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FA 2CK Rapid Review
| Question | Answer |
|---|---|
| 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.” |
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megankirch
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