COMBANK FM COMAT Flashcards
Kid XR showing coin facing you on AP film
coin in esophagus
Kid XR showing coin facing you on lateral film
coin in trachea
- would also show signs of airway compromise
s/sx of tuberculosis
hemoptysis, night sweats, fever, weight loss
alarm sx of GERD
dysphagia, weight loss, bleeding, iron deficiency anemia
- mean it’s complicated GERD
GERD Tx: uncomplicated vs complicated
uncomplicated = PPI complicated = need imaging (upper endoscopy)
HTN meds in black ppl
HCTZ first line (JNC 8 - Outdated)
Empiric outpatient treatment of young patients with CAP (community acquired pneumonia)
Doxycycline or macrolides are good first-line choices
– cover typical and atypical CAP
treatment of CAP (community acquired pneumonia) In patients over 60 years of age or those with significant comorbidities
usually is typical CAP
tx is second or third generation cephalosporins, amoxicillin/clavulanic acid, macrolides, and fluoroquinolones with pneumococcal coverage
who gets flu anti-viral drug tx
pts who fall in the high risk groups or time frame of less than 48 hours
flu vaccine for pts with egg allergy (severe)
inactivated influenza vaccination (IIV3)
pharm tx to lower TG levels
<500mg/dL = statin >500mg/dL = fibrate followed by statin later
Severe hypertriglyceridemia is associated with an increased incidence of
acute pancreatitis.
s/sx peripheral arterial occlusion
Claudication symptoms, pale cool extremity, and decreased distal pulses
s/sx Thrombophlebitis
tenderness to palpation, erythema, and often warmth and swelling in the area of inflammation
s/sx Chronic venous insufficiency
lower leg aching pain and cramping
bilateral lower extremity swelling, varicose veins, and hemosiderin staining (brawny brown deposits) of the anterior shins
live attenuated vaccines
MMR
Varicella
Influenza (nasal spray)
Rotavirus
individuals who are able to make personal health care decisions for those who are incompetent
spouse, followed by a parent, followed by the next of kin, followed by a default surrogate.
new guidelines recommend initiating of HMG-CoA reductase inhibitors (statins) in patients with an LDL-C _____
> 190 mg/dL
New strains of multi-drug resistant organisms should be reported to
cdc
and County health department too
fhx that is risk factor for heart disease
Family history in
father or brother with a heart attack BEFORE age 55,
or in
mother or sister BEFORE age 65
AOM (Acute OM) vs OME (OM with effusion)
OME is middle ear effusion w/o acute symptoms
Inflammation with bulging of the TM on otoscopy is highly predictive of
AOM (Acute OM)
Migraine headaches s/sx
throbbing, usually unilateral headaches that last between 2 and 24 hours
gender diff in migraine vs cluster
Migraine is more common among women, while cluster headaches are seen overwhelmingly in men.
Cluster headaches s/sx
intense pain near the eye with many headaches in a short period of time followed by headache-free periods.
common migraine vs classic migraine
Common migraine by definition does not include an aura.
relation between L5 and sacrum
L5 and the sacrum always rotate in opposite directions.
— Sidebending of L5 engages the ipsilateral sacral oblique axis.
Forward sacral torsions are associated with type I (neutral) mechanics at L5 whereas backward sacral torsions are associated with type II (non-neutral) mechanics at L5
EBV (Mono) dx confirmed by:
latex agglutination assay that detects heterophile antibodies
best diagnostic test for H. pylori
serology
best test for eradication of H. pylori
urea breath test
Overflow incontinence
unpredictable dribbling of urine or weak urine stream due to underactive bladder and/or outlet obstruction
Mixed incontinence
combination of both stress and urge incontinence
First line antibiotic therapy for human bites
amoxicillin/clavulanic acid
What type of drug is Memantine ?
N-methyl-D-aspartate (NMDA) receptor antagonist that is thought to be neuroprotective
initial treatment for mild to moderate dementia symptoms
cholinesterase inhibitor (galantamine or donepezil)
treatment for moderate to severe dementia symptoms
Keep on cholinesterase inhibitor (galantamine or donepezil).
Add NMDA receptor antagonist (memantine) in moderate to severe Alz
Supplement that can prevent Alzheimer’s disease
omega-3 FAs
treatment of depression and mood disorders in dementia patients
SSRI (Ex/ citalopram)
FEV1 and FVC changes in restrictive lung dz
FEV1 and FVC are both decreased, but proportionately so. Therefore, FEV1 is decreased but FEV1/FVC is normal.
Reversible with bronchodilator test.
FEV1 and FVC changes in obstructive lung dz
FEV1 decreases to less than 80% predicted, FEV1/FVC ratio is less than 0.7, and there is incomplete reversal with inhaled bronchodilators.
COPD Tx that improves mortality & QoL
Supplemental oxygen is the only modality that can improve pulmonary artery pressure, dyspnea, survival, and quality of life
restless leg syndrome characteristic sx
bilateral pain or discomfort in legs present at rest but relieved with movement.
lumbar disc herniation characteristic sx
back pain with radiation to bilateral lower extremity. Pain is usually worsened with sitting and backward flexion.
difference between sciatica and piriformis syndrome
piriformis syndrome usually causes pain in the buttocks and hamstrings whereas sciatica typically causes pain in the distal extremity as well
– different hx too
Dx steps in thyroid nodule
- measurement of serum TSH to evaluate for hyperthyroidism or hypothyroidism
- If TSH is normal, the next step in evaluation is ultrasound to evaluate for size and anatomic spread
types of tumors that contain psammoma bodies
PSAMMoma (Papillary thyroid carcinoma, Serous cystadenocarcinoma of the ovary, Adenocarcinoma of the endometrium, Meningioma, Mesothelioma)
adenovirus eye sx
- most common cause of epidemic keratoconjunctivitis
- palpebral conjunctiva is erythematous and copious watery discharge with some scant exudates
- usually an associated pharyngitis, fever, malaise, and preauricular lymphadenopathy
tx of allergic conjunctivitis
- symptomatic with cold compresses, topical vasoconstrictors, antihistamines, and mast cell stabilizers
- – topical nonsteroidal anti-inflammatory agents such as ketorolac are better alternatives to topical glucocorticoids
imaging study of choice in evaluating a second febrile urinary tract infection
Voiding cystourethrogram
Lloyd’s sign
positive costovertebral tenderness significant for pyelonephritis
Osteitis fibrosa cystica dx
- rare manifestation in severe cases of hyperparathyroidism
- characterized by the appearance of brown tumors on x-ray (lesions are cysts filled with blood, fibrous tissue, and osteoclasts)
Epley maneuver
- method of otolith repositioning
- patient is moved through a series of positions that attempt to move the otolith out of the semicircular canal.
- first line of treatment for benign paroxysmal positional vertigo (BPPV).
Dix-Hallpike maneuver
- used to diagnose BPPV
- cannot be used for treatment of BPPV
how to dx primary ovarian failure.
FSH (follicle stimulating hormone) elevation in the menopausal range on 2 occasions separated by at least 1 month
typical organism for UTIs with indwelling catheter
pseudomonas aeruginosa
Claudication in the young, healthy patient may be due to
adventitial cystic disease or popliteal entrapment.
tx of painful diabetic neuropathy
TCAs (amitriptyline, desipramine) or anticonvulsants (pregabalin, gabapentin)
goal INR in a patient with atrial fibrillation who is taking warfarin for anticoagulation for prevention of thrombotic events
2.0 to 3.0
eye finding specific to diabetic retinopathy
neovascularization
eye findings found in both diabetes and HTN retinopathy
cotton wool spots (more HTN)
retinal hemorrhage
microaneurysm (more DM)
eye finding (more) specific to HTN retinopathy
AV nicking
MOA of post-HIV exposure prophylaxis
typically involve NRTIs and/or integrase inhibitors
Activities of daily living (ADLs)
transferring, toileting, continence, feeding, dressing and bathing
– note, NOT meal prep
dosing of Ca and Vit D in osteoporosis
women: combined calcium intake (dietary and supplemental) of 1200 mg of calcium and 800 international units of vitamin D
men: 1000 mg of calcium and 600 international units of vitamin D
most appropriate initial screening test at 11 weeks’ gestation
urine culture to rule out asymptomatic bacteriuria
— recc: screened for between 12-16 weeks gestation or at the first prenatal visit if it is later than 16 weeks
contraindication to PDE-5 inhibitors
(ex/ sildenafil)
contraindicated in patients taking nitrates, as the combination of medication will precipitate dangerously low drop in blood pressure
somatic symptom disorder dx
- must present with multiple physical complains beginning before age of 30 years old.
- physical complaints must consist of at least four different sites of pain
- ROS must be positive for at least 2 gastrointestinal sx, 1 sexual sx, and 1 neurological sx
Acute lymphoblastic leukemia s/sx
- fever, malaise and fatigue in young children
- red flags: weight loss, pallor, petechiae, bone pain, generalized lymphadenopathy and hepatosplenomegaly
1st line tx for Graves
methimazole
over PTU b/c of PTU’s potential hepatotoxicity
AAA management: lesions <5.5cm
monitoring if asymptomatic
- – Small aneurysms (3.0 – 4.0 cm) should be monitored by ultrasound every two years.
- – Aneurysms 4.0 – 5.4 cm should be monitored by ultrasound or CT every six to twelve months
+ smoking cessation!
