CME4LIFE PANCE BOARD REVIEW FLASHCARDS 2018
HIGH YIELD INFO FOR THE 2018 PANCE
What nerve are we checking for with EOM with an orbital fracture?
Infra-orbital Nerve
What kind of lesion represents herpes keratitis?
Dendritic
Where is the tear from retinal detachment most common?
Superior temporal area
What is classically described as a curtain being drawn over the eye from the top to the bottom?
Retinal Detachment
What is the leading cause of irreversible central vision loss?
Macular degeneration
How is the metamorphosis of macular degeneration best measured?
Amsler Grid
What is the leading cause of blindness in the USA?
Diabetic retinopathy
An impediment through what structure leads to glaucoma?
Canal of Schlemm
Which kind of glaucoma is most common?
Open angle
What is the main symptom of glaucoma?
Peripheral visual field loss
What is periorbital cellulitis primarily associated with?
Sinusitis
When is dacryostenosis most common and what is the treatment?
Newborns. Symptomatic treatment.
What is involved with an internal hordeolum and what is the common pathogen?
Meibomian gland, S. Aureus
What is the most common pathogens of bacterial conjunctivitis?
Strep pneumonia, S. Aureus and HFlu
What two diseases are caused by Neisseria?
Gonorrhea and Meningitis
What do we call a yellowish, fleshy conjunctival mass typically on the nasal side?
Pinguecula
What are the main causes of papilledema?
Malignant HTN, Increased intracranial pressure and pseudotumor cerebri
How will papilledema appear?
Disc swollen with margins blurred and obliteration of the vessels
What are the two most common causes of transient vision loss?
Emboli (amaurosis fugax) or giant cell (temporal) arteritis
What causes sudden vision loss?
Central retinal vein occlusion, optic neuropathy, papillitis or retrobulbar neuritis
What is the most common cause of amblyopia?
Strabismus
What is blue/cyanotic discoloration of the sclera associated with?
Osteogenesis imperfecta
With a conduction hearing loss, how will the Webber test respond?
Lateralize to the affected ear
With conductive hearing loss, how will the Rinne test respond?
Bone conduction greater then air conduction
What is the most common cause of sensorineural hearing loss and what kind of hearing is lost?
Presbycusis, high frequency
What are the four main features of Meniere’s disease?
Vertigo, low range hearing loss, tinnitus and ear pressure
What drugs ototoxic agents lead to hearing loss?
Aminoglycosides, loops, and chemotherapy drugs (cisplastin)
What bugs most are most common in otitis media?
Strep, H.flu and M.Cat
What kind of nystagmus is associated with peripheral vertigo?
Horizontal with rotatory component.
What test is used to diagnosis BPPV?
Dix-Hallpike
True or False: Most cases of sinusitis resolves without antibiotics?
TRUE
What symptoms are suggestive of Group A beta hemolytic strep?
Centor’s Criteria
What symptoms are NOT consistent with Group A beta hemolytic strep?
Corzya, hoarse voice or cough
What is the antibiotic of choice for Group A beta hemolytic strep if PCN allergic?
Erythromycin
What is the diagnosis consistent with sore throat, uvula deviation, drooling, and trismus?
Peritonsillar abscess
How will aphthous ulcers appear in the mouth?
Painful, round with yellowish-gray centers & red halos
What is the most common yeast in oral thrush?
Candidia albicans
What is the location of anterior nose bleeds?
Kiesselbach plexus
What is the triad called of nasal polyps, asthma and aspirin sensitivity?
Samter’s triad
What is the most common cause of community acquired pneumonia (CAP)?
Strep pneumonia
What antibiotic is appropriate for outpatient treatment of community acquired pneumonia (CAP)?
Macrolide (not erythromycin) or doxycycline
Who is the pneumococcal polysaccharide vaccine recommended for?
Young and old, sick, sickle cell, smokers, no spleen and liver disease
What are two buzz words that go with Mycoplasma pneumoniae?
Bullous myringitis and cold agglutinins
What are two buzz words with pneumocystis jiroveci?
Elevated LDH and hyper-hypoxia
What is a buzz word for pneumococcal pneumonia? (aka streptococcus pneumonia)
Rust colored sputum
What is a buzz word for klebisella pneumonia?
ETOH abuse and current jelly sputum
What bug is most likely to cause pneumonia in a patient with ETOH abuse?
Klebsiella
What bug is most likely to cause pneumonia in a patient with COPD?
Haemophilus
What bug is most likely to cause pneumonia in a patient with cystic fibrosis?
Pseudomonas
What bug is most likely to cause pneumonia young adults?
Mycoplasma/chlamydia
What bug is most likely to cause pneumonia in a patient with exposure to aerosolized water?
Legionella
What bug is most likely to cause pneumonia in children less than 1 year old?
RSV
What bug is most likely to cause pneumonia in children less than 2 years old?
Parainfluenza
What is the most common hospital acquired infection?
UTI
What is the most likely pathogen for ICU acquired pneumonia?
Pseudomonas
What is the most common opportunistic infection in patients with HIV infection?
Pneumocystis jiroveci (formerly P. carinii)
What are the classic symptoms of TB?
Fever, night sweats, weight loss
What are Ghon complexes that represent healed infection?
Calcified primary focus in the lungs
What is the historical landmark of TB?
Caseating granuloma that is AKA necrotizing granuloma
What are the side effects of INH?
B6 deficiency, hepatitis, neuropathy
What are the side effects of rifampin?
Orange discoloration and hepatitis
What is NOT predictive of bacterial bronchitis?
Sputum color
What is the leading cause of cancer death?
Bronchogenic carcinoma
What radiographic finding is diagnostic for epiglottitis?
Thumbprint sign
What radiographic finding is diagnostic for croup?
Steeple sign
What is the most common cause of bronchogenic CA?
Adenocarcinoma
What is the treatment of choice for Non-small cell CA?
Surgery
What are the three components of asthma?
Obstruction of airflow, hyperreactivity and inflammation
What change in FEV1 after bronchodilation is supportive of the diagnosis of asthma?
10%
What is the most effective anti-inflammatory for chronic asthma?
Inhaled steroids
What is the most contributing cause of COPD?
Smoking
What deficiency leads to COPD?
Alpha 1 antitrypsin
What is the single most important intervention in COPD?
Stopping smoking
What is superior to B agonists in achieving bronchodilation?
Anticholinergics (ipratropium or tiotropium)
What therapy is the only therapy that may alter the course of COPD?
Supplemental oxygen
What are the main symptoms of cystic fibrosis?
Cough, excessive sputum, sinusitis, steatorrhea and ABD pain
What is the gold standard for identifying a pleural effusion?
Thoracentesis
What are the most common irritants used for pleurodesis?
Doxycycline and talc
What type of image reveals the presence of pneumothorax?
Expiratory CXR
What are the risk factors for DVT/PE?
Virchow’s Triad: Damage, Stasis and hypercoaguable state
What are the most common hypercoaguable states?
High estrogen, cancer and genetics
What is the initial method for the diagnosis of PE?
Spiral CT
When is a negative D.Dimer helpful in ruling out PE?
With low pre-test probability
What is the definitive test for PE?
Pulmonary angiogram
What physical findings are suggestive of pulmonary HTN?
Systolic ejection click and splitting/accentuation S2
What causes pneumoconoises?
Coal dust, silicate or other inert dusts
What is used to relieve chronic alveolitis in silicosis?
Steroids
What CXR findings are seen in asbestosis?
Pleural based plaques
What is the number one complication of asbestosis?
Mesothelioma
What disease is a multiorgan disease of idiopathic cause characterized by noncaseating granulomatous inflammation in affected organs?
Sarcoidosis
What is the main presentation of an aspirated foreign body?
Choking, coughing or unexplained wheezing or hemoptysis
What is the most common cause of respiratory disease in a preterm infant?
Hyaline membrane disease
What can be used as prophylaxis or rescue in a patient with established hyaline membrane disease?
Exogenous surfactant
What is the most common cause of shock
Gram negative sepsis
What lab test can identify and monitor sepsis?
Lactate
How should urine output be monitored in a patient with shock?
Indwelling catheter with a urine output of 0.5mL/kg/hour
How long should it take to lower a patient with a HTN urgency?
Hours
How long should it take to lower a patient with HTN emergency?
1 hour
What are the findings of malignant HTN?
Papilledema, encephalopathy or renal failure
What is the most common symptom of HTN?
Headache
What is recommended as the initial agent for HTN?
Diuretic
What diuretic should be used in patients with renal disease?
Loop Diuretics
In which patients are B-blockers most effective?
Younger/Caucasian
What is the initial drug of choice in a diabetic patient with HTN?
ACE Inhibitors
What is the major side effect of an ACE Inhibitor?
Cough
What agent is preferred for HTN in blacks and elderly?
Calcium Channel Blocker
What medications are recommended for BP control in aortic dissection?
Nitroprusside and a B-blocker
What is the anti-HTN medication of choice in a pregnant patient?
Hydralazine
What are the cardiac signs of CHF?
Enlarged heart, diminished first heart sound and S3
What is the most useful image with CHF?
Echocardiogram
What two medications prolong life in a patient with CHF?
ACE Inhibitor and B-Blockers
When is an implantable cardio-defibrillator indicated in a patient with CHF?
EF<35%
What is the most common cause of cardiovascular death and disability?
Atherosclerosis
What are the risk factors for arterial disease?
Smoking, Age (M > 55 and F > 65,) DM, Cholesterol, HTN and family history
Name the three kinds of angina
Stable (predictable,) unstable (unpredictable) and Prinzmetal
What is the most common presentation of unstable angina?
Resting chest pain
What is Levine sign?
Clenched fist and teeth to describe angina pain
How long does stable angina last?
Less than 3 minutes
What is the most sensitive clinical sign of angina on an EKG?
Horizontal or down sloping ST segment depression
What percent of patients with unstable angina will have a normal EKG?
25%
What is the most useful and cost effective noninvasive test for angina?
Exercise stress testing
What is the definitive diagnosis for angina?
Coronary angiogram
What is the primary pharmacotherapy for angina?
Sublingual nitroglycerine
What is the first line therapy for chronic angina?
B-Blockers
What medication prolongs exercise duration and time to angina?
Ranolazine
What disease encompass acute coronary syndrome?
Unstable angina, Non-STEMI and STEMI
What is our primary decision point for patient with chest pain?
EKG
What two acute coronary syndromes are treated the same?
Unstable and NSTEMI
What is the rhythm that most people die from?
V. Fib
When is an AMI most likely to present?
Early morning
What is Dressler’s syndrome (post MI syndrome?)
Pericarditis, fever, leukocytosis, pericardial or pleural effusions
What is the EKG findings of a STEMI?
1 MM ST segment elevation in two contiguous leads
What EKG finding is highly suspicious for STEMI?
LBBB
What are the contraindications to a B-blocker?
Slow hearts, weak hearts (CHF) or bad pulmonary patients
When should aspirin or clopidogrel be used in a patient with a STEMI?
Immediately
Name the 4 cyanotic heart anomalies
Tetralogy of fallot, pulmonary atresia, hypoplastic left heart syndrome, and Transposition of the great vessels
Name the non-cyanotic heart anomalies
ASD, VSD, PDA, AV septal defect (seen in Down’s syndrome) & Coarctation of aorta
What is the most common ASD?
Ostium Secundum
What is the most common congential heart anomaly?
VSD
How do we treat PDA pharmacologically?
Indomethacin
How do we keep the ductus arteriosus open?
IV prostaglandins E
What is the most common valvular disease?
Aortic Stenosis
What is the most common presentation of valvular heart disease?
Dyspnea on exertion/exercise intolerance
What is the definitive method to identify heart structure and functional abnormalities?
Echocardiogram or TEE
How is the murmur of Tetralogy of Fallot identified?
Crescendo/decrescendo holosystolic at left sternal border that radiates to back
What heart defect gives a machinery murmur?
PDA
How are all regurgitation murmurs identified?
Blowing and higher pitch
What valvular pathology has an Austin Flint murmur?
Aortic regurgitation
What is the most common arrhythmia?
A.Fib
What is the key principle of treating an unstable arrhythmia?
Synchronized cardioversion
What is the initial treatment for a symptomatic bradyarrhythmia?
Atropine
How do we define V.Tach?
Three or more PVCs in a row
What are the two most common causes of Torsades?
Hypokalemia and hypomagnesemia
Who is Brugada syndrome most often seen in?
Asian population
What are the drugs of choice for V.Tach?
LAP = Lidocaine, Amiodarone and Procainamide
How do we treat Torsades de pointes?
Magnesium
How do we treat most patients with sick sinus syndrome?
Pacer
What is the most common cardiomyopathy?
Dilated (95% of the cardiomyopathies)
What are the physical findings of a dilated cardiomyopathy?
S3, JVD and rales
What are the physical findings of a hypertrophic cardiomyopathy?
S4 gallop, Bisferiens carotid pulse, jugular venous pulsation with a prominent “a” wave.
What are the key presenting features of a pericarditis?
Pain relieved leaning forward and a friction rub
What are the most common bugs that cause infectious endocarditis?
Strep viridians, S. Aureus and enterococci
What is the most common bug that causes endocarditis in an IV drug user?
S. Aureus
What are the most common bugs that infect a heart valve if infection occurs less than 2 months after implantation?
Gram Negative and fungi
What are the four classic findings of endocarditis?
Roth spots, Splinter hemorrhages, Osler’s nodes & Janeway Lesions
What is the drug of choice for endocarditis prophylaxis
Amoxicillin
What valve is most commonly affected in Rheumatic heart disease?
Mitral
Name the major criteria for rheumatic heart disease? (AKA Jones Criteria)
Carditis, erythema marginatum, Subcutaneous nodules, chorea, polyarthritis
What medication can provide symptoms relief with PVD?
Cilostazol
What is recommended to prevent travel associated DVT?
Frequent ambulation, leg exercises and compression hose
What are the key demographics of temporal arteritis?
Age greater than 50 and a history of polymyalgia rheumatic
What are the signs and symptoms of giant cell arteritis
Unilateral temporal HA, scalp tenderness, jaw claudication, elevated ESR
What is the most common cause of aortic aneurysms?
Atherosclerosis
Who is the classic patient with aortic dissection?
Elderly male smoker with COPD, CAD and renal insufficiency
What is the diagnostic test of choice for AAA?
Ultrasound
What is the diagnostic test of choice for thoracic aneurysms?
Aortagram
What is the best indicator for response to RBC loss?
Reticulocyte count
What conditions lead to an elevated INDIRECT bilirubin?
Hemolysis and Gilberts syndrome
What are the causes of a microcytic anemia?
Sideroblastic, Thalassemia, Iron deficiency and chronic disease
What is the most common sideroblastic anemia basophilic stippling?
Lead
What problem do patients with one alpha globin chain (Hgb H) have?
Stillbirth = hydrops fetalis
What is another name for B-Thalassemia major?
Cooley anemia
What do people with Hgb H disease need?
Folic acid
What is the most common form of anemia?
Iron deficiency
What is the hallmark or iron deficiency?
Pica
What are the most common causes of a macrocytic anemia?
B12 and folate deficiency
What is the most common cause of folate deficiency?
Diet
What cell findings are pathognomonic for folate deficiency?
Macro-ovalocytes, hypersegmented PMN cells and Howell-Jolly bodies
What is the most common cause of Pernicious anemia?
Lack of intrinsic factor
What test looks for antibodies on the RBC thus looking for hemolytic anemia?
Coombs
What stain looks for G6PD?
Heinz body
What daily/lifelong medication should be considered for all patients with sickle cell patients?
Hydroxyurea
What does atypical lymphocytes point towards?
EBV (mono)
What does Auer rods point to?
acute myeloid leukemia (AML)
What cells are pathognomonic for CLL ( chronic lymphocytic leukemia)?
Smudge cells
Which cells point towards Hodgkin’s Disease?
Reed-Sternberg
What virus is seen in 50% of Hodgkin’s?
EBV
What is a trigger for lymph node pain in Hodgkin’s?
Pain after alcohol
Where is the pathology in Multiple Myeloma?
Plasma cells
What is the most common complaint of patients with multiple myeloma?
Bone pain (LBP,) infections and anemia
What is the hallmark of multiple myeloma?
Monoclonal spikes on serum electrophoresis and Bence-Jones protein
What is the most common congenital coagulopathy?
Von Willebrand disease
What is Christmas Disease?
Hemophilia B (Factor IX deficiency)
What is a modality for a patient with significant night time symptoms?
H2 blocker at night and a PPI in the day
What are common viral causes of esophagitis?
CMV and HSV
What are common causes of esophagitis in a patient with HIV?
Mycobacterium tuberculosis, EBV, Mycobacterium Avium Complex
How do we treat HSV esophagitis?
Acyclovir
How do we treat CMV esophagitis?
Ganciclovir
What is a key feature of Zenker’s diverticulum?
Vomiting undigested food after several hours
What is the classic finding on barium swallow in a patient with Achalasia?
Parrot beak
What is the condition called that is caused by thrombosis of the portal vein that leads to esophageal varices?
Budd-Chiari syndrome
What three diseases does H. Pylori cause?
Peptic ulcers, gastric adenocarcinoma and gastric
What is the most common cause of PUD ( peptic ulcer disease)?
H. Pylori
What is the name of a gastrin secreting tumor that causes hypergastrinemia?
Zollinger-Ellison Syndrome
What is diagnostic of Zollinger-Ellison Syndrome?
Fasting Gastrin level greater than 150pg/mL
What is strongly associated with gastric adenocarcinoma?
H. Pylori
What is the supraclavicular lymphadenopathy of gastric adenocarcinoma called?
Virchow’s node
What is the umbilical nodule of gastric adenocarcinoma called?
Sister Mary Joseph nodule
Which organism causes the most rapid onset of diarrhea?
S. Aureus
What denotes an inflammatory process in diarrhea?
WBC in stool
When should a colonoscopy be ordered in a patient with constipation?
Patients older than 50 with new onset constipation
What causes most small bowel obstructions?
Adhesions and hernias
What is the most common cause of a large bowel obstruction?
Tumor
What test distinguishes mal-digestion from mal-absorption?
D-xylose test
What is the most common genetic condition in the USA?
Celiac
What are the screen tests for Celiac disease?
IgA antiendomysial and anti-tissue transglutaminase
What is the age of onset of Crohn’s disease?
25 y/o with M=F
What is possible curative in ulcerative colitis?
Surgery
What is the most common cause of chronic or recurrent ABD pain in the USA?
IBS
What is the most common cause of intussusception in a child and adult?
Child: viral infection and adult: neoplasm
What is the presentation of intussusception?
Colicky pain, current jelly stool and a sausage like mass
How do we both diagnose and treat intussusception in a child?
Barium or air enema
How do we diagnose intussusception in an adult?
CT
What test is avoided in diverticulitis?
Barium enema
What is the risk of inherited polyposis syndrome?
Near-100% risk of CA
What lab test is used to monitor colorectal CA?
Carcinoembryonic antigen (CEA)
What is the most common cause of appendicitis?
Fecalith
What is the most common emergency surgery?
Appendicitis
What is the initial symptom of appendicitis?
Periumbilical or epigastric pain
What are the most common causes of pancreatitis?
ETOH and cholelithiasis
What is the classic pain pattern of pancreatitis?
Epigastric pain radiating to back
What is bleeding into the flanks called?
Grey Turner sign
What is bleeding into the umbilical area called?
Cullen sign
What is a palpable gallbladder and jaundice called?
Courvoisier sign
What is the surgical resection of pancreatic cancer called?
Whipple procedure
What are the complications of choledocholithiasis?
Cholecystitis, pancreatitis and acute cholangitis
What is Charcot triad?
RUQ pain, jaundice and fever
What is Charcot’s triad that also has an altered mental status and hypotension called?
Reynold’s Pentad
What is primary sclerosing cholangitis associated with?
Ulcerative colitis
What is the most common presentation of primary sclerosing cholangitis?
Jaundice and pruritus
What is the only know treatment for primary sclerosing cholangitis?
Liver transplant
What represents ongoing hepatitis B infection?
Hepatitis B SURFACE antigen (HBsAg)
What represents immunity to hepatitis B?
Anti-HBs: Antibody against hepatitis B surface antigen
What medication is used for acetaminophen toxicity?
Acetlycysteine
What is the general cause of a liver abscess?
Entamoeba histolytica
Where is the liver a common source or metastases from?
Lung and breast
Which diseases cause an elevation of Alpha fetoprotein?
Hepatic carcinoma, hepatitis C and cirrhosis
What is the location of an indirect inguinal hernia?
Through internal inguinal ring
What is the location of a direct inguinal hernia?
Through the external ring at Hesselbach’s triangle
What is the basic patient demographic for pyloric stenosis?
5 week old male
What is the radiographic finding of pyloric stenosis?
String sign
What is the disease caused by vitamin D deficiency?
Rickets
What is the disease caused by a lack of Thiamine?
Beriberi
What is another name for vitamin B6?
Pyridoxine
What is the problem with phenylketonuria?
Inability to metabolize phenylalanine
What is the treatment for phenylketonuria?
Low phenylalanine diet and tyrosine supplementation
Which renal function is most sensitive to dehydration?
BUN
How will the urine appear with intrinsic renal disease?
Casts (WBC, RBC, granular, epithelial) and protein
What is a new bio-marker for detecting acute kidney injury?
Cystatin C
What ultrasound finding indicates a chronic renal problem?
A small kidney less then 10cm
What are indications for dialysis?
Acidosis, electrolyte disorder, fluid overload, uremic complications
What are the most common causes of chronic kidney disease?
DM, HTN, glomerulonephritis, and polycystic kidney disease
What are three abnormal symptoms of renal failure?
Metallic taste, hiccups and pruritus
What is the gold standard for identifying renal disease?
GFR
What is the marker for kidney disease?
Proteinuria
What diagnostic test looks for recent strep infection and is helpful in evaluating post streptococcal glomerulonephritis?
ASO Titer
How do we define nephrotic syndrome?
Excretion of more than 3.5grams of protein (per 1.73m2) of body surface area
What are the manifestations of nephrotic syndrome?
Hypoalbuminemia, lipiduria, hypercholesterolemia and edema
What is a key finding in the urine for nephrotic syndrome?
Oval fat body in urine
What is the diagnostic method of choice for polycystic renal disease?
Ultrasound
What are 80% of kidney stones made up from?
Calcium
What stones are produced by infections?
Struvite stones
What is the modality of choice in identifying kidney stones?
CT scan Abd/pelvis without contrast
What are the 5 causes of Diabetes insipidus?
Inherited, lithium, hypokalemia, hypercalcemia or renal disease
What urine osmolality points to DI?
<250 mOsm/kg
How is diabetes insipidus treated?
Intranasal desmopressin
What medication should be administered to patients with hyperkalemia and EKG changes?
Calcium gluconate
What are the EKG changes in hyperkalemia?
Peaking of T waves, QRS wide and flat P waves
What treatment is used to remove potassium from the body?
Sodium polystyrene sulfonate (Kayexalate)
Name the classic sign of hypocalcemia that is identified by tapping on the cheek?
Chvostek sign
Name the classic sign of hypocalcemia that is identified by tourniquet-ing off the arm with a BP cuff?
Trousseau sign
What is the suggested treatment for cystitis?
Fluoroquinolone or nitrofurantoin for 3-5 days
What medications will change your urine red/orange?
Phenazopyridine and Rifampin
What is the most common bug to cause pyelonephritis?
E.Coli
What is the recommended treatment for prostatitis?
Cipro 500mg BID, Levoquin 500mg daily for 2- 6 weeks or TMP-SMZ BID for 6 weeks
What is the bug in male patient with epididymitis less than 35 years old?
GC/Chlamydia
What is the bug in male patient with epididymitis older than 35 years old?
E.coli
What is a classic, yet unreliable sign in epididymitis?
Prehn’s sign
What medication class is effective in treating urge incontinence?
Anticholinergic
What is the most common kind of prostate CA?
Adenocarcinoma
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?
AM
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?
1%
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
