Rapid Review Flashcards
1
Q
Unilateral, severe periorbital headache with tearing and conjunctival erythema
A
Cluster headaches
2
Q
Prophylactic treatment for migraine
A
- Antihypertensives
- Antidepressants
- Anticonvulsants
- Dietary changes
3
Q
Most common pituitary tumor. Treatment?
A
Prolactinoma
-dopamine agonists (e.g. bromocriptine)
4
Q
55 y/o patient presents with acute “broken speech”. What type of aphasia? What lobe and vascular distribution?
A
Broca’s aphasia
- frontal lobe (left MCA distribution)
5
Q
Most common cause of subarachnoid hemorrhage
A
Trauma
- the second most common cause is berry aneurysm
6
Q
Crescent shaped hyperdensity on CT that does not cross the midline
A
Subdural hematoma - bridging veins torn
7
Q
Hx significant for initial AMS w/ an intervening lucid interval. Most likely source? Treatment?
A
Epidural hematoma
- middle meningeal artery torn
- Neurosurgical evacuation
8
Q
CSF findings with subarachnoid hemorrhage
A
- Elevated ICP, RBCs, xanthochromia
9
Q
Albuminocytologic disassociation
A
Guillain-Barre syndrome
- increased protein in CSF w/o a significant increased in cell count
10
Q
Cold water is flushed into a patient’s ear and the fast phase of the nystagmus toward the opposite side. Normal or pathologic?
A
Normal
11
Q
Most common primary source of metastases to the brain
A
Lung breast skin (melanoma) Kidney GI tract
12
Q
May be seen in children who are accused of inattention in class and confused with ADHD
A
Absence seizures
13
Q
Most frequent presentation of intracranial neoplasm
A
Headache
- primary neoplasm are much less common than brain metastases
14
Q
Most common cause of seizures in children (2 - 10 years)
A
Infection
Febrile seizures
Trauma
Idiopathic
15
Q
Most common cause of seizures in young adults (18 - 35 years old)
A
Trauma
Alcohol withdrawal
Brain tumor
16
Q
First line medication for status epilepticus
A
IV benzodiazepines
17
Q
Confusion, confabulation, ophthalmoplegia, ataxia
A
Wernicke’s encephalopathy due to deficiency of thiamine
18
Q
What % lesion is an indication for carotid endarterectomy?
A
Seventy percent if the stenosis is symptomatic
19
Q
The most common causes of dementia
A
Alzheimer’s and multi-infarct
20
Q
A combined UMN and LMN disorder
A
ALS
21
Q
Rigidity and stiffness with unilateral resting tremor and masked facies
A
Parkinson’s disease
22
Q
Mainstay of Parkinson’s therapy
A
Levodopa/carbidopa
23
Q
Treatment of Guillain-Barre syndrome
A
IVIG or plasmapheresis. Avoid steroids
24
Q
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
A
Huntington’s disorder
25
A 6 year old girl presents with a port-wine stain in the V1 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma
Sturge-Weber syndrome
- treat symptomatically.
- possible focal cerebral resection of the affected lobe
26
Multiple cafe au late spots on skin
Neurofibromatosis type 1
27
Hyperphagia, hypersexuality, hyperorality, and hyperdocility
Kluver-Bucy syndrome (amygdala)
28
May be administered to a symptomatic patient to diagnose myasthenia gravis
Edrophonium
29
Classic ECG finding in atrial flutter
"Sawtooth" P waves
30
Definition of unstable angina
Angina that is new, is worsening, or occurs at rest
31
Antihypertensive for a diabetic patient with proteinuria
ACE inhibitors
32
Beck's triad for cardiac tamponade
Hypotension
Distant heart sounds
JVD
33
Drugs that slow heart rate
B-blockers
Calcium channel blockers (CCBs)
Digoxin
Amiodorone
34
Hypercholesterolemia treatment that leads to flushing and pruritis
Niacin
35
Murmur - hypertrophic obstructive cardiomyopathy (HOCM)
Systolic ejection murmur heard along the lateral sternal border that increased with decreased preload (Valsalva maneuver)
36
Murmur - aortic insufficiency
Austin Flint murmur
- diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up
- increased with increased afterload (handgrip maneuver)
37
Murmur - aortic stenosis
Systolic crescendo/descrendo murmur that radiates to the neck with increased with increased preload (squatting maneuver)
38
Murmur - mitral regurgitation
Holosystolic murmur that radiates to axilla
| - increases with increased afterload (handgrip maneuver)
39
Murmur - mitral stenosis
Diastolic, mid-to late, low pitched murmur preceded by opening snap
40
Treatment for atrial fibrillation and atrial flutter
If unstable, cardiovert. If stable or chronic, rate control with CCBs or B-blockers
41
Treatment for ventricular fibrillation
Immediate cardioversion
42
Dressler's syndrome
autoimmune reaction with fever, pericarditis and increased ESR occurring 2-4 weeks post MI
43
IV drug abuse with JVD and holosystolic murmur at the LSB (increases with inspiration). Treatment?
Tricuspid regurgitation
| - treat existing heart failure and replace the tricuspid valve
44
Diagnostic test for hypertrophic cardiomyopathy
Echocardiogram
| - showing a thickened LV wall and outflow obstruction
45
Pulsus paradoxus
a decrease in systolic BP > 10 mm Hg with inspiration
| - seen in cardiac tamponade
46
Classic ECG findings in pericarditis
Low-voltage, diffuse ST segment elevation
47
Definition of hypertension
BP > 140/90 mm Hg on 3 separate occasions 2 weeks apart
48
Eight surgically correctable causes of hypertension
- Renal artery stenosis
- Coarctation of aorta
- Pheochromocytoma
- Conn's syndrome
- Cushing's syndrome
- Unilateral renal parenchymal disease
- Hyperthyroidism
- Hyperparathyroidism
49
Evaluation of a pulsatile abdominal mass and bruit
Abdominal ultrasound and CT
50
Indications for surgical repair of abdominal aortic aneurysm
> 5.5 cm, rapidly enlarging, symptomatic or ruptured
51
Treatment for acute coronary syndrome
- ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitrogen, IV B-blockers
52
Metabolic syndrome
- abdominal obesity
- high triglycerides
- low HDL
- hypertension
- insulin resistance
- prothrombotic or proinflammatory states
53
50 year old man with stable angina can exercise to 85% of maximum predicted heart rate. Appropriate diagnostic test?
Exercise stress treadmill with ECG
54
65 year old woman with left bundle branch block and severe osteoarthritis has unstable angina. Appropriate diagnostic test?
Pharmacological stress test (e.g dobutamine echo)
55
Target LDL in a patient with diabetes
< 70 mg/dL
56
Signs of active ischemia during stress testing
Angina
ST segment changes on ECG
Decreased BP
57
ECG findings suggesting MI
ST segment elevation (depression means ischemia)
Flattened T waves
Q waves
58
Where's the occlusion? Anterior wall MI
LAD / diagonal
| - ST elevations in V1 - V4
59
Where's the occlusion? Inferior wall MI
PDA
| - ST elevations in leads II, III, avF
60
Where's the occlusion? Posterior wall MI
LCX / RCA
61
Where's the occlusion? Septal wall MI
LAD / diagonal
62
Young patient with angina with rest and ST-segment elevation with normal cardiac enzymes
Prinzmental's angina
| - treat with CCBs (e.g. diltiazem)
63
Common symptoms associated with silent MIs
CHF
shock
AMS
64
Diagnostic test for pulmonary embolism
Spiral CT with contrast
65
Protamine
reverse effects of heparin
66
Prothrombin time
coagulation parameter affected by warfarin
67
Young patient with a family hx of sudden death and collapses while exercising
Hypertrophic cardiomyopathy
- decreased murmur with increased preload (squatting, Valsava maneuver)
- increased preload
68
Endocarditis prophylaxis regimens
Oral surgery - amoxicillin for certain situations
| GI or GU procedures - not recommended
69
Virchow's triad
Stasis
hypercoaguability
endothelial damage
70
Most common cause of hypertension in young women
OCPs
71
Most common cause of hypertension in young men
Excessive EtOH
72
Figure 3 sign
Coarctation of aorta
73
Water bottle shaped heart
Pericardial effusion
| - look for pulsus paradoxus
74
Pt presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and AXR reveals of free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus
75
Most likely cause of acute lower GI bleed > 40 years of age
Diverticulosis
76
Diagnostic modality used when ultrasound is equivocal for cholecystitis
HIDA scan
77
Risk factors for cholelithiasis
Fat
Female
Fertile
Forty
78
Inspiratory arrest during palpation of RUQ
Murphy's sign
| - seen in acute cholecystitis
79
Most common cause of small bowel obstruction SBO in patients with no history of abdominal surgery
Hernia
80
Most common cause of SBO in patients with a hx of abdominal surgery
Adhesions
81
Most common organism in diarrhea
Campylobacter
82
Most common cause of diarrhea: recent antibiotic use
Clostridium difficile
83
Most common cause of diarrhea: camping
Giardia
84
Most common cause of diarrhea: Traveler's diarrhea
ETEC
85
Diarrhea organism at church picnics/mayonnaise
S. aureus
86
Diarrhea organism causing uncooked hamburgers
E. coli 0157:H7
87
Diarrhea organism associated with poultry/eggs
Salmonella
88
Diarrhea organism associated with Fried Rice
Bacillus cereus
89
Diarrhea organism associated with raw seafood
Vibrio, HAV
90
Diarrhea organism associated with AIDS
Isospora
Cryptosporidium
Mycobacterium
91
Diarrhea organism associated with pseudoappendicitis
Yersinia
92
25 year old Jewish man presents with pain and watery diarrhea after meals. Examination shows fistula between the bowel and skin and nodular lesions on his tibia
Crohn's disease
93
Inflammatory bowel disease of colon with an increased risk of colon cancer
Ulcerative colitis (greater risk than Crohn's)
94
Extraintestinal manifestations of IBD
Uveitis
Ankylosing spondylitis
Pyoderma gangrenosum
Primary sclerosing cholangitis
95
Medical treatment for IBD
5-ASA agents and steroids during acute exacerbations
96
Difference between Mallory-Weiss and Boerhaave tears
Mallory Weiss: superficial tear in the esophageal mucosa
| Boerhaave: full-thickness esophageal rupture
97
Charcot's triad
Fever
RUQ pain
Jaundice
** signs of ascending cholangitis**
98
Reynold's pentaus
Fever, RUQ pain, jaundice PLUS shock and mental status changes
-- signs of suppurative ascending cholangitis
99
Medical treatment for hepatic encephalopathy
Decreased protein intake
Lactulose
Rifaximin
100
First step in the management of a patien with an acute GI bleed
Manage ABCs
101
4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E.coli 0157:H7
102
Post-HBV exposure treatment
HBV immunoglobulin
103
Classic causes of drug induced hepatitis
TB medications (isoniazid, rifampin, pyrazinamide)
Acetaminophen
Tetracycline
104
40 year old obese woman with elevated alkaline phosphotase, elevated bilirubin, pruritis, dark urine, and clay stools.
Biliary tract obstruction
105
Hernia with highest risk of incarceration -- indirect, direct or femoral?
Femoral hernia
106
50 year old man with a history of EtOH abuse presents with boring epigastric pain that radiates to the back and is relieved sitting forward. Management?
Confirm diagnosis of acute pancreatitis with elevated amylase and lipase.
- Make the patient NPO and IV fluids, oxygen, analgesia, and "tincture of time"
107
Four cases of microcytic anemia
```
TICS
Thalassemia
Iron deficiency
anemia of Chronic disease
Sideroblastic anemia
```
108
Elderly man w/ hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy
| - suspect colorectal cancer
109
Precipitants of hemolytic crisis in patients with G6PD deficiency
Sulfonamides
Antimalarial drugs
Fava beans
110
Most common inherited cause of hypercoagulability
Factor V Leiden mutation
111
Most common inherited bleeding disorder
von Willebrand's disease
112
Most common inherited hemolytic anemia
Hereditary spherocytosis
113
Diagnostic test for hereditary spherocytosis
Osmotic fragility test
114
Pure RBC aplasia
Diamond-Blackfan anemia
115
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au late spots, microcephaly, and pancytopenia
Fanconi's anemia
116
Medications and virus that lead to aplastic anemia
```
Chloramphenicol
Sulfonamides
Radiation
HIV
Chemotherapeutic agents
Hepatitis
Parvovirus B19
EBV
```
117
How to distinguish polycythemia vera from secondary polycythemia
Both have increased hematocrit and RBC mass but polycythemia cera should have normal oxygen saturation and low erythropoietin levels
118
Thrombotic thrombocytopenic purpura (TTP) pentad?
FAT RN:
- Fever
- Anemia
- Thrombocytopenia
- Renal dysfunction
- Neurologic abnormalities
119
HUS triad?
Anemia
Thrombocytopenia
Acute renal failure
120
Treatment for TTP
Emergent large volume plasmapheresis
Corticosteroids
Antiplatelet drugs
** Platelet transfusion is contraindicated!!
121
Treatment for idiopathic thrombocytopenic purpura (ITP) in children
Usually resolves spontaneously,
| may require IVIG and/or corticosteroids
122
Which of the following are increased in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit
Fibrin split products and D-dimer are elevated;
| platelets, fibrinogen and hematocrit are decreased
123
8 year old boy presents with hemarthrosis and increased PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B
| - consider desmopressin (for hemophilia A) or factor VIII or factor IX supplements
124
Nontender abdominal mass associated with elevated VMA and HVA
Neuroblastoma
125
Most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
126
Not contraindications to vaccination
Mild illness and/or low grade fever, current antibiotic therapy, and prematurity
127
Tests to rule out shaken baby syndrome
Ophthalmologic exam, CT, and MRI
128
A neonate has meconium ileus
Cystic fibrosis (Hirschsprung's disease is associated with failure to pass meconium for 48 hrs)
129
Bilious emesis within hours after the first feeding
Duodenal atresia
| - associated with Down's syndrome
130
A 2 month old baby presents with nonbilious projectile emesis. Diagnosis? What are the appropriate steps in management?
Pyloric stenosis
| - correct metabolic abnormalities; then correct pyloric stenosis with pyloromyotomy
131
The most common primary immunodeficiency
Selective IgA deficiency
132
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (due to roseola infantum)
133
What is the immunodeficiency? A boy has chronic respiratory infections. Nitroblue tetrazolium test is negative>
Chronic granulomatous disease
134
What is the immunodeficiency? A child has eczema, thrombocytopenia, and high levels of IgA.
Wiskott-Aldrich syndrome
135
What is the immunodeficiency? A 4 month old boy has life threatening Pseudomonas infection.
Bruton's X-linked aggamaglobulinemia
136
Acute phase treatment for Kawasaki disease
High dose ASA for inflammation and fever
| IVIG to prevent coronary artery aneurysms
137
Treatment for mild and severe conjugated hyperbilirubinemia
Phototherapy (mild) or exchange transfusion (severe)
| - Do not use phototherapy for conjugated hyperbilirubinemia
138
Sudden onset of mental status changes, emesis, and liver dysfunction after ASA intake.
Reye's syndrome
- do not give aspirin to children < 15 years for viral infxns
- bx shows microvascular steatosis in liver, brain,
139
Child has loss right light reflex (white pupil). Diagnosis? The child has an increased risk of what cancer?
Suspect retinoblastoma
| - Osteosarcoma
140
Vaccinations at 6 month well child visit.
```
HBV
DTaP
Hib
IPV
PCV
Rotavirus
```
141
Tanner stage 3 in a 6 year old girl
Precocious puberty
142
Injection of small airways with epidemics in winter and spring
RSV bronchiolitis
143
Cause of neontal RDS
Surfactant deficiency
144
A condition associated with red "currant-jelly" stools, colicky abdominal pain, bilious vomiting, and sausage-shaped mass in the RUQ
Intussusception
145
Congenital heart disease that causes secondary hypertension. What would you find on physical examination?
Coarcation of the aorta
| - decreased femoral pulses
146
First line treatment of otitis media
Amoxicillin x 10 days
147
Most common pathogen causing croup
Parainfluenza virus type I
148
Homeless child is small for his age and has peeling skin and a swollen bell
Kwashiokor (protein malnutrition)
149
Defect in a X-linked syndrome with mental retardation, gout, self-mutilation and choreoathetosis
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)
150
Newborn girl has a continuous "machinery murmur". What drug would you give?
Patent ductus arteriosus (PDA)
| - indomethacin is given to close the PDA
151
Newborn with a posterior neck mass and swelling of the hands.
Turner's syndrome
152
First line pharmacotherapy for depression
SSRIs
153
Antidepressants associated with hypertensive crisis
MAO inhibitors
154
Galactorrhea, impotence, menstrual dysfunction, and decreased libido
Dopamine antagonists
