PANCE

Question 1

Most common virus for actue viral siniusitis?

Answer 1

Rhinovirus

Question 2

What is the antibiotic of choice for hordeolum?

Answer 2

Erythromycin ophthalmic ointment.

Question 3

The rash associated wth Scarlet Fever is produced by streptococcal pyrogens producing what

Answer 3

Eryhrogenic toxins. The toxin has been shown to exhibut pytogenicity and cytoti=oxicity. It usually apprears at the 2nd day of infection on the upper part of the chest and spreads to the rest of the trun towards the body with the palms, soles and face being spared.

Question 4

Corneal Abrassion caused by pseudomonas treated with what?

Answer 4

Cipro eye ggts

Question 5

Cause of hand foot mouth disease?

Answer 5

coxsackie viruses.

Question 6

Herpetic gingivostomatitis treatment and symptoms?

Answer 6

prodrome of flu-like symptoms such as fever and irritability followed by vesicles that coalesce and rupture to form painful ulcers of the oral and perioral tissues. The pain can be severe, and refusal to eat or drink is a clue to the diagnosis. There may be accompanying cervical lymphadenopathy. Diagnosis is usually clinical, but viral cultures, PCR, or serology can be done if the diagnosis is in doubt. Oral acyclovir is recommended for treatment of herpetic gingivostomatitis

Question 7

Explain the differences in the degrees of hearing loss between normal hearing, slight hearing loss, moderate hearing loss, severe hearing loss and profoud hearing loss?

Answer 7

Using a normal voice for testing, someone with normal hearing should hear sounds from at least 18 feet away. Someone with slight hearing loss will not generally hear sounds from more than 12 feet away. An individual with moderate hearing loss is limited to approximately 3 feet of hearing. Severe hearing loss is associated with sound perception only immediately around the meatus. Profound hearing loss is near-total or complete loss of one’s hearing

Question 8

New born baby born with purulent conjunctivitis… how can you differentiate between N. gonorrhoeae and C. trachomatis causes?

Answer 8

Ophthalmia neonatorum is a form of conjunctivitis occurring in infants younger than 4 weeks. The usual incubation period for C. trachomatis is 5 - 14 days and 2 - 5 days for N. gonorrhoeae.

Question 9

What are Epstein’s pearls?

Answer 9

They are 1 of 2 forms of cystic or fluid filled lesions of the palate found in approximately 60% of newborns and more commonly in Caucasian than African-American babies. Epstein’s pearls are located within the fusion of the posterior palatal segments and result from the inclusion of epithelial cells during palatal fusion.

Question 10

Treatment for recurrent apthous ulcers.

Answer 10

The normal treatment is oral steroids, the long term preventative treatment is Amlexanox

Question 11

What does the biopsy of oral hairy leukoplakia show?

Answer 11

the pathology shows hyperkeratosis, “balloon” cells in the upper cell layer, and Epstein-Barr virus (EBV) in the basal epithelial cells.

Question 12

What are the ‘Grades’ of ankle sprains?

Answer 12

Grade I ankle sprain results from only mild stretching of a ligament with potentially microscopic tears. Patients will present with mild swelling and tenderness; there will not be evidence of joint instability, and the patient will be able to bear weight and ambulate fairly easily.

Grade II ankle sprain. This injury typically involves an incomplete tear of a ligament. Patients will experience moderate pain, swelling, tenderness and ecchymosis. There will be mild to moderate joint instability during exam and some restriction of the range of motion as well as loss of function. Ambulation and weight bearing are painful.

Grade III ankle sprain involves a complete tear of a ligament. There will be severe pain, swelling, tenderness, and ecchymosis. Significant instability will be seen on exam, as well as loss of function, with the inability to bear weight or ambulate whatsoever.

Question 13

Neovascularization on fundiscopic exam is the hallmark of

Answer 13

of proliferative diabetic retinopathy. New vessels can appear at the optic nerve and the macula as a result of retinal hypoxia. They are susceptible to rupture, resulting in vitreous hemorrhage, retinal detachment, and blindness. Proliferative retinopathy requires urgent referral to an ophthalmologist and is usually treated with pan retinal laser photocoagulation.

Question 14

Blot hemorrhages, cotton wool spots, and microaneurysms are indicative of

Answer 14

nonproliferative diabetic retinopathy, which is usually seen 10 to 20 years after the onset of diabetes. Nonproliferative retinopathy does not always progress to proliferative retinopathy, but if it becomes extensive, it can result in retinal ischemia, which increases the likelihood of proliferative disease.

Question 15

Flame-shaped hemorrhages are indicative of

Answer 15

hypertensive retinopathy.

Question 16

Injury to the radial nerve is associated with what symptoms

Answer 16

wrist drop with inability of wrist extension

Question 17

what ligaments is injured in ‘game keepers thumb’ and what PE findings are significant?

Answer 17

The ulnar collateral ligament of the thumb, PE shows increased laxity with abduction of the thumb

Question 18

Foot drop and a high-stepping gate are the result of damage to what nerve?

Answer 18

Deep peroneal nerve

Question 19

de Quervain’s tenosynovitis tendons involved:

Answer 19

The inflammation thickens the tendon sheath abductor pollicis longus and extensor brevis on the thumb side of the wrist.

Question 20

Duchenne Muscular Dystrophy PE

Answer 20

is the correct response; symptoms are usually noted between the ages of 3 to 5 years in boys. The disease is present at birth; however, symptoms often are not noted until the child starts walking. A waddling gait, hypertrophy of the calves, lumbar lordosis, and hyporeflexia are all common exam findings with this disease. The way in which the child pushed himself into an upright position is known as Gower’s sign. There is also an increase in creatine kinase. This is the most common form of muscular dystrophy in children.

Question 21

Initial treatment for ankylosing spondylitis

Answer 21

NSAIDS

Question 22

what is usually the first PE finding in compartment syndrome?

Answer 22

Pain with extension of the involved limb is the most reliable early clinical finding.

Question 23

For a patient with scoliosis, what degree of curvature will need bracing? what degree needs surgical correction?

Answer 23

Bracing is reserved for curves >30° in a patient with Risser stage of 3. Surgical referral is not needed until idiopathic curves reach 50° or for curves of 40° to 50° that are likely to progress.

Question 24

To reduce fracture risk in patients with osteoporosis, the National Osteoporosis Foundation recommends daily calcium intake of at least _____and vitamin D _____

Answer 24

calcium intake of at least 1200 mg and vitamin D 800 - 1000 IU,

Question 25

what is the initial treatment for DeQuervain’s tenosynovitis (including the splint name)

Answer 25

Nonsteroidal anti-inflammatory drugs (NSAIDs) and thumb spica splint

Question 26

what are Russell bodies and what disease are they seen in?

Answer 26

are the accumulation of immunoglobulin in plasma cells. Immunoglobulins are proteins.

seen in Multiple Myeloma

Question 27

Children’s legs go thought periods of valgus and various changes… explain when this occurs?

Answer 27

Children are normally bowlegged (genu varum) at birth. By 12 to 18 months of age, the legs become straight. Then children develop knock-knee (genu valgum), which is maximal by about age 3-4 years. This averages 10-15 degrees at this age. The legs then spontaneously “straighten” to 5-10 degrees of valgum, which is the average for adults.

Question 28

Thenar atropthy is associated with what?

Answer 28

Carpal Tunnel

Question 29

what is the most common cause of osteomyelitis of the foot in diabetic patients.

Answer 29

Staphylococcus auerus

Question 30

what is Kehr’s sign

Answer 30

is pain in the left shoulder secondary to splenic rupture.

Question 31

what is the most common cause of osteomyelitis when a penetrating object passes through the sole of the shoe.

Answer 31

Pseudomonas aeruginosa

Question 32

what two blood test can be used to diagnose celiacs?

Answer 32

IgA endomysial antibody and IgA tTg antibody

Question 33

how much fiber should you normally get in a day?

Answer 33

about 30 grams

Question 34

what is the number one cause for small bowel obstructions? what about large bowel?

Answer 34

Small is Post op adhesions, large bowel is cancer.

Question 35

what is the leading cause for iron def anemia?

Answer 35

GI bleed

Question 36

what is Tropical sprue? how do you dx and how do you treat?

Answer 36

it is an acquired disease that affects both visitors and natives to tropical areas such as the Caribbean and South India. Its etiology is not known. Patients usually present with diarrhea. They may also complain of weight loss and report that their stools are soft and bulky (steatorrhea). They may also develop deficiencies of folate and cobalamin. Stool microscopy should be done to look for cysts and trophozoites. Histological examination of small bowel mucosal biopsy aids in making the diagnosis by revealing partial villous atrophy. Treatment is with tetracycline or oxytetracycline.

Question 37

what type of colon polyp has the highest risk for carcinoma

Answer 37

Villous adenoma

Question 38

what are risk factors for a child developing pyloric stenosis?

Answer 38

First born male child

Question 39

what is the initial treatment for UC?

Answer 39

sulfasalazine
Sulfasalazine is a sulfa drug that has important anti-inflammatory properties because it inhibits the synthesis of mediators of the inflammatory response. In some patients, sulfasalazine is poorly tolerated, in which case mesalamine (50-100 mg/kg/day) and balsalazide (110-175 mg/kg/day) are preferable treatments.

Question 40

Esophageal biopsy showing submucosal atrophy with fibrosis of the smooth muscle, what is this indicative of?

Answer 40

Scleroderma

Question 41

Pertissis:
bacteria:
Phases: 
Dx:
Treatment:

Answer 41

• Bacteria: Bordetella pertussis
• Stages: Catarrhal stage: infectious stage, Praxsymal stage, Convalescents
• Dx: Culture sputum
• Treatment: Erythromycin

Question 42

Croup:
Bacteria:
Dx:
Treatment:

Answer 42

parainfluenza virus
dx: steeple sign on X-ray
Treatment: Steroid.

Question 43

Enlargement of the distal segments of the fingers and toes due to proliferation of connective tissue is known as clubbing. Clubbing may be associated with what?

Answer 43

lung cancer, mesothelioma, bronchiectasis, and hepatic cirrhosis.

Question 44

How do you differentiate exudative and transudative fluid collections

Answer 44

Exudative will have a pleural protien to serum protien > 0.5
a Pleural LDH to serum LDH > 0.6
Lower glucose in pleural fluid than serum ( except in malignancy where it will be normal)
Exudative will have a WBC > 1000
Common causes is bacterial PNM and malignancy

Transudative will not have any of these features and will have a WBC less than 100, protein less than 3 g/dL, glucose levels equivalent to serum glucose, and a total nucleated cell count level less than 500/mm with predominantly lymphocytes.
Most common cause is CHF

Question 45

What is the best way to confirm dx and initially manage epiglottis?

Answer 45

Endotrachial intubation

Question 46

Most common cause of bacterial meningitis?

Answer 46

Strep Pneumoniae

Question 47

When should Aanamivir or anatadine be given for influenza?

Answer 47

only if presenting within 48 h of initial symptoms

Question 48

what causes acities or pleural effusion in patients with cirrhosis?

Answer 48

Decreased intra vascular oncotic pressure

Question 49

the clinical picture along with clubbing and the honeycomb appearance on chest X-ray is diagnostic of :

Answer 49

bronchiectasis.

Bronchiectasis is a disease caused by irreversible dilatation of the bronchial tree. Pathogenesis can be obstruction, congenital disorder, and infection. It can develop as a result of severe bacterial infections in childhood, often as a complication of whooping cough or measles.

Question 50

A little on pyogenic infections…

Pyogenic infections are generally caused by bacteria. The entry of bacteria into the body triggers a number of responses: activation of the complement pathway and phagocytosis by what….

Answer 50

neutrophils and macrophages. Macrophages play a major role in chronic granulomatous infections, and neutrophils predominate in acute pyogenic infections.

Question 51

The differential diagnosis of a solitary coin lung lesion includes:

Answer 51

Lung carcinoma (most commonly an adenocarcinoma)
Granuloma
Hamartoma

Question 52

Tuberculosis in pregnancy is treated with an initial regimen of i

Answer 52

soniazid, rifampin, and ethambutol. Because the teratogenicity of pyrazinamide is not determined, pyrazinamide is added only if a resistance to the other drugs is documented/suspected, and susceptibility to pyrazinamide is likely.

Question 53

Workers in the mining industry, because of exposure to silica dust, can develop silicosis. Diatomaceous earth is primarily crystalline silica. what are the X-ray findings ?

Answer 53

Eggshell calcification in the hilar lymph nodes points towards a diagnosis of silicosis as well as nodular opacities in the upper lung fields. Doubly refractile (birefringent) particles with polarized light are seen with silicosis.

Question 54

sweat test levels > than what is diagnostic for CF?

Answer 54

> 60mmol/L

Question 55

for rapid diagnosis of pulmonary TB, direct sputum examination with __________ stain is the best choice

Answer 55

Ziehl-Neelsen

Question 56

what is Tracheomalacia

Answer 56

is a common cause of persistent wheezing in early infancy, with male preponderance in the ratio of 2:1. In primary tracheomalacia, there is insufficient cartilage to maintain the patency of the airway throughout the respiratory cycle. It commonly occurs in premature infants. Secondary tracheomalacia occurs when trachea is compressed by structures like vascular rings or deficient cartilage due to tracheoesophageal fistula.

Question 57

the radiological changes in asbestosis are

Answer 57

The radiological changes in asbestosis are usually confined to the lower 2/3 of the lung-fields. Pleural plaques are a frequent finding in a patient with asbestosis.

The classical clinical feature in asbestosis is increasing exertional breathlessness due to pulmonary fibrosis. Digital clubbing is usually present, and inspiratory crepitations are audible over the lower zones of both lungs.

Question 58

what is the microscopic appearance of strep pneumoniae/

Answer 58

gram positive diplococci

Question 59

What is a major risk factor in almost every epidemiologic study of SIDS ?

Answer 59

maternal smoking during pregnancy

Question 60

chest X-ray of asthma ?

Answer 60

normal- no abnormalities

Question 61

Lambert-Eaton syndrome, what is it?

Answer 61

syndrome is caused by antibodies to the presynaptic calcium channel, which decreases the release of acetylcholine. Repeated stimulation of the nerve ending increases the intracellular calcium concentration, which allows enough acetylcholine to be released to cause muscle contraction. Anticholinergics would not help in this condition. The treatment lies in removing the circulating antibodies using plasmapheresis or immunosuppressants, such as prednisone or azathioprine.

The Lambert-Eaton (or myasthenic syndrome) may occur as a paraneoplastic syndrome of small cell lung cancer. The presentation is similar to myasthenia gravis; however, the weakness is made worse by sustained movement in myasthenia gravis. It is improved in the Lambert-Eaton syndrome. Myasthenia gravis is caused by antibodies to the acetylcholine receptor; consequently, the treatment lies in increasing the acetylcholine concentration in the synaptic cleft using an anti-cholinergic medication such as neostigmine.

Question 62

Pellagra… what is it caused by and what is the neumonic

Answer 62

Niacin Vit B3, Death, Diarrhea, Dermatitis and dementia.

Question 63

A severely anemic patient is brought to the ER and is transfused with 2 units of blood. After the start of the transfusion, the patient complains of nausea, and develops fever and chills. What is the mechanism of this reaction?

Answer 63

cytotoxic hypersensitivity

Question 64

characteristic “slapped cheek” rash… what is it, cause of it and how do you dx?

Answer 64

cause is parvovirus B19, therefore Serology for parvovirus B19 is the appropriate confirmatory test for patients suspected to have Fifth disease (erythema infectiosum), which presents with the characteristic “slapped cheek” rash. It is not helpful in cases of BP.

Question 65

explain the rash in bullous pemphigoid (BP)

Answer 65

This patient is presenting with bullous pemphigoid (BP), a benign autoimmune skin disorder; it is characterized by the presence of bullae (or blisters). BP is relatively rare and tends to affect the elderly. The preceding rash is typically pruritic, and it appears as urticarial plaques, possibly resembling erythema multiforme. This stage may last for months, then the skin blisters. When the blisters rupture (typically within 1 week), the skin heals. Unless the BP is extensive and generalized, the prognosis is good. Skin biopsy with direct and indirect immunofluorescence and light microscopy is the best test for confirming BP.

Question 66

what is the difference of a vesicle, bullae, nodule and pustule?

Answer 66

A vesicle is a circumscribed elevation of the skin less than 1 cm in diameter. It contains fluid.

Bullae are larger than vesiclesand are produced by factors that include chemicals, friction, and heat.

A nodule is a solid lesion larger than 1 cm in diameter. It consists of inflammatory cellular infiltrates or neoplasms.

Pustules are circumscribed accumulation of pus in the skin. The lesion may or may not be raised.

Question 67

and epidural bleed vs subdural bleed on CT scan, and what arteries are involved?

Answer 67

Epidural- middle meningeal artery and looks like a convex lens-

Subdural- bridging vein and looks leek a crescent.

Question 68

what are the PE findings of fit C deficiency and what is the medical term for it?

Answer 68

Scurvy.

Clinical features of vitamin C deficiency
Swollen, spongy gums with bleeding and superadded infection, loosening of teeth
Perifollicular hemorrhages
Spontaneous bleeding and bruising
Corkscrew hair
Anemia
Failure of wound healing

Question 69

Norwalk virus

Entamoeba histolytica colitis

Patients with Enterotoxigenic Escherichia coli food poisoning present with

Patients with Shigella dysenteriae food poisoning present with

In emetic Bacillus cereus food poisoning, patients develop vomiting

Answer 69

Norwalk virus can cause water and food borne outbreaks. The incubation period is 1 to 3 days. Patients present with watery diarrhea and vomiting. They may also report abdominal and muscle pains. In adults, diarrhea is usually more prominent than vomiting. In children, the reverse is true. On examination, they may be febrile. The stool examination is negative for leukocytes, ova, and trophozoites. The mainstay of therapy is hydration, as symptoms usually resolve within 2 days.

Entamoeba histolytica colitis develops 2 to 6 weeks after ingesting contaminated water or food. Patients usually present with bloody and mucoid diarrhea. Stool examination reveals hematophagous trophozoites and cysts.

Patients with Enterotoxigenic Escherichia coli food poisoning present with watery diarrhea 12 to 72 hours after ingesting contaminated water or raw fruit salads. Examination of the stool reveals no fecal leukocytes or trophozoites.

Patients with Shigella dysenteriae food poisoning present with bloody diarrhea; symptoms usually start 16 hours after ingesting contaminated foods like potato salad. A stool examination reveals polymorphonuclear leukocytes.

In emetic Bacillus cereus food poisoning, patients develop vomiting 1 to 6 hours after ingesting contaminated food like reheated fried rice. In the diarrheal form, they develop watery diarrhea 8 to 16 hours after ingestion. There are no fecal leukocytesor trophozoites.

Question 70

According to current recommendations per the Infectious Diseases Society of America, empirical antibiotic management of acute purulent meningitis should be based on patient age. Patients over the age of 50 should be started on what?

Answer 70

vancomycin + ampicillin + 3rd-generation cephalosporin (ceftriaxone/cefotaxime).

Question 71

what is the purpose of the APGAR scale?

Answer 71

Identify infants requiring resuscitation

Question 72

how do you dx a spinal abscess?

Answer 72

MRI

Question 73

____________ it is a rumbling diastolic murmur heard best at the apex in the left lateral position. It may be a result of underlying rheumatic heart disease.

____________presents as a diastolic rumbling murmur that is typically accompanied by a thrill heard along the left sternal border rather than the apex; it is louder on inspiration.

__________ and ___________ are examples of systolic murmurs; a diastolic murmur is heard in this patient.

___________presents as a soft early diastolic, high-pitched murmur heard best when sitting and leaning forward.

Answer 73

mitral stenosis;

Tricuspid stenosis

Mitral valve prolapse and pulmonic stenosis

Aortic regurgitation

Question 74

you suspect at PE When should parenteral anticoagulation therapy be initiated?

Answer 74

during the diagnosis, dont wait for CTA…

Question 75

what is Acute coccidioidomycosis

Answer 75

is a disease caused by breathing in a fungus found in the soil in certain parts of the southwestern United States, Mexico, and Central and South America. Dark-skinned people and people with a weak immune system will have more serious infections. Infection is caused by breathing in spores of a fungus (Coccidioides immitis) found in desert regions. About 60% of infections cause no symptoms and are only recognized by a positive coccidioidin skin test. Symptoms include cough, chest pain (mild pain to severe constriction), fever, chills, night sweats, headache, muscle aches and stiffness, joint stiffness, and rash on the lower legs (erythema nodosum).