PANRE Flashcards

What qualities do an indirect inguinal hernia have?

Answer: Congenital protrusion through the inguinal ring into inguinal canal

An indirect inguinal hernia is characterized by a congenital protrusion through the deep (internal) inguinal ring into the inguinal canal. This occurs when the processus vaginalis, a peritoneal outpouching, fails to close completely after testicular descent, creating a pathway for abdominal contents to herniate. It follows the path of the spermatic cord and can extend into the scrotum.

What would you expect with a positive obturator sign while performing an exam on a patient with probable appendicitis?

Answer: Increased pain when passively flexing and internally rotating the right hip

A positive obturator sign, indicative of probable appendicitis, is characterized by increased pain when passively flexing and internally rotating the right hip. This maneuver stretches the obturator internus muscle, which lies in close proximity to an inflamed appendix. The resulting pain in the right lower quadrant suggests irritation of this muscle by the inflamed appendix.

The following x-ray results would all suggest abuse, with the exception of:

Answer: 10-year-old with distal radius fracture

A distal radius fracture in a 10-year-old is the least likely x-ray result to *alone* suggest abuse. This type of fracture, often called a Colles' fracture, is a common injury resulting from a fall onto an outstretched hand, which is a plausible mechanism for a child of this age. In contrast, rib fractures, skull fractures across suture lines, and spiral fractures of the femur (especially in younger children) are highly suspicious for abuse without a clear, accidental explanation.

Which of the following conditions can be diagnosed with certainty with a temporal artery biopsy?

Answer: Giant cell arteritis

Giant cell arteritis (GCA), also known as temporal arteritis, is a systemic vasculitis affecting large and medium-sized arteries, most commonly the temporal artery. A temporal artery biopsy is the definitive diagnostic test for GCA, revealing characteristic inflammatory changes within the artery wall. While polymyalgia rheumatica is often associated with GCA, it is a clinical diagnosis, and the biopsy is specific for GCA.

At the intensive care unit (ICU), a newborn was being treated for cyanotic episodes and stunted growth. Auscultation reveals a systolic murmur, and an x-ray reveals a heart that resembles a boot. Which diagnosis is more likely?

Answer: Tetralogy of Fallot

The combination of cyanotic episodes, stunted growth, a systolic murmur, and a 'boot-shaped heart' on X-ray is classic for Tetralogy of Fallot (TOF). TOF is a congenital heart defect comprising four anomalies: a ventricular septal defect, pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy. The 'boot-shaped heart' appearance is due to right ventricular hypertrophy and pulmonary artery hypoplasia.

An ECG that has fallen P waves is being examined by you. Which diagnosis is more probable?

Answer: Sick sinus syndrome

If an ECG shows 'fallen P waves,' meaning P waves that are not consistently followed by QRS complexes or are irregularly associated with ventricular activity, Sick Sinus Syndrome (SSS) is a probable diagnosis. SSS refers to a group of rhythm disorders caused by a dysfunctional sinus node, the heart's natural pacemaker. This can manifest as sinus bradycardia, sinus arrest, or sinoatrial exit block, leading to abnormal P wave conduction or absence.

Which of the following drugs increased insulin release from pancreatic beta cells, hence lowering plasma glucose levels?

Answer: Glyburide

Glyburide is a sulfonylurea medication that works by increasing insulin release from pancreatic beta cells. It binds to specific receptors on these cells, leading to the closure of ATP-sensitive potassium channels, which depolarizes the cell and triggers calcium influx. This calcium influx then stimulates the secretion of insulin, thereby lowering plasma glucose levels in patients with type 2 diabetes.