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Board Vitals APMLE III > Medicine > Flashcards

Medicine Flashcards

1
Q

Mechanism for majority of diabetic foot ulcerations

A

Repetitive pressure > 10 kg/cm acting on foot during gait

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2
Q

Tests recommended to assess patient with peripheral arterial disease and disease severity?

A

ABI, toe pressure and TCPO2

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3
Q

What is the most appropriate vascular study for venous insufficiency?

A

Venous doppler with reflux study and ABI, duplex scan

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4
Q

Medications that can cause myalgia and myotoxicity in severe cases (rhabdomyolysis)?

A

Statin medications (HMG-CoA reductase inhibitors) Colchicine Erythromycin Alcohol abuse Methamphetamines Cocaine MDMA (Ecstasy)

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5
Q

Medications that can cause QT prolongation?

A

Macrolides (erythromycin, clarithromycin) Antihistamines (diphenhydramine, loratidine) Zofran Ketoconazole TCAs Type 1C antiarrhythmics (flecainide, encainide) Type 1A antiarrhytmics (quinidine, procainamide, disopyramide) Class III antiarrhythmics (amiodarone) Antipsychotics

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6
Q

Patients presenting with unstable angina relieved by nitro x 3. What would the ECG show? What should be initiated?

A
  1. non-ST elevation consistent with acute coronary syndrome 2. Intensive statin therapy (benefit shown within 30 days)
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7
Q

How does stasis dermatitis typically present?

A

venous malfunction resulting from anatomic abnormalitis (i.e. valvular incompetence). Erythematous plaques with fissuring and yellowish or brown pigmentation superior to medial malleolus. May have weeping or lichenification

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8
Q

What is the mechanism of inverted champagne bottle appearance to legs?

A

Fat necrosis (aka sclerotic panniculitis or lipodermatosclerosis) resulting in permanent sclerosis.

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9
Q

Dermatologic pathology associated with seronegative spondyloarthropathy?

A

plaque psoriatic arthritis 1. Affects 1.5-2% of population 2. Inheritable polygenic trait 3. Results in epidermal hyperproliferation 4. caused by activated T cells infiltrate epidermis and induce keratinocyte production 5. Nail involvement is common 6. Psoriatic arthritis can involve peripheral or axial joints

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10
Q

Cause of equinus in polio patients.

A

muscle imbalance (weak tibialis anterior and toe extensors)

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11
Q

Localized nodular synovitis vs. pigmented villonodular synovitis

A

LNS: single multi-lobulated mass benign, proliferative synovial joint lesion Rarely recurrent PVNS: Considerable recurrent rate More difficult to excise d/t diffuse involvement

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12
Q

TSH and T4 levels in primary hypothyroidism (most common and due to thyroid disease)

A

increased TSH in presence of low serum T4

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13
Q

Characteristic of central hypothyroidism

A

absence of anti-thyroid perodixase antibodies

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14
Q

TSH and T4 levels in euthyroid hypothyroxinemia

A

Normal serum TSH and low T4 with normal free T4

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15
Q

Central hypothyroidism of secondary or tertiary. Causes? TSH and T4 levels?

A

Causes: 1. pituitary mass lesion 2. history of surgery or radiation therap 3. infiltrative disorder of pituitary or hypothalamus 4. head trauma with injury of stalk 5. pituitary apoplexy 6. post-partum pituitary necrosis Levels: low to low-normal serum free T4 and low serum TSH

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16
Q

Skin cancer associated with HPV

A

squamous cell carcinoma of genital or periungual skin surfaces

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17
Q

Creeping substitution

A

cutting cone of new osteoblasts, followed by osteoblasts will invade graft from host bone

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18
Q

Osteogenesis

A

synthesis of new bone by cells residing within graft itself or cells of the host

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19
Q

Osteoinduction

A

substances in graft induce nonosseous tissue to become osteogenic in presence of favorable environments

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20
Q

Osteoconduction

A

graft providing a lattice or scaffold that allows surviving host tissue to invade and facilitate new bone formation.

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21
Q

Effects of hexacarbon abuse

A

Hexacarbons are present in solvents (exposure is occupational) Exposure results in giant axonal swellings and distal slowing of conduction velocity resembling symptoms of Guillain-Bare Syndrome

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22
Q

Describe the mechanism of GBS

A

Myelin destruction in areas of nerve trunks with intense inflammation GBS leads to ascending paralysis (demyelinating polyradiculopathy)

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23
Q

Etiologies of Charcot neuropathy

A

Risk factors: DM, alcoholism, spinal cord injury C: myelomeningocele, spina bifida, CMT, MS, CP, syringomyelia, congenital insensitivity M: DM, alcoholic neuropathy, uremia, pernicious anemia I: tabes dorsalis, polio, leprosy, TB N: tumors in brain, spinal cord, peripheral nerve T: trauma to brain, spinal cord, peripheral nerve D: indomethacin, intra-articular corticosteroids, phenylbutazone

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24
Q

Frostbite degrees

A

1st: pale skin initially, then erythematoous and edematous (no blister or vesicle formation) 2nd: superficial dermis, blisters and eschars 3rd: subcutaneous layer and chronic edema 4th: full thickness, tissue gangrene. skin may slough and epithelialize with recovery, in many situtations gangrene should be left to demarcate and patient may require amputation

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25
Q

How does hyperglycemia contribute to diabetic foot infections?

A

Hyperglycemia impairs neutrophil function and reduces blood flow.

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26
Q

Joints affected in rheumatoid arthritis

A

MTPJs, hips, knees, sacroiliac, glenohumeral, C1-C2 spinal articulation

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27
Q

What may be required in the management of acute inflammatory neuropathies?

A

Urgent and aggressive IV immunoglobulin or plasmapheresis Mechanical ventilation should be considered for patients with FVC ,30% baseline of FVC <20mL/kg or max inspiratory pressure <30cm of water

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28
Q

Direct Coomb’s test for reactions

A

-direct antiglobulin test normal positive in ABO-related acute transfusion reactions (results of C3d complement deposition on circulating red blood cells and anti-A, anti-B or anti-A,B antibodies of recipient) -Coombs test would be negative in febrile non-hemolytic reaction (RBCs in sediment with clear urine supernatant in centrifugation tube)

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29
Q

Acute hemolytic reaction

A

occurs within minutes of transfusion with incompatible ABO blood group Urine turns red and centrifuged urine will distinguish hemoglobinuria from hematuria (hemoglobinuria urine remains red after centrifugation)

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30
Q

Hemoglobinuria vs. hematuria

A

Hematuria: urine and RBCs from lower urinary tract (RBCs settle in bottom of tube and supernatant urine will be clear yellow) Hemoglobinuria: deposits of hemoglobin monomers and dimers filtered by kidney from plasma

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31
Q

How much volume reductions with lymphatic reconstructive microsurgical procedures?

A

42-59% volume reductions

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32
Q

Clark levels of invasion

A

Melanoma invasion: 1: epidermis only (best prognosis) 2: dermis and papillary dermis 3: entire papillary dermis 4: reticular dermis 5: all layers of skin and into fat (worst prognosis)

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33
Q

Lymphatic flow

A

superficial to deep by muscular contraction reflux (deep to superficial) prevented by passive closure of one-way valves

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34
Q

Clinical Etiology Anatomy Pathophysiology (CEAP) classification

A

Lower extremity chronic venous disease C0 to C6 based on appearance Signs include: telangieectasias, varicose veins, edema, pigmentation or eczema, lipodermatosclerosis, ulceration Etiologies: congenital, primary or secondary Anatomy: superficial v deep

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35
Q

Pathognomonic sign for rheumatoid arthrtisis

A

multiple metatarsalgia, prominent and hypertrophic metatarsal heads, limited ankle ROM and synovitis Deformities: clawtoes and digital deformities, equinus Later stage: arch collapse with midfoot and rearfoot collapse

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36
Q

Juvenile rheumatoid arthritis treatment protocol

A

5 different treatment groups: 1. hx of arthritis in <4 joints 2. >5 joints 3. Active sacroiliac arthritis 4. systemic arthritis without active arthritis 5. systemic arthritis w/ active arthritis start therapy with NSAIDs or anakinra

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37
Q

What is helpful in supporting diagnosis of HCV arthritis?

A

Anti-HCV, HCV-RNA by PCR, cryoglobulins, Rh factors (54-82%) anti-CCP antibody positivity in less than 7% Clinically: rapid progressive acute arthralgia Similar pattern to RA Bilirubin or transaminase levels may be elevated (ut normal levels do not exclude infection) 20% of pts with HCV have arthralgia

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38
Q

EBS Weber-Cockayne (epidermolysis bullosa simplex)

A

trauma or friction induced skin blistering autosomal dominant pattern Junctional: skin cleavage within lamina lucida or dermoepidermal junction (autosomal recessive mutation LAMA genes –> preventing assembly and secretion of functional trimeric laminin) Dystrophic: cleavage plane below lamina densa Kindler syndrome: multiple cleavage planes Lethal acantholytic EBS: LOF mutation in DSP and JUP genes

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39
Q

Erythema nodosum

A

acute nodular eruption on extensor surfaces of legs 2/2 delayed hypersensitivity reaction occurs in sarcoidosis, IBS initial phases: ache, flulike, fever, hard painful leasions 2nd week: fluctuant lesions self-limited NSAIDs provide relief

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40
Q

Period after revascularization to optimize local blood flow?

A

4-10 days

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41
Q

Onychauxis

A

thickening of nail plate seen in elderly transverse ridging and lateral deviation

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42
Q

PAD and intermittent claudication

A

significant sign of atherosclerosis treatment targeted at reduction of symptoms and prevention of disease progression Management: statin therapy (LDL < 100 mg/dL) and antiplatelet therapy w/ aspirin or clopidogrel Smoking cessation associated with increased walking time

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43
Q

Pseudoclaudication

A

spinal stenosis (low back pain radiating to lower extremities) s/s: numbness, weakness, fatigue

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44
Q

Claudication s/s

A

cool skin nonpalpable distal pulses nonhealing wounds shiny skin loss of hair abnormal cap refill distal extremity pallor on elevation peripheral neuropathy (stocking glove distribution)

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45
Q

Dexamethasone suppression tests

A

normal patient: low ACTH at any dose Cushing’s: high dose - low ACTH, low dose - no change ACTH pituitary tumors: high dose - low ACTH, low dose - no change ACTH

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46
Q

Westermark Sign

A

pulmonary embolism changes on CXR

47
Q

Stellwag’s sign

A

thyrotoxicosis Pt unable to blink or infrequently blinks

48
Q

Quincke’s sign

A

visible pulsation in capillary bed in ungual region indicates aortic insufficiency associated with aortic regurgitation

49
Q

Wellens’ Sign

A

deep inverted T waves (leads V1-V4) associated with severe disease in left anterior descending artery seen ours after NSTEMI

50
Q

Quincke’s pulses

A

murmur characteristic of aortic regurgitation associated with wide pulse pressure

51
Q

Musset’s sign

A

head bob with each heart beat associated with aortic regurgitation

52
Q

Mitral valve prolapse

A

Mid-systolic click increased intensity with Valsalva maneuver associated with: atypical chest pain Palpitations dyspnea hyperventilation dizziness or syncope panic or anxiety disorders numbness or tingling skeletal abnormalities abnormal ECGs

53
Q

Lichen planus

A

inflammatory disorder affecting skin, nails, hair, mucous membranes longitudinal ridges and fissures thinning of nail plate erythema of lunula trachonychia (roughness and excessive longitudinal ridging, pitting or thickening of cuticle as a result of defective keratinization of proximal nail matrix) proximal nail fold hyperpigmentation longitudinal melanonychia tx: systemic or intralesional corticosteroids

54
Q

Trachonychia

A

Roughness and excessive longitudinal ridging, pitting or thickening of cuticle as a result of defective keratinization of proximal nail matrix

55
Q

Proper nutrition indicated with:

A

serum albumin >3.5 gm/dl help collagen synthesis and tensile strength

56
Q

Risk factors for osteomyelitis

A

previous history of wound wounds extending to bone or joint recurrent or multiple wounds

57
Q

When should osteomyelitis be considered?

A

infected, deep, or large foot ulcer chronic wounds overling bony prominence ulcer depth > 3 mm CRP > 3.2 mg/dL ESR > 60mm/hr

58
Q

Antibiotic length after radical resection of infected bone

A

persistent infected or necrotic bone –> four weeks or longer no infected tissue –> 3-5 days

59
Q

When are occlusive dressings appropriate?

A

clean wound since dressing provides culture medium for bacterial proliferation occlusive dressing effective in removing eschar, but not justified

60
Q

Fracture blisters

A

hemorrhagic blister –> flaccid roof Serous blister –> tense roof fracture blisters lessen the incidence of compartment syndrome

61
Q

Osborne (J) waves

A

associated with hypothermia

62
Q

Lown-Ganong-Levine syndrome

A

associated with accessory pathway connects the atrium to distal AV node

63
Q

Wolf-Parkinson-White syndrome

A

pre-excitation syndrome characterized by congenital atrioventricular bypass tract and tachyarrhythmias ECG: shortened PR interval (<120,s) and initial slurring of QRS complex QRS prolonged (>110ms) and ST and T waves discordant changes

64
Q

Bundle of Kent

A

accessory pathway in WPW

65
Q

Indications for pharmacologic therapy to lower urate in gout patients

A

Tophus or tophi Clinical or radiographic signs of chronic gouty joitn disease frequent or disabling attacks of acute arthritis gout with CKD stage 2 or greater recurrent uric acid nephrolithiasis urinary uric acid >1100mg/day

66
Q

Percentage of people with peripheral neuropathy

A

2.4% of Americans 8% of population seen in family practice clinic

67
Q

Conn’s syndrome –> Cushing’s syndrome –> Pheochromocytoma –> Addison’s disease –>

A
  1. Hyperaldosteronism with adrenal adenomas 2. Excess cortisol 3. Excess catecholamines 4. adrenal insufficiency
68
Q

Legg-Calve-Perthes disease (LCPD)

A

avascular necrosis of proximal femoral head

69
Q

Blount’s disease

A

osteochondrosis of posteromedial part of tibia

70
Q

Osgood-Schlatter

A

apophysitis

71
Q

Osgood-Schlatter

A

apophysitis of tibial tuberosity

72
Q

Preferred method for burn treatment inpatient

A

open method = topical agent applied directly to wound with no overlying dressings

73
Q

Myrmecia

A

warts that grow deep and are usually more painful than common warts occur plantar surface (found on WB surface - heel or met head)

74
Q

Degeneration pattern of CMT disease

A

smaller muscle mass equates to earlier degeneration intrinsics are affected first PL and TP maintained for longer –> workhorse tendons contributing to cavovarus deformity Triceps surae largest muscle mass so last to undergo degeneration

75
Q

Polymyalgia rheumatic

A

> 50 years pain and morning stiffness in shoulders, hips, neck giant cell (temporal) arteritis Scandinavian people muscle tenderness clinical synovitis or bursitis swelling and pitting edema of hands, wrists, ankles and top of feet

76
Q

Urate lowering therapy

A

Allopurinol or febuxostat (XO inhibitor) –> decrease urate production (1st line) (for overproducers) Probenecid or pegloticase (uricosuric) –> increase renal excretion of urate (for under-excretors)

77
Q

T or F: Hyperglycemia impairs T-cell function

A

False: Hyperglycemia impairs neutrophil and reduces host defenses

78
Q

Hypokalemia Periodic Paralysis (HPP)

A

Most common type of periodic paralysis Causes: fatigue, viral illness, beta agonists, insulin or steroids, excess renal or GI loss of K+ Mechanism: change in Na+ and calcium channels –> low K+ serum K+ low, total body K+ not depleted Muscle dysfunction, not nerve conduction abnormality

79
Q

Etiology of myopathies based on acuity of symptom onset

A
  1. weakness progressing rapidly over hours –> toxic etiology or episodic paralysis 2. weakness over days –> acute dermatomyositis or rhabdomyolysis 3. weakness over weeks –> polymyositis, steroid myopathy or endocrine myopathy
80
Q

Muscle groups associated with myopathies

A

Distal muscle weakness: weak grasp, handwriting problems, flapping gait Proximal muscle weakness: difficulty rising, climbing stairs, shaving/combing hair

81
Q

Symptoms of myopathies

A

General signs and symptoms: symmetric proximal muscle weakness, malaises and fatigue, dark urine, fever and normal level of consciousness Dermatomyositis: Gottron papules (pink or violacious scaly areas over knuckles, elbows, knees) Absence or sensory complaints or paresthesias DTRs diminished by hypokalemic paralysis

82
Q

Stemmer sign

A

inability to pinch dorsal aspect of skin btwn 1st and 2nd toes (not 3rd and 4th) seen in pts w/ lymphedema

83
Q

False negative gram stains

A

gram stain sensitivity varies from 29 to 50% negative stain does not rule out early infections or infections by microorganisms such as mycoplasma, mycobacteria, fungi.

84
Q

Problems with gram stains

A

clumps of stain or cellular material incorrect blanching of gram stain presence of crystals in synovial fluid

85
Q

Forms of polio

A

Bulbar (more severe) Bulbospinal (more severe) Spinal (usually foot and ankle) usually tibialis anterior and quadriceps affected bc of 4th lumbar spinal segment

86
Q

Parvovirus B19 induced arthritis

A

Slapped cheek or Fifth disease responsible for 12% of cases of sudden onset polyarticular arthritis in adults exposed to children

87
Q

Rubella induced arthritis

A

arthritis appears one week before or after rash symmetric, polyarticular morning stiffness lasting weeks-months

88
Q

Most common CPs

A
  1. Spastic (pyramidal tract lesions) 2. Dyskinetic (extra-pyramidal tract lesions) 3. Mixed (both) 4. Ataxic (rare)
89
Q

Findings associated with psoriasis

A

Nail pitting dactylitis splinter hemorrhages enthesopathy onycholysis psoriatic vulgaris psoriatic arthritis (asymmetric polyarthritis)

90
Q

Histological characteristics of psoriasis

A

acanthosis (epidermal hyperplasia) parakeratosis dilated blood vessels

91
Q

Preferred nerves for biopsy

A

sural or superficial peroneal nerves (with epidermal skin biopsy)

92
Q

Pneumatic pump is contra-indicated in patients with ____

A

active infection, CHF, DVT

93
Q

Syndromes associated with brachymetatarsia

A

Down, Turner and Larsen

94
Q

Bone stimulation indicated for:

A

nonunion, delayed union, bone grafting, infection/osteo, Charcot, AVN, acute fx

95
Q

Bone stimulation contraindicated in:

A

malunion, synovial pseudoarthrosis, bony deficit greater than half bone diameter

96
Q

Candidates for heparin bridging

A

prior VTE in previosu 3 months and thrombophilia (factor V leiden, protein c or s deficiency, antiphospholipid antibody syndrome)

97
Q

FEV1/FVC

A

proportion of vital capacity a person is able to exhale in 1 second normal is 80% obstruction (COPD) –> FEV1 is significantly decreased, so FEV1/FVC ration is decreased Restrictive (emphysema) –> decreased total lung capacity (TLC)

98
Q

Macrovascular occlusions in diabetics occur in ____

A

infragenicular or tibial aa

99
Q

macrovascular occlusions in non diabetics occur in ___

A

superficial femoral or popliteal aa

100
Q

Myrmecia

A

= deep palmoplantar warts plantar (1,2,4) common (2,7) flat cutaneous (3,10)

101
Q

Natural remedies to be discontinued 1 week prior to surgery

A

Ginger (increases blood clotting time), ginkgo biloba (bleeding during surgery), ginseng (increase bleeding, lower blood sugar, ), Vitamin E (increases bleeding), garlic (alter coagulation) and fish oil (alter coagulation)

102
Q

Cellular response to implanted biomaterials

A

characterized by inflammation, immunologic response , toxicity and carcinogenic evolution

103
Q

Tissue remodeling

A

reactive phase of host biologic response to implanted biomaterials characterized by implant encapsulation, bone resorption and sclerosis

104
Q

Hypersensitivity reactions

A
105
Q

Serous v hemorrhagic blisters

A

Serous filled, tense roof

hemorrhagic filled, flaccid roof (disruption of epidermal-dermal junction)

106
Q

simple syndactyly v complex syndactyly

A

simple (failure of soft tissue separation)

complex (failure of bony and soft tissue separation)

107
Q

Quincke’s sign

A

visible pulsation in capillary bed of ungual region, may indicate aortic insufficiency

108
Q
A
109
Q

lethal acanthylotic epidermolysis bullosa simplex mutation

A

loss of function mutations of the DSP and JUP genes

110
Q

epidermolysis bullosa simplex aka

A

EBS Weber-Cockayne

trauma or friction induced blistering to palms and soles (localized or dissemated)

most common variety (75-85%)

autosominal dominant

111
Q

junctional epidermolysis bullosa

A

skin cleavage at lamina lucida or dermoepidermal junction

autosomal recessive gene mutations at LAMA preventing assembly of trimeric laminin

112
Q

dystrophic epidermolysis bullosa

A

cleavage plane below lamina densa

113
Q

Kindler syndrome

A

epidermolysis bullosa at multiple planes

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