Family Med Flashcards
What are the signs/symptoms of retinal artery occlusion?
Acute-onset, painless, unilateral vision loss
Afferent pupillary defect (dilation of the affected pupil when a swinging flashlight moves toward it)
Retinal pallor on fundoscopic exam
Cherry-red spot in the macula
What is the most common mechanism of injury in an ankle sprain?
Inversion of a plantar flexed foot
What are the stages of hypertension?
Normal: < 120 / < 80
Elevated: 120-129 / < 80
Stage 1: 130-139 systolic OR 80-89 diastolic
Stage 2: >/= 140 systolic OR >/= 90 diastolic
Crisis: >/= 180 systolic OR >/= 120 diastolic
What should be suspected in patients presenting with hemolysis following an oxidative stressor, such as recent administration of a drug?
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
What are the physical exam findings in a patient with bacterial endocarditis?
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli
What leukemia is caused by a reciprocal translocation on the long arms of chromosomes 9 and 22 (AKA the Philadelphia chromosome)?
Chronic myelogenous leukemia (CML)
What are the signs/symptoms of sarcoidosis?
Cough, dyspnea, fever, fatigue, skin lesions, arthralgias
Bilateral hilar adenopathy on CXR
Hypercalcemia, hypercalciuria, elevated serum ACE on labs
What signs/symptoms are pathognomonic for sarcoidosis?
Lupus pernio
Chronic, violaceous, raised plaques and nodules commonly found on the cheeks, nose, and around the eyes
What medications are used as abortive therapy for migraines?
Triptans, DHE, antiemetics, NSAIDs
What medications are used as prophylactic treatment for migraines?
TCAs, beta-blockers, anticonvulsants (valproic acid, topiramate), CCBs
When should you avoid triptans and DHE?
In patients with uncontrolled HTN or cardiovascular disease
What medication class is used to treat symptoms and prostate size in patients with BPH?
5-alpha-reductase inhibitors (ex finasteride)
What is an occupational lung disease associated with nuclear power, nuclear reactor, dental, metal machine shops, and aerospace industries?
Berylliosis
What is the American Diabetes Association diagnostic criteria?
Symptoms & random BG >/= 200
Fasting BG >/= 126 on 2 occasions
BG > 126 2 hrs after 75g GTT
A1C >/= 6.5
What is the treatment for Lyme in a pregnant patient?
Amoxicillin
External hemorrhoids that fail conservative treatment require what treatment?
Hemorrhoidectomy
What is Samter’s triad?
Nasal polyps, asthma, and aspirin-sensitivity (related to allergies)
What are the most common bacterial causes of acute otitis media?
Haemophilus influenzae and Streptococcus pneumoniae
What is the treatment of choice in otherwise healthy patients with community acquired pneumonia?
Amoxicillin or doxycycline
What is cholesteatoma?
Keratinized collection of desquamated epithelial tissue in the middle ear or mastoid
What are the signs/symptoms of cholesteatoma?
Painless, malodorous otorrhea and conductive hearing loss
What type of murmur can be heard as a soft, high-pitched, crescendo-decrescendo murmur during midsystole along the left sternal border?
Still murmur
What maneuver should be performed if you suspect an innocent murmur of childhood?
Standing
What is metabolic syndrome?
The combination of central obesity, insulin resistance, hypertension, high triglycerides (>150), and low HDL (<40-50)
In patients with mono, which lymph nodes are typically enlarged?
Posterior cervical
What is the preferred diagnostic test for nephrolithiasis?
Noncontrast CT of abdomen and pelvis
What is 1st line pharmacologic treatment for chronic glaucoma?
Prostaglandin analog (e.g., latanoprost)
What is an essential tremor relieved and exacerbated by?
Relieved: small amounts of alcohol
Exacerbated: anxiety
Immune thrombocytopenia (ITP) is an immune-mediated disorder characterized by what?
Isolated thrombocytopenia (< 100,000) with normal hemoglobin, hematocrit, and white blood cell counts
What should patients with SLE avoid?
Pregnancy for 6 months following active disease
What lab tests high specificity for SLE?
Anti-double-stranded DNA and anti-Smith antibodies
For patients considered to have high cardiovascular risk, when is follow-up lipid screening performed?
Men: 25 to 30 years
Women: 30 to 35 years
What is the treatment for kids who present with GI symptoms and likely a shigella infection?
Azithromycin
What medication improves symptoms of claudication and can increase walking distance by suppressing platelet aggregation and dilating arterioles?
Cilostazol
What is the recommended first-line therapy for acute bacterial rhinosinusitis?
Augmentin 875 mg/125 mg BID or 500 mg/125 mg TID for 5 to 7 days
Doxycycline if penicillin allergic
What are the most common pathogens causing community-acquired pneumonia?
Streptococcus pneumoniae and Mycoplasma pneumoniae
What makes up the Samter triad?
Asthma, aspirin sensitivity, and nasal polyps
Allergic contact dermatitis is what type of hypersensitivity reaction?
Type IV (mediated by T lymphocytes)
What are common causes of allergic contact dermatitis?
Poison ivy, poison oak, topical antimicrobials (e.g., bacitracin, neomycin), anesthetics, nickel, and adhesive tape
What drug used to treat TB is known to cause neuropathy?
Isoniazid
When prescribing isoniazid, what other medication can be given to help avoid neuropathy?
Vit B6
What is Pancoast syndrome?
A tumor that may develop dermatomal symptoms stemming from C8, T1, and T2 due to involvement of the brachial plexus which can result in muscle atrophy, weakness, and pain.
Horner syndrome can be present.
What is Horner syndrome and what other syndrome is it associated with?
Ipsilateral ptosis and miosis
Associated with Pancoast syndrome
What are the treatment options for warts?
Topical salicylic acid (1st line)
Cryotherapy (1st line)
Topical cantharidin
Laser
Topical immunotherapy (reserved for refractory cases)
What are the physical exam findings in a patient with hypertrophic cardiomyopathy?
Pulsus bisferiens (biphasic pulse due to aortic regurgitation)
Triple apical impulse (prominent atrial filling with early and late systolic impulses)
Prominent a wave due to reduced right ventricular compliance
Loud S4 gallop
What things would cause the murmur associated with hypertrophic cardiomyopathy to decrease or increase?
Decrease: actors that increase the preload (squatting, hand-grip)
Increase: factors that decrease the preload (standing, Valsalva maneuver)
What is a Monteggia fracture?
Fracture of the proximal ulnar shaft with a radial head dislocation
What are the classic findings of rheumatoid arthritis?
Symmetric swelling
Pain and stiffness of multiple joints
Morning stiffness
Symptoms that are worse in the morning, worse after inactivity, and alleviated by mild activity
What are first-line agents for patients with abdominal discomfort or pain due to irritable bowel syndrome?
Antispasmodic agents, such as dicyclomine or hyoscyamine
What are the characteristics of nonproliferative diabetic retinopathy?
Tortuous, dilated retinal vessels in the macula and may cause retinal hemorrhages without neovascularization
What are histopathologic findings indicative of Alzheimer disease?
Amyloid plaques and the accumulation of hyperphosphorylated tau protein in neurofibrillary tangles within the brain
How do patients with polycythemia vera present?
Vasomotor symptoms, such as erythromelalgia and aquagenic pruritus
Headache, dizziness, and early satiety
Facial plethora (ruddy cyanosis) and splenomegaly
Elevated hemoglobin and hematocrit
What type of hearing loss is seen with Ménière disease?
Low-frequency sensorineural hearing loss
What type IV hypersensitivity reaction is associated with herpes simplex virus?
Erythema multiforme
What are clinical manifestations of chronic Addison disease?
Weakness
Fatigue
Loss of appetite
GI symptoms
Weight loss
Dizziness
Hypotension
Hyperpigmentation of the skin
What abnormal gene is associated with familial adenomatous polyposis (FAP)?
APC mutation
What is the first-line drug choice for generalized epileptic seizures?
Valproate
What gram stain results would you expect to find in a patient with bacterial meningitis?
Gram-negative diplococci
What are the T scores associated with osteoporosis and osteopenia?
Osteoporosis: ≤ −2.5
Osteopenia: < −1.0 and > −2.5
When should a pregnant patient with hyperthyroidism be transitioned from PTU to methimazole?
If dx prior to pregnancy and on methimazole: switch to PTU once pregnancy confirmed
If dx in 1st trimester: start on PTU and switch to methimazole in 2nd trimester
If dx after 1st trimester: start with methimazole
What medication is effective in preventing recurrent hepatic encephalopathy?
Rifaximin
What is first-line pharmacological therapy for osteoporosis?
Bisphosphonates (e.g., alendronate, pamidronate, zoledronic acid)
What are the signs/symptoms of acute myeloid leukemia?
Fatigue
Weakness
Easy bleeding
Pallor
Bruising
Shortness of breath
Normocytic, normochromic anemia
Decreased platelet count
Myeloblasts with Auer rods
What bacteria is associated with the development of magnesium ammonium phosphate crystals in the urine, leading to nephrolithiasis?
Proteus mirabilis
What medication is FDA approved to treat Bipolar I?
Quetiapine
What are the signs/symptoms of Bells palsy?
Waking up with unilateral facial nerve paralysis, hyperacusis, and taste disturbance that does NOT spare the forehead
What antibiotic should be prescribed a patient with a corneal abrasion who wears contacts?
Topical gentamicin
What is the effect of low serum estradiol and progesterone (common in birth control) levels on gonadotropin-releasing hormone, follicle-stimulating hormone, and luteinizing hormone at the beginning of the menstrual cycle?
All increase
What are drusen spots?
Atrophic changes and yellow retinal deposits associated with dry macular degeneration
Children who present with early-onset hypertension or a new murmur should be considered for what disorder?
Coarctation of the aorta
Patients with anemia secondary to vitamin B12 deficiency often present with what symptoms?
Fatigue
Shortness of breath
Glossitis
Paresthesia
Numbness
Gait abnormalities
What does the U.S. Preventive Services Task Force suggest for breast cancer screening women with a normal risk?
Bilateral screening mammography at age 50 years and repeating the screening every 2 years until the patient is 74 years old
What is Gilbert syndrome and what occurs in patients who have it?
Most common inherited disorder of bilirubin glucuronidation
There is a deficiency in the enzyme uridine 5’-diphospho-glucuronosyltransferase
Acute bacterial suppurative parotitis is typically caused by what bacteria?
Staphylococcus aureus
What is the treatment for outpatient septic bursitis?
Bactrim if MRSA suspected
Cephalexin or dicloxacillin if MSSA or Streptococcus
10 days
When might you see warfarin-induced skin necrosis?
In patients with protein C deficiency
Patients with a first-degree relative diagnosed with colorectal cancer should begin screening when?
10 years younger than the age at which that relative was diagnosed
HLA-B27 is associated with what disease?
Ankylosing spondylitis
If someone’s sputum culture comes back positive for TB, what results do you expect to see?
Rod-shaped, aerobic, acid-fast bacterium
