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FA 2CK Rapid Review

Classic ECG finding in atrial flutter. “Sawtooth” P waves.
Definition of unstable angina. Angina is new, is worsening, or occurs at rest.
Antihypertensive for a diabetic patient with proteinuria. ACEI.
Beck’s triad for cardiac tamponade. Hypotension, distant heart sounds, and JVD.
Drugs that slow AV node transmission. β-blockers, digoxin, calcium channel blockers.
Hypercholesterolemia treatment that leads to flushing and pruritus. Niacin.
Murmur—hypertrophic obstructive cardiomyopathy (HOCM). Systolic ejection murmur heard along the lateral sternal border that ↑ with Valsalva maneuver and standing.
Murmur—aortic insufficiency. Diastolic, decrescendo, high-pitched, blowing murmur that is best heard sitting up; ↑ with ↓ preload (handgrip maneuver).
Murmur—aortic stenosis. Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ preload (Valsalva maneuver).
Murmur—mitral regurgitation. Holosystolic murmur that radiates to the axillae or carotids.
Murmur—mitral stenosis. Diastolic, mid- to late, low-pitched murmur.
Treatment for atrial fibrillation and atrial flutter. If unstable, cardiovert. If stable or chronic, rate control with calcium channel blockers or β-blockers.
Treatment for ventricular fibrillation. Immediate cardioversion.
Autoimmune complication occurring 2–4 weeks post-MI. Dressler’s syndrome: fever, pericarditis, ↑ ESR.
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment? Treat existing heart failure and replace the tricuspid valve.
Diagnostic test for hypertrophic cardiomyopathy. Echocardiogram (showing thickened left ventricular wall and outflow obstruction).
A fall in systolic BP of > 10 mmHg with inspiration. Pulsus paradoxus (seen in cardiac tamponade).
Classic ECG findings in pericarditis. Low-voltage, diffuse ST-segment elevation.
Definition of hypertension. BP > 140/90 on three separate occasions two weeks apart.
Eight surgically correctable causes of hypertension. Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.
Evaluation of a pulsatile abdominal mass and bruit. Abdominal ultrasound and CT.
Indications for surgical repair of abdominal aortic aneurysm. >5.5 cm, rapidly enlarging, symptomatic, or ruptured.
Treatment for acute coronary syndrome. Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin.
What is metabolic syndrome? Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.
Appropriate diagnostic test? A 50 year old man with angina can exercise to 85% of maximum predicted heart rate. Exercise stress treadmill with ECG.
Appropriate diagnostic test? A 65 year old woman with left bundle branch block and severe osteoarthritis has unstable angina. Pharmacologic stress test (e.g., dobutamine echo).
Target LDL in a patient with diabetes. <70.
Signs of active ischemia during stress testing. Angina, ST-segment changes on ECG, or ↓ BP.
ECG findings suggesting MI. ST-segment elevation (depression means ischemia), flattened T waves, and Q waves.
Coronary territories in MI. Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal).
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal. Prinzmetal’s angina.
Common symptoms associated with silent MIs. CHF, shock, and altered mental status.
The diagnostic test for pulmonary embolism. V/Q scan.
An agent that reverses the effects of heparin. Protamine.
The coagulation parameter affected by warfarin. PT.
A young patient with a family history of sudden death collapses and dies while exercising. Hypertrophic cardiomyopathy.
Endocarditis prophylaxis regimens. Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after.
The 6 P’s of ischemia due to peripheral vascular disease. Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia.
Virchow’s triad. Stasis, hypercoagulability, endothelial damage.
The most common cause of hypertension in young women. OCPs.
The most common cause of hypertension in young men. Excessive EtOH.
“Stuck-on” appearance. Seborrheic keratosis.
Red plaques with silvery-white scales and sharp margins. Psoriasis.
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias. Basal cell carcinoma.
Honey-crusted lesions. Impetigo.
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity. Cellulitis.
(+) Nikolsky’s sign. Pemphigus vulgaris.
(-) Nikolsky’s sign. Bullous pemphigoid.
A 55 year old obese patient presents with dirty, velvety patches on the back of the neck. Acanthosis nigricans. Check fasting blood glucose to rule out diabetes.
Dermatomal distribution. Varicella zoster.
Flat-topped papules. Lichen planus.
Iris-like target lesions. Erythema multiforme.
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry. Contact dermatitis.
Presents with a herald patch, Christmas-tree pattern. Pityriasis rosea.
A 16 year old presents with an annular patch of alopecia with broken-off, stubby hairs. Alopecia areata (an autoimmune process).
Pinkish, scaling, flat lesions on the chest and back; KOH prep has a “spaghetti-and-meatballs” appearance. Pityriasis versicolor.
Four characteristics of a nevus suggestive of melanoma. Asymmetry, border irregularity, color variation, and large diameter.
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma. Actinic keratosis.
“Dewdrops on a rose petal.” Lesions of 1° varicella.
“Cradle cap.” Seborrheic dermatitis. Treat with antifungals.
Associated with Propionibacterium acnes and changes in androgen levels. Acne vulgaris.
A painful, recurrent vesicular eruption of mucocutaneous surfaces. Herpes simplex.
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women. Lichen sclerosus.
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer. Squamous cell carcinoma.
The most common cause of hypothyroidism. Hashimoto’s thyroiditis.
Lab findings in Hashimoto’s thyroiditis. High TSH, low T4, antimicrosomal antibodies.
Exophthalmos, pretibial myxedema, and ↓ TSH. Graves’ disease.
The most common cause of Cushing’s syndrome. Iatrogenic corticosteroid administration. The second most common cause is Cushing’s disease.
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. Hypoparathyroidism.
“Stones, bones, groans, psychiatric overtones.” Signs and symptoms of hypercalcemia.
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis. 1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia).
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic. Pheochromocytoma.
Should α- or β-antagonists be used first in treating pheochromocytoma? α-antagonists (phentolamine and phenoxybenzamine).
A patient with a history of lithium use presents with copious amounts of dilute urine. Nephrogenic diabetes insipidus (DI).
Treatment of central DI. Administration of DDAVP ↓ serum osmolality and free water restriction.
A postoperative patient with significant pain presents with hyponatremia and normal volume status. SIADH due to stress.
An antidiabetic agent associated with lactic acidosis. Metformin.
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment? 1° adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids.
Goal HbA1c for a patient with DM. <7.0.
Treatment of DKA. Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+).
Why are β-blockers contraindicated in diabetics? They can mask symptoms of hypoglycemia.
Bias introduced into a study when a clinician is aware of the patient’s treatment type. Observational bias.
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death. Lead-time bias.
If you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____. Confounding variable.
The number of true positives divided by the number of patients with the disease is _____. Sensitivity.
Sensitive tests have few false negatives and are used to rule _____ a disease. Out.
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a (+) PPD. Highly sensitive or specific? Highly sensitive for TB.
Chronic diseases such as SLE—higher prevalence or incidence? Higher prevalence.
Epidemics such as influenza—higher prevalence or incidence? Higher incidence.
Cross-sectional survey—incidence or prevalence? Prevalence.
Cohort study—incidence or prevalence? Incidence and prevalence.
Case-control study—incidence or prevalence? Neither.
Describe a test that consistently gives identical results, but the results are wrong. High reliability, low validity.
Difference between a cohort and a case-control study. Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR.
Attributable risk? The incidence rate (IR) of a disease in exposed – the IR of a disease in unexposed.
Relative risk? The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed.
Odds ratio? The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed.
Number needed to treat? 1 ÷ (rate in untreated group – rate in treated group).
In which patients do you initiate colorectal cancer screening early? Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer.
The most common cancer in men and the most common cause of death from cancer in men. Prostate cancer is the most common cancer in men, but lung cancer causes more deaths.
The percentage of cases within one SD of the mean? Two SDs? Three SDs? 68%, 95.4%, 99.7%.
Birth rate? Number of live births per 1000 population in one year.
Fertility rate? Number of live births per 1000 females (15–44 years of age) in one year.
Mortality rate? Number of deaths per 1000 population in one year.
Neonatal mortality rate? Number of deaths from birth to 28 days per 1000 live births in one year.
Postnatal mortality rate? Number of deaths from 28 days to one year per 1000 live births in one year.
Infant mortality rate? Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality) in one year.
Fetal mortality rate? Number of deaths from 20 weeks’ gestation to birth per 1000 total births in one year.
Perinatal mortality rate? Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births in one year.
Maternal mortality rate? Number of deaths during pregnancy to 90 days postpartum per 100,000 live births in one year.
True or false: Once patients sign a statement giving consent, they must continue treatment. False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity.
A 15 year old pregnant girl requires hospitalization for preeclampsia. Is parental consent required? No. Parental consent is not necessary for the medical treatment of pregnant minors.
A doctor refers a patient for an MRI at a facility he/she owns. Conflict of interest.
Involuntary psychiatric hospitalization can be undertaken for which three reasons? The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs).
True or false: Withdrawing a nonbeneficial treatment is ethically similar to withholding a nonindicated one. True.
When can a physician refuse to continue treating a patient on the grounds of futility? When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care.
An eight year old child is in a serious accident. She requires emergent transfusion, but her parents are not present. Treat immediately. Consent is implied in emergency situations.
Conditions in which confidentiality must be overridden. Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse.
Involuntary commitment or isolation for medical treatment may be undertaken for what reason? When treatment noncompliance represents a serious danger to public health (e.g., active TB).
A 10 year old child presents in status epilepticus, but her parents refuse treatment on religious grounds. Treat because the disease represents an immediate threat to the child’s life. Then seek a court order.
A son asks that his mother not be told about her recently discovered cancer. A physician can withhold information from the patient only in the rare case of therapeutic privilege or if the patient requests not to be told. A patient’s family cannot require the physician to withhold information from the patient.
A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management? Emergent laparotomy to repair perforated viscus.
The most likely cause of acute lower GI bleed in patients >40 years of age. Diverticulosis.
Diagnostic modality used when ultrasound is equivocal for cholecystitis. HIDA scan.
Risk factors for cholelithiasis. Fat, female, fertile, forty, flatulent.
Inspiratory arrest during palpation of the RUQ. Murphy’s sign, seen in acute cholecystitis.
The most common cause of SBO in patients with no history of abdominal surgery. Hernia.
The most common cause of SBO in patients with a history of abdominal surgery. Adhesions.
Identify key organisms causing diarrhea: Most common organism. Campylobacter.
Identify key organisms causing diarrhea: Recent antibiotic use. Clostridium difficile.
Identify key organisms causing diarrhea: Camping. Giardia.
Identify key organisms causing diarrhea: Traveler’s diarrhea. ETEC.
Identify key organisms causing diarrhea: Church picnics/mayonnaise. S. aureus.
Identify key organisms causing diarrhea: Uncooked hamburgers. E. coli O157:H7.
Identify key organisms causing diarrhea: Fried rice. Bacillus cereus.
Identify key organisms causing diarrhea: Poultry/eggs. Salmonella.
Identify key organisms causing diarrhea: Raw seafood. Vibrio, HAV.
Identify key organisms causing diarrhea: AIDS. Isospora, Cryptosporidium, Mycobacterium avium complex (MAC).
Identify key organisms causing diarrhea: Pseudoappendicitis. Yersinia.
A 25 year old Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias. Crohn’s disease.
Inflammatory disease of the colon with ↑ risk of colon cancer. Ulcerative colitis (greater risk than Crohn’s).
Extraintestinal manifestations of IBD. Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis.
Medical treatment for IBD. 5-ASA agents and steroids during acute exacerbations.
Difference between Mallory-Weiss and Boerhaave tears. Mallory-Weiss—superficial tear in the esophageal mucosa; Boerhaave—full-thickness esophageal rupture.
Charcot’s triad. RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis.
Reynolds’ pentad. Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis.
Medical treatment for hepatic encephalopathy. ↓ protein intake, lactulose, rifaximin.
First step in the management of a patient with an acute GI bleed. Establish the ABCs.
A four year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause? Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7.
Post-HBV exposure treatment. HBV immunoglobulin.
Classic causes of drug-induced hepatitis. TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.
A 40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools. Biliary tract obstruction.
Hernia with highest risk of incarceration—indirect, direct, or femoral? Femoral hernia.
A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management? Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time.”
Created by: megankirch