Exam 3 Flashcards

1
Q

Red flags for abdominal pain

A

fever, chills, leukocytosis with increases neutrophils and bands on the differential, and rebound tenderness
Abdominal pain lasting >6 hours or the pain wakes up the patient at night
New onset constipation >50 years old

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2
Q

RUQ pain

A

cholecystitis, RLL pneumonia, acute hepatitis

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3
Q

LUQ pain

A

Gastritis, pancreatitis, MI, LLL pneumonia

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4
Q

RLQ pain

A

Appendicitis, ectopic pregnancy, ovarian cyst, diverticulitis, endometriosis

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5
Q

LLQ pain

A

Diverticulitis

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6
Q

GI imaging for plain flat/upright

A

Ileus, bowel obstruction, perforation

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7
Q

GI imaging fo abdominal US

A

gallbladder, pelvic organs, appendix, kidneys, liver

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8
Q

GI imaging CT

A

Acute abdominal pain, diverticulitis

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9
Q

GI imaging MRI

A

Hepatocellular carcinoma, metastatic disease

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10
Q

GI imaging EGD

A

Upper GI

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11
Q

GI imaging colonoscopy

A

Lower GI

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12
Q

Lower abdominal pain in females

A

Can indicate gynecologic problem–ovarian cyst, ectopic pregnancy

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13
Q

Causes of acute abdominal pain

A

Appendicits, cholecystitis, diverticulitis, small bowel obstruction, perforated peptic ulcer, peritonitis, ruptured ectopic pregnancy, PID, ruptured AAA, hypercalcemia, superior mesenteric artery syndrome, acute intermittent porphyria

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14
Q

3 s/s most predictive of acute appendicitis

A

Pain that starts in the epigastrium or periumbilical area, migration of the pain to the RLQ, and abdominal rigidity

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15
Q

McBurney point

A

Appendicitis

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16
Q

Rovsing sign

A

RLQ pain elicited by palpating left lower quadrant

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17
Q

Obturator sign

A

Passive rotation of the right leg with the patient supine and right hip and knee flexed

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18
Q

Psoas sign

A

Supine patient raises straightened right leg against resistant

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19
Q

Perioperative antibiotics for appendicitis

A

Metronidazole and ceftizoxime

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20
Q

intermittent and crampy abdominal pain, vomiting, obstipation, abdominal distention, hyperactive bowel sound and fever; pain usually relieved by vomiting, intestinal tube decompression or passage of intestinal contents through partial obstruction

A

Small bowel obstruction

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21
Q

distended tympanic abdomen with peristaltic rushes and high pitched tinkling sounds initially but may be absent as disorder progresses; diffuse midabdominal tenderness common; localized tenderness, abdominal guarding, rebound tenderness and rigidity concerning signs

A

Small bowel obstruction

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22
Q

abrupt onset of severe abdominal pain followed rapidly by peritoneal signs; pains begin in the epigastrium and spread rapidly throughout the abdomen with frequent early radiation of pain to the scapular areas

A

Perforated peptic ulcer

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23
Q

Diagnosis of perforated peptic ulcer

A

Detection of pneumoperitoneum on upright abdominal or chest x ray

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24
Q

high fever, acute abdominal pain that can be diffuse, localized or referred; tenderness, N/V, diarrhea or constipation
abdominal distention, rigidity, decreased bowel sounds, diffuse abdominal tenderness, rebound tenderness, guarding

A

Peritonitis

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25
Q

Antibiotics for peritonitis

A

3rd or 4th generation cephalosporin or quinolone

Decline in leukocyte count after 24-48 hours after antimicrobial therapy

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26
Q

abdominal, flank, or back pain with radiation to the back

Pulsatile painful mass palpated in the abdomen, aortic bruit

A

Ruptured aortic aneurysm

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27
Q

Risk factors for cholesterol stones

A

female, obesity, pregnancy, aging, drug induced, cystic fibrosis, rapid weight loss, spinal cord injury, ileal disease, DM, sickle cell anemia

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28
Q

biliary colic with intermittent or steady, right upper quadrant abdominal pain that radiates to the right posterior shoulder within an hour of eating any type of large meal, specifically high fat

A

Cholecystitis/cholelithiasis

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29
Q

Drugs that increase risk of cholelithiasis

A

Fibric acid derivatives, contraceptives, steroids, estrogen, progesterone, sandostatin, ceftriaxone

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30
Q

RUQ tenderness and guarding and rigidity, distended gall bladder, hypoactive bowel sounds, positive murphy sign, jaundice, dehydration

A

Cholecystitis

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31
Q

Cirrhosis

A

End stage consequence of progressive hepatic fibrosis affecting normal liver function; serious, irreversible disease which is the result of exposure to persistent toxins and resulting in liver failure and death

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32
Q

autoimmune destruction of the intrahepatic bile ducts and eventual development of cirrhosis and liver failure

A

Primary biliary cirrhosis

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33
Q

jaundice, spider angiomata, gynecomastia, ascites, splenomegaly, palmar erythema, digital clubbing, and asterixis may be presenting signs; liver may be nodular, firm, enlarged or shrunken and spleen may be enlarged; fluid wave and increased abdominal girth if ascites is present

A

Cirrhosis

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34
Q

Tx of cirrhosis

A

Immunizations: pneumococcal, flu, hep A and B
Eliminate NSAID and alcohol
Antiviral for Hepatitis

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35
Q

Prevention of GI bleeding in cirrhosis

A

Administer a beta blocker (propranolol), consult with gastroenterologist, monitor PT and platelet count

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36
Q

Constipation

A

<3 bowel movements per week + passage of hard or lumpy stools, sensation of straining, feeling of incomplete evacuation, use of manual maneuvers to aid defecation

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37
Q

Alarm symptoms constipation

A

sudden change in bowel habits, weight loss >10 pounds, blood in stool, anemia, family history of colon cancer or inflammatory bowel disease, constipation resistant to treatment >50 years old

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38
Q

Chronic constipation differential

A

low dietary fiber, fundamental constipation, IBS, fecal impaction, anal fissure, hemorrhoids, drug induced, bowel tumors

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39
Q

First line constipation meds

A

Bulking agents

Psylliym, methylcellulose, polycarbophil

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40
Q

Stool softeners

A

Docusate sodium, mineral oil

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41
Q

Osmotic laxatives

A

Magensium hydroxide, PEG, lactulose, sorbitol

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42
Q

Stimulant laxative

A

Senna, bisacodyl

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43
Q

Osmotic diarrhea

A

Lactase deficienc, magneisum sulfate, small bowel injury

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44
Q

Secretory diarrhea

A

Bacterial enterotoxins such as E Coli, laxative abuse, bile salt malabsorption, endocrine tumors

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45
Q

Treatment of C diff

A

Metronidazole or vancomysin

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46
Q

Treatment of IBD diarrhea

A

Sulfasalazine or mesalamine + steroid

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47
Q

Risk factors for diverticulitis

A

Consumption of red or processed meats, obesity, smoking, low fiber diet

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48
Q

Diverticulosis

A

asymptomatic or symptomatic presence of noninflamed multiple colonic diverticula: outpouching or mucosa through colon wall
may have flattened or ribbon like to hard pellet stools; may have alternating diarrhea and constipation, bouts of steady or crampy pain mainly in left lower quadrant and abdominal distention

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49
Q

Diverticulitis

A

complicated disease associated with inflammation in or more of the diverticula with possible resultant perforation leading to abscess or fistula formation
mild to moderate, colicky to steady, aching abdominal pain usually present in the left lower quadrant accompanied by fever and leukocytosis; may be loose stools or constipation and may be N/V

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50
Q

Treatment of diverticulitis

A

May have spontaneous resolution
Clear liquids, limit physical activity
Oral abx: Bactrim + metronidazole OR augmentin or Cipro + metronidazole
Short term low fiber diet

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51
Q

Treatment of choice for GERD

A

Prescription PPI
Prevents acid production at the final juncture of the histamine, gastrin and acetylcholine pathways
-Prazole

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52
Q

Barrett esophagus

A

Infrequent, pre-malignant condition associated with chronic >5 years esophageal injury resulting from reflux
Patches of normal gray-white stratified squamous cell mucosa of the esophagus change into the light pink columnar epithelium

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53
Q

Hepatitis A

A

caused mostly by contaminated food or water; risk factors include crowded conditions (prisons, nursing homes, daycares)
Transmitted by fecal oral route but can be detected in blood
Can be excreted in feces 2 weeks before symptoms

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54
Q

Hepatitis C

A

Risk factors: IV drug use, sex with IV drug user, tattooing, body piercing, alcohol use

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55
Q

Nonalcoholic fatty liver disease

A

Associated with metabolic syndrome–abdominal obesity, hyperlipidemia, and diabetes

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56
Q

anorexia, fatigue, myalgias, nausea, fever, headaches, arthralgias, vomiting and abdominal pain; jaundice is rare

A

Hepatitis

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57
Q

most accurate test to determine amount of inflammation and scarring in the liver

A

Biopsy

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58
Q

Chronic inflammation of the lining of the colonic mucosa and the submucosal layer; beginning in the rectum and may involve the entire colon or only part of the colon (Worse in the rectum)
4-10 bowel movements per day; small to large amountso f blood and mucous; abdominal pain, impaired nutrition

A

Ulcerative colitis
Smoking protective
Friability, erosions and bleeding

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59
Q

All layers of the intestinal tract wall are affected; can occur in segments of the GI tract (patchy)
Diarrhea with blood intermittently, steatorrhea, abdominal cramping and pain

A

Crohn Disease
Fistulas can occur
Smoking makes worse

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60
Q

abdominal pain (diffuse or localized to the right or left lower quadrants); spasms, urgency and fecal incontinence may be reported with active rectal inflammation; stools loose or watery and may have blood

A

Inflammatory bowel disease

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61
Q

1st line for IBD

A

Mesalamine, sulfasalazine (5-aminosalicylic acid)

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62
Q

Medications for IBS

A

Antispasmodics–dicyclomine (bentyl)

Anti-diarrheals, anti-constipation, antidepressant

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63
Q

Cornerstones of antiemetic therapy

A

5-HT3 recepto blockers: ondansetron and dolasteron

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64
Q

Treatment of generalized N/V

A

Bismuth subsalicylate, metoclopramide, prochlorperazine, promethazine

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65
Q

Treatment of nausea associated with chemo

A

Serotonin blockers (ondansetron), dopamine receptor blockers (phenothiazines), cannabinoids, benzos

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66
Q

Treatment of motion sickness

A

Antihistamine/anticholinergic

Diphenhydramine, meclizine, promethazine, scopolamine

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67
Q

Ranson criteria

A

For acute pancreatitis

if >7 there is 100% mortality

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68
Q

Most common cause of pancreatitis

A

Gallstones

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69
Q

ABC causes of acute pancreatitis

A

Alcohol, autoimmune, arteritis, biliary, congenital, drugs, ERCP, eosinophila, formation of tumors, genetic, hyperlipidemia, hypercalcemia, idiopathic infections

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70
Q

sudden onset of sharp, poorly localized abdominal pain that radiates to the back

A

Pancreatitis

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71
Q

patient usually reluctant to take a deep breath due to severe abdominal pain; pain worse in supine position; abdominal distention due to leakage of fluid into the retroperitoneum; rebound tenderness are late signs

A

Pancreatitis

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72
Q

Diagnostics for pancreatitis

A

Serum amylase and lipase

Rise 6-12 hours after onset of symptoms

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73
Q

Management of acute pancreatitis

A

Early IV hydration
Pain treated with opioid–demerol
Clear fluids when pain-free

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74
Q

Causes of chronic pancreatitis

A

Chronic alcoholism, duct obstruction from tumors, hypercalcemia, hyperlipidemia, genetics, autoimmune

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75
Q

abdominal pain epigastric with potential referral to upper back, anterior chest or flank; N/V may accompany the pain; pain intensifies with alcohol or fatty food; weight loss, diarrhea and steatorrhea due to fat

A

Pancreatitis

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76
Q

2 types of PUD

A

NSAID or H Pylori

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77
Q

epigastric pain (sharp, burning, aching, gnawing pain) or dyspepsia; pain usually relieved by food or antacids or have pain with eating

A

PUD

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78
Q

1st line therapy for PUD

A

Antisecretory therapy

Discontinue NSAID or COX-2 inhibitors

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79
Q

H2 blockers for PUD

A

Cimetifine, famotidine, nizatidine, ranitidine

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80
Q

PPI for PUD

A

Omeprazole, lansoprazole, rabeprazole, esomeprazole

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81
Q

Prostaglandin therapy for PUD

A

Misoprostol only available agent for NSAID induced gastric ulcer

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82
Q

H Pylori treatment

A
  1. Omeprazole + Clarithromycin, then omeprazole
  2. Ranitifine bismuth + Clarithromycin, then ranitidine
  3. Bismuth subsalicylate + Metronidazole + Tetracycline + ranitidine
  4. Lansoprazole, amoxicillin, and clarithromycin
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83
Q

1st line treatment for fever

A

Acetaminophen

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84
Q

Differentials for lymphadenopathy CHICAGO

A

Cancers, hypersensitivities, infection, connective tissue disease, atypical lymphoproliferative disorders, granulomatous lesions, other

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85
Q

fever, chills, headache, malaise, myalgia, loss of appetite

dry cough, nasal congestion with clear discharge and sore throat

A

Influenza

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86
Q

4 treatments of flu

A

Amantadine, rimantadine, zanamivir, oseltamivir

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87
Q

Most common cause of acute diarrhea

A

Norovirus

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88
Q

Most common organism for travelers diarrhea

A

E Coli

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89
Q

Abx for travelers diarrhea

A

Cipro or azithromycin

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90
Q

Treatment of C Diff

A

Oral metronidazole or oral vancomycin

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91
Q

food poisoning 1-6 hours after ingestion

A

Staph aureus, bacillus cereus

92
Q

food poisoning 8-14 hours aftrer ingestion

A

Clostridium perfringens, bacillus cereus

93
Q

fever, pharyngitis, lymphadenopathy, fatigue, atypical lymphocytosis, may have palatal petechiae, hepatomegaly, splenomegaly

A

mono

94
Q

pink-red spherical rash at the site of the tick bite called erythema migrans; usually appears within 3-30 days of the tick bite; has a target-like lesion with central clearing that is painful, burning or itchy

A

Early localized lyme disease

95
Q

Secondary annular lesions, severe malaise or fatigue, headache, fever, chills, regional or generalized lymphadenopathy, migratory arthralgias or arthritis, splenomegaly, neurologic abnormalities, AV block, pancarditis, conjunctivitis, hepatitis, sore throat, sough; occurs within several weeks

A

Early disseminated lyme disease

96
Q

Spastic paraparesis, scleroderma like lesions, ataxic gait, mental disorders, keratisis, fatigue; occurs months after disease onset

A

Late persistent lyme disease

97
Q

Treatment of lyme disease

A

Doxycycline

Second line is amoxicillin

98
Q

fever, severe headache and rash (usually begins around wrist and ankles and may involve the palms and soles)

A

Rocky mountain spotted fever

99
Q

fatigue, anorexia, weight loss, night sweats, cough, chest pain, hemoptysis, irregular mesnes, low grade fever

A

TB

100
Q

First step for TB management

A

Screening with mantoux test

101
Q

Major side effects of INH

A

Hepatitis, peripheral neuropathy

102
Q

Sprain

A

Ligament injury

103
Q

Strain

A

Tendon injury

104
Q

Fibromyalgia

A

> 3 months of musculoskeletal pain present in 19 areas as well as severity of symptoms associated with fibromyalgia

105
Q

Predominant cause of hyperuricemia

A

Undersecretion of urate by the kidneys

106
Q

Treatment of acute gout flare up

A

NSAIDs, colchichine, steroids, ACTH

107
Q

Long term treatment of gout

A

Allopurinol

108
Q

Gout prevention diet

A

Low purine, low protein, alcohol restricted diet

109
Q

Radicular back pain

A

Often have leg and thigh pain greater than back pain; may have numbness, tingling, weakness, reflex changes and root tension signs
Exacerbated by prolonged sitting, coughing, sneezing, bending

110
Q

Medications for low back pain

A

Ice, heat, NSAIDs or acetaminophen, skeletal muscle relaxants (cyclobenzaprine)

111
Q

Drop arm test

A

Shoulder injury

112
Q

Empty can test

A

Rotator cuff injury

113
Q

Impingement test

A

Shoulder injury

114
Q

Hawkin test

A

Shoulder injury

115
Q

Spurling test

A

Shoulder injury

116
Q

shoulder pain aggravated by movement, especially overhead activity and radiating to the anterior aspect of the arm; abduction is painful and weak and tenderness may be elicited over the insertion of the greater tuberosity

A

Rotator cuff tear

117
Q

increased bone fragility and increased susceptibility to fracture

A

Osteoporosis

118
Q

Causes of osteoporosis

A

Aging and estrogen deficiency

Glucocorticoid use

119
Q

Secondary causes of osteoporosis

A

Hyperparathyroidism, hyperthyroidism

120
Q

Treatment of osteoporosis

A

Biphosphanates (alendronate, zoledronic acid), calcitonin, raloxifene, calcium 1000-1200mg, vitamin D 800-1000IU

121
Q

Osteoclasts in the affected area are increased in number, size and activity and cause breakdown of focal areas of bone at great speed

A

Paget disease

122
Q

Chief symptom of paget disease

A
Bone pain
Often tender to touch and warm
Pagetic bone noticebaly enlarged 
Bow shaped bones 
May have enlarged head
123
Q

Diagnosis of Paget disease

A

Serum alkaline phosphatase or urinary n-telopeptide cross links level

124
Q

Treatment of paget disease

A

Biphosphanates, calcitonin, pain management

125
Q

Progressive degenerative joint process; degeneration of articular cartilage layer on the ends of the bones of the joints; increases thickness and sclerosis of the bone plate

A

Osteoarthritis

126
Q

insidious, progressive pain or stiffness of one or more joints; prevalent on arising for less than one hour duration and after a prolonged activity and relieved by rest
Weight bearing causes pain and weakness

A

Osteoarthritis

127
Q

Physical exam findings for OA

A

o Joint crepitus, deformities, swelling, gradual los of motion as condition progresses
o Heberden’s nodes: distal
o Bouchard’s nodes: proximal
o OA of the hip manifests with groin or buttock pain that can radiate to the knee—resultant gait is Trendelenburg gait

128
Q

Tx of OA

A

Acetaminophen, NSAIDs, tramadol

129
Q

• Autoimmune disorder characterized by symmetric inflammatory polyarthritis and varying degrees of extra-articular involvement

A

RA

130
Q

Physical exam of RA

A

o Ulnar deviations, swan neck deformity, boutonniere deformity of thumb
n palpation, inflamed joint feels warm and tender and the synovial membrane feels thickened and boggy; skin may look shiny and have a ruddy color

131
Q

Sjogren syndrome

A

Commonly seen in RA patients

characterized by dry eyes and dry mouth—due to immune mediated destruction of the salivary and lacrimal glands

132
Q

Treatment of RA

A

DMARDs
Steroids
NSAIDs

133
Q

Chronic multisystem inflammatory rheumatic disease

A

SLE

134
Q

malaise and fatigue, anorexia and weight loss, fevers, lymphadenopathy, tachycardia, anemia, butterfly rash, discoid lupus rash, discoid lupus skin lesions

A

SLE

135
Q

Management of SLE

A

Avoid sun exposure
Low dose omega 3
Steroids, statins, NSAIDs, hydroxychloroquine, immunosuppresants

136
Q

Reversible vasospastic disorder that affects the blood flow to the digits

A

Raynauds

137
Q

classic tricolor changes of first white, then blue and then red after vasospasm ends; can be triggered by cold exposure, rapid changes in ambient temperature or emotional stress; may involve single digits or multiple body parts

A

Raynaud’s

138
Q

Management of SLE

A

Environmental measures–keep body warm, stress management, strict avoidance of smoking
Vasodilators (nifedipine), antiplatelets (aspirin), oral and inhaled prostaglandin inhibitors

139
Q

Addison disease

A

Primary adrenal insufficiency
Chronic malaise, dizziness, nausea, chronic abdominal pain, muscle cramps, hyperpigmentation, decreased libido, weight loss, salt craving
Decreased axilla and pubic hair

140
Q

Diagnostics of Addison disease

A

elevated serum ACTH and decreased cortisol; hyponatremia and hyperkalemia, screen for TB

141
Q

Management of addison disease

A

Outpatient: oral hydrocortisone, mineralocorticoid replacement with fludrocortisone

142
Q

Cushing syndrome

A

Overproduction of cortisol

143
Q

Central obesity, moon face, buffalo hump, muscle weakness and wasting, hirsutism, red-purple abdominal skin striae of >1cm

A

Cushing syndrom

144
Q

o Catecholamine-secreting tumor of chromaffin cells

A

Pheochromocytoma

145
Q

Hallmark of new onset of moderate to severe hypertension with systolic pressure >170

A

Pheochromocytoma

146
Q

Management of pheochromocytoma

A

Surgical removal

147
Q

Leading cause of cardiovascular disease, renal failure, blindness, and nontraumatic lower limb amputation

A

Diabetes

148
Q

Pre-diabetic lab values

A

o FPG: 100-125
o OR 2 hour plasma glucose 140-199
o OR A1C 5.7-6.4%

149
Q

Early morning hyperglycemia controlled by

A

Basal insulin

150
Q

Postmeal glucose spikes controlled by

A

Prandial insulin

151
Q

Rapid acting insulin

A

Lispro, aspart, glulisine

Give just before, during or immediately after a meal

152
Q

First drug for type 2 DM

A

Metformin

153
Q

Postmeal BG should be

A

<180 1-2 hours after eating

154
Q

Routine labs for DM

A

HbA1C every 3 months, yearly urinary microalbumin and urinalysis, BUN, Cr, ophthamology, lipid profile

155
Q

After initiating lipid lowering drugs, a second panel should be obtained in

A

4-12 weeks

Initial test of liver fx before beginning statins

156
Q

Most sensitive indicator of overall thyroid function

A

TSH

157
Q

If TSH abnormal,

A

A free T4 should be obtained

158
Q

Most common cause of goiter in the world

A

Iodine deficiency

159
Q

Most common cause of hyperthyroidism

A

Graves disease

160
Q

Drug induced hyperthyroidism

A

Amiodarone, interferon alfa, lithium

161
Q

Management of tremors and palpitations in Graves

A

Propranolol or atenolol

162
Q

Thiamide therapy for hyperthyroidism

A

Methimazole and PTU

Baseline CBC and liver function tests

163
Q

Pregnancy and thiamides

A

PTU limited to first trimester

164
Q

Management of hypothyroidism

A

Levothyroxine
Check TSH every 6 weeks until stable and then every 6-12 months
Take 2 hours before or 4 hours after food
Monitor BG levels

165
Q

Incontinence and aging

A

Not considered normal at any age

166
Q

loss of urine associated with activities that increase intra-abdominal pressure

A

Stress incontinence

167
Q

involuntary loss of urine usually preceded by a strong, unexpected urge to void

A

Urge incontinence

Overactive bladder

168
Q

involuntary loss of urine associated with incomplete emptying

A

Overflow incontinence

169
Q

Tx of stress incontinence

A

 Timed voiding, smoking cessation, weight loss, pelvic muscle exercises, bowel management
 Alpha agonists, TCAs, estrogen

170
Q

Tx of urge incontinence

A

 Bladder training, scheduled voiding, bladder irritant minimization, urge suppression
 Anticholinergic-antimuscarinics (Oxybutynin)

171
Q

Tx of overflow incontinence

A

 Timed voiding, clean intermittent catheterization

 Alpha 1 blockers, 5-alpha-reductase inhibitors

172
Q

Main mediator of prostate growth

A

DHT

173
Q

Management of BPH

A

alpha blockers: terazosin, dozazosin

5-alpha reductase inhibitors: dustaseride and finasteride (may take 6-12 months)

174
Q

Most common sign of bladder cancer

A

Hematuria

175
Q

Hallmark clinical signs of CKD

A

Decreased GFR, increased serum Cr and albumin in urine

176
Q

Management of ED

A

Phosphodiesterase type 5 inhibitors: enhance effects of NO and block degradation of cGMP; do not initiate an erection–sildenafil, vardenafi, tadalafil

177
Q

increased frequency, urgency, dysuria, suprapubic pain, odorous urine, hematuria occasionally

A

UTI

178
Q

Management of UTI

A

Nitrofurantoin
Cephalexin
Amoxicillin
Augmentin

179
Q

Tx of chlamydia

A

Azithromycin 1g or doxycycline

180
Q

Tx of gonorrhea

A

Ceftriaxone IM + azithromycin or doxycycline

181
Q

Tx of syphilis

A

Penicillin

182
Q

Tx of herpes

A

Acyclovir

183
Q

Discoid rash

A

Present in SLE

184
Q

Lachman test

A

Identifies integrity of ACL
with the knee flexed 20-30°, the tibia is displaced anteriorly relative to the femur; a soft endpoint or greater than 4 mm of displacement is positive (abnormal)

185
Q

Anterior drawer test

A

Identify integrity of ACL

186
Q

Bouchard node

A

RA; proximal interphalangeal joints

187
Q

Heberdens nodes

A

RA; distal interphalangeal joints

188
Q

Dawn phenomenon

A

abnormal early morning increase in blood sugar (between 2 and 8am)

189
Q

Somogyi effect

A

rebound hyperglycemia after an episode of hypoglycemia when sleeping

190
Q

Murphy’s sign

A

palpate gallbladder medial to midclavicular line while patient lying supine; tests for cholecystitis

191
Q

McBurney’s sign

A

tests for appendicitis

192
Q

Bulls eye rash

A

Lyme disease

193
Q

TB PPD >5mm is positive for

A

recent contact with active TB patient, nodular or fibrotic changes in chest X ray, organ transplant

194
Q

PPD >10mm positive for

A

recent antivirals, IV drug use, congregate settings, mycobacteriology lab personnel, comorbid conditions, children <4, infants, children and adolescents exposed to high risk categories

195
Q

PPD >15mm positive for

A

Persons with no known risk factors for TB

196
Q

Phenazopyridine

A

Analgesia used to treat dysuria

197
Q

Normal TSH

A

0.4-4

198
Q

When to repeat C4 count in hIV

A

every 3-4 months

199
Q

how much carbs to give if hypoglycemic

A

15g

200
Q

hematuria

A

Defined as >3RBC per high power field

201
Q

Proteinuria value

A

> 150mg per day

30-150mg per day is early renal disease

202
Q

Most accurate way to quantify protein in urine

A

24 hour urine collection

203
Q

Bence jones protein associated with

A

multiple myeloma

204
Q

Transient urinary incontinence related to

A

Delirium, infection, medications, underlying systemic illness

205
Q

overflow incontinence causes

A

DM, injuries to sacral cord, outlet obstruction

206
Q

Causes of stress incontinence

A

Laxity of pelvic floor, bladder outlet or sphincter weakness

207
Q

Do not prescribe Bactrim for UTI if

A

Resistance >20% E Coli

208
Q

Sudden onset fever, shaking, chills, N/V, unilateral or localized flank pain, fatigue, diarrhea

A

Pyelonephritis

209
Q

Urinalysis positive for…. in pyelonephritis

A

Bacteria, proteinuria, leukocyte esterase, urinary nitrites, hematuria, pyuria, WBC casts

210
Q

Diagnostic for pyelonephritis

A

Presence of WBC casts

211
Q

Most common kidney stones

A

MoCalcium oxalate or calcium phosphate

212
Q

Struvite stones

A

Found predominantly in women; associated with UTI; occur when urine is alkaline

213
Q

Oxalate rich foods

A

beets, black tea, chocolate, lamb, nuts, rhubarb, spinach

214
Q

Purine rich food

A

Red meat, seafood, poultry, legumes, whole grains, alcohol

215
Q

sudden and rapid deteriotation of renal function, resulting in an accumulation of nitrogenous wastes

A

Acute renal failure

Often completely reversible

216
Q

Most common causes of AKI

A

Intrarenal causes by nephrotoxins

Decreased blood flow to the kidneys

217
Q

Phases of acute renal failure

A

Initiation
Maintenance/oliguric
Recovery: diuresis common; may have plyuria

218
Q

Common cause of intrarenal failure

A

Acute tubular necrosis

219
Q

Hallmark signs of renal failure

A

Decreased GFR

Increased serum Cr and albuminuria

220
Q

Treatment of prostatitis

A

Fluoroquinolone

Bactrim or doxycycline

221
Q

Treatment of nonbacterial prostatitis

A

may benefit from eyrthromycin, bactrim or fluoroquinolone

222
Q

Screening for syphilis

A

RPR

223
Q

Causes of epididymitis

A

STI

224
Q

What will relieve pain with epididymitis

A

Elevaiton of testes

225
Q

Tx of epididymitis

A

One time dose of ceftriaxone IM and doxycycline

Cipro or Bactrim if not STI

226
Q

Nonpharm tx of epididymitis

A

Bed rest with scrotal eelvation; ice pack or warm compresses, avoidance of physical straining