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FAMILY MED SHELF Flashcards

1
Q

In SCD what is found on peripheral blood smear?

A

Howell- Jolly Bodies

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2
Q

What is a common symptom associated with Sickle Cell Trait?

A

Painless Gross Hematuria + Nocturia

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3
Q

What complications can arise from Sickle Cell Trait?

A

Kidney Dysfunctions: UTIs, CKD, Renal Papillary Necrosis, Renal Medullary Carcinoma

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4
Q

When does DDH (Developmental Dysplasia of the Hip) occur?

A

In Infancy

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5
Q

What is a common osteopathic complication in SCD?

A

Avascular Necrosis

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6
Q

Symptoms of Paroxysmal Nocturnal Hemoglobinuria (PNH)

A 
Dark Urine in Morning
Fatigue, Abdominal Pain, Jaundice
Pancytopenia
Intravascular Hemolysis
Negative Coombs Test
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7
Q

What indicates Intravascular Hemolysis?

A

Unconjugated Hyperbilirubinemia
Elevated LDH
Low Haptoglobin
Hemaglobinuria

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8
Q

Indications of Autoimmune Hemolytic Anemia

A

Hemolytic Anemia
Positive Antiglobulin (Coombs) Test
PBS: RBC + Polychromasia

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9
Q

Symptoms of Intravascular Hemolysis

A

Reticulocytosis
Elevated LDH
Low Haptoglobin
HEMOGLOBINURIA

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10
Q

Symptoms of Extravascular Hemolysis

A

High LDH
Low Haptoglobin
NO HEMAGLOBINURIA

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11
Q

What is Pancytopenia?

A

Low counts in all blood cell lines

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12
Q

What Drugs can cause Aplastic Anemia

A 
Sulfamethoxazole/Trimethoprim
Carbamazepine
Methimazole
NSAIDs
Chloramphenicol
Propylthiouracil
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13
Q

How is Hep A Transmitted?

A

Fecal- Oral, Shellfish Tropical Environments

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14
Q

What Immunoglobulin indicates acute Hep A?

A

Anti-HAV IgM

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15
Q

Treatment of HPV-1 Plantar Warts?

A

Topical Salicylic Acid

Fluorouracil Cream

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16
Q

Clinical Presentation of HSV-2

A

Genital Ulcers
Fever
Tender Inguinal Lymphadenopathy

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17
Q

Clinical Presentation of Treponoma Pallidum

A

STI Syphyllis-

Primary- non-disappearing painless genital ulcer and inguinal lymphadenopathy

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18
Q

Clinical Presentation of Lymphogranuloma Venerum

A

Chlamydia
Small Painless Papule- disappears in 1 week
2-4 weeks later- painful suppurative bilateral inguinal lymphadenopathy
fever, malaise, chills, myalgia

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19
Q

Clinical Presentation of PID

A 
Lower Abdominal Pain
Dysuria
Dyspareunia
Purulent Vaginal Discharge
Cervical Motion Tenderness
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20
Q

Initial Treatment of PID

A

Combo Antibiotic Therapy
IM Ceftriaxone (N. gonorrhoeae)
IM Doxycycline (Chalmydia Trachomatis)
Metronidazole (anaerobic bacteria)

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21
Q

Most common pathogens which cause Pelvic Inflammatory Disease (PID)?

A

Neisseria gonrrhoeae

Chlamydia Trachomatis

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22
Q

PID Follow up Test

A

HIV Test

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23
Q

Clinical Presentation of Herpangina?

A

Painful Oral Erosions with erythematous halo
On Palate, Posterior Pharyngeal Wall
Fever, Throat Pain

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24
Q

Cause of Herpangina?

A

Coxsackie A Virus

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25
Dx and Tx: oral mucosal ulcers with regular margins, yellow fibrinous base in buccal or labial mucosa.
Dx: Apthous Stomatitis (Canker Sores) Tx: Resolve without Treatment in 10-14 days
26
Local Chronic Muscle Pain, Restricted ROM, Local Palpable Mass with History of Overuse
Myositis Ossificans
27
Fx of Marijuana
Slurred Speech + conjunctival Injection (Eye Redness) | Ataxia, Poor Concentration, Euphoria
28
Acute Fx of Cocaine
Euphoria + Irritability (15-60 mins duration)
29
Withdrawal Symptoms of Cocaine
Depression, Anxiety, Increased Appetite
30
Chronic Fx of Cocaine Use
``` Change in Behavior Poor Concentration Decreased Appetite Chronic Rhinitis Perforation of Nasal Septum ```
31
Acute Fx of Phencyclidine
PCP (effects last for hours) Bizarre Behavior, Irritability Ataxia- diaphoresis, seizures Violent Behavior + Hallucinations
32
Withdrawal symptoms of Phencyclidine
Anxiety and Irritability
33
Acute Fx of Aerosol Inhalant Use
``` Rapid Mood Swings, Irritability Poor Concentration, Slurred Speech Anorexia Conjunctival Injection Ataxia (Dysdiadochokinesia) Eczematous Rash in peri-oral area ```
34
Chronic/Severe Fx of Aerosol Inhalant Abuse
Cardiac Arrhythmias CNS Toxicity (seizures, coma) Death (via respiratory depression)
35
How to detect Legionella Pneumophila?
1st- Urine Antigen Assay | 2nd- PCR
36
Tx of Legionella Pneumophila
1st- Fluoroquinolones (Levofloxacin) | 2nd- Macrolides (Azithromycin)
37
Dx - Female- foul-smelling, frothy, vaginal discharge | yellow-green color; pH > 4.5
Trichomonas Vaginalis
38
Treatment of Trichomonas Vaginalis
Oral Metronidazole
39
Dx: Dyspnea, Dry Cough, Low-Grade Fever, Watery Diarrhea, Bilateral Patchy Infiltrates, Hyponatremia
Legionnaires' Disease (Legionella Pneumophila)
40
Dx: Mild Fever, Headache Muscle Aches
Flu or Pontiac Fever
41
Dx: RUQ Pain + Fever + Hypoechoic Lesion + Liver Abscess
Amebiasis , Entamoeba Histolytica
42
Dx: Vaginal Discharge- Gray + malodorous, clue cells positive whiff test. pH >4.5
Gardenerella Vaginalis
43
Dx: Vaginal Discharge, odorless + purulent, positive nucleic acid amplification test
Chlamydia Trachomatis
44
Dx: Vaginal Discharge, Yellow-green, frothy, pH > 4.5, flagellated protozoa
Trichomonas Vaginalis
45
Dx: Vaginal Discharge- odorless, white, crumbly, pruritis, burning, pH < 4.5, pseudohyphae
Candida Albicans
46
Dx: vaginal discharge, odorless, purulent, creamy dysuria, dyspareunia, intermenstrual bleeding
Neisseria Gonorrheoeae
47
Dx: Bloody Stool + Rectal Pain + Perianal Discharge
Anal Fistula
48
Treatment of Anal Fistula
Tract Curettage
49
Treatment of Recurrent Anal Fissures
Anal Spincterotomy
50
Treatment of Anal Fissures
``` Sitz Bath (warm water buttocks bath) Topical Calcium Channel Blocker (nifedipine, diltiazem) ```
51
Dx: Pain + Paresthesias in distal extremities symmetrically, concurrent ascending flaccid muscle paralysis
Guillain-Barre Syndrome
52
Dx: Bilateral non-bloody nipple discharge, normal prolactin
Normoprolactinemia Galactorrhea
53
Common cause of hypogonadotropic hypogonadism
prolactinoma (pituitary adenoma)
54
hypogonadotropic hypogonadism symptoms
Blocks GnRH--> Low FSH + Low LH---> Low Testosterone ED, decreased libido, low testicular volume, infertility, gynecomastia, loss of axillary hair
55
Chronic Hep C Symptom on Dorsal Hand
Porphyria Cutanea Tarda
56
Hep B and Hep C genetic Makeup
Hep B: DNA | Hep C: RNA
57
Treatment of Scabies
Topical Permethrin for 8-12 hours, Oral Histamines + Prophylatic Treatment for Contacts
58
Dx: Fever, Myalgia, Pharyngitis, Posterior Cervical Lymphadenopathy, Young Patient, Mononucleosis
Ebstein Barr Virus (EBV)
59
Diagnosis + Treatment of EBV
Dx: Heterophile Antibody Test Tx: Symptomatic Analgesic + Antipyretics
60
Common Symptom of EBV?
Splenomegaly- Avoid Contact Sports to Avoid Splenic Rupture
61
Malignancies associated with EBV
Nasopharyngeal Carcinoma, Burkitt's Lymphoma, Hodgkin Lymphoma
62
Dx: Epistaxis (bloody nose), painless cervical lymphadenopathy, recurrent otitis media
Nasopharyngeal Carcinoma
63
Virus associated with Kaposi Sarcoma
HHV-8
64
Dx: Multiple Nodular purplish submucosal painless skin plaques in AIDS patient
Kaposi Sarcoma
65
Dx: Fragile Bones, Blue Sclerae, Poor Hearing, Dental Abnormalities, Triangular Facial Structure, Short Child
Osteogenesis Imperfecta (Type I Collagen Defect)
66
Dx: Frontal Bossing, Nodular Deformities at Ribs (Beading at Ribs), Widened Wrists, Bowing Legs, Erosion of Tooth Enamel
Rickets (Vitamin D Deficiency--> Defective Growth Plate Mineralization)
67
Dx: Weakness, Fatigue, Mucosal Bleeding, Curly Hair, Poor Wound Healing, Severe Infections
Scurvy (Vitamin C deficiency)--> low cofactor of prolyl/lysyl hydroxylase)
68
Dx: Short stature/extremities, frontal prominence, microcephaly, scoliosis, trident hands
Achondroplasia (Fibroblast Growth Factor Receptor 3)
69
Dx: cranial nerve palsies, hip abnormalities, long bone fractures
Osteopetrosis (low osteoclast-mediated bone resorption
70
Dx: Low Calcium, Low Phosphates, Elevated PTH, Elevated ALPs
Vitamin D Deficiency
71
Dx: Normal Ca, Phosphates, PTH, Elevated ALPs
Paget's Disease of the Bone
72
Dx: Low Calcium, Elevated Phosphate, Elevated PTH Elevated ALPs
Pseudohypoparathyroidism
73
Dx: Obesity, Round Face, Short Metacarpals, Soft Tissue Calfications, Dental Hypoplasia
Albright Hereditary Osteodystrophy (Pseudohypoparathyroidism)
74
Dx: Diarrhea, Bloating, Wt Loss, Microcytic Anemia
Celiac Disease
75
Dx: Bone Pain/Tenderness, Fractures, Waddle Gait, Myopathy, Hypocalcemia, Osteoporosis
Osteomalacia (Vit D deficiency + Hypocalcemia)
76
ACEi negative side effects
elevated bradykinin--> angioedema, edema of tongue/larynx, upper airway obstruction
77
Dx: fever, arthralgia, low C4
Serum Sickness
78
Drugs which can cause Serum Sickness
Bupropion, IVIG, Rituximab, Infliximad, Cefaclor, Cefprozil, Penicillin, Minocycline
79
Dx: angioedema, dyspnea, pruritis, urticaria
Anaphylactoid Reaction
80
Drugs which cause anaphylactoid reactions
IV radiocontrast, aspirin, vancomycin, opiates
81
Dx: flushing, severe diarrhea, cramps, dyspnea, increased serotonin, GI mass
serotonin syndrome via Carcinoid tumors
82
Dx: dull, persistent headache worsening in morning, gradual vision changes, mass in head
Meningioma
83
Dx: hypernatremia, hypokalemia, fatigue, muscle weakness, elevated aldosterone
Aldosteronoma
84
Dx: severe headache, hypertension, bradycardia, nausea, vomiting, acute onset
Intracranial Hemorrhage
85
Dx: episodic hypertension, excessive sweating, headache, tachycardia, palpitations
Pheochromocytomas
86
Adult presents with cough, dyspnea, whitish sputum for 5 days. What is first step in management
Supportive Treatment: Rest , Hydration, NSAIDs
87
Dx: dyspnea, orthopnea, decrescendo diastolic murmur, after S2, left midclavicular line, opening snap, carotid pulses diminished
Mitral Valve Stenosis
88
Dx: Dyspnea on Exertion, Orthopnea, holosystolic murmur, apex
Mitral Valve Regurgitation
89
Dx: lower extremity edema, hepatomegaly, holosystolic murmur, 4th intercostal space on left sternal border
Tricuspid Valve Regurgitation
90
Dx: exertional, nocturnal dyspnea, early diastolic decrescendo murmur, left sternal border, S3 gallop
Aortic Valve Regurgitation
91
Dx: fatigue, dyspnea, (can be asymptomatic), high frequency mid-systolic click, 5th intercostal mid clavicular line
Mitral Valve Prolapse
92
Dx: Dyspnea on exertion, orthopnea, crescendo-decrescendo systolic murmur, S4, delayed low carotid pulses
Aortic Valve Stenosis
93
Dx: Glass factory worker, dyspnea, dry cough, fatigue, fine crackles, calcifications of hilar lymph nodes (egg shell calcification), upper lobes
Silicosis
94
Complications of advanced silicosis
``` Pulmonary TB (silica disrupts phagolysosomes/macrophage function)—->Annual TB skin testing recommended Lung Cancer, Cor Pulmonale, RA ```
95
Complication of Asbestosis
Malignant Mesothelioma
96
Dx: Fungal Ball in Lungs, Repositions with Movement
Aspergilloma (Chronic Pulmonary Aspergillosis
97
Dx: mold spores, asthmatic, fever, chest pain, hemoptysis
Aspergillosis
98
Common Pneumonia in Immunosuppressed Patients
Pneumocystis Jirovecii
99
Biopsy of Kaposi Sarcoma
Abundant Lymphocytes
100
Dx: AIDS CD4<100, multiple cutaneous papules/nodules, red flesh color- bleed easily, diarrhea, wt loss, hepatosplenomegaly
Bartonella Henselae
101
Biopsy of Bartonella Henselae
Vascular Proliferation + Neutrophilic Infiltrate
102
Treatment of Bartonella Henselae
Abx: erythromycin or doxycycline
103
Dx Test for Acute HIV
HIV Viral Load
104
How long does HIV symptoms take to develop?
3-6 weeks
105
Tx of Postpartum Depression
Sertraline (SSRI)
106
Dx: mild-transient depression, episodes of sadness, insomnia, difficulty concentrating after birth
Post-partum blues
107
Dx: 2 weeks post-birth: depressed mood, anhedonia, significant wt loss, daily insomnia/hypersomnia, slowed down-psychomotor agitation, fatigue, feelings of worthlessness/guilty, difficulty concentrating, recurrent thoughts of death
Postpartum Depression
108
Tx of Adolescent MDD
Follow up within a month and start fluoxetine (or SSRI) on further evaluation
109
Dx: alopecia, scaly patches, inflammatory plaques, thick crusting, pustules, boggy feel
Kerion, tinea Capitis
110
Tx of Kerion
Oral griseofulvin, Oral Terbinafine
111
Decrease preload in Mitral Regurgitation Murmur
Standing or Valsalva Maneuver
112
Dx of Ascites SAAG > 1.1 g/dL
Portal Hypertension: cirrhosis, liver metastasis, portal vein thrombosis, alcoholic hepatitis, Budd-Chiari Syndrome, Heart Failure, Constrictive Pericarditis
113
Dx of Ascites SAAG <1.1g/dL
``` Pancreatitis Nephrotic syndrome TB Serositis Peritoneal carcinomatosis ```
114
Tx: CIN 2
LEEP (loop electrosurgical exicision) + Repeat Pap/HPV test in 12 months
115
Tx: of UTI and Uncomplicated Bacteriuria in pregnancy + uncomplicated cystitis
Nitrofurantoin
116
Contraindication for Rotavirus Vaccine
Increased Risk of Intussusception
117
Live Attenuated Vaccines
``` MMR Varicella Zoster Yellow Fever Rotavirus Influenza Small Pox Adenovirus Typhoid ```
118
Contraindications for administering Live attenuated vaccines
<9 months age (except rotavirus) Pregnant individuals Immunodeficient Individuals
119
Inactivated Whole Vaccines
``` Polio (Salk) Hep A Rabies Typhoid Influenze Pertussis Cholera Japanese Encephalitis Tick Borne Encephalitis ```
120
Inactived Fractionated Protein Vaccines
``` Hep B Influenza Pertussis HPV Anthrax Diptheria Tetanus ```
121
Inactivated Fractional Polysaccharide Vaccines
Hib Pneumococcal Meningococcal Salmonella
122
Immunizations for Travel
Japanese Encephalitis- Southeast Asia- 2 doses month apart Yellow Fever- Africa, Central/South America- 1 dose, 10 days before departure Rabies- Everywhere- 3 does- month Typhoid/Paratyphoid- developing countries- 1 or 4 doses Meningococcal- Africa
123
Pathogens affecting unvaccinated children
``` Measles Rubella Varicella Zoster Mumps Diphtheriae HIb Strep Pneumo Meningitis Polio Tetanus Pertussis Hep A/B ```
124
Dx: High Fever, Erythematous Maculopapular Rash starts neck—> body, bluish-gray spots on buccal lining, generalized lymphadenopathy, malaise, cough, conjunctivitis
Measles
125
Dx: low grade fever, pink maculopapular rash head—>body, postauricular/suboccipital lympadenopathy, malaise, cough, conjunctivitis
Rubella
126
Dx: low fever, macules/papules/vesicles- hypopigmented lesions, rash starts at trunk—> moves out, severe itching
Varicella Zoster- Chicken Pox
127
Dx: fever, malaise, inflammation of salivary glands, unilateral parotitis, orchitis
Mumps
128
Dx: gray-white pseudomembranes, cervical lympadenopathy, bull neck, foul breath, inspiratory stridor
Diphtheriae
129
Dx: high fever, sore throat, dysphagia/odynophagia, drooling, muffled/hot-potato voice, respiratory distress
HIb
130
Dx: Fever, Headache, Neck-stiffness, photophobia, N/V, Altered mental status, seizures
Meningitis (Hib, Strep Pneumo, Neisseria, Polio)
131
Dx: Fever, headache, neck stiffness, pharyngitis
Hib Meningitis
132
Dx: Fever, Headache, Neck Stiffness, Sinusitis
Strep Pneumo Meningitis
133
Dx: Fever, Headache, Neck Stiffness, Myalgia, Petechial/purpuric rash
Neissseria Meningitidis
134
Dx: Fever, Headache, Neck Stiffness, Assymetric flaccid paralysis- legs, proximal muscles
Polio Meningitis and Poliomyelitis
135
``` HBsAg + Anti HBs - HBeAg - Anti- HBe + Anti- HBc IgM - Anti Hbc IgG + ```
Chronic Hepatitis with Low infectivity
136
Global Increase of Alveolar Surface Tension associated with
Cardiogenic Pulmonary Edema + CHF
137
Decreased Pulmonary Compliance Associated with?
Interstitial Lung Disease (Pulmonary Fibrosis, Pneumoconiosis, Sarcoidosis)
138
Local accumulation in kinins—> cough, What drug?
ACEi
139
Irreversible Inflammatory Widening of Bronchi
Bronchiectasis
140
Loss of Functional Residual Capacity (FRC)
Restrictive Lung Disease (Pneumonia)
141
Diagnostic Test for Lactose Intolerance
Hydrogen Breath Test >20 ppm
142
Dx: Dyspnea, productive cough, 4-6months/2years chronic smoker
Chronic Bronchitis
143
Diagnostic Test for Chronic Venous Insufficiency
Duplex Ultrasonography
144
What B blockers should be avoided in COPD/Asthma patients?
Non-selective Beta Blockers- abetolol, propranolol, nadolol, pindolol, timolol, carvedilol
145
High ALP (alphafetoprotein) in liver disease suggests?
Hepatocellular Carcinoma
146
Autoimmune hepatitis specific labs
Anti Smooth muscle antibodies (ASMA) Anti Nuclear Antibody (ANA) High Serum IgG
147
Specific Labs for Primary Biliary Cirrhosis
Anti Mitochondrial Antibodies (AMA)
148
Cholestatic process symptoms
Jaundice + Pruritis
149
Dx: low ceruloplasmin, neurlogic symptoms, brown rings around iris, hepatitis
Wilson Disease
150
Dx: Cirrhosis, HF, DM, bronze skin, arthralgias, high transferrin saturation >50%
Hemachromatosis
151
PSC (primary sclerosing cholangitis) specific test?
pANCA (perinuclear antineutrophil cytoplasmic antibodies)
152
Side FX of ARBs
hyperkalemia
153
Side Fx of non-selective B-blockers?
Bradycardia, hypotension, bronchospasm
154
Side Fx of ACEi
Dry Cough, Angioedema, Hyperkalemia
155
Side Fx of CCBs
Peripheral Edema, Headaches, Dizziness, Facial Flushing, Reflex Tachycardia
156
Complication of untreated group A strep tonsillopharyngitis?
Acute rheumatic fever
157
Dx: child with arthritis, involuntary irregular non-repetitive movements of limbs, subcutaneous nodules, pink rash on trunk and limbs, mitral regurgitation, post infection
Acute Rheumatic fever secondary to untreated group A streptococcal tonsillopharyngitis
158
Dx: dorsal side of each hand pressed together produces pain, tingling pain in thumb, index, and middle finger. Nerve and syndrome?
Median Nerve | Carpel Tunnel Syndrome
159
Dx: Back Pain, Fever, Leukocytosis, cortical destruction, bone marrow edema
Vertebral Osteomyelitis
160
Most common causative pathogen of vertebral osteomyelitis
Staphylococcus Aureus > Staphylococcus Epidermidis, Enterobacteriaceae, Pseudomonas, Streptococci
161
Dx: Oliguria, elevated Cr, elevated BUN, hyperkalemia, fractional excretion of Na > 2%
Acute Tubular Necrosis
162
WBC cast in urinary sediment—-> DDx
Pylonephritis and Acute Interstitial Nephritis (AIN)
163
Dx: dysuria, frequency, fever, costovertebral angle tenderness, flank pain WBC cast in urinary sediment
Pyelonephritis
164
Dx: hematuria, sterile pyuria, eosinophilia, flank pain, fever, rash, WBC cast in urinary sediment
Acute Interstitial Nephritis
165
Pigmented Casts —-> DDx
Rhabdomyolysis + Hemolysis
166
Dx: proteinuria >3.5g, edema, hyperlipidemia, fatty casts
Nephrotic syndrome
167
Dx: proteinuria > 3.5g, edema, hyperlipidemia, fatty casts
AKI secondary to Rhabdomyolysis or Hemolysis
168
Most common cause of intrinsic AKI
Acute Tubular Necrosis
169
Risk Factors of ATN (Acute Tubular Necrosis)
Advanced Age History of sepsis DM Treatment with ACEi
170
Cast Cells associated with ATN (Acute Tubular Necrosis)
Muddy Brown Casts (Granular Casts)
171
Dx: red/cola colored urine, proteinuria < 3.5 g edema, RBC casts
Glomerulonephritis
172
Dx: persistent elevated BP despite treatment, bilateral carotid bruits, abdominal bruits, elevated plasma renin activity, hypokalemia
Renal Artery Stenosis secondary to atherosclerotic disease
173
Complication of RAS (Renal Artery Stenosis)
Unilateral Kidney Atrophy
174
Dx: Headache, depressed mood, fatigue, insomnia, nausea, sensory disturbances, irritability, ataxia, tremor, and myalgia within 4 days of stopping anti-depressant
Antidepressant Discontinuation Syndrome (ADS)
175
Dx: single genital lesion—> raised papule—> painless firm ulcer with indurated borders and smooth base + lymphadenopathy
Treponema Pallidum- Primary Syphillis
176
Dx and Tx: large painless vascular lesions on genitalia, no inguinal lymphadenopathy, appear up to 1 year after exposure.
Dx: Klebsiella granulomatis Tx: Azithromycin until ulcers have completely healed (Screen for otjer STIs)
177
Dx: grouped painful vesicles, pustules, and erosions on genitalia, painful inguinal lymphadenopathy within 2-7 days of exposure
HSV-2 (Herpes)
178
Dx: painful genital ulcers with gray necrotic base + painful inguinal lympadenopathy
Dx: Haemophilus ducreyi | chancre lesions
179
Dx: painless transient painless papule, then lymphadenopathy, fever, malaise, chills 2-6 weeks after.
Lymphogranuloma Venereum (L1-L3 serotypes of Chlamydia Trachomatis
180
Dx: fever, fatigue, productive cough with foul smelling sputum, lung cavity with air-fluid level o CXR
Lung Abscesses
181
Common causes Nosocomial (Hospital Acquired) of Lung Abscess
Aerobes- Pseudomonas Aeruginosa, Acinetobacter baumannii, Nocardia Species, Staphylococcus Aureus
182
Exposure to Bat droppings/ Cave exploration leading to pneumonia is most likely caused by what organism?
Histopasmosis
183
Lung abscesses or tricuspid valve by septic emboli in IV drug users is most commonly associated with which organism?
Staphylococcus aureus
184
Most common cause of lung abscesses
Periodontal diseases via anaerobic bacteria | Peptostreptococcus, Prevotella, Bacteroides, Fusobacterium
185
Dx: women 30-50 y/o- post URTI with fever, malaise, neck/jaw pain, painful swelling in front part of throat, anxious and sweaty state, elevated ESR, reduced radioiodine uptake
Subacute thyroiditis (De Quervain’s thyroiditis)
186
Tx of Subacute thyroiditis
Self-limiting: Triphasic—> initial hyperthyroidism (tachycardia, widened pulse pressure, sweating, resting tremor) then hypothyroidism (fatigue, bradycardia, cold intolerance, constipation, weight gain) back to euthyroidism
187
Most common lung cancer in non-smokers (and women)- located peripherally
Adenocarcinoma - CXR for initial evaluation, CT-guided transthoracic biopsy confirms diagnosis
188
Large peripheral mass on CXR in a smoker
Large cell carcinoma
189
Centrally located cavitary lesions on CXR in a patient who smokes
Squamous Cell Carcinoma
190
Dx: weight loss, fatigue, dry cough, peripheral lymphadenopathy, eye pain and redness, tender nodules and plaques bilateral hilar adenopathy
Sarcoidosis
191
Dx: diarrhea, flushing, wheezing, lesions in bronchial area
Carcinoid Tumor (Neuroendocrine Tumor)
192
Common Bacterial Infections with CD4+ count < 200
Pneumocystis, Mycobacterium Avium, Toxoplasmosis
193
Prevention of disease in CD4 < 200 patient
TMP-SMX + Azithromycin
194
Dx: Obesity, hepatic lipid accumulation, abnormal hepatic findings, no history of alcohol use, Hep A,B,C
NASH (Nonalcoholic Steatohepatitis)
195
Dx and Tx: Fever, Headache, Bilateral diffuse reddening of eyes, muscle ache, living in Hawaii
Leptospirosis (infection with Leptospira)] | 1st line: doxycycline 2nd line: amoxicillin/azithromycin
196
Dx: inability to maintain pregnancy, no contractions, recurrent pregnancy losses/ preterm births
Cervical Insufficiency
197
Dx: constipation, nonpitting pretibial edema, hoarse boice, indurated cool dry skin, obese patient
Hypothydroidism (Hashimoto thyroiditis—> risk for primary thyroid lymphoma
198
Dx: nephritic sediment (hematuria, RBC casts, moderate proteinuria), elevated Cr + BUN, productive cough Extra: chronic sinusitis, saddle nose deformity + cANCA positive
Pulmonary Renal Syndrome | Granulomatosis with Polyangitis (GPA or Wegener’s granulomatosis)
199
Dx: Toddler patient + multiple UTIs complications
``` Vesicoureteral reflux (VUR) (Dx with VCU)—-> renal scarring, pyelonephritis Tx: prophylatic antibiotics or surgical correction ```
200
Dx: Facial erythema, telangiectasia, papules, pustules
Rosacea | Triggers: stress, exercise, hot weather, sun exposure, alcohol consumption
201
Dx: dry, pruritic, erythematous skin rashes, beginning in childhood, improving in adolescence, worsening in adult hood in flexural creases
Filaggrin gene mutations-atopic dermatitis
202
Dx and etiology: fevers, fatigue, myalgias, arthritis
SLE | Complement Component 1q antibody deficiency
203
Complications of Carcinoid Tumors
Tricuspid Insufficiency + Pulmonary Stenosis
204
Dx: abdominal tenderness and cramps, nonbloody watery bowel movements, cutaneous flusing, telangiectasia, tachycardia, wheezing
Carcinoid Tumor
205
What is DAPT? When is it used?
Dual antiplatelet therapy (Aspirin + P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor) Post- MI after stent placement
206
Tx: asymptomatic Baker’s cyst vs. symptomatic baker’s cysts
Asymptomatic popliteal cyst - reassurance and observation- resolve spontaneously in 1-2 years Symptomatic secondary popliteal cysts- underlying disease treatment, arthrocentesis + intraarticular glucocorticoid injection, arthroscopic excision
207
Dx: younger than 50 y/o shortness of breath, with barrel chest, diminished breath sounds,
Alpha-1-antitrypsin deficiency (A1AD)
208
A1AD Complications
Liver damage, cirrhoss, hepatocellular carcinoma (i.e. toxic accumulation of misfolded A1A protein in liver.
209
Which drug has prophylatic medication for malaria for pregnant patients?
Chloroquine, Mefloquine (chloroquine resistant countries), Proguanil,
210
Tuberculin skin test diagnoses what?
Latent TB
211
What does Sputum Culture diagnose in TB?
Active TB
212
What does CXR diagnose in TB?
Active TB in high risk patients
213
Sputum Microscopy in TB?
Moderate to high risk active TB
214
PCR of sputum in TB?
Rapid Diagnosis active TB
215
Interferon-𝛄 release assay
Diagnose exposure to TB
216
Tx of sleep onset insomnia
Short acting drugs (Triazolam)
217
Doxepin Drug Uses
``` Tricyclic antidepressant Sleep maintenance (long acting effect) ```
218
Flurazepam drug uses
Benzidiazepine—> sleep maintenance- long-acting effect
219
Trazodone Drug Uses
Atypical antidepressant— MDD | Sedative effect which can cause daytime drowsiness
220
Suvorexant drug uses
Orexin receptor antagonists—> insomnia treatment—> sleep onset + sleep maintenance Causes next day sleepiness and impairs driving performance.
221
Dx: secondary sexual characteristics, advanced bone age in girl < 8 y/o
Precocious puberty
222
How to differentiate central and peripheral precocious puberty?
GnRH stimulation test Increase LH concentrations > 5mIU - central Increase LH concentrations < 5mIU- peripheral
223
Breast Mass Screening for women <30 y/o and > 40 y/o
Breast Ultrasound <30 | Mammography > 40
224
Dx: prolonged HTN + progressive dyspnea, lower extremity swelling, JVD
Decompensated left heart failure
225
Dx:holosystolic murmur on left lower sternal border
Tricuspid regurgitation
226
Dx: infant with central cyanosis, Tall peaked p-waves, left axis deviation 3 parts
Tricuspid Atresia : Absent Tricuspid valve, Atrial septal defect, Ventricular septal defect
227
Lab Tests for newly diagnosed HTN
Renal Function Tests: Serum electrolytes, Creatinine, UA, Urine albumin/creatinine Endocrine Tests- HbA1c, Lipid Profile, TSH Cardiac- ECG, ECHO Other: CBC, Uric Acid
228
Effects of Direct Renin Inhibitors (aliskiren for HTN)
Natriuresis, decreased serum angiotensin II, decreased aldosterone production
229
FX of ARBs
Act on angiotensin receptors—> do not decrease Angiotensin II , but cause natriuresis and decreased aldosterone production
230
Dx: murmur heard at the first right intercostal space, unequal carotid pulses, differential blood pressure in upper extremity, palpable thrill in suprasternal notch
Supravalvular aortic stenosis
231
Complications of Aortic stenosis
Left ventricular hypertrophy, coronary artery stenosis, subendocardial ischemia
232
Dx: HTN with 3 or more antihypertensive medications
Resistant Hypertension
233
Causes of Resistant Hypertension
Renovascular Hypertension - serum Cr > 30% after starting ACEi/ARB - flash pulmonary edema - diffuse atherosclerosis - assymetric kidney size- small atrophic unilateral kidney) - abdominal bruit
234
Most important Risk factors for HFpEF
Chronic hypertension Obesity and Sedentary Lifestyle CAD and DM
235
Which non-pharmacologic intervention has the greatest impacts on reducing BP?
``` DASH diet- 11 mmHg Weight Loss- 6mmHg/10kg loss Aerobic exercise- 7mmHg Sodium intake changes- 5-8 mmHg Alcohol cessation- 5mmHg ```
236
Prevent DVT post surgery in high risk patients
Prophylatic low molecular weight heparin (Enoxaparin)- for at least 3 weeks post surgery
237
How do IgE mediated allergies present?
Immediate Anaphylaxis reaction in any age (<1hr) —> Urticaria (raised itchy rash), Vomiting/Wheezing, Angioedema (swelling underneath skin), hypotension
238
How do Non-IgE mediated food allergies present in infants <6 months?
Proctocolitis, Insidious onset— painless, bloody stools in a well appearing infant
239
How does non-IgE mediated food allergies present in infants <12 months?
Protein induced- enterocolitis syndrome- onset within hours- profuse vomiting, diarrhea (+/- blood), dehydration, lethargy, ill-appearing.
240
most common cause of protein-induced allergic proctocolitis?
Cow’s Milk
241
Labs of autoimmune hepatitis?
Elevated aspartate aminotransferase, alanine aminotransferase, Normal alkaline phosphatase and bilirubin High autoantibody —> serum globulins + 𝛄 gap Positive serology
242
Chromium deficiency manifestation
Impaired glucose control in diabetes
243
Copper deficiency manifestations
``` Brittle hair Skin depigmentation Neurologic dysfunction (ataxia, peripheral neuropathy) Anemia Osteoporosis ```
244
Selenium Deficiency Manifestations
Thyroid dysfunction Cardiomyopathy Immune Dysfunction
245
Zinc Deficiency Manifestations
``` Alopecia Pustular Skin Rash (perioral region/extremities) Hypogonadism Impaired wound healing Impaired taste Immune dysfunction ```
246
What are patients on parenteral nutrition at risk for?
Trace mineral deficiency
247
Risk factors of trace mineral deficiency?
Malabsorption bowel resection poor nutritional intake dependence on parenteral nutrition
248
Dx: Recurrent episodes of mild jaundice (provoked by stress aka fever, fasting, dehydration, exercise, menstruation, surgery), elevated unconjugated bilirubinemia (indirect hyperbilirubinemia)
Gilbert Syndrome
249
Constipated Infant + Ill appearing
Serious Organic causes: Hirschsprung disease, Cystic Fibrosis, Spinal Dysraphism, Hypothyroidism
250
Constipated + well appearing infant + loose stools +/- blood mucous
Food induced protein enterocolitis
251
Constipated Infant + Well appearing + Normal Stool consistency
Normal Infant dyschezia
252
Constipated Infant + Well-Appearing + Hard or Pellet-like Stools
Functional constipation (+/- anal fissure if blood present)
253
Dx: elderly patient, chronic antacid uses, subtle neurologic defects in lower extremity, dorsal column injury (diminished light touch/vibration sensation)
Vitamin B12 deficiency
254
Dx: elderly female, progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds and distended, fullness in right groin area
Femoral hernia
255
Dx: Diarrhea post radiation, <8 weeks, mucus discharge, tenesmus, minimal bleeding, severe erythema/edema ulcerations on endoscopy
Dx: Acute radiation proctitis Tx: Loperamide and Butyrate Enemas
256
Dx: > 3 years post radiation, severe bleeding +/- strictures with constipation & rectal pain, multiple telangiectasias, mucosal pallor/friability on endoscopy
Dx: Chronic radiation Proctitis Tx: endoscopic thermal coagulation, sucralfate/glucocorticoid enemas
257
Dx: Loose, oily, non-bloody stools, bloating, flatulence, weight loss, decreased linear velocity, contaminated food/water,villous blunting—> malabsorption
Dx: Giardiasis Diagnostic: stool antigen + PCR testing, Tx: 1st line = tinidazole/ nitazoxanide or metronidazole - pregnancy- paromomycin - refractory/recurrent: evaluate for CF/CVID
258
Dx: New IDA in elderly patient
GI blood loss - Check colonoscopy/endoscopy
259
Dx and Tx: Child, ear pain, itch, pain with auricle manipulation, tympanic membrane spared
Otitis Externa- Pseudomonas/ Staph A/ Foreign Object | Tx: Remove Debris, Topical FQ (ciprofloxacin) +/- topical glucocorticoid, wick placement
260
Most concern with Parotid Masses
Cranial nerve dysfunction: facial droop, facial numbness
261
Presbycusis
Age related Hearing Loss (cochlear hair cell loss)
262
Nasopharyngeal Carcinoma is endemic where? Treatment
Asia | Radiation/Chemotherapy
263
EEG?
Test which detects abnormalities in brain waves or in electrical activity of your brain
264
Thyroid Nodules Management?
Fine-Needle Aspiration Bx
265
Complication of recurrent acute otitis media: fever, ear pain, infection behind ear, displacement of auricle
Acute Mastoiditis
266
Dx: painless, white lesions in mouth which cannot be scraped off, fatigue, unintentional weight loss, cervical adenopathy
Oral Hairy Leukoplakia (obtain HIV testing)
267
Dx and Tx: Nasal Drip (rhinorrhea), nasal congestion, sneezing, nasal itching, darkened circles under eyes, transverse nasal crease, pale bluish turbinates, pharyngeal cobblestoning, high arched breathing
Dx: Allergic Rhinitis (Allergic shiners, salute, facies) Tx: intranasal corticosteroids
268
Dx + Tx: infant, middle ear effusion, tympanic membrane inflammation- fever, earache (otalgia), erythema.
Acute Otitis Media: Strep Pneumo, H. Flu, Moraxella, | Tx: amox, amox+clauv or penicillin allergy: clindamycin
269
Complications of acute Otitis Media
TM perforation Conductive Hearing Loss Mastoiditis Meningitis
270
Dx and Tx: child, Respiratory Distress, Dysphagia, dysphonia, drooling, high fever, “thumb sign on X-ray,
Dx: Epiglottitis (H.Flu) Tx: endotracheal intubation + antibiotics Prevent: immunization against Hib
271
Dx: clear unilateral rhinorrhea increasing at times bending over/bowel movements, salty/metallic tast
CSF rhinorrhea- check for trauma- bed rest, elevation of head, avoid strain, lumbar drain placement, surgical repair
272
Dx and Tx: Child: Ear fullness/discomfort, tinnitus, conductive hearing loss, popping sensation
Retracted tympanic membrane—eustachian tube dysfunction predisposing factor for acute otitis media
273
Dx and Tx: ear pain, hearing loss associated with flying
Dx: Barotrauma to the ear Tx: Reassurance and Follow-Up
274
Dx: asthma, bronchospasm, or bland taste for food, nasal congestion (nasal polyposis) with naproxen
AERD (Aspirin Exacerbated Respiratory Disease)
275
Dx + Tx | : chronic mass in hard palate, benign bony growth, congenital or develop later in life
Torus Palatinus | Tx: with Surgery if needed
276
Treatment of Bisphosphonate-related osteonecrosis of the jaw?
Oral Hygiene, Antibacterial Rinses, Antibiotics and debridement
277
Dx: Smoker or Drinker, White patches on Tongue that can't be wiped off
Oral Leukoplakia
278
Dx and Tx: unilateral sensorineural hearing loss and imbalance, facial numbness or paralysis
Dx: Vestibular Schwannoma (CN8 and CN5 dysfunction) Tx: Observation, Surgery, Radiation
279
DDx: Blood streaked stools in a well appearing infant <6 months old
DDx: Anal Fissure or Food-protein induced allergic proctocolitis (FPIAP)
280
Dx + Tx: Blood streaked stools in a well appearing infant <6 months old, normal rectal exam, hx of loose stools, presence of mucous in the stool,
Dx: food protein induced allergic proctocolitis
281
Dx: acute fever. nausea, right upper quadrant pain, hepatomegaly, jaundice elevated liver transanimases >1000
Acute Hep A infection
282
Dx: fatigue, pruritis, elevated Alk Phos, normal common bile duct Test:
Test: antimitochondrial antibodies Dx: PBC (primary biliary cholangitis
283
Dx: Fatigue, pruritis, elevated alk phos, elevated bilirubin
PSC (Primary Sclerosing Cholangitis)
284
Complications of Primary Sclerosing Cholangitis
Association with IBD, UC | Cholangiocarcinoma, Colon Cancer, Biliary Cancer
285
Dx: asymptomatic + high alk phos + high 𝛄- glutamyl transpeptidase
Primary Sclerosing Cholangitis
286
Unmodifiable Risk factors of Pancreatic Cancer
1st Degree Relative with Pancreatic Cancer Hereditary Pancreatitis Germline Mutations
287
Environmental Risk Factors of Pancreatic Cancer
Cigarette Smoking Obesity Nonhereditary Chronic Pancreatitis
288
Dx: Diarrhea (nausea, abdominal pain, loss of appetite), Dermatitis (rough, hyper pigmented scaly skin), Dementia (depressed mood, memory loss, psychosis)
Pellegra- Vitamin B3- Niacin Deficiency
289
Dx: metabolic syndrome, AST/ALT < 1, hyperechoic texture on ultrasound of liver
Non- Alcoholic Fatty Liver Disease + Insulin Resistance
290
When do use anoscopy?
Patients with no clinical features but minimal bleeding: hemorroids or anal fissures
291
F/U with cirrhosis
Diagnostic upper endoscopy- risk of hemorrhage
292
Esophageal Varices—-> variceal hemorrhage prevention
Non-selective beta blocker
293
What medications can cause medication induced esophagitis?
Tetracyclines (doxycycline) Aspirin and NSAIDs Bisphosphonates (Alendronate, Risendronate) Potassium Chloride, Iron
294
dx: abrupt onset retrosternal pain with severe painful swallowing
Medication-induced esophagitis- clinical + endoscopy (ulcers with normal surrounding mucosa
295
Dx: female solitary well-circumscribed mobile mass on chest
Breast Cyst
296
Dx: female, multiple diffuse nodulocystic masses, premenstrual tenderness
Fibrocystic changes
297
Dx: solitary, firm, well-circumscribed and mobile mass, premenstrual tenderness
Fibroadenoma
298
Dx: female, after trauma/surgery, firm, irregular mass +/- ecchymosis, skin/nipple retraction
Fat Necrosis
299
Common sign of hyperandrogenism
Severe nodulocystic acne
300
Dx: Hirsutism, Nodulocystic acne, Androgenic alopecia, high serum testosterone, irregular menses in female
Dx: PCOS (polycystic ovaries on ultrasound)
301
When does Pap test start?
21 y/o
302
Dx & Tx: asymptomatic or vaginal/pelvic pressure, stress urinary incontinence, retention, constipation, incomplete defecation.
Dx: Pelvic Organ Prolapse- Bowel, Bladder, or uterus herniation into vagina Tx: Asymptomatic- Observation, Symptomatic- Pelvic floor kegel exercises, vaginal pessary, surgical repair
303
Dx: chronic pelvic pain and adnexal mass, cellular metaplasia, retrograde menstruation, worsening pain with exercise, dysparenia,
Endometriosis
304
Screening Guidelines of Cervical Screening
``` <21—> No screening 21-29—> Cytology every 3 years 30-65—> Cytology plus HPV every 5 years >65—> no screening needed Hysterectomy—> no screening HIV—-> annual until >3 normal results Immunosuppressed > annual pap test + HPV ```
305
Tx of Menopause Symptoms (vasomotor symptoms, oligomenorrhea/amenorrhea, sleep disturbances, decreased libido, depression, cognitive decline, vaginal atrophy)
Tx: topical vaginal estrogen + systemic Hormone Replacement Therapy
306
Tx: asymptomatic uterine leiomyomas (fibroids)
Tx: observation
307
Dx + Tx: heavy, prolonged menses, pelvic pain, constipation, urinary frequency, irregular ultrasound (heavy, prolonged menses, chronic pelvic pain, bulk symptoms, recurrent pregnancy loss)
Dx: uterine leiomyomata Tx: Hormonal contraception, Surgery
308
Dx, Tx, Cx: chronic constipation and vaginal bulge
Dx: pelvic organ prolapse Tx: pelvic floor muscle exercises, vaginal pessary placement, possible surgical correction Cx: levator ani muscle complex damage
309
Dx and Tx: female, sudden strong urge to urinate and urine leakage
Dx: urgency urinary incontinence Tx: lifestyle behavior pelvic floor exercises 2nd- pharmacotherapy—> oxybutynin (systemic antimuscurinic) or mirabegron (fewer systemic side effects)
310
Dx and Tx: urine leaks with laughing, sneezing, coughing, exercising
Dx: Stress Urinary Incontinence Tx: Midurethral Slings
311
Contraindications for SERMs
Thromboembolism
312
Annual Screening for sexually active females <25
Clamydia and Gonorrhea- NAAT is best (nucleic acid amplification testing)
313
Most important risk factors for Breast Cancer
1. Age 2. Increased estrogen Exposure 3. Family History
314
What is the follow up test if a pap smear test is unsatisfactory?
Endocervical curettage
315
Dx and Tx: pain in first 2-3 days of menses, N/V/D, normal pelvic examination
Primary Dysmenorrhea Tx: NSAIDs (inhibit prostaglandin) in non-sexually active patients Oral contraceptives in sexually active patients
316
Unilateral firm tender mass posterior to the nipple in girl (8-10
First sign of puberty- physiologic thelarche
317
Tx: of Chlamydia Trachomatis
Doxycycline | Azithromycin in pregnant patients
318
Dx + Tx: >40 woman, multiparity, prior uterine surgery with dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, diffuse uterine enlargement, uterine tenderness
Adenomyosis- thickened myometrium + MRI/US + Pathology confirmation Treatment: Hysterectomy
319
Dx + Tx: Young woman, strenous exercise, relative caloric defiiciency, stress fractures, amenorrhea, infertility
Dx: Exercised Induced Hypothalamic Amenorrhea Tx: Increase Caloric Intake, Estrogen, Calcium + Vit D
320
Chronic Abnormal uterine bleeding in obese patient, no menstrual cycles
Anovulation - obesity contributes to increased overall estrone levels —> disrupt Hypothalamic- pituitary- ovarian axis- anovulation and uterine bleeding.
321
Dx + Tx: Maculopapular Rash, Fever, New Drug exposure +/- arthralgias. Labs: pyuria, hematuria, WBC cast
Dx: Acute Interstitial Nephritis Tx: Discontinue new drug, +/- systemic glucocorticoids
322
Dx: malar rash/discoid rash + hypertension, mild proteinuria + RBC casts
Dx: Lupus Nephritis
323
Dx: hematuria, mild proteinuria, RBC casts, fluid retention, hypertension, periorbital edema, 1-2 weeks after episode of streptococcal pharyngitis/skin infection
Dx: Postinfectious glomerulonephritis
324
Dx, Cx, and Tx: Night time urinary incontinence + Boys 5-8,
Nocturnal Enuresis - self-resolves, behavioral modifications, enuresis alarms, desmopressin therapy Cx: constipation (leaky stool)- treat with laxatives
325
diagnostic test for post-renal diseases
Renal ultrasound
326
Dx , Cx, Tx: < 50 y.o. Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion,
Dx: Primary Hyperparathyroidism Cx: Osteoporosis, Nephrolithiasis, CKD Tx: parathyroidectomy
327
Dx, Diagnostic, and Tx: episodic headache, sweating, tachycardia or resistant HTN
Dx: Pheochromocytoma Diagnostic: urine/plasma metanephrines + confirmatory abdominal imaging Tx: pre-operative alpha blockade prior to beta blockade, laparoscopic/open surgical resection
328
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion, Pituitary Tumors (prolactin, visual defects), Pancreatic tumors (gastrinomas)
MEN Type 1
329
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion, Medullary Thyroid Cancer (Calcitonin elevated) Pheochromocytoma (Episodic Headache, tachycardia, Sweating or Resistant HTN)
MEN Type 2A
330
Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion, Medullary Thyroid Cancer (Calcitonin elevated) Mucosal Neuromas/Marfanoid Habitus
MEN Type 2B
331
Difference between pseudogynecomastia and gynecomastia
Pseudo: Excessive deposition of fat without distinct margin True: margin of glandular tissue
332
Squamous Cell Carcinoma with elevated calcium, low phosphorus
Hypercalcemia of malignancy = PTHrP —> low PTH —-> mimics PTH— high calcium low phosphorus
333
Findings associated with T2DM
Obesity, HTN, dyslipidemia, aconthosis nigricans
334
Dx: oligomenorrhea (inconsistent menses), hirsutism (excess terminal hair growth), virilization (clitoromegaly), obesity, T2DM, dyslipidemia, hypertension
PCOS
335
Dx: PCOS (oligomenorrhea, hirsutism, hyperandrogenism, obesity) + elevated serum 17-hydroxyprogesterone
21- hydroxylase deficiency
336
Dx: rapidly progressive hirsutism with virilization + high serum androgens, post menopausal
Androgen-secreting ovarian tumors, ovarian hyperthecosis | Or high androgen secreting neoplasm
337
Dx: Diarrhea (steatorrhea), Wt Loss, Ab Pain, Flatulence/Bloating Dermatitis herpetiformis, atrophic glossitis, Vit D deficiency, secondary hyperparathyroidism (Low Ca, Low Phos, High PTH) Osteomalacia/Osteoporosis/Rickets IDA Peripheral Neuropathy/ Depression Anxiety Can have ulcerative jejunitis, enteropathy- associated T-cell lymphoma
Celiac Disease
338
Best Management of DKD
Reduce BP to <130/80 with ACE/ARB | Reduce HBA1c <7.0 with SGLT2i , GLP-1 agonist
339
Dx + Diagnostic + Tx: hyperpigmentation, athropathy (joint pain), hepatomegaly, cirrhosis (HCC), diabetes mellitus, hypopituitarism, hypogonadism, cardiomyopathy
Dx: Hereditary Hemochromatosis Diagnosis: Elevated Liver Transaminases (ALT, AST), elevated serum ferritin, transferrin saturation Tx: Therapeutic phlebotomy (urgent if ferritin >1000
340
Dx, Diagnostics, and Tx: Fatigue, Weakness, Anorexia/Wt loss, N/V/ Ab Pain, Salt Craving, Postural Hypotension, Hyperpigmentation
Dx: Primary Adrenal Insufficiency Labs: Hyponatremia, hyperkalemia, eosinophilia, low morning cortisol, high ACTH Tx: Glucocorticoids (hydrocortisone, prednisone), Mineralocorticoids (fludrocortisone)
341
Dx: elevated free T4, supressed TSH, tachycardia, anxiety, wt loss, low RAIU, non-tender, enlarged thyroid gland
Self-limiting painless thyroiditis | Tx: propranolol—> control palpitations, tremulousness
342
Hypothyroid features, diffuse goiter, TPO antibody, variable RAIU
Chronic autoimmune thyroiditis (Hashimoto thyroiditis)
343
Mild brief hyperthyroid phase, hypothyroid phase, small non-tender goiter, spontaneous recovery, positive TPO, low RAIU
Painless (silent Thyroiditis)
344
Post-viral URTI, prominent fever, hyperthyroid symptoms (painful/tender goiter), elevated ESR + CRP, Low RAIU
Subacute thyroiditis- de Quervain thyroiditis)
345
Dx: arthralgias (joint pain), jaw widening (increased interdental spaces), macroglossia (enlarged tongue) Headache, visual field defect, cranial nerve defects, skin thickening, hyperhidrosis, Hypogonadism, DM, hypertriglyceridemia Joint involvement in axial and appendicular skeleton, joint space widening
Acromegaly: excessive growth hormone
346
Hypertension hypokalemia + elevated renin/ aldosterone
Secondary hyperaldosteronism (renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretic use
347
Hypertension, hypokalemia, low renin high aldosterone
Primary hyperaldosteronism (aldosterone producing tumor, bilateral adrenal hyperplasia)
348
Hypertension + hypokalemia + low renin, low aldosterone
Non-aldosterone causes- congenital adrenal hyperplasia, deoxycorticosterone producing adrenal tumor, Cushing Syndrome, Exogenous Mineralocorticoids
349
Hyperprolactin symptoms > prolaction 25-100 mg
Medication related -Hyperprolactinemia- gynecomastia, galactorrhea, menstrual dysfunction, decreased libido most- likely risperidone
350
Hyperprolactinism- > 200ng/ml
Prolactinomas- headaches, visual disturbances
351
Mechanism of diabetic neuropathy- large fiber neuropathy
- pressure, proprioception, balance, numbness, poor balance, diminished ankle reflexes, reduced vibration to light tough, axonopathy of large nerve fibers
352
Mechanism of diabetic neuropathy- small fiber neuropathy
Pain and temperature, burning/stabbing pain, reduced pinprick sensation, ankle reflexes reserved
353
Diabetic Nephropathy —> > 30 mg/g- albuminuria, decreased glomerular filtration
Also proliferative diabetic retinopathy
354
What does that CHA2DS2VASC score assess?
Whether a patient should be on anticoagulant therapy | Male > 2 , Female > 3
355
Choice of HTN drug in Angina Pectoris?
B-blocker (-olols) or CCB (amlodipine)
356
HTN drug of choice in post MI
ACEi (lisinopril) or ARB (losartan) or B-blocker (-olols)
357
HTN drug of choice in HFrEF?
ACEi (lisinopril) or ARB (losartan), B-blocker (-olols), diuretic (-thiazide), aldosterone agonist (spironolactone, eplerenone)
358
HTN drug of choice in Afib?
Beta blocker (-olol), nondihydropyridine CCB (diltiazem)
359
HTN drug of choice in CKD?
ACEi (lisinopril) or ARB (losartan)
360
HTN drug of choice in gout
Losartan, other ARB, CCB, avoid diuretics
361
HTN drug of choice in osteoporosis
Thiazide diuretic
362
HTN drug of choice with migraine
B-blocker (olols), CCB (amlodipine)
363
Screening for abdominal aortic aneurysm
One time abdominal duplex US
364
Absolute Contraindication of Hormonal Contraception
``` Active Breast Cancer Migraines with Aura Uncontrolled HTN Active Hepatitis, Cirrhosis, Liver Cancer Age > 35 and 1.5 packs smoking daily Ischemic Heart Disease, Stroke <3 weeks post partum Prolonged immobilization Thrombophilia (Factor V Leiden, Antiphospholipid antibody syndrome) Venous Thromboembolism ```
365
What is recurrent UTI?
>2 infections in 6 months | > 3 infections in 1 year
366
Risk factors for Reccurent UTIs
History of cystitis <15 years old Spermicide Use New Sexual Partner Postmenopausal status
367
Dx of UTI
UA + Urine Culture, Clean Catch
368
Prevention of UTI
Behavior modification- Contraception, Postcoital/Daily Antibiotic prophylaxis Topical Vaginal Estrogen for Post menopausal patients
369
Cx of candida albicans
Erythematous beefy red plaques, mirror image, satellite regions - intertrigo- happens in impaired immunity, obesity, tight fit clothing Tx: Topical azoles (clotrimazole)
370
Tx of Recurrent UTI in postmenopausal patients
Topical Vaginal Postmenopausal patients
371
Dx: Woman Breast feeding, fever, firm red, tender, swollen quadrant of unilateral breast, myalgia, chills, malaise
Frequent Breastfeeding/ Pumping + Antibiotics, analgesia
372
Postmenopausal bleeding causes
Endometrial hyperplasia or cancer (older women and obesity)
373
Approach to menopausal bleeding
``` Endometrial biopsy or TVUS endometrium <4mm observe, >4 mm biopsy (benign - observe) Atypia neoplasia (progestins) ```
374
Pelvic organ prolapse is
Abnormal herniation of uterus, bladder, rectum through the vaginal wall Weakened pelvic floor muscles Most common risk factor is Multiparity Vaginal mass worsening with valsalva
375
Dx: pelvic pressure, obstructed voiding, urinary retention, urinary urgency/incontinence, constipation, fecal urgency/incontinence, sexual dysfunction
Pelvic organ prolapse: Anterior prolapse: bladder (cystocele) - pelvic pressure, obstructed voiding, urinary retention/urgency, incontience Posterior prolapse: Rectum (rectocele- fecal urgency/incontinence enterocele- small intestine Apical prolapse: uterus/ vaginal vault Procidentia: complete herniation
376
Ovarian cyst <4cm with thin walls
Physiologic ovarian cysts
377
Dx + Tx: Acute unilateral lower abdominal pain in reproductive age women- thin-walled ovarian cysts with pelvic free fluid
Ovarian cyst Rupture Tx: observation and reassurance if hemodynamically stable, no infection If infected and hemodynamically unstable- surgery
378
Abnormal uterine bleeding in obese female
Increased peripheral conversion/aromatization of androgens to estrone—> chronic anovulation—-> endometrial hyperplasia
379
Contraindications for using a IUD
Heavy menstrual bleeding
380
Contraception method <1 month post partum + breast feeding
Subdermal progestin-releasing implant
381
Bilateral breast soreness, weight gain, increasing fatigue
Early Pregnancy | Dx with Urine Pregnancy Test
382
Dx: hyperpigmentation on sun-exposed areas of face in pregnancy, symmetric centrofacial, mandibular, malar distribution
Dx: Melasma Tx: self-resolving, use sunscreen
383
Causes of Oligohydramnios
Early: dependent on fetal urine production- aneuploidy, renal agenesis, posterior urethral valves Late: uteroplancental insufficiency: fetal growth restriction, Maternal causes: dehydration rupture of membranes
384
Amniotic fluid <5cm
Oligohydramnios
385
Dx: late term oligohydramnios + increased clear vaginal discharge + asymptomatic
Spontaneous rupture of membranes
386
Dx: late term oligohydramnios + fetal growth restriction + abnormal U/S findings
congenital infections (CMV)
387
What vaccines are recommended during pregnancy?
Tdap Inactivated Influenza Rho (D) Immunoglobulin
388
What vaccines are indicated for high risk pregnant patients?
``` Hep B, Hep A Pneumococcus Haemophilus Influenza (HiB) Meningococcus Varicella-Zoster immunoglobulin ```
389
What vaccines are contraindicated in pregnant patients?
HPV MMR Live-Attenuated Influenza Varicella
390
Absolute Contraindications for Exercising during Pregnancy
``` Amniotic Fluid Leak Cervical Insufficiency Multiple Gestation Placenta Abruption/ Previa Premature Labor Pre-eclampsia/ Gestational Hypertension Severe Heart and Lung Disease ```
391
Unsafe Activities for Pregnant Women
Contact Sports High Fall Risk Scuba Diving Hot Yoga
392
Exercise Recommendations for Pregnant Women
Moderate- Intensity Exercise- Most/All Days - 20-30 mins
393
Causes of Fetal Tachycardia (>160/min)
Maternal Fever Medication Side Effect (B-agonist) Fetal hyperthyroidism Fetal Tachyarrhythmia
394
Causes of Fetal Bradycardia (<110/min)
Maternal hypothermia Medication side effect (B-blockers) Fetal hypothyroidism Fetal Heart Block
395
Lab Test in initial Prenatal Visit
``` Rh(D) type + antibody screening - autoimmune attack of fetus HgB, Hct, MCV, ferritin - IDA, anemia HIV, VDRL/RPR, HbsAg, anti-HCV Ab - HIV, syphilis, Hep A and C Rubella + Varicella Immunity Urine Culture Urine Dipstick for Protein Clamydia PCR Pap test (if indicated) ```
396
Lab Tests in 24-28 weeks gestation
HgB/ Hct- anemia Antibody screen if Rh(D) negative- autoimmune attack of fetus 1-hr 50g GCT - gestational diabetes
397
Lab Tests in 36-38 weeks gestation
Group b Streptococcus Rectovaginal Culture
398
Anemia in Pregnancy HgB <
11.0
399
Appropriate Weight Gain in Pregnancy
<18.5 BMI =28-40 lbs 18.5-24.9 BMI = 25-35lbs 25-29.9 BMI = 15-25lbs >30 BMI = 11-20lbs
400
Harmful Substances to avoid in Pregnancy
Recreational Substances High Mercury Levels Alcohol Caffeine
401
Food Safety in Pregnancy
Avoid undercooked meat, fish, eggs Clean Raw fruits/veggies Avoid unpasteurized dairy
402
Complications of inadequate weight gain in pregnancy
Low birth weight | Pre term delivery
403
Complications of Excessive weight gain in pregnancy
Gestational Diabetes Fetal Macrosomia Cesarean Delivery
404
Contraindications of DTaP vaccinations
Anaphylaxis Unstable Neurologic Disorders (infantile spasms, uncontrolled epilepsy) Encephalopathy (coma, decreased level of consciousness, prolonged seizures)
405
Dx and Tx: Young patient, recurrent sinpulmonary infections, chronic lung disease, non-smoker, progressive cough/dyspnea
CVID Diagnostics: Quantitative Immunoglobulin Assay low IgG low Iga low IgM Tx: Immunoglobulin replacement therapy
406
Tx of Infant constipation (infrequent defecation, hard painful stools, large-caliber or pellet like stools, anal fissures)
Add undigestable, osmotically active carbohydrate (prune/apple juice/puree
407
Dx and Tx: diarrhea, mucus discharge, tenesmus, minimal bleeding, <8 weeks post radiation therapy, endoscopy: severe erythema, edema + ulcerations
Acute Radiation Proctitis | Tx: Antidiarrheals (loperamide) and butyrate enemas
408
Dx and Tx: severe bleeding, strictures with constipation and rectal pain, >3 months radiation endoscopy: multiple telangiectasias, mucosal pallor/friability
Dx: Chronic radiation proctitis Tx: Endoscopic thermal coagulation, sucralfate or glucocorticoid enemas
409
Dx diagnostic Tx: 40s, osmotic diarrhea, abdrominal cramps, bloating, no steatorrhea, flatulence with dairy ingestion
Dx: lactose intolerance diagnostic: Lactose hydrogen breath test, positive stool test for reducing substances, low stool pH, increased stool osmotic gap,
410
Dx, diagnostics, Tx: General: Bulky, foul smelling, floating stools Fat/Protein: loss of muscle mass, loss of subQ fat, fatigue Iron: Pallor (anemia), fatigue Calcium + Vit D- bone pain + fracture Vitamin K- easy bruising Vitamin A- hyperkeratosis
Celiac Disease | Diagnostic: IgA anti-tissue transglutaminase, IgA anti-endomysial antibodies
411
Dx, Diagnostic, Tx: difficulty swallowing (dysphagia), bad breath (hallitosis), history of regurgitating undigested food, gurgling sound, recurrent aspiration pneumonia
Zenker Diverticulum Diagnostic: contrast swallow study Tx: surgical -cricopharyngeal myotomy, diverticulectomy, diverticulotomy
412
Dx and Tx: tender papulopustular eruption on lower extremeties after swimming in heated hotel pool, low grade fever,
Pseudomonas aeruginosa folliculitis (hot tub folliulitis Tx: self-limited
413
Dx, Diagnostic, TX: child, fever, irritability, limited function of a limb, bony tenderness, swelling, elevated ESR, CRP, WBC
Osteomyelitis X-ray, MRI, bone biopsy, blood culture, ESR, CRP WBC count elevated Tx: vancomycin Risk Factors: sickle cell, immunodeficiency
414
Features of Viral Upper Respiratory Syndrome
Slow onset Rhinorrhea, Coryza, sneezing, mild pharyngitis Mild Systemic Symptoms Nasal Edema, slightly erythematous pharynx
415
Influenza Clinical Features
Abrupt dramatic onset respiratory symptoms mild high fever, myalgias, headaches
416
Streptococcal pharyngitis clinical features
Variable onset of symptoms pharyngeal symptoms might be fever and myalgias pharyngeal erythema, tonsillar hypertrophy/exudates, tender cervical lymph nodes
417
Stages of Lyme Disease (Borrelia Burgdorferi
``` Early Localized (days- months)- erythema migrans, fatigue, myalgias, arthralgias Early Disseminated (weeks-months)- multiple erythema migrans, CN VII palsy, meningitis, carditis (AV block), migratory arthralgias Late- arthritis, encephalitis, peripheral neuropathy ```
418
Treatment of Borrelia burgdorferi (Ixodes Scapularis Tick)
Doxycycline
419
Dx and Tx: Traveler's Diarrhea < 2 weeks, watery diarrhea, crampy abdominal pain, ingestion of contaminated water, food
ETEC- Enterotoxigenic Escherichia Coli | Tx: supportive
420
Dx, Diagnostic, Tx: Traveller's Diarrhea > 2weeks, bloody mucid diarrhea, liver abcess
Dx: Entamoeba Histolytica Diagnostic: Stool Analysis: cysts + trophozoites Tx: Metronidazole or Tinidazole
421
Dx, DGx, Tx: traveller's diarrhea > 2 weeks, watery/oily, foul-smelling stools, bloating, fat malabsorption, weight loss (fatigue, N/V)
Dx: Giardia Lamblia DGx: Stool analysis: cysts + multinucleated trophozoites, Immunoassay, PCR Tx: Metronidazole or Tinidazole
422
Dx, DGx, Tx: Traveller's Diarrhea > 2 weeks, watery diarrhea, immunosuppressed patient ( CD4 <100)
Dx: Cryptosporidium DGx: Stool test: acid fast cysts in stool Tx: ORT + consider nitazoxanide
423
Dx: Traveller's Diarrhea > 2 weeks, watery/blood diarrhea, waxing/waning symptoms
Dx: Cyclospora DGx: Stool Test Tx: TMP- SMX
424
Guidelines for PPSV23 vaccine administration
Recommended for all adults > 65 | <65 with chronic liver disease, lung disease, heart disease, diabetes mellitus, smoking history
425
Requirements for Hep A Prophylaxis
Hep A Vaccine or Ig for close personal contacts of Hep A infected patients, Child care center contacts, food prep workers < 2 weeks younger patients <40 should take vaccine, > 40 Hep A Ig
426
Bug with itchy (pruritic), small puncta/ maculopapules in linear groups on unclothed skin
Beg Bug
427
Bug with widespred itching of hair, body or genitalia with visible louse
Lice (pediculosis)
428
Bug with itchy burrows, hemorrhagic crusts in interriginous areas
Scabies
429
Bug with Solitary papule/pustule or wheal and itching
Spider
430
Bug with Painless red papule, itchy during spring/summer
Tick
431
dry scaly flat papules with red base in sun exposed areas
Actinic Keratosis
432
tan, brown, round lesion, well demarcated border, stuck on appearance, benign lesions
Seborrheic keratosis
433
skin tag
acrochordon
434
slow growing papule, nodule, pearly, rolled border, overlying telangiectasias
Basal Cell Carcinoma
435
enlarging non-healing ulcer, bleeding on contact
Squamous Cell Carcinoma secondary to chronic wounds
436
Tx of HPV plantar warts
salicylic acid cream | 5-fluoro uracil cream
437
persistent itchy plaque with lichenification, fissuring
Chronic Allergic Contact Dermatitis (type IV mediated hypersensitivity
438
Tx: of Allergic Contact Dermatitis
avoidance + topical/systemic corticosteroid
439
Dx, DGx, Tx: Scaly plaques + Ulceration, well demarcated patches/plaques
Dx: Squamous Cell Carcinoma in Situ DGx: Punch, Shave, Excisional Biopsy Tx: Excision 4-6mm margins, Mohs Micrographic Surgery, Cryotherapy, Topical 5-FU, imiquimod
440
Pathology of Parkinson Disease
Accumulation of alpha synuclein within neurons of the substantia nigra pars compacta
441
Dx DGx and Tx: elderly, tremor, rigidity in movements, akinesia/bradykinesia, postural instability
Parkinson Disease DGx: Clinical Diagnosis Tx: levodopa
442
Adverse Effects of Benzos in elderly
Increased risk of confusion, falls, baseline cognitive impairment,
443
Recurrent episodes of confusion, aggression, disinhibition within an hour of taking benzos in elderly
Paradoxical agitation
444
Abortive Migraine Therapy
Triptans (Sumatriptan) NSAIDs (Naproxen or Acetominophen) Antiemetics (metoclopramide, prochlorperazine) Ergotamines (dihydroergotamine)
445
Preventive Migraine Therapy
Topiramate Divalproex Sodium Tricyclic Antidepressants (Nortriptyline, Desipramine) Beta Blockers- Propranolol
446
Dx: newborn with diffuse (crosses suture lines) fluctuant scalp swelling and blood loss (pallor, anemia, tachycardia)
Dx: subgaleal hemorrhage (via sugaleal vein shearing)- massive blood accumulation between periosteum and galea aponeurotica
447
Essential coagulation factor in carboxylation that activate coagulation factors
Vitamin K
448
Dx: infancy, bleeding in joints (hemarthrosis), intracranial hemorrhage, prolonged PTT
Hemophilia A - X linked bleeding disorder
449
Dx: venipuncture site oozing, thrombocytopenia, prolonged PT and PTT
Disseminated intravascular coagulation (DIC)
450
Dx: newborn bleeding between skull and periosteum, subperiosteal vessel rupture, firm nonfluctuant swelling that does not cross suture lines
Cephalohematoma
451
Dx, DGX, Tx: Elderly, Wide based Gait with falls, cognitive dysfunction, urinary urgency/incontinence, depressed affect, upper motor neuron signs in lower extremeties
Dx: Normal Pressure Hydrocephalus DGx: improvement of gait with Miller Fisher Lumbar Tap Test (removal of spinal fluid), MRI enlarged ventricles out of proportion to underlying brain atrophy on MRI Tx: Ventriculoperitoneal shunting
452
Generalized Seizure Triggers
Lack of Sleep, Flashing Lights, Emotional Stress
453
Generalized Seizure Event Features
Preceding Aura, Loss of Consciousness and Loss of Postural Tone, Tonic-Clonic Convulsions
454
Generalized Seizure Post Event Features
Delayed Return to Baseline
455
Vasovagal Syncope Triggers
Prolonged Standing + Physical/Emotional Stress
456
Vasovagal Syncope Event Features
Presyncope- Light- headedness, pallor, diaphoresis
457
Vasovagal syncope post event features
Immediate return to baseline
458
Cardiogenic Syncope Triggers
Exertion, Dehydration
459
Cardiogenic Event Features
Sudden Loss of Consciousness without prodrome
460
Cardiogenic Syncope Post event features
Immediate Return to Baseline
461
Dx and Tx: child, pulsatile throbbing headache lasting hours-days, photophobia,phonophobia, N/V, autonomic symptoms (facial sweating, tearing, nasal congestion, preceding aura, normal neurologic examination
Dx: Migraine in Children Tx: Acetominophen, NSAIDs, Triptans (sumatriptan), antiemetics (promethazine, prochlorperazine), Ergots (Dihydroergotamine)
462
Dx: encephalopathy (confusion), oculomotor dysfunction (horizontal nystagmus), gait ataxia, anorexia or chronic alcohol use
Dx: Wernicke Syndrome or Alcohol Withdrawal Syndrome (Thiamine Deficiency) Tx: Thiamine Replenishment
463
Dx, DGx, Tx: adult, unilateral severe stabbing pain in jaw line, triggered by chewing, talking, brushing teeth, light touch)
Dx: Trigeminal Neuralgia DGx: MRI/MRA of brain with contrast, nerve conduction Tx: Carbamezapine or Oxcarbazepine or Surgery for severe medically refractory cases
464
Dx, DGx, Tx: Facial pain with jaw motion, ear pain/ tinnitus, unilateral headache, jaw dysfunction
Dx: temporomandibular joint disorder DGx: clinical, tenderness of mastication muscles, tooth wear/grinding (bruxism), crepitus or clicking with TMJ Tx: Education: avoid triggers, soft foods, dental splints, NSAIDs
465
Dx, DGx, Tx: inattentive, hyperactive symptoms for >6months before age 12, in at least 2 settings
Dx: ADHD DGx: behavioral rating scales from school Tx: Stimulants (Methylphenidate, amphetamines), Non stimulants (atomoxetine), Behavioral therapy
466
SIGECAPS
``` Sleep Disturbance Loss of Interest Guilt Energy Low Concentration Impaired Appetite Change Psychomotor Retardation/Agitation Suicidal Thoughts ```
467
Dx: Excessive Fears of having a serious illness
Illness Anxiety Disorder
468
Dx: bloating, fatigue, headaches, breast tenderness, mood swings, anxiety, difficulty concentrating, decreased libido, irritability lasting for a week, recurring in female
Dx: PMS
469
Dx: prominent irritability, hopelessness, depressed mood, self-critical thoughts, anger, recurrent in a female
PMDD (premenstrual dysphoric disorder)
470
Why avoid citalopram in depressive patients with cardiac disorders?
Dose dependent QT prolongation
471
Dx and Tx: Avoidance of reminders of trauma, emotional detachment, negative mood, decreased interest in activities, sleep disturbance, hypervigilance, irritability
Dx: PTSD Tx: trauma focused cognitive behavioral therapy, antidepressants (SSRIs, SNRIs)
472
Dx: Chronic anemia following subtotal gastrectomy
B12 Deficiency
473
B12 is required cofactor for?
DNA synthesis
474
Increased intramedullary hemolysis causes
Release of heme—-> indirect hyperbilirubinemia and elevating LDH, total RBC/reticulocyte count will be low, thrombocytopenia, leukopenia
475
Tx of Rheumatoid Arthritis
Methotrexate, Hydroxychloroquine, TNF- inhibitors (infliximab, etanercept)
476
Most common malignancy in upper cervical node
Head and neck squamous cell carcinoma
477
Dx: elderly patients with painless cervical waxing and waning lymphadenopathy, leukocytosis
Dx: CLL (Chronic Lymphocytic Leukemia
478
Dx: glomerulonephritis, pulmonary nodules, ear pain, subcutaneous nodules
Granulomatous polyangitis
479
Dx: fever, night sweats, weight loss, painless cervical lymphadenopathy
Dx: Hodgkin Lymphoma
480
Dx: fever, pharyngitis, fatigue, bilateral multiple lymphadenopathy, young patients
Infectious Mononucleosis (EBV)
481
Dx: Dry cough, malaise for long term + bilateral hilar adenopathy
Sarcoidosis | DGx: radiographic + clinical findings
482
Dx: mid 40s patient, non smoking, dyspnea, cough, sputum production, CXR: hyperinflation
Alpha-1- antitrypsin deficiency
483
Dx: adult, fever, weight loss, rhinosinusitis, CXR: pulmonary nodules and alveolar consolidation
Necrotizing pulmonary vasculitis (granulomatosis with polyangitis)
484
Dx: CHF patient, cardiomegaly, cephalization of pulmonary vessels, prominent vascular markings, pleural effusions
Pulmonary venous congestion
485
Risk Factors for Pulmonary Fibrosis
Microscopic alveolar epithelial injury (smoking, GERD, silent aspiration) Inappropriate repair by fibrosis Male, >60y.o., smoking,
486
Dx and Tx: Chronic progressive dyspnea, non productive cough, fatigue, velcro inspiratory crackles, digital clubbing, HRCT: UIP (subpleural honey combing, reticular opacities, restrictive pattern PFTs
Dx: Pulmonary Fibrosis Tx: Antifibrotic Therapy (pirfenidone, nintedanib), smoking cessation, GERD treatment, supplemental oxygen, lung transplant
487
Tx of asthma exacerbation
1. SABA: albuterol 2. SAMA: ipratropium 3. IV Magnesium 4. F/U with systemic glucocorticoids: prednisone/dexamethasone
488
Dx, Tx, Px: Infant, Inspiratory Stridor, Harsh Cough, Hoarseness
Parainfluenza viral infection of larynx and trachea Tx: mild (no stridor at rest)- humidified air + corticosteroids, Moderate/severe (stridor at rest)- corticosteroids + nebulized epinephrine Px: handwashing, decontamination of surfaces, proper ventilation
489
MCC of Mitral Stenosis in adults
Rheumatic Heart Disease
490
Dx: exertional dyspnea, cough, orthopea, left atrial dilation, elevation of left main stem bronchus, atrial fibrilliation, acute decompensated heart failure
Mitral Stenosis in the setting of Rheumatic Heart Disease
491
Dx: acute onset SOB, hypoxia, unilaterally decreased breath sounds in COPD patient, chest pain, hyper-resonance on percussion
Dx: large alveolar bleb ruptures- leak air into pleural space- secondary spontaneous pneumothorax
492
Tx of lumbosacral radiculopathy
Activity Modification First 1-2 weeks: NSAIDs After 2 weeks: consider Physical Therapy, Oral Glucocorticoids (Prednisone) After 4-6 weeks: obtain MRI and assess for surgical indication
493
Dx and Tx: most asymptomatic, headache, hearing loss, spinal stenosis/radiculopathy, bowing, fracture, arthritis of adjacent joints Labs: Ca, Phos = normal, alk phos: elevated X- ray: osteolytic or mixed lesions, DEXA: focal increase in uptake
Paget’s Disease of Bone | Tx: Bisphosphonates
494
Dx and Tx: obese with heavy panniculus, diabetes, or pregnancy, numbness and tingling (pins/needles on lateral thigh, no motor deficits
Dx: Meralgia Paresthetic Tx: avoid tight garments, weight loss, gabapentin or nerve block (if necessary)
495
Dx and Tx: Swelling, heaviness, discomfort Early: soft skin, pitting edema Late: firm, dry and thickened skin, non-pitting edema
Dx: lymphedema Tx: weight loss, limb elevation, compression bandages and physiotherapy, do not use diuretics
496
Indications for preoperative ECG?
Hx of CAD or arrhythmia, MACE risk >1%
497
Indications for preoperative Chest Radiograph
Hx of Cardiopulmonary disease, under going upper abdominal/thoracic surgery
498
Indications for preoperative CBC
Hx of anemia, expected significant blood loss, under going major surgery
499
Indications for coagulation and platelets preoperatively
Hx of abnormal bleeding, anticoagulant use, liver disease, malignancy, planned spinal anesthesia
500
Indications for CMP preoperatively
Hx of Kidney disease, ASCVD risk, predisposing medications (diuretic, ACEi, ARB)
501
Developmental Milestones for 2 month infants
Gross Motor: Lifts head when prone Fine Motor: Opens hands briefly Language: reacts to loud sounds, makes noises Social/Cognitive: Social Smile, Calms when spoken to, tracks past midline
502
Developmental Milestones of 4 month infants
Gross Motor: Holds head steady, pushes up on forearms Fine Motor: Brings hands to midline/mouth, holds to if put in hand Language: Coos, turns to voice Social Cognitive: Seeks attention (smiles/sounds), Enjoys looking at hands
503
Development Milestones for 6 month old infants
Gross Motor: Rolls over, Leans on hands to support seated position Fine Motor: Reaches for toy, puts things in mouth Language: Blows raspberries, squeals Social/Cognitive: Laughs, Recognizes Familiar Faces
504
Development Milestones at 9 months infant
Gross Motor: Gets to sitting unassisted, Sits without support Fine Motor: Transfers object between hands, raking grasp Language: Babbles, Turns to Name Social/Cognitive: Stranger Anxiety, Separation Anxiety
505
Developmental milestones 12 month infant
Gross Motor: Pulls to stand, cruises Fine Motor: Pincer grasp Language: says mama, dada, understands no Social/Cognitive: Plays pat-a-cake, Looks for hidden object
506
Raising the cut off point for a test will do what to specificity and sensitivity?
Increase specificity | Decrease sensitivity
507
Simple vs. Malignant Renal Cysts
Thin, smooth regular wall vs. thick irregular wall Unilocular vs. multilocular No septae vs. multiple septae thick and calcified Homogenous content vs. heterogenous content Asymptomatic vs. may cause pain hematuria or hypertension No follow up vs. requires follow up imaging and urological eval for malignancy
508
Dietary Prevention measures for recurrent nephrolithiasis
Increased fluids (produce > 2L urine/day) Reduced Sodium Reduced Protein Normal calcium intake (1200 mg/day) Increased Citrate (fruits/veggies) Reduced oxalate diet (dark roughage, vitamin C)
509
Drug therapy prevention for recurrent nephrolithiasis
Thiazide diuretic Potassium Citrate/Bicarbonate Salt Allopurinol (hyperuricuria related stones)
510
Dx, DGx, and Tx: night time bed wetting age > 5 w/o prolonged period of continence
Dx: Primary nocturnal enuresis DGx: UA Tx: Reassurance, Behavioral Modifications, Bedwetting Alarm
511
Dx, DGx, Tx: Night time incontinence >5 y.o. After prolong period of continence
Dx: secondary nocturnal enuresis via UTI, DM, psychological stress DGx: UA Tx: treat underlying disease, behavioral modifications
512
MC bacteria in UTI
E. Coli, Klebsiella, Proteus
513
Medication used for passing distal ureteral stone
Alpha 1 antagonists: tamsulosin
514
Drugs that can induce interstitial nephritis (fever, rash, arthralgias, eosinophilia, hematuria, sterile pyuria, eosinophiluria
Penicillins, cephalosporins, sulfonamides
515
Mitral Stenosis —> Atrial Fibrilliation how?
Left atrial dilation
516
DGx and Tx of aortic stenosis
Aortic jet velocity >4.0 or mean transvalvular pressure > 40mm Hg Indications for valve replacement: angina, syncpe, LVEF <50%, CABG
517
Dx and Tx: Leg Edema, Fatigue, Pain, Superficial venous dilation, often worse at the end of the day, no thrombus on US
Dx: Post thromboTic syndrome- chronic venous insufficiency following DVT Tx: exercise: ankle flexion, walking), Compression (bandages or stockings)
518
Common side effect of CCB (amlodipine)
Peripheral Edema
519
Dx: enlarged globular cardiac silhouette on chest X-ray, diminished heart sounds and maximal impulse difficult to palpate
Pericardial Effusion
520
Diagnostic Criteria for Orthostatic Hypotension
Postural decrease of blood pressure by 20 mgHG systolic or 10 mmHg diastolic
521
Dx, Tx, and Cx: rapidly growing nodule with ulceration and keratin plug, spontaneous regression
Dx: Keratoacanthoma Tx: excisional biopsy with complete removal of lesion Cx: can progress to squamous cell carcinoma
522
Dx DGx, and Tx: Scaly, erythematous, pruritic patch with centrifugal spread, subsequent central clearing with annular border
Dx: Tinea Corporis (ringworm) DGx: KOH preparation Tx: topical antifungal (clotrimazole, terbinafine or oral antifungals (terbinafine, griseofulvin)
523
Dx: numerous, ring like widespread plaques with annular or serpinginous border and central clearing, transient, non-pruritic, child associated with rheumatic fever
Dx: erythema marginatum
524
Dx: target shaped rash associated with Lyme Disease
Erythema migrans
525
Dx: Chronic, relapsing, coin shaped patches on extremities, erythematous, pruritic, scant exudate
Nummular eczema
526
Viral prodrome, christmas tree pattern Numerous oval, scaly plaques with large initial lesion, resolves in 6 weeks
Pityriasis Rosea | Tx: Reassurance, antihistamines
527
erythematous target lesions with a dusky center, worse with infections
Erythema Multiforme
528
Dx and Tx: non-inflammatory, hyperkeratinization spots on face
Dx: acne vulgaris (Cutibacterium acnes) Tx: topical retinoid (salicylic, azelaic, glycolic acid)
529
Dx and Tx: scaling, lichenification, fissuring on hands
Dx: contact dermatitis Tx: emollients, topical corticosteroids, and irritant avoidance
530
Dx: itchy (pruritic), scaly patches on palms or annular plaques raised on dorsum, usually unilateral,
Dx: tinea Manuum
531
Dx and Tx: onset in early childhood, diffuse scaly skin with mild pruritus, worse on extensor extremities
Dx: Ichthyosis Vulgaris Tx: long baths to remove scales, moisturization, keratolytics (urea, alpha-hydroxy acid, salicylic acid)
532
Dx, Tx, Cx: pruritic, erythematous patches and papules, extensor surfaces, trunk or facez
Dx: atopic dermatitis (eczema) Tx: emollients, topical corticosteroids 2nd line- pimecrolimus (topical calcineurin inhibitors Cx: impetigo (Staph A) or Eczema herpeticum (HSV)
533
Dx and Tx: papules, pustules, vesicles, golden crusting, weeping, purulence, painful/itch
Dx: Impetigo Tx: topical mupirocin or oral cephalexin (local vs. widespread)
534
Child abuse scald wounds typically have:
Spare flexural creases, sharp line of demarcation, uniform burn depth, absence of splash marks
535
Tx of Vitiligo
Limited: topical corticosteroids Extensive: oral corticosteroids, topical calcineurin inhibitors, PUVA
536
Dx: unilateral/bilateral eye, eye stuck shut, watery, scant, stringy discharge not reappearing after wiping, burning, gritty sensation, prodromal, diffuse injection, follicular or bumpy, rhinorrhea, sore throat, cough
Adenovirus conjunctivitis
537
Dx: unilateral/bilateral eye involvement, eyes stuch shut, purulent thick discharge reappearing after wiping, unremitting discharge, diffuse injection, non-follicular, in adult vs. child
Adult: Staph Aureus Conjunctiviitis Child: Hib, Moraxella Catarrhalis, Strep Pneumo
538
Dx: intensely pruritic erythematous papules, vesicles, and bullae occur symmetrically in grouped clusters on extensor surfaces associated with diarrhea/wt loss (celiac disease
Dx: dermatitis herpetiformis Tx: dapsone, gluten free diet
539
Characteristics of right sided colon tumors
Occult bleeding and Iron deficiency anemia
540
Characteristics of left sided colon cancer?
Obstruction of flow of stool, crampy—> colicky pain, constipation, hematochezia (blood in stool)
541
Rectal tumor characteristics
Hematochezia (blood in stool, frank red blood, narrowed stools, tenesmus, sensation of mass in rectum.
542
Dx: headache, female, family history of headaches, variable onset, unilateral, pulsatile and throbbing, 4-72 hours, Auras, photophobia, phonophobia, nausea
Migraines
543
Dx and Tx: headache, males, no family history, occurs during sleep, behind one eye, excruciating sharp and steady, 15-90 mins, sweating facial flushing, nasal congestion, lacrimation, pupillary changes
Cluster Headache | Tx: prophylatic verapamil, subq sumatriptan + 100% oxygen
544
Dx: Headache female > male, No family history, onset under stress, band like pattern around the head (bilateral), dull tight and persistent, 30 mins-7 days,muscle tenderness in head,neck and shoulders
Tension Headaches
545
Dx: facial pain, rhinorrhea, fever, anosmia
Acute maxillary sinusitis
546
Dx: erythema, edema, tenderness, impaired extraocular movement
Dx: Orbital Cellulitis
547
Dx: sudden onset eye pain, nausea, diminished vision with halos around lights, fixed mid-dilated pupil
Angle Closure Glaucoma
548
Dx: progressive headache, morning nausea, focal neurological deficits
Dx: brain tumor
549
Dx: pure motor hemiparesis, ataxic hemiparesis, dysarthria
Lacunar infarct
550
Dx: sudden onset, persistent, severe headache with vomiting, seizure, decreased level of consciousness
Subarachnoid Hemorrhage
551
Dx: recurrent stabbing pain along mandible and Maxilla, triggered by anything,
Dx: trigeminal neuralgia
552
Complication of Long Term Metformin Use
Vitamin B12 deficiency in terminal ileum
553
Minority neurological manifestations of B12 deficiency
Impaired vibratory/proprioception/sensory ataxia Positive babinski sign Lower extremity paresthesias Irritation/mood changes
554
Mytonia, pain, weakness in distal facial muscles, cardiac arrhythmias, hypogonadism
Myotonic dystrophy- AD CTG repeatexpansion in DMPK
555
Dx and Tx: small vascular tumor <1cm, abnormal capillaries/granulation tissue, friable, dome shaped nodules on hands/trunk, oral mucosa, common in pregnancy, bleed with minor trauma
Pyogenic granuloma or lobular capillary hemangioma | Tx: surgical excision, laser therapy, silver nitrate, can regress post-partum
556
Dx: HIV patient, multiple reddish purple papules that evolve into friable nodular lesions with fever, malaise, night sweats
Dx: Bacillary Angiomatosis (Bartonella Infection)
557
Dx: rapid growing-volcano like nodule with central keratotic plug, non friable
Dx: Keratoacanthoma
558
Dx/ Tx: firm domed, papule with central umbilication in adult, genital or extensive
Dx: Mollusca Contagiosum Tx: cryotherapy, curettage, topical therapy (cantharidin, podophyllotoxin)
559
Tx of tinea pedis
DGx: clinical + KOH prep Tx: Topical Antifungals: miconazole, terbinafine, tolnaftate
560
Dx and Tx: infant, erythematous papules, plaques, spares skinfolds
Dx: irritant contact dermatitis Tx: topical barrier: petrolatum, zinc oxide
561
Dx and Tx: Infant,Beefy-red confluent plaques, involves skin folds, satellite lesions
Dx: Candida Dermatitis Tx: Topical Antifungal (Nystatin)
562
Microblastic anemia serum iron study findings
IDA: low iron, high TIBC, low ferritin Thalassemias: normal/high iron and ferritin Anemia of Chronic Disease: normal iron, normal ferritin low TIBC Sideroblastic anemia: normal iron, ferritin
563
Dx, Dgx, Tx: small papule/pustule—> rapidly progressive painful ulcer with purulent base, violaceous border, ulceration (common in RA or AML)
Dx: pyoderma gangrenosum DGx: Dx of exclusion, mixed inflammation on biopsy Tx: local/systemic glucocorticoids
564
Dx: hemorrhagic pustules —> necrotic ulcers with neutropenia/bacteria, fever, little pain
Dx: ecthyma gangrenosum- pseudomonas aeruginosa
565
Dx: acute panniculitis, tender erythematous nodules/plagues on lower extremeties, no ulceration, resolve after 2-8 weeks
Dx: Erythema Nodosum
566
Dx: small papule/nodule from rose bushes/plants
Dx: Sporotrichosis
567
Dx and Tx: papules and pustules with honey crusted lesions
Dx: nonbullous impetigo (Staph A, or Group A strep (pyogenes) Tx: topical mupirocin (antibiotics) or oral antibiotics (cephalexin)
568
Dx and Tx: enlarging flaccid bullae with yellow fluid
Dx: Staph A- Bullous Impetigo Tx: Oral Cephalexin
569
Dx: bilateral non-tender, non pruritic maculopapular or vesicular rash on palms and soles
Dx: Coxsackie Virus (Hand-Foot-and- Mouth Disease
570
Dx: clusters of painful vesicles on lips, fingers, do not enlarge rapidly
Dx: HSV
571
Dx and Tx: fever, chest pain, hemoptysis in Immunocompromised, Pulmonary nodules with halo sign, positive cultures/cell wall biomarkers
Acute Aspergillosis | Tx: Voriconazole + Caspofungin
572
Dx and Tx: lung disease/damage previous: > 3months weight loss, hemoptysis, fatigue, cavity lesion/fungus ball
Dx: Chronic pulm aspergillosis Tx: Resect aspergilloma, Voriconazole, Embolization
573
Dx and Tx: poorly localized shoulder pain pain and stiffness, decreased ACTIVE and PASSIVE ROM, atrophy of shoulder may occur
Dx: Adhesive Capsulitis DGx: Clinical, X-ray, MRI rule out Tx: ROM exercises, NSAIDs, Corticosteroid Injections, Surgical Release
574
Dx, DGx, Tx: epigastric pain + dark stools (melena) + improves with food
Dx: Duodenal Ulcer- H.Pylori or NSAIDs, DGx: endoscopic biopsy or urea breath test Tx: Antisecretory therapy: PPI (omeprazole/pantoprazole) + Antibiotic eradication + Amoxicillin + Clarithromycin
575
Dx: multiple paracentesis with blood ascites
Dx: Malignancy: MC Hepatocellular Carcinoma Dgx: Cytologic analysis- for underlying tumor should be done
576
Obstructive and Restrictive Lung Disease PFTs
Restrictive - Obesity- Hypoventilation Syndrome- decreased FEV1,TLC and preserved DLCO - Interstitial Disease- normal FEV1, reduced TLC, decreased DLCO Obstructive - Asthma- decreased FEV1, increased TLC, increased DLCO -COPD- decreased FEV1, increased TLC, decreased DLCO
577
Dx and Tx: Infant, increased tearing, eyelash crusting, clear conjunctivae
Dx: congenital dacryostenosis (congenital nasolacrimal duct obstruction Tx: observation, lacrimal sac massages, probing of duct
578
Dx: infant, purulent eye drainage, erythema, warmth, tenderness and swelling over lacrimal sac
Dacryocystitis (NLD infection)
579
Dx: infant, 2-5 days old, profuse, purulent eye drainage, conjunctival injection (bloodshot eyes), eyelid swelling
Dx: Gonococcal eye infection Px: erythromycin eye ointment
580
Dx: clear mucoid eye discharge, erythematous conjunctivae, viral prodrom (fever, congestion)
Dx: viral conjunctivitis
581
Tx of fibromyalgia
Amitriptyline
582
Side effects of amitriptyline (treatment for Fibromyalgia, depression, insomnia)
Anticholinergic symptoms: dry mouth, constipation, urinary retention Histamine symptoms: lethargy Alpha-adrenergic receptors: orthostatic hypotension
583
Dx and Tx: erythematous (red), pruritic (itchy) plaques with greasy scales—-> scalp, central face, ears, chest
Dx: Seborrheic Dermatitis Tx: Topical Antifungals (selenium sulfide, ketoconazole), topical glucocorticoids, topical calcineurin inhibitors (pimecrolimus)
584
Dx and Tx: erthymatous, scaly, annular plaques
Dx: tinea Tx: oral antifungals (terbinafine, itraconazole)
585
Dx & Tx: dry scaly skin on extremities and trunk
Dx: xerosis Tx: Topical Emollients
586
Dx, DGx, & Tx: episodic dyspnea and noisy breathing during exercise, inspiratory stridor
Dx: Paradoxical Vocal Fold Motion (PVFM) DGx: Laryngoscopy Tx: therapy with speech-language pathologist
587
IBS DGx criteria
Rome IV diagnostic criteria 1. Recurrent abdominal pain >1/day for 3 months 2. Related to defecation 3. Changes in stool frequency 4. Change in stool form
588
IBS alarms
``` > 50 age of onset GI bleed Nocturnal diarrhea Worsening pain Unintended weight loss IDA Elevated CRP Positive fecal lactoferrin or calprotectin ```
589
Dx and Tx: lower extremity edema, varicose veins, skin discoloration, medial skin ulceration
Dx: Chronic Venous Insufficiency Tx: leg elevation, exercise, compression therapy
590
Dx & Tx: well-defined erythematous plaques with silvery scale, extensor surfaces
Dx: plaque psoriasis Tx: topical: glucocorticoids, Vit-D analogs, tar, retinoids, calcineurin inhibitors, tazarotene Systemic: methotrexate, calcineurin inhibitors, retinoids, apremilast, biologics
591
Dx DGx, & Tx: painless bright red rectal bleeding,
Dx: hemorhoids DGx: mucosal bulges on anoscopy Tx: increase fluid/ fiber intake, reduce fat intake, moderate EtOH intake, limit sitting on toilet, limit defecation to 1x/day, avoid straining, Topical agents: benzocaine, witch hazel, hydrocortisone
592
Dx & Tx: itchy (pruritic), purple/pink, polygonal, papules and plaques on skin or white papules/plaques, erythema,mucosal atrophy, ulcers in oral mucosa
Dx: Lichen Planus Tx: high potency glucocorticoids: betamethasone, widespread: systemic glucocorticoids, phototherapy
593
antipsychotic medications (Risperidone) block dopamine- SFX?
Hyperprolactinemia, gynecomastia, galactorrhea, menstrual dysfunction, decreased libido
594
Tx of Somatic Symptom Disorder
Regular primary care follow-up that targets coping skills, provides reassurance, and avoids unnecessary tests
595
Dx: hypertension, hypokalemia, elevated bicarb, urine acidification
Hyperaldosteronism | DGx: Serum Renin low, Aldosterone high
596
Dx: hypotension, hyponatremia, hyperkalemia, hypoglycemia, metabolic acidosis
Dx: Addison’s disease (AI failure of adrenal glands
597
Dx, DGx, Tx: Linear white scaly areas with moist raw skin between toes
Dx: Trichophyton Rubrum- Tina pedis DGx: KOH prep- hyphae Tx: topical antifungal: clotrimazole, terbinafine, ketoconazole
598
Dx, DGx, Tx: adult, fatigue, shortness of breath after fever, sore throat, rhinitis, distended veins, basilar crackles, s3 gallop, arrythmia, exercise intolerance, syncope, hypotension, tachypnea, tachycardia
Dx: Viral Endocarditis (Coxsackie B, Parvovirus B19, HHV-6, Adenovirus, HIV DGx: normal ECG, CXR Tx: supportive, resolves in time
599
Dx, DGx, Tx: Child, migratory polyarthralgia, pancarditis, subcutaneous nodules, erythema marginatum, involuntary movements (sydenham chorea) 1-5 weeks after infection
Dx: Acute Rheumatic Fever DGx: strep titers Tx: Penicillin V, or Ceftriaxone
600
Dx, Dgx, Tx: teenager, sore throat, fatigue, malaise, fever, chills, pharyngitis, cervical lymphadenopathy and tenderness, hepatosplenomegaly Labs: atypical lymphocytes, negative strep test
Dx: EBV- Mono DGx: Monospot Test Tx: supportive- no sports, lidocaine gargle Do not use amox—> generalized maculopapular rash
601
Dx and Tx: sore throat, erythema and exudates, cervical lymphadenopathy, oral sex
Gonococcal pharyngitis | IM ceftriaxone
602
Nausea, vomiting, altered mental status, seizures, hepatomegaly in child
Reye Syndrome- oral aspirin in child
603
Depressed mood + cognitive defects in a elderly person,rapid onset, poor cooperation/effort, apathy, normal neurologic findings
Pseudodementia | Tx: SSRIs
604
Dx: rapid progressive dementia with myoclonus (involuntary twitches), ataxia, nystagmus
Creutzfeldt-Jakob disease
605
Dx and Tx: confusion, horizontal/vertical nystagmus, opthalmoplegia, ataxia
Dx: Wernicke’s Encephalopathy- Chronic Alcohol Abuse Tx: fluids and thiamine repletion (B1 deficiency)
606
Dx: encephalopathy, cognitive dysfunction, interstitial nephritis, vomiting, abdominal pain, constipation, anemia in infant,
Dx: lead poisoning DGx: serum lead
607
Dx; delays in speech, language, cognitive development, reciprocal interactions, normal eye contact
Hearing Deficit | DGx: aural stimuli
608
Cx of Down Syndrome
``` Alzheimer’s Dementia ALL/AML Cardiac Septal Defects Duodenal Atresia Hirschsprung Disease ```
609
Dx: delayed communication and social skills, impaired non-verbal communication (no eye contact/facial expressions)
Dx: Autism Spectrum Disorder DGx: Clinical Tx: CBT
610
Dx and Cx: HIV patient, fever pharyngitis, atypical leukocytes, retinitis (visual disturbances, flashing lights, blurred vision), esophagitis, pneumonia
Dx: CMV or HHV-5 Cx: retinal necrosis, edema, detachment
611
Dx: HIV pateint, immunocompromised, dyspnea, pulmonary infiltrate, meningitis, encephalitis
Cryptococcus Neoformans
612
Dx: HIV immunocompromised, self-limiting watery diarrhea, wt loss and dehydration
Cryptosporidium Parvum
613
Dx: HIV immunocompromised, pneumonia, choreoretinitis (decreased visual acuity, eye pain, hepatitis (elevated AST/ALT)
Toxoplasma Gondii
614
Dx and Tx: depressive, anxiety, behavioral changes <6 months with identifiable stressor
Dx: Adjustment Disorder Tx: CBT + SSRI
615
Dx and Tx: increase tolerance to alcohol intake, palpitations, sweating, anxiety, insomnia, tremor, headaches, tonic-clonic seizures on cessation to alcohol (6-24 hrs)
Dx: Alcohol Dependence and AWS Tx: Acute: Benzos (IV if seizures, PO- oxazepam, lorazepam), Haloperidol, IV fluids, thiamine and folate, glucose Chronic: CBT + Pharmacotherapy
616
Dx: 7-9 year old, avoiding school, can’t separate from father, mother, grandmother, guardian,etc
Separation Anxiety Disorder
617
Dx: child/adolescent—> persistent aggression towards people/animals, lying, serious rule violations (destruction of property, deceitfulness < 18 y/o
Dx: Conduct Disorder Tx: CBT
618
Dx, DGx, Tx: malabsorption, flatulence, abdominal bloating, fat in stools (steatorrhea), nutritional deficiencies, iron deficiency anemia, grouped pruritic bilateral subepidermal vesicles (Dermatitis Herpetiformis)
Dx: celiac disease DGx: serum antigliadin antibody assay, Bx: intraepithelial lymphocytosis, villous atrophy, crypt hyperplasia Tx: gluten free diet (no wheat, rye, barley, spelt)
619
Dx, DGx, Tx: cramp pain, relieved with BM, intermittent diarrhea/constipation, associated with stress or fibromyalgia
Dx: IBS DGx: Clinical Tx: Reassurance, Exercise + Diet Modifications
620
Dx, DGx, & Tx: infant > 1 yr, fever, headache, vomiting, sore throat, myalgias in leg, lethargy, confusion, <1day high fever, flexes hip when neck flexed, nonblanch, pinpoint trunk on lower extremities
Dx: N. Meningitidis (strep pneumo) DGx: Clinical + CSF culture Tx: Ceftriaxone or Vanc Cx: Shock, DIC, Adrenal Hemorrhage
621
Dx, DGx, & Tx: infant > 1 yr, fever, headache, vomiting, sore throat, myalgias in leg, lethargy, confusion, <1day high fever, flexes hip when neck flexed, unvaccinated
Dx: HiB meningitis DGx: Clinical + CSF Culture Tx: Ceftriaxone
622
Meningitis Infections in infants by age
<1 months - Listeria Monocytogenes <3 months- group B streptococcus > 1 year- N. Meningitis, Strep pneumo > 1 year + unvaccinated - HiB
623
Dx, DGx, Tx: >45 y/o, progressive loss of vision over a year, sensitivity to glare, halos around lights, opacifcation of lens
Dx: Cataracts Tx: Surgery Early onset in DMII trauma, steroid
624
Dx: unilateral loss of central vision, fluffy granualar retinal with yellow white fluffy lesions, photpsia (flashing light sensitvity), scotomata (blind spots)
CMV retinitis
625
Dx, DGx, Tx: unilateral ocular pain, redness, tearing, with branching/dendritic corneal ulcers
Dx: HSV retinitis DGx: fluoroscein
626
Dx, DGx, Tx: Fever, Low ROM in Joint, Non-weight bearing, acute, elevated WBC,ESR, C-reactive protein
Dx: Septic Arthritis DGx: Arthrocentesis purulent synovial fluid > 50K Tx: operative + Vancomycin + Cefriaxone
627
Dx: slow onset hip pain, child, no fever, leukocytosis
Legg-Calve-Perthes
628
Dx: 10-15y/o- overweight + fracture of hip growth plate
Slipped Capital Femoral Epiphysis
629
Dx, DGx, Tx: young males, unilateral painless testicular nodule/swelling, dull lower abdominal ache, dyspnea, neck mass, low back pain
Dx: Testicular Cancer DGx: scrotal US, tumor markers (AFP, B-hCG, CT scan Tx: radical orchiectomy, chemotherapy
630
Dx and Tx: itchy (pruritic), purple, polygonal papules/plaques on flexural surfaces assx with Hep C (IV users)
Dx: Lichen Planus Tx: resolves spontaneously use betamethasone (topical high-potency glucocorticoids

SHELF EXAMS (3 decks)

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