Challenge Bowl Flashcards
3 Classes of drugs that can be used for PUD
PPI
H2RA
Sucralfate
The existence of this Hep requires the coexistence of Hep B
Hep D
2 different test to dx bacterial ulcer disease
Urea breath test and Stool antigen
Rash w/herald patch and christmas tree distribution
Pityriasis Rosea
1st line treatment for AOM for bilateral w/o otorrhea in 5 mo old
Amoxicillin 80-90mg/kg/day in 2 divided doses and pain management (APAP/ibuprofen)
Define CO
HR*SV
Toddler with scratch on lips, and now there’s a yellowish golden scalp over the scratch
Impetigo
Abdominal pain in RLQ after deep palpation in LLQ
Rovsing’s Sign
H. pylori regimen
> 2 antibiotics and antisecretory drug (PPI/H2RA)
Study of action of drugs on the body
Pharmacodynamics
What is atelectasis?
Dependent collapse of the alveolar sac
Define a heave
Pulsation felt due to a distention of an underlying structure
Most sensitive instument for detection of gallstones
US
3 parenteral routes of drug administration
IV, IM, sublingual, SQ, transdermal, rectal, intranasal
What is a thrombus?
A clot that is formed at the site in the vessels
What % of body is burnt in anterior chest and entire left arm?
27%
Clear and consice reason for a pt seeking care is what?
Chief complaint
Which generation of Cephs has the best gram - coverage?
3/4th generation
What FQ has the best activity against Pseudomonas?
Cipro
Common complaint with varicella is pruritus? T/F
True
Bradycardia is definedd as a HR < how many beats?
<60
Which skin cancer is the most likely to metastasize
Melanoma
What initial therapy is recommended when sinusitis begins?
Antipyretic, Analgesics, nasal irrigation, hydration, +/- intranasal corticosteriod
Which lab test is best used to monitor for long term nutritional status?
Albumin
What should you instruct your patient to take w/each dose of metamucil and why?
8oz. of water so it doesn’t get impacted
Name on organism that causes walking pneumonia?
Mycoplasm
When treating anaphylaxis which med has fastest onset of action?
EPI, middle is antihistamine, slowest is corticosteriod
On which structure is an acoustic neruoma located?
CN VIII (8)
What two advantages do 2nd generation antihistamines have over 1st generation antihistamines?
Less sedation and less anticholinergic effects
Two most common nutrition vitamin deficiencies with ETOH dependence?
Thiamine and Vit B12, Vit K, folic acid
Why do you need to use caution when prescribing cimetidine in a patient on other medications?
CYP Inhibitor - will increase the serum levels of other medications
Listening to pt heart sound, suspicious for aortic stenosis; what would happen to heart sound if you listen when the patient stands up?
It gets softer
What is the treatment recommendation for uncomplicated HTN?
Thiazide diuretic
What is the most common cause of death following an MI
Arryhthmia
What can be used to treat AOM with ammoxicillin allergy?
Ceftriaxone, cefdinir, cefuroxime, ceptidoxine
What are 2 of the 3 core competencies that you can bring to a pt as a provider
Empathy, Genuine, Respect
What is the most effective drug tx for tx of persistent or moderate allergic rhinitis
Intranasal corticosteriod
The rash of rubella starts on which part of the body?
Head or face
Proclorperazine and metoclopromide can cause what type of side effect
EPSE
Is erosion a primary or secondary lesion when describing derm findings?
Secondary
What is the treatment of choice for acute constipation in adults
Bisacodyl
The atrial rate in a flutter is approx between how many BPM
250-300
Which lipid lowering agents lowers LDL and TG, increases HDL, and often causes flushing
Nicotinic Acid
What is the MC sx associated with MVP
Asymptomatic
What labs are used to monitor warfarin and UFH?
Warfarin: INR
UFH: aPPT
What are the 2 pleural linings called?
Visceral and Parietal
How many half lives does it take to reach steady state
5
What is the major intracellular cation
K+
2 Minor Jones criteria for endocarditis (rheumatic)?
Fever, prolonged PR interval, arthralgia, increased CRP, ESR, evidence of +strep culture, antigen test, elevated antibody titer
How much K+ should be in IV fluid for 50kg pt?
?
COPD, pneumovac, when should she be revaccinated?
Pneumovac at age of diagnosis, revaccinated at age 65; older than 65 if it has been greater than 5 years since last dose
Pathologic process for acute appendicitis?
Obstruction of lumen. (fecolith)
What med should a pt with persistent asthma be on
ICS, SAB2A PRN
Massive hemoptysis w/advance liver disease is most likely assoc with what condition
Esophageal varicies
Recommended tx for moderate acne
PO antibiotics +/- Benzoyl peroxide
Psoriasis MC affects the flexor surfaces of elbows and knees? T/F?
False
What 3 bacterial should be treated with more than one abx
H.pylori, pseudomonas, enterococcus
What would be the percussion note heard over the area of a consollidation in the lung?
Dullness
Which lipid lowering agent lower TG substantially, increase HDL?
Fibric acid
List 3 possible causes of chronic cough
Asthma, GERD, PND, ACEI
Scopolimine and anticholinergic agents are suspected to show what type of AE
Anti SLUD: dry eyes, dry mouth, urinary retention, constipation
What is the drug tx of choice for pityriasis rosea
Symptomatic, no drug
Which generation of FQ has the best gram + coverage
4th generation (respiratory FQ)
What is herpatic whitloe?
Herpatic infection of the finger
Name the drug classes used to treat GERD from least to most aggressive:
Least: Antacid, H2RA
Most: PPI
Which common GI diagnostic procedure should not be used with pts with acute diverticulitis
conoscopy
what is necessary after a long term of topical corticosteroids
Taper
What is an appropriate first line tx w/paroxysysmal ventricular tachycardia
Valsalva or carotid sinus massage
What is the recommended tx for anticipatory N/V?
Lorazepam (Benzo)
what are 3 conditions that cause symmetric enlargement of the abdomen?
Gas, fat, fluid
Three possible AE of topical corticosteroids
Acne, striae, atrophy, purpura
Two modifiable risk factors for heart disease
Exercise and diet, smoking, ETOH, decrease cholesterol, HTN
Which class of medication decreases gastric acid secretion the most?
PPI
What physical exam finding would you expect to hear auscultating the heart of the pt who you suspected to have an atrial septal defect?
A fixed split S2
What should the maintenance IV fluid rate be in an otherwise healthy euvolemic patient?
90ml/hr
Which lab test confirms active infection and infectivity of Hep B virus?
Hep B surface antigen
What is the recommended drug treatment for COPD management for a pt in group B?
SA + LA + influenza and pneumococcal vaccine
What are the major jones criteria
Carditis, polyarthritis, chorea, nodules and erythema mirginata
Tx of choice for highly chemo induced N/V
Zofran, dexamethasone
3 sxs of end organ damage from HTN
ventricular hypertrophy, AV nicking, rental failure, carotid disease, TIA
Which GI drug is CI in pregnancy and why?
Misoprostol b/c its a prostaglandin and it induces labor and causes uterine contractions
2nd heart sound is caused by the closer of what valves
Aortic and pulmonic valves
What should you start at the same time you prescribe a narcotic analgesic?
Fluids, physical activity and my need Bisacodyl (stimulate)
Which electrolyte imbalance causes flattening of the T waves on the EKG
K+
What is the LD goal for a pt with DM
<70
You are assessing the pt for problem drinking, you describe to them that the normal amt of alcohol in one drink is?
1.5 oz in a single mixed drink
What outcomes do ACEI have in heart failure treatment
Slow the progression, ventricular remodeling (BB reverse remodeling)
What is the name of the criteria used to predict morbidity and mortality in pancreatitis?
Ranson’s criteria
What agen can be used in diabetic gastroparesis and GERD?
Metocloperamide
What tests assess the % of bound Hgb on the RBCs?
O2 sat
What is the tx of choice for Cdiff?
Metronidazole
What are osler nodes?
Lesions on the hand in endocarditis
What are the most likely bacterial pathogens in CAP?
C, M, S pneumo, Legionella
Which ENT condition is a true emergency?
Epiglottitis
What is the recommended therapy for pregnancy induced N/V?
Pyridozine and Doxylamine
Which part of the artery do atherosclerotic lesions form
Intima
What is used to treat sever recalcitrant acne?
Isotretinoin
Which two viral Hep agents are usually transmitted by annoculation of blood?
B, C
What are the 3 MC causes of PUD?
MC to least: H. pylori, NSAID, Stress induced
Ludwigs angina is an infection of what area?
Between hyoid bone and floor of mouth
One month hx of pain and tinging in index finger. What maneuvers would you perform?
Tinnels, Phalens
Excess DA sxs?
Hallucination, confusion, GI (N/V), orthostasis
How long can sutures be left on the face?
3-5 days
Chronic back pain, decreased proprioception. What part of the spinal cord is most likely affected?
Posterior columns
Total duration of abx for complicated pyelo
Inpt: 14 days
Outpt: 7-10 days
Function of the lens
Focus light on retina
Right sided eye pain, blurred. Dendritic ulcer on Right cornea. Most likely diagnosis?
Herpes opthalmicus
What class of migraine treatment can cause chest pain in some pts
Triptan
4 risk factors for stroke?
HTN, age, Afib, smoking
Hernia MC in females
Direct
Class used to treat open angle can cause bradycardia
BB (Tenolol)
Cause of legal blindness >65 yrs in the US?
Macular degeneration
Features of the Smith Fracture?
Transverse fracture of the distal radius with volar displacement of the distal fracture.
what non opoid analgesic has analgesic and antipyretic effects
APAP
Decreased production vs increase distruction?
Reticulocyte count
T or F. Digital rectal exam has been known to reduce mortality and morbidity in colon CA
False
What meds used to shorten acute MS exacerbation
Prednisone (corticosteroid)
3 common sxs of lower UTI
Suprapubi pain, urgency, frequency
2 test of evaluting meningial irritation?
Brudzinski and kernig
Antidiabetes decreses hepatic production and rarely causes lactic acidosis
Metformin. Class biguanide
Abbreviation TTP stand for?
Thrombotic thrombocytopeic purpura
MC ortopedics dx for joint treatment in primary care
OA of the knee
Anemia of chronic renal failure tx with what agent? MC AE?
EPO, causes HTN
Normal fasting BG rate?
70-100
Tx maneuver for BPPV
Epiley maneuver. (Hallpike to dx)
Opthalmic corticosteroid? What do you need to monitor?
IOP
How is a TIA different from a stroke?
Duration, transiet. Resolved <24 hrs (Some say 2 hrs)
Feature of a colle’s fracture?
Transverse fracture of the distal radius, with dorsal displacement
AED causes hirsutism, ataxia, nystagmus?
Phenytoin (PHT)
Causes of epididymitis in men <35 vs older men?
Men whores :)
STI’s
Pt suffers trauma to the knee, laxity of valgus stress. What injury likely to sustain?
MCL tear
What 3 things are recommended to slow the progression of diabetic neuropathy.
ACEI, BP control, BG control
T or F. Varicose veins may results as a complication of DVT.
True
What are considered first line treatment for urge incontinence?
Antispasmotics and oxybutynin
What is the MC organism causing a UTI
E. coli
What is the onset of typical cases of food poisoning?
1-8 hours after ingestion
What is the recommended treatment for anemia, high TIBC, low ferritin, low serum iron
200mg elemental iron PO in 2-3 divided doses.
325mg PO TID
Name the two coagulation pathways
Intrinsic and Extrinsic
After satisfactory surgical repair of any hernia how long is traditionally recommeded to avoid heavy lifting
4-6wks
Pharm therapy for obesity should be considered for patients with a BMI of what?
> 27 with greater than 2 obesity related risk factors or >30
Single most important factor in obesity
Genetics
Macular degeneration looses sight in what area of vision
Central
Bacterial meningitis what empiric tx is recommended in 1mo to 50yo?
Ceftriaxone and Vancomycin
Define thrombocytopenia
Low platelet count (nl 150,000-450,000)
What % of men with elevated PSA levels are ultimately diagnoses with prostate cancer?
30%
What drug class is recommended BPH when prostate is over 30 grams and when will it start to work?
5 alpha reducatse inhibitor (Finasteride); 6 months
What is the danger in testicular torsion
Losing a testicle; infarction
T or F. Verbal orders are commonly used and are acceptable.
False, 25% of error
Name the insulin with the longest action
Glargine
What is the goal of tx fo all movement D/Os
To restor normal function and improve QOL
Name 4 symptoms of concussion
N/V/HA/amnesia, fogginess, difficulty concentrating, easily confused, difficulty remembering, lack of energy, dizziness, balance difficulties, mood changes, irritability
What class of antidiabetic delays carbohydrate absorption and helps with posprandial hyperglycemia
Alpha glucosidase inhibitors
Leading worldwide cause of microcytic anemia in children
Iron deficiency due to parasitic infections
MC presenting sign of hodgkins dz
Painless lymphadenopathy
Which type of NSAID decreases GI AE?
Cox 2
What is the tx of type 1 and 2 AC separations
RICE, immobilization, pain management
MC type of kidney stone associated with proteal infections
Struvate
What commonly used AED is eliminated renally and does not have significant drug intx
Gabapentin
What is the most serious dz assoc with painless jaundice
Pancreatic Cancer
What is the recommended dash daily intake for a normal healthy individual
<2gm
What is the antidote for the following 4 congested toxins: opiates, iron, TCA, APAP
Opiates: Naloxone
Iron: Desfuroxime
TCA: Bicarb
APAP: Acetylcistine
What is the term used to describe a HA that wakes you from sleep, assoc w/tearing
Cluster HA
3 AED that are cytochrome P450 Inducers?
PB
CBZ
PHT
What is the name of class of heminopsia confined to one visual quadrant
Quadrantopsia
What is the tx of subconjunctival hemorrhage
Watch and wait
Cornea something….exudates
Refer to optho
MC AE of interferons used to tx MS
HA, myalgia, flu like sxs, injection site rxn, depression
Sickle shape collection of blood on a head CT is consistent w/what type of traumatic head injury
Subdural hematoma
What is the name of the deformity seen with progressive RA with hyperextension of the PIP, with flexion of the DIP
Swan neck deformity
AED for status epilipticus
Lorazepam first, phenytoin second
What is a greenstick fx
Incomplete fracture found in children with a portion of the periosteum remaining intact
A hospital H&P should be completed within how long?
24 hrs of admission
What are the Hgb A1C, LDL, BP goals for a pt with DM
LDL <7%
12 yo child is accused of starring off into space a lot?
Absence seizures
Interpret the visual acuity score of 20/40
They can see at 20 feet what a normal person can see at 40
MC opoid AE and most severe
NVC are most common, respiratory depression most severe (Pts dont develop tolerance to Constipation)
2 possible causes of macrocytic anemia
B12, Folate
2 diagnostic tests for ataxia
Tandem gait, RAM, finger taps, toe taps
3 classes of meds MC used for migraine prophylaxis
BB, TCA, AED
Presence of Bence Jones proteins in urine
Multiple Myeloma
If an athlete has physiologic anisicoria, what should be done and why
Document! incase they have a concussion/injury later on. (>0.5mm and reactive to light)
Drug for tx of acute uncomplicated cystitis
Cipro and TMP/SMX but it depends on E coli resistance patters. <20% use TMP/SMX
What are the major cellular targets of HIV
CD4+ cells and Tcells
What is the name of sensorineuro hearing loss assoc with aging
Presbycussys
How long does aspirin inhibit platelet function
Life of a platelet (7-10 days)
The first 3 months following a TIA, what % will progress onto having a stroke?
15%
Which toxidrome is characterized by pinpoint pupils?
Opioid
T or F. Hot nodules in thyroid signifies malgignancy.
False
Name 2 classes of meds that work well in the tx of chronic neuropatic pain
TCA, AED
What is the best test to evaluate a patient for gallstones
US
3 sxs that suggest psycogenic erectile dysfunction
morning wood, early ejaculation, erection with visual stimuli, intermittent occurrence, able to obtain erection with masturbation
Differentiate dizziness with vertigo?
Dizziness has no motion, vertigo is the room spinning
Name 2 conditions that petechia may be suggestive of?
ITP, thrombocytopenia
3 agents to tx hyperthyroidism
BB, Iodine, antithyroid (PTU, methimazole) K+ iodine, surgery
Veravax (Varicella vaccine) in CI in who?
Immunocomprimized, prego
Which pts are at high risk for a GI bleed with NSAIDS
> 60, ASA use, antiplatelet use, Clopidogrel, bisphosphonates, corticosteriod, hx ulcers, SSRIs, chronic use
4 main sxs of parkinson’s dz
Tremor, bradykinesia, ataxia, pill rolling
Acute bacterial prostatitis in men with a low risk of STI
Cipro, levo, TMP/SMX for 10-14 days
Dx of hodgkins dz is based on what diagnostic procedure
Lymph node biopsy
Which specific lab tests are required for participation in sports in MN
None
What is the single greatest risk factor for hip fx
Age
Which radiographic view is most useful in evaluating the cervical spine
Lateral
Lateral C-spine xray detects what % of injury
70%
Name 3 abx that can be used to tx a UTI in a prego pt
TMP, nitrofurantoin, cephalexin, Augmentin
Lump and tightness of throat unrelated to swelling
globus
Which toxidrome is characterized by dilated pupils, diaphroesis, elevated temp, elevated BP
Sympathomimetics (Stimulants)
What is the MC etiology of duodenal ulcers
H pylori
19 yo pt comes in to ER after a car accident in a C collar and spine board. PE reveals no midline tenderness, GCS of 15, not intoicated, complans of his knee which is sore with any movement.
Cannot take of C collar due to distracting injury
What empiric abx tx is recommended for epiditimitis for men <35
Ceftriaxone 250mg x1 IM and doxy 100mg PO BID 10-14 days
On the exam of a prego pt you notice a bluish purple discoloration of the cervix
chadwick’s sign
A potentailly life threatening complication of an antipsychotic therapy, altered LOC, rigidity, and fever
Neuroleptic malignant syndrome
What are the manes of the specific physical exam findings in carpel tunnel syndrome
Tinnel’s and Phalen’s
Which class of commonly used asthma medicatioon has the most rapid onset of action and the slowest
Shortest is SAB2A and the longest is ICS. LAB2A and oral prednisone are inbetween
3 drug classes that can be used to slow the ventricular rate in A fib
BB, CCB (Nondihydropyridine) Dilt/verap and DIgoxin
What is the name given to avascular necrosis of the capital femoral epiphysis in children
Leg calve perthes
A woman has been on the same oral contraceptive and complains of early to mid cycle break through bleeding and has been on it for 4 months
increase estrogen, check adherence
Two categories or classes of drugs used to treat an acute mainic episode in a pt with bipolar disorder
VPA, lithiu, (mood stabilizers) and SGA
In a prego pt, where would you expect to find the fundus at 12 and 20 wks
12 wks: just outside the pelvis; 20 wks: at level of umbilicus
1st line tx for GAD
SSRI
Distant heart sounds, mid line trachea and difuse hyperresonnance to percussion indicative of
COPD
Prego woman develops DVT, what should she be D/C on
LMWH or UFH
During the luteal phase of the menstrual cycle, which hormones are affecting the endometrium
Progesterone and estrogen
3 yr old boy seen in office with 5 days of fever, edema of hands and feet, rash over body, fissuring and erythema of lips and cervical adenopathy. Throat and ASA titer is negative
Kawasaki?
3 risk factors for developing PE
Immobility, hypercoagulable state, vascular injury
3 clinical uses of TCA
Depression, migraine prophylazis, neuropathic pain
MC finding on EKG of person w/longstanding HTN
LVH
T or F. Starting ibuprofen will cause someone on warfarins’s INR to increase
False. Just will increase bleeding risk
4 IADLs
phone use, cooking, shopping, paying bills
Which condition is prostatic massage CI and why
Acute prostatitis, risk of bacteremia
3mo old infant, single red macular nodular rash on back, causes child no problem Dx/
Hemangioma, watch it and it will resolve on its own
Gestational diabetes is treated with what?
Insulin
10 yo obese boy pain in left knee, slight limp, displaced femoral head. likely dx?
SCIFE (slipped capital femoral epiphysis?
Hernia at internal inguinal ring?
indirect hernai
MC cause of CAP in kids >5yo
S. pneumo, Mycoplsma (MC for atypical pneumonia)
Endocrine AE for SGA
weight gain, hyperglycemia, increased TG, increase BP, BMI
3 main components of advanced directives
Living will, health care agent, DNR/DNI order
40 yo female, multiple painful ulcerative lesions on labia? Dx
Herpes
Child with sore throat, small vesicles and punched out lesions in mouth and circular rash on palm and sole.
Hand foot mouth: coxacki
Moro reflex disappears in
3-6 months
3 HTN meds that cause hyperkalemia
ACE, ARB, spironolactone
PE specific for acute pericarditis
Pericardial friction rub
2 drugs that cause kernicterus in neonate
TMP/SMX and Ceftriaxone
TCA with high anticholinergic effects. What are the effects
Anti-SLUD
Organism causing botulism
Clostridium botulininum
Agent to tx obesity decreases dietary fat absorption
Orlistat
Skin condition is greasy yellowish scalp involving eyebrows and eye folds?
Seborrheic dermatitis (Cradle cap)
Which aminoglycoside works agains Pseudomonas
Tobramycin
How to remove a tick
Use tweezer and pull straight up
Translucent papules with keratotic plug and umbilication
Molluscum contagiosum
2 phases of roseola infantum
Fever for 3-5 days, rash on neck and trunk
Which class of med should not be used to tx parkinson’s in pts >60
Anticholinergics
How many dtaps and polios should be received by age 7
5dtaps and 4 polio
Recommended tx for osteoporosis
bisphosphonate, calcium 1500mg, vit d 800IU, wt bearing exercise
4 PE findings in Kawaskai disease
fever, erythema and edema of hands and feet, desquamation of hands and feet, cervical lymphadenopathy, fissuring tongue and strawberry tongue
Most signicant thing different in pharmacotherapy for older aldults
Decreased renal clearance
Coryza, conjunctival injection, cough, koplik spots, elevated temp
Measles
What type of dementia has step wise decline in cognition
vascular
3 yo bitten by black widow spider
Antivenom
Only indication for oral vanco
C diff
Neonates eyes treated at birth for what
Neisseria gonorrhea
Tx for pt with sever MS exacerbation
Oral or IV prednison
Why is polyuria seen in uncontrolled DM
Due to osmotic diuresis
Grasp reflex disappears
3-6mo
Which AED is renally eliminated
Gabapentin
Pain and laxity to knee on valgus stress
MCL
4 risk factors for pressure ulcer
Decreased mobility, nutrition, moisutre, incontinence, friction, age, decreased arteral or blood pressure
Colonoscopy findings in Chron’s dz
Cobblestonning, skip lesions, rectal sparring
Appropriate 1st line tz for smoking cessation
Nicotine replacement, buproprion, wellbutrin, behavioral therapy
What does the macula provide in regards to vision
Central vision acutiy, color, night vision
3 components of human balance system
biomechanical, sensory, neuromotor
MC head trauma in elderly
Subdural hematoma
PUD with Hpylori tx
Amoxicillin, clarithromycin and tinidazole with PPI
Swan neck deformity associated with what autoimmune contion
RA
What med should a pt with persistent asthma be on
ICS and SABA
MC extra hepatic source of an elevated alk phose
Bone, placenta
What is the endocrine condition mainifested by anorexia, wt loss, increased pigmentation
Addisons disease
