deck 2

Question 1

sleep problems management

Answer 1

1st line = sleep hygiene

2nd line –> sleep onset problems + zolpidem (ambient) or eszopiclone (lunesta)

Question 2

management of sleep maintenance problems

Answer 2

zaleplon (sonata)

Question 3

use of melatonin

Answer 3

adjusting to sleep-wake cycle

Question 4

hep A and chronic hepatitis?

Answer 4

never happens

Question 5

incontinence etiologies

Answer 5

1) hyperglycemia
2) diuretics
3) stool impaction
4) atrophic vaginitis

Question 6

antihypertensive that can cause urinary leakage and urgency

Answer 6

b-blockers (inhibit bladder relaxation)

Question 7

first step in evaluation of vaginal bleeding in postmenopausal woman

Answer 7

endometrial biopsy

Question 8

treatment of primary dysmennorhea

Answer 8

NSAIDS — Primary dysmenorrhea is caused by the release of prostaglandin from the endometrium at the time of menstruation. Treatment focuses on the reduction of endometrial prostaglandin production. This can occur either by using medications that inhibit prostaglandin synthesis, or by suppressing ovulation. NSAIDs are generally the first-line therapy, given their favorable risk to benefit ratio and effectiveness. They should be started a day before menstruation, if possible.

Question 9

common med that can cause hyperprolactinemia

Answer 9

• benzos, SSRIs, TCAs

Question 10

progestin challenge test

Answer 10

separates patients with estrogen deficiency from those with normal or excess estrogen. Any bleeding in the week after the administration of Provera indicates that the patient has sufficient estrogen to menstruate, and that the amenorrhea is likely due to anovulation, as in polycystic ovarian syndrome. Those with premature ovarian failure would not have a withdrawal bleed. Neoplasm, Turner syndrome, and Asherman syndrome would not likely present in this way.

Question 11

hyperalert confusion usually due to…

Answer 11

alcohol withdrawal

Question 12

chronic N/V in diabetic patient suggests

Answer 12

gastroparesis

Question 13

mgmt of gastroparesis

Answer 13

metoclopramide

Question 14

impt exam finding with ileus

Answer 14

ABSENT bowel sounds

Question 15

cervical dystonia mgmt

Answer 15

botulinum toxin is first line

Question 16

rapid and irregular heartbeat suggests

Answer 16

afib or aflutter

Question 17

ectopic pregnancy presentation

Answer 17

nausea + colicky pain + adnexal mass

Question 18

erythematous pharynx without exudate suggests…

Answer 18

viral infection (thus only supportive treatment)

Question 19

pathogens responsible for epididymitis

Answer 19

• younger than 35 and sexually active = chlamydia or gonorrhoeae.
• older than 35 = e coli, enterobacter and pseudomonas

Question 20

spermatocele on exam

Answer 20

asymptomatic nodule attached to the spermatic cord

Question 21

contributory factors to acne

Answer 21

Contributory factors to acne include certain medications, emotional stress, and occlusion and pressure on the skin, such as by leaning the face on the hands (acne mechanica). Acne is not caused by dirt, chocolate, greasy foods or the presence or absence of any foods in the diet.

Question 22

treatment of mild acne

Answer 22

combination therapy with topical antibiotics, benzoyl peroxide gels, and topical retinoids

Question 23

pharmacologic therapy of rosacea

Answer 23

topical brimonidine.

Question 24

first line for rosacea

Answer 24

Behavioral changes can be beneficial in patients with erythematotelangiectatic rosacea. We educate all patients on the avoidance of triggers of flushing, proper use of sun protection, and gentle skin care

Question 25

keratoacanthoma vs. SCC vs. BCC

Answer 25

rapid growth (over a couple weeks). BCC and SCC are slow growing.

Question 26

treatment of pityriasis rosea

Answer 26

It will spontaneously resolve in 6 to 12 weeks, and recurrences are uncommon. The treatment is symptomatic, and includes antihistamines or corticosteroids to relieve itch. There is no role for the other agents listed.

Question 27

treatment of hot tub folliculitis

Answer 27

usually self-limited, and therefore reassurance is all that is necessary

Question 28

HSV recurrence management

Answer 28

• No treatment for patients with minimal symptoms
• episodic treatment for patients with prodromal symptoms
• Chronic suppression with acyclovir or valacyclovir helps to reduce the number of clinical HSV episodes in individuals with frequently recurrent lesions

Question 29

treatment of genital herpes

Answer 29

Treatment options for genital herpes include treating each outbreak (episodic therapy) or using chronic antiviral therapy on a daily basis to prevent outbreaks (suppressive therapy). If episodic therapy is used, it should begin at the first sign of an outbreak, but in discordant couples, daily suppressive therapy is now recommended. Suppressive therapy seems to reduce, not eliminate, asymptomatic viral shedding. Suppressive therapy does not alter the natural course of the infection and is not associated with antiviral resistance. Daily suppressive therapy may reduce the risk of HIV transmission or acquisition, but more studies are needed.

Question 30

shingles management

Answer 30

The patient shown has herpes zoster, or “shingles.” Antiviral therapy is the treatment of choice, and can decrease the time for lesion healing and shorten the overall duration of pain if initiated within 72 hours after the onset. In some cases, no benefit will occur if treatment starts after the 72 hour cutoff, but it should be initiated regardless of time in patients over 50, those who are immunosuppressed, or those with eye involvement.

Question 31

tinea capitis treatment

Answer 31

griseofulvin for 4-8 weeks

Question 32

colloquial name for tinea corporis

Answer 32

ringworm

Question 33

most common cause of ringworm

Answer 33

trichophyton rubrum

Question 34

absent feature of conjunctivitis

Answer 34

pain

Question 35

treatment of viral conjunctivitis

Answer 35

supportive – cold compresses + lubricating drops

Question 36

scleritis presentation

Answer 36

Scleritis is a unilateral diffuse injection of the deeper scleral vessels. Symptoms include decreased vision, deep “boring” eye pain, and a surrounding headache. It is usually associated with systemic autoimmune diseases

Question 37

impt feature of sinusitis

Answer 37

• long symptom duration (Duration of illness of less than 7 days may be used as a negative diagnostic criterion. )

Question 38

typical cause of recurrent sinusitis

Answer 38

allergic rhinitis

Question 39

most common bacterial pathogen in bacterial sinusitis

Answer 39

strep pneumoniae

Question 40

treatment of patellofemoral syndrome

Answer 40

strengthening the quadriceps muscles and hip rotators

Question 41

use of tilt table testing

Answer 41

patients with unexplained recurrent syncope in whom cardiac causes including arrhythmias have been ruled out. An abnormal result suggests vasovagal syncope.

Question 42

treatment of recurrent vaginal candidiasis/yeast infections

Answer 42

treat partner, especially if he has balanitis

Question 43

PE presentation

Answer 43

acute shortness of breath + increased RR + wheezing + pleuritic pain

Question 44

treatment of PE

Answer 44

anticoagulation

Question 45

evaluation of wheezing in patient with no history of asthma

Answer 45

CXR

Question 46

ED most commonly due to…

Answer 46

vascular problems