PANCE Review

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Kinikia
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PANCE Review
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2010-08-25 15:43:48
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PANCE Review
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  1. What is the classic presentation of pneumonia (lung exam, fever)? In elderly patients?
    Bronchial breath sounds, egophony, increased tactile fremitus, and dullness to percussion. Fever may be absent, and confusion may be the only presenting symptom in elderly patients.
  2. Lung findings in pulmonary embolism
    Rarely abnormal
  3. Which quadrant is the most common site of retinal detachment?
    Most retinal detachment begins with a tear in the superior temporal quadrant. Vitreous then passes through the tear and becomes lodged behind the sensory retina. The pull of gravity results in progressive detachment.
  4. What is the typical presentation of herpetic gingivostomatitis?
    Decreased intake of foods/liquids and a low-grade fever. Small, white ulcers on the oral mucosa, red gingivae, and regional lymphadenopathy.
  5. What causes herpangina? How does herpangina present?
    Coxsackievirus causes herpangina, which manifests itself as a grayish-white tonsillar and palatal papules that become shallow ulcers. High fevers, malaise, and vomiting are frequently found.
  6. What is the best management for exercise-induced asthma?
    Cromolyn and nedocromil sodium inhaled medications are mast cell stabilizers that are very effective in the prevention of asthma when there is a known precipitant, such as exercise.
  7. What is the most common malignant liver tumor in childhood?
    Hepatoblastoma
  8. How does hemolytic-uremia syndrome present?
    Hemolytic anemia with low platelets, bleeding, proteinuria, and hematuria. No jaundice or splenomegaly.
  9. What are the characteristic embolic findings in endocarditis (IV drug user)?
    Splinter hemorrhages, petechiae, Janeway lesions, Osler nodes
  10. In a patient with clinical features of acute hepatitis, what is the initial screening test for hepatitis C?
    Anti-HCV ELISA
  11. Chest x-ray associations:
    Consolidation
    Kerley B lines
    Air bronchograms
    Visceral pleural lines
    • Consolidation: pneumonia
    • Kerley B lines: CHF
    • Air bronchograms: pneumonia
    • Visceral pleural lines: especially on expiration- pneumothorax
  12. How does Meniere's disease present?
    Hearing loss and episodic vertigo usually accompanied by tinnitus
  13. Common presentation of acoustic neuroma
    unilateral hearing loss with vertigo
  14. Which serum level will be most helpful in diagnosing pancreatitis?
    Serum lipase levels increase in parallel with serum amylase levels. The lipase level remains elevated longer and may help to diagnose pancreatitis after an attack has ended.
  15. Indications for admission to the hospital for patients with PID
    Failure to respond to outpt therapy, inability to tolerate outpatient therapy (e.g., from nausea and vomiting), fever greater than 39 deg C, those with guarding and rebound tenderness in lower quadrants, or patients who look toxic.
  16. What are the early symptoms of renal failure? What are the late symptoms?
    • Early: anorexia, fatigue, weakness
    • Late: Oliguria, dyspnea, chest pain, nausea, vomiting, abdominal pain
  17. Major contraindications to curative resection of a lung tumor
    Distant mets, except for solitary brain and adrenal mets, MI within past 3 mos, SVC syndrome due to metastatic tumor, b/l endobronchial tumor, contralateral lymph node mets, and malignant pleural effusion
  18. Treatment of choice in patients with PE with normal ventricular function and no absolute contraindications
    Anticoagulation
  19. Presentation of viral croup
    barking cough and stridor
  20. Which lesions are most commonly seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders?
    lentigines
  21. Small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. Better felt than seen, having a rough, sandpaper feel and are often tender to palpation. Pre-malignant.
    Actinic keratosis
  22. Usually occurs as isolated lesion on the face appearing as erythematous, dome-shaped nodule with a central keratinaceous plug. low-grade malignancy
    keratoacanthomas
  23. Common benign plaque in elderly, velvety or warty surface associated with stuck-on appearance and greasy feel
    seborrheic keratosis
  24. most common cause of respiratory distress in the premature infant
    hyaline membrane disease
  25. presentation of hyaline membrane disease in the premature infant: clinically and on cxr
    tachypnea, cyanosis, expiratory grunting, on chest x-ray: hypoexpansion and air bronchograms
  26. Drug of choice for treatment of bulimia nervosa
    Fluoxetine (Prozac)
  27. Low output heart failure occurs secondary to...?
    ischemic heart disease, hypertension, dilated cardiomyopathy, and valvular and pericardial disease
  28. High output heart failure occurs in...?
    hyperthyroidism, anemia, pregnancy, arteriovenous fistulas, beriberi, and Paget’s disease
  29. Risk factors for retinopathy of prematurity
    perinatal oxygen therapy, sepsis, low birthweight, prematurity
  30. Which hormone is responsible for producing calcitriol in the kidney?
    PTH
  31. Most common cause of post-partum hemorrhage
    Uterine atony
  32. Treatment for traveler's diarrhea
    ciprofloxacin
  33. How does Peyronie's disease present?
    Fibrotic areas under penile skin along with history of penile curvature during erection
  34. infant's birthweight at 4-5 mos, and then at 1 year
    should double at 4-5 mos, then triple at 1 year
  35. Terminal hematuria- where is the source of bleeding?
    Bladder neck or prostatic urethral source
  36. Hematuria at the beginning of the urinary stream- where is most likely source?
    Anterior/penile source
  37. total hematuria- source?
    bladder or upper urinary tract source (renal pelvis)
  38. recommended age range for MMR vaccination?
    12-15 mos
  39. Ectopia lentis, aortic root dilation, and aortic dissection are major criteria for the diagnosis of what disease?
    Marfan's syndrome
  40. overweight, adolescent male with pain that is referred to the thigh or medial side of the knee associated with a limp. normal x-rays
    slipped capital femoral epiphysis
  41. What is the normal respiratory rate in a newborn?
    30-60 breaths per minute
  42. At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of _.
    LH
  43. High dose oxygen administration to COPD patients precipitate respiratory failure. Why?
    They have chronic hypercapnia.
  44. persistent profuse, frothy, greenish, foul-smelling vaginal discharge and vulvar pruritis. vaginal pH of 6.5. Is this bacterial vaginosis or trichomoniasis?
    trichomonisis- it's frothy and colored d/c; in BV, the d/c is homogenous and grayish-white
  45. What will you see on a positive fern test? on a negative fern test? What do these results mean?
    • The fern frond pattern indicates an estrogenic effect on the mucus without the influence of progesterone;
    • thus, a non-frondlike pattern can be interpreted as showing that ovulation has occurred
  46. A 26 yo female G1p0Ab0 appears to be in the 2nd stage of labor. Vaginal exam reveals fetal head at level of maternal ischial spines. What station is the patient in?
    0
  47. Dark field microscopy is used to test for which disease?
    Syphillis
  48. Ovulation can be confirmed with mid-luteal phase measurement of _.
    Progesterone
  49. What is Nagele's rule?
    LMP + 7 days - 3 mos = estimated date of delivery/confinement
  50. in the treatment of endometriosis, which drug has adverse effects associated with a hypoestrogenic state, particularly loss of bone mineral density? Other side effects include vasomotor symptoms, vaginal dryness, and mood changes.
    Leuprolide (Lupron)
  51. adverse effect of endometriosis treatment: acne, oily skin, deepening of the voice, weight gain, edema, and adverse plasma lipoprotein changes. Most changes are reversible upon cessation of therapy, but some (such as deepening of the voice) may not be. What medication is this?
    Dantrolene (Danazol)
  52. deep regular respirations with periods of apnea
    Cheyne-Stokes respirations
  53. fundal height is at level of umbilicus- what is the gestational age?
    20 weeks
  54. The USPSTF recommends screening mammography, with or without CBE, every how many years for women aged how old?
    every 1-2 years, aged 40 and older
  55. spotting during the first and second trimesters; sudden painless, profuse bleeding in the third trimester, initial cramping in 10% of cases
    placenta previa
  56. What is the drug of choice for reversing magnesium sulfate toxicity in the management of premature labor?
    Calcium gluconate
  57. Which immunoglobulin crosses the placenta?
    igG
  58. chronic anovulation, hyperandrogenism, hirsutism, obesity (80%), increased risk of DM, CV disease, metabolic syndrome
    PCOS
  59. 36 yo woman, worsening PMS, premenstrual inability to cope with job, irritability and depression, regular menses, mild cramping, no other symptoms. normal PE. what is first step?
    chart sx on calendar and return for f/u
  60. What is the most common form on ILP?
    Idiopathic pulmonary fibrosis
  61. Exertional dyspnea, a nonproductive cough, and inspiratory crackles with or without digital clubbing may be present on physical examination. The HRCT lung scans typically show patchy, predominantly basilar, subpleural reticular opacities, often associated with traction bronchiectasis and honeycombing
    IPF
  62. What is Chadwick's sign
    bluish/purplish discoloration of vagina and cervix in a pregnant patient
  63. What is used in the treatment of ovulation disorders in patients who want to become pregnant?
    Clomiphene citrate
  64. What does a positive progestin challenge test mean?
    Infertility is due to anovulation
  65. What is used to treat pre-eclampsia during pregnancy?
    Magnesium sulfate
  66. A patient returns from a hiking trip. Macular rash first appeared on ankles and the rest of the LE. Lesions on soles of feet and the trunk. What is the dx?
    Rocky mountain spotted fever
  67. Why is there an increased BUN level in massive GI bleed?
    when blood is digested, it gives off urea/nitrogen
  68. thickening and roughening of the skin resulting from repetitive irritation caused by scratching is called _.
    lichenification
  69. A classic finding of poorly healing, indolent ulcers on the LE would be found in patients with what disease?
    Inflammatory bowel disease
  70. A patient presents with a rash, characterized by red macules and edematous papules with a clearing center. What is it?
    Erythema multiforme
  71. Treatment of choice for Influenza B?
    Zanamivir (relenza)
  72. What virus has been linked with the development of acute myocarditis?
    Coxsackie B virus
  73. most tumors present with the following characteristics: painless nodule, shiny and waxy, indurated, firm and immobile, pearly, rolled border, and with fine (small) telangiectatic vessels on the surface. What kind of carcinoma is this?
    basal cell carcinoma
  74. What is the post-exposure prophylaxis for rabies in the U.S.?
    In the United States, postexposure prophylaxis consists of a regimen of one dose of HRIG and five doses of rabies vaccine over a 28-day period. Human rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure, preferably within 24 h. Four formulations of three inactivated rabies vaccines are available in the United States, including human diploid cell vaccine (HDCV) (produced in human diploid cells; Imovax, Pasteur Merieux Connaught), rabies vaccine adsorbed (RVA) (produced in fetal rhesus diploid lung cells; Rabies Vaccine Adsorbed, SmithKline Beecham), and purified chick embryo cell culture vaccine (PCEC) (produced in chick embryo cells; RabAvert, Chiron)
  75. In a patient suspected of having seborrheic dermatitis, the most common site involvement would be the _.
    scalp
  76. What are the 4 pathophysiologic features of acne?
    • Hyperkeratinization
    • Sebum production
    • Bacterial proliferation
    • Inflammation
  77. Indication for transferring a patient with 2nd and 3rd degree burns to a burn center?
    • >10% of BSA
    • Burns that involve the face, hands, feet, perineum and major joints
    • Electrical, chemical and inhalation injuries
    • Circumferential burns of an extremity or chest
    • Burns involving trauma
    • Patients with a burn and a complicating medical disorder
  78. Indication for transfer to burn center for patient with 3rd degree burns?
    • > 2% BSA
    • Burns that involve the face, hands, feet, perineum and major joints
    • Electrical, chemical and inhalation injuries
    • Circumferential burns of an extremity or chest
    • Burns involving trauma
    • Patients with a burn and a complicating medical disorder
  79. begins with a 2- to 4-day respiratory prodrome of malaise, cough, coryza, conjunctivitis with lacrimation, nasal discharge, and increasing fever. 1- to 2-mm blue-white spots on a bright red background, typically located on the buccal mucosa- what is this disease and what are these spots?
    measles (rubeola), Koplik's spots
  80. grows as a mold in association with soil and avian habitats, being enriched by alkaline nitrogenous substrates in guano
    H. capsulatum
  81. After inhalation, the conidia develop into yeast cells and are engulfed by alveolar macrophages, where they are able to replicate. On radiographic examination, most patients will have hilar lymphadenopathy and pulmonary infiltrates or nodules. Gram stain of sputum reveals many oval, budding cells. What is this?
    Histoplasma capsulatum
  82. Fine maculopapular rash of 3 days duration; face to trunk to extremities
    Rubella (german measles)
  83. What presents with a prolonged aPTT and normal platelet count and is treated with Factor VIII or cryoprecipitate?
    Hemophilia A
  84. What drug is indicated in vW disease, which presents with a prolonged bleeding time?
    Desmopressin acetate
  85. what is commonly noted in HIV patients and presents with multiple ring-enhancing lesions in the brain?
    toxoplasmosis
  86. What is the treatment of choice for possible toxoplasmosis, acute infection?
    Sulfadiazine and pyrimethamine
  87. what is the treatment of choice for prophylaxis of toxoplasmosis?
    Trimethoprim-sulfamethoxazole
  88. What is Hegar's sign?
    softening of the cervix that often occurs with pregnancy
  89. McDonald's sign?
    when the uterus becomes flexible at the uretocervical junction at 7-8 weeks
  90. What is Cullen's sign?
    Purplish discoloration periumbilically, noted in pancreatitis
  91. What is responsible for breast swelling prior to menses?
    Growth of the lobules and alveoli under the influence of progesterone that is secreted from the corpus luteum.
  92. What causes proliferation of the mammary ducts?
    Estrogen
  93. What portion of the spinal column affects pain and temperature sensation?
    Lateral spinothalamic tract
  94. What portion of the spinal column affects pressures and touch sensations?
    Ventral spinothalamic tract
  95. Which portion of the spinal column affects proprioception and vibration sense?
    Posterior column
  96. Patients with what injury will have loss of sensation distal to the area of injury along with paralysis and hyperactive reflexes in the area distal to the lesion?
    transection of the spinal cord
  97. Risk factors for CAD?
    • F.A.C.H.L.O.
    • Family history of premature CAD
    • Age
    • Cigarette smoking (current)
    • Hypertension
    • Low HDL level (less than 40 for men, 50 for women)
    • Obesity
  98. What will a peak flow reading help you do?
    gauge a patient's current extent of airflow obstruction, monitor effectiveness of any treatment interventions
  99. What is the indication for a V/Q scan?
    suspected PE
  100. Up to 50% of patients with atopic dermatitis develop what condition(s) in the future?
    asthma and/or allergic rhinitis
  101. Fever, bilateral conjunctivitis, oral mucosal changes, rash, cervical lymphadenopathy, peripheral extremity changes, Elevated erythrocyte sedimentation rate and C-reactive protein levels, a vasculitis characterized by the infiltration of vessel walls with mononuclear cells and later by IgA secreting plasma cells that can result in the destruction of the media and aneurysm formation
    Kawasaki's disease
  102. illness of fever and four of the following criteria for at least 5 days: bilateral nonexudative conjunctivitis, mucous membrane changes of at least one type (injected pharynx, erythema, swelling and fissuring of the lips, strawberry tongue), peripheral extremity changes of at least one type (edema, desquamation, erythema of the palms and soles, induration of the hands and feet, Beau lines [transverse grooves of the nails]), a polymorphous rash, and cervical lymphadenopathy greater than 1.5 cm
    Kawasaki's disease
  103. What is the most serious systemic complication of Kawasaki's disease?
    coronary artery aneurysms (in 20% of affected children)
  104. Treatment of choice for variant/Prinzmetal's angina?
    CCB
  105. Pharmacologic treatment of gestational diabetes should include what?
    Insulin
  106. For which hepatitis should ilicit drug users receive the vaccine?
    Hepatitis A
  107. Which axis IDs clinical disorders and other clinical conditions that may be the focus of clinical attention?
    Axis I
  108. Which axis IDs any physical disorder or general medical condition that is present in addition to the mental disorder?
    Axis III
  109. Which axis IDs the psychosocial and environmental problems having a significant contribution to the disorder?
    Axis IV
  110. Which axis IDs personality disorders and mental retardation?
    Axis II
  111. What diagnostic test will help you evaluate hearing loss in a 2 month old infant?
    Auditory evoked potentials
  112. What is the youngest a patient can be to be evaluated with audiometry?
    3 years old
  113. Tympanometry is used to what?
    ID effusion as a cause of hearing loss
  114. A chest x-ray of atelectasis would not be normal.
    A chest x-ray of atelectasis would not be normal.
  115. Which anti-cytokine agent is used in the treatment of RA and has a side effect of reactivation of dormant TB?
    Etanercept
  116. After chronic adminstration of this drug, osteomalacia develops.
    Phenytoin (Dilantin)
  117. Where is hairy leukoplakia commonly seen?
    lateral tongue
  118. What syndrome is due to autonomic degeneration and typically presents with orthostatic hypotension?
    Shy-Drager
  119. Which drugs are frequently implicated in toxic epidermal necrolysis?
    NSAIDs, Abx, anti-convulsants
  120. What is the Somogyi effect?
    Nocturnal hypoglycemia stimulates counter regulatory hormone release resulting in rebound hyperglycemia
  121. Which dermatome is at the level of the umbilicus?
    T10
  122. Pulmonary fibrosis and pulmonary infiltrates are known side effects of which medication?
    Bleomycin (Blenoxane)
  123. Cherry-red fovea and boxcar segmentation of the retinal veins are findings seen in _.
    central retinal artery occlusion
  124. Papilledema is seen with _.
    increased ICP
  125. A-V nicking is common in _.
    chronic hypertension
  126. Abdominal cramps, nausea, and vomiting, and watery diarrhea typically last 1-2 days with what kind of food poisoning?
    S. aureus
  127. What is a probable cause of fetal distress resulting in late decelerations?
    Placental insufficiency
  128. Therapy of choice in patients with symptomatic bradyarrhythmias in sick sinus syndrome?
    permanent pace maker
  129. Drug of choice for insomnia in an elderly patient
    benzodiazepines
  130. what view on plain films is preferred to ID spondylolysis?
    oblique
  131. Humeral mid-shaft fracture impinges on what nerve, and what PE finding will occur?
    radial nerve, inability to extend wrist against resistance
  132. proximal humeral fractures and anterior shoulder dislocations commonly entrap what nerve, what PE finding will occur?
    axillary nerve- numbness over deltoid muscle
  133. what causes winging of the scapula and why?
    injury to long thoracic nerve, due to innervation of serratus anterior muscle
  134. injury to the subscapular nerve results in weakness and pain of which muscle?
    infraspinatus
  135. tx of pyelonephritis in a pregnant patient
    IV cephalosporins
  136. When blood is found at the external urinary meatus prior to insertion of a catheter, what diagnostic test should be performed?
    retrograde urethrography
  137. what test is indicated for blunt trauma including those resulting in hematuria or when renal injury is suspected?
    CT of abd/pel
  138. H2 blocker for mild, intermittent sx of GERD
    Ranitidine (Zantac)
  139. tx of duodenal ulcers
    sulcralfate
  140. first line for gastroparesis and second-line for refractory GERD
    Metoclopramide (Reglan)
  141. prevention of NSAID-induced gastritis
    Misprostol (Cytotec)
  142. Radioactive iodine (131) is most successful in treating hyperthyroidism that results from _.
    Graves
  143. fixed split s2
    atrial septal defect
  144. for single vessel CAD
    PCI, not CABG
  145. Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to what?
    delirium tremens
  146. Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, CV abnormalities are common signs and sx of what?
    delerium tremens
  147. What organism is responsible to dental caries?
    Strep mutans
  148. abnormal uterine bleeding, irregular enlargement of the uterus, pain rarely present unless vascular compromise
    leiomyoma
  149. has effects on bone turnover and bone mass and has been shown to decrease vertebral fractures. It has anti-estrogen effects on the non-skeletal portions of the body and increases hot flashes in perimenopausal females
    Raloxifene (Evista)
  150. A positive Wood's light exam demonstrates what?
    Microsporum
  151. What is the most common cause for acute MI?
    thrombus development at site of vascular injury (not microemboli)
  152. tx for isolated superficial actinic keratosis?
    cryotherapy
  153. what diagnostic findings in urinary sediment is specific for a dx of chronic renal failure?
    broad waxy casts
  154. major risk factors for the development of oral cancer?
    smoking and etoh
  155. mitral stenosis leads to enlargement of the L atrium, which is the major predisposing factor for the development of what?
    a-fib
  156. urine content of -pre-renal ARF; intrarenal disease; postrenal disease
    dec sodium; WBC casts; RBCs

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