Ambulatory Medicine

Question 1

what is a normal intraocular pressure(IOP) in the eye?

Answer 1

<21 mmHg

Question 2

Sx & Dx of open-angle glaucoma

Answer 2

sx: gradual loss of peripheral vision, chronic dx: high IOP and optic disc cupping tx: 1st line prostaglandin agonist(latanoprost), 2nd line a2 adrenergic(brimonidine), nonselective bb(timolol)

Question 3

Tx of open-angle glaucoma

Answer 3

tx: 1st line prostaglandin agonist(latanoprost), 2nd line a2 adrenergic(brimonidine), nonselective bb(timolol)

Question 4

What would you expect to see on funduscopic examination of pt with diabetic retinopathy? Tx?

Answer 4

PE: neovascularization, microaneurysms, flame hemmorages, exudates & macular edema tx: laser photocoagulation, anti-VEGF; can do vitrectomy if large vitreous hemorrhage or macular traction

Question 5

Old dude comes in with fever & headache complaining of burning in his eye. Conjunctivitis of L eye. There are vesicles comming from the side of his head in a line. dx?

Answer 5

HSV! shinges will not cross midline - if effecting the eye(conjunctivitis, kertitis, increased IOP, optic neuropathy, CN palsy) ASAP referral to opthalmologist.

Question 6

MCC of hearing loss in young adults?

Answer 6

Otosclerosis(abnormal remodeling of the bone in the ear impairing conduction)

Question 7

1st line for tx of atopic dermatitis when steroids are C/I(eyelids, groin)?

Answer 7

topical tacrolimus/pimecrolimus

Question 8

1st line tx of psoriasis? Tx for generalized disease? Tx for severe disease?

Answer 8

1st line = topical steroids generalized dz = UVB exposure severe dz= methotrexate, anti-TNF medications

Question 9

45 yo F comes in with erythema and acne looking lesions on cheeks, forehead, nose and chin. She states the redness gets worse when she eats spicy foods or gets really stressed. Dx? Associated sx?

Answer 9

Rosacea! – differentiate this from acne due to pt older age, no comedones(white/black heads) & worsening erythema often but not always associated with spicy foods, alcohol or emotional reactions. *often get rhinophyma(enlarged nose with irregular texture) 2/2 sebaceous gland hyperplasia *may be associated with blepharitis, dry eyes, conjunctival injection and lid margin telangiectasias.

Question 10

1st line tx rosacea? What about tx flushing?

Answer 10

1st line = topical metronidazole *can give clonidine or a-blockers for flushing *surgery referral if rhinophyma present

Question 11

Pemphigus Vulgaris vs Bullous Pemphigoid - nikolsky sign? - Antibodies to what? - Tx?

Answer 11

PV: Nikolsky +, Ab to desmoglein, tx steroids & immunosupressives - can effect esophagus! BP: Ab to basement membrane, Nikolsky -, Tx steroids

Question 12

Young guy comes to you complaining about ED. What u gonna do? why? (assume his partner is super hot and hes totally into her and theres no psyc shit)

Answer 12

Check testosterone! Hes too young to have ED - looking for 1(testicular failure 2/2 infection, trauma, radiation, torsion, etc) vs 2(Pituitary problem 2/2 trauma, tumors, drugs, etc). Also check TSH, Prolactin & Glucose

Question 13

MCC Orchitis is men >35 yoa? <35 yoa?

Answer 13

Orchitis: <35 = chlamydia >35 = E coli

Question 14

Screening for HLD

Answer 14

USPSTF: Men >35 yoa & Women >45 yoa if no toher risk factors

Question 15

Cervical cancer screening

Answer 15

21-30 q3 then 30-65q5y w/HPV testing

Question 16

Breast cancer screening

Answer 16

mammogram 50-74q2y

Question 17

CRC screening

Answer 17

colonoscopy 50q10y or flex sig q3-5y or yearly hemoccult *if 1st degree relative start at age 40 or 10 yrs prior to that relatives dx

Question 18

Prostate cancer screening

Answer 18

Men 55-69 only screen if risk factors: family hx or urinary changes

Question 19

Lung Cancer screening

Answer 19

low-dose CT 55-80q1y if pt has 30+ pk yr hx and has not quit within the last 15 years

Question 20

Osteoporosis screening

Answer 20

DEXA 65+ no more than q2y

Question 21

AAA screening

Answer 21

x1 men age 64-75 who have smoked at any time

Question 22

Treatment of bacterial conjunctivitis? Tx in contact wearers?

Answer 22

Non-contact wearers: Topical macrolide(erythromycin, azithromycin, polymyxin-trimethoprim) Contact wearers: topical FQ

Question 23

Tx viral conjunctivitis

Answer 23

Topical antihistamine/decongestion

Question 24

MC complication of bacterial conjunctivitis? Sx? Tx?

Answer 24

Keratitis: inflammation of the cornea, the clear tissue covering the pupil and iris and bordered by the bulbar conjunctivae. Which presents with photophobia, blurred or impaired vision, and a foreign body sensation with difficulty opening the affected eye. When keratitis is suspected, the patient should be seen urgently by an ophthalmologist to confirm the diagnosis and begin treatment.

Question 25

Ottawa Ankle Rules for Imaging?

Answer 25