PANCE/PACKRAT Missed Questions Review
What are the fundoscopic findings associated with hypertension?
-AV narrowing -AV nicking -hemorrhage & soft exudates -papilledema
What are the best medications for Acute Angle-Closure Glaucoma?
-Acetazolamide: 1st line; decreases aqueous humor production -Topical Beta Blockers: timolol -Miotic/Cholinergics: Pilocarpine, Carbachol; increases aqueous humor drainage
Of the following lung cancers, which present centrally and which present peripherally? -Adenocarcinoma -Large Cell -Squamous Cell -Small Cell
-Adenocarcinoma: peripheral -Large Cell: peripheral -Squamous Cell: central -Small Cell: central
Tell me about the causes of various kidney stones: -Calcium Oxalate: -Uric Acid: -Struvite:
-Calcium Oxalate: Most common -Uric Acid: high protein/purine foods -Struvite: urea-splitting organisms (think women with recurrent UTI's). May form staghorn calculi
What is the treatment for Trigeminal Neuralgia?
-Carbamazepine 1st-line -gabapentin
What are the common lab findings in polycystic ovarian syndrome (PCOS)?
-Elevated testosterone -LH:FSH ration > 3:1 (normally 1.5:1)
What type of vision loss is common in the following diseases: -Giant Cell Arteritis -Pituitary Adenoma -Cataracts -Optic Neuritis -Macular Degeneration -Retinal Detachment -Diabetic Retinopathy -Central Retinal Artery Occlusion -Central Retinal Vein Occlusion -Acute Angle-Closure Glaucoma
-Giant Cell Arteritis: Transient loss of vision in one or both eyes (amaurosis fugax) -Pituitary Adenoma: Gradual bitemporal hemianopsia (loss of lateral aspect of visual fields) -Cataracts: Gradual blurriness, halos around lights, cloudy lens -Optic Neuritis: Sudden monocular vision loss, pain with eye movement, loss of color vision (red) -Macular Degeneration: Gradually progressing bilateral loss of central vision -Retinal Detachment: Sudden painless loss of vision, floaters, curtain coming down -Diabetic Retinopathy: Gradually progressing central vision loss, red spots and floaters -Central Retinal Artery Occlusion: Sudden, painless, monocular vision loss -Central Retinal Vein Occlusion: Sudden, painless monocular vision loss -Acute Angle-Closure Glaucoma: Acute, unilateral painful vision loss, halos
How do you warm patients who have cardiac arrest or ongoing cardiovascular instability due to hypothermia?
Active Internal Warming
A patient diagnosed with Barrett's esophagus is at an increased risk for the development of what type of cancer?
The most serious complication of Barrett's esophagus is esophageal adenocarcinoma
Which laboratory tests should be followed in patients treated with atypical antidepressants?
Fasting Blood Glucose; Patients who take atypical antidepressants should be monitored for the development of diabetes on a quarterly or semiannual basis.
Dialysis is indicated with what GFR and/or Serum Creatinine level?
GFR < 10ml/min Serum Creatinine > 8 mg/dl
What genetic test may be done to determine the cause for emphysema in a non-smoker under the age of 50?
Genetic testing for alpha-1-antitrypsin (AAt) deficiency
Hemarthrosis is associated with what blood disorder?
Hemophilia A (low factor VIII)
What is the cause of Hemophilia A, B and C?
Hemophilia A: deficiency of clotting factor VIII (most common) Hemophilia B: deficiency of clotting factor IX Hemophilia C: deficiency of clotting factor XI
What is the diagnostic test of choice for Epstein-Barr Virus (Mono)?
Heterophile (Monospot) Ab test; may not be positive if done early in the disease (first 1-2 weeks of disease)
Reed-Sternberg cells are pathognomonic for...
Hodgkin's lymphoma
What lab findings suggest menopause?
Increased FSH and LH; decreased estradoil -FSH >30 mIU/mL is diagnostic of menopause. -LH is also elevated in menopause. -Estradiol starts to decrease around menopause to levels of 10-15 pg/mL.
Hypertension, hematuria, and dependent edema are the classic symptomatic triad of what type of kidney disease?
Nephritic Syndrome (glomerulonephritis) -includes RBC casts
What is the pharmacologic therapy of choice in male patients suffering from mild-moderate gynecomastia?
Selective estrogen receptor modulator (SERMs) -tamoxifen -raloxifene
How do you treat MS exacerbations?
Steroids; often IV like methylprednisolone
What is the most common pathogen associated with Community Acquired Pneumonia (CAP)?
Strep Pneumo
What are the common microcytic anemia's?
TICS -Thalassemias -Iron Deficiency (MC) -Chronic Inflammation (anemia of chronic disease) -Sideroblastic (Lead)
What is the most common symptom of acute PE?
Tachypnea
What are the effects of Rubella on a developing fetus?
miscarriage, stillbirth, or birth defects (most often deafness, brain damage, heart defects, and cataracts) if infection occurs during the first 16 weeks of pregnancy.
What is nyctalopia?
night blindness
Empiric treatment for infective endocarditis should target which organisms?
staphylococci, streptococci, and enterococci Most commonly caused by: -IVDA: S. aureus (tricuspid affected) -Native valve: Streptococci, S. aureus (mitral affected)
During illness/surgery, what should a patient with adrenal insufficiency do with their normal dose of steroids?
-Increase the dose to mimic the bodies normal response to "stress." -usually this is a doubling of the dose for illness and even more for surgery
A coin lesion on CXR should make you think of what 3 diagnoses?
-Lung carcinoma (MC adenocarcinoma) -Granuloma -Hamartoma
What anti-hypertensive medications may cause hyperkalemia?
-Potassium Sparing Diuretics (spironolactone, amiloride) -ACE Inhibitors
What is the treatment of cellulitis?
-Simple disease: Dicloxacillin or cephalexin orally -Penicillin allergy: clindamycin -Concern for MRSA: Vancomycin (IV), doxycylcine or Bactrim (TMP-SMX)
What is the treatment for impetigo?
-Topical Mupirocin for small areas -Oral antibiotics (Cephalexin [keflex]) for bigger infections
What is Legg-Calve-Perthes disease?
-avascular necrosis of femoral head -Presents in children four to ten years of age with insidious onset hip or knee pain
What are the effects of an ASD on the heart sounds?
-fixed split S2 heart sound -Increased intensity of P2 heart sound; due to left to right shunt of blood causing increased right-sided blood volume.
What are the symptoms of a Lisfranc fracture?
-pain on a dorsum of the foot -ecchymosis and instability -often confused with an ankle sprain -involves the tarsometatarsal joint TX: ORIF
What are the risk factors for prostate cancer?
1. Age > 65 2. Race (Blacks > Native Americans > Asians) 3. Family history 4. Diet high in fat
An internally rotated and shortened leg should indicate what type of dislocation?
A Posterior Hip Dislocation
What is an aspergilloma?
A ball of fungus and debris that forms in a preexisting cavity, often from previous tuberculous infection.
What effects do AIDS and past BCG immunization have on PPD testing?
AIDS: Any process that results in reduced immune response can cause a false negative PPD BCG Immunization: cause a false positive
What is the most common type of leukemia in children?
Acute lymphocytic leukemia (ALL)
Emphysema in a young nonsmoker think...
Alpha-1 antitrypsin deficiency
What antiarrhythmic drug can be associated with hyper- or hypothyroidism following long-term use?
Amiodarone; it is structurally related to thyroxine and contains iodine, which can induce a hyper- or hypothyroid state.
What is an osteoid osteoma?
An osteoid osteoma is a benign tumor in children age 5-20y, presents with increasing pain, worse at night and relieved by aspirin
What is the CHADS-VASC score?
Anticoagulation risk stratification in patients with A-Fib. >2 = moderate to high risk (chronic anticoagulation recommended) 1 = low risk 0 = very low risk
What is the Koebner phenomenon?
Any trauma to the skin that causes PSORIASIS to develop!
Crescent Sign on a plain radiograph should make you think...
Avascular necrosis (AVN), often seen on the AVN of the femoral head.
What is the antibiotic of choice for treatment and prophylaxis of pertussis?
Azithromycin
What's the best abx for treatment of legionella?
Azithromycin
What is the treatment for pulmonary legionellosis?
Azithromycin (Zithromax)
Occupational or recreational activities outdoors in a geographically limited area of the south-central and midwestern US (Mississippi and Ohio River valleys) is most commonly associated with what pulmonary disease?
Blastomycosis
Loop and Thiazide diuretics have what effect on potassium?
Both cause hypokalemia Thiazides: end in -thiazide mostly Loop: furosemide, torsemide, bumetanide, ethacrynic acid
When you see "high ventricular filling pressures" think...
CHF
What is considered to be the treatment of choice for the pruritus that occurs with primary biliary cirrhosis?
Cholestyramine (Questran); a bile salt sequestrant, is able to decrease the pruritus that occurs from the bile stasis and granulomas.
Describe cholinergic vs anticholinergic symptoms...
Cholinergic: compounds that mimic the effects of acetylcholine. -symptoms of miosis, increased bowel sounds, and diaphoresis Anticholinergic: compounds that block the action of acetylcholine. -symptoms of increased HR, RR, temp, dry flushed skin and mucous membranes, dilated pupils (mydriasis) and decreased bowel sounds
What are the classic symptoms of Horner's syndrome?
Classic Triad: -Miosis -Ptosis -Anhidrosis Horner's Syndrome is the result of cranial sympathetic dysfunction that occurs due to nerve injury below the level of entry into the skull.
Triptans or Ergotamines are the abortive treatment of choice for Migraine headaches. However, they are contraindicated in what patients?
Contraindicated in coronary artery or peripheral vascular disease and uncontrolled HTN due to vasoconstriction.
What are the contraindications to exercise stress testing?
Contraindications to stress testing include rest angina within the last 48 hours, unstable cardiac rhythm, hemodynamically unstable patient, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, and active infective endocarditis.
What is cor pulmonale?
Cor Pulmonale is defined as right ventricular hypertrophy with eventual RV failure resulting from pulmonary HTN, secondary to pulmonary disease.
What diseases will cause a change in cremasteric reflex and Prehn's sign?
Cremasteric Reflex: normal elevation of scrotum with stroking of inner thigh Prehn's Sign: positive if relief of pain with elevation of the scrotum. Diseases: Epidydimitis & Orchitis: positive Prehn's sign and normal cremasteric reflex Testicular Torsion: negative Prehn's sign and loss of cremasteric reflex
Systemic activation of blood coagulation which then depletes clotting factors and platelets leading to life-threatening bleeding is characteristic of what disease?
Disseminated Intravascular Coagulation
What is the recommended treatment for Non-gonococcal urethritis?
Doxycycline 100mg orally for 7 days
What is the most common cause of heritable hypercoagulability?
Factor V Leiden
During the stages of fracture healing what is responsible for producing collagen?
Fibroblasts
How is Grave's Disease diagnosed?
Grave's Diagnosis: -TFT's: ↑T4, T3, ↓ TSH - + Thyroid Stimulating Immunoglobulins (Ab)(most specific) -diffuse uptake of radioactive iodine
How do you differentiate Grave's Disease (toxic diffuse goiter) vs Toxic Multinodular Goiter?
Graves Disease (Toxic Diffuse Goiter): -MC in women age 20-40y -Sx: goiter, exopthalmos, pretibial or localized edema -Labs: hyperthyroidism, +TS immunoglobulins antibodies -RAIU: diffuse generalized uptake Toxic Multinodular Goiter: -MC in elderly women -Sx: goiter, nodules, NO eye or skin changes -Labs: hyperthyroid labs only -RAIU: patchy areas of increased and decreased uptake
What is the most common electrolyte abnormality found in patients on oxcarbazepine
Hyponatremia
Isolated thrombocytopenia (low platelets) and Antiplatelet IgG on labs should make you think of what disease?
Immune Thrombocytopenic Purpura (ITP) Other Symptoms: easy bruising and petechiae
What is the next medication of choice in allergic rhinitis that is refractory to antihistamines and intranasal steroids?
Immunotherapy
What is the Tzanck smear used for?
It is used on active genital lesions to diagnose HSV. -PCR testing is more definitive however for HSV just so you know
How does hydroxyurea help treat sickle cell?
It works by increasing the levels of HbF
A positive PPD but negative chest film indicates....
Latent TB; requires treatment but not full RIPE protocol. TX: Isoniazid with Rifampin
At what lead levels should chelation therapy begin?
Lead levels > 45 mcg/dL
What is the initial treatment of choice for status epilepticus?
Lorazepam (Ativan)
What are the common macrocytic anemia's?
Many things but think... -B12 deficiency anemia (pernicious anemia) -Folic Acid deficiency
What are the common hemolytic anemia's?
Many things but think... -sickle cell disease -G6PD deficiency -transfusion
What are the common normocytic anemia's?
Many things but think.... -Renal disease (low erythropoetin) -Inflammatory block -Zero production (Aplastic Anemia)
Rouleaux formation seen in RBC's should make you think...
Multiple Myeloma Rouleaux Formation = stacking of RBC's
What is the treatment for adynamic ileus?
NPO or dietary restriction
Did you know that methotrexate is contraindicated in patients with chronic hepatitis?
No, but now I do!
What is the treatment of choice for candidal esophagitis?
Oral Fluconazole -presents as odynophagia and yellow/white plaques on endoscopy. -common in immunocompromised
What is the best treatment for sarcoidosis?
Oral Steroids -observation is acceptable as well as most cases will spontaneously resolve within 2 years without treatment
Giant Cell Arteritis is commonly associated with what other disease?
Polymyalgia Rheumatica
What is perseveration?
Persistent repetition of words or concepts in the process of speaking. This is often seen in cognitive disorders, schizophrenia, and other mental illness.
What is the medication of choice for HTN in patients with pheochromocytoma?
Phenoxybenzamine is an alpha-blocker utilized to control hypertension in patient with a pheochromocytoma
How can you differentiate polymyositis vs polymyalgia rheumatica?
Polymyositis: -proximal weakness rather than pain -labs: ↑ creatine kinase and aldolase -if rash present, it's dermatomyositis (malar rash, heliotrope rash, Gottron's papules) Polymyalgia Rheumatica: -proximal aching/stiffness rather than weakness -labs: ↑ ESR -associated with Giant Cell Arteritis
What is the most common cause of sensorineural hearing loss in adults?
Presbycusis; age related hearing loss
Compare and contrast Osteoarthritis vs. Rheumatoid Arthritis in the following categories: -Primary Joints Affected: -Heberdon & Bouchard Nodes: -Stiffness: -Labs: -Treatment:
Primary Joints Affected: -OA: DIP, thumb -RA: ulnar deviation, MCP, PIP (DIP sparing) Heberdon & Bouchard Nodes: -OA: present in OA only -RA: think boutonniere and swan neck deformity Stiffness: -OA: morning stiffness < 60 minutues, worse with use -RA: morning stiffness > 60 minutes, worse with rest Labs: -OA: none really, osteophytes on imagining and asymmetric joints -RA: +RF, +anti-CCP antibody Treatment: -OA: NSAIDS, rest, steroid injections -RA: DMARDS (Methotrexate)
What should you be monitored while on TB meds?
RIPE: -Rifampin -Isoniazid -Pyrazinamide -Ehtambutol Monitor liver function (AST/ALT's)
Where is the head of the radius and what findings are common with fracture of the radial head?
Radial head is on the proximal end of the radius, in the elbow area. -Radial head fracture associated with "Sail Sign" (anterior fat pad) and posterior fat bad on lateral x-ray of the elbow
What is the most common cause of secondary hypertension?
Renal parenchymal disease is the most common cause of secondary hypertension. Most cases are related to increased intravascular volume or increased activity of the rennin-angiotensin-aldosterone system.
What is Samter's triad?
Samter's Triad: -Asthma -Nasal Polyps -Aspirin/NSAIDs sensitivity Aspirin use in these patients leads to Aspirin Exacerbated Respiratory Disease (AERD) which casuses severe reactions with both upper and lower respiratory symptoms.
What test is best for diagnosing secondary syphilis?
Serum FTA-Absoprtion Test
What laboratory test differentiates seizures from pseudoseizures?
Serum Prolactin which will rise briefly in a real seizure
Monitoring of what electrolyte is necessary in patients receiving desmopressin (DDAVP)?
Sodium! DDAVP can cause severe hyponatremia
What are the most common pathogens associated with cellulitis?
Staph Aureas and Strep Pyogenes
A positive blood dipstick without RBC's on microscopy should make you think...
The dipstick is positive due to myoglobin, not hemoglobin. This is common in rhabdomyolysis!
What is the difference between upper motor and lower motor neuron damage in the face?
Upper Motor Neuron: Central Facial Palsy -effects contralateral side -only effects lower half of the face, can wrinkle forehead Lower Motor Neuron: Bell's Palsy -effects ipsalateral side -effects full side of face, can't wrinkle forehead
What is Wickham Striae?
Wickham striae are whitish lines visible in the papules of lichen planus
A positive direct Coomb's test indicates...
autoimmune antibodies commonly seen in.... -transfusion reactions -Rh sensitization -autoimmune hemolytic anemia.
A cloudy lens indicates...
cataracts
What is the first-line medication for benign prostatic hyperplasia (BPH)?
α1-receptor blocker: end in -osin -tamsulosin -terazosin -alfuzosin -doxazosin