rosh review questions

Question 1

what are the different mechanism of action between PPIs and H2 receptor blockers?

Answer 1

Proton-pump inhibitors directly block the hydrogen-potassium ATPase action on parietal cells to effectively decrease acid suppression.
H2 Blockers: competitively bind with gastric parietal cells to inhibit gastric acid secretion
Proton-pump inhibitors have greater effectiveness in treating esophagitis because they act on the final pathway of acid secretion rather than one of its receptors.

Question 2

what is pre-tibial myedema?

Answer 2

it is a skin condition in Grave’s disease- hyperthyroidism- looks like peripheral vascular disease - it is caused by the deposition of hyaluronic acid (hydrophilic glycosaminoglycans in the dermis)

Question 3

when do you add dextrose to IV fluid replacement in DKA treatment?

Answer 3

when anion gap is still elevated but glucose is < 200.

Question 4

when would you give sodium bicarb in DKA?

Answer 4

if pH is < 6.9. otherwise it’s controversial to add this when bicarb level is low.

Question 5

how is anion gap calculated?

Answer 5

Anion Gap = Sodium - (Chloride + Bicarbonate).

Potassium may or may not be included in anion gap calculation- if it is, it changes the normal range.

Question 6

what are physical barriers of innate immune system?

Answer 6

physical barriers which include the skin, sweat, oral secretions, stomach acid, and mucosa

Question 7

what are physical exam findings of bacterial infective endocarditis?

Answer 7

fever, Roth spots, Osler nodes, murmur, Janeway lesions, anemia, nailbed hemorrhages, emboli (FROM JANE)

Question 8

what are Roth spots

Answer 8

retinal changes from infective endocarditis

Question 9

what are osler nodes vs janeway lesions

Answer 9

infective endocarditis
osler nodes- on hands, more like hard bumps or moles
janeway lesions- hemorrhagic lesions

Question 10

what are the most common bacteria for endocarditis- mechanical vs. natural valve

Answer 10

IVDA: Staphylococcus aureus, tricuspid

Native valve: Staphylococcus aureus, viridans streptococci (most common in previously diseased), mitral

Question 11

Pneumopericardium- what are the impacts on hemodynamic status? what’s the severe complication?

Answer 11

increased pulmonary capillary wedge pressure, decreased cardiac output, and increased systemic vascular resistance.
can develop into cardiac tamponade and cardiogenic shock

Question 12

what is risk with succinylcholine? which patients to avoid this for rapid sequence intubation?

Answer 12

succinylcholine (suxamethonium) is a rapid-acting depolarizing skeletal muscle relaxant that can cause fatal hyperkalemia and, less commonly, malignant hyperthermia
avoid in ESRD

Question 13

what does positive Murphy’s sign indicate?

Answer 13

acute cholecystitis- RUQ pain

Question 14

imaging recommendations for acute cholecystitis workup

Answer 14

initial: ultrasound- better detection of gallstones compared to CT scan
gold standard: HIDA scan

Question 15

basal cell carcinoma defining features

Answer 15

translucent, pearly nodule and rolled raised edge.

Question 16

thyroid storm medication regimen

Answer 16

propranolol, propylthiouracil, potassium iodide, dexamethasone
Grave’s disease
propranolol first because decreasing peripheral conversion of T4 to T3. Propylthiouracil- block synthesis of thyroid hormone potassium iodide- prevent release of stored thyroid. dexamethasone- concern for adrenal insufficiency and decrease peripheral conversion of T4 to T3

Beta-blocker (propranolol)
Thioamide (propylthiouracil or methimazole)
Iodine solution
Glucocorticoids

Question 17

what is treatment for 3rd degree HB?

Answer 17

electrophysiology consult: permanent pacemaker placement

Question 18

what anticoagulant is approved during/after pregnancy

Answer 18

enoxaparin- low molecular weight heparin

Question 19

describe hyperparathyroidism

Answer 19

Labs will show high PTH, high calcium, low phosphorus

Most commonly caused by an adenoma with unregulated overproduction of PTH

Question 20

hereditary angioedema

Answer 20

deficiency of C1 inhibitor- part of the compliment system
excessive bradykinin
Tx: replase C1 esterase inhibitor- FFP

Question 21

levothyroxine dosing adults vs older adults

Answer 21

Lower for older adults because; due to risk for cardiac dysrhythmias, myocardial infarction, and angina pectoralis

Question 22

what is a risk factor for non-Hodgkin lymphoma?

Answer 22

Hashimoto disease (hypothyroidism)

Question 23

what is mechanism of action of carvidopa-levodopa combination agent

Answer 23

Carbidopa is usually combined with levodopa to inhibit decarboxylase from converting levodopa to dopamine in the systemic circulation

Question 24

importance of dicrotic notch

Answer 24

aortic valve closure- measured on arterial wave form. use to time opening of aortic balloon pump with aortic valve closure

Question 25

asymptomatic AAA

Answer 25

feel for abdominal mass

Question 26

what does abdominal bruit signal

Answer 26

renal artery stenosis

Question 27

what antibiotic medications cause QTc prolongation

Answer 27

Antimicrobials known to cause QT prolongation include macrolides, fluoroquinolones, and high-dose fluconazole

Question 28

aortic stenosis atributes

Answer 28

``` crescendo-decrescendo murmur systolic ejection murmur diminished carotid pulses split S2 narrow pulse pressure decreases murmur with Valsalva maneuver ```

Question 29

burn: painless, escar =

Answer 29

full thickness burn

Question 30

when is PSA screening indicated

Answer 30

age 55-69, with consideration of family history of prostate cancer. this is a soft recommendation because the risks can outweigh the benefits Screening for prostate cancer is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age).This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.

Question 31

diarrhea vs vomiting metabolic abnormalities

Answer 31

Diarrhea is the most common cause of external loss of alkali resulting in metabolic acidosis. Biliary, pancreatic, and duodenal secretions are alkaline and are capable of neutralizing the acidity of gastric secretions vomiting- metabolic alkalosis because of loss of gastric acid.

Question 32

what is mydriasis?

Answer 32

fixed pupil; brain herniation

Question 33

define assault (legal terms)

Answer 33

occurs when one individual is in immediate fear or apprehension of harmful touching without their consent. It does not include physical harm

Question 34

define abuse in legal terms

Answer 34

the intentional harm or injury to another individual. In medicine, abuse includes practices that are inconsistent with recommended medical treatment resulting in services rendered that are not medically necessary or fail to meet the recognized standards of care.

Question 35

define battery in legal terms

Answer 35

the unlawful touching of an individual with the intent of causing harm

Question 36

define intimidation in legal terms

Answer 36

the act of filling with fear through strength of position or force of personality that encourages a specific action.

Question 37

define secondary prevention

Answer 37

early detection of a disease

Question 38

define primary prevention

Answer 38

prevent disease well before it develops and reduce risk factors

Question 39

define tertiary prevention

Answer 39

treat established disease to prevent deterioration

Question 40

positive Trousseau's sign or Chovstek's sign

Answer 40

hypOcalcemia

Question 41

alcoholic hepatis lab trends

Answer 41

2:1 ratio AST:ALT

Question 42

viral hepatitis lab trends

Answer 42

10x higher AST/ALT levels

Question 43

adduction testing

Answer 43

Varus. lateral colateral ligament LCL | ankle in, knee out

Question 44

abduction testing

Answer 44

Valgus test, ankle out (abduction), knee force in | MCL testing

Question 45

ACL

Answer 45

anterior drawer test/ Lachman's test

Question 46

PCL

Answer 46

posterior drawer test

Question 47

what is most common dysrhytmia in Wolf Parkinson White syndrome/

Answer 47

Orthodromic AVRT is the most common tachydysrhythmia seen in WPW syndrome and accounts for 65% of dysrhythmias seen in WPW patients

Question 48

what are the EKG characteristics of Wolf Parkinson White Syndrome?

Answer 48

Short PR interval < 0.12 seconds Delta wave- curved upstroke of QRS complex Wide QRS > 0.12 seconds

Question 49

what is the accessory pathway of WPW syndrome?

Answer 49

Bundle of Kent

Question 50

what is characteristic of WPW syndrome? what is treatment?

Answer 50

Tachyarrhythmias; palpitations, syncope 1st tx: vagal maneuver 2nd: adenosine push 3rd: beta blocker or calcium channel blocker definitive treatment: ablation of alternative pathway If unstable: emergent cardioversion

Question 51

describe presentation of acute appendicitis, physical exam findings and diagnostic testing

Answer 51

Presentation: periumbilical pain that migrates to RLQ pain, nausea, vomiting, fever, anorexia, diarrhea, general malaise, flatulence, dyspepsia (last 4 are atypical signs) McBurney's point (RLQ), Rosvig's sign- referred RLQ pain from palpation of LLQ. Psoas sign; hip extension while left side lying Obturator sign; flexion of knee and internal rotation of hip elicits pain Diagnostic: CT scan is gold standard

Question 52

what is antiphospholipid antibody syndrome

Answer 52

autoimmune multisystem disorder characterized by arterial venous or small vessel thromboembolic events. may be associated with Lupus testing: anticardiolipin antibodies or lupus anticoagulant levels or anti-beta-2-glycoprotein I antibodies