EOR Topics to Review Flashcards
What are the criteria for metabolic syndrome?
Have to have 3 of the following:
- Abdominal obesity
- HTN
- Triglycerides > 150
- Fasting glucose > 110
- HDL < 40 for M, < 50 for F
What organism is most common in endocarditis with a prosthetic valve?
Staphylococcus epidermidis
Criteria for diagnosing diabetes
Random plasma glucose > 200 + symptoms of DM
2 hour OGTT > 200
Fasting plasma glucose > 126
A1C > 6.5%
Recommendations for DM health maintenance
Vaccines: hep B if no previous vax or infection, yearly pneumococcal (for 65 and younger) and influenza
yearly podiatry, ophthamology exams (get appt at time of diagnosis)
What is the goal A1C for DM management?
< 7%
What is the pneumococcal vaccine order?
FIRST: PCV15 or PCV 20
THEN: PCV23 1 year later (can be given after 8 weeks in certain populations) if received PCV15 first
Cosyntropin stimulation test is used to diagnose…
Adrenal disorders (Addison’s)
Dexamethasone suppression test is used to diagnose…
Cushing’s disease/syndrome
Water deprivation test is used to diagnose…
Central versus nephrogenic DI
Which diabetes medication has a black box warning in patients with a personal or family history of medullary thyroid cancer?
GLP1 agonists (-tide)
What are the 3 biggest risk factors in predicting future fractures in patients with osteoporosis?
- Age
- Low bone mineral density (most specific predictor)
- History of previous fracture
How do you differentiate GERD versus Zenker’s diverticulum?
GERD = retrosternal burning chest pain as hallmark sx
Zencker’s = more a/w dysphagia and food regurgitation
BOTH can have halitosis
Differentiating aortic stenosis versus mitral valve regurg
AS = systolic crescendo decrescendo murmur heard best at LUSB/RUSB, radiating to the carotids with audible S4 due to LVH
MR = holosystolic murmur heard best at the APEX and radiating to the axilla
Distinguishing orbital versus preseptal cellulitis
Orbital = (+) proptosis, pain with EOM and vision loss, febrile (Tx = broad spectrum abx, vanco and CTX + ophtho consult)
Preseptal = (+) tenderness only to palpation but not with EOM, afebrile, rarely see chemosis
first line treatment for uncomplicated UTI?
Fluoroquinolones x5-7 days (unless pt is pregnant, then macrobid x7 days)
What is the most important marker to monitor when patients are on allopurinol?
Creatinine bc kidneys are responsible for uric acid excretion (also initially want to monitor uric acid, CBC, and LFT levels Q2-4 weeks)
What is the physical exam finding called a/w point tenderness in the RLQ and appendicitis?
McBurney’s sign
Cervical cancer screening guidelines
Age 21-29: pap with cytology alone every 3 years
Age 30-65: pap w cervical cytology every 3 years OR pap with hrHPV testing every 5 years OR cotesting with cervical cytology and hrHPV testing every 5 years
Adhesive capsulitis treatment
PT with gentle ROM exercises + analgesia with NSAIDs or intra-articular steroid injections
Best modality for diagnosis and treatment of FB aspiration?
Bronchoscopy/endoscopy
What is a pterygium and how do you treat it?
Fibrovascular tissue growth on cornea, treated with NSAIDs and artificial tears for lubricant, potential surgical excision
How do you treat urethritis in a sexually active male?
Cover for BOTH chlamydia and gonorrhea – doxycycline 100 mg bid x7 days, ceftriaxone 500 mg IM
Differentiating pulmonic versus aortic stenosis
Aortic = radiating to the carotids, a/w syncope/angina/dyspnea on exertion
Pulmonic = nonradiating, often not symptomatic until adulthood
Mnemonic for drug induced lupus causes
HIPPS
Hydralazine
INH/isoniazid
Phenytoin
Procainamide
Sulfonamides
Mnemonic for drugs causing SJS
PCP LAPSE
Phenytoin
Carbamazepine
Phenobarbital
Lamotrigine
Allopurinol
Penicillins
Sulfa drugs
Erythromycin
(+) JAK2 mutation means…
Polycythemia vera (Excess RBC production)
Pruritus with hot water = common manifestation
Hyperpigmented macules on sun exposed areas should make you think…
Melasma
Which anticonvulsant is a known teratogen?
Valproic acid (neural tube defects)
At what LDL level do you start high intensity statins?
LDL >/= 190
Examples of high intensity statins
Rosuvastatin 20-40 mg
Atorvastatin 40-80 mg
How often do you screen for dyslipidemia per USPSTF?
Start thinking about this at age 40 - assess ASCVD risk and use this to determine statin initiation (high ASCVD risk = start high intensity statin, DM = start moderate intensity statin)
What are the AHA’s criteria for calculating an ASCVD score to potentially initiate statin use?
Age > 40
Total cholesterol >/= 200
SBP > 130
Hodgkin’s lymphoma remission health maintenance
- Follow up q3 months in the first 5 years of remission – H&P + labs (CBC, LDH, lipids, ESR, glucose) at each visit
- Yearly TSH check in the first 5 years of remission
- For women over 40 or younger women who are 5-8 years post radiation, yearly mammogram
- Stress test, cardiac US, and echo should be done 10 years post radiation
Ruptured TM treatment of choice
Ofloxacin 0.3% otic drops
What is the most important intervention to decrease mortality rates in pts with COPD?
Smoking cessation
What labs should you order to assess etiology of hypertriglyceridemia?
TSH (looking for hypothyroidism), LFTs (looking for signs of excessive alcohol intake), lipid analysis, fasting blood glucose (looking for diabetes), UA (looking for nephrotic syndromes)
What triglyceride value is considered to be elevated if pt is fasting?
> /= 150 mg/dL
Cotton wool spots and flame hemorrhages c/w
Hypertensive or diabetic retinopathy
Cherry red spot
Retinal arterial occlusion
Drusen deposits
Dry macular degeneration
(versus wet macular degeneration shows neovascularization, similar to proliferative diabetic retinopathy)
What meds are contraindicated in 2nd or 3rd degree AV block?
Digoxin (or other negative inotropes that slow heart conduction, i.e. adenosine)
At what age do you start giving meningococcal vaccine (MenACWY)?
Can give anywhere between 11 and 18, though 11-12 y/o is preferred (assuming immunocompetent), booster given >/= 16 years old and must have at least 8 weeks between doses
***no booster needed if primary dose given after 16 y/o
Gold standard for evaluating PAD?
Contrast arteriography (ABI is highly specific, but not gold standard)
Difference between pre, postmenopausal and perimenopausal?
Similar sx (hot flashes, sleep disturbances, vaginal dryness, mood changes – though hot flashes more severe in perimenopausal patients)
Premenopausal: no irregular bleeding, HALLMARK/MC SX = HOT FLASHES, but also a/w vaginal dryness
Perimenopausal: average age of onset is 47, a/w variable estrogen levels and increasingly elevated FSH levels
Postmenopausal: occurs after 12 months of amenorrhea, FSH peaks at 70-100 then begins to decline, estrogen continuously low
Drug therapy for primary dysmenorrhea (pelvic/menstrual pain with no other pathology present)
NSAIDs (first line) – naproxen
Estrogen-progestin OCPs (second line)
Primary dysmenorrhea versus secondary
Primary = no underlying pathology, begins within 6 months of menarche; pain starts just before menstruation begins and dissipates within 48-72 hours
Secondary = arises later in life or due to underlying pathology (i.e. PID, endometriosis)
USPSTF breast cancer screening recommendation
Screening mammo every 2 years for women aged 40-74, d/c screening at age 75
Recommends AGAINST self examination
Contraindications to influenza vaccination
Absolute CI: Anaphylaxis or severe allergic reaction in the past
Relative CI: Chronic medical conditions (i.e. autoimmune disorders, GBS – weigh risks and benefits before readministration)
Which statins are best for CAD and why?
Rosuvastatin and atorvastatin – proven to decrease size of atherosclerotic plaques
Med of choice in patients with panic disorder and history of alcohol/substance abuse
Citalopram (SSRIs have less risk of dependency than benzos do, which would be typical first line treatment)
What is the treatment of choice for testicular cancer without metastasis?
Inguinal orchiectomy
What behavioral factors can play a role in the development of fibrocystic changes?
Frequent alcohol consumption
+/- caffeine consumption
First line treatment for anxiety disorders (not including panic attacks)
SSRI or SNRI
MCC of Cushing’s SYNDROME
Long term exogenous steroid use
Clinical manifestations of vitamin B3 (niacin) deficiency
The 3D’s: Diarrhea, dementia (confusion, memory loss) and dermatitis
A/w photosensitive, hyperpigmented rash that appears similar to a sunburn
Causes of niacin deficiency in the US
Prolonged isoniazid use, carcinoid syndrome
What do platelets look like on a smear in ITP?
Predominantly normal but will have isolated TCP
Treatment mainstay for salmonella
CORNERSTONE = HYDRATION!!!
Can give concurrent antimicrobials with cipro 500 mg x7 d if pt is immunocompromised or showing signs of severe inf (persistent fever), or needs to be hospitalized
What lifestyle modification has the biggest impact on lowering SBP in HTN?
DASH diet (reduced fat intake and more whole grains, vegetables, fruits)
Hordeolum versus chalazion presentation
Hordeolum (bacterial infection): PAINFUL stye that presents in or near an eyelash follicle
Chalazion (blocked sebaceous gland): PAINLESS swelling ABOVE the lash line
Treatment: both require warm compresses, abx w/ staph coverage for hordeolum, steroid injections + incision and curettage for chalazion
First line antihypertensives for patients with DM and proteinuria
ACEi and ARB
Treatment of choice for thrombosed hemorrhoids
Excision (elliptical incision)
Prostatitis treatment
Nonsexually active men = cover for E. coli with FQ or bactrim
Sexually active men = cover for chlamydia and gonorrhea with doxy and ceftriaxone
What interventions are associated with decreased mortality in COPD patients?
Oxygen supplementation and smoking cessation
What ENT manifestation can excessive ibuprofen use cause?
Tinnitus
Ototoxic agents that can cause tinnitus
Salicylates
NSAIDs
Quinine
Abx (aminoglycosides -mycin, erythromycin, vancomycin)
Chemo agents
PJP radiography findings
Diffuse bilateral, interstitial or alveolar infiltrates
Differentiating aphthous versus herpetic ulcers
Aphthous = small, shallow, circular white lesions with surrounding erythema
Herpetic = irregularly shaped white lesions and appear in clusters, usually outside the mouth (CONTAGIOUS UNTIL THEY DISAPPEAR)
GDMT for HFrEF?
- Beta blocker
- ACEi/ARB/ARNI
- SGLT2 inhibitor
- Mineralocorticoid receptor antagonist (i.e. spironolocatone)
Definitive treatment for chronic CAD/single vessel blockage (think unstable angina) ?
A) Alteplase
B) Coronary artery bypass graft
C) Heparin
D) Percutaneous transluminal coronary angioplasty
D
A - more useful in acute STEMI
B - more useful in triple vessel disease or widowmaker (> 50% occlusion of LAD)
C - also more useful in acute MI
In what situations do you anticoagulate (i.e. xarelto or eliquis) before getting rate control with symptomatic afib patients?
If symptoms have been persistent for > 48 hours b/c there is an increased risk of stroke
Afib acute treatment of choice for pts with HF
Amiodarone
Valsalva impact on venous return?
Decreases venous return, so most murmurs DECREASE in intensity (except MVP and HCOM associated murmurs)
AAA screening per USPSTF
Abdominal US for 65-75 y/o M with smoking history
Innocent murmur description
Midsystolic crescendo decrescendo murmur heard best at the left sternal border with MINIMAL RADIATION and little to no symptoms
Treatment post stent placement
DAPT (aspirin unless CI + ticagrelor) + BP control with BB + statin for cholesterol reduction
Xanthelasmas (soft, yellow, thin plaques) indicate…
Hypertriglyceridemia ( > 150 mg/dL)
What are recommended medications for hypertriglyceridemia?
Statins for levels of 150-500
Fibrate (i.e. fenofibrate) for levels > 500 to decrease risk of developing pancreatitis OR in lower levels for patients intolerant of statins
HTN management choices
First line for no sign PMH = ACEi/ARB, thiazides
PMH of DM/CKD = ACEi/ARB
First line for black pts = CCBs, thiazides
Stage 1 HTN according to ACC/AHA versus JNC
ACC/AHA: SBP 130-139 OR DBP 80-89
JNC: SBP 140-159 OR DBP 90-99
Healthy lipid panel
Total cholesterol < 200
Triglycerides < 150
LDL < 100
HDL > 60
When to initiate Holter versus event (loop) monitor versus implantable loop
Holter = for daily symptoms not apparent in office
Event (loop) = for less frequent symptoms (i.e. weekly or biweekly)
Implantable = even less frequent sx (i.e. monthly)
Universal lipid screening guidelines
Once with a nonfasting lipid panel from 9-11 y/o, then again from 17-21 y/o
Follow up lipid screening recommendations after universal
Depends on CVD risk:
- Low risk = screen again at age 35 for women and 45 for men
- High risk (hx of HTN, DM, history of cigarette use) = screen again at age 25-30 for men, 30-35 for women
What does universal lipid screening involve?
Non fasting lipid panel and calculation of non HDL levels
If universal screening labs come back abnormal, what are the follow up labs?
Fasting lipid panel
Brief atherosclerotic disease patho/timeline
LDLs accumulate in tunica intima, deposits get taken up by macrophages and becomes foam cells
Fatty streak develops post foam cell
Fibroblasts deposit collagen over fatty streak to form fatty plaque
Meniere’s versus labyrinthitis versus vestibular neuritis pres
Meniere’s = HL + tinnitus + vertigo that COMES AND GOES, no signs of inf
Labyrinthitis = HL + CONSTANT vertigo that usually develops post infection
Vestibular neuritis = vertigo that may or may not develop after infection
Type of HL associated with Meniere’s
Low frequency SNHL
When can you see fungal otitis externa?
After abx treatment for bacterial otitis externa (pts will report slight improvement with abx but not complete resolution, otoscopic exam shows fine fungal filaments and spores)
Causative agents and treatment of fungal otitis externa
Candida, aspergillus
Tx: topical antifungals such as topical clotrimazole
Physical exam findings of corneal ulcer
Opacities on penlight exam, that DO take up fluorescein
Acute retinal artery occlusion treatment
Ophtho consult IMMEDIATELY!
Any emboli breaking internventions should be initiated within 100 mins of vision
+/- on IV tPA
Supportive measures while waiting for ophtho: ocular massage, topical agents to decrease IOP such as mannitol, oral vasodilators (nitro)
What medication can you NOT take if on sildenafil?
Nitroglycerin (can lead to prolonged erection)
nonproliferative versus proliferative diabetic retinopathy
Nonproliferative = DILATED veins, hard exudates
Proliferative = NEOVASCULARIZATION, vitreous hemorrhage
Aphthous ulcer treatment algorithm
Primarily:
- maintain good oral hygiene, use soft bristle tooth brush to avoid excess trauma, avoid exacerbating factors and control pain (topical anesthetics such as lido)
Other options:
- Sulfate containing toothpaste
- Dexamethasone elixir if complicated stomatitis
Centor criteria for strep pharyngitis
+1 for age 3-14
-1 for age >/= 45
+1 for tonsillar exudate or swelling
+1 for lack of cough
+1 for T > 100.4
+1 for anterior cervical lymphadenopathy or tenderness
Mono lymphadenopathy classic location
Posterior cervical
Samter’s triad
Asthma + aspirin sensitivity + nasal polyps
Treat small nasal polyps with topical intranasal corticosteroids
Large polyps require polypectomy
Severe or recurrent polyps require ethmoidectomy
Labs a/w bulimia nervosa
Hypokalemia, contraction alkalosis
Management of acute depression a/w BPD
Quetiapine or lurasidone
Management of acute mania a/w BPD
Lithium
Long term management of BPD
Lithium, lamotrigine
Bulimia nervosa associated disorders?
Specific phobia disorder
Borderline, avoidant, dependent, paranoid, histrionic and OCD personality disorders
EKG changes c/w anorexia
Sinus bradycardia
Electrolyte imbalances with anorexia
Hypochloremia
Hypokalemia
How long do you have to have phobia symptoms to make a diagnosis?
6 months
Big ADR of buproprion
Lowers seizure threshold – cannot use for smoking cessation or mood control in patients with seizure hx
Two most effective pharmacotherapies for smoking cessation
Varenicline (most effective) and buproprion
Relative CIs for varenicline
Manic depression, schizophrenia, alcohol use disorder
respiratory sx + erythema nodosum (erythematous painful nodules on shins) should make you think…
sarcoidosis –> diagnosis/test of choice is transbronchial biopsy
Mycoplasma tuberculosis morphology description
Rod shaped aerobic, acid fast bacterium
Sarcoidosis versus amyloidosis manifestation
Sarcoid = not usually a/w chest pain, more a/w chronic cough and fatigue
Amyloidosis = has chest pain component b/c it affects cardiac more than respiratory tissues, often causes pleural effusions leading to dyspnea
Interstitial lung disease a/w nuclear power/reactors
Berylliosis
Green sputum
Pseudomonas
What type of med is ipratropium?
Short acting anticholinergic/antimuscarinic, acts as a BRONCHODILATOR
Stepwise approach to COPD treatment
1) Bronchodilator (ipratropium)
2) LABA (formoterol) or LAMA (tiotropium) + short acting bronchodilator for symptomatic relief
3) Tiotropium
4) Add on ICS to previously tried therapies
When do you administer a SABA in patients with mild asthma?
Prior to exercise (and during symptoms if they arise)
Age ranges for PCV20 vaccine?
19+ years
When do you give PCV23?
In a patient who previously received PCV15
When is the pneumococcal vaccine indicated for adults?
Adults >/= 65 y/o OR adults < 65 y/o with pulmonary risk factors (i.e. COPD)
What happens to the FEV1 and FVC in asthma after giving bronchodilator therapy?
Increase in both FEV1 and FVC
What do FEV1 and FVC represent?
FEV1 = max amount of air that can be expired in 1 second
FVC = max amount of air that can be exhaled after taking a maximal inspiration breath
Cutoff for positive bronchodilator response for asthma?
Increase in FEV1/FVC by at least 12%
Asbestosis presentation
Typically asymptomatic for DECADES (have history of industrial jobs), then MC report gradually worsening breathlessness (cough, wheezing uncommon)
What is the biggest risk factor for development of mesothelioma?
Asbestos exposure
Who gets the PCV13 vaccine?
Kids
CXR findings c/w interstitial lung disease?
Reticulonodular opacities
Ground glass opacities
What afib drug can cause ILD?
Amiodarone
Next best step after discovering incidental pulmonary nodule on CXR?
Look for prior CXR to compare – if no growth, nodule is unlikely to be malignant
If no prior films available, CT chest is next best step
MCC of large versus small bowel obstruction
Large = malignancy
Small = post op adhesions
Possible adverse syndromes/diseases a/w lung cancer?
Superior vena cava syndrome
Lambert Eaton myasthenic syndrome (a/w small cell lung cancer)
Horner syndrome (ipsilateral ptosis, miosis, anhidrosis) + shoulder pain a/w Pancoast tumors (derive in the superior sulcus of the lung)
1st line treatment for focal seizures?
Carbamazepine (focal seizures usually don’t have a postictal phase and only impact discrete locations within the brain)
How would sx a/w BPPV be described?
Positional vertigo (i.e. worsened/triggered by getting out of bed)
Most sensitive test to diagnose esophageal/hiatal hernias?
Barium swallow
Migraine prophylaxis options
1st line = propranolol
2nd line = TCAs or verapamil
3rd line = anticonvulsants (valproate/valproic acid/depakote/divalproex – teratogen, should not be given in pts who are trying to or could become pregnant) or topiramate (a/w weight gain and decreases effectiveness of OCPs)
Which type of hiatal hernia is the most common?
Type 1 (sliding) – reproduces GERD like sx or can often be asymptomatic, does not typically quire surgery
Retrocardiac air fluid level on CXR is c/w?
Hiatal hernia
What kind of peptic ulcer does H. pylori cause?
Type B – affects antrum and body of stomach
Most common type of peptic ulcer?
Type A – affects gastric fundus
Anemia a/w H. pylori?
Iron deficiency (peptic ulcers impede on iron absorption)
pH a/w H. pylori gastritis?
Hypochlohydria, pH > 3.0
Tendons involved in deQuervains?
EPB, APL
MCC of UGIB?
PUD (which is most commonly caused by H. pylori infection)
What sense does Bell’s palsy impact?
Loss of taste on anterior 2/3 of tongue
Forehead appearance on affected side of Bell’s Palsy
No forehead wrinkling (indicates peripheral nerve involvement)
What is usually more painful, external hemorrhoids or anal fissure?
Anal fissure (severe ripping/tearing pain with defecation)
Diagnostic test of choice for peptic ulcer disease
Endoscopy with biopsy
Diagnostic test of choice for hiatal hernia
Barium swallow study
MCC of foul smelling, loose stool with cramping and flatulence
Giardia
Cobblestone appearance on colonoscopy most c/w UC or Crohn’s?
Crohn (with skip lesions present)
Uniform sandpaper appearance on colonoscopy most c/w UC or Crohn’s?
UC
Tonic clonic vs myoclonic seizures
Tonic clonic = abrupt LOC first followed by muscular spasm
Myoclonic = brief (< 1 sec) muscle contractions
Different types of headache prophylaxis
Cluster: first line = verapamil, 2nd line = lithium
Tension: first line = TCAs
Migraine: first line = BBs (propranolol) or valproate/valproic acid/depakote, 2nd line = topiramate (less a/w with weight gain than valproic acid derivatives)
Gastroenteritis MCC viral and bacterial cause
Viral = norovirus
Bacterial = salmonella
Gastroenteritis definition/sx
ABRUPT onset of diarrhea a/w N/V, abdominal pain, fever
Gastroenteritis treatment
If pt is stable: supportive care as most cases are viral (rehydration, loperamide antidiarrheal, antiemetics)
If pt showing signs of severe infection, dehydration: IV rehydration, abx (Bactrim, ampicillin or cipro)
How to differentiate esophagitis versus GERD?
Esophagitis typically not a/w heartburn
Stroke prevention therapies
1st line = DAPT (aspirin + ticagrelor, clopidogrel) if high risk for recurrent stroke, only aspirin if low risk
If stroke was 2/2 cardiac issue (afib, CAD, etc.) = DOAC (i.e. rivaroxaban or apixaban)
Treatment of choice for refractory internal vs external hemorrhoids
Internal = rubber band ligation (painful so cannot be done on external) or sclerotherapy
External = hemorrhoidectomy
Gene a/w familial adenomatous polyposis (FAP)
APC (start screening at 12 every year w/ colonoscopy until colon is removed, 100% chance of developing cancer)
What imaging modality is most sensitive for detecting stroke?
MRI, but it is not used clinically because it takes too long
US findings consistent with PCOS
Multiple small ovarian follicles around the periphery (aka string of pearls)
Wide split S2 is c/w
Mitral valve regurg
BEST treatment for Meniere’s
reduced salt intake (can add on diuretics if refractory)
MCC of viral pharyngitis
Adenovirus
Bitemporal hemianopsia more c/w Cushing syndrome or disease?
Disease bc pituitary tumor sits in sella turcica on top of optic nerve
What is the vitamin B analog that should be given with isoniazid to avoid peripheral neuropathy?
Pyridoxine
First line osteoporosis treatment
Bisphosphonates (long term use increases risk of jaw necrosis, pts CI to take if they cannot stay upright for 30 minutes after administration)
What is the MCC of female infertility and what is the first line treatment?
PCOS – infertility aspect can be treated with letrozole
Hernia of posterior vaginal wall is _______
Hernia of anterior vaginal wall is _______
Rectocele; cystocele
Uric acid goal when treating patients with allopurinol?
< 6
Next step if pap cytology comes back abnormal?
Colposcopy
Diagnostic criteria for BPD I versus BPD II
BPD I - at least ONE manic episode (sx for at least one week)
BPD II - hypomania (no psychotic features, doesn’t necessitate hospitalization) with at LEAST ONE depressive episode
Pterygium versus pinguecula
Pterygium = corneal involvement
Pinguecula = SOLELY conjunctival involvement
Gonorrhea is a gram (negative/positive) (morphology)
Gram negative diplococci
Plantar fasciitis presentation and treatment
Presentation = heel pain WORST when walking first thing in the morning, lessens with gradually increased activity
Treatment = stretching plantar fascia and calf muscles, heel inserts NSAIDs (can try glucocorticoid PO and local steroid injection)
MOA of acutane (oral isotretinoin)
Decreases sebum production
Requires monitoring of LFTs, two forms of birth control
Indicated in SEVERE acne (Deep seeded, nodulopustular, impeded on social interactions)
2nd MCC of SJS behind drugs?
Mycoplasma pneumoniae infection
BEST test for diagnosing cholecystitis?
HIDA scan (if US is inconclusive)
Tumor marker (+) in adenocarcinoma of the lungs?
CEA
Howell Jolly bodies seen in which type of anemia?
Sickle cell
Schistocytes indicate…
Hemolysis
When is fasting C peptide useful?
In distinguishing type 1 vs type 2 diabetes
Erythema multiforme
Multiple targetoid lesions throughout the body in response to infection or it can be drug induced
T or F: influenza vaccine is CI in pregnancy
FALSE – pregnant pts have a higher risk of developing severe illness from influenza infection and the vaccine is actually recommended
HLA a/w RA
HLA-DRB1
where do you feel indirect vs direct inguinal hernia when evaluating the scrotum?
Direct = side of finger
(THINK: SlIDE directly into the DMs)
Indirect = tip of finger
Treatment of choice for Lyme disease in kids or pregnant patients
Pregnant: Amoxicillin
Kids: doxy or amoxicillin
Where do most meningiomas most commonly occur?
Falx cerebri (arises from arachnoid mater)
Best drug for hyperemesis gravidarum?
Pyridoxine alone OR in combination with doxylamine
(Contradicting studies on whether or not zofran causes birth defects, not contraindicated in preg but not first line)
***ginger also proven to be helpful
MCC of erythema multiforme
HSV
Erythema multiforme treatment
ACUTE MANAGEMENT: supportive (topical gels or mouthwashes made of diphenhydramine, antacids and lido)
PREVENTATIVE: Acyclovir or valacyclovir
MC complication of radiation therapy for facial squamous cell carcinoma?
Xerostomia – decreased saliva production can lead to deterioration of dentition and oral cavity –> follow with dentist referral
Is Crohn or UC more likely to cause bloody diarrhea?
UC
How can the subretinal fluid and hemorrhages c/w wet macular degeneration be described?
Grayish-green discoloration near the macula
What is congenital dacryostenosis?
Congenital obstruction of the nasolacrimal duct
Congenital dacryostenosis treatment?
1st line = Crigler (lacrimal sac) massage 2-3x per day, cleanse with warm water, and observation
If refractory after 6-10 months –> simple lacrimal duct probing (surgical procedure) or nasolacrimal duct obstruction intubation for older kids under general anesthesia
Last resort = more invasive procedures such as balloon dacryoplasty, dacryocystorhinostomy
Herpes simplex vaginalis treatment for patients in 1st/2nd trimester versus 3rd trimester
1st/2nd trimester: 7-10 day course of antivirals
3rd trimester: initiate antiviral therapy at 36 weeks to prevent preterm delivery and neonatal transmission
Antiviral of choice = ACYCLOVIR
Suppurative versus stenosing flexor tenosynovitis
Suppurative = bacterial infection without any “triggering” or catching with passive extension – needs to be treated with IV antibiotics and surgical I&D
Stenosing = trigger finger, causes catching or triggering with flexion and extension
Description of pretibial edema a/w Graves
Raised, violaceous papules on the shins
Best non-invasive method for detecting H. pylori
Urea breath testing (have to be off of PPIs for 1-2 weeks prior)
Most sensitive test for trich?
NAAT but wet mount used more frequently in clinical practice (just less sensitive)
Do you treat the sexual partners of patients with trich?
Yes, and should undergo abstinence while getting treatment
ASD murmur description
Wide, fixed split S2 with midsystolic murmur
Pathogenesis of otitis externa
FIRST STEP = Breakdown of skin-cerumen barrier within ear canal
Leads to inflammation and edema, then pruritus and obstruction
Then causes elevation of ear canal pH and impaired epithelial migration that allows organisms to thrive within the canal
Essential tremor treatment in pts with concurrent asthma
Primidone
(First line = propranolol or primidone but NON SELECTIVE BETA BLOCKERS ARE CI IN ASTHMA BC THEY CAN INDUCE BRONCHOCONSTRICTION)
Nephrosclerosis can cause…
CKD 2/2 intrinsic renal vascular disease
Simple partial seizure (aka focal aware) definition
Motor, sensory, autonomic or psychomotor sx WITHOUT LOC
Generalized seizure definition
Sudden LOC followed by postictal confusion
EEG findings of focal aware/simple partial seizures
Focal rhythmic discharge at onset of seizure
Differentiate Heberden versus Bouchard nodes in OA
Bouchard = PIP
Heberden = DIP
Hilar adenopathy seen in TB versus sarcoid
Sarcoid = BILATERAL hilar adenopathy
TB = UNILATERAL hilar adenopathy (can also see associated cavitary lesions, Ghon focus complexes, upper cavitary lobe lesions)
Labs c/w sarcoid
Hypercalcemia, elevated ACE, hypercalciuria
Sarcoid biopsy findings
(+) non caseating granulomas
Would you expect hypo or hyperreflexia in MS?
Hyperreflexia due to UMN lesion
What is internuclear ophthalmoplegia and what is it a common finding of?
Adduction weakness + nystagmus in contralateral abducting eye with lateral gaze
Common finding in MS
Corneal abrasion findings on fluorescein staining?
(+) punctuate contigious breakdown surrounding cornea
Branching dendritic pattern on fluorescein staining
Herpes keratitis
Round white spot on fluoresecin staining
Corneal ulcer
Streaming of fluorescein staining on exam
Aka Seidel sign – a/w penetrating eye injuries (caused by aqueous humor leaking from the eye)
Mastitis treatment
First line = dicloxacillin and cephalexin (anti-staphylococcal agents)
If MRSA risk (recent abx, hospitalization, IV drug use) = clinda or bactrim
How do 5ARIs work in BPH and what are some examples?
Decrease conversion of testosterone to DHT, which reduces prostate size
Ex: finasteride, dutasteride
1st line pharmacologic treatment for BPH
Alpha 1 agonists (tamsulosin, terazosin)
Initiate after patient has tried LSM (double voiding, decreased fluid intake before bed, etc.) and if sx are still bothersome
In what situations are triptans avoided with respect to migraine or tension HA treatment?
In pts with history of CVD or HTN
Triptans act as vasoconstrictors and can worsen elevated BP and increase risk of clotting
Test of choice to identify cardioembolic source of TIA
Prolonged cardiac monitoring on admission + echocardiogram
Which thyroid storm treatment is CI in pregnant patients?
Atenolol bc it is a/w intrauterine growth restriction
High association between ankylosing spondylitis and….
Crohn/IBD
S/sx of cirrhosis
Hepatomegaly
Ascites
Caput medusae
Gynecomastia
Facial tenangiectasias
Icterus
Palmar erythema (d/t impaired sex hormone breakdown)
Ecchymosis (d/t defective coagulation)
Finger clubbing
Asterixis
3 C’s of measles
Cough, coryza, conjunctivitis + (C)Koplik spots (white/gray/blueish with an erythematous base on buccal mucosa near the molars)
OTHER FINDINGS:
Maculopapular rash begins on face and spreads to trunk
Supportive treatment can include vitamin A
Superficial induration with extremity pain and previous venous catheter placement should make you think…
Superficial thrombophlebitis
Kids less than __ months old should NOT receive the live influenza vaccine
6
Live vaccines should not be given to HIV patients whose CD4 count is less than ____
200
What are the live vaccines
THINK: MY ROME TRIP
Mumps
Yellow Fever
Rubella
OPV (oral typhoid)
Measles
Endemic typhus
TB vaccine (BCG)
Rubella
Influenza
Plague
Hallmark findings of fibromyalgia
Fibro fog
Tenderness more marked over soft tissues than joints – WIDESPREAD MSK PAIN for at LEAST 3 MONTHS
Sleep disturbance, fatigue
Normal inflammatory markers
Fibromyalgia treatment
TCAs, SNRIs
***AVOID OPIOIDS
Bell palsy treatment
Prednisone daily and valtrex TID for 7 days
Supportive adjuncts: eye patch and artificial tears if pt is unable to fully close eye
Biggest risk factor for spontaneous abortion in healthy women?
Advanced maternal age
(+) HFE genetic testing confirms…
Hereditary hemochromatosis
(Tx = therapeutic phlebotomy)
Signs of hyperprolactinemia
Amenorrhea, infertility, headache, nipple discharge
Is Crohn or UC more likely to have extraintestinal manifestations?
Crohn – look for aphthous ulcers!
First line allergic rhinitis treatment?
Fluticsaone or another intranasal steroid, can be used in cojunction with 2nd gen antihistmaine (zyrtec, claritin, allegra) which are less sedating than 1st gen
Type I vWD versus type 2/3
Type I = decreased AMOUNT of vWF
Type 2/3 = decreased QUALITY of vWF (plenty available, but it doesn’t work well)
Chlorthalidone medication class
Thiazide like diuretic
Bisphosphonate contraindications
Renal disease
Esophageal disease
Pts unable to stay upright 30 minutes after administration
Antipsychotic of choice in acutely agitated, elderly patients
Oral risperidone
Usually start with haloperidol however increases risk of Parkinsonian ADRs in the elderly
Molluscum contagiosum cause
Poxvirus
First line treatment for PTSD
SSRIs + CBT
CURB-65 criteria
Confusion present +1
Urea (BUN) > 19 +1
RR >/= 30 +1
SBP </= 90 or DBP </= 60 +1
65 or older +1
If 0-1 points, out pt management
If 2 points, consider admission versus very close out pt f/u
If 3 points, certain admission
Chronic NSAID induced PUD treatment
8 weeks of PPI therapy
MCC of bacterial sinusitis
Strep pneumo – treat with augmentin or doxy
Labs supporting CLL diagnosis
Lymphocytosis
Smudge cells on peripheral smear
HPV strains a/w cervical cancer
HPV 16 and 18
Innervation of anterior compartment of lower leg
Peroneal aka fibular nerve – damage leads to decreased dorsiflexion and decreased sensation in between 1st and 2nd toe
Achalasia presentation, dx and tx
Pres = substernal burning pain, food regurgiation, difficulty swallowing solids and liquids
Dx = barium swallow (+) bird’s beak appearance (dilated, aperistaltic distal esophagus with a closed LES)
Tx = surgical myotomy
Abx of choice in AOM w PCN allergy
Azithro
Best test to confirm genital herpes?
Viral culture
Neisseria meningiditis morphology
Gram negative diplococci
a/w bacterial meningitis, petechiae/purpura rash on LE, common in college kids or people living in close quarters
Cellulitis description
Erythematous patches with overlying warmth, IRREGULAR BORDER/POORLY DEMARCATED
Erythema multiforme causative organism
HSV – prophylaxis with acyclovir if recurrent rashes develop
Treatment for shigella
Oral rehydration therapy and antibiotics if indicated, i.e. if severe dehydration or refractory to supportive matters (FQ but NOT in kids, azithro or 3rd gen cephalosporin)
Testing of choice for chlamydia/gonorrhea induced urethritis
NAAT or a UA from a first void urinary specimen or a urethral swab
Verrucous wart treatment
salicylic acid plaster after paring, liquid nitro and cryo if refractory
Complications of untreated balanitis
Paraphimosis (cannot retract back to anatomic position) and/or phimosis (cannot retract proximally)
Paronchyia (soft tissue infection of tissue lateral to nailbed) treatment of choice
If NO FLUCTUANCE = warm compresses, NSAIDs, abx with staph coverage (cephalexin, dicloxacillin if no MRSA suspicion; doxy, clinda or bactrim if MRSA concern)
If FLUCTUANT = IMMEDIATE I&D followed by warm compresses, NSAIDs, etc.
Urticaria presentation
Pruritic wheals or hives that are transient (come and go) and last < 24 hours individually
Treat with antihistamines, epi in severe allergic reactions
Which organism is most likely to cause struvite stones?
Proteus mirabilis
MC type of kidney stone?
Calcium oxalate
Tylenol poisoning treatment
Activated charcoal at 1g/kg
Differentiate ulna versus radius on lateral elbow XR
Ulna = hook at proximal portion to form olecranon joint at elbow
Radius = flat radial head proximally
Common spots of testicular cancer metastasis
Lungs, lymph nodes
Look for LE edema, cough, back pain
Warfarin induced skin necrosis should make you think…
Protein C deficiency
MCC of lateral hip pain in adults
Greater trochanteric pain syndrome (glut medius/minimus tendinopathy causes regional inflammation of surrounding bursae)
Pencil in cup deformity
Psoriatic arthritis
RA XR findings
Joint erosions
FB aspiration presentation
If FB stays within upper airway: perioral cyanosis
If FB descends farther into airway: hyperresonance on imaging
