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QBank Pearls Flashcards

1
Q

What medications can cause a first degree AV block?

A

Beta blockers, calcium channel blockers, digoxin

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2
Q

How frequently should OB patients be seen in clinic?

A

q4weeks in first trimester
q2 weeks up to week 35
qweekly until delivery

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3
Q

How does Morton’s neuroma present?

A

Occurs in the 3rd intermetatarsal space and may be associated w/ high heels or certain foot conditions.

Pain in the lateral forefoot w/ paresthesias shooting into the toes; pain elicited when squeezing metatarsal heads together

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4
Q

What are some medications that carry a higher risk of Stevens-Johnson syndrome?

A

lamotrigine, sulfonamides, allopurinol (usually w/in 8wks)

Prodrome of 1-2 days of fever, fatigue, arthritis

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5
Q

What is MAT (multifocal atrial tachycardia) and what condition is it associated with?

A

An arrhythmia associated w/ COPD which causes variably shaped P waves on EKG

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6
Q

What is the most common type of pituitary macroadenoma?

A

Prolactinoma (hyperlucent pituitary mass on MRI which may present w/ visual changes due to mass effect, fertility/menstrual issues, or gynecomastia)

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7
Q

What’s the first line treatment for uncomplicated genococcal infections?

A

Single IM dose of ceftriaxone 500mg

(Treat for chlamydia concurrently w/ doxycycline 100mg BID x7 days or azithromycin 1gm x1 if no negative test)

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8
Q

What’s the next step in treatment for a COPD patient who has an exacerbation requiring hospitalization?

A

LABA + LAMA

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9
Q

When should multidrug-resistant gram-negative UTI be suspected?

A

In pts w/ any of the following in the past 3mo
- multidrug-resistant gram negative urinary isolate or fluoroquinolone-resistant Pseudomonas isolate
- inpatient hospital stay
- use of fluroquinolone, TMP-SMX, or broad-spectrum beta lactam
- travel to parts of the world where these infections are prevalent

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10
Q

What is the first line outpatient treatment for UTI?

A

If no concern for multidrug-resistant gram neg UTI and no contraindications to fluroquinolones…

  • ciprofloxacin 500mg BID x5-7days
  • ciprofloxacin 1000mg ER QD
  • levofloxacin 750mg QD

In pts w/ contraindications to fluoroquinolones…
- TMP-SMX, amoxicillin-clavulanate, cefpodoxime, cefadroxil

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11
Q

What is the typical presentation of roseola?

A
  • child <3yo
  • rapid onset fever, anorexia, rhinorrhea, cough, vomiting, diarrhea
  • after fever resolves, diffuse maculopapular rash appears on torso, spreading peripherally
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12
Q

What is the first-line drug for rheumatoid arthritis?

A

Methotrexate (disease-modifying antirheumatic agent, DMARD)
- the earlier the better
- goal is to decrease/prevent synovitis and decrease/prevent erosions of bone and joint space narrowing

**all pts should be on DMARD unless contraindicated (pregnancy, liver dz, EtOH use, renal impairment)

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13
Q

What are the signs/symptoms of myxedema or myxedema coma due to decompensated hypothyroidism?

A
  • hypothyroid symptoms
  • progressive AMS
  • nonpitting edema of face and extremities
  • bradycardia
  • HTN (usually diastolic)
  • hypothermia
  • hyponatremia
  • macrocytic anemia
  • elevated creatinine kinase
  • transaminitis
  • respiratory acidosis
  • hyperlipidemia
  • leukopenia
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14
Q

Why shouldn’t aminoglycosides be used in pregnant patients? (gentamycin, neomycin, amikacin, tobramycin, streptomycin)

A

Can result in renal damage and CN VIII damage in the fetus

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15
Q

Which drugs are known to cause kernicterus in fetuses?

A

Sulfonamides/sulfa drugs can cause brain damage in infants due to high levels of unconjugated bilirubin

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16
Q

What anti-HTN med could slow demineralization of bone in osteoporosis?

A

Thiazide diuretics

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17
Q

What are the indications for ankle/foot XRs according to the Ottawa Ankle Rules?

A
  • bone tenderness at posterior edge/tip of lateral or medial malleolus
  • bone tenderness to the base of the fifth metatarsal or navicular
  • inability to bear wear both immediately and on initial evaluation for a minimum of four steps
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18
Q

How is pancreatitis treated?

A

Aggressive fluid resuscitation for 24-48hrs, pain control, and bowel rest.

  • can start low-fat, low-residue diet when pain is decreasing, inflammatory markers improve, and N/V resolve
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19
Q

When is esophageal adenocarcinoma more likely than esophageal squamous cell carcinoma?

A

Adenocarcinoma:
- 50-60yo males, white, GERD, obesity, smoking, Barrett’s esophagus

SCC:
- 60-70yo males, achalasia, smoking, EtOH hx, black

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20
Q

What are the indications for screening for brain aneurysms in pts w/ polycystic kidney disease?

A
  • new onset headaches
  • CNS symptoms
  • family hx of brain aneurysm
  • upcoming surgery or high risk job

** there is no time-based indication for regular screening

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21
Q

What is the hierarchy of potency in opioids?

A

tramadol < codeine < hydrocodone = morphine < oxycodone < hydromorphone < fentanyl

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22
Q

What is juvenile idiopathic scoliosis and what are the next steps?

A

Scoliosis in kids 4-9 w/o congenital spinal column abnormalities which usually resolves spontaneously

  • spinal curve of 5-9 degrees requires re-examination in 6mo
  • curve >10 degrees warrants XR eval and Cobb angle measurement
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23
Q

What is the effect of hypercalcemia on cardiac function?

A

Shortens QT interval, which predisposes pt for arrhythmia

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24
Q

What are the mainstays in treatment for acute asthma exacerbations?

A
  • oxygen
  • inhaled short-acting beta agonists
  • systemic corticosteroids
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25
Q

What is the first line treatment for nausea/vomiting in pregnancy?

A

Vitamin B6 (pyridoxine)

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26
Q

What features define intermittent asthma?

A
  • daytime asthma symptoms 2 or less times per week
  • two or less nocturnal awakenings per month
  • SABA use for symptom relief 2 or more days a week
  • normal activity interference
  • FEV1 > 80% predicted
  • normal FEV1/FVC ratio
  • no more than one exacerbation requiring oral glucocorticoids per year
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27
Q

What defines mild persistent asthma?

A

FEV >80% predicted and normal FEV1/FVC ration with any of the following
- symptoms more than twice a week but not daily
- 3 or more nocturnal awakenings a month
- SABA use 2 or more days a week but not daily
- minor limitation w/ normal activities
- 2 or more exacerbations requiring oral glucocorticoids per year

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28
Q

What defines moderate persistent asthma?

A
  • daily symptoms
  • nighttime awakenings more than once a week
  • daily use of SABA
  • some limitations in daily activities
  • FEV1 60-80% predicted w/ FEV1/FVC reduced up to 5%
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29
Q

What defines severe persistent asthma?

A
  • daily symptoms
  • nighttime awakenings nearly daily
  • daily use of SABA
  • extreme limitation in daily activities
  • FEV1 <60% predicted w/ FEV1/FVC reduced more than 5%
30
Q

What is first line monotherapy for the prevention of seizures and delirium in alcohol withdrawal?

A

Long-acting benzos chlordiazepoxide or diazepam

31
Q

What are some common causes of metabolic alkalosis?

A

Diuretic use, vomiting, antacid use, and hyperalosteronism.

32
Q

How does hyperventilation syndrome present?

A

Tachypnea and hyperpnea lead to respiratory alkalosis as CO2 is blown off –> hypocarbia –> reduced ionized calcium and phosphate levels –> involuntary contraction of feet or hands

33
Q

What are the long-term risks associated w/ PCOS?

A
  • Endometrial cancer due to unopposed estrogen secretion
  • DM/metabolic syndrome/obesity –> increased risk of cardiovascular disease
34
Q

What type of deficiency can result in secondary hyperparathyroidism?

A

Vitamin D deficiency

(or anything that causes hypocalcemia, ex: CKD, malabsorption, pancreatic dysfunction, gastric bypass, lack of sun exposure)

35
Q

What is are treatment options for rosacea?

A
  • minimize abrasion/inflammation of the face
  • topical metronidazole, azelaic acid, ivermectin, brimonidine
  • oral tetracyclines for inflammation and ocular involvement
36
Q

What are the characteristics of junctional tachycardia?

A
  • regular rhythm
  • P waves may or may not be present
  • P waves may occur independently from QRS complexes
  • originates from ectopic site in AV node
37
Q

What is the most common cause of death in sickle cell disease?

A

Acute chest syndrome
- chest pain
- fever
- tachypnea
- wheezing/cough

38
Q

How does rubella present?

A
  • mild/absent fever
  • malaise
  • generalized nonconfluent rash beginning at the hairline and spreading inferiorly
  • tender LAD in postauricular, submandibular, suboccipital regions
39
Q

When are patients w/ rubella contagious? What’s the disease course?

A
  • contagious for 7 days after rash appears
  • self-limited; supportive tx and isolation
40
Q

What is the preferred initial treatment for acute hyperkalemia?

A

FIRST:
- IV Ca (stabilizes myocardium)

THEN:
- IV insulin + glucose
- albuterol
- sodium polystyrene

41
Q

What is the proper dosing of insulin in DKA?

A

0.1 units/kg bolus followed by 0.1 units/kg/hr infusion added to IV fluids 1-2hrs after fluids are initiated

0.14 units/kg/hr if no bolus dose

42
Q

What is the common extraintestinal (derm) physical exam finding of celiac disease?

A

Dermatitis herpetiformis
- very pruritic
- often on the forearms near elbows, knees, buttons, hairline

43
Q

What is the definition of an afferent (sensory) pupillary defect?

A

Paradoxical pupillary dilatation when exposed to light

44
Q

Why should pts w/ hyperparathyroidism undergo parathyroidectomy before becoming pregnant? (or in 2nd trimester if dx made during pregnancy)

A

There is risk of accelerated fetal bone loss

45
Q

How are most pts w/ primary hyperparathyroidism diagnosed?

A

Incidentally elevated serum calcium on routine lab work
- may be suspected in pts w/ nephrolithiasis
- confirmed by elevated PTH concentrations and hypercalcemia
- urinary Ca excretion and 25-hydroxyvitamin D levels should be obtained

46
Q

What drugs are most commonly associated w/ drug-induced (pill) esophagitis?

A
  • doxycycline/tetracycline
  • NSAIDs
  • ASA
  • K/Fe supplements
  • quindine
  • corticosteroids
47
Q

How frequently should a pt w/ IBD w/ colonic involvement have colonoscopies w/ bx?

A

q1-2yrs beginning 8-10yrs after diagnosis

48
Q

What are the most likely causative organisms for community-acquired meningitis for different age groups?

A

Older pts –> Streptococcus pneumoniae
Young pts/children –> Neisseria meningitidis
>60yo or immunocompromised –> Listeria monocytogenes
Underdeveloped countries –> Haemophilus influenzae

49
Q

What test is NOT considered useful anymore in the evaluation of male infertility?

A

Antisperm antibody testing

50
Q

What does res ipsa loquitur refer to?

A

A legal precedence applied in medical malpractice cases only when negligence of the physician may be inferred from facts which laymen can understand from their common experience.

51
Q

What is the medical-legal rule embodied by respondeat superior?

A

An employer is responsible for the negligent acts or omissions of its employees.

52
Q

What are the stipulations of the anti-kickback statute?

A

It is illegal for physicians to knowingly and willfully accept bribes or other forms of remuneration in return for generation Medicare, Medicaid, or other federal health care program business.

53
Q

What is the first step in management of suspected peritonsillar abscess?

A

Needle aspiration (both therapeutic and diagnostic)
- lack of pus should prompt evaluation for peritonsillar cellulitis, retropharyngeal abscess, neoplasm, etc

54
Q

What is an odds ratio?

A

Used in case-control studies to estimate relative risks when relative risk cannot be explicitly calculated. Determines odds of exposure among pts w/ a dz vs odds of exposure in pts w/o dz.

** most accurate when cases are of rare/low prevalence diseases **

55
Q

What is the typical presentation of medial tibial stress syndrome (MTSS)? aka shin splints

A

Bilateral posteromedial tibia pain in the setting of high impact activities (ie running) and a recent increase in activity level
- pain often improves after several minutes if activity is continued but may worsen if MTSS is very severe

Tenderness to palpation +/- mild swelling

** looks similar to stress fractures **

56
Q

What is the recommended daily intake of calcium for teenagers?

A

1300 mg/day for ages 9-18

57
Q

What is the first-line tx for chronic bacterial prostatitis?

A

Fluoroquinolones for 4-6 weeks

58
Q

What are the implications of cystine kidney stones?

A

Cystinuria due to autosomal recessive defect in reabsorptive transport of cystine and dibasic amino acids (ornithine, arginine, lysine) from luminal fluid of renal proximal tubule and small intestine
- a/w acidic urine
- pt will have recurrent urolithiasis

*surgery is necessary but dietary and medical prevention of stone formation is key

59
Q

How should chronic exertional compartment syndrome be confirmed prior to surgical intervention?

A

Compartment pressure testing for pts w/ exertional pain relieved by rest after vascular causes have been ruled out.

60
Q

What is the next best step in management of a pt w/ presentation consistent w/ scaphoid fracture and a negative x-ray on presentation?

A

Place pt in thumb spica splinting and repeat x-ray w/in 1 week; if still negative, obtain MRI

61
Q

What key feature will often be included in the history of a pt w/ subclavian steal syndrome?

A

Performing hand or upper extremity exercise prior to syncope or other neurologic presentation (blood flow diverted from brain to ipsilateral arm via vertebral artery when there is an occlusion or stenosis in subclavian a. proximal to its origin)

62
Q

When should asymptomatic children be screened for DM?

A

BMI >85th percentile AND 2+ of the following
- first/second degree relative w/ T2DM
- Asian, African American, Hispanic, Native American, Pacific Islander
- maternal hx of DM (including gestational)
- conditions a/w insulin resistance (HTN, DLD, PCOS)
- signs of insulin resistance (acanthosis nigricans, etc)

*begin at age 10 or onset of puberty (whichever is first) and repeat q3-5 years

63
Q

In which direction are patellar dislocations commonly displaced?

A

Laterally. They occur after twisting on a flexed knee and are palpable after the injury occurs.

64
Q

How does Bruton’s agammaglobulinemia present?

A
  • affects mostly boys
  • presents after 6mo of age when passive immunity from mom is lost
  • profound lack of B cells
  • increased risk for severe bacterial infections, especially from encapsulated organisms like Strep. pneumo
65
Q

Describe DiGeorge syndrome.

A
  • lack of thymus –> lack of mature T-cells –> risk of viral, fungal, intracellular bacterial infections
  • commonly presents w/ tetany due to hypocalcemia from absent parathyroid glands
66
Q

Describe chronic granulomatous disease.

A
  • deficiency in NADPH oxidase
  • increased risk for infection w/ catalase positive organisms (ex: Staph, Aspergillus)
  • Dx confirmed by lack of respiratory burst phase measured by nitroblue tetrazolium test
67
Q

Describe C1 esterase deficiency.

A
  • recurrent life-threatening angioedema
  • presents in late childhood/adolescence
  • episodes provoked by stress, infection, trauma
68
Q

Describe Chediak-Higashi syndrome.

A
  • defect in neutrophil chemotaxis
  • a/w albinism and neutrophils w/ giant cytoplasmic granules
69
Q

What is PALM COEIN?

A

Mnemonic for causes of abnormal uterine bleeding (PALM = structural; COEIN = non-structural)

P- polyps
A- adenomyosis
L- leiomyoma
M- malignancy

C- coagulopathy
O- ovulatory dysfunction
E- endometrial
I- iatrogenic
N- not otherwise classified

70
Q
A

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