Term
| A pt c/o of hearing loss has PE findings of Weber lateralizing to the good ear and Rinne AC > BC. What type of hearing loss do you suspect? |
|
Definition
| Sensorineural Hearing loss |
|
|
Term
| A pt c/o of hearing loss has PE findings of Weber lateralizing to the bad ear and Rinne BC > AC. What type of hearing loss do you suspect? |
|
Definition
|
|
Term
| If a pt has sx of pharyngitis, plus a cough, what can you almost always r/o as a cause? |
|
Definition
|
|
Term
| What rash has characteristic 'pastia lines' or redness at skin folds? |
|
Definition
|
|
Term
| Oral findings with a pt complaining or a sore throat include erythematous-based clear vesicles, what condition do you suspect? |
|
Definition
|
|
Term
| Pt present with a sore throat and gray pseudomembrane in pharynx, and shot records are not up to date, what do you suspect? |
|
Definition
|
|
Term
| What disease is the Centor Criteria associated with, and what are its 4 parts? |
|
Definition
Grp A beta-hemolytic strep
1) Fever > 38C
2) Tender anterior cervical lymphadenopathy
3) Lack of cough
4) Peritonsillar exudate |
|
|
Term
| Pt presents with sore throat, tonsillitis with shaggy white-purplish tonsillar exudate and marked lymphadenopathy, what do you suspect? |
|
Definition
|
|
Term
| If a pt has chronic laryngitis, what evaluative test should be performed? |
|
Definition
|
|
Term
| Thumb-print sign associated with? |
|
Definition
|
|
Term
| Cherry red epiglottis is an indicator of? |
|
Definition
|
|
Term
| What is the initial sx of epiglottitis? |
|
Definition
|
|
Term
| Bleeding in the front portion of the eye is known as? |
|
Definition
|
|
Term
| Pt presents with oral lesions described as white raised, painless patches that can be scraped off to reveal red areas. What condition do you suspect? |
|
Definition
| Mucocutaneous candidiasis |
|
|
Term
| How can candidiasis be confirmed? |
|
Definition
|
|
Term
| Pt presents with red pruritic conjunctiva, copious watery d/c with scanty exudate, pre-auricular lymphadenopathy, normal visual acuity and foreign body sensation bilaterally. What condition (and etiology) do you suspect? |
|
Definition
|
|
Term
| What is the hallmark sx of bacterial conjunctivitis? |
|
Definition
| Severe copious purulent d/c |
|
|
Term
| In which type of pts is bacterial conjunctivitis MC? |
|
Definition
| Contact lens wearers (pseudomonas) and pts with chronic ocular conditions |
|
|
Term
| Is lymphadenopathy usually present with bacterial conjunctivitis? |
|
Definition
|
|
Term
| Pt presents with mild ocular pruritis, copious purulent ocular d/c, chemosis of the conjunctiva and no change in visual acuity. What condition (and etiology) do you suspect? |
|
Definition
|
|
Term
| Pt presents with a rapid onset of ocular redness, itching, stringy d/c, photophobia and conjunctival hyperemia. PMH includes asthma and allergies, what is your suspected dx? |
|
Definition
|
|
Term
| Pt presents with edema around the eye, inability to open the eye, painful proptosis, decreased visual acuity and erythema. What condition do you think this pt has? |
|
Definition
|
|
Term
| A pt presents with a complaint of gardening and the wind blowing strongly and a bit of leaves and possibly dirt hitting him in the eye. His L eye immediately began to sting and was painful. He feels like something is in his eye still and notes the eye is excessively tearing and is very sensitive to light. What condition do you suspect? |
|
Definition
|
|
Term
| In which pt population are cataracts MC seen in? |
|
Definition
|
|
Term
| A 65 y/o pt presents with c/o of difficulty seeing in the bright light of the day and difficulty seeing at night. On PE there is a mild white reflex and the lens appears cloudy. What do you suspect? |
|
Definition
|
|
Term
| Pt presents with acute onset severe unilateral ocular pain, intermittent blurred vision with halos around lights, lacrimation, photophobia, nausea, vomiting and an ipsilateral HA. On PE the cornea appears steamy and the pupil is mildly dilated and non-reactive. What do you suspect? |
|
Definition
|
|
Term
| What is the regular intraocular pressure? |
|
Definition
|
|
Term
| What are the earliest visual field defects seen in open angle glaucoma? |
|
Definition
Paracentral Scotomas
Peripheral Nasal Steps |
|
|
Term
| What maneuver is used to diagnose BPPV? |
|
Definition
|
|
Term
| What maneuver is used to treat BPPV? |
|
Definition
|
|
Term
| What are the three stages of diabetic retinopathy? |
|
Definition
1 - Nonproliferative
2 - Preproliferative
3 - Proliferative |
|
|
Term
| What are "cotton wool spots" indicative of? |
|
Definition
|
|
Term
| At what stage of diabetic retinopathy does visual loss occur? |
|
Definition
|
|
Term
| At what stage of diabetic retinopathy do "cotton wool spots" occur? |
|
Definition
|
|
Term
| What is the treatment for diabetic retinopathy? |
|
Definition
| Good glucose control, ARBs (candesartan), and yearly ophthalmologic checkups |
|
|
Term
| On tympanometry what tests indicate hearing loss? |
|
Definition
| Type B or C indicate fluid or retraction of the TM |
|
|
Term
| In a pt with OM, when should a hearing screening be considered? |
|
Definition
| After 3 months of OM and suspected hearing loss |
|
|
Term
| If treatment of OM fails, what should be considered? |
|
Definition
| Tympanocentesis if treatment fails, followed by a myringotomy |
|
|
Term
| When is radiologic eval necessary with OE? What radiologic tests should be used? |
|
Definition
| If necrotizing OE is suspected; high-resolution CT, MRI, gallium scan and bone scan |
|
|
Term
| What is the gold-standard test for evaluating sinusitis? |
|
Definition
| Transnasal endoscopic or sublabial maxillary antrum aspiration culture |
|
|
Term
| With sinusitis when should a CT of the sinuses be considered? |
|
Definition
| After 3 weeks of lack of response to antibiotic therapy |
|
|
Term
| What tests should be done in the evaluation of epistaxis? |
|
Definition
CBC
Platelets
Prothrombin time |
|
|
Term
| What is the Warm Thayer-Martin plate or antigen testing used for? |
|
Definition
|
|
Term
| What test is used to diagnose mononucleosis? |
|
Definition
Positive heterophil agglutination test
Anti-EBV titer |
|
|
Term
| On microscopy you see Gram-positive rods in the pathognomonic Chinese character configuration, what is this indicative of? |
|
Definition
|
|
Term
| On direct laryngoscopy you visualize red, inflamed and hemorrhagic vocal cords, what is your dx? |
|
Definition
|
|
Term
| Thumb-print sign indicates? |
|
Definition
|
|
Term
| What is diagnostic of epiglottitis, but is rarely used? |
|
Definition
| Cherry red, edematous epiglottis |
|
|
Term
| If a hyphema is present and there was no hx of trauma, what diagnostic test should be done and why? |
|
Definition
| A CT should be done to r/o a tumor |
|
|
Term
| A barium swallow shows a cobblestoning appearance to the esophagus, the pt has HIV and had oral candidiasis diagnosed 2 days ago. What condition do you suspect? |
|
Definition
|
|
Term
| What test is ALWAY recommend with conjunctivitis screening? Why? |
|
Definition
| Fluorescein Stain; There should be no uptake by the cornea, if corneal uptake then refer to ophthalmologist as conjunctivitis is complicated by keratitis |
|
|
Term
| How can bacterial and viral conjunctivitis be differentiated diagnostically? |
|
Definition
| RPS (Rapid Pathogen Screening) for Adenoviral Antigen OR with Slit-Lamp Examination (Look at the “tear lake” or the meniscus of tears that forms btwn the lower eyelid and the inferior cornea. If “tear lake” is free of cells the conjunctivitis is likely viral in etiology, if there are inflammatory cells in the tear lake then the etiology is likely bacterial) |
|
|
Term
| What exam is best to detect corneal abrasions? |
|
Definition
| slit-lamp exam with fluoroscein staining |
|
|
Term
| If a pt presents with neurological symptoms accompanying his vertigo, what test should be done? |
|
Definition
|
|
Term
| If a pt presents with vertigo and you suspect Meniere's dz or an acoustic neuroma, what diagnostic test should be done? |
|
Definition
|
|
Term
| First-line treatment for sudden SNHL? |
|
Definition
|
|
Term
| First-line treatment for OM? If PCN allergic? |
|
Definition
Amoxicillin
If PCN allergic - Cefdinir, Cefpodoxime, Cefuroxime |
|
|
Term
| Second-line treatment for OM? |
|
Definition
| Amox-Clavulanate OR Ceftriaxone |
|
|
Term
| First-line treatment for bacterial OE |
|
Definition
Neomycin/Polymyxin B/ Hydrocortisone (Cortisporin)
Bethmethasone |
|
|
Term
| First-line treatment for fungal OE |
|
Definition
2% acetic acid
Clotrimazole 1%
Itraconazole oral |
|
|
Term
| First-line treatment for Ramsey-hunt syndrome |
|
Definition
|
|
Term
| First-line treatment for necrotizing OE |
|
Definition
|
|
Term
| First-line antibiotic treatment for sinusitis |
|
Definition
Amoxicillin
Trimethoprim-sulfamethoxazole
Doxycycline |
|
|
Term
| What is the TOC for strep pharyngitis? |
|
Definition
| PCN; If PCN allergic use Erythromycin ethysuccinate |
|
|
Term
|
Definition
| Benzathine PCN Injection or PCN |
|
|
Term
| What med should be avoided if Mono is a possibility? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Diptheria antitoxin (equine) + Erythromycin (parentally or PO) |
|
|
Term
| What med can reduce hoarseness and cough associated with laryngitis? |
|
Definition
|
|
Term
| What is the MOST important element of treating epiglottitis? |
|
Definition
|
|
Term
| What does the Hib vaccine prevent? |
|
Definition
|
|
Term
| First-line tx for oral candidiasis? |
|
Definition
Clotrimazole (Mycelex); Hard troche (like candy)
Nystatin (aka Magic Mouthwash) |
|
|
Term
| DOC for candidiasis in pregnancy? |
|
Definition
|
|
Term
| What is the treatment for orbital cellulitis? |
|
Definition
IMMEDIATE EMERGENT Ophthalmology referral required
IV antibiotics (Nafcillin, Vancomycin, Cefazolin, Cefotaxime) |
|
|
Term
| First line treatment for corneal abrasions |
|
Definition
| Topical NSAIDs [Ketorlac 0.5% (Acular), Diclofenac 0.1% (Voltaren), Bromfenac 0.09% (Xibrom)] |
|
|
Term
| What medication is used in the treatment of closed angle glaucoma? |
|
Definition
|
|
Term
| What is the definitive treatment for glaucoma? |
|
Definition
| laser iridotomy or surgery iridectomy |
|
|
Term
|
Definition
|
|
Term
| What test is the most specific and clinically useful test for the diagnosis of OM? |
|
Definition
|
|
Term
| What is the MC form of OE? |
|
Definition
| acute diffuse otitis externa (90% bacterial) |
|
|
Term
| When is OE considered chronic? |
|
Definition
|
|
Term
| Where is the origin of most nose bleeds? |
|
Definition
|
|
Term
| What is the mainstay of treatment for a URI? |
|
Definition
|
|
Term
| What is the MCC of bacterial pharyngitis? |
|
Definition
|
|
Term
| What is the MCC of hoarseness? |
|
Definition
|
|
Term
| What is the 2nd MCC of epiglottitis? |
|
Definition
|
|
Term
| What is the MC site of bleeding in Hyphemas? |
|
Definition
| Tear at the anterior aspect of the ciliary body |
|
|
Term
| What should all AA pts with hyphemas be screened for? |
|
Definition
|
|
Term
| What pathogen is the MCC of oral candidiasis? |
|
Definition
|
|
Term
| What is the MC eye disease? |
|
Definition
|
|
Term
| What type of conjunctivitis has Copious watery d/c? |
|
Definition
|
|
Term
| What type of conjunctivitis has Copious purulent d/c? |
|
Definition
|
|
Term
| What type of conjunctivitis has Severe copious mucopurulent d/c? |
|
Definition
| Gonococcal Conjunctivitis |
|
|
Term
| What type of conjunctivitis has stringy d/c? |
|
Definition
|
|
Term
| What are the MC bacterial pathogens involved in bacterial conjunctivitis? |
|
Definition
| staph or strep, H. influenzae |
|
|
Term
| Which type of conjunctivitis is a MAJOR cause of blindness worldwide? |
|
Definition
| Chlamydial Trachoma Conjunctivitis |
|
|
Term
| What are the MC pathogens of orbital cellulitis? |
|
Definition
|
|
Term
| What is the usual underlying cause of orbital cellulitis? |
|
Definition
| Infection of the paranasal sinuses |
|
|
Term
| If a pt has all the signs/sx of corneal abrasions but does not have the hx of trauma, what should you suspect? |
|
Definition
|
|
Term
| What is the leading cause of blindness worldwide? |
|
Definition
|
|
Term
| What is the MC etiology of most cases of cataracts? |
|
Definition
|
|
Term
| With Open Angle Glaucoma tx using prostaglandins, in which pts should this tx be avoided? |
|
Definition
|
|
Term
| What is over 90% of chronic tinnitus associated with? |
|
Definition
| sensorineural hearing loss |
|
|
Term
| What is the leading cause of irreversible, severe visual loss in persons > 65y/o? |
|
Definition
|
|
Term
| Which stage of Macular degeneration accounts for the majority of cases of severe vision loss? |
|
Definition
| 80% are neovascular/exudative stages |
|
|
Term
| In order to help screen for macular degeneration, how often should pts see an ophthalmologist? |
|
Definition
from 40 - 65y/o = every 2 - 4 yrs
> 65y/o = every 1 -2 yrs |
|
|
Term
| A pt uses the Amsler grid and notices broken, distorted and missing lines. What condition do you suspect? |
|
Definition
|
|
Term
| A 67y/o notices distorted central vision and on fundoscopic exam you notice drusen and neovascular changes. What condition do you suspect? |
|
Definition
|
|
Term
| What is a common risk factor for macular degeneration? |
|
Definition
|
|
Term
| What has been found to reduce the progression of macular degeneration? |
|
Definition
| high-dose regimen of anti-oxidant vitamins and mineral supplements |
|
|
Term
| What are neurotrophic corneal ulcerations due to? |
|
Definition
| lack of 5th nerve innervation |
|
|
Term
| If tongue pain continues after treatment for oral candidiasis, what should be suspected? |
|
Definition
|
|
Term
| Pt presents with a white patch on the oral mucosa. On PE the white patch does not scape off. This 40 y/o pt has a 22 pk year hx of smoking. What condition should you suspect? |
|
Definition
|
|
Term
| Which location for leukoplakia is most concerning for becoming cancerous? |
|
Definition
| 60% on floor of mouth on lateral border of tongue are cancerous |
|
|
Term
| What is important to note about the care or treatment of leukoplakia? |
|
Definition
| low but significant rate of malignant transformation can occur even after successful treatment |
|
|
Term
| Which type of brachial cleft cysts are MC? |
|
Definition
| 2nd brachial cleft cysts (@ the hyoid bone and tonsillar fossa) |
|
|
Term
| What is the appropriate treatment for a brachial cleft cyst? |
|
Definition
|
|
Term
| What is the MC etiology of corneal ulcers? |
|
Definition
|
|
Term
| A 50y/o presents with a painful red eye that has copious watery, with circumcorneal injection, photophobia and visual deficits. How can you confirm dx and what is your tx? |
|
Definition
| Confirm diagnosis with a slit-lamp and fluorescein stain (uptake into cornea suggests corneal ulceration); Send to ophthalmology |
|
|
Term
| Treatment for esophageal candidiasis? |
|
Definition
| Oral fluconazole (or other systemic azoles) |
|
|
Term
| What type of CA does leukoplakia turn occasionally transform into? |
|
Definition
|
|
Term
| What are the MAJOR risk factors for development of oral CA? |
|
Definition
|
|
Term
| What oral lesions should be referred for biopsy? |
|
Definition
1 - Erythroplakia
2 - Enlarging leukoplakia
3 - Lesion with submucosal depth
4 - Ulcerative lesions |
|
|
Term
| 21 y/o pt presents with a soft mass posterior to her SCM, that she noticed 2 days ago as that area had enlarged and began to cause her discomfort. She has no other signs or symptoms and exam reveals a fluctuant well defined cystic mass posterior to the R SCM. What do you suspect? |
|
Definition
|
|
Term
| When does a brachial cleft cyst generally present? |
|
Definition
| In the 2nd or 3rd decade of life |
|
|
Term
| When does a thyroglossal cyst usually present? |
|
Definition
|
|
Term
| An 18y/o pt presents with a midline neck mass, just below his hyoid., that moves with swallowing. What test should be done to confirm your dx? What is the probable dx? What is the tx? |
|
Definition
- U/S to confirm thyroid location
- Thyroglossal duct cyst
- Surgical removal of cyst and entire fistulous tract |
|
|
Term
| What lung condition is described as a chronic inflammatory disorder of the airways with histologic features including inflammatory cell infiltrates (eosinophils, neutrophils, and lymphocytes - especially T-lymphocytes, goblet cell hyperpla) as well as occasional findings of plugging of small airways with thick mucous? |
|
Definition
|
|
Term
| What is the strongest identifiable predisposing factor to asthma? |
|
Definition
|
|
Term
| A 13 y/o pt presents to your office with c/o chest tightness, cough, and inability to take a deep breath which especially worsens in the mornings. This has lasted for 2 months. He has also noticed that while in the shower he produces a lot of mucous. What condition do you suspect? |
|
Definition
|
|
Term
| What should the eval of asthma always include? |
|
Definition
| spirometry before and after the administration of a short acting B-agonist |
|
|
Term
| What is airflow obstruction on spirometry indicated by? |
|
Definition
|
|
Term
| What is the TOC for intermittent asthma? |
|
Definition
| Short acting Beta Agonist |
|
|
Term
| What are the first line agents for persistent asthma exacerbations? |
|
Definition
| low dose inhaled corticosteroids |
|
|
Term
| What are the inhaled long-acting B-agonists? |
|
Definition
|
|
Term
| What are cromolyn and nedocromil? When should they be used? |
|
Definition
| Mediator inhibitors; Used with allergic asthma to modulate mast cell mediators and eosinophil release |
|
|
Term
| What is theophyllin treatment best for? |
|
Definition
|
|
Term
| What device can be used to help monitior asthma symptoms and treatment effectiveness at home once asthma is dx? |
|
Definition
|
|
Term
| Which type of asthma severity classification is described as symptoms occurring <2 days/week, night time awakenings < 2x per month, SABA use <2 days/week, no interference with normal activity, FEV1 >80% and FEV1/FVC ratio >85%? |
|
Definition
|
|
Term
| Which type of asthma severity classification is described as symptoms occurring >2 days/week (not daily), night time awakenings 1 - 4x per month, SABA use >2 days/week (not daily), minor limitations to normal activity, FEV1 >80% and FEV1/FVC ratio >80%? |
|
Definition
|
|
Term
| Which type of asthma severity classification is described as symptoms occurring daily, night time awakenings 3 - 4x per month, SABA use daily, some limitation in normal activity, FEV1 60 - 80% and FEV1/FVC ratio 75 - 80%? |
|
Definition
|
|
Term
| Which type of asthma severity classification is described as symptoms occurring throughout the day, night time awakenings >1x per week, SABA several times per day, extremely limited normal activity, FEV1 <60% and FEV1/FVC ratio <75%? |
|
Definition
|
|
Term
| What are the components of atopy? |
|
Definition
| eczema, allergic conjunctivitis, allergic rhinitis, asthma |
|
|
Term
| What is the only definitive test for asthma dx? |
|
Definition
| Bronchoprovocation (metacholine, histamine, cold air or exercise) |
|
|
Term
| What condition is described as inflammation of the trachea, bronchi and bronchioles resulting from a respiratory tract infection or chemical irritant? |
|
Definition
|
|
Term
| What is the predominant symptom of bronchitis? |
|
Definition
|
|
Term
| What is the etiology of most cases of bronchitis? |
|
Definition
|
|
Term
| What condition is caused by an injury to the epithelial surfaces in the lungs resulting in an increased mucous production and thickening of the bronchiole wall? |
|
Definition
|
|
Term
| A 40y/o pt with no known medical conditions presents to you with c/o a cough that has lasted for approximately 1 week. Initially it began as a dry cough but now it is productive and he is noticing difficulty breathing in a full breath as well as mild fever, fatigue and a little wheezing. Two of his coworkers had similar symptoms at the beginning of the month. On PE you confirm wheezing, as well as rales and rhonci but not evidence of pulmonary consolidation. What condition do you suspect? |
|
Definition
|
|
Term
| What is the treatment for uncomplicated bronchitis with bronchospasm? |
|
Definition
| albuterol (SABA) and Steroids (Usually does not require treatment with antibiotics) |
|
|
Term
| What do recurrent bouts of bronchitis or seasonal episodes of bronchitis suggest? |
|
Definition
| Suggestive of another disease process such as asthma |
|
|
Term
| Pt presents with a stuffy nose in which they are not able to breath in through, bouts of sneezing, a scratchy throat and PND, mild cough, and no fever for the last 2 days. OTC anti-histamines have no provided relief. On PE there is inflamed mucosa, clear rhinorrhea, PND, erythema of the throat and fluid behind the OM. What is your Dx? What is your tx? |
|
Definition
URI; Primary tx is supportive therapy as infection usually self limited
NSAIDs
Topical Decongestants - Oxymetazoline,
Oral Decongestant - Pseudoephedrine or phenylephrine,
Anti-histamines - Chlorpheniramine |
|
|
Term
| What is considered chronic bronchitis? |
|
Definition
| Productive cough for > 3 mo in at least 2 consecutive years |
|
|
Term
| What condition is described as a pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchioles with destruction of their walls and w/out obvious fibrosis? |
|
Definition
|
|
Term
| What is clearly the most important causative factor in the development of COPD in N. america and W. europe? |
|
Definition
|
|
Term
| A hallmark of which disease is the exacerbation of symptoms beyond normal day-to-day variations, often including increased dyspnea, an increased severity or frequency of cough, increased sputum volume? |
|
Definition
|
|
Term
| In the later stages of severe COPD what are the findings of the PFT? |
|
Definition
| An marked increase in FVC |
|
|
Term
| A plain radiograph shows lung hyperinflation and flattening of the diaphragm, what condition is this characteristic of? |
|
Definition
|
|
Term
| Which test is the most sensitive and specific for the diagnosis of COPD? |
|
Definition
|
|
Term
| What is the ONLY drug therapy documented to improve the natural hx of COPD in pts with hypoxemia? |
|
Definition
|
|
Term
| What is the single most important clinical intervention in COPD sufferers? |
|
Definition
|
|
Term
| What drugs can be used for symptomatic relief in COPD sufferers? |
|
Definition
| Inhaled bronchodilators and Inhaled Corticosteroids |
|
|
Term
| What is the 4th leading COD in America? |
|
Definition
|
|
Term
| What dz is characterized by airflow limitation that is not fully reversible, is progressive and inflammation is present? |
|
Definition
|
|
Term
| What genetic condition should you look for as a causative factor for COPD if there is no evidence of family or self smoking hx, no evidence neonatal viral lung infection and no other environmental causative factor? |
|
Definition
| Anti-protease deficiency (due to a1 antitrypsin deficiency) |
|
|
Term
| 50 y/o with a 30pk/yr hx of smoking presents with c/o dyspnea, weight loss, 2 to 3 respiratory infections in the past year a mild cough on occasion. He is barrel chested, has pursed lips with breathing and diminished breath sounds on exam. What condition do you suspect? |
|
Definition
|
|
Term
| A 6o y/o female presents with a chronic cough for the last 4 yrs that is productive of sputum, she also indicates that she often has HAs upon waking in the morning and notes she has been to the doctor 5 or 6 times since last year for respiratory infections. On exam you note a weight gain from her last visit, wheezing, and distant heart sounds. What condition do you suspect? |
|
Definition
|
|
Term
| What vaccines should all pts with COPD receive? |
|
Definition
| Influenza and pneumococcal vaccines |
|
|
Term
| A pt describes a sharp, fleeting chest pain that worsens with movement and coughing. EKG and PE are WNL. What condition do you suspect? |
|
Definition
|
|
Term
| In young adults, what is the MC etiology for pleuritis? |
|
Definition
| Viral infection or pneumonia |
|
|
Term
| What meds can be used in the treatment of pleurisy? |
|
Definition
Analgesics and NSAIDs - Indomethacin
Codeine can be used to reduce cough
Underlying disease causing pleuritis must be treated |
|
|
Term
| Which type of pneumonia) are MC in young adults? How can they be differentiated? |
|
Definition
Mycoplasma and Chlamydophilia pneumonia
Chlamydophilia has prodromal sx lasting longer (approx 2 weeks) and sore throat and hoarseness is a common finding (Isolation of this organism is difficult) |
|
|
Term
| Which type of pneumonia is seen MC in alcoholic pts? |
|
Definition
|
|
Term
| Which type of pneumonia pathogen is commonly found in contaminated construction sites with a water source? |
|
Definition
|
|
Term
| Which type of pneumonia pathogen is associated with skin rashes and bullous myringitis? |
|
Definition
|
|
Term
| Which type of pneumonia is especially common in individuals with cystic fibrosis? |
|
Definition
|
|
Term
| Which type of pneumonia is found in pts who are immunocompromised with HIV? |
|
Definition
|
|
Term
| What is the tx for pneumocystis jiroveci? |
|
Definition
|
|
Term
| TOC for CAP (not caused by s. pneumo) in younger adult? |
|
Definition
| Doxycycline or Erythromycin; 2nd Line Azithromycin or Clarithromycin |
|
|
Term
| What is the treatment for klebsiella pneumonia? |
|
Definition
| Third generation cephalosporin |
|
|
Term
| What is the most common cause of CAP? |
|
Definition
|
|
Term
| What are the common viral causes of pneumonia? |
|
Definition
| Influenza, RSV, adenovirus, parainfluenza virus |
|
|
Term
| A 32 y/o pt presents with a fever, productive cough, and difficulty breathing. He notes sharp fleeting pain in his chest that worsens when he coughs or breaths in deeply. This has been ongoing for the last 4 days, but yesterday and through last night he experienced shaking chills, fatigue, myalgias and a HA. Not being able to attend work as a sales account manager for the second day in a row, he is seeking treatment. What is your dx? What is your tx? |
|
Definition
| CAP; PCN G, Amox, (second-line = Macrolides, Cephalosporins, Doxicycline) |
|
|
Term
| On CXR how would typical pneumonia appear? |
|
Definition
|
|
Term
| On CXR how would atypical pneumonia appear? |
|
Definition
|
|
Term
| If pharyngitis is primary c/o with accompanying nasal congestion what should be r/o? |
|
Definition
|
|
Term
| MCC of laryngotracheobronchitis? |
|
Definition
|
|
Term
| Is stridor inspiratory or expiratory when associated with laryngotracheobroncitis? |
|
Definition
|
|
Term
| steeple-sign on lateral neck x-ray indicates ? |
|
Definition
|
|
Term
| Tx for laryngotracheobronchitis? |
|
Definition
cool mist air
inhaled or IM corticosteroids
aerosolized racemic epi and intubation for severe exacerbations |
|
|
Term
| Which vaccines (3) protect children from the most dangerous forms of croup? |
|
Definition
| Hib, diptheria and measles |
|
|
Term
| When is croup MC seen in the northern hemisphere? |
|
Definition
|
|
Term
| What is the predominate age of incidence for bronchiolitis? |
|
Definition
|
|
Term
| What condition is described as an infection resulting in necrosis and lysis of epithelial cells and subsequent release of inflammatory mediators along with edema and mucous secretion that combined with accumulating necrotic debris results in luminal obstruction? |
|
Definition
|
|
Term
| MC pathogen responsible for bronchiolitis? |
|
Definition
|
|
Term
| A 7 m/o presents with hx of irritability for the last 5 days, fever and cough x 2 days and poor feeding x 2 days. Most concerning to the mother, today the infant began grunting and vomiting. She has noticed increased breathing, rhinorrhea and wheezing. Based on this clinical presentation, what is your diagnosis and method of treatment? |
|
Definition
Bronchiolitis
ADMIT to hospital and give O2, Nebulized albuterol and/or epi, corticosteroids |
|
|
Term
| What is the leading cause of hospitalizations (infectious) in infants and children? |
|
Definition
|
|
Term
| What children/infants are most susceptible or at high risk for RSV infection? |
|
Definition
| pre-term, low birth weight, the very young infants, day care exposure |
|
|
Term
| To what category of viruses does RSV belong? |
|
Definition
|
|
Term
| What is RSV confirmed bronchiolitis in children under 13 y/o associated with? |
|
Definition
|
|
Term
| DOC for aspiration pneumonia? |
|
Definition
|
|
Term
| Pt presents with fever, malaise, and productive cough with foul-smelling expectorant and difficulty breathing. On exam you note poor dentition and rales and rhonchi in the lungs. There is also a 20 yr history of alcohol abuse in this pt. What condition do you suspect and what is the appropriate treatment? |
|
Definition
| Aspiration pneumonia; clindamycin |
|
|
Term
| On CXR, what findings favor aspiration pneumonia as the cause? |
|
Definition
|
|
Term
| A 45y/o male pt presents with a fever, fatigue, weight loss of 10 lbs in the past month, night sweats and a chronic cough for 1 month. On PE the pt is ill-appearing and pale and malnourished, otherwise there is no abnormal findings. What is your suspected dx? |
|
Definition
| Progressive Primary Tuberculosis |
|
|
Term
| What test helps determine if a pt has been exposed to TB? What findings are indicative of a TB exposure? |
|
Definition
TB skin test
Pos if >15 mm rxtn - In healthy indiv with no risk factors |
|
|
Term
| How long does it take for a PPD to be positive after exposure to TB? |
|
Definition
|
|
Term
| What is the treatment for an otherwise healthy individual with their first active TB infection? |
|
Definition
Report infection to local and state health dept
2 months of RIPE - Rifampin, Isoniazid, Pyrazinamide and Ethambutol
4 months of RI - Rifampin and Isoniazid |
|
|
Term
| In a prego pt being treated for TB infection, what should always be added as part of her regimen? |
|
Definition
| Pyridoxine in combo with Isoniazid to prevent peripheral neuropathy |
|
|
Term
| In a 2 step PPD test, how much time should lapse between the first and the second test? |
|
Definition
|
|
Term
| Pathologic findings of what disease include acid fast bacteria? |
|
Definition
|
|
Term
| Pathologic findings of what disease include granulomas with central caseating necrosis? |
|
Definition
|
|
Term
| What are most cases of hemoptysis in the outpt setting due to? |
|
Definition
| Infection (acute or chronic bronchitis, pneumonia or TB) |
|
|
Term
| If hemoptysis is accompanied by hematuria, what condition would you suspect? |
|
Definition
|
|
Term
| Who is the influenza vaccine recommended for? |
|
Definition
| All people > 6mo old (starting in fall 2010) |
|
|
Term
| How long does the immunization for influenza take to provide immunity? |
|
Definition
| 1 - 2 weeks after immunization |
|
|
Term
| When can an influenza infection in pregnancy cause major complications? |
|
Definition
|
|
Term
| What are the contraindications to an influenza vaccine (TIV)? |
|
Definition
allergy to eggs
prego during 1st trimester |
|
|
Term
| What is the appropriate prophylactic measure for a prego pt at risk of an influenza complications? |
|
Definition
| inactivated influenza vaccine should be given regardless of which trimester she is in |
|
|
Term
| When is antiviral therapy in the treatment of the flu MOST effective? |
|
Definition
| If given within the 1st 48 hours |
|
|
Term
| What treatment can be used for influenza infection? |
|
Definition
Anti-virals within the 1st 48 hrs
-Zanamivir
-Rimantidine
-Amantadine
-Oseltamivir |
|
|
Term
| In which pts should Zanamivir for flu treatment be used with caution? |
|
Definition
|
|
Term
| In which pts should Amantadine for flu treatment be used with caution? |
|
Definition
| Psychiatric, Addiction or neurologic d/o |
|
|
Term
| In which pts should Rimantadine for flu treatment be used with caution? |
|
Definition
|
|
Term
| Pt presents with abrupt onset of fever, chills, malaise, muscle ache, coryza, sore throat and cough, as well as nausea and a HA. What condition do you suspect? |
|
Definition
|
|
Term
| What combo of sx during influenza is highly predictive of the flu during flu season? |
|
Definition
|
|
Term
| What is the MC secondary infection following an influenza infection? |
|
Definition
|
|
Term
| During pregnancy, when is PE most likely? |
|
Definition
| During the post-partum period |
|
|
Term
| What is the general prophylactic therapy for PE? |
|
Definition
|
|
Term
| What are the components of Virchow's triad? |
|
Definition
Venous stasis
Injury
Changes in blood coagulation |
|
|
Term
| Where do the majority of PE's come from? |
|
Definition
|
|
Term
| Pt presents with c/o dyspnea, and pleuritic chest pain. She feels anxious and is concerned something very serious is occurring. On PE her exam is normal except for tachypnea, tachycardia, and soreness in her calf region with palpation. She is 30y/o and works as a teacher and arrived yesterday from an overseas flight to research her family heritage in Ireland. What condition do you suspect? |
|
Definition
|
|
Term
| How can a PE de diagnosed? |
|
Definition
|
|
Term
| What is the GOLD STANDARD for detecting a PE? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the MC inherited cause of hypercoaguability in caucasian populations? |
|
Definition
| Factor V laden (Protein C resistance) |
|
|
Term
| What EKG changes can sometimes be seen in pts with a PE? |
|
Definition
| sinus tachycardia & non-specific ST and T wave changes |
|
|
Term
| What condition do CXR signs including Hampton's hump and Westermark sign indicate? |
|
Definition
|
|
Term
| Which CXR sign is described as a prominent central pulmonary artery with local oligemia? |
|
Definition
|
|
Term
| Which CXR sign is described as pleural based areas of increased opacity that represent intraparenchymal hemorrhage? |
|
Definition
|
|
Term
| What are the absolute contraindications to thrombolytic therapy? |
|
Definition
Active internal bleeding
Stroke in past 2 months |
|
|
Term
| What is the major complication to anticoagulation therapy? |
|
Definition
|
|
Term
| How long after a PE should anticoagulation therapy be continued? |
|
Definition
|
|
Term
| In which pts should thrombolytic therapy be considered? |
|
Definition
| In pts with PE who are at a high risk of death as they remain hemodynamically unstable despite heparin therapy |
|
|
Term
| A 35 y/o pt presents with an abrupt onset illness in which he complains of a non-productive cough, fever, SOB and tachypnea. In the pts history he admits to being sexually active with a monogamous partner of 3 years. He denies current alcohol, smoking or drug use, but does admit to being an IV drug user in his 20's for 5 years. For the last four months he has felt ill, fatigued, and has been experiencing unwanted weight loss prior to the current symptoms. On PE you find a very ill-appearing individual who is tachypneic on lung auscultation you hear bibasillar crackles. On CXR you note bilateral diffuse interstitial dz with NO hilar adenopathy. What is your suspected dx? |
|
Definition
| Pneumocystosis jiroveci pneumonia |
|
|
Term
| What is the treatment for P. jiroveci pneumonia? |
|
Definition
|
|
Term
| What is the target INR for warfarin therapy? |
|
Definition
|
|
Term
| What exposure is associated with a higher risk of developing idiopathic pulmonary fibrosis? |
|
Definition
| Exposure to dust, metals, organic solvents and agricultural employment |
|
|
Term
| What is a common extrinsic cause of restrictive lung disease? |
|
Definition
|
|
Term
| In which population does Lymphangioleiomyomatosis (LAM) specifically occur in? |
|
Definition
|
|
Term
| What is the predominant symptom of restrictive lung disease? |
|
Definition
|
|
Term
| On PE you hear "velcro crackles" a sign common in most people with what lung condition? |
|
Definition
| Interstitial lung disorders |
|
|
Term
| What lung disease is found in coal workers? |
|
Definition
|
|
Term
| In which restrictive lung disease are serum levels of ACE elevated? |
|
Definition
|
|
Term
| What is the MC CXR pattern seen in pts with intrinsic reticular lung disease? |
|
Definition
| Reticular pattern (thin, well-defined linear densities - honeycombing) |
|
|
Term
| What is used to assess diaphragm paralysis? |
|
Definition
|
|
Term
| What is the first-line treatment for pts with interstitial lung disease? |
|
Definition
| Corticosteroids - slow the progression of pulmonary parenchymal fibrosis |
|
|
Term
| Treatment for sarcoidosis? |
|
Definition
|
|
Term
| What lung condition creates an exudative pleural effusion consisting of serous to grossly bloody fluid? |
|
Definition
|
|
Term
| What are the underlying causes of pulmonary infarction? |
|
Definition
| embolus and sickle cell anemia |
|
|
Term
| Which lung condition has findings including noncaseating granulomas? |
|
Definition
|
|
Term
| How can cardiogenic causes be differentiated from noncardiogenic causes of pulmonary edema? |
|
Definition
EKG is a quick tool to distinguish
Fluid Specimen:
Cardiogenic = protein poor
Non-cardiogenic = protein rich |
|
|
Term
| What does high BNP levels indicate? |
|
Definition
| 90% positive predictive value for heart failure |
|
|
Term
| Acute dyspnea, pink frothy sputum, diaphoresis and cyanosis... what is the dx? |
|
Definition
|
|
Term
| What can present as the first manifestation of cardiac disease? |
|
Definition
|
|
Term
| What condition causes a characteristic "butterfly pattern" of distribution of alveolar edema? |
|
Definition
|
|
Term
| What med is very useful in pulmonary edema as it increases venous capacitance, lowers LA pressure and relieves anxiety? |
|
Definition
|
|
Term
| Initial tx for pulmonary edema? |
|
Definition
|
|
Term
| Condition described as respiratory disfunction resulting in abnormalities of oxygenation or ventilation (CO2 elimination) severe enough to threaten the functioning of vital organs? |
|
Definition
| Acute respiratory failure |
|
|
Term
Arterial blood gas criteria for respiratory failure?
- PO2: ?
- PCO2: ? |
|
Definition
PO2: < 60 mmHg
- PCO2: > 50 mmHg |
|
|
Term
| In acute respiratory failure, what is the chief symptom of hypoxemia? |
|
Definition
|
|
Term
| What are the cardinal symptoms of hypercapnia? |
|
Definition
|
|
Term
| Pt has dyspnea, cyanosis, restlessness, tachypnea, anxiety, confusion, delirium, HTN, cardiac dysrhythmias and tremors. These are all signs and sx of what condition? |
|
Definition
|
|
Term
| Pt presents with a HA, is dyspneic, has peripheral and conjunctival hyperemia, HTN, tachycardia, tachypneic, impaired level of conciousness, papilledema and asterixis. These are all signs of what condition? |
|
Definition
|
|
Term
| What is the gold standard test used to diagnose cystic fibrosis? |
|
Definition
| Sweat Chloride Test (>60 on two occasions) |
|
|
Term
| A pt with cystic fibrosis would have what findings on spirometry? |
|
Definition
| obstruction on spirometry |
|
|
Term
| A 30 y/o pt has had recurrent bout of pancreatitis, distal intestinal obstruction syndrome, chronic hepatic dz, nutritional deficiencies, recurrent infections, bronchiectasis and scarring on chest radiographs. What chronic underlying condition is this suggestive of? |
|
Definition
|
|
Term
| What is the MCC of chronic lung disease in young adults? |
|
Definition
|
|
Term
| What is the MC fatal hereditary d/o of whites in the U.S.? |
|
Definition
| cystic fibrosis (autosomal recessive) |
|
|
Term
| In which disease condition is there a derangement in the chloride channels causing almost all exocrine glands to secrete abnormal mucous that causes obstructions? |
|
Definition
|
|
Term
| What genitourinary abnormality do almost all men with cystic fibrosis have? |
|
Definition
| Congenital bilateral absence of the vas deferens with azoospermia |
|
|
Term
| What acid base imbalance is commonly found in cystic fibrosis pts? |
|
Definition
| compensated respiratory acidosis |
|
|
Term
| On imaging peribronchial cuffing, mucus plugging, bronchiectasis (ring shadows and cysts), increased interstitial markings, small rounded peripheral opacities and focal atelectasis are seen. What condition are these findings congruent with? |
|
Definition
|
|
Term
| What is currently the only definitive treatment for advanced cystic fibrosis? |
|
Definition
|
|
Term
| Which vitamins are deficient in pts with cystic fibrosis? |
|
Definition
|
|
Term
| What condition is linked to the occurrence of a meconium ileus at birth? |
|
Definition
|
|
Term
| A child with chronic diarrhea and failure to thrive. What condition MUST you r/o? |
|
Definition
|
|
Term
| What should all children with nasal polyps be evaluated for? |
|
Definition
|
|
Term
| What does a rapid decline in pulmonary function in a pt with cystic fibrosis suggest? |
|
Definition
| Acquisition of resistant organisms |
|
|
Term
| A pt presents with a chronic productive cough with purulent sputum and dyspnea, with a long hx of recurrent pulmonary infections. On PE there is wheezing and persistent crackles at the lung bases. On imaging there is dilated, thickened airways and scattered, irregular opacities. What condition do you suspect? |
|
Definition
|
|
Term
| What condition causes over half of all cases of bronchiectasis? |
|
Definition
|
|
Term
| "tram-tracking" is consistent with what condition? |
|
Definition
|
|
Term
| What is the diagnostic study of choice for bronchiectasis? |
|
Definition
|
|
Term
| How is an acute exacerbation of bronchiectasis treated? |
|
Definition
|
|
Term
| What is the leading cause of CA deaths in both men and women? |
|
Definition
|
|
Term
| What causes more than 90% of lung CA? |
|
Definition
|
|
Term
| What is the MC type of lung CA? |
|
Definition
|
|
Term
| Which type of lung CA is typically associated with centrally located, intraluminal sessile or polypoid mass? |
|
Definition
|
|
Term
| Which type of lung CA presents with peripheral nodules or masses? |
|
Definition
|
|
Term
| Which type of lung CA has central or peripheral masses at presentation? |
|
Definition
|
|
Term
| Which type of lung CA has legions that begin centrally and cause narrowing or obstruction of the bronchus, w/out discrete masses, and also hilar and mediastinal abnormalities are common? |
|
Definition
|
|
Term
| Which type of lung CA has associated hemoptysis? |
|
Definition
|
|
Term
| Tx for small cell carcinoma? |
|
Definition
|
|
Term
| Tx for non-small cell carcinoma? |
|
Definition
|
|
Term
| MCC of Heart Failure in the US? |
|
Definition
|
|
Term
| What is the cardinal sign of L sided heart failure? |
|
Definition
|
|
Term
| What is the single most useful test in diagnosing HF? |
|
Definition
|
|
Term
| A pt has sx including exertional dyspnea, cough, fatigue, orthopnea, paroxysmal nocturnal dyspnea, cardiac enlargement, rales, gallop rhythm and pulmonary venous congestion. What condition do you suspect? |
|
Definition
|
|
Term
| Pt has sx including elevated venous pressure, hepatomegaly, dependent edema. What condition do you suspect? |
|
Definition
|
|
Term
| What should be the initial therapy to relieve symptoms of congestive heart failure? |
|
Definition
| diuretic and ACE I (beta-blockers for management) |
|
|
Term
| What is considered pre-hypertension? |
|
Definition
Systolic - 120 - 139
Diastolic - 80 - 89 |
|
|
Term
| What is considered stage 1 hypertension? |
|
Definition
Systolic - 140 - 159
Diastolic - 90 - 99 |
|
|
Term
| What is considered stage 2 hypertension? |
|
Definition
Systolic - >160
Diastolic - > 100 |
|
|
Term
|
Definition
| When BP is measured on 2 separate occasions with systolic > 140 or diastolic > 90 |
|
|
Term
| "copper" or "silver" wiring indicates what? |
|
Definition
|
|
Term
| HA present upon awakening and occipital in nature is a symptom of what condition? |
|
Definition
|
|
Term
| Which drug shows the most proven benefit in the treatment of HTN? |
|
Definition
| Thiazide diuretics (Chlorthalidone may be more superior to commonly used HCTZ) |
|
|
Term
| First-line tx for diabetic pts with HTN? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do B-blockers end in? |
|
Definition
|
|
Term
| What medication can worsen gout? |
|
Definition
|
|
Term
| In which pts are b-blockers contraindicated? |
|
Definition
reactive airway dz
heart block
diabetes
Peripheral vascular dz |
|
|
Term
| Which HTN meds are contraindicated in prego pt? |
|
Definition
|
|
Term
| What condition are ACE I contraindicated in? |
|
Definition
| bilateral renovascular dz |
|
|
Term
| Which HTN med can cause rebound HTN if d/c abruptly? |
|
Definition
|
|
Term
| What precipitating factor has the highest incidence of varicose vein formation? |
|
Definition
|
|
Term
| Which veins are MC involved in varicosities? |
|
Definition
| greater saphenous vein and its tributaries |
|
|
Term
| Pt c/o a dull, aching heaviness and a feeling of fatigue after standing at her job for long periods of time. Distal pulses are 2+ and skin is warm and soft. What condition is this characteristic of? |
|
Definition
|
|
Term
| What is the Perthes test used to diagnose? |
|
Definition
| Clinical test for assessing the patency of the deep femoral veins |
|
|
Term
| What imaging test is used to dx varicose veins? |
|
Definition
|
|
Term
| What is the trendelenburg test using a tourniquet used to diagnose? |
|
Definition
|
|
Term
| What is the #1 killer in the US and worldwide? |
|
Definition
|
|
Term
| What is the #1 preventable cause of cardiovascular disease worldwide? |
|
Definition
|
|
Term
| First line treatment for CAD? |
|
Definition
| ASA or clopidogrel; ACE I |
|
|
Term
| MCC of superficial thrombophlebitis? |
|
Definition
|
|
Term
| What vein is most commonly involved in superficial thrombophlebitis? |
|
Definition
|
|
Term
| A pt present with a dull pain in her leg. On exam you see induration, redness and tenderness along the course of the long saphenous vein. What condition do you suspect? |
|
Definition
| Superficial Thrombophlebitis |
|
|
Term
| A pt had an IV line placed on the right dorsum of the hand and today presents with localized redness and induration as well as chills and a high fever. What condition do you suspect and what is the treatment? |
|
Definition
| Septic phlebitis; aggressive debridement is warranted |
|
|
Term
| What is the treatment for superficial thrombophlebitis? |
|
Definition
|
|
Term
| What is the MC thrombophelia? |
|
Definition
|
|
Term
| What is the Well's criteria? |
|
Definition
A criteria for the diagnosis of DVT (Risk factors and symptoms)
Active CA w/in 1 mo
Paralysis or immobilization of LE
Recently bedridden
Tenderness/cord along vein
Increased calf circumference |
|
|
Term
|
Definition
| Pain or resistance to ankle dorsiflexion; Sign of a DVT |
|
|
Term
|
Definition
| Pain on medial tibia percussion; Sign of a DVT |
|
|
Term
| What is Bancroft or Moses' sign? |
|
Definition
| Pain on compression of the calf against the tibiain the anteroposterior plane; Sign of a DVT |
|
|
Term
| What is the GOLD STANDARD test for diagnosing a DVT? |
|
Definition
|
|
Term
| What is the first-line treatment for a DVT? |
|
Definition
| Unfractionated heparin OR Enoxaparin (Lovenox) OR Dalteparin (Fragmin) OR Fondaparinux (Arixtra) |
|
|
Term
| How long should Heparin and Warfarin overlap for a minimum of how long? |
|
Definition
|
|
Term
| What is the usual initial symptom of chronic venous insufficiency? |
|
Definition
| progressive edema of the leg |
|
|
Term
| Pt presents with edema of her LE, pruritis, and a discomfort in her LE especially after standing for long periods of time. On PE you note shiny skin at the ankle with a brownish pigmentation. What condition do you suspect? |
|
Definition
| Chronic Venous Insufficiency |
|
|
Term
| What is the mainstay of treatment for chronic venous thrombosis? |
|
Definition
| Compression Stockings during the day and intermittent elevation of legs |
|
|
Term
| What artery is MC affected in the LE with chronic arterial insufficiency? |
|
Definition
| superficial femoral artery |
|
|
Term
| Pt presents with c/o of cramping after walking around the grocery store or around his neighborhood. On PE you note skin changes including thinning of hair, thinning of skin and sub-Q, and diffuse atrophy of the muscles. The pedal pulses are reduced. What condition are you considering? |
|
Definition
| Chronic arterial occlusion |
|
|
Term
| What exam test is indicative of chronic arterial insufficiency? |
|
Definition
| Ankle-Brachial index is reduced (levels below 0.5 suggests severe reduction in flow) |
|
|
Term
| What is the treatment for chronic arterial insufficiency? |
|
Definition
| bypass surgery, Endovascular surgery, Thromboendarterectomy |
|
|
Term
| Pt c/o of intermittent chest pain that worsens with activity and improves with rest, it seems to be triggered after meals and when he walks outside into the cold air. He describes the pain as burning and squeezing that begins to the left of the sternum and moves centrally or substernally. The pain only lasts for moments and there is no residual pain or weakness following the events. Resting EKG is normal. Cardiac enzymes are WNL. What condition do you suspect? |
|
Definition
|
|
Term
| What is the MC test used to evaluate suspected angina? |
|
Definition
|
|
Term
| What indicates Unstable Angina versus other forms? |
|
Definition
| Length of duration of pain in unstable angina is >30min |
|
|
Term
| What is the definitive diagnostic procedure for CAD? |
|
Definition
|
|
Term
| What is the DOC for acute management of angina? |
|
Definition
|
|
Term
| What are SE of nitroglycerin? |
|
Definition
| HA, Nausea, light-headedness, hypotension |
|
|
Term
| What lab value is the most accurate predictor of coronary disease? |
|
Definition
|
|
Term
| When should lipid screening in men and women begin? |
|
Definition
Men = 35 (if no risks), 20 - 35 (in men with risk factors)
Women = 45 (if no risk), 20 -45 (if risk factors are present) |
|
|
Term
| What drug is most effective at lowering LDL? |
|
Definition
| Statins (Can also lower trig and raise HDL) |
|
|
Term
| What effect do fibrates have on cholesterol? |
|
Definition
| raise HDL and lower trigs |
|
|
Term
| What effect does fish oil have on cholesterol? |
|
Definition
|
|
Term
| On EKG you see variations in the contour of the P-waves, what arrhythmia do you suspect? |
|
Definition
|
|
Term
| Pt has noticed episodes of palpitations for which she reports to your office. She is 32 y/o and is in good health otherwise. On EKG you note a rapid regular rhythm at 168 BPM. What condition do you suspect? |
|
Definition
| Paroxysmal Supraventricular Tachycardia |
|
|
Term
| What IV med can be used to quickly terminate PSVT? |
|
Definition
|
|
Term
| What arrhythmia has a characteristic short PR interval with a delta wave on EKG? |
|
Definition
| Wolff-Parkinson-White Syndrome |
|
|
Term
| What is the MC chronic arrhythmia? |
|
Definition
|
|
Term
| Which arrhythmia is irregularly irregular on EKG and is common in the elderly population? |
|
Definition
|
|
Term
| What is the treatment for a-fib in a stable pt? ... in an unstable pt? |
|
Definition
stable - Anti-coagulant
unstable - cardioversion |
|
|
Term
| Which arrhythmia has a sawtooth pattern on EKG? |
|
Definition
|
|
Term
| What arrhythmia is seen more commonly in pts with COPD? |
|
Definition
|
|
Term
| Which rhythm is seen commonly in digitalis toxicity? |
|
Definition
|
|
Term
| What is the DOC for ventricular premature beats? |
|
Definition
|
|
Term
| Tx for Torsades de Pointes? |
|
Definition
|
|
Term
| Which type of AV block is described as progressive lengthening of the PR interval b4 a dropped beat? |
|
Definition
| Mobitz type 1 (Wenckebach) |
|
|
Term
| Which type of AV block is described as intermittently non-conducted atrial beats? |
|
Definition
|
|
Term
| Which type of heart block is described as a widened QRS and a lower rate (usually <45bpm)? |
|
Definition
|
|
Term
| What is the treatment for type 2 and 3 heart blocks? |
|
Definition
|
|
Term
| What is the MCC of STEMI? |
|
Definition
| Occlusive coronary thrombus |
|
|
Term
| When do most infarctions occur? |
|
Definition
| In the morning, and at rest |
|
|
Term
| What is the classic evolution of EKG changes due to an MI? |
|
Definition
| peaked ("hyperacute") T-waves, to S-T elevation, to Q-wave development to T-wave inversion |
|
|
Term
| Who can you not administer nitrates to for an MI? |
|
Definition
| Someone who has recently taken PDE-4 Inhibitors (Sildenafil w/in 24 hrs; Tildenafil w/in 48hrs) |
|
|
Term
| What is the diagnosis of rheumatic fever based upon? |
|
Definition
| Jones criteria and Pos Strep test |
|
|
Term
| Which valve is MC affected in Acute Rheumatic Fever? |
|
Definition
| Mitral valve (aortic attacked 30% of the time) |
|
|
Term
| What rash is associated with acute rheumatic fever? |
|
Definition
|
|
Term
| Which rash is described as rapidly enlarging macules that assume the shape of rings or crescents with clear centers that may be raised or confluent? What dz is this rash associated with? |
|
Definition
| Erythema Marginatum; Associated with Rheumatic Fever |
|
|
Term
| What is the least common sign of rheumatic fever, but is the most diagnostic? |
|
Definition
|
|
Term
| What are the major criteria in the Jones criteria? |
|
Definition
Major:(PECS)
P - Polyarthritis
E - Erythema Marginatum
C - Carditis
S - Sydenham's Chorea |
|
|
Term
| What antibiotic should be used in Rheumatic Fever? |
|
Definition
| PCN or Erythromycin if PCN allergic |
|
|
Term
| Pt presents with a fever, and anterior pleuritic chest pain that is worse lying down. On PE you not a pericardial rub, elevated ESR. EKG reveals diffuse ST elevation with associated PR depression. What condition do you suspect? |
|
Definition
|
|
Term
| What is the MCC of pericarditis? |
|
Definition
| Viral Causes - Coxsackie, Echovirus, Influenza, EBV, hepatitis, mumps and HIV) |
|
|
Term
| In which type of pericarditis is the pericardium characteristically "shaggy"? |
|
Definition
|
|
Term
| First line treatment for pericarditis? |
|
Definition
|
|
Term
| A pt presents with chest pain, dyspnea and has a cough. On PE a pericardial rub is heard the pt is tachycardic, tachypneic, and has a narrow pulse pressure. What condition do you suspect? |
|
Definition
| Pericardial Effusion and cardiac tamponade |
|
|
Term
| Pulsus Paradoxus is a classic sign of what condition? |
|
Definition
|
|
Term
| What is the treatment for cardiac tamponade? |
|
Definition
|
|
Term
| If a pericardial effusion is present along with paradoxical pulse and hypotension, what does this suggest? |
|
Definition
| hemodynamic compromise...immediate referral warranted |
|
|
Term
| Gold standard for the dx of valvular heart disease? |
|
Definition
|
|
Term
| Which condition presents with the classical symptoms of angina, exertional syncope and dyspnea when accompanied with PE findings including a systolic ejection murmur that radiates to the neck? |
|
Definition
|
|
Term
| What is the only effective treatment for aortic stenosis? |
|
Definition
|
|
Term
| MCC of mitral valve stenosis? |
|
Definition
|
|
Term
| Pt presents with exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On PE there is an apical rumbling, diastolic murmur that follows an opening-snap. The murmur is accentuated when the pt is in the Left Lateral Decubitus Position. What condition does this pt have? |
|
Definition
|
|
Term
| Treatment for Mitral Valve Stenosis? |
|
Definition
|
|
Term
| Pt presents with orthopnea, dyspnea and fatigue. On PE, a diastolic blowing murmur heard along the left sternal border that intensifies with valsalva maneuver. What condition do you suspect? |
|
Definition
|
|
Term
| On PE a pt has a holosystolic murmur that radiates to the axilla. What condition do you suspect? |
|
Definition
|
|
Term
| Pt presents with chest pain and dyspnea as well as palpitations and anxiety. On PE there is a mid-systolic click with late systolic murmur which is accentuated when standing What condition do you suspect? |
|
Definition
|
|
Term
| What imaging is generally diagnostic of cardiomyopathy? |
|
Definition
|
|
Term
| MCC of restrictive cardiomyopathy? |
|
Definition
|
|
Term
| A pt who presents with sx of chronic bronchitis has an EKG done which shows tall, peaked P waves, right axis deviation and RVH. What condition do you suspect? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 53 y/o pt present with a unilateral temporal HA. Additionally she c/o pain in her jaw when she eats and tenderness of her face on the ipsilateral side. What condition do you suspect? |
|
Definition
| Temporal (Giant Cell) Arteritis |
|
|
Term
| Gold Standard diagnostic procedure for Giant Cell Arteritis? |
|
Definition
|
|
Term
| What is the tx for temporal arteritis? |
|
Definition
| high dose corticosteroids |
|
|
