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Leik Review Book > Content > Flashcards

Content Flashcards

1
Q

Leading causes of death in all ages/genders

A

Heart disease, CA, chronic lower respiratory disease

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2
Q

Leading cause of death in adolescents

A

MVA, suicides, homicides

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3
Q

Most common skin cancer

A

Basal cell carcinoma

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4
Q

SpIn

A

SPECIFIC test rules IN diagnosis (detects true negatives)

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5
Q

SnNout

A

SENSITIVE test rules OUT diagnosis (detects true positive)

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6
Q

Screenings, taking daily aspirin to prevent future MI

A

Secondary prevention

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7
Q

Support groups, education on current disease, rehab

A

Tertiary prevention

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8
Q

Acute onset severe eye pain, phototobia, tearing, blurred vision in one eye

A

Herpes keratitis

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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

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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

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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

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12
Q

Sudden onset of floaters with looking through curtain and sudden flashes of light

A

Retinal detachment

Refer to ED

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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

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14
Q

Battle sign

A

Periorbital ecchymosis and bruising behind ear appearing 2-3 days post trauma
Rule out basilar or temporal bone fracture

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15
Q

Clear golden fluid from nose/ear

A

Indicates basilar skull fracture

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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

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17
Q

Sore throat, fever, swollen neck

Gray to yellow pseudomembrane of throat

A

Diphtheria
Contact prophylaxis
Refer to ED

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18
Q

Age related due to decreased ability of eye to accommodate stiffening of lenses

A

Presbyopia

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19
Q

Normal TM

A

Translucent off white-gray color with cone of light intact

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20
Q

Bluish, pale, boggy nasal turbinates

A

Indicate allergic rhinitis

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21
Q

Leukoplakia

A

White to light gray patch that appears on tongue, floor or mouth or cheek

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22
Q

Aphthous stomatitis

A

Canker sores

Tx with magic mouthwash–benadryl, viscous lidocaine, steroid

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23
Q

Papilledema

A

optic disc swelling with blurred edges due to increased ICP secondary to bleeding, brain tumor, abscess, pseudotumor cerebri

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24
Q

Hypertensive retinopathy

A

Copper and silver wire arterioles, AV nicking, retinal hemorrhages

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25
Q

Diabetic retinopathy

A

Microaneurysms, cotton wool spots

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26
Q

Opacity of lens, difficulty with glare, halos around lights, blurred vision

A

Cataracts

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27
Q

Koplik spots

A

Small red papules with white centers clustered on cheeks

Measles

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28
Q

Ishihara chart

A

Tests for color blindness

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29
Q

Legal blindness

A

20/200

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30
Q

When should vision be 20/20

A

Age 6

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31
Q

Weber test

A

Tuning fork placed on midline of forehead; normal finding is no lateralization

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32
Q

Rinne test

A

Tuning fork on mastoid process than at front of ear

Normal is AC > BC

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33
Q

Causes of conductive hearing loss

A

OE, cerumen, OM, obstruction

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34
Q

Causes of sensorineural hearing loss

A

Presbycusis, meniere disease, ototoxic drugs, stroke

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35
Q

Acute onset severe eye pain with tearing, feeling of foreign body

A

Corneal abrasion

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36
Q

Tx of contact lens related keratitis

A

Topical ophthalmic abx with pseudomonal coverage (cipro, ofloxacin, polytrim) for 3-5 days

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37
Q

Acute onset swollen, red, and warm abscess on eye

A

Hordeolum

Tx with warm compresses 5-10 minutes BID to TID

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38
Q

Chronic inflammation of melbumian gland on eye; painless and moveable

A

Chalazion

tx: I+D, surgery, steroid injections

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39
Q

Wedge shaped yellow thickening of conjunctiva due to sun exposure

A

pterygium

Tx: sunglasses

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40
Q

Sudden onset bright red blood in eye with no pain

A

Subconjunctival hemorrhage

Resolves on its own in 1-3 weeks

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41
Q

Gradual increase in IOP with gradual change in peripheral vision first

A

Primary open-angle glaucoma

Tx: timolol eye drops or latanoprost topical prostaglandin

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42
Q

Insidious onset eye pain with conjunctival injection; complication of autoimmune disorder

A

Anterior uveitis–iritis

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43
Q

Painless loss of central vision

A

Macular degeneration
Results in blindness
More common in smokers

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44
Q

Chronic autoimmune disorder with decreased function of lacrimal and salivary glands
Daily dry mouth and eyes >3 months

A

Sjogrens syndrome
Eye drops TID
Refer to ophthamologist and rheumatologist

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45
Q

Inflammation of eyelid; itching and irritation, eye redness

A

Blepharitis
Tx: baby shampoo and warm water
May use erythromycin BID to TID

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46
Q

Clear mucus rhinorrhea, postnasal drip, nasal itch, family history of atopy, pale/boggy turbinates, under eye bags, nasal crease, cobblestoning

A

Allergic rhinitis
Tx: nasal steroids (flonase)
2nd line is topical antihistamines
Decongestants PRN

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47
Q

abrupt onset fever, sore throat, pain on swallowing, enlarged submandibular lymph nodes, purulent exudates on tonsils, enlarged anterior notes, absence of cough

A

strep throat

Tx: penicillin 500mg BID 10 days

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48
Q

Possible complications of strep throat

A

Scarlet fever, rheumatic fever, peritonsillar abscess, post strep glomerulonephritis

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49
Q

Most common organisms in AOM

A

Strep pneumoniae, H. influenzae, M. catarrhalis

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50
Q

Ear pain, muffled hearing, recent cold, afebrile or low fever

A

AOM

Tx: amoxicillin high dose 5-7 days

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51
Q

Unilateral facial pain with nasal congestion >10 days; purulent nasal/postnasal drip

A

Acute bacterial rhinosinusitis
Tx: High dose Augmentin BID 5-7 days
Tx of sx: decongestants, guaifenesin, flonase, dextromethorphan, benzonatate

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52
Q

OE due to

A

Psuedomonas or staph aureus

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53
Q

Tx of OE

A 
Cortisporin otic (polymyxin B-Neomycin-Hydrocortisone) 4 drops QD 7 days 
Ofloxacin or cipro otic drops BID 7 days
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54
Q

Fever, pharyngitis, posterior lymph nodes, fatigue, hepatosplenomegaly, maculopapular rash

A

Mono

Tx: symptomatic

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55
Q

Rinne test with conductive hearing loss

A

BC >AC

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56
Q

Weber test with conductive hearing loss

A

Lateralization to bad ear

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57
Q

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

A

Rocky mountain spotted fever

Tx: doxycycline

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58
Q

Expanding red rash with central clearing (target lesion)

A 
Erythema migrans (Lyme disease)
Tx: doxycyline
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59
Q

Sore throat, cough, fever, HA, stiff neck, phototobia, changes in LOC, may have petechial rash

A

Meningitis

Rifampin prophylaxis if outbreak

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60
Q

Pearly or waxy skin lesion with atrophic/ulcerated lesion that may bleed easily

A

Basal cell carcinoma

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61
Q

Numerous dry, round, red-colored lesions with rough texture

A

Actinic keratoses

Pre-cancerous squamous cell carcinoma

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62
Q

Anatomy of skin

A

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

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63
Q

Most common skin CA

A

Basal cell carcinoma

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64
Q

Macule

A

<1cm, flat

Freckles, lentigo

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65
Q

Papules

A

Palpable solid lesion <0.5cm

Moles, acne, cherry angioma

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66
Q

Plaque

A

Flat elevated >1cm

Psoriasis

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67
Q

Bulla

A

Elevated blister filled >1cm

Impetigo, SJS

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68
Q

Vesicle

A

Elevated <1cm filled with serous fluid

Herpes

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69
Q

Pustule

A

Elevated <1cm filled with purulent fluid

Acne

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70
Q

Erythematous/raised skin lesions with discrete borders; wheals

A

Urticaria–hives

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71
Q

Soft, wart like fleshy growths on the trunk; appear in the middle age
Painless

A

Seborrheic keratoses

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72
Q

Xanthelasma

A

Raised, yellow plaques on eyes

50% of these patients have hyperlipidemia

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73
Q

Melasma

A

Bilateral brown/tan stains on face on pregnant women

Usually permanent

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74
Q

Vitiligo

A

Hypopigment of skin that spreads over time
Risk factors: autoimmune disease
Tx: steroids, light therapy, avoid sun

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75
Q

Acanthosis Nigricans

A

velvety thickening of skin behind neck

associated with DM, metabolic syndrome, GI cancer

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76
Q

Avoid what medication in fungal infection

A

Steroids

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77
Q

Koebner phenomenon

A

In psoriasis, new plaques develop over sites of trauma

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78
Q

Auspitz sign

A

In psoriasis, pinpoint bleeding when scales are removed

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79
Q

Pruritic erythematous plaques covered with silvery white scales

A

Psoriasis
Tx: topical steroids, topical retinoids
For refractory: methotrexate, cyclosporine, biolics

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80
Q

Hypopigmented round macules on chest, shoulders

A

Tinea versicolor

Tx: selenium sulfide, topica azoles

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81
Q

Multiple small vesicles that rupture; lesions become lichenified from chronic itching

A

Atopic dermatitis (eczema)
Tx: hydrocortisone if mild, triamcinolone if moderate
Oral antihistamines for itching
Skin lubricants–Eucerin, baby oil

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82
Q

Inflammatory skin reactions due to contact with irritating external substance
Bright red and pruritic lesions that evolve into bullous or vesicles

A

Contact dermatitis

Tx: if lichenified, use high potency steroids

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83
Q

Bright red/shiny lesions that itch and burn; may have sattelite lesions
Common in obese/moist areas

A

Superficial candidiasis

Tx: nystatin or topical antifungals

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84
Q

Most common opportunistic infection in hIV patient

A

Oropharyngeal candidiasis

Tx: oral fluconazole

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85
Q

Acute diffuse pink/red skin poorly demarcated with advancing margins; warm and may form abscess; may have red streals

A

Cellulitis

Tx: amoxicillin

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86
Q

Folliculitis

A

infection of hair follicle

Tx: bactroban

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87
Q

Subtype of cellulitis involving the upper dermis/superficial lymphatics
Due to GAS

A

Erysipelas

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88
Q

Tx for human bites

A

Augmentin PO BID 10 days

If allergic to penicillin..doxycycline BID, Bactrim DS BID + Flagyl BID

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89
Q

Impetigo

A

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

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90
Q

Meningococcemia prophylaxis

A

Rifampin q12 hours 2 days for close contacts

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91
Q

Tx for meningococcemia

A

Ceftriaxone 2g IV q12 hours + Vanco IV q8-12

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92
Q

Tx of lyme disease

A

Doxycycline BID (adults and children)

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93
Q

Labs for lyme disease

A

ELISA

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94
Q

How long is varicella contagious for

A

1-2 days before onset of rash until all lesions have crusted over

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95
Q

Fever, pharyngitis, malaise, followed by pruritic vesicular lesions

A

Chickenpox

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96
Q

Labs for varicella

A

PCR

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97
Q

Tx varicella

A

Acyclovir X 5 days or valacyclovir X 10 days

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98
Q

Tx of postherpetic neuralgia

A

TCAs, anticonvulsants, gabapentin

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99
Q

Tx herpetic whitlow

A

NSAIDs and acyclovir if severe

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100
Q

Bacterial skin infection of lateral nail folds

A

Paronychia

Tx: topical mupirocin and soak in warm wate r

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101
Q

Oval lesions with fine scales that follow skin lines with christmas tree pattern

A

Pityriasis Rosea

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102
Q

Tx of scabies

A

Permethrin for 8 hours and repeat in 7 days

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103
Q

Tx of tinea capitus

A

Griseofulvin 6-12 weeks

Baseline LFT and 2 weeks after tx

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104
Q

Nails become opaque, yellow, thickened with scaling under nail

A

Onychomycosis

Tx: oral terbinafine or itraconazole

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105
Q

Tx mild acne

A

Tretinoin topical (retin A), benzoyl peroxicde gel, erythromycin/clindamycin topical

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106
Q

Tx moderate acne

A

Topical/oral abx: tetracycline or minocycline or erythromycin or clindamycin

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107
Q

Tx of severe acne

A

Isotretinoin

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108
Q

Tx rosacea

A

Metronidazole gel, azelaic acid gel, low dose tetracycline

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109
Q

Dome shaped papules with central umbilication due to poxvirus

A

Molluscum contagiosum

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110
Q

Tx of MRSA if allergic to Bactrim

A

Minocycline, doxycycline, clindamycin

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111
Q

Gradual onset intense and steady chest discomfort and pain produced by physical exertion or eating heavy meal

A

Acute MI

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112
Q

Acute or gradual dyspnea, fatigue, dry cough, swollen feet, crackles in lung with S3 heart sound

A

CHF

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113
Q

Fever, chills, and malaise associated with onset new murmur

May have subungual hemorrhages, petechiae on palate, janeway lesions

A

infective endocarditis

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114
Q

Sudden onset, severe, sharp, excruciating pain in abdomen/flank/back

A

Dissecting abdominal aortic aneurysm

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115
Q

S3 heart sound

A

May indicate HF
Always abnormal if >35 years
Normal in children, pregnant women, athletes

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116
Q

Systolic murmurs

A 
Aortic stenosis
Pulmonary stenosis
Tricuspid regurg
Mitral regurg
MVP
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117
Q

Grade murmur first time thrill is present

A

4

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118
Q

Grade murmur when you can hear off of stethoscope slightly off chest

A

5

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119
Q

Grade murmur when you can hear off of stethoscope

A

6

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120
Q

Sudden onset heart palpitations with feelings of weakness, dizziness, dyspnea, syncope

A

A fib

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121
Q

Labs for new onset A Fib

A

TSH, EKG, electrolytes, renal function, BNP, troponin,

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122
Q

Tx of A fib rate control

A

Beta blockers, CCB, digoxin

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123
Q

Tx of A fib clot control

A

Warfarin, direct Xa inhibitors (ravoxaban)

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124
Q

INR goal for A fib

A

2-3

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125
Q

SE thiazide diuretics

A

Hypergluycemia, hyperuricemia, hypertriglyceridemia, hypokalemia, hyponatremia, hypomagnesia

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126
Q

SE loop diuretics

A

Hypokalemia, hyponatremia, hypomagnesia

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127
Q

SE aldosterone receptor antagonists

A

Gynecomastia, galactorrhea, hyperkalemia, GI upset

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128
Q

CCB CI in

A

Heart failure, bradycardia, 2nd/3rd degree heart block

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129
Q

Crackles, cough, dyspnea, decreased breath sounds, dullness to percussion

A

LVF

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130
Q

JVD, enlarged spleen, enlarged liver, edema

A

RVF

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131
Q

Tx HF

A

Initial: furosemide 20mg

If stable with htn: ACEI/ARB + beta blocker, spirinolactone

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132
Q

Homan sign

A

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

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133
Q

Patient with a history of smoking + Hyperlipidemia complains of worsening pain on ambulation instantly relieved by rest

A

Peripheral artery disease
Dx: ABI <0.9
Tx: aspirin + smoking cessation

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134
Q

Chronic and recurrent episodes of color changes on fingertips in symmetric pattern

A

Raynauds Phenomenon

Tx: avoid triggers, smoking cessation, nifedipine

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135
Q

Abx prophylaxis for endocarditis

A

Only if previous hx of prosthetic valves–amoxicilin 2g PO 1 hour before procedure

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136
Q

S2 click followed by systolic murmur

A

MVP

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137
Q

Tall/thin female with fatigue, palpitations, light headedness aggravated by heavy exertion

A

MVP

Tx: beta blockers if palpitations

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138
Q

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

A

PE

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139
Q

Breath sounds in lower lobes

A

Vesicular

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140
Q

Breath sounds in upper lobes

A

Bronchial

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141
Q

PE in emphysema

A

Increased AP diameter, decreased breath sounds, pursed lip breathing, weight loss, hyperressonance percussion, tactile fremitus decreased

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142
Q

Tx COPD

A

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

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143
Q

Acute onset fever, purulent sputum and wheezing in a patient with COPD

A

Susoect H Influenzae pneumonia

Tx: Bactrim, Doxy, Ceftin BID 10 days

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144
Q

The only treatment known to prolong life in COPD

A

O2

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145
Q

Bacteria that causes the most deaths in outpatient CAP

A

Strep pneumoniae

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146
Q

Most common pathogen in CF patients with CAP

A

Pseudomonas

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147
Q

PE in CAP

A

Rhonchi, crackles, wheezing, dullness, increased tactile fremitus

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148
Q

Tx CAP if no co-morbidity

A

Azithromycin for 5 days

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149
Q

Tx CAP if co-morbidity

A

Respiratory fluoroquinolone ALONE

OR Augmentin + Azithromycin

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150
Q

CURB criteria for CAP

A

Confusion, BUN >19, Resp >30, BP <90/60

Poor prognosis

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151
Q

Young adult with several weeks of fatigue and severe paroxysmal coughing that is nonproductive

A

Atypical pneumonia
Due to mycoplasma pneumoniae usually
Tx: Doxy, azithromycin or levaquin

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152
Q

Coughing >14 days, inspiratory whooping

A

Pertussis

Tx: azithromycin

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153
Q

Chest X ray in TB

A

Cavitations and adenopathy with granulomas

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154
Q

Fever, anorexia, fatigue, night sweats, mild nonproductive cough which progresses to hemoptysis with weight loss

A

TB

Tx: Rifampin, INH, ethambolol, pyrazamide

155
Q

PPD positive results

A

> 5mm: HIV, recent contact, chest X ray positive, immunocompromised
10mm: recent immigrant, IV drug user, health care worker, homeless
15mm: no risk factors

156
Q

Asthma treatments step 1-4

A

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
Q

Acute onset saddle anesthesia, bladder incontinence, fecal incontinence, and BL leg weakness

A

Cauda equina syndrome

158
Q

Within first 48 hours of exercise injury

A

Do not exercise, use ice, do not do any ROM exercises

159
Q

McMurray Test

A

+ suggests injury to medial meniscus

160
Q

Lachman test

A

+ suggests ACL damage

161
Q

Tx shin splints

A

RICE, compression bandage, low impact exercise

162
Q

Inflammation of digital nerve of foot between third and fourth metatarsals

A

Mortons neuroma

163
Q

Early morning joint stiffness and with inactivity

A

OA

Tx: first line is Tylenol

164
Q

Woman complains of maculopapular butterfly rash in middle of face

A

SLE
Do a UA to look for proteinuria
Tx: steroids, plaquenil, methotrexate, biologics
Education: avoid sun and cover with sunblock

165
Q

Gradual onset daily fatigue, low grade fever, body aches, myalgia, generalized joint pain, early morning stiffness, warm and tender swollen fingers

A

RA

Tx: NSAIDs, steroids, methotrexate, sulfasalazine, cyclosporine, hydroxychloroquine

166
Q

Gold standard for diagnosing gout

A

Joint aspiration of synovial fluid
Tx acute: indomethacin or naproxen or NSAID + colchicine
Maintenance: Allopurinol

167
Q

Tx of ankylosing spondylitis

A

NSAIDs

168
Q

Acute onset high fever, muscular rigidity, mental status changes, hyperreflexia and uncontrolled shivering
Hx of taking SSRI

A

Acute serotonin syndrome

169
Q

Atypical antipsychotics

A

Olanzapine, risperidone, quetiapine (Seroquel)S

SE: obesity and DM

170
Q

Typical antipsychotics

A

Haldol, chlorpromazine

SE: increased lipids, malignant neuroleptic syndrome

171
Q

SSRI

A

Paroxetine, fluoxetine, citalopram, sertraline, escitalopram

SE: anxiety, insomnia, impotence

172
Q

SNRI

A

Duloxetine, venlafaxine

SE: may precepitate acute narrow angle glaucoma

173
Q

Rule out what with depression

A

Thyroid issues, Vitamin B12 deficiency, anemia, autoimmune disorders

174
Q

Korsakoff’s syndrome

A

Complication from chronic alcohol abuse
Hypotension, visual impairment, coma
Tx: thiamine

175
Q

Gold standard for sleep apnea

A

Sleep lab (polysomnography)

176
Q

Tx of anti-depressant induced sexual dysfunction

A

Bupropion

177
Q

Best SSRI for elderly

A

Citalopram

178
Q

Avoid what in patients with anorexia

A

Wellbutrin due to increased seizure threshold

179
Q

Most common SSRI to cause ED

A

Paxil (Paroxetine)

180
Q

Hypoglycemia

A

FBG<50; weakness, syncope, hand tremors, anxiety

more common in type 1 DM

181
Q

Peak diagnosis of type 1 DM

A

age 4-6 and then 10-14

182
Q

Thyroid CA

A

Hoarseness and dysphagia, nodules on upper 1/2 lobe

183
Q

S/S pheochromocytoma

A

Headache, diaphoresis, tachycardia, hypertension

184
Q

Hypothalamus secretes

A

TRH, GnRH, CRH, GHRH, somatostatin

185
Q

Anterior pituitary secretes

A

FSH, LH, TSH, GH, ACTH, Prolactin, melanocyte stimulating hormone

186
Q

Posterior pituitary

A

ADH and oxytocin

187
Q

Primary hyperthyroidism

A

Thyrotoxicosis
Very low TSH with increase in free T4 and T3
Most common cause is Graves

188
Q

Medications for hyperthyroidism

A

PTU and methimazole
SE: skin rash, aplastic anemia, thrombocytopenia, hepatic necrosis
Beta blockers for palpitations

189
Q

Goal TSH with hyperthyroidism

A

<5

190
Q

Drugs that can induce hyperthyroidism

A

Lithium, amiodarone, high doses of iodine, inter feron alfa, dopamine

191
Q

Primary hypothyroidism

A

High TSH and low free T4

Most common cause is hashimoto’s thyroiditis

192
Q

Myxedema

A

Severe hypothyroidism

193
Q

Tx hypothyroidism

A

Levothyroxine 25-50mcg; increase until TSH normalizes
-Start with lowest dose for elderly
Check TSH every 6-8 weeks

194
Q

Microvascular damage of DM

A

Retinopathy, nephropathy, neuropathy

195
Q

Macrovascular damage of DM

A

Atherosclerosis, CAD, MI

196
Q

Pre-diabetes labs

A

A1C between 5.7 and 6.4%
FBG between 100-125
2 hour OGTT 140-199

197
Q

Diabetes labs

A

A1C >6.5
FBG >126
Random BG >200

198
Q

Routine labs if have DM

A

A1C every 6 months, lipid annually, random urine for microalbuminemia annually

199
Q

Dawn phenomenon

A

Increase FBG in the morning between 4 and 8am due to increase in GH
Increase evening dose of insulin

200
Q

Somogyi effect

A

Severe nocturnal hypoglycemia causes glucagon release causing increase in FBG by 7am; decrease evening dose of insulin

201
Q

Diabetic retinopathy

A

Neovascularization, microaneurysms, cotton wool spots, soft/hard exudates

202
Q

1st line tx DM

A

Biguanides: metformin
Decreases gluconeogenesis + decreases insulin resistance
CI: renal, hepatic disease, alcoholics, hypoxia
Monitor renal function and LFT
Increased risk of lactic acidosis

203
Q

Sulfonylureas

A

Glipizide, glyburide, glimepiride
Stimulates beta cells to secrete insulin
SE: hypoglycemia and photosensitivity
May cause weight gain

204
Q

Thiazolidenodiones

A

Pioglitazone
Enhances insulin sensitivity in muscle tissues and decreases hepatic glucagon production
Take with breakfast
CI: HF (water retention)

205
Q

Rapid acting insulin

A

Lispro, aspart, glutisine

206
Q

Short acting insulin

A

Insulin humulin R

207
Q

GLP-1 mimetics

A

Exanatide, liraglutide

Once a day SC

208
Q

GLT2 inhibitors

A

-Flozin

Increases glucosuria

209
Q

Lantus

A

Basal insulin; once a day

210
Q

Order of rx diabetic meds

A

Metformin 500mg QD, increase dose of metformin, + sulfonylurea, + 3rd agent + basal insulin

211
Q

Abx causing c diff colitis

A

clinda, fluoroquinolones, cephalosporins, penicillins

212
Q

Zollinger Ellison syndrome

A

Gastrinoma on pancreas; stimulates high levels of acid production–development of ulcers

213
Q

RUQ

A

Liver, gallbladder, ascending colon, right kidney

214
Q

LUQ

A

Stomach, pancreas, descending colon, left kidney

215
Q

RLQ

A

Appendix, ileum, cecum, right ovary

216
Q

LLQ

A

Sigmoid colon, left ovary

217
Q

Psoas sign

A

Flex hips 90 degrees and ask patient to push against resistance and straighten leg

218
Q

Obturator sign

A

Inward rotation of hip

219
Q

Rovsings sign

A

Deep palpation of LLQ results in referred pain to RLQ

220
Q

McBurneys point

A

Tenderness indicates appendicitis

221
Q

Murphys maneuver

A

Press deeply on RUQ during inspiration

222
Q

Barretts esophagus increases risk of

A

Esophageal squamous cell cancer

223
Q

1st line tx of GERD

A

Lifestyle changes

224
Q

Meds for GERD

A

H2 blockers: ranitidine, famotidine, rizatidine

PPI: omeprazole

225
Q

Long term use of PPI

A

May cause hip fractures, pneumonia, C diff

Do not D.C abruptly

226
Q

Tx IBS

A

Fiber (metamucil)
Antispasmodics (dicyclomine)
Diarrhea (loperamide)

227
Q

Labs for PUD

A

CBC and FOBT

228
Q

tx H Pylori PUD

A

Clarithromycin + amoxicillin (or flagyl) + PPI

229
Q

Tx of diverticulitis

A

Cipro 500mg BID + flagyl 500mg TID X10-14 days

230
Q

Acute pancreatitis can be due to

A

Alcohol abuse, gallstones, triglyceridemia and infections

231
Q

S/S acute pancreatitis

A

Acute onset fever, N/V, abdominal pain radiating to midback, + cullen sign and grey turner sign

232
Q

Labs in pancreatitis

A

Increased amylase, lipase, trypsin

233
Q

IgG anti-HAV positive

A

Antibodies present, no virus, not infectious

Hx of HAV vaccine

234
Q

IgM anti-HAV positive

A

Acute infection, patient contagious

235
Q

Increased ALT indicates

A

liver inflammation

More specific than AST

236
Q

Increased alkaline phosphatase may be due to

A

Healing fractures, osteomalacia, bone malignancy, vitamin D deficiency

237
Q

Most common cause of liver cancer

A

Hepatitis C

238
Q

R/O for headaches

A

subarachnoid hemorrhage, leaking aneurysm, bacterial meningitis, brain abscess, brain tumor

239
Q

Most common pathogens in bacterial meningitis for adults

A

Strep pneumoniae, N. meningitides, H. Influenzae

240
Q

Tx bacterial meningitis in infants

A

ampicillin + 3rd gen ceh

241
Q

Tx bacterial meningitis in adults

A

3rs gen ceph + chloram phenicol

242
Q

Prophylaxis of bacterial meningitis

A

Rifampin or ceftriaxone

243
Q

Abortive tx for migraines

A

NSAIDs, codeine/hydrocodone

Sumatriptan (rule out CV disease first)

244
Q

Prophylactic tx of migraines

A

Beta blockers: propranolol
TCA: amitriptyline
Anticonvulsants: gabapentin, valproate

245
Q

Mean age of dx for temporal arteritis

A

72

246
Q

Gold standard dx test for temporal arteritis

A

temporal artery Biopsy

247
Q

Tx temporal arteritis

A

High dose steroids (prednisone)

248
Q

bilateral joint stiffness and aching in shoulders, neck, hips, torso

A

Polymyalgia rheumatica

249
Q

Sudden onset severe and sharp shooting pain on one side of the face; triggered by chewing, eating cold foods

A

Trigeminal neuralgia
CN 5
Tx: high dose anticonvulsants and muscle relaxants

250
Q

Wake up with one side of face paralyzed; difficulty chewing and swallowing food

A

Bells palsy
CN 7
TX: high dose steroids, acyclovir if herpes suspected, eye lubricant

251
Q

R/O what with bells palsy

A

Stroke, TIA, mastoid infection, bone fracture, lyme disease, tumor

252
Q

Prophylaxis cluster headache

A

Verpamil

253
Q

Tx cluster headache

A

High dose O2 and sumatriptan

254
Q

Risk factors for carpal tunnel syndrome

A

Hypothyroidism, pregnancy, obesity

255
Q

Acute onset high fever, chills, dysuria, frequency, unilateral flank pain

A

Pyelonephritis

256
Q

Abrupt onset oliguria, edema, weight gain due to fluid retention, loss of appetite

A

Acute renal failure

257
Q

Smoker and painless hematuria

A

Bladder cancer

258
Q

Average daily UO

A

1500mL

259
Q

Oliguria

A

<400ml/day

260
Q

Dx for UTI in UA

A

> 10^5 colony of bacteria

261
Q

Hematuria seen in

A

Kidney stones, pyelonephritis, cystitis

262
Q

Tx UTI in female 18-65

A 
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
Q

Tx UTI complicated

A

Minimum 7 days
Cipro 500mg BID or levaquin 750mg qD
Bactrim 500mg BID or Cefixime 400mg BID

264
Q

Prophylaxis UTI

A

Bactrim 500mg QHS

265
Q

UA in pyelo

A

Large amount of leukocytes, hematuria, WBC casts, proteinuria

266
Q

TX pyelo

A

Fluoroquinolone or ceftriaxone 1g IM

Second line: augmentin or Bactrim

267
Q

Majority of kidney stones

A

Ca Oxalate

268
Q

High oxalate foods

A

Rhubarb, spinach, beets, chocolate, tea, meats

269
Q

Best measure of kidney function

A

eGFR

270
Q

How much blood loss reuslts in orthostatic hypotension

A

> 15%

271
Q

How long after acute hemorrage do hct and hgb levels decrease

A

24 hours

Increase in reticulocytes

272
Q

Vitamin b12 deficiency

A

Gradual onset peripheral neuropathy, ataxia, impaired memory, dementia

273
Q

Cancer of B cells, night sweats, fevers, pruritus, painless enlarged lymph nodes ,weight loss

A

Hodgkins Lymphoma

274
Q

Fatigue, weakness, bone pain, bence jones protein in urine, hypercalcemia

A

Multiple myeloma

275
Q

Easy bruising, bleeding gums, nosebleeds, hematuria

A

Thrombocytopenia

276
Q

normal hgb

A

14-18 men

12-16 women

277
Q

What may cause polycythemia

A

Long term high altitude or chronic hypoxia, smoking

278
Q

normal hct

A

42-52% men

37-47% women

279
Q

Normal MCV

A

80-100

280
Q

Most sensitive test for iron deficiency

A

Serum ferritin
Decreased in iron deficiency
Increased in thalassemia trait

281
Q

normal WBC

A

5000-10,000

282
Q

Gold standard test ot diagnose sickle cell, thalassemia

A

Hemoglobin electrophoresis

283
Q

Pallor of skin, conjunctiva and nail beds; daily fatigue; exertional dyspnea; glossitis and angular cheilitis, pika

A

Iron deficiency anemia

284
Q

Most common cause of iron deficiency anemia

A

Blood loss

285
Q

Tx iron deficiency anemia

A

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
Q

Meds that can decrease hgb

A

ARB and ACEI

287
Q

Thalassemia minor

A

bone marrow produces abnormal hgb; results in microcytic/hypochromic anemia
Majority asx
No tx required

288
Q

Anemia of chronic kidney disease

A

Due to decreased EPO in CKD

289
Q

Gold standard test for aplastic anemia

A

Bone marrow biopsy

290
Q

How long does body supply of B12 last

A

3-4 years

291
Q

Pernicious anemia

A

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
Q

How long does body’s supply of folic acid last

A

2-3 months

293
Q

Sickle cell anemia has increased risk of death from

A

S. pneumoniae, H. influenzae

Due to hyposplenia

294
Q

dx test for sickle cell

A

Hgb electrophoresis

295
Q

If pt has MCV <80…

A

Test TIBC, Ferritin, serum iron
If ferritin and iron are low: iron deficiency
If ferritin and iron normal: thalassemia

296
Q

If pt has MCV >100

A

Order folate and vit B12

297
Q

Foods high in folate

A

Leafy green vegetables, grains, beans, liver

298
Q

Risk factors for priapism

A

Sickle cell, ED meds, cocaine, quadriplegia

299
Q

Wake up with abrupt onset painful/swollen red scrotum with N/V
Affected testicle is higher and closer to the body

A

Testicular torsion
Cremasteric reflex missing
Must be corrected within 6 hours
Doppler US with color flow study

300
Q

Blue colored round mass on testicular surface resembling a blue dot

A

Torsion of appendix testis

301
Q

Where does spermatogenesis take place

A

Seminiferous tubules of testes

Require 3 months to mature

302
Q

Testes function

A

Production of testosterone/androgens stimulated by LH

Spermatogensis stimulated by testosterone and FSH

303
Q

Epididymis

A

Located in posterior aspect of testis; storage area for immature sperm

304
Q

Vas deferens

A

Transport sperm from epididymis to urtethra

This is cut in a vasectoy

305
Q

Cremasteric reflex

A

Testicle elevates up in response to stroking thigh

Absent in testicular torsion

306
Q

Risk factors for prostate CA

A

> 50, AA, obesity, family history

307
Q

Tx for BPH

A

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
Q

Chronic bacterial prostatitis

A

> 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
Q

Acute onset high fever and chills, perineal pain may radiate to back, UTI sx

A

Acute prostatitis
DRE: extremely tender prostate that is warm and boggy
LABS: leukocytosis with left shift, increased WBC in UA and hematuiia

310
Q

Tx acute prostatitis

A

<35: ceftriaxone IM + doxy X10 days (tx like STD)

>35: cipro or levaquin 4-6 weeks

311
Q

Acute onset swollen red scrotum painful with unilateral testicular tenderness with urethral discharge green and purulent

A

Acute bacterial epididymitis

Relief of pain with scrotal elevation

312
Q

tx acute bacterial epididymitis

A

<35: doxy and IM ceftriaxone (tx like STD)
>35: Ofloxacin or levaquin X 10 days
Scrotal elevation + bed rest

313
Q

Chronic scaly red rash resembling eczema starting on nipple and spreading to areola

A

Paget disease of breast

314
Q

No period for 6-7 weeks, lower abdominal/pelvic pain worse when supine

A

Ectopic pregnancy

315
Q

Where is majority of breast CA located

A

Upper outer quad of breasts: tail of spence

316
Q

Heavy bleeding, pelvic pain, bleeding between periods

A

Fibroids

Usually benign

317
Q

Acne, hirsutism, oligomenorrhea, insulin resistance

A

PCOS

318
Q

Palpable ovary in menopausal woman

A

always abnormal

Order US

319
Q

Follicular phase

A

Days 1-14

FSH stimulates eggs to produce estrogen which stimulates growth of endometrial lining

320
Q

Ovulatory phase

A

Day 14

LH produces ovulation ; follicle migrates into fallopian tube

321
Q

Luteal phase

A

Days 14-28

Progesterone produced; sitimulates stability of endometrial lining

322
Q

Menstruation

A

Estrogen + progesterone drop dramatically

323
Q

Drugs that decrease efficacy of birth control

A

Phenytoin, phenobarb, griseofulvin, itraconazole, ampicillin, tetracyclines, rifampin

324
Q

Depo return of fertility

A

Can decrease for up to 1 year due to severe uterine atrophy

325
Q

Low dose OCP contains how much estrogen

A

20-25mcg ethinyl estradiol

326
Q

Mefenamic acid

A

NSAID very effective against menstrual pain

327
Q

Tx PCOS

A

OCP, spirinolactone, metformin (induces ovulation)

328
Q

Tx osteoporosis

A

Biphosphanates: alendronate

-Take with full glass of water sitting up and do not chew tablets

329
Q

Tx bacterial vaginosis

A

Metronidazole X 5 days

330
Q

Tx candidal vaginitis

A

Monistat OTC or diflucan 1 dose

331
Q

Tx Trich vaginitis

A

Flagyl X 7 days

Treat partner also

332
Q

Growth charts

A

WHO until 2 years old and then CDC

333
Q

Microcephaly with shortened palpebral fissures with epicanthal folds and flat nasal bridge and smooth philtrum

A

FAS

334
Q

Cryptorchidism

A

Undescended testes

Increased risk of testicular CA

335
Q

Tx chalmydia pneumonia

A

Erythromycin X2 weeks

336
Q

White 1-2mm papules commonly on nose or cheeks that resolves spontaneously

A

Milia

337
Q

Small pustules surrounded by red base that resolves spontaneously

A

Erythema toxicum neonatorum

338
Q

Faun tail nevus

A

Tufts of hair on spinal column; may be sign of spina bifida

Order US

339
Q

Nevus flammeus

A

Port wine stain

340
Q

Weight gain 0-6 months

A

6-8oz per week and 1in per month

341
Q

Weight gain 6-12 months

A

3-4oz per week and 1/2in per month

342
Q

Caput succedoneum

A

Crosses midline

Normal

343
Q

Cephalohematoma

A

Does not cross midline

Abnormal

344
Q

White papules found on gum line resembling an erupting tooth

A

Epstein’s Pearls

345
Q

moro reflex disappears by

A

3-4 months

346
Q

Step reflex disappears by

A

6 weeks

347
Q

Rooting reflex disappears by

A

3-4 months

348
Q

4 month development

A

Social smile, holds head steady, rolls front to back

349
Q

6 month development

A

Palmar grasp, reaches, passes objects, sits independently, rolls both directions, consonants

350
Q

9 month development

A

Pincer grasp, waves, feeds self, pulls self to stand, crawls and cruises, peek a boo, stranger anxiety

351
Q

12 month development

A

Sippy cup, stands, walks, 2-4 words, knows name

352
Q

15 month developemnt

A

Feeds self with spoon, drinks from cup, 4-6 words

353
Q

18 months

A

Turns pages of book, walks up steps, points to 4 body parts, 10-20 words

354
Q

Physiologic jaundice

A

Neonatal unconjugated hyperbili
Bili >5
Starts after 24 hours and clears within 2-3 weeks

355
Q

Breast milk jaundice

A

Onset >7 days
Can take 2-3 weeks to clear
Due to decreased breast milk production
Tx: phototherapy

356
Q

Dx for coractation of aorta

A

Absence of femoral pulse when compared to brachial pulse

357
Q

Ortolani test

A

Click or clunk sound is + finding

358
Q

Barlow test

A

Clunk sound on palpating trochanter

359
Q

Abdominal mass that is fixed, firm, irregular

Frequently crosses midline

A

Neuroblastoma
50% present with metastasis
Imaging: US
May have weight loss, fever, racoon eyes, bone pain

360
Q

Asymptomatic abdominal mass that is nontender and smooth

Rarely crosses midline

A

Nephroblastoma–Wilms tumor
Most common renal malignancy in children
Palpate GENTLY

361
Q

Prophylaxis for epiglottitis

A

Rifampin

362
Q

Top 3 CA in children

A

Leukemia, brain or nervous system, neuroblastoma

363
Q

2 year old development

A

2-3 word sentences
Stacks 6 cubes
Can copy straight line, runs, jumps, climbs, temper tantrums, says no

364
Q

3 year old development

A

3-5 word sentences
Knows age and sexual identity
Magical thinking
Copies circle, throws ball, stacks 9 cubes, rides tricycle

365
Q

High fever and enlarged lymph nodes in neck, bright red rash, conjunctivitis, strawberry tongue, edema

A

Kawasaki disease

366
Q

Tx kawasaki disease

A

High dose aspirin and gamma globulin

Follow up in cardiologist for several years

367
Q

Extreme fatigue and weakness, pale skin, easy bruising, petechial bleeding, bleeding gums and noses

A

Leukemia

368
Q

Most common type of leukemia

A

ALL

369
Q

Hx of febrile illness with salicylate intake

A

Reyes syndrome

370
Q

Mortality rate of reyes syndrome

A

50%

371
Q

Stage 1 reyes syndrome

A

Sever vomiting, diarrhea, lethargy, increased AST and ALT

372
Q

Stage 2 reyes syndrome

A

Personality changes, aggression

373
Q

Stage 3-5 reyes syndrome

A

Confusion, delirium, coma, death

374
Q

Large head circumference, mental retardation, delayed physical development, hyperactive

A

Fragile X

375
Q

Acute onset fever, severe sore throat, HA, multiple small blisters on hands and feet; ulcers in mouth and on tonge

A

hand foot and mouth

376
Q

Initial test for testicular torsion

A

Doppler US

377
Q

Precocious puberty girls

A

<8 years

378
Q

Delayed puberty girls

A

No breast development by age 12

379
Q

Precocious puberty boys

A

<9

380
Q

Delayed puberty boys

A

No testicular growth by age 14

381
Q

Tanner stages boys

A

2: Testes enlarge
3: Penis elongates
4: penis thickens and increases in size
5: adult

382
Q

Tanner stages girls

A

2: breast bud
3: breast mound
4: areola/nipples separate to form 2nd mound
5: adult

383
Q

Primary amenorrhea

A

No menarche at age 15; usually due to chromosome disorder

384
Q

Secondary amenorrhea

A

no menses for 6 months; most common cause is pregnancy

other: ovarian disorder, stress, anorexia, PCOS

Leik Review Book (2 decks)

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