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PANCE Flashcards

1
Q

What are the 4 main causes of obstructive shock?

A

1) massive pulmonary embolism
2) Cardiac tamponade
3) Tension Pneumothorax
4) Aortic Dissection or stenosis

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2
Q

What EKG finding is typical of pulmonary emobolism?

A

S1Q3T3

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3
Q

What are the 4 types of distributive shock and which is most common?

A

1) Septic shock ( most common)
2) Anaphylactic shock
3) Neurogenic shock
4) Endocrine Shock

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4
Q

What is the criteria for SIRs?

A

At least two of the following:

1) Fever >38 or hypothermia <36
2) pulse >90
3) RR >20 or PaCO2 <32
4) WBC >12,000 or <4,000

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5
Q

What is the only kind of shock associated with increased CO?

A

Early (warm) septic shock

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6
Q

What is the triad of symptoms associated with pheochromocytoma?

A

Palpitations, headache, and excessive sweating

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7
Q

What thyroid antibodies are found in patients with Hashimotos?

A

Anti-thyroid peroxidase (TPOab) and antithyroglobulin

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8
Q

What antibodies are found in Graves Disease?

A

TRab

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9
Q

What is Charcots triad and what disease is it associated with?

A

Associated with Acute Cholangitis

1) Fever/Chills
2) RUQ pain
3) jaundice

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10
Q

What is cullens sign and what disease is it associated with?

A

Associated with acute pancreatitis, periumbilical ecchymosis

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11
Q

What is grey turner sign and what disease is it associated with?

A

Associated with acute pancreatitis, frank ecchymosis due to retroperitoneal bleeding from pancreatic necrosis

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12
Q

What is the treatment for uncomplicated diverticulitis?

A

Outpatient treatment with Metronidazole and either Cipro or Levaquin

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13
Q

What is it called when you have extreme colon dilation >6cm and signs of systemic toxicity?

A

Toxic megacolon

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14
Q

When do you need to calculate anion gap?

A

Metabolic acidosis

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15
Q

What is a normal anion gap?

A

8-12

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16
Q

How do you calculate anion gap?

A

Na- (Cl+ HCO3)

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17
Q

What are the causes of metabolic acidosis with increased anion gap?

A 
MUDPILES
Methanol
Uremia
DKA
Propylene Glycol
Iron/Isoniazid
Lactic acidosis
Ethylene Gycol
Salicylate/starvation
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18
Q

What drugs do you want to avoid is myasthenia gravis?

A

Fluoroquinolones, beta blockers, and hydroxychloroquine

**These can further reduce the effectiveness of neuromuscular transmission

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19
Q

What two antibodies are present in myasthenia gravis?

A

Acetylcholine receptor antibodies and Muscle specific tyrosine kinase antibodies

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20
Q

What is the first line medical management of myasthenia gravis?

A

Acetylcholinesterase inhibitors: Pyridostigmine and Neostigmine

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21
Q

What is the test of choice to diagnose MS?

A

MRI with contrast

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22
Q

What is the first line prophylactic medication for cluster headaches?

A

Verapamil

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23
Q

What CSF finding is indicative of MS?

A

High IgG (oligoclonal bands)

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24
Q

What is the most common etiology of acute mastitis

A

S. Aureus

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25
Q

What is the first line medical treatment for gynecomastia?

A

Tamoxifen: SERM that is an estrogen antagonist in the breast

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26
Q

What is the most common type of breast cancer?

A

Infiltrative ductal carcinoma

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27
Q

What is the best diagnostic test for cervical insufficiency?

A

Transvaginal US, insufficiency is present if cervical length is 25mm or less before 24 weeks

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28
Q

What serum test can you order in the first trimester to test for Down syndrome?

A

PAPP-A ( Serum pregnancy associated plasma protein A)

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29
Q

When should you order a nuchal translucency US for a pregnant patient?

A

10-13 weeks

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30
Q

What causes late decelerations on fetal heart rate monitoring?

A

Uteroplacental insuffiency

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31
Q

What causes variable decelerations on fetal heart rate monitoring?

A

Cord compression

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32
Q

What should the fundal height be at 20 weeks gestation?

A

At the umbilicus

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33
Q

When should you screen for gestational diabetes?

A

24-28 weeks

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34
Q

When should you screen for GBS in pregnancy?

A

36- 37 6/7 weeks

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35
Q

How should you treat GBS in pregnancy?

A

First line: IV Pen G

Second line: Ampicillin, ES penicillins

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36
Q

What pathogen causes TSS?

A

S. Aureus

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37
Q

What is the triad of Vasa Previa?

A

Rupture of membranes, painless vaginal bleeding, and fetal distress

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38
Q

What is Samters triad?

A

Asthma, chronic rhinosinusitis with nasal polyps, and sensitivity to aspirin

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39
Q

On brain biopsy, you see spindle cells concentrically arranged in a whorled pattern with Psammoma bodies. What kind of tumor should you be concerned for?

A

Meningioma

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40
Q

On brain biopsy, you see perivascular pseudo rossettes. What kind of tumor should you be concerned about?

A

Ependymoma

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41
Q

What is the most effective chemotherapy for CNS lymphoma?

A

Methotrexate

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42
Q

What is the first line choice of antibiotics for a UTI in children?

A

Cephalosporins

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43
Q

Red blood cell casts are diagnostic of what?

A

Glomerulonephritis

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44
Q

What is the classic tetrad of HSP?

A

Palpable purpura, arthralgia, abdominal pain, and renal disease

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45
Q

What is the DOC for giardia?

A

Metronidazole

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46
Q

Does giardia or amoebiasis cause bloody diarrhea?

A

Amobiasis, caused by E. Histolytica

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47
Q

What is the DOC for Amoebiasis?

A

Metronidazole

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48
Q

What should you think when you hear rice water stool?

A

Cholera

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49
Q

What is the DOC for absence seizures?

A

Ethosuximide

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50
Q

What is the DOC for status epilepticus?

A

Valium or Ativan

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51
Q

What is Charcots triad and what disease is it associated with?

A

Associated with acute ascending cholangitis: fever/chills, RUQ pain, and jaundice

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52
Q

What is the MOA of Thiazolidinediones?

A

Increase insulin sensitivity

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53
Q

What is the MOA of sulfonylureas?

A

Stimulate beta cell insulin release

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54
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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55
Q

What is the first line treatment for Minimal change disease?

A

Prednisone

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56
Q

What is the most common primary cause of Nephrotic syndrome in adults?

A

Membranous nephropathy

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57
Q

Is hematuria typical of nephrotic or nephritic syndrome?

A

Nephritic

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58
Q

You see “Maltese crosses” and oval fat bodies on urinalysis. What should you be concerned for?

A

Nephrotic syndrome

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59
Q

What is Hydronephrosis?

A

Urinary tract obstruction leading to dilation of the collecting system in one or both kidneys

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60
Q

What are the 3 primary causes of nephrotic syndrome?

A

Minimal change, membranous nephropathy, and focal segmental glomerulosclerosis

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61
Q

What are Gottrons papules? What is a heliotrope rash? What condition are both of these associated with?

A

Gottrons papules: Raised violaceous scaly patches typically on the PIP and MCP joints
Heliotrope rash: edema and blue/purple discoloration of the upper eyelids

Both associated with dermatomyositis

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62
Q

What two forms of malaria can be dormant?

A

P. Vivax and P. Ovale.

P. Falciparum and P. Malariae do not have dormant forms

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63
Q

What are the most common side effects of Chloroquine?

A
  • Retinal and corneal toxicity
  • Hemolysis (caution in G6PD deficient patients)
  • QT Prolongation
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64
Q

What is the DOC for the radial cure of P. Vivax and P. Ovale?

A

Primaquine

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65
Q

What antibodies are a hallmark finding of drug induced lupus?

A

Anti-histone antibodies

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66
Q

What antibodies are positive in Sjögren’s syndrome?

A

ANA, Anti Ro, and Anti La

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67
Q

What is Takayasu arteritis?

A

Chronic large vessel vasculitis that affects the aorta and its primary branches, causing vessel ischemia, LE claudication, bruits, and asymmetric BP

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68
Q

What is the treatment for Kawasaki disease?

A

IVIG and aspirin

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69
Q

How is eosinophilic granulomatosis with polyangitis (Chung-Strauss) diagnosed?

A

Eosinophilia and P-ANCA positive is hallmark

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70
Q

What is Henoch-Schonlein purpura?

A

AKA IgA vasculitis, acute systemic IgA mediated small vessel vasculitis that occurs mostly in children

71
Q

What is Polyarteritis Nodosa?

A

Systemic vasculitis primarily of medium sized vessels (commonly renal, CNS, and GI). Pulmonary vessels are not involved.
-Commonly associated with Chronic Hep B and C

72
Q

What is the treatment for all stages of syphilis?

A

Penicillin

73
Q

What is Jarisch-Herxheimer reaction?

A

An acute self limited febrile reaction that usually occurs within the first 24 hours after receiving therapy for a spirochete injection. Presents with fever, headache, myalgia, hypotension, worsening of rash

74
Q

What is Argyll Robertson pupil?

A

Small, irregular pupil that constricts with accommodation but is not reactive to light

75
Q

What is the bulls eye rash seen with Lyme disease called?

A

Erythema Migrans

76
Q

What pathogen causes Amebiasis?

A

E. Histolytica

77
Q

What is the most common cause of travelers diarrhea?

A

Enterotoxigenic E. Coli, from contaminated food and water

78
Q

What is the recommended treatment for cholera?

A

First is rehydration and electrolyte replacement. Tetracyclines if needed to shorten disease course in patients who are severely ill .

79
Q

What pathogen is the most common cause of death from seafood consumption in the US?

A

Vibrio Vulnificus

80
Q

What are the 3 problems that V. Vulnificus can cause?

A

Gastroenteritis, necrotizing fasciitis, and cellulitis

81
Q

What antibiotic most commonly causes C. Diff?

A

Clindamycin

82
Q

How is Campylobacter enteritis treated?

A
  • fluid and electrolyte replacement is mainstay

- If severe disease, Macrolides

83
Q

Why should you avoid antibiotics in patients with enterohemorrhagic E. Coli?

A

Increased incidence of HUS

84
Q

Why shouldnt you treat a menopausal women with estrogen only?

A

Unopposed estrogen can lead to endometrial hyperplasia and endometrial cancer. Must give progestin with estrogen if they have an intact uterus.

85
Q

What is the pharmacologic treatment for vulvovaginal atrophy?

A
  • Ospemifene: SERM that is an estrogen agonist in the vagina and bone, and antagonist in the breast and uterus
  • topic vaginal estrogens
86
Q

What is adenomyosis? What is the only effective treatment?

A

When endometrial tissue grows within the myometrium

-Total hysterectomy

87
Q

What is the classic triad of endometriosis?

A

Premenstrual pelvic pain, dysmenorrhea, and dyspareunia

88
Q

What is the most common gynecological malignancy in the US?

A

Endometrial cancer

**adenocarcinoma is most common type

89
Q

What is the first line therapy for PMDD?

A

SSRIs (fluoxetine and sertraline)

90
Q

What is Fitz Hugh- Curtis syndrome?

A

-Perihepatitis with hepatic fibrosis, scarring, and peritoneal surface of the anterior RUQ in the setting of PID

91
Q

Buzzword: What should you think when you hear violin string adhesions?

A

Fitz Hugh-Curtis syndrome

92
Q

What is the recommended treatment for bacterial vaginosis?

A

Metronidazole x7 days

** Partners do not need treatment

93
Q

What is the recommended treatment for trichomoniasis?

A

Metronidazole 2g oral dose or 500mg BID x7 days

**partners need treatment

94
Q

Patient presents with dyspnea, pulmonary edema, and rhonchi. What kind of heart failure should you be considering?

A

Left heart failure

95
Q

What extra beat is commonly see with systolic heart failure?

A

S3 gallop

96
Q

A patient presents with peripheral edema, JVD, and hepatic congestion. What kind of heart failure should you be considering?

A

Right sided heart failure ( most commonly caused by left sided heart failure)

97
Q

What are the best two drugs for decreasing mortality in heart failure?

A

ACEI and Beta blockers

***discontinue beta blockers in decompensated HF!

98
Q

What drug causes Grey Baby Syndrome?

A

Chloramphenicol

99
Q

What is the treatment for Tetanus?

A

Metronidazole and IM tetanus immune globulin

100
Q

What pathogen is the most common cause of traumatic gas gangrene?

A

Clostridium Perfringens

101
Q

What antibiotics can be taken orally for MRSA coverage?

A

Doxycycline, Clindamycin, Bactrim, and Linezolid

102
Q

What are the two main causes of Hypercalcemia?

A

Primary hyperparathyroidism and malignancy

103
Q

What is the most common cause of hypocalcemia?

A

Hypoparathyroidism

104
Q

What symptoms often arise from hypocalcemia?

A
  • Increased muscular contractions, muscle cramps, bronchospasm
  • Chvostek sign and Trousseaus sign
105
Q

What is Chvostek sign?

A

Symptom of hypocalcemia, facial spasm with tapping of the facial nerve

106
Q

What is the EKG finding associated with hypocalcemia?

A

Prolonged QT

107
Q

What is the most common type fo pituitary adenoma?

A

Prolactinoma

108
Q

What is the treatment for prolactinoma?

A

Dopamine agonists (Bromocriptine and Cabergoline)

***Dopamine inhibits prolactin release

109
Q

What is metabolic syndrome?

A

A syndrome of multiple metabolic abnormalities that increase the risk for complications such as diabetes and cardiovascular resistance

110
Q

What is the criteria for a diagnosis of metabolic syndrome?

A

Must have 3 of the 5:

  • Decreased HDL
  • Increased BP
  • Increased fasting triglycerides
  • Increased fasting blood sugar
  • Increased abdominal obesity
111
Q

What is the first line management for absence seizures?

A

Ethosuximide

112
Q

Patient presents after a traumatic head injury. On exam, there are battle signs, raccoon eyes, and hemotympanum. What kind of skull fracture should you be concerned about?

A

Basilar skull fracture

113
Q

What is the first line treatment for a panic attack?

A

Benzos

114
Q

What is the first line treatment for Schizophrenia?

A

Atypical antipsychotics (Risperdal)

115
Q

What is the female athlete triad?

A

Disordered eating, amenorrhea, and osteoporosis

116
Q

What is indicative of scoliosis on XR?

A

Cobbs angle > 10 degrees

117
Q

What is thoracic outlet syndrome?

A

Idiopathic compression of the brachial plexus, subclavian vein, or subclavian artery

118
Q

What is Adson sign and what is it associated with?

A
  • Associated with thoracic outlet syndrome

- Loss of radial pulse when head is rotated to the affected side

119
Q

What is the treatment if there is clinical suspicion of Cauda Equina

A

Dexamethasone 10mg IV x1 immediately, then get MRI with contrast

120
Q 
What kind of drugs are the following:
Albuterol
Formoterol
Ipratropium bromide 
Tiotropium Bromide
Advair
Symbicort
A 
SABA
LABA
SAMA
LAMA
Fluticasone-Salmeterol
Budesonide-formoterol
121
Q

What is the stepwise approach to COPD treatment?

A
  • SABA or SAMA
  • LAMA or LABA
  • LAMA
  • LAMA or LABA-LAMA
122
Q

What is the treatment for uncomplicated vulvovaginal candidiasis?

A

Oral fluconazole

123
Q

what is the treatment for Chlamydia?

A

Azithromycin 1gm PO or Doxycycline 100mg PO BID x 7 days

124
Q

What is the treatment for Gonorrhea?

A

Ceftriaxone 250mg IM plus azithromycin 1gm PO single dose

125
Q

What are the diseases caused by Thiamine deficiency?

A

Beriberi

Wernicke-Korsakoff syndrome

126
Q

What are the two types of Noninvasive (In Situ) Breast carcinomas?

A

Lobular (LCIS) and Ducati (DCIS)

127
Q

Is DCIS or LCIS treated as malignant?

A

DCIS is because it has the potential to develop into invasive cancer. LCIS does not become invasive cancer if left untreated

128
Q

What findings do you see in mammogram if there is DCIS?

A

Clustered pleomorphic calcifications

129
Q

What are the two types of invasive breast carcinomas?

A

Infiltrating ducal carcinoma (IDC) and infiltrating lobular carcinoma (ILC)

130
Q

What is Paget’s disease of the breast?

A

Rare condition associated with breast cancer that causes eczema like changes to the breast. Usually a sign of breast cancer behind the tissue)

131
Q

What is familial adenomatous polyposis (FAP)?

A

An autosomal dominant gene mutation that results is >100 adenomatous polyps that begin to emerge around age 16.

**significant risk for CRC by age ~39 if left untreated. Prophylactic colectomy is typically recommended

132
Q

When should you start CRC screening in patients with FAP?

A

Ages 10-12 and repeating every 1-2 years

133
Q

What is Lynch syndrome?

A
  • Hereditary NonPolyposis Colon Cancer (HNPCC)
  • Autosomal dominant mutation that results in increased risk for CRC that usually emerges from 45-60 years.
  • Multiple family members are affected
  • ENDOMETRIAL CANCER commonly associated
134
Q

What is the Amsterdam criteria?

A

Used to diagnose Lynch syndrome (3-2-1 Rule)
-Should be at least 3 affected relatives from two successive generations, and at least one should be diagnosed before age 50

135
Q

Is a calcified or non-calcified SPN associated with malignancy?

A

Non-calcified

136
Q

What study should you order for work up of an SPN?

A

Helical CT Chest without contrast with low dose radiation

137
Q

What is Superior Vena Cava syndrome?

A
  • Due to compression or direct invasion of the SVC (Commonly from cancer, NSCLC)
  • Dyspnea, facial swelling, dilated neck veins
138
Q

What are the contraindications to live vaccines?

A

Pregnancy and immunocompromised

139
Q

Which vaccine is contraindicated if there is a histor of intussusception?

A

Rotavirus

140
Q

How many doses is the IPV vaccine?

A

4

141
Q

How many does is the DTaP?

A

5

142
Q

Which vaccine is contraindicatied when the patient has an allergy to yeast?

A

Hep B

143
Q

When is the Hep A vaccine administered?

A

Two doses separated by 6-18 months beginning between 12-23 months

144
Q

When is MMR administered?

A

1st: 12-15 months
2nd: 4-6 years

Varicella is the same

145
Q

How many doses is the PVC13 vaccine?

A

4, first administered at 2 months

146
Q

How many doses is the H. Flu vaccine?

A

2 or 3, first administered at 2 months

147
Q

What is the possible fatal condition that can occur years after a measles infection?

A

Subacute sclerosing panencephalitis: fatal degenerative disease of CNS that causes behavioral and intellectual deterioration and seizures

148
Q

How do loop diuretics affect calcium and magnesium?

A

They increase calcium and magnesium excretion

149
Q

How do thiazide diuretics affect calcium levels?

A

They increase calcium reabsorption

150
Q

Why should you not give digoxin if a patient is taking thiazide or loop diuretics?

A

They drugs cause hypokalemia. Since digoxin compete with potassium for binding, hypokalemia can cause digoxin toxicity

151
Q

What is the DOC for Lithium induced diabetes insipidus?

A

Amiloride (Potassium sparing diuretic)

152
Q

How is muscarinic agonist toxicity treated?

A

Atropine (muscarinic antagonist) and albuterol to reverse bronchoconstriction

153
Q

When is physostigmine used?

A

Atropine poisoning

154
Q

What are the signs of organophosphate poisoning?

A 
SLUDE
Salivation
Lacrimation
Urination
Defecation
Gastric Distress
Emesis
155
Q

How is organophosphate poisoning treated?

A

Administer atropine until pupils dilate. Administer 2-Pam if less than 3-4 hours since exposure

156
Q

What disorder is associated with an an ADAMTS13 deficiency?

A

TTP

157
Q

What is the Pentad associated with TTP?

A 
Thrombocytopenia
Microangiopathic hemolytic anemia
Neurologic symptoms
Fever
AKI
158
Q

What is the initial treatment of choice for TTP?

A

Plasmapheresis

159
Q

What is the DOC for partial seizures and trigeminal neuralgia?

A

Carbamazepine (tegretol)

160
Q

What are the indications for lamotrigine (Lamictal)?

A

Partial seizures and bipolar disorder

161
Q

What are the indications for valproic acid?

A

Absence and general tonic clinic seizures (mixed seizures)

  • Bipolar
  • Migraine prophylaxis
162
Q

What is the use of Lurasidone (Latuda)?

A

Depression associated with bipolar disorder

163
Q

What is the triad associated with chronic pancreatitis?

A

Calcifications, Steatorrhea, and DM

164
Q

What is the renal threshold for plasma glucose and glucose starts to spill into the urine?

A

150-180

165
Q

What kind of urine cast is common in normal urine?

A

Hyaline casts

166
Q

What is the normal range for sodium?

A

135-145

167
Q

What is the normal range for potassium?

A

3.5-5.0

168
Q

What is commonly used for rapid correction fo hyperkalemia?

A

Calcium chloride (calcium directly antagonizes the effects of potassium at membrane potential)

169
Q

What are tenofovir, entecavir, and lamivudine used to treat?

A

Hep B, Tenofovir is DOC

170
Q

What is the recommended treatment for SBP?

A

Cefotaxime or ceftriaxone

171
Q

What are the contraindications to statins?

A

Pregnancy and active hepatic disease

  • Avoid P405 inhibitors (grapefruit, macrolides, verapamil)
  • Avoid P450 activators (phenytoin, barbs, rifampin)
172
Q

What are the indications to prophylactically treat for endocarditis?

A

1) Prosthetic valve
2) heart repair using prosthetic material
3) hx of endocarditis
4) CHD

173
Q

What is Libman-Sacks endocarditis?

A

Non bacterial thrombotic endocarditisi is a non infectious endocarditis due to sterile platelet thrombi deposition on the affected valve, commonly affecting the mitral and aortic valves
-Seen with malignancy, SLE, rheumatic fever, etc

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