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SHELF EXAMS > FAMILY MED SHELF > Flashcards

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
Q

Dx and Tx: oral mucosal ulcers with regular margins, yellow fibrinous base in buccal or labial mucosa.

A

Dx: Apthous Stomatitis (Canker Sores)
Tx: Resolve without Treatment in 10-14 days

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26
Q

Local Chronic Muscle Pain, Restricted ROM, Local Palpable Mass with History of Overuse

A

Myositis Ossificans

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27
Q

Fx of Marijuana

A

Slurred Speech + conjunctival Injection (Eye Redness)

Ataxia, Poor Concentration, Euphoria

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28
Q

Acute Fx of Cocaine

A

Euphoria + Irritability (15-60 mins duration)

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29
Q

Withdrawal Symptoms of Cocaine

A

Depression, Anxiety, Increased Appetite

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30
Q

Chronic Fx of Cocaine Use

A 
Change in Behavior
Poor Concentration
Decreased Appetite
Chronic Rhinitis
Perforation of Nasal Septum
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31
Q

Acute Fx of Phencyclidine

A

PCP (effects last for hours)
Bizarre Behavior, Irritability
Ataxia- diaphoresis, seizures
Violent Behavior + Hallucinations

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32
Q

Withdrawal symptoms of Phencyclidine

A

Anxiety and Irritability

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33
Q

Acute Fx of Aerosol Inhalant Use

A 
Rapid Mood Swings, Irritability
Poor Concentration, Slurred Speech
Anorexia
Conjunctival Injection
Ataxia (Dysdiadochokinesia)
Eczematous Rash in peri-oral area
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34
Q

Chronic/Severe Fx of Aerosol Inhalant Abuse

A

Cardiac Arrhythmias
CNS Toxicity (seizures, coma)
Death (via respiratory depression)

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35
Q

How to detect Legionella Pneumophila?

A

1st- Urine Antigen Assay

2nd- PCR

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36
Q

Tx of Legionella Pneumophila

A

1st- Fluoroquinolones (Levofloxacin)

2nd- Macrolides (Azithromycin)

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37
Q

Dx - Female- foul-smelling, frothy, vaginal discharge

yellow-green color; pH > 4.5

A

Trichomonas Vaginalis

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38
Q

Treatment of Trichomonas Vaginalis

A

Oral Metronidazole

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39
Q

Dx: Dyspnea, Dry Cough, Low-Grade Fever, Watery Diarrhea, Bilateral Patchy Infiltrates, Hyponatremia

A

Legionnaires’ Disease (Legionella Pneumophila)

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40
Q

Dx: Mild Fever, Headache Muscle Aches

A

Flu or Pontiac Fever

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41
Q

Dx: RUQ Pain + Fever + Hypoechoic Lesion + Liver Abscess

A

Amebiasis , Entamoeba Histolytica

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42
Q

Dx: Vaginal Discharge- Gray + malodorous, clue cells positive whiff test. pH >4.5

A

Gardenerella Vaginalis

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43
Q

Dx: Vaginal Discharge, odorless + purulent, positive nucleic acid amplification test

A

Chlamydia Trachomatis

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44
Q

Dx: Vaginal Discharge, Yellow-green, frothy, pH > 4.5, flagellated protozoa

A

Trichomonas Vaginalis

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45
Q

Dx: Vaginal Discharge- odorless, white, crumbly, pruritis, burning, pH < 4.5, pseudohyphae

A

Candida Albicans

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46
Q

Dx: vaginal discharge, odorless, purulent, creamy dysuria, dyspareunia, intermenstrual bleeding

A

Neisseria Gonorrheoeae

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47
Q

Dx: Bloody Stool + Rectal Pain + Perianal Discharge

A

Anal Fistula

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48
Q

Treatment of Anal Fistula

A

Tract Curettage

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49
Q

Treatment of Recurrent Anal Fissures

A

Anal Spincterotomy

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50
Q

Treatment of Anal Fissures

A 
Sitz Bath (warm water buttocks bath)
Topical Calcium Channel Blocker (nifedipine, diltiazem)
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51
Q

Dx: Pain + Paresthesias in distal extremities symmetrically, concurrent ascending flaccid muscle paralysis

A

Guillain-Barre Syndrome

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52
Q

Dx: Bilateral non-bloody nipple discharge, normal prolactin

A

Normoprolactinemia Galactorrhea

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53
Q

Common cause of hypogonadotropic hypogonadism

A

prolactinoma (pituitary adenoma)

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54
Q

hypogonadotropic hypogonadism symptoms

A

Blocks GnRH–> Low FSH + Low LH—> Low Testosterone

ED, decreased libido, low testicular volume, infertility, gynecomastia, loss of axillary hair

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55
Q

Chronic Hep C Symptom on Dorsal Hand

A

Porphyria Cutanea Tarda

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56
Q

Hep B and Hep C genetic Makeup

A

Hep B: DNA

Hep C: RNA

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57
Q

Treatment of Scabies

A

Topical Permethrin for 8-12 hours, Oral Histamines + Prophylatic Treatment for Contacts

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58
Q

Dx: Fever, Myalgia, Pharyngitis, Posterior Cervical Lymphadenopathy, Young Patient, Mononucleosis

A

Ebstein Barr Virus (EBV)

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59
Q

Diagnosis + Treatment of EBV

A

Dx: Heterophile Antibody Test
Tx: Symptomatic Analgesic + Antipyretics

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60
Q

Common Symptom of EBV?

A

Splenomegaly- Avoid Contact Sports to Avoid Splenic Rupture

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61
Q

Malignancies associated with EBV

A

Nasopharyngeal Carcinoma, Burkitt’s Lymphoma, Hodgkin Lymphoma

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62
Q

Dx: Epistaxis (bloody nose), painless cervical lymphadenopathy, recurrent otitis media

A

Nasopharyngeal Carcinoma

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63
Q

Virus associated with Kaposi Sarcoma

A

HHV-8

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64
Q

Dx: Multiple Nodular purplish submucosal painless skin plaques in AIDS patient

A

Kaposi Sarcoma

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65
Q

Dx: Fragile Bones, Blue Sclerae, Poor Hearing, Dental Abnormalities, Triangular Facial Structure, Short Child

A

Osteogenesis Imperfecta (Type I Collagen Defect)

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66
Q

Dx: Frontal Bossing, Nodular Deformities at Ribs (Beading at Ribs), Widened Wrists, Bowing Legs, Erosion of Tooth Enamel

A

Rickets (Vitamin D Deficiency–> Defective Growth Plate Mineralization)

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67
Q

Dx: Weakness, Fatigue, Mucosal Bleeding, Curly Hair, Poor Wound Healing, Severe Infections

A

Scurvy (Vitamin C deficiency)–> low cofactor of prolyl/lysyl hydroxylase)

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68
Q

Dx: Short stature/extremities, frontal prominence, microcephaly, scoliosis, trident hands

A

Achondroplasia (Fibroblast Growth Factor Receptor 3)

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69
Q

Dx: cranial nerve palsies, hip abnormalities, long bone fractures

A

Osteopetrosis (low osteoclast-mediated bone resorption

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70
Q

Dx: Low Calcium, Low Phosphates, Elevated PTH, Elevated ALPs

A

Vitamin D Deficiency

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71
Q

Dx: Normal Ca, Phosphates, PTH, Elevated ALPs

A

Paget’s Disease of the Bone

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72
Q

Dx: Low Calcium, Elevated Phosphate, Elevated PTH Elevated ALPs

A

Pseudohypoparathyroidism

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73
Q

Dx: Obesity, Round Face, Short Metacarpals, Soft Tissue Calfications, Dental Hypoplasia

A

Albright Hereditary Osteodystrophy (Pseudohypoparathyroidism)

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74
Q

Dx: Diarrhea, Bloating, Wt Loss, Microcytic Anemia

A

Celiac Disease

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75
Q

Dx: Bone Pain/Tenderness, Fractures, Waddle Gait, Myopathy, Hypocalcemia, Osteoporosis

A

Osteomalacia (Vit D deficiency + Hypocalcemia)

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76
Q

ACEi negative side effects

A

elevated bradykinin–> angioedema, edema of tongue/larynx, upper airway obstruction

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77
Q

Dx: fever, arthralgia, low C4

A

Serum Sickness

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78
Q

Drugs which can cause Serum Sickness

A

Bupropion, IVIG, Rituximab, Infliximad, Cefaclor, Cefprozil, Penicillin, Minocycline

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79
Q

Dx: angioedema, dyspnea, pruritis, urticaria

A

Anaphylactoid Reaction

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80
Q

Drugs which cause anaphylactoid reactions

A

IV radiocontrast, aspirin, vancomycin, opiates

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81
Q

Dx: flushing, severe diarrhea, cramps, dyspnea, increased serotonin, GI mass

A

serotonin syndrome via Carcinoid tumors

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82
Q

Dx: dull, persistent headache worsening in morning, gradual vision changes, mass in head

A

Meningioma

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83
Q

Dx: hypernatremia, hypokalemia, fatigue, muscle weakness, elevated aldosterone

A

Aldosteronoma

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84
Q

Dx: severe headache, hypertension, bradycardia, nausea, vomiting, acute onset

A

Intracranial Hemorrhage

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85
Q

Dx: episodic hypertension, excessive sweating, headache, tachycardia, palpitations

A

Pheochromocytomas

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86
Q

Adult presents with cough, dyspnea, whitish sputum for 5 days. What is first step in management

A

Supportive Treatment: Rest , Hydration, NSAIDs

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87
Q

Dx: dyspnea, orthopnea, decrescendo diastolic murmur, after S2, left midclavicular line, opening snap, carotid pulses diminished

A

Mitral Valve Stenosis

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88
Q

Dx: Dyspnea on Exertion, Orthopnea, holosystolic murmur, apex

A

Mitral Valve Regurgitation

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89
Q

Dx: lower extremity edema, hepatomegaly, holosystolic murmur, 4th intercostal space on left sternal border

A

Tricuspid Valve Regurgitation

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90
Q

Dx: exertional, nocturnal dyspnea, early diastolic decrescendo murmur, left sternal border, S3 gallop

A

Aortic Valve Regurgitation

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91
Q

Dx: fatigue, dyspnea, (can be asymptomatic), high frequency mid-systolic click, 5th intercostal mid clavicular line

A

Mitral Valve Prolapse

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92
Q

Dx: Dyspnea on exertion, orthopnea, crescendo-decrescendo systolic murmur, S4, delayed low carotid pulses

A

Aortic Valve Stenosis

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93
Q

Dx: Glass factory worker, dyspnea, dry cough, fatigue, fine crackles, calcifications of hilar lymph nodes (egg shell calcification), upper lobes

A

Silicosis

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94
Q

Complications of advanced silicosis

A 
Pulmonary TB (silica disrupts phagolysosomes/macrophage function)—->Annual TB skin testing recommended
Lung Cancer, Cor Pulmonale, RA
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95
Q

Complication of Asbestosis

A

Malignant Mesothelioma

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96
Q

Dx: Fungal Ball in Lungs, Repositions with Movement

A

Aspergilloma (Chronic Pulmonary Aspergillosis

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97
Q

Dx: mold spores, asthmatic, fever, chest pain, hemoptysis

A

Aspergillosis

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98
Q

Common Pneumonia in Immunosuppressed Patients

A

Pneumocystis Jirovecii

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99
Q

Biopsy of Kaposi Sarcoma

A

Abundant Lymphocytes

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100
Q

Dx: AIDS CD4<100, multiple cutaneous papules/nodules, red flesh color- bleed easily, diarrhea, wt loss, hepatosplenomegaly

A

Bartonella Henselae

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101
Q

Biopsy of Bartonella Henselae

A

Vascular Proliferation + Neutrophilic Infiltrate

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102
Q

Treatment of Bartonella Henselae

A

Abx: erythromycin or doxycycline

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103
Q

Dx Test for Acute HIV

A

HIV Viral Load

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104
Q

How long does HIV symptoms take to develop?

A

3-6 weeks

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105
Q

Tx of Postpartum Depression

A

Sertraline (SSRI)

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106
Q

Dx: mild-transient depression, episodes of sadness, insomnia, difficulty concentrating after birth

A

Post-partum blues

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107
Q

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

A

Postpartum Depression

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108
Q

Tx of Adolescent MDD

A

Follow up within a month and start fluoxetine (or SSRI) on further evaluation

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109
Q

Dx: alopecia, scaly patches, inflammatory plaques, thick crusting, pustules, boggy feel

A

Kerion, tinea Capitis

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110
Q

Tx of Kerion

A

Oral griseofulvin, Oral Terbinafine

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111
Q

Decrease preload in Mitral Regurgitation Murmur

A

Standing or Valsalva Maneuver

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112
Q

Dx of Ascites SAAG > 1.1 g/dL

A

Portal Hypertension: cirrhosis, liver metastasis, portal vein thrombosis, alcoholic hepatitis, Budd-Chiari Syndrome, Heart Failure, Constrictive Pericarditis

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113
Q

Dx of Ascites SAAG <1.1g/dL

A 
Pancreatitis
Nephrotic syndrome
TB
Serositis
Peritoneal carcinomatosis
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114
Q

Tx: CIN 2

A

LEEP (loop electrosurgical exicision) + Repeat Pap/HPV test in 12 months

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115
Q

Tx: of UTI and Uncomplicated Bacteriuria in pregnancy + uncomplicated cystitis

A

Nitrofurantoin

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116
Q

Contraindication for Rotavirus Vaccine

A

Increased Risk of Intussusception

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117
Q

Live Attenuated Vaccines

A 
MMR
Varicella
Zoster
Yellow Fever
Rotavirus
Influenza
Small Pox
Adenovirus
Typhoid
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118
Q

Contraindications for administering Live attenuated vaccines

A

<9 months age (except rotavirus)
Pregnant individuals
Immunodeficient Individuals

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119
Q

Inactivated Whole Vaccines

A 
Polio (Salk)
Hep A
Rabies
Typhoid
Influenze
Pertussis
Cholera
Japanese Encephalitis
Tick Borne Encephalitis
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120
Q

Inactived Fractionated Protein Vaccines

A 
Hep B
Influenza
Pertussis
HPV
Anthrax
Diptheria
Tetanus
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121
Q

Inactivated Fractional Polysaccharide Vaccines

A

Hib
Pneumococcal
Meningococcal
Salmonella

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122
Q

Immunizations for Travel

A

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

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123
Q

Pathogens affecting unvaccinated children

A 
Measles
Rubella
Varicella Zoster
Mumps
Diphtheriae
HIb
Strep Pneumo
Meningitis
Polio
Tetanus
Pertussis
Hep A/B
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124
Q

Dx: High Fever, Erythematous Maculopapular Rash starts neck—> body, bluish-gray spots on buccal lining, generalized lymphadenopathy, malaise, cough, conjunctivitis

A

Measles

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125
Q

Dx: low grade fever, pink maculopapular rash head—>body, postauricular/suboccipital lympadenopathy, malaise, cough, conjunctivitis

A

Rubella

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126
Q

Dx: low fever, macules/papules/vesicles- hypopigmented lesions, rash starts at trunk—> moves out, severe itching

A

Varicella Zoster- Chicken Pox

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127
Q

Dx: fever, malaise, inflammation of salivary glands, unilateral parotitis, orchitis

A

Mumps

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128
Q

Dx: gray-white pseudomembranes, cervical lympadenopathy, bull neck, foul breath, inspiratory stridor

A

Diphtheriae

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129
Q

Dx: high fever, sore throat, dysphagia/odynophagia, drooling, muffled/hot-potato voice, respiratory distress

A

HIb

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130
Q

Dx: Fever, Headache, Neck-stiffness, photophobia, N/V, Altered mental status, seizures

A

Meningitis (Hib, Strep Pneumo, Neisseria, Polio)

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131
Q

Dx: Fever, headache, neck stiffness, pharyngitis

A

Hib Meningitis

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132
Q

Dx: Fever, Headache, Neck Stiffness, Sinusitis

A

Strep Pneumo Meningitis

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133
Q

Dx: Fever, Headache, Neck Stiffness, Myalgia, Petechial/purpuric rash

A

Neissseria Meningitidis

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134
Q

Dx: Fever, Headache, Neck Stiffness, Assymetric flaccid paralysis- legs, proximal muscles

A

Polio Meningitis and Poliomyelitis

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135
Q 
HBsAg +
Anti HBs -
HBeAg -
Anti- HBe +
Anti- HBc IgM -
Anti Hbc IgG +
A

Chronic Hepatitis with Low infectivity

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136
Q

Global Increase of Alveolar Surface Tension associated with

A

Cardiogenic Pulmonary Edema + CHF

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137
Q

Decreased Pulmonary Compliance Associated with?

A

Interstitial Lung Disease (Pulmonary Fibrosis, Pneumoconiosis, Sarcoidosis)

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138
Q

Local accumulation in kinins—> cough, What drug?

A

ACEi

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139
Q

Irreversible Inflammatory Widening of Bronchi

A

Bronchiectasis

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140
Q

Loss of Functional Residual Capacity (FRC)

A

Restrictive Lung Disease (Pneumonia)

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141
Q

Diagnostic Test for Lactose Intolerance

A

Hydrogen Breath Test >20 ppm

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142
Q

Dx: Dyspnea, productive cough, 4-6months/2years chronic smoker

A

Chronic Bronchitis

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143
Q

Diagnostic Test for Chronic Venous Insufficiency

A

Duplex Ultrasonography

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144
Q

What B blockers should be avoided in COPD/Asthma patients?

A

Non-selective Beta Blockers- abetolol, propranolol, nadolol, pindolol, timolol, carvedilol

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145
Q

High ALP (alphafetoprotein) in liver disease suggests?

A

Hepatocellular Carcinoma

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146
Q

Autoimmune hepatitis specific labs

A

Anti Smooth muscle antibodies (ASMA)
Anti Nuclear Antibody (ANA)
High Serum IgG

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147
Q

Specific Labs for Primary Biliary Cirrhosis

A

Anti Mitochondrial Antibodies (AMA)

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148
Q

Cholestatic process symptoms

A

Jaundice + Pruritis

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149
Q

Dx: low ceruloplasmin, neurlogic symptoms, brown rings around iris, hepatitis

A

Wilson Disease

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150
Q

Dx: Cirrhosis, HF, DM, bronze skin, arthralgias, high transferrin saturation >50%

A

Hemachromatosis

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151
Q

PSC (primary sclerosing cholangitis) specific test?

A

pANCA (perinuclear antineutrophil cytoplasmic antibodies)

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152
Q

Side FX of ARBs

A

hyperkalemia

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153
Q

Side Fx of non-selective B-blockers?

A

Bradycardia, hypotension, bronchospasm

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154
Q

Side Fx of ACEi

A

Dry Cough, Angioedema, Hyperkalemia

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155
Q

Side Fx of CCBs

A

Peripheral Edema, Headaches, Dizziness, Facial Flushing, Reflex Tachycardia

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156
Q

Complication of untreated group A strep tonsillopharyngitis?

A

Acute rheumatic fever

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157
Q

Dx: child with arthritis, involuntary irregular non-repetitive movements of limbs, subcutaneous nodules, pink rash on trunk and limbs, mitral regurgitation, post infection

A

Acute Rheumatic fever secondary to untreated group A streptococcal tonsillopharyngitis

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158
Q

Dx: dorsal side of each hand pressed together produces pain, tingling pain in thumb, index, and middle finger. Nerve and syndrome?

A

Median Nerve

Carpel Tunnel Syndrome

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159
Q

Dx: Back Pain, Fever, Leukocytosis, cortical destruction, bone marrow edema

A

Vertebral Osteomyelitis

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160
Q

Most common causative pathogen of vertebral osteomyelitis

A

Staphylococcus Aureus > Staphylococcus Epidermidis, Enterobacteriaceae, Pseudomonas, Streptococci

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161
Q

Dx: Oliguria, elevated Cr, elevated BUN, hyperkalemia, fractional excretion of Na > 2%

A

Acute Tubular Necrosis

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162
Q

WBC cast in urinary sediment—-> DDx

A

Pylonephritis and Acute Interstitial Nephritis (AIN)

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163
Q

Dx: dysuria, frequency, fever, costovertebral angle tenderness, flank pain WBC cast in urinary sediment

A

Pyelonephritis

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164
Q

Dx: hematuria, sterile pyuria, eosinophilia, flank pain, fever, rash, WBC cast in urinary sediment

A

Acute Interstitial Nephritis

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165
Q

Pigmented Casts —-> DDx

A

Rhabdomyolysis + Hemolysis

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166
Q

Dx: proteinuria >3.5g, edema, hyperlipidemia, fatty casts

A

Nephrotic syndrome

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167
Q

Dx: proteinuria > 3.5g, edema, hyperlipidemia, fatty casts

A

AKI secondary to Rhabdomyolysis or Hemolysis

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168
Q

Most common cause of intrinsic AKI

A

Acute Tubular Necrosis

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169
Q

Risk Factors of ATN (Acute Tubular Necrosis)

A

Advanced Age
History of sepsis
DM
Treatment with ACEi

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170
Q

Cast Cells associated with ATN (Acute Tubular Necrosis)

A

Muddy Brown Casts (Granular Casts)

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171
Q

Dx: red/cola colored urine, proteinuria < 3.5 g edema, RBC casts

A

Glomerulonephritis

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172
Q

Dx: persistent elevated BP despite treatment, bilateral carotid bruits, abdominal bruits, elevated plasma renin activity, hypokalemia

A

Renal Artery Stenosis secondary to atherosclerotic disease

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173
Q

Complication of RAS (Renal Artery Stenosis)

A

Unilateral Kidney Atrophy

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174
Q

Dx: Headache, depressed mood, fatigue, insomnia, nausea, sensory disturbances, irritability, ataxia, tremor, and myalgia within 4 days of stopping anti-depressant

A

Antidepressant Discontinuation Syndrome (ADS)

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175
Q

Dx: single genital lesion—> raised papule—> painless firm ulcer with indurated borders and smooth base + lymphadenopathy

A

Treponema Pallidum- Primary Syphillis

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176
Q

Dx and Tx: large painless vascular lesions on genitalia, no inguinal lymphadenopathy, appear up to 1 year after exposure.

A

Dx: Klebsiella granulomatis
Tx: Azithromycin until ulcers have completely healed
(Screen for otjer STIs)

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177
Q

Dx: grouped painful vesicles, pustules, and erosions on genitalia, painful inguinal lymphadenopathy within 2-7 days of exposure

A

HSV-2 (Herpes)

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178
Q

Dx: painful genital ulcers with gray necrotic base + painful inguinal lympadenopathy

A

Dx: Haemophilus ducreyi

chancre lesions

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179
Q

Dx: painless transient painless papule, then lymphadenopathy, fever, malaise, chills 2-6 weeks after.

A

Lymphogranuloma Venereum (L1-L3 serotypes of Chlamydia Trachomatis

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180
Q

Dx: fever, fatigue, productive cough with foul smelling sputum, lung cavity with air-fluid level o CXR

A

Lung Abscesses

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181
Q

Common causes Nosocomial (Hospital Acquired) of Lung Abscess

A

Aerobes- Pseudomonas Aeruginosa, Acinetobacter baumannii, Nocardia Species, Staphylococcus Aureus

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182
Q

Exposure to Bat droppings/ Cave exploration leading to pneumonia is most likely caused by what organism?

A

Histopasmosis

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183
Q

Lung abscesses or tricuspid valve by septic emboli in IV drug users is most commonly associated with which organism?

A

Staphylococcus aureus

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184
Q

Most common cause of lung abscesses

A

Periodontal diseases via anaerobic bacteria

Peptostreptococcus, Prevotella, Bacteroides, Fusobacterium

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185
Q

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

A

Subacute thyroiditis (De Quervain’s thyroiditis)

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186
Q

Tx of Subacute thyroiditis

A

Self-limiting: Triphasic—> initial hyperthyroidism (tachycardia, widened pulse pressure, sweating, resting tremor) then hypothyroidism (fatigue, bradycardia, cold intolerance, constipation, weight gain) back to euthyroidism

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187
Q

Most common lung cancer in non-smokers (and women)- located peripherally

A

Adenocarcinoma - CXR for initial evaluation, CT-guided transthoracic biopsy confirms diagnosis

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188
Q

Large peripheral mass on CXR in a smoker

A

Large cell carcinoma

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189
Q

Centrally located cavitary lesions on CXR in a patient who smokes

A

Squamous Cell Carcinoma

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190
Q

Dx: weight loss, fatigue, dry cough, peripheral lymphadenopathy, eye pain and redness, tender nodules and plaques bilateral hilar adenopathy

A

Sarcoidosis

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191
Q

Dx: diarrhea, flushing, wheezing, lesions in bronchial area

A

Carcinoid Tumor (Neuroendocrine Tumor)

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192
Q

Common Bacterial Infections with CD4+ count < 200

A

Pneumocystis, Mycobacterium Avium, Toxoplasmosis

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193
Q

Prevention of disease in CD4 < 200 patient

A

TMP-SMX + Azithromycin

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194
Q

Dx: Obesity, hepatic lipid accumulation, abnormal hepatic findings, no history of alcohol use, Hep A,B,C

A

NASH (Nonalcoholic Steatohepatitis)

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195
Q

Dx and Tx: Fever, Headache, Bilateral diffuse reddening of eyes, muscle ache, living in Hawaii

A

Leptospirosis (infection with Leptospira)]

1st line: doxycycline 2nd line: amoxicillin/azithromycin

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196
Q

Dx: inability to maintain pregnancy, no contractions, recurrent pregnancy losses/ preterm births

A

Cervical Insufficiency

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197
Q

Dx: constipation, nonpitting pretibial edema, hoarse boice, indurated cool dry skin, obese patient

A

Hypothydroidism (Hashimoto thyroiditis—> risk for primary thyroid lymphoma

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198
Q

Dx: nephritic sediment (hematuria, RBC casts, moderate proteinuria), elevated Cr + BUN, productive cough
Extra: chronic sinusitis, saddle nose deformity + cANCA positive

A

Pulmonary Renal Syndrome

Granulomatosis with Polyangitis (GPA or Wegener’s granulomatosis)

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199
Q

Dx: Toddler patient + multiple UTIs complications

A 
Vesicoureteral reflux (VUR) (Dx with VCU)—-> renal scarring, pyelonephritis
Tx: prophylatic antibiotics or surgical correction
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200
Q

Dx: Facial erythema, telangiectasia, papules, pustules

A

Rosacea

Triggers: stress, exercise, hot weather, sun exposure, alcohol consumption

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201
Q

Dx: dry, pruritic, erythematous skin rashes, beginning in childhood, improving in adolescence, worsening in adult hood in flexural creases

A

Filaggrin gene mutations-atopic dermatitis

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202
Q

Dx and etiology: fevers, fatigue, myalgias, arthritis

A

SLE

Complement Component 1q antibody deficiency

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203
Q

Complications of Carcinoid Tumors

A

Tricuspid Insufficiency + Pulmonary Stenosis

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204
Q

Dx: abdominal tenderness and cramps, nonbloody watery bowel movements, cutaneous flusing, telangiectasia, tachycardia, wheezing

A

Carcinoid Tumor

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205
Q

What is DAPT? When is it used?

A

Dual antiplatelet therapy (Aspirin + P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor)
Post- MI after stent placement

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206
Q

Tx: asymptomatic Baker’s cyst vs. symptomatic baker’s cysts

A

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

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207
Q

Dx: younger than 50 y/o shortness of breath, with barrel chest, diminished breath sounds,

A

Alpha-1-antitrypsin deficiency (A1AD)

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208
Q

A1AD Complications

A

Liver damage, cirrhoss, hepatocellular carcinoma (i.e. toxic accumulation of misfolded A1A protein in liver.

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209
Q

Which drug has prophylatic medication for malaria for pregnant patients?

A

Chloroquine, Mefloquine (chloroquine resistant countries), Proguanil,

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210
Q

Tuberculin skin test diagnoses what?

A

Latent TB

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211
Q

What does Sputum Culture diagnose in TB?

A

Active TB

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212
Q

What does CXR diagnose in TB?

A

Active TB in high risk patients

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213
Q

Sputum Microscopy in TB?

A

Moderate to high risk active TB

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214
Q

PCR of sputum in TB?

A

Rapid Diagnosis active TB

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215
Q

Interferon-𝛄 release assay

A

Diagnose exposure to TB

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216
Q

Tx of sleep onset insomnia

A

Short acting drugs (Triazolam)

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217
Q

Doxepin Drug Uses

A 
Tricyclic antidepressant
Sleep maintenance (long acting effect)
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218
Q

Flurazepam drug uses

A

Benzidiazepine—> sleep maintenance- long-acting effect

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219
Q

Trazodone Drug Uses

A

Atypical antidepressant— MDD

Sedative effect which can cause daytime drowsiness

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220
Q

Suvorexant drug uses

A

Orexin receptor antagonists—> insomnia treatment—> sleep onset + sleep maintenance
Causes next day sleepiness and impairs driving performance.

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221
Q

Dx: secondary sexual characteristics, advanced bone age in girl < 8 y/o

A

Precocious puberty

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222
Q

How to differentiate central and peripheral precocious puberty?

A

GnRH stimulation test
Increase LH concentrations > 5mIU - central
Increase LH concentrations < 5mIU- peripheral

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223
Q

Breast Mass Screening for women <30 y/o and > 40 y/o

A

Breast Ultrasound <30

Mammography > 40

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224
Q

Dx: prolonged HTN + progressive dyspnea, lower extremity swelling, JVD

A

Decompensated left heart failure

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225
Q

Dx:holosystolic murmur on left lower sternal border

A

Tricuspid regurgitation

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226
Q

Dx: infant with central cyanosis, Tall peaked p-waves, left axis deviation 3 parts

A

Tricuspid Atresia : Absent Tricuspid valve, Atrial septal defect, Ventricular septal defect

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227
Q

Lab Tests for newly diagnosed HTN

A

Renal Function Tests: Serum electrolytes, Creatinine, UA, Urine albumin/creatinine
Endocrine Tests- HbA1c, Lipid Profile, TSH
Cardiac- ECG, ECHO
Other: CBC, Uric Acid

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228
Q

Effects of Direct Renin Inhibitors (aliskiren for HTN)

A

Natriuresis, decreased serum angiotensin II, decreased aldosterone production

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229
Q

FX of ARBs

A

Act on angiotensin receptors—> do not decrease Angiotensin II , but cause natriuresis and decreased aldosterone production

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230
Q

Dx: murmur heard at the first right intercostal space, unequal carotid pulses, differential blood pressure in upper extremity, palpable thrill in suprasternal notch

A

Supravalvular aortic stenosis

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231
Q

Complications of Aortic stenosis

A

Left ventricular hypertrophy, coronary artery stenosis, subendocardial ischemia

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232
Q

Dx: HTN with 3 or more antihypertensive medications

A

Resistant Hypertension

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233
Q

Causes of Resistant Hypertension

A

Renovascular Hypertension

  • serum Cr > 30% after starting ACEi/ARB
  • flash pulmonary edema
  • diffuse atherosclerosis
  • assymetric kidney size- small atrophic unilateral kidney)
  • abdominal bruit
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234
Q

Most important Risk factors for HFpEF

A

Chronic hypertension
Obesity and Sedentary Lifestyle
CAD and DM

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235
Q

Which non-pharmacologic intervention has the greatest impacts on reducing BP?

A 
DASH diet- 11 mmHg
Weight Loss- 6mmHg/10kg loss
Aerobic exercise- 7mmHg
Sodium intake changes- 5-8 mmHg
Alcohol cessation- 5mmHg
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236
Q

Prevent DVT post surgery in high risk patients

A

Prophylatic low molecular weight heparin (Enoxaparin)- for at least 3 weeks post surgery

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237
Q

How do IgE mediated allergies present?

A

Immediate Anaphylaxis reaction in any age (<1hr) —> Urticaria (raised itchy rash), Vomiting/Wheezing, Angioedema (swelling underneath skin), hypotension

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238
Q

How do Non-IgE mediated food allergies present in infants <6 months?

A

Proctocolitis, Insidious onset— painless, bloody stools in a well appearing infant

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239
Q

How does non-IgE mediated food allergies present in infants <12 months?

A

Protein induced- enterocolitis syndrome- onset within hours- profuse vomiting, diarrhea (+/- blood), dehydration, lethargy, ill-appearing.

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240
Q

most common cause of protein-induced allergic proctocolitis?

A

Cow’s Milk

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241
Q

Labs of autoimmune hepatitis?

A

Elevated aspartate aminotransferase, alanine aminotransferase,
Normal alkaline phosphatase and bilirubin
High autoantibody —> serum globulins + 𝛄 gap
Positive serology

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242
Q

Chromium deficiency manifestation

A

Impaired glucose control in diabetes

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243
Q

Copper deficiency manifestations

A 
Brittle hair
Skin depigmentation
Neurologic dysfunction (ataxia, peripheral neuropathy)
Anemia
Osteoporosis
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244
Q

Selenium Deficiency Manifestations

A

Thyroid dysfunction
Cardiomyopathy
Immune Dysfunction

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245
Q

Zinc Deficiency Manifestations

A 
Alopecia
Pustular Skin Rash (perioral region/extremities)
Hypogonadism
Impaired wound healing
Impaired taste
Immune dysfunction
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246
Q

What are patients on parenteral nutrition at risk for?

A

Trace mineral deficiency

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247
Q

Risk factors of trace mineral deficiency?

A

Malabsorption
bowel resection
poor nutritional intake
dependence on parenteral nutrition

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248
Q

Dx: Recurrent episodes of mild jaundice (provoked by stress aka fever, fasting, dehydration, exercise, menstruation, surgery), elevated unconjugated bilirubinemia (indirect hyperbilirubinemia)

A

Gilbert Syndrome

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249
Q

Constipated Infant + Ill appearing

A

Serious Organic causes: Hirschsprung disease, Cystic Fibrosis, Spinal Dysraphism, Hypothyroidism

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250
Q

Constipated + well appearing infant + loose stools +/- blood mucous

A

Food induced protein enterocolitis

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251
Q

Constipated Infant + Well appearing + Normal Stool consistency

A

Normal Infant dyschezia

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252
Q

Constipated Infant + Well-Appearing + Hard or Pellet-like Stools

A

Functional constipation (+/- anal fissure if blood present)

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253
Q

Dx: elderly patient, chronic antacid uses, subtle neurologic defects in lower extremity, dorsal column injury (diminished light touch/vibration sensation)

A

Vitamin B12 deficiency

254
Q

Dx: elderly female, progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds and distended, fullness in right groin area

A

Femoral hernia

255
Q

Dx: Diarrhea post radiation, <8 weeks, mucus discharge, tenesmus, minimal bleeding, severe erythema/edema ulcerations on endoscopy

A

Dx: Acute radiation proctitis
Tx: Loperamide and Butyrate Enemas

256
Q

Dx: > 3 years post radiation, severe bleeding +/- strictures with constipation & rectal pain, multiple telangiectasias, mucosal pallor/friability on endoscopy

A

Dx: Chronic radiation Proctitis
Tx: endoscopic thermal coagulation, sucralfate/glucocorticoid enemas

257
Q

Dx: Loose, oily, non-bloody stools, bloating, flatulence, weight loss, decreased linear velocity, contaminated food/water,villous blunting—> malabsorption

A

Dx: Giardiasis
Diagnostic: stool antigen + PCR testing,
Tx: 1st line = tinidazole/ nitazoxanide or metronidazole
- pregnancy- paromomycin
- refractory/recurrent: evaluate for CF/CVID

258
Q

Dx: New IDA in elderly patient

A

GI blood loss - Check colonoscopy/endoscopy

259
Q

Dx and Tx: Child, ear pain, itch, pain with auricle manipulation, tympanic membrane spared

A

Otitis Externa- Pseudomonas/ Staph A/ Foreign Object

Tx: Remove Debris, Topical FQ (ciprofloxacin) +/- topical glucocorticoid, wick placement

260
Q

Most concern with Parotid Masses

A

Cranial nerve dysfunction: facial droop, facial numbness

261
Q

Presbycusis

A

Age related Hearing Loss (cochlear hair cell loss)

262
Q

Nasopharyngeal Carcinoma is endemic where? Treatment

A

Asia

Radiation/Chemotherapy

263
Q

EEG?

A

Test which detects abnormalities in brain waves or in electrical activity of your brain

264
Q

Thyroid Nodules Management?

A

Fine-Needle Aspiration Bx

265
Q

Complication of recurrent acute otitis media: fever, ear pain, infection behind ear, displacement of auricle

A

Acute Mastoiditis

266
Q

Dx: painless, white lesions in mouth which cannot be scraped off, fatigue, unintentional weight loss, cervical adenopathy

A

Oral Hairy Leukoplakia (obtain HIV testing)

267
Q

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

A

Dx: Allergic Rhinitis (Allergic shiners, salute, facies)
Tx: intranasal corticosteroids

268
Q

Dx + Tx: infant, middle ear effusion, tympanic membrane inflammation- fever, earache (otalgia), erythema.

A

Acute Otitis Media: Strep Pneumo, H. Flu, Moraxella,

Tx: amox, amox+clauv or penicillin allergy: clindamycin

269
Q

Complications of acute Otitis Media

A

TM perforation
Conductive Hearing Loss
Mastoiditis
Meningitis

270
Q

Dx and Tx: child, Respiratory Distress, Dysphagia, dysphonia, drooling, high fever, “thumb sign on X-ray,

A

Dx: Epiglottitis (H.Flu)
Tx: endotracheal intubation + antibiotics
Prevent: immunization against Hib

271
Q

Dx: clear unilateral rhinorrhea increasing at times bending over/bowel movements, salty/metallic tast

A

CSF rhinorrhea- check for trauma- bed rest, elevation of head, avoid strain, lumbar drain placement, surgical repair

272
Q

Dx and Tx: Child: Ear fullness/discomfort, tinnitus, conductive hearing loss, popping sensation

A

Retracted tympanic membrane—eustachian tube dysfunction predisposing factor for acute otitis media

273
Q

Dx and Tx: ear pain, hearing loss associated with flying

A

Dx: Barotrauma to the ear
Tx: Reassurance and Follow-Up

274
Q

Dx: asthma, bronchospasm, or bland taste for food, nasal congestion (nasal polyposis) with naproxen

A

AERD (Aspirin Exacerbated Respiratory Disease)

275
Q

Dx + Tx

: chronic mass in hard palate, benign bony growth, congenital or develop later in life

A

Torus Palatinus

Tx: with Surgery if needed

276
Q

Treatment of Bisphosphonate-related osteonecrosis of the jaw?

A

Oral Hygiene, Antibacterial Rinses, Antibiotics and debridement

277
Q

Dx: Smoker or Drinker, White patches on Tongue that can’t be wiped off

A

Oral Leukoplakia

278
Q

Dx and Tx: unilateral sensorineural hearing loss and imbalance, facial numbness or paralysis

A

Dx: Vestibular Schwannoma (CN8 and CN5 dysfunction)
Tx: Observation, Surgery, Radiation

279
Q

DDx: Blood streaked stools in a well appearing infant <6 months old

A

DDx: Anal Fissure or Food-protein induced allergic proctocolitis (FPIAP)

280
Q

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,

A

Dx: food protein induced allergic proctocolitis

281
Q

Dx: acute fever. nausea, right upper quadrant pain, hepatomegaly, jaundice elevated liver transanimases >1000

A

Acute Hep A infection

282
Q

Dx: fatigue, pruritis, elevated Alk Phos, normal common bile duct
Test:

A

Test: antimitochondrial antibodies
Dx: PBC (primary biliary cholangitis

283
Q

Dx: Fatigue, pruritis, elevated alk phos, elevated bilirubin

A

PSC (Primary Sclerosing Cholangitis)

284
Q

Complications of Primary Sclerosing Cholangitis

A

Association with IBD, UC

Cholangiocarcinoma, Colon Cancer, Biliary Cancer

285
Q

Dx: asymptomatic + high alk phos + high 𝛄- glutamyl transpeptidase

A

Primary Sclerosing Cholangitis

286
Q

Unmodifiable Risk factors of Pancreatic Cancer

A

1st Degree Relative with Pancreatic Cancer
Hereditary Pancreatitis
Germline Mutations

287
Q

Environmental Risk Factors of Pancreatic Cancer

A

Cigarette Smoking
Obesity
Nonhereditary Chronic Pancreatitis

288
Q

Dx: Diarrhea (nausea, abdominal pain, loss of appetite), Dermatitis (rough, hyper pigmented scaly skin), Dementia (depressed mood, memory loss, psychosis)

A

Pellegra- Vitamin B3- Niacin Deficiency

289
Q

Dx: metabolic syndrome, AST/ALT < 1, hyperechoic texture on ultrasound of liver

A

Non- Alcoholic Fatty Liver Disease + Insulin Resistance

290
Q

When do use anoscopy?

A

Patients with no clinical features but minimal bleeding: hemorroids or anal fissures

291
Q

F/U with cirrhosis

A

Diagnostic upper endoscopy- risk of hemorrhage

292
Q

Esophageal Varices—-> variceal hemorrhage prevention

A

Non-selective beta blocker

293
Q

What medications can cause medication induced esophagitis?

A

Tetracyclines (doxycycline)
Aspirin and NSAIDs
Bisphosphonates (Alendronate, Risendronate)
Potassium Chloride, Iron

294
Q

dx: abrupt onset retrosternal pain with severe painful swallowing

A

Medication-induced esophagitis- clinical + endoscopy (ulcers with normal surrounding mucosa

295
Q

Dx: female solitary well-circumscribed mobile mass on chest

A

Breast Cyst

296
Q

Dx: female, multiple diffuse nodulocystic masses, premenstrual tenderness

A

Fibrocystic changes

297
Q

Dx: solitary, firm, well-circumscribed and mobile mass, premenstrual tenderness

A

Fibroadenoma

298
Q

Dx: female, after trauma/surgery, firm, irregular mass +/- ecchymosis, skin/nipple retraction

A

Fat Necrosis

299
Q

Common sign of hyperandrogenism

A

Severe nodulocystic acne

300
Q

Dx: Hirsutism, Nodulocystic acne, Androgenic alopecia, high serum testosterone, irregular menses in female

A

Dx: PCOS (polycystic ovaries on ultrasound)

301
Q

When does Pap test start?

A

21 y/o

302
Q

Dx & Tx: asymptomatic or vaginal/pelvic pressure, stress urinary incontinence, retention, constipation, incomplete defecation.

A

Dx: Pelvic Organ Prolapse- Bowel, Bladder, or uterus herniation into vagina
Tx: Asymptomatic- Observation, Symptomatic- Pelvic floor kegel exercises, vaginal pessary, surgical repair

303
Q

Dx: chronic pelvic pain and adnexal mass, cellular metaplasia, retrograde menstruation, worsening pain with exercise, dysparenia,

A

Endometriosis

304
Q

Screening Guidelines of Cervical Screening

A 
<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
Q

Tx of Menopause Symptoms (vasomotor symptoms, oligomenorrhea/amenorrhea, sleep disturbances, decreased libido, depression, cognitive decline, vaginal atrophy)

A

Tx: topical vaginal estrogen + systemic Hormone Replacement Therapy

306
Q

Tx: asymptomatic uterine leiomyomas (fibroids)

A

Tx: observation

307
Q

Dx + Tx: heavy, prolonged menses, pelvic pain, constipation, urinary frequency, irregular ultrasound (heavy, prolonged menses, chronic pelvic pain, bulk symptoms, recurrent pregnancy loss)

A

Dx: uterine leiomyomata
Tx: Hormonal contraception, Surgery

308
Q

Dx, Tx, Cx: chronic constipation and vaginal bulge

A

Dx: pelvic organ prolapse
Tx: pelvic floor muscle exercises, vaginal pessary placement, possible surgical correction
Cx: levator ani muscle complex damage

309
Q

Dx and Tx: female, sudden strong urge to urinate and urine leakage

A

Dx: urgency urinary incontinence
Tx: lifestyle behavior pelvic floor exercises
2nd- pharmacotherapy—> oxybutynin (systemic antimuscurinic) or mirabegron (fewer systemic side effects)

310
Q

Dx and Tx: urine leaks with laughing, sneezing, coughing, exercising

A

Dx: Stress Urinary Incontinence
Tx: Midurethral Slings

311
Q

Contraindications for SERMs

A

Thromboembolism

312
Q

Annual Screening for sexually active females <25

A

Clamydia and Gonorrhea- NAAT is best (nucleic acid amplification testing)

313
Q

Most important risk factors for Breast Cancer

A
  1. Age
  2. Increased estrogen Exposure
  3. Family History
314
Q

What is the follow up test if a pap smear test is unsatisfactory?

A

Endocervical curettage

315
Q

Dx and Tx: pain in first 2-3 days of menses, N/V/D, normal pelvic examination

A

Primary Dysmenorrhea
Tx: NSAIDs (inhibit prostaglandin) in non-sexually active patients
Oral contraceptives in sexually active patients

316
Q

Unilateral firm tender mass posterior to the nipple in girl (8-10

A

First sign of puberty- physiologic thelarche

317
Q

Tx: of Chlamydia Trachomatis

A

Doxycycline

Azithromycin in pregnant patients

318
Q

Dx + Tx: >40 woman, multiparity, prior uterine surgery with dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, diffuse uterine enlargement, uterine tenderness

A

Adenomyosis- thickened myometrium + MRI/US + Pathology confirmation
Treatment: Hysterectomy

319
Q

Dx + Tx: Young woman, strenous exercise, relative caloric defiiciency, stress fractures, amenorrhea, infertility

A

Dx: Exercised Induced Hypothalamic Amenorrhea
Tx: Increase Caloric Intake, Estrogen, Calcium + Vit D

320
Q

Chronic Abnormal uterine bleeding in obese patient, no menstrual cycles

A

Anovulation - obesity contributes to increased overall estrone levels —> disrupt Hypothalamic- pituitary- ovarian axis- anovulation and uterine bleeding.

321
Q

Dx + Tx: Maculopapular Rash, Fever, New Drug exposure +/- arthralgias. Labs: pyuria, hematuria, WBC cast

A

Dx: Acute Interstitial Nephritis
Tx: Discontinue new drug, +/- systemic glucocorticoids

322
Q

Dx: malar rash/discoid rash + hypertension, mild proteinuria + RBC casts

A

Dx: Lupus Nephritis

323
Q

Dx: hematuria, mild proteinuria, RBC casts, fluid retention, hypertension, periorbital edema, 1-2 weeks after episode of streptococcal pharyngitis/skin infection

A

Dx: Postinfectious glomerulonephritis

324
Q

Dx, Cx, and Tx: Night time urinary incontinence + Boys 5-8,

A

Nocturnal Enuresis - self-resolves, behavioral modifications, enuresis alarms, desmopressin therapy
Cx: constipation (leaky stool)- treat with laxatives

325
Q

diagnostic test for post-renal diseases

A

Renal ultrasound

326
Q

Dx , Cx, Tx: < 50 y.o. Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion,

A

Dx: Primary Hyperparathyroidism
Cx: Osteoporosis, Nephrolithiasis, CKD
Tx: parathyroidectomy

327
Q

Dx, Diagnostic, and Tx: episodic headache, sweating, tachycardia or resistant HTN

A

Dx: Pheochromocytoma
Diagnostic: urine/plasma metanephrines + confirmatory abdominal imaging
Tx: pre-operative alpha blockade prior to beta blockade, laparoscopic/open surgical resection

328
Q

Dx: Asymptomatic, renal stones, moans, groans, bones, hypercalcemia, elevated PTH, elevated 24 hr urinary calcium excretion, Pituitary Tumors (prolactin, visual defects), Pancreatic tumors (gastrinomas)

A

MEN Type 1

329
Q

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)

A

MEN Type 2A

330
Q

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

A

MEN Type 2B

331
Q

Difference between pseudogynecomastia and gynecomastia

A

Pseudo: Excessive deposition of fat without distinct margin
True: margin of glandular tissue

332
Q

Squamous Cell Carcinoma with elevated calcium, low phosphorus

A

Hypercalcemia of malignancy = PTHrP —> low PTH —-> mimics PTH— high calcium low phosphorus

333
Q

Findings associated with T2DM

A

Obesity, HTN, dyslipidemia, aconthosis nigricans

334
Q

Dx: oligomenorrhea (inconsistent menses), hirsutism (excess terminal hair growth), virilization (clitoromegaly), obesity, T2DM, dyslipidemia, hypertension

A

PCOS

335
Q

Dx: PCOS (oligomenorrhea, hirsutism, hyperandrogenism, obesity) + elevated serum 17-hydroxyprogesterone

A

21- hydroxylase deficiency

336
Q

Dx: rapidly progressive hirsutism with virilization + high serum androgens, post menopausal

A

Androgen-secreting ovarian tumors, ovarian hyperthecosis

Or high androgen secreting neoplasm

337
Q

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

A

Celiac Disease

338
Q

Best Management of DKD

A

Reduce BP to <130/80 with ACE/ARB

Reduce HBA1c <7.0 with SGLT2i , GLP-1 agonist

339
Q

Dx + Diagnostic + Tx: hyperpigmentation, athropathy (joint pain), hepatomegaly, cirrhosis (HCC), diabetes mellitus, hypopituitarism, hypogonadism, cardiomyopathy

A

Dx: Hereditary Hemochromatosis
Diagnosis: Elevated Liver Transaminases (ALT, AST), elevated serum ferritin, transferrin saturation
Tx: Therapeutic phlebotomy (urgent if ferritin >1000

340
Q

Dx, Diagnostics, and Tx: Fatigue, Weakness, Anorexia/Wt loss, N/V/ Ab Pain, Salt Craving, Postural Hypotension, Hyperpigmentation

A

Dx: Primary Adrenal Insufficiency
Labs: Hyponatremia, hyperkalemia, eosinophilia, low morning cortisol, high ACTH
Tx: Glucocorticoids (hydrocortisone, prednisone), Mineralocorticoids (fludrocortisone)

341
Q

Dx: elevated free T4, supressed TSH, tachycardia, anxiety, wt loss, low RAIU, non-tender, enlarged thyroid gland

A

Self-limiting painless thyroiditis

Tx: propranolol—> control palpitations, tremulousness

342
Q

Hypothyroid features, diffuse goiter, TPO antibody, variable RAIU

A

Chronic autoimmune thyroiditis (Hashimoto thyroiditis)

343
Q

Mild brief hyperthyroid phase, hypothyroid phase, small non-tender goiter, spontaneous recovery, positive TPO, low RAIU

A

Painless (silent Thyroiditis)

344
Q

Post-viral URTI, prominent fever, hyperthyroid symptoms (painful/tender goiter), elevated ESR + CRP, Low RAIU

A

Subacute thyroiditis- de Quervain thyroiditis)

345
Q

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

A

Acromegaly: excessive growth hormone

346
Q

Hypertension hypokalemia + elevated renin/ aldosterone

A

Secondary hyperaldosteronism (renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretic use

347
Q

Hypertension, hypokalemia, low renin high aldosterone

A

Primary hyperaldosteronism (aldosterone producing tumor, bilateral adrenal hyperplasia)

348
Q

Hypertension + hypokalemia + low renin, low aldosterone

A

Non-aldosterone causes- congenital adrenal hyperplasia, deoxycorticosterone producing adrenal tumor, Cushing Syndrome, Exogenous Mineralocorticoids

349
Q

Hyperprolactin symptoms > prolaction 25-100 mg

A

Medication related -Hyperprolactinemia- gynecomastia, galactorrhea, menstrual dysfunction, decreased libido most- likely risperidone

350
Q

Hyperprolactinism- > 200ng/ml

A

Prolactinomas- headaches, visual disturbances

351
Q

Mechanism of diabetic neuropathy- large fiber neuropathy

A
  • pressure, proprioception, balance, numbness, poor balance, diminished ankle reflexes, reduced vibration to light tough, axonopathy of large nerve fibers
352
Q

Mechanism of diabetic neuropathy- small fiber neuropathy

A

Pain and temperature, burning/stabbing pain, reduced pinprick sensation, ankle reflexes reserved

353
Q

Diabetic Nephropathy —> > 30 mg/g- albuminuria, decreased glomerular filtration

A

Also proliferative diabetic retinopathy

354
Q

What does that CHA2DS2VASC score assess?

A

Whether a patient should be on anticoagulant therapy

Male > 2 , Female > 3

355
Q

Choice of HTN drug in Angina Pectoris?

A

B-blocker (-olols) or CCB (amlodipine)

356
Q

HTN drug of choice in post MI

A

ACEi (lisinopril) or ARB (losartan) or B-blocker (-olols)

357
Q

HTN drug of choice in HFrEF?

A

ACEi (lisinopril) or ARB (losartan), B-blocker (-olols), diuretic (-thiazide), aldosterone agonist (spironolactone, eplerenone)

358
Q

HTN drug of choice in Afib?

A

Beta blocker (-olol), nondihydropyridine CCB (diltiazem)

359
Q

HTN drug of choice in CKD?

A

ACEi (lisinopril) or ARB (losartan)

360
Q

HTN drug of choice in gout

A

Losartan, other ARB, CCB, avoid diuretics

361
Q

HTN drug of choice in osteoporosis

A

Thiazide diuretic

362
Q

HTN drug of choice with migraine

A

B-blocker (olols), CCB (amlodipine)

363
Q

Screening for abdominal aortic aneurysm

A

One time abdominal duplex US

364
Q

Absolute Contraindication of Hormonal Contraception

A 
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
Q

What is recurrent UTI?

A

> 2 infections in 6 months

> 3 infections in 1 year

366
Q

Risk factors for Reccurent UTIs

A

History of cystitis <15 years old
Spermicide Use
New Sexual Partner
Postmenopausal status

367
Q

Dx of UTI

A

UA + Urine Culture, Clean Catch

368
Q

Prevention of UTI

A

Behavior modification- Contraception,
Postcoital/Daily Antibiotic prophylaxis
Topical Vaginal Estrogen for Post menopausal patients

369
Q

Cx of candida albicans

A

Erythematous beefy red plaques, mirror image, satellite regions - intertrigo- happens in impaired immunity, obesity, tight fit clothing
Tx: Topical azoles (clotrimazole)

370
Q

Tx of Recurrent UTI in postmenopausal patients

A

Topical Vaginal Postmenopausal patients

371
Q

Dx: Woman Breast feeding, fever, firm red, tender, swollen quadrant of unilateral breast, myalgia, chills, malaise

A

Frequent Breastfeeding/ Pumping + Antibiotics, analgesia

372
Q

Postmenopausal bleeding causes

A

Endometrial hyperplasia or cancer (older women and obesity)

373
Q

Approach to menopausal bleeding

A 
Endometrial biopsy or TVUS endometrium
<4mm observe, >4 mm biopsy (benign - observe)
Atypia neoplasia (progestins)
374
Q

Pelvic organ prolapse is

A

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
Q

Dx: pelvic pressure, obstructed voiding, urinary retention, urinary urgency/incontinence, constipation, fecal urgency/incontinence, sexual dysfunction

A

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
Q

Ovarian cyst <4cm with thin walls

A

Physiologic ovarian cysts

377
Q

Dx + Tx: Acute unilateral lower abdominal pain in reproductive age women- thin-walled ovarian cysts with pelvic free fluid

A

Ovarian cyst Rupture
Tx: observation and reassurance if hemodynamically stable, no infection
If infected and hemodynamically unstable- surgery

378
Q

Abnormal uterine bleeding in obese female

A

Increased peripheral conversion/aromatization of androgens to estrone—> chronic anovulation—-> endometrial hyperplasia

379
Q

Contraindications for using a IUD

A

Heavy menstrual bleeding

380
Q

Contraception method <1 month post partum + breast feeding

A

Subdermal progestin-releasing implant

381
Q

Bilateral breast soreness, weight gain, increasing fatigue

A

Early Pregnancy

Dx with Urine Pregnancy Test

382
Q

Dx: hyperpigmentation on sun-exposed areas of face in pregnancy, symmetric centrofacial, mandibular, malar distribution

A

Dx: Melasma
Tx: self-resolving, use sunscreen

383
Q

Causes of Oligohydramnios

A

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
Q

Amniotic fluid <5cm

A

Oligohydramnios

385
Q

Dx: late term oligohydramnios + increased clear vaginal discharge + asymptomatic

A

Spontaneous rupture of membranes

386
Q

Dx: late term oligohydramnios + fetal growth restriction + abnormal U/S findings

A

congenital infections (CMV)

387
Q

What vaccines are recommended during pregnancy?

A

Tdap
Inactivated Influenza
Rho (D) Immunoglobulin

388
Q

What vaccines are indicated for high risk pregnant patients?

A 
Hep B, Hep A
Pneumococcus
Haemophilus Influenza (HiB)
Meningococcus
Varicella-Zoster immunoglobulin
389
Q

What vaccines are contraindicated in pregnant patients?

A

HPV
MMR
Live-Attenuated Influenza
Varicella

390
Q

Absolute Contraindications for Exercising during Pregnancy

A 
Amniotic Fluid Leak
Cervical Insufficiency
Multiple Gestation
Placenta Abruption/ Previa
Premature Labor
Pre-eclampsia/ Gestational Hypertension
Severe Heart and Lung Disease
391
Q

Unsafe Activities for Pregnant Women

A

Contact Sports
High Fall Risk
Scuba Diving
Hot Yoga

392
Q

Exercise Recommendations for Pregnant Women

A

Moderate- Intensity Exercise- Most/All Days - 20-30 mins

393
Q

Causes of Fetal Tachycardia (>160/min)

A

Maternal Fever
Medication Side Effect (B-agonist)
Fetal hyperthyroidism
Fetal Tachyarrhythmia

394
Q

Causes of Fetal Bradycardia (<110/min)

A

Maternal hypothermia
Medication side effect (B-blockers)
Fetal hypothyroidism
Fetal Heart Block

395
Q

Lab Test in initial Prenatal Visit

A 
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
Q

Lab Tests in 24-28 weeks gestation

A

HgB/ Hct- anemia
Antibody screen if Rh(D) negative- autoimmune attack of fetus
1-hr 50g GCT - gestational diabetes

397
Q

Lab Tests in 36-38 weeks gestation

A

Group b Streptococcus Rectovaginal Culture

398
Q

Anemia in Pregnancy HgB <

A

11.0

399
Q

Appropriate Weight Gain in Pregnancy

A

<18.5 BMI =28-40 lbs
18.5-24.9 BMI = 25-35lbs
25-29.9 BMI = 15-25lbs
>30 BMI = 11-20lbs

400
Q

Harmful Substances to avoid in Pregnancy

A

Recreational Substances
High Mercury Levels
Alcohol
Caffeine

401
Q

Food Safety in Pregnancy

A

Avoid undercooked meat, fish, eggs
Clean Raw fruits/veggies
Avoid unpasteurized dairy

402
Q

Complications of inadequate weight gain in pregnancy

A

Low birth weight

Pre term delivery

403
Q

Complications of Excessive weight gain in pregnancy

A

Gestational Diabetes
Fetal Macrosomia
Cesarean Delivery

404
Q

Contraindications of DTaP vaccinations

A

Anaphylaxis
Unstable Neurologic Disorders (infantile spasms, uncontrolled epilepsy)
Encephalopathy (coma, decreased level of consciousness, prolonged seizures)

405
Q

Dx and Tx: Young patient, recurrent sinpulmonary infections, chronic lung disease, non-smoker, progressive cough/dyspnea

A

CVID
Diagnostics: Quantitative Immunoglobulin Assay low IgG low Iga low IgM
Tx: Immunoglobulin replacement therapy

406
Q

Tx of Infant constipation (infrequent defecation, hard painful stools, large-caliber or pellet like stools, anal fissures)

A

Add undigestable, osmotically active carbohydrate (prune/apple juice/puree

407
Q

Dx and Tx: diarrhea, mucus discharge, tenesmus, minimal bleeding, <8 weeks post radiation therapy, endoscopy: severe erythema, edema + ulcerations

A

Acute Radiation Proctitis

Tx: Antidiarrheals (loperamide) and butyrate enemas

408
Q

Dx and Tx: severe bleeding, strictures with constipation and rectal pain, >3 months radiation endoscopy: multiple telangiectasias, mucosal pallor/friability

A

Dx: Chronic radiation proctitis
Tx: Endoscopic thermal coagulation, sucralfate or glucocorticoid enemas

409
Q

Dx diagnostic Tx: 40s, osmotic diarrhea, abdrominal cramps, bloating, no steatorrhea, flatulence with dairy ingestion

A

Dx: lactose intolerance
diagnostic: Lactose hydrogen breath test, positive stool test for reducing substances, low stool pH, increased stool osmotic gap,

410
Q

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

A

Celiac Disease

Diagnostic: IgA anti-tissue transglutaminase, IgA anti-endomysial antibodies

411
Q

Dx, Diagnostic, Tx: difficulty swallowing (dysphagia), bad breath (hallitosis), history of regurgitating undigested food, gurgling sound, recurrent aspiration pneumonia

A

Zenker Diverticulum
Diagnostic: contrast swallow study
Tx: surgical -cricopharyngeal myotomy, diverticulectomy, diverticulotomy

412
Q

Dx and Tx: tender papulopustular eruption on lower extremeties after swimming in heated hotel pool, low grade fever,

A

Pseudomonas aeruginosa folliculitis (hot tub folliulitis

Tx: self-limited

413
Q

Dx, Diagnostic, TX: child, fever, irritability, limited function of a limb, bony tenderness, swelling, elevated ESR, CRP, WBC

A

Osteomyelitis
X-ray, MRI, bone biopsy, blood culture, ESR, CRP WBC count elevated
Tx: vancomycin
Risk Factors: sickle cell, immunodeficiency

414
Q

Features of Viral Upper Respiratory Syndrome

A

Slow onset
Rhinorrhea, Coryza, sneezing, mild pharyngitis
Mild Systemic Symptoms
Nasal Edema, slightly erythematous pharynx

415
Q

Influenza Clinical Features

A

Abrupt dramatic onset
respiratory symptoms mild
high fever, myalgias, headaches

416
Q

Streptococcal pharyngitis clinical features

A

Variable onset of symptoms
pharyngeal symptoms
might be fever and myalgias
pharyngeal erythema, tonsillar hypertrophy/exudates, tender cervical lymph nodes

417
Q

Stages of Lyme Disease (Borrelia Burgdorferi

A 
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
Q

Treatment of Borrelia burgdorferi (Ixodes Scapularis Tick)

A

Doxycycline

419
Q

Dx and Tx: Traveler’s Diarrhea < 2 weeks, watery diarrhea, crampy abdominal pain, ingestion of contaminated water, food

A

ETEC- Enterotoxigenic Escherichia Coli

Tx: supportive

420
Q

Dx, Diagnostic, Tx: Traveller’s Diarrhea > 2weeks, bloody mucid diarrhea, liver abcess

A

Dx: Entamoeba Histolytica
Diagnostic: Stool Analysis: cysts + trophozoites
Tx: Metronidazole or Tinidazole

421
Q

Dx, DGx, Tx: traveller’s diarrhea > 2 weeks, watery/oily, foul-smelling stools, bloating, fat malabsorption, weight loss (fatigue, N/V)

A

Dx: Giardia Lamblia
DGx: Stool analysis: cysts + multinucleated trophozoites, Immunoassay, PCR
Tx: Metronidazole or Tinidazole

422
Q

Dx, DGx, Tx: Traveller’s Diarrhea > 2 weeks, watery diarrhea, immunosuppressed patient ( CD4 <100)

A

Dx: Cryptosporidium
DGx: Stool test: acid fast cysts in stool
Tx: ORT + consider nitazoxanide

423
Q

Dx: Traveller’s Diarrhea > 2 weeks, watery/blood diarrhea, waxing/waning symptoms

A

Dx: Cyclospora
DGx: Stool Test
Tx: TMP- SMX

424
Q

Guidelines for PPSV23 vaccine administration

A

Recommended for all adults > 65

<65 with chronic liver disease, lung disease, heart disease, diabetes mellitus, smoking history

425
Q

Requirements for Hep A Prophylaxis

A

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
Q

Bug with itchy (pruritic), small puncta/ maculopapules in linear groups on unclothed skin

A

Beg Bug

427
Q

Bug with widespred itching of hair, body or genitalia with visible louse

A

Lice (pediculosis)

428
Q

Bug with itchy burrows, hemorrhagic crusts in interriginous areas

A

Scabies

429
Q

Bug with Solitary papule/pustule or wheal and itching

A

Spider

430
Q

Bug with Painless red papule, itchy during spring/summer

A

Tick

431
Q

dry scaly flat papules with red base in sun exposed areas

A

Actinic Keratosis

432
Q

tan, brown, round lesion, well demarcated border, stuck on appearance, benign lesions

A

Seborrheic keratosis

433
Q

skin tag

A

acrochordon

434
Q

slow growing papule, nodule, pearly, rolled border, overlying telangiectasias

A

Basal Cell Carcinoma

435
Q

enlarging non-healing ulcer, bleeding on contact

A

Squamous Cell Carcinoma secondary to chronic wounds

436
Q

Tx of HPV plantar warts

A

salicylic acid cream

5-fluoro uracil cream

437
Q

persistent itchy plaque with lichenification, fissuring

A

Chronic Allergic Contact Dermatitis (type IV mediated hypersensitivity

438
Q

Tx: of Allergic Contact Dermatitis

A

avoidance + topical/systemic corticosteroid

439
Q

Dx, DGx, Tx: Scaly plaques + Ulceration, well demarcated patches/plaques

A

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
Q

Pathology of Parkinson Disease

A

Accumulation of alpha synuclein within neurons of the substantia nigra pars compacta

441
Q

Dx DGx and Tx: elderly, tremor, rigidity in movements, akinesia/bradykinesia, postural instability

A

Parkinson Disease
DGx: Clinical Diagnosis
Tx: levodopa

442
Q

Adverse Effects of Benzos in elderly

A

Increased risk of confusion, falls, baseline cognitive impairment,

443
Q

Recurrent episodes of confusion, aggression, disinhibition within an hour of taking benzos in elderly

A

Paradoxical agitation

444
Q

Abortive Migraine Therapy

A

Triptans (Sumatriptan)
NSAIDs (Naproxen or Acetominophen)
Antiemetics (metoclopramide, prochlorperazine)
Ergotamines (dihydroergotamine)

445
Q

Preventive Migraine Therapy

A

Topiramate
Divalproex Sodium
Tricyclic Antidepressants (Nortriptyline, Desipramine)
Beta Blockers- Propranolol

446
Q

Dx: newborn with diffuse (crosses suture lines) fluctuant scalp swelling and blood loss (pallor, anemia, tachycardia)

A

Dx: subgaleal hemorrhage (via sugaleal vein shearing)- massive blood accumulation between periosteum and galea aponeurotica

447
Q

Essential coagulation factor in carboxylation that activate coagulation factors

A

Vitamin K

448
Q

Dx: infancy, bleeding in joints (hemarthrosis), intracranial hemorrhage, prolonged PTT

A

Hemophilia A - X linked bleeding disorder

449
Q

Dx: venipuncture site oozing, thrombocytopenia, prolonged PT and PTT

A

Disseminated intravascular coagulation (DIC)

450
Q

Dx: newborn bleeding between skull and periosteum, subperiosteal vessel rupture, firm nonfluctuant swelling that does not cross suture lines

A

Cephalohematoma

451
Q

Dx, DGX, Tx: Elderly, Wide based Gait with falls, cognitive dysfunction, urinary urgency/incontinence, depressed affect, upper motor neuron signs in lower extremeties

A

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
Q

Generalized Seizure Triggers

A

Lack of Sleep, Flashing Lights, Emotional Stress

453
Q

Generalized Seizure Event Features

A

Preceding Aura, Loss of Consciousness and Loss of Postural Tone, Tonic-Clonic Convulsions

454
Q

Generalized Seizure Post Event Features

A

Delayed Return to Baseline

455
Q

Vasovagal Syncope Triggers

A

Prolonged Standing + Physical/Emotional Stress

456
Q

Vasovagal Syncope Event Features

A

Presyncope- Light- headedness, pallor, diaphoresis

457
Q

Vasovagal syncope post event features

A

Immediate return to baseline

458
Q

Cardiogenic Syncope Triggers

A

Exertion, Dehydration

459
Q

Cardiogenic Event Features

A

Sudden Loss of Consciousness without prodrome

460
Q

Cardiogenic Syncope Post event features

A

Immediate Return to Baseline

461
Q

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

A

Dx: Migraine in Children
Tx: Acetominophen, NSAIDs, Triptans (sumatriptan), antiemetics (promethazine, prochlorperazine), Ergots (Dihydroergotamine)

462
Q

Dx: encephalopathy (confusion), oculomotor dysfunction (horizontal nystagmus), gait ataxia, anorexia or chronic alcohol use

A

Dx: Wernicke Syndrome or Alcohol Withdrawal Syndrome (Thiamine Deficiency)
Tx: Thiamine Replenishment

463
Q

Dx, DGx, Tx: adult, unilateral severe stabbing pain in jaw line, triggered by chewing, talking, brushing teeth, light touch)

A

Dx: Trigeminal Neuralgia
DGx: MRI/MRA of brain with contrast, nerve conduction
Tx: Carbamezapine or Oxcarbazepine or Surgery for severe medically refractory cases

464
Q

Dx, DGx, Tx: Facial pain with jaw motion, ear pain/ tinnitus, unilateral headache, jaw dysfunction

A

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
Q

Dx, DGx, Tx: inattentive, hyperactive symptoms for >6months before age 12, in at least 2 settings

A

Dx: ADHD
DGx: behavioral rating scales from school
Tx: Stimulants (Methylphenidate, amphetamines), Non stimulants (atomoxetine), Behavioral therapy

466
Q

SIGECAPS

A 
Sleep Disturbance
Loss of Interest
Guilt
Energy Low
Concentration Impaired
Appetite Change
Psychomotor Retardation/Agitation
Suicidal Thoughts
467
Q

Dx: Excessive Fears of having a serious illness

A

Illness Anxiety Disorder

468
Q

Dx: bloating, fatigue, headaches, breast tenderness, mood swings, anxiety, difficulty concentrating, decreased libido, irritability lasting for a week, recurring in female

A

Dx: PMS

469
Q

Dx: prominent irritability, hopelessness, depressed mood, self-critical thoughts, anger, recurrent in a female

A

PMDD (premenstrual dysphoric disorder)

470
Q

Why avoid citalopram in depressive patients with cardiac disorders?

A

Dose dependent QT prolongation

471
Q

Dx and Tx: Avoidance of reminders of trauma, emotional detachment, negative mood, decreased interest in activities, sleep disturbance, hypervigilance, irritability

A

Dx: PTSD
Tx: trauma focused cognitive behavioral therapy, antidepressants (SSRIs, SNRIs)

472
Q

Dx: Chronic anemia following subtotal gastrectomy

A

B12 Deficiency

473
Q

B12 is required cofactor for?

A

DNA synthesis

474
Q

Increased intramedullary hemolysis causes

A

Release of heme—-> indirect hyperbilirubinemia and elevating LDH, total RBC/reticulocyte count will be low, thrombocytopenia, leukopenia

475
Q

Tx of Rheumatoid Arthritis

A

Methotrexate, Hydroxychloroquine, TNF- inhibitors (infliximab, etanercept)

476
Q

Most common malignancy in upper cervical node

A

Head and neck squamous cell carcinoma

477
Q

Dx: elderly patients with painless cervical waxing and waning lymphadenopathy, leukocytosis

A

Dx: CLL (Chronic Lymphocytic Leukemia

478
Q

Dx: glomerulonephritis, pulmonary nodules, ear pain, subcutaneous nodules

A

Granulomatous polyangitis

479
Q

Dx: fever, night sweats, weight loss, painless cervical lymphadenopathy

A

Dx: Hodgkin Lymphoma

480
Q

Dx: fever, pharyngitis, fatigue, bilateral multiple lymphadenopathy, young patients

A

Infectious Mononucleosis (EBV)

481
Q

Dx: Dry cough, malaise for long term + bilateral hilar adenopathy

A

Sarcoidosis

DGx: radiographic + clinical findings

482
Q

Dx: mid 40s patient, non smoking, dyspnea, cough, sputum production, CXR: hyperinflation

A

Alpha-1- antitrypsin deficiency

483
Q

Dx: adult, fever, weight loss, rhinosinusitis, CXR: pulmonary nodules and alveolar consolidation

A

Necrotizing pulmonary vasculitis (granulomatosis with polyangitis)

484
Q

Dx: CHF patient, cardiomegaly, cephalization of pulmonary vessels, prominent vascular markings, pleural effusions

A

Pulmonary venous congestion

485
Q

Risk Factors for Pulmonary Fibrosis

A

Microscopic alveolar epithelial injury (smoking, GERD, silent aspiration)
Inappropriate repair by fibrosis
Male, >60y.o., smoking,

486
Q

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

A

Dx: Pulmonary Fibrosis
Tx: Antifibrotic Therapy (pirfenidone, nintedanib), smoking cessation, GERD treatment, supplemental oxygen, lung transplant

487
Q

Tx of asthma exacerbation

A
  1. SABA: albuterol
  2. SAMA: ipratropium
  3. IV Magnesium
  4. F/U with systemic glucocorticoids: prednisone/dexamethasone
488
Q

Dx, Tx, Px: Infant, Inspiratory Stridor, Harsh Cough, Hoarseness

A

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
Q

MCC of Mitral Stenosis in adults

A

Rheumatic Heart Disease

490
Q

Dx: exertional dyspnea, cough, orthopea, left atrial dilation, elevation of left main stem bronchus, atrial fibrilliation, acute decompensated heart failure

A

Mitral Stenosis in the setting of Rheumatic Heart Disease

491
Q

Dx: acute onset SOB, hypoxia, unilaterally decreased breath sounds in COPD patient, chest pain, hyper-resonance on percussion

A

Dx: large alveolar bleb ruptures- leak air into pleural space- secondary spontaneous pneumothorax

492
Q

Tx of lumbosacral radiculopathy

A

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
Q

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

A

Paget’s Disease of Bone

Tx: Bisphosphonates

494
Q

Dx and Tx: obese with heavy panniculus, diabetes, or pregnancy, numbness and tingling (pins/needles on lateral thigh, no motor deficits

A

Dx: Meralgia Paresthetic
Tx: avoid tight garments, weight loss, gabapentin or nerve block (if necessary)

495
Q

Dx and Tx: Swelling, heaviness, discomfort
Early: soft skin, pitting edema
Late: firm, dry and thickened skin, non-pitting edema

A

Dx: lymphedema
Tx: weight loss, limb elevation, compression bandages and physiotherapy, do not use diuretics

496
Q

Indications for preoperative ECG?

A

Hx of CAD or arrhythmia, MACE risk >1%

497
Q

Indications for preoperative Chest Radiograph

A

Hx of Cardiopulmonary disease, under going upper abdominal/thoracic surgery

498
Q

Indications for preoperative CBC

A

Hx of anemia, expected significant blood loss, under going major surgery

499
Q

Indications for coagulation and platelets preoperatively

A

Hx of abnormal bleeding, anticoagulant use, liver disease, malignancy, planned spinal anesthesia

500
Q

Indications for CMP preoperatively

A

Hx of Kidney disease, ASCVD risk, predisposing medications (diuretic, ACEi, ARB)

501
Q

Developmental Milestones for 2 month infants

A

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
Q

Developmental Milestones of 4 month infants

A

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
Q

Development Milestones for 6 month old infants

A

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
Q

Development Milestones at 9 months infant

A

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
Q

Developmental milestones 12 month infant

A

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
Q

Raising the cut off point for a test will do what to specificity and sensitivity?

A

Increase specificity

Decrease sensitivity

507
Q

Simple vs. Malignant Renal Cysts

A

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
Q

Dietary Prevention measures for recurrent nephrolithiasis

A

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
Q

Drug therapy prevention for recurrent nephrolithiasis

A

Thiazide diuretic
Potassium Citrate/Bicarbonate Salt
Allopurinol (hyperuricuria related stones)

510
Q

Dx, DGx, and Tx: night time bed wetting age > 5 w/o prolonged period of continence

A

Dx: Primary nocturnal enuresis
DGx: UA
Tx: Reassurance, Behavioral Modifications, Bedwetting Alarm

511
Q

Dx, DGx, Tx: Night time incontinence >5 y.o. After prolong period of continence

A

Dx: secondary nocturnal enuresis via UTI, DM, psychological stress
DGx: UA
Tx: treat underlying disease, behavioral modifications

512
Q

MC bacteria in UTI

A

E. Coli, Klebsiella, Proteus

513
Q

Medication used for passing distal ureteral stone

A

Alpha 1 antagonists: tamsulosin

514
Q

Drugs that can induce interstitial nephritis (fever, rash, arthralgias, eosinophilia, hematuria, sterile pyuria, eosinophiluria

A

Penicillins, cephalosporins, sulfonamides

515
Q

Mitral Stenosis —> Atrial Fibrilliation how?

A

Left atrial dilation

516
Q

DGx and Tx of aortic stenosis

A

Aortic jet velocity >4.0 or mean transvalvular pressure > 40mm Hg
Indications for valve replacement: angina, syncpe, LVEF <50%, CABG

517
Q

Dx and Tx: Leg Edema, Fatigue, Pain, Superficial venous dilation, often worse at the end of the day, no thrombus on US

A

Dx: Post thromboTic syndrome- chronic venous insufficiency following DVT
Tx: exercise: ankle flexion, walking), Compression (bandages or stockings)

518
Q

Common side effect of CCB (amlodipine)

A

Peripheral Edema

519
Q

Dx: enlarged globular cardiac silhouette on chest X-ray, diminished heart sounds and maximal impulse difficult to palpate

A

Pericardial Effusion

520
Q

Diagnostic Criteria for Orthostatic Hypotension

A

Postural decrease of blood pressure by 20 mgHG systolic or 10 mmHg diastolic

521
Q

Dx, Tx, and Cx: rapidly growing nodule with ulceration and keratin plug, spontaneous regression

A

Dx: Keratoacanthoma
Tx: excisional biopsy with complete removal of lesion
Cx: can progress to squamous cell carcinoma

522
Q

Dx DGx, and Tx: Scaly, erythematous, pruritic patch with centrifugal spread, subsequent central clearing with annular border

A

Dx: Tinea Corporis (ringworm)
DGx: KOH preparation
Tx: topical antifungal (clotrimazole, terbinafine or oral antifungals (terbinafine, griseofulvin)

523
Q

Dx: numerous, ring like widespread plaques with annular or serpinginous border and central clearing, transient, non-pruritic, child associated with rheumatic fever

A

Dx: erythema marginatum

524
Q

Dx: target shaped rash associated with Lyme Disease

A

Erythema migrans

525
Q

Dx: Chronic, relapsing, coin shaped patches on extremities, erythematous, pruritic, scant exudate

A

Nummular eczema

526
Q

Viral prodrome, christmas tree pattern Numerous oval, scaly plaques with large initial lesion, resolves in 6 weeks

A

Pityriasis Rosea

Tx: Reassurance, antihistamines

527
Q

erythematous target lesions with a dusky center, worse with infections

A

Erythema Multiforme

528
Q

Dx and Tx: non-inflammatory, hyperkeratinization spots on face

A

Dx: acne vulgaris (Cutibacterium acnes)
Tx: topical retinoid (salicylic, azelaic, glycolic acid)

529
Q

Dx and Tx: scaling, lichenification, fissuring on hands

A

Dx: contact dermatitis
Tx: emollients, topical corticosteroids, and irritant avoidance

530
Q

Dx: itchy (pruritic), scaly patches on palms or annular plaques raised on dorsum, usually unilateral,

A

Dx: tinea Manuum

531
Q

Dx and Tx: onset in early childhood, diffuse scaly skin with mild pruritus, worse on extensor extremities

A

Dx: Ichthyosis Vulgaris
Tx: long baths to remove scales, moisturization, keratolytics (urea, alpha-hydroxy acid, salicylic acid)

532
Q

Dx, Tx, Cx: pruritic, erythematous patches and papules, extensor surfaces, trunk or facez

A

Dx: atopic dermatitis (eczema)
Tx: emollients, topical corticosteroids
2nd line- pimecrolimus (topical calcineurin inhibitors

Cx: impetigo (Staph A) or Eczema herpeticum (HSV)

533
Q

Dx and Tx: papules, pustules, vesicles, golden crusting, weeping, purulence, painful/itch

A

Dx: Impetigo
Tx: topical mupirocin or oral cephalexin (local vs. widespread)

534
Q

Child abuse scald wounds typically have:

A

Spare flexural creases, sharp line of demarcation, uniform burn depth, absence of splash marks

535
Q

Tx of Vitiligo

A

Limited: topical corticosteroids
Extensive: oral corticosteroids, topical calcineurin inhibitors, PUVA

536
Q

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

A

Adenovirus conjunctivitis

537
Q

Dx: unilateral/bilateral eye involvement, eyes stuch shut, purulent thick discharge reappearing after wiping, unremitting discharge, diffuse injection, non-follicular, in adult vs. child

A

Adult: Staph Aureus Conjunctiviitis
Child: Hib, Moraxella Catarrhalis, Strep Pneumo

538
Q

Dx: intensely pruritic erythematous papules, vesicles, and bullae occur symmetrically in grouped clusters on extensor surfaces associated with diarrhea/wt loss (celiac disease

A

Dx: dermatitis herpetiformis
Tx: dapsone, gluten free diet

539
Q

Characteristics of right sided colon tumors

A

Occult bleeding and Iron deficiency anemia

540
Q

Characteristics of left sided colon cancer?

A

Obstruction of flow of stool, crampy—> colicky pain, constipation, hematochezia (blood in stool)

541
Q

Rectal tumor characteristics

A

Hematochezia (blood in stool, frank red blood, narrowed stools, tenesmus, sensation of mass in rectum.

542
Q

Dx: headache, female, family history of headaches, variable onset, unilateral, pulsatile and throbbing, 4-72 hours, Auras, photophobia, phonophobia, nausea

A

Migraines

543
Q

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

A

Cluster Headache

Tx: prophylatic verapamil, subq sumatriptan + 100% oxygen

544
Q

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

A

Tension Headaches

545
Q

Dx: facial pain, rhinorrhea, fever, anosmia

A

Acute maxillary sinusitis

546
Q

Dx: erythema, edema, tenderness, impaired extraocular movement

A

Dx: Orbital Cellulitis

547
Q

Dx: sudden onset eye pain, nausea, diminished vision with halos around lights, fixed mid-dilated pupil

A

Angle Closure Glaucoma

548
Q

Dx: progressive headache, morning nausea, focal neurological deficits

A

Dx: brain tumor

549
Q

Dx: pure motor hemiparesis, ataxic hemiparesis, dysarthria

A

Lacunar infarct

550
Q

Dx: sudden onset, persistent, severe headache with vomiting, seizure, decreased level of consciousness

A

Subarachnoid Hemorrhage

551
Q

Dx: recurrent stabbing pain along mandible and Maxilla, triggered by anything,

A

Dx: trigeminal neuralgia

552
Q

Complication of Long Term Metformin Use

A

Vitamin B12 deficiency in terminal ileum

553
Q

Minority neurological manifestations of B12 deficiency

A

Impaired vibratory/proprioception/sensory ataxia
Positive babinski sign
Lower extremity paresthesias
Irritation/mood changes

554
Q

Mytonia, pain, weakness in distal facial muscles, cardiac arrhythmias, hypogonadism

A

Myotonic dystrophy- AD CTG repeatexpansion in DMPK

555
Q

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

A

Pyogenic granuloma or lobular capillary hemangioma

Tx: surgical excision, laser therapy, silver nitrate, can regress post-partum

556
Q

Dx: HIV patient, multiple reddish purple papules that evolve into friable nodular lesions with fever, malaise, night sweats

A

Dx: Bacillary Angiomatosis (Bartonella Infection)

557
Q

Dx: rapid growing-volcano like nodule with central keratotic plug, non friable

A

Dx: Keratoacanthoma

558
Q

Dx/ Tx: firm domed, papule with central umbilication in adult, genital or extensive

A

Dx: Mollusca Contagiosum
Tx: cryotherapy, curettage, topical therapy (cantharidin, podophyllotoxin)

559
Q

Tx of tinea pedis

A

DGx: clinical + KOH prep
Tx: Topical Antifungals: miconazole, terbinafine, tolnaftate

560
Q

Dx and Tx: infant, erythematous papules, plaques, spares skinfolds

A

Dx: irritant contact dermatitis
Tx: topical barrier: petrolatum, zinc oxide

561
Q

Dx and Tx: Infant,Beefy-red confluent plaques, involves skin folds, satellite lesions

A

Dx: Candida Dermatitis
Tx: Topical Antifungal (Nystatin)

562
Q

Microblastic anemia serum iron study findings

A

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
Q

Dx, Dgx, Tx: small papule/pustule—> rapidly progressive painful ulcer with purulent base, violaceous border, ulceration (common in RA or AML)

A

Dx: pyoderma gangrenosum
DGx: Dx of exclusion, mixed inflammation on biopsy
Tx: local/systemic glucocorticoids

564
Q

Dx: hemorrhagic pustules —> necrotic ulcers with neutropenia/bacteria, fever, little pain

A

Dx: ecthyma gangrenosum- pseudomonas aeruginosa

565
Q

Dx: acute panniculitis, tender erythematous nodules/plagues on lower extremeties, no ulceration, resolve after 2-8 weeks

A

Dx: Erythema Nodosum

566
Q

Dx: small papule/nodule from rose bushes/plants

A

Dx: Sporotrichosis

567
Q

Dx and Tx: papules and pustules with honey crusted lesions

A

Dx: nonbullous impetigo (Staph A, or Group A strep (pyogenes)
Tx: topical mupirocin (antibiotics) or oral antibiotics (cephalexin)

568
Q

Dx and Tx: enlarging flaccid bullae with yellow fluid

A

Dx: Staph A- Bullous Impetigo
Tx: Oral Cephalexin

569
Q

Dx: bilateral non-tender, non pruritic maculopapular or vesicular rash on palms and soles

A

Dx: Coxsackie Virus (Hand-Foot-and- Mouth Disease

570
Q

Dx: clusters of painful vesicles on lips, fingers, do not enlarge rapidly

A

Dx: HSV

571
Q

Dx and Tx: fever, chest pain, hemoptysis in Immunocompromised, Pulmonary nodules with halo sign, positive cultures/cell wall biomarkers

A

Acute Aspergillosis

Tx: Voriconazole + Caspofungin

572
Q

Dx and Tx: lung disease/damage previous: > 3months weight loss, hemoptysis, fatigue, cavity lesion/fungus ball

A

Dx: Chronic pulm aspergillosis
Tx: Resect aspergilloma, Voriconazole, Embolization

573
Q

Dx and Tx: poorly localized shoulder pain pain and stiffness, decreased ACTIVE and PASSIVE ROM, atrophy of shoulder may occur

A

Dx: Adhesive Capsulitis
DGx: Clinical, X-ray, MRI rule out
Tx: ROM exercises, NSAIDs, Corticosteroid Injections, Surgical Release

574
Q

Dx, DGx, Tx: epigastric pain + dark stools (melena) + improves with food

A

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
Q

Dx: multiple paracentesis with blood ascites

A

Dx: Malignancy: MC Hepatocellular Carcinoma
Dgx: Cytologic analysis- for underlying tumor should be done

576
Q

Obstructive and Restrictive Lung Disease PFTs

A

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
Q

Dx and Tx: Infant, increased tearing, eyelash crusting, clear conjunctivae

A

Dx: congenital dacryostenosis (congenital nasolacrimal duct obstruction
Tx: observation, lacrimal sac massages, probing of duct

578
Q

Dx: infant, purulent eye drainage, erythema, warmth, tenderness and swelling over lacrimal sac

A

Dacryocystitis (NLD infection)

579
Q

Dx: infant, 2-5 days old, profuse, purulent eye drainage, conjunctival injection (bloodshot eyes), eyelid swelling

A

Dx: Gonococcal eye infection
Px: erythromycin eye ointment

580
Q

Dx: clear mucoid eye discharge, erythematous conjunctivae, viral prodrom (fever, congestion)

A

Dx: viral conjunctivitis

581
Q

Tx of fibromyalgia

A

Amitriptyline

582
Q

Side effects of amitriptyline (treatment for Fibromyalgia, depression, insomnia)

A

Anticholinergic symptoms: dry mouth, constipation, urinary retention
Histamine symptoms: lethargy
Alpha-adrenergic receptors: orthostatic hypotension

583
Q

Dx and Tx: erythematous (red), pruritic (itchy) plaques with greasy scales—-> scalp, central face, ears, chest

A

Dx: Seborrheic Dermatitis
Tx: Topical Antifungals (selenium sulfide, ketoconazole), topical glucocorticoids, topical calcineurin inhibitors (pimecrolimus)

584
Q

Dx and Tx: erthymatous, scaly, annular plaques

A

Dx: tinea
Tx: oral antifungals (terbinafine, itraconazole)

585
Q

Dx & Tx: dry scaly skin on extremities and trunk

A

Dx: xerosis
Tx: Topical Emollients

586
Q

Dx, DGx, & Tx: episodic dyspnea and noisy breathing during exercise, inspiratory stridor

A

Dx: Paradoxical Vocal Fold Motion (PVFM)
DGx: Laryngoscopy
Tx: therapy with speech-language pathologist

587
Q

IBS DGx criteria

A

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
Q

IBS alarms

A 
> 50 age of onset
GI bleed
Nocturnal diarrhea
Worsening pain
Unintended weight loss
IDA
Elevated CRP
Positive fecal lactoferrin or calprotectin
589
Q

Dx and Tx: lower extremity edema, varicose veins, skin discoloration, medial skin ulceration

A

Dx: Chronic Venous Insufficiency
Tx: leg elevation, exercise, compression therapy

590
Q

Dx & Tx: well-defined erythematous plaques with silvery scale, extensor surfaces

A

Dx: plaque psoriasis
Tx: topical: glucocorticoids, Vit-D analogs, tar, retinoids, calcineurin inhibitors, tazarotene
Systemic: methotrexate, calcineurin inhibitors, retinoids, apremilast, biologics

591
Q

Dx DGx, & Tx: painless bright red rectal bleeding,

A

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
Q

Dx & Tx: itchy (pruritic), purple/pink, polygonal, papules and plaques on skin or white papules/plaques, erythema,mucosal atrophy, ulcers in oral mucosa

A

Dx: Lichen Planus
Tx: high potency glucocorticoids: betamethasone, widespread: systemic glucocorticoids, phototherapy

593
Q

antipsychotic medications (Risperidone) block dopamine- SFX?

A

Hyperprolactinemia, gynecomastia, galactorrhea, menstrual dysfunction, decreased libido

594
Q

Tx of Somatic Symptom Disorder

A

Regular primary care follow-up that targets coping skills, provides reassurance, and avoids unnecessary tests

595
Q

Dx: hypertension, hypokalemia, elevated bicarb, urine acidification

A

Hyperaldosteronism

DGx: Serum Renin low, Aldosterone high

596
Q

Dx: hypotension, hyponatremia, hyperkalemia, hypoglycemia, metabolic acidosis

A

Dx: Addison’s disease (AI failure of adrenal glands

597
Q

Dx, DGx, Tx: Linear white scaly areas with moist raw skin between toes

A

Dx: Trichophyton Rubrum- Tina pedis
DGx: KOH prep- hyphae
Tx: topical antifungal: clotrimazole, terbinafine, ketoconazole

598
Q

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

A

Dx: Viral Endocarditis (Coxsackie B, Parvovirus B19, HHV-6, Adenovirus, HIV
DGx: normal ECG, CXR
Tx: supportive, resolves in time

599
Q

Dx, DGx, Tx: Child, migratory polyarthralgia, pancarditis, subcutaneous nodules, erythema marginatum, involuntary movements (sydenham chorea) 1-5 weeks after infection

A

Dx: Acute Rheumatic Fever
DGx: strep titers
Tx: Penicillin V, or Ceftriaxone

600
Q

Dx, Dgx, Tx: teenager, sore throat, fatigue, malaise, fever, chills, pharyngitis, cervical lymphadenopathy and tenderness, hepatosplenomegaly
Labs: atypical lymphocytes, negative strep test

A

Dx: EBV- Mono
DGx: Monospot Test
Tx: supportive- no sports, lidocaine gargle
Do not use amox—> generalized maculopapular rash

601
Q

Dx and Tx: sore throat, erythema and exudates, cervical lymphadenopathy, oral sex

A

Gonococcal pharyngitis

IM ceftriaxone

602
Q

Nausea, vomiting, altered mental status, seizures, hepatomegaly in child

A

Reye Syndrome- oral aspirin in child

603
Q

Depressed mood + cognitive defects in a elderly person,rapid onset, poor cooperation/effort, apathy, normal neurologic findings

A

Pseudodementia

Tx: SSRIs

604
Q

Dx: rapid progressive dementia with myoclonus (involuntary twitches), ataxia, nystagmus

A

Creutzfeldt-Jakob disease

605
Q

Dx and Tx: confusion, horizontal/vertical nystagmus, opthalmoplegia, ataxia

A

Dx: Wernicke’s Encephalopathy- Chronic Alcohol Abuse
Tx: fluids and thiamine repletion (B1 deficiency)

606
Q

Dx: encephalopathy, cognitive dysfunction, interstitial nephritis, vomiting, abdominal pain, constipation, anemia in infant,

A

Dx: lead poisoning
DGx: serum lead

607
Q

Dx; delays in speech, language, cognitive development, reciprocal interactions, normal eye contact

A

Hearing Deficit

DGx: aural stimuli

608
Q

Cx of Down Syndrome

A 
Alzheimer’s Dementia
ALL/AML
Cardiac Septal Defects
Duodenal Atresia
Hirschsprung Disease
609
Q

Dx: delayed communication and social skills, impaired non-verbal communication (no eye contact/facial expressions)

A

Dx: Autism Spectrum Disorder
DGx: Clinical
Tx: CBT

610
Q

Dx and Cx: HIV patient, fever pharyngitis, atypical leukocytes, retinitis (visual disturbances, flashing lights, blurred vision), esophagitis, pneumonia

A

Dx: CMV or HHV-5
Cx: retinal necrosis, edema, detachment

611
Q

Dx: HIV pateint, immunocompromised, dyspnea, pulmonary infiltrate, meningitis, encephalitis

A

Cryptococcus Neoformans

612
Q

Dx: HIV immunocompromised, self-limiting watery diarrhea, wt loss and dehydration

A

Cryptosporidium Parvum

613
Q

Dx: HIV immunocompromised, pneumonia, choreoretinitis (decreased visual acuity, eye pain, hepatitis (elevated AST/ALT)

A

Toxoplasma Gondii

614
Q

Dx and Tx: depressive, anxiety, behavioral changes <6 months with identifiable stressor

A

Dx: Adjustment Disorder
Tx: CBT + SSRI

615
Q

Dx and Tx: increase tolerance to alcohol intake, palpitations, sweating, anxiety, insomnia, tremor, headaches, tonic-clonic seizures on cessation to alcohol (6-24 hrs)

A

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
Q

Dx: 7-9 year old, avoiding school, can’t separate from father, mother, grandmother, guardian,etc

A

Separation Anxiety Disorder

617
Q

Dx: child/adolescent—> persistent aggression towards people/animals, lying, serious rule violations (destruction of property, deceitfulness < 18 y/o

A

Dx: Conduct Disorder
Tx: CBT

618
Q

Dx, DGx, Tx: malabsorption, flatulence, abdominal bloating, fat in stools (steatorrhea), nutritional deficiencies, iron deficiency anemia, grouped pruritic bilateral subepidermal vesicles (Dermatitis Herpetiformis)

A

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
Q

Dx, DGx, Tx: cramp pain, relieved with BM, intermittent diarrhea/constipation, associated with stress or fibromyalgia

A

Dx: IBS
DGx: Clinical
Tx: Reassurance, Exercise + Diet Modifications

620
Q

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

A

Dx: N. Meningitidis (strep pneumo)
DGx: Clinical + CSF culture
Tx: Ceftriaxone or Vanc
Cx: Shock, DIC, Adrenal Hemorrhage

621
Q

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

A

Dx: HiB meningitis
DGx: Clinical + CSF Culture
Tx: Ceftriaxone

622
Q

Meningitis Infections in infants by age

A

<1 months - Listeria Monocytogenes
<3 months- group B streptococcus
> 1 year- N. Meningitis, Strep pneumo
> 1 year + unvaccinated - HiB

623
Q

Dx, DGx, Tx: >45 y/o, progressive loss of vision over a year, sensitivity to glare, halos around lights, opacifcation of lens

A

Dx: Cataracts
Tx: Surgery
Early onset in DMII trauma, steroid

624
Q

Dx: unilateral loss of central vision, fluffy granualar retinal with yellow white fluffy lesions, photpsia (flashing light sensitvity), scotomata (blind spots)

A

CMV retinitis

625
Q

Dx, DGx, Tx: unilateral ocular pain, redness, tearing, with branching/dendritic corneal ulcers

A

Dx: HSV retinitis
DGx: fluoroscein

626
Q

Dx, DGx, Tx: Fever, Low ROM in Joint, Non-weight bearing, acute, elevated WBC,ESR, C-reactive protein

A

Dx: Septic Arthritis
DGx: Arthrocentesis purulent synovial fluid > 50K
Tx: operative + Vancomycin + Cefriaxone

627
Q

Dx: slow onset hip pain, child, no fever, leukocytosis

A

Legg-Calve-Perthes

628
Q

Dx: 10-15y/o- overweight + fracture of hip growth plate

A

Slipped Capital Femoral Epiphysis

629
Q

Dx, DGx, Tx: young males, unilateral painless testicular nodule/swelling, dull lower abdominal ache, dyspnea, neck mass, low back pain

A

Dx: Testicular Cancer
DGx: scrotal US, tumor markers (AFP, B-hCG, CT scan
Tx: radical orchiectomy, chemotherapy

630
Q

Dx and Tx: itchy (pruritic), purple, polygonal papules/plaques on flexural surfaces assx with Hep C (IV users)

A

Dx: Lichen Planus
Tx: resolves spontaneously use betamethasone (topical high-potency glucocorticoids

SHELF EXAMS (3 decks)

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