Content Flashcards
1
Q
Leading causes of death in all ages/genders
A
Heart disease, CA, chronic lower respiratory disease
2
Q
Leading cause of death in adolescents
A
MVA, suicides, homicides
3
Q
Most common skin cancer
A
Basal cell carcinoma
4
Q
SpIn
A
SPECIFIC test rules IN diagnosis (detects true negatives)
5
Q
SnNout
A
SENSITIVE test rules OUT diagnosis (detects true positive)
6
Q
Screenings, taking daily aspirin to prevent future MI
A
Secondary prevention
7
Q
Support groups, education on current disease, rehab
A
Tertiary prevention
8
Q
Acute onset severe eye pain, phototobia, tearing, blurred vision in one eye
A
Herpes keratitis
9
Q
Elderly with acute onset of severe eye pain with headaches, N/V, halos, decreased vision, cloudy cornea, cupping of optic nerve on fundoscopic exam
A
Acute angle-closure glaucoma
Refer to ED
10
Q
Young adult female with new loss of vision in one eye; may have nystagmus; daily fatigue on awakening worse through day; heat exacerbates
A
Optic neuritis from multiple sclerosis
Refer to neurologist
11
Q
Acute onset erythematous swollen eyelid with proptosis and eye pain; pain on eye movement; history of recent rhinosinusitis or URI
A
Orbital cellulitis
Refer to ED
12
Q
Sudden onset of floaters with looking through curtain and sudden flashes of light
A
Retinal detachment
Refer to ED
13
Q
Cauliflower growth on ear and foul smelling ear discharge; hearing loss; TM not visible due to tumor
A
Cholesteatoma
Tx with antibiotic and surgical debridement
14
Q
Battle sign
A
Periorbital ecchymosis and bruising behind ear appearing 2-3 days post trauma
Rule out basilar or temporal bone fracture
15
Q
Clear golden fluid from nose/ear
A
Indicates basilar skull fracture
16
Q
Severe sore throat, difficulty swallowing, painful swallow, hot potato voice; unilateral swelling or peritonsillar area; uvula deviation away
A
Peritonsillar abscess
Refer to ED
17
Q
Sore throat, fever, swollen neck
Gray to yellow pseudomembrane of throat
A
Diphtheria
Contact prophylaxis
Refer to ED
18
Q
Age related due to decreased ability of eye to accommodate stiffening of lenses
A
Presbyopia
19
Q
Normal TM
A
Translucent off white-gray color with cone of light intact
20
Q
Bluish, pale, boggy nasal turbinates
A
Indicate allergic rhinitis
21
Q
Leukoplakia
A
White to light gray patch that appears on tongue, floor or mouth or cheek
22
Q
Aphthous stomatitis
A
Canker sores
Tx with magic mouthwash–benadryl, viscous lidocaine, steroid
23
Q
Papilledema
A
optic disc swelling with blurred edges due to increased ICP secondary to bleeding, brain tumor, abscess, pseudotumor cerebri
24
Q
Hypertensive retinopathy
A
Copper and silver wire arterioles, AV nicking, retinal hemorrhages
25
Diabetic retinopathy
Microaneurysms, cotton wool spots
26
Opacity of lens, difficulty with glare, halos around lights, blurred vision
Cataracts
27
Koplik spots
Small red papules with white centers clustered on cheeks
| Measles
28
Ishihara chart
Tests for color blindness
29
Legal blindness
20/200
30
When should vision be 20/20
Age 6
31
Weber test
Tuning fork placed on midline of forehead; normal finding is no lateralization
32
Rinne test
Tuning fork on mastoid process than at front of ear
| Normal is AC > BC
33
Causes of conductive hearing loss
OE, cerumen, OM, obstruction
34
Causes of sensorineural hearing loss
Presbycusis, meniere disease, ototoxic drugs, stroke
35
Acute onset severe eye pain with tearing, feeling of foreign body
Corneal abrasion
36
Tx of contact lens related keratitis
Topical ophthalmic abx with pseudomonal coverage (cipro, ofloxacin, polytrim) for 3-5 days
37
Acute onset swollen, red, and warm abscess on eye
Hordeolum
| Tx with warm compresses 5-10 minutes BID to TID
38
Chronic inflammation of melbumian gland on eye; painless and moveable
Chalazion
| tx: I+D, surgery, steroid injections
39
Wedge shaped yellow thickening of conjunctiva due to sun exposure
pterygium
| Tx: sunglasses
40
Sudden onset bright red blood in eye with no pain
Subconjunctival hemorrhage
| Resolves on its own in 1-3 weeks
41
Gradual increase in IOP with gradual change in peripheral vision first
Primary open-angle glaucoma
| Tx: timolol eye drops or latanoprost topical prostaglandin
42
Insidious onset eye pain with conjunctival injection; complication of autoimmune disorder
Anterior uveitis--iritis
43
Painless loss of central vision
Macular degeneration
Results in blindness
More common in smokers
44
Chronic autoimmune disorder with decreased function of lacrimal and salivary glands
Daily dry mouth and eyes >3 months
Sjogrens syndrome
Eye drops TID
Refer to ophthamologist and rheumatologist
45
Inflammation of eyelid; itching and irritation, eye redness
Blepharitis
Tx: baby shampoo and warm water
May use erythromycin BID to TID
46
Clear mucus rhinorrhea, postnasal drip, nasal itch, family history of atopy, pale/boggy turbinates, under eye bags, nasal crease, cobblestoning
Allergic rhinitis
Tx: nasal steroids (flonase)
2nd line is topical antihistamines
Decongestants PRN
47
abrupt onset fever, sore throat, pain on swallowing, enlarged submandibular lymph nodes, purulent exudates on tonsils, enlarged anterior notes, absence of cough
strep throat
| Tx: penicillin 500mg BID 10 days
48
Possible complications of strep throat
Scarlet fever, rheumatic fever, peritonsillar abscess, post strep glomerulonephritis
49
Most common organisms in AOM
Strep pneumoniae, H. influenzae, M. catarrhalis
50
Ear pain, muffled hearing, recent cold, afebrile or low fever
AOM
| Tx: amoxicillin high dose 5-7 days
51
Unilateral facial pain with nasal congestion >10 days; purulent nasal/postnasal drip
Acute bacterial rhinosinusitis
Tx: High dose Augmentin BID 5-7 days
Tx of sx: decongestants, guaifenesin, flonase, dextromethorphan, benzonatate
52
OE due to
Psuedomonas or staph aureus
53
Tx of OE
```
Cortisporin otic (polymyxin B-Neomycin-Hydrocortisone) 4 drops QD 7 days
Ofloxacin or cipro otic drops BID 7 days
```
54
Fever, pharyngitis, posterior lymph nodes, fatigue, hepatosplenomegaly, maculopapular rash
Mono
| Tx: symptomatic
55
Rinne test with conductive hearing loss
BC >AC
56
Weber test with conductive hearing loss
Lateralization to bad ear
57
Abrupt onset high fever, chills, severe headache, N/V, phototobia, myalgia, arthralgia followed by 2-5 days fever
Petchiae rash on wrist, forearms, ankles and progressing to trunk
Rocky mountain spotted fever
| Tx: doxycycline
58
Expanding red rash with central clearing (target lesion)
```
Erythema migrans (Lyme disease)
Tx: doxycyline
```
59
Sore throat, cough, fever, HA, stiff neck, phototobia, changes in LOC, may have petechial rash
Meningitis
| Rifampin prophylaxis if outbreak
60
Pearly or waxy skin lesion with atrophic/ulcerated lesion that may bleed easily
Basal cell carcinoma
61
Numerous dry, round, red-colored lesions with rough texture
Actinic keratoses
| Pre-cancerous squamous cell carcinoma
62
Anatomy of skin
Epidermis: no blood vessels--top layer squamous epithelial cells, bottom layer melanocytes
Dermis: blood vessels, sebaceous glands, hair follicles
Subcutaneous layer: fat, sweat glands, hair follicles
63
Most common skin CA
Basal cell carcinoma
64
Macule
<1cm, flat
| Freckles, lentigo
65
Papules
Palpable solid lesion <0.5cm
| Moles, acne, cherry angioma
66
Plaque
Flat elevated >1cm
| Psoriasis
67
Bulla
Elevated blister filled >1cm
| Impetigo, SJS
68
Vesicle
Elevated <1cm filled with serous fluid
| Herpes
69
Pustule
Elevated <1cm filled with purulent fluid
| Acne
70
Erythematous/raised skin lesions with discrete borders; wheals
Urticaria--hives
71
Soft, wart like fleshy growths on the trunk; appear in the middle age
Painless
Seborrheic keratoses
72
Xanthelasma
Raised, yellow plaques on eyes
| 50% of these patients have hyperlipidemia
73
Melasma
Bilateral brown/tan stains on face on pregnant women
| Usually permanent
74
Vitiligo
Hypopigment of skin that spreads over time
Risk factors: autoimmune disease
Tx: steroids, light therapy, avoid sun
75
Acanthosis Nigricans
velvety thickening of skin behind neck
| associated with DM, metabolic syndrome, GI cancer
76
Avoid what medication in fungal infection
Steroids
77
Koebner phenomenon
In psoriasis, new plaques develop over sites of trauma
78
Auspitz sign
In psoriasis, pinpoint bleeding when scales are removed
79
Pruritic erythematous plaques covered with silvery white scales
Psoriasis
Tx: topical steroids, topical retinoids
For refractory: methotrexate, cyclosporine, biolics
80
Hypopigmented round macules on chest, shoulders
Tinea versicolor
| Tx: selenium sulfide, topica azoles
81
Multiple small vesicles that rupture; lesions become lichenified from chronic itching
Atopic dermatitis (eczema)
Tx: hydrocortisone if mild, triamcinolone if moderate
Oral antihistamines for itching
Skin lubricants--Eucerin, baby oil
82
Inflammatory skin reactions due to contact with irritating external substance
Bright red and pruritic lesions that evolve into bullous or vesicles
Contact dermatitis
| Tx: if lichenified, use high potency steroids
83
Bright red/shiny lesions that itch and burn; may have sattelite lesions
Common in obese/moist areas
Superficial candidiasis
| Tx: nystatin or topical antifungals
84
Most common opportunistic infection in hIV patient
Oropharyngeal candidiasis
| Tx: oral fluconazole
85
Acute diffuse pink/red skin poorly demarcated with advancing margins; warm and may form abscess; may have red streals
Cellulitis
| Tx: amoxicillin
86
Folliculitis
infection of hair follicle
| Tx: bactroban
87
Subtype of cellulitis involving the upper dermis/superficial lymphatics
Due to GAS
Erysipelas
88
Tx for human bites
Augmentin PO BID 10 days
| If allergic to penicillin..doxycycline BID, Bactrim DS BID + Flagyl BID
89
Impetigo
Superficial skin infection due to G+
Tx: severe cephalexin or dicloxacillin
If no bullae, mupirocin
Do not return to daycare until 48-72 hours after treatment
90
Meningococcemia prophylaxis
Rifampin q12 hours 2 days for close contacts
91
Tx for meningococcemia
Ceftriaxone 2g IV q12 hours + Vanco IV q8-12
92
Tx of lyme disease
Doxycycline BID (adults and children)
93
Labs for lyme disease
ELISA
94
How long is varicella contagious for
1-2 days before onset of rash until all lesions have crusted over
95
Fever, pharyngitis, malaise, followed by pruritic vesicular lesions
Chickenpox
96
Labs for varicella
PCR
97
Tx varicella
Acyclovir X 5 days or valacyclovir X 10 days
98
Tx of postherpetic neuralgia
TCAs, anticonvulsants, gabapentin
99
Tx herpetic whitlow
NSAIDs and acyclovir if severe
100
Bacterial skin infection of lateral nail folds
Paronychia
| Tx: topical mupirocin and soak in warm wate r
101
Oval lesions with fine scales that follow skin lines with christmas tree pattern
Pityriasis Rosea
102
Tx of scabies
Permethrin for 8 hours and repeat in 7 days
103
Tx of tinea capitus
Griseofulvin 6-12 weeks
| Baseline LFT and 2 weeks after tx
104
Nails become opaque, yellow, thickened with scaling under nail
Onychomycosis
| Tx: oral terbinafine or itraconazole
105
Tx mild acne
Tretinoin topical (retin A), benzoyl peroxicde gel, erythromycin/clindamycin topical
106
Tx moderate acne
Topical/oral abx: tetracycline or minocycline or erythromycin or clindamycin
107
Tx of severe acne
Isotretinoin
108
Tx rosacea
Metronidazole gel, azelaic acid gel, low dose tetracycline
109
Dome shaped papules with central umbilication due to poxvirus
Molluscum contagiosum
110
Tx of MRSA if allergic to Bactrim
Minocycline, doxycycline, clindamycin
111
Gradual onset intense and steady chest discomfort and pain produced by physical exertion or eating heavy meal
Acute MI
112
Acute or gradual dyspnea, fatigue, dry cough, swollen feet, crackles in lung with S3 heart sound
CHF
113
Fever, chills, and malaise associated with onset new murmur
| May have subungual hemorrhages, petechiae on palate, janeway lesions
infective endocarditis
114
Sudden onset, severe, sharp, excruciating pain in abdomen/flank/back
Dissecting abdominal aortic aneurysm
115
S3 heart sound
May indicate HF
Always abnormal if >35 years
Normal in children, pregnant women, athletes
116
Systolic murmurs
```
Aortic stenosis
Pulmonary stenosis
Tricuspid regurg
Mitral regurg
MVP
```
117
Grade murmur first time thrill is present
4
118
Grade murmur when you can hear off of stethoscope slightly off chest
5
119
Grade murmur when you can hear off of stethoscope
6
120
Sudden onset heart palpitations with feelings of weakness, dizziness, dyspnea, syncope
A fib
121
Labs for new onset A Fib
TSH, EKG, electrolytes, renal function, BNP, troponin,
122
Tx of A fib rate control
Beta blockers, CCB, digoxin
123
Tx of A fib clot control
Warfarin, direct Xa inhibitors (ravoxaban)
124
INR goal for A fib
2-3
125
SE thiazide diuretics
Hypergluycemia, hyperuricemia, hypertriglyceridemia, hypokalemia, hyponatremia, hypomagnesia
126
SE loop diuretics
Hypokalemia, hyponatremia, hypomagnesia
127
SE aldosterone receptor antagonists
Gynecomastia, galactorrhea, hyperkalemia, GI upset
128
CCB CI in
Heart failure, bradycardia, 2nd/3rd degree heart block
129
Crackles, cough, dyspnea, decreased breath sounds, dullness to percussion
LVF
130
JVD, enlarged spleen, enlarged liver, edema
RVF
131
Tx HF
Initial: furosemide 20mg
| If stable with htn: ACEI/ARB + beta blocker, spirinolactone
132
Homan sign
Lower leg pain on dorsiflexion of foot; indicats DVT
Labs: D-dimer, platelets, CVC, clotting time, EKG, US
Tx DVT: hep IV then warfarin 3-6 months
133
Patient with a history of smoking + Hyperlipidemia complains of worsening pain on ambulation instantly relieved by rest
Peripheral artery disease
Dx: ABI <0.9
Tx: aspirin + smoking cessation
134
Chronic and recurrent episodes of color changes on fingertips in symmetric pattern
Raynauds Phenomenon
| Tx: avoid triggers, smoking cessation, nifedipine
135
Abx prophylaxis for endocarditis
Only if previous hx of prosthetic valves--amoxicilin 2g PO 1 hour before procedure
136
S2 click followed by systolic murmur
MVP
137
Tall/thin female with fatigue, palpitations, light headedness aggravated by heavy exertion
MVP
| Tx: beta blockers if palpitations
138
Older adult with sudden onset of dyspnea/coughing may be productive or pink tinged; feeling of impending doom; history of A fib, estrogen, smoking, surgery, immobility
PE
139
Breath sounds in lower lobes
Vesicular
140
Breath sounds in upper lobes
Bronchial
141
PE in emphysema
Increased AP diameter, decreased breath sounds, pursed lip breathing, weight loss, hyperressonance percussion, tactile fremitus decreased
142
Tx COPD
Cat A: SABA PRN + short acting anticholinergic
Cat B: LABA or long acting anticholinergic
Cat C: LAMA or LAMA + LABA
Cat D: Refer to pulminologist
143
Acute onset fever, purulent sputum and wheezing in a patient with COPD
Susoect H Influenzae pneumonia
| Tx: Bactrim, Doxy, Ceftin BID 10 days
144
The only treatment known to prolong life in COPD
O2
145
Bacteria that causes the most deaths in outpatient CAP
Strep pneumoniae
146
Most common pathogen in CF patients with CAP
Pseudomonas
147
PE in CAP
Rhonchi, crackles, wheezing, dullness, increased tactile fremitus
148
Tx CAP if no co-morbidity
Azithromycin for 5 days
149
Tx CAP if co-morbidity
Respiratory fluoroquinolone ALONE
| OR Augmentin + Azithromycin
150
CURB criteria for CAP
Confusion, BUN >19, Resp >30, BP <90/60
| Poor prognosis
151
Young adult with several weeks of fatigue and severe paroxysmal coughing that is nonproductive
Atypical pneumonia
Due to mycoplasma pneumoniae usually
Tx: Doxy, azithromycin or levaquin
152
Coughing >14 days, inspiratory whooping
Pertussis
| Tx: azithromycin
153
Chest X ray in TB
Cavitations and adenopathy with granulomas
154
Fever, anorexia, fatigue, night sweats, mild nonproductive cough which progresses to hemoptysis with weight loss
TB
| Tx: Rifampin, INH, ethambolol, pyrazamide
155
PPD positive results
>5mm: HIV, recent contact, chest X ray positive, immunocompromised
>10mm: recent immigrant, IV drug user, health care worker, homeless
>15mm: no risk factors
156
Asthma treatments step 1-4
Step 1: FEV1>80%; daytime sx <2 days per week; use SABA
Step 2: FEV1<80%; daytime sx >2 days per week but not daily; SABA PRIN + low dose ICS
Step 3: FEV1 between 60 and 80; use SABA PRN + low dose ICS + LABA
Step 4: FEV1 <60; Daily symptoms; use SABA PRN + Medium dose ICS + LABA
157
Acute onset saddle anesthesia, bladder incontinence, fecal incontinence, and BL leg weakness
Cauda equina syndrome
158
Within first 48 hours of exercise injury
Do not exercise, use ice, do not do any ROM exercises
159
McMurray Test
+ suggests injury to medial meniscus
160
Lachman test
+ suggests ACL damage
161
Tx shin splints
RICE, compression bandage, low impact exercise
162
Inflammation of digital nerve of foot between third and fourth metatarsals
Mortons neuroma
163
Early morning joint stiffness and with inactivity
OA
| Tx: first line is Tylenol
164
Woman complains of maculopapular butterfly rash in middle of face
SLE
Do a UA to look for proteinuria
Tx: steroids, plaquenil, methotrexate, biologics
Education: avoid sun and cover with sunblock
165
Gradual onset daily fatigue, low grade fever, body aches, myalgia, generalized joint pain, early morning stiffness, warm and tender swollen fingers
RA
| Tx: NSAIDs, steroids, methotrexate, sulfasalazine, cyclosporine, hydroxychloroquine
166
Gold standard for diagnosing gout
Joint aspiration of synovial fluid
Tx acute: indomethacin or naproxen or NSAID + colchicine
Maintenance: Allopurinol
167
Tx of ankylosing spondylitis
NSAIDs
168
Acute onset high fever, muscular rigidity, mental status changes, hyperreflexia and uncontrolled shivering
Hx of taking SSRI
Acute serotonin syndrome
169
Atypical antipsychotics
Olanzapine, risperidone, quetiapine (Seroquel)S
| SE: obesity and DM
170
Typical antipsychotics
Haldol, chlorpromazine
| SE: increased lipids, malignant neuroleptic syndrome
171
SSRI
Paroxetine, fluoxetine, citalopram, sertraline, escitalopram
| SE: anxiety, insomnia, impotence
172
SNRI
Duloxetine, venlafaxine
| SE: may precepitate acute narrow angle glaucoma
173
Rule out what with depression
Thyroid issues, Vitamin B12 deficiency, anemia, autoimmune disorders
174
Korsakoff's syndrome
Complication from chronic alcohol abuse
Hypotension, visual impairment, coma
Tx: thiamine
175
Gold standard for sleep apnea
Sleep lab (polysomnography)
176
Tx of anti-depressant induced sexual dysfunction
Bupropion
177
Best SSRI for elderly
Citalopram
178
Avoid what in patients with anorexia
Wellbutrin due to increased seizure threshold
179
Most common SSRI to cause ED
Paxil (Paroxetine)
180
Hypoglycemia
FBG<50; weakness, syncope, hand tremors, anxiety
| more common in type 1 DM
181
Peak diagnosis of type 1 DM
age 4-6 and then 10-14
182
Thyroid CA
Hoarseness and dysphagia, nodules on upper 1/2 lobe
183
S/S pheochromocytoma
Headache, diaphoresis, tachycardia, hypertension
184
Hypothalamus secretes
TRH, GnRH, CRH, GHRH, somatostatin
185
Anterior pituitary secretes
FSH, LH, TSH, GH, ACTH, Prolactin, melanocyte stimulating hormone
186
Posterior pituitary
ADH and oxytocin
187
Primary hyperthyroidism
Thyrotoxicosis
Very low TSH with increase in free T4 and T3
Most common cause is Graves
188
Medications for hyperthyroidism
PTU and methimazole
SE: skin rash, aplastic anemia, thrombocytopenia, hepatic necrosis
Beta blockers for palpitations
189
Goal TSH with hyperthyroidism
<5
190
Drugs that can induce hyperthyroidism
Lithium, amiodarone, high doses of iodine, inter feron alfa, dopamine
191
Primary hypothyroidism
High TSH and low free T4
| Most common cause is hashimoto's thyroiditis
192
Myxedema
Severe hypothyroidism
193
Tx hypothyroidism
Levothyroxine 25-50mcg; increase until TSH normalizes
-Start with lowest dose for elderly
Check TSH every 6-8 weeks
194
Microvascular damage of DM
Retinopathy, nephropathy, neuropathy
195
Macrovascular damage of DM
Atherosclerosis, CAD, MI
196
Pre-diabetes labs
A1C between 5.7 and 6.4%
FBG between 100-125
2 hour OGTT 140-199
197
Diabetes labs
A1C >6.5
FBG >126
Random BG >200
198
Routine labs if have DM
A1C every 6 months, lipid annually, random urine for microalbuminemia annually
199
Dawn phenomenon
Increase FBG in the morning between 4 and 8am due to increase in GH
Increase evening dose of insulin
200
Somogyi effect
Severe nocturnal hypoglycemia causes glucagon release causing increase in FBG by 7am; decrease evening dose of insulin
201
Diabetic retinopathy
Neovascularization, microaneurysms, cotton wool spots, soft/hard exudates
202
1st line tx DM
Biguanides: metformin
Decreases gluconeogenesis + decreases insulin resistance
CI: renal, hepatic disease, alcoholics, hypoxia
Monitor renal function and LFT
Increased risk of lactic acidosis
203
Sulfonylureas
Glipizide, glyburide, glimepiride
Stimulates beta cells to secrete insulin
SE: hypoglycemia and photosensitivity
May cause weight gain
204
Thiazolidenodiones
Pioglitazone
Enhances insulin sensitivity in muscle tissues and decreases hepatic glucagon production
Take with breakfast
CI: HF (water retention)
205
Rapid acting insulin
Lispro, aspart, glutisine
206
Short acting insulin
Insulin humulin R
207
GLP-1 mimetics
Exanatide, liraglutide
| Once a day SC
208
GLT2 inhibitors
-Flozin
| Increases glucosuria
209
Lantus
Basal insulin; once a day
210
Order of rx diabetic meds
Metformin 500mg QD, increase dose of metformin, + sulfonylurea, + 3rd agent + basal insulin
211
Abx causing c diff colitis
clinda, fluoroquinolones, cephalosporins, penicillins
212
Zollinger Ellison syndrome
Gastrinoma on pancreas; stimulates high levels of acid production--development of ulcers
213
RUQ
Liver, gallbladder, ascending colon, right kidney
214
LUQ
Stomach, pancreas, descending colon, left kidney
215
RLQ
Appendix, ileum, cecum, right ovary
216
LLQ
Sigmoid colon, left ovary
217
Psoas sign
Flex hips 90 degrees and ask patient to push against resistance and straighten leg
218
Obturator sign
Inward rotation of hip
219
Rovsings sign
Deep palpation of LLQ results in referred pain to RLQ
220
McBurneys point
Tenderness indicates appendicitis
221
Murphys maneuver
Press deeply on RUQ during inspiration
222
Barretts esophagus increases risk of
Esophageal squamous cell cancer
223
1st line tx of GERD
Lifestyle changes
224
Meds for GERD
H2 blockers: ranitidine, famotidine, rizatidine
| PPI: omeprazole
225
Long term use of PPI
May cause hip fractures, pneumonia, C diff
| Do not D.C abruptly
226
Tx IBS
Fiber (metamucil)
Antispasmodics (dicyclomine)
Diarrhea (loperamide)
227
Labs for PUD
CBC and FOBT
228
tx H Pylori PUD
Clarithromycin + amoxicillin (or flagyl) + PPI
229
Tx of diverticulitis
Cipro 500mg BID + flagyl 500mg TID X10-14 days
230
Acute pancreatitis can be due to
Alcohol abuse, gallstones, triglyceridemia and infections
231
S/S acute pancreatitis
Acute onset fever, N/V, abdominal pain radiating to midback, + cullen sign and grey turner sign
232
Labs in pancreatitis
Increased amylase, lipase, trypsin
233
IgG anti-HAV positive
Antibodies present, no virus, not infectious
| Hx of HAV vaccine
234
IgM anti-HAV positive
Acute infection, patient contagious
235
Increased ALT indicates
liver inflammation
| More specific than AST
236
Increased alkaline phosphatase may be due to
Healing fractures, osteomalacia, bone malignancy, vitamin D deficiency
237
Most common cause of liver cancer
Hepatitis C
238
R/O for headaches
subarachnoid hemorrhage, leaking aneurysm, bacterial meningitis, brain abscess, brain tumor
239
Most common pathogens in bacterial meningitis for adults
Strep pneumoniae, N. meningitides, H. Influenzae
240
Tx bacterial meningitis in infants
ampicillin + 3rd gen ceh
241
Tx bacterial meningitis in adults
3rs gen ceph + chloram phenicol
242
Prophylaxis of bacterial meningitis
Rifampin or ceftriaxone
243
Abortive tx for migraines
NSAIDs, codeine/hydrocodone
| Sumatriptan (rule out CV disease first)
244
Prophylactic tx of migraines
Beta blockers: propranolol
TCA: amitriptyline
Anticonvulsants: gabapentin, valproate
245
Mean age of dx for temporal arteritis
72
246
Gold standard dx test for temporal arteritis
temporal artery Biopsy
247
Tx temporal arteritis
High dose steroids (prednisone)
248
bilateral joint stiffness and aching in shoulders, neck, hips, torso
Polymyalgia rheumatica
249
Sudden onset severe and sharp shooting pain on one side of the face; triggered by chewing, eating cold foods
Trigeminal neuralgia
CN 5
Tx: high dose anticonvulsants and muscle relaxants
250
Wake up with one side of face paralyzed; difficulty chewing and swallowing food
Bells palsy
CN 7
TX: high dose steroids, acyclovir if herpes suspected, eye lubricant
251
R/O what with bells palsy
Stroke, TIA, mastoid infection, bone fracture, lyme disease, tumor
252
Prophylaxis cluster headache
Verpamil
253
Tx cluster headache
High dose O2 and sumatriptan
254
Risk factors for carpal tunnel syndrome
Hypothyroidism, pregnancy, obesity
255
Acute onset high fever, chills, dysuria, frequency, unilateral flank pain
Pyelonephritis
256
Abrupt onset oliguria, edema, weight gain due to fluid retention, loss of appetite
Acute renal failure
257
Smoker and painless hematuria
Bladder cancer
258
Average daily UO
1500mL
259
Oliguria
<400ml/day
260
Dx for UTI in UA
>10^5 colony of bacteria
261
Hematuria seen in
Kidney stones, pyelonephritis, cystitis
262
Tx UTI in female 18-65
```
Bactrim BID X3 days
Nitrofurantoin BID X3 days
Augmentin BID 5-7 days
Alt: Cipro or Levaquin X3 days
Pyridium BID X 2 days PRN for pain
```
263
Tx UTI complicated
Minimum 7 days
Cipro 500mg BID or levaquin 750mg qD
Bactrim 500mg BID or Cefixime 400mg BID
264
Prophylaxis UTI
Bactrim 500mg QHS
265
UA in pyelo
Large amount of leukocytes, hematuria, WBC casts, proteinuria
266
TX pyelo
Fluoroquinolone or ceftriaxone 1g IM
| Second line: augmentin or Bactrim
267
Majority of kidney stones
Ca Oxalate
268
High oxalate foods
Rhubarb, spinach, beets, chocolate, tea, meats
269
Best measure of kidney function
eGFR
270
How much blood loss reuslts in orthostatic hypotension
>15%
271
How long after acute hemorrage do hct and hgb levels decrease
24 hours
| Increase in reticulocytes
272
Vitamin b12 deficiency
Gradual onset peripheral neuropathy, ataxia, impaired memory, dementia
273
Cancer of B cells, night sweats, fevers, pruritus, painless enlarged lymph nodes ,weight loss
Hodgkins Lymphoma
274
Fatigue, weakness, bone pain, bence jones protein in urine, hypercalcemia
Multiple myeloma
275
Easy bruising, bleeding gums, nosebleeds, hematuria
Thrombocytopenia
276
normal hgb
14-18 men
| 12-16 women
277
What may cause polycythemia
Long term high altitude or chronic hypoxia, smoking
278
normal hct
42-52% men
| 37-47% women
279
Normal MCV
80-100
280
Most sensitive test for iron deficiency
Serum ferritin
Decreased in iron deficiency
Increased in thalassemia trait
281
normal WBC
5000-10,000
282
Gold standard test ot diagnose sickle cell, thalassemia
Hemoglobin electrophoresis
283
Pallor of skin, conjunctiva and nail beds; daily fatigue; exertional dyspnea; glossitis and angular cheilitis, pika
Iron deficiency anemia
284
Most common cause of iron deficiency anemia
Blood loss
285
Tx iron deficiency anemia
Ferrous sulfate 325mg PO TID between meals for 3-6 months
Increase fiber and fluids and iron rich foods
Check reticulocyte and CBC 2 weeks later
286
Meds that can decrease hgb
ARB and ACEI
287
Thalassemia minor
bone marrow produces abnormal hgb; results in microcytic/hypochromic anemia
Majority asx
No tx required
288
Anemia of chronic kidney disease
Due to decreased EPO in CKD
289
Gold standard test for aplastic anemia
Bone marrow biopsy
290
How long does body supply of B12 last
3-4 years
291
Pernicious anemia
Autoimmune; decreased IF and decreased absorption of B12
Paresthesia of feet and hands occur first
Tx: B12 injections weekly X 4 weeks and then monthly for a lifetime
292
How long does body's supply of folic acid last
2-3 months
293
Sickle cell anemia has increased risk of death from
S. pneumoniae, H. influenzae
| Due to hyposplenia
294
dx test for sickle cell
Hgb electrophoresis
295
If pt has MCV <80...
Test TIBC, Ferritin, serum iron
If ferritin and iron are low: iron deficiency
If ferritin and iron normal: thalassemia
296
If pt has MCV >100
Order folate and vit B12
297
Foods high in folate
Leafy green vegetables, grains, beans, liver
298
Risk factors for priapism
Sickle cell, ED meds, cocaine, quadriplegia
299
Wake up with abrupt onset painful/swollen red scrotum with N/V
Affected testicle is higher and closer to the body
Testicular torsion
Cremasteric reflex missing
Must be corrected within 6 hours
Doppler US with color flow study
300
Blue colored round mass on testicular surface resembling a blue dot
Torsion of appendix testis
301
Where does spermatogenesis take place
Seminiferous tubules of testes
| Require 3 months to mature
302
Testes function
Production of testosterone/androgens stimulated by LH
| Spermatogensis stimulated by testosterone and FSH
303
Epididymis
Located in posterior aspect of testis; storage area for immature sperm
304
Vas deferens
Transport sperm from epididymis to urtethra
| This is cut in a vasectoy
305
Cremasteric reflex
Testicle elevates up in response to stroking thigh
| Absent in testicular torsion
306
Risk factors for prostate CA
>50, AA, obesity, family history
307
Tx for BPH
Alpha blockers : terazosin or tamsulosin
-Watch for orthostatic hypotension
5-alpha-reductase inhibitors: finasteride
--Work directly on prostate gland to shrink it; cat X drug
308
Chronic bacterial prostatitis
>6 weeks
due to E coli or proteus
Perineal discomfort with dysuria, nocturia, frequency
UA normal, urine mixed with prstate fluid + for E coli
309
Acute onset high fever and chills, perineal pain may radiate to back, UTI sx
Acute prostatitis
DRE: extremely tender prostate that is warm and boggy
LABS: leukocytosis with left shift, increased WBC in UA and hematuiia
310
Tx acute prostatitis
<35: ceftriaxone IM + doxy X10 days (tx like STD)
| >35: cipro or levaquin 4-6 weeks
311
Acute onset swollen red scrotum painful with unilateral testicular tenderness with urethral discharge green and purulent
Acute bacterial epididymitis
| Relief of pain with scrotal elevation
312
tx acute bacterial epididymitis
<35: doxy and IM ceftriaxone (tx like STD)
>35: Ofloxacin or levaquin X 10 days
Scrotal elevation + bed rest
313
Chronic scaly red rash resembling eczema starting on nipple and spreading to areola
Paget disease of breast
314
No period for 6-7 weeks, lower abdominal/pelvic pain worse when supine
Ectopic pregnancy
315
Where is majority of breast CA located
Upper outer quad of breasts: tail of spence
316
Heavy bleeding, pelvic pain, bleeding between periods
Fibroids
| Usually benign
317
Acne, hirsutism, oligomenorrhea, insulin resistance
PCOS
318
Palpable ovary in menopausal woman
always abnormal
| Order US
319
Follicular phase
Days 1-14
| FSH stimulates eggs to produce estrogen which stimulates growth of endometrial lining
320
Ovulatory phase
Day 14
| LH produces ovulation ; follicle migrates into fallopian tube
321
Luteal phase
Days 14-28
| Progesterone produced; sitimulates stability of endometrial lining
322
Menstruation
Estrogen + progesterone drop dramatically
323
Drugs that decrease efficacy of birth control
Phenytoin, phenobarb, griseofulvin, itraconazole, ampicillin, tetracyclines, rifampin
324
Depo return of fertility
Can decrease for up to 1 year due to severe uterine atrophy
325
Low dose OCP contains how much estrogen
20-25mcg ethinyl estradiol
326
Mefenamic acid
NSAID very effective against menstrual pain
327
Tx PCOS
OCP, spirinolactone, metformin (induces ovulation)
328
Tx osteoporosis
Biphosphanates: alendronate
| -Take with full glass of water sitting up and do not chew tablets
329
Tx bacterial vaginosis
Metronidazole X 5 days
330
Tx candidal vaginitis
Monistat OTC or diflucan 1 dose
331
Tx Trich vaginitis
Flagyl X 7 days
| Treat partner also
332
Growth charts
WHO until 2 years old and then CDC
333
Microcephaly with shortened palpebral fissures with epicanthal folds and flat nasal bridge and smooth philtrum
FAS
334
Cryptorchidism
Undescended testes
| Increased risk of testicular CA
335
Tx chalmydia pneumonia
Erythromycin X2 weeks
336
White 1-2mm papules commonly on nose or cheeks that resolves spontaneously
Milia
337
Small pustules surrounded by red base that resolves spontaneously
Erythema toxicum neonatorum
338
Faun tail nevus
Tufts of hair on spinal column; may be sign of spina bifida
| Order US
339
Nevus flammeus
Port wine stain
340
Weight gain 0-6 months
6-8oz per week and 1in per month
341
Weight gain 6-12 months
3-4oz per week and 1/2in per month
342
Caput succedoneum
Crosses midline
| Normal
343
Cephalohematoma
Does not cross midline
| Abnormal
344
White papules found on gum line resembling an erupting tooth
Epstein's Pearls
345
moro reflex disappears by
3-4 months
346
Step reflex disappears by
6 weeks
347
Rooting reflex disappears by
3-4 months
348
4 month development
Social smile, holds head steady, rolls front to back
349
6 month development
Palmar grasp, reaches, passes objects, sits independently, rolls both directions, consonants
350
9 month development
Pincer grasp, waves, feeds self, pulls self to stand, crawls and cruises, peek a boo, stranger anxiety
351
12 month development
Sippy cup, stands, walks, 2-4 words, knows name
352
15 month developemnt
Feeds self with spoon, drinks from cup, 4-6 words
353
18 months
Turns pages of book, walks up steps, points to 4 body parts, 10-20 words
354
Physiologic jaundice
Neonatal unconjugated hyperbili
Bili >5
Starts after 24 hours and clears within 2-3 weeks
355
Breast milk jaundice
Onset >7 days
Can take 2-3 weeks to clear
Due to decreased breast milk production
Tx: phototherapy
356
Dx for coractation of aorta
Absence of femoral pulse when compared to brachial pulse
357
Ortolani test
Click or clunk sound is + finding
358
Barlow test
Clunk sound on palpating trochanter
359
Abdominal mass that is fixed, firm, irregular
| Frequently crosses midline
Neuroblastoma
50% present with metastasis
Imaging: US
May have weight loss, fever, racoon eyes, bone pain
360
Asymptomatic abdominal mass that is nontender and smooth
| Rarely crosses midline
Nephroblastoma--Wilms tumor
Most common renal malignancy in children
Palpate GENTLY
361
Prophylaxis for epiglottitis
Rifampin
362
Top 3 CA in children
Leukemia, brain or nervous system, neuroblastoma
363
2 year old development
2-3 word sentences
Stacks 6 cubes
Can copy straight line, runs, jumps, climbs, temper tantrums, says no
364
3 year old development
3-5 word sentences
Knows age and sexual identity
Magical thinking
Copies circle, throws ball, stacks 9 cubes, rides tricycle
365
High fever and enlarged lymph nodes in neck, bright red rash, conjunctivitis, strawberry tongue, edema
Kawasaki disease
366
Tx kawasaki disease
High dose aspirin and gamma globulin
| Follow up in cardiologist for several years
367
Extreme fatigue and weakness, pale skin, easy bruising, petechial bleeding, bleeding gums and noses
Leukemia
368
Most common type of leukemia
ALL
369
Hx of febrile illness with salicylate intake
Reyes syndrome
370
Mortality rate of reyes syndrome
50%
371
Stage 1 reyes syndrome
Sever vomiting, diarrhea, lethargy, increased AST and ALT
372
Stage 2 reyes syndrome
Personality changes, aggression
373
Stage 3-5 reyes syndrome
Confusion, delirium, coma, death
374
Large head circumference, mental retardation, delayed physical development, hyperactive
Fragile X
375
Acute onset fever, severe sore throat, HA, multiple small blisters on hands and feet; ulcers in mouth and on tonge
hand foot and mouth
376
Initial test for testicular torsion
Doppler US
377
Precocious puberty girls
<8 years
378
Delayed puberty girls
No breast development by age 12
379
Precocious puberty boys
<9
380
Delayed puberty boys
No testicular growth by age 14
381
Tanner stages boys
2: Testes enlarge
3: Penis elongates
4: penis thickens and increases in size
5: adult
382
Tanner stages girls
2: breast bud
3: breast mound
4: areola/nipples separate to form 2nd mound
5: adult
383
Primary amenorrhea
No menarche at age 15; usually due to chromosome disorder
384
Secondary amenorrhea
no menses for 6 months; most common cause is pregnancy
| other: ovarian disorder, stress, anorexia, PCOS
