Rapid Review

Question 1

classic ECG finding in atrial flutter

Answer 1

sawtooth P waves

Question 2

definition of unstable angina

Answer 2

angina that is new, is worsening, or occurs at rest

Question 3

antihypertensive for a diabetic patient with proteinuria

Answer 3

ACEI

Question 4

Beck’s triad for cardiac tamponade

Answer 4

hypotension, muffled heart sounds, JVD

Question 5

drugs that slow heart rate

Answer 5

beta- blockers, calcium channel blockers, digoxin, amiodarone

Question 6

hypercholesterolemia treatment that leads to flushing and pruritis

Answer 6

niacin

Question 7

murmur- hypertrophic obstructive cardiomyopathy (HOCM)

Answer 7

a systolic ejection murmur heard along the lateral sternal border that increase with decreased preload (valsalva)

Question 8

murmur- aortic insufficiency

Answer 8

Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increased afterload (handgrip maneuver)

Question 9

murmur- aortic stenosis

Answer 9

systolic crescendo/decrescendo murmur that radiates to the neck; increases with increase preload (squatting maneuver)

Question 10

murmur- mitral regurgitation

Answer 10

holosystolic murmur that radiates tot he axilla; increases with increase afterload (handgrip maneuver)

Question 11

murmur- mitral stenosis

Answer 11

diastolic, mid- to- late, low- pitched murmur preceded by an opening snap

Question 12

treatment for atrial fibrillation and atrial flutter

Answer 12

if unstable, cardiovert. If stable or chronic, rate control with CCBs or beta blockers

Question 13

treatment for ventricular fibrillation

Answer 13

immediate cardioversion

Question 14

Dressler syndrome

Answer 14

autoimmune reaction with fever, pericarditis, and increased ESR occurring 2-4 weeks post MI

Question 15

IV drug use with JVD and a holosystolic murmur at the left sternal border. Treatment?

Answer 15

Treat existing heart failure and replace the tricuspid valve

Question 16

Diagnostic test for hypertrophic cardiomyopathy

Answer 16

echocardiogram (showing a thickened left ventricular wall and outflow obstruction)

Question 17

pulsus paradoxus

Answer 17

a decrease in systolic BP of more than 10mm Hg with inspiration; seen in cardiac tamponade

Question 18

classic ECG findings in pericarditis

Answer 18

low- voltage, diffuse ST- segment elevation

Question 19

definition of hypertension

Answer 19

BP> 140/90 mm Hg on 3 separate occasions 2 weeks apart

Question 20

eight surgically correctable causes of hypertension

Answer 20

renal artery stenosis, coarctation of aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism

Question 21

evaluation of a pulsatile abdominal mass and bruit

Answer 21

abdominal ulstrasound and CT

Question 22

indications for surgical repair of abdominal aortic aneurysm

Answer 22

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

Question 23

treatment for acute coronary syndrome

Answer 23

ASA, heparin, clopidogrel, morphine, O2, sublingual nitrogen, IV beta-blockers

Question 24

metabolic syndrome

Answer 24

abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states

Question 25

Appropriate diagnotic test for a 50yo man with stable angina who can exercise to 85% of maximum predicted heart rate

Answer 25

exercise stress treadmill with ECG

Question 26

Appropriate diagnotic test for a 65yo woman with left bundle branch block and severe osteoarthritis who has unstable angina

Answer 26

pharmacologic stress test (dobutamine echo)

Question 27

target LDL in a patient with diabetes

Question 28

signs of active ishemia during stress testing

Answer 28

angina, ST-segment changes on ECG, or decrease in BP

Question 29

ECG findings suggesting MI

Answer 29

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves

Question 30

coronary territories in MI

Answer 30

``` anterior wall (LAD/diagonal) inferior wall (PDA) posterior wall (left circumflex/oblique, RCA/marginal) septal wall (LAD/diagonal) ```

Question 31

A young patient with angina at rest and ST-segment elevation with normal cardiac enzymes

Answer 31

Prinzmetal's anging

Question 32

common symptoms associated with silent MIs

Answer 32

CHF shock altered mental status

Question 33

diagnostic test for pulmonary embolism (PE)

Answer 33

spiral CT with contrast

Question 34

protamine

Answer 34

reveres effects of heparin

Question 35

prothrombin time

Answer 35

coagulation parameter affected by warfarin

Question 36

young patient with a family history of sudden death collapses and dies while exercising

Answer 36

hypertrophic cardiomyopathy

Question 37

endocarditis prophylaxis regimens

Answer 37

oral surgery-amoxicillin for certain situations; GI or GU procedures- not recommended

Question 38

Virchow's triad

Answer 38

stasis, hypercoagulability, endothelial damage

Question 39

MCC htn in young women

Answer 39

OCPs

Question 40

MCC HTN in young men

Answer 40

excessive EtOH

Question 41

Figure 3 sign

Answer 41

aortic coarctation

Question 42

Water-bottle-shaped heart

Answer 42

percardial effusion- look for pulsus paradoxus

Question 43

"stuck on" appearance

Answer 43

seborrheic keratosis

Question 44

red plaques with silvery-white scales and sharp margins

Answer 44

psoriasis

Question 45

MC type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias

Answer 45

basal cell carcinoma

Question 46

honey-crusted lesions

Answer 46

impetigo

Question 47

febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity

Answer 47

cellulitis

Question 48

positive Nikolsky sign

Answer 48

pemphigus vulgaris

Question 49

negative Nikolsky sign

Answer 49

bullous pemphigoid

Question 50

55-year old obese patient presents with dirty, velvety patches on the back of the neck

Answer 50

acanthosis nigricans. check fasting blood glucose to rule out diabetes

Question 51

dermatomal distribution

Answer 51

varicella zoster

Question 52

flat- topped papules

Answer 52

lichen planus

Question 53

iris- like target lesion

Answer 53

erythema multiforme

Question 54

lesions characteristically orrutting in a linear pattern in areas where skin comes into contact with clothing or jewelry

Answer 54

contact dermatitis

Question 55

presents with a herald patch, christmas-tree pattern

Answer 55

pityriasis rosea

Question 56

pinkish, scaling, flat lesions on the chest and back; KOH prep has a 'spagghetti-and-meatballs' appearance

Answer 56

tinea (pityriasis) versicolor

Question 57

four characteristics of a nevus suggestive of melanoma

Answer 57

asymmetry, border irregularity, color variation, and large diameter

Question 58

a premalignant lesion from sun exposure that can lead to squamous cell carcinoma

Answer 58

actinic keratosis

Question 59

"dewdrops on a rose petal"

Answer 59

lesions of primary varicella

Question 60

cradle cap

Answer 60

seborrheic dermatitis | treat conservatively with bathing and moisturizing agents

Question 61

associated with propionibacterium acnes and changes in androgen levels

Answer 61

acne vulgaris

Question 62

painful, recurrent vesicular eruption of mucocutaneous surfaces

Answer 62

herpes simplex

Question 63

inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women

Answer 63

lichen sclerosus

Question 64

exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer

Answer 64

squamous cell carcinoma

Question 65

MCC hypothyroidism

Answer 65

Hashimoto thyroiditis

Question 66

Lab findings in Hashimoto thyroiditis

Answer 66

High TSH, low T4, anti-TPO abs

Question 67

Exophthalmos, pretibial myxedema, and decreased TSH

Answer 67

Graves' disease

Question 68

MCC Cushing syndrome

Answer 68

iatrogenic corticosteroid administration. second most common cause is Cushing disease

Question 69

a patient presents with signs of hypocalcemia, high phosphorus, and low PTH

Answer 69

hypoparathyroidism

Question 70

"stones, bones, groans, psychiatric overtones"

Answer 70

signs and symptoms of hypercalcemia

Question 71

a patient complains of headache, weakness, and pulyuria; examination reveals hypertension and tetany. Labs show hypernatremia, hypokalemia, and metabolic alkalosis

Answer 71

primary hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)

Question 72

a patient presents with tachycardia, wild swings in BP, HA, diaphoresis, AMS, and a sense of panic

Answer 72

pheochromocytoma

Question 73

which should be used first in treating pheochromocytoma, alpha or beta antagonists?

Answer 73

alpha antagonists (phentolamine and phenoxybenzamine)

Question 74

A patient with a history of lithium use presents with copious amounts of dilute urine

Answer 74

nephrogenic diabetes insipidus (DI)

Question 75

Treatment of central DI

Answer 75

Administration of DDAVP and free- water restriction

Question 76

A postoperative patient with significant pain presents with hyponatremia and normal volume status

Answer 76

SIADH due to stress

Question 77

An antidiabetic agent associated with lactic acidosis

Answer 77

Metformin

Question 78

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

Answer 78

primary adrenal insufficiency (Addison disease). Treat with glucocorticoids, mineralocorticoids, and IV fluids

Question 79

Goal HbA1C for a patient with DM

Question 80

Treatment of DKA

Answer 80

fluids, insulin, and electrolyte repletion (eg K+)

Question 81

Why are beta blockers contraindicated in diabetics?

Answer 81

they can mask symptoms of hyperglycemia

Question 82

How do you interpret the following 95% CI for RR of 0.582 (0.502, 0.637)

Answer 82

These data are consistent with RRs ranging from 0.502 to 0.673 with 95% confidence (ie we are confident that the true RR will be between 0.502 and 0.637 95 out of 100 times)

Question 83

Bias introduced into a study when a clinician is aware of the patient's treatment type

Answer 83

observational bias

Question 84

bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death

Answer 84

lead-time bias

Question 85

if you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by SES, then SES is a

Answer 85

confounding variable

Question 86

the proportion of people who have the disease and test positive is the

Answer 86

sensitivity

Question 87

sensitive tests have few false negatives, and are used to rule ___ a disease

Answer 87

out

Question 88

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a positive PPD. Highly sensitive or specific?

Answer 88

Highly sensitive for TB (screening tests with high sensitivity are good for diseases with low prevalence)

Question 89

chronic diseases such as SLE- higher prevalence or incidence?

Answer 89

higher prevalence

Question 90

epidemics such as influenza- higher prevalence or incidence?

Answer 90

higher incidence

Question 91

what is the difference between incidence and prevalence?

Answer 91

Prevalence is the percentage of cases of disease in a population at 1 snapshot in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk.

Question 92

cross- sectional survey- incidence or prevalence?

Answer 92

prevalence

Question 93

cohort study- incidence or prevalence?

Answer 93

incidence and prevalence

Question 94

case- control study- incidence or prevalence?

Answer 94

neither

Question 95

describe a test that consistently gives identical results, but the results are wrong

Answer 95

high reliability (prevision), low validity (accuracy)

Question 96

difference between a cohort and a case- control study

Answer 96

cohort studies can be used to calculate RR, incidence, and/or odds ratio (OR). Case- control studies can be used to calculate an OR, which is an estimate of RR when the disease prevalence is low.

Question 97

Attributable risk?

Answer 97

difference in risk in the exposed and unexposed groups (ie the risk that is attributable to the exposure)

Question 98

relative risk?

Answer 98

incidence in the exposed group divided by incidence in the non-exposed group

Question 99

the results of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an RR of 1.5?

Answer 99

in patients who took ASA, the risk of heart disease was 1.5 times that of patients who did not take ASA

Question 100

Odds ratio?

Answer 100

In cohort studies, the odds of developing the disease in the exposed group divided by the odds of developing the disease in the non-exposed group. In case- control studies, the odds that the cases were exposed divided by the odds that the controls were exposed. In cross- sectional studies, the odds that the exposed group has the disease divided by the odds that the non-exposed group has the disease

Question 101

The result of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an OR of 1.5?

Answer 101

In patients who took ASA, the odds of acquiring heart disease were 1.5 times those of patients who did not take ASA.

Question 102

In which patients do you initiate colorectal cancer screening early?

Answer 102

Patients with IBD; those with familial adenomatous polyposis (FAP)/ hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first- degree relatives with adenomatous polyps (

Question 103

The most common cancer in men and the most common cause of death from cancer in men

Answer 103

prostate is the most common cancer in men. Lung cancer causes more deaths

Question 104

percentage of cases within 1 SD of the mean? 2 SDs? 3 SDs?

Answer 104

68%, 95.4%, 99.7%

Question 105

birth rate?

Answer 105

number of live births per 1000 population in 1 year

Question 106

mortality rate?

Answer 106

number of deaths per 1000 population in 1 year

Question 107

neonatal mortality rate?

Answer 107

number of deaths from birth to 28 days per 1000 live births in 1 year

Question 108

infant mortality rate?

Answer 108

number of deaths from birth to 1 year of age per 1000 live births (neonatal and postnatal mortality) in 1 year

Question 109

maternal mortality rate

Answer 109

number of deaths during pregnancy to 90 days postpartum per 100,000 live births in 1 year