PANCE Miscellaneous tests
What is the major cause of death among those with type 2 diabetes?
cardiovascular disease!
What is echo finding consistent with pericardial tamponade?
diastolic collapse of RV!
What are recommendations for Varicella Zoster vaccine?
immunocompetent patients over the age of 50! should NOT be given to immunocompromised individuals or people with chronic diseases like crohns..
What is metabolic syndrome?
truncal obesity, insulin resistance, increased triglycerides (fasting glucose >100) (triglycerides >150) (waist >100 in males and 88 in females)
What is the recommended pediatric schedule for DTaP?
2 months, 4 months, 6 months, 15-18 months and 4-6 years.
What is the rule of 2s for meckels diverticulum?
2% of population 2 inches long 2 ft from ileocecal valve 2 types of tissue (gastric and pancreatic) younger than 2 years old presents with painless bleeding most common congenital malformation of GI tract
What is diagnostic of febrile seizures in pediatrics?
<15 minutes 6 months- 5 years old Most commonly caused by rapid raise in temperature at least 38 F fever at slight increased risk for epilepsy development Tx: Supportive
What are burn center criteria?
>10% Surface involvement Inhalation, Chemical, and Electrical burns Burns involving face, hands, feet, genitalia, perineum or major joints Third degree burns
What is the antibody associated with Crohn's disease?
ASCA present in 60-70% of patients with Crohn's disease!
What type of cardiac conduction defect is associated with Lyme disease?
AV node conduction block! Specifically 2nd or 3rd degree block!
What sutures are absorbable vs non absorbable?
Absorbable: PDS, Vicryl, Gut Non absorbable: Prolene, Silk, Nylon, Polyester
Consumption is which type of beverage may transiently improve symptoms of benign essential tremor?
Alcohol!
What are recommendations for Pneumococcal vaccine?
All patients greater that 65 years of age or patients who are immunocompromised or who have a chronic disease.
Which of the following medications should be used in the treatment of cluster headache if high-flow oxygen is ineffective? Prophylactic for cluster headache?
Alternative: Sumatriptan! Prophylaxis: Verapamil!
Which medications should be avoided in patients with suspected Epstein-Barr virus (EBV)?
Ampicillin and amoxicillin should be avoided since these may induce a rash that can be confused for a penicillin allergy. Tx for Mono = symptomatic care
What are recommendations for hepatitis A vaccine?
Any person with chronic liver disease or traveling and working in endemic areas! NOT a live attenuated virus
What is a DeBakey type 2 dissection?
Aortic dissection involving the ascending aorta!
What is the Cushing triad?
BRADYCARDIA HYPERTENSION IRREGULAR breathing secondary to INCREASED INTRACRANIAL PRESSURE
What presents with pt complaining of hand tremor that is exacerbated by action and improved after alcohol consumption? Tx?
Benign Primary Essential Tremor Tx: Propanolol
Blockade of which receptor helps to reduce the incidence of extrapyramidal effects?
Blockade of MUSCARINIC ACETYLCHOLINE RECEPTORS suppresses the emergence of extrapyramidal effects!
What presents with symmetric descending paralysis ("floppy baby"), feeble cry and constripation? Tx?
Botulism! ingestion of honey Tx: IV botulism Ig or Equine serum heptavalent botulism antitoxin.
What is the leading cause of nonhereditary sensorineural hearing loss (SNHL)?
CMV (Cytomegalovirus)!
What is the preferred diagnostic study post abdominal trauma before intervention?
CT in STABLE patient Laparotomy if crashing or peritoneal signs
What presents in newborn with chorioretinitis, periventricular calcifications, sensorineural hearing loss, hepatosplenomegaly, thrombocytopenia, petechiae, purpura, and intrauterine growth restriction? Tx?
CYTOMEGALOVIRUS! Thrombocytopenia, Petechia, Purpura = BLUEBERRY MUFFIN RASH Tx: IV GANCYCLOVIR
Which electrolyte should be monitored 48 hours after presentation of acute pancreatitis?
Calcium!
What is the most common cause of anaphylaxis?
Children: Food Adults: Medications & Insect Stings
What medication should be used in the treatment of RMSF in pregnant patients or those with allergies to tetracyclines?
Chloramphenicol
What antibiotic covers for pseudomonas on puncture wound?
Ciprofloxacin!
What presents with symptomatic neonate include petechiae, jaundice at birth, hepatosplenomegaly, small size for gestational age, microcephaly, sensorineural hearing loss, lethargy or hypotonia, poor suck, chorioretinitis, seizures, hemolytic anemia, and pneumonia? Dx and Tx?
Cytomegalovirus! Dx: Urine and saliva testing Tx: IV Gancyclovir
Does dementia or delirium have symptoms that fluctuate?
Delirium!
What presents with fever, migratory arthritis, erythematous or hemorrhagic papules developing into pustules/vesicles with erythematoud halos and tenosynovitis?
Disseminated gonococcal infection!
What is treatment of choice for patient with syphillis and penicillin allergy?
Doxycycline!
Which of the following is the most common location of aortoenteric fistula formation?
Duodenum!
What is diagnostic and treatment of Spontaneous Bacterial Peritonitis?
Dx: >250 Neutrophils on aspiration Gram stain/culture Tx: Cefotaxamine (3rd gen ceph)
Most common cause of viral meningitis? Tx?
Enterovirus! Tx: Supportive!
What congenital heart anomaly is a possible result of lithium treatment and a reason it is contraindicated in pregnant patients?
Epstein's anomaly! a congenital malformation in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart.
What botulism antitoxin is used to treat botulism?
Equine serum heptavalent botulism antitoxin. Common organism: CLOSTRIDIUM botulinum
What presents with weakness, pallor, fatigue, tachycardia, atrophic glossitis or koilonychia (spoon nails)?
Fe Deficiency Anemia!
What is the most common cause of anemia?
Fe deficiency anemia!
What are lab findings consistent with anemia of chronic disease?
Ferritin: INCREASED TIBC: DECREASED Serum Fe: NORMAL/ INCREASED
What is the standard dosing schedule for the MMR vaccine?
First dose at age 12-15 months and second dose at school entry, 4-6 years.
A 67-year-old woman presents with one month of progressive wheezing. On review of systems she also reports recent diarrhea. Which of the following findings on this patient's physical exam is most consistent with the diagnosis of carcinoid tumors? Dx and Tx?
Flushed skin! Triad: Wheeze, Diarrhea, Flushed skin Caused by hyper secreting tumor of serotonin Dx: 24 hour urine: 5-hydroxyindoleacetic acid (5-HIAA) TX: Somatostatin analogies: Ocreotide
What is the most common cause of acute pancreatitis worldwide?
Gallstones! then alcohol
What is treatment for lyme disease in general, and in kids/pregnancy?
General: Doxycycline Kids/Pregnancy: Amoxicillin
What presents with diarrhea, malaise, foul-smelling and fatty stools, abdominal cramps and bloating, nausea, and weight loss after hiking trip with water contamination potential? Tx?
Giardia! Tx: Flagyl
What is typical finding on CSF for viral meningitis?
Glucose: NORMAL Protein: mildly ELEVATED protein (< 200 mg/dL) WBCs: lymphocytic pleocytosis
What is the most common cause of septic arthritis in patients under 35 years of age?
Gonococcal Arthritis!
What presents with unilateral eye pain, eye redness, blurred vision, photophobia, a foreign body sensation, or a watery discharge? PE will show conjunctival injection near the limbus (ciliary flush), decreased corneal sensation Dx and Tx?
Herpes Simplex Keratitis! Dx: Slit lamp fluorescent stain: Dendrites lesion on cornea **** pathognomonic Tx: Topical and oral antivirals
What presents with 21-year-old man presents to the emergency department complaining of left eye pain. Fluorescein staining reveals a dendritic lesion over the cornea? Tx?
Herpetic Keratitis! Dx: Fluorescein stain: Dendrite lesion Tx: Topical antiviral (gancyclovir) AVOID TOPICAL STEROIDS (MAY WORSEN) can lead to blindness because of scarring and opacification of the cornea.
What is the most common cause of non traumatic intracerebral hemorrhage in adults?
Hypertensive Vacsulopathy!
What electrolyte disturbance is associated with ileus?
Hypokalemia!
What is the treatment for acute hypoparathyroidism?
IV Calcium Gluconate!
What are typical labs of primary hypoparathyroidism?
LOW PTH LOW Calcium ELEVATED Phosphorous
What is management of intra-abdominal bleeding following trauma?
Laparotomy!
What presents with diarrhea, vomiting, tremor, mild ataxia, drowsiness, muscle hyperirritability or muscular weakness on treatment for Bipolar disorder? Will also show impaired renal function
Lithium Toxicity! Renal function issues due to mainly metabolized in liver Tx: Mild: Cessation of drug and administration at lower dosage in 24-48 hours Severe: Hydration, forced diuresis, and possible Dialysis
What is the most common mechanism of injury in radial head subluxation?
Longitudinal traction of the arm with elbow extended!
What is a common cause of bilateral peripheral facial nerve palsy?
Lyme Disease!
What tool is commonly used at 18 months of age to screen for an autism spectrum disorder?
M-CHAT Questionnaire!
What are the lab findings consistent with Fe deficiency anemia?
MICROCYTIC, HYPOCHROMIC Serum Fe: DECREASED TIBC: INCREASED Ferritin: DECREASED
What are the live attenuated viruses?
MMR Herpes Zoster Rotavirus Typhoid Smallpox Yellow fever Influenza (FLUMIST)
What class of antibiotics is most effective for treatment of pertussis?
Macrolides! azithromycin
What is the most common congenital malformation of the GI tract? Dx and Tx?
Meckel's Diverticulum! Dx: Mechels scan with technetium 99 Tx: Surgery
What is typical blood smear for B12 (cobalamine) deficiency?
Megaloblastic anemia, Macrocystic, hypersegmented neutrophils ELEVATED homocysteine ELEVATED Methylamonic acid
What pathognomonic hair manifestation can occur in patients with secondary syphilis?
Moth-eaten alopecia!
What is first line management for aortic dissection?
Negative Ionotropes! Labetolol, Nitroprusside
What is most common type of WPW? Initial vs definitive tx?
Orthodromic! Tx: Initial: Vagal, Procainamdide Definitive: Radio frequency ablation
What is best diagnostic test for Pertussis? Tx?
PCR! Tx: Macrolide
What are the "6 P's" of acute arterial occlusion?
Pain, Pallor, Paresthesias, Poikilothermia, Paralysis, and Pulselessness
What should you suspect with even one eosinophils on CSF fluid?
Parasitic infection!
What is the pediatric vs adult tetanus vaccinations and when are they given?
Pediatric: DTap 2,4,6, and 15-18 months, and 4-6 years old (5 total) Adult: TDap > 7 years old at 11 Pregnant women: TDap during 27-36th week of pregnancy
What presents with painful flaccid bullae on mucosal surfaces associated with Myasthenia Gravis and Thymoma? PE will show flaccid blisters that extend with lateral pressure (Nikolsky sign positive) involving mucous membranes Dx and Tx?
Pemphigus Vulgaris! Dx: Biopsy Tx: High dose steroids autoimmune reaction
What presents with irregularly grouped, discrete red papulopustules on a red base on the face, but spare the vermilion border? Dx and Tx?
Perioral Dermatitis! Dx: Clinical Tx: Metronidazole or Erythromycin ointment WORSE with steroids
Which antiepileptic medication can cause hirsutism and gingival hyperplasia?
Phenytoin!
What is treatment for latent TB?
Previous Exposure no longer active (+) PPD, (-) Chest Xray and symptoms Tx: ISONIAZID (INH) x 9 months! Alternative: Rifampin x 4 months!
What medication is given with isoniazid to prevent isoniazid-related neuropathy?
Pyridoxine ! (b6)
What is cornestone for frostbite treatment?
Rapid WET rewarming!
What presents with flushing, erythema and indications of allergic reaction after Vancomycin ? Tx?
Red Man Syndrome! NOT a true allergic reaction Tx: Diphenhydramine (antihistamine)
What vaccine protects from a common cause of severe watery diarrhea in children?
Rotavirus Vaccine!
What is the proper technique used to fix a radial head subluxation (nursemaids elbow?)
SUPINATION followed by FLEXION of elbow!
What is proper management of patient without symptoms that recently had close exposure to positive influenza patient?
Script for Oseltamavir! Spread by respiratory droplets post exposure prophylaxis should only be used if within 48 hours of exposure (mostly in patients with extremes of age, <2 or >65, or immunocompromised)
What is the most common sequelae of congenital CMV?
Sensorineural Hearing Loss!
How is diagnosis of Rocky Mountain spotted fever confirmed?
Skin biopsy or serology!
What presents as reaction with vesicles and bullae involving the mucous membranes? Tx?
Steven Johnson! Tx: Supportive and referral to burn center
What has a greater risk of infection, cutaneous or subcutaneous sutures?
Subcutaneous!
What are the EEG findings consistent with Absence seizures? Tx?
Symmetric spike and wave! Tx: Ethosuxamide may also use Valproic acid
What presents as painless ulcer with punched out appearance, indurated, raised border, red smooth base, with scant serous secretions? Dx and Tx?
Syphillis! Dx: Dark Field Microscopy: Treponema Pallidum Tx: IM Penicillin G
What is contraindicated in treatment of herpes simplex keratitis?
TOPICAL CORTICOSTEROIDS! may worsen dendritic lesions on cornea
What are contraindications for MMR vaccine?
The MMR vaccine contains trace amounts of neomycin, therefore patients with a history of anaphylaxis to neomycin should not receive it. Previous severe allergic reaction to any component of the vaccine individuals who are immunocompromised pregnancy hematologic or solid tumors HIV infection with immunosuppression.
When is the greatest risk of sudden death after a myocardial infarction?
The first few hours after secondary to ventricular tachycardia, ventricular fibrillation or cardiogenic shock.
How should a penicillin allergic pregnant patient be treated for syphilis?
They should be desensitized to and treated with penicillin.
What is the most common location for zoster to occur in?
Thorax, followed by the face (trigeminal nerve)
What is myasthenia graves associated with?
Thymoma! also pemphigus vulgaris..
What is the most common cause of acute compartment syndrome?
Tibial fracture!
What is presentation of mysasthenic crisis? Tx?
Triggered by infection, respiratory failure, mechanical ventilation Tx: Plasma exchange, IVIG
What are the differences in type a and b influenza?
Type A: Pandemic (country large region) Type B: Endemic (specific area)
What inflammatory bowel disease is at increased risk for colon cancer and toxic megacolon?
Ulcerative Colitis!
What virus causes herpes ophthalmicus?
Varicella Zoster Virus!
What is most common causative agent of shingles?
Varicella Zoster!
What are contraindications for tissue adhesive usage?
Wounds under TENSION Wounds over JOINTS MUCOSAL surfaces HAIRY areas BITE wounds Allergy to adhesive Cyanoacrylate is the commonly used adhesive with strength equivalent to 4-0 suture