When treating systolic hypertension in the elderly, what is considered class of medication is considered first line?
At what dose should HCTZ not be exceeded in elderly patients, as it may result in more side effects and not blood pressure control?
What is a common presentation of aortic stenosis in the elderly?
Syncope, CHF & Fatigue
When should preoperative creatinine levels be obtained?
Patients older than 40 years
What is the best determinant of bleeding tendencies during surgery?
Coagulation response to minor trauma
In what patient populations are silent myocardial infarctions more commonly seen?
Elderly and diabetics
When is a pregnancy test indicated in the preoperative evaluation of a surgical patient?
All women of childbearing age
When evaluating a patients potential for risk of DVT, what has been the classic identifiers?
Virchow?s Triad: stasis, intimal damage, and hypercoagulability
What is the preferred DVT prophylaxis for trauma patients or those with abdominal or pelvic cancer?
True/False: Does the dose of enoxaprin have to be adjusted in patients with renal impairment?
When considering a potential cause of diarrhea in a patient receiving enteral feedings, what should always be ruled out?
What is the leading cause of death between the ages of 1 and 44 years?
Unintentional and violence-related injuries
What is the leading cause of accidental death in the United States?
Motor vehicle accidents
What are the signs that characterize cardiac tamponade?
Beck?s Triad: jugular venous distention, hypotension, and muffled heart sounds
How are most cases of penetrating chest traumas managed?
What is the test of choice for detecting intra-abdominal injury?
Focused Assessment with Sonography for Trauma (FAST) examination
True/False: The presence of a pulse distal to the site of vascular injury rules out significant vascular injury?
When evaluating a head trauma patient, you appreciate rhinorrhea, otorrhea, ecchymosis of the lids (raccoon eyes), and ecchymosis behind the ears (Battle?s sign), what do you suspect?
Basilar Skull Fracture
Injury to what artery is the usual cause of epidural hematomas?
Middle meningeal artery
When considering the mental status of a head injury patient, what is a common presentation of a patient with an epidural hematoma?
A brief period of unconsciousness is followed by a lucid interval.
What is the triad of signs indicative of brain herniation?
Coma, fixed and dilated pupils, and decerebrate posturing
What is the most common type of burn?
How are first degree burns characterized?
Erythema, tenderness and the absence of blisters
A burn victim presents with thin-walled, fluid-filled blisters, that are moist, blanche with pressure and are painful, what do you suspect?
What is the characteristic appearance of the skin following a third degree burn?
Dry, with a white, leathery or charred appearance, and without sensation
When estimating the percentage of burn, the palm of the victim?s hand is roughly what percentage?
What is the most commonly used topical burn ointment?
What is the most common complication associated with all burns?
When considering postoperative fever, what is the most likely cause within the first 24-48 hrs postoperatively?
What would you suspect the cause of a fever in a patient 48-72 hours after surgery?
What is the most common cause of postoperative fever after 72 hours and which is the common pathogen that causes this?
Wound infection, Staphylococcus aureus
What is the most common nosocomial acquired infection?
What is the most effective approach to preventing pressure ulcers?
Frequent position changes, removal of moistures
In what patient populations is necrotizing fasciitis more commonly seen?
DM, alcoholics, and IV drug abusers
What is the most important complication of laparoscopic cholecystectomy?
What is the most common complication of surgically repairing an inguinal hernia?
Recurrence of the hernia
What is the most common complication of open appendectomy?
What is the most common complication of laparoscopic appendectomy?
What is the most important preoperative evaluation performed by the surgical team?
History and physical exam
What is a common postoperative complication seen with the use of unfractionated heparin?
When considering the primary survey (ABC?s) in a trauma patient, what is the most common indication for and preferred modality of intubation?
Altered mental status
Usually a self-limited disease, how long is the duration of pharyngitis?
The rash of erysipelas is typically confined to what area of the body?
Thick, crusted, golden "honey" yellow lesions, best describes what?
Impetigo (Streptococcus pyoderma)
What is the most common cause of cellulitis in the United States?
Group A streptococci
True/False: When diagnosing acute rheumatic fever using the Jones criteria, the presence of two major criteria or one major and two minor criteria plus evidence of recent B-hemolytic streptococci (culture or ASO titer) makes the diagnosis?
541. When using the Centor's criteria, what is the percentage of chance a sore throat is caused by group A B-hemolytic streptococcus is the cause when 3 out of 4 criteria are present?
What should be avoided in infants due to increased risk of botulism?
A sudden onset of severe, frequent 'rice water diarrhea is suggestive of what?
What is the incubation period of tetanus following a puncture wound?
5 days to 15 weeks
In patients with tetanus, hyperreflexia and muscle spasms develop most commonly in what areas?
Jaw and face
What should be given as part of the treatment of tetanus?
IM tetanus immunoglobin and PCN
Salmonella bacteremia is most commonly seen in what type of patients?
True/False: When considering shigellosis, individuals who are HLA-B27 positive may mount a reactive arthritis because of temporary disaccharidase deficiency.
What is the treatment of choice in shigellosis?
What two antibiotics are effective in the treatment of diphtheria?
PCN or erythromycin
What is the medication of choice in the treatment of pertussis?
What is the vaccine of choice for adults in the prevention of pertussis?
What is the most characteristic disease with EBV as the implicated cause?
Mononucleosis (the kissing disease')
Splenomegaly is present in what percentage of cases of EBV infection?
Administration of what antibiotic increases the incidence of rash in patients with EBV infection?
Patients with mononucleosis with associated splenomegaly should be counseled against what?
How do you define Reyes syndrome?
Fatty liver with encephalopathy
Ingestion of what medication increases the incidence of Reyes syndrome in children with influenza A or varicella infection and what age does this peak?
Aspirin, 5-14 years
What two medications are no longer recommended as single therapy agents in the treatment of influenza because of resistance?
Amantadine and rimantadine
When is varicella-zoster the most contagious?
The day before the rash appears
What is the characteristic description of the lesions seen in varicella-zoster?
Lesions begin as erythematous macules and papules, form superficial vesicles ('dewdrops on rose petal'), and later crust over
Eruptions of zoster lesions on the tip of the nose (Hutchinson sign) indicates involvement of what cranial nerve and risks corneal involvement?
How is AIDS defined by the CDC?
CD4 count below 200
When examining the eyes of an immunocompromised patient, you notice neovascularization and proliferative lesions, commonly referred to as 'pizza pie,' what do you suspect?
What is the most common form of pathogenic Candida species?
What is the name of a dimorphic fungus found in soil infested with bird or bat droppings?
What is the name of an encapsulated, budding yeast found in soil contaminated with dried pigeon dung?
What test is helpful in the diagnosis of cryptococcal infection?
India ink stain
What is the treatment of choice for pneumocystis jiroveci pneumonia?
What is an alternative treatment to TMP-SMX in the treatment of pneumocystis jiroveci pneumonia?
What is the recommended treatment for hookworms?
Mebendazole twice per day for 3 days
What is the only host for Enterobius vermicularis?
What are the characteristic symptoms found in patients with pinworms?
Perianal pruritus, insomnia, weight loss, enuresis, and irritability
True/False: All members of a household of a patient with pinworms should be treated.
In the treatment of pinworms, a single dose of albendazole, mebendazole, or pyrantel is given and then repeated when?
2-4 weeks later
In making the diagnosis of malaria, blood films are stained with what?
Giemsa or Wright stain
What is the drug of choice for both the prophylaxis and treatment of malaria?
Primary syphilis is characterized by what?
Chancre: a painless ulcer with clean base and firm, indurated margins
Gummatous lesions involving the skin, bones and viscera are seen in what stage of syphilis?
Late (tertiary) syphilis
Hutchinson teeth are a common manifestation of infants not treated with what disease?
In what disease states can the fluorescent treponemal antibody absorption test yield a false positive result?
Lyme disease, systemic lupus erythematous, malaria or leprosy
What is the treatment of choice for syphilis?
Benzathine penicillin G 2.4 million U IM in a single dose
In the treatment of syphilis, what can occur when there is massive destruction of spirochetes?
Jarisch-Herxheimer reaction (fever, toxic state)
Without treatment, gonorrhea can progress to involve what structures in males?
Prostate, epididymis, and periurethral glands
What is the treatment of choice for gonorrhea?
IM ceftriaxone or oral cefixime
Lymphogranuloma venereum starts with vesicular or ulcerative lesions which may spread to the lymph nodes causing what?
What is the drug of choice in the treatment of chlamydia in pregnant women?
Trichomoniasis is what type of organism?
What is the most common vector-borne disease in the United States?
What is the drug of choice in patients with erythema migrans or a suspicion of Lyme disease based on clinical findings and a history of tick bite?
What is transmitted by the wood tick?
Treatment with what has been shown to hasten recovery in patients with Rocky Mountain spotted fever?
Doxycycline or chloramphenicol
Rubbing a lesion that causes urticarial flare is referred to as?
Pinpoint bleeding after a scale is removed is referred to as?
Pushing a blister causing further separation of the dermis is referred to as?
A patch test demonstrates what?
Minor trauma leading to new lesions at the site of trauma is referred to as?
What test is used to identify dermatophyte infection?
Potassium hydroxide preparation (KOH prep)
Thickened skin with distinct borders, often resulting from excessive scratching or prolonged irritation is referred to as?
You are examining a child with diaper rash and you notice satellite lesions, what do you suspect?
Where is the rash of atopic dermatitis most commonly located?
Flexural surfaces, neck, eyelids, forehead, face and dorsum of the hands and feet
What is the mainstay of treatment of atopic dermatitis?
In the treatment of dandruff, shampoos with which two elements has been shown beneficial in acute flare ups?
Selenium and zinc
Describe the skin manifestations of lichenification.
Well-circumscribed plaques that are highly pruritic, which sets up a cycle of itch-scratch lesions
Round, salmon-colored, slightly raised, popular and macular lesions aligned in a ?Christmas tree-like distribution?, what do you suspect?
Pityriasis rosea is a self-limiting condition of what duration?
What is the cause of molluscum contagiosum?
What are the 4 P?s of lichen planus?
Purple, polygonal, pruritic, papule
Describe the lesion of lichen planus.
Flat-topped, shiny, violaceous papules with fine white lines on the surface (Wickham striae)
True/False: Koebner phenomenon is seen in lichen planus?
All patients with lichen planus should be screened for what disease state?
In what climate is dyshidrotic eczematous dermatitis (dyshidrosis) seen?
Hot, humid weather
What is the basic pathology found in psoriasis?
Enhanced epidermal cell turnover
In psoriatic lesions, peeling away a scale produces specks of bleeding from the capillaries. What is this called?
In patients with psoriasis, scratching leads to more lesions. What is this referred to?
What is the most common variant of psoriasis?
Which form of psoriasis involves the entire skin surface?
Pemphigus vulgaris is more commonly seen in people of what decent?
Jewish or Mediterranean
In pemphigus vulgaris, there is lateral extension of the lesions when they are pushed. What is this referring to?
What are the hallmark lesions of acne?
What are the topical preparations used in the treatment of mild acne?
Retinoids, azelaic acid, and salicylic acid
What is the drug of choice in the treatment of more serious or cystic acne?
True/False: Acne rosacea is a chronic acneiform disorder mainly affecting females between 30 and 50 years of age.
What are typical triggers of acne rosacea?
Heat, alcohol, sun, or hot, spicy foods
What is characterized by the insidious onset of scattered, small papulopustules and sometimes nodules, in which comedones are absent and the face appears red or flushed?
What does the suffix ?phyma mean?
What is the most common cause of folliculitis?
What is the cause of folliculitis seen in hot tub users?
What are three common causes of erythema multiforme?