Packrat review Qs 2 Flashcards
Which antiarrhythmic drug can be associated with hyper- or hypothyroidism following long-term use?
Amiodarone
is structurally related to thyroxine and contains iodine, which can induce a hyper- or hypothyroid
state.
Dx test after MVA to determine C-spine stability?
A cervical spine series (Xray)
which view of the Xray of Cervical spine detects 80% of traumatic spine injuries? what are the other two views?
consists of a lateral view, anteroposterior (AP) view, and an odontoid view. The lateral view detects up
to 80% of traumatic spine injuries.
Decreased tactile fremitus and dullness to percussion would be found in what pulmonary pathology?
pleural effusion
MC location of venous stasis ulcer?
medial ankle
where are diabetic ulcers usually found?
pressure points on the foot (occur from atherosclerosis + arterial insufficiency + diabetic neuropathy)
what 3 groups need hospital care if bitten by a black widow?
children, pregnant women, and patients
with preexisting cardiovascular disease.
what 3 groups need hospital care if bitten by a black widow?
children, pregnant women, and patients
with preexisting cardiovascular disease. (symptomatic care)
most accurate way to measure spine of scoliosis?
Cobb angle (uses AP and lateral Xray films
treatment of croup - mild vs moderate/severe
mild- oral dexamethasone
moderate/severe - (stridor at rest or hypoxia) - nebulized (racemic) epinephrine
When instituting diuretic therapy for patients with heart failure, which of the following is considered the treatment of
choice as first-line therapy in a failing kidney due to its improved sodium clearance
bumetanide (bumex) [loop diuretic]
megaloblastic anemia (like from B12 deficiency) shows what early signs?
neuro manifestation - parasthetias hands/feet
jaundice and hepatosplenomegaly are signs of what type of anemia?
hemolytic
This compensatory mechanism is common in any type of anemia due to the hypoxemic effects of the anemia.
tachycardia
A 20 year-old male presents with 3 weeks of constitutional and upper respiratory symptoms, including malaise, sore throat, dry cough, and fever. Lung auscultation demonstrates diffuse crackles bilaterally. What is the most likely infectious agent involved?
mycoplasma pneumonia (MC atypical PNA: indolent onset of constitutional symp) [ strep pneumo (typical) would present w/ a more severe/fulminant course]
5months growing lesion, reveals a one centimeter, firm nodule at the right temple with heavy keratinization. There is no fluctuance or skin discoloration. Dx?
squamous cell carcinoma
older patients with light skin tones as a rapidly growing, firm, nontender, shiny, flesh-colored or bluish-red, intracutaneous nodule
merkel cell carcinoma (neuroendocrine)
benign chronic skin condition that causes raised reddish or skin-colored bumps (lesions) in a ring pattern, usually on the hands and feet. MC kids
granuloma annulare
In addition to supportive treatment, the most commonly used medications for neuroleptic malignant syndrome
are ________ and ________
dantrolene (Dantrium) and bromocriptine (Parlodel).
first line txt for PMS
SSRI (rather than birth control)
mechanism of injury for ACL tear
mechanism of injury can be due to a
direct blow to the knee or as a result of sudden deceleration and rotation of the knee
What is the recommendation for primary prevention of stroke in a patient under sixty years of age with atrial
fibrillation?
none
Which of the following is first-line treatment for a symptomatic bradyarrhythmia due to sick sinus syndrome?
permanent pacemaker
penile epispadias vs glandular epispadis vs penile/glans hypospadias
penile epispadias: opening on the dorsal penis.
glandular epispadias: opening occurs on dorsal glans penis
hypospadias: abnormality occurs on the ventral surface of the penis or glans
What is the most likely mechanism responsible for retinal hemorrhages and neurologic complications in a patient with infective endocarditis?
embolization of vegetations
During the stages of fracture healing which of the following is responsible for producing collagen?
fibroblasts
child w/ cold-like symptoms, then gross hematuria (coca cola urine) = ?
IgA nephropathy
how does post-strep glomerulonephritis present?
2-3 weeks after a streptococcal infection (pharyngeal or skin) –> nephritic symptoms (edema, hypertension, cola-colored urine). This is due to trapping of the
streptococcal antigen within the glomerulus
what are 4 risk factors for retinopathy of prematurity?
low birth weight, perinatal O2 therapy, prematurity and sepsis
Which of the following medications inhibits prostaglandin synthesis in a patient with rheumatoid arthritis?
ASA
Dx choice for pt with progressive dysphagia?
endoscopy (so you have the option to biopsy)
HTN retinopathy vs DM retinopathy on fundoscopy
HTN: AV nicking
DM: neovascularizations and microaneursyms
Elevation of the right testicle brings relief of the pain. This is known as a positive ____?
phrehn’s sign (epidydimitis)
right vs left atrial enlargement on EKG?
right: peaked P waves in lead II, large positive deflection in initial p wave V1
left: wide p waves in lead II, deep negative deflection in p wave V1
right vs left ventricle hypertrophy on EKG?
Right: large R wave in lead AvR along with a deep S
wave in leads V5 or V6.
Left: tall R waves in leads V5 and V6, deep S waves in
AvR and V1, and tall R waves in AvL and AvF.
short arm gutter splints are useful for what?
metacarpal and phalanges fx (i.e. boxers)
best splint to stabilize wrist, elbow, forearm
sugar tong
2 yo with high fever, grainy appearance on buccal mucosa opposite second molars
rubeola (measles) - koplik spots
high fever followed by lacey reticular rash
roseola (herpes virus VI)
who should be screened for lung CA?
- Have a history of heavy smoking, and
- Smoke now or have quit within the past 15 years, and
- Are between 55 and 80 years old.
- screen with CT chest
A 23 year-old male being treated for an acute bacterial prostatitis has been taking antibiotics for less than 24 hours. He presents to the emergency room today with acute urinary retention for 12 hours. Which of the following is the most appropriate next step?
percutaenous suprapubic tube (anything in ureter is CI cause of bacterial prostatitis)
right-sided extremity weakness and left-sided weakness of the face. Where is the lesion?
brainstem
cerebellum lesions present with what 3 symptoms ?
ataxia, intention tremor, and dysmetria.
basal ganglia lesions present with what 3 symptoms?
bradykinesia, akinesia, and loss of postural reflexes.
severe allergic rhinitis + failed avoidance therapy, as well as antihistamines and intranasal corticosteroids. next step is?
immunotherapy
what condition is assoc. w/ increased intensity of the P2 heart sound?
ASD: from increased vol in right ventricle
what are the A2 and P2 heart sounds?
The second sound (S2) is made of two component sounds: Aortic valve closure (A2) which happens first. Pulmonic valve closure (P2) which happens second. heard with split S2
benign tumor in children age 5 to 20, presents with increasing pain, worse at night and
relieved by aspirin. dx? what does Xray show?
osteoid osteoma - radiolucent nidus surrounded by osteosclerosis
what prophylaxis should be considered initially for all burn pts?
tetanus
when are IV fluids indicated for burn pts?
for severe partial thickness burns covering more than 10% TBSA or in burns with
complications.
what are the three initial interventions for plantar fascititis txt?
Arch supports, NSAIDs and stretching exercises
steroid injections for plantar fascititis?
Steroid injections can be used to relieve symptoms but may be harmful by causing rupture if given in the
plantar tendon greater than 3 or 4 times.
why is elevated levels of lipoprotein a risk factor for CAD? (through what mechanism?)
competes for binding with plasminogen receptor - so plasminogen isn’t able to activate plasmin (which facilitates degradation of fibrin complexes)
all close contacts with to a patient with pertussis should be given what prophylaxis? (regardless of age, immunostatus and symptoms)
macrolides
paroxysms of cough followed by a deep inspiration,
and occasional post-tussive emesis. During severe paroxysms, he exhibits transient cyanosis.
pertussis
Which of the following medication classes is the recommended treatment for patients who have an anterior wall myocardial infarction with poor left ventricular function
ACEs (first line for left ventricular dysfunction)
MVC –> blood at the meatus and the patient is suspected of having a pelvic fracture. Dx study to eval urethral system?
urethrogram (xray w/ contrast through urethra)
txt for acute brochiolitis
O2 to correct low levels + bronchodilators
how does cocksackie virus group A present?
early by petechiae or papules/vesicles on the soft palate that become shallow ulcers in about 3 days.
treatment for bleeding of patients with type 1, 2, and 3 von willenbrand dz?
type 1: DDAVP (causes release of vWF and factor VIII
type 2 and 3: vWF factor
txt for bleeding with hemophilia A?
factor VIII
triptans are contraindicated for what pts as treatment for migraines?
those with CAD or PVD
Which histologic type of lung cancer is typically centrally located?
squamous cell
txt protocol for heparin induced thrombocytopenia (HIT)
- immediately discontinue heparin
- direct thrombin
* NOT indicated: platelets or plasmapharesis
txt for heparin overdose
protamine sulfate
how long will trop stay positive after MI?
about a week
Which age group is most likely to present with Duchenne’s muscular dystrophy?
toddler-aged males
An inherited disorder of progressive muscular weakness, typically in boys.
duchennes muscular dystrophy
syncope w/ changes position (rolling over in bed, bending over). Which of the following is the
most likely explanation for this presentation?
atrial myxoma - positional changes = gravitation effect on the tumor
Dx of Spina bifida occulta, what is the screening for it?
Dx: Xray spine
screening: elevated alpha feta protein = neural tube defect such as spina bifida (16-18wks pregnancy)
disorder of the red blood cell membrane = trapping of RBCs in spleen+ hemolysis. which type of anemia is this?
hereditary spherocytosis
G6PD deficiency anemia is caused by what? what does G6PD do? what pt population is it MC in?
increased destruction of RBCs (G6pd helps RBCs work and protects them from harmful substances). MC in males
Which of the following causes of pneumonia is most likely to be complicated by diarrhea?
legionella
At what age should a child’s eyes be consistently well-aligned?
6 months
contraindications for exercise stress testing
rest angina within the last 48 hours, unstable cardiac rhythm, hemodynamically unstable patient, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, and active infective endocarditis.
