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Cam's Cards > Family Medicine EOR > Flashcards

Family Medicine EOR Flashcards

1
Q

Presenting symptoms of a cervical neck strain?

A

Pain or stiffness with neck movement.

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2
Q

Causes of cervical neck strains?

A

Minor injury or physical stressors such as poor posture or sleep habbits.

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3
Q

Name some red flags when evaluating what you think may be a cervical neck strain?

A

Major trauma, weakness, bowel or bladder dysfunction, cancer symptoms, IVDU, visual changes, anterior neck pain.

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4
Q

Where should you expect tenderness in a cervical neck strain patient?

A

Paraspinal and trapezius muscles.

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5
Q

T/F? You should get a c spine x-ray in evaluation of cervical neck strains.

A

False

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6
Q

Treatment for cervical neck strains?

A

NSAIDs

nonbenzo skeletal muscle relaxers are 2nd line.

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7
Q

How long should a cervical neck strain take to resolve?

A

Within 6 weeks.

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8
Q

Non-pharmacologic treatments for cervical neck strains?

A

Home exercise program, heat or cold, modification of posture.

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9
Q

What medications can result in decreased lower esophageal sphincter pressure, causing GERD?

A

Anticholinergics, antihistamines, CCBs, nitrates, progesterone, and TCAs.

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10
Q

What foods are associated with GERD?

A

Any large meal, acidic foods, alcohol, fatty foods, spicy foods, chocolate, and peppermint.

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11
Q

Name some atypical GERD symptoms.

A

Asthma, chronic cough, chronic laryngitis, sore throat, chest pain, and sleep disturbances.

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12
Q

Concerning GERD features?

A

Dysphagia, odynophagia, weight loss, IDA

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13
Q

Treatment for typical GERD without concerning symptoms?

A

8 week trial of BID H2RA or QD PPI

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14
Q

Patients who do not respond to PPI or H2RA, or have concerning features should have what procedure?

A

Endoscopy.

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15
Q

Gold standard for GERD diagnosis?

A

Esophageal pH testing

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16
Q

Long term PPI use side effects?

A

Infectious gastroenteritis, IDA, Vit B12 deficiency, hympomagnesemia, pneumonia, hip fractures.

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17
Q

Surgical treatment for GERD if pharmacologic therapy is not an option?

A

Surgical fundoplication.

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18
Q

First line therapy for H. pylori?

A

Amoxicillin, clarithromycin, PPI x 14 days

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19
Q

H. pylori is known to cause?

A

Peptic ulcer disease.

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20
Q

In patients age 30-55, where does peptic ulcer disease most commonly cause ulcers?

A

Duodenum

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21
Q

In patients age 55-70, where does PUD most commonly cause ulcers?

A

Gastric

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22
Q

Classic symptom of PUD?

A

Dull, aching, or gnawing epigastric pain

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23
Q

Pain from PUD can be relieved by?

A

Eating

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24
Q

How can you test for H. pylori?

A

Urea breath test or fecal antigen testing

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25
Q

When should a test for cure be done for a patient treated for H. pylori?

A

4 weeks after completing treatment.

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26
Q

Where is an ulcer located if pain is alleviated by ingesting food?

A

Duodenum

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27
Q

Where is an ulcer located if it is exacerbated by ingesting food?

A

Stomach

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28
Q

Is a hordeolum (stye) painful or nonpainful?

A

Painful

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29
Q

Cause of a hordeolum?

A

Purulent inflammation of the eyelid often due to bacterial infections (staph aureus)

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30
Q

Upon inspection of a patients eyelid, you see what appears to be an external hordeolum, however it is not painful. You know that it must be a?

A

Chalazion

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31
Q

Cause of a chalazion?

A

A blocked oil gland (Meibomian or Zeis gland.)

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32
Q

Diffuse inflammation of the eyelid is called?

A

Blepharitis

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33
Q

Most common causes of acute pericarditis?

A

Enteroviruses including coxsackie, adenoviruses, and parvovirus

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34
Q

3 P’s of pericarditis chest pain?

A

Pleuritic, persistent, postural.

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35
Q

First line treatment for acute pericarditis?

A

aspirin or NSAIDs + Colchicine to prevent recurrence

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36
Q

EKG findings in pericarditis?

A

PR elevation in aVR, PR depression, and diffuse ST elevation.

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37
Q

What medication can be added in treatment for acute pericarditis for refractory or severe cases?

A

Corticosteroids

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38
Q

Acute pericarditis after a myocardial infarction is known as?

A

Dressler syndrome

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39
Q

First line treatment for Dressler syndrome?

A

Aspirin and colchicine

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40
Q

Most common side effect of colchicine?

A

GI upset

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41
Q

What labs should be ordered to rule out treatable causes of dementia?

A

Vit B12 level

TSH (hypothyroidism)

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42
Q

Two main classes of drugs for treatment of dementia?

A

Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists

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43
Q

Name 3 causes of conjunctivitis.

A

Bacterial, viral, allergic

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44
Q

Most common pathogens for bacterial conjunctivitis?

A

Strep pneumo, H. influenzae, M. catarrhalis, staph aureus.

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45
Q

What type of conjunctivitis causes an eye to be “stuck shut” in the morning?

A

All of them

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46
Q

What is the preferred treatment of bacterial conjunctivitis in contact lens wearers?

A

Fluoroquinalone drops such as moxifloxacin or ofloxacin drops

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47
Q

What eye drops can be beneficial in treatment of viral or allergic conjunctivitis?

A

Topical ophthalmic antihistamines or decongestants, such as ketotifen.

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48
Q

A neonate develops severe conjunctivitis 10 days post delivery. What organism do you suspect?

A

Chlamydia - occurs between 5-14 days of life

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49
Q

A neonate develops severe conjunctivitis 3 days post delivery. What organism do you suspect?

A

Gonorrhea - occurs betewen 2-5 days of life

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50
Q

A patient presents with deep-seated itching of the ear 1 week after being treated for otitis externa. What do you suspect?

A

Fungal external otitis. (otomycosis)

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51
Q

What fungi are commonly responsible for fungal external otitis?

A

Aspergillus and Candida species.

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52
Q

Otoscopic evaluation of a patient reveals “fine coal dust” lining the ear canal. What is the most likely organism?

A

Aspergillus

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53
Q

Otoscopic evaluation of a patient reveals a soft white pseudo membrane lining the canal. What is the most likely organism?

A

Candida

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54
Q

Treatment of otomycosis?

A

Meticulous cleaning and removal of debris, topical antifungals.

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55
Q

What is the preferred agent and duration of therapy for treating otomycosis?

A

Clotrimazole 1% solution BID x 10-14 days

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56
Q

What class of medications used to treat otitis externa should be avoided in the presence of tympanic membrane perforation?

A

Aminoglycosides (tobramycin, gentamycin)

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57
Q

Salmonella outbreaks are most commonly associated with?

A

Poultry and eggs

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58
Q

Definitive diagnosis of salmonellosis is made by?

A

Stool culture

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59
Q

Most important component of therapy for salmonellosis?

A

Replacement of fluids and electrolytes

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60
Q

Which virus is associated with outbreaks of gastroenteritis on cruise ships?

A

Norovirus

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61
Q

Differentiating factors between stable and unstable angina?

A

Stable - predictably triggered, relieved by rest, less than 30 minute duration
Unstable - acute onset not relieved by rest, lasts longer than 30 minutes, and not relieved by nitroglycerin.

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62
Q

When is a coronary artery bypass graft indicated in coronary artery disease patients?

A

Left main coronary artery involvement >50% stenosis, >70% stenosis 3 vessel disease, or decreased left ventricular ejection fraction.

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63
Q

When is percutaneous transluminal coronary angioplasty indicated for CAD patients?

A

1 or 2 vessel disease without left main coronary artery involvement

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64
Q

What is the gold standard diagnostic test for coronary artery disease?

A

Coronary angiography

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65
Q

What is the cause of syncope?

A

Inadequate cerbreal blowflow

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66
Q

Four main causes of syncope?

A

Reflex syncope, orthostatic syncope, cardiac dysrhythmias, and structural cardiopulmonary disease.

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67
Q

Name some symptoms that accompany reflex syncope.

A

Lightheadedness, warm or cold, sweating, palpitations, nausea, decreased vision or hearing, pallor.

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68
Q

Workup for syncopal episode should include?

A

H and P, neuro exam, cardiopulmonary exam, EKG

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69
Q

Name some cardiac dysrhythmias that may be seen on EKG in patients with syncope.

A

Brugada syndrome, short QT syndrome, long QT syndrome, preexcitation, and heart block.

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70
Q

On a stool ova and parasite test, flagellated trophozoites and cysts are reported. What do you suspect the infection to be?

A

Giardia lamblia

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71
Q

Risk factors for giardia infections?

A

Wilderness activities, impaired immunity, MSM.

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72
Q

Incubation period of giardia?

A

1-3 weeks

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73
Q

First line treatment for Giardiasis?

A

Metronidazole 250mg TID x 5-7 days tinadazole 2g PO single dose.

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74
Q

What patient education can you give on water purification in order to avoid giardia?

A

Chlorination of water does NOT inactivate cysts. You must filter with a pore size less than 1 mcm or bring water to a boil.

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75
Q

A patient presents 7 days after ingestion of river water while camping. Stool ova and parasite test reveals banana shaped motile sporophytes. What organism do you suspect?

A

Cryptosporidium parvum

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76
Q

What is the most common medication for malaria to be resistant to?

A

Chloroquine

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77
Q

Most common patient population to have fibromyalgia?

A

Women 20-50 years old.

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78
Q

Fibromyalgia is commonly associated with what conditions?

A

RA, hypothyroidism, anxiety, depression.

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79
Q

What labs are abnormal in fibromyalgia?

A

None

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80
Q

Nonpharmacologic treatment for fibromyalgia?

A

CBT, patient education, sleep hygiene, low impact aerobic exercise.

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81
Q

Pharmacologic treatment for fibromyalgia?

A

TCAs, SSRIs, SNRIs, cyclobenzaprine, pregabalin, gabapentin.

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82
Q

What are the 3 FDA-approved medications for treatment of fibromylgia?

A

Duloxetine (SNRI), Pregabalin, and milnacipran.

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83
Q

Most common cause of small bowel obstruction?

A

Adhesions from prior abdominal surgeries.

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84
Q

How is diagnosis of small bowel obstruction made?

A

Abdominal x rays prone and standing.

CT abd also helps determine the severity.

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85
Q

Do you suspect a small bowel obstruction patient to be acidotic or alkalotic?

A

Could be either, acidotic if there is ischemic bowel or dehydration.
Alkalotic if patient had hyperemesis.

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86
Q

First steps in treatment of small bowel obstruction?

A

Nasogastric tube

Withdrawal of oral intake

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87
Q

What x-ray finding for a small bowel occlusion requires immediate surgery?

A

Free air in the abdomen indicating a bowel perforation

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88
Q

What is the most common cause of a large bowel obstruction?

A

Neoplasm

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89
Q

What do bowels sound like during small bowel obstruction?

A

High pitched bowel sounds

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90
Q

What two specific x-ray terms indicate small bowel obstruction?

A

Stack of coins or string of pearls sign

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91
Q

Most common cause of PID?

A

STIs (gonorrhea and chlamydia are most common)

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92
Q

What exam finding strongly suggests PID?

A

Cervical motion tenderness

chandelier sign

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93
Q

What is the most worrisome complication of PID?

A

Perihepatitis (Fitz-Hugh Curtis syndrome)

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94
Q

First line treatment for PID?

A

1 time IM ceftriaxone followed by 14 day course of oral doxycycline

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95
Q

Name some physical exam findings for allergic rhinitis.

A

Pale bogy turbinates, allergic shiners, allergic salute.

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96
Q

Treatment for allergic rhinitis?

A

Intranasal corticosteroid, second generation antihistamines

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97
Q

Vasomotor rhinitis, a common cause of clear rhinorrhea in older patients, is associated with an increased sensitivity of which nerve?

A

The vidian nerve.

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98
Q

Lab findings in allergic rhinitis?

A

Elevated serum IgE

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99
Q

What is Samters triad?

A

Nasal polyps, asthma, and aspirin sensitivity.

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100
Q

Describe the typical patient with immune thrombocytopenia (idiopathic thombocytogenic purpura).

A

2-5 year old with history of a recent viral infection.

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101
Q

Lab findings in ITP patient?

A

Platelets <100k (but not uncommon to see below <30k)

Normal hemoglobin, hematocrit, and WBC count.

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102
Q

Treatment for severe ITP includes?

A

Platelets, glucocorticoids, IVIG

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103
Q

How long does resolution of ITP typically take?

A

3-6 months

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104
Q

When can ITP patients be managed outpatient?

A

If they do not need rapid elevation in platelets, and if bleeding is limited to mild cutaneous bleeding.

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105
Q

Name a common neurologic finding associated with vitamin B12 deficiency anemia.

A

Gait ataxia

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106
Q

What peripheral blood smear finding is common in Vit B12 deficiency anemia?

A

Hypersegmented neutrophils.

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107
Q

What labs can help differentiate between a Vit B12 deficiency and folate deficiency?

A

Methylmalonic acid and homocysteine.

Elevated indicates B12 deficiency, normal indicated folate deficiency.

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108
Q

What is an appropriate regimen to correct a B12 deficiency?

A

1,000 mcg injection of B12 once a week until corrected, then once a month

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109
Q

What skin finding can be noted in severe iron deficiency anemia?

A

Chlorosis (pale green discoloration)

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110
Q

What nail finding is expected in iron deficiency anemia?

A

Koilonychia (spoon nails)

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111
Q

What is a physical exam finding that can help you differentiate between B12 and folate deficiency anemia?

A

Folate deficiency can present with oral ulcers.

B12 can present with neuropathy.

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112
Q

Name some causes of B12 deficiency.

A

Veganism, metformin, conditions affecting nutrient absorption (Chron’s)

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113
Q

When a patient presents with a fib, it is important to rule out reversible causes such as ____ and _____.

A

Thyroid disorders and diabetes mellitus

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114
Q

List the components of CHA2DS2-VASc

A 
CHF
HTN
Age (64-74=1. >75=2_
DM
Stroke
TIA or VTE
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115
Q

Which of the following oral antifungals is no longer recommended as first-line oral treatment due to the risk of drug-induced hepatitis?

A

Ketoconazole.

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116
Q

What organism is the most common cause of tinea versicolor?

A

Malassezia species

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117
Q

Treatment for tinea versicolor?

A

Selenium sulfide

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118
Q

First line treatment for hypertension in black patients?

A

Thiazide like diuretic or long-acting dihydropyridine CCB

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119
Q

First line treatment for hypertension in young patients?

A

ACEIs, ARBs, (Beta blokcers if they have other conditions that would benefit)

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120
Q

First line treatment for hypertension in old patients?

A

Thiazide-like diuretic or long-acting CCB

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121
Q

What type of hypertension can be treated with lifestyle modifications?

A

Primary hypertension (resulting from multiple genetic and environmental factors including age, obesity, high-sodium diet, and physical inactivity)

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122
Q

Name 3 common manifestations of SLE.

A

Malar rash sparing nasolabial folds
Raynaud phenomenon
Photosensitivity
(these were the bolded ones in rosh, I know theres a lot)

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123
Q

What lab tests have high specificity for SLE?

A

Anti-double-stranded DNA

anti-Smith antibodies

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124
Q

Can patients with SLE receive vaccines?

A

Only before starting immunosuppressive therapies.

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125
Q

An SLE patient comes into primary care for pre-conception counseling. What do you make sure to advise her of?

A

She should avoid pregnancy for 6 months after active diesase.

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126
Q

Which antibody is associated with drug-induced lupus erythematosus?

A

Antihistone antibody.

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127
Q

At what location is the murmur for aortic regurgitation heard?

A

Left upper sternal border

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128
Q

Symptoms of aortic regurgitation?

A

Exertional dyspnea, hyperdynamic apical pulse, wide pulse pressure.

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129
Q

What does the murmur of aortic regurgitation sound like?

A

Acute - low pitched, early diastolic murmur

Chronic - high-pitched, holodiastolic murmur

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130
Q

What should a aortic regurgitation murmur do when the patient preforms a Valsalva maneuver?

A

Decrease in intensity

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131
Q

The initial imaging test of choice for aortic regurgitation is?

A

Transthoracic echocardiogram

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132
Q

What is the definitive management for aortic regurgitation?

A

Surgical repair or replacement

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133
Q

What is the most common cause of aortic regurgitation?

A

Endocarditis

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134
Q

What medication should a patient be started on after a aortic valve replacement?

A

warfarin

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135
Q

What is the goal INR for a valve replacement patient?

A

2.5-3.5

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136
Q

What is an Austin Flint murmur?

A

A late diastolic murmur best heard at the apex. The sound heard is due to retrograde blood flow competing with antegrade flow from the left atrium.

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137
Q

What is Duroziez sign?

What is it a sign of?

A

A systolic and/or diastolic thrill or murmur heard over the femoral arteries.
It is a sign of aortic regurgitation

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138
Q

What type of airway disease is asthma?

A

Obstructive

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139
Q

What do you expect FEV1 and FVC to be in asthma?

A

Increased FEV1 and decrease FVC.

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140
Q

What is the FEV1/FVC ratio expected in obstructive airway conditions?

A

<0.70

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141
Q

Treatment for intermitent asthma?

A

SABA PRN

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142
Q

Treatment for mild persistent asthma?

A

SABA + low dose ICS

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143
Q

Treatment for moderate persistent asthma?

A

LABA + low dose ICS

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144
Q

Treatment for severe persistent asthma?

A

LABA + medium dose ICS

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145
Q

Which class of medication is montelukast?

A

Leukotriene inhibitor.

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146
Q

Name some medications that can cause erosive esophagitis?

A 
NSAIDs
Bisphosphonates
Potassium Chloride
Quinidine
Vit C
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147
Q

Symptoms of erosive esophagitis?

A

Dysphagia, odynophagia, retrosternal chest pain

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148
Q

In a patient with esophagitis, what red flags would make you want to perform an upper endoscopy?

A

Hematemesis, abd pain, weight loss, persistent symptoms after discontinuation of medication

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149
Q

What measures can be taken to prevent esophagitis caused by medications?

A

Standing upright for 30 minutes after taking medication, eating meal after taking the medication, taking the medication with at least 8oz water.

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150
Q

What is the first-line treatment for benign esophageal strictures?

A

Esophageal dilation.

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151
Q

What is the diagnostic criteria for chronic insomnia?

A

Difficulty falling or staying asleep at least 3 times a week for > 3 months

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152
Q

What is the preferred first-line treatment for insomnia?

A

CBT

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153
Q

What are some pharmacologic treatments for insomnia?

A

Benzos

Non-benzo receptor agonists (Z drugs)

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154
Q

What are the two most common relaxation-based strategies used for insomnia disorder?

A

Progressive muscle relaxation and diaphragmatic breathing.

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155
Q

What lab values are abnormal in irritable bowel syndrome?

A

none

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156
Q

What type of diet can be beneficial for IBS?

A

FODMAP

Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols

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157
Q

First line treatment for abdominal pain in IBS?

A

Antispasmodics such as dicyclomine of hyoscyamine.

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158
Q

Which COPD therapy has been shown to improve survival?

A

Long-term continuous oxygen therapy.

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159
Q

What are the two most common risk factors for CAD?

A

HTN and DM

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160
Q

What two diagnostics are important in the evaluation of CAD?

A

Cardiac enzymes and EKG

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161
Q

A lesion in which vessel is indicated by ST elevations in leads V1, V2, V3, and V4?

A

Left anterior descending (LAD).

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162
Q

What is the cause of diabetes mellitus type 1?

A

Pancreatic islet B cell destruction which is primarily autoimmune.

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163
Q

Describe the typical age of a patient at time of diagnosis of DM 1

A

Child to young adult

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164
Q

What is the cause of diabetes mellitus type 2?

A

Pancreatic beta cell dysfunction combined with insulin resistance.

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165
Q

When is DM II usually diagnosed?

A

Predominantly occurs in adults.

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166
Q

What is the most important environmental factor causing insulin resistance?

A

Obesity.

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167
Q

Symptoms of DM I?

A

Polyuria, polydipsia, weight loss with normal appetite.

Patients may have muscles wasting and weakness, paresthesias, and peripheral neuropathy.

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168
Q

Symptoms of DM II?

A

Typically asymptomatic because progression is slow.

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169
Q

Name 1 skin finding associated with insulin resistance.

A

Acanthosis nigricans

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170
Q

What is the criteria for diagnosing diabetes?

A

Random plasma glucose >200 in a symptomatic pt
Fasting plasma glucose >126 on two sperate occasions.
Glucose level >200 2 hours post oral glucose tolerance test.
H1C >6.5%

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171
Q

What type of obesity is associated with insulin insensitivity?

A

Visceral obesity due to the accumulation of fat in the omental and mesenteric regions.

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172
Q

An acute gout attack should be treated with?

A

NSAID such as indomethacin

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173
Q

Name some medications that increase risk for hyperuricemia.

A

Diuretics, thiazides, aspirin, cyclosporine, niacin.

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174
Q

Name 2 dietary risk factors for gout.

A

Excessive alcohol ingestion (particularly beer) and a high-purine diet.

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175
Q

What joint is most commonly affected by gout?

A

The MTP of the great toe

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176
Q

The definitive diagnosis of gout is made by?

A

Joint fluid aspirate showing Negatively birefringent needle shaped sodium urate crystals.

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177
Q

What x ray finding is expected in chronic gout?

A

Rat bite erosions

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178
Q

What medications reduce the risk of recurrence of gout and what is their mechanism?

A

Allopurinol - decreases production of uric acid

Colchicine and probenecid increase urinary excretion of uric acid.

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179
Q

What diagnosis are positively birefringent, rhomboid-shaped crystals in synovial fluid consistent with?

A

Pseudogout, also known as calcium pyrophosphate deposition.

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180
Q

What are the most common side effects of metformin?

A

Nausea, vomiting, diarrhea, flatulence, abd cramping.

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181
Q

What is the mechanism of action of saxagliptin?

A

Saxagliptin is a dipeptidyl peptidase-4 inhibitor that prolongs incretin levels and decreases glucagon secretion.

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182
Q

Describe the genetic mutation known as the Philadelphia chomosome.

A

Reciprocal translocation on the long arms of chromosomes 9 and 22

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183
Q

What disorder is caused by the Philadelphia chromosome?

A

Chronic myelogenous leukemia

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184
Q

What is the age range that patients begin to develop symptoms of CML?

A

40-60

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185
Q

What are the symptoms of CML?

A

splenomegaly, fever, night sweats, and weight loss

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186
Q

Lab findings in CML?

A

Increased WBC count

Peripheral blood smear shows greater percentage of blast cells.

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187
Q

Treatment for CML?

A

Allogenic hematopoietic cell transplantation

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188
Q

What is the most common childhood leukemia?

A

Acute lymphocytic leukemia

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189
Q

Auer rods are seen in what type of leukemia?

A

Acute myelogenous leukemia

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190
Q

What is the most common adult leukemia?

A

Chronic lymphocytic leukemia

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191
Q

Smudge cells are seen in what type of leukemia?

A

Chronic lymphocytic leukemia

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192
Q

What disease causes non-caseating granulomas forming throughout the body?

A

Sarcoidosis

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193
Q

What two organs are most commonly affected by sarcoidosis?

A

Skin and lungs

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194
Q

Describe skin findings of sarcoidosis.

A

Erythematous, painful, warm patches and nodules that appear on the shins, arms, and buttocks.

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195
Q

What is the name of the rash caused by sarcoidosis?

A

Erythema nodosum

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196
Q

What are the chest x ray findings on a typical sarcoidosis patient?

A

Bilateral hilar adenopathy

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197
Q

Diagnostic test of choice for sarcoidosis?

A

Transbronchial lung bopsy

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198
Q

On what test are lambda and panda signs seen?

A

Gallium scintigraphy

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199
Q

What abnormal bloodwork is present in sarcoidosis?

A

Hypercalcemia and elevated serum ACE, ESR and CRP elevated.

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200
Q

Treatment for sarcoidosis?

A

steroids

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201
Q

When does symptom onset for parkinsons typically occur?

A

45-65 years

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202
Q

Name the common clinical manifestations of parkinsons.

A

Resting or pill-rolling tremor, cogwheel or lead pipe rigidity, bradykinesia, postural instability, masked facies.

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203
Q

What is dysdiadochokinesia?

A

Loss of ability to preform rapid alternating movements.

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204
Q

What is the mainstay of treatment of parkinsons for patients >65?

A

Levodopa carbidopa

205
Q

What is the treatment of parkinsons for patients <65?

A

Dopamine agonists such as pramipexole, ropinirole, and bromocriptine

206
Q

What sign seen in Parkinson disease is characterized by a sustained blink response to repetitive tapping over the bridge of the nose?

A

Myerson sign.

207
Q

What is the most common bacterial cause of perotitis?

A

Staph aureus

208
Q

Parotitis is particularly common in what patient population?

A

Elderly post op patients

209
Q

Do parotitis patients need to be admited?

A

Yes, they need IV antibiotics because infection can spread to the deep fascial p

210
Q

What culture should be preformed for parotitis patients?

A

Gram stain and culture of the Stensen duct

211
Q

What are the empiric antibiotic recommendations for community acquired vs. hospital acquired parotitis?

A

Community acquired - ampicillin-sulbactam or cefuroxime + metronidazole
Hospital acquired - either vancomycin or linezolid plus one of the following (cefepime and metronidazole) (imipenem) (meropenem) (piperacillin tazobactam)

212
Q

What are the risk factors for methicillin-resistant Staphylococcus aureus?

A

Intravenous drug use, residence in a long-term care facility, discharge from a hospital within the preceding 12 months, and hemodialysis.

213
Q

Describe the rash caused by cellulitis.

A

Single, painful, erythematous patch with poorly demarcated borders and overlying warmth

214
Q

What rash is described as multiple lesions with three concentric zones of color change?

A

Erythema multiforme

215
Q

What rash is described as purple, pruritic, polygonal, planar, papular plaques?

A

Lichen planus

216
Q

What rash is described as raised, purpuric, target-like lesions with two zones of color change?

A

Stevens-Johnson syndrome and toxic epidermal necrolysis.

217
Q

What form of cellulitis is characterized by a bright red plaque with raised and sharply demarcated borders?

A

Erysipelas

218
Q

What is the only antianginal agent proven to improve mortality in patients with CAD?

A

Beta blockers

219
Q

Which reflex originates in the cardiac sensory receptors and promotes parasympathetic activity, resulting in bradycardia, vasodilation, and hypotension?

A

The Bezold-Jarisch reflex

220
Q

What is the single most common cause of acute bacterial sinusitis?

A

Strep pneumo

221
Q

What is the most common bacteria causing chronic sinusitis?

A

Staph aureus

222
Q

What is a major side effect of pseudoephedrine, especially if used for more than 3 days?

A

Rhinitis medicamentosa

rebound congestion

223
Q

What is the most sensitive test used to diagnose inflenza?

A

Reverse transcriptase PCR

224
Q

Antiviral therapy may be considered in which influenza patients?

A

Patients with severe influenza, those at risk for complications, and those not at high risk who present with 48 hours of onset of illness

225
Q

What medication is used to treat influenza?

A

Oseltamivir

226
Q

What is the most common complication of influenza?

A

pneumonia

227
Q

What is the initial treatment for frozen shoulder.

A

Initially treat with PT

+/- steroid injections

228
Q

What is the treatment for frozen shoulder that persists past 10-12 months?

A

Manipulation under anesthesia or arthroscopic surgical release.

229
Q

What two movements of the shoulder are most commonly affected by frozen shoulder?

A

External rotation and abduction

230
Q

What nerve passes through the quadrangular space of the shoulder?

A

The axillary nerve.

231
Q

What virus is responsible for warts?

A

Human papillomaviruses

232
Q

Treatment for nongenital warts?

A

Liquid nitrogen cryotherapy or salicylic acid plaster after paring

233
Q

Treatment for genital warts?

A

Liquid nitrogen cryotherapy, podophyllum resin, imiquimod 5% cream, excision and electrocautery, and laser therapy

234
Q

Which two human papillomavirus types are most commonly associated with condyloma acuminata?

A

Human papillomavirus types 6 and 11.

235
Q

What are the black dots that appear within warts?

A

Thrombosed capillaries

236
Q

What is a positive murphy sign?

A

Pain and cessation of breathing upon palpation in the area of the gallbladder fossa while the patient is taking a deep breath.

237
Q

What condition is defined as inflammation of the gallbladder as a result of cystic duct obstruction?

A

Cholecystitis.

238
Q

What is the initial choice of imaging for a suspected cholecystitis?

A

Ultrasound

239
Q

What ultrasound findings correlate with the diagnosis of cholecystitis?

A

Presence of stones, gallbladder wall thickening, or pericholecystic fluid.

240
Q

What is the preferred definitive treatment for cholecystitis?

A

Cholecystectomy.

241
Q

What is Charcot triad?

A

Jaundice, fever, and right upper quadrant abdominal pain.

242
Q

What is the gold standard imaging for suspected cholecystitis?

A

HIDA scan

243
Q

An upright Xray, CT scan, or MRI showing a retrocardiac air-fluid level is diagnostic of what condition?

A

Hiatal hernia

244
Q

What is a type I hiatal hernia, and what are they associated with?

A

Type I is a sliding hernia, and it is associated with trauma, congenital malformations, and iatrogenic factors.

245
Q

Type II, III, and IV hiatal hernias are known as what type of hernias?

A

Paraesophageal hernias

246
Q

What are paraoesophageal hernias associated with?

A

Surgical procedures.

247
Q

Treatment of hiatal hernias?

A

Usually just involved management of GERD symptoms.

Surgical repair reserved for symptomatic patients.

248
Q

What is the most commonly performed surgical procedure to correct a hiatal hernia?

A

Nissen fundoplication.

249
Q

What is the most common cause of bronchitis?

A

Viruses (influenza, coronavirus, and rhinovirus are most common)

250
Q

How long does the cough associated with bronchitis typically last?

A

Up to 3 weeks

251
Q

Treatment for bronchitis?

A

Throat lozenges, hot tea, honey, smoking cessation.

252
Q

What is the name of the pulmonary physical exam test performed by placing the ulnar aspects of both hands against the patient’s chest while the patient says the number 99?

A

Tactile fremitus.

253
Q

What is the triad of symptoms associated with bulimia nervosa?

A

Caloric restriction, binge eating, and self-induced vomiting.

254
Q

List some comorbid conditions associated with bulimia nervosa.

A

Unipolar depression and specific phobia disorder are the two most common

255
Q

What emetic is often misused by patients with bulimia nervosa?

A

Syrup of ipecac.

256
Q

Mild to moderate non-throbbing headache that is bilateral with pain in the frontal and occipital region describes what type of headache?

A

Tension headache

257
Q

What are common associated symptoms with tension headaches?

A

Photophobia or phonophobia.

258
Q

Treatment for tension headaches?

A

NSAIDs or aspirin

259
Q

What is the first line preventative treatment for tension headaches?

A

Amytriptyline

260
Q

What is the first-line acute treatment for cluster headache?

A

100% oxygen.

261
Q

What are the two most common pathogens for otitis media?

A

H flu and Strep pneumo

262
Q

AOM is most common in what age range?

A

6-24 months

263
Q

What is the first line antibiotic for AOM?

What if they’ve had a beta lactam in the past 30 days?

A

Amoxicillin

Amox-clav if recent beta lactam use

264
Q

Which antibiotics can be used to treat acute otitis media in children with anaphylactic reactions to amoxicillin?

A

Azithromycin or clindamycin.

265
Q

Pyelonephritis with struvite stones is associated with what bacteria?

A

Proteus mirabilis and other urease producing bacteria

266
Q

What is the most common pathogen of pyelonephritis?

A

E. coli

267
Q

What is the empiric outpatient therapy for pyelonephritis?

A

1g ceftriaxone + one of the following: (trimethoprime-sulfamethoxazole) (amox-clav) (a cephalosporin) (a fluoroquinalone)

268
Q

Inpatient empiric treatment for pyelonephritis?

A

Antipseucomonal carbapenem and vancomycin

269
Q

How many colony-forming units of a single organism on urine culture are suggestive of a urinary tract infection?

A

10^5

100,000

270
Q

What is the most common cause of heel pain in the US?

A

Plantar fasciitis

271
Q

Treatment for plantar fasciitis?

A

ice, stretching, and rest

NSAIDs, acetaminophen, and orthotics may also be appropriate.

272
Q

What Xray finding may be seen in plantar fasciitis?

A

Calcaneal spurs

273
Q

What medical term is used to describe the pain that occurs after a period of rest and is associated with plantar fasciitis?

A

Poststatic dyskinesia.

274
Q

What is Löfgren syndrome?

A

Combination of erythema nodosum, hilar adenopathy, migratory polyarthralgia, and fever observed in patients with sarcoidosis.

275
Q

A small, round to oval ulcer with peripheral erythema and yellowish central exudate in the mouth describes the appearance of?

A

An aphthous ulcer (aphthous stomatitis)

276
Q

Complex aphthosis is characterized by the presence of lesions where?

A

In the mouth AND geneital mucosa

277
Q

Patients with complex aphthosis should be tested for?

A

Behçet syndrome

278
Q

Patients with Behçet syndrome will have a postive ______ test.

A

Pathergy

279
Q

Treatment for simple apthosis?

A

2% viscous lidocaine for analgesia and topical steroids at onset of symptoms

280
Q

Which virus causes a flesh-colored, cauliflower-like genital lesion?

A

Human papillomavirus.

281
Q

Treatment for Torsades?

A

Defib if hypotensive and mag sulfate.

282
Q

Name 4 classes of laxatives and give and example of each.

A

Stimulant laxatives -biscodyl
Osmotic laxatives - sorbitol
Surfactant laxatives - docusate
Bulk Forming laxatives - psyllium, methylcellulose

283
Q

What are the possible adverse effects of using sodium phosphate enemas in older adults?

A

Volume depletion, hypotension, hyperphosphatemia, hypokalemia, hyperkalemia, metabolic acidosis, and acute kidney injury.

284
Q

What are the risk factors for sleep apnea. Be specific.

A

BMI >29
Neck circumference > 17 in men and >16 in women
Crowded oropharyngeal airway
Waist:Height >100.4cm for men and 95.5 for women

285
Q

What is the gold standard test for sleep apnea?

A

In-laboratory polysomnography

286
Q

What indicates a positive polysomnography test?

A

five or more obstructive respiratory events/hour

287
Q

The mainstay of treatment for sleep apnea is?

A

CPAP

288
Q

What is Cheyne-Stokes breathing?

A

An abnormal pattern of breathing characterized by periods of tachypnea and hyperpnea alternated by periods of apnea.

289
Q

What is the first line treatment for an essential tremor?

A

Propanolol

290
Q

What is the most common isolated focal dystonia?

A

Cervical dystonia.

291
Q

First line treatment for Bipolar disorder?

A

Quetiapine or lursidone

292
Q

What is the first-line treatment for bipolar disorder in pregnant patients?

A

Lamotrigine.

293
Q

What is the typical number of leads on a traditional Holter monitor?

A

Three (although 12-lead monitors are available).

294
Q

In long term untreated carpal tunnel syndrome, is thenar atrophy or hypothenar atrophy seen?

A

Thenar atrophy

295
Q

What physical exam testing is associated with carpal tunnel syndrome?

A

Tinel sign and Phalen sign

296
Q

List 3 risk factors for carpal tunnel syndrome?

A

Female sex, pregnancy, diabetes.

297
Q

What is the first line treatment for carpal tunnel syndrome?

A

Night splints, NSAIDs, physical therapy, exercise, stretching.

298
Q

What is the definitive therapy for carpal tunnel syndrome?

A

Surgical decompression.

299
Q

When is Chvostek’s sign positive?

A

Hypocalcemia

300
Q

A positive Adson test is indicative of?

A

Thoracic outlet syndrome

301
Q

How many tendons are located within the carpal tunnel?

A

Nine.

302
Q

Carpal tunnel syndrome is most commonly caused by the compression of what nerve?

A

Median nerve

303
Q

Addison disease is most commonly caused by?

A

Autoimmune dysfunction

304
Q

What hormones are chronically elevated in Addison disease?

A

ACTH and melanocyte stimulating hormones

305
Q

Symptoms of Addison disease?

A

Abd pain, nausea, vomitting, diarrhea, confusion, Fatigue, weakness, weight loss, salt craving, hypotension.

306
Q

Lab findings in Addison disease?

A

Hyponatremia and Hyperkalemia

307
Q

What tests are indicative of primary adrenal insufficiency?

A

Cosyntropin stimulation test or corticotropin-releasing` hormone stimulation test

308
Q

Treatment for Addison disease?

A

Corticosteroid replacement therapy with hydrocortisone and mineralocorticoid replacement therapy with fludrocortisone.

309
Q

What test is used to diagnose Cushing syndrome?

A

Dexamethasone suppression test.

310
Q

Which androgen is androstenedione converted into?

A

Testosterone

311
Q

A warm, edematous, exquisitely tender prostate are signs of?

A

Prostatitis

312
Q

What is the most common pathogen of prostatitis?

A

E. coli

313
Q

Inpatient management of prostatitis?

A

IV ampicillin and aminoglycoside (gentamycin)

314
Q

Outpatient treatment for prostatitis?

A

6 week course of oral antibiotics (trimethoprim-sulfa, ciprofloxacin)

315
Q

What class of medications is recommended as the initial treatment for symptomatic benign prostatic hyperplasia?

A

Alpha-1 adrenergic antagonists (e.g., tamsulosin, terazosin).

316
Q

Initial diagnostic approach for CHF?

A

EKG, Chest XR.

317
Q

What is the most commonly used diagnostic study for CHF?

A

Echocardiography

318
Q

What is the gold standard diagnostic for CHF?

A

Right heart catheterization

319
Q

Therapy for CHF?

A

Decreasing sodium intake, ACEI, diuretic, and beta blockers

320
Q

What is the name of the horizontal lines on a chest radiograph resulting from interstitial edema that may be seen in heart failure patients?

A

Kerley B lines.

321
Q

List the symptoms of retina detachment.

A

painless loss of vision, floaters, flashing lights, curtain lowering sensation

322
Q

What is the most common cause of epididymitis in patients younger than 35 years old?

A

Chlamydia trachomatis

Neisseria gonorrhoeae is 2nd

323
Q

What is a positive Prehn sign?

A

Relief of pain with support of the testicle.

324
Q

Treatment for epididymitis for patients younger than 35?

Older than 35?

A

Younger - ceftriaxone 250mg IM once + doxycycline 100mg BID x 10 days
Older - levofloxacin 500mg QD x 10 days

325
Q

Epididymitis in patients who participate in anal sex should be treated with?

A

Ceftriaxone and levofloxacin

326
Q

What diagnosis is the blue dot sign associated with?

A

Torsion of the appendix of the testicle.

327
Q

List the symptoms of Meniere’s disease.

A

Episodic vertigo, tinnitus, and low-frequency sensorineural hearing loss

328
Q

Are symptoms typically unilateral or bilateral in Meniere’s disease?

A

Unilateral

329
Q

What dietary restrictions can you give to a patient to improve Meniere’s disease?

A

Limit sodium, caffeine, alcohol, nicotine, and MSG.

330
Q

Pharmacologic treatment for Meniere’s disease consists of?

A

A diuretic or chronic betahistine +/- a benzodiazepine

331
Q

Which disorder is characterized by progressive unilateral sensorineural hearing loss, disequilibrium, and facial numbness secondary to compression of the vestibulocochlear nerve?

A

Vestibular schwannoma, also known as acoustic neuroma

332
Q 
Which of the following types of lung cancers is less likely associated with smoking?
A. Adenocarcinoma
B. Large cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
A

Adenocarcinoma

333
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

334
Q

What is the classic presentation of breast cancer?

A

A hard immobile breast mass.

335
Q

Diagnosis of breast cancer is made by?

A

Biopsy of breast tissue with malignant cells.

336
Q

What are two factors that may reduce breast cancer risk?

A

Breastfeeding and increased regular physical activity.

337
Q

What is the most common pathogen responsible for infective endocarditis.

A

Staph aureus

338
Q

List the classic signs of infective endocarditis.

A

Cardiac murmur
Petechiae
Spinter hemorrhages
Janeway lesions (painless lesions on palms and soles)
Osler nodes (painful lesions on fingers, toes, or feet)
Roth spots (lesions on retina)

339
Q

What is the diagnostic of choice for endocarditis?

A

Echocardiogram

340
Q

What criteria are used to diagnose endocarditis?

A

Duke criteria

341
Q

How many criteria must be positive to diagnose a patient with endocarditis using Duke criteria?

A

Two major
One major and three minor
Five minor

342
Q

What are the major and minor criteria?

A

Major: + blood cultures, evidence of endocardial involvement
Minor: IVDU, fever, vascular phenomena, immunologic phenomena, and microbiologic evidence.

343
Q

Which heart valve is most affected by infective endocarditis in intravenous drug users?

A

Tricuspid valve.

344
Q

What is the most common acute leukemia in adults?

A

AML

345
Q

Peripheral blood smear in AML shows presence of ?

A

Auer rods

346
Q

Diagnosis of AML is confirmed by?

A

Bone marrow biopsy

347
Q

Bone marrow biopsy must show blast cells greater than ___% to diagnose AML.

A

20%

348
Q

First line treatment for AML?

A

Combination chemotherapy most commonly with anthracycline and cytarabine in a 7+3 regimen

349
Q

What are the metabolic abnormalities associated with tumor lysis syndrome?

A

Hyperphosphatemia, hypocalcemia, hyperuricemia, and hyperkalemia.

350
Q

Give examples of two high intensity statin therapies.

A

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

351
Q

If a patient develops endocarditis within 2 months of a valve replacement, what are the most common organisms?

A

Staph aureus
Gram negative bacilli
Candida

352
Q

If a patient develops endocarditis 2-12 months after a valve replacement, what is the most common organism?

A

Staph epidermidis

353
Q

If a patient develops endocarditis greater than 12 months after a valve replacement, what is the most common organism?

A

Strep viridans or strep bovis

354
Q

What organisms make up the HACEK group of organisms?

A

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella.

355
Q

What is a pancoast tumor?

A

A lung tumor (non-small cell is most common) that occurs in the superior sulcus causing dermatomal symptoms resulting from brachial plexus involvement.

356
Q

What are the symptoms of a pancoast tumor?

A

Honer syndrome, ipsilateral ptosis and miosis, superior vena cava syndrome, muscle atrophy, weakness, and pain.
Also the expected symptoms of lung cancer like cough, sob, hemoptysis ect.

357
Q

What are the two phases of the menstrual cycle?

A

The follicular phase and the luteal phase.

358
Q

During the beginning of the follicular phase, what are the serum estradiol and progesterone levels?

A

Low

359
Q

Low levels of estradiol and progesterone stimulate the hypothalamus to ?

A

Release GnRH in pulses

360
Q

Increased GnRH causes?

A

Release of FSH and LH from the anterior pituitary.

361
Q

When do estradiol levels peak?

A

1 day before ovulation

362
Q

What amount of blood loss during a menstrual cycle defines heavy menstrual bleeding?

A

> 80 mL.

363
Q

Hallmark symptom of classic Hodgkin lymphoma?

A

Diffuse lymphadenopathy

364
Q

Hodgkin lymphoma is most common in what age range?

A

15-35

365
Q

Biopsy of a lymph node in hodgkin lymphoma will show?

A

Reed Sternberg cells (Bilobed nucleus that looks like an owls eyes.

366
Q

True or false: eosinophilia is a common finding in Hodgkin lymphoma.

A

True. Increased production of chemokines induces eosinophilia.

367
Q

What is the most common location for a ganglion cyst?

A

The dorsal aspect of the wrist over the scaphlunate joint

368
Q

Do ganglion cysts transilluminate?

A

Yes

369
Q

What is the initial treatment for a ganglion cyst?

A

Reassurance and waiting. 50% will resolve spontaneously

370
Q

What is the definitive treatment for a ganglion cyst?

A

Surgical excision

371
Q

What condition secondary to ligamentous injury is suspected when the Terry-Thomas sign is seen on wrist X-ray?

A

Scapholunate dissociation.

372
Q

List physical exam findings in hypertrophic cardiomyopathy.

A

Pulsus bisferiens (biphasic pulse due to aortic regurgitation)
Triple apical impulse
S4 gallop

373
Q

Does the murmur from hypertrophic cardiomyopathy increase of decrease with valsalva?

A

Increase

374
Q

How is hypertrophic cardiomyopathy diagnosed?

A

Echocardiogram

375
Q

Pharmacologic treatment for hypertrophic cardiomyopathy?

A

beta blocker or CCB to decrease myocardial contractility.

376
Q

Which gallop heard on cardiac auscultation can be a normal finding in patients < 30 years of age?

A

S3 gallop.

377
Q

What is the only FDA approved treatment for pain associated with fibrocystic breast disease?

A

Danazol

378
Q

Breast pain in fibrocystic breast disease is caused by what?

A

Fluctuating estrogen levels during menstrual cycles.

379
Q

When does breast pain and tenderness peak in fibrocystic breast disease?

A

before each mensuration

380
Q

What is the name of the fibroadenoma-like tumor with cellular stroma that grows rapidly and has a leaf-like pattern on histology?

A

Phyllodes tumor.

381
Q

What is more common, hyper or hypothyroidism?

A

Hypothyroidism.

382
Q

What is the most common cause of hyperthyroidism?

A

Graves disease

383
Q

What lab studies are diagnostic of hyperthyroidism?

A

A low TSH and a high T4

384
Q

What is the most sensitive test for diagnosing graves disease?

A

Antithyrotropin receptor antibody test

385
Q

What are the treatments of choice for graves diease?

A

Methimazole or PTU

386
Q

Which antithyroid modulating drug is the drug of choice in pregnant women?

A

PTU

387
Q

What is the treatment for graves disease in patients whose symptoms are not controlled by antithyroid modulating drugs?

A

Radioactive iodine ablation or thyroidectomy.

388
Q

What are potential complications of untreated exophthalmos?

A

Corneal dryness and damage, keratoconjunctivitis, compression of the optic nerve or optic artery, and blindness.

389
Q

What is the most common pathogen in septic bursitis?

A

Staph aureus

390
Q

Will a patient with septic bursitis have full passive range of motion?

A

Yes - because the infection is isolated to the bursa.

Diminished ROM can be a sign of septic arthritis.

391
Q

What is the gold standard for diagnosis of septic bursitis?

A

Bursa fluid culture

392
Q

What is the outpatient treatment for septic bursitis with no concerns of MRSA?

A

Cephalexin or dicloxacillin. x 10 days

393
Q

What is the outpatient treatment for septic bursitis with concerns of MRSA?

A

Trimethoprim-sulfamethoxazole x 10 days

394
Q

True or false: aseptic bursitis can be caused by gout.

A

True.

395
Q

What is a common but harmless side effect of taking the tuberculosis medication rifampin?

A

It can cause body fluids (urine, sweat, saliva, tears) to change color to yellow, orange, red, or brown.

396
Q

If a patient has a positive PPD test, what is recomended next?

A

A confirmatory interferon-gamma release assy (IGRA)

397
Q

What vaccine can cause a positive PPD?

A

bacillus Calmette-Guerin vaccination

398
Q

Therapy for latent TB usually includes what two medications?

A

Rifampin or isoniazid (alone or together)

399
Q

Does psoriasis typically affect flexor or extensor surfaces?

A

Extensor

400
Q

What are some nail findings common is psoriasis?

A

Nail pitting and separation from the nailbed.

401
Q

What is the Koebner phenomenon?

A

Plaque formation at the site of prior trauma developing 1-2 weeks after the injury.

402
Q

What is the auspitz sign?

A

Punctate bleeding spots when scales are lifted. This is a finding of psoriasis.

403
Q

What is the treatment for psoriasis if <10% BSA is involved.

A

High-potency to ultra-high-potency topical steroids.

404
Q

T/F? Psoriatic arthritis flare ups should be treated with oral corticosteroids.

A

False - rebound effects are are severe

405
Q

What is the treatment for psoriasis if 10%-30% BSA affected?

A

Ultraviolet phototherapy.

406
Q

What is the treatment for psoriasis if >30% BSA affected?

A

Narrowband ultraviolet phototherapy, Psoralen plus UVA photochemotherapy, or systemic agents such as methotrexate or biologics.

407
Q

The diagnosis of Cushing syndrome is made with what tests?

A

24 hour urine cortisol and ACTH levels

408
Q

The diagnosis of cushing disease can be made with what test?

A

High-dose dexamethasone suppression test

409
Q

What drugs increase the metabolism of dexamethasone leading to impaired cortisol suppression?

A

Antiseizure drugs (e.g., phenytoin, phenobarbital) and rifampin.

410
Q

What is the most common cause of cushing syndrome?

A

Cushing disease - ACTH secreting pituitary tumor

411
Q

How often should someone with normal risk for breast cancer be screened for breast cancer? What is the preferred screening modality?

A

Bilateral screening mammography every 2 years

412
Q

How often should someone with high risk for breast cancer be screened for breast cancer? What is the preferred screening modality?

A

Annual breast MRIs

413
Q

When is breast ultrasound used?

A

Patients younger than 30 presenting with a breast mass.

414
Q

What is the preferred screening modality for an AAA?

A

Ultrasonography

415
Q

Who should receive screening for AAA?

A

Men ages 65-75 who have ever smoked

416
Q

What are the two greatest interventions to reduce the risk for developing an abdominal aortic aneurysm?

A

Smoking cessation and blood pressure control.

417
Q

List the deformities you would expect to see in rheumatoid arthritis.

A 
Ulnar deviation
Swan neck deformity
Boutonniere deformity
Bow string sign
Rheumatoid nodules
418
Q

What joints are commonly affected by rhemuatoid arthritis?

A

MCPs, PIPs, MTPs, wrists, knees, and ankles

419
Q

First line treatment for rheumatoid arthritis?

A

DMARDs such as methotrexate.

Low dose corticosteroids as bridge until DMARD starts working.

420
Q

Pencil-in-cup deformity is seen in what disease?

A

Psoriatic arthritis.

421
Q

How long does morning stiffness last in rheumatic arthritis?

A

> 30 minutes

422
Q

What are lab findings in RA?

A

Positive RF and anti-cyclic citrullinated peptide antibodies.
(but you can also have seronegative RA)

423
Q

What is the classic patient presentation of acute pancreatitis?

A

Epigastric pain radiating to back, nausea, and vomiting.

424
Q

What physical exam findings are suggestive of pancreatitis?

A

Grey Turner sign (flank ecchymosis) and Cullen sign (umbilical eccymosis)

425
Q

Most common cause of pancreatitis?

A

Gallstones, then alcohol

426
Q

What labs are elevated in pancreatitis?

A

Lipase and amylase are most reliable

also BUN, leukocytes, glucose

427
Q

What can be used to assess the severity of pancreatitis?

A

Ranson criteria

428
Q

Treatment for pancreatitis?

A

Bowel rest, bed rest, IV fluids, and pain control

429
Q

What gastrointestinal disorder is autoimmune pancreatitis commonly associated with?

A

Celiac disease.

430
Q

List the hallmark of glaucoma on fundoscopy?

A

Optic disc cupping

Cup to disc ratio >0.5

431
Q

What is considered an increased IOP?

A

> 21 mm Hg

432
Q

First line treatment for chronic glaucoma?

A

Prostaglandin analog such as latanoprost +/- Topical beta blocker such as timolol.

433
Q

What procedure is standard for chronic open-angle glaucoma?

A

Trabeculectomy

434
Q

What is the second line treatment for chronic gloaucoma?

A

Alpha 2 agonists such as brimonidine or carbonic anhydrase inhibitors such as acetazolamide

435
Q

What surgical procedure is used as definitive treatment for angle-closure glaucoma?

A

Peripheral iridotomy.

436
Q

What is the antibiotic of choice for patients with corneal abrasion?

A

Erythromycin ointment for non-contact lens wearers

Fluoroquinolone or aminoglycoside drops from contact lens wearers for pseudomonas coverage.

437
Q

Which screening test for corneal disorders is used to evaluate for the presence of anterior chamber leakage into the cornea?

A

Seidel test.

438
Q

True or false: montelukast is effective in treating exercise-induced asthma.

A

True.

439
Q

Does mononucleosis cause anterior or posterior cervical chain lymphadenopathy?

A

Posterior

440
Q

How is labyrinthitis distinguished from vestibular neuritis?

A

Labyrinthitis involves inflammation of the cochlear part of the vestibulocochlear nerve causing hearing loss and tinnitus.

441
Q

Causes of labyrinthitis?

A

Viruses such as herpes simplex, varicella-zoster, and epstein-barr.

442
Q

What are the symptoms of labyrinthitis?

A

Hearing loss, tinnitus, PERSISTENT vertigo (as compared to intermitent in BPPV), horizontal nystagmus.

443
Q

What is the treatment of vestibular neuritis?

A

Corticosteroids (prednisone)

Antihistamines, benzodiazepines, and antiemetics can also be used for symptomatic treatment.

444
Q

What are the absolute contraindications to administering alteplase in the treatment of an acute ischemic stroke?

A

Intracranial hemorrhage on CT; neurosurgery, head trauma, or stroke within the past 3 months; uncontrolled hypertension (> 185/110 mm Hg); history of intracranial hemorrhage; known arteriovenous malformation, aneurysm, or neoplasm; suspected or confirmed endocarditis; known bleeding diathesis; and glucose < 50 mg/dL.

445
Q

What maneuver is used to diagnose BPPV?

What maneuver is used to treat it?

A

Dix-halpike is the diagnosing maneuver

Epley maneuver is used to treat it.

446
Q

What is the initial test of choice for gonorrhea?

A

nucleic acid amplification testing of first-catch urine or urethral swab in men, or a vaginal or endocervical swab in women.

447
Q

What is the preferred antibiotic regimen for urethritis?

A

Ceftriaxone 500mg IM once and Doxycycline 100mg BID x 7 days

448
Q

What inflammatory syndrome involving the Glisson capsule can occur in patients with pelvic inflammatory disease secondary to Chlamydia trachomatis and Neisseria gonorrhoeae?

A

Fitz-Hugh-Curtis syndrome

449
Q

What is the preferred antibiotic regimen in patients with chlamydia urethritis who have had a Gonorrhea infection ruled out?

A

Doxycycline 100mg BID x 7 days

450
Q

What is a common arrhythmia in patients with anorexia nervosa?

A

Sinus bradycardia

451
Q

What antidepressant should be avoided in patients with eating disorders?

A

Bupropion, due to lowering of the seizure threshold.

Seizures can occur in patients with eating disorders due to hypoglycemia

452
Q

What is the expected FEV1/FVC ratio in COPD?

A

Decreased

453
Q

What are the 3 subtypes of COPD?

A

Emphysema, chronic bronchitis, and chronic obstructive asthma

454
Q

What is the treatment for COPD?

A

inhaled bronchodilators, oxygen, and pulmonary rehabilitation.

455
Q

Which hereditary disorder should patients with suspected COPD be evaluated for?

A

Alpha-1 antitrypsin deficiency.

456
Q

Which patients are known as pink puffers and which are known as blue bloaters?

A

Pink Puffer emPhysema

Blue Bloater Bronchitis

457
Q

Signs of retinal artery occlusion on fundoscopy?

A

Retinal pallor, cherry red fovea,

458
Q

Is retinal artery occlusion painless or painful?

A

Painless

459
Q

In a patient over 50 in whom you suspect CRAO, what must you rule out and how do you rule it out?

A

Giant cell arteritis with ESR

460
Q

Vision may be spared if an retinal artery embolus can be removed within what time frame?

A

100 minutes

461
Q

Treatment for CRAO?

A

Ophthalmology STAT and ocular massage

462
Q

Name 3 rashes that can occur on the palms and soles of the feet.

A

Erythema multiforme
Coxsackie virus
Secondary syphilis

463
Q

Describe the rash of erythema multiforme.

A

Raised blanching target shaped lesions with 3 concentric zones of color change.

464
Q

Erythema multiforme is associated with what virus?

A

Herpes simplex virus

The rash is caused by a type IV herpsensitivity reachion.

465
Q

Describe the rash associated with secondary syphilis.

A

Diffuse symmetric macular or papular rash affecting the trunk as well as the extremities including the palms and soles.

466
Q

What is the treatment for erythema multiforme?

A

Oral antihistamines or low potency topical steroids.

467
Q

What drugs can cause erythema multiforme?

A

SOAPS

Sulfa, Oral hypoglycemic, Anticonvulsants, Penicillin, nSAIDs

468
Q

Describe the murmur of mitral valve prolapse.

A

Midsystolic click that increases with valsalvaa.

469
Q

Mitral valve prolapse is diagnosed by?

A

Echocardiography.

470
Q

Treatment for mitral valve prolapse?

A

Lifestyle modifications such as increasing aerobic exercise, decreased caffeine and alcohol intake, and reducing stress.

471
Q

Which valvular disorder is associated with an Austin Flint murmur?

A

Aortic regurgitation.

472
Q

What is an Austin Flint murmur?

A

a low-pitched rumbling heart murmur which is best heard at the cardiac apex

473
Q

What is a positive Dix-Hallpike maneuver?

A

Vertigo beginning within 30 seconds and resolving within 30 seconds of preforming the maneuver.

474
Q

What is canalithiasis?

A

Calcium debris in the semicircular canal.

475
Q

An ABI below __ is diagnostic of PAD.

A

0.9

476
Q

What is the gold standard for diagnosis of PAD?

A

Arteriography.

477
Q

An ABI of <0.4 is diagnostic of what?

A

Critical limb ischemia

478
Q

What is the pharmacologic treatment for PAD?

A

Cilostazol.

479
Q

What is the most common artery involved in PAD?

A

The superficial femoral artery

480
Q

What is the definitive treatment for severe PAD?

A

Revascularization via percutaneous transluminal angioplasty or bypass

481
Q

Name the likely bacteria for each of the following sputum descriptions:
Red currant-jelly sputum
Green Sputum
Rust colored sputum

A

Red currant-jelly sputum - Kelbsiella pneumo
Green Sputum - haemophilus influenza or pseudomonas
Rust colored sputum - Strep pneumo

482
Q

What physical exam findings suggest lobar consolidation?

A

egophony, whispered pectoriloquy, and tactile fremitus.

483
Q

What tool is used to determine if a patient with pneumonia should be admitted?

A

CURB65 score

484
Q

What are the components of a curb 65 score?

A 
Confusion
Urea >7
RR > 30
SBP <90
age >65
Each is worth 1 point
485
Q

A CURB65 of ___ or higher needs admission.

A

3

486
Q

What is the preferred treatment for pneumonia caused by strep pneumo

A

Penicillin G or amoxicillin

487
Q

Pneumonia caused by what organism leads to bradycardia rather than tachycardia?

A

Legionella pneumophila

488
Q

Which pathogen is responsible for pneumonia with mild symptoms and is commonly called walking pneumonia?

A

Mycoplasma pneumoniae.

489
Q

What are a patients expected thyroid labs in graves disease?

A

Decreased TSH, increased T3 and T4.

490
Q

What is the most common cause of hypothyroidism?

A

Hashimoto thyroiditis.

491
Q

What is a Monteggia fracture?

A

A proximal to mid unla fracture with radial head dislocation.

492
Q

What is a Galeazzi fracture?

A

A distal radius fracture with distal radioulnar joint dislocation

493
Q

What is a Maisonneuve fracture?

A

Fracture of the proximal fibular and a tear of the tibiofibular sysdesmosis.

494
Q

What is a Smith fracture?

A

A fracture of the distal radius with volar angulation.

495
Q

What is the mechanism of injury for a Maisonneuve fracture?

A

External rotation of the foot relative to the tibia.

496
Q

What is the mechanism of injury for a Smith fracture?

A

Fall onto a flexed wrist of direct blow to the dorsal forearm

497
Q

What is the name of the radiographic finding that describes the metaphyseal triangular portion in a Salter II fracture?

A

Thurstan Holland fragment.

498
Q

What medication has been shown to reduce suicide risk in depressed patients?

A

Lithium.

499
Q

What is the most common pathogen in atypical pneumonia?

A

Mycoplasma pneumoniae

500
Q

What clinical features distinguish atypical pneumonia from typical pneumonia?

A

Insidious onset of dry cough

501
Q

What is the treatment for atypical pneumonia?

A

Macrolides or doxycycline.

502
Q

What are the signs of trichomoniasis?

A

frothy greenish yellow thin discharge, strawberry cervix, pH >5.0.

503
Q

Describe the wet mount findings of trichomoniasis.

A

Flagellated motile trichomonads.

504
Q

Which test can be used to confirm the diagnosis of trichomoniasis?

A

Nucleic acid amplification testing.

505
Q

What is the definitive diagnosis for Alheimer disease?

A

Brain biopsy.

506
Q

What are the histopathologic findings indicative of Alzheimer disease?

A

Amyloid plaques, accumulation of hyperphosphorylated tau protein in neurofibrillary tangles.

507
Q

Accumulation of Negri bodies in the hippocampus is associated what what disease?

A

Rabies.

508
Q

What is finger agnosia?

A

The loss of the ability to recognize one’s own fingers, the fingers of others, and any drawing or representation of fingers.

509
Q

Treatment for Alzheime disease?

A

Cholinesterase inhibitors such as donepezil or NMDA antagonists such as memantine

Cam's Cards (103 decks)

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