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2013-10-26 15:42:46

Study for ABFM
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  1. Phencyclidine
    • PCP
    • Intoxication produces maladaptive behaviors and nystagmus
    • (PCP/"angel dust")
    • -hallucinogen that causes psychotic reactions and impaired judgment
    • -OD leads to nystagmus, life-threatening HTN, and seizures
    • -NMDA receptor antagonist
  2. Sjogren's Syndrome
    • Autosomal disorder
    • Destroys exocrine glands that produce saliva and tears
    • disease with chronic inflammatory autoimmune attack resulting in dryness of mucous membranes and lymphocyte infiltration. Dry mouth and eyes.
  3. Shigella
    • Gram-; Rod; Enterobacteriaceae; Non-Lactose;
    • Non-H2S-
      • Non-motile, Only in humans, can cause HUS
      • Very LOW infectious dose
      • GI-->large intesting--> Gastroenteritis, meningitis, seizures
      • high sequence homology w/ E.coli b/c of plasmids
      • Tx with Rocephin x 5 days
  4. Clopidogrel
    • Plavix
    • Higher risk of bleeding in older patients
  5. Aggrenox= Aspirin + Dypiridamole (Persantine)
    • Indication after non embolic TIA
    • Stroke secondary prophylaxis
    • inhibitor adenosine uptake and cGMP phosphodiesterase activity; vasodilator
  6. Status migranous
    • Sever migraine for more than 72 hrs.
    • B blockers are used for recurrent HA's
  7. Corneal abrasions
    Do not use topical anesthetic due to corneal toxicity

    • By rubbing foreign body
    • SX: pain, watering or eye, photophobia, spasm of orbicular muscle of eyelid
    • TX: patch and refer, antibiotic ointment, do not use topical anesthetic due to corneal toxicity
  8. Toxic Epidermal Necrolisis
    • Life threatening drug reaction
    • Hallmark is massive keratinocyte apoptosis
  9. Giardia infection
    • Stool is negative for leukocytes
    • Waterborne transmission
    • Hikers/campers
    • Most common parasite GI infection
    • Oro-fecal transmission
    • Asymptomatic carriers need to be treated to avoid transmission of cysts.
    • Cysts are resistant to chlorination
    • Cysts are sensitive to heat.
    • Tx with Flagyl
  10. Bacterial vaginosis
    • Clue cells
    • Fishy odor
    • Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Peptostreptococcus.
    • Tx with Flagyl BID x 7 days or Clindamycin po x 7 days
    • -vaginal infection from sex (NOT STD)
    • -aka Gardnerella vaginalis, Haemophilus vaginalis, or Nonspecific Vaginitis, CLUE CELLS
    • S: profuse discharge "constant wetness" with "foul, fishy, rotten" odor
    • O: thin, creamy, gray-white malodorous discharge; surface parasite; no inflammation on vaginal wall or cervix; vaginal pH >4.5; "whiff test"
    • Tx: Flagyl, Clindamycin
  11. Wegener's granulomatosis
    Best confirmatory test is biopsy of affected tissue
  12. Wheal
    Papule or plaque with dermal edema, white central pallor and irregular borders.
  13. Pulmonary circulation loop
    Virtually bypassed in fetal circulation
  14. TIA
    • Risk of converting to a stroke in 30 days:
    • 1. Age >60
    • 2. Blood pressure >140/90
    • 3. Clinical sx of unilateral weakness and speech impediment
    • 4. Duration of sx x >10 minutes.
  15. Kawasaki syndrome
    • Autoimmune disease
    • Vasculitis of medium size vessels
    • Children < 5 y/o

    • -Mucocutaneous lymphoid syndrome w/ no known toxin
    • -fever 5+ days
    • -red/edematous palms/soles-->desquamation
    • -exanthem on trunk
    • -mucosal erythema
    • -cervical lymphadenopathy -conjunctivitis
  16. Cystic fibrosis
    • Tx. Exercise, MTV, Flu vaccine. Fluids
    • inherited condition of exocrine gland malfunction causing secretion of abnormally thick, viscous mucus that obstructs passageways within the body, commonly affecting the lungs and digestive tract; mucus that obstructs the airways leads to infection, inflammation, and damage of lung tissue
    • Tx: Running is ok, MTV, Fluids, Exercise, Flu vaccine.
    • No scuba or marathon running
  17. Excessive alcohol
    • Increases: 
    • Cardiac output, BP, HR, Oxygen consumption, Risk of MI, Incidence of cancer

    heavy drinking: M: drinking more than 2 drinks/day, F: more than 1 drink/day

    • binge drinking: M: 5 or more drinks in single sitting, F: 4 or more drinks in single sitting
    • Increases: Cardiac output, BP, HR, Risk MI, Myocardial Oxygen consumption
  18. Pyelonephritis
    • E. coli
    • Tx with Ampicillin and Gentamycin IV
    • -Kidney infection, results from UTI.
    • -Sx= Pain, hematuria, dysuria BUT SYSTEMIC TOO (fever, chills, N/V).
    • -Mx=Admission, IV abx Ampicillin and Gentamycin. FLUOROQUINOLONES.only oral approved.
  19. H1N1
    • Best test is real time reverse transcriptase by PCR
    • sometimes called “swine flu” is a new influenza virus causing illness in people.
  20. Histoplamosis
    Associated with bird poop (chicken coop)

      • Dimorphic fungi (mold in soil; yeast in tissue). Hides within macrophages!
      • Mississippi and Ohio River valleys.
      • Associated with bird/bat droppings. chicken coop
      • infected person usually has no symptoms/generally self limiting.
      • Rx: amphotericin B, followed by oral itraconazole.
  21. Bipolar and Schizophrenia
    • Overlap between them and some genetic underpinnings
    • share genetic, neuroanatomical, and cognitive abnormalities
    • -some think bipolar is more closely related to schizophrenia than depression (especially bipolar I)
  22. Acute Coronary Syndrome ACS
    • Sx of angina, ST depression, T wave inversion, blood clot is the most common cause
    • NSTEMI does not have to have increased troponin.
    • signs and symptoms resulting from conditions in which the coronary arteries are suddenly narrowed or occluded(thrombus) and lead to cardiac cell hypoxia

    • manifests as:
    • ST elevation/T wave inversion
    • unstable angina
    • myocardial infarction(NSTEMI (no need for increase in Troponin or STEMI)
  23. Anuria
    Less than 50 ml/day of urine
  24. Oliguria
    Less than 400 ml of urine per day
  25. Septic arthritis
    • WBC in fluid of > 50,000/mm is a diagnosis until proven otherwise
    • Gram stain only 50% sensitive
    • Crystals make diagnosis less likely
    • RA and Gout increase risk
    • caused by an agent invading the joint cavity.

      • hematogenous seeding - comes through blood from a distant site that is actively infected
      • also introduced through trauma or surgery
      • usually impact large joints of knee/hip
  26. Duchenne Muscular Dystrophy
    • Defect of the short arm of Chromosome X
    • Disease of the muscle contractile proteins, most severe and most common of MD in childhood, x-linked recessive trait, 1: 3600 male births
    • Characteristics: onset age 3-5, progressive muscle weakness, wasting and contractures, progressive generalized weakness in adolescence, death from resp or cardiac failure
    • DX: clinical appearance, family hx, confirmation by EMG, muscle biopsy, and DNA, may detect prenatally by 12 wks - amnio
  27. Chronic Myeloid Leukemia CML
    • Philadelphia chromosome
    • Translocation of chromosomes 9,22
  28. Raynaud's phenomenon
    • intermittent attacks of vasoconstriction of the arterioles (causing pallor of the fingers or toes), followed by cyanosis and then redness before returning to normal color; initiated by exposure to cold or emotional disturbance.
    • No need to do provocative test.
    • Tx Nifedipine, Prazosin, Amlodipine
  29. Warfarin
    • Primrose oil increases PT.
    • Coenzyme Q, melatonin, St. John's wort decrease PT.
  30. Legionella
    Fatal form of pneumonia that leads to multi-organ failure.

      • gram neg, not seen in gram stain, no person-person
      • granulomatous response (facultative intracellular)
      • legionnaries disease - severe pneumonia with multiorgan failure, AC units
      • Pontiac fever - mild flu like symptoms
      • fluoroquinolones (Cipro) or macrolide
  31. Osteoporosis
    • T score less than -2.5.
    • Tx with Calcium, Vit D and Fosamax 70 mg /wk
    • - Associated with calcium deficiency (need 1000-1500 mg/day)
    • - Loss of bone density, bones become brittle - break easily and hunched posture
    • - Occurs in 50% of older women and 25% of older men
    • - Also associated with Vitamin D deficiency, smoking, excessive alcohol intake, sedentary lifestyle, being thin (BMI<19)
  32. Osteopenia
    T score between -1.5 to -2.5
  33. Anthrax
    Painless black eschar

      • bacillus anthracis, gram(+) , spore forming rod produces anthrax toxin
      • only bacterium w a polypeptide capsule (contains D-gluatamate)
      • Black skin lesions -Painless black eschar (necrosis) surrounded by edematous ring. caused by lethal factor and edema factor
  34. Cats
    • Pasteurella multocida highest rate in cats
    • The definitive host of toxoplasmosis
  35. Periodontitis
    • Increase CHD
    • Pathogen Actinobacillus actinomycetem comitans
    • (infection and inflammation of the soft tissue & bones that support the teeth) main cause of tooth loss

  36. Low Molecular Weight Heparin
    • Lovenox
    • Tx for prophylaxis for DVT and PE x 7-10 days
    • Targets factor Xa specifically, more predictable effects, longer half life, subcutaneous 1-2xdaily, weight dosed, used for prophylaxis DVT and PE x 7-10 days, thromboembolic disorders, ACS, monitor for bleeding, thrombocytopenia
    • Generally does not increase PT or PTT.
  37. H pylori
    • Ulcer
    • Gram (-) spiral rod, urease (+)Virulence factors: CagA, VacA. No known reservoirs except humans and primates, Causes gastric cancers, MALT lymphomas, ulcers (duodenal more than gastric)
    • Dx: Best is breath test. After treatment also can follow up with stool antigen test.

        • Treatment requires triple therapy for long duration (2 wks) - 1 or 2 antibiotics + antacid

        • Triple therapy advised- Peptobismol + Flagyl + Tetracycline or Amoxicillin x 4 weeks.

        • Double therapy- Omeprazole + Amoxicillin x 2 weeks

        • Short course- 1 week of Flagyl + Omeprazole + Biaxin
  38. Aminoglycosides
    • Used against E coli and Staph
    • Work by inhibiting bacterial protein synthesis

        • Amino group bonded to carbs

        • affects protein synthesis

        • binds to bacterial ribosome

        • active against mainly Gram negative bacteria and mycobacterium

        • Ototoxicity affects CN VIII

        • ex streptomycin, neomycin, tobramycin
  39. Polycystic Ovarian Syndrome PCOS
    • Rule out pregnancy
    • First line tx for infertility is Clomiphene
    • If that does not help you can add Metformin
    • increased LH --> increased testosterone and estrogen, decreased FSH
    • rule out pregnancy
    • tx: weight loss, low-dose OCP's (decrease LH and androgenesis), spironolactone (acne/hirsutism)
  40. FEV1
    • Best for monitoring COPD
    • Measures obstructive lung disease
    • forced expiratory volume
    • -vol of air that can be expired in 1st sec of forced max exp
    • -normally 80% of FVC
  41. Asymptomatic bacteriuria
    • Screen pregnant women early
    • Tx if positive even in asymptomatic pt
    • Could become pyelonephritis
    • Antibiotics x 3-7 days
    • refers to > 105cfu/mL in pt w/o complaints consistent of UTI

    • no tx required unless pregnant (screen early) or preschool child
    • If + treat for 3-7 days
  42. Dressler's syndrome
    • Pericarditis after MI
    • Usually 2-3 weeks after
    • Tx with NSAID's and stop anticoagulation
    • An autoimmune reaction with fever, pericarditis, and increased ESR occurring 2-4 weeks post-MI
    • Tx; NSAID's and stop  anticoagulation
  43. Atrial fibrillation
    • Independent risk factors:
    • Hyperthyroidism
    • Male
    • Age> 60 y/o
    • Obesity
    • DM
    • Alcohol
    • Sleep apnea
    • Caffeine
    • Stress
    • Rheumatic heart disease
    • atria quivering 350 -600 bpm
    • the is no P wave (no atrial contraction)
    • QRS is present
    • most common dysrhythmia
    • Thrombus and Embolus risk from pooling
    • metoprolol used to decrease HR
    • coumadin used for long term anticoagulant
  44. Autoimmune disease
    • Caused by failure of the body to recognize self antigens
    • Examples: SLE and Hashimoto's thyroiditis
  45. Polymyalgia rheumatica
    • Age > 50 y/o
    • Elevated CRP, ESR
    • Symmetrical gallium uptake in shoulders and pelvis
    • Refractory to NSAID's

    • Negative findings in X Rays
    • -usually large joint involvement (hips/shoulders)
    • -systemic S/S, age >50 y/o, elevated ESR
    • -similar lab results as seen in RA, elevated CRP
    • -often seen with giant cell arteritis
    • -treat with course of higher dose systemic corticosteroids

  46. Achondroplasia
    • Dwarfism
    • • AD disease.
    • • Cell-signaling defect of fibroblast growth factor (FGF) receptor 3.  
    • • Results in dwarfism; short limbs, but head and trunk are normal size.
    • • Associated with advanced paternal age.
  47. Osler-Weber-Rander Syndrome
    • Hereditary hemorrhagic telangiectasia
    • Affects blood vessels and produces bleeding
    • Recurrent epistaxis, oral telangiectasia, pulmonary AVM.
    • Worsens with physical activity.

    • Granulomatous vasculitis with eosinophilia.Worse w exercise.
    • Presents with asthma, sinusitis, skin lesions, and peripheral neuropathy (foot/wrist drop)
    • p-ANCA is a strong marker
  48. Huntington' disease
    • Neurodegenerative genetic disease
    • Affects muscle coordination
    • Chorea- abnormal involuntary movements
    • Autosomal dominant
    • - Condition caused by a genetically programmed degeneration of neurons in the brain- Autosomal dominant disorder involving a defect on chromosome 4- Leads to progressive atrophy of the brain, particularly in the basal ganglia and frontal cortex
    • -Abnormal involuntary movements
  49. Neurofibromatosis
    • Genetic condition
    • Autosomal dominant
    • Cafe au lait spots
    • High risk of tumor formation
    • - Condition caused by a genetically programmed degeneration of neurons in the brain- Autosomal dominant disorder involving a defect on chromosome 4- Leads to progressive atrophy of the brain, particularly in the basal ganglia and frontal cortex
    • von Recklinghausen’s disease
    • autosomal dominant

    • Multiple skin/oral neurofibromas
    • Oral lesions may be pendulous
    • May be hundreds of neurofibromas
    • Skin pigmentation (cafe au lait spots)
  50. Sturge Weber Syndrome
    • Congenital neurological condition and skin disorder
    • Port wine stains of face
    • Glaucoma
    • Meningiomas
    • Seizures and mental retardation
    • Congenital

    CM: Port-wine stains in V1 distribution, ipsi leptomeningeal angioma, pheochromocytoma

    Also causes glaucoma, seizure, hemiparesis, mental retardation
  51. Parkinson's disease
    a neurological disorder characterized by tremors, rigidity of the limbs, poor balance, and difficulty in initiating movements; caused by degeneration of a system of dopamine-secreting neurons.
  52. Multiple sclerosis
    characterized by sclerotic plaque replacement of the myelin sheath on nerve cells in the central nervous system.
  53. Rheumatoid arthritis
    • PIP, metcarpophalangeal, wrist most affected.
    • Fusiform or spindle-shaped swelling of PIP in acute.
    • Chronic disease swelling of metacarpophalangeal and PIP joints.
    • "Swan Neck" seen
    • produce antibodies against cartilage of uncleared Ig+Ag complexes deposits in joints
  54. Rickets
    deficiency in vitamin D in children. since vitamin D controls the proper absorption of Ca++ from the gut, therefore a deficiency leads to hypocalcemia (low serum Ca++) and resulting in skeletal and dental deformities (as well as neuromuscular problems). due to lack of Ca++ there is no mineralization of the cartilage at the epiphyseal plate and bone osteoid. therefore, bones lack structural strength and bend due to the enlarged zone of calcification (because the cartilage cells don’t die). this is characterized by ‘bow legs’. note that low Ca++ in diet can also cause rickets, but most common cause is low vit D. treat with vitamin D and calcium.
  55. Paget's disease
    • increase in both osteoblastic and osteclastic activity
    • maybe viral - like paramyxovirus
    • Alkaline Phosphatase increased!

    • hat size increase
    • hearing loss is common due to auditory canal narrowing
    • increased blood flow from AV shunts
    • osteogenic sarcoma
  56. Multiple sclerosis
    a progressive autoimmune disorder characterized b inflammation that causes demyelination of the myelin sheath. This scars the brain, spinal cord, and optic nerves and disrupts the transmission of nerve impulses. This damage leaves the patient with varying degrees of pain plus physical and cognitive problems
  57. Anticholinergic Syndrome
    • 1) develops in response to high doses of Atropine or scopolamine
    • 2) s/s: central: restlessness, agitation, shivering, mania, hallucinations, delirium, drowsiness, excitation, disorientation, short-term memory loss, motor incoordination; peripheral: blurred vision, dry mouth and skin, ST, rash on face, neck, chest, HOTN
    • 3) peds and elderly are most sensitive   
    • 4) TX: physostigmine 15-60 mcq/kg IV, crosses BBB   
    • 5) Red as beet, dry as a bone, blind as a bat, mad as a hatter, hot as hell
  58. Asthma
    • I- Intermittent
    • II- Mild persistent- Think about pulmonology referral
    • III-Moderate persistent
    • IV-Severe persistent
    • Clinically classified according to the frequency of sx and the forced FEV1
    • Bronchoprovocation with Methacholine, histamine, cold air or exercise is the only definitive diagnostic test.
  59. Plavix
    • -clopidogrel
    • -anti-platelet agent
    • -covalently modifies ADP receptor, preventing ADP action
    • -higher risk of bleeding in older patients
  60. GI bleeding
    • Upper: peptic ulcers, gastritits, varices, esophagitis, Mallory-Weiss tear, AV malformation
    • Lower: diverticula, IBD, perianal disorders, carcinoma, AV malformation
    • Can be also caused by: stress, NSAIDS, alcohol, steroids, and aspirin.
    • Early endoscopy is the first test to order
  61. Gastroparesis
    • -delayed emptying
    • -Gastric atony in DM

    • -associated with chemical/neurological factors
    • -causes many times unknown (idiopathic)
    • -causes can be diabetes/obstruction/surgery
    • -In DM it means a disease of > 10 yrs.
  62. Regurgitant murmurs
    • Valve is insufficient or doesn't close all the way.
    • Backward flow causes turbulent sound.
    • Mitral and tricuspid.
    • Usually harsh and pansystolic.
  63. Scotty dog fracture
    • Fracture of the Pars Interarticularis
    • L4-L5 usually
    • Spondylolysis
    • Spondylolisthesis
  64. Heart murmurs
    • Aortic-R sternal border
    • Pulmonic- L sternal border
    • Erb's point- 3rd L ICS
    • Tricuspid- 4th L ICS
    • Mitral- 5th L Mid clavicular
  65. Henoch Schonlein Purpura
      • Petechiae
      • Abdominal pain
      • Renal involvement (IgA) can produce persistent nephritis
      • Self limited in children
      • Can be triggered by infections, medications, chemicals or vaccines.
  66. Digoxin
    • Does not change mortality in CHF.
    • Improves morbidity in CHF.
  67. Ischemic stroke management
    • Aspirin or anti platelet agent in first 48 hrs.
    • Heparin not indicated.
    • IV rt-PA should be given in first 3 hrs.
    • Neither bed positioning, O2, IVF's are helpful.
  68. Lactose intolerance
    • - osmotic diarrhea
    • - deficiency in intestinal lactase
    • - watery large volume
    • - follows ingestion of milk products
    • - Can tolerate up to 1 cup of milk (12 gm of lactose) with no sx
  69. Crohn's disease
    • -Chronic inflammatory bowel disease affecting the terminal ileum and sometimes the colon.
    • -More likely to be smokers than pts with UC.
    • -Multi-factorial pathogenesis.
  70. MCV elevation
    Can occur with recent and chronic alcohol use.
  71. Hypertrophic cardiomyopathy
    • -common cause of sudden cardiac death in young athletes
    • -LVH
    • -B blockers are the treatment of choice
  72. Fructosamine
    • -In cases of elevated IgA you can see high fructosamine levels.
    • -It is an alternative to HgbA1c in pts with Sickle cell.
    • -Burn pts have low levels of fructosamine.
  73. Myasthenia gravis
    • Autoimmune disease that causes chronic, progressive damage of the neuromuscular junction.
    • Immune system produces antibodies that bind and block ACh receptors.May be related to thymus. More seen in women.Muscles in face and neck are affected. Weakness of eye muscles. Double vision.Weakness of throat muscles. Death from paralysis of the respiratory muscles. Progressive weakness

    Tx: Anticholinesterase drugs, plasmopheresis, thymectomy in patients below 60 y/o.
  74. Alzheimer's dementia
    • Amyloid-beta protein-forming plaques,
    • Neurofibrillary tangles,
    • Decreased acetylcholine production – decreased transmission of impulses across conduction
    • Memoryimpairment
    • Apraxia
  75. Lewy Body Dementia
    • - clinical features: either Parkinsonism s/s OR dementia, hallucinations
    • - eye movements: vertical gaze palsy
    • - pathology: Lewy bodies in cerebral cortex
    • - cause: unknown
  76. Pick's disease
    • Rare cause of dementia characterized by the destruction of frontal lobes.
    • -pronounced atrophy of the temporal and frontal lobe (not diffuse atrophy like in AZD)
    • -Neuronal loss only in the frontotemporal lobes
    • -Pick bodies (cytoplasmic inclusions of microtubule-associated Tau proteins)
    • -Behavior abnormalities, speech and language decline
    • -urinary incontinence
  77. Borderline personality disorder
    • Characterized by instability in relationships, self-image, mode, and lack of impulse control.
    • Intense anger, mood swings
  78. Grave's disease
    • thyrotoxicosis; most common type of hyperthyroidismtachycardia, palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos, and weight loss
    • Autoimmune disease
    • Goiter
  79. Tympanic membrane perforation
    • -Principal cause is infection
    • -Usually presents with transient vertigo and tinnitus
    • -Select worse ear to fix first
    • -No high dose antibiotics needed
  80. Scotty dog fracture
    • Fracture of the Pars Interarticularis
    • L4-L5 usually
    • Spondylolysis
    • Spondylolisthesis
  81. Cough variant asthma
    • -coughing is only symptom
    • -bronchospasm is not severe enough to cause airflow obstruction
    • -difficulty w/ air movement can create a feeling of suffocation
    • -Pt may feel increasingly anxious
    • -Normal spirometry
    • -Nocturnal persistent dry cough
  82. H2 blocker in duodenal ulcer
    90% cure if used for 8 weeks
  83. Common variable immunodefficiency
    • Recurrent infections in ears, sinuses, nose, bronchi and lungs
    • Most common organism; H. flu, Pneumococci and Staph.
  84. Sleepwalking
    • Definition: Sleep disorder characterized by walking in one's sleep during Stage 3 or 4 of NREM sleep; aka somnambulism
    • 4-8 y/o/ 15 % of children/ more common boys and it runs in families.
  85. Foreign body in soft tissue
    • CT needed for wood and plastic.
    • X Ray can see glass and metal.
  86. Post rabies exposure
    1. Wash the wound with soap and water2. Administration of rabies Ig (RIg) so as to infiltrate all around the wound (neutralizes the virus locally)3. Administration of rabies virus vaccines on days 0, 3, 7, 14. Test animal and treat only if positive. Skunks, raccoons, foxes or bats are regarded as rabid. Bites from squirrells, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, rabbits almost never require prophylaxis
  87. Osteoporosis screening
    • Post-menopausal women with the following conditions:
    • -Prolonged use of steroids
    • -Past or recurrent Anorexia Nervosa
    • -Prolonged or recurrent amenorrhea
    • -Hyperparathyroidism
    • -RA
    • -Hyperthyroidism
  88. White fingernails
    Suggestive of Renal, Hepatic, Cardiac disease, Pneumonia, Hypoalbuminemia and Arsenic poisoning.
  89. Aortic dissection
    • - acute, life threatening!!
    • - hemorrhage into vessel wall w/  longitudinal tearing or separation
    • Marfan Syndrome is the most common disorder of connective tissue.
    • Marfan patients have a predisposition to Aortic dissection.
  90. Overactive bladder
    • Tx w anticholinergicsdry mouth, constipation, dry eyes, retention, narrow angle glaucoma.
    • They block muscarinic receptors at the detrussor muscle reducing bladder contractility.
  91. Folic acid recommendation
    Daily recommendation is 0.4 mg
  92. Colonoscopy follow up
    • 10 yrs- if no polyps or if polyps are hyperplastic
    • Less than 3 yrs - if >10 polyps
  93. Orbital cellulitis
    • - Peri orbital swelling and redness. Painful limited extra ocular movement
    • - Req IV abx and admit.
    • - Usually stept pna or staph aur
    • - Blood cultures and periorbital tissue fluid. CT scan to r/o intracranial involvement.
    • - Referral
  94. Amyloidosis
    • Beta-pleated sheet: visualized by apple-green birefringence on Congo Red stainunder Polarized Light.
    • Often accompanying diseases like Multiple myeloma, TB and RA.
    • eg. Artery wall is waxy
  95. Sarcoidosis
    Soft red brown papules and plaques located around eyes and ears.
  96. Roseola
    Several days of high fever, rash appears as fever resolves, cause by herpes 6, generalized more subtle pink rash
  97. Rocky Mountain Spotted fever
    • Caused by r. rickettsi carried by dog and wood ticks.
    • Infection causes distinct spotted migratory rash. Acute reactions include heart and CNS damage. IT IS POTENTIALLY FATAL AND REQUIRES IMMEDIATE TREATMENT.
    • Tx: Doxycycline
  98. Rubella
    Pinkish maculopapular rash in face with adenopathy
  99. Measles
    • -maculopapular viral disease caused by rubeola virus (RNA)
    • -extremely infectious (airborne)
    • -acquired by respiratory route, systemic disease with rash
    • -often complicated by secondary infections like S. aureus pneumonia and ear infections
    • -Koplik's spots- bright red spots with bluish center in molars.
  100. Eye pain treatment
    Homatropine or Cyclopentolate
  101. Positive ring test
    Rust ring that forms in cornea as a reaction to a metal foreign body
  102. Positive Seidel test
    Perforated ruptured globe
  103. Hypopyon
    • -collection of leukocytes/pus (white blood cells) in anterior chamber
    • -treat aggressively
    • -white/gray exudates in anterior chamber, injected bulbar conj, pain
    • -no direct treatment; fix underlying cause:
    • 1. Penetration
    • 2. Infection
    • 3. chronic uveitis
  104. Hutchinson's sign
    herpes zoster lesions on tip/side of nose
  105. Hypertrophic cardiomyopathy
    • Systolic murmur
    • Mitral position
  106. Mitral Valve Prolapse
    • Systolic murmur
    • Mitral position
    • Mid systolic click
  107. Mitral regurgitation
    • Systolic murmur
    • Mitral position
    • Holo-systolic murmur
    • 3rd heart sound gallop in diastole
  108. Aortic stenosis severe
    • Systolic murmur
    • Holo-systolic
  109. Aortic stenosis mild
    • Systolic murmur
    • Aortic position
    • Aortic ejection click
  110. Aortic sclerosis
    • Systolic murmur
    • Aortic position
    • Loud in early systole
    • Musical murmur
  111. Innocent murmur
    • Systolic murmur
    • Pulmonic position
    • Early systole
    • Present in pregnancy, hyperthyroidism, exercise, anemia.
  112. Systolic murmurs
    • Innocent murmur
    • Aortic sclerosis murmur
    • Aortic stenosis mild
    • Aortic stenosis severe
    • Mitral regurgitation
    • MVP
    • Hypertrophic cardiomyopathy
  113. Haldol
    Adverse event is prolonged QT and Torsades de pointes
  114. Hyperviscocity syndrome
    • Clinical manifestations when the blood's viscocity is 4-5 times of normal serum.
    • IgA has the highest viscocity
    • Initial treatment is diuresis and IVF's
  115. Hereditary spherocytosis
    • Etiology: defective spectrin or ankryn
    • Elevated MCHC, RDW
    • Splenomegaly, APLASTIC CRISIS
    •          (B19 suppresses BM)
    • Positive osmotic fragility test (lyse to NaCL)
    • Tx: splenectomy is curative.
  116. Epiglottitis v/s Retropharyngeal abscess
    Epiglottitis- mostly now seen in older population.

    Abscess- seen in children
  117. BNP
    • Peptide that causes natriuresis. Elevation indicates presence of heart failure. Helps distinguish between respiratory and cardiac dyspnea.
    • Above 100 is abnormal.
  118. Acute Iron toxicity
    Vomiting is the clinical sign mostly associated.
  119. Eclampsia
    A more serious form of preeclampsia, is characterized by convulsions and sometimes coma. treatment for this condition is delivery of the fetus
  120. Preeclampsia
    Hypertension, proteinuria, and edema in pregnancy due to decreased blood flow to organs and activated coagulation cascade.
  121. HELP Syndrome
    A complication of pre-eclampsia with a combined liver and blood clotting disorder HELLP syndrome occurs in approximately 10% of pregnant women with pre-eclampsia or eclampsia (seizures).  HELLP may occur without an associated elevation of blood pressure. H = hemolysis, EL = Elevated Liver Enzymes, and LP = Low Platelets ONLY treatment:  DELIVER THE BABY!!!!
  122. Tetanus immunization
    • 5 yrs shot- no need to re-vaccinate even if the wound is contaminated.
    • Surgical debridment needs to happen after the shots are given.
  123. Influenza
    Droplet precautions
  124. Haldol
    Adverse event is prolonged QT and Torsades de pointes
  125. Hyperviscocity syndrome
    • Clinical manifestations when the blood's viscocity is 4-5 times of normal serum.
    • IgA has the highest viscocity
    • Initial treatment is diuresis and IVF's
  126. Sleep apnea
    • Chicago criteria:
    • Normal- AHI < 5 per hour.
    • Mild- AHI 5-15 per hour.
    • Moderate- AHI 15-30 per hour.
    • Severe- AHI >30 per hour.
  127. Lyme disease
    • Rash: Bulls-eye lesion.
    • Tx only if tick is in for >24 hrs.
    • Tx with Doxycycline x 21 days.
    • Amoxicillin in young children and pregnancy.
    • Dx: Western Blot assay Antibody test
  128. Intussusception
    An infolding of a segment of the intestine within another segment; usually occurs in infants and young children and may result in bowel obstruction.
  129. Coma or altered mental status treatment
    Tx: DONT forget.

    • D- Dextrose
    • O- Oxygen
    • N- Narcan
    • T- Thiamine
  130. Chronic pain mechanism
    Central activation of the NMDA receptors.
  131. Grief
    Delirium is not present
  132. GBS + treatment
    In patients with PCN allergy you give Vancomycin.
  133. PVC's
    • Tx with B blocker only in unstable patient as 1st choice.
    • If B blockers cannot be tolerated use Amiodarone.
  134. Methotrexate
    • Contraindications:
    • Breast feeding, Immunodeficiency, Liver disease, Acute pulmonary disease, PUD

    • Relative contraindication:
    • Mass greater than 3.5 cm/Cardiac arrhythmia/ Undesired fertility
  135. Cerebral contusion
    1/3 of elderly patients with head injuries
  136. Spinal shock
    • A transiet period functional loss following injury.
    • Penetrating spinal cord trauma rarely results in spinal shock.
  137. Ischemic stroke
    • Cardioembolism in non rheumatic heart AF patients is not the main cause.
    • Unknown etiology is the most common cause.
  138. BRCA mutations
    • Autosomal dominant.
    • <10% of breast cancers.
    • Genetic testing should be done in index case when feasible.
    • If index case is not available or dead then genetic counseling should be offered.
    • BRCA1- medullary CA and serous CA of ovary
    • BRCA2- breast CA in males (invasive ductal)
  139. Salicylate toxicity
    No need for B blocker administration.
  140. Cervical spine injury in child
    If neg X ray it is a Neurosurgical emergency due to elasticity of tissues.
  141. Heat stroke
    Crystalloid resuscitation is given even in the presence of pulmonary edema.
  142. Bradycardia in aging
    In aging patient results due to apoptosis of AV pacemaker cells.
  143. Folic acid
    Women of childbearing age should use 0.4 mg per day.
  144. Appendicitis
    In a classic presentation no need for CT, surgery should be the course of treatment.
  145. Dilated cardiomyopathy
    Main cause is IHD
  146. 2nd degree AV block
    In children can be caused by Rheumatic fever. Also associated with athletes due to their increased vagal tone at rest.
  147. Sulfonylurea
    • Amaryl
    • Glyburide

    Precose does not cause hypoglycemia.
  148. Insulin
    • If c peptide is low then the insulin is exogenous.
    • If c peptide is high then the insulin is produced in islet cells.
  149. Nesidioblastosis
    Islet cell hyperplasia.
  150. Scleritis
    Inflammation of deep layer of sclera with deep boring pain.
  151. Episcleritis
    Superficial inflammation of sclera. No pain.
  152. Cullen's sign
    • Bluish discoloration of umbilicus.
    • Sx of intra-abdominal or retro peritoneal hemorrhage.
  153. Grey Turner's sign
    • Bluish discoloration or echymosis of abdominal wall or flank.
    • Sx of intra-abdominal or retro peritoneal hemorrhage.
  154. Fentanyl
    • Very low incidence of potentially serious complications in ED.
    • Can cause muscle rigidity.
    • It can be absorbed orally.
  155. Threatened abortion
    Os is closed although patient is bleeding.
  156. Inevitable abortion
    Os is open and patient is bleeding.
  157. ACTH stimulation test
    • 250 micrograms can be given at any time of the day.
    • Useless in adrenal failure due to acute ACTH deficiency.
  158. Conjunctivitis
    Most common cause is viral by Adenovirus.
  159. Ulcer
    Area most suitable for biopsy is the periphery of the ulcer adjacent to normal healthy tissue.
  160. Leg edema
    Do echo only in the presence of increased JVD.
  161. Hyperprolactinemia
    • Drugs that produce it:
    • Anti-psychotics, Cocaine, Opiates, MAOI, SSRI's, Verapamil, Methyldopa
  162. Steven Johnson's Syndrome
    Target lesions after antibiotic use.
  163. Digoxin toxicity
    • Visual color disturbances, weakness, nausea and arrhythmias.
    • Hypokalemia due to diuretics can cause digoxin toxicity.
  164. Pericarditis
    • MI, malignancy, collagen vascular disease and uremia.
    • Alcohol is not a direct cause.
  165. Multiple sclerosis
    • Plaques in MRI are not definitive dx.
    • There is no single test for diagnosis.
  166. Myasthenia gravis
    Effective tx is extra corporeal Ig elimination by immunoadsorption.
  167. Pseudogout
    Birefringent crystals in joint fluid. It can cause meniscal calcium in X-rays of the affected joint.
  168. Bronze tone of skin
    Iron overload.
  169. Von Willebrand's disease
    • - disorder of platelet function, most common hereditary coagulopathy
    • - normal platelet count, but bleeding time is markedly prolonged (normal is 3-10 min)
    • - may have prolonged PTT
    • - mucus membrane bleeding common = epistaxis, easy bruising, menorrhagia, gingival & GI bleeding
    • - may also have low factor VIII
  170. Marfan's Syndrome
    • Genetic disorder of connective tissue.
    • Sx: Long limbs, dislocated lenses, aortic root dilatation
  171. Vitamin D toxicity
    Muscle weakness, anorexia, polyuria, polydipsia, HTN, hypercalcemia
  172. Fibromyalgia
    Tx with Lyrica, Savella or Cymbalta.
  173. HgbA1c
    In patients with anemia that have uncontrolled DM you can see a normal HgbA1c level due to new RBC not having time to accumulate glycosylated Hgb.
  174. Peutz Jegher's Syndrome
    • Hereditary polyposis syndrome.
    • Polyps and pigmentation in lips.
  175. MEN I
    • Parathyroid hyperplasia.
    • Parathyroid adenoma.
    • Pituitary adenoma (Prolactinoma)
    • Pancreatic tumors
  176. MEN IIA
    • -Medullary thyroid CA
    • -Pheo
    • -Parathyroid adenoma or hyperplasia.
  177. MEN IIB
    • Medullary thyroid CA.
    • Pheo
    • Mucosal and GI ganglio-neuromatosis.
  178. MEN IV
    • Bilateral pheo
    • Hyper-parathyroidism
    • Paraganglioma
    • Thyroid hyperplasia
    • Carcinoid tumor
    • Hyperplasia of endocrine pancreas
  179. Hepatitis C treatment
    • Ribavarin
    • Peg Interferon
  180. Cluster HA's
    • -More common in men.
    • -Especially at night.
    • -Last 30-60 min.
    • -Sympathethic paresis.
  181. Selenium
    Major component of Antioxidant System.
  182. Live attenuated vaccines
    • MMR
    • Oral polio
    • Varicella
  183. Fat pad in elbow
    • Ortho emergency.
    • Treat as an undisplaced fracture of elbow, supracondylar fracture is the most common.
  184. Renal cell carcinoma
    • Triad of initial symptoms:
    • -Gross hematuria.
    • -Flank pain.
    • -Abdominal mass.
  185. Cauda equina syndrome
    • Mid-line rupture of disc at L4-L5.
    • Urinary retention is the most consistent finding.
  186. IV regional anesthesia contraindications
    • Scleroderma
    • Raynaud's
    • Tumors
    • Increased intracranial pressure.
    • Sickle cell
    • DVT
    • Vascular insufficiency

    Due to exanguination and the use of tourniquet.
  187. Histoplasmosis
    • Fastest test for diagnosis is
    • Urine Elisa test for antigen.
  188. Wegener's granulomatosis
    Respiratory damage plus renal disease with mild glomerulitis with proteinuria, hematuria and RBC casts.
  189. Small cell CA of lung
    • Associated with paraneoplastic syndromes.
    • Cushing's and Lambert Eaton.
  190. Alcoholic ketoacidosis
    2ry to inadequate intake of CARBOHYDRATES
  191. Neuroleptic malignant syndrome
      • due to increased dopamine blockade throughout the body 2nd to anti-psychotic tx
      • usually early in tx course
      • FEVER: Fever, Encephalopathy, Vital signs are unstable, Elevated creatine phosphokinase 2nd to muscle breakdown and Rigid muscles
      • Treat with dantrolene and bromocriptine
  192. Herald patch
    • Pityriasis rosea
    • Causes discomfort
  193. PCOS
    • First line of tx for infertility is Clomiphene.
    • If that fails you can add Metformin.
  194. PPD testing
    • False + = BCG vaccine (assume they have TB)
    • False - = Immunodeficiency
    • Positives: induration
      • 5mm: close contacts, old CXR evidence, HIV
      • 10mm: foreigner, prison, IVDU, Health Care worker, infants
      • 15mm: pt's with no other risk factors
  195. Heckerling Decision Rule
    • Determining the need for a CXR in a patient with pneumonia.
    • Fever >100
    • HR >100
    • Tachypnea >20
    • Decreased BS, rales in the absence of asthma
  196. Amiodarone
    Can produce dyspnea by producing pulmonary fibrosis.
  197. Wide pulse pressure
    • Hyperthyroidism
    • Pregnancy
  198. Dyspnea
    • Can use opiates at low dose for anxiety.
    • Do not use Benzodiazepine because of sedation and decreased respiratory effort.
  199. Chronic cough
    Lasting more than 30 days.
  200. Normal cough
    • -Up to 11 times a day in children.
    • -Maybe habit in adults.
    • -Tourette's syndrome
  201. Nasal signs
    • Red mucosa in pt with a cold.
    • Pale mucosa in pt with allergies.
  202. VQ scan
    • Check blood flow and ventilation exchange
    • For Pulmonary Embolism- normal ventilation with decreased perfusion.
  203. Pulmonary Embolism
    • D dimer is sensitive. Will rule out the diagnosis.
    • Treatment for reversible causes is Warfarin for 3 months.
  204. Sensitivity v/s Specificity
    • Sensitive- If + rules out SNOUT
    • Specificity- If + rules in SPIN
  205. Trouseau's Syndrome
    • -Migratory thrombophlebitis.
    • -Sign of  malignancy.
    • -Warfarin does not work, treat with Heparin.
  206. Xeralta
    • -Direct factor Xa inhibitor.
    • -No need for INR monitoring.
    • -Cannot be reversed rapidly.
    • -Interacts with Plavix.
  207. Cystic fibrosis
    • -GI and Pulmonary sx especially in children and adolescents.
    • -GI- Pale and clay color stools
    • -Dx test is sweat chloride test
    • -Avoid contact sports, can exercise.
    • -Vaccines up to date, Pneumovax and Influenza.
    • -MTV with D, E, K, A.
    • -Pancreatic enzyme supplementation.
  208. Lung CA
    • Risk is 20X in smokers, Menthol cigarettes higher risk, Radon gas, Cigar smoking but not marihuana.
    • Screening- CXR no benefit. CT only in high risk. (current or former smokers, Age 55-74, 30 pack year hx, no lung CA)
    • Gold standard for diagnosis is BIOPSY.
    • Small cell- SIADH secretion, very low 5 yr survival.
    • Non-small cell- Better survival than small cell.
    • Prevention: Eat more vegetables.
  209. Procalcitonin
    • Biomarker that becomes elevated during bacterial infections; appears to reflect severity of infections. Viral infections level less than 0.25.
    • Bacterial infection >0.50
  210. Pneumonia
    • Who to hospitalize?
    • CURB65
    • C- Confusion-
    • U- Urea BUN > 19-
    • R- Tachypnea >30-
    • B- Systolic BP<90 or diastolic <60
    • 65- Age > 65 y/o
    • 1 point each- >= 3 points need to hospitalize.
  211. Community acquired pneumonia
    Tx with Macrolide, Doxycycline or Fluoroquinolone but no Cipro.
  212. Pneumovax
    • All children <23 months.
    • High risk children older than 2 y/o should get PCV7 if no prior vaccination.

    • All adults > 65 y/o.
    • Insitutionalize adults.
    • Co-morbidities.
    • Alcoholics and HIV.
    • Splenectomy pt or Sickle cell do q 5 yrs.
  213. Acute bronchitis
    •   Inflammation of the trachea and bronchi that is self-limiting, of short to moderate duration
    •         DX: few pulmonary signs but may be the result of chemical irritants or virus 90%
    •         Complications: Usually mild except w/ elderly and chronic disease
    •   Treatment is symptomatic, involving cough 
    •  suppressants, rest, and hydration
  214. Pertussis
        1. Catarrhal stage: Unidentifiable cough/cold, low fever, 1-2 weeks
      Paroxysmal stage: rapid outbreaks of coughing, difficulty expelling thick mucus, high pitched whoop, 2-5 weeks
    • Convalescent stage: gradual recovery, subsequent respiratory infections, 1-2 weeks.
  215. Pertussis
    • Whooping cough, DTap vacc.
    • Tx 1.Macrolide 2. Rifampin
    • Rifampin can cause orange coloration of mucosa.
    • Respiratory isolation until 5th day of antibiotic is given.
  216. Bronchiolitis
    • RSV is main cause.
    • Prevention only in premature children with Synagis.
    • High risk infants:
    • -Less than 2 yrs with chronic lung disease
    • -Less than 1 yr old born 28 weeks or earlier
    • -Less than 6 mo old born 29-32 weeks
    • -Less than 6 mo born 32-35 weeks with one risk factor (day care or 3+ siblings)
  217. TB
    • Best diagnosis in physical exam is rales in apex after cough.
    • Newer screening method in BCG + pt is IGRA which is a test  for response of Mycobacterium tuberculosis antigens.
    • Tx: INH 6-9 mo. or Rifampin.
  218. Spirometry
    • Screening tool in:
    • -Smokers age >56
    • -Preop testing
    • -Occupational exposure
    • -Baseline testing before chemo or Amiodarone.
  219. Obstructive disease
    Asthma v/s COPD
    • Both show abnormal spirometry.
    • Difference is reversibility.
    • Asthma will show FEV1 increase by 15%. COPD will show no or minimal reversibility.
  220. COPD
    • Gold criteria
    • Stage 0- Normal spirometry
    • Stage I- Mild COPD
    • Stage II- Moderate COPD
    • Stage III- Severe COPD
    • Stage IV- Very severe COPD- resp failure or Right heart failure.
  221. COPD treatment
    • Stage 0- Decrease risks
    • Stage I- Short acting bronchodilator
    • (1st anticholinergics- Atrovent to decrease mucus)
    • Stage II- Combination bronchodilators
    • Stage III- Add inhaled corticosteroid
    • Stage IV- Add O2 and consider lung reduction surgery
  222. Smoking cessation
    • 5A's
    • Ask, Advise, Asses, Assist, Arrange
    • Pulmonary rehab does not increase survival.
    • O2 and smoking cessation improve survival in COPD.
  223. Asthma classification
    • Intermittent- Sx < 2 d/wk
    • Mild persistent- Sx>2 d/wk minor interference w activities
    • Moderate persistent- Sx daily.
    • Severe persistent- Sx throughout the day.
  224. Asthma treatment
    • Step 1- Albuterol
    • Step 2- Low dose ICS
    • Step 3- Low dose ICS + LABA (Serevent)= Advair
    • Step 4- Medium dose ICS + LABA
    • Step 5- High dose ICS + LABA
    • Step 6- High dose ICS + LABA + oral steroid
    • Leukotriene- can be steroid sparing
    • Do not use LABA by itself use w ICS
    • Xolair for allergic patients, Mag sulfate in children.
    • Bronchial thermoplasty very mild response
  225. Peak flow in asthma
    • Personal best!
    • Green zone: 80-100%
    • Yellow zone: 50-79%
    • Red zone: <50%
    • Start plan of action in yellow zone.
  226. Valsalva manuever
    • Increases murmur of hypertrophic cardiomyopathy.
    • Decreases most other murmurs.
  227. PEG tube
    • Risk of use of restraints increases.
    • No decreased risk of aspiration.
    • Do not improve nutritional status or quality of life in dementia patients.
  228. Patients with ocular problems
    • Should have visual acuity tested first.
    • Exception is chemical burn where you irrigate for 30 minutes first.
  229. Hearing loss in newborns
    Most common cause is genetics.
  230. Secondary hypothyroidism
      • Due to destruction of pituitary gland
      • Loss of TSH
      • Results in low T3/T4, high TRH, low TSH
  231. Herbal for anxiety disorder
    • Kava
    • Caution alcohol use due to liver mechanism.
  232. Tx for Atrial flutter and AF
      • If unstable, cardioversion
      • If stable or chronic, rate control with calcium channel blockers or beta-blockers AND anticoagulate
  233. SIDS
    • unknown cause
    • incidence: lower in 1st month, increased at 2nd mo, peak at 3-4 mos, usually no chance after 6 mos
    • seasonal variability
  234. BP control after ischemic stroke
    • -goal is to achieve 10-15% reduction in BP w/in the 1st 12-24 hours!!
    • -lower if:
    • --->BP is> 220-140mmHg (if NOT eligible for t-PA)
    • --->BP is >180/105mmHg in pts. given t-PA
    • --->evidence of aortic dissection or MI
    • --->Pulmonary edema, hypertensive encephalopathy, or acute renal failure
  235. Troponin elevation
    Can happen in patients with myocardial damage after chemotherapy.
  236. Metabolic syndrome
    • Atherogenic dyslipidemia- High Trig + Low HDL
    • Insulin resistance
    • Elevated BP
    • Obesity (waist circumference)
  237. ASHD Major risk factors
    • Age
    • Family Hx- Male <55 y/o, Female <65 y/o
  238. CAD Equivalent Conditions
    • -DM
    • -Atherosclerosis of non-coronary arteries- (low ABI, carotid bruits, TIA or ischemic stroke, aortic aneurysm)
    • -CKD
    • -Framingham risk score >20%
  239. Framingham Risk Calculator
    • Age, gender, TC, HDL, smoking status, systolic BP, diagnosis of HTN.
    • It predicts 10 year risk of MI or cardiac death.
  240. Factors NOT associated with increased ASHD
    • OCP use in non-smokers
    • HIV infected patients
    • Dairy consumption
    • Egg consumption <2/day
    • Coffee consumption
    • Serum K level
    • Leptin level
  241. Secondary prevention of ASHD
    • Early sx response education
    • NTG SL use
    • LDL <100
    • HDL >40 (Niacin best alternative)
    • Dietary restrictions (Low fat, low cholesterol, low trans fatty acids)
    • Dietary supplements (Fiber, Omega 3 fatty acids)
    • Weight loss (loss of 10% body weight)
    • Exercise (30 min/day 5 d/wk)
    • Smoking cessation
    • BP control (Procardia should never be used for tx of HTN)
    • ACE or ARB for STEMI patients
    • B blockers for MI, ACS or systolic dysfunction
    • ASA (75-162 mg)
    • ASA + Plavix for 1 year in post PCI pt's
    • ASA + Plavix + Warfarin if in addition the pt has a DVT.
  242. Angina treatment
    • Multiple studies show no difference in rate of MI or death between revascularization and medical management.
    • Decision to pursue intervention is dependent on sx, severity of ischemia on imaging, prognosis and an informed discussion.
  243. Medications to use for Angina
    • B blockers
    • Long acting Ca channel blockers
    • Nitrates (not better than B blockers or Ca++)
    • Ranolazine (Ranexa) slight reduction
    • Atorvastatin
    • Magnesium supplementation
    • Coenzyme Q10
    • Chinese herbal medications (Shenshao tablets)
    • Testosterone
  244. Atenolol
    • Does not offer cardioprotection.
    • Use Carvedilol instead.
  245. Pre-hypertension
    • Most patients graduate to HTN in less than 1 year.
    • BP 120-139/80-89
  246. Neurogenic bladder
    • Dysfunctional urinary bladder due to lesion of central or peripheral nervous system.
    • Causes: DM, MS, Spinal cord injury.
    • A set schedule for urination is the treatment .
  247. Hematuria
    • More than 3 RBC/hpf.
    • Up to 10% have malignancies.
    • Need to do complete workup.
    • US, Cytology and Cystoscopy.
  248. Streptoccocus bovis infection
    Associated with occult colonic malignancies
  249. Specificity
    The ability of the test to identify correctly those who do not have the disease.

  250. Sensitivity
    Proportion of diseased correctly identified as positive.

  251. Number needed to treat
    The expected number of people who would have to receive a treatment to prevent an unfavorable outcome in one person; a small NNT indicates a more effective intervention.

    NNT=1/ARR (or Absolute Rate Reduction)
  252. Negative predictive value
    Proportion of persons w/ negative test who do not have condition

    NPV= d / (c+d)
  253. Positive predictive value
    Proportion who test positive with disease. Probability that a person that tests positive actually has the disease.

    True positives / all those with a positive test result.
  254. CAGE-AID questionnaire
    • C: concerned, cut down
    • A: annoyed
    • G: guilty
    • E: eye-opener

    Adapted to Include Drugs
  255. Demerol
    Should be avoided in elderly due to risk of seizures.
  256. Traveler's diarrhea
    • Adults- Cipro
    • Children less than 12- Zithromax
  257. Polymyalgia rheumatica
    There is no increase in CK levels.
  258. Latex allergic patients
    Can have allergies to foods:

    • Avocados
    • Bananas
    • Chestnuts
    • Kiwi
  259. Thiazide
    • Decrease urinary Calcium
    • Decrease risk in kidney stones
  260. Loop diuretics
    • Increase urinary Calcium
    • Increased risk of kidney stones
  261. Granuloma annulare
    • Self limiting immune response to unknown Ag causing necrosis and granulomas.
    • No treatment needed.
  262. Hawkins test
          • assesses shoulder rotator cuff impingement or tear

          • abduct shoulder 90*

          • flex elbow90*, internally rotate to it's limit

          • pain indicates inflammation or tear

          • Rotator cuff: Supraspinatus, Infraspinatus, teres minor and subscapularis muscles.
  263. TB test in pt with BCG in the past
    IGRA-Interferon Gamma Release assay
  264. TB tx
    • First choice INH for 9 mo
    • 2nd Rifampin for 4 months
  265. Spirometry results in obstruction
    FEV1 low, FVC normal, FEV1/FVC ratio low
  266. Spirometry results in restrictive disease
    FEV1 low, FVC low, FEV1/FVC ratio normal
  267. Smoking cessation
    • 5A's
    • Ask
    • Advise
    • Assess
    • Assist
    • Arrange
  268. COPD treatment
    • Pulmonary rehab does not improve survival.
    • Oxygen supplementation improves survival.
    • Smoking cessation improves survival.
  269. Asthma treatment
    • Intermittent- B agonist prn
    • Mild persistent- Add medium strength ICS
    • Moderate persistent- Add LABA
    • Severe persistent- Add LK or oral steroid

    • LK is steroid sparring drug.
    • Xolair for patients with severe allergic asthma.
    • Systemic steroids work in 6-8 hours.
    • Magnesium sulfate improves lung function.
  270. Peak flow in asthma
    • Use personal best.
    • Green zone- >80% of personal best
    • Yellow zone- 50-80% of personal best
    • Red zone- <50% of personal best
    • Start plan of action when in yellow zone.
  271. Sleep apnea
    • Apnea Hypopnea Index (AHI)
    • Chicago criteria:
    • Normal- AHI < 5 events per hour of sleep
    • Mild OSA- AHI 5-15 events/ hr
    • Moderate OSA- AHI 15-30 events/hr
    • Severs OSA- AHI >30 events/hr
  272. Metabolic syndrome
    • Atherogenic dyslipidemia- High TG and Low HDL
    • Insulin resistance
    • Elevated BP
    • Obesity (waist circumference)
  273. CAD Major risk factors
    • Age
    • FHX on 1st degree relative M<55 y/o, F<65 y/o
    • Smoking
    • Elevated C reactive protein
    • DM
  274. CAD Equivalent conditions
    • DM
    • Atherosclerosis of non coronary vessels
    • CKD
    • Framingham score >20%
    •       Framingham score predicts the 10 yr risk of cardiac death using the following; Age, gender, TC, BP, smoking status.
  275. Secondary prevention for high lipids
    • Diet restrictions
    • Low saturated fats <7%
    • Cholesterol <200 mg/day
    • Minimize trans fatty acids

    • Supplements:
    • Fiber 10 g/day
    • Omega 3 fatty acids 1g/day
  276. BP classification
    • Prehypertension- 120-139/80-89
    • Stage I- 140-159/90-99
    • Stage II- >160/100

    Home BP readings correlate better to target organ damage and CV outcomes
  277. DASH Diet
    • Dietary Approaches to stop hypertension
    • Is low in salt, saturated fat, cholesterol and total fat.
    • Emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products.
    • Includes whole grains, fish, poultry and nuts.
    • Limits the amount of red meat, sweets, added sugars and sugar-containing beverages in your diet.
    • Is rich in potassium, magnesium and calcium, as well as protein and fiber.
  278. BP changes
    • OCP's increase BP
    • HRT does NOT increase BP.
  279. BP treatment
    • Do not forget Chlorthalidone.
    • Double the potency of HCTZ.
    • Produces hypokalemia.
  280. BMI definition
    BMI= Weight/Height to the square
  281. Tetralogy of Fallot
    • Cyanosis
    • Pulmonary ejection systolic murmur
    • RVH
    • Single Second Sound (Aortic)
  282. CHF definitions
    • Systolic CHF- EF <40%
    • Diastolic CHF- EF >50%

    • Staging of CHF:
    • A- At risk for HF but no structural damage
    • B- Structural heart disease without CHF sx.
    • C- Structural heart damage with prior or current CHF sx.
    • D- Refractory CHF.

    Dx BNP secreted more in ventricles with increased intraventricular pressure. Level over 100 is very sensitive for dx of CHF.
  283. Hypothyroidism is associated with
    • Galactorrhea
    • Cushing's
  284. Paget's disease
    Treatment with Fosamax
  285. Osteoporosis risk factors
    • Age
    • Caffeine 
    • Female sex
    • Late menarche
    • Early menopause
    • Cigarette smoking
    • Family history
    • Low BMI
    • Steroid use
    • Asian ethnicity
    • Heavy alcohol use
    • Whites more than blacks or hispanics
  286. Metformin use in kidney disease
    • Not to be used in creatinine over
    • >1.5 in males
    • >1.4 females.
    • Creatinine clearance less than 70 ml/min
  287. BNP
    • Normal less than 100.
    • >400 is usually CHF
  288. Interstitial cystitis
    • Dysuria, frequency, urgency, nocturia, dyspareunia, pelvic pain.
    • Sx with negative urine culture, no genital infection sx, no radiation.
    • Dx with cystoscopy.
  289. Iron supplementation is affected with
    • Increased:
    •      Acidic environment
    •      Ascorbic acid Vit C
    • Decreased:
    •      Antacids
    •      Soy protein
    •      Tea
    •      Bran
  290. Genital herpes incubation period
    4 days
  291. Bariatric surgery indications
    • BMI >35 with medical conditions
    • BMI >40 with associated medical conditions.

    Alcohol abuse is a contraindication for bariatric surgery.
  292. Ehrlicosis
    Transmitted by Lone Star Tick
  293. Schistosomiasis vector
    Fresh water snails
  294. Plague transmission vector
  295. Arrhythmia associated with sudden death in patients with prolonged QT
    Torsades de pointes (V fib)
  296. What single gene disorder is the most common in white americans?
    Hereditary hemochromatosis

    • Classic triad is: Cutaneous hyper pigmentation
    •                      Cirrhosis
    •                      DM
  297. Supplemental Oxygen needed at what O2 sat?
    Sea level PO2 less than 70
  298. Polycythemia vera
    Epo levels are low  in primary cases
  299. Which malignancy is associated with B HCG?
    Liver and germ cell tumors
  300. Celiac disease
    • Most common presentation:
    •       Anemia (Iron deficiency) and Osteoporosis or Osteopenia
    • Lab for diagnosis:
    •       Endomysial antibody
    • Diet intolerance to GLUTEN
    • Diagnostic test: Xylose absorption test, biopsy of jejunum.
  301. SVT drug of choice in stable patient
  302. Treatment for Salmonella enterocolitis
    • Observation
    • Antibiotics are contraindicated because they tend to prolong the carrier state.
  303. Restless leg syndrome treatment
    Dopamine agonist
  304. WPW
    • Delta waves (Ski slope in QRS)
    • Widened QRS
    • Short PR interval
    • Bradycardia
    • Inverted T wave without reciprocal ST elevation.

    Medications that can cause V Fib in these patients are: Digoxin and Verapamil.
  305. Sickle cell treatment of painful crisis
  306. Bell's palsy
    Differentiation from a central supranuclear process
    • Bell's palsy there is weakness of the entire face.
    • Supranuclear process the weakness is partial.
  307. Loffler's syndrome
    Parasitic infection of Ascariasis
  308. Rebound hypertension
    Alpha antagonist like Clonidine
  309. Amiodarone
    • Hypothyroidism
    • Pulmonary toxicity (Pulmonary hypertension)
  310. Cushing's disease
      • metabolic disorder
      • abnormally increased secretion of cortisol, caused by increased amounts of adrenocorticotropic hormone (ACTH) secreted by pituitary gland
      • Dx test: Dexamethasone suppression test
  311. Addison's disease
    • Primary adrenal insufficiency
    • hyperkalemia (>5),
    • hyponatremic (131) b/c secreting K means losing Na + b/c ↓cortisol>> BP low >> SIADH secretion (↑water retention, losing Na/ dilutes Na concentration)
    • hyperpigmentation
    • Dx; ACTH (Cosyntropin) stimulation test
  312. Creutzfeldt-Jakob Disease
    • "Mad cow disease" in humans
    • Spongiform changes in brain
    • Seizures
    • FATAL
  313. Hypercoagulable state conditions
    • Antithrombin III deficiency
    • Protein C deficiency
    • Protein S deficiency
    • Factor V Leiden mutation
    • Lupus anticoagulant
    • Antiphospholipid syndrome
  314. Alport's syndrome
    Glomerulonephritis with deafness
  315. Tumor marker
    • Pancreatic cancer- CA 19-9
    • Breast cancer- CA 15-3, 27-29
    • Bladder cancer- NMP22
    • Melanoma- S-100
    • Testicular cancer- LDH
    • Medullary carcinoma of thyroid- Calcitonin
  316. Jaundice treatment with photo-therapy
    • >15 in 25-48 hrs old
    • >18 in 48-72 hrs old
    • >20 in older than 72 hrs old.
  317. Risk factors for retinal detachment
  318. Renal tubular acidosis
    Type 1: distal tubules, can't excrete H+ (hypokalemia)

    Type 2: proximal tubules, can't reabsorb HCO3- (hypokalemia)

    Type 4: can't respond to aldosterone (hyperkalemia)
  319. Sun damage
    • UV B rays are the dangerous.
    • PABA is used in sunscreens.
    • Pt's with allergy to Thiazides, benzocaine and sulfonamides can react to PABA.
  320. Cocaine overdose
    • Diazepam for neurologic symptoms.
    • Phentolamine for arrhythmias.
  321. CHADS2 score
    • C = cardiac failure
    • H = HTN
    • A = Age >75 y/o
    • D = Diabetes
    • (Each 1 point)
    • Stroke or TIA= 2 points
    • More than 2 points you anticoagulate with Warfarin. Less than 2 points only ASA needed.
    • determines risk of stroke
    • Regardless of the approach, the need for anticoagulation is based on stroke risk and not on whether sinus rhythm is maintained.
  322. U wave
  323. QT prolongation
    • Calcium
    • Magnesium
  324. Atrial fibrillation
    • Rate control is as effective as rhythm control.
    • 10% EF improvement can be seen with rate control.
  325. Pradaxa
    • Indication for AF.
    • Direct thrombin inhibitor.
    • Less variable anticoagulant effect.
    • No antidote
    • It is dialyzable. Renal metabolism, no hepatic metabolism.
  326. Xarelto
    • Indication for AF, DVT and PE.
    • Factor Xa inhibitor
  327. SBE no longer indicated in:
    • MVP with or without murmur
    • Bicuspid aortic valve
    • GI/GU procedures
  328. SBE meds
    • Amoxicillin 2gm 30-60 min before procedure
    • In Pen allergic patient is Cephalexin, Zithromax, Biaxin or Clindamycin.
  329. Anticoagulation in valve replacement
    • Pig valves- No
    • Mechanical valves- Yes
  330. Aortic regurgitation
    • Austin flint murmur in diastole
    • Heard in L sternal border
  331. TIMI score
    • Thrombolysis in MI risk score is used to risk stratify patients to help determine which should undergo aggressive treatment. Event rates increase significantly as the TIMI risk score increases. Each of the 7 risk factors is one point.
    • Age >65
    • > 3 CAD risk factors
    • Known CAD
    • ASA less than 7 days ago
    • Recent angina
    • Increased Troponin
    • ST elevation
  332. Jones criteria:
    Rheumatic fever
    • Major:
    • Carditis
    • Polyarthritis
    • Sydenham chorea
    • Erythema marginatum (painless rash)
    • Subcutaneous nodules

    • Minor:
    • Arthralgia
    • Fever
    • Elevated acute phase reactant
    • Prolonged PR interval
  333. Allodynia
    • When non painful things become painful.
    • Disorder of pain processing.
    • Fibromyalgia
  334. Pauciarticular
    Few joints affected < than 5.

    Polyarticular- many joints
  335. OA
    • You can see morning stiffness
    • Lasts 15 min v/s RA which lasts 1-2 hrs.

    • Heberden nodules- DIP
    • Bouchard nodules- PIP
  336. Capsaicin
    Substance P depleter
  337. Wilm's tumor
    • Malignant kidney tumor (Nephrobalstoma)
    • Small round blue cell tumor of kidney of
    •         1-5 y/o
    • Presentation: flank mass + hematuria

    • Likes to invade vessels
    • Tx- surgery, chemo
  338. Rheumatoid factor
    • RA 80%
    • SLE, Sjogren's
    • Hep B and C
    • SBE
    • Lung disease
  339. Most specific test for RA
    Anti-citrullinated protein antibody

    • Most specific than RF
    • Correlates with erosive arthritis.

    • Earliest X Ray finding is periarticular osteopenia.
    • Most common X Ray findings is articular joint erosions.
  340. Spine concern in RA
    Cervical spine due to possibility of medullary cord compression.
  341. RA treatment
    • Methotrexate is the best drug. Adding folate decreases the toxicity.
    • DMARD start early to reduce joint damage.
    • Plaquenil- yearly retinal exam due to retinal toxicity.
    • TNF- tumor necrosis factor inhibitors- may reactivate TB and risk of lymphoma
  342. JRA
    • More common in girls < 7 y/o
    • Associated with + ANA and uveitis.
    • RF + has worse prognosis
  343. Felty's syndrome
    • RA
    • Splenomegaly
    • Granulocytopenia
  344. Rheumatic fever
    Long term Penicillin G or Macrolide prevents recurrences.
  345. SLE
    • Most specific test is
    •      Positive antibody against double stranded DNA. dsDNA
    • Best treatment is Cell-cept since it is less toxic.
  346. Triad of reactive arthritis
    • Joint
    • Eye
    • GU inflammation

    Asymmetric arthritis
  347. Scleroderma diagnosis
    Anti-Scl-70-topoisomerase antibody is highly specific.
  348. Legg-Calve Perthes Syndrome
    • Can present with hip or knee pain when hip is moved.
    • Hip osteochondritis with idiopathic avascular osteonecrosis.
    • Young kids
  349. Slipped Capital Femoral Epiphysis
    • Fracture of the growth plate of head of the femur.
    • Can present with knee and hip pain.
    • Adolescents
  350. Thalidomide
    Used for bone pain in Multiple Myeloma patients.
  351. Retropharyngeal abscess pt
    Will not look up due to neck pain.
  352. Cervical radiculopathies
    • C5- weak biceps
    • C7- weak triceps
    • C8-T1- weak hand
  353. Syringomyelia
    Loss of pain and temperature sensation in back and arms.
  354. Disc herniation v/s Myelopathy
    Disc herniation- Decreased reflexes

    Myelopathy- Increased reflexes
  355. Nerve root involvement
    • L2- Decreased hip flexor strength
    • L3- Decreased patellar reflex, weakness in quadriceps muscle
    • L4- Pain in anterior leg
    • L5- Weakness in anterior tibialis, great toe, and hip
    • S1- Decreased Achilles tendon reflex
  356. In a patient with calcaneus fracture
    Always X Ray the low back due to high probability of lumbar fracture due to fall.
  357. Jones fracture
    • 5th metatarsal fracture
    • High degree of non-union without fixation.
  358. Tarsal tunnel syndrome
    • Entrapment of the tibial nerve.
    • Dx with EMG.
  359. Rupture of Achilles tendon
    • Can happen with Dexamethasone and Quinolones.
    • Clinical diagnosis- Thompson test
  360. Baker's cyst
    If related to intra-articular condition fixing the condition will make the Baker's cyst get better.
  361. Knee ligament problems
    • ACL- usually need surgery.
    •         Lachman test +

    PCL- no need for surgery
  362. Osgood-Schlatter Disease
    Epiphysitis of the tibial tubercle.
  363. AVN of the femur in adults
    Risk factor is daily alcohol use > than 3 drinks per day.
  364. Congenital Hip Dysplasia
    • Barlow and Ortolani Maneuver
    • Dx: Early with US, after 3 months X Ray.
  365. Hip dislocations
    90% are posterior.
  366. Fracture associated with Fosamax use
    Transverse proximal femoral shaft fracture
  367. Clavicle fractures
    Most respond to conservative treatment.
  368. Shoulder dislocations
    Most are anterior
  369. Scaphoid fracture
    • Frequent delay in diagnosis
    • Splint for 7-10 days then redo X Ray.
    • If after that still pain then do CT, MRI or bone scan.
    • Frequent non-unions.
  370. Gamekeeper's thumb (Skier's thumb)
    Tear of the ulnar collateral ligament
  371. Mallet finger v/s Boutonniere deformities
    Mallet is DIP

    Boutonniere is PIP
  372. Fracture healing
    Impaired by:

    • Colchicine
    • NSAID's
    • Steroids
  373. Cancers with metastasis to bone
    Lead kettle (Pb Kettle)

    • Prostate
    • Breast
    • Kidney
    • Thyroid
    • Lung
  374. SIRS
    Systemic Inflammatory Response Syndrome

    • Temp <36 or >38.
    • Heart rate >90
    • Respiratory rate >20 or PCO2 <32
    • WBC's <4,000 or >12,000 or >10% bands
  375. Gastroparesis
    In a diabetic patient BYETTA worsens gastroparesis.
  376. HgbA1c >9
    Initial treatment is Insulin.

    Every other oral medication will decrease A1c by 1 point each.

    Average sugar= (HgbA1c -2) x 30.
  377. GTT
    • Every pregnant patient should have a Glucola test with 50gm of sugar.
    • If abnormal then needs a 3 hr GTT.
    • Abnormal results would be:
    •      Fasting >95
    •      1 hr >180
    •      2 hrs >155
    •      3 hrs >140
    • Elevations in any two is abnormal
  378. Type I DM
    • C peptide levels are absent.
    • Insulin usually split 50-50 between long acting and short acting.
  379. Hyperosmolar state
    • High glucose but no ketones.
    • Is a precursor of DKA
  380. DKA
    Start replacing K when K is below 5.
  381. Pituitary hormones
    • ADH
    • Oxytocin

    • Come from posterior pituitary.
    • PAO
  382. Cushing's Disease
    Excess ACTH.

    Sx. weight gain, hypertension, DM, proximal muscle weakness, violaceous striae, acne and hirsutism
  383. Addison's disease
    Adrenal insufficiency (WADAO- weak and dizzy all over)

    • Sx:
    • Weakness
    • Fatigue
    • Anorexia
    • Abdominal pain
    • Orthostatic hypotension
    • Salt craving
    • Hyperpigmentation of the skin
  384. Central or Secondary Hypothyroidism
    Low TSH and Low T4. Increased TRH
  385. Circulating thyroid hormones
    T4 main product of thyroid gland. Levothyroxine or T4 is the tretment of choice for hypothyroidism.

    • T3 is the active hormone at the cellular level.
    • T3 comes from the peripheral conversion of T4.
  386. Cretinism
    Stunted physical and mental growth due to congenital thyroid deficiency.
  387. Iodine therapy in thyroid disease
    Iodine 123 is for diagnosis.

    Iodine 131 is for treatment
  388. Anti-thyroid medications
    PTU and Methimazole have high risk of agranulocytosis.
  389. Thyroid nodule evaluation
    • If TSH is normal then do FNA then get thyroid scan. If cancer or microfollicular disease then surgical referral.
    • If macrofollicular disease then follow exam and US.
  390. Thyroid cancers prognosis
    Better to worse:

    • Papillary
    • Follicular
    • Medullary
    • Anaplastic- worse prognosis, does not produce thyroglobulin
  391. Anaplastic carcinomas
    Prostate- do not produce PSA

    Thyroid- do not produce thyroglobulin.
  392. Hypothyroidism in pregnancy
    Will require 25-30% more thyroid hormone in pregnancy after the first month.
  393. Thyroid scan
    Increased in GRAVES' disease, decreased in others.
  394. Diuretic effects in Calcium
    Thiazides- decrease Calcium in urine and increase in blood.

    Loop diuretics- increase Calcium in urine and decrease in blood. Used in kidney stones pts.
  395. Hypocalcemia
    • Produced by hypoparathyroidism
    • Vit D deficiency.

    Produces QT prolongation.
  396. Hypercalcemia
    • Thyrotoxicosis
    • Vitamin D intoxication
    • Adrenal insufficiency
    • Milk alkali syndrome
    • Thiazide diuretics
    • Lithium
    • Sarcoidosis
    • TB
  397. Calcium and Phosphorus
    • PTH- Raises Ca+, Slight lowering of PO4.
    • Vit D 1-25- Raises Ca+, Raises PO4.
    • Calcitonin- Lowers Ca+, lowers PO4
  398. Felon
    Infection of the distal pulp space of a phalanx.
  399. Trichinosis
    Parasitic infection from eating raw PORK, BEAR or WALRUS.
  400. Leishmaniasis
    Tx with Antimonial compound
  401. Ankle sprain
    Most common ligament affected is

    Anterior Talofibular Ligament.
  402. Alcoholism
    Is not a risk factor for MI
  403. Lung cancers
    • Small cell- SIADH secretion, Cushing's, Eaton Lambert.
    • Squamous cell- Hypercalcemia
    • Large cell- gynecomastia
    • Adenocarcinoma- Clubbing, thrombophlebitis
  404. Diverticular disease
    R sided diverticuli are more likely to bleed than L sided.

    L sided get more infected.
  405. Pyloric stenosis
    • Males
    • 1st child
    • Neonates
    • Metabolic alkalosis
    • Hypochloremia
  406. Zollinger-Ellison Syndrome
    • Gastrinoma
    • Sx: severe PUD, diarrhea
    • Tx: PPI, surgery
  407. Long term PPI
    Associated with gastric polyps which are pre-malignant.
  408. Gastric bypass patient annual labs
    • Vit B12
    • CBC and ferritin
    • PTH and Calcium
    • Vit D
  409. Colonic pseudoobstruction v/s Toxic Megacolon
    Colonic pseudoobstruction- tx with colonoscopic decompression

    Toxic megacolon- Colonoscopy contra-indicated.
  410. Lab to evaluate post vaccine immunity
  411. NASH
    Non Alcoholic Steatohepatitis

    • Benign non alcoholic fatty liver
    • Can lead to cirrhosis

    No treatment
  412. Candida rash in children
    • Satellite lesions
    • Involves genitocrural folds
  413. Contact diaper dermatitis
    • Spares the crural folds
    • Do not use combination steroid and antifungal creams in neonates.
  414. Job Syndrome
    • Hyper IgE and eosinophilia
    • Triad:
    • 1. eczema (atopic dermatitis)
    • 2. recurrent S. aureus abscess (biblical Job with boils)
    • 3. course facial features, frontal bossing, doughy skin; 2 ROWS OF TEETH
  415. Maintenance treatment of Atopic dermatitis
    Emollients- wet based creams
  416. Psoriasis
    Pink scaly plaques

    • Extensor surfaces of elbows and knees
    • Base of scalp
    • Peri-umbilical area
    • Lower back
    • Nail disease- more in psoriatic arthritis
  417. Acne treatment
    • Benzoyl peroxide- most common
    • Retin A-

    Do not use both in the same treatment

    Accutane- Tx of severe nodular or cystic acne.
  418. Tetracyclines
    • Avoid concurrent administration with;
    •        Antacids
    •        Iron
    •        Dairy products
  419. Skin tags
    Associated with HPV types 6 and 11
  420. Dermatofibroma
    Pathognomonic is the Fitzpatrick's sign
  421. Leser-Trelat sign
    Explosive onset of seborrheic keratosis lesions is associated with underlying malignancies of the stomach, colon or breast.
  422. Melanoma recognition

    • Asymmetry
    • Border irregularity
    • Color variation
    • Diameter
    • Enlargement
    • Family history
  423. Necrobiosis Lipoidica Diabeticorum
    Most commonly in the shins of diabetic patients

    Tx: Topical and intralesional steroids
  424. Cellulitis
    ALL- 1st- Staph 2nd Group A Strep

    EXTREMITIES- 1st- Strep 2nd Staph

    MRSA- Tx Bactrim and if allergic Doxycycline or Clindamycin

    • Avoid Bactrim in last trimester of pregnancy and children less than 2 months old.
    • Avoid Tetracyclines in pregnancy and children less than 8 y/o.
  425. Erysipelas
    • Strep infection
    • Pharyngitis may precede rash.
    • Usually in face and it looks like malar rash of SLE.
    • Tx: PCN
  426. Erythrasma
    • Intertriginous superficial bacterial infection
    • Dx: Wood's lamp flouresces coral red
    • Tx: Erythromycin po
  427. Impetigo
    • Most common bacterial infection in children.
    • Staph aureus and Group A Strep

    Tx: Bactroban, Keflex
  428. Folliculitis associated with hot tubs and swimming pools
    • Pseudomonas infection
    • Tx: Bactroban
  429. Herpes labialis
    • Tx can start as long as 72 hrs after appearance of lesion.
    • Papules to grouped vesicles on an erythematous base.
    • Tx: Acyclovir, Valtrex, Abreva cream
  430. Varicella
    • Recommended exclusion from school for 5 days from start of rash.
    • Prodrome 1-3 days with fever and malaise then the rash.
    • Lesions in many stages. Clear teardrop vesicles.
    • Tzanck smear shows multinucleated giant cells.
    • Tx: within 24 hrs of rash shown to reduce sx.
    • Post-herpetic neuralgia- Age is the biggest predictor.
  431. Zostavax vaccine
    • Recommended after age 60.
    • Contraindication is pregnancy.
    • To avoid reduce immune response give Zostavax and Pneumovax 4 weeks apart.
  432. Molluscum contagiosum
    • DNA poxvirus
    • Transmission is direct contact.
    • Tx: Avoidance.
    • Aldara cream works.
  433. Warts
    Etiology- HPV
  434. Warts v/s Callus
    • Callus do not contain black dots.
    • Callus do not interrupt skin markings like warts do.
    • Calluses are more painful on direct contact than lateral pressure and warts are more painful on lateral pressure than direct pressure.
  435. Tinea capitis
    • Very contagious
    • Sx: Scalp pruritus, Scalp scaling, Alopecia, occipital adenopathy
    • Tx: Grispeg
  436. Scabies
    • Rash is a delayed hypersensitivity reaction.
    • Tx: Elimite (Permethrine)

    Kwell lotion has a blackbox warning due to severe neurotoxicity.
  437. Lice
    Removal of nits is not necessary to reduce spread or return to school.
  438. Hair loss
    • Post-partum- Telogen effluvium
    • Post chemo tx- Anagen effluvium
  439. Paronychia
    Infections with Staph in nails.

    • Tx: Acute- antibiotics
    •       Chronic- topical steroids
  440. Onychomycosis
    Antibiotics have shown to not improve outcomes and should not delay surgery.
  441. Herpangina
    • Oral lesions (stomatitis) in children
    • Caused by Coxsackie virus group A.
  442. Hand Foot Mouth Disease
    • Coxsackie virus A16.
    • Tx: Supportive.
  443. Sertraline
    Can produce Persistent Pulmonary Hypertension of the newborn
  444. Bupropion
    Contraindicated in bulimia due to seizures
  445. Risperdal
    • Hyperprolactinemia producing galactorrhea.
    • Gynecomastia.
  446. Amphetamine induced psychosis
    Visual or tactile hallucinations
  447. Axis of mental conditions
    • I- Mental condition
    • II- Trait condition (personality disorder or mental retardation)
    • III- Medical comorbid condition
    • IV- Psychosocial stressors
    • V- Global assessment of function 1-100
  448. Tramadol
    Has SNRI properties so it should not be used in pt's on SSRI or SNRI because it can cause serotonin syndrome.
  449. ADHD
    • Sx before age 7.
    • Tx w Amphetamine decreases the risk of developing a substance abuse condition.
  450. IQ
    • Less than 70 is mental retardation if dx before age 18.
    • IQ= (Mental age/Chronological age) x 100
  451. Fragile X syndrome
    • FMR-1 gene is the test for diagnosis.
    • MR most common inherited cause.
  452. FISH
    Fluorescent in Situ Hybridization:

    Test for identifying chromosomal and genetic abnormalities
  453. Mental Retardation Common causes
    • Most common inherited- Fragile X
    • Most common chromosomal- Down's Syndrome
    • Most preventable- Fetal Alcohol Syndrome
  454. Down's Syndrome
    • Trisomy 21
    • Macroglosia
    • Iris white spots (Brushfield spots)
    • Congenital hypothyroidism
    • ASD, VSD
  455. Lesch-Nyhan Syndrome
    • Severe MR
    • Deficiency in purine metabolism
    • Increased in uric acid- sever gout
    • Deficiency in B12
  456. Phenylketonuria
    • Deficiency of hepatic enzyme phenylalanine hydroxylase.
    • Diagnosed in neonates screening after 2nd day of life. Test has to be done after first feeding has occurred.
  457. Fetal alcohol syndrome
    Facies: short palpabreal fissure, microcephaly, epicanthal folds, thin upper lip, short nose, micrognathia, ear abnormalities.
  458. Risk for lead poisoning
    Abuse or neglect children
  459. Autism
    Pervasive Developmental Disorder PDD

    • Highly genetic disorder
    • Some recognized teratogens are:
    •     Lead
    •     Mercury
    •     Thalidomide
    •     Cytotec
    •     Valproic acid
  460. Autism DSM IV Classification
    6 symptoms in 3 categories

    • Social and communication problems before the age of 3.
    • >2 social criteria
    • >1 Communication criteria
    • >1 behavior problem criteria
  461. Tuberous sclerosis
    • MR
    • Seizures
    • Hamartomas or angiofibromas
  462. Asperger's syndrome
    Autism lite

    • Type I-
    • Type II- No cognitive or language delay.
  463. Rett's syndrome
    • Normal development until 5 months of age.
    • After that;
    • Deceleration of head growth
    • Loss of hand skills
    • Loss of social engagement
    • Poorly coordinated gait
    • Psychomotor retardation

    Only on girls because boys do not survive.
  464. Bereavement v/s Major Depressive Disorder
    • Time- MDD > 2 mo
    • Suicidal ideation- MDD often present, absent in bereavement.
    • Emotional state- MDD- guilt, worthlessness
    • Psychotic sx- MDD Sustained, transient in bereavement.
    • Function is normal in bereavement.
  465. SNRI
    Effexor and Cymbalta
  466. Antidepressant in pregnancy
    • Use SSRI except Paxil which is Category D.
    • Usually Prozac or Zoloft are the first choice.
  467. Bipolar disorder
    • Depression does not need to be present.
    • Bipolar I- Mania or mixed.
    • Bipolar II- Hypomania
  468. Valproic acid
    Can produce PCOS
  469. Carbamazepine
    Can produce Steven-Johnson's syndrome or TEN.
  470. Suicide
    • Highest rate and highest completion is in
    • ELDERLY.
  471. PTSD

    • Exposure
    • Re-experiencing
    • Avoidance
    • Arousal

    Debriefing is contraindicated in PTSD.
  472. OCD
    You do not have to have obsessions and compulsions for the diagnosis.
  473. Olfactory hallucinations
    Temporal lobe epilepsy
  474. Parkinson's disease

    • Tremor
    • Rigidity
    • Akinesia
    • Postural instability
  475. Neuroleptic Malignant Syndrome

    • Fever
    • Encephalopathy
    • Vital sign instability
    • Elevated CK
    • Rigidity

    Tx: Stop antipsychotic, IVF's, Dantrolene.
  476. Anorexia nervosa
    • Complications:
    • Russel's sign- abrasion in knuckles from purging.

    Hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hypophosphatemia

    Do dexa scan if amenorrheic for more than 3 months.

    • Complement factor 3 is a sensitive measure of malnutrition
    • Tx: Cognitive Behavioral Treatment. There are no medications approved by FDA.
  477. Bulimia
    Tx: Prozac.
  478. Stages of change in substance abuse
    • Precontemplation
    • Contemplation
    • Determination
    • Action
    • Maintenance with some relapses.
  479. Gold standard in experimental design
    Randomized clinical trial

    Assigns causality v/s association in an observational study.
  480. Strength of recommendations
    • A- Consistent, good quality patient oriented evidence
    • B- Inconsistent or limited quality evidence
    • C- Consensus, usual practice, expert opinion.
  481. Case control studies
    Useful to study rare outcomes.
  482. Cohort studies
    • People without disease are followed up to see if they develop the disease.
    • Observational study.
    • Two types: Prospective and retrospective.
    • In prospective the exposure occurs now and then you observe for outcome later.
    • In retrospective the exposure occurred time ago and you observe to see if the outcome occurred.
  483. Precision v/s accuracy
    • Precision is how reliable the results are.
    • Accuracy is how valid the results are.
  484. Sensitivity and specificity
    They do not depend on the prevalence of the condition.
  485. Relative risk v/s Odds ratio
    RR= Risk of exposed group/Risk of unexposed group

    • Odds ratio= used in case control studies
    •    Odds that case was exposed/odds that a control was exposed.
  486. Number needed to treat
    NNT= 1/ARR

    The lower the number the better.
  487. Levels of prevention
    • Primary: Prevent disease from happening thus preventing its complications.
    •     Immunizations, Fluorinated drinking water, diet, exercise, helmets, seatbelts, screening tests.

    • Secondary: Aimed at early detection of the disease and preventing progression.
    •      In DM checking BS, eye exam,HgbA1c.

    • Tertiary: Disease is already present and you attempt to minimize complications.
    •       In a pt with recent stroke is smoking cessation, daily aspirin, cholesterol control, rehabilitation.
  488. Sickle cell disease
    Increased reticulocyte count
  489. B thalassemia major
    Cooley's anemia- severe microcytic anemia that need transfusions.

    • Osteoporosis
    • Dilated cardiomyopathy
    • Delayed growth and development
    • Hepatomegaly
  490. Lead toxicity
    • From pain in old homes made before 1970
    • Produces microcytic anemia that is refractory to Iron supplementation.
    • Lab finding- basophilic stippling
  491. Vit B12 deficiency
    • Pernicious anemia- no Intrinsic factor
    • Need to test for thyroid disease q 1-2 yrs.
  492. Folate deficiency
    Dilantin can produce it.
  493. Prenatal vitamin v/s MTV
    Prenatal have more Iron and folate.
  494. G6 PD
    • X linked disorder
    • Men have it and women are carriers.
    • Hemolysis.
  495. Myeloproliferative neoplasms
    • JAK-2- signal for normal cell growth
    • Mutation of this gen produces proliferation

    • Polycythemia vera- Tx Phlebotomy and  
    •                Hydroxyurea
    • ASA 81mg to prevent vascular complications.
  496. Hemophilia
    • A- Factor 8
    • B- Factor 9

    Only men have disease, women are carriers.
  497. Von Willebrand disease
    • Affected is the synthesis in endothelium and megakaryocytes.
    • PTT is not prolonged.
  498. Trousseau's syndrome
    Migratory thrombophlebitis in a cancer patient.
  499. TTP
    • Thrombotic Thrombocytopenic Purpura
    • Schistocytes

    • Clinical findings:
    • Fever
    • Neurologic changes
    • Renal impairement
    • Hemolytic anemia
    • Thrombocytopenia

    Decreased antibody to ADAMTS-13.
  500. DVT risk factors
    • Protein S deficiency
    • Protein C deficiency
    • Antithrombin deficiency
    • Factor V Leiden is the most common factor
  501. PE
    D dimer when negative it rules out PE. It has a high negative predictive value.

    A positive D dimer does not rule in a PE.
  502. Nephrotic syndrome
    • Minimal change disease does not produce renal failure.
    • It responds to steroids.
  503. Percentage of cardiac output that goes to kidneys
  504. Bacterial endocarditis
    • Fever
    • Splinter hemorrhage
    • New murmur
  505. Acute kidney injury
    • Pre-renal- Most common of AKI
    •                 BUN/Creatinine ratio >20
    •                 Urine osmolality >500
    •                 Urine specific gravity >1.020
    •                 Urine sediment - Hyaline casts
    •                 FENa- <1% (suggests preserved kidney function)

    • Intra-renal- BUN/Creatinine ratio 10-20
    •                   Urine specific gravity 1.01-1.02 
    •                   Urine osmolality- 300-500
    •                   Urine sediment- granular casts
    •                   FENa- >1-2
    • FENa is the fractional excretion of Na. It is low if the kidneys are still working.
  506. Proteinuria
    Nephrotic range- 3-3.5 gm/day
  507. Pediatric UTI's
    • Males- Posterior urethral valves
    • Females- Vesicoureteral reflux

    • Workup: VCUG and US
    • -Children under 5 y/o with UTI
    • -Any child with UTI and fever
    • -School aged children who have had two or more UTI's
    • -Any boy with an UTI.
  508. Butt red rash
    HSP- Henoch Schonlein Purpura
  509. Acid base conditions
    Increased anion gap metabolic acidosis


    • Methanol
    • Uremia
    • DKA
    • Paraldehyde
    • Isoniazid
    • Lactic acidosis
    • Ethylene glycol
    • Salicylates
  510. Romberg test
    Is positive in condition of spinal cord causing sensory ataxia.

    Is not a cerebellar function test.
  511. Upper v/s Lower motor neurons
    • Upper- origin of nerve root
    • Lower- innervate skeletal muscle cells

    Lesions of upper motor neurons- Disinhibition produce spasticity, hyperreflexia, clonus

    Lesions of lower motor neurons- Flaccidity and hyporeflexia.
  512. Nerve roots and reflexes
    • C5- Biceps
    • C7- Triceps
    • L3-4- Knee jerk
    • L5- No reflex
    • S1- Ankle reflex
  513. Eye movements
    • SO4- Superior oblique CN4
    • LR6- Lateral rectus CN6
    • Everything else CN3
  514. Horner's syndrome
    • Sympathetic nervous system
    • -Ptosis
    • -Myosis
    • -Anhydrosis

    • Caused by:
    • Cluster headaches
    • Carotid artery dissection
    • Posterior cerebral artery infarctions
    • Pancoast lung tumor
  515. Migraine with aura
    Strong risk factor for MI and stroke.

    Psychiatric comorbidities are much higher with migraine with aura.
  516. Hemiplegia
    Middle cerebral artery stroke- CONTRALATERAL

    Brain stem- IPSILATERAL.
  517. Aphasia
    • Expressive- Broca's from medial insular cortex
    • Receptive- Wernicke's- posterior temporal lobe
  518. Pinpoint pupils
    • Pontine lesions
    • Heroin
    • Pilocarpine
  519. Conn's syndrome
    Conn's syndrome is primary hyperaldosteronism caused by an aldosterone-producing adenoma.
  520. Progressive Multifocal leukoencephalopathy
    JC virus, a papovavirus. Most commonly seen as a complication of AIDS.
  521. Warfarin inhibits which clotting factors
    Factors 2, 7, 9, 10
  522. ACE contraindications
    • Angioedema
    • Pregnancy
    • Renal artery stenosis
  523. Allergic to PABA in sun screens
    Could have cross reaction with Thiazide diuretics.
  524. E.coli producing Shiga toxin
    • Bloody diarrhea
    • Tx is supportive only
    • If antibiotics are given you can produce HUS
  525. Sport contraindicated in pt with uncontrolled Stage 2 HTN
    Rowing because it is static exercise in which BP load is more significantly increased.
  526. Osteoporosis screening
    Done in all women over 65 y/o and all men over 70 y/o
  527. Diarrhea and bacterial infections
    • Staph aureus- Incubation 1-6 hrs
    • Clostridium botulinum- canned foods
    • Campylobacter jejuni- Incubation 2-4 days
    • Enterohemorrhagic E. coli- produces bloody diarrhea and antibiotics should not be given due to HUS.
  528. Risk of physiologic hyperthyroidism
    • A pt with high dose of levothyroxine and a low TSH.
    • Higher risk of vertebral and hip fracture.
  529. Physical finding of Slipped Capital Femoral Epiphysis
    Limited internal rotation of the flexed hip
  530. Intermittent claudication risk factors
    • DM
    • Smoking
    • Hypertension
    • Hyperlipidemia
  531. PE tx with Lovenox
    At least given for 5 days and discontinued when the INR has been at 2.0 for 24 hrs
  532. Gadolinium associated nephrogenic systemic fibrosis
    • Skin condition with no treatment.
    • Usually in patients with severe renal dysfunction on dialysis.
    • A skin biopsy is diagnostic.
  533. Vancomycin monitoring
    • The best predictor of Vancomycin efficacy is
  534. Testosterone use risks
    • Infertility
    • Increased risk of prostate cancer
    • Increased sx of BPH
    • Liver toxicity and tumor
    • Worsening of sleep apnea
    • Heart failure
    • Gynecomastia
    • Skin diseases
  535. Apraxia
    Transmission disturbance on the output side. Pt understands the task but cannot do it immediately and can do it with a delay.
  536. Agnosia
    Inability to recognize previously familiar sensory inputs.
  537. Acute angle closure glaucoma v/s retinal detachment
    Glaucoma- pain

    Retinal detachment- painless
  538. Average BS calculation from HgbA1c
    (HgbA1c-2)x 30
  539. Byetta
    Needs to be discontinued in patients with gastroparesis
  540. Leading cause of death after bariatric surgery
  541. Hashimoto's v/s Graves
    Hashimoto's- Hypothyroidism and TSH receptor blocking antibodies

    Graves- Hyperthyroidism and TSH receptor site antibodies.
  542. Forteo
    Indicated in patients with severe osteoporosis with failure to biphosphonates.
  543. RA
    Best initial therapy is Methotrexate.
  544. Pseudoaddiction
    Patient behaviors that may occur when pain is under-treated. It is distinguished from addiction because the behaviors disappear when the pain is effectively treated.
  545. Fibromyalgia
    An exaggerated response to tactile stimuli by the CNS
  546. Amiodarone indications
    Treatment of sustained ventricular tachyarrhythmias in patients with poor hemodynamic stability.

    Perioperative period of cardiac surgery.

    AF in symptomatic patients.
  547. Pulmonary wedge capillary pressure values
    • Normal 6-12
    • Pulmonary edema- More than 20