Physical signs of illness is another area well covered by the boards, additionally
we can encounter these at any given day in our clinical practice....may be as soon as
tomorrow!?
So, lets review some of the interesting ones.
Q: What is the HUTCHISON'S SIGN?
A: The appearance of vesicles on the tip or lateral aspect of the nose indicating involvement
of the nasociliary nerve branch by VZV (VARICELLA ZOSTER VIRUS). An opthalmology
referral is warranted, as it is likely to indicate onset of Herpes Zoster Opthalmicus.
Q: What is the sign of LESER-TRELAT?
A: Abrupt onset (eruption) of many pruritic Seborrheic Keratosis (scaly,reddish
lesions) on the face, most commonly associated with imminent dx. of GASTRIC
ADENOCARCINOMA.
Q: What is DARIER'S sign?
A: Eruption of a pigmented salmon-brown lesions with pruritus (Urticaria Pigmentosa)
at the site of stroking of the skin. This is found in MASTOCYTOSIS, a condition
caused by systemic histamine release, due to mast cell proliferation.
Q: What underlying condition does RACOON EYES (non-traumatic) represent?
A: PRIMARY AMYLOIDOSIS. They are peri-orbital "dark circles". Not to be confused
with melasma a normal hyperpigmentation associated with pregnancy.
Q: What is the NIKOLSKY'S SIGN?
A: Refers to superficial seperation of skin with lateral pressure on the lesion.
On the boards mainly associated with ERYTHEMA MULTIFORME.
Thanks again for your time!
Thursday, August 27, 2009
Monday, August 24, 2009
Rheumatology Bits...
Rheumatology is a HOT TOPIC on the boards.....as in the past.
So, it's useful to be updated on the subject.
Speaking of updates, I want to share a bit of NEW information regarding the choice
diagnostic testing of RA. I had a great conversation today, about this exact subject
so, it's only befitting to mention it.
The latest test of choice for the diagnosis of Rheumatoid Arthritis, is called... Anti-CCP-Ab.
This test has replaced the previous one, namely the RF (Rheumatoid Factor), which has
become totally outdated.
Having shared that...let's continue with some rheumatology ONE-LINERS.
Q: What is the most sensitive physical exam test for Carpal Tunnel Syndrome?
A: Eliciting weakness of the Abductor Pollicis Brevis
Q: Which blood test is diagnostic of Drug- Induced Lupus?
A: Anti-Histone Ab
Q: What is the hallmark physical finding of Psoriatic Arthtritis?
A: Sausage digits (dactylytis)
Q: What is Anserine Bursitis?
A: Inflammation of the bursa under the sartorius attachement, causing pain about 4 cm below
the MEDIAL aspect of the knee, especially in mid-elderly women with DM.
TX: Acetaminophen
Q: Which spinal fracture can be common in patients with Ankylosing Spondylitis, even with
trivial injuries?
A: C7 (cervical spine) fracture.
Thanks for your time! We'll be back shortly.
So, it's useful to be updated on the subject.
Speaking of updates, I want to share a bit of NEW information regarding the choice
diagnostic testing of RA. I had a great conversation today, about this exact subject
so, it's only befitting to mention it.
The latest test of choice for the diagnosis of Rheumatoid Arthritis, is called... Anti-CCP-Ab.
This test has replaced the previous one, namely the RF (Rheumatoid Factor), which has
become totally outdated.
Having shared that...let's continue with some rheumatology ONE-LINERS.
Q: What is the most sensitive physical exam test for Carpal Tunnel Syndrome?
A: Eliciting weakness of the Abductor Pollicis Brevis
Q: Which blood test is diagnostic of Drug- Induced Lupus?
A: Anti-Histone Ab
Q: What is the hallmark physical finding of Psoriatic Arthtritis?
A: Sausage digits (dactylytis)
Q: What is Anserine Bursitis?
A: Inflammation of the bursa under the sartorius attachement, causing pain about 4 cm below
the MEDIAL aspect of the knee, especially in mid-elderly women with DM.
TX: Acetaminophen
Q: Which spinal fracture can be common in patients with Ankylosing Spondylitis, even with
trivial injuries?
A: C7 (cervical spine) fracture.
Thanks for your time! We'll be back shortly.
Saturday, August 22, 2009
Power of ONE-LINERS
We'll continue the one liners, as they are the backbone of any examination, especially the boards.
They take pride in challenging your intellect and years of hard memorization....so, the more you
know, the higher you'll score.
Q: What is the most common cause of death among teenagers?
A: Motor vehicle accidents
Q: Which type of E.Coli causes bloody diarrhea, due to consumption of undercooked beef?
A: E.HE.C. (Entero-Hemorrhagic-Escherichia-Coli).....Serotype O157:H7 !!!
Q: What illness can be a serious complication of O:157:H7 E.Coli infection?
A: Hemolytic Uremic Syndrome (HUS)
Q: What rheumatologic condition is associated Gottron's papules(scaly, light erythema @ MCP
joints).
A: Dermatomyosytis
Q: Which syndrome causes mild, asymptomatic lifelong,unconjugated hyperbilirubinemia?
A: Gilbert's Syndrome. This can be mistaken for chronic hepatitis or other liver disorders.
Thanks for your time...we'll continue soon.
They take pride in challenging your intellect and years of hard memorization....so, the more you
know, the higher you'll score.
Q: What is the most common cause of death among teenagers?
A: Motor vehicle accidents
Q: Which type of E.Coli causes bloody diarrhea, due to consumption of undercooked beef?
A: E.HE.C. (Entero-Hemorrhagic-Escherichia-Coli).....Serotype O157:H7 !!!
Q: What illness can be a serious complication of O:157:H7 E.Coli infection?
A: Hemolytic Uremic Syndrome (HUS)
Q: What rheumatologic condition is associated Gottron's papules(scaly, light erythema @ MCP
joints).
A: Dermatomyosytis
Q: Which syndrome causes mild, asymptomatic lifelong,unconjugated hyperbilirubinemia?
A: Gilbert's Syndrome. This can be mistaken for chronic hepatitis or other liver disorders.
Thanks for your time...we'll continue soon.
Thursday, August 20, 2009
We're moving on to more exciting stuff of medicine....the ONE LINERS which must be memorized,period. There is no alternative but to know these cold, but you can simplify
the process, as we'll show you later.
Many of these questions will be on your exam verbatim...so it will be very worthwhile for you
to memorize them and keep repeating them, until ad nauseum.
Q: What is the most common cause of Bacterial Endocardititis?
A: Streptococcus Viridans
Q: Best therapy for Macular Degeneration?
A: Low vision aids (large unfashionable dark glasses)
Q: Which pathogen is most serious of Human Bites?
A: Eikenella Corrodens (Clenched fist injury, i.e. a skin tear of the hand by the teeth)
Q: What vesicular infection is common in wrestlers?
A: Herpes Gladiatorum (Head and neck skin infection in young "gladiators")
Q: What is Pott's Disease
A: Tuberculosis involvement of the thoracic spine (plain films will show irregular bone
erosion of end plates)
Q: What is the most common cause of sudden death in young adults?
A: HCM (Hypertrophic Cardio-Myopathy) due to paroxysmal ventricular fibrillation.
Q: Which cardiac medication has been shown to be of both short and long term survival
benefit?
A: Beta Blockers (ACE Inhibitors is the other answer, if B-blocker is not a choice)
Q: What is the most common congenital heart disease?
A: VSD (Ventricular Septal Defect)
Q: What particular ethnic group has an increased risk of breast cancer?
A: Ashkenazi Jews (due to increased BRCA-1 mutations)
Q: What is the most common type of skin cancer?
A: Basal Cell Carcinoma (About 70-80% of skin cancers)
Thanks for you participation today....see you soon.
the process, as we'll show you later.
Many of these questions will be on your exam verbatim...so it will be very worthwhile for you
to memorize them and keep repeating them, until ad nauseum.
Q: What is the most common cause of Bacterial Endocardititis?
A: Streptococcus Viridans
Q: Best therapy for Macular Degeneration?
A: Low vision aids (large unfashionable dark glasses)
Q: Which pathogen is most serious of Human Bites?
A: Eikenella Corrodens (Clenched fist injury, i.e. a skin tear of the hand by the teeth)
Q: What vesicular infection is common in wrestlers?
A: Herpes Gladiatorum (Head and neck skin infection in young "gladiators")
Q: What is Pott's Disease
A: Tuberculosis involvement of the thoracic spine (plain films will show irregular bone
erosion of end plates)
Q: What is the most common cause of sudden death in young adults?
A: HCM (Hypertrophic Cardio-Myopathy) due to paroxysmal ventricular fibrillation.
Q: Which cardiac medication has been shown to be of both short and long term survival
benefit?
A: Beta Blockers (ACE Inhibitors is the other answer, if B-blocker is not a choice)
Q: What is the most common congenital heart disease?
A: VSD (Ventricular Septal Defect)
Q: What particular ethnic group has an increased risk of breast cancer?
A: Ashkenazi Jews (due to increased BRCA-1 mutations)
Q: What is the most common type of skin cancer?
A: Basal Cell Carcinoma (About 70-80% of skin cancers)
Thanks for you participation today....see you soon.
Monday, August 17, 2009
The dynamics of the examination questions...
There is a definite reward in mastering the art of exam taking....you will get the question right!
The trick is to "dissect" each question for clues to the correct/best answer, while remembering
this very important rule:
Rule No.1. Every question must contain the answer!
Think about it. How can a question be asked by the examiner without giving ALL the clues
to the correct answer within the framework of the question itself. It is impossible!!!
The exceptions are the one liners...which you must know cold, pure rote memory. But we'll
show you how to skillfully answer them as well, with confidence.
Example: Which organism is the most common cause of Trench Fever?
Answer: Bartonella Quintana.
An example of a complex question, to "dissect":
A 42 year old white male presents to the E.R. with fever, chills, malaise and generalized body
aches and back pain of 3 days duration. Pt. was well prior to the onset of these symptoms.
PMH: Negative. PSH: Appendectomy SH: Smokes 1ppd. ETOH: Socially. FH: Prostate cancer/ HTN/ Ulcerative Colitis. Occupation: Welder. Married with 2 children.
Current medications: None. Allergies: None.
Physical Exam: T: 100.7 HR: 101 BP: 122/66 mm/Hg RR: 18 Pulse Ox: 98% on room air.
Pt. appears prostrated, but non toxic.
Skin: Warm and dry. No petechiae/purpura/jaundice. Nailfolds show faint vertical lines at tips.
HEENT: Essentially unremarakble, except for small prominent blood vessels on conjuntiva.
LUNGS: Clear to auscultation/percusssion
HEART: S1 S2 audible. No murmur/rub/dullness.
ABDOMEN: Soft, non tender, bowel sounds wnl, no organomegaly.
MUSCULOSKELETAL: No CVA tenderness. No joint effusions/synovitis. No needle tract marks.
Noted are small purplish spots on the tip of fingers, that are reportedly painful.
NEUROLOGIC EXAM: Normal.
LABS: CBC with diff. WBC 12.2 Hb/Hct: 14.4/38.6 Platelets: 244K
Electrolytes: Normal
Blood Cultures: Pending
Sed Rate: 48 mm/hr
ASO Titer: Negative
Urinalysis: RBC's 2 + No wbc/trace bacteria. Normal sediment
CXR: Normal
EKG: Sinus rhytm. 98/min. Normal axis. No acute changes.
What is your diagnosis:
A. Acute Viral Syndrome
B. Acute Urinary Tract Infection
C. Acute Bacterial Endocarditis
D. Fever of Unknown Etiology
E. Adult Still's Disease
Correct anwser: C. Acute Bacterial Endocarditis
The question contained all the clues(answers) to pick the correct diagnosis.
Main clues: Fever/malaise/back pain. Of these, back pain is the most important...because
@ 40% of cases of bacterial endocarditis will manifest this symptom.
Vertical lines at nailfolds: Splinter hemorrhages
Conjunctiva: Conjunctival hemorrhages
Purplish spots on fingertips: Osler's nodes (OUCH) on pads of digits.
Missing are two more prominent findings of endocarditis not seen in this patient:
1. Roth spots. White centered retinal hemorrhages are PATHOGNOMONIC.
2. Janeway lesions. Painless purplish hemorrhagic spots on the palmar/soles.
Incidentally, the back back pain occurs, due to microspopic papillary necrosis of the kidneys,
leading to slight HEMATURIA and back pain, of course.
Remember: ALL THE PHYSICAL FINDINGS OF BACTERIAL ENDOCARDITIS ARE FOUND
ON THE HANDS/FEET AND EYES. There are NO other bodily findings!
You have just dissected your first question, succesfully!
The trick is to "dissect" each question for clues to the correct/best answer, while remembering
this very important rule:
Rule No.1. Every question must contain the answer!
Think about it. How can a question be asked by the examiner without giving ALL the clues
to the correct answer within the framework of the question itself. It is impossible!!!
The exceptions are the one liners...which you must know cold, pure rote memory. But we'll
show you how to skillfully answer them as well, with confidence.
Example: Which organism is the most common cause of Trench Fever?
Answer: Bartonella Quintana.
An example of a complex question, to "dissect":
A 42 year old white male presents to the E.R. with fever, chills, malaise and generalized body
aches and back pain of 3 days duration. Pt. was well prior to the onset of these symptoms.
PMH: Negative. PSH: Appendectomy SH: Smokes 1ppd. ETOH: Socially. FH: Prostate cancer/ HTN/ Ulcerative Colitis. Occupation: Welder. Married with 2 children.
Current medications: None. Allergies: None.
Physical Exam: T: 100.7 HR: 101 BP: 122/66 mm/Hg RR: 18 Pulse Ox: 98% on room air.
Pt. appears prostrated, but non toxic.
Skin: Warm and dry. No petechiae/purpura/jaundice. Nailfolds show faint vertical lines at tips.
HEENT: Essentially unremarakble, except for small prominent blood vessels on conjuntiva.
LUNGS: Clear to auscultation/percusssion
HEART: S1 S2 audible. No murmur/rub/dullness.
ABDOMEN: Soft, non tender, bowel sounds wnl, no organomegaly.
MUSCULOSKELETAL: No CVA tenderness. No joint effusions/synovitis. No needle tract marks.
Noted are small purplish spots on the tip of fingers, that are reportedly painful.
NEUROLOGIC EXAM: Normal.
LABS: CBC with diff. WBC 12.2 Hb/Hct: 14.4/38.6 Platelets: 244K
Electrolytes: Normal
Blood Cultures: Pending
Sed Rate: 48 mm/hr
ASO Titer: Negative
Urinalysis: RBC's 2 + No wbc/trace bacteria. Normal sediment
CXR: Normal
EKG: Sinus rhytm. 98/min. Normal axis. No acute changes.
What is your diagnosis:
A. Acute Viral Syndrome
B. Acute Urinary Tract Infection
C. Acute Bacterial Endocarditis
D. Fever of Unknown Etiology
E. Adult Still's Disease
Correct anwser: C. Acute Bacterial Endocarditis
The question contained all the clues(answers) to pick the correct diagnosis.
Main clues: Fever/malaise/back pain. Of these, back pain is the most important...because
@ 40% of cases of bacterial endocarditis will manifest this symptom.
Vertical lines at nailfolds: Splinter hemorrhages
Conjunctiva: Conjunctival hemorrhages
Purplish spots on fingertips: Osler's nodes (OUCH) on pads of digits.
Missing are two more prominent findings of endocarditis not seen in this patient:
1. Roth spots. White centered retinal hemorrhages are PATHOGNOMONIC.
2. Janeway lesions. Painless purplish hemorrhagic spots on the palmar/soles.
Incidentally, the back back pain occurs, due to microspopic papillary necrosis of the kidneys,
leading to slight HEMATURIA and back pain, of course.
Remember: ALL THE PHYSICAL FINDINGS OF BACTERIAL ENDOCARDITIS ARE FOUND
ON THE HANDS/FEET AND EYES. There are NO other bodily findings!
You have just dissected your first question, succesfully!
Sunday, August 16, 2009
Taking my first steps...
Hi,
I am taking the very first step, in the world of blogging...not even certain quite how to proceed, but bear with me, it will be worth it.
I want to share a bit of my knowledge of medicine, specifically geared towards physician's assistant students...who will be taking their board exams or those already practicing and are due to recertify.
Why am I doing this...well it is a sort of giving back! And I throughly enjoy teaching. It gives me great pleasure and something very worthy to do with my free time...without wanting anything in return.
So, feel free to ask anything related to your board preperation in the hope of your total
success and confidence in passing the exam.
Sincerely,
Doc Tibor
I am taking the very first step, in the world of blogging...not even certain quite how to proceed, but bear with me, it will be worth it.
I want to share a bit of my knowledge of medicine, specifically geared towards physician's assistant students...who will be taking their board exams or those already practicing and are due to recertify.
Why am I doing this...well it is a sort of giving back! And I throughly enjoy teaching. It gives me great pleasure and something very worthy to do with my free time...without wanting anything in return.
So, feel free to ask anything related to your board preperation in the hope of your total
success and confidence in passing the exam.
Sincerely,
Doc Tibor
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