Family Medicine COMAT Flashcards
What vaccines are recommended for every child at age 11?
Tdap and meningococcal. Also can begin HPV vaccinations
What are the Ottawa ankle rules?
- Inability to bear weight for 4 steps
- Tenderness over the distal 6 cm of the fibula or tibia
- Tenderness over the medial or lateral malleolus
- Tenderness at the base of the 5th metatarsal (suspicious of Jones fracture)
- Tenderness of the navicular bone
What does chest radiography of histoplasmosis reveal?
bilateral hilar lymphadenopathy with or without infiltrate
What are the phases of subacute thyroiditis and when should you suspect it?
thyrotoxicosis, euthyroid state, hypothyroid state, recovery. Suspect subacute thyroiditis in patients presenting with tender thyromegaly after a viral prodrome.
When can menstrual migraine prophylaxis be considered? What drug might be considered?
Consider frovatriptan. Can be considered with >/=2 episodes per month, long duration >12 hours, with significant disability, failure/contraindications/adverse events to abortive therapy (sumatriptan or other)
What are the four causes of postpartum hemorrhage?
Four T’s: Tone (uterine atony), Trauma (lacerations), Tissue (retained products of conception), and Thrombin (clotting disorders)
What is a first line intervention for uterine atony?
Uterine fundal massage
What two medications are appropriate to use in postpartum hemorrhage?
Misoprostol and oxytocin
What drug should be avoided in postpartum hemorrhage?
methylergonovine - increases tone, rate, and amplitude of contractions
What is the next step in management if only the Barlow test is positive? What about if only the Ortolani test is positive? Both?
If only Barlow = monitor
If only Ortolani = Ortho referral
If both = Ortho referral
What is a missed abortion? What will ultrasound and physical exam reveal?
intrauterine fetal demise before 20 weeks gestation without associated symptoms of spontaneous abortion (bleeding, pelvic pain, expulsion of products of conception). Ultrasound and physical exam will reveal a closed os and a nonviable intrauterine pregnancy.
What is a complete abortion? What will ultrasound and physical exam reveal?
complete spontaneous abortion of the products of conception from the uterus. Physical examination will reveal a closed cervix and contracted uterus. Ultrasound will show an empty uterine cavity.
What is an incomplete abortion? What will ultrasound and physical exam reveal?
incomplete evacuation of the products of conception. Physical examination will reveal an open cervical os with visible products of conception within the cervical canal or evidence of retained products on ultrasound.
What is an inevitable abortion? What will ultrasound and physical exam reveal?
the beginning stages of a spontaneous abortion in which the cervix is dilated but no products of conception have evacuated. Physical examination will reveal an open cervical os and the products of conception can be felt or visualized within the internal cervical os
What is a threatened abortion?
vaginal bleeding without evidence of spontaneous abortion in the first twenty weeks of gestation
When is GBS prophylaxis indicated?
- In all women GBS positive except with planned C section and no rupture of membranes
- In women with unknown GBS status with prolonged rupture of membranes (>18 hours), intrapartum temp >100.4, or imminent delivery due to preterm labor (<37 weeks), or preterm premature rupture of membranes (PPROM)
- In any woman who has previously delivered a child with invasive GBS disease (testing shouldn’t even be performed in this case)
In what case does GBS need to be tested again even when previously negative?
If tested before 35-37 weeks or if mom presents for care >5 weeks after testing
When do you do screening for AAA and how?
Age 65 if they have ever smoked; do abdominal US
When do you do lung cancer screening? How?
Anyone 55 and older with a 30 pack year smoking history, currently smokes, or have quit smoking within 15 years; low dose CT scan
When do you do a colonoscopy?
50 years old, q 10 years OR if positive family history of colorectal cancer, screen at 40 years old or 10 years before the youngest member of the family was Dx
When do you do a Pap smear?
q 3 years starting at age 21. Can stop at age 65.
When do you do mammograms?
q 1-2 years starting at age 40.
When and how do you screen for osteoporosis?
Age 65; DEXA scan of the lumbar spine
When do you give the herpes zoster vaccine?
60 yo
When do you give the HPV vaccine?
9-26 yo
When do you do chlamydia and gonorrhea screening?
In females who are sexually active and < 24 yo
When do you do HIV screening?
Anyone between 15-65 yo
What is the FEV1 value for stage 1 (mild) COPD? What is the treatment?
80%; albuterol (SABA)
What is the FEV1 value for Stage 2 (moderate) COPD? What is the treatment?
50-80%; albuterol + LABA (salmeterol)
What is the FEV1 value for Stage 3 (severe) COPD? What is the treatment?
30-50%; albuterol + LABA + inhaled steroid
What is the FEV1 value for Stage 4 (very severe) COPD? What is the treatment?
< 30%; albuterol + LABA + inhaled steroid + O2 therapy
What are 3 indications for home O2 therapy?
- very severe COPD with FEV1 < 30%
- O2 sat < 88%
- PaO2 < 55
What is first line treatment for gout? What about in CKD?
NSAID like indomethacin (pick this one first) or colchicine; intra-articular steroid injection with CKD
What is the first step for diagnosis of a possibly septic joint? What would you see if it is septic? inflammatory?
arthrocentesis; you will see >50,000 leukocytes if septic (with 90%+ neutrophils); between 10,000-50,000 leukocytes if inflammatory
What medications are used to treat chronic gout? Which conditions would make you pick one over the other?
probenecid or allopurinol; check uric acid of urine - if low = underexcreter -> use probenecid; if high = over producer -> use allopurinol
What do you want to order at the first prenatal visit?
CBC, UA, STD, HIV, Hep B, PAP, blood type, rubella
What do you want to order at the 28 week prenatal visit?
CBC (check for anemia), diabetes screening, rhogam shot if Rh (-)
Describe diabetes screening during the 28 week prenatal visit.
- Start with 50g oral glucose; after 1 hour, if > 140, proceed
- 100 g oral glucose load; measure at hours 1, 2, and 3; if high at 2/3 hours -> gestational diabetes Dx (at hour 1 >180, hour 2 > 160, hour 3 > 140)
What do you want to check at weeks 35-37 prenatal visit?
Group B strep (give penicillin prophylaxis 4 hours before delivery if positive)
What are 3 outcomes of Pap smears?
- ASCUS - atypical squamous cells of undetermined significance (low grade or high grade)
What do you do if a Pap smear comes back as ASCUS?
HPV test, if positive -> colposcopy
What if a pregnant patient’s Pap smear comes back as HSIL or LSIL?
proceed to colposcopy
For what age groups is chlamydia screening recommended?
all sexually active women age 24 and younger, all pregnant women age 24 and younger, and all women aged 25 and older who are at increased risk due to hx of chlamydial infections, inconsistent condom use, multiple sexual partners, or spouse/partner infidelity
For what age groups is blood pressure screening recommended?
All adults age 18 and older
What is the next step in management if a blood pressure screening comes back greater than 140/90?
The patient should receive a repeat blood pressure check at least one week later. If it remains above these limits, the patient is diagnosed with hypertension.
What is the next step in management if a blood pressure screening comes back between 120-139/80-89?
The patient should be screened again in one year
What is the next step in management tif a blood pressure screening comes back lower than 120/80?
The patient should be screened again in two years.
What would you look for in a case of suspected retained products of conception?
Look for a patient with increased or persistent vaginal bleeding more than two weeks following a surgical evacuation procedure without evidence of infection
What would you look for in a case of suspected postpartum endometriosis?
Look for the combination of fever, uterine tenderness, and purulent loch in the first ten days after parturition
What would you look for in a case of suspected septic abortion?
Look for a patient that presents with a relatively rapid onset of high fevers, chills, and abdominal pain accompanied by vaginal bleeding and purulent discharge after a surgical abortion procedure. Look also for hypotension, tachycardia, and tachypnea indicating likely progression to septic shock.
What drug class is the first line treatment for premature ejaculation?
selective serotonin reuptake inhibitors
What is the criteria for diagnosis of premature ejaculation?
- Time to ejaculation less than 1 minute
2. Loss of ejaculatory control that provokes distress or anxiety int he patient and /or patient’s partner
What is the GET SMASHED mnemonic for the causes of acute pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hypertriglyceridemia Endoscopic retrograde cholangiopancreatography Drugs
What are the TORCH infections and what are they all associated with?
Toxoplasmosis other (syphilis) Rubella CMV HSV They are all associated with an increased risk for congenital hearing loss
What is the treatment of mild to moderate in severity C. diff diarrhea? (w/o risk factors for complications)
oral vancomycin
What are risk factors for complications in patients with C. difficile diarrhea?
elderly patients above age 65, patients with other debilitating or severe diseases, patients with inflammatory bowel disease
What is the definition of preeclampsia without severe features?
new-onset of elevated blood pressures greater than or equal to 140/90 mmHg and less than 160/110 mmHg taken at least six hours apart and within seven days in a previously normotensive woman occurring after 20 weeks gestation with proteinuria greater than 300mg and less than 5g in a 24 hour urine collection and without end-organ damage (omg seriously?)
What does HELLP syndrome stand for? What is the treatment?
Hemolysis
Elevated Liver enzymes
Low Platelets (It is a complication in patients with severe preeclampsia) Treatment = delivery
What is the definition of eclampsia?
diagnosed when a pregnant patient or a patient within six weeks postpartum experiences a new onset of grand Mal seizure or unexplained coma
If presented with a pregnant patient seizing in the 2nd trimester, what should you think?
molar pregnancy or choriocarcinoma
If presented with a postpartum patient seizing after six weeks postpartum, what should you think?
diagnoses other than eclampsia (epilepsy, neoplasms, etc)
How is gestational hypertension different from the diagnosis of preeclampsia?
gestational hypertension does not have protein leaking into the urine
What pharmacologic agent is proven to increase survival rates in ALS? What is its MOA?
Riluzole; inhibits glutamate release
What is the most common cause of secondary nephrotic syndrome in adults?
diabetes mellitus
What are the five complications of nephrotic syndrome?
- protein malnutrition (due to protein wasting int he urine and bowel edema)
- hypovolemia (due to over-diuresis, especially with albumin levels < 1.5 g/dL)
- AKI
- infection (the leading cause of death in nephrotic syndrome)
- Thromboembolism
What are the most common sites of venous thrombosis?
deep veins of the lower extremities and the renal vein
What is the correct correction rate for hyponatremia?
very low sodium levels (less than 125) should not exceed a rate of 0.5-1 mEq/L/hr and a total increase should not exceed more than 8-12 mEq/L/day and/or 18 mEq/L over the first 48 hours
What is a complication of a duodenal ulcer that can cause an acute abdomen? What about a gastric ulcer?
Untreated duodenal ulcers can cause perforation fo the gastroduodenal artery due to the artery’s proximity to the duodenum; gastric ulcer can perforate the left gastric artery
What 3 things are the main treatment for an acute asthma exacerbation?
- inhaled beta-2-agonists
- oral corticosteroids
- oxygen
If a colposcopy comes back as cancerous, what is the next step in management?
hysterectomy
When is the TdaP vaccine given in pregnancy?
Between weeks 27-36
What is the pediatric milestone for 2 months?
lift head off of ground in the prone position
What is the pediatric milestone for 4 months?
Roll over
What is the pediatric milestone for 6 months?
sit up on own
What is the pediatric milestone for 9 months?
crawling or cruising
What is the pediatric milestone for 12 months?
can use 1-3 words other than mama and dada
What is the pediatric milestone for 2 years old?
Hundreds of words and two word phrases (hundreds = 2 zeros = 2 years old)
What is the pediatric milestone for 3 years old?
1000s of words (3 zeros) and three word phrases
What is the pediatric milestone for 5 years old?
dress yourself and write your name
What is the pediatric milestone for 6 years old?
tying your own shoes and identify left and right
When should vision and hearing testing start?
around 4 years old
When does a baby’s first flu shot happen?
6 months
When does a baby’s first live vaccine occur?
MMR at 1 year
What is the most common cause of folate deficiency?
alcohol abuse
What is the next step in management for a patient with acute gastroenteritis and hematochezia?
stool analysis to check for WBC (if present, confirms inflammatory diarrhea), rehydrate with oral or IV fluids (if hypotensive)
What are the main culprits of inflammatory diarrhea?
campylobacter, EHEC, Salmonella, shigella, yersinia
What is the treatment for inflammatory diarrhea?
supportive; only give Abx if very young pt, very old pt, or immunocompromised (DO NOT give antidiarrheals like loperamide bc it will trap the bacteria in)
What is a complication of giving an antibiotic when suspecting inflammatory diarrhea caused by EHEC? What is the treatment for the complication?
Giving an Abx can precede HUS; dialysis
What is the definition of chronic diarrhea and what is the next best step in management?
diarrhea for > 1 month; stool analysis for ova and parasites
What are the two most common causes of viral, watery diarrhea?
norovirus and rotavirus
What results of the DEXA scan indicate osteoporosis and osteopenia?
T score < -2/5 = osteoporosis
T score -1 to -2/5 = osteopenia
What is first line therapy for osteoporosis?
bisphosphanates
What is triple therapy for H. pylori? Quadruple therapy?
Triple therapy:
- PPI dose twice daily
- Amoxicillin 1g twice daily
- Clarithromycin 500mg twice daily (OAC)
Quadruple therapy:
- PPI standard dose once or twice daily
- Metronidazole 250mg four times daily
- Tetracycline 500mg four times daily
- Bismuth subsalicylate 525 mg four times daily
With first detection of proteinuria/hematuria on urine dipstick, what is the next step in management?
Repeat UA this time with microscopic analysis
What does RBC casts on UA with microscopic analysis indicate?
glomerular bleeding
What is the main side effect of PTU/methimazole?
agranulocytosis (deficiency of granulocytes, which are basophils, neutrophils, eosinophils)
What are the next steps in management after finding a thyroid nodule?
TSH and ultrasound
If you find that a thyroid nodule is hyperthyroid, what is the next step in management?
radionucleotide thyroid scan
If the radionucleotide thyroid scan comes back diffuse, what is the diagnosis?
Graves’ disease
If the radionucleotide thyroid scan is taken up in one area, what is the diagnosis?
Toxic adenoma
If the radionucleotide thyroid scan is taken up in multiple areas (but not diffusely), what is the diagnosis?
Toxic multi nodular goiter
What is the treatment for thyroid toxic adenoma and toxic multi nodular goiter?
radioactive iodine ablation therapy
If you find a cold thyroid nodule that is > 1 cm, what do you want to do next for management?
Fine needle aspiration biopsy
What is normal for fetal heart sound tracings?
110-160
What does fetal heart rate > 160 indicate?
mom has an infection
What does sinusoidal pattern for fetal heart rate indicate?
baby has anemia
What does a complete heart block on fetal heart rate indicate?
mom has lupus
What is the 15 for 15, 2 in 20 rule?
If the heart rate raises by 15 and lasts at least 15 seconds, and you see 2 of those within 20 minutes, rules out hypoxia (Baby is health) -> indicates good stress test AKA reactive stress test
If the mom feels like there is reduced movement of the baby, what do you do next?
non stress test - this is where you check for acceleration
If no accelerations (no 15 in 15, 2 and 20) are seen on the non stress test with reduced fetal movement, what is the next step?
biophysical profile (breathing, tone, amniotic fluid volume, movement) If score < 4 -> procede to delivery
What is the first step in treatment of hypercalcemia?
IV fluids (hypercalcemia = over 10)
What is normal serum osmolarity range?
275-295 (osmolarity = 2*Na + 1/3BUN + 1/18Glucose)
What is the treatment for hypovolemic hyponatremia without symptoms?
normal saline
What is the treatment for severe hyponatremia (Na < 120) with symptoms? (lethargy, possible coma)
hypersonic saline (3%)
What is the treatment for euvolemia or hypovolemic hyponatremia? (like in SIADH)
fluid restriction
What is the first line treatment for hyperkalemia (K+ > 5) with EKG changes? why? then what?
calcium glutinate to stabilize the cardiac membranes
Then you can give insulin to push potassium into the cell
What is the typical cause of bronchitis? How does it usually start?
viral; usually starts with runny nose and no fever
What are the most common causes of otitis media?
Strep pneumo, H. influenza, and moraxella
What are the most common causes of pneumonia and bacterial sinusitis?
Strep pneumo, H. influenza, and moraxella
What are the most common causes of meningitis?
Strep pneumo, H. influenza, neisseria meningitis (rash)
What is the most common cause of otitis externa? In what patient populations should you consider it? What is the treatment?
Pseudomonas; swimmers and diabetics; amoxicillin
What drugs are commonly used for tocolysis?
beta-adrenergic agonists (terbutaline, ritodrine, albuterol), CCB (nifedipine), NSAIDs (indomethacin), oxytocin antagonists (atosiban), and magnesium sulfate
What drugs are commonly used for tocolysis?
beta-adrenergic agonists (terbutaline, ritodrine, albuterol), CCB (nifedipine), NSAIDs (indomethacin), oxytocin antagonists (atosiban), and magnesium sulfate
What milestones should a 2 year old be able to do?
kick ball, run, undress, form two-word sentences, have a vocal of 50 words with preference for word “no.” They can climb two steps and play in parallel. Also might start holding a spoon.
What milestones would you expect a 3 year old to meet?
draw a circle, ride a tricycle, speak 3 words sentences, dress/undress without buttons
What milestones would you expect a 4 year old to meet?
draw a cross or a rectangle, hop on one foot, cooperative play, recognize colors/numbers
What milestones would you expect a 5 year old to meet?
draw a square, skip, catch a ball, print own name, tie shoelaces
What condition commonly occurs alongside giant cell arteritis?
polymyalgia rheumatica
How long does it take PTU and methimazole to begin working?
2-8 weeks (start at the same time as propranolol, which will relieve symptoms quicker)
What factors falsely lower the HgA1C?
- sickle cell disease and sickle cell trait
- acute blood loss
- hemolytic anemia
- erythropoietin therapy
- Chronic renal failure with hemodialysis
- B12, iron, folate treatment
What factors falsely elevate the HgA1C?
- anemia due to deficiency of Vit B12, folate, or iron
- chronic renal failure with elevated concentrations of urea
- African American, Hispanic, or Asian descent
How do you differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?
Coomb’s test (direct anti globulin) is positive in AIHA and negative in hereditary spherocytosis
What are the hallmarks of autoimmune hemolytic anemia?
- anemia with an elevated reticulocyte count, a positive direct anti globulin (Coomb’s) test, and spherocytes on peripheral blood smear
What is the triad of hemolytic uremic syndrome? What will you see on peripheral smear? What is the Coomb’s test (+ or -)?
- thrombocytopenia
- hemolytic anemia
- acute kidney injury
will see schistocytes on peripheral blood smear. The Coomb’s test (direct antiglobulin) is negative.
Friedrich ataxia - inheritance, chromosome, initial complaints, other abnormality associated with, symptom onset
- autosomal recessive
- chromosome 9
- clumsiness (wide-based gait), incomprehensible speech (explosive dysarthria), bilateral Babinski sign, and bilateral loss of deep tendon reflexes (hyporeflexia)
- Most common cardiac abnormality with FA is hypertrophic obstructive cardiomyopathy
- symptom onset = elementary school age
What tumors do those with VHL experience?
hemangioblastomas in the cerebellum and spinal cord, retinal angiomas, pheochromocytoma, endolymph tumors of the ear, serous cyst adenomas, and neuroendocrine tumors the pancreas, papillary cyst adenomas of the epididymis and broad ligament, and clear cell renal cell carcinomas
What tumors do those with Li-Fraumeni syndrome develop?
many tumors but mostly sarcomas, breast cancer, brain tumors, and adrenocortical carcinomas
What tumors do those with neurofibromatosis 1 develop? What mutation is it associated with?
cafe au last spots, neurofibromas, osseous tumors, central nervous system tumors, neurofibrosarcomas, and leukemias; Was
When are diphtheria, tetanus, and pertussis administered in vaccines?
2, 4, 6, 15-18 months, and 4-6 years.
When is the MMR vaccine administered?
12-15 months and 4-6 years.
When is the varicella vaccine given?
12-15 months and 4-6 years
When is the Hib vaccine administered?
2, 4, 6, and 12-15 months
When is the 13-valent pneumococcal vaccine administered?
2, 4, 6, and 12-15 months
What is the treatment for acute otitis media?
amoxicillin
What three drugs have been shown to decrease mortality in MI?
- ACE inhibitors
- beta blockers
- aspirin
What are the three qualifiers for acute coronary syndrome?
- unstable angina
- NSTEMI
- STEMI
What is the treatment for medical treatment of ACS while waiting for serial troponins?
MONACBASH M - morphine O - oxygen N - nitrate A - aspirin C - clopidogrel B - beta blockers A - ACE inhibitors S - statin H - heparin
If timi score is 0-2, what do you do?
If timi score is 3+, what do you do?
0-2 = stress test 3+ = Cath lab
What are the criteria for calculating a timi score?
- Age >/= 65+ -> 1 point
- > /= 3 risk factors for CAD -> 1 point (obesity, smoking, HLD, HTN, DM)
- Use of ASA (last 7 days) -> 1 point
- Known CAD (prior stenosis >/= 50%) -> 1 point
- > 1 episode rest angina in <24 hours -> 1 point
- ST-segment deviation -> 1 point
- Elevated cardiac markers -> 1 point
What is the most common cause of death from CKD? What about rheumatoid arthritis?
cardiovascular causes (RA accelerates atherosclerosis)
What is BP goal for patients with CKD?
< 140/90
What are the next steps in management in a patient with unstable hematochezia?
- fluids
2. EGD
What is the treatment for diverticulitis?
fluoroquinolones and metronidazole
Ulcerative colitis complications/associations
colon cancer, toxic megacolon, primary sclerosing cholangitis
Rust colored sputum? (name that bug)
strep pneumo
Legionella
Sx: pneumonia, diarrhea, hyponatremia
Associated with elderly smokers who hangout in areas with dirty AC or areas with contaminated sources of water
What is the treatment for in patient pneumonia?
fluoroquinolones
Outpatient pneumonia treatment? To cover typicals? atypicals?
typicals - amoxicillin
atypicals - macrolide (azithromycin)
Most common atypical pneumonia causes?
mycoplasma, chlamydia, legionella
Most common typical pneumonia causes?
S. pneumo, H. influenza, Moraxella
Curb 65 criteria consists of what and is used for what?
used to decide whether to admit someone to the hospital for pneumonia
1. Confusion - 1 point
2. Uremia (BUN > 20) - 1 point
3. Respiratory rate ( >30 breaths/min) - 1 point
4. Blood pressure (systolic < 90 or diastolic < 60) - 1 point
5. Age ( >65) - 1 point
2 or more = admit
What does SIGECAPS stand for? What is it used for?
Used for diagnosing depression S - sleep changes I - interest loss G - guilt E - energy loss C - cognition/concentration difficulties A - appetite loss and/or weight loss P - psychomotor (agitation) S - suicidal ideations
What is the first line treatment for depression?
SSRI (remember, it takes 4-6 weeks to begin working, treat for at least 9 months)
What are contraindications to breast feeding?
HIV and chemotherapy
What is the first line treatment for mastitis?
dicloxacillin
How do you treat each of the classes of CHF?
Class 1 - ACE inhibitor
Class 2 - ACE inhibitor + beta blocker
Class 3 - ACE inhibitor + beta blocker + diuretic (like spironolactone)
Class 4 - all above + add inotropic agents like digoxin
What are the three drugs that can decrease mortality in CHF?
- ACE inhibitor
- beta blocker
- spironolactone
How is CHF diagnosed?
Echocardiogram
What is the first line treatment for CHF exacerbation?
furosemide
In what cases are OCPs contraindicated?
- those with migraines with aura
2. smokers that are > 35 years old
What three drugs are first line treatment for HTN?
- ACE inhibitors
- Calcium channel blockers
- thiazide diuretics
What is the criteria for the diagnosis of HTN?
> 140/90 on 3 consecutive visits
What helps you differentiate between intussusception and mid gut volvulus?
intussusception has colicky abdominal pain while mid gut volvulus has constant pain (remember can see corkscrew sign on barium X-ray)
What causes duodenal atresia? What will you see on imaging?
caused by vascular accident in utero, specifically maternal cocaine use
triple bubble sign on X-ray
What is the double bubble sign and in what patients will you see it?
failure of the duodenum to reanalyze; will see in patients with Down syndrome
What two things can predispose to intussusception?
- henoch-schonlein purpura
2. rotavirus vaccine
What is the migraine criteria? (POUND criteria)
POUND P - pulsating or throbbing pain O - 4-72 hours in a adults and 1-72 hours in children U - unilateral N - Nausea, vomiting D - disables activities \+/- aura
What differentiates chronic vs episodic migraines?
episodic = < 15 days/month chronic = >15 days/month of > 3 months
What are red flags for headaches?
- headache that is getting worse
- headache that increases with valsalva or exercise
- headache associated with recent head trauma
- headache in the morning with projectile vomiting (suspicious for intracranial mass)
- headache that awakens you from sleep
What is the treatment for severe/refractory migraines? (first line is lifestyle/tylenol)
sumatriptan (serotonin agonist); prophylaxis = beta blockers or TCAs
What are the four types of patients that get statin therapy?
- LDL > 190
- Patients with ASCVD
- 40 years old + DM + LDL > 70
- 40 years old + ASCVD risk 7.5% + LDL > 70
What is niacin best at with treatment of cholesterol? Fibrates?
Niacin is best at increasing HDL and fibrates are best at decreasing triglycerides
Name the SSRIs
- paroxetine
- fluoxetine
- citalopram
- escitalopram
- sertraline
What is the first line treatment for aphthous ulcers?
triamcinolone (rinse)
Slipped capital femoral epiphysis (SCFE) (presentation, pathophys, treatment)
usually in an obese 11 year old; epiphysis slips off; treated with surgical splinting
Legg-Calve-Perthes disease (presentation, pathophys, treatment)
idiopathic avascular necrosis of the hip; treated conservatively; usually in a younger pt than SCFE
Septic arthritis (presentation, management, most common bugs)
hot and swollen, red joint, unable to move or bear weight; aspirate joint; most common bugs = staph aureus and strep pyogenes
What test can you do in office if you suspect ankylosing spondylitis? If that test is positive, what is the next step in diagnosis?
FABER (flexion, abduction, external rotation); lumbar and sacral x-ray that will show bamboo spine
What will you see on CXR in someone with aspiration pneumonia? What do you use for treatment?
right lower lobe infiltrates - multiple cavities with fluid level (can progress to lung abscess); zosyn (piperacillin-tazobactam) or clindamycin
If you suspect a DVT, what is the first step in management?
start heparin (BEFORE doppler or CT angiogram) then bridge to warfarin; can also be treated with factor X inhibitors like rivaraxaban
What bug causes epiglottitis? What is the first step in management?
H. influenza; intubation
What bug causes croup? What is the treatment?
parainfluenza virus; treat with corticosteroids, nebulized epinephrine (racemic epinephrine if stridor at rest or respiratory distress)
What can croup progress to? What is the best next step in management? What bug usually causes this?
bacterial tracheitis (with purulent sputum); intubate; staph aureus
What signs/symptoms do you look for with peritonsillar abscess?
deviated uvula, difficulty swallowing, muffled voice, fever, leukocytosis
What three antibodies can those with celiac disease have? What can untreated celiac disease lead to?
anti tissue transglutaminase, anti gliadin, anti endomysial; can lead to intestinal lymphoma
What is the first step in treatment for cocaine overdose? What do you not want to give?
first give benzodiazepines (lorazepam), do NOT give beta blockers (unopposed alpha vasoconstriction can cause MI)
What two drugs are first line for those wanting to quit drinking alcohol?
naltrexone and acamprosate
What is first line treatment for patients wanting to quit smoking?
nicotine patch/gum (1st line), buproprion, varenicline (chantix)
What is the first line treatment for stable AND unstable supra ventricular tachycardia
adenosine if stable; cardioversion if unstable
What is the first line treatment for stable AND unstable ventricular tachycardia?
amiodarone if stable; cardioversion if unstable
What bug do cat and dog bites usually grow? What is the treatment?
pasteurella multicida; augmentin (amoxicillin + clavulonic acid)
What bugs usually grow with a human bite? What is the treatment? What prophylactic treatment should be given?
multi-bug; HACEK organisms (Haemophilus, Actinomycetemcomitans, cardiobacterium hominis, eikenella corodens, kingella); augmentin treatment (amoxicillin + clavulonic acid); Hepatitis B and HIV prophylaxis
What is the greatest risk factor for stroke?
hypertension
When do you give tPA for a stroke? What is the first step in management of a stroke?
give tPA within 4.5 hours; want to do a head CT without contrast if suspecting stroke to rule out hemorrhage
How do you treat a hemorrhagic stroke? What is the first line treatment and why?
maintain blood pressure at a low level so they don’t bleed more; use a calcium channel blocker first line bc it also prevents cerebral vasospasm
What are the 3 tests you want to order once you know you have a stroke?
To look for the source, order:
- echocardiogram
- carotid doppler
- EKG
What is the next step in management when you have a carotid artery with > 70% stenosis?
carotid endarterectomy
At what CD4 count do you start prophylaxis against pneumocystis jiroveci? With what?
CD4 count of 200; use TMP-SMX
How does pneumocystis jiroveci pneumonia present?
fever, dry cough, interstitial infiltrates
At what CD4 count do you start prophylaxis against MAC? With what?
CD4 count of 50; use azithromycin
If you see primary ring enhancing lesions on brain imaging, what should you think of?
primary CNS lymphoma (seen in AIDS), toxoplasmosis, or a brain abscess (can happen in healthy people with sinus or face infections)
What lab value is considered hyperbilirubinemia? What about to be considered direct/conjugated hyperbilirubinemia?
> 1; to be direct hyperbilirubinemia, the conjugated portion must be > 20%
What is the Courvoisier’s sign? What does it indicate?
Courvoisier’s sign is painless jaundice + painless palpable gallbladder; it indicates pancreatic cancer
What are warning signs in GERD? What would be your next step in management of a case of GERD with alarm features?
alarm features = dysphagia, microcytic anemia, weight loss; urgent endoscopy to look for cancer
If an old diabetic woman complains of upper abdominal pain, what might you think of?
atypical presentation of MI; get an EKG
What are the complications of chronic PPI use?
C. diff and osteoporosis
In a child less than 30 days old with a fever, what 2 things should you suspect? What is the treatment? What are the most common bugs causing meningitis in children < 3 months old?
meningitis or pneumonia; treat empirically with ampicillin and gentamicin; group B strep, E. coli, and listeria
What are the most common bugs causing meningitis in adults? What is the empiric treatment?
Strep pneumo, H. influenza, and Neisseria; treat with ceftriaxone and vancomycin
What is the difference between smallpox and chicken pox?
small pox vesicles are all the same stage of development; chicken pox vesicles can have different crops/stages across skin
What is the difference between measles and rubella?
They both start with a rash that begins on the head and progresses down to the lower extremity; measles has the four C’s: cough, coryza, coplik spots, conjunctivitis; rubella does not have the 4 C’s and has arthralgias (both preventable with MMR given at 12 months old)
What are 2 complications of measles?
can progress to pneumonia or subacute sclerosing panencephalitis (SSPE) - brain infection that happens 10 years later; treat with Vitamin B6
What is the difference between roseola and parvovirus?
Roseola is fever that breaks then a rash that follows; parvovirus is slapped cheek with a lacy reticular rash
What is a baby at risk for if a mom develops parvovirus while pregnant?
hydrops fetalis (because Parvo attacks erythrocytes)
What is the next best step in management if a breast mass is found in a woman less than 30 years old? Over 30 years old?
less than 30 years old -> ultrasound; greater than 30 years old -> mammogram
What is unilateral nipple bleeding suggestive of? What imaging test should you do?
intraductal papilloma; mammogram
When do mammogram screenings begin? How often are they repeated?
begin at age 40 and happen every year
How is diabetes diagnosed?
- fasting glucose 126+
- random glucose 200+ with symptoms
- HbA1C 6.5+
In what conditions is metformin contraindicated?
kidney disease and CHF bc it can cause lactic acidosis
When is diabetes considered well controlled?
- BP < 140/90
- HgA1C < 7
- LDL < 100
What is the difference between disc herniation and spinal stenosis?
disc herniation is:
- worsened with any type of valsalva maneuvers (sneezing, coughing)
- improved with extension of the back, such as lying down,
- worsened with bending forward
- presents with pain that radiates down the leg.
Spinal stenosis is better with flexion and worsened with extension (feels better when they walk up hill, feels worse when they walk downhill)
What is the next best step in management when you suspect cauda equina?
MRI and prepare for immediate surgery
How is a herniated disc diagnosed? How is it treated?
diagnosed clinically; treated conservatively with NSAIDs and Tylenol for 1 month -> if no improvement, proceed with imaging like MRI
What is essential tremor and how is it treated?
tremor evident with movement and better at rest and with drinking alcohol; treated with propranolol (usually genetic)
How is Tourette’s treated?
clonidine or gaunfisine (alpha blockers) or a typical antipsychotic; motor and vocal tic for greater than 1 year
What is a treatment for Huntington’s disease?
tetrabenazine
criteria for mild intermittent asthma?
- daily symptoms 2x/week
- night symptoms 2x/month or less
- lungs fine between attacks
- treat with albuterol PRN
criteria for mild persistent asthma?
- daily symptoms 2+/week
- night symptoms 2+/momth
- interference with daily activities
- add low dose steroid to SABA
criteria for moderate persistent asthma?
- daily symptoms daily
- night symptoms 1+/week
- interference with daily activities
- add medium dose steroid
criteria for severe persistent asthma?
- daily symptoms daily
- night symptoms frequently
- daily activities limited
- add high dose steroid
What antibiotic is given to a patient in COPD exacerbation? to cover for what?
fluoroquinolones to cover pseudomonas
What is a long-term complication of untreated OSA?
right sided heart failure due to hypoxemic vasoconstriction of the pulmonary arteries
What is the greatest risk factor for osteoporosis?
age
What is the greatest risk factor for breast cancer?
age
Where will an ulcer show up in a case of chronic venous insufficiency?
medial malleolus
What is the triad of meniere’s disease? What causes it? What is the treatment?
- tinnitus
- hearing loss
- vertigo
due to increased pressure in the endolymph; treat with diuretics or antihistamines like meclizine
What is vestibular neuritis?
hearing loss and vertigo that follows a viral URI
What is the most dangerous type of polyp? When do you follow up with colonoscopy if ANY polyp is found?
villous; follow up in 3 years
A patient presents with a unilateral headache located in the temporal region that is associated with visual disturbances and jaw pain on the same side. What is the most likely diagnosis?
giant cell arteritis
What is the first step in work-up of a patient suspected to have peripheral arterial occlusive disease?
ankle-brachial index (then angiography)
What is the first line in workup of a breastfeeding patient with a lump?
ultrasound (mastitis or breast abscess suspected)
What is the treatment for group A strep pharyngitis? What if allergic to the first line?
penicillin V; azithromycin
What is a Still’s murmur? Wha tis indicated for workup?
low-pitched vibratory systolic ejection murmur loudest at the left lower sternal border; becomes louder with maneuvers that increase blood flow to the heart (lying in the supine position); this is the most common innocent heart murmur of childhood and odes not require any workup
pelvic itching, pain, dyspareunia associated with malodorous green/yellow frothy discharge -> diagnosis? what will be seen on microscopy?
trichomoniasis; motile trichomonads (may also see strawberry cervix -> visualized punctate hemorrhages)
What does the USPSTF recommend regarding AAA screening?
one time screening by ultrasonography in men ages 65-75 yo who have ever smoked
sore throat, fevers, fatigue, bilateral posterior cervical LAD, tonsillar enlargement/exudates, and palatal petechiae, splenomegaly on abdominal examination
mononucleosis by EBV
If serum ferritin is less than or equal to 30 ng/mL, what is the next step in workup? What if serum ferritin is between 31 and 99?
upper endoscopy and colonoscopy to look for GI bleeds/cancer; order serum iron, TIBC, and transferrin to further differentiate anemia
What workup is indicated for patients presenting with peripheral nerve palsy (Bells palsy)? Treatment?
lyme serology in patient living in an endemic area; head imaging, lumbar puncture, and electrodiagnostic studies IF the diagnosis is unclear; give lubricating eye drops for corneal protection, short course of glucocorticoids
What is the treatment for Lyme disease?
2-3 week course of doxycycline or amoxicillin (in those less than 8 years old)
What is Tdap given? What about DTaP?
Tdap should be given to all patient aged 11 to 64 who have not yet received it. For 11-18, it should be given as the scheduled booster regardless of if they have had it or not. Above age 65, Tdap or DTaP can be given. DTaP is even to children below age 7 for extra protection from pertussis
When should alpha-1-adrenergic antagonists be taken? Why?
(ex: terzosin, doxazosin, tamsulosin, alfuzosin, silodosin); should be taken at night due to side effects of postural hypotension and lightheadedness
What are symptoms of malrotation in a newborn and what is the best diagnostic test?
bilious vomiting, abdominal distention, abdominal pain; can have hemodynamic instability, hematochezia, and peritonitis; best diagnostic step is upper GI barium contrast series, which will show proximal duodenal dilation, bird beak obstruction, and then a spiral or corkscrew duodenal configuration
What factors does the prothrombin time (PT) measure?
extrinsic pathway, namely Factor VII
What factors does the partial thromboplastin time (PTT) measure?
intrinsic pathway (TENET) XII, XI, IX, VIII, X)
What factors are in the common pathway?
X, I, II, V, XIII
What will iron studies look like for anemia of chronic disease? (MCV, iron, ferritin, TIBC)
low MCV, low iron, high ferritin, low TIBC
What will iron studies look like for iron deficiency anemia? (MCV, iron, ferritin, TIBC)
low MCV, low iron, low ferritin, high TIBC
What will iron studies look like for thalassemia? (MCV, iron, ferritin, TIBC)
low MCV, normal iron, normal ferritin, normal TIBC
What will iron studies look like for hemochromatosis? (MCV, iron, ferritin, TIBC)
normal MCV, high iron, high ferritin, low TIBC)
What antibodies will be seen in dermatomyositis?
anti-Mi-2 antibodies
A combination of upper and lower motor neuron signs in a patient with a history of osteoarthritis? Workup?
cervical stenosis/cervical spondylosis; MRI of the cervical spine (presentation similar to ALS but probably in an older person)
What is the most common cause of sideroblastic anemia? What causes it? What will you see on peripheral smear?
excessive alcohol use; heme synthesis is disrupted causing iron to accumulate in mitochondria, which causes the bone marrow to produce “ringed sideroblasts.”; will see siderocytes, hypochromic RBCs with basophilic stippling that stain positive fo iron
What are causes of acquired sideroblastic anemia?
lead poisonings, alcohol, chloramphenicol, copper deficiency, and zinc toxicity (excessive alcohol intake is most common)
What are the risk factors for development of erb-duchenne palsy?
- operative vaginal delivery (vacuum and forceps assisted delivery)
- multiparty
- large for gestational age (greater than 90th percentile)
- maternal diabetes
- breech presentation
- previous child with birth-related brachial plexus injury
- shoulder dystocia
- prolonged second stage of labor (greater than 120 minutes)
What is the most likely finding on ECG with a pulmonary embolism?
sinus rhythm with ventricular rate of 132 bpm (S-waves in lead I, Q-waves in lead III, and inverted T-waves in lead III also indicate PE but is not the most common finding)
non-productive cough, stridor, wheezing, and dyspnea; flattening of the inspiratory loop on spirometry and a normal FVC and FEV1/FVC ratio
vocal cord dysfunction (often confused with asthma)
What vaccines are recommenced in all pregnant patients no matter what?
- inactivated influenza vaccine (not live, attenuated influenza vaccine)
- tetanus, diphtheria, acellular pertussis (Tdap)
What vaccines are recommenced in pregnant patients only if there is a specific indication?
- Hep A
- Hep B
- Meningococcal series
- Inactivated polio vaccine (NOT live, attenuated polio vaccine)
What vaccines are contraindicated with pregnancy?
- live, attenuated influenza vaccine
- MMR
- Zoster vaccine
- Varicella vaccine
A patient in their 60s and 70s with a history of thyroid disease, a rapidly growing neck mass, and symptoms of local (cough, dysphagia, dyspnea, and neck pain) and distant invasion should make you consider what? What’s the workup?
anaplastic thyroid carcinoma; biopsy
What are common sites of distant metastases for anaplastic thyroid carcinoma?
lungs (dyspnea and effusion), bones (pain and pathologic fractures), and brain (altered mental status and ataxia)
What is the first line treatment of juvenile myoclonic epilepsy in children?
valproic acid; women of child-bearing age should be given lamotrigine, levetiracetam, or topiramate and supplement with folic acid
What is the most common cause of neonatal conjunctivitis? What days will it present? What is the treatment?
chlamydia; days 7-14; topical antibiotics as well as oral erythromycin
What days will conjunctivitis caused by Neisseria gonorrhoeae present? What is the treatment?
between days 3 and 5; topical erythromycin nd intravenous therapy with a third-gen cephalosporin (ceftriaxone)
Which tumors can cause Cushing syndrome? What is the diagnostic test?
small cell carcinoma of the lung and adrenocortical carcinoma; high dose dexamethasone suppression test (would show elevated ACTH and elevated cortisol)
What does initial routine screening on a pregnant woman entail?
- Pap smear (if over age 21)
- blood group and Ab screen to evaluate Rh status
- rubella antibody status
- screening for sexually transmitted infections, including HIV, syphilis, gonorrhea, and chlamydia, hep B surface Ag
- urinalysis and culture
When is administration of TdaP recommenced for pregnant women?
recommended for everyone between 27-36 weeks gestation in EVERY pregnancy
When is gestational diabetes tested for in pregnancy?
Between 24-28 weeks
What is CHARGE syndrome?
- Coloboma (a hole in the iris, retina, optic disc, or choroid)
- Heart defects (septal defects, aortic valve stenosis, aortic coarctation, ToF)
- Choanal atresia (back of the nasal passage is blocked by bone or soft tissue)
- restricted growth
- genital hypoplasia
- ear anomalies (small, low-seat) and deafness
What is Kallmann syndrome?
anosmia and hypogonadotropic hypogonadism with failure to progress into or through puberty
What is VACTERL syndrome?
V - vertebral abnormalities - fused or missing
A - anal atresia
C - cardiac defects
T - trachea-esophageal fistula
R - renal abdnormalities - renal genesis, horseshoe kidney
L - limb abnormalitites
In adults, what usually precede osteomyelitis?
soft tissue infection
What is the MOA of ezetimibe?
inhibits dietary cholesterol absorption in the intestine by binding to the Niemann-Pick C1-like 1 protein; no proven benefit as mono therapy but often combined with statins
What is the greatest risk factor in development of periductal mastitis?
smoking
What are the encapsulated organisms that asplenic individuals are susceptible to?
SHiNE SKiS (shiny skis): Strep pneumonia, Haemophilus influensa B, Neisseria meningitidis, E. coli, Salmonella, Klebsiella, Strep agalactiae
What is Naegele’s rule for estimating date of confinement?
In women with normal, 28-day menstrual cycles, add 7 days to the patient’s first day of her last menstrual period, and add 9 months.
What is the first step in diagnosis of polycystic kidney disease?
renal ultrasonography
What are the developmental milestones expected of a 9 month old?
pull up to a stand, cruise around on furniture, grasp objects with 2 fingers and their thumb, and bang two blocks together. They would also be expected to have stranger anxiety, play gesture games, and wave bye-bye. Finally, they should have polysyllabic babbling, and speak “mama” non-specifically
What will be found on X-ray of RA? What are the most common locations affected?
eroding joint spaces with eventual destruction of joints; most commonly involved joints are the bilateral wrists, PIP, and MCP of th hands.
What will be found on X-ray of OA?
joint space loss and sclerosis in all of the affected joints (osteophytes also)
What cancer causes the paraneoplastic syndrome of PTHrP?
squamous cell carcinoma (lung)
dizziness, headaches, blurry vision, constant burning pain in hands, pruritus, flushing, splenomegaly, engorged retinal veins, increased Hgb, increased WBC, increased platelet count - diagnosis? Treatment?
polycythemia vera; repeated phlebotomy
What is the difference between pemphigoid gestationis and bullous pemphigoid?
use the “salt split technique” to see the location of antibody deposition. Pemphigoid gestationis has deposition along the floor of the blister. Bullous pemphigoid has deposition along the roof of the blister. (Both have direct immunofluorescence positive for deposition of C3 and/or IgG)
What is the next step in management when someone is found to have a AAA 4-5.4 cm in diameter?
evaluated by ultrasonography every 6-12 months to monitor for further dilation
What is the next step in management when someone is found to have a AAA > 5.5 cm in diameter?
elective surgical repair
What testicular tumor secretes beta HCG?
choriocarcinoma
What testicular tumor secretes alpha fetoprotein?
yolk sac tumors
What disease has a mutation in COL5A1 or COL5A2?
classic Ehlers-Danlos
What disease has a mutation in COL1A1/COL1A2?
osteogenesis imperfecta
What is the first line treatment for insomnia?
cognitive behavioral therapy is the most effective first step in the management of insomnia
What is the best diagnostic test for hypertrophic obstructive cardiomyopathy? What is treatment?
echocardiogram; beta blockers, surgical excision or alcohol ablation of the inter ventricular septum, and pacemaker and.or implantable cardioverter-defibrillator placement
What is the normal weight gain during pregnancy for a woman with normal BMI?
25-35 pounds
Tetanus IVIG/toxoid booster algorithim
At least 3 lifetime doses of tetanus vaccines: clean wound and no booster within last 10 years -> get booster; dirty wound and no booster within last 5 years -> get booster
Less than 3 lifetime doses of tetanus vaccines: always give toxoid booster; if wound is dirty, give IVIG too
What is the diagnostic test of choice for posterior urethral valves?
voiding cystourethrogram
What are the two significant risk factors for avascular necrosis of the femoral head? What will plain film imaging show?
chronic corticosteroid use and heavy alcohol consumption are significant risk factors; plain film imaging will show the “crescent sign,” a subchondral crescent-shaped radiolucent area representing an are of necrotic bone
When is surgical elliptical excision indicated for patients with hemorrhoids?
patients with acute onset of excruciating pain with thromboses external hemorrhoids presenting within 72 hours of the onset of symptoms (rubber band ligation is procedure of. choice for internal hemorrhoids that do not respond to conservative treatment
What must be done to the levothyroxine dose of a pregnant woman?
increase dose of levothyroxine by 30%
What drug should be used to treat HER2/neu positive breast cancer? What about estrogen/progesterone receptor positive?
trastuzumab; tamoxifen
When is aspirin for cardio protection recommenced?
for males aged 45 to 79 and females aged 55 to 79 without a history of GI bleeding. It should also be avoided in patients with a history of peptic ulcer disease
What is the triad of HUS?
thrombocytopenia, hemolytic anemia, and acute kidney injury (commonly presents in children less than 5 yo with prodromal episode of abdominal pain and bloody diarrhea followed by symptoms of pallor, fatigue, easy bruising, and hematuria or oliguria about 1 seek later) can have schistocytes on blood smear
What is the pentad of TTP?
thrombocytopenia, hemolytic anemia, renal disease, fever, and neurologic changes; schistocytes on blood smear
How does immune thrombocytopenia usually present?
mucous membrane bleeding, cutaneous bleeding (no fever, fatigue, or weight loss), lab findings will show thrombocytopenia
What is the USPSTF recommendation for Pap smears based on age?
Pap smears every 3 years for women between 21-29 when used for cervical cancer screening. Between 30-65 yo every 5 years if combined with HPV co-testing
Tay-Sachs disease is an enzymatic deficiency of what enzyme and causes an accumulation of what product? How is it inherited?
deficiency of hexosaminidase A; accumulation of Gm2 ganglioside; autosomal recessive
Fabry disease is an enzymatic deficiency of what enzyme and causes an accumulation of what product? How is it inherited?
deficiency of alpha-galactosidase A; accumulation of glycosphingolipids; X-linked
Gaucher disease is an enzymatic deficiency of what enzyme and causes an accumulation of what product? How is it inherited?
deficiency of beta-glucosidase; accumulation of glucocerebroside; autosomal recessive
Niemann-Pick disease is an enzymatic deficiency of what enzyme and causes an accumulation of what product? How is it inherited?
deficiency of sphingomyelinase; accumulation of sphingomyelin; autosomal recessive
At what age should fluoride supplementation begin?
6 months
nipple inversion, discharge that appears white with a creamy consistency (or blood-tinged), normal appearing areola, ductoscopy shows dilated ducts filled with secretions and fibrotic debris - diagnosis?
duct ectasia
Cardiac examination of a 7 year old female reveals a normal s1 and a fixed, split s2 heart sound. There is a systolic ejection murmur loudest over the second left intercostal space. Name that murmur!
atrial septal defect - often asymptomatic in childhood. ASDs result in a left to right shunting of oxygenated blood across the atrial defects and increased pulmonary blood flow. Patients may become symptomatic around age 40 with fatigue, dyspnea on exertion, palpitations, and arrhythmia.
What paraneoplastic syndrome is caused by small cell carcinoma of the lung? What will you see on labs?
SIADH; hyponatremia with slightly elevated urine osmolality (above 800)
Patient presents with reactive arthritis, genital infection, and eye infection. STI?
chlamydia
Young patient with bloody diarrhea, weight loss, night sweats, intermittent abdominal pain, elevated ESR and CRP, and a positive pANCA
ulcerative colitis (Crohn’s disease is positive for ASCA)
What would the Weber and Rinne tests be for conductive hearing loss?
Weber heard best in affected ear
Rinne bone conduction > air conduction
What would the Weber and Rinne tests be for sensorineural hearing loss?
Weber heard best in unaffected ear
Rinne air conduction > bone conduction (positive)
What will EKG show for third degree AV block?
wide QRS, regular P-P intervals, and dissociation of the QRS from P waves.
Narrow QRS, irregularly irregular P-P interval, and some conducted P-waves describes what EKG?
atrial fibrillation
What is the CHA2DS2-VASc scoring system?
CHF, HTN, age over 75, diabetes, stroke, vascular disease (prior MI, PAD), age 65-75, and female sex
Age over 75 and stroke both get 2 points
Narrow QRS, regular P-P interval, and slowed conduction of P-waves describe what?
first-degree AV block
Narrow QRS, regularly irregular P-P interval, and some conducted P-waves describe the EKG findings of what?
atrial flutter
Wide QRS, regular P-P interval, and some conducted P-waves describe what EKG?
Mobitz II second-degree heart block
maternal fever, tachycardia, uterine tenderness, and fetal tachycardia - diagnosis? What’s the greatest risk factor for developing this?
chorioamnionitis; greatest risk factor is premature rupture of membranes
What is the difference between immune thrombocytopenia and thrombotic thrombocytopenia purpura?
ITP has purpura/petechiae and low platelets only; TTP has fever, hemolytic anemia, renal failure, thrombocytopenia, and neurologic symptoms
What are the possible results of a negative Hep B core antibody?
- patient is susceptible (all tests are negative)
2. patient is vaccinated (only anti-HBs is positive)
What are the possible results of a positive Hep B core antibody?
If there are other results that are positive, then the patient has had an actual infection:
- Presence of HBsAg means the patient is infectious and has an acute or chronic infection (if IgM is detected, it is acute)
- Negative HBsAg means they recovered from infection and are immune
A patient with a thyroid nodule and normal TSH/free T4 - what is the next step in workup?
ultrasound-guided fine needle aspiration biopsy to differentiate between benign and malignant thyroid tumors (do uptake scan if TSH is low)
What is the first step in treatment of someone in alcoholic keotacidosis?
thiamine and glucose
What parasite infection could cause Vitamin B12 deficiency?
diphyllobothrium latum
What is an Austin-flint murmur?
murmur caused by pure aortic regurgitation; diastolic rumbling murmur that differs from mitral stenosis by the absence of an opening snap; palpitations are uncomfortable with AR due to widened pulse pressure
How do you diagnose alpha-1 antitrypsin deficiency?
genetic testing
What is Samter’s triad?
aspirin intolerance, nasal polyps, and asthma (triad of aspirin-exacerbated respiratory disease)
What symptoms and laboratory findings would you expect in a case of post-infectious glomerulonephritis?
(AKA post-streptococcal glomerulonephritis); Sx = edema, HTN, and gross hematuria following strep pharyngitis or skin infection; laboratory findings include nephritis urinary sediment (hematuria, RBC casts, and proteinuria), a low complement C3 level, and positive testing for anti-streptolysin (ASO) or anti-DNAse B Abs
What is the HgA1C level for insulin resistance?
fasting glucose between 100-125 and HgA1C of 5.7-6.4%
What is the HgA1C level for diabetes?
greater than 6.4%
What is a side effect of ethosuximide? When is this contraindicated and what drug do you use? When is the alternative drug contraindicated?
pancytopenia; do not use in patients with pancytopenia; alternative is valproic acid; cannot use valproic acid in pregnancy
What vaccines should be given to an unvaccinated person with asplenia?
Hib, monovalent meningococcal serogroup B (MenB) series, quadrivalent meningococcal conjugate ACWY (Men ACWY) series, and the 13-valent pneumococcal conjugate vaccine (PCV13)
GI symptoms of Crohn’s disease?
non-bloody, non-purulent chronic diarrhea with diffuse abdominal pain relieved by defecation
What is the first step in workup of a TIA? What about the second step?
First step in workup of a TIA is a head CT. If that is negative, MRI of brain is next
