COMBANK Level 3 Flashcards
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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?

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

    What are the criteria for brain death?

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

    Levonorgestrel IUD is a good option for whom?

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

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

    <p>Successful vaccination</p> Signup and view all the answers

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

    <p>Proximal portion</p> Signup and view all the answers

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

    <p>Child-Pugh, MELD scores</p> Signup and view all the answers

    What is associated with the best prognosis for pancreatic cancer?

    <p>Resectable pancreatic tumors</p> Signup and view all the answers

    Panic disorder is commonly associated with which psychiatric disorder?

    <p>Depression</p> Signup and view all the answers

    What is assist-control ventilation?

    <p>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.</p> Signup and view all the answers

    What is continuous positive airway pressure (CPAP)?

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

    What does controlled mechanical ventilation entail?

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

    What is intermittent mandatory ventilation?

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

    Type I DM is associated with which disease?

    <p>Autoimmune hepatitis</p> Signup and view all the answers

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

    <p>Check TSH, T4, T3</p> Signup and view all the answers

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

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

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

    <p>Tuberous sclerosis</p> Signup and view all the answers

    What muscles does the ulnar nerve innervate?

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

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

    <p>Angiogram</p> Signup and view all the answers

    What bones make up the pterion?

    <p>Temporal, parietal, sphenoid, frontal</p> Signup and view all the answers

    What is the follow-up treatment of sarcoma botryoides?

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

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

    <p>Cyanide poisoning</p> Signup and view all the answers

    What is the Thompson test used for?

    <p>To detect Achilles rupture</p> Signup and view all the answers

    What is the Thomas test used for?

    <p>To detect hip flexor contracture and tightness</p> Signup and view all the answers

    Magnesium sulfate is contraindicated in which condition?

    <p>Myasthenia gravis</p> Signup and view all the answers

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

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

    What is necrobiosis lipoidica?

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

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

    <p>Subendothelial and mesangial deposits, associated with membranoproliferative nephropathy</p> Signup and view all the answers

    Anti-GBM deposits are associated with which syndrome?

    <p>Goodpasture's syndrome</p> Signup and view all the answers

    Glomerular basement membrane splitting is associated with?

    <p>Alport syndrome</p> Signup and view all the answers

    What can exacerbate myasthenia gravis symptoms?

    <p>Antibiotics such as macrolides, aminoglycosides, tetracyclines, fluoroquinolones, antiarrhythmics</p> Signup and view all the answers

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

    <p>ERCP</p> Signup and view all the answers

    Excessive laxative use will result in which electrolyte effect?

    <p>Hypokalemia and acidosis</p> Signup and view all the answers

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

    <p>A strong bisphosphonate, i.e., zoledronic acid</p> Signup and view all the answers

    What is subchondral sclerosis associated with?

    <p>Osteoarthritis</p> Signup and view all the answers

    What medication should be avoided in patients with digoxin toxicity?

    <p>Calcium channel blocker (diltiazem)</p> Signup and view all the answers

    When is procainamide or diltiazem used in atrial fibrillation?

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

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

    <p>C-reactive protein</p> Signup and view all the answers

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

    <p>11-20 lb</p> Signup and view all the answers

    Which antibodies require oxygen for uptake into bacterial cells?

    <p>Aminoglycoside</p> Signup and view all the answers

    Which medication slows the progression of primary biliary cirrhosis?

    <p>Ursodeoxycholic acid</p> Signup and view all the answers

    What is the lead level cutoff?

    <p>5 micrograms per deciliter</p> Signup and view all the answers

    What is the best test to confirm sickle cell disease?

    <p>Hemoglobin electrophoresis</p> Signup and view all the answers

    Which diuretic has the greatest oral bioavailability?

    <p>Bumetanide</p> Signup and view all the answers

    What antibiotic is given for traveler's diarrhea?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What amount of radiation causes harm to the fetus?

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

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

    <p>Acute renal failure</p> Signup and view all the answers

    Oculomasticatory myorhythmia is associated with what disease?

    <p>Whipple disease</p> Signup and view all the answers

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

    <p>Obtain a chest X-ray</p> Signup and view all the answers

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

    <p>Annual ultrasound</p> Signup and view all the answers

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

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

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

    <p>BMP</p> Signup and view all the answers

    What lifestyle changes are needed for hypertension?

    <p>Exercise, quit smoking, DASH diet, weight loss</p> Signup and view all the answers

    What is the initial approach to improving GERD?

    <p>Formula thickening with a small amount of baby cereal</p> Signup and view all the answers

    What is the treatment for cyanide toxicity?

    <p>Amyl nitrate and oxygen</p> Signup and view all the answers

    What is the antidote for disulfiram treatment?

    <p>Fomepizole</p> Signup and view all the answers

    What is the treatment for iron toxicity?

    <p>Deferoxamine</p> Signup and view all the answers

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

    <p>Vitamin C deficiency</p> Signup and view all the answers

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

    <p>Hemophilia A</p> Signup and view all the answers

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

    <p>Von Willebrand's disease</p> Signup and view all the answers

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

    <p>Idiopathic thrombocytopenic purpura</p> Signup and view all the answers

    What is the treatment for lead poisoning?

    <p>Dimercaprol or succimer</p> Signup and view all the answers

    What structure is removed when removing a thyroglossal duct cyst?

    <p>Hyoid bone</p> Signup and view all the answers

    What medication is a bulimic person likely to abuse?

    <p>Laxatives</p> Signup and view all the answers

    What is Russell's sign?

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

    Which Doppler ultrasound finding is indicative of severe peripheral disease?

    <p>Monophasic waveform</p> Signup and view all the answers

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

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

    Increased methylmalonic acid and increased homocysteine indicate?

    <p>Vitamin B12 deficiency</p> Signup and view all the answers

    What is a complication of oral burns?

    <p>A delayed complication is labial artery bleeding</p> Signup and view all the answers

    McCune-Albright syndrome is caused by?

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

    At what age should you start doing mammograms?

    <p>50</p> Signup and view all the answers

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

    <p>Chromium</p> Signup and view all the answers

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

    <p>Copper</p> 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?

    <p>Zinc</p> Signup and view all the answers

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

    <p>Selenium</p> Signup and view all the answers

    How do you manage a pelvic fracture?

    <p>Apply a pelvic binder</p> Signup and view all the answers

    For aspirin toxicity, what test do you need?

    <p>ABG</p> Signup and view all the answers

    What is the treatment for hyperkalemia?

    <p>Calcium gluconate</p> Signup and view all the answers

    What is the treatment for magnesium toxicity?

    <p>Calcium gluconate</p> Signup and view all the answers

    Boutonniere deformity is seen with which condition?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What are the hormone levels during menopause?

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

    What hormone is used in the diagnosis of menopause?

    <p>FSH</p> Signup and view all the answers

    What is the treatment for Behcet syndrome?

    <p>Prednisone</p> Signup and view all the answers

    What is the treatment for anthrax?

    <p>Doxycycline or ciprofloxacin for 60 days</p> Signup and view all the answers

    What tests should be ordered for a patient with diverticulitis?

    <p>CBC, electrolyte, CT scan</p> Signup and view all the answers

    What is the treatment for diverticulitis?

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

    What should be done after an acute episode of diverticulitis?

    <p>Colonoscopy, high fiber diet</p> Signup and view all the answers

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

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

    Evisceration of the eyes is defined as?

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

    Exogenous endophthalmitis is caused by?

    <p>Staphylococcus epidermidis</p> Signup and view all the answers

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

    <p>ERCP</p> Signup and view all the answers

    What should be done with neck trauma?

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

    What is a rare but serious complication of DKA?

    <p>Rhinocerebral mucormycosis</p> Signup and view all the answers

    What is an adverse effect of amphotericin B?

    <p>Nephrotoxicity</p> Signup and view all the answers

    What symptoms are associated with Klinefelter syndrome?

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

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

    <p>Klinefelter syndrome</p> 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.

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