ABFM Questions Flashcards
CXR findings of Bronchiectasis
Bronchial dilation and bronchial wall thickening
CXR findings of Left Heart Failure
Pulmonary Edema
CXR findings in Diffuse Panbronchiolitis
Diffuse small centrilobular nodule opacities along with hyperinflation
CXR findings of interstitial lung disease
Reticular or increased Interstitial markings
Pharmacologic treatment for BPH and lower UTI symptoms in male
alpha-adrenergic blocker, or 5-alpha-reductase inhibitor (if evidence of prostatic enlargement or PSA >1.5), PDE-5inhibitor or antimuscarinic therapy
First test for male with hypogonadism (mild fatigue, decreased libido, erectile dysfunction)
FSH and LH levels (to distinguish between primary and secondary hypogonadism)
Functional constipation (4 year old with hard stool)
Miralax (polyethylene glycol) is effective. Fiber not supported in treatment of functional constipation
Patients treated with amiodarone (cordarone) should be monitored for:
Hyper vs. hypothyroidism (baseline TFTs with f/u every 6 months)
First line treatment for primary dysmenorrhea
NSAIDs (started at the onset of menses and continued for the first 1-2 days of menstrual cycle)
Tremors:
Abrupt onset, spontaneous remission, changing characteristics, extinction with distraction
Psychogenic tremor
Tremors:
intention tremor with ipsilateral involvement on the side of the lesion
Cerebellar tremor (you will see past-pointing on finger-to-nose testing), CT/MRI diagnostic test of choice
Tremors:
At rest, asymmetric, decreases with voluntary movement, sometimes bradykinesia, rigidity and postural instability are noted
Parkinsonian tremor (if atypical presentation, a single-photon emission CT or position emission tomography may help)
Tremors:
symmetric, fine tremors that involve the hands, wrists, head, voice or lower extremities, improve with alcohol
Essential tremor
How to treat essential tremor
Propranolol or Primidone
Tremors:
Postural tremor of low amplitude exacerbated by medication (history of caffeine or anxiety)
Enhanced physiologic tremor
Weakness with internal rotation of the shoulder
Tear of subcapularis tendon
If you have hyponatremia and low serum osmolality, what confirms SIADH?
Elevated urine osmolality. Patient should be euvolemic and have not taken diuretics in the past 24-48 hours
First line tx for HTN in African American pts
Thiazide diuretics and CCBs
Liraglutide, Exenatide, Dulaglutide
GLP-1 agonists
Liraglutide
Lowers risk of cardiovascular events and DM
Empagliflozin
SGLT-2 inhibitor, secondary prevention of cardiovascular disease and DM
Appropriate screening for 2-16 years old with SCD
Screen with transcranial Doppler ultrasonography because of increased risk of vascular disease
Clinodactyly
Curvature of fifth digit of hand - FAS
Camptodactyly
Flexion deformity of fingers - FAS
Camptydactyly + Clinodactyly + other flexion contractors + radioulnar synostosis, scoliosis, spinal malformations
Fetal Alcohol Syndrome
Tx for child with otitis media with effusion
No treatment and follow up in three months
Polyneuropathy, macrocytic anemia, history of chronic PPI use
Vitamin B12 deficiency
Causes of silicosis
Stone cutting, sand blasting, mining, quarrying exposure
Causes of chronic beryllium lung disease
Occupational exposure to beryllium (inorganic dust)
Causes of Farmer’s Lung
Exposure to organic agricultural dusts (fungal spores, vegetable products, insect fragments, animal dander, animal feces, microorganisms, pollens)
How to confirm primary adrenal insufficiency
plasma ACTH level, should be greater than twice the upper limit of the reference range
Cause of the hyperpigmentation of Addison’s disease
Caused by the MSH (melanocyte-stimulating hormone) effect of elevated plasma levels of ACTH
Initial tx for symptomatic HOCM
BB (Metoprolol), or CCB if BB is not tolerated
For dysfunctional uterine bleeding, progestin is effective in which menstrual phase?
Only effective when used on a 21 day cycle, but not if used only during the luteal phase
Low TSH level with normal free T4 and free T3 = ?
Subclinical hyperthyroidism
Causes of subclinical hyperthyroidism?
Grave’s disease, autonomous functioning thyroid adenoma, multi nodular toxic goiter
What is the preferred antidepressant for older patients?
Escitalopram (Lexapro)
Which antidepressants should be avoided in the elderly?
Amitriptyline, imipramine, paroxetine (highly anticholinergic and sedating, cause orthostatic hypotension)
What is the first line treatment for social anxiety disorder?
Escitalopram (Lexapro) (SSRI)
Most common hip disorder in adolescents (ages 8-15)?
SCFE, slipped capital femoral epiphysis
Name the skin condition: Wood’s Lamp turns coral pink florescence
Corynebacterium minutissimum (erythematous, well demarcated patches with some scale)
Name the skin condition:
Wood’s lamp turns yellow florescence
Tinea infections
Name the skin condition:
Wood’s lamp turns pale blue florescence
Pseudomonas infections
Name the skin condition: Wood’s lamp turns white
Vitiligo
Pap test recs for women 21-29 years old
Every 3 years
Metatarsal stress fractures treatment
No weight bearing for a few days, possibly using a posterior splint, transitioning to a walking boot or short leg cast, and then a rigid-soled shoe in 4-6 weeks
How to rule out proteinuria in children?
Spot protein/creatinine ratio on the first morning urine
Treatment for traveler’s diarrhea
Azithromycin
Pityriasis rosea is associated with what birth defect?
Spontaneous abortion in the first 15 weeks
Donepezil (Aricept) causes what side effect?
Increased risk of bradycardia, part of Beers Criteria. Avoid in patient’s with syncope. Can cause prolonged PR interval.
Avoid which medication in patient with reduced EF?
CCB (verapamil or diltiazem) because they have a negative inotropic effect, and the heart already isn’t beating well
Significant risk factors for esophageal adenocarcinoma
GERD and obesity
In a patient with AS and systolic murmur, what symptom would be most concerning?
Exertional dyspnea, first presentation of a downward spiral and the need for rapid valve replacement
treating acute aortic dissection
IV esmolol, loading dose of 500-1000 mcg/kg/min over 1 min and then infusion rate of 50/mcg/kg/min, max infusion rate is 200mcg/kg/min
Idiopathic thrombocytopenia purpura (ITP), first line treatment?
Corticosteroids is first line therapy. IVIG and rituximib
Idiopathic thrombocytopenia purpura (ITP), second line treatment?
thrombopoietin-receptor agonists and splenectomy. further evaluation is bone marrow biopsy to rule out MDS or lymphoproliferative disorders
Chronic rhinosinusitis defined as?
2/4 cardinal symptoms: nasal drainage, nasal obstruction, facial pain or pressure, hyposmia or anosmia, 6-8 days
Dx: overuse and causes pain at the insertion of the patellar ligament on the midline proximal tibia
Osgood-Schlatter disease
Dx: pain localized to medial joint line of knee rather than distal to the joint line, +McMurray
Medial meniscus tear
Dx: repetitive use, medial knee pain
Pes anserine bursitis
Dx: overuse, pain in the lateral knee
Iliotibial band syndrome
Dx: thin, clear discharge, associated with thin, friable vaginal mucosa
Atrophic vaginitis
Dx: burning and soreness with vulvar erythema, but no discharge
Irritant/allergic vaginitis
Dx: thin, homogenous discharge with fishy odor and no cervical or vaginal inflammation
Bacterial vaginosis
Dx: white, thick, cheesy or curdy discharge
Vulvovaginal candiasis
Dx: greenish-yellow, frothy discharge with a foul odor, inflammation of the vagina and cervix, sometimes punctate hemorrhages (strawberry cervix)
Trichomoniasis
Which medication for diabetes has an increased risk for candidiasis?
SGLT-2 inhibitors (causes yeast vaginitis, because the MOA is blocking the renal uptake of glucose, which results in an increase in glucosuria
Side effects of GLP-1 receptor agonists?
Nausea, early satiety, weight loss
Side effects of sulfonylureas?
Weight gain and hypoglycemia
Side effect of metformin?
GI upset
Vitamin D intake in 2 week year old that’s primarily breastfed?
Daily intake of 400 IU of Vit D a day in infants, especially in primarily breastfed babies
Foot X-Ray Requirements
Ottawa:
- bone tenderness at fifth metatarsal
- bone tenderness at navicular
- inability to bear weight immediately in the ED for four steps
Ankle X-Ray Requirements
Ottawa:
- bone tenderness at posterior edge or tip of lateral malleolus
- bone tenderness at posterior edge or tip of medial malleolus
- inability to bear weight both immediately and in the ED for 4 steps
Best indicator of iron absorption and bone marrow response to oral iron therapy
Reticulocyte count (at 4 days)
Chronic urticaria (hives) treatment after 3 months of loratadine
Ranitidine, combine H1 and H2 together after H1 doesn’t work, and then go to steroids
Cimetidine/Ranitidine
H2 receptor antagonist
TB induration 5 or above
- recent contact with infectious TB
- radiographic evidence for prior TB
- HIV infected persons
- immunosuppressed patients
TB induration 10 or above
increased risk of TB
TB induration 15 or above
no risks of TB
SGLT-2 inhibitor
Empagliflozin
GLP-1 agonists
liraglutide, exenatide, dulaglutide
sugar tong splint
for distal radial fractures
radial gutter splint
for uncomplicated fractures of second and third metacarpals
thumb spica splint
suspected scaphoid fracture
At which opioid dosage do you prescribe naloxone?
the risk of an opioid overdose increases at a threshold of 50 MME/day
chronic kidney disease with mildly low ionized calcium level will have which PTH and phosphorus levels?
elevated PTH and elevated phosphorus
this is because phosphate is not appropriately excreted and the subsequent hyperphosphatemia leads to secondary hyperparathyroidism
if you see a 1cm wide dimple on the sacrum, 1 cm superior to the anus, what is the next step?
ultrasound to rule out spinal dysraphism (tethered cord)
In an obese patient with peripheral neuropathy, erythema of the foot, but no fever, leukocytosis or inflammatory markers, what is the most likely diagnosis?
Charcot neuroarthropathy
Tx for Charcot neuroarthropathy
Immobilization with total contact casting, for 3-4 months but can be up to 12 months
goal fasting blood glucose level in patients with gestational diabetes?
<95 mg/dL
which NSAID is not associated with an increased risk of MI?
naproxen
which med used for anxiety also reduces the symptoms of IBS?
Celexa (Citalopram)
Causes of HTN in children
Renal parenchymal disease (glomerulonephritis, congenital abnormalities, and reflux nephropathy)
carbonic anhydrase inhibitor, which induces a
metabolic acidosis that leads to hypercalciuria and the formation of calcium phosphate stones
Topiramate
TSH level in pregnancy
The TSH reference range is lower during pregnancy because of the cross-reactivity of the -subunit of
hCG. Levels of hCG peak during weeks 7–13 of pregnancy, and hCG has mild TSH-like activity, leading
to slightly high free T4 levels in early pregnancy.
transient or persistent thyroid dysfunction that occurs within 1 year
of childbirth, miscarriage, or medical abortion
Postpartum thyroiditis
How is postpartum thyroiditis confirmed?
Release of preformed thyroid hormone in the bloodstream initially results in hyperthyroidism. During the hyperthyroid phase, radioactive iodine uptake will be low, which can help to confirm the diagnosis. Pregnancy and breastfeeding are contraindications to radionuclide
imaging. T
Thyrotropin receptor antibody levels are positive in
Grave’s disease
Thyroid peroxidase antibody levels are elevated with
Hashimoto’s thyroiditis
Koilonychia, also known as spoon nail, is a finding that can be associated with multiple systemic conditions
Iron deficiency, SLE, hypothyroidism
Treatment of eosinophilia esophagitis
Application of corticosteroids to the esophagus is generally the treatment of choice,
either in the form of an oral suspension of budesonide or an inhaled corticosteroid sprayed into the mouth
and swallowed.
Characteristics that are more common with pulmonary malignant lesions are consistent with:
a nonsolid “ground glass” appearance, a size >6 mm, noncalcified lesions, a lesion size or volume doubling time between 1 month and 1 year, and irregular or spiculated borders.
6-month-old male is brought to the urgent care center with a 3-day history of rhinorrhea, cough, and increased respiratory effort. His temperature is 37.5°C (99.5°F), his heart rate is 120 beats/min, his respiratory rate is 42/min, and his oxygen saturation is 96% on room air. On examination the child appears well hydrated with clear secretions from his nasal passages, there is diffuse wheezing heard bilaterally, and there is no nasal flaring or retractions
Viral bronchiolitis, treat with supportive care and hydration
American Academy of Otolaryngology defines chronic rhinosinusitis as the presence of two of four cardinal symptoms, which include:
nasal drainage, nasal obstruction, facial pain or pressure, and hyposmia or anosmia, along with objective signs on examination or radiographic studies
__________ are known to cause an increased risk of yeast vaginitis because their mechanism of action involves blocking renal uptake of glucose, which results in an increase in glucosuria
SGLT2 inhibitors such as empagliflozin (Jardiance)
Glucose goals in gestational DM
Fasting <95
1 hr post-prandial: <145
2 hr post-prandial: <120
eczematous rash in semiprotected folds of skin such as the web spaces of fingers, the umbilicus, the axillae, or the genital region
Scabies
screening for elevated serum cholesterol levels in children
9-11 yo
Children, screened annually for depression beginning at?
11-21 yo
Universal screening for anemia (children)
12 months of age and again at 15–30 months of age if the patient is determined to be high risk
Which antidepressant lowers seizure threshold?
Bupropion
Hereditary hemochromatosis
Cardiomyopathy, cirrhosis and HCC
Cardiac murmur asso with marfan’s
Mitral valve prolapse, aortic root dilation, aortic insufficiency
Drugs for IBS
Neomycin first constipation predominant
SSRIs or SNRIs for diarrhea predominant
GLP-1 agonists are contraindicated in patients with:
medullary thyroid cancer or multiple endocrine neoplasm syndrome, or with a family history of these conditions
Mild SLEtreatment
Hydroxychloroquine reduces arthritis pain in lupus patients and is the preferred initial treatment for lupus arthritis
Treatment for severe lupus or lupus nephritis
Cyclosporine and azathioprine
Treatment for refractory lupus or lupus nephritis
Mycophenolate
Treatment for severe refractory lupus
Rituximab
NT-proBNP level is affected by:
NT-proBNP is negatively correlated with kidney function as measured by the estimated glomerular filtration rate (GFR) and albumin levels. Patients with a low GFR or a low level of albumin have higher NT-proBNP levels.
A higher BMI is associated with a lower NT-proBNP. Thus, the utility of NT-proBNP to rule out heart failure in obese patients is decreased
physical examination reveals isolated tenderness with palpation at the medial and lateral aspects of the knee, and the grind test is also positive
Patellofemoral pain syndrome
Pain and tenderness over the tibial tubercle and the distal patellar tendon is the most common presentation
Osgood Schlatter disease
typically causes infrapatellar pain, and findings include extensor mechanism malalignment, weakness of ankle flexors, and tightness of the hamstring, heel cord, and/or quadriceps
Patellar tenidopathy
osteochondrosis at the insertion of the Achilles tendon on the calcaneal tuberosity. It occurs during periods of rapid growth, causes heel pain during and after activity, and is relieved with rest
Sever’s disease
How to diagnose nephrotic range proteinuria
protein-to-creatinine ratio from a single urine sample
Current criteria for the diagnosis of diabetes mellitus:
- hemoglobin A1c ≥6.5%
- a fasting plasma glucose level ≥126 mg/dL
- a 2-hour plasma glucose level ≥200 mg/dL OR in a symptomatic patient, a random blood glucose level ≥200 mg/dL.
26-year-old female presents with a 3-month history of abdominal pain, lightheadedness with standing, and some hyperpigmentation. Her CBC is normal, but a basic metabolic panel reveals a slightly low sodium level and a slightly high potassium level, what’s the diagnosis?
Primary adrenal insufficiency
What is used to screen for adrenal hyperplasia in hypertensive patients and also for establishing the existence of mineralocorticoid insufficiency in patients with Primary Adrenal Insufficiency?
Serum aldosterone paired with plasma renin activity
In patients ≥65 years of age treated with medication for type 2 diabetes mellitus, hemoglobin A1c values of _____ have shown the greatest reduction in mortality in multiple studies
7-8% to prevent hypoglycemia
high fever in a child with either mild upper respiratory symptoms or no other symptoms. After the fever subsides, a rash will appear
Roseola infantum, caused by HHV-6
single herald patch that is oval-shaped and scaly with central clearing, followed by a symmetric rash on the trunk in a typical distribution along the Langer lines
Pityriasis rosea
The child will typically have mild symptoms then an erythematous facial rash that has a “slapped cheek” appearance. This is sometimes followed by pink patches and macules in a reticular pattern. Once the rash appears the child is no longer contagious
Erythema infectiosum is caused by parvovirus B19 and is also known as fifth disease
scaly, erythematous plaques, commonly on the flexor surfaces of the extremities
Atopic dermatitis
Mild persistent asthma is defined as:
symptoms present >2 days per week but not daily, nighttime awakenings 3–4 times per month, and inhaler use >2 days per week but not daily and not more than once on any day. The FEV1 is >80% of predicted.
Severe asthma present as:
symptoms present throughout the day, nighttime awakenings up to 7 times per week, inhaler use several times per day, and an FEV1 <60% of predicted. Normal activities are extremely limited by severe asthma
Moderate persistent asthma presents as:
symptoms are present daily, nighttime awakenings occur >1 time per week but not nightly, and an inhaler is required daily
Intermittent asthma presents as:
symptoms are present ≤2 days per week, nighttime awakenings occur ≤2 times per month, an inhaler is required ≤2 days per week, and the FEV1 is >80% of predicted
unexplained proteinuria, peripheral neuropathy, enlargement of the tongue, cardiomegaly, intestinal malabsorption, bilateral carpal tunnel syndrome, and orthostatic hypotension
Primary amyloidosis
Common agents that cause viral pericarditis:
Enteroviruses, herpesviruses, adenovirus, and parvovirus B19
Organisms that cause infection of puncture wound of foot through shoe
Staphylococcus aureus is the most common, followed by other staphylococcal and streptococcal species. When the puncture wound is through the rubber sole of an athletic shoe, Pseudomonas is the most frequent pathogen (use Cipro)
Patients with a history of cryptorchidism are at high risk for the development of ______, especially if orchiopexy is performed after puberty
Testicular cancer
If mass is suspicious for testicular cancer, what should be performed?
If sonography shows a hypoechoic mass, a testicular biopsy is contraindicated, since it may contaminate the scrotum or alter the lymphatic drainage. Radical inguinal orchiectomy is both diagnostic and therapeutic
Causes of subclinical hyperthyroidism
Graves disease, autonomous functioning thyroid adenoma, and multinodular toxic goiter
Labs suggesting subclinical hypothyroidism
low TSH level with normal free T4 and free T3 levels
Even in the absence of overt hyperthyroidism patients with subclinical hypothyroidism are at higher risk for several health conditions, including:
atrial fibrillation, heart failure, and osteoporosis
Lactulose, also an osmotic laxative, should be avoided in patients with IBS because?
it is broken down by colonic flora and produces excessive gas
The only proven therapy for pulmonary hypertension related to COPD is?
Supplemental oxygen should be recommended when the PaO2 is <60 mm Hg, because it has been shown to improve mortality by lowering pulmonary arterial pressures
Which antihypertensive drug may reduce the severity of sleep apnea?
Potassium sparing diuretics
Resistant hypertension is common in patients with obstructive sleep apnea. Resistant hypertension is also associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing upper airway obstruction
most sensitive test to diagnose primary hyperaldosteronism?
aldosterone/renin ratio
There are multiple tools for evaluation of pneumonia severity, including:
SMART-COP (predicts the likelihood of the need for invasive ventilation or vasopressor support), the Pneumonia Severity Index (predicts the risk of 30-day mortality and the need for admission to the intensive-care unit), and CURB-65 or CRB-65
hyperextension of the wrist leads to:
Triquetral fractures
Absolute contraindications for testosterone replacement therapy
Absolute contraindications include breast cancer, prostate cancer, a prostate-specific antigen (PSA) level >4 ng/dL, an abnormal rectal examination with nodules, and polycythemia with a hematocrit >54%
Testosterone stimulates erythropoiesis and increases the risk of thrombosis
Node-blocking medications such as
diltiazem and metoprolol should not be used for the long-term treatment of WPW, due to
The increased risk of VFib
Chronic kidney disease–mineral and bone disorder (CKD-MBD)
In patients with CKD, phosphate is not appropriately excreted and the subsequent
hyperphosphatemia leads to secondary hyperparathyroidism and binding of calcium. Decreased production of calcitriol in patients with CKD also leads to hypocalcemic hyperparathyroidism. Patients with CKD stages 3a–5 should have phosphorus, calcium, parathyroid hormone, and 25-hydroxyvitamin D levels. checked regularly, and consultation with a nephrologist or endocrinologist should be obtained if CKD-MBD is suspected.
affected skin appears as erythematous patches with white to yellow greasy scales
Seborrheic dermatitis, treat with topical antifungals
Tdap is recommended for all women with each pregnancy, preferably between:
27-36 weeks gestation
Leser-Trélat sign may be defined as:
the abrupt onset of multiple seborrheic keratoses, which is an unusual finding that often indicates an underlying malignancy, most commonly an adenocarcinoma of the stomach
well circumscribed brown, oval, rough papules with a “stuck-on” appearance on his trunk and proximal extremities
considered a second-line choice for patients who are intolerant of metformin?
SGLT2 (Empagliflozin)
Both sitagliptin, a DPP-4 inhibitor, and liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution in patients with a history of?
Pancreatitis
In the newborn period the two most common causes of neonatal sepsis are
Group B STREP & E. coli
Both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) are recommended for patients with
Chronic renal failure
How to CONFIRM diagnose Cushing’s syndrome
24 hr urinary free cortisol
Dexamethasone test is only for screening
Current criteria for obesity hypoventilation syndrome (OHS) include:
hypoventilation leading to carbon dioxide retention (PaCO2 >45 mm Hg) in an individual with a BMI > 30 kg/m2 when other causes of chronic alveolar hypoventilation have been ruled out
These patients retain bicarbonate to compensate for respiratory acidosis
A 42-year-old female presents with shortness of breath that has slowly worsened over the past 6 months. She can now walk only 10 feet without becoming short of breath. She does not have a cough or chest pain. Her history is significant only for obesity. She smoked one pack of cigarettes per day for 20 years and quit smoking 6 years ago. Her blood pressure is 138/88 mm Hg, pulse rate 92 beats/min, respiratory rate 18/min, and oxygen saturation 92% on room air. Her BMI is 42 kg/m2.
Her heart has a regular rate and rhythm with no murmurs and her lungs are clear to auscultation. Her lower extremities have bilateral 1+ edema. A chest radiograph is normal. Spirometry reveals a decreased FVC with a normal FEV1/FVC ratio. A CBC, a TSH level, and a basic metabolic panel are all normal except for a serum bicarbonate level of 35 mEq/L (N 22–29).
These findings are most consistent with:
Obesity hypoventilation syndrome
Management of systolic heart failure without exacerbation whose EF is 35% and they cannot tolerate ace/arb due to angioedema in African American patient
a combination of direct-acting vasodilators such as isorbide and hydralazine is preferred
A young man with weight loss, oral thrush, lymphadenopathy, and ulcerative esophagitis is likely to have:
HIV infection (IV drug use)
The most common pathogens causing esophageal ulceration in HIV-positive patients include:
Candida, herpes simplex virus, and cytomegalovirus
The majority of cases of viral conjunctivitis are caused by
Adenovirus
(which cause pharyngeal conjunctival fever and epidemic keratoconjunctivitis. Pharyngeal conjunctival fever is characterized by high fever, pharyngitis, and bilateral eye inflammation. Keratoconjunctivitis occurs in epidemics, and is associated with a watery discharge, hyperemia, and ipsilateral lymphadenopathy in >50% of cases)
Viral, no treatment
47-year-old female presents to your office with a complaint of hair loss. On examination she has a localized 2-cm round area of complete hair loss on the top of her scalp
Alopecia areata (thought to be caused by a localized autoimmune reaction to hair follicles)
The initial treatment of choice for patients older than 10 years of age, in cases where alopecia areata affects less than 50% of the scalp, is:
Intralesional corticosteroid injections
_____ is an alternative for children younger than 10 years of age or for patients in whom alopecia areata affects more than 50% of the scalp.
Minoxidil
In a patient with CAP and history of AAA, what antibiotic should be avoided?
Fluoroquinolones because they cause increased risk of aortic dissection in patients who already have aortic aneurysm or increased risk of aortic aneurysm
In a young adult with community-acquired pneumonia who is not sick enough to be hospitalized, the current recommendation is to empirically treat with
macrolide antibiotic such as azithromycin. This covers the atypical organism Mycoplasma pneumoniae, which is one of the most common causes of community-acquired pneumonia. Certain fluoroquinolones such as levofloxacin also cover atypical causes, but ciprofloxacin does not
Nonprolactin-secreting adenomas, especially those >10 mm in size (macroadenomas), require
Neurosurgical evaluation
Microadenomas <10 mm in size that are secreting prolactin are treated with
Dopaminertic agent such as bromocriptine
Indications for an adult patient with acute bronchitis to have a chest radiograph include:
bloody sputum, rusty-colored sputum, or dyspnea; a pulse rate >100 beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest radiograph is also indicated if there are abnormal findings on a chest examination such as fremitus, egophony, or focal consolidation.
Risk factors for septic arthritis include
underlying joint disease such as rheumatoid arthritis or osteoarthritis, and immunosuppressive states such as HIV infection, diabetes mellitus, and taking immunosuppressive medications
Leser-Trelat sign
Sudden onset of seborrheic keratosis means adenocarcinoma of stomach
What causes falsely elevated A1c
Vitamin B12 def bc of decreased erythropoiesis
Iron def anemia bc of decreased erythropoiesis
CKD may increased RBC glycation through liquid peroxidaxe and extends erythrocytes lifespan due to do erythropoietin levels
What falsely lowers A1c
Hemolytic anemia bc if decreased RBC lifespan
Most common cause of neonatal sepsis
E. Coli, GBS
Lichen nitidus
Benign but uncommon.
Discreet pinhead sized hypopigmented papules that are asymptomatic
Lichen sclerosis
Common, appear as hypoigmented lesions with texture of cellophane, on glans or prepuce
Atrophy, erosions and bullae are common
Patients present with itching, pain , bleeding, possibly phimosis or obstructed voiding
Angiokeratomas
Asymptomatic, circumscribed, red or blueish papules
Brown sputum plug in asthma patients with multiple exacerbation
Aspergillosis
the most common cause of polyhydramnios
Anencephaly due to transudation from the exposed meninges
Treatment of cocaine-associated chest pain is similar to that of acute coronary syndrome, unstable angina, or acute myocardial infarction, but there are exceptions. The hypertension, tachycardia, and chest pain will often respond to
IV Benzos
BB contraindicated in cocaine induced ischemia bc they can exacerbate coronary artery spasm
herpes zoster ophthalmicus (four vesicles on upper eyelid)
In addition to treatment with a systemic antiviral agent, it is important that the patient see an ophthalmologist to be evaluated for corneal disease and iritis, as vision can be lost. This is a viral infection, so corticosteroids could worsen the infection.
Hepatotoxicity resulting from timed-release formulations of _____ have been reported in the elderly
Niacin
postpartum urinary retention risk factors
more likely to occur in patients who are primiparous, have a prolonged first or second stage of labor, have instrumented vaginal deliveries, or require a cesarean section for failure to progress
Postpartum urinary retention
defined as a post-void bladder residual of at least 150 cc that is present 6 hours or more after delivery
Nausea in pregnancy
methylprednisolone is also effective
but should be avoided in the first trimester as it is associated with
with an increased risk of cleft palate if used before 10 weeks of gestation
Scopolamine is effective for nausea and vomiting of pregnancy but should be avoided in the first trimester
due to
possibility of causing trunk and limb deformities
First line therapy for nausea in pregnancy
Vitamin B6
All causes of polyhydraminos
Anencephaly, esophageal atresia, heart failure, and maternal α-thalassemia
Intrauterine heart failure, whether due to dysrhythmias, structural defects, or severe anemia, often leads to
Fetal hydrops which is associated with polyhydraminos
α-Thalassemia, relatively common in Asians, can also cause
Fetal hydrops and polyhydraminos
Most commonly associated with oligonydraminos
Posterior urethral valves
In many normally developing infants there may be imperfect coordination of eye movements and alignment during the early days and weeks of life, but proper coordination should be achieved by
Age 4-6 months
Less than 3 month olds is normal, otherwise kid is at risk of developing amblyopia
Primary ovarian failure is defined as:
This is defined as menopause before the age of 40 due to ovarian follicular depletion. Laboratory findings will usually reveal a low serum estradiol and elevated FSH and LH levels.
