USMLE World key info Flashcards
mid diastolic rumble suggests what cardiac abnormality
mitral stenosis
how do you treat a patient who had rheumatic fever in year past but was not treated and why do you even treat?
prophylactic antibiotic regimen b/c of high risk of recurrence of RF w/ subsequent strep infections
=IM Penicillin G q4weeks
-for RF w/o carditis duration is 5 years or until age 21 (whichever is longer)
-for RF w/ carditis, but no residual valve disease duration is 10 years or until 21 (whichever is longer)
-for RF w/ persistent heart disease duration is 10 years or until 40 (whichever is longer)
top 3 cardiac diseases associated with Down’s syndrome listed in order of incidence
- complete atrioventricular septal defect (poorly formed AV valves + ASD + VSD)
- VSD
- ASD
5 P’s of limb ischemia
pulselessness, pallor, pain, parasthesias, paralysis (and hyPothermia)
widened pulse pressure and water hammer pulse suggest what valvular abnormality and why do these findings occur?
AR: widened pulse pressure due to open communication between aorta and LV after systole allowing back-leak of a portion of the stroke volume;
water hammer pulse occurs for the same reason, there is a strong SBP, but DBP drops significantly due to retrograde flow of some of the stroke volume
treat Wolf-Parkinson White with ________ and avoid _________ b/c ___________
treat WPW with antiarrhythmics like procainamide and avoid AV nodal blockers like CCB’s, digoxin and adenosine because they enhance accessory pathway conduction by slowing AV node conduction
treatment for infective endocarditis with PCN susceptible strep (2 options)
IV Penicillin G every 4-6 hours OR IV Ceftriaxone qd for 4 weeks
what is a cholesteatoma and how does it present
epithelial tumor of the middle ear that can disrupt the tympanic membrane
presentation: continued ear drainage despite abx and sudden onset of hearing loss; on ear exam a retraction pocket or granulation tissue on the TM may be seen
at what age should you start DEXA screening
do an initial screen for all woman over 65 years of age
T-score more negative than 2.5 is considered osteoporosis
ascites, JVP, LE edema and hepatomegaly in a patient s/p treatment for Hodgkin’s lymphoma should make you think of what etiologic condition
constrictive pericarditis due to radiation Tx resulting in right heart failure (JVP, ascites, peripheral edema, hepatomegaly)
a kid with bulging tympanic membranes and a middle ear effusion should be given what treatment
for acute otitis media 1st line therapy= amoxicillin
2nd line= amox-clavulanate
which 4 medications should be given for mortality benefit after myocardial infarction
beta blockers
statins
ACE-inhibitors
aspirin
what are the guidelines for ASA and clopidogrel after NSTEMI? after PCI?
after NSTEMI: clopidogrel for 12 months, ASA indefinitely
after PCI: clopidogrel for 30 after bare metal and 6-12 months after DES; ASA indefinitely
what hgb is considered anemic in pregnancy
at what age should you assume cryptoorchidism will not spontaneously resolve
if it persists at 6 months move to surgery
surgery should be done before 1 year
how do you treat a hairline fracture of the metatarsal
rest and analgesia (only casting if after time symptoms do not resolve; nonunion is uncommon due to natural splinting of adjacent bones)
nasal obstruction, visible nasal mass and recurrent epistaxis in a peds patients should make you think
juvenile angiofibroma
lifting of the tibial tubercle from the shaft or a break in the tibial tubercle seen on x-ray is suggestive of what condition
Osgood-Schlatter disease (traction apophysitis)
uveitis/conjunctivitis/inflammation of one eye after the other eye has suffered penetrating injury suggests what condition
sympathetic ophthalmia: uncovering of “hidden antigens” in the protected space of the eye leads to autoimmune attack on the other eye
until what age should most women get regular pap smears
until age 65
what is the drug of choice to treat malignant otitis externa
IV cipro (covers pseudomonas)
what is the age range and screening interval for breast cancer screening
ages 40-75, every 2 years
what is the age range and screening interval for cervical cancer
ages 21-65
21-29 pap every 3 years, then continue until 65 or switch to cotesting every 5 years until 65
what is the age range and screening interval for colon cancer
age 50-75
colonoscopy every 10 years if normal
or FOBT yearly
what is the age range and screening interval for hyperlipidemia
men over 35
lipid panel every 5 years
what is the age range and screening interval for hypertension
after age 18
BP checks every 2 years
otosclerosis is a conductive hearing disorder that involves overgrowth of what structure
the stapes
what is the most common congenital cyanotic defect?
most common congenital heart defect overall?
transposition of the great vessels
most common overall=VSD
what is the difference between validity and accuracy
trick question! there is no difference
validity=accuracy
what treatment is indicated for a GSW to the abdomen who is hemodynamically unstable and has an indeterminate FAST
emergent laparotomy; this is a penetrating trauma and anything below the 4th intercostal space is considered abdomen
what infection is erythema multiforme often associated with
herpes simplex virus
a whistling sound in the nose on inspiration after rhinoplasty is likely
nasal septal perforation
what are the typical x-ray findings for cervical spondylosis
osteophytes (bony spurs) and sclerotic facet joints
a dome shaped painless nodule with a central punctum that regresses and recurs is likely
epidermal inclusion cyst
what is Ramsey Hunt syndrome
Herpes zoster that causes Bell’s palsy
what is serous otitis media and how does it present
commonly seen in AIDS, serous otitis media is a non-infectious inflammation and effusion of the middle ear
presentation= hearing loss, dull and hypomobile tympanic membrane
how do you treat tinea capitis (the scalp fungal infection that causes bald spots)
oral griseofulvin
selenium sulfide or ketoconazole shampoo for household contacts
what is the treatment for hydrocoele in an infant
reassurance and observe; most resolve by 1 year of age (no imaging needed)
a patient has a firm testicular mass and ultrasound suggests cancer; what is the next best step
radiacal orchiectomy
KILL FIRST AND INVESTIGATE LATER
biopsies are contraindicated due to spillage of highly invasive cells
by 1 year of age a child’s weight should increase by how much
weight should triple, height should increase by half
what can a patient do to decrease risk of Meniere’s disease
low salt diet, avoiding triggers like alcohol, caffeine and nicotine which increase endolymphatic retention
a knee injury during athletic activity resulting in rapid hemarthrosis should make you think of what
ACL injury (tends to present more commonly with more rapid hemarthrosis than other ligament tears)
pain at the knee that is pretibial and medial with negative x-ray with no swelling and valgus stress test is likely
anserine bursitis (the anserine bursa is just medial to the infrapatellar bursa and causes pain, but no swelling when inflamed)
cancers on the lip are usually basal cell or squamous cell carcinoma?
squamous cell carcinoma
initial drug of choice for pain in mild to moderate osteoarthritis?
acetaminophen (can’t use NSAIDs because chronic use would increase GI toxicity risk)
nasopharyngeal carcinoma (an undifferentiated cancer of squamous origin) is associated with what risk factors
EBV, smoking, nitrosamines (salted fish)
what is Felty syndrome
splenomegaly and neutropenia in a patient with rheumatoid arthritis
what are the side effects of MTX?
hepatotoxicity, stomatitis, cytopenias
how do sulfasalazine and hyroxychloroquine work (mechanism of action)?
TNF and IL-1 suppression
acute otitis media vs. otitis media with effusion
both involve middle ear effusion however acute otitis media has signs of acute infection such as fever, bulging TM
what intervention is most effective in reducing medication reconcilliation errors during transitions of care from different facilities/institutions
interventions that target pharmacists and high-risk patients
what is torus palatinus
a congenital benign bony mass located in the central suture of the hard palate
what renal side effect do patients with diffuse scleroderma develop
scleroderma renal crisis (involves renal failure, malignant hypertension, thrombocytopenia and microangiopathic hemolytic anemia)
when do you see Burr cells (RBCs with serrated edges)
liver disease and ESRD
when do you have to add tetanus immunoglobulin to post-exposure ppx toxoid vaccine?
when the wound is dirty or severe
what is the treatment for cat-scratch disease
oral azithromycin
which kind of neurologic condition involves a lucid interval after trauma
EPIDURAL hematoma
