rosh review questions Flashcards
what are the different mechanism of action between PPIs and H2 receptor blockers?
Proton-pump inhibitors directly block the hydrogen-potassium ATPase action on parietal cells to effectively decrease acid suppression.
H2 Blockers: competitively bind with gastric parietal cells to inhibit gastric acid secretion
Proton-pump inhibitors have greater effectiveness in treating esophagitis because they act on the final pathway of acid secretion rather than one of its receptors.
what is pre-tibial myedema?
it is a skin condition in Grave’s disease- hyperthyroidism- looks like peripheral vascular disease - it is caused by the deposition of hyaluronic acid (hydrophilic glycosaminoglycans in the dermis)
when do you add dextrose to IV fluid replacement in DKA treatment?
when anion gap is still elevated but glucose is < 200.
when would you give sodium bicarb in DKA?
if pH is < 6.9. otherwise it’s controversial to add this when bicarb level is low.
how is anion gap calculated?
Anion Gap = Sodium - (Chloride + Bicarbonate).
Potassium may or may not be included in anion gap calculation- if it is, it changes the normal range.
what are physical barriers of innate immune system?
physical barriers which include the skin, sweat, oral secretions, stomach acid, and mucosa
what are physical exam findings of bacterial infective endocarditis?
fever, Roth spots, Osler nodes, murmur, Janeway lesions, anemia, nailbed hemorrhages, emboli (FROM JANE)
what are Roth spots
retinal changes from infective endocarditis
what are osler nodes vs janeway lesions
infective endocarditis
osler nodes- on hands, more like hard bumps or moles
janeway lesions- hemorrhagic lesions
what are the most common bacteria for endocarditis- mechanical vs. natural valve
IVDA: Staphylococcus aureus, tricuspid
Native valve: Staphylococcus aureus, viridans streptococci (most common in previously diseased), mitral
Pneumopericardium- what are the impacts on hemodynamic status? what’s the severe complication?
increased pulmonary capillary wedge pressure, decreased cardiac output, and increased systemic vascular resistance.
can develop into cardiac tamponade and cardiogenic shock
what is risk with succinylcholine? which patients to avoid this for rapid sequence intubation?
succinylcholine (suxamethonium) is a rapid-acting depolarizing skeletal muscle relaxant that can cause fatal hyperkalemia and, less commonly, malignant hyperthermia
avoid in ESRD
what does positive Murphy’s sign indicate?
acute cholecystitis- RUQ pain
imaging recommendations for acute cholecystitis workup
initial: ultrasound- better detection of gallstones compared to CT scan
gold standard: HIDA scan
basal cell carcinoma defining features
translucent, pearly nodule and rolled raised edge.
thyroid storm medication regimen
propranolol, propylthiouracil, potassium iodide, dexamethasone
Grave’s disease
propranolol first because decreasing peripheral conversion of T4 to T3. Propylthiouracil- block synthesis of thyroid hormone potassium iodide- prevent release of stored thyroid. dexamethasone- concern for adrenal insufficiency and decrease peripheral conversion of T4 to T3
Beta-blocker (propranolol)
Thioamide (propylthiouracil or methimazole)
Iodine solution
Glucocorticoids
what is treatment for 3rd degree HB?
electrophysiology consult: permanent pacemaker placement
what anticoagulant is approved during/after pregnancy
enoxaparin- low molecular weight heparin
describe hyperparathyroidism
Labs will show high PTH, high calcium, low phosphorus
Most commonly caused by an adenoma with unregulated overproduction of PTH
hereditary angioedema
deficiency of C1 inhibitor- part of the compliment system
excessive bradykinin
Tx: replase C1 esterase inhibitor- FFP
levothyroxine dosing adults vs older adults
Lower for older adults because; due to risk for cardiac dysrhythmias, myocardial infarction, and angina pectoralis
what is a risk factor for non-Hodgkin lymphoma?
Hashimoto disease (hypothyroidism)
what is mechanism of action of carvidopa-levodopa combination agent
Carbidopa is usually combined with levodopa to inhibit decarboxylase from converting levodopa to dopamine in the systemic circulation
importance of dicrotic notch
aortic valve closure- measured on arterial wave form. use to time opening of aortic balloon pump with aortic valve closure
asymptomatic AAA
feel for abdominal mass
what does abdominal bruit signal
renal artery stenosis
what antibiotic medications cause QTc prolongation
Antimicrobials known to cause QT prolongation include macrolides, fluoroquinolones, and high-dose fluconazole
aortic stenosis atributes
crescendo-decrescendo murmur systolic ejection murmur diminished carotid pulses split S2 narrow pulse pressure decreases murmur with Valsalva maneuver
burn: painless, escar =
full thickness burn
when is PSA screening indicated
age 55-69, with consideration of family history of prostate cancer. this is a soft recommendation because the risks can outweigh the benefits
Screening for prostate cancer is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age).This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.
diarrhea vs vomiting metabolic abnormalities
Diarrhea is the most common cause of external loss of alkali resulting in metabolic acidosis. Biliary, pancreatic, and duodenal secretions are alkaline and are capable of neutralizing the acidity of gastric secretions
vomiting- metabolic alkalosis because of loss of gastric acid.
what is mydriasis?
fixed pupil; brain herniation
define assault (legal terms)
occurs when one individual is in immediate fear or apprehension of harmful touching without their consent. It does not include physical harm
define abuse in legal terms
the intentional harm or injury to another individual. In medicine, abuse includes practices that are inconsistent with recommended medical treatment resulting in services rendered that are not medically necessary or fail to meet the recognized standards of care.
define battery in legal terms
the unlawful touching of an individual with the intent of causing harm
define intimidation in legal terms
the act of filling with fear through strength of position or force of personality that encourages a specific action.
define secondary prevention
early detection of a disease
define primary prevention
prevent disease well before it develops and reduce risk factors
define tertiary prevention
treat established disease to prevent deterioration
positive Trousseau’s sign or Chovstek’s sign
hypOcalcemia
alcoholic hepatis lab trends
2:1 ratio AST:ALT
viral hepatitis lab trends
10x higher AST/ALT levels
adduction testing
Varus. lateral colateral ligament LCL
ankle in, knee out
abduction testing
Valgus test, ankle out (abduction), knee force in
MCL testing
ACL
anterior drawer test/ Lachman’s test
PCL
posterior drawer test
what is most common dysrhytmia in Wolf Parkinson White syndrome/
Orthodromic AVRT is the most common tachydysrhythmia seen in WPW syndrome and accounts for 65% of dysrhythmias seen in WPW patients
what are the EKG characteristics of Wolf Parkinson White Syndrome?
Short PR interval < 0.12 seconds
Delta wave- curved upstroke of QRS complex
Wide QRS > 0.12 seconds
what is the accessory pathway of WPW syndrome?
Bundle of Kent
what is characteristic of WPW syndrome? what is treatment?
Tachyarrhythmias; palpitations, syncope
1st tx: vagal maneuver
2nd: adenosine push
3rd: beta blocker or calcium channel blocker
definitive treatment: ablation of alternative pathway
If unstable: emergent cardioversion
describe presentation of acute appendicitis, physical exam findings and diagnostic testing
Presentation: periumbilical pain that migrates to RLQ pain, nausea, vomiting, fever, anorexia, diarrhea, general malaise, flatulence, dyspepsia (last 4 are atypical signs)
McBurney’s point (RLQ), Rosvig’s sign- referred RLQ pain from palpation of LLQ.
Psoas sign; hip extension while left side lying
Obturator sign; flexion of knee and internal rotation of hip elicits pain
Diagnostic: CT scan is gold standard
what is antiphospholipid antibody syndrome
autoimmune multisystem disorder characterized by arterial venous or small vessel thromboembolic events. may be associated with Lupus
testing: anticardiolipin antibodies or lupus anticoagulant levels or anti-beta-2-glycoprotein I antibodies
