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Primary Care 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Warning signs for skin CA

A

open sore that does not heal for 3 weeks, a spot or sore that burns, itches, stings, crusts or bleeds; any mole or spot that changes in size or texture, develops irregular borders, or appears pearly, translucent, or multicolored

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2
Q

Skin photaged by sun damage

A

Coarse with yellow discoloration (solar elastosis), irregularly pigmented, rough or atrophic with deep wrinkling

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3
Q

ABCDE screening for MM

A

asymmetry, border irregularities, color, diamet >6mm, elevation

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4
Q

Shave or punch biopsy for

A

non-melanocytic skin cancer

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5
Q

Excisional biopsy for

A

MM

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6
Q

Solar actinic keratosis

A

Pre-malignant

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7
Q

Disorder of pilosebaceous follicles causing increased sebum production, keratinization, inflammation, and bacterial colonization

A

Acne Vulgaris

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8
Q

Blackhead

A

Obstruction of follicle filled with stratum corneum cells

Open comedone

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9
Q

Whitehead

A

Cystic swelling of the comedone–precursor of inflammatory papules and pustules
Closed comedone

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10
Q

Length of time for acne treatment

A

6-12 weeks to be effective

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11
Q

First line therapy for acne

A

Topical

Trentinoin (Retin A), Adapalen, tazarotene, benzoyl peroxide, salicylic acid

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12
Q

Tx for inflammatory acne

A

Erythromycin, clindamycin, metronidazole, sulfonamide, azelaic acid

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13
Q

Oral abx for severe acne

A

Erythromycin, tetracycline, doxycycline, minocycline

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14
Q

Rosacea

A

age 30-50
No comedones
Facial flushing, facial erythema, inflammatory papules and pustules, edema, watery or irritated eyes
Avoid triggers

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15
Q

Tx of acne rosacea

A

Topical metronidazole, azelaic acid, sulfacetamide-sulfur

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16
Q

Signs of compartment syndrome

A

Pain, pallor, paresthesia, paralysis

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17
Q

Tx of bite wounds

A

Irrigate with 150ml sterile saline solution, tetanus vaccine, do not suture

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18
Q

Prophylactic abx for bite wounds

A

Augmentin 875mg/125mg BID for 5-7 days

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19
Q

superficial or partial thickness burns involving only the epidermis—glossy, red and painful

A

First degree

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20
Q

partial thickness burn involving the dermis—dull or glossy with pink, red or white pigmentation; may blister and be severely painful

A

2nd degree burn

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21
Q

full thickness burns that extend to subcutaneous fat—matte and may be white, brown, red, or black loss of sensation

A

3rd degree burn

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22
Q

Management of 1st degree burn

A

Cool tap water, closed wound dressing (silver sulfadiazine cream–silvadene), gels, hydrocolloids, aloe vera

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23
Q

Most prevalent organisms in cellulitis

A

Group A strep

Staph if deep penetrating wounds

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24
Q

spreading erythema, warmth, induration and pain, possible lymphadenitis

A

Cellulitis

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25
Q

Tx of mild cellulitis

A

Penicillin, amoxicillin, augmentin, cephalexin, clindamycin

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26
Q

Tx for purulent cellulitis

A

Bactrim, doxycycline, cephalexin, dicloxacillin

ED

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27
Q

exophthalmos, orbital pain, restricted eye movement, occasional visual disturbances

A

Orbital cellulitis–medical emergency

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28
Q

Irritant contact dermatitis

A

 Due to direct cytotoxic action of an agent on the cells of the epidermis and dermis
 Ex. Soaps, detergents, acids, alkalis

lichenification, scaling, fissuring

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29
Q

Most common cause of allergic contact dermatitis

A

nickel, neomycin, bacitracin, poison ivy or oak

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30
Q

Diagnostics for contact dermatitis

A

KOH slide, cultures, inspection

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31
Q

Tx of contact dermatitis

A
  1. avoid offending agent

2. medium to high dose steroid ointments

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32
Q

grouped round vesicles containing cloudy fluid on an erythematous base

A

Herpes

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33
Q

Diagnostic test for herpes

A

Tzanck smear or PCR

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34
Q

Tx of herpes

A

Acyclovir 400mg PO TID for 7-10 days OR acyclovir 200mg PO 5X day for 5 days

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35
Q

How to diagnose fungal infections

A

Woods lamp

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36
Q

Tx of pain in shingles

A

Gabapentin, amitryptiline

Narcotics do not help

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37
Q

Diagnostics for shingles

A

Tzanck test, PCR

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38
Q

Tx of shingles

A

Antiviral within 72 hours

Topical agents for anesthetic–lidocaine patch, NSAID patch, capsaicin cream

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39
Q

well-circumscribed erythematous macular and papular lesions with loosely adherent silvery white scale

A

Psoriasis

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40
Q

Tx of psoriasis

A

Potent topical steroid + vitamin D analog first line

Systemic: oral retinoids, methotrexate, cyclosporine

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41
Q

Tx of refractory psoriasis

A

Methotrexate

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42
Q

Tx scabies

A

Topical permethrin–leave for 8-12 hours, wash off and repeat in 1-2 weeks
Antihistamine for itching

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43
Q

Tx of seborrheic dermatitis

A

Topical antifungals or steroids

Shampoos: keoconazole, selenium sulfide 1-2 times per week for 4 weeks

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44
Q

hemosiderin staining of skin—due to decreased blood flow to legs

A

Stasis dermatitis

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45
Q

Tx of stasis dermatitis

A

Compression therapy gold standard, topical emollients daily, systemic abx if cellulitis, topical steroids for itching

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46
Q

o Edematous pink or red wheals surrounded by bright red flare with pruritus

A

Hives

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47
Q

Tx for hives

A

Antihistamines first line–loratadine, cetirizine, fexofenadine, desioratadine
TCAs may be used

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48
Q

Classic triad of ruptured abdominal aortic aneurysm

A

Hypotension, pulsatile abdominal mass, abdominal or back pain

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49
Q

Who should undergo US screening for detection of aortic aneurysm

A

 Men 60 years of age and older who are either a sibling or offspring of someone with AAA
 Men who are 65-75 who have ever smoked

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50
Q

Pathophysiology of carotid artery disease

A

Carotid stenosis due to plaques and atherosclerosis

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51
Q

visual disturbances, monocular blindness (amaurosis fugax), weakness or numbness of the contralateral arm, leg or face, dysarthria, aphasia

A

Carotid stenosis

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52
Q

Modifiable risk factors for carotid artery disease

A

high BP, smoking, hyperlipidemia, DM, hyperhomocysteinemia, obesity, nutrition, physical inactivity, CKD, heavy alcohol use, sleep apnea, depression

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53
Q

First line diagnostic for carotid artery disease

A

Duplex ultrasound

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54
Q

Tx for carotid artery disease

A

Aspirin + statin + management of hypertension

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55
Q

dyspnea and fatigue, lower extremity edema, JV, patient’s history, ROS, and physical exam findings

A

Heart failure

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56
Q

Tx of heart failure

A

ACEI, Beta blockers, hydralazine, oral nitrates, aldosterone, loop diuretics, digoxin

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57
Q

Cough in HF

A

Moist and productive

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58
Q

Goal BP in hypertension

A

<140/90 <60 years or <150/90 if older than 60 (JNC 8 recommendation)

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59
Q

TX of hypertension in non-black with or without diabetes

A

Thiazide diuretic, CCB, ACEI, ARB

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60
Q

Tx of hypertension in black individual

A

Thiazide diuretic of CCB

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61
Q

Tx of hypertension in diabetic

A

ACEI

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62
Q

Hypertensive emergency

A 
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina pectoris
Acute myocardial infarction
Pulmonary edema
Eclampsia
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63
Q

Hypertensive urgency

A

Upper levels of stage 2 hypertension
Hypertension with optic disc edema
Progressive target organ complications
Severe perioperative hypertension

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64
Q

Stepwise tx in hypertension

A

Thiazide diuretic + ACEI/ARB/ beta blocker/ CCB

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65
Q

Risk factors for peripheral artery diseade

A

DM, HTN, Hyperlipidemia, hyperhomocysteinemia, tobacco use

66
Q

exertional leg symptoms of claudication or with ischemic rest pain, abnormalities of lower extremity pulses

A

Peripheral artery disease

67
Q

Tx of peripheral artery disease

A

Tobacco cessation, hypertensio and hyperlipidemia and diabetes management, compression stockings, daily exercise, low dose aspirin, anti-platelet therapy, statins

68
Q

Systolic murmurs

A

Aortic stenosis, pulmonary stenosis, Tricuspid regurgitation, mitral regurgitation

69
Q

Diastolic murmurs

A

Aortic regurgitation, pulmonary regurgitation, tricuspid stenosis, mitral stenosis

70
Q

Dyspnea at rest, sense of chest tightness, feeling of suffocation and inability to get air in

A

Anxiety

71
Q

chest pain that is tight or viselike, constricting or heavy pressure

A

MI

72
Q

Chest pain that is positional, sharp or reproducible

A

Not cardiac

73
Q

How . to rule out musculoskeletal source of chest pain

A

NSAIDs, rest, ice

74
Q

Primary cause of acute bronchitis

A

Viral–Influenza A, B, RSV, parainfluenza

75
Q

Causes of atypical CAP

A

Bordatella pertussis, mycoplasma pneumoniae, moraxella catarrhalis and chlamydia pneumoniae
More common in patients with comorbidities

76
Q

Most common cause of bacterial CAP

A

strep pneumoniae

77
Q

a cough without sputum production for 10-20 days or longer; burning substernal pain; cough may be dry and nonproductive or as it progresses it may be wet and productive or purulent sputum; low grade fever, wheezes, rhonchi and coarse rales may be present

A

Acute bronchitis

78
Q

Tx of acute bronchitis

A

Antitussives–dextromethorphan, benzonatate, codeine/hydrocodone
Bronchodilators
ABX if pertussis–macrolides first line, bactrim second line
Anti-flu if influenza

79
Q

When is chest X ray indicated for bronchitis

A

If cough >3 weeks

80
Q

Chronic, reversible inflammatory disorder of the airways; increased responsiveness of tracheobronchial tree to various stimuli; episodic reversible narrowing and inflammation of airways

A

Asthma

81
Q

Step 1 asthma treatment

A

SABA PRN

82
Q

Step 2 asthma treatment

A

Low doseICS

83
Q

Step 3 asthma treatment

A

Low dose ICS + LABA
OR
Medium dose ICS

84
Q

Step 4 asthma treatment

A

Medium dose ICS + LABA

85
Q

Step 5 asthma treatment

A

High dose ICS + LABA

86
Q

Step 6 asthma treatment

A

High dose ICS + LABA + Oral steroid

87
Q

Oral steroids for asthma

A

Prednisolone, prednisone, methylprednisilone

88
Q

Inhaled steroids for asthma

A

Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone

89
Q

Most common complaint of COPD

A

Dyspnea on exertion

90
Q

Clinical presentation of COPD

A

clubbing of nails, increase in AP diameter, abnormal retractions, pursed lip breathing with prolonged expirations, increased resonance on percussion, decreased breath sounds, early inspiratory crackles, maybe wheezing, neck vein distention, pedal and ankle edema

91
Q

Gold standard diagnostic for COPD

A

spirometry

92
Q

Blue boaters

A

chronic bronchitis and pulmonary hypertension, edema, cyanosis and polycythemia

93
Q

Pink puffers

A

emphysema and severe dyspnea; relatively normal ABGs, barrel chest

94
Q

First line treatment for COPD

A

Anticholinergics–ipatropium and tiotropium

95
Q

1st line abx for COPD

A

Amoxicillin, clarithromycin, levofloxacin, ciprofloxacin, moxifloxacin

96
Q

fever, chills, malaise, cough with or without sputum production; may have hemoptysis, dyspnea, and pleuritic chest symptoms

A

Pneumonia

97
Q

Gold standard diagnostic for pneumonia

A

Chest X ray

98
Q

Low risk management of CAP

A

macrolides

doxycyline

99
Q

High risk management of CAP (co-morbidities)

A

Respiratory fluoroquinolone or beta lactam + macrolide

100
Q

Headache, myalgia, nasal congestion, rhinorrhea, sneezing, scratchy throat

A

Common cold URI

101
Q

Abrupt onset, Fever, chills, malaise, myalgia, headache, nasal congestion, sore throat, nausea, cough, fever for 3-5 days

A

Influenza

102
Q

dyspnea, tachypnea, pleuritic chest pain, calf or thigh pain and swelling

A

Pulmonary embolism

103
Q

Key history to obtain for PE workup

A

recent surgery, trauma, fracture, travel, immobility, malignancy, stroke, paralysis, HF, smoking, pregnancy, estrogen

104
Q

Mainstay of treatment for PE

A

Anticoagulation: heparin, LMWH (first line), fondaparinus, warfarin, rivaroxaban

105
Q

Progressive loss of memory and behavioral changes which interferes with independence in ADLs

A

Dementia

106
Q

Lewy body dementia

A

Decrease in dopamine and Ach

Do not give antipsychotics

107
Q

Initial symptom of AD

A

Usually short term memory loss with symptoms of depression and anxiety

108
Q

Disgnostic tests for AD

A

get up and go, mmsr, montreal cognitive exam

109
Q

Tx of AD

A

Cholinesterase inhibitors: donepezil, rivastigmine, galantamine
NMDA antagonists: memantine
SSRI for depression

110
Q

Leading complication of hospitalization for older adults

A

Delirium

111
Q

Acute, unilateral weakness or paralysis of the facial nerve with onset <72 hours and unknown etiology

A

Bell’s palsy

112
Q

What CN is bell’s palsy

A

CN 7

113
Q

Risk factors for bell’s palsy

A

DM, hypothyroidism, recent URI, obesity, family history, hypertension

114
Q

Bells Palsy may be due to

A

Virus

HSV1, HSV2, ZVZ

115
Q

smooth forehead and widened palpebral fissures; inability to close eye, flattened nasolabial fold, asymmetric smile

A

Bell’s palsy

116
Q

Tx of bells palsy

A

Prednisone or prenisolone within 72 hours
Acyclovir or Valacyclovir if viral
Critical to protect eye-lubricating eye drops, eyeclasses, close and tape shut eyelids

117
Q

Presyncope or lightheadedness is commonly result of

A

CV problem–orthostatic hypotension, vasovagal episodes, hyperventilation, decreased CO

118
Q

Physical exam tests for dizziness

A

Gait, balance, rinne, weber

119
Q

 Symptoms are precipitated by change in head position

 Nystagmus is characteristic

A

Benign paroxysmal positional vertigo

120
Q

Diagnostics for Benign paroxysmal positional vertigo

A

Hallpike-dix maneuver

121
Q

Tx of BPPV

A

Canalith repositioning proceudre

Meclizine for severe vertigo

122
Q

Factors of headache to ask

A

Provocation, quality, region, strength, timing

123
Q

Targeted physical exam for headaches

A

Fundoscopic, vascular, musculoskeletal, neuro, mental status

124
Q

ipsilateral headache that is pounding or throbbing, moderate to severe intensity, aggravated by physical activity, lasts 4-72 hours, may be associated with N/V, phototobia and phonophobia; usually has a trigger

A

Migraine

125
Q

tight band around head; no N/V, mild to moderate pain, not exacerbated by physical activity; commonly triggered by stress

A

Tension headache

126
Q

usually awakened at night with severe unilateral retro-orbital pain; usually lasts 90 minutes with agonizing pain and can not sit still; may be suicidal; usually resistant to medications

A

Cluster headache

127
Q

Diagnostics for temporal arteritis

A

ESR or CRP

128
Q

Preventative headache medications

A

CCB, Beta blocker, anticonvulsants

129
Q

First line for mild to moderate headache

A

Acetaminophen and aspirin

130
Q

Tx of moderate to severe migraine

A

Ergot derivatives
Ergotamine tartrate and dihydroergotamine
Need anti-emetic

131
Q

Most prevalent stroke

A

Ischemic

132
Q

o Hemiparesis, hemisensory loss, visual field defects, ataxia, dysarthria, reflex asymmetry, babinski’s sign

A

Stroke

133
Q

Most common initial imaging for stroke

A

Head CT, non-contrash

134
Q

Management of post-stroke

A

Statin, BP control,thrombolytic therapy, ACEI

aspirin, smoking cessation, blood sugar and cholesterol management

135
Q

Biggest risk factor for stroke

A

History of previous stroke

136
Q

Causes of meningitis

A

Herpes virus, GABS, E coli, H. Influenzae

137
Q

Causes of encephalitis

A

CMV, EBV, HIV

138
Q

fever, headache, stiff neck, N/V, phototobia

A

Bacterial meningitis

139
Q

nuchal rigidity, kernig sign, Brudzinski sign (neck flexion), purpura and petechiae, neuro focal deficits

A

Bacterial meningitis

140
Q

Tx for meningitis

A

Refer to ED

Ampicillin usually

141
Q

Prophylaxis for meningitis oubreak

A

rifampin (600mg BID 2 days), ceftriaxone (250mg IM once) or cipro (500mg once)

142
Q

Tx for essential tremor

A

Beta blockers, anticonvulsant, benzos, alcohol

143
Q

o Slowly progressive neurodegenerative disease; insidious onset with cardinal features of asymmetric resting tremor, bradykinesia, rigidity, postural changes

A

PD

144
Q

PD due to decrease in

A

Dopamine

145
Q

Tx of PD

A

Selegiline: monoamine oxidase type B inhibitor
Levodopa-Carbidopa
Dopamine agonists: ropinirole, pramipexole, bromocriptine
Anticholinergics: trihexyphenidyl and benzotropine
Amantadine

146
Q

1st line for seizure

A

Levetiracetam: Keppra

Must monitor blood levels

147
Q

 Burning, stabbing, sharp, penetrating or electric shock-like and usually on one side of the face

A

Trigeminal neuralgia

148
Q

CN in trigeminal neuralgia

A

CN 5

149
Q

1st line tx for trigeminal neuralgia

A

Anticonvulsants–carbamezapine, oxcarbazepine

150
Q

Microcytic anemia

A

MCV <80

Iron deficiency, anemia of chronic disease, thalassemia, sideroblastic

151
Q

S/S of microcytic anemia

A

Tachycardia/palpitations, fatigue, SOB, dyspnea, dizziness, pale mucous membranes

152
Q

Normocytic anemia

A

MCV 81-99

Chronic disease state, acute blood loss, hemolysis

153
Q

Macrocytic anemia

A

MCV >100
Vitamin B12 deficiency, folate deficiency
Chronic alcoholism, liver disease

154
Q

stomatitis, glossitis, nausea, anorexia, diarrhea, peripheral neuropathies, malaise

A

macrocytic anemia

155
Q

SMooth beefy red tongue

A

Vitamin B12 deficiency

156
Q

Tx of vitamin B12 deficiency

A

IM or SQ injections of 1000mcg of vitamin B12 daily for first week, then weekly for first month, then monthly for life

157
Q

CURB 65 stands for

A

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

158
Q

Most common type of anemia

A

iron deficiency

159
Q

Elevated reticulocytes

A

Sickle cell anemia

160
Q

Hgb SS

A

Sickle cell disease

161
Q

Hgb AS

A

Sickle cell trait

Primary Care 1 (3 decks)

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