Board Vitals Flashcards
How does infection with Mycoplasma pneumoniae present?
Atypical community-acquired pneumonia
Does Mycoplasma pneumoniae infection cause agglutination?
Yes
How long after Mycobacterium pneumoniae infection do cold agglutinin titers decline?
6 - 8 weeks
What conditions cause chronic cold agglutinin titers?
- Certain B-cell neoplasms
- Infectious mononucleosis
How much should the initial fluid challenge for sepsis-induced hypoperfusion be?
30 mL/kg
Have SSRIs shown a benefit in treating irritable bowel syndrome?
No
What is the next step in patients with irritable bowel syndrome who have already been treated with lifestyle interventions and addressed underlying motility issue?
As needed anti-spasmodic to be taken when stressed or for known triggers.
What is the next step if antispasmodics do not resolve symptoms in irritable bowel syndrome?
Tricyclic antidepressants
Which artery supplies the posteromedial papillary muscle in the heart?
Posterior descending artery
In patient with left dominant circulation, where can a thrombus dislodged from the left circumflex artery during PCI end up?
Posterior descending artery
What is the best way to evaluate for stool overflow incontinence?
Digital rectal exam
What is the next step if digital rectal exam does not show palpable fecal impaction in cases of overflow incontinence?
Abdominal X-rays
What is the treatment of fecal impaction?
- Disimpaction
- Colonic evacuation
- Maintenance regimen
What is the usual treatment of acute colonic ischemia?
Supportive care
When is surgery indicated for colonic ischemia?
- If it is associated with hypotension, tachycardia and abdominal pain without rectal bleeding
- Pancolonic ischemia
- Gangrene
What percentage of acute renal failure in hospitalized patients is attributed to intrinsic acute renal failure?
69%
In acute renal failure, does the glomerular filtration rate decrease faster or slower than the renal plasma flow?
Faster
Which is better vascularized - the renal medulla or renal cortex?
Renal cortex
What is the distribution of tubular necrosis in the kidney?
Patchy distribution
Is tubular necrosis correlated to the degree of renal dysfunction?
No
Is the fractional excretion of sodium lower or higher than 1% in acute tubular necrosis?
Higher
Which test can differentiate between vitamin B12 deficiency and folate deficiency?
Methylmalonic acid
What happens to methylmalonic acid in vitamin B12 deficiency?
It is elevated.
What happens to methylmalonic acid in folate deficiency?
It is normal.
What happens to homocysteine in vitamin B12 deficiency?
It is elevated.
What happens to homocysteine in folate deficiency?
It is elevated.
What should you use first to treat benign paroxysmal positional vertigo (BPPV)?
Epley maneuver
Should vestibular therapy be used in acute vertigo?
No
Metoclopramide and prochlorperazine are anti-dopaminergic and should be avoided in which medical condition?
Parkinson’s disease
Are most allergic reactions to penicillin IgE-mediated or not?
Most are not IgE-mediated
What kind of allergies is skin testing sensitive for?
IgE-mediated allergies
What percentage of patients report an allergy to penicillin?
5 - 10%
What percentage of patients with self-reported penicillin allergy will have negative skin testing?
90%
What type of allergic reaction do people usually have to penicillin - delayed reaction or IgE-mediated?
Delayed reaction
What are most allergic reactions to penicillin - delayed or IgE-mediated?
Delayed
Are the results of desensitization therapy long-lasting?
No
How long do the results of desensitization therapy for penicillin last?
As long as the patient is exposed to penicillin.
What deficiency causes Wernicke’s encephalopathy?
Thiamine
Which psychiatric disorder has the highest mortality rate?
Anorexia nervosa
Do people with body dysmorphic disorder fixate on their weight?
No
What are the possible causes of a patient having positive Hepatitis C antibody test and negative HCV RNA testing?
- Old resolved infection
- False positive
Do patients with limited life expectancy benefit from statin therapy to prevent cardiovascular events?
No
Which protein is a well-established risk factor for Alzheimer’s disease?
Apolipoprotein E
Which gene codes for apolipoprotein E?
APOE
Which chromosome is the APOE gene that encodes for apolipoprotein E located on?
19
Which allele on chromosome 19 is associated with a higher risk of Alzheimer’s disease?
Epsilon 4
What kind of flow volume loop does paradoxical vocal cord motion disorder have?
Flattening of inspiratory loop
Do patients with asthma have flattening of inspiratory loop on flow volume loops?
No
What is the treatment of paradoxical vocal cord motion disorder?
Cognitive behavioral therapy
What is the gold standard for diagnosing paradoxical vocal cord motion disorder?
Laryngoscopy
What is the most effective treatment for preventing long term complications in patients with atrial flutter?
Ablation
What is an Allay lamp used for?
Treatment of photophobia (emits only green light)
What is a Cafaly device used for?
Aborting or preventing a migraine
What is a single pulse transcranial magnetic stimulation (TMS) device used for?
Preventing a migraine
What is a Nerivio arm stimulator used for?
Aborting of migraine
What is a GammaCore vagus nerve stimulator used for?
Aborting of migraine (acute treatment during an attack)
Which patient populations get Listeria meningoencephalitis?
- Immunocompromised
- Elderly
- Pregnant
Which organism has gram-positive or gram-variable rods?
Listeria monocytogenes
How does Neisseria meningitidis show up on a gram stain?
Gram negative diplococcus
What is the most common complication of a Zenker’s diverticulum?
Aspiration
Is carbamazepine a P450 inducer or inhibitor?
P450 inducer
Is grapefruit juice a P450 inducer or inhibitor?
P450 inhibitor
What are the indications for surgery in scoliosis patients?
- Cobb angle more than 25 degrees in any patient
- Progression of 5 degrees or more in Cobb angle of any patient
- Cobb angle of 20 - 24 degrees in premenarchal females
- Cobb angle of 20 - 24 degrees in males aged 12 - 14 years
Is bracing recommended for skeletally immature patients with scoliosis?
Yes
Is bracing recommended for skeletally mature patients with scoliosis?
No
Are physiotherapeutic scoliosis-specific exercises generally recommended in scoliosis?
No
How often should methadone be dosed?
Every 6 - 8 hours
What type of drugs are butorphanol and buprenorphine?
Partial opioid agonists
What type of drug is nalbuphine?
Opioid agonist/antagonists
Should you give opioid partial agonists or agonist/antagonist drugs with methadone?
No
Why should you not give opioid partial agonists or agonist/antagonist drugs with methadone?
They can cause opioid withdrawal symptoms.
Is diarrhea a side effect of hyoscyamine?
No
Is bradycardia a side effect of hyoscyamine?
No
Is xerostomia a side effect of hyoscyamine?
Yes
Is urinary frequency a side effect of hyoscyamine?
No
Is hyperhydrosis a side effect of hyoscyamine?
No
What is a tender testicular mass that develops within 24 hours?
Testicular torsion
If newborn screening shows an abnormally elevated level of immunoreactive trypsinogen - what is the diagnosis?
Cystic fibrosis
What electrolyte abnormality are patients with cystic fibrosis prone to?
Hyponatremia
Why are patients with cystic fibrosis prone to hyponatremia?
Because of excessive salt wasting
What can be considered prior to prescribing opioids in a patient who reports inadequate pain relief?
Querying the State’s prescription drug monitoring program
What are the most common side effects of prostaglandin therapy for erectile dysfunction?
- Penile pain
- Urethral trauma
What is a first line therapy for erectile dysfunction?
Oral phosphodiesterase inhibitors (e.g. sildenafil)
Is penile pain and urethral burning more common when prostaglandin E1 (alprostadil) is given via the intraurethral route by suppository or by the intracavernosal route by injection?
Intraurethral via suppository
Is prostaglandin E1 (alprostadil) more effective when given via the intraurethral route by suppository or by the intracavernosal route by injection?
Intracavernosal route
Is prostaglandin E1 (alprostadil) associated with higher rates of discontinuation when given via the intraurethral route by suppository or by the intracavernosal route by injection?
Intracavernosal route
Is prostaglandin E1 (alprostadil) associated with higher rates of fibrosis when given via the intraurethral route by suppository or by the intracavernosal route by injection?
Intracavernosal route
Should an erection last longer than 4 hours?
No - seek medical attention
How high can the ALT and AST be in severe acetominophen poisoning?
> 10,000
Can PT be prolonged in severe acetaminophen poisoning?
Yes
Can bilirubin be elevated in severe acetaminophen poisoning?
Yes
Which drugs have the greatest tendency to induce drug-induced lupus?
- Hydralazine
- Procainamide
- Isoniazid
Toxicity such as anemia and thrombocytopenia is worsened for which immunotherapy drug when it is used with allopurinol?
Azathioprine
Can fibrates cause hepatotoxicity?
Yes
Can fibrates cause myopathy?
Yes
Can sensitivity, specificity and prevalence be used to calculate positive predictive value and negative predictive value?
Yes
(UpToDate Calculator)
Which ion is responsible for membrane depolarization (phase 0)?
Sodium
What is the hypercalcemia in sarcoidosis due to?
Increased 1 alpha-hydroxylase activity
Which antibodies do patients with drug induced lupus have?
Anti-histone antibodies
Is imaging typically required in patients who present with low back pain?
No - not unless there are red flags.
When correcting for severe hypernatremia, in addition to sodium level, what also needs to be monitored closely?
Glucose
Does tacrolimus more commonly cause hyperkalemia or hypokalemia?
Hyperkalemia
Does tacrolimus cause hypomagnesemia or hypermagnesemia?
Hypomagnesemia
Does tacrolimus cause hypocalciuria or hypercalciuria?
Hypercalciuria
Is creatinine an anion or a cation?
Cation
How is creatinine transported in the renal tubule?
Organic cation transporter (OCT)
Does cimetidine competitively inhibit creatinine secretion, leading to reversible rise in creatinine?
Yes
In what age groups do women have a similar of higher risk of stroke compared to men?
Age 25 - 34 years, and over 85 years
It is harder to induce diuresis in patients with low albumin or high albumin?
Low albumin
What is the primary cause of mortality in burn patients?
Hypovolemia
What does the McMurray test help identify?
Meniscal tear
What does the Lachman test help identify?
Anterior cruciate ligament (ACL) injury
What does the pivot-shift test help identify?
Anterior cruciate ligament (ACL) injury
What does the Thompson test help identify?
Achilles tendon rupture
What does the anterior drawer test help identify?
Anterior cruciate ligament (ACL) injury
Is hypothyroidism a common adverse effect of paclitaxel?
No
Is cardiomyopathy a common adverse effect of paclitaxel?
No
Is pulmonary fibrosis a common adverse effect of paclitaxel?
No
Is paresthesia a common adverse effect of paclitaxel?
Yes
Is hemorrhagic cystitis a common adverse effect of paclitaxel?
No
Is cardiomyopathy a common adverse effect of doxorubicin?
Yes
Is hypothyroidism a common adverse effect of pembrolizumab?
Yes
Is pulmonary fibrosis a common adverse effect of bleomycin?
Yes
Is hemorrhagic cystitis a common adverse effect of cyclophosphamide?
Yes
What acid base imbalance does high altitude cause?
Respiratory alkalosis (compensated)
Samples may allow estimations of error in resulting statistics.
True or false?
True
What is the treatment of patellofemoral pain syndrome (PFPS)?
Physical therapy
What is the lactate level in patients with D-lactic acidosis?
Normal
What patients are more likely to get D-lactic acidosis?
Short-bowel syndromes
What should be monitored in patients on nitroprusside?
Thiocyanate level
What kind of dietary restrictions do patients have when they are on monoamine oxidase inhibitors (MOAI)?
Cannot take foods containing tyramine
Can dronedarone be used in severe heart failure or decompensated heart failure?
No
What is the mechanism of action of varenicline?
Nicotine partial agonist
What is the mechanism of action of clonidine?
Alpha-2 agonist
What is the mechanism of action of gabapentin?
GABA (gamma-aminobutyric acid) analog
What is the mechanism of action of bupropion?
Neuronal norepinephrine and dopamine reuptake inhibitor
Which type of anemia is associated with restless leg syndrome?
Iron deficiency anemia
What can help the treatment of restless leg syndrome if ferritin is less than 75 mcg/L?
Iron replacement
Is silver nitrate used to treat hyperhydrosis?
No
Is botulinum toxin therapy used to treat hyperhydrosis?
Yes
What is the first line treatment for hyperhydrosis?
- Topical aluminum chloride 12%
- Topical glycopyrronium tosylate solution
Can oral oxybutynin effectively treat hyperhidrosis?
Yes (but not first line)
What is the treatment of male pattern alopecia?
- Topical minoxidil
- Oral finasteride
Can phenytoin cause gingival hyperplasia?
Yes
Can vigabatrin cause visual field defects?
Yes
What is availability bias?
Believing a diagnosis that occurred recently is more likely to occur again.
Does propofol cause a dissociative state?
No
Does ketamine cause a dissociative state?
Yes
Does routine pre-procedural fasting reduce risk of aspiration during procedural sedation and analgesia?
No
Where is a direct inguinal hernia in relation to the inferior epigastric artery?
Medial to the inferior epigastric artery
What is another name for drug reaction with eosinophilia and systemic symptoms (DRESS)?
Drug-induced hypersensitivity syndrome (DIHS)
Which of the following develop 1- 2 weeks after starting a new medication?
Drug-induced hypersensitivity syndrome
Stevens-Johnson syndrome
Toxic Epidermal Necrolysis
Stevens-Johnson syndrome
Toxic Epidermal Necrolysis
Which of the following develop 2- 6 weeks after starting a new medication?
Drug-induced hypersensitivity syndrome
Stevens-Johnson syndrome
Toxic Epidermal Necrolysis
Drug-induced hypersensitivity syndrome
How many half-lives does a drug take to reach steady state?
5
What is the mechanism of action of phenelzine?
Monoamine oxidase inhibitor
What happens if you take tyrosine containing foods (e.g. cheese) when taking an MOA inhibitor (e.g. phenelzine)?
Hypertensive crisis