Family Med Clerkship Flashcards
1
Q
Changes to potassium for these medications?
- ACE inhibitors
- ARBs
- Chlorthalidone and HCTZ (diuretics)
- Amlodipine
A
- and 2. : Hyperkalemia is a known side effect of ACE inhibitors and angiotensin receptor blockers such as olmesartan.
— The risk of hyperkalemia is increased with chronic kidney disease, diabetes mellitus, moderately severe to severe heart failure, NSAID use, and older adults. - Chlorthalidone and hydrochlorothiazide can cause hypokalemia
- amlodipine have no significant effect on potassium levels.
2
Q
Treatment of
functional constipation
A
Daily use of polyethylene
glycol (PEG) solution has been found to be more effective than lactulose, senna, or magnesium hydroxide
in head-to-head studies.
–another 1st line drug is psyllium
3
Q
In what age range is acne abnormal and prompt endocrine laboratory testing for possible systemic disease
A
- mid childhood
acne can happen in infants (6-12 months) and then starting preadolescent (8 or 9 years)
4
Q
- Elevated BP
- Spontaneously low potassium level
- Possibly persistent HTN despite use of medication
- what could be causing HTN?
A
Primary hyperaldosteronism
- This can be evaluated by checking a serum renin activity level and a serum aldosterone concentration and determining the aldosterone/renin ratio. Primary hyperaldosteronism typically presents with a very low serum renin activity level and an elevated serum aldosterone concentration
5
Q
What typical infections can cause erythema nodosum (painful, subcutaneous, nonulcerated, erythematous nodules)?
A
- coccidioidomycosis (valley fever)
- Streptococcal infection
- Tuberculosis
6
Q
What is a infection that is associated with IV drug users + fever
A
Infectious endocarditis
- first step is blood cultures to check for bacteremia
7
Q
Define
1. Psychogenic tremor
2. Physiologic tremor
3. Essential tremor
A
- characterized by an abrupt onset, spontaneous remission, changing characteristics,
and extinction with distraction. - Enhanced physiologic
tremor is a postural tremor of low amplitude exacerbated by medication. There is usually a history of
caffeine use or anxiety. - Essential tremor have symmetric, fine tremors that may involve the hands, wrists, head,
voice, or lower extremities. This may improve with ingestion of small amounts of alcohol. There is no
specific diagnostic test but the tremor is treated with propranolol or primidone
8
Q
Pregnant people should receive a dose of Tdap between (Blank A) and (Blank B) weeks gestation to protect against pertussis, Tdap is the best choice for this patient.
A
Pregnant people should receive a dose of Tdap between 27 and 36 weeks gestation to protect against pertussis, Tdap is the best choice for this patient.
9
Q
Treatment for
1. gonorrhea positive only
2. When you don’t know if its either gonorrhea or chlamydia
A
For gonorrhea only infection: First-line therapy is one dose of ceftriaxone
Patients presenting with an unknown cause of urethritis should be prescribed a combination of one dose of ceftriaxone and doxycycline
—> Azithromycin as a single dose, may be used as an alternative to doxycycline for treatment of chlamydial infection
10
Q
What is the Rotterdam 2003 criteria most widely used diagnostic criteria for PCOS
A
The Rotterdam 2003 criteria are the most widely used diagnostic criteria for PCOS
Require the presence of two out of the following three features:
—oligomenorrhea, hyperandrogenism, and the presence of polycystic ovaries on ultrasonography.
When the first two of these criteria are clearly met, ultrasonography to establish the presence of polycystic ovaries is not required.
11
Q
CHA2DS2-VASc score of atleast 2 + Afib indicates what medications should be given for anticoagulation?
A
Anticoagulation with either a direct oral anticoagulant (DOAC) such as apixaban OR a vitamin K antagonist such as warfarin is recommended in patients with atrial fibrillation who have a CHA2DS2-VASc score 2.
Aspirin monotherapy is considered an ineffective antithrombotic strategy and inferior to a DOAC or warfarin for preventing thromboembolic events in patients with atrial fibrillation. Adding aspirin therapy to warfarin does not confer extra benefit and increases the risk of major bleeding.
12
Q
Which one of the following is the most common radiologic finding in early pulmonary sarcoidosis?
A
The most common finding is bilateral hilar adenopathy alone (stage 1). Other findings, which usually develop over time, include infiltrates and, in some patients, ultimately fibrosis.
13
Q
The American Academy of Pediatrics recommends annual blood pressure screening at what age
A
The American Academy of Pediatrics recommends annual blood pressure screening at well child checks beginning at 3 years of age. This recommendation does not differ for children who have a strong family history of hypertension.
14
Q
triptan medications are contraindicated in patients with what kinds of conditions
A
Because of their vasoconstricting properties, triptan medications are contraindicated in patients with established coronary artery disease, cerebrovascular disease, or peripheral vascular disease; patients with uncontrolled or multiple cardiovascular risk factors; and patients with certain high-risk migraine syndromes, including basilar and hemiplegic migraines.
Triptan use for the treatment of migraine headaches would not be contraindicated with a history of depression with psychotic features, poorly controlled diabetes mellitus, hypertension requiring two medications, or stage 4 chronic kidney disease.
15
Q
35-year-old female at 36 weeks gestation presents to your office. She reports that for the past few days she has had itching of her palms and soles that has been quite bothersome. She has tried moisturizer with no improvement. A physical examination is unremarkable with no rashes, erythema, or warmth of the palm and soles. The patient otherwise feels well.
What is the most likely cause?
A
Intrahepatic cholestasis of pregnancy (ICP) presents with pruritus of the palms and soles with or without jaundice along with an elevation in serum bile acid concentrations. ICP, which is most common in the late second and/or third trimester, can cause significant risk to the fetus, including fetal death, and is therefore treated aggressively with ursodeoxycholic acid and often early delivery
16
Q
What medication can be used alongside treatment for PTSD to diminish sleep disturbance
A
Prazosin is an effective augmenting therapy for patients with PTSD and sleep disturbance
17
Q
Tumor Lysis Syndrome
what happens to
–uric acid levels
–calcium levels
–potassium levels
–phosphate levels
A
- The breakdown of nucleic acids releases large amounts of uric acid and leads to acute kidney failure, which limits clearance of potassium, phosphorus, and uric acid. This leads to
–hyperuricemia
–secondary hypocalcemia
–hyperkalemia
–hyperphosphatemia.
It can result in acute renal failure, arrhythmia, seizure, and sudden death. While tumor lysis syndrome has been reported with many cancer types, it is more common with acute leukemia and high-grade lymphomas
18
Q
- When is cardiac stress testing indicated
- What about contraindicated
A
- cardiac stress testing is indicated when there is an intermediate probability of acute coronary syndrome. Also indicated in a preoperative assessment when surgery is at least a moderate risk and the patient cannot reach 4 METs of exertion (climbing a single flight of stairs) without cardiac symptoms.
- Cardiac stress testing is contraindicated after a recent stroke or TIA and in patients with severe symptomatic aortic stenosis.
19
Q
Differentiate between ASA I, ASA II, ASA III, ASA IV, ASA V, ASA VI
A
ASA I - normal healthy patient
ASA II - patient with mild systemic dx (smoker, social alcohol drinker, pregnancy, obesity BMI 30-40, well controlled HTN, mild lung disease)
ASA III - A patient with severe systemic disease
ASA IV - A patient with severe systemic disease that is a constant threat to life
ASA V - A moribund patient who is not expected to survive without the operation
ASA VI - A declared brain-dead patient whose organs are being removed for donor purposes
20
Q
- All patients who are having major surgery should be offered preoperative lab testing including what two things?
A
CBC and renal function testing
21
Q
What is the recommended treatment for metatarsal stress fractures
A
The recommended treatment for metatarsal stress fractures is
1. No weight bearing for a few days, possibly using a posterior splint
2. Transitioning to a walking boot or short leg cast
3. Then a rigid-soled shoe in 4–6 weeks
22
Q
What is next step lab after getting a dipstick urinalysis when trying to differentiate between serious illness from benign causes of proteinuria
A
- spot protein/creatinine ratio is reliable test for ruling out proteinuria
–if persistent proteinuria occurs then a specialist referral, blood analysis, and ultrasound can be done
23
Q
Antipsychotics (such as quetiapine) are frequently used for tx of Behavioral and psychological symptoms of dementia include delusions, hallucinations, aggression, and
agitation.
–How should this medication be managed if symptoms have stabilized or pt has not responded
A
For patients who have been taking antipsychotics for 3 months and whose symptoms have
stabilized, or for patients who have not responded to an adequate trial of an antipsychotic, it is
recommended that the drug be tapered slowly (SOR B).
24
Q
What risk factors increase 30 day mortality for patients with community acquired pneumonia?
A
- increased respiratory rate 30/min
- Hypotension
- Confusion or disorientation
- BUN level 20 mg/dL
- age > 65 years
- male sex
- Heart failure or COPD
25
what is megestrol for?
appetite stimulant
- not recommended in older adults due to potential harmful side effects and a lack of evidence supporting improved outcomes for the treatment of cachexia in the geriatric population
26
What condition shows erythematous patches with slightly elevated scaly borders + rash on the back has a “Christmas tree” pattern
- for what population is this condition dangerous for and why
Pityriasis rosea is associated with an increased rate of
spontaneous abortion in the first 15 weeks of gestation.
27
Diarrhea that develops in patients with ileal Crohn’s disease or following ileal resection is usually due to...
Due to increased amounts of bile acid remaining in the stool. This affects colonic secretion and motility and various protein factors in the gut, resulting in the development of bile acid diarrhea (BAD).
--a therapeutic trial with a bile acid sequestrant such as cholestyramine is most often used for both the diagnosis and treatment of BAD
28
What is the most accurate and appropriate maneuver to detect an anterior cruciate ligament tear?
Lachman test is the most accurate test for an anterior cruciate ligament (ACL) tear (SOR A). The Lachman test has higher validity based on a sensitivity of 68% for partial ruptures and 96% for complete ruptures.
29
What type of drug is donepezil?
- what does it do?
1. This is an cholinesterase inhibitor. Increases risk of bradycardia or heart block in patients with or without underlying cardiac conduction abnormalities due to vagotonic effect on the SA and AV nodes.
2. used to treat symptoms of alzheimers disease like memory loss and confusion
30
What is the appropriate treatment for viral bronchiolitis?
Supportive therapy, including
adequate hydration, is recommended for treatment
-- symptoms include runny nose, fever, stuffy nose, loss of appetite and cough are the first signs of the infection. Symptoms may worsen after a few days and may include wheezing, shortness of breath, and worsening of the cough
31
1. spironolactone/eplerenone MOA
2. ACE inhibitors MOA
3. ARBs MOA
1. competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule
2.prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels
3. The ARBs' mechanism of action, selective inhibition of angiotensin II by competitive antagonism of the angiotensin II receptors
32
Aldosterone MOA
1. Aldosterone stimulates the secretion of K+ into the tubular lumen.
2. Aldosterone stimulates Na+ and water reabsorption from the gut, salivary and sweat glands in exchange for K+.
3. Aldosterone stimulates secretion of H+ via the H+/ATPase in the intercalated cells of the cortical collecting tubules.
33
The first step in the evaluation of nonmassive hemoptysis is ...
The first step in the evaluation of nonmassive hemoptysis is to obtain a chest radiograph
-- If this is normal and there is a high risk of malignancy (patient age 40 years or older with at least a 30-pack year smoking history), chest CT should be ordered. Bronchoscopy should also be considered in the workup of high-risk
patients.
34
What does sarcoidosis usually present with on chest radiograph?
- Among patients with sarcoidosis, 75–90% will present with mediastinal and hilar lymphadenopathy.
35
What are significant risk factors for esophageal adenocarcinoma?
gastroesophageal reflux and obesity are the main risk factors.
36
The diagnostic cutoff point for type 2 diabetes is a
-- fasting plasma glucose level of (BLANK A)
-- a hemoglobin A1c of (BLANK B)
The diagnostic cutoff point for type 2 diabetes is a
-- fasting plasma glucose level 126 mg/dL
-- a hemoglobin A1c 6.5%.
The diagnosis requires confirmation by repeat testing or by obtaining both a fasting glucose level and hemoglobin A1c.
37
Immune (idiopathic) thrombocytopenic purpura
1. what is this
2. how is it treated?
1. Acquired immune-mediated disorder defined as isolated thrombocytopenia not found to have another cause.
2. Treatment is usually restricted to severe
thrombocytopenic cases (platelet count <50,000/mm3) unless there is evidence of acute bleeding. Corticosteroids are considered the first-line therapy (SOR C)
38
What drug can help improve antidepressant-related sexual arousal dysfunction (SOR B)
- Bupropion
Bupropion is used to treat depression and to prevent depression in patients with seasonal affective disorder (SAD), which is sometimes called winter depression. It is also used as part of a support program to help people stop smoking.
39
What antihypertensive medication should be given for patients with chronic kidney disease (CKD) and proteinuria
JNC 8 advises more intensive blood pressure control in patients with chronic kidney disease (CKD) and proteinuria.
This is most often achieved with combination therapy, with either an
1. ACE inhibitor or an angiotensin receptor blocker (ARB)
2. PLUS either a thiazide diuretic or a calcium channel blocker.
40
- Glipizide, glyburide, and glimepiride
-What type of medication are these?
- MOA?
1. sulfonylureas
2. stimulate release of insulin from pancreatic beta cells and thereby lower blood glucose concentrations. Only useful in patients with some beta cell function
41
1. what infants need vitamin D supplementation
2. When should vitamin D supplementation start
1. Breastfeeding does not provide adequate levels of vitamin D. Exclusive formula feeding probably provides adequate levels of vitamin D, but infants who consume less than 1 liter of formula per day need supplementation with 400 IU of vitamin D daily.
2. Vitamin D supplementation should be started within the first 2 months of life.
42
What are the three major risk factors for curve progression of idiopathic scoliosis
1. the magnitude of the curve at presentation
2. the potential for future growth
3. female sex.
The Cobb angle is based on spine radiology that quantifies the magnitude of the scoliosis curve. If the Cobb angle is 20° there is a high risk that the curve will progress and that the patient may need treatment
Reminder: Scoliosis typically does not cause pain
43
The evidence shows that the risk of an opioid overdose increases at the threshold of (BLANK) MME/day.
50 MME/day.
- It is therefore recommended by the CDC that a prescription for naloxone be ordered when an opioid dosage reaches 50 MME/day, which is a high dosage. In general one should avoid prescribing 90 MME/day because of the substantially higher risk of an overdose at this dosage level.
44
What is Charcot neuroarthropathy?
an inflammatory condition that occurs in obese patients with peripheral neuropathy and ultimately leads to foot deformities (the classic rocker-bottom foot) and resultant ulcerations and infections. Its clinical appearance can easily be initially mistaken for cellulitis. However, the absence of tenderness and other signs of infection such as fever, an elevated WBC count, and inflammatory markers is not consistent with cellulitis. Radiography is an appropriate initial imaging modality but the results are often interpreted as normal early in the disease process. MRI is the modality
of choice for a definitive diagnosis and may demonstrate periarticular bone marrow edema, adjacent soft-tissue edema, joint effusion, and microtrabecular or stress fractures.
The treatment of acute Charcot neuroarthropathy is immobilization with total contact casting, which increases the total surface area of contact to the entire lower extremity, distributing pressure away from
the foot. Immobilization is typically required for at least 3–4 months but in some cases may be needed for up to 12 months
45
(BLANK A) should be started for
all patients with PAD regardless of their LDL-cholesterol levels (SOR A).
Statins should be started for all patients with PAD regardless of their LDL-cholesterol levels (SOR A). High-intensity statins should be used if tolerated.
46
1. Elevated BP is defined as...
2. Stage I hypertension
3. Stage II hypertension
1. systolic pressure of 120–129 mm Hg and a diastolic pressure <80 mm Hg.
2. A blood pressure of 130–139/80–89 mm Hg
3. A systolic pressure 140 mm Hg or a diastolic pressure 90 mm Hg
47
1. What is the goal fasting blood glucose for patients with gestational diabetes?
2. goal 2-hour postprandial glucose level is??
3. goal 1-hour postprandial glucose level is??
1. <95 mg/dL
2. goal 2-hour postprandial glucose level is <120 mg/dL
3. goal 1-hour postprandial glucose level is <140 mg/dL
48
What should you immediately administer to someone with a STEMI
Along with initiating the hospital’s protocol for myocardial infarction, immediate
treatment should
--- include dual antiplatelet therapy with a 325-mg dose of nonenteric aspirin, a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor)
--- and an anticoagulant (unfractionated heparin or bivalirudin).
49
What antidepressants have helped with IBS symptoms
-- SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and tricyclic antidepressants included amitriptyline, desipramine, and imipramine.
--Exercise, probiotics, antibiotics, antispasmodics, antidepressants, psychological treatments, and peppermint oil all have evidence that they may improve IBS symptoms (SOR B)
50
1. What is the preferred agent for preventing acute mountain sickness (AMS)
2. What is the first-line treatment for acute mountain sickness of any severity
1. Acetazolamide is the preferred agent for preventing acute mountain sickness (AMS). Multiple trials have demonstrated its efficacy in preventing AMS.
2. Dexamethasone is a first-line treatment for acute mountain sickness of any severity but is a second-line drug for prevention because of its side-effect profile.
51
When dual antiplatelet therapy is needed for more than a year what should be used instead
(Blank) or (Blank) in addition to aspirin
For dual antiplatelet therapy that continues beyond a year
--either ticagrelor, 60 mg twice daily
--or clopidogrel, 75 mg daily, is recommended in addition to aspirin.
52
FDA issued a warning that systemic (BLANK) can increase the occurrence of aortic dissections or ruptures.
FDA issued a warning that systemic fluoroquinolones can increase the occurrence of aortic dissections or ruptures.
53
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy
-- How is this treated?
The clinical presentation and laboratory studies can mirror acute coronary syndrome and should be treated similarly. Once symptoms and cardiac abnormalities resolve, treatment is no longer indicated and may be withdrawn if there are no signs of coronary disease.
54
Med treatment of acute coronary syndrome
a diuretic, ACE inhibitor, and -blocker are indicated.
55
Who should be screened for syphilis infection? (USPSTF)
-Asymptomatic, nonpregnant adults
and adolescents who are at increased risk be screened for syphilis infection
--Factors associated with increased prevalence rates for syphilis in the United States include a history of incarceration or commercial sex work, living in the southern or western United States, residing in a major metropolitan area, African-American ethnicity, and being a male younger than 29 years of age. The risk for syphilis infection is highest among men who have sex with men and among persons who are HIV-positive.
56
What values are most useful predictors of severity of pancreatitis
Hematocrit, BUN, and creatinine levels are the most useful predictors of the severity of pancreatitis, reflecting the degree of intravascular volume depletion
57
For someone with hemoglobinopathies, what are ways to monitor glycemic control?
Serum fructosamime level
58
What is normal ejection fraction?
50% or higher
--EF <40% means your heart isn't pumping enough blood and may be failing
59
1. Dapagliflozin MOA:
2. What type of heart failure scenarios is it used for?
1. inhibits SGLT2, blocks reabsorption of filtered glucose in kidney increasing urinary glucose excretion and reducing blood glucose levels + taking out more fluid in urine
-- Dapagliflozin is approved by the FDA for the treatment of New York Heart Association class II–IV heart failure with reduced ejection fraction regardless of the presence of diabetes mellitus
60
Digoxin MOA:
induces an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility.
61
(BLANK) provides a mortality benefit in patients who are unable to tolerate an ACE inhibitor or angiotensin receptor blocker.
Isosorbide dinitrate/hydralazine provides a mortality benefit in patients who are unable to tolerate an ACE inhibitor or angiotensin receptor blocker.
62
Ivabradine MOA:
heart-rate-lowering agent that acts by selectively and specifically inhibiting the cardiac pacemaker current (If), a mixed sodium-potassium inward current that controls the spontaneous diastolic depolarization in the sinoatrial (SA) node and hence regulates the heart rate.
63
1. what type of medication is apixaban (Eliquis)
2. what type of medication is clopidogrel (Plavix)
- anti-platelet vs anticoagulant
1. anticoagulant (inhibits factor Xa)
2. antiplatelet (inhibits ADP mediated platelet activation and aggregation)
64
1. Oral anticoagulation is indicated for patients with CHA2DS2-VASc score of (BLANK)
2. CHA2DS2-VASc score of (BLANK) have low to medium risk of thromboembolism so they can use (BLANK) meds
1. 2 or more
2. 0-1 ;; aspirin with or without clopidogrel (antiplatelet)
65
What is tylenol vs advil/motrin
-- NSAID vs acetominophen
1. Tylenol is acetominophen
2. Advil or Motrin are NSAIDs
66
What are the most common causes of HTN in preadolescent children?
glomerulonephritis, congenital abnormalities, and reflux nephropathy
are the most common cause of hypertension in preadolescent children. Preadolescent children with HTN should be evaluated for possible secondary causes and renal ultrasonography should be the
first choice of imaging in this age group.
67
What is topiramate used for?
-MOA?
-side effects?
- used to treat epilepsy
-It is a carbonic anhydrase inhibitor, which induces a metabolic acidosis that leads to hypercalciuria and the formation of calcium phosphate stones
68
Treatment for ... (think 5th metatarsal)
1. Nondisplaced tuberosity fractures
2. Minimally displaced (<3 mm) avulsion fractures
3. displacement is >3 mm
1. Nondisplaced tuberosity fractures can generally be treated with compressive dressings such as an Aircast or Ace bandage, with weight bearing and range-of-motion exercises as tolerated.
2. Minimally displaced (<3 mm) avulsion fractures of the fifth metatarsal tuberosity can be treated with a short leg walking boot.
3. If the displacement is >3 mm, an orthopedic referral is warranted.
69
What test is useful for evaluating acute cognitive changes.
Confusion Assessment Method (CAM) is a delirium diagnosis tool useful for evaluating acute cognitive changes.
70
In the treatment of active tuberculosis, what is direct observational therapy (DOT)?
involves providing the antituberculosis drugs directly to patients and watching them swallow the medication
Among the important benefits of DOT are that it has been shown to decrease both the acquisition and transmission of drug-resistant tuberculosis and to increase treatment success in HIV-positive patients.
71
the American Academy of Pediatrics now recommends screening for elevated serum cholesterol levels in children (blank-blank years old)
the American Academy of Pediatrics now recommends screening for elevated serum cholesterol levels in children 9–11 years of age (SOR C).
72
When do patients get screened for iron deficiency anemia
Universal screening for iron deficiency anemia is recommended at 12 months of age and again at 15–30 months of age if the patient is determined to be high risk
73
what condition will cause high radioactive iodine uptake on a thyroid scan
Only Graves disease, however, will cause high radioactive iodine uptake on a thyroid scan.
74
What diabetes medication have increasingly been shown to be associated with diabetic ketoacidosis
SGLT2 inhibitors such as dapaGLIFLOZIN have increasingly been shown to be associated with diabetic ketoacidosis under certain circumstances
75
Febrile neutropenia
- what is this?
- treatment?
1. It is defined as a single oral temperature of 38.5°C (101.3°F) or a sustained temperature of 38°C (100.4°F) for at least 1 hour in patients with an absolute neutrophil count (ANC) <500 cells/mm.
2. Treatment: guidelines recommend administration of empiric intravenous antibiotics within an hour of presentation. Early administration of intravenous antibiotics has been shown to reduce the potential 11% mortality rate of febrile neutropenia (SOR B).
76
Influenza vaccination schedule for previously unvaccinated patients ages 6 months - 8 years
Previously unvaccinated patients ages 6 months to 8 years should receive
two doses of either trivalent or quadrivalent vaccine separated by 1 month.
77
1. A positive flexion, abduction, external rotation (FABER) test that produces pain at the sacroiliac joint, lumbar
spine, and posterior hip is associated with...
2. log roll test involves passive
supine internal and external rotation of the hip. When this test is positive for pain it is associated with...
1. sacroiliac joint dysfunction
2. piriformis syndrome
78
Current guidelines recommend anticoagulation treatment for at least (BLANK) months in patients who have a venous thromboembolism (VTE)
Patients who have a venous thromboembolism (VTE) require anticoagulation therapy for at least 3 months.
patients who have
a reversible provoking factor such as surgery, anticoagulation beyond 3 months is not recommended.
79
The recommended first-line treatment for primary focal hyperhidrosis is BLANK
topical 20% aluminum chloride
should be applied to affected areas nightly for 6–8 hours and works by obstructing the eccrine sweat
glands and destroying secretory cells
80
The presence of a new onset of right bundle branch block in a patient presenting with a sudden onset of shortness of breath and chest pain, especially in the setting of active cancer, should raise suspicion of ... BLANK
pulmonary embolism
In the absence of renal failure, a computed tomography pulmonary angiogram (CTPA) is the most appropriate diagnostic study and would be preferred over a ventilation-perfusion (V/Q) scan.
81
1. Breast cancer survivors should undergo a history and physical examination every (BLANK - BLANK months) for the first 3 years after treatment
2. then every BLANK -BLANK months for the next 2 years
3. then annually thereafter
Breast cancer survivors should undergo a history and physical examination every 3–6 months for the first 3 years after treatment, then every 6–12 months for the next 2 years, and then annually thereafter (SOR
C).
82
what are the Ottawa Knee Rules (5 of them)
Knee X-ray indications after acute knee injury:
1. aged 55 years or over
2. tenderness at the head of the fibula
3. isolated tenderness of the patella
4. inability to flex knee to 90 degrees
5. inability to bear weight (defined as an inability to take four steps, ie. two steps on each leg, regardless of limping) immediately and at presentation
83
What are the Pittsburgh Knee Rules
Radiographs of the knee should performed if the mechanism of injury is a fall or blunt trauma and either one of the following:
1. Patient is younger than 12 or older than 50
2. Inability to walk four weight-bearing steps
84
1. Thyroid peroxidase antibody levels are elevated with..
2. Thyrotropin receptor antibody levels are positive..
1. Chronic autoimmune thyroiditis
(Hashimoto’s thyroiditis)
2. Graves disease
85
what would be found in urine sediment of poststreptococcal glomerulonephritis (APSGN)
1. RBC casts
2. (APSGN), with the onset of
gross hematuria associated with hypertension and systemic edema. This is most commonly seen in school-age children, usually 1–2 weeks after an episode of pharyngitis or 3–4 weeks after an episode of
impetigo, caused by so-called nephritogenic strains of Group A -hemolytic Streptococcus. The hematuria is caused by immune complex–mediated glomerular injury.
86
Urine sediment findings:
1. WBC casts
2. urinary eosinophils
1. WBC casts are seen with acute
pyelonephritis (a bacterial infection causing inflammation of the kidneys)
2. urinary eosinophils indicates acute interstitial nephritis (a kidney lesion that typically causes a decline in kidney function and is characterized by an inflammatory infiltrate in the kidney interstitium)
87
Function of prochlorperazine or promethazine or metoclopramide
1. all of these have antiemetic properties
1. prochlorperazine (antipsychotic and antiemetic) - It can also treat anxiety and schizophrenia.
1. promethazine (antihistamine and antiemetic) - It can treat allergies and motion sickness. It can be used as a sedative before and after surgery and medical procedures. This medication can also help control pain.
1. metoclopramide (Antiemetic and Gut motility stimulator) - can treat gastroesophageal reflux disease (GERD), gastroparesis in patients with diabetes
88
Patients with a BMI of (BLANK) should be referred for consideration of bariatric
surgery (SOR B).
Patients with a BMI 40 kg/m2 should be referred for consideration of bariatric
surgery (SOR B)
89
The National Institutes of Health advises that patients must have both (BLANK) and (BLANK) to meet the criteria for PCOS.
The National Institutes of Health advises that patients must have both hyperandrogenism and oligomenorrhea to meet the criteria for PCOS.
90
eosinophilic esophagitis (EoE) treatment
Application of corticosteroids to the esophagus is generally the treatment of choice, either in the form of an oral suspension of budesonide or an inhaled corticosteroid sprayed into the mouth
and swallowed.
91
1. First line treatment for dysmenorrhea
2. secondary benefit of this first line tx
3. Another therapy used in conjunction to first line treatment
1. First-line treatment is an NSAID at moderate to maximum dosing, such as naproxen, 500 mg every 12 hours. Any NSAID can be used and should be started 1–2 days before the onset of menses and continued through the first several days of bleeding.
2. A secondary benefit to NSAID use is a reduction in heavy menstrual bleeding.
3. Combined estrogen/progestin oral contraceptives may also be used as first-line therapy or in conjunction with NSAIDs.
92
What is included in The Hunter Serotonin Toxicity Criteria ?
1. hypertonia
2. agitation, tremor
3. hyperreflexia
4. temperature
5. clonus (most important sign in this criteria)
93
What ages should get Herpes zoster vaccine for those with HIV?
All adults age 19 and older with HIV
94
For children up to 4 years of age who only have wheezing with respiratory infections, using (BLANK) when a respiratory infection develops reduces exacerbations
For children up to 4 years of age who only have wheezing with respiratory infections, using an inhaled corticosteroid (IC) daily when a respiratory infection develops reduces exacerbations and the use of systemic corticosteroid therapy.
95
The American Academy of Otolaryngology defines chronic rhinosinusitis as the presence of two of four cardinal symptoms, which include
nasal drainage
nasal obstruction
facial pain or pressure
hyposmia or anosmia
--- along with objective signs on examination or radiographic studies.
96
Metformin should be avoided in those with a glomerular filtration rate
30 mL/min/1.73 m2.
97
classically presents as a greenish-yellow, frothy discharge with a foul odor. Erythema and inflammation of the vagina and cervix are often present and can include punctate hemorrhages (strawberry
cervix).
Trichomoniasis
98
1. (BLANK) is characterized by cough, coryza, conjunctivitis, and Koplik spots
2. (BLANK) is characterized by a pruritic rash with fluid-filled blisters
1. Measles
2. Varicella
99
chronic paroxysmal hemicrania
1. what is it
2. how to treat
1. resembles cluster headache but has some important differences. Like cluster headaches, these headaches are unilateral and accompanied by conjunctival hyperemia and rhinorrhea. However, these headaches are more frequent in women, and the paroxysms occur many times each day.
2. indomethacin-responsive headaches
100
bacterial endocarditis prophylaxis
Amoxicillin is the preferred medication for prophylaxis.
Clindamycin or azithromycin can be used in patients with a penicillin allergy.
If the penicillin allergy is not associated with anaphylaxis, angioedema, or urticaria, then cephalexin would be an appropriate antibiotic choice.
101
Prevention traditionally has been divided into three categories: primary, secondary, and tertiary.
explain them
Primary prevention targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition.
Secondary prevention targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications.
Tertiary prevention targets individuals with a known disease, with the goal of limiting or preventing future complications.
102
The Centers for Disease Control and Prevention (CDC) provides specific recommendations for backup
contraception after IUD insertion.
1. within 7 days after menstrual bleeding started
2. more than 7 days
1. does not need backup contraception
2. abstain from sex for the next 7 days
103
what does elevated alkaline phosphatase mean
source of elevated isoenzymes is the liver or bone
A gamma-glutamyl transferase or 5 -nucleotidase level can also indicate whether the elevation of the alkaline phosphatase is from the liver. These enzymes are rarely elevated in conditions other than liver disease.
Severe vitamin D deficiency can lead to osteomalacia with an elevated alkaline phosphatase.
104
Medications shown to improve mortality in patients with heart failure with a reduced ejection fraction include
ACE inhibitors
angiotensin receptor blockers
β-blockers (carvedilol, bisoprolol, and metoprolol succinate)
aldosterone antagonists
----African-American patients, direct-acting vasodilators.
105
In a patient with sepsis, vasopressors are indicated when fluid resuscitation does not restore organ perfusion and blood pressure.
1. which are the first line drugs?
1. Norepinephrine (levophed) first and then dopamine (high dose)
*Vasopressin is employed after high-dose conventional vasopressors have failed.
106
1. positive Hawkins indicates
2. positive empty-can rotator cuff test indicates
3. negative drop-arm rotator cuff test is evidence of
1. shoulder impingement syndrome
2. supraspinatus tendinopathy
3. complete rotator cuff tear
107
JNC 8 panel recommended (BLANK) as initial therapy for most HTN patients
JNC 8 panel recommended thiazide-type diuretics as initial therapy for most patients. Although ACE inhibitors, ARBs, and calcium channel blockers (CCBs) are acceptable alternatives, thiazide-type diuretics still have the best evidence of efficacy.
108
Postexposure prophylaxis after exposure to invasive meningococcal disease is what 4 options
1. ciprofloxacin, 500 mg orally one time
2. azithromycin, 500 mg orally one time
3. ceftriaxone, 250 mg intramuscularly one time
4. rifampin, 600 mg orally twice daily for 2 days.
indicated for any close contact regardless of immunization status.
109
1. Muscle weakness, stiffness, or soreness
2. Problems swallowing
3. Purple color to the upper eyelids
4. Nonpalpable macules over the extensor surface of joints (gottron papules)
5. Shortness of breath
6. Difficulty swallowing
what is this
Dermatomyositis
110
Patients <75 years of age with established coronary artery disease should be on high-intensity statin regimens if tolerated.
--what are the options
These regimens include atorvastatin, 40–80 mg/day, and rosuvastatin, 20–40 mg/day.
-moderate intensity dose include simvastatin, 40 mg/day
111
Even in the absence of overt hyperthyroidism patients with hyperthyroidism are at higher risk for several health conditions, including (blank A, B, C)
1. atrial fibrillation, heart failure, and osteoporosis.
2. The American Thyroid Association recommends treating patients with complications who are either over age 65 or have a TSH level <0.1 μU/mL.
112
Randomized studies have shown that even with mild croup (an occasional barking cough with no stridor at rest), (BLANK) provide some benefit.
Oral corticosteroids provide some benefit.
113
What treatments for PCOS is associated with greater live-birth and ovulation rates
1. Letrozole (Femara)
- Spironolactone and finasteride are both used to treat PCOS in women who do not desire pregnancy.
114
- gliflozin
- gliptin
- glutide
what meds are these
1. SGLT2 inhibitors
2. DPP-4 inhibitors
3. GLP-1 receptor agonist
115
COPD is present if the FEV1/FVC ratio is reduced to (BLANK) and is irreversible with bronchodilator therapy
<70%
116
cubital tunnel syndrome - what is it?
second most common peripheral neuropathy. Symptoms develop because of ulnar nerve compression in the upper extremity, leading to sensory paresthesias in the ulnar digits and intrinsic muscular weakness. Vague motor problems, including poor coordination of the fingers and hand clumsiness, are frequent complaints
117
Community-acquired pneumonia in children is treated based on age. The most likely etiologic agents in a school-age child are Mycoplasma pneumoniae , Chlamydia pneumoniae , and Streptococcus pneumoniae
- what medication is used here
The preferred treatment for community-acquired pneumonia is a macrolide antibiotic such as azithromycin.
118
Elemental iron supplementation (2 mg/kg per day) should begin at (BLANK) age for exclusively breastfed infants born before 37 weeks gestation
Elemental iron supplementation (2 mg/kg per day) should begin at 1 month of age for exclusively breastfed infants born before 37 weeks gestation and should continue until 12 months of age, unless the infant had multiple blood transfusions.
119
If hyperplastic polyps are found on colonoscopy is this considered abnormal or normal?
- abnormal colonoscopies should be repeated every how many years
1. normal
--abnormal would be adenomatous polyps
2. 5 years
120
1. Treatment for hemangiomas during infancy?
2. Treatment for small, bulky, well localized lesions in infants
3. Treatment for early lesions or residual telangiectasia
4. Treatment for involuted lesions
1. oral propanolol
2. intralesional corticosteroids
3. laser therapy
4. surgical excision
121
BP goals
For adults < 60 yo:
For adults > 60 yo:
For adults < 60 yo: <140/90
For adults > 60 yo: <150/90
122
Glucose goals for those having diabetes treatment
Before a meal:
Two hours after the start of a meal:
Before a meal: 80 to 130 mg/dL.
Two hours after the start of a meal: Less than 180 mg/dL
123
(BLANK) reduces arthritis pain in lupus patients (SOR A) and is the preferred initial treatment for lupus arthritis
Hydroxychloroquine reduces arthritis pain in lupus patients (SOR A) and is the preferred initial treatment for lupus arthritis
124
Guideline-directed therapy for PAD includes
1. low-dose aspirin
2. moderate- to high-intensity statin therapy
3. an ACE inhibitor or angiotensin receptor blocker
4. a structured exercise program
5. smoking cessation
125
impetigo, a skin infection caused by Staphylococcus aureus and/or Streptococcus pyogenes
1. treatment for isolated lesion
1. mupirocin (Bactroban)
126
patients ≥65 years of age treated with medication for type 2 diabetes mellitus, hemoglobin A1c values of (BLANK) have shown the greatest reduction in mortality in multiple studies.
7%–8%
127
This patient has the classic presentation for (BLANK) which is caused by human herpesvirus 6. The typical history includes a high fever in a child with either mild upper respiratory symptoms or no other symptoms. After the fever subsides, a rash will appear. The rash is self-limited and no treatment is required.
roseola infantum
128
A pleural protein to serum protein ratio (BLANK)
or
a pleural fluid LDH to serum LDH ratio (BLANK) suggests an exudative effusion.
A pleural protein to serum protein ratio >0.5
or
a pleural fluid LDH to serum LDH ratio >0.6 suggests an exudative effusion.
Lower ratios suggest a transudative process. With transudates, the pleural fluid pH is typically between 7.40 and 7.55, with fewer than 1000 WBCs, and the glucose level is similar to the serum glucose level.
Exudates are fluids, CELLS, or other cellular substances that are slowly discharged from BLOOD VESSELS usually from inflamed tissues. Transudates are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES.
129
Unexplained proteinuria, peripheral neuropathy, enlargement of the tongue, cardiomegaly, intestinal malabsorption, bilateral carpal tunnel syndrome, and orthostatic hypotension
Amyloidosis
defined as the extracellular deposition of the fibrous protein amyloid at one or more sites.
130
(BLANK) should be the first-line pharmacotherapy option for adolescents after a trial of psychotherapy.
- fluoxetine
If fluoxetine is ineffective, sertraline and citalopram are recommended as alternatives. Venlafaxine should be avoided in adolescents because it is associated with a statistically increased risk of suicidal behavior or ideation
131
What is likely to reduce a patient's risk of breast cancer? (a patient with no family history of breast cancer)
1. obesity (most impactful if changed)
2. exogenous estrogen administration
3. alcohol and tobacco use
4. lack of physical activity
132
1. Chronic history of epigastric abdominal pain 1 hour after eating that is relieved by antacids is most commonly (BLANK)
2. Most common cause of this disease is..
1. peptic ulcer disease in stomach or duodenum --- pain related to consumption (gastric) or lack of consumption (duodenal ulcer) of food
2. H. pylori infection
--eradication therapy is done using a triple or quadruple combined therapy for H. pylori
133
All patients with signs and symptoms of hyperthyroidism as well as low TSH concentration should undergo (BLANK)
- thyroid ultrasonography along with testing for thyroid stimulating antibodies
134
Initial recommended therapy for patients with a diagnosis of heart failure with reduced ejection fraction is a combo of 5 classes of medications
which are...
1. A beta-adrenergic antagonist
2. A renin-angiotensin-aldosterone system inhibitor
3. diuretic
4. mineralcorticoid receptor antagonist (such as aldosterone antagonist)
5. SGLT2 inhibitor
135
What medication can be used to prevent recurrence of otitis externa (swimmers ear)?
1. Alcohol-acetic acid ear drops gently remove cerumen, desquamted skin, and purulent material which prevents inflammation and limits likelihood of bacteria superinfection
136
1. intraepithelial lymphocytosis, villous atrophy, and crypt hyperplasia
2. Chronic diarrhea, weight loss, steatorrhea, and nutritional deficiencies
3. Iron deficiency anemia - MCW of <80 um3
-what can this indicate?
1. celiac disease
137
Hypercalcemia symptoms
painful bones, renal stones, abdominal groans, and psychic moans
1. chronic bone pain
2. nephrolithiasis
3. abdominal discomfort
4. psychiatric disturbances
also: hypophosphatemia, subperiosteal bone resorption, ESKD
138
the most common bacterial cause of community acquired pneumonia in adults
1. strep pneumo. Chest imaging shows lobar infiltrate
- mycoplasma pneumonia is more common in young adults. Chest imaging shows alveolar and interstitial infiltrates
139
Treatment of acute flare of gout consists of..
1. NSAIDs such as naproxen, indomethacin, colchicine or corticosteroids
140
Indications for a chest radiograph include ... (6 things)
1. dyspnea
2. tachypnea
3. tachycardia
4. temperature >100.0°F
5. bloody sputum
6. signs of focal consolidation on lung auscultation
