Family medicine Flashcards
Chorioretinitis, hydrocephalus, and intracranial calcifications
congenital toxoplasmosis
Woman with recurrent HA, pulsatile tinnitus, neck pain, or flank pain, HTN
Fibromuscular dysplasia
Treatment of bacterial endocarditis with ischemic stroke
IV antibiotics
Surgery if significant dysfunction with HF, or continued septic embolization
2 mo old with seizures, increased head circumference, AMS after minor trauma
Think abuse
Subdural bleeding
Newborn with closed fists and overlapping fingers, micrognathia, prominent occiput
Trisomy 18 (edwards syndrome)
Three types of proteinuria in children
Transient
Orthostatic
Persistent
Most common cause of unilateral acute lymphadenitis in children
S. aureus, Strep pyogenes
intoxication causing tachycardia, HTN, dry mouth, conjunctival injection and increased appetite
MJ
corneal vesicles and dendritic ulcers
Herpes simplex keratitis
Vaccines for pts with HIV
- Hep B
- Annual flu
- PCV13 and PPSV23
- Varicella
Tx for patients with severe penicillin allergy and syphilis
Doxycycline
profuse frequent (10-20) BM per day. Nocturnal BM with painful abd cramps. Dark brown discoloration of colon with pale lymph follicles
Factitious diarrhea
laxative abuse
Abdominal pain radiating to the scapula
Think gallbladder
epigastric pain radiating to the back
pancreatitis
presentation of appendicitis in elderly
Abnormal presentation
must have high suspicion with abdominal pain and fever
Diagnosis of choledocholithaisis
ERCP
Initial Ranson’s criteria
>55yo WBC >16,000 Glucose >200 LDH>350 AST>250
When do you repeat a pap if it shows atypical squamous cells of unknown significance with negative HPV?
When next pap is due (3yrs)
HPV+ on pap. then what?
Colposcopy
Labs for AoCD
Serum iron and TIBC decreased
Ferritin increased
prophylactic tx for sickle cell pain crisis
adequate O2 and H2O
Screening Age: Breast cancer
Women 50-75
Screening frequency: Breast cancer
Mammogram every 2 years
Screening age: Cervical cancer
Women 21-65
Screening frequency: Cervical cancer
pap every 3 years
Screening age: colon cancer
50-75
Screening frequency: colon cancer
Fecal occult blood test yearly OR colonoscopy every 10 yrs
Screening age: HIV
15-65
Screening frequency: HIV
One time
Screening age: Hyperlipidemia
Men 35+ (unless there are risk factors)
Screening frequency: Hyperlipidemia
Lipid panel every 5 years
Screening age: HTN
18+
Screening frequency: HTN
BP every 2 years
Screening age: Osteoporosis
Women 65+
Screening frequency: Osteoporosis
At least one DEXA
Overweight woman with HA, transient vision loss, papilledema, pulsatile tinnitus
Idiopathic intracranial HTN
Diagnosis of idiopathic intracranial hypertension
MRI +/- MRV
then LP for opening pressure (>250)
Relative risk associated with what kind of study
Cohort study
Odds ratio associated with what kind of study?
Case-Controlled
When can odds ratio approximate the relative risk?
When the disease is rare and disease incidence is low
Equation for relative risk
RR=[a/(a+b)] / [c/(c+d)]
Equation for odds ratio
OR=ad/bc
Most common cause of brain abscess
Viridians strep
or
S. aureus
Muffled voice, unilateral lymphadenopathy, and deviated uvula after fever, chills and sore throat
Peritonsillar abscess
Treatment of a peritonsillar abscess
Aspiration and IV antibiotics
Most common head and neck cancer
SCC
Treatment for severe cancer pain
Short acting opioids (morphine, hydromorphone, oxycodone)
How to diagnose follicular thyroid cancer
Excision of tumor and identification of invasion of the tumor capsule and/or blood vessels
Treatment of pyelonephritis in diabetic patient
IV ceftriaxone w/in 48 hrs
then switch to oral fluoroquinolone and bactrim 10-14d
Treatment for uncomplicated infection
Bactrim or cipro
OR ceftriaxone if severe
Screening for hemoglobinopathies
CBC
Monocular transient vision loss with sense of “a curtain falling down”
Amaurosis fugax
Cause: retinal emboli
When to use steroids in the treatment of PCP
if PaO2 <70 or A-a gradient >35
With TMP-SMX
diagnosis of pesudoachalasia
endoscopy
flaccid bullae, easy separation of epidermis, mucosal erosions
Pemphigus vulgaris
pruritic tense bullae in flexural surfaces, groin and axilla
bullous pemphigoid
Risk factors for squamous cell carcinoma of the esophagus
smoking, alcohol, dietary deficiency of beta-carotene, B1, zinc, hot beverages, smoked foods
Risk factors for adenocarcinoma of the esophagus
GERD, obesity, high dietary calorie and fat intake.
Causes of rapidly progressive ascending paralysis
Tick-borne paralysis: absence of fever and sensory abnl w/ nl CSF
GBS: autonomic dysfunction and abnl CSF
Causes/risks of Bartonella infection
- Cat exposure
- Homelessness (lice)
- Severe immunocomprimise
Manifestations of Bartonella
Vascular cutaneous lesion (small reddish/purple papule--> nodular lesions) Constitutional symptoms (fever, malaise night sweats)
Risk factors for C. diff
- Recent antibiotics
- Hospitalization
- PPI
Who should get PPSV23 alone
Chronic heart, lung, or liver dz
DM, smoker, alcoholics
all under 65
First line treatment of acute otitis media
Amoxicillin
Cause of acute otitis media
S. pneumo
Treatment for otitis externa
topical antibiotics
LE edema that spares the feet
Lipedema
Chronic unilateral leg swelling
Venous insufficiency
Compression stockings
HIV pt w/ CD4<50, nonspecific systemic symptoms, splenomegaly, elevated alk phos
MAC
CD4 count <50 prophylaxis
Bactium (PCP)
Azithromycin (MAC)
Appearance of SCC
Keratinized (thickened and rough), ulcerated with crusting and bleeding
Most common skin malignancy in pts on chronic immunosuppression
SSC
Treatment for cancer related anorexia
Progesterone analogues (megestrol acetate) OR corticosteroids
Most common malignancy of the lip
SCC
SE of cyclosporine
Nephrotoxicity HTN Neurotoxicity Glucose intolerance infection Gingival hyperplasia GI issues
SE tacrolimus vs. cyclosporine
same except tacrolimus does not have hirsutism and gum hypertrophy
Major toxicity of Mycophenolate
Marrow supression
Major toxicity of azathioprine
dose-related diarrhea, leukopenia, hepatotoxicity
dome-shaped, firm, freely moving cystic nodule with small central ounctum
Epidermal inclusion cyst
Elevated conjugated bili and alk phos
Malignancy, PBC, PSC, Choledocholithiasis
Get abdominal US
difference between vascular dementia and NPH
VaD has asymmetric neurologic findings and occurs suddenly
Clinical presentation of disseminated gonococcal infection
Purulent arthritis w/o skin lesions
OR
Triad: Tenosynovitis, Dermatitis, Migratory asymmetric polyarthralgia
Treatment for disseminated gonococcal infection
IV ceftriaxone 1g/day for 7-14 days then switch to PO cefixime when clinically improved
Plus azithromycin for chlamydia
Treatment for multi-drug resistant pyelo
Aminoglycosides
(amikacin)
Can be nephrotoxic
Treatment for viral conjunctivitis
treat symptoms
associated with adenovirus
Chest pain at night or that is precipitated by exercise, hyperventilation, emotional stress, or cold exposure. Plus transient ST elevation
Variant angina
Treatment of variant angina
CCB or nitrates
What region effected if there is contralateral sensory loss and burning pain weeks to months later
Lacunar stroke of the posterolateral thalamus
Ovarian cyst that has hyper echoic nodules and calcifications on US
Dermoid ovarian cyst
Adnexal fullness in asymptomatic patient
Mature cystic teratoma (dermoid ovarian cyst)
Sudden, severe, unilateral pelvic pain w/ n/v with history of enlarged ovary
Ovarian torsion (decreased blood flow leading to ischemia and necrosis)
Sudden onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity. With pelvic free fluid
Ruptured ovarian cyst
Treatment for stable ectopic pregnancy
methotrexate
How to diagnose intraamniotic infection (chorioamnioitis)
Maternal fever and one or more of:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous amniotic fluid
- purulent vaginal discharge
Risk factor for chorioamnionitis
- Prolonged rupture of the membranes
- prolonged labor
Treatment for chorioamnionitis
IV Broad spectrum antibiotics (amp, gentamicin, clinda)
- Oxytocin to accelerate labor
- Antipyretics
Treatment for erb-duchenne palsy
gentle massage and PT to prevent contracturs
Surgical intervention if infant with no improvement by age 3-6mo
Recovery from erb-duchenne palsy
up to 80% spontaneous recovery w/in 3 mo
Ddx for night sweats, insomnia and irregular menses in middle-aged woman
Menopause
Hyperthyroidism
Presentation of cryptococcal meningoencephalitis
HA, fever, malaise, signs of elevated ICP
Subacute
When HIV pts get Cryptococcus neoformans
CD4 <100
Signs and symptoms of JC virus
Progressive multifocal leukoenchephalopahty
MRI shows patchy areas of white matter consistent with demyelination
Causes of acute epididymitis in <35yo
Sexually transmitted (chlamydia, gonorrhea)
Causes of acute epididymitis in >35yo
Bladder outlet obstruction (coliform bacteria, e coli)
Treatment for acute epididymitis in >35yo
Levo
Type of lung cancer associated with PTHrP production
Squamous cell carcinoma
Paraneoplastic syndromes associated with small cell carcinoma
ACTH production and SIADH
Elevated Maternal alpha fetal protein associations
Open neural tube defects
ventral wall defects
multiple gestations
Associations with low alpha fetal protein
Aneuplodies
Reversal for warfarin
Vitamin K
Adding back factors (prothrombin complex concentrate)
Reversal of heparin
Protamine sulfate
Causes of acute limb ischemia
cardiac emboli, thrombosis (hypercoag or vascular stent) or trauma
Cardiac source of arterial emboli
Left ventricular thrombus
thrombus due to a fib
aortic atherosclerosis
How to screen for LV thrombus
Echo
Management of LV thrombus
anticoag, vascular surgery, TTE
Difference between toxic epidermal necrolysis and stevens johnson syndrome
SJS <10% of body
TEN >30%
What size PPD induration to treat with no exceptions
> or = 15mm
Treatment for outpatient cellulitis
Oral nafcillin
SIRS criteria
Fever >38
RR >20
HR >90
WBC > 12,000
Treatment for Iron def anemia
Oral ferrous sulfate
Click after S1 loudest at the apex
think about MVP
When to start colon cancer screening for pts with one first degree relative with hx colon cancer before 60yo or two second degree relatives
start screening at age 40 or 10yrs before earliest age family member was effected.
Repeat every 5 years.
drugs that cause pleuritis
Hydralazine, procainamide, quinidine
Recommendation for daily aspirin in women (what for)
women ages 55-79 to prevent stroke
Recommendation for daily aspirin in men (what for)
ages 45-79 for preventing MI
Findings of hypocalcemia
Hyperreflexia, trousseau’s sign, heart block, seizures, paresthesias
When to test a woman with gestational diabetes for diabetes post partum
6-12 wks
Nail changes in cirrhosis
- Muehrcke’s nails (transverse white bands)
- Terry’s nails (whitish nail beds sparing the tips)
USPSTF recommendation for ovarian cancer screening
Recommends against it.
Tests for spondylolysis
Single photon emission computed tomography
HTN med that acts directly on the heart
Diltiazem and verapamil
Contraindications to estrogen
History of migraines
DVT
breast cancer in past 5 yrs
smoking, ischemic heart disease, stroke, liver disease, major surgery with immobilization, poorly controlled HTN
HbH disease treatment
Lifelong blood transfusion and deferoxamine
When does acute stress disorder become PTSD
one month of symptoms
How to prevent addisonian crisis post pituitary gland tumor removal
pre treat with glucocorticoids (dexamethasone)
JVD, decreased heart sounds, hypotension
Beck’s triad
Cardiac tamponade
Four mechanisms that produce shock after trauma to the thorax
- cardiac tamponade (cardiogenic)
- Tension pneumothorax (cardiogenic)
- Cardiac wall rupture (cardiogenic)
- Hypovolemic
First line treatment for PSC
Ursodeoxycholic acid
treatment for uncomplicated pyelonephritis
fluoroquinolones (cipro)
First line treatment for symptomatic hyperthyroidism
Beta blocker (treat cardiac symptoms)
Second line treatment for hyperthyroidism once symptoms are controlled
Methimazole
Side effects of hydroxyurea that require monitoring
- myelosupression (cbc with retic count)
- hepatotoxicity (LFT)
Most common kidney stone with hyperPTH
Calcium phosphate
first line treatment for CAP in output
Azithromycin
First line for CAP in pts that need to be hospitalized
CTX and azithromycin
Causes of diarrhea in patients with AIDS: severe watery diarrhea, low-grade fever, weight loss
Cryptosporium
CD4 less than 180
Causes of diarrhea in pt with AIDS: watery diarrhea, cramps, weight loss, no fever
Microsporidium/isosporidium
CD4 less than 100
Pt with AIDS, watery diarrhea, High fever, weight loss
MAC
CD4 less than 50
Pt with AIDS, small, frequent volume diarrhea, hematochezia, abdominal pain, low grade fever, weight loss
CMV
CD4 less than 50
Location of morton neuroma pain
between third and fourth toes on plantar surface with clicking sensation
Diagnosing VAP
- abnormal chest x-ray
2. culture sputum
Diagnosis of aortic dissection
- CT if hemodynamically stable
- TTE (good for pts with renal insufficiency)
Bladder pain with filling, relief with voiding, increased frequency and urgency, dyspareunia
Interstitial cystitis (painful bladder syndrome)
Treatment of WPW
Procainamide and amiodarone
Treatment for mild persistent asthma
ICS and PRN SABA
treatment for moderate persistent asthma
ICS+LABA OR Montelukast
Target of infliximab
TNF inhibitor
Infliximab increases risk of what?
Infections
Screen for TB, Hep B and C before starting
Positive hep C antibody enzyme immunoassay and recombinant assay with negative HCV RNA PCR means what?
Past infection with HCV now resolved
When to hold metformin
Prior to CT with IV contrast due to risk of kidney dysfunction thus lactic acidosis
Also preop when risk of lactic acidosis
ODC: do pts recognize that obsessions are excessive?
yes
Treatment for HAP
(antipesudomonal PCN or ceph or carbapenem) + (FQ or genta+azithro) + MRSA coverage
Treatment for outpt pneumonia with no recent abx
macrolide or doxycycline
Treatment for outpt pneumonia with recent abx or comorbidities:
resp FQ or (macrolide + (high dose amox+clav Or 2 gen ceph)
Which SSRI should be avoided in pregnancy?
Paroxetine
20 yo female with acute dysuria, frequency and pyuria with negative culture
STI
chlamydia, gonorrheae, HSV
Top intervention for anorexia nervosa
family based treatment
when to stop preventative aspirin
80 yo
baby with microcytic, hypo chromatic anemia. next steps?
prescribe oral iron
Symptomatic treatment for mitral valve prolapse
Beta blockers
Treatments for high altitude sickness
Acetazolamide (sulfa)
Dexamethasone
Most common drug to cause acute interstitial nephritis
Antibiotics
PENICILLINS
cephalosporins
sulfonamides
Most common cause of erythema multiforme
HSV
Treatment for pyogenic tenosynovitis
W/in 1st 48hrs- PO abx and splinting
>48hrs- Surgical drainage and abx
Causes of elevated BNP
heart failure, renal failure, PE, Pulm HTN, chronic hypoxia
what further evaluation pre op does a pt with <4 METs require
A dipyridamole-thallium scan (cardiac stress test)
risks of long term omeprazole use
increased risk of CAP and C. diff. decreased absorption of B12 and Ca (increased risk of hip frx)
older than 35 with abnormal vaginal bleeding. what is next step?
Assess for endometrial assessment to exclude endometrial hyperplasia or cancer
Treatment for hemodynamically unstable patients with a flutter
electrical cardiovert
Treatment for atrial flutter in hemodynamically stable patient
Digoxin and verapamil
treatment for unipolar depress with multiple failed SSRIs
Lithium or T3
treatment for acute cervical radiculopathy and normal x-ray
NSAIDs
