PANCE Flashcards
1
Q
Childhood Exanthems
A
“My Scarlet Ran Very Excitedly In Her Race”
- Measles (Rubeola): 3C’s, Koplik
- Scarlet Fever: GAS, strawberry tongue
- Rubella (German Measles)
- *nothing- Varicella (Chicken Pox): dew drop
- Erythema Infectiosum: Parvovirus B19, “slapped cheek”
- Roseola: HHV-6 or 7, high fevers, 6mo-3yo
2
Q
5 Post-Op Fevers
A
- Wind
- Water
- Wound
- Walking
- Wonder drugs
3
Q
Unconjucated Bilirubinemia
A
Indirect
Not water soluble (not in urine)
1. Hemolysis (SS, G6PD,Thala)
2. Inherited (Gilbert’s)
4
Q
Conjugated
A
Direct
Soluble (dark urine)
Light colored stools if obstruction
MANY Causes (Heaptocellular dysfunction, biliary obstruction, drugs)
5
Q
Interpreting LFT’s
A
High ALT>AST = LIVER
High ALP & GGTP= BILIARY problem
“P = tree problem”
6
Q
Fluid Analysis (CSF/ Pericardial/ Effusion) What indicates possible CA?
A
LDH > 0.6
7
Q
Earliest marker of AMI
A
Myoglobin (w/in 3 hrs)
only pick this answer if that’s the question…otherwise it’s probably wrong
8
Q
U/A
+Hgb
No RBC’s on microscopic
A
Myoglobinuria
9
Q
CK-MB
A
Rises 3-6 hrs, peak’s at 24hrs
- Helpful in quantifying the degree of necrosis
- what is the MB Fraction and MB %? <4?
10
Q
What is a negative vs positive Trop value?
A
Neg: <0.02
Pos: +0.08 (Renal clearance)
11
Q
Anion Gap Formula
Causes Metabolic Acidosis
A
AG= Na- (Cl+HCO3)
MUDPILES
(Methanol/Metformin, Uremia, DKA, Paraldehyde, Infec/Isoniazide, LA, Ethylene Glycol, Salicylates)
12
Q
CXR sign on perforated bowel
A
Pneumoperitoneum (look R hemidiaphrgam)
13
Q
Dz’s a/w HLA-B27
A
"PAIR" Psoriasis Ankylosing Spondylitis "squaring of vetebral bodies" IBD RA
14
Q
Galeazzi vs Monteggia Fx
A
GRUsome MURder
Galeazzi: Radius fx, Ulnar dislocation
Monteggia: Ulnar fx, Radial head dislocation
15
Q
Osgood Schlatter Disease
A
Males 10-15yo, sports, overuse
Tibial tubercle
16
Q
Legg-Calve- Perthes Disease (LCPD)
A
4-10 yo
Painless Limp
AVN Femoral Hip
17
Q
Slipped Capital Femoral Epiphysis (SCFE)
A
Male, 12-16
Obese
“Slipped of ice cream-cone”
18
Q
Developmental Hip Dysplasia (DDH)
A
Female
AVN Femoral Head
Barlow & Ortolani
19
Q
Jefferson
A
C1 (Atlas)
Ant-Pos Fx
Halo or C- collar
20
Q
Hangmans
A
C2 (Axis)
Fx of both pedicles
Spinal Chord injury
21
Q
Polymyalgia Rheumatica (PMR)
A
Elderly, proximal, symmetrical pain & stiffness in shoulder, neck and pelvic girdle
Tx: Low dose steroids
22
Q
Fibromyalgia
A
MSK pain in 11 of 18 trigger points, fatigue, sleep, memory disturbances
Fatigue not relieved by rest
23
Q
Vaccines okay around 4 mo
A
"HH_DRIP" Hep B (High risk of becoming chronic) Hib Dtap (Diptheria, tetanus, Pertussis) Rotavirus IPV (Inactivated poliovirus) PCV 13 (Pneumococcal-Prevnar)
24
Q
Vaccines after 1 year
A
MMR
Varicella
Hep A
25
Ranson Criteria
```
Est Mortality for pt's with Pancreatitis: "FLAAW"
FBG >200
LDH>350
Age>55
AST>250
WBC>16k
```
26
Indirect vs direct inguinal hernia
Indirect: MC, young, internal inguinal ring, scrotum
Direct: older, hasselbach's triangle
27
Henoch-Schonlein Purpura
| Sm Venule Vasculitis
```
"JARS"
Joints
Abd pain
Renal (Glomerulonephritis)
Skin
Dx: skin biopsy
Tx: Prednisone
```
28
Tx for H. pylori
```
MOCK + Bismuth: 2 weeks
Metronidazole (Flagyl)
PPI (Omeprazole)
Tetracycline (Clarithromycin)
Bismuth (Pepto)
```
Triple Therapy "ACO"
Amoxicillin
Clarithromycin
Omeprazole
29
MC cx of gastric CA
H. pylori
30
MC type of thyroid CA
Papillary > Follicular
31
Tx approaches to renal stones
< 5 mm pass
5-10 mm lithrotripsy (SWL)
+20 mm Retrieval
32
Hypercalcemia
```
"Stones, Bones, Groans, Moans & Psychic overtones"
Stones: Kidney Stones
Bones: Bone Pain
Groans: Constipation
Moans: Peptic Ulcer, Pancreatitis
Overtones: Depression, Confusion
Tx: NS 0.9%, dialysis if +18mg/dL
```
33
Hepatic CA
Esophageal CA
Pancreatic CA
Colon CA
AFP (Alpha feto-protein)
SCC
CEA, CA-19 (Carcinoembryonic Antigen)
CEA
34
Zollinger-Ellison Syndrome
"Kissing-ulcers"
| Gastrinomas - secrete acid cx'ing peptic ulcers
35
Hepatitis B surface antigen
| HBsAg
person is infectious
36
Hepatitis B surface antibody
| anti-HBs
indicating recovery & immunity
37
Hepatitis B core antibody
| anti-HBc
previous or ongoing infection
38
IgM antibody to hepatitis B core antigen
| IgM anti-HBc
presences indicates infection <6mo
| Acute hep B
39
HBsAg negative
anti-HBc negative
anti-HBs positive
Immune due to hepatitis B vaccination
40
HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative
Chronically infected
41
HBsAg negative
anti-HBc positive
anti-HBs positive
Immune due to natural infection
42
Inducers of CYP3A4
"induces metabolism" increasing excretion
1. Rifampin
2. Anticonvulsants
3. Dexamethasone
Rifampin + Warfarin = LOW INR
43
Inhibitors of CYP3A4
"inhibits metabolism" accumulating drug
1. Fungals- "Azoles"/ Diflucan
2. CCBs
3. Erythromycin/Azithryomycin
4. SSRI's
5. Grapefruit juice
* Azole + Warfarin = HIGH INR = BLEEDING
* CCB + Statin = Rhabdo
44
Most important PE on a pt w/ HTN
Abdominal Exam (r/o bruits)
45
Black w/ HTN
Thiazide
| CCB
46
Conductive HL
Outer & Middle Ear
Weber- lateralize to affected ear
Rinne- bone > air
47
SNHL
1. Meniere's
2. Labyrinth
3. Acoustic Neuroma CN8 -concert
4. Brain tumor
Weber- lateralize to the good ear
48
Central Vertigo
Less Common, MOST important
1. Insidious Onset
2. No HL or tinnitus
3. Vertical Nystagmus, does not fatigue
Tx: NEED an MRI (MS, Meniere's, stroke, tumor)
49
Peripheral Vertigo
Common, pt is miserable
1. Acute Onset
2. mild SNHL with ear "fullness" and tinnitus
3. Horizontal Nystagmus, easily fatigued
Acute labyrinthitis, Vestibular neuritis, BPV
Tx: self limiting unless, persists --> ENT referral or MRI
50
Anticholinergic SE's
"Blind as a bat, Mad as a hatter, red as a beet, hot as a hare, Dry as a bone,"
1. Blurred vision, mydriasis
2. Hallucinations, pyschosis, drowsy
3. Flushing
4. Fever
5. Dry mouth, dry eyes, urinary retention
Ie) antihistamines, antidepressants
51
Cholinergic SE's
"SLUD"
1. Salivation
2. Lacrimation
3. Urination
4. Defecation (Diarrhea)
ie) Mushrooms
52
Sulfonylureas
"Secretagogues"
Boost insulin release from beta cells of the pancreas
SE: Hypoglycemia, WG
53
Metformin
"it's all about glucose"
1. Decrease Glucose prod (hepatic gluconeogenesis) from liver
2. Increases muscle cell uptake of glucose
SE: LA (CKD), GI upset
54
GLP-1
Glucagon like peptide is a hormone released after a sugary drink, stimulating the release of insulin. In diabetics this is inhibited. However, incretin (hormone) stimulates the release of GLP .....incretin mimetics
55
GLP-1 Increin Mimetics
Byetta (exenatide)
| Januvia (sitagliptin) DPP-4
56
Difficulty brushing hair
| Pain at night
Rotator Cuff Tear
SITS
PE:+Neer's sign , +Hawkins sign
Dx: MRI
57
Meckel's Diverticulum
-Incomplete obliteration of vitelline duct
-Painless Bleeding
-Rules of 2: 2 yo, 2ft from ileocecal valve, 2in long, 2% of population
Dx: Technetium 99m scan
Tx: Surgical resection
58
Eisenmenger Syndrome
R--->L shunting *cyanosis
| Complication of VSD (MC congenital heart defect)
59
Guillian-Barre Syndrome
Ascending weakness
Decrease in DTR
Follows Respiratory or GI illness
Tx: IV immunoglobulin
60
MC fx'd carpal bone
Scaphoid
"Some Lovers Try Positions That They Can't Handle"
Radius-TTCH (distal)
Radius-SLTqP (proximal)
61
ITP
| Idiopathic Thrombocytopenic Purpura
```
2-6yo
Recent URI
Petechia, Purpura, Gingival Bleeding
Plt <50k
Tx: Observe
```
62
Black Widow
```
Hourglass
Neurotoxin
m. cramping & CNS excitation
Tx: Supportive (Opioids & benzo's)
Anti-venom
```
63
Brown Recluse
Violin
Cytotoxin
Local tissue destruction
No anti-venom
64
Marfans
```
Aortic root dilation/dissection
MVP
spontaneous PTX
ectopia lentis
mutation in FBN1
```
65
Ehlers Danlos
CT d/o
| skin laxity
66
Parkland Formula
mL=(4)(kg)(TBSA)
50% mL in first 8 hrs
50% mL in remaining 16hrs
LR
67
Myasthenia Gravis
- Ptosis, diplopia, m. fatigue improves with rest
- Autoimmune destruction of Ach receptors
- Tensilon (edrophonium) Test (m. will get stronger after being injected)
68
BV
```
Amsel Criteria (3 of 4)
1. thin, white homogenous d/c
2. clue cells
3. pH >4.5
4. + whiff test
Gardnerella vaginalis
Tx: Metronidazole or clindamycin
```
69
Trichomoniasis
-frothy, greenish d/c
-vaginal/ cervical erythema w/ petechiae (strawberry spots)
-Motile flagellates
Tx: Metronidazole
70
Aortic Dissection dx
CT or TEE (urgent)
| tx: IV esmolol
71
Diagnostic Criteria for DM
1. symptoms plus a random glucose +200
2. FPG > 126
3. Plasma glucose +200 two hrs after a 75g glucose load
4. A1C +6.5
72
Only dz modifying therapy approved for sickle cell
```
Hydroxyurea
Increases HbF (fetal)
```
73
What increases a hypertrophic cardiomyopathy murmur?
Valsalva
Standing up
(decreases preload)
74
What decreases a hypertrophic cardiomyopathy murmur?
Squatting
| Trendelenberg
75
Treatment for
A) Non-obstructive HCM
B) Obstructive HCM
Pharm: BB + CCB
A) Cardiac transplant
B) Pacing / myectomy / septal ablation
76
Chagas Dz
```
Trypanosoma cruzi
Flu-like symptoms
South/ Central America
Acute Myocarditis
Tx: anti-parasitic agent (Benznidazole)
```
77
Kawasaki Dz
<5yo
| Inflam of medium size vessels
78
MS
```
Demyelinating d/o
Optic Neuritis (Marcus Gunn)
Lhermitte's phenomenon
CSF: oligoclonal bands of immunoglobulin G + WBC
Rx: methylpredisolone
```
79
Trigeminal Neuralgia Tx
Carbamazepine 100mg BID
| Excruciating paroxysmal facial pain
80
Lb poisoning
Basophilic stippling
Lead Lines
Tx: Succimer (PO), IV EDTA
