PANCE

What manifestations are associated with CF? What manifestation seen in a baby? What is the treatment for CF?

recurrent pulmonary infections, loose stool, meconium ileus

Treatment: airway clearance, high fat diet, pancreatic e enzyme replacement

What do you see on Fibrocystic breast changes?

bilateral breasts, multiple diffuse nodular masses

fluctuation in size during menstrual cycle

When to contact Child Protective Services?

When you have any suspicion.

How do you prevent further pulmonary complications for a rib fracture?

Pain control

What is TORCH infections? And what is the most common infection out of all of these

Toxoplasmas gondii, Other infections like parvovirus, rubella, cytomegalovirus, HSV

Name the two diseases that a newborn can have when they are not sick

Erythema Toxicum neotorium and neonatal cephalic pustulosis.

Erythema toxicum can happen within days and neonatal cephalic normally to the head It happens three weeks later

What is the difference between neuroleptic malignant syndrome and serotonin syndrome?

Name 6 differentials for Thrombocytopenia

Immune thrombocytopenic purpura (ITP), Disseminated intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), Heparin induced thrombocytopenia (HIT), Thrombotic thrombocytopenic, purpura (TTP)

How do you treat Slipped capital femoral epiphysis

Physis stabilization with screw fixation

For a palpable breast mass, at what ages do you ultrasound vs when do you do a mammography?

Postpartum thyroiditis

Postpartum is a variant of Hashimoto thyroiditis (low thyroid) that presents a few months after delivery

What lab findings do you see in bulimia nervosa

Hypophosphatemia, hypokalemia

What is the treatment for ileus? And differentiate that between SBO

Bowel rest and serial examinations. The difference is Ileus revealed uniformly dilated bowel loops and SBO has discrete transition point obstruction that results in dilated small bowel proximal to the obstruction

At which weeks do you do you administer Rogam in a pregnant patient? And when do you do it?

For RH NEGATIVE patients at 26-28 weeks and again 72 hours after delivering

A patient's father has tuberculosis. He is treated with TB medicine. The patient has 8mm induration after a PPD test what is the treatment

Isoniazid for 9 months

What are the clinical manifestations of multiple sclerosis

Optic neuritis, Uhthoff phenomenon (heat worsens symptoms), Lhermitte sign (electric shock with neck flexion), babinski sign

What is the difference between factitious disorder and malingering

Both display falsification of illness and symptoms however malingering is for obvious external rewards

What is the treatment for SBO

Nasogastric tube

Tell me all about celiac's disease

You look for IGA antibodies, dermatitis herpetiformis

What are the symptoms of tinea capitis? What is the treatment?

Itchy scaly erythematous patch with scattered alopecia

Oral griseofulvin

Tell me all you know about DIC

Rename it to DDIC and it stands for dripping blood, D dimer elevated, ILL, clots, PT/PTT elevated

Differentials for hypoxia? What are the can not miss?

pneumonia, pulmondary edema, CHF, COPD exacerbation, OSA
Cannot miss: pulmonary embolism, pneumothorax

Tell me about TTP

Adam TS13 deficiency, fat RN, treatment plasmapheresis

Tell me about HUS

Bloody diarrhea, Urinary symptoms like dysuria, AKI, seen in children, Avoid antibiotic

Tell me about HIT (Heparin Induced Thrombocytopenia)

You will have thrombosis like DVT, venous gangrene and you stop the heparin and start non heparin agent like Direct Thrombin Inhibitors (Argatroban)
Direct Oral anticoagulants (Apixaban)

What is the difference between Acute otitis media and Otitis media with effusion?

What is treatment for AOM?

Otitis Media with effusion has no erythema, no fever, no ear pain and is sometimes seen after AOM.

Treatment is symptomatic care

What is the cause of acute angle glaucoma? And is it painful or painless

Impaired aqueous humor drainage

What physical exam finding would you find in a patellar tendon rupture vs. quadriceps tendon rupture?

Patellar tendon rupture: physical examination will show a high riding patella (patella alta) and a palpable defect at the inferior pole of the patella

Quadrcipes tendon rupture physical exma shows low riding patella

What is the treatment for cluster headache?

Oxygen and sumatriptan

Headache tension symptoms? What is the treatment for acute vs chronic?

What is the treatment for kidney abscess

Empiric intravenous antibiotics that provide coverage for methicillin-resistant Staphylococcus aureus and gram-negative bacilli, typically vancomycin plus either piperacillin-tazobactam or cefepime.

Name some X-link recessive disorders

G6PD, Hemophila A & B

A 35-year-old woman presents to the clinic for evaluation of chronic bilateral leg pain. Which of the following signs or symptoms is most likely to be found in a patient with suspected chronic venous insufficiency?

Ulcer near medial malleolus, hyperpigmentation skin, varicose vein, ankle edema

In patients who have leimyoma and wants to get pregnant still, what is the treatment?

Myomectomy - a surgery to remove uterine fibroids while leaving the uterus intact

In the setting of urge incontinence where a patient has done bladder training already and still feels symptoms, what is the treatment?

Anticholinergic medications such as oxybutynin

What is the treatment for anterior vaginal wall prolapse? Also what is another name for this?

AKA cystocele. Pelvic floor exercises

Do you administer human tetanus immune globulin (TIG) at a separate injection site and TDAP vaccine on the same arm?

No

Most common STI in the US?

HPV

Patient wants birth control, but has had prior DVT. Why can’t we give estrogen? What do you give instead?

It is a contraindication, so use progesterone-only therapy (medroxyprogesterone)

Which of the following is the initial laboratory study used for gestational diabetes screening?

1 hour glucose test

How many mL do you lose to consider it to be post partum hemorrhage?

Postpartum hemorrhage, excessive bleeding after delivery, is defined as blood loss > 1,000 mL. It can be fatal to the mother. The most common cause is uterine atony.

What is the recommended to use as an antihypertensive in a pregnant patient?

Alpha-methyldopa

Are ruptured ovarian cysts painful, mildly painful, or not painful?

All of the above

What is chadwick sign? and is it common in pregnancy?

Bluish discoloration of the vagina and cervix caused by an increase in pelvic vasculature. Yes it is common

Name 3 differentials for MSK in children

Slipped Capital femoral epiphysis, Osgood Squatter disease, Osteosarcoma

Name 5 drugs that cause QT prolongation

Ondansetron, Fluroquinolones, SSRi, Macrolides, Clozapine

PAD vs CVI (Chronic venous insufficiency)

In chronic venous insufficiency (CVI):

• Pain worsens with prolonged standing and dependency (gravity increases venous pooling and venous hypertension) [1]

• Pain improves with leg elevation (reduces venous pressure) [1]

• Pain improves with walking (activates the calf muscle pump, aiding venous return) [1]

In peripheral artery disease (PAD) — specifically chronic limb-threatening ischemia (CLTI):

• Ischemic rest pain is worsened by leg elevation (reduces already compromised arterial perfusion pressure to the foot) [2-3]

• Pain is relieved by dependency — patients classically dangle their legs over the bedside at night to obtain relief [2-3]

• Claudication pain is triggered by exertion/walking and relieved by rest (within ~10 minutes), not by positional changes [2][4]

What are smudge cells? What disease is it related to?

ruptured white blood cells—typically lymphocytes—that break apart when a lab technician prepares a blood smear. CLL (Chronic Lymphocytic Leukemia)

What is pulsus paradoxus? What disease is it seen in?

A large drop in systolic blood pressure (>10 mmHg) during inhalation. In cardiac tamponade

Name 5 Pediatric GI disorders

Meckels Diverticulum, Pyloric Stenosis, intussusception, Duodenal Atresia, Phenylketonuria

What physical exam finding do you see on pyloric stenosis?

Is it bilious or non bilious vomiting?

At what age do you see it in kids?

It is stenosis of the pylorus, most commonly due to macrolides, olive shaped mass on physical exam, nonbilious vomiting.

Age is 2 weeks to 2 months. (compare this to duodenal atresia)

What symptom do you see with duodenal atresia? At what age do you see it in kids?

Age is seen within first 48 hours

What is Meckel Diverticulum? At what age is this seen?

Reman portion of embryonic vitelline duct. You will see painless rectal bleeding. Rule of 2s: 2 years old, 2 feet from ileocecal valve, males

Name 5 differentials for inspiratory stridor

Croup, epiglottitis, retropharyngeal abscess, pertonisllar absecess, foreign body aspiration

What is valley fever?

It is a fever found in Arizona and New Mexico. And the disease that causes it is coccidiodies immitis

Lithium is known to cause what toxicity?

Hypothyroidism

Urethral stricture can cause post residual volume? True or false

True

What diseases do you see with strawberry tongue?

Kawasaki

What are common causes of asthma?

House dust mites, pollen, cats, dogs, Cockroach

What is the most common lung cancer seen in smokers and non smokers?

Adenocarcinoma

There are two types of diaper dermatitis. Name them and their characteristics

Candida dermatitis has beefy red plaques.

Diaper dermatitis spares the inguinal folds

What has a stuck on appearance?

Seborrheic keratosis

What is the most common skin cancer in the US?

Basal cell carcinoma

True or false. Actonic keratosis is a precursor to squamous cell carcinoma?

True

True or false. Psoriasis causes pitting of the nails and arthritis?

True

What has Rice watery stool?

Cholera

What has greasy foul smelling diarrhea?

Giardia Lamblia

What is the treatment for enuresis after a child has tried enuresis alarm and motivational rewards?

Desmopressin

True or false. Do you receive TDAP for every pregnancy regardless if you've had Tdap before?

True

What paraneoplastic syndromes are associated with small cell lung cancer?

Superior vena cava syndrome, Lambert Eaten syndrome, SIADH

What has raised border with central clearing?

Tinea Corpus

True or false. Hanging of foot makes the pain better in PAD? Peripheral artery disease

True

Name four diseases of Group A strep

Cellulitis, Erysipelas, Impetigo, strep throat

What is the treatment for testicular torsion?

Surgery

What are the causes of pneumonia? 5 Typicals vs 3 Atypical

What is the gram staining of staph aureus? What is the gram staining of Strep pneumo?

Staph aurues is cluster of grapes. Strep pneumo is G+ cocci

What are the SE of Amiodarone?

PFT test, Thyroid, Liver function, Corneal deposition

What is permetherin used for?

Scabies and lice

What are the bacteria that causes AOM? Can it lead to mastoiditis?

Streptococcus pneumoinia and Haemophilus Influenzae. Yes it does.

Cat scratches, body lice, low grade fever, enlarged lymph nodes after 1-3 weeks. What is the organisim?

Bartonella

Painful genital ulcers, swollen lymph nodes. PE: tender, non indurated soft ulcer with irregular edges and bleed easily when touched, inguinal lymphadenopathy. What is the gram stain. What is the tx?

haemophilus ducreyi, gram negative rods, azithromycin or ceftriaxone

Unvaccinated with fever, hoarseness, and sore throat. PE: whitish gray membrane covering tonsils and pharynx. What is the diagnosis?

Diptheria

6 year old boy at daycare centers, fecal oral transmission. Sx: abrupt with bloody/mucus diarrhea. What is the diagnosis? What is the treatment?

Shigellosis, Azithromycin

Name 6 fungal infections that affect the lungs

Blastomycosis, Candidiasis, Coccidioidomycosis, Cryptocococcis, Histoplasmosis, Pneumocystis


Blastomycosis - soil or decaying wood seen in immunocompetent men, verrucous crusted cutaneous lesions

52 year old vaccinated Filipino male construction worker presents to a clinic in his home town of Yuma Arizona with complaints of cough, “flu-like” symptoms, fever, sweats, and fatigue. Patient also complains of numerous skin lesions that vary in size and appearance. What is the most likely causative organism?

Coccidiomycosis aka Valley Fever

Travelers to endemic areas (Central/South America, Africa, India, SE Asia), abdominal cramps, bloody diarrhea with mucus, testing shows trophozoites with ingested RBCs

Entamoeba histolytica infection

What is another name for plasmodium falciparum? and where do you usually see this disease at?

Malaria, South Africa, Africa in general, Asia

A 23-year-old female with HIV gives birth to a baby girl. During the latter months of her pregnancy she experienced only mild symptoms including intermittent malaise, fatigue, and occasional myalgias. The infant presents with the pathologic findings seen on imaging. What is the organism?

Toxoplasmosis gondii

What kind of disease is Creutzfeldt-Jakob?

Prion disease - 65-year-old man is brought to the ED by his family due to progressive memory loss, unsteady gait, and personality changes over the past 2 months. Neurologic exam shows myoclonus and ataxia. MRI of the brain reveals hyperintensity in the caudate nucleus and putamen. EEG shows periodic sharp wave complexes.

What are the manifestations that can happen with Cytomegalovirus?

You can have painless vision loss especially in a patient with HIV and splenomegaly.

Name the 3 Common Respiratory Medications. List some side effects for each

Tell me about obstructive vs restrictive lung diseases

Obstructive disease - trouble getting air out - asthma, COPD, cystic fibrosis

Restrictive disease - trouble getting air IN

What are the chest x-ray findings of active TB? Define them as well.

Ghon complexes AND Caseating granulomas.

Ghon complexes are pulmonary lesion with ipsilateral hilar lymph node involvement

Tell me about Blastomycosis

Seen in immunocompetent men around soil or decaying wood. Can have pneumonia and cutaneous lesions that are crusted or ulcerated

What is pancoast tumors? and what disease is it associated with?

Tumors in the apex of lungs. Present more with neuromuscular symptoms (from compression of brachial plexus) - shoulder pain, muscle weakness, numbness tingling, upper arm swelling

Associated with squamous cell lung carcinoma

GINA guidlines of Asthma management

Start with ICS (Symbicort) + formoterol

What is formoterol?

A LABA and you never use this alone. Use this with a ICS

What are the symptoms of Bronchiectasis? What does chest x-ray show?

Sputum and hemoptysis, chest x-ray shows tram-tracking

When a baby has a C-section, what are they at greatest risk of?

Interstitial lung disease

Sarcoidosis what 2 labs are elevated?

Serum ACE and hypercalcemia