COMBANK Level 3 Flashcards

Questions and Answers

What is associated with Charcot's triad?

RUQ pain

Jaundice

Fever/chills

All of the above (correct)

What does Reynolds pentad include?

RUQ pain

Jaundice

Fever/chills

All of the above plus shock and altered mental status (correct)

Which lab marker would you find in a patient with juvenile idiopathic arthritis?

ANA

What is the rule of 10 associated with pheochromocytoma?

10% are extra-adrenal, 10% are familial, 10% are bilateral, 10% are malignant, 10% occur in children Signup and view all the answers

What are the criteria for brain death?

Irreversible absence of brain and brainstem function, absent brainstem reflexes, no drug intoxication, core body temperature >35°C, isoelectric silence on EEG Signup and view all the answers

Levonorgestrel IUD is a good option for whom?

Patients who are not compliant with daily pills and have heavy menstrual bleeding Signup and view all the answers

What does the presence of antibodies to the Hepatitis B surface antigen but not the core antigen indicate?

Successful vaccination Signup and view all the answers

Where is the most common site for adenocarcinoma of the colon in hereditary nonpolyposis colon cancer?

Proximal portion Signup and view all the answers

What scores are used to determine preoperative risk in cirrhotic patients?

Child-Pugh, MELD scores Signup and view all the answers

What is associated with the best prognosis for pancreatic cancer?

Resectable pancreatic tumors Signup and view all the answers

Panic disorder is commonly associated with which psychiatric disorder?

Depression Signup and view all the answers

What is assist-control ventilation?

A type of ventilatory support where the patient initiates a breath, and the ventilator delivers a breath at a preset tidal volume with a backup rate. Signup and view all the answers

What is continuous positive airway pressure (CPAP)?

A setting in which specific pressure is set to keep airways open while allowing spontaneous breaths. Signup and view all the answers

What does controlled mechanical ventilation entail?

The machine does not allow spontaneous breaths nor supports them, used when the patient is making no effort. Signup and view all the answers

What is intermittent mandatory ventilation?

The patient can initiate breaths, and the machine supports them based on the preset pressure and the patient's own pattern. Signup and view all the answers

Type I DM is associated with which disease?

Autoimmune hepatitis Signup and view all the answers

What should you do with a child with type 1 DM?

Check TSH, T4, T3 Signup and view all the answers

What is the appropriate recommended daily increase in caloric intake during pregnancy?

340 kcal/day during the second trimester and 452 kcal/day during the third trimester Signup and view all the answers

What disease affects the skin, CNS, and other organs?

Tuberous sclerosis Signup and view all the answers

What muscles does the ulnar nerve innervate?

Intrinsic muscles of the hands, flexor carpi ulnaris, extensor carpi ulnaris, ulnar half of the flexor digitorum profundus Signup and view all the answers

What is the gold standard test for pulmonary embolism (PE)?

Angiogram Signup and view all the answers

What bones make up the pterion?

Temporal, parietal, sphenoid, frontal Signup and view all the answers

What is the follow-up treatment of sarcoma botryoides?

Complete evaluation with ultrasonography of the pelvis following CT to assess vaginal structure involvement Signup and view all the answers

What does smoking house + bitter aroma suggest in differential diagnosis?

Cyanide poisoning Signup and view all the answers

What is the Thompson test used for?

To detect Achilles rupture Signup and view all the answers

What is the Thomas test used for?

To detect hip flexor contracture and tightness Signup and view all the answers

Magnesium sulfate is contraindicated in which condition?

Myasthenia gravis Signup and view all the answers

What are the reasons for valve replacement in case of infective endocarditis?

Prosthetic valve endocarditis, uncontrolled infection, local complications, ineffective therapy, systemic embolization, refractory heart failure Signup and view all the answers

What is necrobiosis lipoidica?

A vasculitis primarily occurring in diabetics that produces areas of atrophy Signup and view all the answers

What causes tram track appearance of the basement membrane in kidneys?

Subendothelial and mesangial deposits, associated with membranoproliferative nephropathy Signup and view all the answers

Anti-GBM deposits are associated with which syndrome?

Goodpasture's syndrome Signup and view all the answers

Glomerular basement membrane splitting is associated with?

Alport syndrome Signup and view all the answers

What can exacerbate myasthenia gravis symptoms?

Antibiotics such as macrolides, aminoglycosides, tetracyclines, fluoroquinolones, antiarrhythmics Signup and view all the answers

What is the most definitive test for confirmation of ascending cholangitis?

ERCP Signup and view all the answers

Excessive laxative use will result in which electrolyte effect?

Hypokalemia and acidosis Signup and view all the answers

What is the drug of choice for Paget's disease?

A strong bisphosphonate, i.e., zoledronic acid Signup and view all the answers

What is subchondral sclerosis associated with?

Osteoarthritis Signup and view all the answers

What medication should be avoided in patients with digoxin toxicity?

Calcium channel blocker (diltiazem) Signup and view all the answers

When is procainamide or diltiazem used in atrial fibrillation?

Procainamide is used in WPW with atrial fibrillation; diltiazem is used in normal atrial fibrillation Signup and view all the answers

What is the most important lab value to monitor to see a response to treatment of osteomyelitis?

C-reactive protein Signup and view all the answers

What is the weight gain during pregnancy for a BMI of 29?

11-20 lb Signup and view all the answers

Which antibodies require oxygen for uptake into bacterial cells?

Aminoglycoside Signup and view all the answers

Which medication slows the progression of primary biliary cirrhosis?

Ursodeoxycholic acid Signup and view all the answers

What is the lead level cutoff?

5 micrograms per deciliter Signup and view all the answers

What is the best test to confirm sickle cell disease?

Hemoglobin electrophoresis Signup and view all the answers

Which diuretic has the greatest oral bioavailability?

Bumetanide Signup and view all the answers

What antibiotic is given for traveler's diarrhea?

Ciprofloxacin Signup and view all the answers

What amount of radiation causes harm to the fetus?

No harm if less than 50 mGy (5 rads) Signup and view all the answers

What can excessive calcium intake lead to in milk-alkali syndrome?

Acute renal failure Signup and view all the answers

Oculomasticatory myorhythmia is associated with what disease?

Whipple disease Signup and view all the answers

What should you do next for an intubated patient with acute agitation and oxygen desaturation?

Obtain a chest X-ray Signup and view all the answers

For an abdominal aortic aneurysm measuring 3-4 cm, what should be done?

Annual ultrasound Signup and view all the answers

What is the first-line blood pressure medication for African American patients?

Hydrochlorothiazide (starting at 12.5 and increasing to 25) and/or a calcium channel blocker like amlodipine Signup and view all the answers

After starting a patient on a diuretic, what test would you do?

BMP Signup and view all the answers

What lifestyle changes are needed for hypertension?

Exercise, quit smoking, DASH diet, weight loss Signup and view all the answers

What is the initial approach to improving GERD?

Formula thickening with a small amount of baby cereal Signup and view all the answers

What is the treatment for cyanide toxicity?

Amyl nitrate and oxygen Signup and view all the answers

What is the antidote for disulfiram treatment?

Fomepizole Signup and view all the answers

What is the treatment for iron toxicity?

Deferoxamine Signup and view all the answers

Normal PT, normal PTT, normal bleeding time, normal PLT indicates?

Vitamin C deficiency Signup and view all the answers

Normal PT, increased PTT, increased BT, normal PLT indicates?

Hemophilia A Signup and view all the answers

Normal PT, increased PTT, increased BT, normal PLT indicates?

Von Willebrand's disease Signup and view all the answers

Normal PT, normal PTT, increased BT, decreased PLT indicates?

Idiopathic thrombocytopenic purpura Signup and view all the answers

What is the treatment for lead poisoning?

Dimercaprol or succimer Signup and view all the answers

What structure is removed when removing a thyroglossal duct cyst?

Hyoid bone Signup and view all the answers

What medication is a bulimic person likely to abuse?

Laxatives Signup and view all the answers

What is Russell's sign?

Callus formation on the back of the index and long finger due to self-inflicted vomiting Signup and view all the answers

Which Doppler ultrasound finding is indicative of severe peripheral disease?

Monophasic waveform Signup and view all the answers

What is the ankle-brachial index for normal, claudication likely, and rest pain?

1 or greater - normal, 0.5-0.8 - claudication likely, less than 0.4 - 0.5 often experience pain at rest Signup and view all the answers

Increased methylmalonic acid and increased homocysteine indicate?

Vitamin B12 deficiency Signup and view all the answers

What is a complication of oral burns?

A delayed complication is labial artery bleeding Signup and view all the answers

McCune-Albright syndrome is caused by?

An activating mutation in the receptor for FSH/LH Signup and view all the answers

At what age should you start doing mammograms?

50 Signup and view all the answers

What deficiency is associated with decreased glucose intolerance, increased insulin intake, and short bowel syndrome?

Chromium Signup and view all the answers

What deficiency is associated with a baby showing muscle weakness, hypopigmentation, hepatosplenomegaly, kinky hair, and microcytic anemia?

Copper Signup and view all the answers

What deficiency is associated with an erythematous mixed vesiculobullous and pustular rash around a baby's mouth and anus?

Zinc Signup and view all the answers

What deficiency is associated with a baby swelling in the lower extremities, white nail beds, macrocytosis, and cardiomyopathy?

Selenium Signup and view all the answers

How do you manage a pelvic fracture?

Apply a pelvic binder Signup and view all the answers

For aspirin toxicity, what test do you need?

ABG Signup and view all the answers

What is the treatment for hyperkalemia?

Calcium gluconate Signup and view all the answers

What is the treatment for magnesium toxicity?

Calcium gluconate Signup and view all the answers

Boutonniere deformity is seen with which condition?

Rheumatoid arthritis Signup and view all the answers

What are the hormone levels during menopause?

Decrease estrogen, increase FSH/LH, increased GnRH Signup and view all the answers

What hormone is used in the diagnosis of menopause?

FSH Signup and view all the answers

What is the treatment for Behcet syndrome?

Prednisone Signup and view all the answers

What is the treatment for anthrax?

Doxycycline or ciprofloxacin for 60 days Signup and view all the answers

What tests should be ordered for a patient with diverticulitis?

CBC, electrolyte, CT scan Signup and view all the answers

What is the treatment for diverticulitis?

Antibiotics (ceftriaxone and metronidazole), NPO, admit to medicine, IV fluid resuscitation Signup and view all the answers

What should be done after an acute episode of diverticulitis?

Colonoscopy, high fiber diet Signup and view all the answers

A patient had diverticulitis, recovered, and then had an abscess...what should be done?

Broad-spectrum antibiotics, fluid bolus 30 mL/kg, IR consultation for percutaneous drainage, medicine admission, NPO, stat surgery consult Signup and view all the answers

Evisceration of the eyes is defined as?

Removal of the contents of the globe while leaving the sclera and extraocular muscles intact Signup and view all the answers

Exogenous endophthalmitis is caused by?

Staphylococcus epidermidis Signup and view all the answers

What is the most sensitive test to detect carcinoma of the pancreatic head?

ERCP Signup and view all the answers

What should be done with neck trauma?

Obtain an angiogram, esophagoscopy, or laryngoscope for zone 1 and 2; surgery for zone 2 Signup and view all the answers

What is a rare but serious complication of DKA?

Rhinocerebral mucormycosis Signup and view all the answers

What is an adverse effect of amphotericin B?

Nephrotoxicity Signup and view all the answers

What symptoms are associated with Klinefelter syndrome?

Gynecomastia, taller height, disproportionately longer limbs, firm and small testicles, high-pitched voice, female fat distribution, mitral valve prolapse, venous disorder Signup and view all the answers

What condition is indicated by decreased bone mineral density, increased gonadotropin, increased estradiol, increased FSH/LH?

Klinefelter syndrome Signup and view all the answers

Study Notes

Key Medical Terms and Definitions

Charcot's Triad: RUQ pain, jaundice, fever/chills; associated with cholangitis.
Reynolds Pentad: RUQ pain, jaundice, fever/chills, shock, altered mental status; severe cholangitis presentation.
Juvenile Idiopathic Arthritis (JIA): ANA positive; characterized by chronic arthritis in children; typically involves four or fewer joints.

Pheochromocytoma Characteristics

Rule of 10: 10% are extra-adrenal, familial, bilateral, malignant, or occur in children.

Brain Death Criteria

Brain Death Diagnosis: Irreversible absence of brain and brainstem function; apnea, absent brainstem reflexes, no drug intoxication, temperature >35°C, isoelectric EEG.

Levonorgestrel IUD

Recommended for non-compliant patients with heavy menstrual bleeding; reduces menstrual flow.

Hepatitis B Indicators

Presence of antibodies to surface antigen (anti-HBs) but not core antigen (anti-HBc) indicates successful vaccination.

Hereditary Nonpolyposis Colon Cancer (Lynch Syndrome)

Most common site for adenocarcinoma of the colon: proximal portion.

Preoperative Risk Scores

Utilization of Child-Pugh and MELD scores for assessing preoperative risk in cirrhotic patients.

Pancreatic Cancer Prognosis

Best prognosis associated with resectable tumors in the pancreatic head; minimal invasion of surrounding structures.

Panic Disorder Associations

Commonly associated with depression.

Types of Ventilation

Assist-Control Ventilation: Patient initiates breathing; ventilator supports with set tidal volume and back-up rate.
Continuous Positive Airway Pressure (CPAP): Maintains airway pressure; allows for spontaneous breaths.
Controlled Mechanical Ventilation: No patient effort; ventilator controls all breaths.
Intermittent Mandatory Ventilation: Patient can initiate breaths; machine supports based on patient's pattern.

Autoimmune Connections

Type I Diabetes Mellitus: Associated with autoimmune hepatitis.
Thyroid Screening: 20% of children with Type I DM will have thyroid antibodies; screen TSH, T4, T3.

Pregnancy and Caloric Needs

Recommended calorie increase: 340 kcal/day in the second trimester and 452 kcal/day in the third trimester.

Tuberous Sclerosis

Systemic disease affecting skin, CNS, and other organs; features include shagreen patch (connective tissue nevi).

Ulnar Nerve Innervation

Innervates intrinsic muscles of the hands, flexor carpi ulnaris, extensor carpi ulnaris, and ulnar half of the flexor digitorum profundus.

Pulmonary Embolism Testing

Gold Standard: Angiogram for confirmation.

Pterion Structure

Comprised of temporal, parietal, sphenoid, and frontal bones.

Sarcoma Botryoides Follow-Up

Evaluate with pelvic ultrasound post CT scan for involvement of vaginal structures.

Cyanide Poisoning

Differential diagnosis includes smoking houses with a bitter aroma; treat with amyl nitrite and thiosulfate.

Thompson Test

Used to detect Achilles tendon rupture.

Thomas Test

Detects hip flexor contracture.

Magnesium Sulfate Contraindication

Should not be used in myasthenia gravis patients.

Valve Replacement in Endocarditis

Replacement indicated for prosthetic endocarditis, uncontrolled infection, suppurative complications, ineffective therapy, and recurrent systemic emboli.

Necrobiosis Lipoidica

Vasculitis in diabetics, with painless skin lesions primarily on the shins.

Nephrology Terms

Tram Track Appearance: Subendothelial and mesangial deposits associated with membranoproliferative nephropathy.
Anti-GBM Deposits: Associated with Goodpasture's syndrome.
Basement Membrane Splitting: Characteristic of Alport syndrome.

Factors Exacerbating Myasthenia Gravis

Certain antibiotics: macrolides, aminoglycosides, tetracyclines, fluoroquinolones.

Ascending Cholangitis Confirmation

Most definitive test: ERCP.

Excessive Laxative Use Consequences

Results in hypokalemia and acidosis.

Paget's Disease Treatment

Bisphosphonate, specifically zoledronic acid.

Osteomyelitis Treatment Monitoring

Key lab value: C-reactive protein for treatment response.

Hypertension Management

Lifestyle changes include exercise, smoking cessation, DASH diet, and weight loss.

Pregnancy Weight Gain Guidelines

Overweight individuals (BMI 29) should gain 11-20 lbs.

Lead Poisoning Treatment

Dimercaprol and succimer as antidotes.

Thyroglossal Duct Cyst Removal

Requires removal of the hyoid bone.

Laxative Abuse in Bulimia

Commonly abused laxatives include Bisacodyl, cascara, senna.

Klinefelter Syndrome Features

Symptoms: gynecomastia, taller than average height, delayed development, firm and small testicles.

Diverticulitis Management

Initial assessment includes CBC, electrolytes, and CT scan; treatment involves antibiotics and possible surgical consultation.

Advanced Emergency Interventions

Evisceration of the eyes defined as removal of contents while retaining globe structure; neck trauma requires angiogram or surgical intervention.

Risk of Radiation Exposure

No harm if less than 50 mGy (5 rads) during pregnancy.

Treatment for Cyanide Toxicity

Use amyl nitrate and oxygen.

Complications Known with DKA

Rhinocerebral mucormycosis may present and requires IV amphotericin B for treatment.

Ranson's Criteria for Pancreatitis

Important clinical criteria used for assessing severity and prognosis in acute pancreatitis patients.

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Test your knowledge with these COMBANK level 3 flashcards, focusing on key medical terms and definitions. Each card presents important concepts related to specific medical conditions and laboratory markers. Challenge yourself and enhance your understanding of critical clinical concepts.