General Medical

Question 1

What is the name of the syndrome in which:

The RIGHT COMMON Iliac Artery overlies the LEFT Common Iliac VEIN…

…causing LLE DVT?

Answer 1

May-Thurner Syndrome

Question 2

What is an approximate threshold for serum Glucose at which the urine begins to have positive glucose measurement on dip urinalysis?

What meds will lower that threshold?

Answer 2

200mg/dL serum glucose is threshold typically where UA is positive for ‘glucose’.

“Gliflozins” are SGLT inhibitors (inhibit nephron glucose reabsorption) and may prompt glucosuria at serum glucoses much lower than 200mg/dL.

Question 3

What is a normal minimum value for Ankle-Brachial Index (ABI)?
What is the upper limit of normal and what may that indicate?

Answer 3

Minimum of 0.91 to maximum of 1.3.
0.9 or less is not considered normal.

High values (over 1.3) can indicate arteriosclerosis, which is its own separate problem.

Question 4

What is a WBI and how is it done?

What is a normal minimum value for this?

Answer 4

Wrist-Brachial Index.
Take the higher of the Brachial BP’s (whichever arm is highest) as the denominator.
Then measure (w/a pencil Doppler) the Radial AND Ulnar arterial pressures. Use the highest value of the Radial vs Ulnar as the numerator.
Minimum threshold of normal is 1.0.

Question 5

What does the acronym FABER mean?

Does it indicate a specific diagnosis?

Answer 5

Flexion ABduction External Rotation.

If positive, it can indicate several issues within and near the hip—not necessarily indicative of a singular pathology.

Question 6

What is a Coumadin Ridge and how does it get that name?

Answer 6

It is a congenital piece of tissue that mimics a “clot” in the Left Atrium between the pulmonary vein and the Left Atrial Appendage.

It is a “Coumadin Ridge” because it gets mistaken for clot and patients end up on Coumadin unnecessarily.

Question 7

What is the mnemonic for troubleshooting a vent alarm?

Answer 7

“DOPES”

Dislodged tube, Obstructed tube, Pneumothorax, Equipment malfunction, Stacking breaths

Question 8

What are the elements of the PERC Rule ?

There is a mnemonic

Answer 8

“H A D C L O T S”

Hormone use, Age >50, DVT (History of VTE), Coughing blood, Leg swollen (unilateral), Oxygen sat <95%, Tachycardia (100 or more), Surgery (trauma, surgery , immobilization in last 4 weeks)

Question 9

What is the dose of PCC to fully reverse anticoagulation?
What is in it?
How long does it last?
What does PCC NOT reverse?

Answer 9

Emergency reversal: 50 IU/kg IV
Factors 2, 7, 9, 10 and Prot C and Prot S.
Each factor has a different T-1/2 though clin studies show it has effect up to 24 hours.
Dabigatran/Pradaxa, and anti-platelet agents (plavix, effient, etc)

Question 10

After a TIA, what is the risk of CVA in:
—the next TWO days?
—the next THIRTY days?
—the next NINETY days?

Answer 10

At 2 days, 10% have stroke.
At 30 days, 13% have stroke.
At 90 days, 17% have stroke

(Lancet 2007; meta-analysis)

Question 11

What are the criteria for Status Epilepticus?

Answer 11

A seizure lasting more than 5 minutes
OR
A recurrent seizure without full resolution of the post-ictal period.

Question 12

What are the three categories of hepatic dysfunction on liver function testing?

Answer 12

1. Cholestatic pattern
2. Hepatocellular Damage
3. Functional Impairment

Question 13

What are the three hepatic panel markers for cholestatic pattern?

Answer 13

Alkaline Phosphatase, GGT, and Bilirubin.

Question 14

With an elevated alkaline phosphatase, how does GGT help differentiate the cause?

(What —beyond hep-Biliary pathology — can produce elev Alk. Phos?)

Answer 14

Gamma Glutamyl-Transferase (GGT) helps to indicate a hepatic etiology when it is high in setting of high alkaline phosphatase.

Elevated alkaline phosphatase with normal GGT, probably indicates another, non-hepatic, source — such as bone, placenta, intestine, even Kidney.

Question 15

What are the Scarbossa criteria?

What is the Modified Scarbossa Criterion?

Answer 15

1. Concordant STE 1mm.
2. STD 1mm V1, V2, V3.
3. Discordant STE 5mm.

Modified: Ratio of ST vs R or S amplitude > 25%.
(Really it is the ST-E / S wave ratio > 0.25)

Question 16

What is the percentage from 100% with one s.d. ?

What is percentage from 100% with 2 s.d. ?

What is the percentage from 100% with 3 s.d. ?

Answer 16

16% (84th %ile)

2. 2% (98th %ile)
3. 1% (99th %ile)

Question 17

What does it tell me about the specific nephron site of the problem when the urine sediment has “brown casts”, versus “RBC casts”?

Answer 17

RBC casts indicate that red blood cells have leaked from the blood into the filtrate. The only site of interface where such leakage could happen is the Glomerulus—hence, Glomerulonephritis.

Muddy casts are epithelial cells from distal to the glomerulus—the tubules. Thus this indicates ATN (Acute Tubular Necrosis).

Question 18

What was the percentage of M.A.C.E. with a “low-risk” H.E.A.R.T. Score?

What was the time period for MACE?

What if you added in the time zero AND A 3HOUR NEG hsTn-I – what was the MACE at that point with a low risk H.E.A.R.T Score?

Answer 18

MACE with the CDR alone: 1.6%

30 days.

0.8% MACE with HEART + 0 and 3 hr hsTrop.

Question 19

What are the elements of the H.E.A.R.T. Score?

What is the score category for Low Risk”?

Answer 19

History, ECG, Age, Risk factors, Troponin

Point scores between 0 to 3 are “Low Risk”.

Question 20

What are the components in the Surviving Sepsis “1 hour bundle”?

(5 components)

Answer 20

1. Obtain Lactate level
2. BCX and done prior to ABX
3. Broad-Spectrum ABX
4. Initiate 30ml/kg crystalloid IVF bolus if Lactate >4 or hypotension
5. Pressors for MAP <65m Hg during or after IVF bolus..

Question 21

What is the actual cause of death in the majority of pediatric DKA cases ?

Answer 21

Cerebral Edema is the most common cause of death in pediatric DKA. ( quoted btw 60% to 90% )

Question 22

What is the syndrome’s name where the colon is interposed between the liver and the diaphragm?

There is the presence of colon there, asymptomatically, versus the actual syndrome (which indicates that they are symptomatic).

Answer 22

Chilaiditi’s Syndrome is colonic interposition with symptoms or abdominal pain. If no symptoms, then it is simply colonic interposition.

Only in the context of unexplained recurrent abdominal pain is this interposition referred to as Chilaiditi Syndrome.

Question 23

What are the 5 W’s in post-op fever and when do they happen (in chron order)?

Answer 23

Wind (atelectasis) 1-2 days
Water (UTI) 2-3 days
Wound (infection) 3-7 days
Walk (DVT or phlebitis) 5-7 days
Wonder Drugs 7 days and beyond

Atelectasis (‘wind) is overstated as early post-op fever. The first 1-2 days is typically correlated with Il-6 levels and the degree of tissue trauma from the operation, and hence non-infectious, but rather, rel to the cytokines.

Question 24

What are the Cornell Criteria for LVH?

Answer 24

S in V3    
PLUS    
R in aVL   
> 28 mm in men   
> 20 mm in women