Bronze Review Flashcards
If a patient has a fever, chills, nausea, rash on forearms and ankles, palms, and soles of feet after hiking or camping in the mountains
-Rocky Mountain spotted fever
How do you treat RMSF
-Doxycyline
Middle age lady has been out in the yard, long grass, has target bulls eye rash what is the likely diagnosis
- lyme
- Erythema migrains
Middle-aged man notes a lesion on arm with irregular borders, different colors, with some black. What is the likely diagnosis?
-melanoma
Slivery white scales on an erythematous base that are pruritic
-psoriasis
Koebner phenomenon
when there is a trauma and a scab forms but psoriatic plaque forming over top
Auspitz sign
If you take a psoriatic plaque and it starts pinpoint bleeding
Mom brings in 5 year old child. Child is complaining of itching, mostly at night, interdigital burrowing happening
scabies
What tx or instructions do you give for scabies
- permethrain cream
- treat close contacts
- wash everything in VERY hot water
Atopic triad is
- allergies
- asthma
- atopic dermatitis
Mom brings in 10-year-old child, who is scratching his leg, notes a ring with central clearing that is pruritic
-tinea corporis
Actinic keratosis is the precursor
SCC
Where do you usually see actinic keratosis
- sun-exposed area
- face
- nose
- ears
Actinic keratosis is
-a dry, pink, raised lesion
How do you treat actinic keratosis
5-FU cream
Cryotherapy
What is the gold standard for diagnosing skin lesions
-punch biopsy
Black or tan lesion that looks pasted on the skin, waxy, wart-like
seborrheic keratosis
What is cellulitis
- A skin infection
- Reddened
If you have a patient with diabetes and cellulitis you are concerned for:
-osteomyelitis
PAD presentation
- intermittent claudication (feels better at rest, painful when walking)
- feels better when dangling
- shiny
- hairless
- no edema
What is the test for PAD
ABI
What is an ABI diagnostic level for PAD
<0.9
What is 1 thing PAD patients must do?
-STOP smoking
Venous insufficiency presentation
- edema
- discoloration: leg is red/purple/dark
- varicose veins
What is happening in varicose veins and what is the risk associated with this?
- Blood is pooling
- risk for DVT
Erysipelas treatment
-penicillins (usually dicloxacillin)
Erysipelas
-well-demarcated rash on the face, like cellulitis of the face
If you have inflamed/infection skin you would consider
Keflex/Cephalosporins/Penicillin
Mastitis treatment and education
Keflex or Penicillin
-educate to continue to breastfeed
What is the treatment of MRSA
BCD
- Bactrim
- Clindamycin
- Doxycycline
If your patient is pen allergic, what medications would you give
Macrolide (ie. Azithromycin)
Whats the most common skin cancer
BCC
What does BCC look like
- Pearly
- Waxy
- Ulcerated center
Patient presents at 7 years old with a dome-shaped lesion, belly button looking, white plug, umbilication
-Molluscum contagiousum
If you see molluscum contagiosum in the genital region of children you need to
-consider abuse and report
The maculopapular vesicular rash starts on the trunk and spreads to heads, pruritic
Varicella (chickenpox)
Patients with varicella can return to regular activities when
lesions have crusted over
Acne 1st line treatment
-Topicals (Benzoyl Peroxides)
Acne that is not improved by topicals you will next implement
-Oral antibiotic (Tetracyclines)
If acne is not improved by topical or oral antibiotics, then you want to consider
-refer to derm for accutane
If patient is experiencing skin irritation from acne treatments suggest
- decrease frequency
- sun safety
Honey crusted lesions
Impetigo
How is impetigo treated
Mupirocin (Bactroban)
“iMpetigo and Mupirocin”
Scarlet Fever or Scarletina rash
sandpaper rash
Herald patch that starts on truck that then turns into a Christmas tree pattern
-pityriasis rosacea
1st-degree burn
and treatment
- redness, stinging and burning
- cold water, ice, topical burn cream or gel
2nd-degree burn and treatment
- partial-thickness
- redness
- blisters form** (BUZZWORD)
- pain
- tx: Silver, abx ointment, don’t pop blister
3rd-degree and treatment
- full-thickness
- painless
- go to ED
Rule of 9’s in burns adults
- Chest 18%
- Back 18%
- Arms: 9% each
- Head (front and back)= 9%
- Legs: 18% each
- Perineum 1%
Rule of 9’s in burns children
- Head (front and back) 18%
- Back 18%
- Chest 18%
- Arms 9% each
- Legs 13.5% each
- perineum 1%
Marijuana lowers ____ count
sperm count
Cocaine can cause ____ bleed
nosebleeds
Macular degeneration is a loss of ____ vision
Central
Patient presents with eye pain, cloudy cornea, tearing, halos what is the dx and mgmt
- acute angle closure
- “close the door” get them to the ER
What should the intraocular eye pressure be?
8-21
Patient presents saying they are seeing floater, flashes and like someone has closed the curtain on their vision
-retinal detachment
A cauliflower-like growth in the ear and the management
Cholesteatoma; refer to ENT
Ulceration on the inside of cheek or lip
-stomatitis
There is viral and apthous
-viral is multiple
-apthous is just 1
Optic disc that is swollen with blurred edges what is this?
-Papilledema
What is the underlying disease process in papilledema?
-Hypertension
When the artery in the eye crosses over the vein this is called
AV nicking; decreased blood flow to the eye; can have blurry vision or diplopia
AV nicking is seen in
hypertension
Whats the first thing to do if you have a patient present with a visual complain
-visual acuity
Koplik spots are associated with
Measles (Rubeola)
Measles presents with ___ and the 3 c’s
Fever +
- conjunctivitis
- cough
- coryza
and koplik spots
sensorineural hearing loss is always categorized y a ____ because conductive is simply a blockage
drug or otoxic drug
Meniere’s disease presents with
- vertigo
- tinnitus
- N/V
- nystagmus
- hearing loss
Weber lateralizes to ____ in conductive hearing loss
affected ear in conductive hearing loss
Rinne in the affected ear will be ____ in conductive
BC > AC
Weber lateralizes to ____ in sensorineural hearing loss
opposite ear
Rinne will be ____ in sensorineural loss
Normal
First line treatment for otitis media is
amoxicillin
If patient has had an antibiotic within 30 days and has OM treat with
Augmentin
What is the main organism that causes OM
-Strep pneumo
OME is treated with
decongestant
How is OE treated
Corticosporin drops
Xanthelasma is
Lipid deposits around the eye
Allergic Conjunctivits presents like
- bilaterally
- tearing
- *Stringy mucous
Bacterial Conjunctivitis presents like
- unilateral can go to bilateral (cross contamination)
- profuse tearing
- a lot of excuadte
- yellow crusted
What is the test for mono
- mono
- heterophile
Viral conjunctivitis presents like
- unilateral but can go to bilateraly
- a little tearing
- not a lot of exudate
Mono presents with
- fatigue
- pharyngitis
- cervical lymphadenopathy
- enlarged spleen
Mono patients can return to physical activity
when spleen is no longer enlarged ~`4-6 weeks; check by ultrasound
Viral rhinitis first-line treatment is
intranasal corticosteroid spray
You can only use afrin for ___ days otherwise patients will experience
3 days or less; rhinitis medicamentosa
Mitral Regurgitation
- Systolic
- Harsh, loud, blowing
Mitral Stenosis
- Diastolic
- soft, blowing
What murmur radiates to the axilla
-Mitral Regurge
MR wants to be the head but hes not
When will you hear S3
- pregnancy
- CHF
When will you hear S4
- elderly
- left ventricular hypertrophy
What is the treatment for ISH
-CCB
An EKG with a prolonged PR interval is
A 1st degree block
An EKG with no P wave is
atrial fibrillation
Thiazides benefits and AE
-stimulates osteoclasts good in osteoporosis
- Hyperglycemia
- Hyperuricemia
- Hypertriglycerides
Metabolic sydrome
Have at least
- Hypertension
- DM
- Hyperlipidemia
- Waist circumference >40 in men; >38 in women
What is the presentation with endocarditis
- fever
- chills
- osler nodes (only on 1 digit)
- janeway lesions (on palms)
- Splinter hemorrhages on the finger nails
Asthmatic patient presents with a BP drop of 10mmHg or more on inspiration
-pulsus paradoxus
If a patient has diabetes what is 1st line for hypertension
ACEi or ARBs (renal protective)
If a patient has BPH and hypertension what would you give
Hytrin
What is 1st line in Raynaud’s
CCB
In a patient with GERD and hypertension what medication do you not want to give?
CCB
Would you give CCB to a patient with CHF?
No
In patients with gout or kidney stones what hypertensive medications would you not want to give
Thiazide diuretics
What hypertensive medication is contraindicated in COPD
Beta Blockers
If you put a patient on a statin you need to avoid ___ juice
Grapefruit juice
Group A COPD minimally symptomatic low risk of exacerbations treatment
SABA or in combination with SAMA
Group B COPD more symptomatic but low risk of exacerbations
LAMA or LABA or SABA PRN
Group C COPD minimally symptomatic but high risk for exacerbation
LAMA is first line; SABA for sx relief
Group D COPD
Refer
If a COPD patient has poor symptom relief with a SAMA (ipratropium) then you should add
SABA
Intermittent asthma 1st line treatment
SABA
Mild asthma 1st line treatment
low dose ICS
Moderate asthma 1st line treatment
low dose ICS + LABA
Mod to Severe asthma 1st line
Med dose ICS = LABA
GINA Stepwise approach to asthma
- Step 1 (Sx <2x/mth): Low dose ICS- formoterol PRN
- Step 2: (sx >2x/mth but less than daily) Low dose ICS-Formeterol daily
- Step 3 (sx daily, waking with asthma 1x/wk or more) low dose ICS + LABA, or med dose ICS + Laba or low dose ICS + LTRA
- Step 4: Refer
CURB-65
-Confusion
-Urea (>19.6)
-Respiratory (>30)
-Blood pressure >90/60
Age >65
If you hear a bruit you should consider the following diagnosis
- renal vascular hypertension
- renal vascular stenosis
A TB test induration of 5mm is + in
HIV; Immunocompromised; recent exposure
A TB Test induration of 10mm is + in
Migrant farmers; healthcare workers and immigrants
If you find a single nodule on a thyroid it is more likely to be ____ than multinodular
malignant
An A1C >9 you should
start basal insulin
Addison disease presents like
- hyperpigmentation (bronzing skin)
- Salt craving
- thin
- low cortisol levels
- low sodium (sodium follows cortisol)
- High potassium (has inverse relationship with sodium)
Cushing presents like
- obesity
- buffalo hump
- fatigued
- high cortisol levels
- High sodium levels
- Low potassium
Dawn phenomenon management
manage with night time insulin
Somgyi phenomenon management
- is a dip and it goes back up think backwards S
- manage by giving them a snack before bed
- decrease nighttime insulin
Currant jelly stools and sausage shape mass
-Intussception
Projectile vomiting and olive shape mass
-pyloric stenosis
Pencil thin stools signify
-descending colon cancer
CKD labs will show
- Hyperkalemia
- Elevated Creatinine
- eGFR will be low
Urge
Stress
Overflow
Functional
Incontinence
- Urge: Strong urges to go, need to go now
- Stress: Increased intra-abdominal pressure
- Overflow: Difficulty emptying the bladder (think BPH)
- Functional: Inability to make it to the bathroom (think like disability or injury)
Child with uti consider ordering
U/S
Pyelonephritis key finding in the UA
- Nitrates +
- WBC with casts***
glomeurlonephritis key finding in the UA is
RBC casts
and proteinuria
Trigeminal nerve is cranial nerve #
5
Which cranial nerves control occular movement
3,4,6
Shoulder shrugs is cranial nerve
8
Cranial nerve ___ is indicated in bells palsy
7
Cranial nerve ___ is smell
1 (1 nose)
What is the treatment for cluster headache
100% O2 at 12L x 15 minutes
What can you use to prophylactically treat a migraine
propranolol
What are abortive treatment for migraines
Triptans
How do you dx fibromyalgia
-need 11 out of 18 tender points for 3 months
Subarchnoid hemorrhage what is the key finding
-WORSE HEADACHE OF MY LIFE
Subdural hemorrhage the neuro exam is ____ and how do you dx
Positive; CT
What labs will you order to distinguish between Dementia and Delirium
CBC, CMP, TSH, UA, Folate and B12
Alzhemiers
Lewy Body
Vascular
- Alzhemiers: affects frontal lobe think loss of executive function
- Lewy body : mimics parkinsons; postural tremors, instability
- Vascular: mimics alzheimers but due to a vascular event (like after a stroke)
Shoulder, hip, pelvic girdle pain, elevated ESR/CRP what is this
polymyalgia rheumatica
How is polymyalgia rheumatica treated?
High dose steroid
can be up to 9-12 months
If polymyalgia rheumatica patient has sudden vision loss what do they likely have
-temporal arteritis
What is gold standard for sickle cell and thlassemia
hemoglobin electrophoresis
Bicep tendon rupture presents with
- arm pain
- big bulge
What is 1st line treatment for OA
Acetaminophen
What is 1st line for osteoporosis
Bisphosphonates
Symmetrical joint swelling, takes a while to get moving in the morning >1 hr, morning stiffness
RA
What is 1st line treatment for RA?
NSAIDs
Shin splint education
RICE, anti-inflammatory
Burning and numbness between 3/4th metatarsal
Morton’s neuroma
Vit D is recommended at ____ units for those 19-70
600 units
How much calcium is recommended per day
1200
Atypical antipsychotics
Risperdal
Zyprexa
Seroquel
With atypical antipsychotics you need to check
- weight
- BMI
- blood glucose
Serotonin syndrome presents like
- high fever
- hyperreflexia
- tachycardia
- muscular ridgidity
What is the #1 reason men stop taking psych meds
ED
What is the #1 reason women stop taking psych meds
Weight gain
Herbal treatment for anxiety and sleep
Kava Kava
Acute prostatitis presents like
- Suprapubic and perineal pain
- flu like symptoms
- warm and boggy prostate
The prostate exam on a patient with BPH
- firm
- symmetrically enlarged
If you just wanted to shirk the prostate you can use
Proscar
If you want to use a natural herb for BPH
Saw palmetto
Ectopic pregnancy presents with
- spotting
- jarring movements are painful
- hypotensive
What is natural estrogen treatment
- Black cohosh
- Isoflavone
- soy beans
In postmenopausal bleeding you will need to order
- transvaginal ultrasound
- endometrial biopsy
LSIL management
- 21-24: watching and repeat in 12 months
- 25+: colposcopy
HSIL
Colposcopy for everyone
Suspected galactorrhea order
Prolactin
What is 1st line treatment for UTI
Macrobid
Screening tests for syphillis
VDRL
RPR
What is the confirmation test for syphilis
FTA-ABS
5ths disease or erythema infectiosum is caused by
parvovirus B19
Slapped cheek, lacy rash is
5th’s disease or erythema infectiosum
Positive signs of pregnancy
you verified these !!
- Fetal Heart Tones
- Ultrasound
Probable signs of pregnancy
- Hegars sign
- Chadwicks
- Urine pregnancy tests
Presumptive signs of pregnancy
(verified by mom)
- fetal movements
- weight gain
- nausea/vomiting
- breast tenderness
Fundus above symphilis pubis occurs at
12 Weeks
Fundus at the umbilicus
20 weeks
Give rhogam at ____ and ____
28 weeks and 72 hours
What test, tests mom and baby antibodies
Coombs
When there is a traumatic delivery, or there is a resulting cephalohematoma then you should consider that the baby is at risk for
-Elevated bilirubin levels
Where will you see jaundice first
-sclera
Where will you see cyanosis 1st
-mouth/mucous membranes
When do anterior fontanelles close
15 to 18 months
Posterior fontanelle closes at
2-3 months
If you see white eye when trying to elicit red reflex
-leukocoria
Neuroblastmoas do they cross the midline
Yes
Babies weight doubles at ____ months and triples at _____
6 months and triples at 1 year
Legg-Calve-Perthes (avascular necrosis or osteonecrosis)
+ Trendelenburg test
What cardiac finding in marfans
MVP click
Klinefelter’s syndrome
- wider hips
- smaller penis
- smaller testicles
- softer features
- worry is infertility
Turner’s
-ovarian failure (concern is infertility)
-webbed neck
-
If your parents are heterogeneous for sickle cell what is the percent chance you will have it
25%
At 2 months babys are expected to
Coo
At 4 months babys are expected to
Smile spontaneously
Babble
Hands to mouth
At 6 months babys are expected to
Sit up
At 9 months babys are expected to
Wave bye
Try and feed self
At 12 months babys are expected to
Stand and walk
Use a sippy cup
Can say 2-4 words (mama, dada)
Know their name
A 2 years old they can
speak 2-3 word sentences
understand simple directions
running, active
No
At 3 year old they can
- speak in 3-5 word sentences
- stranger can understand them
- Can copy a circle and throw a ball
- Ride a tricycle
At 4 years old they can
- Draw a cross
- Playing mom and dad