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Crash Course Flashcards

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1
Q

What is the other name for canker sores

A

Apthous Stomatitis

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2
Q

What is the primary difference of location between apthous stomatitis and herpes

A

AS is typically inside the mouth while herpes is usually outside mouth/on lips

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3
Q

Ideal timeframe to begin treatment for oral herpes

A

48-72 hours

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4
Q

What is a chronic form of apthous stomatitis?

A

chronic ulcerative stomatitis (CUS)

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5
Q

What causes chronic ulcerative stomatitis

A

it is an autoimmune disorder but can be caused by lichen planis

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6
Q

What is the difference between CUS and apthous stomatitis

A

CUS lesions are larger in size and number and can take weeks to months to resolve

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7
Q

How to treat CUS

A

oral steroids and hydroxyfluroquin

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8
Q

What is keratosis pilaris commonly called

A

“chicken skin”

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9
Q

How to treat keratosis pilaris

A

emollients and moisturizers
(this condition is commonly outgrown)

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10
Q

What is the classic look of impetigo?

A

Honey crusted or yellow tinged lesions

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11
Q

What are the two most common bacterial causes of impetigo?

A

-Strep pyogenes
-Staph aureus

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12
Q

How to treat bollous impetigo

A

must have oral abx (keflex, dicloxacillin, doxy)

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13
Q

How to treat non-bollous impetigo

A

topical mupuricin ointment (bactroban)

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14
Q

What has a classic “christmas tree” pattern with a “herald patch”

A

Pityriasis rosea

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15
Q

Treatment for pityrasis rosea?

A

it usually self resolves

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16
Q

What does a brown recluse spider bite look like

A

-Deep purple spot with white halo around it
-VERY tender

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17
Q

How to treat rocky mountain spotted feaver

A

doxycycline

(even if pregnant or a kid)

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18
Q

When/where does the rash develop after a bite in rocky mt spotted fever

A

Starts 3-5 days after initial s/s and starts on palms and soles initially

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19
Q

What is erythema migrans

A

lyme disease

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20
Q

What does the rash of erythema migrans look like

A

“bulls eye” lesion

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21
Q

How to treat erythema migrans or lyme disease

A

1st- doxycycline
2nd- amoxicillin if pregnant or allergy to doxy

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22
Q

What is the other name for measles

A

Rubeola

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23
Q

What are the three distinguishing signs or symptoms of rubeola (measles)

A

“The three C’s”
-Cough
-congestion
-conjnctivitis

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24
Q

When does the rash develop in rubeola (measles)

A

3-5 days after the “3 C’s”

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25
Q

What are the oral lesions in rubeola (measles) and what do they look like

A

-Koplik spots
-Look like grains of sand with a red halo
-starts 3-5 days after the 3 c’s with the rash

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26
Q

How to prevent rubeola (measles)

A

vaccination at 12mo (live vax)

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27
Q

What is the most common symptom of mumps?

A

parotid gland swelling
“mumps with a jaw bumps”

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28
Q

Describe atinic keratosis

A

-dry, scaly lesion
-sun exposed area
-pink, yellow, tan, pale, brown in color

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29
Q

Treatment for atinic keratosis

A

– 5-FU (fluroicil)
– cryotherapy

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30
Q

What does actinic keratosis commonly lead to if untreated

A

squamous cell carcinoma

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31
Q

Describe squamous cell carcinoma

A

-red, scaly “crusty
-Bleeds easily
-sun exposed area

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32
Q

How to diagnosis squamous cell carcinoma

A

-biopsy

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33
Q

What do cafe au laid spots look like

A

-flat areas of darkened skin

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34
Q

if the patient has more than 6-8 cafe au lait spots, what other dx needs to be considered

A

-neurofibromatosis

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35
Q

What skin condition is usually described as “stuck on” brown spots

A

seborrheic keratosis which is benign

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36
Q

Describe basal cell carcinoma

A

-Telangiectasias (visible vessels)
-Shiny, waxy, pearly

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37
Q

Most common type of skin cancer

A

Basal Cell
(most common spice)

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38
Q

What to do if we suspect basal cell carcinoma

A

-Biopsy and refer to derm for removal

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39
Q

What is the other name for eczema

A

Atopic dermatitis

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40
Q

Describe atopic dermatitis

A

-flexor surfaces
-The itch that rashes

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41
Q

How to treat atopic dermatitis

A

-Emollients
-Topical steroids

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42
Q

What are the three a’s that commonly come together (atopic triad)

A

-atopic dermatitis
-asthma
-allergies

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43
Q

Describe plaque psoriasis

A

-Thick silvery scales
-Auspitz sign
-Koebner’s phenomenon

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44
Q

What is Auspitz sign

A

When plaque psoriasis lesions are scratched and pinpoint bleeding occurs

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45
Q

What is Koebner’s phenomenon

A

When trauma to the skin produces new lesions in plaque psoriasis pts

“Koby is always hurting himself”

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46
Q

How to treat plaque psoriasis

A

-topical steroids
-coal tar
-derm referral

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47
Q

When to start acyclovir for shingles

A

within 48-72 hours

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48
Q

How to treat contact dermititis

A

-topical steroids
-avoid irritant

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49
Q

Describe shingles

A

-follows across a dermatome
-vesicular
-proceeded by burning/tingling

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50
Q

Describe stage one pressure ulcer

A

Skin is intact but non-blanching

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51
Q

How to treat stage one pressure ulcer

A

Foam dressing- cushions the area

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52
Q

When is a pressure ulcer unstageable

A

when you cant see the wound bed

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53
Q

When is eschar on heels good?

A

-no s/s of infection
-seals out bacteria in DM pts

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54
Q

S/S of scabies

A

-Very itchy (everyone in house)
-Marks between fingers

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55
Q

How to treat scabies

A

Treat everyone with permethrin cream and wash everything in HOT water

(treat x2 often needed)

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56
Q

What is varcella

A

chicken pox

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57
Q

How is varcella often described

A

“lesions in various stages of healing”

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58
Q

When can kids with varcella return to school

A

when all lesions have crusted over

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59
Q

When is the varcella first given

A

at 12mo (live)

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60
Q

S/s of head lice

A

-itching of scalp day and night

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61
Q

Lice treatment

A

-Permethrin cream kills live ones
-Comb nits/eggs out
-wash everything in HOT water

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62
Q

Describe a molluscum contagiosum lesion

A

-flesh colored
-indent in the middle of lesion (umbillicated)

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63
Q

How to treat molluscum contagiosum lesions

A

-they self resolve
-consider sexual abuse if in the genital region on a kid

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64
Q

Describe antrax lesion

A

-ulcerated
-black
-painless

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65
Q

who might you see anthrax in

A

cattle farmers

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66
Q

how to treat anthrax

A

1st- ciprofloxacin
2nd- tetracyclines (doxy)

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67
Q

Risks of hidradenitis suppurativea

A

-obesity
-smoking
-genetics

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68
Q

Common areas for hidradenitis suppurativa

A

-groin
-thighs
-axilla
-breast folds

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69
Q

How to treat HS

A

Mild- warm comprsses
Severe- I&D, culture

Abx if infection is suspected

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70
Q

What is folliculitis

A

infection of the hair follicle plus surrounding skin

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71
Q

How to treat folliculitis

A

-Usually self resolves
-Warm compresses
-topical mupuricn ointment (bactroban)
-oral abx if severe (keflex, pcn)

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72
Q

Describe the rosacea rash

A

A facial rash that does NOT spare the nasal fold

(you dont spare your nose when smelling a rose)

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73
Q

How to treat rosacea

A

Metronidazole gel

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74
Q

Describe lupus rash

A

“mallar rash” or butterfly rash that does spare the nasal folds

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75
Q

What symptoms are consistent with sjogren’s syndrome

A

-dry eyes and mouth

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76
Q

what is erysipelas

A

a more superficial form of cellulitis

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77
Q

Describe erysipleas

A

-sharply defined/well demarcated borders
-superficial redness

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78
Q

How to treat erysipleas

A

-keflex
-PCNs

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79
Q

How to treat purulent cellulitis

A

(could be MRSA)
-Bactrim
-Clindamycin
-Doxycycline

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80
Q

How to treat non-purulent cellulitis

A

-Keflex
-PCNs

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81
Q

First line acne treatment

A

-Topical benzynol peroxide

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82
Q

Second line acne treatment

A

-topical abx (clindamycin)
-Topical retinoids (tretoinin)

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83
Q

Third line acne tx

A

oral abx (doxy)

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84
Q

4th line acne tx

A

-derm referral

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85
Q

What is the black box warning associated with isotretoinin

A

YOU CANNOT GET PREGNANT

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86
Q

What must you wear with tetracyclines?

A

SUNSCREEN

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87
Q

what can cause a geographical tongue

A

Spicy/hot foods

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88
Q

Can you scrape off oral candidiasis

A

yes

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89
Q

What disease causes “slapped cheeks”

A

Fifth’s disease

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90
Q

How do pts with fifth’s disease present

A

-Fever first
-Slapped cheeks rash
-lacy, net-like rash across body

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91
Q

When is a pt with fifths disease no longer contagious

A

when the rash APPEARS

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92
Q

Who needs to stay away from those with fifths disease?

A

pregnant people- fetal demise and miscarrage

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93
Q

what is enterobiasis

A

pin worms

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94
Q

s/s of enterobiasis

A

very itchy genital region at night

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95
Q

how to treat enterobiasis

A

mebendazole, abendazole
OTC pyrental pamoate

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96
Q

How to dx enterobiasis

A

scotch tape test

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97
Q

Abx for animal bites

A

augmentin

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98
Q

What is amblyopea

A

“lazy eye”

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99
Q

What is 20/200 vision

A

legal blindness

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100
Q

First step with any pt that comes in with a visual complaing

A

test acuity

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101
Q

what usually causes amblyopea

A

strabismus

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102
Q

what tests for color blindness

A

-anomaloscope
-ishihara chart

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103
Q

What cranial nerves are associated with the eye

A

II
III
IV
VI

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104
Q

CN II

A

optic- visual acuity

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105
Q

CNIII

A

oculomotor- focus

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106
Q

CNIV

A

trochler- downward and inward mvts

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107
Q

CN VI

A

abducens- outward mvt and side to side mvt

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108
Q

Which are lighter on fundoscopic exam arteries or veins

A

retinal arteries are thinner and lighter than veins

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109
Q

Describe a normal optic disc

A

-Sharp margins

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110
Q

What is papillidema

A

swelling of the optic disc- refer!

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111
Q

What fundoscopic exam findings are associated with HTN

A

-Papilledema
-AV nicking
-copper wire arteries
-flame hemmorrhages

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112
Q

What fundoscopic exam findings are associated with DM

A

-cotton wool spots
-blot hemorrhages
-microanurysms
-neurovascularazation

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113
Q

What are copper wire arteries on fundoscope

A

when the arteries look red

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114
Q

what is AV nicking on fundoscope

A

when an artery crosses a vein causing it to bulge at the intersection

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115
Q

what is neovascularization on fundoscope

A

formation of new tiny blood vessels

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116
Q

Describe the S/S of acute angle-closure glaucoma

A

-sudden SEVERE pain
-blurred vision
-eye feels firm (tonometry with increased IOP)

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117
Q

What is someone with acute angle glaucoma at risk of

A

blindness- refer to ED

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118
Q

Describe typical description of a retinal detachment

A

-“curtain being pulled over eye”
-Painless
-Frequent flashes/floaters/blurred vision

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119
Q

What are pts with retinal detachment at risk of

A

blindness- refer to ED

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120
Q

What is arcus senilis

A

grey halo around iris

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121
Q

What is xanthelasma

A

-yellow patches near corner of eye

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122
Q

When is xanthelasma considered benign

A

in old folks

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123
Q

how does cholesterol concerns present in the eye

A

-arcus senilis
-xanthelasma

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124
Q

What is the med term for pink eye

A

edenoviral conjuctivitis

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125
Q

Where is a pterygium

A

-encroaches on the corneaa

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126
Q

Where is a pinguecula

A

does NOT extend into the cornea

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127
Q

What is a chalazion and how to treat

A

-A blocked duct
TX: Warm compress

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128
Q

what causes a horeolum and how to treat

A

-Caused frequently by staph

-TX: warm compresses and abx

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129
Q

Which type of conjunctivitis starts bilaterally

A

allergic

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130
Q

Which type of conjunctivitis will have cervical lymphadenopathy

A

allergic

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131
Q

which type of conjunctivitis has serous and stringy drainage

A

allergic

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132
Q

Which type of conjunctivitis has purulent drainage

A

bacterial

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133
Q

Which conjunctivitis has preauricular and submandibular lymphadenopathy

A

viral

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134
Q

which type of conjunctivitis has no w`1

A

bacterial

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135
Q

what is leukoria

A

white reflex

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136
Q

when might you see leukoria

A

with cataracts

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137
Q

what is presbyopia and when does it usually begin

A

age related vision loss starting after 40

They will often state “my arms are too short”

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138
Q

What eye concern is often associated with bells palsey

A

corneal abrasions because they cannot close their eye- LUBE!

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139
Q

how to dx a corneal abrasion

A

-florascene stain
-tonometry if we need to R/O AAG

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140
Q

How would a pt with iritis present

A

-eye pain that is light sensitive
-poor visual acuity
-inflammation and swelling of the iris

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141
Q

how to treat iritis

A

refer! risk for blindness

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142
Q

How would a patient present with a cranial tumor

A

-dull persistent headache that is always in the same spot
-N/V
-Vision changes
-Behavioral/personality changes

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143
Q

How to DX cranial tumor

A

head CT

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144
Q

When will symptoms of a TIA vs Stroke dissapear

A

within one hour

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145
Q

What causes wernicke-korsakoff syndrome

A

-alcoholism related B1 vitamin deficiency (thiamine)

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146
Q

Which type is wernickes

A

receptive

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147
Q

which type is broca’s

A

expressive

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148
Q

Evaluation of stroke pts

A

“BE FAST”

-balance
-eyes
-face
-arm
-speech
-time

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149
Q

Describe a cluster headache presentation

A

-one sided
-tearing/runny nose
-occurs around same time daily

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150
Q

Cluster HA tx

A

-100% 02
-CCBs (verapimil)
-Imatrex?

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151
Q

How to definitively dx temporal arteritis

A

bx

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152
Q

What can temporal arteritis lead to

A

blindness

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153
Q

What is temporal arteritis also called

A

giant cell arteritis

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154
Q

Describe temporal arteritis s/s

A

-One sided HA
-possible visual impairment
-temple pain/pulsing
-increased ESR on bloodwork

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155
Q

Tx or giant cell arteritis

A

long term oral steroids

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156
Q

What condition is commonly associated with giant cell?

A

polymyalgia rheumatica

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157
Q

Describe a HTN HA

A

-occipital HA
-typically present upon awakening

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158
Q

How to tx HTN HA

A

-change or add meds

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159
Q

Describe migraine s/s

A

-difficulty with noise and light
-trobbing/pulsating
-N/V
-aura prior

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160
Q

What are the migrane abortive meds and who are they contraindicated in

A

-triptans

-Contraindicated in pts with uncontrolled HTN and those taking SSRIs

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161
Q

Which neurotransmitter is the issue with parkinsons

A

dopamine

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162
Q

What are the three main symptoms in parkinsons

A

-bradykanesia (most debilitating)
-tremors
-ridigity

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163
Q

What is the main tx of parkinsons

A

levodopa/carbadopa

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164
Q

Which two tests are helpful to dx meningitis

A

-brudzinski’s
-Kernig’s

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165
Q

Positive brudzinski’s

A

“B=Back of head”

Flexing back of head causes knees and legs to also flex

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166
Q

positive kernig’s

A

“K=Knee”

-Cant extend knee past 90 degrees without severe pain

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167
Q

What are the three “A”s associated with alxheimers

A

–Apraxia- inability to carry out skilled movements
–Aphasia
–Agnosia- inability to name objects/people

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168
Q

What is the overall goal of alzheimers tx

A

-slow progression

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169
Q

What tool is most often used to assess alzheimers

A

MMSE

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170
Q

CN order mnemonics

A

oh oh oh to touch and feel a great vein, ah heaven

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171
Q

CN function mnemonic

A

some say marry money but my brother says big brains matter more

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172
Q

Which nerve is associated with trigeminal neuralgia

A

the trigeminal- CN V

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173
Q

S/S of trigeminal neuralgia

A

-severe stabbing pain in the face (so severe that these folks are at risk of suicide)

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174
Q

First line treatment for trigeminal neuralgia

A

-tegretol (carbamazepine)
-Is an anticonvulsant

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175
Q

which CN is associated with bells palsey

A

CN VII

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176
Q

which two test assess CN VIII

A

Rinne and weber

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177
Q

Normal Rinne finding

A

air is 2x longer than bone conduction

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178
Q

Abnormal rinne finding

A

Bone conduction is longer than air

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179
Q

Normal weber finding

A

no lateralization to either ear

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180
Q

abnormal Weber finding

A

lateralization to either ear

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181
Q

S/S of meinere’s disease

A

-vertigo
-tennitus
-ear pressure
-nystagmus

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182
Q

Biggest concern with minere’s disease

A

risk for permanent hearing loss

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183
Q

Why do most pts stop SSRI/SNRI

A

-sexual dysfunction
-wt gain

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184
Q

What supplement can be used to treat depression

A

St Johns wart

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185
Q

When is St Johns wart contraindicated

A

with any other serotonin meds!

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186
Q

S/S of serotonin syndrome

A

-shivering
-shaking
-seizures
-tachy
-aggitation

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187
Q

What to do in no change in PHQ after starting SSRI 4-6 weeks ago

A

increase dose or look for other cause

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188
Q

Advise if N/V on SSRI/NRI

A

GI symptoms usually self resolve in a few weeks

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189
Q

When to try to taper off SSRI/NRI

A

Stay on for at least 6mo when well controlled

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190
Q

How to approach suicidal ideation

A

-be straight forward
-Ask about plan and refer for 72 hour hold if they do

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191
Q

Which SSRI should be avoided in the elderly and why

A

-Fluoxetine (prozac) because it has a very long half-life
- Tticyclics- anticholinergic SEs

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192
Q

Why are TCAs not first line for depression

A

Lots of anticholinergic SEs
(doxepin, nortriptyline, amitriptyline)

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193
Q

Which two antidepressants are safest in the elderly

A

-Sertraline
-Escitalopram

Both have safe SE profiles

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194
Q

Which SSRI is most sedating

A

Paxil (paroxetine)

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195
Q

Which SSRI should be avoided in an anxious patient and why

A

Fluoxetine (prozac)- it can produce jitteriness

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196
Q

Biggest SEs of ziprexa and seroquel?

A

-Wt gain
-Increase hyperlipedemia
-Get a lipid, BG and wt prior to initiating

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197
Q

Describe the two phases of bipolar

A

Mania- no sleep, impulse issues, over excitement

Depression- lack of motivation

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198
Q

What is commonly used to treat bipolar

A

Lithium

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199
Q

what is the therapeutic range for lithium

A

0.5-1.2

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200
Q

What are some issues with lithium

A

-Very narrow therapeutic range
-Long term SEs
-Induces hypothyroidism with long term use

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201
Q

S/S of PTSD

A

-nightmares
-hypervigilance
-exaggerated startle
-flash backs
insomnia

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202
Q

first line tx for PTSD

A

SSRIs but poorly researched

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203
Q

Tx for seasonal affective disorder

A

more light

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204
Q

Which enzyme pathway is responsible for why we cant give SSRI with st. johns wart

A

CYP3A4

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205
Q

Which pathway impacts an asian’s ability to metabolize pain meds and reduce their effectiveness

A

CYP2C19

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206
Q

What is the ASCVD risk cutoff for initiating a statin

A

7.5%

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207
Q

Normal total cholesterol

A

<200

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208
Q

Normal HDL

A

40-60

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209
Q

Normal LDL

A

<100

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210
Q

Normal triglycerides

A

<150

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211
Q

How often to check lipids if no risk factors present

A

Q5y

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212
Q

How often to recheck lipid after initiating statin

A

Q1-3m then yearly

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213
Q

Which two HMG CoA reductase inhibitors can be high intensity

A

atorvastatin and rosuvastatin

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214
Q

S/S to watch for with statins

A

-new muscle pain (check CK, stop statin, can lead to acute renal failure)

-S/S of jaundice (draw LFT)

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215
Q

What dietary thing to avoid with statins

A

grapefruit juice

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216
Q

When should you be concerned with triglycerides

A

when it is over 500

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217
Q

When triglycerides are over 500, what to tx and why

A

fenofibrate to prevent pancreatitis

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218
Q

JNC8 HTN goal

A

<140/90

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219
Q

When to initiate treatment in those older than 60? for the JNC8

A

> 150/90

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220
Q

Goal for AHA/ACC

A

<130/80

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221
Q

Stage 1 HTN treatment with ASCVD cutoff for AHA at

A

10%

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222
Q

ACE monitoring

A

-Renal function: GFR, BUN, Creat
-K+ (at risk for hyperkalemia)
-Watch for angioedema and cough

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223
Q

When do we switch to an ARB

A

when they fail an ACE (me)

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224
Q

TZD is bad for who?

A

-DM (increase BG)
-Gout (increases uric acid)
-Hyperlipidemia (increases triglycerides)

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225
Q

Which pt is a thiazide particularly good for?

A

those with osteoporosis because it stimulates osteoblasts and Ca+ retention

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226
Q

Typical SE of CCB

A

-ankle edema
-HAs
-Worsens GERD symptoms (relaxes sphincter)

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227
Q

Renal protective antiHTN

A

ACEi

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228
Q

What BP meds are safe in pregnancy

A

“New Little Momma”
-Nifedipine
-Labetaolol
-Methyldopa

(do not give ACE, ARB, Statins, Methotrexate)

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229
Q

What are the two most common causes of CKD

A

HTN and DM

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230
Q

What is ideal for isolated systolic hypertension in the elderly

A

(caused by stiffening of blood vessels)

CCB because it relaxes the smooth muscle

(Apparently Tzds as well)

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231
Q

What is it called when there is a variance in inspiration and expiration?

A

respiratory sinus arrhythmia

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232
Q

In what population is respiratory sinus arrhythmia common in

A

-Associated with young and healthy people
-Doesnt need treatment

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233
Q

What is pulsus paradoxus

A

When there is a 10+pt drop in systolic BP upon inspiration

-EMERGENCY as it can indicate a cardiac tampanaude or status asthmaticus

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234
Q

Why are CCBs not recommended in HF?

A

decreases the force of contraction

(they should also DC NSAIDS as it increases Na+ retention)

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235
Q

Diagnostic HF labs/tests

A

-BNP
-EKG
-CXR- cardiomegaly
-Echo- measures EJ

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236
Q

what is the ejection fraction in those with HF

A

<40 is HF

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237
Q

What kind of sound will you hear with HF

A

S3 (associated due to fluid overload)
(also heard in pregnancy)

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238
Q

Why are TZDs and CCBs not used in HF?

A

both cause edema

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239
Q

When should a HF pt call you with increased weight

A

if they gain more than 2kg per day

(increase/add a diuretic)

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240
Q

Why avoid NSAID with HF?

A

Encourages Na+ retention

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241
Q

A fib is the 1# risk for what

A

clot, stroke

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242
Q

Describe ekg of a-fib

A

irregularly irregular with NO P wave

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243
Q

What two meds will a chronic A-fibber be on

A

-Anticoags- stroke prevention
-BBlocker for rate control

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244
Q

Normal INR for those not on antigcoag

A

around 1

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245
Q

Therapeutic INR on warfarin

A

2-3

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246
Q

Antidote for warfarin

A

Vitamin K

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247
Q

When to give Vitamin K

A

-Active bleeding
-INR over 10

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248
Q

How to treat raynaud’s?

A

-CCB (relaxes small vessels)
-Avoid triggers (cold, stress)

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249
Q

Order of valve

A

Aortic
pulmonic
tricuspid
mitral

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250
Q

What makes the S1 sound

A

-Closure of the mitral and tricuspid valves (AV)

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251
Q

What makes an S2 sound

A

Closure of the semi-lunar valves: aortic and pulmonic

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252
Q

Which is the only sound heard at the base of the heart

A

S2

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253
Q

When is the S3 heard

A

in cases of fluid overload like HF and Pregnancy

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254
Q

When is an S4 heard

A

In uncontrolled HTN with left ventricular hypertrophy

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255
Q

When is a split S2 NORMAL

A

-on INSPIRATION only

Abnormal if heard on inspiration and expiration (REFER)

256
Q

nemonic for systolic murmurs

A

“Mr. Peyton Manning As MVP”

257
Q

nemonic for diastolic murmurs

A

“ARMS”

258
Q

What are the systolic murmurs

A

“MR”- Mitral Regurgitation
“Peyton Manning”- Physiologic Murmur
“AS” - Aortic stenosis
“MVP”- mitral valve prolapse

259
Q

What are the diastolic murmurs

A

“ARMS”
AR- aortic regurgitation
MS- mitral stenosis

260
Q

Three steps for murmurs

A

1) systolic or diastolic
2) WHERE
3) associated symptoms

261
Q

Which type of murmurs radiate?

A

ONLY SYSTOLIC

262
Q

Which murmurs are worst

A

diastolic = Doom

263
Q

Which murmur radiates to the neck

A

Aortic stenosis (is systolic, closest to neck)

264
Q

Which murmur radiates to the arm pit

A

Mitral regurgitation (is systolic and close to the arm)

265
Q

What grade of murmur will have a palpable trill?

A

Grade 4

266
Q

S/S of intermittent claudication and what disease is it associated with

A
  • Pain relieved with rest and dangling
    -Associated with PAD
267
Q

S/S of PAD

A

-purple/hyperpigmented legs
-shiny legs
-Toe ulcerations

268
Q

Diagnostic test for PAD

A

Ankle bracheal index of < 0.9
Ankle/arm=ABI

269
Q

Biggest risk factor for PAD

A

smoking

270
Q

Treatment for PAD and intermittent claudication

A

continue to walk

271
Q

s/s of venous insufficiency

A

-red/brown color legs
-edema

272
Q

what are chronic venous insufficiency pts at risk for?

A

DVT due to poor venous return and blood pooling

(get doppler and D-dimer)

273
Q

Most common asthma symptom

A

cough

274
Q

Order of asthma severity

A

-intermittent
-mild
-moderate
-severe

275
Q

How to measure treatment success in asthma

A

-peak flow monitoring

-success is not based on rescue inhaler use

276
Q

Which asthma med do we NEVER give alone and why

A

-LABAs
-They MUST always be combined with an ICS!!!! risk for sudden death

277
Q

What three things impact peak flow

A

“HAG”
-height (largest predictor in adults)
-age
-gender

(peds considers weight as well)

278
Q

What is NOW the cornerstone of asthma treatment

A

low lose ICS (budesonide)

279
Q

What is NOW the preferred rescue inhaler?

A

ICS with LABA?????????

280
Q

Ending for all bronchodialators?

A

“-terol” (like albuterol!)

281
Q

Ending for ICS

A

“-ide” (budesonide)
“-sone” (fluticasone)

282
Q

Treatment foe intermittent asthma

A

ICS+LABA PRN

(PRN rescue med)

283
Q

Tx for mild asthma

A

Low dose ICS daily

+ ICS/LABA rescue

284
Q

Tx for moderate asthma

A

ICS/LABA daily
or
ICS and monalucast

ICS/LABA= budesonide/fomotrol

285
Q

COPD is a combo of what two diseases

A

chronic bronchitis
emphysema

286
Q

How to Dx COPD

A

FEV1/FVC of less than 0.7 or 70%

287
Q

s/s of COPD

A

-barrel chest
-clubbing of fingers
-chronic cough
-hyperresonance

288
Q

Treatment groups for COPD

A

A, B, C, D

289
Q

Medication flow for COPD meds

A

SABA, LABA, LAMA, COMBO

A- SABA
B- LABA
C- LAMA
D- LAMA or combo (lama-ICS)

290
Q

What should you be concerned about if a pt with COPD loses weight??

A

-investigate for lung CA
-Could also be that they are just burning so many calories from work of breathing

291
Q

Antibiotics for PNE in healthy, outpt adults

A

“MAD”
-Macrolide (azithromycin)
-Amoxicillin
-Doxycycline

292
Q

s/s of PNE

A

-Cough/ronchi/wheezing
-Fever
-Chills
-Increased tactile fremitus

293
Q

Treatment for PNE with comorbidities or Abx in the last 90 days

A

-Respiratory fluoroquinolones (levofloxacin)

or

-Augmentin (amoxacillin clavulanic acid) plus a macrolide (azithromycin)

CIPRO IS NOT A RESPIRATORY FLUOROQUINOLONE

294
Q

What are the CURB criteria and how many points send the pt to the hospital

A

-Confusion
-Urea (BUN) >19
-Respiratory rate over 20-30
-BP <90/60
-Age over 65

Each is one point, admit if over 3

295
Q

Where will you see infiltrates for TB

A

upper lobes

(lower in PNE)

296
Q

At what induration on the TB skin test is positive for those with HIV, exposed, or immunocompromised?

A

> 5mm

297
Q

At what induration on the TB skin test is positive for immigrants

A

> 10mm

298
Q

At what induration is considered positive for TB in the general/healthy population

A

> 15mm

299
Q

How to confirm TB

A

-sputum cultures

300
Q

When does HIV turn to AIDES

A

when CD4 is less than 200

301
Q

Untreated strep can lead to what

A

-rhumatic fever
-glomularnephritis

302
Q

How to treat strep

A

PCN

303
Q

How to treat mono

A

Symptom management

304
Q

When can a pt with mono go back to sports

A

-get spleen US first

305
Q

Why cant we treat a pt with strep and mono with amoxicillin?

A

PCN plus mono= morbilliform rash

-you can use Pen VK though
-Can also use macrolide or cephalosporin

306
Q

Key findigs in peritonsillar abcess

A

-large, erythematous, tonsil
-DEVIATED UVULA

307
Q

most common cause of peritonsillar abcess

A

strep

308
Q

What to do with a pt with a peritonsillar abcess?

A

-send to ED/ENT for drainage they can lead to sepsis and airway blockage

309
Q

most common cause of bronchitis

A

viral

310
Q

symptoms of bronchitis

A

chronic, nagging cough

311
Q

when to treat bronchitis

A

only if it is pertussus

Macrolides erythromycin, clarithromycin, and azithromycin* are preferred for the treatment

312
Q

What can chronic sinus infections lead to

A

nasal polyps

313
Q

S/S of sinusitis

A

-recent URI (7-10 days ago)
-Recurrence of symptoms
-pain when bending over
-unilateral toothache

314
Q

how to treat sinusitis

A

-amoxicillin or augmentin to prevent periorbital cellulitis

315
Q

Allergic rhinitis treatment

A

1st- intranasal corticosteroids
2nd- antihistamines

316
Q

normal TSH

A

0.5-5.0

317
Q

how often to recheck TSH after starting medicaiton

A

4-8 weeks

318
Q

Cardiac rate control for hyperthyroidism

A

BBlockers

319
Q

1st trimester antithyroid drug

A

-PTU

320
Q

2nd trimester antithyroid drug

A

-Tapazole

321
Q

Three antithyroid drugs

A

-PTU
-Methimazole
-Tapazole

322
Q

what does the parathyroid do

A

keeps Ca+ and Phosphorous levels balanced

323
Q

CA and phos in hyperparathyroid

A
  • increased CA and decreased Phos
324
Q

Ca and phos in hypoparathyroid

A

-decreased Ca and phos

325
Q

what is smogyi effect

A

(dip and rebound sugars)
There is a dip in the middle of the night and rises in the AM

326
Q

management of somogyi effect

A

-change night insulin dosing
-take a snack
-dont exercise before bed

327
Q

Dawn phenomenon

A

Blood glucose steadily rises all night due to an increase in nighttime hormones

common in kiddos going through a growth spurt

328
Q

ADA DM screening reccomendations

A

start at age 45 and q3y but those with risks should be screened earlier

329
Q

A!C diagnostic for DM

A

6.5

330
Q

max dose per day of metformin

A

2000-2550 per day (depends on which type)

331
Q

What can long term metformin lead to

A

B12 deficiency

332
Q

SE of metformin

A

GI upset (diarrhea) start low and go slow

333
Q

monitoring for metformin and when to change dosing

A

renal function

if less than <46 1/2 dose
if less than <30 DC

334
Q

avoid metformin in who and why

A

alcoholics- lactic acidosis risk
getting contrast- kidney damage

335
Q

chich medications are most likely to give you hypoglycemia

A

sulfonylureas

336
Q

which diabetic meds are considered cardio protective

A

SgLT2 (flozyn)
GLP-1

337
Q

Annual DM screenings

A

-podiatry
-optho
microalbumin
A1c

338
Q

at what A1c to start insulins

A

> 9%

339
Q

does metformin cause hypoglycemia?

A

NO

340
Q

which disease is too little cortisol

A

addisons

341
Q

which is too much cortisol

A

cushings

342
Q

s/s of addisons

A

-hyperpigmentation
-hyperkalemia (but everything else decreased)

343
Q

s/s cushings

A

-all labs are increased except K+
-moon face
-purple striae
-truncal obesity

344
Q

safety concerns with addisons

A

addisonian crisis which can happen anywhere so they must carry steroids anywhere

345
Q

how to Dx lupus

A

ANA alone is not enough but if ANA is positive with sterotypical symptoms it can be diagnostic

346
Q

what is the Lupus rash and describe

A

-Malar rash (butterfly) which DOES spare the nasolabial folds

347
Q

s/s of sjogrens syndrome secondary to lupus and how to treat

A

-dry mouth - gum
-dry eyes -eye gtts

348
Q

what organ is most beat up from lupus

A

kidneys- keep eye on renal function
lupus nephritis is a thing

349
Q

normal MCV level

A

80-100

350
Q

MCV <80 what type anemia and causes

A

microcytic

“LIT”
-lead
-iron
-thalassemia

351
Q

MVC of >100 what anemia and causes

A

Macrocytic

-folate
-b12

352
Q

Anemia type and why in alcoholics

A

macrocytic due to increase in b12 and folate deficiencies

353
Q

Neurologic symptoms in b12 deficiency anemia

A

-tingling hands and feet
-unsteady gait
-beefy red tongue (glossitis)

354
Q

What is MCV

A

side of red blood cells

355
Q

iron deficiency anemia s/s

A

-nail spooning
-pica
-pale
-fatigue

356
Q

how to dx sickle cell AND thalassemia

A

hemoglobin electrophoresis

357
Q

Two common causes of a sickle cell crisis

A

1) illness
2. dehydration

358
Q

how to manage sickle cell crisis

A
  • refer to ed for IVF and IV pain meds
359
Q

Positive HBsAg means

A

There IS an infection (acute or chronic)

Ag= always growing

360
Q

positive IgM means

A

M= misery this minute

Positive in an active acute infection

361
Q

Positive IgG means

A

G=Gone

Positive in an old infection which is over
except if the Ag is also +

362
Q

+ Ag and + G

A

chronic infection

363
Q

-Ag and + G

A

infection over but was there

364
Q

What to do to an exposed but unvacinated hep b

A

viccinate at gieve immunoglobulin

365
Q

Is the hep B vaccine safe in pregnancy?

A

YES

366
Q

What can thalassemia lead to and how to treat it??

A

-Hemacromatosis (Iron overload)
-Polycythemia vera (clotting risk)

Treat by blood letting!

367
Q

Causes for polycythemia vera

A

-thalassemia
-living at high altitudes
-COPD

368
Q

TNM staging

A

T= tumor size
N= nodes
M= metastasis

369
Q

Two types of cancers of the lymphatic system

A

Hodgkin’s and non hodgkins lymphoma

370
Q

Which is the most common type of lymphoma in adults

A

non-hodgkins

371
Q

S/S of lymphoma

A

-enlarged nodes
-fevers
-night sweats
-wt. loss
-fatigue

Workup with CBC

372
Q

two types of lukemia

A

CLL
CML

373
Q

CML cardinal symptoms

A

-spleen enlargement
-liver enlargement
-anemia

374
Q

when is leukemia commonly found

A

on routine blood count (VERY HIGH WHITE COUNT)

375
Q

how is CLL and CML differ in symptoms

A

CLL has overall less symptoms and may not require treatment

CLL with better prognosis

376
Q

Leukemia symptoms for both CLL and CML

A

-night sweats
-fever
-fatigue
-bruising
-wt loss
-lymphademopathy

377
Q

Describe a positive psoas

A

positive if pain on raising leg against pressure/resistance

Signals appendix

378
Q

Describe a positive markle

A

(also called heel drop)
Positive if pain on Right side when pt hops on one foot

signals appendix

379
Q

Describe a positive blumberg

A

(classic rebound tenderness sign)

Positive if pain upon releasing palpation of RLQ

APPENDiX

380
Q

Describe a positive mcburney’s point

A

(location 2/3 the distance from navel to right anterior superior iliac spine)

Positive if tender on palpation

indicates appendix

381
Q

Describe a positive murphys sign

A

Pain produced with deep palpation of RUQ while pt takes deep breath

order a US if positive as indicates cholecystitis

382
Q

Describe a positive oburator sign

A

positive in internal rotation of right hip at 90 degrees causes RLQ pain

signals appendix

383
Q

How to confirm an appy?

A

CT

(US can be used but CT is betta!)

384
Q

Describe a positive rovsing sign

A

(think reverse)
positive if palpation of the left produces pain on the right

indicates appendix

385
Q

when to order a HIDA scan

A

when we suspect cholesystitis but US is negative (will tell us how the gallbladder is functioning in more detail)

386
Q

why cant we do a HIDA first?

A

cant do it if there ARE gallstones

387
Q

Describe cullens sign

A

“cullen=center”

Bruising around the umbillicus

sign of necrotizing pancreatitis, ectopic preg., or any abdominal bleeding

388
Q

describe gray turner’s sign

A

“turn the pt to see the turners”

bruising at the flanks

sign of necrotizing pancreatitis, ectopic preg., or any abdominal bleeding

389
Q

Pancreas specific labs

A

amylase, lipase

390
Q

patients with hypocalcemia are at risk for what

A

seizures

391
Q

when would we see chvostek and trousseau signs

A

with very low Ca+ levels

(typically happens after a thyroidectomy when the parathyroid was accidentally damaged or removed)

392
Q

Describe Chvostek sign

A

taping on pts cheek and one side grimaces

“stek=cheek”

393
Q

describe trousseaus sign

A

inflation of bp cuff draws arm up with involuntary contraction

394
Q

why might a H2 be more appropriate?

A

-cheaper
-good for mild cases
-those with osteoporosis, B12 deficiency or C. Diff

395
Q

Long term PPI use can lead to

A

-c. diff
-B12 deficiency
-osteoporosis

396
Q

who is a PPI particularly good to start on

A

anyone who has failed a H2

397
Q

When to refer GERD pts

A

if no improvement with tx= get egd and h. pylori testing

398
Q

Long term uncontrolled GERD can lead to

A

barretts esophagus

399
Q

Most common cause of peptic ulcer disease

A

h. pylori

400
Q

What is triple therapy for H. Pylori

A

“CAP”
-Clarithromycin +
-Amoxicillin +
-PPI

Use metronidazole instead of amoxicillin if PCN allergy

401
Q

Quad therapy for h. pylori

A

-Tetracycline +
-metronidazole +
-PPI +
-Bismuth

402
Q

WHy is quad therapy becoming more popular in h. pylori tx

A

abx resistance

403
Q

How does a AAA present

A

pulsating abdominal mass and back pain

404
Q

What are ultrasounds good at detecting outpt

A

-kidney stones
-AAA
-cholecystitis

405
Q

what age to start colonoscopies and how often

A

CDC- 50
American cancer society- 45

Then q10 if clear w/ annual fecal occult

406
Q

Who needs a colonoscopy earlier than 45

A

-history of colorectal Ca
-1st degree relative with CA
-Inflammatory bowel disease history (crohns, ulcerative colitis)

407
Q

S/s of colorectal Ca

A
  • ribbon stools
408
Q

Where do most polyps occur in colon

A

descending

409
Q

Difference between IBS and IBD

A

IBS is NOT inflammatory like IBD therefore CRP and ESR will NOT be elevated in IBS

410
Q

Types of IBD

A

-UC
-Crohns

411
Q

Differentials in all 4 quadrants

A

RUQ- cholecystitis, hepatitis, liver disease
RLQ- appendicitis
LUQ- pancreatitis
LLQ- diverticulitis

412
Q

what is gluten found in

A

-wheat
-rye
-barley

413
Q

s/s of trichomoniasis and how to treat

A

“strawberry cervix” (pinpoint hemorrhages)

Metronidazole

414
Q

s/s of BV and treatment

A

-glue cells and positive wiff test

Metronidazole

415
Q

S/S of gonorrhea and how to treat

A

-friable cervix and increased WBC

Rocephen

416
Q

s/s of chlamydia and how to treat

A

-friable cervix and increased WBC

1st- doxycycline or azithromycin

417
Q

S/s of herpes simplex and treatment

A

-painful, burning, vesicles

Acyclovir initiated in the first 48-72 hours

418
Q

How to Dx syphilis

A

RPR first with FTA-AVS to confirm

419
Q

s/s of syphillis

A

rash on palms and soles

420
Q

how to treat syphilis

A

Pen G IM (bicillin)

421
Q

Normal vaginal PH

A

3.8-4.5

422
Q

what to avoid with flagyl and why

A

alcohol due to disulfram like reaction

423
Q

Which is a reportable STI

A

HIV
syphilis
gonorrhea
chlamydia

424
Q

what is herpes keratosis

A

herpes of the cornea

425
Q

How to treat gonorrhea AND chlamydia together

A

Doxy plus rocephen

426
Q

When is there true kidney damage on lab

A

whenever there are RBC (glomulo) and WBC (pylonephritis) casts on urine

REFER with casts!

427
Q

three main kidney labs

A

-GFR
-Creatinine
-BUN

428
Q

UTI dipstick results in a UTI

A

positive leukocytes and nitrites

429
Q

Avoid bactrim in patients who also take

A

warfarin (increased bleeding risk)

430
Q

Aboid cipro with pts who have a history of

A

tendon pain with prior floroquinolone

431
Q

how to treat UTI in pregnant patients

A

PCN (augmentin, amoxicillin if covered)

432
Q

BPH on DRE

A

symmetrically enlarged, rubbery prostate

433
Q

first line tx for BPH

A

“-zosin” drugs
-terazosin, famsulosin

(relax bladder and prostate muscles)

434
Q

how does finesteride (proscar) work

A

5-alpha-reductase inhibitor

Actually shrinks the prostate

435
Q

What herbal supplement is popular for prostate issues and what does it interact with

A

saw palmetto

antiplatelets/anticoags

436
Q

what is the PSA cuttoff before referring

A

4

437
Q

s/s of epididymitis

A

1) positive prehn’s sign (pain relieved when lifting scrotum)
2) unilateral pain
3) scrotum is swollen

438
Q

Tx of epididymitis if under 35 yo

A

doxy or ceftriaxone

(usually caused by an STI)

439
Q

tx of epididymitis if over 35yo

A

levofloxacin

440
Q

S/s of testicular torsion

A

unilateral pain
absent cremasteric reflex

REFER

441
Q

1st line tx for ED

A

PDE-5 (slidinafil, tadalafil)

442
Q

what is a contraindication for PDE-5’s

A

NITRO

other undiagnosed heart concerns

443
Q

Who are good candidates for progestin-only birth control

A

-breastfeeding
-HTN
-smokers
-Migrain pts with aura

444
Q

Non-hormonal BC

A

copper IUD

445
Q

what does the depo increase the risk of

A

osteoporosis (limit to 5yr use and take Vt. D)

446
Q

Highest clot risk birth control

A

zulane patch

447
Q

Who is not a good candidate for estrogen contrining OCP

A

-migrains with aura
-clot history
-liver disease
-older than 35
-smokers

448
Q

what should always be ordered with a women under 50 who has an abd complaint?

A

HCG preg test

449
Q

Minors do NOT need parental consent for:

A

-STI tx
-contraception
-pregnancy care

450
Q

When to start pap smears

A

ACOG- 21
ACS- 25 yrs

451
Q

risks of hormone replacement

A

-increased CVC, clot and CA risk

452
Q

HRT increases what type of cancer

A

ovarian

453
Q

What SSRI can be used for nightsweats and hot flashes associated with menopause

A

paroxatine (Paxil)

454
Q

does topical estrogen carry the same risk as oral?

A

no

455
Q

Herbal supplement often used for menopause and its contraindications

A

ginko (anticoags)
Black cohosh

456
Q

PCOS is caused by

A

high androgen levels

457
Q

PCOS increases the risk of

A

-fertility issues
-DM
-hyperlipidemia
-increased endometrial and ovarian CA

458
Q

treatment for PCOS

A

-metformin
-OCP

459
Q

Causes of glactorrhea

A

-stimulation
-medication SE

not associated with CA

460
Q

What to check with galactorrhea

A

-Prolactin level (if high it could be a prolactoma)
-medication list (atypical antipsychotics olanzapine, ziprexa)

461
Q

Subjective or presumptive pregnancy signs

A

-amenorrhea
-nausea
-breast tenderness

(there are other possible causes)

462
Q

Probable pregnancy signs

A

“HCG”

-helgar sign (cervical softening)
-Chadwick sign (blue cervix)
-Goodell sign (cervical softening)
-positive preg test (could be something other than a viable fetus)

463
Q

positive or objective pregnancy signs

A

-Palpation of fetus
-Ultrasound of fetus
-fetal heart tones

464
Q

Most common cause of ectopic pregnancy

A

-misshapened fallopian tube
-PID/STI hx
-endometrosis
-Prior ectopic preg

465
Q

Fundal height at 12 week

A

symphsis pubis

466
Q

fundal height at 20 w

A

level of umbilicus

467
Q

when to test for GBS in preg

A

36-37w

468
Q

when to test for GDM in preg

A

24-28w

469
Q

You cannot give which vaccines in pregnancy

A

live vaccines
-MMR
-Rota
-Intranasal flu
-Varacilla

470
Q

who and when is rhogam given to

A

all Rh- moms at 28 weeks

if babe is Rh+ mom gets another at 72hrs postpartum

471
Q

Do we need to treat asymptoatic UTIs in pregnancy

A

YES

472
Q

how to treat UTI in pregnancy

A

“CAMP”
-cephalosporins (check trimester)
-amoxicillin
-macrobid (check trimester)
-PCN

473
Q

When do we do AFP testing

A

15-20

474
Q

What is AFP looking for

A

neural tube defects if high
if low= downs

475
Q

what prevents neural tube defects

A

folic acid- start before conceving

476
Q

what are downs people at risk for

A

-alzheimers
-hypothyroidism
-cervical spine instability (get cspine xray prior to sports)

477
Q

What is placental abruption and s/s

A

a medical emergency in the 3rd trimester
-severe pain
-bleeding and ridged abdomen

478
Q

What is placental previa and s/s

A

-placenta is covering the cervical opening
-Light, PAINLESS bleeding

479
Q

how to treat mastitis

A

-dicloxacillin

if pcn allergy- keflex or clindamycin

480
Q

if tx failure in mastitis

A

refer for mammo

481
Q

Should mastitis pts stop breastfeeding

A

no

482
Q

osteoporosis on dexa value

A

-2.5+

483
Q

value of osteopenia on dexa

A

-1 to -2.5

484
Q

What increases the risk of osteoporosis

A

-PPI
-Steroids
-Depo
-Smoking

485
Q

How to prevent osteoporosis

A

take Ca and Vt. D
wt. bearing exercise

486
Q

Drugs used to treat osteoporosis

A

Bisphosphonates:
-alendronate (fosamax)
-Ibandronate (boniva)
-Zoledronic acid (reclast)

487
Q

when and where would you see bouchards nodes?

A

in BOTH RA and OA
Boney swelling of the proximal interphalangeal joint

488
Q

When and where would you see heberdens nodes?

A

in OA

swelling od distal interphalangeal joint

489
Q

When do you see swan neck deformity

A

RA

490
Q

S/S of RA

A

SYSTEMIC SYMPTOMS
-any age
- fast onset
- bilateral
- stiffness for over one hour
-swan neck deformity

491
Q

s/s of OA

A
  • occurs as patient ages
    -slow onset
    -unilateral
    -stiffness in AM for less than 1 hr
    -No systemic symptoms
492
Q

treament for RA

A

DMARs - methotrexate

493
Q

Treatment for OA

A

Nsaids
tylenol
exercise

494
Q

What deficiency can come from methotrexate

A

folic acid deficiency

495
Q

OA on xray

A

joint space narrowing

496
Q

what and where is ankylosing spondylitis

A

A autoimmune and chronic inflamatory arthritic disease

Starts low and works up

497
Q

How to dx ankylosing spondylitis

A

Xray or MRI

498
Q

what is a “bamboo spine”

A

a description of ankylosing spondylitis on xray

499
Q

What is a scaphoid fracture also called

A

navicular fracture or snuffbox fracture

500
Q

how to diagnose and when for a scaphoid/navicular/snuffbox fx

A

x-ray and can take 2 weeks to “show up”

501
Q

how do we treat scaphoid/navicular/snuffbox fractures

A

-place pt in thumb spica splint even if xray is negative (prevent osteonecrosis)

502
Q

two signs for carpal tunnel

A

-Phalen’s (backward prayer hands)
-Timel’s (taping inner wrist)

503
Q

how to treat carpal tunnel

A

-splint
-steroids

504
Q

Pt says there is a “pebble” in shoe between 3rd and 4th toes with N/T

A

morton’s neuroma

505
Q

Lateral epicondylitis aka

A

tennis elbow

506
Q

medial epicondilitis aka

A

golfers elbow

507
Q

tx of lateral and medial epicondylitis

A
  • RICE
    -NSAID
    -PT/OT
508
Q

Mcmurray test

A

lateral and medial meniscus

positive with clicks

supine, knee at 90 degrees and twist

509
Q

apleys test

A

meniscus

prone, bend knee, twist heel

510
Q

valgus (knockneed)

A

MCL

511
Q

lachmans test

A

ACL rupture

pushing femur and lower leg in opposite direction

512
Q

anterior drawer

A

ACL
pulling lower leg forward

513
Q

varus (bowlegged)

A

LCL

514
Q

continued knee popping

A

meniscus

515
Q

how to evaluate for sciatica

A

straight leg raise

516
Q

diminished knee jerk after squat and rise

A

L4

517
Q

numbness in the big toee when heel walking

A

L5

518
Q

absent ankle gerk when walking on toes

A

S1

519
Q

Rotator cuff tear tests

A

-Arm drop test- abduct arm out, ask them to return it slow, will be + if arm suddenly “drops”

-Empty can test- (supraspanatous specifically)- arms out, thumbs down, against resistance

520
Q

which med is used for prevention of gout flares

A

allopurinol

521
Q

SE of allopurinol

A

-Bone marrow suppression

522
Q

Medications used in a gout flare

A

-NSAID (indomethacin, naproxen)
-steroids
-colchicine (multiple joints/severe)

523
Q

lifestyle modifications for gout

A

-low purine diet
-no alcohol
avoid diuretics (tzd can increase uric acid)

524
Q

Diagnosis of gout

A

elevated uric acid level (not always elevated in an acute attack)

525
Q

What is fibromyalgia

A

condition with widespread pain and sensitivity

526
Q

How to dx fibromyalgia

A

Must have these for 3+ months
-pain
-fatigue
-walking up not feeling refreshed
-cognitive problems

527
Q

Treatment for fibromyalgia

A

“treat your celf”
-duloxetine (cymbalta)
-amitriptyline (elavil)
-pregabalin (lyrica)
- cyclobenzaprine (flexeril)

528
Q

what key lifestyle modification for fibromyalgia

A

exercise

529
Q

what is hallus valgus aka

A

bunion

530
Q

Which joint is affected with hallux valgus

A

first metatarsophalngeal joint

531
Q

how to treat hallux valgus

A

-brace
-surgery

532
Q

how to dx hallux valgus

A

x-ray

533
Q

Where is the pain located with plantar fasciitis

A

heel

534
Q

who is plantar fasciitis most common in

A

runners

535
Q

when is the pain with plantar fasciitis worst

A

in the am then it goes away thorugout day

536
Q

treatment for plantar fasciitis

A

-stretches
-ice
-supportive inserts
-NSAID
-surgery referral

537
Q

Cauda Equina s/s

A

-sever low back pain
-saddle anesthesia
-new incont.

538
Q

how to tx cauda equina

A

ER for sx

539
Q

De quervains tenosynovitis s/s

A

pain in the lower thumb and wrist

540
Q

how to test for de quervains

A

finklstein test (grip thumb and angle wrist down)

541
Q

bursitis of elbow aka

A

olecranon bursitis

542
Q

tx of bursitis

A

-rest
-ice
-NSAID
-joint aspiration and abx if needed

INJECT ONLY LARGE BURSAS

543
Q

posterior fontenelle closure

A

2-3 mo

544
Q

strabismus disappears

A

4-6mo

545
Q

palmer grasp disappears

A

5-6mo

546
Q

kid can stand

A

12mo

547
Q

kid can sit up unassisted

A

6mo

548
Q

separation anxiety

A

9mo

549
Q

say momma and dadda

A

12mo

550
Q

can walk

A

12-17mo

551
Q

anterior fontenelle closes

A

12-18mo

552
Q

hold spoon

A

15-18

553
Q

genu varum (bowlegs) dissapear

A

2-3yrs

554
Q

copy a circle

A

3yrs

555
Q

draw a cross

A

4yrs

556
Q

ride a bike

A

5-6yrs

557
Q

birth wt doubles

A

6mo

558
Q

birth weight tripples

A

12mo

559
Q

walk up steps

A

2yrs

560
Q

draw person with 3 parts

A

4 yrs

561
Q

draw person with 6 parts and coppy a square

A

5yr

562
Q

can count to 10

A

5 yr

563
Q

draw some letters and numbers

A

5 yrs

564
Q

birth reflexes

A

-rooting
-tonic neck
-grasp
-morow
-stepping

565
Q

toilet training starts at

A

2yr and may take 1-2 to complete

566
Q

What supplement do breastfed babes need

A

vt. d.

567
Q

what does HIB protect against

A

epiglotitis (drooling, respiratory distress)

568
Q

who gets dtap vs tdap

A

less than 7 gets Dtap

569
Q

bili level for lights

A

15

570
Q

Mnemonic for kid vaccines

A

“its time for many happy happy vaccines”

IPV
Tdap
MMR/MENG
hepb
HIB/HPV
varcilla

571
Q

How to check for leukocoria

A

white reflex

572
Q

what does leukocoria indicate

A

-retinoblastoma
-conginital cataracts

573
Q

when does regression usually occur

A

with big life changes

574
Q

what age is too early for puberty

A

girls- before 8
boys- before 9

575
Q

throw out which of the 5 tanner stages

A

1-nothing
5-everything

576
Q

what tanner stage does puberty start

A

stage 2 with breast budding and straight pubic hair

577
Q

what stage does menses start

A

stage 4 (2-3 yrs after start of puberty)

578
Q

what stage is most important for boys

A

stage 3- penis grows in length

579
Q

when to investigate no menses

A

after 15

580
Q

when will girls reach adult height

A

when they start periods

581
Q

long term SE of anorexia

A

bone loss
heart disease

582
Q

long term SE of bulimia

A

dental errosion
esophageal concerns

583
Q

indicators eating disorders are improving

A

-menses returns
-gain wt

584
Q

what are salter harris fractures, who are they common in and risks

A

-fractures along the growth plate
-common in pediatric long bone fx
-stunted growth is a risk of not treated

585
Q

what is cryptorchidism

A

undecended teste

586
Q

what does cryptorchidism increase risk of

A

testicular CA

587
Q

what is a hydrocele

A

abnormal fluid around teste

588
Q
A
589
Q

cause of hydrocele

A

trauma or born with it

590
Q

Treatment for hydrocele

A

most self resolve

591
Q

slate gray nevi aka

A

mongolian spots

592
Q

when do most slate gray nevi resolve

A

by age 5

593
Q

treatment of acute otitis media

A

amoxicillin after 2-3 day watchful period

594
Q

otitis externa caused by

A

pseudomonias

595
Q

how to treat otitis externa

A

-ofloxicin gtts
-steroid gtts
-analgesic gtts

596
Q

how to treat a cholesteatoma

A

refer to ENT for removal

597
Q

what is a cholesteatoma

A

cauliflower-like growth in ear

598
Q

s/s of coarctation of the aorta

A

-higher bp in arms, lower in legs
-poor lower pulses when compaired to uper

599
Q

how to diagnose vesicoureteral reflux?

A

voiding cystourethrogram (graded 1-5)

600
Q

what is vesicoureteral reflux

A

when urine flows back into the ureters and leads to dilation of the kidneys

601
Q

when do we refer for vesicoureteral reflux

A

stage 3

602
Q

s/s of fetal alcohol

A

-thin upper lip
-smooth philtrum
-low nasal bridge

603
Q

cause of acne

A

-genetics
-increase in androgens

604
Q

three step acne treatment approach

A

-benzoyl peroxide
-topical abx
-oral abx

605
Q

s/s turners syndrome

A

-female
-short stature
-webbed neck

606
Q

long term effects of turners

A

-delayed puberty (14yo+)
-fertility issues

607
Q

how to confirm turner’s syndrome

A

karyotype

608
Q

osgood-schlatter disease is what

A

pain over the anterior tibial terbercle near tendon insertion

609
Q

osgood-schlatter disease treatment

A

-NSAID
-ICE
will outgrow when bones stop growing

610
Q

s/s of nasal foreign object

A

-nasal pain
-unilateral drainage

611
Q

Hypertrophic scar will

A

regress over time

612
Q

S/s of kawasaki disease

A

-fever 5+ days
-Strawberry tongue
-Peeling rash

613
Q

Treatment for kawasaki disease

A

-high dose ASA
-IViG

614
Q

Raye’s stage 1

A

stage1: severe vomiting, diarrhea, lethargy, stupor, increased alt/ast

615
Q

Rayes stage 2

A

personality changes
irritability, aggression, hyperactive

616
Q

rayes stage 3-5

A

confusion, delerium
cerebral edema
coma
seizures
death

617
Q

what causes pyloric stenosis

A

swelling or thickening of the pyloric sphincter preventing passage of food from stomach to small intestine

618
Q

what causes intussusception

A

when part of instesting slides inside or “telescopes” into itself

619
Q

s/s of pyloric stenosis

A

-projectile vomiting
-olive shaped mass on palpation

620
Q

s/s of intussusception

A

-jelly like stools
-sausage shaped mass on palpation

621
Q

dx for pyloric stenosis and intussusception

A

US then refer!

622
Q

St. john’s wart

A

used for depression

concern for serotonin syndrome when taken with SSRI/NRI

623
Q

giko

A

memory and cognition

concern for increased bleeding when taken with anti-platelets or blood thinners

624
Q

black cohosh

A

menopausal symptoms

625
Q

CoQ10

A

cardiac health

626
Q

echinacea

A

cold/flu symptoms and immune support

627
Q

evening primrose

A

PMS and menopausal symptoms

628
Q

Kava Kava

A

anxiety

629
Q

Sam-E

A

depression

630
Q

saw palmetto

A

BPH symptoms

631
Q

Soy isoflavones

A

menopausal symptoms

mimic estrogen

632
Q

valerian root

A

insomnia

633
Q
A
634
Q
A
635
Q

Laba examples

A

salmeterol,
formoterol,
olodaterol

636
Q

ICS examples

A

-budesonide
-fluticasone
-beclomethasone
-mometasone

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