Random Subject Review Part I Flashcards
1
Q
complication of LP in patient with elevated intracranial presure
A
uncal herniation
2
Q
diagnosis: child presents to ER with altered mental status, hypoglycemia, and lesions suggestive of chickenpox
A
rye’s syndrome (hepatoencephalopathy)
3
Q
symptoms of basilar artery stroke
A
cranial nerve deficits, altered mental status/coma, contralateral full body weakness and decreased sensation, vertigo
4
Q
TCA overdose signs and management
A
anticholingeric symptoms, cardiac and CNS toxicity
treat cardiac with sodium bicarb, and CNS with benzos
5
Q
treatment for lithium induced nephrogenic diabetes insipidus
A
HCTZ and amiloride (binds lithium stimulated sodium channels)
6
Q
treatment of acute dystonia
A
anticholinergics (benadryl, benztropine)
7
Q
treatment of tardive dyskinesia
A
discontinue typical antipsychotic, switch to atypical antipsychotic
8
Q
EEG pattern seen in absence seizures
A
3 cycle/second spike and wave pattern
9
Q
typical complaint of patient with retinal detachment
A
sudden painless onset of flashing lights, floaters, and shade coming down over vision unilaterally
10
Q
treatment for benign paroxysmal positional vertigo
A
epply maneuver to reposition otoliths
11
Q
todd’s paralysis
A
post-ictal hemiparesis < 24 hours
12
Q
drugs combined with SSRIs known for causing serotonin syndrome
A
SSRIs, SNRIs, MAOIs, levadopa, mepiridine, lithium, amphetamines, cocaine, ecstasy, LSD, st. john’s wort
13
Q
most common cause of sensorineural hearing loss
A
prebycusis (progressive symmetric high-frequency loss of the elderly)
14
Q
most common cause of conductive hearing loss
A
otosclerosis
15
Q
most common complication of recurrent otitis media
A
hearing loss
16
Q
medications used in ADHD
A
stimulants, TCAs, buproprion, alpha-2 agonists (clonidine)
17
Q
medications used in tourette’s
A
fluphenazine, pimizide, tetrabenazine
18
Q
most worrisome side effect of ADHD drug atomoxetine
A
increased suicidal ideation, hepatotoxicity
19
Q
diagnosis: patient presents with hearing loss and vertigo, grayish-white “pearly” TM lesion apparent on PE
A
cholesteatoma
20
Q
symptoms of basilar skull fracture
A
raccoon eyes (orbital fracture)
battle sign (bruising over mastoid process)
blood behind tympanic membrane
CSF coming out of nose or ears
21
Q
diagnosis and next step: chest trauma, hypotension, JVD, and distant heart sounds
A
cardiac tamponade
pericardiocentesis
22
Q
diagnosis and next step: chest trauma, JVD, hypotension, and respiratory distress
A
tension pneumothorax
needle decompression and chest tube placement
23
Q
how to evaluate neck trauma
A
neck zone 1: CT angiogram
neck zone 2: surgical exploration
neck zone 3: CT angiogram and triple endoscopy
24
Q
how to manage elevated ICP
A
elevated head of bed lidocaine prior to intubation mannitol hyperventilation decompressive surgery
25
next step: pelvic fracture, DPL shows blood in pelvis
emergent laparotomy
26
next step: pelvic fracture, DPL shows urine in pelvis
urgent laparotomy (bladder injury)
27
next step: pelvic fracture, DPL shows nothing but there is hemodynamic instability
suspect retroperitoneal hematoma, angiography with possible embolization
28
next step: blunt abdominal trauma, unstable vital signs, FAST shows fluid in pelvis
emergent laparotomy (assume it is blood)
29
next step: blunt abdominal trauma, unstable vital signs, FAST shows no fluid in pelvis
retroperitoneal hematoma, angiogram with possible embolization
30
next step: blunt abdominal trauma, unstable vital signs, FAST inconclusive
perform DPL
31
empiric treatment for brain abscess
antibiotics, needle aspiration, corticosteroids
32
treatment for cluster headaches
100% oxygen
| triptans and ergotamines
33
when are triptans contraindicated for headaches
pregnancy, CAD, prinzmetal's angina
| cause vasoconstriction
34
side effects of theophylline overdose
seizures, excessive muscle contraction, hyperthermia, hypotension, cardiac tachyarrhythmias
35
ST elevation in multiple arteries
acute pericarditis
36
diagnosis: cardiac cath shows equal pressure in all chambers
constrictive pericarditis
37
antidote for methanol
fomepazole
| 2nd line: alcohol
38
antiode for ethylene glycol
fomepazole
| 2nd line: alcohol
39
antiode for arsenic
dimercaperol, succimer, or penicillamine
40
burn patient fluid replacement
lactate ringers
4 mL/kg x % burn area + maintenance fluids
1/2 first 8 hours
1/2 next 16 hours
41
treatment for neuroleptic malignant syndrome
discontinue offending medication
IV fluids and dantrolene (stops muscle contraction)
2nd line: bromocriptine or amantidine
42
paget's disease lab abnormalities
elevated alkaline phosphatase
43
osteomalacia/rickets lab abnormalities
vitamin D deficiency
decreased calcium
increased PTH
increased or normal alkaline phosphatase
44
osteoperosis lab abnormalities
all values normal
45
osteopetrosis lab abnormalities
all values normal
46
pseudohypoparathyroidism lab abnormalities
decreased calcium
increased phosphate
increased PTH
(defective receptors)
47
diagnosis: hypertension, depression, kidney stones
hyperparathyroidism
48
complications arising from using vasopressors in shock
ischemia and necrosis of distal extremities
| mesenteric ischemia and renal failure
49
most effective intervention for reducing blood pressure
weight loss
50
preferred initial antihypertensive in a patient with no comorbidities
HCTZ or chlorthalidone
51
first-line hypertensive for diabetics
ACE-inhibitor
52
first-line hypertensive for CHF patients
ACE-inhibitor
| beta-blocker and spironolactone
53
first-line hypertensive for BPH
alpha-blocker
54
first-line hypertensive for LVH
ACE-inhibitor
| considered pre-CHF
55
first-line hypertensive for hyperthyroidism
non-selective beta-blocker
56
first-line hypertensive for osteoporosis
HCTZ
57
first-line hypertensive for benign essential tremor
beta-blocker
58
first-line hypertensive for post-menopausal female
HCTZ
59
first-line hypertensive for migraines
beta-blocker
60
most likely cause of secondary HTN with proteinuria
renal disease
61
most likely cause of secondary HTN with hypokalemia
hyperaldosteronism
62
most likely cause of secondary HTN with tachycardia, diarrhea, and heat intolerance
hyperthyroidism
63
most likely cause of secondary HTN with hyperkalemia
renal artery stenosis and renal failure
64
most likely cause of secondary HTN with episodic sweating, tachycardia
pheochromocytoma
65
antihypertensive side effect profile: first dose orthostatic hypotension
alpha-blocker
66
antihypertensive side effect profile: hypertrichosis
minoxidil
67
antihypertensive side effect profile: dry mouth, sedation, rebound HTN
clonidine
| must be dosed every three hours
68
antihypertensive side effect profile: bradycardia, impotence, asthma exacerbation
non-selective beta-blocker
69
antihypertensive side effect profile: reflex tachycardia
vasodilators
70
antihypertensive side effect profile: cough
ACE-inhibitor
71
antihypertensive side effect profile: sulfa allergy
HCTZ, loop diuretics
72
antihypertensive side effect profile: angioedema
ACE-inhibitor or less likely ARB
73
antihypertensive side effect profile: drug-induced lupus
hydralazine
| anti-histone antibodies
74
antihypertensive side effect profile: cyanide toxicity
nitroprusside
75
vasodilating effects of nitroglycerin and dihyropyridine calcium channel blockers
venodilators
76
vasodilating effects of nitroprusside
arteriodilators and venodilators
77
JONES criteria for rheumatic heart disease
```
J - joint polyarthritis
O - pancarditis
N - nodules
E - erythema nodosum
S - syndenham's chorea
```
78
major DUKE criteria for endocarditis
serial positive blood cultures
presence of vegetations or cardiac abscess on ECHO
new onset valvular regurgitation
blood culture positive for Coxiella
79
minor DUKE criteria for endocarditis
predisposing heat condition or IV drug use
fever > 38C
vascular phenomenon (septic emboli, infarc, mycotic aneruysm, intracranial hemorrhage, janeway lesions)
immunologic phenomenon (glomerulonephritis, osler's nodes, roth spots, positive rheumatoid factor)
positive cultures not meeting requirements for major criteria or serologic evidence of infection without positive culture
80
most common nephritic syndrome
membranous glomerulonephritis
81
endocarditis prophylaxis for oral surgery
amoxicillin before and after the procedure
82
endocarditis prophylaxis for GI/GU surgery
amipicillin + gentamicin before and amoxicillin after the procedure
83
treatment for mild unconjugated hyperbilirubinemia
UV therapy
84
when is the greatest risk for post-op MIs
first 48 hours
85
pressor causes vasoconstriction with bradycardia
phenylephrine
86
high dose pressor that maximizes alpha-1 constriction
epinephrine
87
when to stop warfarin prior to surgery
3-4 days
88
when to stop aspirin prior to surgery
5-7 days
89
treatment for DIC
FFP and possibly platelets
90
preferred placement of swan-ganz catheter
right IJ or left subclavian
91
protective measures for kidney with IV contract
n-acetylcysteine
IV fluids
sodium bicarbonate
92
treatment for cluster headaches
100% oxygen
| triptans, ergotamines
93
antihypertensive contraindicated in bilateral renal artery stenosis
ACE-inhibitors
| unilateral okay
94
antihypertensive contraindicated in advanced renal failure
ACE-inhibitors if they have hyperkalemia, otherwise okay
| no potassium-sparing diuretics
95
antihypertensive contraindicated in gout
HCTZ
96
heart defect seen in chromosome 22q11 deletions
truncus arteriosus, tetralogy of fallot
97
heart defect seen in down syndrome
endocardial cushion defects
98
heart defect seen in congenital rubella
PDA, pulmonary artery stenosis
99
heart defect seen in turner's syndrome
coarctation of the aorta
100
heart defect seen in marfan's syndrome
aortic regurgitation
101
medication combination used in treatment of TB meningitis
RIPE drugs
102
features of a patient presenting with pericarditis
pleuritic chest pain, dyspnea, fever, cough
| pain worse in supine position, pulsus paradoxus
103
classic ECG appearance in atrial flutter
saw-tooth pattern 2:1 or 3:1 P wave to QRS complex
104
60 year old obese patient with dirty, velvety patches on back of neck
acanthosis nigricans
| fingerstick glucose and assess for visceral malignancies
105
most common cause of hypothyroidism
hashimoto's thyroiditis
106
type of bias introduced when screening detects a dsiease earlier and thus lengthens the time from diagnosis to death
lead-time bias
107
exceptions to the requirement of informed consent
unable to give consent (mentally disabled)
emergency decisions
patients who waive the right for informed consent
108
palpable flank mass, hematuria, and U/S showing bilateral enlarged kidneys with cysts, what brain anomaly is associated
berry aneurysm
109
four main causes of microcytic anemia
iron deficiency anemia
thalassemia
anemia of chronic disease
lead poisoning
110
US region where lyme disease is endemic
northeast US
111
hand joints affected in rheumatoid arthritis
MCP and PIP
112
xerostomia + parotid enlargement + xerophthalmia + anti-La antibodies
sjogren's syndrome
113
most common cause of seizures in young adults
trauma, alcohol withdrawal, brain tumors
114
most common cause of non-obstetric postpartum death
thromboembolic disease
115
immunodeficiency presenting with eczema, thrombocytopenia, and high levels of IgA
wiskott-aldrich syndrome
116
defense mechanism displayed when a woman calmly describes a gory murder in great detail
isolation
117
treatment for mild, persistent asthma
low-dose inhaled corticosteroid
118
EKG with peaked T waves and widened QRS
hyperkalemia
119
treatment for iron overdose
deferroxamine
120
imaging study used to diagnose DVT
compressive venous U/S
121
radiographic study used to diagnose injury to the urethra
retrograde cystourethrogram
122
drug of choice for trigeminal neuralgia
carbamazepine
123
treatment for normal pressure hydrocephalus
VP shunt
124
treatment for normal pseudotumor cerebri
weight loss. acetazolamide
| if refractory, consider serial LPs
125
treatment for guillain-barre syndrome
endotracheal intubation
| plasmapheresis or IVIG (not both)
126
somogyi effect v. dawn phenomenon
somogyi: 3am glucose low
dawn: insufficient NPH insulin, 3am glucose high
127
when does chronic COPD qualify for home O2
pulse ox < 88%
| pulmonary HTN, peripheral edema, or polycythemia
128
method used to calculate fluid repletion in burn victims
4 mL/kg x %burn
first half in 8 hours
second half in next 16 hours
129
salicylate ingestion results in what type of acid-base disorder
respiratory alkalosis
| metabolic acidosis
130
medication commonly used to induce ovulation
clomiphene citrate
| second life: pulsatile leuprolide
131
psychiatric condition when personal travels a long distance and takes a new name and has no memory of prior life
dissociative fugue
132
congenital infection may present with a "blueberry-muffin" rash
rubella
133
breast cancer that increases future risk of invasive carcinoma in both breasts
LCIS
134
classic symptoms of placenta previa
painless bleeding
135
anterior knee pain in active 14-year-old boy
oshgood-schlotter disease
136
rhomboid-shaped, positively birefringent crystals in joint space
pseudogout
137
oral infection with branching rods
actinomyces
138
next step in evaluation of patient with two consecutive pap smears with ASCUS
colposcopy with ECC
139
45-year-old obese female with pruritis, clay-colored stools, dark urine, elevated alkaline phosphate and elevated bilirubin
biliary tract obstruction
140
infection causing diarrhea and pseudoappendicitis
yersinia
141
most likely cause of acute lower GI bleed in patients older than 40
diverticulosis
142
most common underlying cause of pathologic fractures in elderly thin women
osteoporosis
143
causative agent in pityriasis versicolor
malassia furur
144
chest pain in young patient with angina at rest, T-segment elevation, normal cardiac enzymes
prinzmetals angina
145
hypercholesterolemia medication causing flushing and pruritis
niacin
146
target lesions with red center, pale zone, and dark outer ring appearing on palms and soles with a prodrome of malaise and myalgias
erythema multiforme
147
what percentage of the population falls within 1SD, 2SD, and 3SD
1 standard deviation: 68%
2 standard deviations: 95%
3 standard deviations: 99.7%
148
equation for odds ratio
AD/BC
149
equation for relative risk
A/(A+B) / C/(C+D)
150
when is odds ratio a good approximation of relative risk
when disease is very rare
151
what does it mean when relative risk is equal to one
no association
152
what to do when parents refuse life-saving treatment for a child in an emergent situation
perform therapy and go to ethics board after
153
patient is emergently intubated after MVA, after family brings a signed DNR stating what she did not wish to be intubated, what do you do
extubate
154
patient tells you she does not want to know the results of her lung biopsy but her family is begging you to tell them, what do you do
withhold information
155
study shows that taking 325 mg of aspirin has no effect on ischemic cardiac events, what type of error is this
type II error
156
treatment for acute mesenteric ischemia
broad spectrum antibiotics, NG tube decompression, diagnose with angiogram, heparin to anticoagulate, reduce arterial vasospasm with papaverine, embolectomy, resection of necrotic bowel
157
when is rifampin prophylaxis indicated for bacterial meningitis
close contacts of neisseria or haeomphilus
158
treatment for acromegaly
transsphenoidal surgical resection, external beam therapy, or ocreotide
last choice: cabergoline dopamine agonist
159
COPD patient comes to ER with tachycardia and hypotension, begins to have seizures, what is the most likely etiology
theophylline intoxication
160
ACLS treatment for asystole
transcutaneous pacing
CPR, alternative epinephrine and atropine
cannot give more than 1mg IV atropine x 3 doses
do not shock these patients
161
treatment for febrile seizures
evaporative cooling
162
empiric treatment for pneumonia in a 2-month old
macrolide +/- cefotaxime
163
empiric treatment for pneumonia in a 2-year old
amoxicillin or ampicillin
164
autoimmune complication occurs 2-4 weeks after an MI
dressler's syndrome (autoimmune pericarditis)
165
name given to stress-related hair loss and what is the treatment
tilogen effluveum, just reassure, should go away with stress
166
most common cause of cushing's syndrome
exogenous steroid use
| second most common is pituitary tumor
167
most likely cause of galactorrhea, impotence, and decreased libido in a patient with a history of schizophrenia
medication (dopamine antagonist)
168
ethical problem if doctor refers patient for MRI at a facility he owns
conflict of interest
169
two most common foodborne bacterial GI tract infections in the US
salmonella and campylobacter
170
diagnostic test for hereditary spherocytosis
osmotic fragility test
171
bullous skin disease with negative nikolsky sign
bullous pemphigoid
172
white plaques on tongue and back of throat that can be scraped off with a tongue depressor
candida albicans, screen for HIV
173
young male with hip and back pain along with stiffness that improves with activity and worsens with rest
ankylosing spondilitis
174
cold water is flushed into a patients ear and fast phase of nystagmus is towards the opposite side
normal
175
findings expected in post-term pregnancy > 42 weeks
oligohydramnios, passage of meconium in utero, dry peeling skin, mature placenta with calcifications
176
annual screening recommended for women with strong family history of ovarian cancer
CA-125 and transvaginal U/S
177
defense mechanism used by pedophile who enters a monastery
reaction formation
178
causes of exudative pleural effusion
pneumonia, malignancy, tuberculosis, pulmonary emboli, pancreatitis
179
eosinophilic casts found in urine
acute interstitial nephritis (drug-induced)
180
side effects of corticosteroids
hyperglycemia, hypertension, emotional lability, insomnia, cataracts, osteoporosis, thin skin, cushingoid features
181
classic findings of henoch-schonlein purpura
abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs
182
ranson's criteria for pancreatitis
hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L
183
entamoeba histolytica diarrhea treatment
metronidazole
184
giardia lamblia treatment
metronidazole
185
salmonella treatment
fluoroquinolone/TMP-SMX only in severe case (increases carrier state)
186
shigella treatment
fluoroquinolone/TMP-SMX only in severe case
187
campylobacter treatment
erythromycin
188
vasculitis with weak pulses in upper extremities
takayasu's arteritis (pulseless disease)
189
vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis
wegener's granulomatosis
190
vasculitis with necrotizing immune complex inflammation of visceral and renal vessels
polyarteritis nodosa
191
vasculitis of young male smokers
buerger's disease
192
vasculitis of young asian women
takayasu's arteritis
193
vasculitis of young asthmatics
cherg-strauss
194
vasculitis of infants and young children involving coronary arteries
kawasaki disease
195
most common vasculitis
giant cell arteritis (temporal arteritis)
196
vasculitis associated with hepatitis B infection
polyarteritis nodosa
197
vasculitis where occlusion of ophthalmic artery can lead to blindness
giant cell arteritis
198
vasculitis with perforation of nasal septum
wegener's granulomatosis
199
vasculitis with unilateral headache and jaw claudication
giant cell arteritis
200
lipid lowering agent that causes facial flushing
niacin
201
lipid lowering agent that causes elevated LFTs and myositis
statins and fibrates
202
lipid lowering agent that causes GI discomfort and bad taste
cholestyramine
203
lipid lowering agent that causes best effect on HDL
niacin
204
lipid lowering agent that causes best effect on triglycerides and VLDL
fibrates
205
lipid lowering agent that causes best effect on LDL and cholesterol
statins
206
lipid lowering agent that binds c. diff toxin
cholestyramine
207
drug known for causing elevated prolactin levels
dopamine antagonists, verapamil, methyl-dopa
208
classic findings of henoch-schonlein purpura
abdominal pain, vomiting, blood in stool, intususception, hematuria/proteinuria, joint symptoms, palpable purpura on legs
209
ranson's criteria for pancreatitis
hyperglycemia, AST, LDH, age >45, WBC count, calcium, hematocrit, BUN, base defecit, fluid sequestration > 6 L
210
entamoeba histolytica diarrhea treatment
metronidazole
211
giardia lamblia treatment
metronidazole
212
salmonella treatment
fluoroquinolone/TMP-SMX only in severe case (increases carrier state)
213
shigella treatment
fluoroquinolone/TMP-SMX only in severe case
214
campylobacter treatment
erythromycin
215
vasculitis with weak pulses in upper extremities
takayasu's arteritis (pulseless disease)
216
vasculitis with necrotizing granulomas of lung and necrotizing glomerulonephritis
wegener's granulomatosis
217
vasculitis with necrotizing immune complex inflammation of visceral and renal vessels
polyarteritis nodosa
218
vasculitis of young male smokers
buerger's disease
219
vasculitis of young asian women
takayasu's arteritis
220
vasculitis of young asthmatics
cherg-strauss
221
vasculitis of infants and young children involving coronary arteries
kawasaki disease
222
most common vasculitis
giant cell arteritis (temporal arteritis)
223
vasculitis associated with hepatitis B infection
polyarteritis nodosa
224
vasculitis where occlusion of ophthalmic artery can lead to blindness
giant cell arteritis
225
vasculitis with perforation of nasal septum
wegener's granulomatosis
226
vasculitis with unilateral headache and jaw claudication
giant cell arteritis
227
lipid lowering agent that causes facial flushing
niacin
228
lipid lowering agent that causes elevated LFTs and myositis
statins and fibrates
229
lipid lowering agent that causes GI discomfort and bad taste
cholestyramine
230
lipid lowering agent that causes best effect on HDL
niacin
231
lipid lowering agent that causes best effect on triglycerides and VLDL
fibrates
232
lipid lowering agent that causes best effect on LDL and cholesterol
statins
233
lipid lowering agent that binds c. diff toxin
cholestyramine
234
drug known for causing elevated prolactin levels
dopamine antagonists, verapamil, methyl-dopa
235
how to differentiate between microcytic anemia of iron deficiency and thalassemia
iron deficiency: high RDW > 20% and low reticulocyte count
thalassemia: normal RDW and high reticulocyte count
