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Herkimer 2021 > old questions > Flashcards

old questions Flashcards

1
Q

history to rule out “central vertigo”

A
  • diplopia
  • dysarthria
  • paresthesia/ numbness
  • ataxia gait/ imbalance
  • focal weakness
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2
Q

What is the physical maneuver to confirm peripheral vertigo?

A

Dix-Hallpike maneuver

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3
Q

risk factors of AOM?

A
  • daycare, nursery contact
  • expose to second-handed smoking
  • bottle-feeding/ shorter duration of breastfeeding, soother, pacifier
  • crowded living condition
  • any type of feeding in a supine/flat position
  • enlarged tonsils + adenoids, anatomic anomaly (e.g. cleft palate
    ?? male, white ethinicity, family hx, first nation or Inuit
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4
Q

Indications of ENT referral for tympanostomy

A
  • persistent effusion ( >3 months)
  • (bilateral) hearing loss
  • speech delay/ language problems
  • recurrent episodes of AOM (> 3 episodes in 6 mo, > 4 episodes in 12 mo)
  • atelectasis/ retraction of the tympanic membrane

&- cleft palate/ craniofacial malformations

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5
Q

diagnosis criteria of panic attack

A

4 of 13 - peak in 10 minutes

STUDENTS Fear the 3Cs 
S   sweating 
T   trembling 
U   unsteadiness, dizziness 
D   DEREALIZATION 
E   excess HR, palpitation 
N  nausea 
T   tingling 
S   SOB

Fear of death/going crazy

3Cs
choking
chest pain +/- agoraphobia
chills

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6
Q

DM microvasculopathy and macrovasculopathy

A

micro

  • nephropathy
  • retinopathy
  • neuropathy

Macro-

  • CVD
  • CVA
  • PAD
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7
Q

screening methods for DM microvascular diseases

A
  • Urine test for albumin-to-creatinine ratio (ACR)
  • neurological exam/ ankle reflex test/ monofilament testing/ vibration testing/ propioception testing
  • optometrist/ ophthalmology referral for eye exam
  • foot exam/ referral to podiatrist
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8
Q

lifestyle that can cause primary hypothalamic-pituitary dysfunction and subsequent anovulation

A
  • excessive stress
  • excessive exercise
  • excessive dieting/ an eating disorder
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9
Q

What hormonal diseases/conditions could be responsible for anovulatory cycles?

A
  • polycystic ovarian syndrome (PCOS)
  • thyroid disorder
  • Cushing’s syndrome/ congenital adrenal hyperplasia
  • prolactinemia/ hyperprolactinemia
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10
Q

Clinical manifestations of cirrhosis

A 
∙ Encephalopathy 
∙ Xanthelasma 
∙ Icterus 
∙ Jaundice 
∙ Fetor hapticus 
∙ Spider angioma 
∙ Gynecomastia 
∙ Muscle wasting 
∙ Bruising 
∙ Testicular atrophy 
∙ Ankle edema 
∙ Palmar erythema 
∙ Asterixis 
∙ Dupuytren‘s contracture 
∙ Leuconycia 
∙ Clubbing
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11
Q

Ten adverse effects of SSRIs

A

CV

  • prolonged QT interval
  • hyponatremia

GI

  • dyspepsia, nausea, loss of appetite
  • gastrointestinal bleeding
  • xerostomia
Neuro-psychi
- suicidal thought
- insomnia 
- seizure 
- somnolence 
- tremor 
- asthenia (lack of energy) 
- falls and fractures (elderly, first 6 weeks)
GU
- impotence
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12
Q

Serotonin syndrome - symptoms

A

Fever > 38.5
Confusion/ delirium
sustained clonus/ rigidity
rhabdomyolysis

hyperreflexia 
diaphoresis
agitation/ restlessness 
inducible clonus 
side-to-side eye movements (ocular clonus)
nervousness 
insomnia 
tremor 
nausea/diarrhea 
dilated pupils
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13
Q

diagnosis of serotonin syndrome

A

[Hunter’s criteria ]
Requires one of the following features or groups of features:
- spontaneous clonus;
- inducible clonus with agitation or diaphoresis;
- ocular clonus with agitation or diaphoresis;
- tremor and hyperreflexia;
- hypertonia;
- temperature above 100.4°F (38°C) with ocular or inducible clonus

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14
Q

Management of serotonin syndrome

A
  • withdrawal of the offending serotonergic drugs
  • provision of supportive care
    [ antidote ]
  • Cyproheptadine, a serotonin 2A antagonist, is usually recommended and is the most widely used antidote
  • Benzodiazepines may be used for control of agitation and tremor
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15
Q

Five classes of medications for dyslipidemia

A 
Statins
Nicontinics (niacin) 
Fibrates (eg fenofibrate) 
Resins (eg cholestyramine) 
Ezitimibe (ezetrol)
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16
Q

Inclusion criteria of polymyalgia rheumatica

A
  • Age > 50 y/o
  • duration > 2 weeks (some guideline say 1 month)
  • abrupt onset
  • morning stiffness > 45min
  • bilateral shoulder +/- pelvic girdle pain
  • elevated ESR/CRP
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17
Q

Exclusion criteria of polymyalgia rheumatica

A 
Malignancy 
infection 
Giant cell arteritis 
inflammatory or non-inflammatory conditions 
drug induced
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18
Q

what condition can combine with polymyalgia rheumatica

A

giant cell arteritis

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19
Q

treatment of polymyalgia rheumatica

A

prednisone 15-20mg daily while monitoring ESR

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20
Q

Treatment for scabies

A

Apply Permethrin 5 % cream from neck down to sole for 8-14 hours, repeat 7 days later if necessary

21
Q

Lice treatment

A

Pyrethrins (>2mo) or Permethrin apply to dry air + scalp, let sit for 10 min, rinse with cool water and avoid body exposure, repeat in 7d

22
Q

Epidemiology: Which parameters depend on disease prevalence?

A

Positive and negative predictive value (not specificity or sensitivity)

23
Q

Panic attack symptoms and diagnosis criteria

A

4 out of 13 peak in 10 minutes
- STUDENTS Fear the 3Cs -

sweating 
tremor 
unsteadiness/ dizziness 
derealization
excess HR, PALPITATION
nausea
tingling 
sob

Fear : death, going crazy

Choking
Chest pain
Chills

24
Q

Four types of antidepressants

A

∙ Selective serotonin reuptake inhibitors
∙ Selective norepinephrine reuptake inhibitor
∙ Benzodiazepine
∙ Tricyclinic antidepressant
∙ Monoamine oxidase inhibitor

25
Q

Neonate with jaundice, 10 questions to ask mother

A 
∙ Complications during pregnancy 
∙ Gestational diabetes 
∙ Blood type (for ABO or Rh incompatibility) 
∙ Breast feeding or formula 
∙ Intake 
∙ Birth trauma (cephalohematoma) 
∙ Group B Strep status 
∙ Infections 
∙ Premature? 
∙ Medications 
∙ When jaundice started (before or after 24 hours)
26
Q

Complications of phototherapy

A 
∙ Dehydration 
∙ Hyperthermia 
∙ Erythematous rash 
∙ Loose bowel movements 
∙ Retinal degeneration
27
Q

Non-infections complications of strep throat (GAS)

A

∙ Acute rheumatic fever
∙ acute glomerulonephritis
- pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
(The disorders whose symptoms get worse include obsessive compulsive disorder (OCD) and tic disorders such as Tourette’s syndrome)

** Scarlet fever needs penicillin to treat

28
Q

Treatment of strep throat

A

penicillin V or amoxicillin for 10 days

29
Q

Noninfectious causes of macroscopic hematuria in a child

A 
recurrent: IgA nephropathy, benign familial hematuria, Alport’s syndrome
Acute poststreptococcal
glomerulonephritis
Systemic lupus erythematosus
Henoch-Schonlein purpura
Goodpasture’s disease
Acute pyelonephritis
Acute interstitial nephritis
Tuberculosis
Hematologic (sickle cell disease, coagulopathies von Willebrand’s disease, renal vein thrombosis,
thrombocytopenia)

Urinary tract Bacterial or viral (adenovirus) infection–related

Nephrolithiasis and hypercalciuria
Structural anomalies, congenital anomalies, polycystic kidney disease
Trauma
Tumors
Exercise
Medications
30
Q

Causes of asymptomatic isolated

microscopic hematuria in children

A 
Common
Undetermined
Benign familial Idiopathic hypercalciuria
IgA nephropathy
Sickle cell trait or anemia
Transplant
Less common
Alport nephritis
Post-infectious glomerulonephritis
Trauma
Exercise
Nephrolithiasis
Henoch-Schonlein purpura
31
Q

clinical presentation of Hydatidiform mole (molar pregnancy)

A

classic signs of complete mole

  • Vaginal bleeding
  • Hyperemesis
  • Hyperthyroidism

other symptoms:
Excessive uterine size
Hypertension of pregnancy

32
Q

Most important risk factor of Hydatidiform Mole

A

mother’s age

33
Q

clinical features of Bacterial Vaginosis

A

[most common cause of vaginal discharge, 50% asymptomatic]

  • transparent/grey thin vaginal discharge
  • fish odor
  • NO vulva/ vaginal irritation
34
Q

diagnostic test of bacterial vaginosis

A

Whiff test ++

saline wet mount shows >20% clue cells

35
Q

treatment of bacterial vaginosis

A

Treat only symptomatic
Increase PROM during pregnancy, avoid vaginal route
Metronidazole 500mg BID for 7 days
OR metronidazole 0.75% cream 5g intravaginally for 5 d

36
Q

pathogen of chicken pox

A

varicella zoster virus (VZV)

37
Q

what are the complications of chickenpox

A
  • secondary bacterial infection (most common): e.g. pneumonia, pharyngitis, AOM, gastroenteritis
  • cerebral ataxia
  • encephalitis
  • fetal varicella syndrome (for pregnant women)
38
Q

prevention/prophylaxis of chickenpox

A

For immunocompromised persons, pregnant women and exposed infants

  • varicella-zoster immune globulin, which must be given within 96 hours of exposure to be effective
  • A one-week course of high-dose acyclovir started early can prevent chickenpox
39
Q

Generalized rash over trunk and limbs, along the Langer lines, 2 weeks after a herald patch on trunk
can associated with flu-like symptoms
the most likely diagnosis and ddx

A

Pityriasis rosea

DDx:  
secondary syphilis
seborrheic dermatitis
nummular eczema
pityriasis lichenoides chronica
tinea corporis
viral exanthems
lichen planus
drug eruption
40
Q

treatment of pityriasis rosea

A

self-limited course within a few months
oral antihistamine or topical steroid for symptoms mgt
phototherapy for severe cases

41
Q

DDx with rosacea

A
  • Acne vulgaris
  • photodermatitis
  • seborrheic dermatitis
  • systemic lupus erythematosus
  • carcinoid syndrome
42
Q

management of rosacea

A
  • avoid triggers
  • use mild cleansing agents
  • use photoprotection
  • topical metronidazole or azelaic acid or brimonidine; for papulopustular rosacea, can try topical ivermectin
  • ocular rosacea: lid hygiene + artificial tears +/- topical cyclosporine
  • severe phymatous: oral doxycycline or tetracycline
43
Q

what is the best predictor of response to Naloxone? and what is the dosage?

A

Respiratory rate < 12 /min

Naloxone 0.4mg IV or 2mg intranasal q4min

44
Q

Universal Antidotes in altered mental status

A
  • Dextrose: 50mL of D50W or Glucagon 1mg IM
  • Oxygen: 100% O2 in carbon monoxide poisoning
  • Naloxone (Narcan):
    • – 2mg initially up to 10mg
    • – 0.1mg initially doubled every 2 minutes up to 10mg
  • Thiamine
    • – given 100mg IV/IM/PO with 25g dextrose (50mL of D50W) to prevent Wernicke’s encephalopathy
45
Q

Antidotes to prevent Wernicke’s encephalopathy

A

Given 100mg IV/IM/PO with 25g dextrose (50mL of D50W)

46
Q

a/e of isotretinoin

A 
Severe birth defects
Miscarriage, Stillbirth
Photosensitivity 
Dry skin, severely chapped lips
depression, suicidal 
burning, redness, itching, or other signs of eye inflammation
IBD
Pruritis 
Dry mucous membranes 
nosebleeds
Bone or joint pain
47
Q

STEMI management

A

depends on duration from onset of symptoms
= or < 12 hours: Reperfusion goals
1) Door-to-balloon inflation (PCI) goal of 90 min
2) Door-to-needle (fibrinolysis) goal of 30 min

48
Q

Absolute contraindication of fibrinolysis for STEMI

A

Absolute contraindication:

  • intracranial hemorrhage
  • cerebral lesion
  • malignancy
  • head/facial trauma < 3 mo
  • ischemic stroke < 3 mo
  • active bleeding (excluding menses)
  • aortic dissection
  • intracranial/ intraspinal surgery < 2 mo
  • severe uncontrolled HTN
49
Q

relative contraindications of fibrinolysis for STEMI

A

relative contraindication

- hx poorly controlled HTN

Herkimer 2021 (21 decks)

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