cramps?
1. hypo-mg
2. hypo-Ca
3. hypo-K
4. hypo-phos
5. hypo-Na
Only hyponatremia will cause muscle cramps.
92
How do you treat elevated prolactin (regardless of cause)?
Dopamine agonists- Cabergoline or bromocriptine
93
What do you need before you can prescribe pioglitazone for type 2 DM?
LFTs
94
cystic fibrosis - how is it inherited?
Autosomal recessive
95
What do you give for a narrow-complex tachycardia?
Adenosine (acts at AV node)
96
Rhythm looks like QRS T QRS T with no p-waves?
SVT
97
Most likely cause of acute exacerbation of chronic bronchitis? Tx?
H. influenza
| Tx is doxycycline or TMP-SMX
98
When is ipecac syrup contraindicated?
caustic, acidic, or alkaline fluid ingestion
99
Pt with high potassium, low cortisol, high BUN has...
Addison's
100
Normal serum cortisol
10-20
101
How to treat palpitations in thyroiditis?
Beta blocker (propanolol)
102
Young woman with fever, arthritis, leg nodules that are palpable. Dx and Tx
RA. Primary tx is with DMARD, either methotrexate, sulfasalazine, hydroxycholorquine, chloroquine or a biologic like entericept of infliximab. NSAIDs and steroids are adjuncts.
103
How to treat SVT?
Adenosine
104
Non-transilluminating testicular mass...
testicular cancer
105
What to do if you get an abnormal protein dipstick in a 16 yo?
In 2-3 days get a first morning void sample and run protein to creatinine ratio to test for nephrotic range proteinuria.
106
EKG, looks like SVT but the R-R intervals are irregular
Afib with RVR
107
Ligament involved in de Quervain's tenosynovitis?
Abductor pollicis longus
108
Most common adverse affect of sulfasalazine? What's it used for?
RA, UC.
| Side effect is headache.
109
When do you CT a patients head vs observe following head trauma?
Indications for CT are:
1. Intoxicated
2. Age>65
3. Fall from >3 feet, >5 stairs, MVC
4. Any neuro defect
5. Vomits twice
6. amnesia before for 30+ mins
7. Seizure
8. GCS
110
Imaging for a suspected blowout fracture
CT
111
EKG looks like PVC (normal qrs) followed by ventricular (wide qrs) back and forth...what's the diagnosis?
ventricular bigeminy
112
Undercooked seafood pathogen
vibrio parahemolyticus
113
What part of bowel would be spared from an infarct of the superior mesenteric artery?
Supplies small intestine from duodenum to cecum, large intestine until the transverse colon.
Descending colon would not work.
114
Beta thalassemia major- what is a likely complication of untreated disease in a child
Hemochromatosis (iron overload)
115
Abx for peritonsillar abscess and etiologies
Etiologies:
1. Fusibacterium necrophorum
2. GAS
3. Other streptococci
Note that F. necorphorum is resistant to macrolides (Azithro, erythro, clarithro). Tx is penicillin VK, Augmentin, or clindamycin. IV options are Unisyn, Pen G, Clinda.
116
Drug contraindicated in bulimia?
Bupropion- decreased seizure threshold.
117
How do you manage Vtach?
Pt dead? Defibrillate, epi
Polymorphic VT gets shock.
Pt alive but unstable monomorphic VT? (hypotension, altered, shock, chest pain)?Cardiovert?
Pt VT stable with monomorphic? Adenosine
Narrow QRS (SVT) can get vagal, adenosine, beta blocker
118
When do you cardiovert?
Unstable SVT, Unstable Afib, Unstable Aflutter, Unstable regular monomorphic VT with pulse. Note that irregular Vtach gets unsynchronized shock.
119
Tx for unstable bradycardia? 2nd line? if stable?
Atropine. Then pace, dopamine, or epinephrine. If stable just observe.
120
India ink stain?
Cryptococcus
121
Treatment for ankylosing spondylitis?
NSAIDs first, sulfasalazine
122
Loud "opening snap" on auscultation?
Mitral stenosis
123
Decrescendo diastolic murmur heard over L second interspace.
Aortic insufficiency (regurge)- no
Sitting leaned forward accentuates this murmur.
Also described as "blowing"
