buzz words 2 Flashcards
tx pcp pneumonia
pneumocystis jiroveci pneumonia
bactrim
tx for tetanus
pcn
immune globulin
supportive care - resp esp.
how do hookworm larvae enter the body
through the skin
usually the soles of the feet
tx hookworm
azoles
what type mosquitoes carry malaria
anopheles
tx white oral plaques that can be scraped off
candida
topical nystatin or oral fluconazole 1mg
ct scan shows ring enhancing lesions in an HIV pt
dx
toxoplasmosis
drug of choice for toxoplasmosis
bactrim
what organism causes toxoplasmosis
toxoplasma gondii
what drug do you use to treat pinworm
everyone in the house with albendazole
tx again 2 weeks later
scotch tape test dx?
pinworm
nisseria gram + or -
gram -
syphilis is caused by what organism
treponema pallidum
gram positive organism in chains
dx
strep
gram - diplococci
dx
neisseria
most common pre-op prophylaxis
ancef, cephalexin
oral abx for pseudomonas
cipro
suffix for most fluoroquinolones
oxacin
why aren’t fluoroquinolones used more often
lots of side effects
pt with ruptured achilles tendon
recent abx, which class
fluoroquinolones
why can’t you give fluoroquinolones to kids
cause cartilage development problems
class of abx for community acquired pneumonia
macrolides
list macrolides
erythromycin
azithromycin
clarithromycin
abx class for chlamydia
macrolides
class of abx for its effects on increasing GI motility
macrolides
which is worse for pads
tetracycline or aminoglycoside
tetracycline
pizza pie retinopathy
dx
CMV
cytomegalovirus
pt with metallic taste and dark brown urine
what abx on?
flagyl
abx most likely to cause c.diff
clindamycin
drug of choice MRSA
vancomycin
pt on rifampin
warn of what side effect
orange-red discoloration of body fluids
infuse vanc too fast
red man syndrome
2 oral meds for MRSA
linezolid (zyvox)
bactrim
organism most commonly responsible for community acquired pneumonia
strep pneumoniae
most common organism for UTI
E. Coli
gummas or granulomatous nodules
dx?
tertiary syphilis
bloody stool with cysts and trophozoites
dx
amebiasis
community acquired carditis is most often caused by one of the HACEK organisms
List HACEK organisms
haemophilus actinobacillus cardiobacterium eikenella kingella
3 meds combined to tx h pylori
omeprazole (prilosec)
clarithromycin
amoxicillin
prophylactic abx before dental procedure
dose?
amoxicillin
2gm po 1 hr before procedure
pregnant women and cat litter
dx?
toxoplasmosis
tx for urethritis neisseria
dx?
ceftriaxone
klebsiella gram + or -
gram -
gram + clusters
dx
staph
best test for dx rocky mountain spotted fever
indirect immunofluorescent antibodies
gram - coccobaccili found in sputum with pneumonia
dx
H flu
med used as prophylaxis for meningococcal meningitis
rifampin
secretory phase of the menstraul cycle
day 14-28 is dominated by what hormone
progesterone
nulliparous or multiparous women more likely to develop preeclampsia
nulliparity
since a genetic cause is the number one reason for primary amenorrhea
one important test
karyotype
purulent cervical dc
dx
neisseria gonorrhoeae
young girl with a web neck or wide chest
dx
turner’s syndrome
cervical bx comes back as CIN1 next step
repeat pap smear in 6 months and repeat colposcopy in 12 months
most common cause of secondary amenorrhea
pregnancy
3 labs if considering secondary amenorrhea
beta hcg
tsh
prolactin
define premature birth
delivery 20-36 weeks
a unilateral, single, mobile, firm, non-tender solid breast mass
dx
fibroadenoma
metrorrhagia
bleeding between menstrual cycles
postmenopausal bleeding
dx
endometrial cancer
what portion of the menstrual cycle does pms occur
second half and menstruations should relieve sxs
BV tx
flagyl x 7 days
location within the pelvis is endometriosis found
on an ovary
gold standard lab for chlamydia
nucleic acid amplification test
are fibrocystic breast masses usually b/l or unilateral
bilateral
definitively dx endometriosis
ex lap
most common uterine tumor
leiomyoma, fibroids
ethnic background increased risk of fibroids
AA 5x more likely
tx vaginal candida
fluconazole po 1 dose or azole cream x 1 week
1st step of tx for endometrial cancer
total hysterectomy and b/l salpingo-oophorectomy
chocolate cyst
dx
endometrioma
surge in what hormone leads to ovulation
luteinizing hormone
irregular menses, hirsutism and infertility
dx
PCOS
what endocrine issues is associated with PCOS
insulin insensitivity
pt with PCOS wants to get pregnant
2 meds to start on
metformin
clomid
medical tx for early ectopic
methotrexate
ovarian cyst with hair and teeth
dx
teratoma
mean age for ovarian cancer
63
think of in an older pt with vague and sxs
second stage of labor
fully dilated to delivery
66yo female pt with bouts of N, wt loss, vague and pain
dx
ovarian cancer
when to begin pap smears
when you are sexually active or 21 yo
cervical bx CIN2 or CIN3
next step
excision
LEEP
cold knife (incompetent cervix)
cryotherapy
2 risk factors for cervical ca
multiple sexual partners
smoking
how much time needs to pass before dx secondary amenorrhea
if cycles have been nl 3 months
if cycles have been irregular 6 months
what is a cystocele
a herniation of the bladder into the vagina
tx for turners syndrome
cyclical estrogen
progesterone
3 txs for uterine prolapse
pessary
kegel maneuvers
surgery
most common organism for mastitis
staph aureus
about how pregnant is the uterus at the umnilicus
20 weeks
most common cause of postpartum hemorrhage
uterine atony
defined missed ab
no vaginal bleeding, cervix is closed, POC inside
what age is primary amenorrhea dx
14 if no secondary sex characteristics
16 is some secondary development
tx for mastitis
1st line dicloxacillin
2nd line cephalexin or erythromycin
should breast feeding stop for mastitis
mastitis no
abscess yes
PE- retroverted uterus or uterosacral ligament nodularity
dx?
endometriosis
at how many weeks can you do an amniocentesis
15-20 weeks
5 risk factors for breast cancer
BRCA1 or 2 positive unopposed estrogen nulliparity early menarche late menopause
avg age of menopause
51
cottage cheese dc
dx
vaginal candidiasis
follicular phase of menstruation dominated by what hormone
estrogen
how wt should you gain during pregnancy
20-35 lbs
thin, sticky, malodorous vag d/c
dx?
BV
vaginal infection with motile flagellated protozoa
dx
trichomonas
2 meds used for htn in pregnancy
methyldopa
labetalol
triad of pre-eclampsia
htn
edema
proteinuria
why is ovarian cancer so hard to dx
there are no good markers and sxs are very vague
2 important things to tell its on flagyl
stay out of the sun
no alcohol
define inevitable ab
vaginal bleeding
cervix is open
POC inside
how is the first day of the menstrual cycle defined?
1st day of menstrual bleeding is 1st day of the cycle
what is the karotype for patient with turner’s syndrome
(45,X)
they are missing one sex chromosome
give the time frame for preterm labor
20-37 weeks
pt presents with mucopurulent dc and CMT
dx
chlamydia - cervicitis
4 human papillomaviruses are linked to cervical ca
16, 18, 31, 33
clue cells
dx?
BV
hallmark of PE for placenta previa
trick ?
never do a pelvic on someone with presumed placenta previa
medium to grow out gonorhea
thayer-martin
age range for HPV vaccination
9-26 yo
pt with primary amenorrhea and low FSH
dx
hypothalamic pituitary insufficiency
characteristic that sets apart PID from other and issues
bilateral pain
6 risk factors for ovarian ca
BRCA1 family hx nulliparity late menopause caucasian asian
define ab
delivery of urerine contents before 20 weeks
mastitis tend to be unilateral or bilateral
unilateral and only one quadrant
full term?
37-42 weeks
when does quickening occur
nulliparous 18-20 weeks
multiparous 14-16 weeks
quickening
the first motion of a fetus in the uterus felt by the mother
5 risk factors for placental abruption
htn smoking ama (advance maternal age) cocaine use PROM
tx for ovarian ca
total hysterectomy
bilateral salpingo-oophorectomy
chemo + radiation
pt is pregnant and slight blue on cervix
name of that sign?
Chadwick’s sign
how many weeks when uterus is at the level of the symphysis pubis
12 weeks
snowstorm appearance on US
dx?
hydatidiform mole
med used to control bleeding due to uterine atony
oxytocin (pitocin)
term when placenta is implanted directly over the cervical os
placenta previa
at how many weeks of pregnancy can chorionic villus sampling be done?
10-13 weeks
why is folic acid given in pre-natals
low folic acid can lead to neural tube defects
most common endometrial ca
75% are adenocarcinomas
strawberry cervix with copious yellow/green dc
dx?
trichomonas
what organism causes us to warn pregnant pt to not eat deli meats and soft cheeses
listeria
baby was delivered several mins ago
sudden increase in blood flow from vagina and cord lengthens
cause?
placental separation
2 meds to induce labor
cervidil (prostaglandin gel applied to the cervix) - which encourages cervical ripening
oxytocin - encourages uterine contractions
antepartum testing a + stress test
what does that mean?
they have had 2 heart rate accelerations in a 20 min period of 15 beats above baseline for at least 15 secs, this is a good thing
is FSH high or low in turner’s syndrome
high
there are no ovaries to respond to FSH and so there is no negative feedback
most common ovarian cyst
functional cyst - no tx
define threatened ab
vaginal bleeding, closed cervix, POC inside
10 risk factors for endometrial cancer
chronic unopposed estrogen nulliparity early menarche late menopause tamoxifen dm obesity htn breast ca ovarian ca
what do you see on a KOH prep if pt has vaginal candidiasis
pseudohyphae
1 cause of septic arthritis is sexually active young adults
gonorrhea
how many days after conception is a serum beta positive
8
if the pap smear results come back anything other than negative or ASCUS
next step?
colposcopy and bx
3 risk factors for an ectopic
previos ectopic
scarred tubes (hx PID or salpingitis)
IUD
grape-like vesicles or a sack of grapes on US
dx?
hydatidiform mole
what med is used to increase surfactant levels and help with lung maturity if you are worried about pre-term labor
betamethasone
2 tocolytic meds
mag sulfate
calcium channel blockers
tocolytic meds
anti-contraction medications or labor repressants
medications used to suppress premature labor
pt thinks in pre-term labor, 1st tx
give IV fluids
most often just dehydration
pap smear comes back ASCUS next step
repeat pap in 4-6 months
3 ways you can check for ruptured membranes
ferrying pattern on a slide
visualize leakage from the cervix
pooling in the vagina
nl fetal heart rate
120-160
menorrhagia?
heavy prolonged menstraul flow
Rh combo for mom and dad might cause the mother to create antibodies against the baby’s red blood cells
mom rh -
dad rh +
at what point is PhoGAM given
28 weeks
complete ab?
vaginal bleeding
cervix open
POC have passed
gestational DM - mom and baby at risk for 3 things
preeclampsia
macrosomia (traumatic birth)
slowing in fetal lung development
painful 3rd trimester bleeding
placental abruption
3 causes fro a postpartum hemorrhage
uterine atony
genital laceration
retained placenta
3rd stage of labor
delivery of baby to delivery of placenta
what meds tx a postpartum metritis
clindamycin and gentamicin together
most common STD
chlamydia
interference with work or school is part of which PMS syndrome
premenstrual dysphoric disorder
which reproductive cancer carries the higher rates of death in women
ovarian cancer
most common infection after c-section
metritis
tx trich
flagyl
define incomplete ab
vaginal bleeding
cervix is open
POC partially passed
what is the most common site of an ectopic
within a fallopian tube
early in pregnancy how often beta double
48-72 hours
define procidentia
uterine prolapse beyond the introitus
what is the more popular term for stein-leventhal syndrome
PCOS
formula for calculating EDD
first day of last period +7 days - 3 months
5 parts of the biophysical profile
non-stress test fetal breathing 2 gross body movements fetal tone amniotic fluid index
define 1st stage of labor
onset of contractions to full dilation of the cervix
rope like breast mass
dx
fibrocystic breast mass
what should a pcp do for a presumed retinal detachment
refer & position patient with head down
what age range do you expect to find amaurosis fugax
older then 50
1 cause of retinal artery occlusion
carotid atherosclerotic disease
tx for herpes keratitis
topical antiviral, topical steroid or both
don’t use steroids
topical antiviral
refer
pt describes his vision loss as a curtain coming down and going back up
dx?
amaurosis fugax
Amaurosis fugax
sx CAD - occurs when a piece of plaque in one of these arteries breaks off and travels to an artery in the eye.
pt with a painful red nodule on the eye lid
dx? tx?
hordeolum (sty)
warm compress and progress to topical abx if needed
fundal exam shows a cherry-red spot
dx
central retinal artery occlusion
college student with a little purulent drainage from one eye and contender pre auricular lymphadenopathy
dx and pathogen?
chlamydia conjunctivitis
what should pcp due with presumed central retinal artery occlusion
ophthalmic emergency
refer and intermittent pressure and release of the eye
pt with unilateral blurriness over a few days
fundal exam shows a “blood and thunder” pattern
dx
central vein occlusion
tx for central vein occlusion
self limited
tx underlying dx
glaucoma more prevalent in males or femaales
females 3:1
2 risk factors for glaucoma
african american
DM
yellow brown fleshy mass on the conjunctiva, usually doesn’t interfere with vision
pinguecula
fundal exam shows a cup to disc ratio of >0.5
vessels bending over the disc
dx
glaucoma
pt presents saying he doesn’t need glasses anymore after 30 yrs
dx
cataract
pt has metamorphopsia and central blind spot
dx
macular degeneration
metamorphopsia
type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank
most likely quadrant for a retinal detachment
superior temporal
pt presents with pain in one eye
cornea is hazy and pupils are fixed
dx?
glaucoma
most common way of testing for metamorphopsia
amsler grid
notice drusen deposits on fundal exam
dx?
macular degerneration
drusen deposits
yellow deposits under the retina, the light-sensitive tissue at the back of the eye.
Drusen are made up of lipids, a fatty protein.
pt presents with irritated, burning and tearing eyes
some scurf and scales
where do you begin tx?
dx - blepharitis
tx - good hygiene and abx as needed
pt has a hx of multiple stys
now with painless nodule on his eyelid and minor conjunctivitis
dx?
chalazion
most common colors lost in color blindness
red and green
term for eyelids that turn in
entropion
term for bilateral yellow plaques near the eyes
xanthelasma
fundal exam shows an opalescent retina and boxcarring of arterioles
dx
central rentinal artery occlusion
most common preceding event for orbital cellulitis
URI
vision loss described as curtain coming down
dx
retinal detachment
bowing of the iris on exam
dx
glaucoma
CT scan of the head shows broad infiltration or orbital fat
dx?
orbital cellulitis
pt presents with watery bilateral d/c from eyes and nontender per auricular adenopathy
dx?
most common pathogen?
viral conjunctivitis
adenovirus
how do you test for color blindness?
ishihara plates
pt with hx of asthma presents complaining of stringy d/c from both eyes and severe swelling around the eyes
dx?
allergic conjunctivitis
name of the triangular or wedge shaped growth on the conjunctiva that may interfere with vision
pterygium
name of the test for dry eyes
schirmer’s test
pt having undergone cataract sx presents complaining of vision loss in the operative eye
dx?
retinal detachment
pt presents with sudden painless complete unilateral vision loss
dx?
central retinal artery occlusion
dendritic lesion is seen with fluorescein stain
dx
herpes keratitis
which nerve is involved in herpes zoster ophthalmicus
trigeminal nerve, CN 5
hutchinson’s sign
dx?
herpes zoster ophthalmicus
pt with a dense corneal infiltrate and an epithelial defect seen with fluroescein stain
dx
corneal ulcer
feathery border on eye exam
dx?
fungal infection
pt in recovery room after foot sx is complaining of severe photophobia, feels like there is something in her eye
dx?
corneal abrasion
its scratch their eyes before they are awake from anesthesia
tx for subconjunctival hemorrhage
reassurance
19yo male took an elbow to the face while playing basketball
whole face is swollen and can’t look up
dx?
orbital fracture
pt ℅ of seeing halos and rainbows around lights
also ℅ of moderate photophobia
dx
glaucoma
1st thing you should be thinking of if a peds pt comes in with blood in the anterior chamber of the eye (hyphema)
child abuse until proven otherwise
how long after radiant energy burn do symptoms typically show
6-12 hours
term for eyelids that turn out
ectropion
initial tx for a chemical burn to the eyes
irrigate, irrigate, irrigate
color blindness genetics
dominant x-linked
term for nearsighted?
type of lens to correct it?
myopia
concave lens
college student with copious purulent drainage from one eye
dx
neisseria conjunctivitis
1st line tx for orbital cellulitis
IV abx, then 2 weeks po abx
term for being farsighted
type of lens to correct it
hyperopia
convex
what is tonometry used for
determining intraocular pressure
most common pt complaint with emphysema
SOB
at what age should vaccinations for pneumonia begin
65 yo
prolonged expiration (low FEV1) dx?
asthma or COPD
hampton’s hump on CXR
dx?
PE
hampton’s hump?
shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface.
how long after given ppd do u read it
48-72 hours
pt w/o a functioning spleen is more susceptible to what organism
encapsulated organisms
most commonly strep pneumonia or H flu
most common cause of pneumonia in children less than 1 year old
RSV
tx for PCP pneumonia
bactrim
what occupations are associated with berylliosis
aerospace
nuclear plant workers
CXR finding for berylliosis
diffuse infiltrates with hilar adenopathy
gold standard for dx of pleural effusion
thoracocentesis
when performing a decompression for a tension pneumo where do u put the needle
2nd interconstal space at the midclavicular line
tamiflu can be given to childer over what age
1
Zanamivir (relenza) maybe given to kids over what age
7
HIV pt with ground glass appearance on CXR
dx?
PCP
noncaseating granuloma
dx
sarcoidosis
pearl formation on CXR
dx
squamous cell lung cancer
Ghon or Ranke complexes on CXR
dx
TB
westermark sign on CXR
dx
PE
mesothelioma most common lung location
80% in the pleural lining
CXR that will make you think of mesothelioma
pleural thickening
hyperinflation on CXR as well as eosinophilia on CBC
dx
asthma
organism is most common cause pneumonia in a pt with CF
pseudomonas
college student with pneumonia
2 organisms?
chlamydia
mycoplasma
at what size in HIV pt is ppd +
5mm
suspect pneumo
instructions for CXR
should be an end expiratory view in order to look for visceral pleural air
3 most commonly used med txs for COPD
O2
ipratropium
albuterol
4 meds that might cause asthma
beta blockers
NSAIDS
ACEI
ASA
nodular opacities in the upper lung fields
dx?
silicosis
initial tx for active TB
INH + RIF + PZA + EMB x several months
followed by INH + RIF after sensitivities come back
caseating granulomas
dx?
TB
blue bloater
dx?
chronic bronchitis
contralateral mediastinal shift
dx?
tension pneumo
best test dx bronchiectasis
CT
main side effects of isoniazid 2
hepatitis
peripheral neuropathy
treating a pt for TB
noticed orange tint
cause?
rifampin
ethambutol has what 2 major side effects
optic neuritis
red green vision loss
rats and pt with pneumonia
organism?
yersinia pestis
most common organism causing pneumonia in COPD pts
Haemophilus influenzae
where is a pancoast tumor found on CXR
at the apex of either the right or left lung
tb in upper or lower lobes on CXR
upper
pt has pneumonia with rust colored sputum
dx?
strep pneumonia
coal miners lung often shows nodular opacities in what lung fields
upper lung fields
when you step up dx from intermittent asthma to mild persistent asthma what med should you add
an inhaled steroid like fluticasone
rabbits and pneumonia
dx
tularemia
dullness to percussion
dx
lobar pneumonia
young child in er, tripod position
dx
epiglottitis
+ppd in healthcare worker
10mm
6 extra pulmonary complications of lung cancer
SPHERE SVC syndrome pancoast tumor Horner's syndrome endocrine problems recurrent laryngeal sxs effusions (exudative)
currant jelly sputum
dx
klebsiella pneumoniae
what happens to total lung capacity in sarcoidosis
it goes down
what will the likely findings be on a CXR of a pt with asbestosis
linear opacities at the bases with pleural plaques
tympany to percussion
dx
large pneumo
3 most common cancers to mets to the lungs
breast
liver
colon
thumbprint sign on X-ray
2 dxs?
lateral C-spine = epiglottitis
abd= intestinal ischemia
barrel chest
dx
emphysema
are the lungs noisy or quiet in COPD
quiet
4 indications for the flu vaccine
kids 6-59 months (5yo)
pregnant female
healthcare worker
older then 50
posttussive rales
dx
TB
parenchymal mets and blebs on CXR
dx
emphysema
rhonci or wheezes that clear after coughing
dx
bronchitis or atelectasis
does FEV1 go up or down with asthma
down
very sick pt with diffuse infiltrates that spare costophrenic angles
dx
ARDS
most common cause of bronchiectasis
CF
gold standard to dx CF
sweat chloride test
exudative pleural effusion
dx
TB
lung cancer
tx for epiglottitis
2nd or 3rd generation cephalosporin (ceftriaxone)
macroclides may also be used (clindamycin)
transudative pleural effusions
dx
CHF
2 lung cancers typically found centrally on CXR
small cell lung cancer and squamous cell
2 lung cancers typically found peripherally on CXR
adenocarcinoma
large cell
pertussis most commonly treated with what abx
erythromycin
4 most common places lung ca will met to
bone
brain
adrenals
liver
pt with erythema nodosum and an enlarged parotid gland
dx
sarcoidosis
erythema nodosum
tender red nodules
usually on the shins
thin looking heart
flattened diaphragm on cxr
dx?
emphysema
alcoholic who has pneumonia
most likely organism
klebsiella pneumonia
honeycombing and tram tracks on CXR
dx
bronchiectasis
idopathic pulmonary fibrosis
paradoxical pulses in what pulmonary disorder
asthma
older pt with pneumonia and diarrhea
dx
legionella pneumonia
eggshell opacities on the CXR
dx
silicosis
4 causes of decreased tactile fremitus
copd
asthma
pleural effusion
pneumothorax
hyperresonance to percussion
dx - 3
emphysema
pneumo
asthma
crackles in the lung files
4 pulmonary issues in differential
pneumonia
fibrosis
CHF
bronchitis
does total lung capacity go up or down in COPD
goes up
3 things on diff with wheezes
asthma
copd
bronchitis
pt says “ee” but on auscultation you here “ay”
egophony
PE - egophony
dx
lobar pneumonia
cxr shows vascular redistribution and blurred vascular outlines
dx
CHF
difficulty swallowing
dysphagia
birds-beak esophagus on barium swallow
dx
achalasia
most common location for an anal fissure
posterior midline
crown’s is found where in the GI tract
esophagus to anus
HBsAg (hep B surface antigen) indicate
active hep B infection
tx for achalasia
loosen up the muscle
botox
dilation or
sx
a corkscrew appearance on barium study
dx
esophageal spasms
epigastric abdominal pain rad to back
dx
pancreatitis
in order to contract hep D what must you already have
hepatitis B
LLQ pain
dx
diverticullitis
tx for most mallory-weiss tears
watchful waiting
typically resolve within 48 hours
thumbprint on an and film
dx
intestinal ischemia
bowel sounds be early on in a SBO
later?
early hyperactive
late they are absent
pt has gerd for yrs
past year increase in difficulty swallowing his food
dx
esophageal strictures
2 txs for esophageal strictures
dilation of the esophagus
long term PPIs
2 predisposing factors for esophageal varices
portal htn
cirrhosis from alcoholism
common sx with CP from gerd pts
dry cough
med most commonly used for long term tx of GERD
PPI
omeprazole
lansoprazole
pantoprazole
imaging for pancreatitis
CT
best test to check for h pylori
urea breath test
PUD more common in the duodenum or stomach
duodenum
most common location for a pancreatic tumor
75% occur in the head of the pancreas
gastric ulcer
sxs exacerbated or relieved with food
exacerbated
fasting gastrin will be above what level with gastrinoma
> 150 pg/ml
projectile vomiting
sx
pyloric stenosis
most gall stones made of what
cholesterol
pt shows inhibited inspiration with pressure over RUQ
dx
murphy’s sign
cholecystitis
most specific test for acute chole
HIDA
gold standard for dx, tx of bile duct stones
ERCP
charcot’s triad
RUQ pain
fever
jaundice
ascending cholangitis
reynold’s pentad
why does it matter
charcot’s triad
+ htn+AMS
indicates a high risk of sepsis
dx as an immunologic response to gluten
celiac
rick factor for esophagitis
immunocompromised pt
an endoscopy for presumed esophagitis shows multiple shallow ulcers
dx
herpes simplex virus
list 4 common offending agents for pill induced esophagitis
NSAIDS
KCl
iron
abx
30yo AA women with dyspagia
thickened skin
barium swallow demonstrates the absence of peristalsis
dx
scleroderma
pt ℅ of regurgitating undigested food several hours after a meal
dx
zenkers diverticulum
most common cause PUD
h pylori
most specific dx test for PUD
endoscopy
only curative tx for gastric adenocarcinoma
surgical resection
pt ℅ RUQ pain 20 mins after meals
dx
cholecystitis
ERCP stand for
endoscopic retrograde cholangiopancreatography
most common cause of acture bacterial cholangitis
choledocholithiasis
onion ring fibrosis from a bile duct bx
dx
primary sclerosing cholangitis
2 viral hepatitis infection are self limiting
hep A and E
pica often related to what anemia
iron deficiency anemia
what does an Anti-HBc (hep B core antibody)
previous or ongoing hep B infection
what does Anti-HBs (hep B surface antibody)
recovery from infection or immunization to hep B
recommended tx for hep C infection
pegylated interferon aplha-2
what med is used in hep B infection helps prevent the need for liver transplant
lamivudine
vaccines for which 2 heps
hep A and hep B
pt with achalasia have dysphagia to liquids, solids or both
both
heartburn that does not improve with meds
dx
gastrinoma
2 main complications of cirrhosis
portal HTN
liver insufficiency
2 main causes of pancreatitis
cholelithiasis
ETOH
cullen’s sign
umbilical ecchymosis often related to pancreatitis
5 points of ranson’s criteria on admission
older then 55 wbc > 16 glucose >200 LDH >350 AST >250
1st step in treating GERD
lifestyle modifications
steatorrhea
dx
pancreatitis
courvoisier’s sign
contender palpable gallbladder which may indicate pancreatic neoplasm
tumor marker can be used to follow pancreatic ca
ca-19-9
pt ℅ of periumbilical pain which has moved over mcBurney’s point
dx
appendicitis
how to do psoas sign
pt is supine and attempts to raise R leg against resistance
term for painful swallowing
odynophagia
how to perform the obturator sign
pt is supine and attempts to flex and internally rotate right hup
best imaging for acute appy
ct
2 blood test to dx celiac
IgA endomysial abtibody
IgA tTG antibody
how much fiber do you need in a day
30 grams
tx should be started for asymptomatic diverticulosis
none
is sx curative for crohn’s or ulcerative colitis
UC
what causes mallory-weiss tears
forced vomiting or retching
often involving alcohol
colonoscopy that shows cobblestone or skip lesions
dx
crohn’s disease
class of medication is 1st line to treat inflammatory bowel disease in the maintenance phase
5-ASA products
sulfasalazine, mesalamine
currant jelly stool
dx
intussusception
severe abd pain 30 mins after a meal
dx
intestinal ischemia
most common cause lower GI bleed
diverticulosis
most common location of colorectal cancer
cecum about 38%
colorectal ca its are almost all older than what age
90% older then 50
epigastric olive-shaped mass
dx
pyloric stenosis
an elevated serum amylase and lipase dx
pancreatitis
age begin screening colonoscopies
50
1 cause SBO
postop adhesions
air fluid levels on abd X-ray
dx
bowel obstruction
which hernia more likely to pass into the scrotum
direct or indirect
indirect
string sign on barium swallow
dx
pyloric stenosis
1st line tx for an anal fissure
fluid and fiber
4 things that an anal fissure off midline might suggest
crohn’s
syphilis
hiv
neoplasm
med tx for gastrinoma
PPI
term for an abscess in the sacroccygeal cleft
pilonidal dx
tx for H pylori
PPI + 2 abx
omeprazole + clarithromycin and amoxicillin
or
PPI + flagyl + tetracycline
painless bright red blood per rectum
dx
hemorrhoids
pt on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin
folate
most common anorectal problem affecting its over 50
hemorrhoids
a gastrinoma is aka what syndrome
zollinger-ellison syndrome
salivary amylase breaks down what macronutrient
carbs
medical term for feelings like there is a lump in your throat
globus
most common vessel blocked with intestinal ischemia
superior mesenteric artery
describe Grey-Turner’s sign
flank ecchymosis
often related to pancreatitis
1st 3 steps of managing pancreatitis
NPO
pain meds
fluids
pt presents with unproductive retching, acute localized epigastric distention and inability to pass NG tube
dx
gastric volvulus
most common cause folate deficiency
alcoholism
should diverticulitis always be admitted
no mild cases can be outpt
rest and clear fluids
which NSAID has the highest rate of peptic ulceration
naproxen
diagnostic test of choice for Zenker’s diverticulum
barium swallow
will show the diverticulum
leading cause of iron deficiency anemia
chronic GI bleed
age start fecal occult blood tests
50 and yearly
how often should its with pernicious anemia have a screening endoscopy
every 5 years
looking for signs of gastric carcinoma
are one half of all adult hernias direct or indirect inguinal hernias
indirect inguinal hernias makeup 50% of all adult hernias
how is celiac dx most commonly diagnosed
endoscopic biopsy
define pellagra
niacin (B3) deficiency
an endoscopy for presumed esophagitis shows several solitary deep ulcers
dx
cytomegalovirus
which are more painful, hemorrhoids above or below the dentate line
below
internal hemorrhoids are not painful
an abd exam with pain out of proportion to the exam
dx
intestinal ischemia
does adenocarcinoma arises from the proximal or distal esophagus
distal
german measles is aka
rubella
bruises may be purple, green, yellow, and brown
purple 1-5 days
green 5-7 days
yellow 7-10 days
brown 10-14 days
pain with movement of the pinna or tragus
dx
otitis externa
1st line tx for pertussis
erythromycin
by what age should a child be able to hold up her head
3 months
a salter harris type 1 fracture affects what area of the bone
only the physis (growth plate)
by what age should a child be able to sit up
6 months
an overweight 15 yo boy with a limp presents to the office with knee pain
no hx trauma
dx
slipped capital femoral epiphysis
premature infant with hyaline membrane disease will have what appearance on CXR
bilateral atelectasis or ground glass appearance
atypical or walking pneumonia
what pathogen
mycoplasma
abx 1st line for mycoplasma pneumonia
a macrolide
a pt is having seizures along with a mouse-like odor from the urine
dx
phenylketonuria
description of a dew drop on a rose petal
dx
chickenpox
pale and boggy nasal mucosa
dx
allergic rhinitis
5 major jones criteria for dx rheumatic fever
polyarthritis carditis subcuticular nodes erythema marginatum chorea
describe erythema marginatum
pink rings on the trunk and inner surfaces of the limbs
a child with bulky greasy stool
dx
cystic fibrosis
at what age should an infant begin cooing
2 months
what is the most common cause of an URI
rhinovirus
koplik spots are clusters of white clustered lesions on the buccal mucosa
what virus
measles/rubeola
1st line abx for otitis media
amoxicillin
tx a pt with respiratory syncytial virus
albuterol
steroids
fluids
child presents with painful ulcers in his mouth
PE- also on hands and feet
virus?
coxackie virus
what is the gold standard for the dx of cystic fibrosis
sweat chloride test
by what age able to walk
12 months
FB obstructing a child’s breathing what type of CXR
expiratory view looking for hyperinflation due to air trapping
medical term for lazy eye
amblyopia
pt presents with a staccato cough but no fever
dx
chlamydia pneumoniae
most serious complication of kawasaki syndrome
aortic aneurysm
a musical vibratory murmur best heard at the apex in a child
dx
still’s murmur
kawasaki syndrome
is an immune disease in which the medium-sized blood vessels throughout the body become inflamed. It is largely seen in children under five years of age. It affects many organ systems, mainly those including the blood vessels, skin, mucous membranes, and lymph nodes;
still’s murmur
benign or “innocent” functional heart murmur that is not associated with any sort of cardiac disorder or any other medical condition.[1] It can occur at any age although it is most common among children two to seven years of age and it is rare in adulthood.
palpable olive shaped epigastric mass in a 1 month old
dx
pyloric stenosis
at what age should a child be able to use a spoon and stack 3-4 blocks
18 months
x-ray finding that supports dx of a slipped capital femoral epiphysis
ice cream falling of the cone
viral exanthem often has conjunctivitis as one sx
measles/rubeola
most common congenital heart defect
VSD
boot shaped heart of cxr
dx
tetralogy of fallot
PE- tubular or sausage-shaped mass
dx
intussusception
tx for a volvulus in a child
barium enema
by what age should a child be able to roll over
4 months
what is pertussis aka
whooping cough
which heart valve is most associated with rheumatic fever
mitral
loud harsh holosystolic murmur in a child
best heard at the LLSB
dx
VSD
child with paroxysmal abd pain, nausea, vomiting and diarrhea
dx
intussusception
child begin to feed themselves
6 months
currant jelly stool
dx
intussusception
is an URI include hoarseness bacterial or viral
viral
describe barlows test
adduct and internal rotation of the hips
CXR finding of notched ribs in a child
dx
coarctation of the aorta
how long should you wait for a swallowed marble to pass before considering sx
24 hours
4 yo boy presents between october and march with wheezing, coughing, a runny nose and increased respiratory rate
pathogen?
RSV
describe wt gain in an infant over the following time periods 1 week 6 months 12 months 3 yo 4yo
newborns lose 10% of birth weight and are back to birth at 10 days 6m = 2x birth 12m = 3x birth 3yo = 30 lbs and 30 inches 4yo - 40 lbs and 40 inches
what age should a child be able to kick a ball
24 months
child with a fever lasting longer then 5 days
dx
kawasaki syndrome
widely split fixed S2
dx
atrial septal defect
nasal polyps
dx
cystic fobrosis
in order to diagnose rheumatic fever what 1 thing
evidence of a strep infection
2 major criteria or 1 major and 2 minor criteria
forchheimer spots
rubella
salter-harris type III fx what area of the bone
the physics (growth plate) as well as the epiphysis
a lacey pink rash
dx
erythema infectiosum aka 5th disease aka slapped cheek
unilateral purulent rhinitis
dx
FB
medical term for cross-eyed
strabismus
organism most common cause of otitis media
strep pneumonia
at what age to say mamma, dadda
12 months
