Pance Review Q&A

A PANCE REVIEW b Study online at quizlet.com/_9h06b 1.

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"pencil in cup" deformities

proximal phalanx on radiograph in psoriatic arthritis

ABI of peripheral artery disease

decreased libido

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ADRs of Niacin

facial flushing Increase in serum uric acid levels ( x gout patients) increase in gastric acid secretion ( x gerd patients) abnormal LFTs

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Adult hemoglobin

2 alpha 2 beta chains

alcoholic with DOE, heart failure

primary dilated CM

alcoholic with palpitations, arrhythmia

afib (holiday heart)

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Risk factors: local arterial trauma septic emboli endocarditis hypercoagulable state

80% of primary sclerosing cholangitis is assoc with?

IBD, generally UC

90% of acute bronchitis is caused by?

viruses: rhinovirus, coronavirus, RSV

abdominal pain that improves with food

duodenal ulcer (gastric ulcer-pain worsens with food)

ABI indicative of PAD

5days w/o fever

acute bronchitis.

cough which persists for 3 months in 2 successive years

chronic bronchitis

cough, coryza, and conjunctivitis

Measles (rubeola)

crescendodecrescendo holosystolic at LSB radiating to back

Tetralogy of Fallot

Crescendodecrescendo systolic murmur heard best at 2nd IC space

congenital aortic stenosis

CREST

calcinosis cutis Raynauds Esophageal dysmotility Sclerodactyly Telangectasia

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CT of epidural hematoma

lens-shaped, convex hyperdensity

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Cushings disease psych sx's?

irritability agitation hypomania panic attacks

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CXR finding of adenocarcinoma lung ca

small peripheral lesions

CXR finding of klebsiella/aspiration pneumonia

Right upper lobe abscess

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CXR finding of Large cell lung ca

Large peripheral lesions

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CXR finding of small cell lung ca

mediastinal mass/lymph nodes or Coin lesion

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CXR finding of squamous cell lung ca

Central bronchus solitary tumor

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CXR of acute bronchiolitis

can be normal or air trapping peribronchial thickening

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CXR of aortic valve disorders

LAE and ventricular hypertrophy

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CXR of mitral valve disorders

atrial enlargement alone

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CXR of mycoplasma or viral infections

patchy diffuse infiltrates

CXR of pneumococcal pneumonia

lobar consolidation

CXR of Pneumocystis jirovecii pneumonia

diffuse interstitial infiltrates

CXR: fibrocavitary apical disease, nodules, infiltrates, posterior and apical segments of the right upper lobe, apical-posterior segments of the left upper lobe, superior segments of the lower lobes.

Reactivation TB

CXR: homogeneous infiltrates, hilar/paratracheal lymph node enlargement, segmental atelectasis, cavitations with progressive disease

primary TB

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criteria used to dx infective endocarditis

Dukes

cryptococcus pneumonia pts are at risk for developing what

meningitis

cryptococcus pneumonia tx

amphotericin B

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CSF lab findings in bacterial meningitis

appearance: cloudy WBCs: elevated (PMNs) Glucose: decreased (bacteria eat glucose)/ Protein:increased pressure: increased

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CSF opening pressure in bacterial vs viral meningitis

Bacterial: increased Viral: normal

CT chest of idiopathic pulmonary fibrosis

diffused patchy fibrosis with pleural based honeycombing

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DASH diet

low saturated fat, cholesterol, and total fat increased fruits, vegetables fat-free/low-fat milk increased fiber

DDAVP challenge test in central vs nephrogenic diabetes insipidus

central: decrease urine output and increase urine osmolarity nephrogenic: will not decrease urine output.

deadly complication of Graves

thyroid storm

decreased active and passive ROM

adhesive capsulitis

definition of chronic mesenteric ischemia (CMI)

blood supply is present but insufficient to meet the needs of the intestine

definition of preload

volume of blood in ventricle at end-diastole

Definitive dx for PCP pneumonia

Bronchoalveolar lavage fluid eval (PCR)

definitive dx of TB requires

identification of mycobacterium tuberculosis from cultures or by DNA/RNA amplification techniques

definitive tx for varicose veins 300mOsm

non-ketotic hyperglycemia or hyperosmolar coma

most common inherited cause of unconjugated hyperbillirubinemia

Gilberts disease

most common interstitial lung disease

idiopathic pulmonary fibrosis

most common joints involved in pseudogout

knee wrist elbow

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most common ocular disorder of MS

optic neuritis

most common opportunistic infection in HIV

PJP

Most common organism in septic arthritis? Tx?

Staph Aureus. Dicloxacillin

most common organism of bacterial septic arthritis

s. aureus

most common organisms of otitis media

strep. pneumoniae H. inlfuenza Moraxella cat

most common overuse injury of the elbow

lateral epicondylitis (tennis elbow)

most common pathogen of acute cholangitis

E. coli

most common presenting sign signs of primary sclerosing cholangitis

jaundice and pruritis

most common primary benign bone tumor of the hand

enchondroma (cartilaginous tumor)

most common primary malignant bone tumor? presentation?

osteosarcoma. pain and a mass in the distal femur or proximal tibia.

most common reason for intraoperative MI?

hypotension

most common salter harris fx

Type 2 (metaphysis and physis)

most common secondary cause of hyperparathyroidism

phosphate retention in chronic kidney diseaseleads to renal osteodystrophy

most common site for a talus fracture

neck-risk of osteonecrosis

most common site of aortic dissection

infra-renal

most common site of prostate cancer

peripheral zone

most common site of scoliosis

1. right thoracic curves at T7 or T8 2. double major (right thoracic & left lumbar)

most common spinal cord tumor

ependymoma

most common symptom of scleroderma

raynauds

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Most common symptoms of Myasthenia Gravis

Ptosis (pupil size is always normal) diplopia jaw fatigue dysarthria

most common tarsal fx

calcaneus (r/o spine injury)

most common tumor that causes ectopic ACTH

small cell carcinoma of the lung- produces hypercortisolism and hypokalemia

most common type of bronchogenic carcinoma

adenocarcinoma

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most common valvulopathy assoc with angina

aortic stenosis

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most people with MI will die of what

V-fib

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Most sensitive cardiac biomarker

Troponin I

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most sensitive lab test to dx herpes simplex virus?

PCR

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most sensitive test for detecting ACL injury

Lachmans test

Most specific cardiac biomarker

CK-MB

Moth eaten bone destruction

osteomyelitis

motor deficit from herniation to L3-L4?

quadriceps

motor deficit from herniation to L4-L5?

dorsiflexion

motor deficit from herniation to L5-S1?

plantar flexion

mousy urine

PKU

mucopurulent cercicitis and a red, swollen and fraible cervix - dx and tx?

gonorrhea. tx with ceftriaxone

multiple hamartomas or polyps scattered throughout the entire GI tract.

peutz-jeughers syndrome

murmur & hx of rheumatic heart disease

mitral stenosis#1 tricuspid stenosis #2

murmur associated with aortic regurgitation

austin flint murmur

murmur associated with Ebstein anomaly

Tricuspid regurgitation

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murmur of pulmonary hypertension

Graham steell murmur- high pitched early diastolic decrescendo murmur heard over the left upper to left midsternal area.

murmurs that get louder with exhalation

Aortic and mitral murmurs

murmurs that get louder with inspiration

pulmonic and tricuspid murmurs- increases venous return

murmus of mitral valve prolapse

systolic click and late systolic murmur

muscles assoc with deQuervains disease

abductor pollicis longus extensor pollicus brevis

muscles involved in lateral epicondylitis

tendinous insertion of the extensor carpi radialis brevis

muscles involved in medial epicondylitis

flexor-pronator muscles

Muscles of rotator cuff? tests associated on PE

Supraspinatus-Empty can test (pain with extension of arm and inward rotation Infraspinatus-Elbow to side, resist external rotation of the forearm Teres Minor-external rotation Subscapularis-internal rotation

narrow splitting and accentuation of the second heart sound and a systolic ejection click

pulmonary hypertension

Neer classification

assesses humeral fractures

nephrogenic diabetes insipidus tx

HCTZ ameloride indomethacin

nerve affected in carpal tunnel

median

neuro complications of sarcoidosis

cranial mononeuropathy (Bells Palsy) peripheral neuropathy hypothalmic inflammation with central diabetes insipidus

new murmur after MI

mitral regurgitation (papillary muscle rupture)

newborn after the first month of life when lacrimal duct does not open

dacryostenosis (usually resolves by 9 months of age- tx: warm compress/massage)

Newborn infant with meconium ileus

think CF

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Niacin deficiency

Pellegra (4 D's-dermatitis, diarrhea, dementia, death), bright red tongue

nonpharmacologic measures in CHF

progressive aerobic exercise low-sodium diet stress reduction

nonbilious vomiting that is projectile

pyloric stenosis

noncaseating granulomas

sarcoidosis

Normal FEV1/FVC ratio

70%

Nosocomial bacterial pneumonia

Pseudomonas

numbness and tingling in ulnar distribution (4 and 5 digits)

cubital tunnel syndrome

obstructive vs restrictive lung disease in regards to FEV/FVC

>70% = restriction 250 Arterial PO2 40inches in men, >35 in women. 2. triglycerides >150 3. HDL200

What is the treament of Primary sclerosing cholangitis

Ursodiol and endoscopic management of stricture liver transplant is the only treatment with a known survival benefit

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what is the virus of EBV

human herpes 4 transmitted by saliva

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what is Virchow's node

Supraclavicular LAD (L>R), metastatic abdominal cancer

what is vision like in a pt with macular degeneration. What can it be measured with?

Metamorphopsia is the phenomenon of wavy or distorted vision and can be measured with an Amsler grid.

What lab finding do you have with PCP pneumonia

Elevated LDH

what lab findings in stool denote an inflammatory process

WBCs

What lab should you check when starting Lithium therapy

BUN/CR q 2-3 months for first 6 months, then avery 6-12 months.

what lab testing will confirm hashimotos thyroiditis autoimmune disease

antithyroid peroxidase antithyroglobulin antibodies

what may be elevated in hepatic carcinoma

AFP

what med can be given to close a PDA

indomethacin

what med can cause pyloric stenosis in an infant

macrolides (clarithromycin)

what med can worsen claudication

Bblockers

what med could cause wheezing and cough in a pt with asthma

beta blockers

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what is the most common extranodal site for non-hodgkins lymphoma

stomach

what is the most common lab finding in gastric adenocarcinoma

IDA

what is the most common primary malignant bone tumor? second?

1. multiple myeloma 2. osteosarcoma

what is the most infection stage of pertussis

catarrhal stageinsidious onset of sneezing, coryza, loss of appetite, malaise with hacking cough at night. Often misdiagnoses as URI

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what is the most prevalent form of primary osteoporosis

Type 1 postmenopausal

what is the most sensitive imaging modality for pancreatitis

ERCP

what is the most spastic artery in the body

brachial artery

what is the preferred approach to recurrent SVT

radiofrequency ablation

what is the preferred tx of permanent control of hyperthyroidism. who is it contraindicated in?

Radioactive iodine (131I) ablation. CI in pregnant patients-surgery is preferred.

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what med should be administered to a pt with Type 1 VWF to control bleeding BEFORE a surgical procedure?

intranasal desmopressin acetate

what med should you give prophylactically when giving chemo

allopurinol (tumor lysis syndrome)

what medications can cause pancreatitis

HIV antiretroviral meds

what meds can exacerbate psoriasis

lithium bblockers anti-malarials

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What meds can increase serum Lithium concentrations

HCTZ Metronidazole NSAIDS (except ASA)

what motor nerve root evaluates strength of ankle and great toe dorsiflexion

L5

what must be ruled out in polymyalgia rheumatica

Giant cell arteritis

what must you do while initiating anti-malarial meds

eye exam- can damage rods and cones

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what nerve root is tested by evaluating ankle reflexes and sensation at the posterior calf and lateral foot

S1-weakness of plantar flexion

what other comorbidities are berry aneurysms associated with

polycystic kidney disease coarctation of the aorta

what phase is first half of menstrual cycle?

proliferative estrogen predominant

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What phase is the second half of menstrual cycle?

secretoryprogesterone predominant. occurs only after ovulation.

What should be avoided in acute diverticultis

barium enema-may cause perforation and peritonitis

what should be considered in adults with dermatomyositis

underlying malignancy

what should not be administered to pts with acute angle closure glaucoma

atropine (mydriatics)

What should you avoid a few days post MI

corticosteroids-can predispose to ventricular wall rupture

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what should you screen patients for with Lichen planus

Hep C

what size corneal abrasion needs patching and for how long

>5 to 10mm no longer than 24hours

what test is diagnostic for Addison's

simplified cosyntropin stimulation test. A serum cortisol rise of more than 20 after administration of cosyntropin is normal.

what test is done to r/o a achilles tendon rupture

Thompson test

what test is helpful in detecting a meniscal tear

McMurrays and Apleys

what test is used in Sjogrens to test the lacrimal gland. What is a positive test

Schirmers test. wetting of less than 5 mm of filter paper placed in the lower eyelid for 5 min is positive for decreased secretions

what type of anemia is seen in psoriatic arthritis

normocytic normochromic

what type of bone is affected in Type I osteoporosis

trabecular bone

what type of bone is affected in Type II osteoporosis

trabecular and cortical

what type of COPD presents with tachypnea, use of accessory muscles and diminished breath sounds

Emphysema

what type of heart failure is HOCM

Diastolic

what type of leukemia presents with bleeding into the skin and mucosa or overwhelming infection.

ALL

what type of overdose leads to a high anion gap acidosis?

aspirin overdose

what type of patients are at high risk for epiglottitis

diabetics

what type of shoulder problem is common in diabetics

adhesive capsulitis (frozen shoulder)

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what type of shunt is in cyanotic congenital heart disease

right to left

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what type of tissue is found in the yellow ligaments of the vertebral column and walls of hollow organs, such as large arteries

elastic connective tissue

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what vaccine should COPD patients get

pneumococcal and influenza yearly

what valve is affected in IVDA endocarditis

tricuspid

what valve is most commonly assoc with IVDA endocarditis

tricuspid

what will scaphoid avascular necrosis look like on radiograph

ground-glass appearance of the proximal pole or increased bone density

wheezing, prolonged expiration

asthma

when does a scaphoid fracture require ORIF

displacement >1mm

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when is a posterior dislocation? what is seen on xray

seizures and electrocution light bulb sign

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When is AFP measured? why

16-18wks, neural tube defects

when placing a pt on hydroxychloroquine (plaquenil) for SLE, what exam must you perform?

retinal exams. caution for retinal toxicity (rare but dose dependent)

When should family members of pts with familial polyposis syndrome be monitored

every 1-2 years beginning at age 10-12

when should thrombolytics be administered in an acute MI

if cardiac cath is >90min or not available.

when to hospitalize in acute bronchiolitis

O2 sats 70 Atelectasis on Chest X-Ray

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where are anal fissures most commonly found

posterior midline

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where are most gastrinomas found

pancreas or duodenum

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where do you find increased alpha feto protein

hepatocellular carcinoma germ cell tumor of the testes neural tube defect

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where does coarctation mostly occur

proximal thoracic aorta (just below the left subclavian artery)

where does spondylosis most commonly occur

C5-6

where does the injury occur in cauda equina

L4-L5

where is the most common site of bony metastasis

spine

which abx may prolong QT interval?

macrolides and some fluoroquinolones

which heart lesion is considered high risk for development of infectious endocarditis?

VSD

which NSCLC can be detected through sputum cytology?

squamous cell carcinoma bc it presents with hemoptysis

which thyroid cancer has high serum calcitonin and CEA

medullary carcinoma

which type of diabetes is at more risk for renal disease

Type I

which type of lung cancer has the highest survival rate

bronchoalveolar cell carcinoma- a subtype of adenocarcinoma

which type of lung cancer is ctyologic exam of sputum diagnostic?

squamous cell

which type of thyroid cancer causes flushing, diarrhea, fatigue and Cushings syndrome

Medullary carcinoma

Why do a CT for orbital cellulitis

Check for underlying subperiosteal abscess or sinusitis

Why do ACEI cause a cough

they increase bradykinins (ARBs do not increase bradykinins therefore do not cause a cough)

why do anorexic pts have amenorrhea

decreased secretion of GnRH

why does graves dz cause hyperthryroidism

autoantibodies attach to TSH receptors and cause hyperfunction of thyroid (TSH receptor antibodies)

why is anorexia and weight loss assoc with gastric ulcer?

because pain worsens with food

why is local spread of esophageal cancer to the mediastinum common?

bc the esophagus has no serosa

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widened pulse pressure

aortic insufficiency

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widening of the softened area of the isthmus (sign)?

Hegars sign

with standing most murmurs diminish, what are two exceptions? Same for valsalva

HOCM-gets louder. MVP-gets longer and louder.

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XXY

Klinefleters (hypogonadism)

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young person with MI or angina

most likely congenital artery aneurysm or congenital cardiac anomaly

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