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PANCE review > Review with Michelle > Flashcards

Review with Michelle Flashcards

1
Q

short term effects of lithium

A

LMN (loose stool, memory loss and nausea)

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2
Q

the most common cause of acute kidney failure?

A

dehydration

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3
Q

seizure med known for causing gingival hyperplasia?

A

Phenytoin (dilantin)

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4
Q

antibiotic most likely to cause c.dif?

A

Clindamycin

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5
Q

bug that causes whooping cough

A

bordatella

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6
Q

bilateral peripheral vestibular dysfunction

A

oscillopsia (blurring with head movement

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7
Q

two meds used to treat HTN with preclampsia

A

labetalol and methyldopa

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8
Q

uterine procidentia

A

uterus descends beyond vulva

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9
Q

Ethambutol an HIV drug can cause?

A

vision loss

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10
Q

stroke + fever =

A

endocarditis

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11
Q

how does the K+ level change in chronic renal failure?

A

increased serum potassium

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12
Q

cardiac nuclear scan looks for?

A

vessel patency

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13
Q

Romberg tests

A

proprioception of the posterior/dorsal column of the spinal cord

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14
Q

if patient is ataxic but romberg is negative what part of the brain is likely affected?

A

Cerebellum=soberity and balance

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15
Q

patient’s taking valproate (depakote) must have what labs drawn?

A

Liver enzymes

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16
Q

spontaneous pneumo is caused by

A

sub pleural apical bleb due to high negative pressure

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17
Q

test of choice for DVT

A

doppler and human’s sign….. it will be swollen

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18
Q

test of choice for arterial claudiation

A

arterial duplex scan

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19
Q

you say mesthelioma, I say…..

A

asbestos

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20
Q

Kleb pneumonia = what type of antibiotic

A

IV-cefoxamine

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21
Q

prognosis of lung CA with liver mets

A

horrible —-no resection

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22
Q

dull aching, heaviness, in LE brought on by standing

A

Venous thrombosis

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23
Q

pain in calf with ambulation

A

Claudication - Arterial

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24
Q

OSA can cause what heart problem

A

right sided heart failure

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25
Q

S1 references what heart valve?

A

mitral

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26
Q

bones, stones, and groins =

A

hypercalcemia

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27
Q

vitamin deficiency = smooth red tongue

A

B12 (also think neuropathy of hands and feet)

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28
Q

hemarthrosis means?

A

bleeding into joint space

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29
Q

glucose 6 phosphate deficiency

A

x linked genetic deficiency

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30
Q

primaquine is a anti malaria drug, it may trigger

A

hemolysis

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31
Q

Philly chromosome

A

CML ( philly sandwich: Cheese, Meat, or Long bread)

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32
Q

Hyperthyroid med

A

propylthiouracil (PTU)

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33
Q

most common cause of hyperthyroidism

A

graves

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34
Q

gentamicin is toxic to….

A

fetus and ears

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35
Q

brown recluse bite description

A

ring of pallor/bleb in middle

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36
Q

erythema nodosum

A

unknown cause, may be post viral.. located on shins, red spots/inflammation. linked to HLA-B27. may also appear with sarcoidosis.

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37
Q

McMurray tests what in the knee?

A

positive McMurray = torn medial/lateral meniscus

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38
Q

bladder infection but allergic to sulfa, best alternative antibiotic?

A

Ampicillin

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39
Q

define pulse pressure

A

difference between systolic and diastolic BP

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40
Q

RA-hand deformities

A

swan neck, button hook, boutonniere and ulnar deviation

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41
Q

uterine leiomyomas

A

common, benign, represent localized proliferation of smooth muscle cells surrounded by compressed muscle fibers

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42
Q

During inhalation _______valve abnormalities are heard?

A

Right side-tricuspid

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43
Q

During exhalation________valve abnormalities are heard?

A

Left sided- mitral valve

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44
Q

double bubble sign—GI imagining

A

Pylori stenosis

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45
Q

Seidel’s sign / Waterfall

A

Flurosein pouring out of ruptured globe

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46
Q

Cloudy cornea, mid-fixed pupil and firm

A

acute angle glaucoma

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47
Q

abnormal swing flashlight test

A

marcus-gunn

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48
Q

bloody diarrhea, occurs at night, and exacerbated at night

A

UC

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49
Q

how many fasting glucose tests to dx DM

A

2

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50
Q

Rheumatic fever causes what heart condition

A

mitral stenosis

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51
Q

type of murmur heard with cardiac rheumatic fever, mitral stenosis?

A

apical diastolic murmur

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52
Q

mono virus causes lymphadenopathy of what lymph chain

A

posterior chain

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53
Q

lab test to evaluate and dx hemochromatosis?

A

Ferritin and iron studies

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54
Q

I say Bence Jones, you say?

A

MM

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55
Q

Patient has known Aortic stenosis, can you do a treadmill stress echo?

A

No, do a drug stress echo

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56
Q

lung findings-Asbestosis

A

dyspnea, interstitial fibrosis of lower lobes, thickened pleura plaques

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57
Q

Asbestosis is a restrictive or congestive lung disease?

A

Restrictive

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58
Q

exposure to silica = lung findings

A

small rounded opacities throughout the lungs and calcified hilar lymph nodes

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59
Q

how do you dx nephrotic type of proteinuria

A

24 hour urine catch

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60
Q

I say polymyagia rheumatic, you say

A

giant cell arteritis

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61
Q

100% of dermatitis herpetiform have….

A

celiac dz

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62
Q

tx for chronic psoriasis

A

light treatment

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63
Q

dermatitis herpetiform is

A

papules on the extensor surface of elbow and knees

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64
Q

malignant otitis media

A

cellulitis with DM or other immunocompromised illnesses

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65
Q

most common genital tract malignancy in US

A

Endometrial carcinoma

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66
Q

most common cancer in the world

A

breast cancer

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67
Q

4 things to know w/ molar pregnancy

A
  1. painless bleeding 2. uterine size and date discrepancy 3. passage of tissue 4. exaggerated AM sickness
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68
Q

molimina

A

mild form of PMS-3 or 4 symptoms = fluid retention, fluctuation of mood, headache and food craving

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69
Q

why not use antihistamines for sinus infection?

A

impairs drainage

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70
Q

what CN may be effected with septic cavernous sinus thrombophlebitis?

A

3 (oculomotor), 4(trochlear), and 6(abducens)

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71
Q

how do you dx purulent otitis media?

A

needle aspiration

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72
Q

quinsy throat aka….

A

peritonsillar abscess. complication of of strep A

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73
Q

antibiotics for peritonsillar abscess

A

pen G with clindamycin or metronidazole

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74
Q

antibiotic for pneumonia bug h.flu and m.cat

A

levofloxacin

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75
Q

antibiotic for s.pneumo

A

erythromycin

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76
Q

antibiotic for m.pneuno

A

doxycycine

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77
Q

neuroleptic malignant syndrome (NMS)

A

abrupt withdrawal of antiparkinson drugs, many dopamine receptors go unfilled = muscular rigidity

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78
Q

psych med that reduces seizure threshold?

A

wellbutrin

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79
Q

uncommon psych disorder in which agitation progresses to muscle rigidity and hyperthermia

A

lethal catatonia

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80
Q

cat scratch fever

A

bartonella henslae, playing with cats

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81
Q

trench fever

A

bartonella quintana, human lice

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82
Q

carrion’s disease

A

bartonella bacilliformes , sand fly bites

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83
Q

symptoms of cat scratch fever

A

fever, lymph node enlargement, papule or pustule at inoculation site

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84
Q

beta lactam work by

A

inhibit transpeptidation of the cell wall

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85
Q

Macrolide (azithromycin) works by

A

50S ribosomal subunit

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86
Q

Sulfa drugs work by…

A

inhibit dihydropterate and folate reproduction

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87
Q

Tetracycline works by….

A

binds 30S ribosomal subunits

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88
Q

Quinolones work by….

A

inhibit DNA replication

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89
Q

“B” symptoms refer to what disease?

A

non-hodgkin lymphoma

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90
Q

Amiodarone side effect?

A

hypothyroidism

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91
Q

Tendons involved in DeQuervian’s tenosynovitis?

A

Extensor Pollcis brevis and abductor pollis tendon

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92
Q

Test performed to confirm DeQuerivian’s

A

Finkelstein

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93
Q

Test performed to confirm ruptured achilles tendon

A

Thompson, place pt is prone position legs off of table, squeeze calf and watch for planter flexion

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94
Q

Ligament involved in Game keepers thumb

A

ulnar collateral ligament

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95
Q

homen’s sign

A

make sure patient’s knee is flexed and then dorsiflex foot forcefully

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96
Q

1st line treatment for Abnormal uterine bleeding in a 40 year old?

A

Levonorgestrol IUD

97
Q

Best imaging to dx a PE?

A

CT

98
Q

What murmur can be heard best when pt is placed in left lateral decubitus position

A

mitral stenosis

99
Q

isometric handgrip increases arterial & left ventricular pressure, this increases what type of murmur?

A

Aortic regurgitation

100
Q

most common drug to cause pill induced esophagitis?

A

Ibuprofen

101
Q

skin tags are associated with what syndrome?

A

metabolic syndrome

102
Q

Lyme dz symptoms

A

fever, vomiting, meningeal sign, and photophobia

103
Q

treatment for clostridium tetani?

A

Tetanus immuneglobin, tetanus toxoid, and metronidazole

104
Q

Breathing pattern associated with DKA

A

Kussmaul

105
Q

First line treatment for giant cell arteritis is high dose steroids, how many mg of prednisone? And what is the dx modality?

A

60mg, dx with biopsy

106
Q

meconium ileus

A

cystic fibrous

107
Q

when does pylori stenosis most often occur?

A

3 to 6 months old

108
Q

most common cause of non traumatic subarachnoid hemorrhage

A

cerebral aneurysm

109
Q

how long should a non-complicated shoulder dislocation be in a sling?

A

2 to 4 weeks

110
Q

fall onto outstretched abducted arm =

A

shoulder dislocation, majority are anterior

111
Q

Cullen’s sign

A

sign of retroperitoneal hemorrhage such as periumbicilical (Cullen’s sign)

112
Q

Grey-Turner’s sign

A

flank ecchymosis, a sign of retroperitoneal hemorrhage

113
Q

AAA larger than ____cm are at higher risk of rupturing

A

5cm

114
Q

How is a AAA diagnosed?

A

US is unstable or CT is the gold standard if patient is stable.

115
Q

Risk factors AAA?

A

Hypertension, congenital heart disease, pregnancy, Marfans or iatrogenic from cardiac cath

116
Q

how dissections occur

A

Intima is damaged allowing blood to enter the media and dissect between the initial and adventitial layers, developing a false lumen.

117
Q

Common sites of AAA?

A

ascending aorta and the region of the ligamentum arteriosum

118
Q

Gold standard to dx AAA?

A

Angiography

119
Q

ER care of AAA-control hypertension with…

A

B-Blockers

120
Q

where are most of DVTs located?

A

80% are located in or proximal to the popliteal vein.

121
Q

negative ELISA D-dimer tell you that….

A

97% sure there is no clot

122
Q

Treatment for DVT?

A

low molecular weight heparins (LMWH)

123
Q

Common low molecular weight heparins?

A

dalteparin, enoxaparin, and tinzaparin

124
Q

what is phlegmasia cerulean dolens

A

is an uncommon severe form of dvt which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb.

125
Q

common location for acute arterial occlusion?

A

femoropopliteal, tibial, aortoiliac, and brachiocephalic

126
Q

treat acute arterial occlusion with?

A

unfractionated heparin, catheter embolectomy using Fogarty ballon. All patient’s should be admitted and placed on telemetry.

127
Q

dilated myopathy causes what type of heart failure?

A

Systolic, due to dilatation of the ventricle

128
Q

Aortic regurgitation causes what type of heart failure?

A

Systolic

129
Q

Beriberi, anemia, thyrotoxicosis, and pheochromocytoma all cause what type of heart failure?

A

High output failure –high metabolic output

130
Q

Where is BUN produced? When is it increased?

A

Produced in the liver as a byproduct of protein metabolism and secreted by kidneys. Increased in dehydration, GI bleeding, and if renal excretion of urea is decreased (renal failure)

131
Q

BNP stands for? Level that suggests cardiac cause of dyspnea?

A

Brain natriuretic peptide >200 =coronary cause of dyspnea

132
Q

BNP <100 and dyspnea = what type of etiology?

A

pulmonary

133
Q

patient is 65 years old, anemic, has bone pain, proteinuria and renal failure, this is…..

A

Multiple myeloma

134
Q

cushing’s syndrome is a disorder of ?

A

cortisol

135
Q

true or false cushing’s syndrome can cause osteopenia?

A

true

136
Q

needle shaped crystals?

A

gout

137
Q

Aspiration of joint shows >50,000 cell count?

A

septic joint

138
Q

you think a patient has a lower leg DVT, how is this dx?

A

LE Doppler US

139
Q

what is more specific and sensitive a myocardial perfusion scan (MPI) or an exercise stress test?

A

myocardial perfusion scan, is a nuclear medicine procedure that illustrates the function of the heart muscle

140
Q

Glucose level, CSF mononuclear, and total protein level in Viral meningitis will be increased or decreased?

A

Viral meningitis: Increase in mononuclear cells and total protein. Glucose may be normal

141
Q

Is C-reactive protein elevated in viral or bacterial meningitis?

A

Bacterial, glucose will be low

142
Q

patient is female with a hx of iritis and erythema nodosum, fever, malaise, and dyspnea. Think?

A

Sarcoidosis

143
Q

Iritis is a hint for?

A

autoimmune disorders

144
Q

most common congenital viral infection in US?

A

CMV

145
Q

babies infected with CMV prior to birth will have:

A

hearing loss, visual impairment, mental retardation and enlargement of liver / spleen.

146
Q

What is sarcoidosis

A

idiopathic disease, noncaseating granulomatous inflammation in affected organs. 90% have lung involvement.

147
Q

Physiological changes during severe hypothermia

A

fixed pupils, ventricular fibrillation

148
Q

palmar cord causing palmar flexion of 4th and 5th fingers

A

Dupuytren’s

149
Q

Red reflex tests?

A

corneal clarity and retinal mass

150
Q

test done for strabismus?

A

corneal light reflex and uncover/cover test

151
Q

Corneal light reflex is used on PE to evaluate?

A

Strabismus

152
Q

Patient has AIDS and interstitial infiltrates, what is the most common opportunistic infection in HIV?

A

Pneumocystis jiroveci (PCP pneumonia)

153
Q

what can be used as prophylaxis for pneumocystis jiroveci in HIV patient when CD4 count is below 200?

A

Bactrim

154
Q

Patient presents complaining of 12 plus weeks of laryngitis and a slight cough. She has a h/o mitral regurg. Indirect laryngoscopy performed in the office reveals vocal cords that do not move with phonation. what is the next step in her evaluation?

A

If the vocal cords do not move it is no longer an ENT problem, but a chest or left recurrent laryngeal nerve problem. It is possible that mitral regurg has caused increase of her marked enlargement of her atrium, putting tension on the nerve

155
Q

What is the most common anomaly associated with coarctation?

A

Bicuspid aortic valve (congenital)

156
Q

reduced HCO3 bicarbonate concentration on the ABG may be due to….

A

anytime there is a significant change in the HC03 you are looking at a metabolic problem. Loss of bicarb means a loss of a base, and would therefore cause a metabolic acidosis.

157
Q

do changes in CO2 affect the metabolic or respiratory side of the equation?

A

respiratory

158
Q

highest populations affected by sarcoidosis

A

north american blacks and northern europeans

159
Q

Organs affected in sarcoidosis?

A

Lungs, lymph nodes, eyes, skin, liver, spleen, parotid glands, heart and nervous system

160
Q

Symptoms of sarcoidosis?

A

fever, cough, chest discomfort, erythema nodosum, malasie

161
Q

How do you dx sarcoidosis?

A

Transbronchial biopsy of the lung or fine needle node biopsy. It will show noncaseating granulomas

162
Q

treatment for sarcoidosis?

A

steroids

163
Q

What labs are elevated in sarcoidosis?

A

Eosinophilia, erythrocyte sedimentation rate, angiotensin-converting enzyme.

164
Q

Frost bite 1st degree

A

freeze no blister

165
Q

Frost bite 2nd degree

A

freeze + blister

166
Q

3rd stage frost bite

A

freeze = dead skin

167
Q

4th stage frost bite

A

full thickness including bone

168
Q

treatment for high altitude sickness

A

descent, oxygen, dexamethasome, acetazolamide

169
Q

antidote for acetaminophen

A

acetylcysteine

170
Q

antidote for organophosphate

A

atropine

171
Q

antidote for benzos

A

flumazenil

172
Q

antidote for b-blockers

A

glucagon

173
Q

antidote for CCB

A

calcium

174
Q

Antidote for digoxin

A

digibind

175
Q

antidote for heparin

A

protamine

176
Q

antidote for narcotics

A

naloxone (narcan)

177
Q

antidote for tricyclic antidepressants?

A

sodium bicaronate

178
Q

antidote for warfarin?

A

vitamin K

179
Q

what electrolyte abnormality causes paralytic ileus

A

hypokalemia

180
Q

sudden painless complete vision loss eye with cherry red fovea. treatment?

A

this is central retinal artery occlusion

tx with ocular massage and acetazolamide ( same drug used for altitude sickness

181
Q

what electrolyte abnormality goes with DKA

A

hyperkalemia and low bicarb

182
Q

Type II DM, with infection, weakness, polydipsia, glucose >600 most likely has?

A

hyperosmolar hyperglycemic state

183
Q

Hypoglycemia is BG <50, what is the treatment

A

IV glucose or IM glucagon, thiamine to alcoholics

184
Q

Thyroid storm treatment

A

volume replacement. b-bloker, PTU, methimazole and steroids

185
Q

EKG changes that occur with thyroid storm?

A

tachycardia, a fib or flutter and prolonged QRS

186
Q

absent cremasteric reflex =

A

testicular torsion (this is a surgical fix)

187
Q

what cardiac med is responsible for angioedema

A

ACE

188
Q

do steroids help with steven johnson syndrome?

A

no, just stop the offending agent

189
Q

treatment for staph scalded skin syndrome

A

tx nafacillin or oxacillin

190
Q

pemphigus vulgaris

A

loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction (in which antibodies bind to antigens on the body’s own tissues). It is characterized by extensive flaccid blisters and mucocutaneous erosions. Tx is fluids and steroids

191
Q

1 cause of hypercalcemia?

A

primary hyperparathyroidism

192
Q

2 cause of hypercalcemia?

A

malignancies

193
Q

cardiac symptoms of hypercalcemia

A

short QT, bradycardia, hypertension

194
Q

band keratopathy in the eye are associated with what electrolyte abnormality?

A

hypercalcemia

195
Q

a patient with vomiting, lower chest pain and subcutaneous emphysema most likely has?

A

Esophageal rupture (boerhaaves syndrome)

196
Q

tx for esophageal rupture?

A

NPO, IV antibiotics and surgery

197
Q

What drug do you give for any pulseless rhythm?

A

Epi 1mg

198
Q

what drug do you give for SVT?

A

Adenosine 6-6-12mg

199
Q

What drug do you give for bradycardia?

A

Atropine 0.5-1mg

200
Q

what node does atropine excite?

A

AV node

201
Q

Patient presents with torsades de points

A

give Mg 1-2grams

202
Q

For VF and pulseless VT give?

A

vasopressin

203
Q

Hypertensive emergency give?

A

IV labetalol and IV Nitroprusside

204
Q

What type of aortic dissection is fixed surgically?

A

Type A (ascending aorta)

205
Q

most likely cause of metabolic alkalosis

A

vomiting-volume depletion

206
Q

what is the pH and bicarb level in metabolic alkalosis

A

pH is >7.45 and bicarb is >26

207
Q

Treatment for metabolic alkalosis?

A

acetazolamide ( this is also given for altitude sickness and central retinal artery occlusion

208
Q

Name two conditions that cause Carpopedal spasm (painful contractions with adduction of the thumb, flexion of MCP joint, extension of the IP joints and flexion of the wrist)

A

Hypocalcemia and Respiratory acidosis

209
Q

what are level of Ca+ that are considered hypo and hyper?

A

hypo <11

210
Q

most common cause of hypocalcemia?

A

Chronic kidney disease, others include: hypoalbuminemia, hypoparathyroidism, vitamin d deficiency and low Mg

211
Q

Signs and symptoms of hypocalcemia?

A

Tetany, tingling paresthesias and carpopedal spasm

212
Q

A patient with MM is found to have hypercalcemia, what is the first line treatment?

A

Glucocorticoid steroids

213
Q

Name 3 treatments for hypercalcemia

A
  1. Hydration to diruesis 2. IV biphosphonates to inhibit osteoclasts 3. Calcitonin
214
Q

asthmatic attack will show what on ABGs?

A

respiratory acidosis

215
Q

how does BiPAP help asthmatics

A

lowers the CO2 level

216
Q

treatment for hypocalcemia

A

calcium chord of calcium gluconate

217
Q

chvostek’s sign, what electrolyte imbalance is it testing?

A

tap the cheek causes contraction, hypocalcemia

218
Q

Trousseau’s sign

A

hypocalcemia, use BP cuff to induce carpel spasm

219
Q

EKG findings with hypocalcemia?

A

QT is prolonged (quite tense and longing for ca+)

220
Q

Respiratory acidosis pH level and CO2 level

A

pH 45

221
Q

guillian barre and myasthenia gravis will have what type of acid/base disorder?

A

respiratory acidosis

222
Q

pH >7.45 and pCO2 <35

A

respiratory alkalosis

223
Q

A patient presents with symptoms of pituitary tumor, what is the next step in evaluating whether or not this tumor is causing bitemporal hemianopsia?

A

since the question is asking about vision the next step is to formally evaluate peripheral field testing. Adenomas that affect the optic chiasm may cause irreversible vision changes.

224
Q

Peripheral blood cell count in AIDS are best characterized as?

A

Decreased helper T cells and Lymphopenia

225
Q

name the splint for the scaphoid fracture

A

thumb spica splint, refer to ortho

226
Q

kiddo swallows battery- next step?

A

esophagogastroduodenoscopy b/c battery can cause a caustic erosion of the esophagus

227
Q

Explain S4?

A

S4 is the sound of blood ejected during atrial contraction and striking the stiff ventricular wall of hypertrophy or stunned myocardium

228
Q

If S4 is the sound of blood hitting the stiff enlarged ventricle or stunned myocardium. What heart conditions will you hear S4

A

Left or right Ventricle hypertrophy (heart failure), post MI, and cor pulmonale

229
Q

If thyroid gland and parathyroid is removed, why may a patient have a positive chvostek sign?

A

Likely to have hypocalcemia, b/c parathyroid is responsible for calcium regulation

230
Q

what does the Glasgow coma scale measure

A

Best eye movement, verbal response, and motor response

231
Q

One category of the GCS is eye response, name the 4 levels of eye movement

A

1pt. no eye opening
2pt. eyes open to pain
3pt. eyes open to verbal response
4pt. eyes open spontaneously

232
Q

Name the 5 levels of motor response according to the GCS

A

1pt. no response
2pt. extension to pain
3pt. flexion to pain
4pt. withdrawal to pain
5pt. localizes to pain
6pt. obeys commend

233
Q

Name the 5 levels of verbal response according to the GCS

A 
1pt no verbal
2pt incomprehensible sounds
3pt inappropriate sound
4pt confused 
5pt orientated
234
Q

What class of drug is Verapamil

A

CCB

235
Q

what are CCB avoided in CHF

A

significant negative inotropic effect and reduces the EF and CO

236
Q

What CCB is sometimes used in CHF due to it’s semi positive effects on contractility?

A

Amlodipine

237
Q

what tests are the most S&S for RA?

A

CCP (cyclic citrullinated peptide) is 96%

238
Q

Cholesteatoma

A

destructive/expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Can still cause problems because of their erosive and expansile properties resulting in the destruction of the ossicles and spread through the base of the skull into the brain.

PANCE review (19 decks)

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