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PANCE Flashcards

1
Q

Childhood Exanthems

A

“My Scarlet Ran Very Excitedly In Her Race”

  1. Measles (Rubeola): 3C’s, Koplik
  2. Scarlet Fever: GAS, strawberry tongue
  3. Rubella (German Measles)
  4. *nothing- Varicella (Chicken Pox): dew drop
  5. Erythema Infectiosum: Parvovirus B19, “slapped cheek”
  6. Roseola: HHV-6 or 7, high fevers, 6mo-3yo
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2
Q

5 Post-Op Fevers

A
  1. Wind
  2. Water
  3. Wound
  4. Walking
  5. Wonder drugs
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3
Q

Unconjucated Bilirubinemia

A

Indirect
Not water soluble (not in urine)
1. Hemolysis (SS, G6PD,Thala)
2. Inherited (Gilbert’s)

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4
Q

Conjugated

A

Direct
Soluble (dark urine)
Light colored stools if obstruction
MANY Causes (Heaptocellular dysfunction, biliary obstruction, drugs)

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5
Q

Interpreting LFT’s

A

High ALT>AST = LIVER
High ALP & GGTP= BILIARY problem
“P = tree problem”

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6
Q 
Fluid Analysis (CSF/ Pericardial/ Effusion)
What indicates possible CA?
A

LDH > 0.6

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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

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8
Q

U/A
+Hgb
No RBC’s on microscopic

A

Myoglobinuria

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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?
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10
Q

What is a negative vs positive Trop value?

A

Neg: <0.02
Pos: +0.08 (Renal clearance)

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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)

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12
Q

CXR sign on perforated bowel

A

Pneumoperitoneum (look R hemidiaphrgam)

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13
Q

Dz’s a/w HLA-B27

A 
"PAIR"
Psoriasis 
Ankylosing Spondylitis "squaring of vetebral bodies" 
IBD
RA
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14
Q

Galeazzi vs Monteggia Fx

A

GRUsome MURder
Galeazzi: Radius fx, Ulnar dislocation
Monteggia: Ulnar fx, Radial head dislocation

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15
Q

Osgood Schlatter Disease

A

Males 10-15yo, sports, overuse

Tibial tubercle

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16
Q

Legg-Calve- Perthes Disease (LCPD)

A

4-10 yo
Painless Limp
AVN Femoral Hip

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17
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

Male, 12-16
Obese
“Slipped of ice cream-cone”

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18
Q

Developmental Hip Dysplasia (DDH)

A

Female
AVN Femoral Head
Barlow & Ortolani

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19
Q

Jefferson

A

C1 (Atlas)
Ant-Pos Fx
Halo or C- collar

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20
Q

Hangmans

A

C2 (Axis)
Fx of both pedicles
Spinal Chord injury

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21
Q

Polymyalgia Rheumatica (PMR)

A

Elderly, proximal, symmetrical pain & stiffness in shoulder, neck and pelvic girdle
Tx: Low dose steroids

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22
Q

Fibromyalgia

A

MSK pain in 11 of 18 trigger points, fatigue, sleep, memory disturbances
Fatigue not relieved by rest

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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)
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24
Q

Vaccines after 1 year

A

MMR
Varicella
Hep A

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25
Q

Ranson Criteria

A 
Est Mortality for pt's with Pancreatitis: "FLAAW"
FBG >200
LDH>350
Age>55
AST>250
WBC>16k
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26
Q

Indirect vs direct inguinal hernia

A

Indirect: MC, young, internal inguinal ring, scrotum
Direct: older, hasselbach’s triangle

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27
Q

Henoch-Schonlein Purpura

Sm Venule Vasculitis

A 
"JARS"
Joints
Abd pain
Renal (Glomerulonephritis) 
Skin
Dx: skin biopsy
Tx: Prednisone
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28
Q

Tx for H. pylori

A 
MOCK + Bismuth: 2 weeks
Metronidazole (Flagyl)
PPI (Omeprazole)
Tetracycline (Clarithromycin)
Bismuth (Pepto)

Triple Therapy “ACO”
Amoxicillin
Clarithromycin
Omeprazole

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29
Q

MC cx of gastric CA

A

H. pylori

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30
Q

MC type of thyroid CA

A

Papillary > Follicular

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31
Q

Tx approaches to renal stones

A

< 5 mm pass
5-10 mm lithrotripsy (SWL)
+20 mm Retrieval

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32
Q

Hypercalcemia

A 
"Stones, Bones, Groans, Moans &amp; 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
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33
Q

Hepatic CA
Esophageal CA
Pancreatic CA
Colon CA

A

AFP (Alpha feto-protein)
SCC
CEA, CA-19 (Carcinoembryonic Antigen)
CEA

34
Q

Zollinger-Ellison Syndrome

A

“Kissing-ulcers”

Gastrinomas - secrete acid cx’ing peptic ulcers

35
Q

Hepatitis B surface antigen

HBsAg

A

person is infectious

36
Q

Hepatitis B surface antibody

anti-HBs

A

indicating recovery & immunity

37
Q

Hepatitis B core antibody

anti-HBc

A

previous or ongoing infection

38
Q

IgM antibody to hepatitis B core antigen

IgM anti-HBc

A

presences indicates infection <6mo

Acute hep B

39
Q

HBsAg negative
anti-HBc negative
anti-HBs positive

A

Immune due to hepatitis B vaccination

40
Q

HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative

A

Chronically infected

41
Q

HBsAg negative
anti-HBc positive
anti-HBs positive

A

Immune due to natural infection

42
Q

Inducers of CYP3A4

A

“induces metabolism” increasing excretion

  1. Rifampin
  2. Anticonvulsants
  3. Dexamethasone

Rifampin + Warfarin = LOW INR

43
Q

Inhibitors of CYP3A4

A

“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
Q

Most important PE on a pt w/ HTN

A

Abdominal Exam (r/o bruits)

45
Q

Black w/ HTN

A

Thiazide

CCB

46
Q

Conductive HL

A

Outer & Middle Ear
Weber- lateralize to affected ear
Rinne- bone > air

47
Q

SNHL

A
  1. Meniere’s
  2. Labyrinth
  3. Acoustic Neuroma CN8 -concert
  4. Brain tumor
    Weber- lateralize to the good ear
48
Q

Central Vertigo

A

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
Q

Peripheral Vertigo

A

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
Q

Anticholinergic SE’s

A

“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
Q

Cholinergic SE’s

A

“SLUD”

  1. Salivation
  2. Lacrimation
  3. Urination
  4. Defecation (Diarrhea)

ie) Mushrooms

52
Q

Sulfonylureas

A

“Secretagogues”
Boost insulin release from beta cells of the pancreas
SE: Hypoglycemia, WG

53
Q

Metformin

A

“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
Q

GLP-1

A

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
Q

GLP-1 Increin Mimetics

A

Byetta (exenatide)

Januvia (sitagliptin) DPP-4

56
Q

Difficulty brushing hair

Pain at night

A

Rotator Cuff Tear
SITS
PE:+Neer’s sign , +Hawkins sign
Dx: MRI

57
Q

Meckel’s Diverticulum

A

-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
Q

Eisenmenger Syndrome

A

R—>L shunting *cyanosis

Complication of VSD (MC congenital heart defect)

59
Q

Guillian-Barre Syndrome

A

Ascending weakness
Decrease in DTR
Follows Respiratory or GI illness
Tx: IV immunoglobulin

60
Q

MC fx’d carpal bone

A

Scaphoid
“Some Lovers Try Positions That They Can’t Handle”
Radius-TTCH (distal)
Radius-SLTqP (proximal)

61
Q

ITP

Idiopathic Thrombocytopenic Purpura

A 
2-6yo
Recent URI
Petechia, Purpura, Gingival Bleeding
Plt <50k 
Tx: Observe
62
Q

Black Widow

A 
Hourglass 
Neurotoxin
m. cramping &amp; CNS excitation
Tx: Supportive (Opioids &amp; benzo's)
Anti-venom
63
Q

Brown Recluse

A

Violin
Cytotoxin
Local tissue destruction
No anti-venom

64
Q

Marfans

A 
Aortic root dilation/dissection
MVP
spontaneous PTX
ectopia lentis
mutation in FBN1
65
Q

Ehlers Danlos

A

CT d/o

skin laxity

66
Q

Parkland Formula

A

mL=(4)(kg)(TBSA)
50% mL in first 8 hrs
50% mL in remaining 16hrs
LR

67
Q

Myasthenia Gravis

A
  • Ptosis, diplopia, m. fatigue improves with rest
  • Autoimmune destruction of Ach receptors
  • Tensilon (edrophonium) Test (m. will get stronger after being injected)
68
Q

BV

A 
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
Q

Trichomoniasis

A

-frothy, greenish d/c
-vaginal/ cervical erythema w/ petechiae (strawberry spots)
-Motile flagellates
Tx: Metronidazole

70
Q

Aortic Dissection dx

A

CT or TEE (urgent)

tx: IV esmolol

71
Q

Diagnostic Criteria for DM

A
  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
Q

Only dz modifying therapy approved for sickle cell

A 
Hydroxyurea
Increases HbF (fetal)
73
Q

What increases a hypertrophic cardiomyopathy murmur?

A

Valsalva
Standing up
(decreases preload)

74
Q

What decreases a hypertrophic cardiomyopathy murmur?

A

Squatting

Trendelenberg

75
Q

Treatment for
A) Non-obstructive HCM
B) Obstructive HCM

A

Pharm: BB + CCB
A) Cardiac transplant
B) Pacing / myectomy / septal ablation

76
Q

Chagas Dz

A 
Trypanosoma cruzi
Flu-like symptoms 
South/ Central America 
Acute Myocarditis 
Tx: anti-parasitic agent (Benznidazole)
77
Q

Kawasaki Dz

A

<5yo

Inflam of medium size vessels

78
Q

MS

A 
Demyelinating d/o
Optic Neuritis (Marcus Gunn) 
Lhermitte's phenomenon
CSF: oligoclonal bands of immunoglobulin G + WBC
Rx: methylpredisolone
79
Q

Trigeminal Neuralgia Tx

A

Carbamazepine 100mg BID

Excruciating paroxysmal facial pain

80
Q

Lb poisoning

A

Basophilic stippling
Lead Lines
Tx: Succimer (PO), IV EDTA

PANCE Review (10 decks)

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