CME4LIFE PANCE BOARD REVIEW FLASHCARDS 2018 Flashcards by Jason Sajulan

What nerve are we checking for with EOM with an orbital fracture?

Infra-orbital Nerve

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What kind of lesion represents herpes keratitis?

Dendritic

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Where is the tear from retinal detachment most common?

Superior temporal area

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What is classically described as a curtain being drawn over the eye from the top to the bottom?

Retinal Detachment

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What is the leading cause of irreversible central vision loss?

Macular degeneration

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How is the metamorphosis of macular degeneration best measured?

Amsler Grid

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What is the leading cause of blindness in the USA?

Diabetic retinopathy

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An impediment through what structure leads to glaucoma?

Canal of Schlemm

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Which kind of glaucoma is most common?

Open angle

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What is the main symptom of glaucoma?

Peripheral visual field loss

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What is periorbital cellulitis primarily associated with?

Sinusitis

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When is dacryostenosis most common and what is the treatment?

Newborns. Symptomatic treatment.

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What is involved with an internal hordeolum and what is the common pathogen?

Meibomian gland, S. Aureus

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What is the most common pathogens of bacterial conjunctivitis?

Strep pneumonia, S. Aureus and HFlu

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What two diseases are caused by Neisseria?

Gonorrhea and Meningitis

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What do we call a yellowish, fleshy conjunctival mass typically on the nasal side?

Pinguecula

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What are the main causes of papilledema?

Malignant HTN, Increased intracranial pressure and pseudotumor cerebri

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How will papilledema appear?

Disc swollen with margins blurred and obliteration of the vessels

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What are the two most common causes of transient vision loss?

Emboli (amaurosis fugax) or giant cell (temporal) arteritis

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What causes sudden vision loss?

Central retinal vein occlusion, optic neuropathy, papillitis or retrobulbar neuritis

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What is the most common cause of amblyopia?

Strabismus

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What is blue/cyanotic discoloration of the sclera associated with?

Osteogenesis imperfecta

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With a conduction hearing loss, how will the Webber test respond?

Lateralize to the affected ear

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With conductive hearing loss, how will the Rinne test respond?

Bone conduction greater then air conduction

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What is the most common cause of sensorineural hearing loss and what kind of hearing is lost?

Presbycusis, high frequency

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What are the four main features of Meniere’s disease?

Vertigo, low range hearing loss, tinnitus and ear pressure

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What drugs ototoxic agents lead to hearing loss?

Aminoglycosides, loops, and chemotherapy drugs (cisplastin)

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What bugs most are most common in otitis media?

Strep, H.flu and M.Cat

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What kind of nystagmus is associated with peripheral vertigo?

Horizontal with rotatory component.

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What test is used to diagnosis BPPV?

Dix-Hallpike

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True or False: Most cases of sinusitis resolves without antibiotics?

TRUE

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What symptoms are suggestive of Group A beta hemolytic strep?

Centor’s Criteria

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What symptoms are NOT consistent with Group A beta hemolytic strep?

Corzya, hoarse voice or cough

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What is the antibiotic of choice for Group A beta hemolytic strep if PCN allergic?

Erythromycin

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What is the diagnosis consistent with sore throat, uvula deviation, drooling, and trismus?

Peritonsillar abscess

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How will aphthous ulcers appear in the mouth?

Painful, round with yellowish-gray centers & red halos

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What is the most common yeast in oral thrush?

Candidia albicans

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What is the location of anterior nose bleeds?

Kiesselbach plexus

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What is the triad called of nasal polyps, asthma and aspirin sensitivity?

Samter’s triad

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What is the most common cause of community acquired pneumonia (CAP)?

Strep pneumonia

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What antibiotic is appropriate for outpatient treatment of community acquired pneumonia (CAP)?

Macrolide (not erythromycin) or doxycycline

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Who is the pneumococcal polysaccharide vaccine recommended for?

Young and old, sick, sickle cell, smokers, no spleen and liver disease

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What are two buzz words that go with Mycoplasma pneumoniae?

Bullous myringitis and cold agglutinins

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What are two buzz words with pneumocystis jiroveci?

Elevated LDH and hyper-hypoxia

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What is a buzz word for pneumococcal pneumonia? (aka streptococcus pneumonia)

Rust colored sputum

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What is a buzz word for klebisella pneumonia?

ETOH abuse and current jelly sputum

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What bug is most likely to cause pneumonia in a patient with ETOH abuse?

Klebsiella

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What bug is most likely to cause pneumonia in a patient with COPD?

Haemophilus

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What bug is most likely to cause pneumonia in a patient with cystic fibrosis?

Pseudomonas

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What bug is most likely to cause pneumonia young adults?

Mycoplasma/chlamydia

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What bug is most likely to cause pneumonia in a patient with exposure to aerosolized water?

Legionella

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What bug is most likely to cause pneumonia in children less than 1 year old?

RSV

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What bug is most likely to cause pneumonia in children less than 2 years old?

Parainfluenza

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What is the most common hospital acquired infection?

UTI

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What is the most likely pathogen for ICU acquired pneumonia?

Pseudomonas

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What is the most common opportunistic infection in patients with HIV infection?

Pneumocystis jiroveci (formerly P. carinii)

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What are the classic symptoms of TB?

Fever, night sweats, weight loss

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What are Ghon complexes that represent healed infection?

Calcified primary focus in the lungs

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What is the historical landmark of TB?

Caseating granuloma that is AKA necrotizing granuloma

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What are the side effects of INH?

B6 deficiency, hepatitis, neuropathy

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What are the side effects of rifampin?

Orange discoloration and hepatitis

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What is NOT predictive of bacterial bronchitis?

Sputum color

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What is the leading cause of cancer death?

Bronchogenic carcinoma

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What radiographic finding is diagnostic for epiglottitis?

Thumbprint sign

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What radiographic finding is diagnostic for croup?

Steeple sign

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What is the most common cause of bronchogenic CA?

Adenocarcinoma

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What is the treatment of choice for Non-small cell CA?

Surgery

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What are the three components of asthma?

Obstruction of airflow, hyperreactivity and inflammation

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What change in FEV1 after bronchodilation is supportive of the diagnosis of asthma?

10%

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What is the most effective anti-inflammatory for chronic asthma?

Inhaled steroids

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What is the most contributing cause of COPD?

Smoking

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What deficiency leads to COPD?

Alpha 1 antitrypsin

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What is the single most important intervention in COPD?

Stopping smoking

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What is superior to B agonists in achieving bronchodilation?

Anticholinergics (ipratropium or tiotropium)

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What therapy is the only therapy that may alter the course of COPD?

Supplemental oxygen

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What are the main symptoms of cystic fibrosis?

Cough, excessive sputum, sinusitis, steatorrhea and ABD pain

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What is the gold standard for identifying a pleural effusion?

Thoracentesis

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What are the most common irritants used for pleurodesis?

Doxycycline and talc

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What type of image reveals the presence of pneumothorax?

Expiratory CXR

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What are the risk factors for DVT/PE?

Virchow’s Triad: Damage, Stasis and hypercoaguable state

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What are the most common hypercoaguable states?

High estrogen, cancer and genetics

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What is the initial method for the diagnosis of PE?

Spiral CT

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When is a negative D.Dimer helpful in ruling out PE?

With low pre-test probability

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What is the definitive test for PE?

Pulmonary angiogram

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What physical findings are suggestive of pulmonary HTN?

Systolic ejection click and splitting/accentuation S2

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What causes pneumoconoises?

Coal dust, silicate or other inert dusts

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What is used to relieve chronic alveolitis in silicosis?

Steroids

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What CXR findings are seen in asbestosis?

Pleural based plaques

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What is the number one complication of asbestosis?

Mesothelioma

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What disease is a multiorgan disease of idiopathic cause characterized by noncaseating granulomatous inflammation in affected organs?

Sarcoidosis

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What is the main presentation of an aspirated foreign body?

Choking, coughing or unexplained wheezing or hemoptysis

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What is the most common cause of respiratory disease in a preterm infant?

Hyaline membrane disease

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What can be used as prophylaxis or rescue in a patient with established hyaline membrane disease?

Exogenous surfactant

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What is the most common cause of shock

Gram negative sepsis

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What lab test can identify and monitor sepsis?

Lactate

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How should urine output be monitored in a patient with shock?

Indwelling catheter with a urine output of 0.5mL/kg/hour

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How long should it take to lower a patient with a HTN urgency?

Hours

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How long should it take to lower a patient with HTN emergency?

1 hour

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What are the findings of malignant HTN?

Papilledema, encephalopathy or renal failure

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What is the most common symptom of HTN?

Headache

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What is recommended as the initial agent for HTN?

Diuretic

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What diuretic should be used in patients with renal disease?

Loop Diuretics

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In which patients are B-blockers most effective?

Younger/Caucasian

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What is the initial drug of choice in a diabetic patient with HTN?

ACE Inhibitors

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What is the major side effect of an ACE Inhibitor?

Cough

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What agent is preferred for HTN in blacks and elderly?

Calcium Channel Blocker

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What medications are recommended for BP control in aortic dissection?

Nitroprusside and a B-blocker

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What is the anti-HTN medication of choice in a pregnant patient?

Hydralazine

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What are the cardiac signs of CHF?

Enlarged heart, diminished first heart sound and S3

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What is the most useful image with CHF?

Echocardiogram

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What two medications prolong life in a patient with CHF?

ACE Inhibitor and B-Blockers

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When is an implantable cardio-defibrillator indicated in a patient with CHF?

EF<35%

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What is the most common cause of cardiovascular death and disability?

Atherosclerosis

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What are the risk factors for arterial disease?

Smoking, Age (M > 55 and F > 65,) DM, Cholesterol, HTN and family history

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Name the three kinds of angina

Stable (predictable,) unstable (unpredictable) and Prinzmetal

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What is the most common presentation of unstable angina?

Resting chest pain

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What is Levine sign?

Clenched fist and teeth to describe angina pain

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How long does stable angina last?

Less than 3 minutes

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What is the most sensitive clinical sign of angina on an EKG?

Horizontal or down sloping ST segment depression

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What percent of patients with unstable angina will have a normal EKG?

25%

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What is the most useful and cost effective noninvasive test for angina?

Exercise stress testing

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What is the definitive diagnosis for angina?

Coronary angiogram

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What is the primary pharmacotherapy for angina?

Sublingual nitroglycerine

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What is the first line therapy for chronic angina?

B-Blockers

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What medication prolongs exercise duration and time to angina?

Ranolazine

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What disease encompass acute coronary syndrome?

Unstable angina, Non-STEMI and STEMI

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What is our primary decision point for patient with chest pain?

EKG

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What two acute coronary syndromes are treated the same?

Unstable and NSTEMI

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What is the rhythm that most people die from?

V. Fib

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When is an AMI most likely to present?

Early morning

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What is Dressler’s syndrome (post MI syndrome?)

Pericarditis, fever, leukocytosis, pericardial or pleural effusions

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What is the EKG findings of a STEMI?

1 MM ST segment elevation in two contiguous leads

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What EKG finding is highly suspicious for STEMI?

LBBB

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What are the contraindications to a B-blocker?

Slow hearts, weak hearts (CHF) or bad pulmonary patients

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When should aspirin or clopidogrel be used in a patient with a STEMI?

Immediately

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Name the 4 cyanotic heart anomalies

Tetralogy of fallot, pulmonary atresia, hypoplastic left heart syndrome, and Transposition of the great vessels

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Name the non-cyanotic heart anomalies

ASD, VSD, PDA, AV septal defect (seen in Down’s syndrome) & Coarctation of aorta

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What is the most common ASD?

Ostium Secundum

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What is the most common congential heart anomaly?

VSD

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How do we treat PDA pharmacologically?

Indomethacin

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How do we keep the ductus arteriosus open?

IV prostaglandins E

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What is the most common valvular disease?

Aortic Stenosis

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What is the most common presentation of valvular heart disease?

Dyspnea on exertion/exercise intolerance

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What is the definitive method to identify heart structure and functional abnormalities?

Echocardiogram or TEE

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How is the murmur of Tetralogy of Fallot identified?

Crescendo/decrescendo holosystolic at left sternal border that radiates to back

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What heart defect gives a machinery murmur?

PDA

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How are all regurgitation murmurs identified?

Blowing and higher pitch

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What valvular pathology has an Austin Flint murmur?

Aortic regurgitation

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What is the most common arrhythmia?

A.Fib

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What is the key principle of treating an unstable arrhythmia?

Synchronized cardioversion

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What is the initial treatment for a symptomatic bradyarrhythmia?

Atropine

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How do we define V.Tach?

Three or more PVCs in a row

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What are the two most common causes of Torsades?

Hypokalemia and hypomagnesemia

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Who is Brugada syndrome most often seen in?

Asian population

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What are the drugs of choice for V.Tach?

LAP = Lidocaine, Amiodarone and Procainamide

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How do we treat Torsades de pointes?

Magnesium

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How do we treat most patients with sick sinus syndrome?

Pacer

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What is the most common cardiomyopathy?

Dilated (95% of the cardiomyopathies)

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What are the physical findings of a dilated cardiomyopathy?

S3, JVD and rales

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What are the physical findings of a hypertrophic cardiomyopathy?

S4 gallop, Bisferiens carotid pulse, jugular venous pulsation with a prominent “a” wave.

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What are the key presenting features of a pericarditis?

Pain relieved leaning forward and a friction rub

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What are the most common bugs that cause infectious endocarditis?

Strep viridians, S. Aureus and enterococci

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What is the most common bug that causes endocarditis in an IV drug user?

S. Aureus

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What are the most common bugs that infect a heart valve if infection occurs less than 2 months after implantation?

Gram Negative and fungi

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What are the four classic findings of endocarditis?

Roth spots, Splinter hemorrhages, Osler’s nodes & Janeway Lesions

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What is the drug of choice for endocarditis prophylaxis

Amoxicillin

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What valve is most commonly affected in Rheumatic heart disease?

Mitral

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Name the major criteria for rheumatic heart disease? (AKA Jones Criteria)

Carditis, erythema marginatum, Subcutaneous nodules, chorea, polyarthritis

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What medication can provide symptoms relief with PVD?

Cilostazol

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What is recommended to prevent travel associated DVT?

Frequent ambulation, leg exercises and compression hose

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What are the key demographics of temporal arteritis?

Age greater than 50 and a history of polymyalgia rheumatic

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What are the signs and symptoms of giant cell arteritis

Unilateral temporal HA, scalp tenderness, jaw claudication, elevated ESR

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What is the most common cause of aortic aneurysms?

Atherosclerosis

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Who is the classic patient with aortic dissection?

Elderly male smoker with COPD, CAD and renal insufficiency

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What is the diagnostic test of choice for AAA?

Ultrasound

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What is the diagnostic test of choice for thoracic aneurysms?

Aortagram

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What is the best indicator for response to RBC loss?

Reticulocyte count

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What conditions lead to an elevated INDIRECT bilirubin?

Hemolysis and Gilberts syndrome

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What are the causes of a microcytic anemia?

Sideroblastic, Thalassemia, Iron deficiency and chronic disease

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What is the most common sideroblastic anemia basophilic stippling?

Lead

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What problem do patients with one alpha globin chain (Hgb H) have?

Stillbirth = hydrops fetalis

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What is another name for B-Thalassemia major?

Cooley anemia

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What do people with Hgb H disease need?

Folic acid

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What is the most common form of anemia?

Iron deficiency

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What is the hallmark or iron deficiency?

Pica

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What are the most common causes of a macrocytic anemia?

B12 and folate deficiency

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What is the most common cause of folate deficiency?

Diet

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What cell findings are pathognomonic for folate deficiency?

Macro-ovalocytes, hypersegmented PMN cells and Howell-Jolly bodies

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What is the most common cause of Pernicious anemia?

Lack of intrinsic factor

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What test looks for antibodies on the RBC thus looking for hemolytic anemia?

Coombs

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What stain looks for G6PD?

Heinz body

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What daily/lifelong medication should be considered for all patients with sickle cell patients?

Hydroxyurea

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What does atypical lymphocytes point towards?

EBV (mono)

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What does Auer rods point to?

acute myeloid leukemia (AML)

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What cells are pathognomonic for CLL ( chronic lymphocytic leukemia)?

Smudge cells

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Which cells point towards Hodgkin’s Disease?

Reed-Sternberg

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What virus is seen in 50% of Hodgkin’s?

EBV

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What is a trigger for lymph node pain in Hodgkin’s?

Pain after alcohol

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Where is the pathology in Multiple Myeloma?

Plasma cells

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What is the most common complaint of patients with multiple myeloma?

Bone pain (LBP,) infections and anemia

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What is the hallmark of multiple myeloma?

Monoclonal spikes on serum electrophoresis and Bence-Jones protein

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What is the most common congenital coagulopathy?

Von Willebrand disease

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What is Christmas Disease?

Hemophilia B (Factor IX deficiency)

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What is a modality for a patient with significant night time symptoms?

H2 blocker at night and a PPI in the day

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What are common viral causes of esophagitis?

CMV and HSV

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What are common causes of esophagitis in a patient with HIV?

Mycobacterium tuberculosis, EBV, Mycobacterium Avium Complex

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How do we treat HSV esophagitis?

Acyclovir

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How do we treat CMV esophagitis?

Ganciclovir

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What is a key feature of Zenker’s diverticulum?

Vomiting undigested food after several hours

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What is the classic finding on barium swallow in a patient with Achalasia?

Parrot beak

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What is the condition called that is caused by thrombosis of the portal vein that leads to esophageal varices?

Budd-Chiari syndrome

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What three diseases does H. Pylori cause?

Peptic ulcers, gastric adenocarcinoma and gastric

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What is the most common cause of PUD ( peptic ulcer disease)?

H. Pylori

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What is the name of a gastrin secreting tumor that causes hypergastrinemia?

Zollinger-Ellison Syndrome

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What is diagnostic of Zollinger-Ellison Syndrome?

Fasting Gastrin level greater than 150pg/mL

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What is strongly associated with gastric adenocarcinoma?

H. Pylori

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What is the supraclavicular lymphadenopathy of gastric adenocarcinoma called?

Virchow’s node

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What is the umbilical nodule of gastric adenocarcinoma called?

Sister Mary Joseph nodule

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Which organism causes the most rapid onset of diarrhea?

S. Aureus

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What denotes an inflammatory process in diarrhea?

WBC in stool

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When should a colonoscopy be ordered in a patient with constipation?

Patients older than 50 with new onset constipation

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What causes most small bowel obstructions?

Adhesions and hernias

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What is the most common cause of a large bowel obstruction?

Tumor

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What test distinguishes mal-digestion from mal-absorption?

D-xylose test

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What is the most common genetic condition in the USA?

Celiac

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What are the screen tests for Celiac disease?

IgA antiendomysial and anti-tissue transglutaminase

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What is the age of onset of Crohn’s disease?

25 y/o with M=F

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What is possible curative in ulcerative colitis?

Surgery

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What is the most common cause of chronic or recurrent ABD pain in the USA?

IBS

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What is the most common cause of intussusception in a child and adult?

Child: viral infection and adult: neoplasm

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What is the presentation of intussusception?

Colicky pain, current jelly stool and a sausage like mass

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How do we both diagnose and treat intussusception in a child?

Barium or air enema

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How do we diagnose intussusception in an adult?

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What test is avoided in diverticulitis?

Barium enema

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What is the risk of inherited polyposis syndrome?

Near-100% risk of CA

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What lab test is used to monitor colorectal CA?

Carcinoembryonic antigen (CEA)

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What is the most common cause of appendicitis?

Fecalith

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What is the most common emergency surgery?

Appendicitis

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What is the initial symptom of appendicitis?

Periumbilical or epigastric pain

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What are the most common causes of pancreatitis?

ETOH and cholelithiasis

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What is the classic pain pattern of pancreatitis?

Epigastric pain radiating to back

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What is bleeding into the flanks called?

Grey Turner sign

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What is bleeding into the umbilical area called?

Cullen sign

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What is a palpable gallbladder and jaundice called?

Courvoisier sign

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What is the surgical resection of pancreatic cancer called?

Whipple procedure

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What are the complications of choledocholithiasis?

Cholecystitis, pancreatitis and acute cholangitis

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What is Charcot triad?

RUQ pain, jaundice and fever

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What is Charcot’s triad that also has an altered mental status and hypotension called?

Reynold’s Pentad

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What is primary sclerosing cholangitis associated with?

Ulcerative colitis

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What is the most common presentation of primary sclerosing cholangitis?

Jaundice and pruritus

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What is the only know treatment for primary sclerosing cholangitis?

Liver transplant

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What represents ongoing hepatitis B infection?

Hepatitis B SURFACE antigen (HBsAg)

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What represents immunity to hepatitis B?

Anti-HBs: Antibody against hepatitis B surface antigen

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What medication is used for acetaminophen toxicity?

Acetlycysteine

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What is the general cause of a liver abscess?

Entamoeba histolytica

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Where is the liver a common source or metastases from?

Lung and breast

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Which diseases cause an elevation of Alpha fetoprotein?

Hepatic carcinoma, hepatitis C and cirrhosis

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What is the location of an indirect inguinal hernia?

Through internal inguinal ring

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What is the location of a direct inguinal hernia?

Through the external ring at Hesselbach’s triangle

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What is the basic patient demographic for pyloric stenosis?

5 week old male

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What is the radiographic finding of pyloric stenosis?

String sign

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What is the disease caused by vitamin D deficiency?

Rickets

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What is the disease caused by a lack of Thiamine?

Beriberi

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What is another name for vitamin B6?

Pyridoxine

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What is the problem with phenylketonuria?

Inability to metabolize phenylalanine

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What is the treatment for phenylketonuria?

Low phenylalanine diet and tyrosine supplementation

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Which renal function is most sensitive to dehydration?

BUN

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How will the urine appear with intrinsic renal disease?

Casts (WBC, RBC, granular, epithelial) and protein

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What is a new bio-marker for detecting acute kidney injury?

Cystatin C

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What ultrasound finding indicates a chronic renal problem?

A small kidney less then 10cm

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What are indications for dialysis?

Acidosis, electrolyte disorder, fluid overload, uremic complications

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What are the most common causes of chronic kidney disease?

DM, HTN, glomerulonephritis, and polycystic kidney disease

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What are three abnormal symptoms of renal failure?

Metallic taste, hiccups and pruritus

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What is the gold standard for identifying renal disease?

GFR

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What is the marker for kidney disease?

Proteinuria

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What diagnostic test looks for recent strep infection and is helpful in evaluating post streptococcal glomerulonephritis?

ASO Titer

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How do we define nephrotic syndrome?

Excretion of more than 3.5grams of protein (per 1.73m2) of body surface area

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What are the manifestations of nephrotic syndrome?

Hypoalbuminemia, lipiduria, hypercholesterolemia and edema

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What is a key finding in the urine for nephrotic syndrome?

Oval fat body in urine

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What is the diagnostic method of choice for polycystic renal disease?

Ultrasound

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What are 80% of kidney stones made up from?

Calcium

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What stones are produced by infections?

Struvite stones

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What is the modality of choice in identifying kidney stones?

CT scan Abd/pelvis without contrast

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What are the 5 causes of Diabetes insipidus?

Inherited, lithium, hypokalemia, hypercalcemia or renal disease

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What urine osmolality points to DI?

<250 mOsm/kg

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How is diabetes insipidus treated?

Intranasal desmopressin

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What medication should be administered to patients with hyperkalemia and EKG changes?

Calcium gluconate

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What are the EKG changes in hyperkalemia?

Peaking of T waves, QRS wide and flat P waves

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What treatment is used to remove potassium from the body?

Sodium polystyrene sulfonate (Kayexalate)

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Name the classic sign of hypocalcemia that is identified by tapping on the cheek?

Chvostek sign

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Name the classic sign of hypocalcemia that is identified by tourniquet-ing off the arm with a BP cuff?

Trousseau sign

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What is the suggested treatment for cystitis?

Fluoroquinolone or nitrofurantoin for 3-5 days

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What medications will change your urine red/orange?

Phenazopyridine and Rifampin

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What is the most common bug to cause pyelonephritis?

E.Coli

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What is the recommended treatment for prostatitis?

Cipro 500mg BID, Levoquin 500mg daily for 2- 6 weeks or TMP-SMZ BID for 6 weeks

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What is the bug in male patient with epididymitis less than 35 years old?

GC/Chlamydia

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What is the bug in male patient with epididymitis older than 35 years old?

E.coli

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What is a classic, yet unreliable sign in epididymitis?

Prehn’s sign

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What medication class is effective in treating urge incontinence?

Anticholinergic

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What is the most common kind of prostate CA?

Adenocarcinoma

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What is the most common renal cancer?

Adenocarcinoma

What is the classic triad for renal cancer?

Hematuria, flank pain and palpable mass

What is the most common solid renal tumor in children?

Wilms tumor (nephroblastoma)

What is the initial image testing to evaluate abdominal masses?

Ultrasound

What is the most common cancer in young men?

Testicular

What are the risk factors for testicular cancer?

Cryptorchidism or past testicular CA

What diagnostic markers are diagnostic for non-seminomatous germ cell testicular CA?

Alpha fetoprotein and B-human gonadotropin

What is it called when we can’t retract the foreskin over the glans penis?

Phimosis

What leads to paraphimosis?

Frequent cauterizations without reducing the foreskin

What is a fibrous plaque causing penile curvature?

Peyronie’s disease

What is the class of medications used for erectile dysfunction?

Phosphodiesterase 5 inhibitor

Which two scrotal masses trans-illuminate?

Hydrocele and Spermatocele

Which scrotal mass has a bag of worms presentation?

Variocele

How can the presentation of a varicocele be more pronounced?

Valsalva

What is the most common cause of secondary amenorrhea?

Pregnancy

What are the two most common causes of secondary amenorrhea in patients with normal estrogen?

Asherman syndrome and polycystic ovarian syndrome

What is another name for gonadal dysgenesis?

Turner’s syndrome

What lab test is diagnostic for menopause?

FSH > 30mIU/mL

What is the most common presentation of a leiomyomata (uterine fibroid)?

Vaginal bleeding

What is recommended in most cases of a leiomyomata?

Observation

What is the most common gynecological cancer?

Endometrial cancer (adenocarcinoma)

What is the cardinal symptom of endometrial cancer?

Vaginal bleeding

What patient population is most common in endometriosis?

Nulliparous 30 years old

What are the most common ovarian growths?

Cysts

What is the most common cause of androgen excess and hirsutism?

Polycystic ovarian syndrome

Bilateral enlarged cystic ovaries, amenorrhea and infertility are the key features of this disease?

Polycystic Ovarian Syndrome

How will the ultrasound appear in a patient with Polycystic ovarian syndrome?

Sting of pearls or oyster ovaries

How is infertility of polycystic ovarian syndrome treated?

Clomiphene

When is Cervical itraepithelial neoplasia (CIN) most common to occur?

Women in their 20s

When has the CDC recommend patients receive the HPV vaccine?

Boys and girls age 11-12. Three injections over 5 months.

What kind of cancer are women exposed to diethylstilbestrol (DES) at increased risk for?

Clear cell adenocarcinoma

What bug most commonly causes mastitis?

S. Aureus

What is the antibiotic of choice for mastitis?

Penicillinase resistance antibiotics (dicloxacillin)

What is the most frequent benign condition of the breast?

Fibrocystic Breast Disease

What benign breast lesion is more common in black woman?

Fibroadenoma

What is the most common cancer in woman and what kind is the most common?

Breast, Infiltrating ductal carcinoma

What ductal carcinoma presents with eczematous lesions of the nipple?

Paget disease

What is the best screen test for breast neoplasms?

Mammography

What is the most effective form of contraception?

Oral contraception

What is the black box warning for IM depo injections?

Osteoporosis: thus only to be used for 2 years

What is the most common cause of infertility?

Ovulatory disorders

What is the physical exam finding of pelvic inflammatory disease (PID)?

Chandelier sign

Where should the uterus be at 20 weeks of gestation?

Umbilicus

When should we hear fetal heart tones (FHT)?

10 weeks

What is bluish discoloration of the vagina and cervix called that is seen in pregnancy?

Chadwick sign

Where are most ectopic pregnancies located?

Fallopian tube

What is the most common cause of ectopic pregnancy?

Adhesions

What is the classic triad of ectopic pregnancy?

Unilateral ABD pain, amenorrhea and tenderness/mass on exam

What hCG level should show evidence of an IUP?

1,500 mU/mL

What patients should receive RhoGam with an abortion?

Rh-negative woman

How does a hydatiform mole present on ultrasound?

“grapelike vesicles “or a “snow storm pattern”

What is the most common cause of non-congenital malformation deaths in a neonate?

Preterm delivery

What is a major risk factor of premature rupture of membranes?

Infection

What test can confirm rupture or membranes and spilling of amniotic fluid?

Nitrazine paper and the fern test

What is administered to enhance fetal lung maturity if under 34 weeks gestation?

Betamethasone

What is the classic triad of preeclampsia?

HTN, edema and proteinuria

What is HELLP syndrome?

Hemolysis, elevated liver function and low platelets

What is the most common risk factor for pre-eclampsia?

Nulliparity

What is the first line medication to decrease the risk of seizure in mild pre- eclampsia?

magnesium sulfate (MGSO4)

What BP medication should be given to decrease the BP in a pregnant woman?

Hydralazine or labetalol

What is administered to Rh-negative Moms at 28 weeks?

Rho-Gam

What is the test to measure fetomaternal hemorrhage?

Kleihauer-Betke (KB) stain

What is the condition that develops if Rh-incompatibility leads to severe fetal anemia and death?

Fetal hydrops

What is the most common cause of third trimester bleeding and when does it occur?

Abruptio placenta, after 20 weeks

What is the major symptom in abruptio placenta?

Painful vaginal bleeding

What is contraindicated in a patient with placenta previa?

Digital exam

What is the key differentiating feature of placenta previa from abruption?

Previa is painless

At what time interval is the APGAR assessed?

1 and 5 minutes

What medication decreases blood loss by stimulating contractions?

Oxytocin

What is the leading indication for cesarean section?

Dystonia

When is endometritis most common?

After C-section or PROM for more than 24 hours before delivery

What is the first line treatment for endometritis?

Clindamycin + gentamycin

What is the most common arthopathy?

Osteoarthritis (OA)

What is osteoarthritis involving the DIP called?

Heberden nodes

What is osteoarthritis involving the PIP called?

Bouchard Nodules

What joint is usually spared in Rheumatoid Arthritis?

DIP

What labs are present in 90% of patients with Rheumatoid Arthritis?

RF and anti-cyclic citrullinated peptide

What is the frequent initial disease modifying antirheumatic drug (DMARDs) in RA?

Methotrexate

What is systemic RA called in a child?

Still disease

What is it called when a rash is brought out when scratching an area?

Koebner phenomenon

What is the most common joint pathogen in septic arthritis?

S. Aureus

What cancers met to bone?

Prostate, breast, lung and thyroid

What is the most common benign bone neoplasm?

Enchondroma

What is the most common primary sarcoma?

Chondrosarcoma

What is the most common primary malignant bone tumor?

Multiple myeloma

What is the age range and location of Ewing sarcoma?

5-25 and diaphysis of long bones/ribs

What is the age range and location of Osteosarcoma?

10-20 and in the metaphyseal area of long bones

What type of pain is most often associated with malignancy?

Night pain

What test is used to identify the specific abnormal globulin of multiple myeloma?

Protein electrophoresis

What are the modifiable risk factors of osteoporosis?

ETOH, smoking, low body weight, sedentary lifestyle, low calcium, low Vit D, and steroids

What is the first line treatment for osteoporosis?

Bisphosphonate

How is a Colles fracture described?

Dorsal displacement of distal radius

How is a Smith fracture described?

Volar displacement of distal radius

What orthopedic finding is a red flag for child abuse?

Multiple fractures in various stages of healing

What is the most common cause of facial pain?

TMJ

What is the most common condition affecting the cervical spine?

Spondylosis

What are the most painful conditions of the hand and wrist?

OA and RA

What is OA of the wrist from osteonecrosis of the lunate bone called?

Kienbock disease

What condition affects palmer aponeurosis causing painful nodules, pitting and contractures?

Dupuytren’s disease

What is the most common mononeuropathy?

Carpal Tunnel Syndrome

What is it called when tapping on the volar aspect of wrist causes pain?

Tinel sign

What is it called when flexion of the wrist causes pain?

Phalen sing

What bug infects from a person’s bite and how do you treat this bug?

Eikenella corrodens, Augmentin

What is the most common fracture of the wrist?

Colles Fracture

What is it called when there is a sprain of the ulnar collateral ligament?

Gamekeeper’s thumb

What is the most common fracture of the elbow in the adults?

Radial head fracture

How is the diagnosis of radial head fracture usually diagnosis?

Posterior fat pad or “sail sign” of the anterior fat pad

What is the most common fracture of the carpal bones?

Scaphoid

What is tenosynovitis of the abductor pollicis and extensor pollicis brevis called?

De Quervains disease

What test is used to diagnosis de Quervains disease?

Finkelstein test

What is the most common cause of low back pain?

Prolapsed intervertebral disk

Where is the pain from sciatica felt?

Posterior leg to lateral malleolus

What pain is worse when walking and relieved by leaning forward?

Spinal stenosis

What exercises are helpful for low back pain?

McKenzie exercises

What is the most common location and presentation of scoliosis?

T7/T8 and to the right

What is juvenile kyphosis called?

Scheuermann’s disease

What is TB of the spine called?

Pott’s disease

What is the most common extrapulmonary location of TB?

Spine

What is a seronegative spondyloarthropathy that progresses to fusion called?

Ankylosing spondylosis

What lab test is positive in Ankylosing spondylitis and Reiter’s syndrome?

HLA-B27

What is considered the best exercise for Ankylosing spondylitis?

Swimming

What is aseptic necrosis of the hips called in kids?

Legg-Calve-Perthes disease

What is the name of the XRAY used to diagnosis slipped capital femoral epiphysis?

Frog leg lateral pelvis

What part of the meniscus is most often injured?

Medial

What tests are helpful to diagnosis meniscal tears?

McMurray and Apley

What is the average age and sex of Osgood-Schlatter disease?

12 year old boy

What ligament is most common injured in the knee?

ACL

What test is most sensitive to diagnosis ACL tear?

Lachman’s test

What is the most common sports related injury?

Ankle sprains

How can stability of the ankle be checked?

Anterior drawer test

What is another name for a bunion?

Hallux valgus

When is the pain of plantar fasciitis most common?

What does PTH cause to happen in the body?

Calcium to rise

What is the most common cause of hypercalcemia in ambulatory patients?

Hyperparathyroidism

What is the most common cause of hypercalcemia in hospitalized patients?

Cancer

What is the most common pathological fracture site?

Jaw

What lab test confirms hyperparathyroidism?

Elevated PTH

What is a disorder of excessive systemic copper called?

Wilson’s disease

What is Kayser-Fleischer rings?

Copper deposits in the eye from Wilson’s disease

What is a congenital cause of hypocalcemia due to parathyroid hypoplasia, thymic hypoplasia and cardiac outflow track defect called?

DeGeorge Syndrome

What is the etiology of 80% of hyperthyroidism?

Graves

How are the reflexes in hyperthyroidism?

Brisk

What antibodies are positive in Graves?

Perioxidase and thyroglobulin antibodies

What medication is used to control the symptoms of hyperthyroidism?

B-Blocker like propranolol

What is the drug of choice for hyperthyroidism in a pregnant or lactating female?

PTU

What is the most common cause of hypothyroidism?

Hashimoto’s

What two medications commonly cause hypothyroidism?

Lithium and Amiodarone

What is Sheehan’s syndrome?

Necrosis of pituitary gland that occurs after childbirth

What are the two most common symptoms of hypothyroidism?

Weakness and course dry skin

What is the single best screen test for hypothyroidism?

TSH

What is the hallmark of Myxedema crisis?

Altered mental status

What is the most common cause of a painful thyroid?

de Quervain’s

What is the treatment of choice for de Quervain’s?

Aspirin

What is the most common cause of a sporadic goiter in kids and also the most common thyroid disease in the US?

Hashimoto’s

What is the most common benign nodule of the thyroid?

Follicular Adenoma

What cell has eosinophil staining and malignant potential in the thyroid?

Hurtle Cell

Which thyroid nodules require surgery?

Cold hypo-functioning nodules

What is the most sensitive test to identify thyroid lesions?

Ultrasound

What thyroid CA is most common?

Papillary

What thyroid CA often metastasizes to lung/liver & brain/bone?

Follicular

What childhood exposure increases the risk of thyroid CA 25 times?

Radiation

What is the most common cause of large for gestational age infants?

Maternal diabetes

What are the most common serious presentations of heart disease in the infant?

Cyanosis, CHF & Diminished peripheral pulses

The passage of an infant’s first stool is delayed more than 24 hours after birth, what do you suspect?

Hirschsprung disease

Chromosomal abnormalities and adrenal hyperplasia are most often associated with what finding on an infant?

Ambiguous genitalia

What are the most common causes of unconjugated hyperbilirubinemia in an infant?

Physiologic jaundice, Prematurity and breast-feeding jaundice

What is the classic and most efficient way of gauging sexual maturation in males and females?

Tanner stages

What is the most common neurodevelopmental disorder in children?

Attention-deficit hyperactivity disorder (ADHD)

What is the most common causes of speech and/or language delay in children?

Conductive hearing loss due to chronic middle ear effusion

What are the risk factors for the development of spina bifida (myelomeningocele)?

Insufficient folic acid during pregnancy and maternal use of valproate

Congenital heart disease is common in children with Trisomy 21 (Down syndrome); what is the most common?

Atrial septal defects

What vaccines should be avoided during pregnancy?

Live vaccines: MMR and varicella, and live attenuated influenza vaccine

If a child is immunocompromised, what vaccines should be avoided?

MMR & Varicella

What is a contraindication to giving the tetanus, diphtheria, pertussis (Tdap)/DtaP vaccine?

Chronic seizure disorder

A child presents to the ER with an overdose of acetaminophen, what is the specific antidote?

Acetylcysteine

Activated charcoal and physostigmine can be used to treat an overdose of what class of medications?

Antihistamines

What medication is used to treat iron overdose?

Desferoxamine

What is the current first-line treatment for most ingested poisons?

Activated charcoal

What is the most common innocent murmur of childhood?

Still’s murmur

What is the treatment of Kawasaki disease?

IV immunoglobulin & high-dose ASA

What is the cause of erythema infectiosum, otherwise known as Fifth Disease?

Human parvovirus B19

A child presents with a red face, described as a “slapped cheek” appearance with a lacy, pink macular rash on the torso; what do you suspect?

Erythema infectiousum (Fifth disease, Slapped Cheek)

A child presents with fever x 4 days with an associated pink, macular rash. The child’s mother informs you that the fever has resolved before the rash. What do you suspect?

Roseola

A maculopapular rash common on the face to extremities with associated Koplik spots in the mouth, are indicative of what viral exanthem?

Measles (Rubeola)

What is a common complication of the rubella virus?

Teratogenic (birth defects)

What is a common complication in geriatric patients following surgical admission to the hospital?

Delirium

What are two reasons to avoid NSAID’s in the elderly population?

Risk of GI bleed & renal toxicity

What class of medication should be avoided in the elderly due to the potential for delirium and other anticholinergic effects?

Tricyclic antidepressants

True/False: Incontinence is a normal part of aging?

False: Incontinence is NOT a normal part of aging and new onset requires further investigation.

True/False: Impairment of cognition is not a normal part of aging.

TRUE

What are the drugs of choice for treating depression in the elderly?

SSRI’s

When treating anxiety in the elderly, what classes of medication should be avoided?

Benzodiazepines and Antihistamines

How do you characterize senile psychosis?

Hallucinations and delusions

What are common drugs that can cause taste disturbances?

Anticholinergic agents, Digitalis & ACE inhibitors

When treating systolic hypertension in the elderly, what is considered class of medication is considered first line?

Thiazide diuretics

At what dose should HCTZ not be exceeded in elderly patients, as it may result in more side effects and not blood pressure control?

25 mg

What is a common presentation of aortic stenosis in the elderly?

Syncope, CHF & Fatigue

When should preoperative creatinine levels be obtained?

Patients older than 40 years

What is the best determinant of bleeding tendencies during surgery?

Coagulation response to minor trauma

In what patient populations are silent myocardial infarctions more commonly seen?

Elderly and diabetics

When is a pregnancy test indicated in the preoperative evaluation of a surgical patient?

All women of childbearing age

When evaluating a patients potential for risk of DVT, what has been the classic identifiers?

Virchow’s Triad: stasis, intimal damage, and hypercoagulability

What is the preferred DVT prophylaxis for trauma patients or those with abdominal or pelvic cancer?

Lovenox (enoxaprin)

True/False: Does the dose of enoxaprin have to be adjusted in patients with renal impairment?

TRUE

When considering a potential cause of diarrhea in a patient receiving enteral feedings, what should always be ruled out?

Clostridium difficile

What is the leading cause of death between the ages of 1 and 44 years?

Unintentional and violence-related injuries

What is the leading cause of accidental death in the United States?

Motor vehicle accidents

What are the signs that characterize cardiac tamponade?

Beck’s Triad: jugular venous distention, hypotension, and muffled heart sounds

How are most cases of penetrating chest traumas managed?

Tube thoracotomy

What is the test of choice for detecting intra-abdominal injury?

Focused Assessment with Sonography for Trauma (FAST) examination

True/False: The presence of a pulse distal to the site of vascular injury rules out significant vascular injury?

False:

When evaluating a head trauma patient, you appreciate rhinorrhea, otorrhea, ecchymosis of the lids (raccoon eyes), and ecchymosis behind the ears (Battle’s sign), what do you suspect?

Basilar Skull Fracture

Injury to what artery is the usual cause of epidural hematomas?

Middle meningeal artery

When considering the mental status of a head injury patient, what is a common presentation of a patient with an epidural hematoma?

A brief period of unconsciousness is followed by a lucid interval.

What is the triad of signs indicative of brain herniation?

Coma, fixed and dilated pupils, and decerebrate posturing

What is the most common type of burn?

Scald burns

How are first degree burns characterized?

Erythema, tenderness and the absence of blisters

A burn victim presents with thin-walled, fluid-filled blisters, that are moist, blanche with pressure and are painful, what do you suspect?

Second-degree burn

What is the characteristic appearance of the skin following a third degree burn?

Dry, with a white, leathery or charred appearance, and without sensation

When estimating the percentage of burn, the palm of the victim’s hand is roughly what percentage?

What is the most commonly used topical burn ointment?

Sulfadiazine (Silvadene)

What is the most common complication associated with all burns?

Infection

When considering postoperative fever, what is the most likely cause within the first 24-48 hrs postoperatively?

Atelectasis (Wind)

What would you suspect the cause of a fever in a patient 48-72 hours after surgery?

UTI (Water)

What is the most common cause of postoperative fever after 72 hours and which is the common pathogen that causes this?

Wound infection, Staphylococcus aureus

What is the most common nosocomial acquired infection?

UTIs

What is the most effective approach to preventing pressure ulcers?

Frequent position changes, removal of moistures

In what patient populations is necrotizing fasciitis more commonly seen?

DM, alcoholics, and IV drug abusers

What is the most important complication of laparoscopic cholecystectomy?

Biliary injury

What is the most common complication of surgically repairing an inguinal hernia?

Recurrence of the hernia

What is the most common complication of open appendectomy?

Wound infection

What is the most common complication of laparoscopic appendectomy?

Intra-abdominal abscess

What is the most important preoperative evaluation performed by the surgical team?

History and physical exam

What is a common postoperative complication seen with the use of unfractionated heparin?

Hematoma

When considering the primary survey (ABC’s) in a trauma patient, what is the most common indication for and preferred modality of intubation?

Altered mental status

Usually a self-limited disease, how long is the duration of pharyngitis?

3-4 days

The rash of erysipelas is typically confined to what area of the body?

Face

Thick, crusted, golden “honey” yellow lesions, best describes what?

Impetigo (Streptococcus pyoderma)

What is the most common cause of cellulitis in the United States?

Group A streptococci

True/False: When diagnosing acute rheumatic fever using the Jones criteria, the presence of two major criteria or one major and two minor criteria plus evidence of recent B-hemolytic streptococci (culture or ASO titer) makes the diagnosis?

TRUE

When using the Centor’s criteria, what is the percentage of chance a sore throat is caused by group A B-hemolytic streptococcus is the cause when 3 out of 4 criteria are present?

40-60%

What should be avoided in infants due to increased risk of botulism?

Honey

A sudden onset of severe, frequent ‘rice water diarrhea is suggestive of what?

Cholera

What is the incubation period of tetanus following a puncture wound?

5 days to 15 weeks

In patients with tetanus, hyperreflexia and muscle spasms develop most commonly in what areas?

Jaw and face

What should be given as part of the treatment of tetanus?

IM tetanus immunoglobin and PCN

Salmonella bacteremia is most commonly seen in what type of patients?

Immunosuppressed

True/False: When considering shigellosis, individuals who are HLA-B27 positive may mount a reactive arthritis because of temporary disaccharidase deficiency.

TRUE

What is the treatment of choice in shigellosis?

TMP-SMX

What two antibiotics are effective in the treatment of diphtheria?

PCN or erythromycin

What is the medication of choice in the treatment of pertussis?

Erythromycin

What is the vaccine of choice for adults in the prevention of pertussis?

Tdap

What is the most characteristic disease with EBV as the implicated cause?

Mononucleosis (the kissing disease’)

Splenomegaly is present in what percentage of cases of EBV infection?

50%

Administration of what antibiotic increases the incidence of rash in patients with EBV infection?

Amoxicillin

Patients with mononucleosis with associated splenomegaly should be counseled against what?

Contact sports

How do you define Reyes syndrome?

Fatty liver with encephalopathy

Ingestion of what medication increases the incidence of Reyes syndrome in children with influenza A or varicella infection and what age does this peak?

Aspirin, 5-14 years

What two medications are no longer recommended as single therapy agents in the treatment of influenza because of resistance?

Amantadine and rimantadine

When is varicella-zoster the most contagious?

The day before the rash appears

What is the characteristic description of the lesions seen in varicella-zoster?

Lesions begin as erythematous macules and papules, form superficial vesicles (‘dewdrops on rose petal’), and later crust over

Eruptions of zoster lesions on the tip of the nose (Hutchinson sign) indicates involvement of what cranial nerve and risks corneal involvement?

Trigeminal

How is AIDS defined by the CDC?

CD4 count below 200

When examining the eyes of an immunocompromised patient, you notice neovascularization and proliferative lesions, commonly referred to as ‘pizza pie,’ what do you suspect?

CMV retinitis

What is the most common form of pathogenic Candida species?

Candida albicans

What is the name of a dimorphic fungus found in soil infested with bird or bat droppings?

Histoplasma capsulatum

What is the name of an encapsulated, budding yeast found in soil contaminated with dried pigeon dung?

Cryptococcus neoformans

What test is helpful in the diagnosis of cryptococcal infection?

India ink stain

What is the treatment of choice for pneumocystis jiroveci pneumonia?

TMP-SMX

What is an alternative treatment to TMP-SMX in the treatment of pneumocystis jiroveci pneumonia?

Dapsone

What is the recommended treatment for hookworms?

Mebendazole twice per day for 3 days

What is the only host for Enterobius vermicularis?

Humans

What are the characteristic symptoms found in patients with pinworms?

Perianal pruritus, insomnia, weight loss, enuresis, and irritability

True/False: All members of a household of a patient with pinworms should be treated.

TRUE

In the treatment of pinworms, a single dose of albendazole, mebendazole, or pyrantel is given and then repeated when?

2-4 weeks later

In making the diagnosis of malaria, blood films are stained with what?

Giemsa or Wright stain

What is the drug of choice for both the prophylaxis and treatment of malaria?

Chloroquine

Primary syphilis is characterized by what?

Chancre: a painless ulcer with clean base and firm, indurated margins

Gummatous lesions involving the skin, bones and viscera are seen in what stage of syphilis?

Late (tertiary) syphilis

Hutchinson teeth are a common manifestation of infants not treated with what disease?

Congenital syphilis

In what disease states can the fluorescent treponemal antibody absorption test yield a false positive result?

Lyme disease, systemic lupus erythematous, malaria or leprosy

What is the treatment of choice for syphilis?

Benzathine penicillin G 2.4 million U IM in a single dose

In the treatment of syphilis, what can occur when there is massive destruction of spirochetes?

Jarisch-Herxheimer reaction (fever, toxic state)

Without treatment, gonorrhea can progress to involve what structures in males?

Prostate, epididymis, and periurethral glands

What is the treatment of choice for gonorrhea?

IM ceftriaxone or oral cefixime

Lymphogranuloma venereum starts with vesicular or ulcerative lesions which may spread to the lymph nodes causing what?

Inguinal buboes

What is the drug of choice in the treatment of chlamydia in pregnant women?

Erythromycin

Trichomoniasis is what type of organism?

Flagellated protozoan

What is the most common vector-borne disease in the United States?

Lyme disease

What is the drug of choice in patients with erythema migrans or a suspicion of Lyme disease based on clinical findings and a history of tick bite?

Doxycycline

What is transmitted by the wood tick?

Rickettsia

Treatment with what has been shown to hasten recovery in patients with Rocky Mountain spotted fever?

Doxycycline or chloramphenicol

Rubbing a lesion that causes urticarial flare is referred to as?

Darier’s sign

Pinpoint bleeding after a scale is removed is referred to as?

Auspitz sign

Pushing a blister causing further separation of the dermis is referred to as?

Nikolsky’s sign

A patch test demonstrates what?

Hypersensitivity reaction

Minor trauma leading to new lesions at the site of trauma is referred to as?

Koebner phenomenon

What test is used to identify dermatophyte infection?

Potassium hydroxide preparation (KOH prep)

Thickened skin with distinct borders, often resulting from excessive scratching or prolonged irritation is referred to as?

Lichenification

You are examining a child with diaper rash and you notice satellite lesions, what do you suspect?

Candida infection

Where is the rash of atopic dermatitis most commonly located?

Flexural surfaces, neck, eyelids, forehead, face and dorsum of the hands and feet

What is the mainstay of treatment of atopic dermatitis?

Topical corticosteroids

In the treatment of dandruff, shampoos with which two elements has been shown beneficial in acute flare ups?

Selenium and zinc

Describe the skin manifestations of lichenification.

Well-circumscribed plaques that are highly pruritic, which sets up a cycle of itch-scratch lesions

Round, salmon-colored, slightly raised, popular and macular lesions aligned in a “Christmas tree-like distribution”, what do you suspect?

Pityriasis rosea

Pityriasis rosea is a self-limiting condition of what duration?

3-8 weeks

What is the cause of molluscum contagiosum?

Poxvirus

What are the 4 P’s of lichen planus?

Purple, polygonal, pruritic, papule

Describe the lesion of lichen planus.

Flat-topped, shiny, violaceous papules with fine white lines on the surface (Wickham striae)

True/False: Koebner phenomenon is seen in lichen planus?

TRUE

All patients with lichen planus should be screened for what disease state?

Hepatitis C

In what climate is dyshidrotic eczematous dermatitis (dyshidrosis) seen?

Hot, humid weather

What is the basic pathology found in psoriasis?

Enhanced epidermal cell turnover

In psoriatic lesions, peeling away a scale produces specks of bleeding from the capillaries. What is this called?

Auspitz sign

In patients with psoriasis, scratching leads to more lesions. What is this referred to?

Koebner phenomenon

What is the most common variant of psoriasis?

Psoriasis vulgaris

Which form of psoriasis involves the entire skin surface?

Psoriatic erythroderma

Pemphigus vulgaris is more commonly seen in people of what decent?

Jewish or Mediterranean

In pemphigus vulgaris, there is lateral extension of the lesions when they are pushed. What is this referring to?

Nikolsky’s sign

What are the hallmark lesions of acne?

Comedones

What are the topical preparations used in the treatment of mild acne?

Retinoids, azelaic acid, and salicylic acid

What is the drug of choice in the treatment of more serious or cystic acne?

Tetracycline’s

True/False: Acne rosacea is a chronic acneiform disorder mainly affecting females between 30 and 50 years of age.

TRUE

What are typical triggers of acne rosacea?

Heat, alcohol, sun, or hot, spicy foods

What is characterized by the insidious onset of scattered, small papulopustules and sometimes nodules, in which comedones are absent and the face appears red or flushed?

Acne rosacea

What does the suffix “-phyma” mean?

Enlarged

What is the most common cause of folliculitis?

Staph aureus

What is the cause of folliculitis seen in hot tub users?

Pseudomonal folliculitis

What are three common causes of erythema multiforme?

1.Drugs (sulfonamides, phenytoin, barbiturates, PCN, allopurinol) 2. Infections (HSV, Mycoplasma) 3. Idiopathic: 50% of cases

What is the hallmark of erythema multiforme major?

Mucosal lesions that are painful and erode

What two conditions are mucocutaneous blistering reactions most often caused by a drug reaction?

Steven-Johnson syndrome and toxic erythema necrolysis (TEN)

Where should SJS/TEN patients with extensive necrolysis be care for?

Burn unit

What pathogen is the most common cause of furuncles?

Staph aureus

What is the first step in the treatment of furuncles and carbuncles?

Warm, moist compresses

When beginning broad spectrum antibiotic treatment for cellulitis, what three organisms should be covered?

Haemophilus influenza, Streptococcus and Staphylococcus

In patients who are allergic to penicillin, what is the most appropriate antibiotic alternative?

Erythromycin

What should patients taking griseofulvin be advised to avoid?

Alcohol

What is the cause of tinea versicolor?

Malassezia furfur

What is the characteristic feature of tinea versicolor?

Hypo- or hyperpigmented macules that do not tan in areas of overgrowth

What is the treatment of choice of tinea versicolor?

Selenium sulfide shampoo

What is the most common distribution seen in scabies?

Hands, wrists, web spaces

What is the most important spider bite that can puncture the skin in the United States?

Brown recluse (Loxosceles reclusa)

What three topical insecticides are considered the first line treatment of pediculosis (lice)?

Permethrin, pyrethrins, and malathion

What is the most common type of malignant melanoma?

Superficial spreading malignant melanoma

How is prognosis determined in melanoma patients?

Depth of the lesion (Breslow depth)

What are the two most common neoplasms of the skin?

Squamous and basal cell carcinomas

What is the typical presentation of squamous cell lesions?

Sharply demarcated, scaling, or hyperkeratotic macule, papule, or plaque

How are stage I decubitus ulcers characterized?

Non blanching erythema of intact skin

What is the most effective solutions in patients with new onset and smaller areas of hair loss?

Minoxidil

Alopecia areata may be seen in what four disease states?

Thyroiditis, pernicious anemia, systemic lupus erythematosus (SLE), Addison disease

What is a felon?

Subcutaneous infection of the pulp space of the nail

What is the most significant and treatable risk factor for stroke?

HTN

Strokes involving the anterior circulation are likely to produce what signs and symptoms?

Hemispheric: aphasia, apraxia, hemiparesis, hemisensory loss, and/or visual field defects

Strokes involving the posterior circulation are likely to produce what signs and symptoms?

Evidence of brain stem dysfunction: coma, drop attacks, vertigo, nausea, vomiting, and/or ataxia

What is the best imaging modality for differentiating ischemic from hemorrhagic stroke and is recommended during the acute phase?

Noncontrast CT

Thrombolytic therapy is found to be most effective in reducing the extent of deficit caused by a stroke if given within how long of symptoms onset?

3 hours

What is the indication for endarterectomy?

Greater than 70% stenosis of the common or internal carotid artery

What two disease processes are often associated with cerebral aneurysms?

Polycystic kidney disease and coarctation of the aorta

A patient presents to the ER with complaints of an unusually severe, generalized headache of sudden onset, stating “this is the worst headache I’ve had in my life.” What do you suspect?

Subarachnoid hemorrhage

What is the treatment of status epilepticus?

IV diazepam or lorazepam until the seizure stops with a loading dose of phenytoin or fosphenytoin

What is the pathogenesis associated with multiple sclerosis?

Inflammation associated with multiple foci of demyelination in the CNS white matter

True/False: Age of onset for multiple sclerosis in 18-45 years and is more common in women than men.

TRUE

What are the two most common presenting symptoms of multiple sclerosis?

Sensory complaints in the limbs and vision loss (high correlation with optic neuritis)

What diagnostic test allows for visualization of white matter lesions in the CNS?

MRI with gadolinium

What is commonly found in the CSF of patients with multiple sclerosis?

Oligoclonal bands

What two medications have been shown to improve spasticity commonly seen with multiple sclerosis?

Baclofen and diazepam

What is the most common form of dementia?

Alzheimer disease

What class of medication may be used to delay the progression of Alzheimer disease and improve memory function?

Acetylcholinesterase inhibitors

What medication has been used in the treatment of moderate to severe Alzheimer disease?

memantine (Namenda)

What is a potential cause of frontotemporal dementia and what is this associated with?

Pick disease, Amyotrophic lateral sclerosis

What are common frontal lobe symptoms associated with frontotemporal dementia?

Behavioral symptoms (euphoria, apathy, disinhibition) and compulsive disorders.

What is the most common type of headache?

Tension headaches

What is the treatment of choice for cluster headaches?

Oxygen and/or injection of SC sumatriptan

What is the preferred therapy for prophylaxis of cluster headaches?

Verapamil

What medication is used in controlling benign essential tremors?

Propanolol

What are the essential clinical features that establish a diagnosis of Parkinson disease?

Resting tremor, bradykinesia, rigidity, and postural instability

When considering bradykinesia is patients with Parkinson disease, what is are common facial features?

Infrequent blinking and mask-like faces

When testing passive range of motion on a patient’s suspected of having Parkinson disease, what would you expect to find?

Cogwheel rigidity

On what chromosome is the gene responsible for Huntington disease found?

Chromosome 4

What are the characteristic features seen in Huntington disease?

Progressive chorea and dementia

What is the most common initial manifestation seen with Tourette syndrome?

Phonic tics: grunts, barks, hisses, coughing or verbal utterances

What disease process is characterized by a chronic impairment of muscle tone, strength, coordination or movements?

Cerebral palsy

When do the symptoms of restless leg syndrome most commonly occur?

During periods of prolonged inactivity or rest

In addition to prescription medication management, a trial of what is now recommended in all patients with restless leg syndrome?

Iron (avoid in patients with iron overload)

On which side of the face is Bell palsy most common to occur?

Right side: 60% of cases

In what two patient populations is Bell palsy more prominent?

Pregnant women and diabetics

What cranial nerve supplies the muscles affected in Bell palsy?

CN VII

When does the facial weakness of Bell palsy peak?

About 21 days or less

What other disease processes lead to facial palsy that should be ruled out prior to the diagnosis of Bell palsy?

Stroke, tumors, Lyme disease, AIDS, sarcoidosis

What is the most common form of neuropathy diagnosed in the western hemisphere?

Diabetic neuropathy

What medication has recently been approved for the treatment of painful diabetic neuropathy?

duloxetine (Cymbalta): SNRI

What is the most common precipitant of Guillain-Barre syndrome (acute idiopathic polyneuropathy)

Campylobacter jejuni

Describe the pattern of weakness noted in patients with Guillain-Barre syndrome.

Symmetrical extremity weakness that begins distally and ascends

In what percentage of patients with Guillain-Barre syndrome are cranial nerves affected?

45-75%

What form of treatment has been shown to reduce the time required for recovery and may reduce the likelihood of residual neurologic deficits in patients with Guillain-Barre syndrome?

Plasmapheresis

In the treatment of Guillain-Barre syndrome, what form of treatment is preferred over plasmapheresis in adults with cardiovascular instability and in children?

IV immunoglobulin (IVIG)

Describe the characteristics of myasthenia gravis.

Muscle weakness and fatigability, which improves with rest

What is the mainstay of treatment for myasthenia gravis?

Cholinesterase inhibitors, such as pyridostigmine

What are the three primary causes of bacterial meningitis?

Streptococcus pneumonia, Neisseria meningitidis, and group B streptococci

What is the most common bacterial cause of meningitis in neonates younger than 1 month of age?

Group B Streptococcus

What clinical feature is characteristic of Neisseria meningitidis?

Petechial rash

Prompt lumbar puncture and CSF analysis are essential in making the diagnosis of bacterial meningitis. Prior to the lumbar puncture, what diagnostic test must be performed and why?

CT scan to rule out space-occupying lesion

Neonates with bacterial meningitis are commonly treated with what antibiotic regimen?

Ampicillin and cefotaxime

What is the treatment of choice for bacterial meningitis in immunocompetent children older than 3 months of age and adults younger than 55 years?

cefotaxime or ceftriaxone plus vancomycin

What two potential combinations are used in the treatment of bacterial meningitis in adults older than 55 years and those of any age with alcoholism or debilitating illness?

Ampicillin plus cefotaxime or ceftriaxone plus vancomycin

What is the combination of antibiotics given to hospital-acquired, post traumatic or post neurosurgery meningitis, or if the patient is immunocompromised?

Ampicillin plus ceftazidime plus vancomycin

What medication is recommended in adults with meningitis secondary to S. pneumonia and in children older than 1 month of age with meningitis secondary to Hib?

Dexamethasone

What is the treatment for suspected herpes viral meningitis?

Acyclovir

What are the presenting symptoms seen in patients with a brain abscess?

Vomiting, fever, altered mental status and focal neurologic signs

Lumbar puncture is contraindicated in patients with what type of presenting symptoms and signs?

Focal neurologic symptoms or focal neurologic signs as brain stem herniation may be precipitated

In patients who suffered head trauma, loss of conscious of what duration implies a worse prognosis?

2 minutes

What would you expect to find in a patient with central cord syndrome?

Lower motor neuron deficit and loss of pain and temperature with sparing of the posterior column functions

What are the most common primary intracranial neoplasms?

Gliomas

What are the most common sources of intracranial metastasis?

Lung, breast, kidney and GI tract cancer

What are the six major hormones produced by the anterior pituitary gland?

ACTH, THS, LH, GH, FSH, prolactin

What are the two hormones stored in the posterior pituitary gland?

ADH (vasopressin), oxytocin

What are the diagnostic criteria for prediabetes?

HbA1c (%): 5.7- 6.4, fasting glucose: 100-125 mg/dL, oral glucose tolerance test: 140-199 mg/dL

In patients with poor control of their metabolic syndrome with diet and exercise alone, what medication is recommended?

Metformin

In the United States, what is the leading cause of blindness in adults over 60 years of age?

Diabetic retinopathy

What is the most common complication of DM?

Neuropathy

What is the characteristic pattern of occurrence scene in diabetic neuropathy?

Peripheral symmetric polyneuropathy (stocking and glove distribution)

As a first line intervention, all diabetics should be counseled on what?

Diet

In patients with diabetes, what is used in the primary prevention in patients with increased cardiovascular risk?

Daily ASA (75-325 mg/d)

What is the most common first line agent in the treatment of DM?

metformin

Deficiency of what vitamin can be seen with prolonged use of metformin?

Vitamin B12

How often are ophthalmologic exams recommended in monitoring for diabetic retinopathy?

Annual

Elevated LDL levels increase the risk of what disease process?

CAD

Severe elevations of triglycerides can cause what disease process?

Pancreatitis

What is the recommended first line management in patients with hyperlipidemia?

Lifestyle modifications: diet and at least 30 minutes of daily exercise

What are common side effects seen with the use of statins (HMG-CoA inhibitors)?

Myalgia’s and GI complaints

What is a common side effect seen with niacin and how can it be reduced?

Prostaglandin-induced flushing: reduce by taking ASA 30 minutes prior or a daily NSAID

What class of medications are the most potent for lowering triglyceride levels and raising HDL?

Fibric acid derivatives

What are potential complications from treatment with fibric acid derivatives?

Gallstones, hepatitis, myositis

What are common symptoms of hypercortisolism?

Obesity, HTN, thirst, polyuria

What are the characteristic features associated with hypercortisolism?

Buffalo hump, moon facies, supraclavicular pads

What are the most specific signs indicative of hypercortisolism?

Proximal muscle weakness and pigmented striae more than 1 cm wide

You suspect a patient of having hypercortisolism, what diagnostic tests would aid in your decision making?

Dexamethasone suppression test, 24-hr urine collection for free cortisol and creatinine

At what diagnostic threshold of plasma or serum ACTH would be suggestive of an adrenal tumor?

ACTH < 20 pg/mL

What characteristic finding is only found in primary Addison disease?

Hyperpigmentation due to elevated ACTH

What signs and symptoms would you expect to see in a patient with Addison’s crisis?

Hypotension, acute pain (abdomen, low back), vomiting, diarrhea, dehydration, altered mental status

What class of medications is considered first line in the treatment of mood disorders and how long should they be continued to determine efficacy?

SSRIs and 4-6 weeks

What are common side effects associated with lithium?

Weight gain, tremor, nausea, increased thirst and urination, drowsiness, hypothyroidism, arrhythmias, and seizures

Which personality disorder is characterized by a lifelong pattern of voluntary social withdrawal, and is often perceived as eccentric and reclusive?

Schizoid personality disorder

What class of medications is used to control hostility and brief psychotic episodes in patients with borderline personality disorder?

Antipsychotics

What is the most common mental disorder in the United States?

Phobias

What is a common lab finding in patients with eating disorders?

Hypochloremic hypokalemic metabolic alkalosis

What are the most commonly abused drugs?

Alcohol, nicotine, and caffeine

When would you expect withdrawal symptoms to present in a patient who abuses alcohol?

6-18 hours after cessation of alcohol

What medication is used in the reversal of any opioid?

Naloxone

You are evaluating a baby in the ER and notice retinal hemorrhages and hyphema, what do you suspect?

Shaken baby syndrome

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