ROSH Quick Questions

Question: On angiography, fibromuscular dysplasia creates what type of pattern?

"Beads on a string".

One Step Further Question: What is Caplan's syndrome?

A patient, typically a miner, with rheumatoid arthritis who acquires any of the pneumoconioses.

Question: Women of what race have the highest incidence of breast abscess?

African American.

Question: What type of precautions are necessary for a patient with active/suspected tuberculosis?

Airborne precautions.

Which sex and race are more commonly affected by a slipped capital femoral epiphysis?

Boys more than girls. African Americans more than Caucasian or Hispanic children. Slipped Capital Femoral Epiphysis (SCFE) Patient will be an obese male 12 - 16 years old Complaining of a progressive limp and knee pain PE will show loss of hip internal rotation Xray will show "scoop of ice cream slipping off an ice cream cone" Diagnosis is made by AP and frog-lateral X-rays Treatment is non-weight bearing and urgent orthopedic consultation

Question: What is the immunoprophylactic agent for RSV?

Bronchiolitis: Patient will be an infant Complaining of difficulty breathing PE will show respiratory distress, polyphonic wheezing, and rales CXR will show diffuse infiltrates Diagnosis is made by history and physical exam Most commonly caused by respiratory syncytial virus (RSV) Treatment is supportive care

Question: What is the most common childhood malignancy in equatorial Africa?

Burkitt lymphoma.

Question: What are the classic symptoms of active tuberculosis?

Persistent malaise, anorexia, weight loss, fever, night sweats, and a chronic cough are classic symptoms

Question: If lifestyle modification fails to treat stress incontinence, what is the second-line non-pharmacological treatment approach?

Placement of a pessary.

One Step Further Question: What are the three laboratory criteria for an exudative effusion?

Pleural:Serum Protein >0.5; Pleural:Serum LDH >0.6; Pleural fluid LDH greater than 2/3 upper limit of normal for serum LDH

Question: What qualifies as a complicated pneumonia?

Pneumonia involving a parapneumonic effusion or empyema, necrotizing pneumonia, lung abscess, or pneumatocele.

Question: Which perforation related to peptic ulcer disease classically will not show on X-ray?

Posterior duodenal.

One Step Further Question: Antidiuretic hormone is released from which part of the brain?

Posterior pituitary gland.

Question: How soon after blood transfusion initiation will anaphylaxis occur?

soon after blood transfusion initiation will anaphylaxis occur? Within minutes. It is triggered by presence of IgA antibodies in IgA-deficient patients.

Question: What is a physiologic complication of noninvasive positive pressure ventilation?

Barotrauma including pneumothorax.

Question: What pulmonary finding is pathognomonic for sarcoidosis?

Bilateral hilar adenopathy.

Question: What is the most useful test to confirm a diagnosis of sarcoidosis?

Biopsy of the affected organ.

One Step Further Question: The tendons of what three muscles comprise the pes anserinus?

Gracilis, sartorius and semitendinosus.

One Step Further Question: Which bacteria is most commonly associated with postinfectious glomerulonephritis?

Group A Streptococcus pyogenes.

Question: What is the most common cause of pleural effusion in the U.S.?

Heart failure.

One Step Further Question: Is the lactate dehydrogenase level high or low in an exudate pleural fluid?

High.

What is the common side effect of rifampin?

Orange discoloration of body fluids.

Question: Name 2 clinical prediction rules that may be used to help determine whether a patient with CAP requires inpatient or outpatient management?

PORT/PSI (Pneumonia Severity Index) and the CURB 65

Question: What is the rate of recurrence of herpetic whitlow?

20%.

Question: What is the blood pressure goal for patients with diabetes mellitus type 2?

< 140/90.

Question: What is lichenification?

A condition of hyperpigmentation, thickening of the skin and accentuation of skin furrows caused by repeated scratching and rubbing.

Question: Which condition should be suspected in patients with severe pain, swelling, and dramatic erythema of the pad of the fingertips?

A felon.

Question: What is the choroidal tubercle?

A granuloma in the choroid of the retina that is specific for disseminated TB.

Question: What is the significance of a high amylase level in a pleural fluid sample?

A high amylase level usually indicates the presence of pancreatitis, esophageal rupture or malignancy.

Question: What arterial blood gas finding is concerning for impending respiratory failure in an asthmatic?

A normal, elevated or rising carbon dioxide.

One Step Further Question: What is the most common form of lung cancer?

Adenocarcinoma.

Question: What laboratory value predicts gallstone pancreatitis?

An ALT greater than 150 U/L within 48 hours of symptom onset.

Question: What is an arteriovenous malformation?

An abnormal connection between the arteries and veins.

Question: What is aspiration pneumonia?

An alveolar space infection resulting from the inhalation of pathogenic material from the oropharynx.

Question: What is a saddle pulmonary embolism?

An embolus that lodges in the bifurcation formed by the main pulmonary artery and right and left pulmonary arteries.

Question: What is the prognosis for a patient with dilated cardiomyopathy?

Approximately 1/3 worsen and die, 1/3 recover completely, and 1/3 have residual cardiac dysfunction.

Question: What is the most common cause of lung abscess?

Aspiration pneumonia.

One Step Further Question: What is the difference between aspiration pneumonitis and aspiration pneumonia

Aspiration pneumonitis is an inflammatory reaction which results from the aspiration of gastric acidic fluid from the stomach. Aspiration pneumonia is a bacterial pneumonia caused by aspiration.

Question: Why does aspirin toxicity result in hyperpyrexia?

Aspirin uncouples oxidative phosphorylation, which allows potential energy to escape as heat.

Question: Name two steroid-sparing alternative medications used for pulmonary sarcoidosis.

Azathioprine and methotrexate.

Question: What is the name of the fracture created when the glenoid labrum is disrupted during dislocation and a bone fragment is avulsed?

Bankart lesion.

Question: In which population is Klebsiella pneumonia most commonly seen in?

COPD, Alcoholics and the elderly.

One Step Further Question: What is a grade III ankle sprain?

Complete tear of the ligament with marked joint instability.

Question: What is the preferred form of management in patients with sarcoidosis?

Corticosteroids (eg, prednisone).

Question: What is the most common complication of pneumonia in children?

Dehydration.

One Step Further Question: Which benzodiazepine can be given rectally to treat status epilepticus?

Diazepam.

Question: What is the name of the provoking maneuver used in the diagnosis of BPPV?

Dix-Hallpike maneuver.

One Step Further Question: What chromosomal disorders are associated with an increased frequency of celiac disease?

Down syndrome and Turner syndrome.

Question: In children, the oculocardiac reflex causes what symptoms?

Drowsiness and bradycardia Rapid Review Hyphema Patient with a history of blunt or penetrating trauma Complaining of blurry vision PE will show unequal pupils, injected conjunctiva/sclera and blood in anterior chamber Treatment is eye protection and rest with the head of the bed at 30 degrees all the times

Question: What is the most common source of excess endogenous estrogen?

Excess adipose tissue (obesity).

One Step Further Question: What is the most common approach to a fetus in breech position?

External cephalic rotation before labor with a trial of labor if the version is successful and cesarean delivery if unsuccessful.

One Step Further Question: What is the most common inherited risk factor for thromboembolic disease?

Factor V Leiden

True or false: Bacterial infections are the most common cause of acute bronchitis?

False.

One Step Further Question: What is the most frequent presenting complaint in patients with SLE?

Fatigue.

One Step Further Question: What is the most common cause of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis.

Question: What genetic condition should be suspected in patients who have had multiple epidermal inclusion cysts?

Gardner syndrome, or familial colorectal polyposis

Question: Why is airway compromise in epiglottitis less common in adults than in children?

In adults, there is an increased trachea diameter to epiglottis diameter making airway compromise unusual.

Question: What is one of the most significant risks associated with recombinant erythropoietin use?

Increased risk of venous and arterial thrombosis. Anemia of Chronic Disease Patient will be complaining of fatigue Labs will show normocytic anemia, low serum iron, high or normal ferritin

One Step Further Question: What host factors are associated with an increase in severity of Rocky Mountain spotted fever?

Increasing age, male sex, and glucose-6-phosphate dehydrogenase deficiency

Question: What is the CURB-65 score?

It attempts to predict the severity of pneumonia to help determine inpatient vs. outpatient treatment.

Question: Which ethnic groups have the highest rate of developmental dysplasia of the hip?

Lapps and Native Americans.

One Step Further Question: What are the local and systemic side effects of inhaled corticosteroids?

Local: Cough, dysphonia, oropharyngeal candidiasis. Systemic: Adrenal suppression, osteoporosis, skin thinning, easy bruising and cataracts.

Question: The differential diagnosis of interstitial lung disease (ILD) includes which three major conditions?

Lung malignancy, lung infection and congestive heart failure.

Question: What is the most common location of extrapulmonary TB?

Lymph nodes.

Question: Which sexually transmitted disease produces a groove sign (buboes that swell above and below the inguinal ligament)?

Lymphogranuloma venereum.

Question: What are the most common sites of hemorrhage in massive hemoptysis?

Massive hemoptysis typically involves the bronchial or pulmonary arteries.

One Step Further Question: What are the contraindications to using antenatal corticosteroid therapy?

Maternal systemic infections, namely chorioamnionitis. Infant (Neonatal) Respiratory Distress Syndrome

Question: What is a side effect of dapsone that can lead to hypoxia?

Methemoglobinemia.

Question: Should antibiotics be given in routine urinary retention due to benign prostatic hyperplasia?

No, antibiotics should not be given unless a urinary tract infection is suspected.

One Step Further Question: What histopathological biopsy finding is typically seen in patients with sarcoidosis?

Noncaseating granulomas.

Question: What ethnic groups have the highest incidence rate of polymyalgia rheumatica?

Northern European and Scandinavians.

Question: Why should a patient not be sent home with proparacaine drops after a corneal injury?

Ophthalmologic proparacaine overuse can result in corneal opacification leading to blindness.

Question: What are the mechanisms of pulmonary bleeding?

Pulmonary hypertension, erosion into a blood vessel, and coagulopathy.

Question: What diagnostic test, although low sensitivity, is often used when influenza is suspected?

Rapid influenza test.

Question: What are the three ways that mumps virus is transmitted?

Respiratory droplets, direct contact, and fomites

Question: What is the most common method of transmitting human parvovirus B19?

Respiratory secretions. Erythema Infectiosum (Fifth Disease) Patient will be a child With a history of URI symptoms 3 - 4 days prior to rash PE will show "slapped cheek" rash Most commonly caused by parvovirus B19 Comments: Aplastic crisis in sickle cell patients

Question: What are the classic ECG changes in a patient with cor pulmonale?

Right axis deviation, R/S ratio >1 in V1 and <1 in V6, P-pulmonale (increased P wave amplitude in leads 2, 3 and aVF).

Where are most aspirated foreign bodies located?

Right main bronchus.

Question: What is the most common bacterial cause of pneumonia in hospitalized patients?

S. pneumoniae.

Question: What is the name of the bone-cartilage junction in the external auditory canal?

Santorini's fissure.

Question: What diagnostic criteria is used in Light's criteria?

Serum protein and pleural fluid lactate dehydrogenase are used in Light's criteria, which is used to distinguish between transudative and exudative pleural effusions.

Question: Which type of lung cancer results in the majority of malignancy-related syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Small cell lung cancer.

Question: Folate deficiency during pregnancy is linked to what birth defect?

Spina bifida.

Question: What pathogen causes pneumonia that is associated with bullous myringitis?

Streptococcus pneumoniae. Bullous myringitis was previously linked to Mycoplasma pneumoniae but it appears, based on middle ear aspirate culture results, that typical acute otitis media pathogens are the true cause.

One Step Further Question: What is the operative procedure of choice for toxic megacolon that has failed medical therapy?

Subtotal colectomy with end-ileostomy.

Question: A pleural effusion is most difficult to detect in which radiographic position?

Supine.

One Step Further Question: What is the treatment of asbestosis?

Supportive care: oxygen, pulmonary rehabilitation, pneumococcal and influenza immunization and pulmonary function monitoring.

Question: What is the treatment of choice for respiratory distress syndrome?

Surfactant.

Question: What is the gold standard diagnostic test for spontaneous pneumomediastinum?

The CT scan.

oculocardiac reflex

The Oculocardiac reflex, also known as Aschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball

Question: Systemic involvement of kaposi sarcoma in which organ has a median survival of less than 6 months?

The lungs.

Question: What is the principal vector of Cryptococcus neoformans?

The pigeon.

One Step Further Question: What is xanthochromia?

The presence of bilirubin in the cerebrospinal fluid used to differentiate between a hemorrhage versus a traumatic lumbar puncture.

One Step Further Question: Weber testing of a patient with left-sided hearing loss due to an acoustic neuroma lateralizes to which side?

The sound would lateralize to the right side, the unaffected side.

Question: Carcinoid tumors are most likely to develop in which other organ system besides the pulmonary system?

These tumors tend to develop in the gastrointestinal tract and produce similar symptoms of carcinoid syndrome.

Question: Fewer than how many bowel movements per week is considered to be abnormal?

Three Irritable Bowel Syndrome Patient will be a woman With a history of constipation alternating with diarrhea Complaining of abdominal discomfort which is relieved with bowel movements Diagnosis is made by Rome criteria Treatment is symptomatic - dietary management and drugs

One Step Further Question: How is rabies transmitted from a rabid animal?

Through a bite. Rabies Patient with a history of exposure to raccoons, bats, or skunks Complaining of hydrophobia, agitation, spasms Treatment is wound care (scrubbing), Ig at wound site, vaccination

Question: What bedside test can be performed to aid in the diagnosis of a hydrocele?

Transillumination of the scrotum.

Question: In a patient with AIDS, what medication is given prophylactically at a CD4 count of less than 100 cells/μL to prevent infection with toxoplasmosis gondii?

Trimethoprim/sulfamethoxazole

Question: Can amiodarone be used in patients with heart failure?

Yes, one of the attractive features of using amiodarone over other antidysrhythmics.