Term
| What are the complications of Friedrich's ataxia? |
|
Definition
Neurological: Ataxia (frequent falls) and dysarthria
Endocrine: Diabetes
Cardiac: Concentric Hypertrophic Cardiomyopathy
Skeletal: Scoliosis, Hammer Toes |
|
|
Term
| In what age group is transient synovitis of the hip seen? |
|
Definition
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|
Term
| How can you distinguish transient synovitis of the hip from septic arthritis? |
|
Definition
Suspect septic arthritis if at least 3/4 are met:
1. WBC > 12000
2. ESR > 40
3. Temperature > 39
4. Child refuses to bear weight on that side |
|
|
Term
| What are the characteristics of physiological vaginal discharge in neonates? When can it occur? |
|
Definition
| Colorless (milky white). May be bloody. Can occur up to 3 months of age. |
|
|
Term
| What are the signs of epiglottitis? How is it diagnosed? How might one differentiate it from croup? |
|
Definition
| High fever, stridor, tripod position, drooling, respiratory distress. Diagnosed with lateral x-ray which shows the "thumb sign" (swollen epiglottis). A barking cough does not occur in epiglottitis and is specific to croup. Drooling on the other hand is not generally seen in croup. |
|
|
Term
| What is the most common cause of end stage renal disease in children? |
|
Definition
| Vesico-ureteral reflux leading to upper urinary tract infections and renal scarring |
|
|
Term
| What is the sign of posterior urethral valves? How is this condition diagnosed? Does it occur in boys or girls? |
|
Definition
| Midline mass in the lower abdomen representing a distended bladder. Diagnosis by VCUG. Occurs in boys. |
|
|
Term
| When do symptoms of pyloric stenosis appear most commonly? At what age does pyloric stenosis leave the differential? And how is it diagnosed? |
|
Definition
| Symptoms usually appear between 3 and 5 weeks of age, and up to 12 weeks of age. Diagnosis is by abdominal ultrasound. |
|
|
Term
| What are the complications of vitamin A deficiency? |
|
Definition
| Mainly ophthalmological: night blidness, eventually leading to complete blindness, xeropthalmia, keratomalacia, corneal perforations. Other: Immunodeficiency, nonspecific rash. |
|
|
Term
| What is the ONLY bacteria that causes meningitis and a rash |
|
Definition
| Neiserria meningitidis. Streptococcus pneumoniae and Haemophilus influenza also cause meningitis but do NOT cause a rash. |
|
|
Term
|
Definition
| Fever in a patient with an absolute neutrophil count < 500 |
|
|
Term
| What lab findings are seen in vitamin D deficiency and why? |
|
Definition
| Hypophosphatemia is usually the prominent finding. Vitamin D deficiency causes decreased serum calcium levels, which results in secondary hyperparathyroidism, returning calcium levels toward normal but decreasing phosophate |
|
|
Term
| What is the cause of hypochloremic metabolic alkalosis? |
|
Definition
| Volume contraction, for example from excessive vomiting or loop diuretics. |
|
|
Term
| What is the hallmark of a Proteus infection on urinalysis? |
|
Definition
|
|
Term
| What organism is most commonly responsible for osteomyelitis from stepping on a nail? |
|
Definition
|
|
Term
| What clinical signs are typical of an MCA vs. ACA. |
|
Definition
| ACA = contralateral lower body sensory and motor defecit. MCA = contralateral upper body sensory and motor deficit. |
|
|
Term
| How might sickle cell disease affect the genitourinary system? |
|
Definition
| Can cause painless hematuria as a result of sickling in the renal papilla, causing papillary necrosis. |
|
|
Term
| What is torticollis and what is the cause? |
|
Definition
| Focal dystonia of the SCM muscle. Usually caused by medications but can be idiopathic. |
|
|
Term
| What does a high A-a gradient mean? |
|
Definition
| Could either mean shunt, V/Q mismatch (dead space), or diffusion problems |
|
|
Term
| What skin condition occurs with increased frequency in both HIV and Parkinson's? |
|
Definition
|
|
Term
| List the major causes of urinary incontinence |
|
Definition
1. "Transient" causes (DIAPPERS)
Delirium
Infection (UTI)
Atrophic urethritis/vaginitis
Pharmaceuticals
Psychiatric (severe depression) - rare
Excess urine output (fluid intake, diuretics, alcohol, caffeine)
Restricted Mobility
Stool Impaction.
2. "Real" causes
Detrusor overactivity (urge incontinence)
Detrusor underactivity (rare)
Stress Incontinence
Urethral Obstruction |
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|
Term
| In which type of ulcers is the pain RELIEVED by food and in which type is the pain EXACERBATED by food? |
|
Definition
RELIEVED = duodenal
EXACERBATED = gastric |
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|
Term
| Describe the typical rash of Molluscum contagiosum |
|
Definition
| flesh colored dome-shaped papules with a central umblication, located on the extremities, truck, and ano-genital area |
|
|
Term
| How is molluscum contagiosum transmitted? |
|
Definition
| Skin to skin contact, or sexual contact |
|
|
Term
| What often can precipitate pseudogout? How is it diagnosed? |
|
Definition
| Surgery, or an acute medical illness. Rhomboid-shaped, positively birefringent crystals on joint aspiration |
|
|
Term
| What is the cause of "contraction alkalosis"? |
|
Definition
| Volume loss leads to aldosterone production through the RAA system. Aldosterone. Aldosterone stimulates ENaC, which results in increased sodium absorption in the distal tubule, which results in increased potassium and hydrogen ion excretion. |
|
|
Term
| When endocarditis is due to intravenous drug use, what valve is usually affected? |
|
Definition
|
|
Term
| What type of gait is caused by foot drop? |
|
Definition
| A "steppage" (high-stepping) gait |
|
|
Term
| What are the most common causes of foot drop? |
|
Definition
1. Peripheral neuropathy
2. Common peroneal nerve damage
3. L5 radiculopathy |
|
|
Term
| What type of vision is lost in macular degeneration and which type is spared? |
|
Definition
| Central is lost while peripheral is spared |
|
|
Term
| What is the mechanism of statin-induced myopathy? |
|
Definition
| Statins inhibit HMG-CoA reductase, which produces mevalonate. This substance is needed to produce coezyme Q10. The lack of Coenzyme q10 is thought to cause statin myopathy. |
|
|
Term
| What is the classic presentation of steroid-induced myopathy? |
|
Definition
| Proximal muscle weakness in the lower extremities (can't get out of a chair) |
|
|
Term
| What is the most common cause of adrenal insufficiency in developing countries? What about in developed countries? |
|
Definition
Developing - adrenal tuberculosis
Developed - autoimmune adrenalitis |
|
|
Term
| What is seen on adrenal tuberculosis on CT scan? |
|
Definition
| Calcifications within the adrenal gland |
|
|
Term
| In what population is de Quervain tenosynovitis seen? |
|
Definition
| New mothers (due to irritation of the extensor pollicis brevis and abductor pollicis longus against the radius when the mother holds the baby with her hands around it) |
|
|
Term
| What is the definition of systemic sclerosis? |
|
Definition
| Scleroderma + internal organ involvement |
|
|
Term
| What vaccine is indicated for all HIV patients, as long as the CD4 count is greater than 200 |
|
Definition
|
|
Term
| What special test should be ordered on a diabetic's urine and why? |
|
Definition
| Albumin/Creatinine ratio. Provides an estimate of the 24 hr excretion of albumin in the urine. Dipstick only detects macroproteinuria (>300mg/24 hr) so are not good enough. Normal is <30 mg/24 hrs. |
|
|
Term
Define Relative Risk and Odds Ratio.
How is odds mathematically related to risk/probability? |
|
Definition
Relative Risk = the risk of getting cancer if you smoke/the risk of getting cancer if you don't smoke.
Odds Ratio = the odds of getting cancer if you smoke/the odds of getting cancer if you don't smoke.
Odds = risk/(1-risk)
Risk = odds/(odds+1) |
|
|
Term
| A jejunal ulcer is pathognomic for what condition? |
|
Definition
|
|
Term
| Why is steatorrhea seen in Zoster-Ellison syndrome? |
|
Definition
| The small intestine is too acidic so pancreatic enzymes are inactivated. |
|
|
Term
| How does a stroke in the posterior limb of the internal capsule manifest? |
|
Definition
| Motor defect in the face, arm, or leg, without higher cortical dysfunction or visual field defect. |
|
|
Term
| What is the most common cause of secondary hypertension? |
|
Definition
|
|
Term
| What does someone with an anal fissure commlain of? |
|
Definition
| Extreme pain on defection with bright red blood in the stool |
|
|
Term
| Where are anal fissures located on the anus? |
|
Definition
| Midline, either posterior or anterior |
|
|
Term
| How are anal fissures treated? |
|
Definition
1. Fiber supplements, stool softeners.
2. Sitz baths after defecation
3. Nitroglycerin ointment if tolerated
4. If this fails after several works, surgery: internal sphincterotomy, which works because the fissure is due to a hypertrophic internal sphincter cutting off blood supply to the anus. |
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|
Term
| How does acute cholecystitis happen? |
|
Definition
| A stone becomes lodged in the cystic duct, causing obstruction. Bacterial overgrowth of the gall bladder occurs, which causes inflammation. |
|
|
Term
| What is the treatment of acute cholecystitis? |
|
Definition
1. NPO
2. IV antibiotics
3. Pain medication
4. Cholecystectomy once stable |
|
|
Term
| What are the four most common things you will see in a patient with acute cholecysitis? |
|
Definition
1. RUQ pain, sudden onset, usually after meal
2. Fever
3. Leukocytosis
4. Vomiting |
|
|
Term
| What do post-MI PVCs portend and what do you do about them? |
|
Definition
| They are associated with a worse prognosis, but there's nothing you can do about them. If they are symptomatic than a beta blocker is prescribed. |
|
|
Term
| What conditions often accompany autoimmune adrenalitis? |
|
Definition
| Autoimmune thyroid, parathyroid, or ovarian diseases. Also vitiligo and pernicious anemia. |
|
|
Term
| List the major anti-emetics by mechanism |
|
Definition
1. Serotonin antagonist = ondansetron (Zofran)
2. Histamine antagonist = diphenhydramine (Benadryl) and Promethazine (Phenergan)
3. Dopamine antagonist = Prochlorperazine (Compazine), Metoclopramide (Reglan)
4. Anticholinergics (Scopolamine) |
|
|
Term
| What are the serum calcium levels and phosphorus levels in Vitamin D deficiency? |
|
Definition
|
|
Term
| What are the causes of primary hypoparathyroidism? |
|
Definition
1. Thyroid surgery
2. Congenital (common with DiGeorge)
3. Autoimmune (seen in APECED syndrome)
4. Parathyroid glands cannot sense calcium levels. |
|
|
Term
| What causes primary, secondary, and tertiary hyperparathyroidism? |
|
Definition
Primary = Parathyroid adenoma
Secondary = Chronic kidney disease causes vitamin D deficiency, leading hypocalcemia leading to hyperparathyroidism
Tertiary = Chronic stimulation of the parathyroid due to the above condition leads to an autonomous parathyroid gland. |
|
|
Term
| What causes hypertension and hypokalemia together? |
|
Definition
1. Renin-secreting tumor
2. Renovascular disease
3. Primary hyperaldosteronism |
|
|
Term
| What does foul-smelling sputum tend to indicate? |
|
Definition
|
|
Term
| What skin lesion is associated with celiac sprue? |
|
Definition
| Deramititis herpetiformis |
|
|
Term
|
Definition
| Heat rash, seen in hot climates. Consists of vesicles, papules, and pustules on the trunk that may itch or burn. |
|
|
Term
| How is molluscum contagiosum treated? |
|
Definition
| Liquid nitrogen or curettage. Treatment is to prevent spread. |
|
|
Term
| What is a likelihood ratio? How is it calculated from a 2x2 table? |
|
Definition
| The test is this much more likely to be positive in the presence of disease than in the absence. In 2x2 table, (a,b on top, c,d on bottom): (a/(a+c))/(b/(b+d)) |
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|
Term
| In a population with low disease prevalence, the PPV of a diagnostic test will (increase/decrease). The NPV will (increase/decrease). |
|
Definition
| The PPV will decrease while the NPV will incrase |
|
|
Term
| What is lead-time bias? Give an example. |
|
Definition
| Lead-time bias is when a study falsely shows an increased survival time when studying time from diagnosis to death. This is because early screening catches the disease before you would catch it without screening, but the person still lives the same amount of time. Example; a chest x ray will catch lung cancer sooner and thus will have an increased time between diagnosis and death, but it has no effect on mortality. |
|
|
Term
| What is length-time bias? |
|
Definition
| Refers to falsely promising results of an early screening and treatment program for slow-growing cancers. More cancers are caught in the early screening group than would have ever been caught in real life (pt dies from other causes); making the results of treatment seem falsely promising. |
|
|
Term
| What is a test's reliability? Give two synonyms |
|
Definition
| Also known as reproducibility and precision; means how well does the test keep getting the same values on repeated trials. |
|
|
Term
| What is a test's validity? |
|
Definition
| It's accuracy; it's similarity to the actual state of things. |
|
|
Term
| What's the latest you can give t-PA for an MI? When's the window that it works the best. |
|
Definition
| Best within 3 hours, some effect has been observed up to 12 hours. |
|
|
Term
| What are contraindications for t-PA? |
|
Definition
1. Active internal bleeding or aortic dissection.
2. A site that might be predisposed to bleed, ex. surgery, trauma
3. An intracranial process, such as neoplasm or ischemic stroke, or head trauma
4. Pregnancy |
|
|
Term
| What imaging test must every MI pt have before leaving the hospital? When should they have their stress test? |
|
Definition
1. Echo to evaluate EF
2. Stress test in 4-6 weeks |
|
|
Term
| Describe the pathophysiology of plaque formation. |
|
Definition
Risk factors: Smoking, hypertension, high LDL, diabetes. Endothelial cell injury leads to smooth muscle cell proliferation, lipid accumulation.
1. Fatty streaks. Present in children
2. Fibrous plaques. Seen in ages 30-40s
3. Unstable plaques. Seen in 50s-60s. |
|
|
Term
| Name 5 causes of sinus bradycardia, in the order from most to least lethal. |
|
Definition
1. Hypoxemia
2. Inferior MI (RCA): Check EKG!
3. Medications: Beta blockers esp.
4. Vasovagal.
5. Young athlete. |
|
|
Term
| A person is having an acute MI. In what three instances can you NOT give them nitroprusside? |
|
Definition
1. Hypotension (SBP < 90)
2. Taking PDE5 inhibitors (Viagra, Cialis, etc.)
3. There is a right ventricular MI. |
|
|
Term
| What are the 6 steps of reading a blood gas? |
|
Definition
1. Does this blood gas make sense? [H+] = 24 x PCO2/HCO3-. 7.40 = [H+] of 40. 7.5 = [H+] of 30, 7.3 = [H+] of 50, etc.
2. Acidemia or alkalemia
3. Metabolic or respiratory
4. What is the anion gap? (MANDATORY!) Anion gap = Na+ - HCO3- - Cl
5. If there is an anion gap, what is the delta gap? Delta gap = anion gap - 12.
6. Is the compensation appropriate? Look up formulas. |
|
|
Term
| What are the causes of respiratory acidosis? |
|
Definition
PCO2 = Production/RR(TV-DS)
So either excess production, slow respiratory rate, poor tidal volume, or too much dead space |
|
|
Term
| What are the causes of respiratory alkalosis? |
|
Definition
CNS: ASA toxicity, sepsis, CVA, meningitis
Respiratory: Any cause of hypoxemia (PE, ARDS, etc.)
Liver: ESLD (unknown why)
Pregnancy |
|
|
Term
| What are the causes of metabolic acidosis? |
|
Definition
1. Anion gap? Y = MUDPILES. Think Lactate 95%, 5% uremia or DKA.
Methanol
Uremia
DKA
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylic acid overdose (ASA)
2. No anion gap ("hyperchloremic)
a. Diarrhea
b. RTA
c. Too much NS (only bolus a person 2 liters) |
|
|
Term
| What are the causes of lactic acidosis? How do you know the difference between them? |
|
Definition
1. Poor oxygen delivery (sats, Hb, CO)
2. Tissues cannot use the oxygen they are given (a. sepsis, or b. cyanide poisoning, which you can get from burning furniture or from nitroprusside)
3. A clot, usually in the gut
4. Meds: Metformin, protease inhibitors, epinephrine, ativan (because its carrier is ethylene glycol). 1 will have a low SvO2. 2 will have a high SvO2. 3 and 4 will have normal SvO2 |
|
|
Term
| What are the causes of metabolic alkalosis? |
|
Definition
1. Chloride-responsive (Low urine chloride) = contraction alkalosis.
2. Chloride-resistant = Primary aldosteronism or Cushing's syndrome, refeeding syndrome. |
|
|
Term
| What medications cause vasodilation? |
|
Definition
1. Calcium channel blockers
2. alpha blockers
3. Propofol
4. Epidural with bupivocaine
5. Hydralazine
6. Nitrates |
|
|
Term
Generic: Quetiapine.
1. Brand name?
2. Class?
3. Mechanism?
4. Adverse effects? |
|
Definition
1. Seroquel
2. Atypical antipsychotic
3. Dopamine antagonist
4. a. sedative
b. EPS, but less so than other antipsychotics
c. Weight gain
d. Prolongs QT interval
e. Cataracts |
|
|
Term
| How is unstable angina differentiated from an NSTEMI? |
|
Definition
|
|
Term
| Name 2 causes of ischemic chest pain aside from coronary artery disease |
|
Definition
|
|
Term
| What drugs are used in all forms of CAD and why? |
|
Definition
1. Antiplatelet agent, aspirin being the most common, but plavix, others can be used also.
2. Beta blocker. Reduces myocardial oxygen demand
3. Statin.
Other meds in addition could include nitro for pain relief and a calcium channel blocker in addition. |
|
|
Term
| What is the treatment of unstable angina? |
|
Definition
| Aggressive anti-platelet and anti-coagulation: aspirin, plavix, heparin or lovenox, +/- Gb2/3a inhibitor. Beta blocker. Pain relief with nitroglycerine and morphine. +/- cath lab (based on severity) |
|
|
Term
| When do symptoms of Prinzmetal angina generally occur? |
|
Definition
| Early morning waking the pt from sleep |
|
|
Term
| CABG is shown to better than PTCA in which situations? |
|
Definition
Diabetic with multi-vessel disease.
Left main or proximal LAD. |
|
|
Term
|
Definition
1. New severe angina pectoris
2. Angina at rest
3. Angina that is rapidly getting worse |
|
|
Term
| What is the thirty day mortality of a non-STEMI ACS? |
|
Definition
|
|
Term
| Is revascularization indicated for chronic stable angina? Why/Why not? |
|
Definition
| Usually not, there has not been any evidence of benefit to mortality. However, it can be used in high-risk patients, such as those with easily-provoked ischemia, diabetes, impaired LV function, or LAD/left main involvement. |
|
|
Term
| Any total cholesterol value of ??? is high, unless ???? is true. |
|
Definition
| 200, unless TC/HDL ratio is normal. |
|
|
Term
| Who should be screened for high ch cholesterol and what needs to be measured? |
|
Definition
| Males over 35 and females over 45, unless they already have a risk factor for CAD, in which case you start earlier? |
|
|
Term
| What is the normal value for LDL cholesterol? |
|
Definition
|
|
Term
| On the lipid profile, which is the most important number in terms of being a risk factor for CAD? |
|
Definition
|
|
Term
| What are the 5 major risk factors for CAD? |
|
Definition
1. Smoking
2. HTN
3. Diabetes
4. Family history (primary male <55 or female <65)
5. Age (males > 45 and females > 55) |
|
|
Term
| What are "CAD risk factor equivalents?" |
|
Definition
| Disease, that if present, are equal to major risk factors in terms of the development of CAD. They include diabetes, peripheral vascular disease, symptomatic carotid stenosis, and AAA. |
|
|
Term
| Define high triglycerides, and what does this usually mean? |
|
Definition
| 250 or greater is high. Usually seen in diabetic patients with poor control. |
|
|
Term
| What testing must be done on a patient starting a statin and why? |
|
Definition
| Measure LFTs before starting therapy, at 12 weeks, at 6 months, and then yearly. Check LFTs if you change the dose. Statins can be hepatotoxic. Also measure CPK if the patient complains of MSK pain because statins can be toxic to skeletal muscle. |
|
|
Term
| What is the expected change in LDL cholesterol with a statin? |
|
Definition
|
|
Term
| What is the expected change in the lipid profile with niacin? |
|
Definition
| Decreases LDL by 35%, decrease TG by 75%, and increase HDL by 100% |
|
|
Term
| What are the side effects of niacin? |
|
Definition
1. Can irritate the stomach and cause gastritis
2. Can cause PUD to worsen/come back
3. Can precipitate gout
4. Can make glycemic control worse in diabetics.
5. Can cause cutaneous flushing and dry/scaly skin |
|
|
Term
| How does a lipid profile relate to CAD risk? |
|
Definition
| LDL is the biggest risk factor, HDL is second, TC is third, and TG is 4th. |
|
|
Term
| What blood pressure meds affect plasma lipids adversely? |
|
Definition
|
|
Term
| What is the treatment of choice for hypertriglyceridemia. |
|
Definition
| A fibric acid derivative such as gemfibrozil. |
|
|
Term
| Name 3 causes of hypertriglyceridemia? |
|
Definition
1. Poor glycemic control in diabetes
2. Alcohol abuse
3. OCPs |
|
|
Term
| How can H+P differentiate systolic from diastolic heart failure. |
|
Definition
| Diastolic tends to occur in elderly women. Systolic, you will have an S4 and persistent, as opposed to paroxysmal, atrial fib. |
|
|
Term
| What is good BP control for a diabetic pt? |
|
Definition
|
|
Term
| What is appropriate non-pharm therapy for CHF? |
|
Definition
| Salt resitriction! And bed rest for very severely ill patients. |
|
|
Term
| In general, not to say there aren't exceptions, what 2 medications are the mainstay of treating CHF? |
|
Definition
| Ace inhibitors/ARBs and betablockers. ACEis may prevent remodeling and they decrease afterload. Betablockers stop the heart from working too hard. |
|
|
Term
| Name 3 drugs that interact with digoxin: How? |
|
Definition
| Amiodarone, verapamil, and nifedipine. They increase the level of digoxin. |
|
|
Term
| What are the 2 indications for dig in CHF? |
|
Definition
| Afib with RVR and/or a decreased EF. |
|
|
Term
| What are the classes of heart failure and how should each be treated? |
|
Definition
A-asymptomatic with risk factors. Address risk factors.
B-asymptomatic with structural defects of the heart. Should be on ACE-inhibitor +/- beta blocker
C-Symptomatic. ACE-inhibitor, beta blocker, diuretics if needed, oxygen if needed, spironolactone if needed. Revascularization or valve repair if necessary.
D-refractory to treatment. inotropes, assist devices, transplants, etc. |
|
|
Term
| Uremia causes what 3 major problems? |
|
Definition
1. encephalopathy
2. coagulopathy (decreased platelet function)
3. Pericarditis |
|
|
Term
| Name 3 causes of pulsus paradoxus |
|
Definition
1. hypovolemia
2. tamponade
3. COPD (due to increase in transmural pressure, and therefore afterload, with inspiration) |
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