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Family medicine > Family medicine > Flashcards

Family medicine Flashcards

1
Q

Chorioretinitis, hydrocephalus, and intracranial calcifications

A

congenital toxoplasmosis

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2
Q

Woman with recurrent HA, pulsatile tinnitus, neck pain, or flank pain, HTN

A

Fibromuscular dysplasia

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3
Q

Treatment of bacterial endocarditis with ischemic stroke

A

IV antibiotics

Surgery if significant dysfunction with HF, or continued septic embolization

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4
Q

2 mo old with seizures, increased head circumference, AMS after minor trauma

A

Think abuse

Subdural bleeding

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5
Q

Newborn with closed fists and overlapping fingers, micrognathia, prominent occiput

A

Trisomy 18 (edwards syndrome)

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6
Q

Three types of proteinuria in children

A

Transient
Orthostatic
Persistent

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7
Q

Most common cause of unilateral acute lymphadenitis in children

A

S. aureus, Strep pyogenes

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8
Q

intoxication causing tachycardia, HTN, dry mouth, conjunctival injection and increased appetite

A

MJ

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9
Q

corneal vesicles and dendritic ulcers

A

Herpes simplex keratitis

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10
Q

Vaccines for pts with HIV

A
  • Hep B
  • Annual flu
  • PCV13 and PPSV23
  • Varicella
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11
Q

Tx for patients with severe penicillin allergy and syphilis

A

Doxycycline

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12
Q

profuse frequent (10-20) BM per day. Nocturnal BM with painful abd cramps. Dark brown discoloration of colon with pale lymph follicles

A

Factitious diarrhea

laxative abuse

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13
Q

Abdominal pain radiating to the scapula

A

Think gallbladder

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14
Q

epigastric pain radiating to the back

A

pancreatitis

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15
Q

presentation of appendicitis in elderly

A

Abnormal presentation

must have high suspicion with abdominal pain and fever

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16
Q

Diagnosis of choledocholithaisis

A

ERCP

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17
Q

Initial Ranson’s criteria

A 
>55yo
WBC >16,000
Glucose >200
LDH>350
AST>250
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18
Q

When do you repeat a pap if it shows atypical squamous cells of unknown significance with negative HPV?

A

When next pap is due (3yrs)

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19
Q

HPV+ on pap. then what?

A

Colposcopy

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20
Q

Labs for AoCD

A

Serum iron and TIBC decreased

Ferritin increased

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21
Q

prophylactic tx for sickle cell pain crisis

A

adequate O2 and H2O

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22
Q

Screening Age: Breast cancer

A

Women 50-75

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23
Q

Screening frequency: Breast cancer

A

Mammogram every 2 years

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24
Q

Screening age: Cervical cancer

A

Women 21-65

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25
Q

Screening frequency: Cervical cancer

A

pap every 3 years

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26
Q

Screening age: colon cancer

A

50-75

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27
Q

Screening frequency: colon cancer

A

Fecal occult blood test yearly OR colonoscopy every 10 yrs

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28
Q

Screening age: HIV

A

15-65

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29
Q

Screening frequency: HIV

A

One time

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30
Q

Screening age: Hyperlipidemia

A

Men 35+ (unless there are risk factors)

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31
Q

Screening frequency: Hyperlipidemia

A

Lipid panel every 5 years

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32
Q

Screening age: HTN

A

18+

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33
Q

Screening frequency: HTN

A

BP every 2 years

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34
Q

Screening age: Osteoporosis

A

Women 65+

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35
Q

Screening frequency: Osteoporosis

A

At least one DEXA

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36
Q

Overweight woman with HA, transient vision loss, papilledema, pulsatile tinnitus

A

Idiopathic intracranial HTN

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37
Q

Diagnosis of idiopathic intracranial hypertension

A

MRI +/- MRV

then LP for opening pressure (>250)

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38
Q

Relative risk associated with what kind of study

A

Cohort study

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39
Q

Odds ratio associated with what kind of study?

A

Case-Controlled

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40
Q

When can odds ratio approximate the relative risk?

A

When the disease is rare and disease incidence is low

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41
Q

Equation for relative risk

A

RR=[a/(a+b)] / [c/(c+d)]

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42
Q

Equation for odds ratio

A

OR=ad/bc

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43
Q

Most common cause of brain abscess

A

Viridians strep
or
S. aureus

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44
Q

Muffled voice, unilateral lymphadenopathy, and deviated uvula after fever, chills and sore throat

A

Peritonsillar abscess

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45
Q

Treatment of a peritonsillar abscess

A

Aspiration and IV antibiotics

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46
Q

Most common head and neck cancer

A

SCC

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47
Q

Treatment for severe cancer pain

A

Short acting opioids (morphine, hydromorphone, oxycodone)

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48
Q

How to diagnose follicular thyroid cancer

A

Excision of tumor and identification of invasion of the tumor capsule and/or blood vessels

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49
Q

Treatment of pyelonephritis in diabetic patient

A

IV ceftriaxone w/in 48 hrs

then switch to oral fluoroquinolone and bactrim 10-14d

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50
Q

Treatment for uncomplicated infection

A

Bactrim or cipro

OR ceftriaxone if severe

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51
Q

Screening for hemoglobinopathies

A

CBC

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52
Q

Monocular transient vision loss with sense of “a curtain falling down”

A

Amaurosis fugax

Cause: retinal emboli

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53
Q

When to use steroids in the treatment of PCP

A

if PaO2 <70 or A-a gradient >35

With TMP-SMX

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54
Q

diagnosis of pesudoachalasia

A

endoscopy

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55
Q

flaccid bullae, easy separation of epidermis, mucosal erosions

A

Pemphigus vulgaris

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56
Q

pruritic tense bullae in flexural surfaces, groin and axilla

A

bullous pemphigoid

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57
Q

Risk factors for squamous cell carcinoma of the esophagus

A

smoking, alcohol, dietary deficiency of beta-carotene, B1, zinc, hot beverages, smoked foods

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58
Q

Risk factors for adenocarcinoma of the esophagus

A

GERD, obesity, high dietary calorie and fat intake.

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59
Q

Causes of rapidly progressive ascending paralysis

A

Tick-borne paralysis: absence of fever and sensory abnl w/ nl CSF

GBS: autonomic dysfunction and abnl CSF

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60
Q

Causes/risks of Bartonella infection

A
  • Cat exposure
  • Homelessness (lice)
  • Severe immunocomprimise
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61
Q

Manifestations of Bartonella

A 
Vascular cutaneous lesion (small reddish/purple papule--> nodular lesions)
Constitutional symptoms (fever, malaise night sweats)
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62
Q

Risk factors for C. diff

A
  • Recent antibiotics
  • Hospitalization
  • PPI
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63
Q

Who should get PPSV23 alone

A

Chronic heart, lung, or liver dz
DM, smoker, alcoholics

all under 65

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64
Q

First line treatment of acute otitis media

A

Amoxicillin

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65
Q

Cause of acute otitis media

A

S. pneumo

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66
Q

Treatment for otitis externa

A

topical antibiotics

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67
Q

LE edema that spares the feet

A

Lipedema

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68
Q

Chronic unilateral leg swelling

A

Venous insufficiency

Compression stockings

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69
Q

HIV pt w/ CD4<50, nonspecific systemic symptoms, splenomegaly, elevated alk phos

A

MAC

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70
Q

CD4 count <50 prophylaxis

A

Bactium (PCP)

Azithromycin (MAC)

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71
Q

Appearance of SCC

A

Keratinized (thickened and rough), ulcerated with crusting and bleeding

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72
Q

Most common skin malignancy in pts on chronic immunosuppression

A

SSC

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73
Q

Treatment for cancer related anorexia

A 
Progesterone analogues (megestrol acetate)
OR corticosteroids
74
Q

Most common malignancy of the lip

A

SCC

75
Q

SE of cyclosporine

A 
Nephrotoxicity 
HTN
Neurotoxicity
Glucose intolerance
infection
Gingival hyperplasia
GI issues
76
Q

SE tacrolimus vs. cyclosporine

A

same except tacrolimus does not have hirsutism and gum hypertrophy

77
Q

Major toxicity of Mycophenolate

A

Marrow supression

78
Q

Major toxicity of azathioprine

A

dose-related diarrhea, leukopenia, hepatotoxicity

79
Q

dome-shaped, firm, freely moving cystic nodule with small central ounctum

A

Epidermal inclusion cyst

80
Q

Elevated conjugated bili and alk phos

A

Malignancy, PBC, PSC, Choledocholithiasis

Get abdominal US

81
Q

difference between vascular dementia and NPH

A

VaD has asymmetric neurologic findings and occurs suddenly

82
Q

Clinical presentation of disseminated gonococcal infection

A

Purulent arthritis w/o skin lesions
OR
Triad: Tenosynovitis, Dermatitis, Migratory asymmetric polyarthralgia

83
Q

Treatment for disseminated gonococcal infection

A

IV ceftriaxone 1g/day for 7-14 days then switch to PO cefixime when clinically improved

Plus azithromycin for chlamydia

84
Q

Treatment for multi-drug resistant pyelo

A

Aminoglycosides

(amikacin)

Can be nephrotoxic

85
Q

Treatment for viral conjunctivitis

A

treat symptoms

associated with adenovirus

86
Q

Chest pain at night or that is precipitated by exercise, hyperventilation, emotional stress, or cold exposure. Plus transient ST elevation

A

Variant angina

87
Q

Treatment of variant angina

A

CCB or nitrates

88
Q

What region effected if there is contralateral sensory loss and burning pain weeks to months later

A

Lacunar stroke of the posterolateral thalamus

89
Q

Ovarian cyst that has hyper echoic nodules and calcifications on US

A

Dermoid ovarian cyst

90
Q

Adnexal fullness in asymptomatic patient

A

Mature cystic teratoma (dermoid ovarian cyst)

91
Q

Sudden, severe, unilateral pelvic pain w/ n/v with history of enlarged ovary

A 
Ovarian torsion 
(decreased blood flow leading to ischemia and necrosis)
92
Q

Sudden onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity. With pelvic free fluid

A

Ruptured ovarian cyst

93
Q

Treatment for stable ectopic pregnancy

A

methotrexate

94
Q

How to diagnose intraamniotic infection (chorioamnioitis)

A

Maternal fever and one or more of:

  • uterine tenderness
  • maternal or fetal tachycardia
  • malodorous amniotic fluid
  • purulent vaginal discharge
95
Q

Risk factor for chorioamnionitis

A
  • Prolonged rupture of the membranes

- prolonged labor

96
Q

Treatment for chorioamnionitis

A

IV Broad spectrum antibiotics (amp, gentamicin, clinda)

  • Oxytocin to accelerate labor
  • Antipyretics
97
Q

Treatment for erb-duchenne palsy

A

gentle massage and PT to prevent contracturs

Surgical intervention if infant with no improvement by age 3-6mo

98
Q

Recovery from erb-duchenne palsy

A

up to 80% spontaneous recovery w/in 3 mo

99
Q

Ddx for night sweats, insomnia and irregular menses in middle-aged woman

A

Menopause

Hyperthyroidism

100
Q

Presentation of cryptococcal meningoencephalitis

A

HA, fever, malaise, signs of elevated ICP

Subacute

101
Q

When HIV pts get Cryptococcus neoformans

A

CD4 <100

102
Q

Signs and symptoms of JC virus

A

Progressive multifocal leukoenchephalopahty

MRI shows patchy areas of white matter consistent with demyelination

103
Q

Causes of acute epididymitis in <35yo

A

Sexually transmitted (chlamydia, gonorrhea)

104
Q

Causes of acute epididymitis in >35yo

A

Bladder outlet obstruction (coliform bacteria, e coli)

105
Q

Treatment for acute epididymitis in >35yo

A

Levo

106
Q

Type of lung cancer associated with PTHrP production

A

Squamous cell carcinoma

107
Q

Paraneoplastic syndromes associated with small cell carcinoma

A

ACTH production and SIADH

108
Q

Elevated Maternal alpha fetal protein associations

A

Open neural tube defects
ventral wall defects
multiple gestations

109
Q

Associations with low alpha fetal protein

A

Aneuplodies

110
Q

Reversal for warfarin

A

Vitamin K

Adding back factors (prothrombin complex concentrate)

111
Q

Reversal of heparin

A

Protamine sulfate

112
Q

Causes of acute limb ischemia

A

cardiac emboli, thrombosis (hypercoag or vascular stent) or trauma

113
Q

Cardiac source of arterial emboli

A

Left ventricular thrombus
thrombus due to a fib
aortic atherosclerosis

114
Q

How to screen for LV thrombus

A

Echo

115
Q

Management of LV thrombus

A

anticoag, vascular surgery, TTE

116
Q

Difference between toxic epidermal necrolysis and stevens johnson syndrome

A

SJS <10% of body

TEN >30%

117
Q

What size PPD induration to treat with no exceptions

A

> or = 15mm

118
Q

Treatment for outpatient cellulitis

A

Oral nafcillin

119
Q

SIRS criteria

A

Fever >38
RR >20
HR >90
WBC > 12,000

120
Q

Treatment for Iron def anemia

A

Oral ferrous sulfate

121
Q

Click after S1 loudest at the apex

A

think about MVP

122
Q

When to start colon cancer screening for pts with one first degree relative with hx colon cancer before 60yo or two second degree relatives

A

start screening at age 40 or 10yrs before earliest age family member was effected.

Repeat every 5 years.

123
Q

drugs that cause pleuritis

A

Hydralazine, procainamide, quinidine

124
Q

Recommendation for daily aspirin in women (what for)

A

women ages 55-79 to prevent stroke

125
Q

Recommendation for daily aspirin in men (what for)

A

ages 45-79 for preventing MI

126
Q

Findings of hypocalcemia

A

Hyperreflexia, trousseau’s sign, heart block, seizures, paresthesias

127
Q

When to test a woman with gestational diabetes for diabetes post partum

A

6-12 wks

128
Q

Nail changes in cirrhosis

A
  • Muehrcke’s nails (transverse white bands)

- Terry’s nails (whitish nail beds sparing the tips)

129
Q

USPSTF recommendation for ovarian cancer screening

A

Recommends against it.

130
Q

Tests for spondylolysis

A

Single photon emission computed tomography

131
Q

HTN med that acts directly on the heart

A

Diltiazem and verapamil

132
Q

Contraindications to estrogen

A

History of migraines
DVT
breast cancer in past 5 yrs
smoking, ischemic heart disease, stroke, liver disease, major surgery with immobilization, poorly controlled HTN

133
Q

HbH disease treatment

A

Lifelong blood transfusion and deferoxamine

134
Q

When does acute stress disorder become PTSD

A

one month of symptoms

135
Q

How to prevent addisonian crisis post pituitary gland tumor removal

A

pre treat with glucocorticoids (dexamethasone)

136
Q

JVD, decreased heart sounds, hypotension

A

Beck’s triad

Cardiac tamponade

137
Q

Four mechanisms that produce shock after trauma to the thorax

A
  1. cardiac tamponade (cardiogenic)
  2. Tension pneumothorax (cardiogenic)
  3. Cardiac wall rupture (cardiogenic)
  4. Hypovolemic
138
Q

First line treatment for PSC

A

Ursodeoxycholic acid

139
Q

treatment for uncomplicated pyelonephritis

A

fluoroquinolones (cipro)

140
Q

First line treatment for symptomatic hyperthyroidism

A

Beta blocker (treat cardiac symptoms)

141
Q

Second line treatment for hyperthyroidism once symptoms are controlled

A

Methimazole

142
Q

Side effects of hydroxyurea that require monitoring

A
  • myelosupression (cbc with retic count)

- hepatotoxicity (LFT)

143
Q

Most common kidney stone with hyperPTH

A

Calcium phosphate

144
Q

first line treatment for CAP in output

A

Azithromycin

145
Q

First line for CAP in pts that need to be hospitalized

A

CTX and azithromycin

146
Q

Causes of diarrhea in patients with AIDS: severe watery diarrhea, low-grade fever, weight loss

A

Cryptosporium

CD4 less than 180

147
Q

Causes of diarrhea in pt with AIDS: watery diarrhea, cramps, weight loss, no fever

A

Microsporidium/isosporidium

CD4 less than 100

148
Q

Pt with AIDS, watery diarrhea, High fever, weight loss

A

MAC

CD4 less than 50

149
Q

Pt with AIDS, small, frequent volume diarrhea, hematochezia, abdominal pain, low grade fever, weight loss

A

CMV

CD4 less than 50

150
Q

Location of morton neuroma pain

A

between third and fourth toes on plantar surface with clicking sensation

151
Q

Diagnosing VAP

A
  1. abnormal chest x-ray

2. culture sputum

152
Q

Diagnosis of aortic dissection

A
  • CT if hemodynamically stable

- TTE (good for pts with renal insufficiency)

153
Q

Bladder pain with filling, relief with voiding, increased frequency and urgency, dyspareunia

A

Interstitial cystitis (painful bladder syndrome)

154
Q

Treatment of WPW

A

Procainamide and amiodarone

155
Q

Treatment for mild persistent asthma

A

ICS and PRN SABA

156
Q

treatment for moderate persistent asthma

A

ICS+LABA OR Montelukast

157
Q

Target of infliximab

A

TNF inhibitor

158
Q

Infliximab increases risk of what?

A

Infections

Screen for TB, Hep B and C before starting

159
Q

Positive hep C antibody enzyme immunoassay and recombinant assay with negative HCV RNA PCR means what?

A

Past infection with HCV now resolved

160
Q

When to hold metformin

A

Prior to CT with IV contrast due to risk of kidney dysfunction thus lactic acidosis

Also preop when risk of lactic acidosis

161
Q

ODC: do pts recognize that obsessions are excessive?

A

yes

162
Q

Treatment for HAP

A

(antipesudomonal PCN or ceph or carbapenem) + (FQ or genta+azithro) + MRSA coverage

163
Q

Treatment for outpt pneumonia with no recent abx

A

macrolide or doxycycline

164
Q

Treatment for outpt pneumonia with recent abx or comorbidities:

A

resp FQ or (macrolide + (high dose amox+clav Or 2 gen ceph)

165
Q

Which SSRI should be avoided in pregnancy?

A

Paroxetine

166
Q

20 yo female with acute dysuria, frequency and pyuria with negative culture

A

STI

chlamydia, gonorrheae, HSV

167
Q

Top intervention for anorexia nervosa

A

family based treatment

168
Q

when to stop preventative aspirin

A

80 yo

169
Q

baby with microcytic, hypo chromatic anemia. next steps?

A

prescribe oral iron

170
Q

Symptomatic treatment for mitral valve prolapse

A

Beta blockers

171
Q

Treatments for high altitude sickness

A

Acetazolamide (sulfa)

Dexamethasone

172
Q

Most common drug to cause acute interstitial nephritis

A

Antibiotics
PENICILLINS
cephalosporins
sulfonamides

173
Q

Most common cause of erythema multiforme

A

HSV

174
Q

Treatment for pyogenic tenosynovitis

A

W/in 1st 48hrs- PO abx and splinting

>48hrs- Surgical drainage and abx

175
Q

Causes of elevated BNP

A

heart failure, renal failure, PE, Pulm HTN, chronic hypoxia

176
Q

what further evaluation pre op does a pt with <4 METs require

A

A dipyridamole-thallium scan (cardiac stress test)

177
Q

risks of long term omeprazole use

A

increased risk of CAP and C. diff. decreased absorption of B12 and Ca (increased risk of hip frx)

178
Q

older than 35 with abnormal vaginal bleeding. what is next step?

A

Assess for endometrial assessment to exclude endometrial hyperplasia or cancer

179
Q

Treatment for hemodynamically unstable patients with a flutter

A

electrical cardiovert

180
Q

Treatment for atrial flutter in hemodynamically stable patient

A

Digoxin and verapamil

181
Q

treatment for unipolar depress with multiple failed SSRIs

A

Lithium or T3

182
Q

treatment for acute cervical radiculopathy and normal x-ray

A

NSAIDs

Family medicine (1 decks)

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