Packrat review Qs Flashcards
what ages does the first tooth erupt in an infant?
6-8mo
S+S of morton’s neuroma and what is the txt?
pain on plantar surface of foot in third metatarsal head (inflammed/compressed intertarsal nerve)
txt: NSAIDs, foot cushion, PT
(failed conservative –> steroid injection , then Sx)
S+S ganglion cyst + txt?
swelling along tendon sheath (MC dorsal wrist) +/- pain. txt: watch (50% spont resolve), immobilize, aspirate
weight loss, diarrhea, steatorrhea, + antiendomysial antibody (AEA)… what is the Dx?
celiac sprue (celiac dz)
what is “whipples dz”: MC population, S+S?
tropheryma whippelii - MC farmers around contaminated soil. = malabs: weight loss, steatorrhea, fever, lymphadenopathy, nondeforming arthritis, neurologic symptoms, rhythmic motion of eye muscles while chewing. (“whipping up stomach, whipping eyeballs”
Dx of whipples dz
duodenal bx = periodic acid-schiff (PAS) - positive macrophages, non acid-fast bacilli, dilation of lacteals (lymphatic vessels of small intestine)
txt of whipples dz
PCN or tetracycline for 1-2 years
confirmed pulseless ventricular tachycardia. IV access is obtained following the second shock given. Which of the following medications is to be administered immediately?
epinephrine
what med is given for slow pulseless PAEA or asystole?
atropine
Dx test of choice for toxoplasmosis? what is the result?
MRI of brain = ring-enhancing mass lesions
(ECG) shows a sinus rhythm with varying T wave heights, axis changes every other beat and a wandering baseline. Which of the following is most likely the diagnosis?
pericardial effusion
ECG: artifact vs poor lead placement?
artifact: wandering baseline (no Axis changes)
poor lead placement: you see something youve never seen before or the limb leads show negative q and PRS
As a rule, solid foods such as cereal and fruits are best introduced into an infant’s diet at approximately what age?
4-6mo
mitral regurg from papillary muscle rupture (post MI) - what is the txt?
mitral valve replacement
pain is elicited with palpation below the anterior acromion. Anterior shoulder pain is also reported when
the patient flexes and extends his arm
impingement
Dx of shoulder nerve impingement?
Dx lidocaine injection (subacromial) = transient but dramatic improvement
pericarditis txt
anti-inflammatories (i.e. indomethacin)
chest pain with inspiration, fever and general
malaise. Cardiac examination reveals a rub with muffled heart sounds. Labs show an elevated erythrocyte
sedimentation rate (ESR) and leukocytosis.
pericarditis
Anti-Saccharomyces cerevisiae antibodies (ASCA) = Dx?
crohns (most likely, although positive in some w/ UC)
Antineutrophil cytoplasmic antibodies (ANCA)
Ulcerative colitis (and less likely crohns)
what are the established risk factors for osteoporosis?
low body weight, female sex, advanced age, Caucasian race, and bilateral oophorectomy before menopause without estrogen replacement.
(NOT parity)
endometrial biopsy and is diagnosed with
atypical adenomatous hyperplasia. What is the next step in the management of this patient
total abdominal hysterectomy
The radioactive iodine uptake is
elevated while the thyroid hormone levels are increased with TSH levels being suppressed. Which of the following is the most likely diagnosis?
grav’es dz
The source of pain experienced during a migraine headache is a result of activation of which nerve?
trigeminal
Which of the following is the only disease that forms an ulcer at the site of inoculation?
tularemia
early decels, variable decels and late decels are significant of what?
early - head compression
variable - cord
late - uteroplacental insufficiency
when is fetal hypoxia a concern based on the FHmonitoring?
when there are deep LATE decels WITHOUT beat to beat variability
what is the pneumonic to remember fetal heart rate pattern and the cause?
VEAL CHOP variable - cord compression/prolapse early decels - head compression accelerations- Okay late decels - placental insufficiency
splint for a colles fracture (metaphysis of distal radius w/ dorsal displacement and angulation)?
volar forearm (WITHOUT thumb spica)
who is at risk for developing erythrasma and how is it Dx?
People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those
with hyperhidrosis
Dx: coral red fluorescence
what is erythrasma?
bacterial (normal flora overgrowth) skin rash = brown scaly skin patches in areas of heat/moisture/folds
A 60 year-old patient presents with elevated blood pressure and peripheral edema.
BUN of 58 mg/dl and a creatinine of 4.5 mg/dl - for six months ago.
UA: specific gravity of 1.002, 2+ protein, and trace glucose.
Which of the following laboratory findings would be most consistent for this patient?
CKD = anemia, hypoCa+, metabolic acidosis, hyperK+
what causes a pleural effusion - transudate vs exudate vs empyema ?
Transudates: from increased hydrostatic or decreased oncotic pressures across normal capillaries.
Exudate: Increased production of fluid due to inflammatory or malignant processes
Empyema: Infection in the pleural space
Which of the following medications decreases the exchange of hydrogen for potassium by inhibiting H+, K-ATPase?
PPIs
how do you Dx rocky mountain spotted fever (rickettsia) ?
immunofluorescent assay (for viral or bacterial antigen-antibody detection )
heterophile agglutination is used to dx what?
EBV - mono
When evaluating jugular venous pulsations a prominent a wave represents which of the following?
A wave corresponds to right atrial contraction, a prominent one = contraction against a closed tricuspid valve
what is the significance of each part of the JVP waveform? (a, c, x, v, y, c-v, v-y)
a- atrial contraction (atrial systole to atrial diastole)
c- tricupsid closes at the start of ventricular systole.
x- ventricular systole + atrial filling
v- tricuspid opens (peak right A pressure just before this)
y- opening of triscuspid –> right atrium passive emptying
c-v ventricular systole
v-y ventricular diastole
first-line prophylaxis for migraines?
propanolol, timolol (BBs)
depakote and topamax (topiramate) - neuron stabilizers
sumatriptan is preventative or abortive txt for migraines?
abortive (also CCBs and ergotamine) - best when taken early in the attack
pts with marfans also commonly have what cardiac abnormality? what is the murmur assoc with it?
aortic regurg: Grade 2/6 high-frequency diastolic murmur at the third right intercostal space
what defect is this? Grade 2/6 systolic ejection murmur at the second left intercostal space with a fixed widely split S2
ASD
what defect is this? Grade 2/6 continuous murmur heard best at the high left sternal border
patent ductus arteriosis
what cardiac abnormality is this? Grade 2/6 systolic murmur at the fourth left intercostal space that decreases with squatting
HOCUM
worsening fatigue, weight loss, and weakness, recurrent bouts of abdominal pain and losing her pubic hair. + orthostatic hypotension. Which of the following conditions is most likely?
addisons (primary adrenal failure - from autoimmune or hemorrhage of adrenal gland)
A 2 month-old infant has been diagnosed with pneumonia due to Chlamydia trachomatis. Which of the following is the treatment of choice?
erythromycin (doxycycline and FQs are contraindicated in kids)
what are the guidelines with tetracyclines and FQs for pediatrics?
tetracycline (doxycycline): CI in < 8 yo secondary to damaging effects on bone and teeth enamel.
FQ (levofloxacin): CI in < 18 yo secondary to
damaging effects with growing cartilage.
A 65 yo, recent anterior MI returns for f/u 6wks later. no CP, but reports decreased exercise tolerance.
ECG: persistent ST elevation in V2- V4.
Which of the following is the most likely diagnosis?
ventricular aneursym
Occlusion of the right coronary artery would show what in ECG?
ST elevation in the inferior leads
RV infarction is present in one-third of patients who had an inferior wall MI and typically show what in ECG?
ST elevation in V4 along with the inferior leads.
what physical exam lung sounds are consistent with lobar pneumonia?
late inspiratory crackles, dullness to
percussion, increased tactile fremitus
txt for acute prostatitis?
ampicillin and gentamicin
txt for acute epididymitis?
ceftriaxone and doxy
An 18 year-old w/ bacterial conjunctivitis. Gram stain = gram-negative intracellular diplococci. txt?
gonorrhea = ceftriaxone
The bite from which of the following is associated with fever, lacrimation, rhinorrhea, bradycardia, hypertension, and tachyarrhythmias?
black widow
what does a bite from a brown recluse spider cause?
mild uriticaria –> full thickness skin necrosis
A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). next step is colposcopy w/ endometrial curretage or endometrial sampling?
endometrial sampling (b/c most dangerous one) [+ endometrial curettage would be for LGSIL, HGSIL, or squamous cell] - only repeat pap or ASCUS
Which of the following is the leading cause of injury-related death in children between the ages of 1 and 15?
MVCs
A positive osmotic fragility test is seen in which of the following?
hereditary spherocytosis (defective RBC membrane)
Patients with primary adrenal insufficiency will have which of the following electrolyte abnormalities?
hyperK+ (As a result of the lack of the mineralocorticoid aldosterone, the kidney will not save sodium and
will instead save potassium.)
Which of the following physical exam findings suggests worsening or SEVERE aortic stenosis?
Palpable thrill over the right second intercostal space
primary sclerosing cholangitis vs choledocolithiasis
primary sclerosing cholangitis: chronic dz of liver from bile duct attacked and scarred down (areas of stenosis and dilationg)
choledocolithiasis: stone in bile duct, usually not poor prognosis
Perfusion of the coronary arteries occurs primarily during which of the following? (systole, diastole, preload or afterload)
diastole
preload vs afterload
Preload: initial stretching of the cardiac myocytes (muscle cells) prior to contraction. (left Vent end diastolic pressure)
Afterload: force or load against which the heart has to contract to eject the blood
what are included in the interstitial lung dz group?
injury to lung causes abnormal healing response = progressive scarring of the lung (fibrosis)- enviornmental/occupational exposures (i.e. asbestos or silicosis) OR autoimmune (i.e. rheumatoid arthritis, sarcoidosis, scleroderma)
late inspiratory crackles, dyspnea on exertion and cough with minimal sputum production are signs of what?
interstitial lung dz
two options for most effective prophylaxis for traveller’s diarrhea?
FQs (i.e. ciprofloxacin) or TMP/SMX
what is clostridial infection?
clostridium myonecrosis (gas gangrene)
txt options for Clostridial infection ( gas gangrene)
hyperbaric oxygen therapy, penicillin
therapy, and radical surgical excision.
what kinds of things is hyperbaric oxygen therapy used for?
used to speed up healing of carbon monoxide poisoning, gas gangrene, stubborn wounds, and infections in which tissues are starved for oxygen.
also scuba diving “bends”
classic Xray findings for ewing sarcoma, osteochondroma, multiple myeloma, osteoid osteoma
ewing sarcoma = “onion skinning”/ lytic mass with a multi-laminated periosteal reaction (young pt w/ night pain)
osteochondroma= stalk or broad based projection from surface of the bone
MM = lytic lesion (older people w/ back pain)
osteid osteoma = round lucency surrounded by sclerotic bone
In a patient with amaurosis fugax what is the most appropriate initial diagnostic study?
carotid ultrasound - to find atherosclerotic plaque
An adult patient who has undergone a splenectomy secondary to idiopathic thrombocytopenic purpura should receive
which prophylactic agent?
pneumococcal vaccine once (for strep pneumo)
Bicillin 1.2 million units IM every month is prophylaxis for what?
pts w/ rheumatic fever for group a beta hemolytic strep
Gamma globulin IM every month is prophylaxis for what?
prophylaxis to hepatitis exposure
myocardial infarction, relief with rest or nitro?
NO! that would be angina
A 52 yo female, bouts of anxiety and depression(<24 hours). “I often feel like I am going to jump out of my skin”. Her periods have become less frequent over the past 6 mo. denies SI. She is not sleeping through the night. Which of the following the most
appropriate next step in this patient?
check FSH to check for menopause - causing pysch symptoms
Maternal blood pressure normally decreases the most during what period of pregnancy?
second trimester
Which of the following is the most common presentation for an elderly female patient with primary
hyperparathyroidism?
asymptomatic
4 yo falls frequently and “stands funny”, has lost the ability to easily stand from a seated position. he met developmental milestones as an infant. Which of the following is the most likely cause?
muscular dystrophy - onset by age 5 and begins in the pelvic girdle
what is muscular dystrophy?
group of diseases that cause progressive weakness and loss of muscle mass. abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle.
Pulmonary capillary wedge pressure INDIRECTLY measures which of the following?
left atrial filling pressure :
(enters SVC - right atrium into pulmonary artery - balloon occludes here and measures pressure from pulmonary artery through pulmonary capillaries to left atrium)
What should be the initial evaluation of the etiology of infertility in a 25 year-old female who has been trying to
conceive for 1 year?
basal body temp - screening test for ovulation to help time coitus
palpable ovaries in postmenopausal pt indicate what likely dx?
ovarian cancer until proven otherwise
CSF results for viral meningitis?
Increased CSF mononuclear cells and normal glucose
Which of the following is considered the antibiotic of choice in the treatment of human bite wounds?
augmentin
What is the most common location of anterior nasal epistaxis?
Kiesselbach’s triangle/area
The neuromuscular hallmark of polymyalgia rheumatica is what?
proximal muscle pain and stiffness
A male is found to have an eunuchoid body habitus, gynecomastia, diminished secondary sex characteristics, and small and firm testicles. dx?
klinefelter sydrome: XXY - boys are phenotypically normal until puberty. low serum testosterone
what size kidney stone needs lithotripsy?
stones > 6 mm in size or intractable pain.
what factors distinguish rubella from rubeola and roseola?
fever AFTER rash (unlike roseola)
lymphadenopathy and lack of systemic symptoms
A 74 yo w/ one month history of right shoulder pain- right paraspinous musculature to the right deltoid with occasional radiation down the arm.
Pain is worse with movement of the shoulder and is not relieved by acetaminophen. He reports numbness of the right index finger and thumb. Physical examination of the shoulder is limited by pain. There is decreased grip strength and absent pinprick sensation in the index finger and thumb. Relexes are normal. What Dx study to obtain?
Xray of neck: Cervical radiculopathy may be due to intervertebral foraminal osteophytes
Which of the following findings confirm the adequacy of a sputum specimen for Gram stain and culture?
The presence of increased polymorphonuclear leukocytes and the absence of squamous epithelial cells
trauma pt given 12 units packed RBCs and still bleeding, what do you give next?
FFP : When a patient receives more than one total blood volume (10 units) without replacement of clotting factors, the patient will continue to bleed without administration of fresh frozen plasma.
A Gram stain and culture of the sputum = gram-positive cocci in clumps and a chest x-ray reveals multiple patchy infiltrates with some cavitations.. what is likely in this pts history?
IV drug use -
This patient has pneumonia caused by Staphylococcus aureus which is commonly associated with a history of
intravenous drug use, influenza epidemics and the hospital setting.
first line txt for guillan-barre?
IVIG (donated blood with healthy antibodies - for the autoimmune destruction of nerve myelin)
What is considered the most common physical examination finding for intestinal obstruction?
distension
what class of antidepressants most commonly cause anticholinergic ADRs?
TCAs
what is eisenmenger syndrome?
complication of a congenital heart defect : abnormal blood flow + pulm HTN
explanation: ASD or VSD –> left to right shunting of blood –> pulmonary HTN –> irreversible pulm vasc injury + then resistance –> right to left shunt = hypoxia + erythrocytosis
Dx? 27 yo - worsening low back pain and stiffness for the past two years. worse upon awakening and improve throughout the day. Lumbosacral flexion is less than
50%. Lumbosacral spine films show erosions in the joint line of both sacroiliac joints. HLA-B27 test is positive
ankylosing spondylitis
first line txt for ankylosing spondylitis
NSAIDs
recommendation to reduce the risk of SIDS ?
pacifier at naptime and sleep in the supine position
Which agent can be used as a urinary tract analgesic?
Phenazopyridine (Pyridium)
what is oxybutynin used for?
antispasmodic and anticholinergic used in the treatment of overactive bladder.
severe explosive diarrhea, nausea, vomiting and abdominal cramps six hours after having homemade potato salad and hot dogs. Multiple people who ate at this picnic have similar symptoms. There is no associated fever. likely cause?
Staph aureus (only common acute ingestion of preformed toxin)
24yo male : 1wk pain and swelling of entire right upper extremity. He exercises frequently. pain worsening while lifting weights. PE= enlarged cutaneous veins over the right anterior chest wall with a palpable cord. His right hand appears dusky. Dx?
Axillary-subclavian venous thrombosis
common w/ strenuous exercise
