PANCE prep 1 Flashcards
most common site for aortic aneurysm?
infrarenal aorta (aka abdominal)
12 year old girl with prolonged menstrual bleeding, bruising, prolonged aPTT and normal PT. what condition does she likely have?
Von willenbrand Dz
characteristic sign of hemophilia B?
bleeding into joints
MC x-linked genetic dz
hemophilia A (deficiency of plasma clotting factor VIII)
what is hemophilia B?
deficiency of plasma coagulation factor IX
CD4 count <200 need prophylaxis for what? what drug is used?
PJP (pneumocystitis jiroveci pneumonia) with TMP/SMX
CD4 counts <100 need prophylaxis for what?
toxoplasmosis and cryptococcus
CD4 counts <50 need prophylaxis for what?
CMV and MAC
txt for torsades?
unstable = defib stable = Mg
men experiencing problems with prostate dysfunction should receive what screening tests?
prostate-specific antigen test + DRE (for CA) UA (for infection)
MC childhood cancer and what ages does it MC occur?
ALL, 2-4yo
screening for AAA?
USPTF recommends a one-time screen for all men 65-75yo w/ any history of smoking.
cough, coryza (runny nose) and conjunctivitis may indicate what infectious childhood dz?
measles (rubeola)
-also with koplik spots (white/blue on buccal mucosa)
recommended treatment for human bites
Augmentin
what is addisons disease?
adrenal insufficiency from destruction or dysfxn of adrenal cortex
tests for addisons disease
low plasma cortisol land high ACTH
GOLD: cosyntropin stimulation test - rise in serum cortisol of 20 mcg/dL after administration with synthetic ACTH= normal functioning cortex
This is characterized by lateralization to the right ear with Weber test, and bone conduction > air conduction of the right ear with Rinné test.
conductive hearing loss of right ear
initial treatment for acute closure angle glaucoma
acetazolamide - carbonic anyhydrase inhibitor. reduces intraocular pressure by decreasing formation of aqueous humor
MC elbow fracture in pediatric trauma
supracondylar humerus Fx - present with posterior fat pad +/- anterior fat pad (sail sign)
1 week intermittent ear fullness, off- balance w/ moving the head. Hx of smoking, no URI. bogginess of nasal conchae = Dx?
eustachian tube dysfxn : unknown etiology but increased risk with smoking/smoke exposure
txt for eustachian tube dysfxn
intranasal corticosteroids
MC cardiac abnormality with lupus?
pericarditis
does a ganglion cyst transluminate?
YES
2yo w/ acute fatigue, anorexia, painful mouth lesions - small vesicles w/ red base and ulceration that bleed when scraped - on lips, tongue, buccal mucosa, hard palate = Dx?
gingivostomatitis (HSV 1)
Symptoms include unexplained weight loss (>4 Kg), livedo reticularis, testicular pain or tenderness, myalgias (excluding shoulder & hip girdle), muscle weakness or tenderness, mono- or poly-neuropathy, and new-onset diastolic blood pressure >90 mmHg. ANA negative . Dx=?
polyarteritis nodosa (vasculitis of medium-sized arteries)
what causes polyarteritis nodosa?
idiopathic or from chronic hep B
teen volleyball player, pain in bilateral knees with jumping and going down stairs
patellar tendonitits - “jumpers knee”
Presentation is typically either as a painless rounded midline anterior neck swelling or, if infected, as a red warm painful lump. It may move with swallowing, and classically elevates on tongue protrusion.
thyroglossal duct cyst - MC congenital neck cyst
Centor criteria help in the medical decision making process when evaluating for Group A streptococcus (GAS). Centor criteria include what 4 things?
tonsillar exudates,tender anterior cervical lymphadenopathy, fever, absence of cough
first line agent for acute otitis media? what if they are severely allergic to amoxicllin?
amoxicillin, macrolide - Azithromycin
txt options for viral conjunctivitis
warm compress, lubricating drops, topical antihistamines
what can help differential acoustic neuroma from meneire’s dz?
facial numbness/tingling (enlargement may affect other cranial nerves)
MC cause of URI in adults
rhinovirus
how do you test sensory fxn of median nerve?
anterolateral pinprick
txt for 2mo with thrush?
topical miconazole or nystatin
abx for animal bite wound?
augmentin (often polymycrobial so coverage of anaerobes and pasturella is needed)
positive straight leg raise, decreased dorsiflexion of the foot, and decreased patellar reflex of the left side when compared with the right. What level is the herniation?
L4
first line therapy for bacterial sinus infection?
high dose augmentin (azithromycin no longer reccomended b/c resistance)
duputeynne contracture vs volkmann contracture
duputeyenne: palmar thickening = flexion of finger (MC ring)
volkmann: supracondylar humeral fx, brachial artery occlusion, compartment syndrome = wrist flexion + claw fingers
polymyositis vs polymyalgia rheumatics
polymyositis: inflamm dz, proximal muscle weakness
polymyaglia rheumatica: muscle and joint pain in shoulders and pelvis, assoc w/ temporal arteritis. RF negative
positive straight leg raise, decreased sensation over the dorsal foot and great toe, and inability to extend the great toe. Deep tendon reflexes are symmetric bilaterally. which level is herniated?
L5
screening for mammogram guidelines (age and time period)
annually age 50-54 then every 2 years
treatment for rheumatic fever
PCN or erythromycin
Urine that appears to be bloody, primarily in the morning and episodic in nature, along with thrombosis of dermal veins, nonspherocytic red cells and Coombs negative intravascular hemolysis
paroxysmal nocturnal hemoglobinuria
2 most common causes of hypercalcemia
hyperParathyroidism and malignancy
Pediatric ophthalmology referral criteria for 3- to 5-year-old children
LESS than 20/40 in either eye or difference of greater than 2 lines between the eyes
What is the most common site of an acute arterial occlusion due to embolic disease?
femoral artery
definition of fetal distress (when reading FHR)
absence of baseline variability, and either bradycardia (FHR<110) or recurrent variable or late decelerations
when should first time pregnancies be induced for lowest complication risk?
39 weeks
haloperidol, chlorpromazine, loxapine are all what type of medication?
typical antipyschotics (1st gen)
three stages of frozen shoulder
- painful stage (increasing pain & stiffness, 3-9 months)
- adhesive stage (decreasing pain but increasing stiffness, 4-12 months+
- recovery stage (minimal pain & gradual improvement of stiffness, 12-42 months+
In chronic dry eye syndrome that is unresponsive to artificial tears and other conservative therapies, what is the next best step in treatment?
topical cyclosporine (restasis) = increases tear production
A patient presents with loss of the left visual field in each eye. What is the most likely location for the lesion?
right optic tract
Wrist pain when the patient presses her palms together with the elbows flexed to ninety degrees.
This maneuver describes the reverse Phalen test which, if positive, suggests compression of the median nerve in the carpal tunnel.
Restricted upward gaze may indicate what injury?
blowout fx: Restricted upward gaze due to entrapment of eye muscles
distinguishing osteomalacia from simple osteoporosis.. what symptoms?
Painful proximal muscle weakness can help distinguish. although pts with osteomalacia will also have OA
what is osteomalacia and what are the symptoms? xray findings?
deficiency in vitamin D.
- progressively worsening diffuse bone pain- focused on the lower back, pelvis, and lower extremities.
- Painful proximal muscle weakness
xray: Pseudofractures from low trauma falls
lab findings for osteomalacia
increased alkaline phosphatase, decreased 25-hydroxy-vitamin D, hypocalcemia, and hypophosohatemia
what symptoms does hypophosphatemia cause?
muscle weakness and, if severe enough, can cause dysphagia and impairment of the respiratory muscles
what is the MC cause of ARDS ?
sepsis
what FBs in ear need urgent referral to ENT rather than removal?
An urgent referral to an ENT prior to any removal attempts is indicated for button batteries, objects with potential to cause perforation, or an object directly contacting the tympanic membrane.
MC cause of myocarditis?
viral - parvovirus
superior vena cava syndrome
name given to the symptoms that occur when the blood flow through the superior vena cava is blocked or compressed. These symptoms include breathing problems, lightheadedness, and swelling in the upper body
MC cause superior vena cava syndrome
Lung CA (particularly adenocarcinoma)
MC cause of mitral valve stenosis
prior Group A strep infection
what are common symptoms of mitral stenosis
palpitations that are the result of persistent atrial fibrillation as the atrium remodels to accommodate the stenosis.
Orthopnea, dyspnea on exertion, and paroxysmal nocturnal dyspnea
what is epstiens anamoly and what murmur can it result in?
abnormal development of the septal and posterior leaflets of the tricuspid valve. –> tricuspid regurgitation, which has a characteristic holosystolic murmur
When considering the diagnosis of compartment syndrome, permanent damage to the muscle begins after how many hours of ischemia?
> 8 hrs
initial treatment of acute epiglottitis
airway maintenance/ intubation +/- abx (IV steroids not shown to benefit much)
treatment for ventricular bigeminy ?
bigeminy in itself does not require any treatment. If it does become symptomatic, beta-blockers can be used to try and suppress ventricular ectopy. Class I and III agents are generally avoided as they can provoke more serious arrhythmias
what is bigeminy rhythm?
PVCs - each normal heartbeat is followed by a premature one (series of long and short beats = irregular rhythm)
what is chemosis?
sign of eye irritation. The outer surface of the eye (conjunctiva) may look like a big blister. It can also look like it has fluid in it - often from allergies
what is olopatadine?
antihistamine eye drop for allergic conjunctivitis
delta wave on EKG: what does it look like and what does it indicate?
upward slope of S wave = WPW
treatment choiced for WPW?
class 1C antiarrythmics - flecanide. also procainamide, sotalol, amiodarone
what causes congenital cataracts?
maternal infection - HSV, CMV, syphilis, toxoplasmosis - if found it requires further workup for systemic infection
Wilms’ tumor. What is the most common finding at presentation?
abdominal mass, also hematuria (a nephroblastoma)
S+S kid with cushing syndrome versus exogenous obesity
Cushing syndrome: short stature, delayed skeletal maturity, truncal obesity with thin extremities, purplish striae, and a slowed growth rate,
obese children: advanced maturation, heavy extremities, pinkish striae, and an increased growth rate.
ADR risk of doxorubicin - antiCancer drug
cardiotoxicity and precipitate HF
recurrent symptomatic episodes related to atrial fibrillation - treatment?
ablation therapy
thiamine deficiency - aka beriberi can cause what cardiac issue?
high output CHF
what is reyes syndrome
causes swelling in liver- hepatic failure and brain -encephalopathy. MC children and teenagers recovering from a viral infection, most commonly the flu (influenza B) or chickenpox
what two categories in calculating CHADS-VASC score (for risk of thromboembolic event - stroke) are worth 2 points?
age >75 and prior TIA/CVA/TE
most common cause of massive lower gastrointestinal bleeding?
diverticular dz
child with petechiae, ecchymoses, and gingival bleeding. pancytopenia, lymphoblasts on smear and bone pain. Dx?
ALL
severe hemophilia A + an automobile accident. Concern is for hemorrhage. What is the best intervention to raise factor VIII levels to hemostatic levels?
recombinate (commercialized Factor 8 concentrate)- can raise factor levels in smaller volumes than FFP or cryoprecipitate
What is the most appropriate pharmaceutical management for primary prophylaxis in hemophilia A
Primary prophylaxis with either factor VIII three times a week or factor IX twice a week is the standard of care
define polycythemia vera
a disorder of the myeloid/erythroid stem cell that causes overproduction of all three hematopoietic cell lines, most prominently the red blood cells
symptoms of polycythemia vera
symptoms associated with increased blood volume and viscosity or impaired platelet function
-itching after hot shower (histamine release), TIA, enlarge spleen, dizziness/HA/tinnitus, enlarged retinal veins
labs for factor XI deficiency (PT, PTT, plt)
prolonged aPTT, normal PT, and normal platelets count.
Anemia can develop in days, along with jaundice and splenic enlargement. - suspicion for what is high?
autoimmun hemolytic anemia
Dx for autoimmune hemolytic anemia
positive coombs test
management of renal impairment with multiple myeloma patient
supportive: hydration and calcitonin to decrease serum hyperCa+ (if severely high Ca+ that needs rapid correction - IV bisphosphonate)
peripheral blood smear for pt with multiple myeloma will show what?
rouleaux formation, an RBC phenomenon that is caused by an increased concentration of plasma proteins in the blood that causes the cells to stick together
