3 Flashcards
What are two signs for appendicitis
Psoas and obturator sign
Describe psoas sign
assive extension of patient’s thigh as s/he lies on his/her side with knees extended, or asking the patient to actively flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.
Describe obturator sign
Examiner has patient supine with right hip flexed to 90 degrees; takes patient’s right ankle in his right hand as he uses his left hand to externally/internally rotate patient’s hip by moving the knee back and forth. Elicitation of pain in the abdomen implies acute appendicitis.
Is the pain with duodenal ulcer relieved or worsened with food?
relieved, antiacids would also help
In what situations are plain abdominal films useful?
when suspect 1) acute intestinal obstruction or 2) free air from a perforated hollow viscus
When to order bnp?
primarily useful in distinguishing chronic obstructive pulmonary disease from congestive heart failure, especially in the evaluation of shortness of breath
What is the role of a HIDA scan if you suspect gallstones?
f the patient has typical symptoms of biliary colic but no visible stones on the gallbladder ultrasound, a HIDA scan might be obtained to look for gallbladder dysfunction and reproducible pain
When to get ERCP?
If there was jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis)
terms used to describe primary skin lesions
macule, patch, papule, plaque, nodule, tumor, vesicle, bulla, pustule and wheal
What is a macule?
Flat and less than 1 cm in diameter.
What is a patch?
macule greater than 1 cm in diameter
Is a patch a big macule?
YES
What is a papule?
solid raised lesion that has distinct borders and is less than 1 cm in diameter
What is a plaque?
a solid, raised, flat-topped lesion greater than 1 cm in diameter. It is analogous to the geological formation, the plateau.
What is a nodule?
a raised solid lesion and may be in the epidermis, dermis or subcutaneous tissue.
What is a bulla?
a circumscribed fluid filled lesion that is greater than 1 cm in diameter.
What is a wheal?
an area of elevated edema in the upper epidermis.
What does it mean that skin exams are an I recommendation?
current evidence is insufficient to assess the balance of benefits and harms of a primary care clinician performing a whole body skin examination or a patient doing a skin self-examination for the early detection of skin cancers
Rash involvement in palms and soles is seen with what?
erythema multiforme, secondary syphilis and eczema
Where do you typically see eczema?
behind the ears and on flexural areas
Describe appearance of basal cell carcinoma
may be plaque-like or nodular with a waxy, translucent appearance, often with ulceration and/or telangiectasia.
Describe typical appearance of psoriasis
usually bilateral and involves extensor surfaces of elbows and knees.
What are common side effects of topical corticosteroids?
skin atrophy and hypopigmentation
List two oral anti-fungals used for treatment of tinea caput and ungiuim
griseofulvin, itraconazole and terbinafine
What is the diagnostic method of choice if there is a strong suspicion of malignant melanoma?
Excisional biopsy
Is a shave biopsy possible in a macule or patch?
NO because they are both flat. Need raised lesion for a shave biopsy.
What is the D in the ABCDEs of skin lesions?
Diameter greater than 6 mm
What are some symptoms of prostatitis?
pain (in the perineum, lower abdomen, testicles and penis, and with ejaculation), bladder irritation, bladder outlet obstruction, and sometimes blood in the semen.
What is necessary to evaluate when considering BPH?
A. Presence of classic lower urinary tract symptoms (LUTS).
B. Examination of prostate.
C. Urinalysis.
D. Serum prostate specific antigen (PSA).
E. Serum BUN and Creatinine
What are complications of untreated BPH?
urinary tract infections
acute urinary retention
obstructive nephropathy
What is a good first line treatment for BPH?
alpha-adrenergic antagonists (tamsulosin, alfuzosin, terazosin and doxazosin)
When may combination treatment with an alpha-adrenergic antagonist and a 5-alpha-reductase inhibitor be desirable?
In men with severe symptoms, those with a large prostate (>40 g), and in those who do not get an adequate response to maximal dose monotherapy with an alpha-adrenergic antagonist
Does BPH lead to prostate cancer?
NO
What are the three kinds of primary HA?
Tension, cluster, and migraine
What are serious causes of HA to rule out?
Meningitis
Brain tumor
Intracranial hemmorhage
Traumatic brain injury (concussion)
Associated symptoms of migraine?
Often occur with nausea and vomiting, photophobia, or hyperacusis. May occur with aura.
What are the number of migraines necessary for diagnosis?
5 episodes needed for diagnosis.
What are associated symptoms of cluster headaches?
Associated with rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, and ptosis.
What two questions are included in the GAD 2?
Feeling nervous, anxious, or on edge?
Not being able to stop or control worrying
What are two things evaluated in the PHQ2?
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
What are two groups of migraine-specific treatment?
Triptans and ergot alkaloids
What are triptan side effects?
Dizziness, sleepiness, nausea, fatigue, paresthesia, throat tightness/closure, chest pressure.
Potential side effects of ergot alkaloids?
MI, ventricular tachyarrhythmias, stroke, hypertension, nausea, vomiting, diarrhea, dry mouth, rash.
What is a good non-specific treatment for HA?
Excedrin (acetaminophen/aspirin/caffeine)
You wish to prescribe sumatriptan for a man with headaches. Which medication would concomitant use be dangerous with?
SSRI due to risk of serotonin syndrome
Can metoprolol, propranolol, and timolol be used prophylactically against migraines?
YES
In addition to beta-blockers which additional two groups of meds can be used prophylactically against migraines?
TCA (amitryptaline) and neurostabilizers (divalproex sodium, topiramate)
