Family Medicine EOR Flashcards
Presenting symptoms of a cervical neck strain?
Pain or stiffness with neck movement.
Causes of cervical neck strains?
Minor injury or physical stressors such as poor posture or sleep habbits.
Name some red flags when evaluating what you think may be a cervical neck strain?
Major trauma, weakness, bowel or bladder dysfunction, cancer symptoms, IVDU, visual changes, anterior neck pain.
Where should you expect tenderness in a cervical neck strain patient?
Paraspinal and trapezius muscles.
T/F? You should get a c spine x-ray in evaluation of cervical neck strains.
False
Treatment for cervical neck strains?
NSAIDs
nonbenzo skeletal muscle relaxers are 2nd line.
How long should a cervical neck strain take to resolve?
Within 6 weeks.
Non-pharmacologic treatments for cervical neck strains?
Home exercise program, heat or cold, modification of posture.
What medications can result in decreased lower esophageal sphincter pressure, causing GERD?
Anticholinergics, antihistamines, CCBs, nitrates, progesterone, and TCAs.
What foods are associated with GERD?
Any large meal, acidic foods, alcohol, fatty foods, spicy foods, chocolate, and peppermint.
Name some atypical GERD symptoms.
Asthma, chronic cough, chronic laryngitis, sore throat, chest pain, and sleep disturbances.
Concerning GERD features?
Dysphagia, odynophagia, weight loss, IDA
Treatment for typical GERD without concerning symptoms?
8 week trial of BID H2RA or QD PPI
Patients who do not respond to PPI or H2RA, or have concerning features should have what procedure?
Endoscopy.
Gold standard for GERD diagnosis?
Esophageal pH testing
Long term PPI use side effects?
Infectious gastroenteritis, IDA, Vit B12 deficiency, hympomagnesemia, pneumonia, hip fractures.
Surgical treatment for GERD if pharmacologic therapy is not an option?
Surgical fundoplication.
First line therapy for H. pylori?
Amoxicillin, clarithromycin, PPI x 14 days
H. pylori is known to cause?
Peptic ulcer disease.
In patients age 30-55, where does peptic ulcer disease most commonly cause ulcers?
Duodenum
In patients age 55-70, where does PUD most commonly cause ulcers?
Gastric
Classic symptom of PUD?
Dull, aching, or gnawing epigastric pain
Pain from PUD can be relieved by?
Eating
How can you test for H. pylori?
Urea breath test or fecal antigen testing
When should a test for cure be done for a patient treated for H. pylori?
4 weeks after completing treatment.
Where is an ulcer located if pain is alleviated by ingesting food?
Duodenum
Where is an ulcer located if it is exacerbated by ingesting food?
Stomach
Is a hordeolum (stye) painful or nonpainful?
Painful
Cause of a hordeolum?
Purulent inflammation of the eyelid often due to bacterial infections (staph aureus)
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?
Chalazion
Cause of a chalazion?
A blocked oil gland (Meibomian or Zeis gland.)
Diffuse inflammation of the eyelid is called?
Blepharitis
Most common causes of acute pericarditis?
Enteroviruses including coxsackie, adenoviruses, and parvovirus
3 P’s of pericarditis chest pain?
Pleuritic, persistent, postural.
First line treatment for acute pericarditis?
aspirin or NSAIDs + Colchicine to prevent recurrence
EKG findings in pericarditis?
PR elevation in aVR, PR depression, and diffuse ST elevation.
What medication can be added in treatment for acute pericarditis for refractory or severe cases?
Corticosteroids
Acute pericarditis after a myocardial infarction is known as?
Dressler syndrome
First line treatment for Dressler syndrome?
Aspirin and colchicine
Most common side effect of colchicine?
GI upset
What labs should be ordered to rule out treatable causes of dementia?
Vit B12 level
TSH (hypothyroidism)
Two main classes of drugs for treatment of dementia?
Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists
Name 3 causes of conjunctivitis.
Bacterial, viral, allergic
Most common pathogens for bacterial conjunctivitis?
Strep pneumo, H. influenzae, M. catarrhalis, staph aureus.
What type of conjunctivitis causes an eye to be “stuck shut” in the morning?
All of them
What is the preferred treatment of bacterial conjunctivitis in contact lens wearers?
Fluoroquinalone drops such as moxifloxacin or ofloxacin drops
What eye drops can be beneficial in treatment of viral or allergic conjunctivitis?
Topical ophthalmic antihistamines or decongestants, such as ketotifen.
A neonate develops severe conjunctivitis 10 days post delivery. What organism do you suspect?
Chlamydia - occurs between 5-14 days of life
A neonate develops severe conjunctivitis 3 days post delivery. What organism do you suspect?
Gonorrhea - occurs betewen 2-5 days of life
A patient presents with deep-seated itching of the ear 1 week after being treated for otitis externa. What do you suspect?
Fungal external otitis. (otomycosis)
What fungi are commonly responsible for fungal external otitis?
Aspergillus and Candida species.
Otoscopic evaluation of a patient reveals “fine coal dust” lining the ear canal. What is the most likely organism?
Aspergillus
Otoscopic evaluation of a patient reveals a soft white pseudo membrane lining the canal. What is the most likely organism?
Candida
Treatment of otomycosis?
Meticulous cleaning and removal of debris, topical antifungals.
What is the preferred agent and duration of therapy for treating otomycosis?
Clotrimazole 1% solution BID x 10-14 days
What class of medications used to treat otitis externa should be avoided in the presence of tympanic membrane perforation?
Aminoglycosides (tobramycin, gentamycin)
Salmonella outbreaks are most commonly associated with?
Poultry and eggs
Definitive diagnosis of salmonellosis is made by?
Stool culture
Most important component of therapy for salmonellosis?
Replacement of fluids and electrolytes
Which virus is associated with outbreaks of gastroenteritis on cruise ships?
Norovirus
Differentiating factors between stable and unstable angina?
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.
When is a coronary artery bypass graft indicated in coronary artery disease patients?
Left main coronary artery involvement >50% stenosis, >70% stenosis 3 vessel disease, or decreased left ventricular ejection fraction.
When is percutaneous transluminal coronary angioplasty indicated for CAD patients?
1 or 2 vessel disease without left main coronary artery involvement
What is the gold standard diagnostic test for coronary artery disease?
Coronary angiography
What is the cause of syncope?
Inadequate cerbreal blowflow
Four main causes of syncope?
Reflex syncope, orthostatic syncope, cardiac dysrhythmias, and structural cardiopulmonary disease.
Name some symptoms that accompany reflex syncope.
Lightheadedness, warm or cold, sweating, palpitations, nausea, decreased vision or hearing, pallor.
Workup for syncopal episode should include?
H and P, neuro exam, cardiopulmonary exam, EKG
Name some cardiac dysrhythmias that may be seen on EKG in patients with syncope.
Brugada syndrome, short QT syndrome, long QT syndrome, preexcitation, and heart block.
On a stool ova and parasite test, flagellated trophozoites and cysts are reported. What do you suspect the infection to be?
Giardia lamblia
Risk factors for giardia infections?
Wilderness activities, impaired immunity, MSM.
Incubation period of giardia?
1-3 weeks
First line treatment for Giardiasis?
Metronidazole 250mg TID x 5-7 days tinadazole 2g PO single dose.
What patient education can you give on water purification in order to avoid giardia?
Chlorination of water does NOT inactivate cysts. You must filter with a pore size less than 1 mcm or bring water to a boil.
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?
Cryptosporidium parvum
What is the most common medication for malaria to be resistant to?
Chloroquine
Most common patient population to have fibromyalgia?
Women 20-50 years old.
Fibromyalgia is commonly associated with what conditions?
RA, hypothyroidism, anxiety, depression.
What labs are abnormal in fibromyalgia?
None
Nonpharmacologic treatment for fibromyalgia?
CBT, patient education, sleep hygiene, low impact aerobic exercise.
Pharmacologic treatment for fibromyalgia?
TCAs, SSRIs, SNRIs, cyclobenzaprine, pregabalin, gabapentin.
What are the 3 FDA-approved medications for treatment of fibromylgia?
Duloxetine (SNRI), Pregabalin, and milnacipran.
Most common cause of small bowel obstruction?
Adhesions from prior abdominal surgeries.
How is diagnosis of small bowel obstruction made?
Abdominal x rays prone and standing.
CT abd also helps determine the severity.
Do you suspect a small bowel obstruction patient to be acidotic or alkalotic?
Could be either, acidotic if there is ischemic bowel or dehydration.
Alkalotic if patient had hyperemesis.
First steps in treatment of small bowel obstruction?
Nasogastric tube
Withdrawal of oral intake
What x-ray finding for a small bowel occlusion requires immediate surgery?
Free air in the abdomen indicating a bowel perforation
What is the most common cause of a large bowel obstruction?
Neoplasm
What do bowels sound like during small bowel obstruction?
High pitched bowel sounds
What two specific x-ray terms indicate small bowel obstruction?
Stack of coins or string of pearls sign
Most common cause of PID?
STIs (gonorrhea and chlamydia are most common)
What exam finding strongly suggests PID?
Cervical motion tenderness
chandelier sign
What is the most worrisome complication of PID?
Perihepatitis (Fitz-Hugh Curtis syndrome)
First line treatment for PID?
1 time IM ceftriaxone followed by 14 day course of oral doxycycline
Name some physical exam findings for allergic rhinitis.
Pale bogy turbinates, allergic shiners, allergic salute.
Treatment for allergic rhinitis?
Intranasal corticosteroid, second generation antihistamines
Vasomotor rhinitis, a common cause of clear rhinorrhea in older patients, is associated with an increased sensitivity of which nerve?
The vidian nerve.
Lab findings in allergic rhinitis?
Elevated serum IgE
What is Samters triad?
Nasal polyps, asthma, and aspirin sensitivity.
Describe the typical patient with immune thrombocytopenia (idiopathic thombocytogenic purpura).
2-5 year old with history of a recent viral infection.
Lab findings in ITP patient?
Platelets <100k (but not uncommon to see below <30k)
Normal hemoglobin, hematocrit, and WBC count.
Treatment for severe ITP includes?
Platelets, glucocorticoids, IVIG
How long does resolution of ITP typically take?
3-6 months
When can ITP patients be managed outpatient?
If they do not need rapid elevation in platelets, and if bleeding is limited to mild cutaneous bleeding.
Name a common neurologic finding associated with vitamin B12 deficiency anemia.
Gait ataxia
What peripheral blood smear finding is common in Vit B12 deficiency anemia?
Hypersegmented neutrophils.
What labs can help differentiate between a Vit B12 deficiency and folate deficiency?
Methylmalonic acid and homocysteine.
Elevated indicates B12 deficiency, normal indicated folate deficiency.
What is an appropriate regimen to correct a B12 deficiency?
1,000 mcg injection of B12 once a week until corrected, then once a month
What skin finding can be noted in severe iron deficiency anemia?
Chlorosis (pale green discoloration)
What nail finding is expected in iron deficiency anemia?
Koilonychia (spoon nails)
What is a physical exam finding that can help you differentiate between B12 and folate deficiency anemia?
Folate deficiency can present with oral ulcers.
B12 can present with neuropathy.
Name some causes of B12 deficiency.
Veganism, metformin, conditions affecting nutrient absorption (Chron’s)
When a patient presents with a fib, it is important to rule out reversible causes such as ____ and _____.
Thyroid disorders and diabetes mellitus
List the components of CHA2DS2-VASc
CHF HTN Age (64-74=1. >75=2_ DM Stroke TIA or VTE
Which of the following oral antifungals is no longer recommended as first-line oral treatment due to the risk of drug-induced hepatitis?
Ketoconazole.
What organism is the most common cause of tinea versicolor?
Malassezia species
Treatment for tinea versicolor?
Selenium sulfide
First line treatment for hypertension in black patients?
Thiazide like diuretic or long-acting dihydropyridine CCB
First line treatment for hypertension in young patients?
ACEIs, ARBs, (Beta blokcers if they have other conditions that would benefit)
First line treatment for hypertension in old patients?
Thiazide-like diuretic or long-acting CCB
What type of hypertension can be treated with lifestyle modifications?
Primary hypertension (resulting from multiple genetic and environmental factors including age, obesity, high-sodium diet, and physical inactivity)
Name 3 common manifestations of SLE.
Malar rash sparing nasolabial folds
Raynaud phenomenon
Photosensitivity
(these were the bolded ones in rosh, I know theres a lot)
What lab tests have high specificity for SLE?
Anti-double-stranded DNA
anti-Smith antibodies
Can patients with SLE receive vaccines?
Only before starting immunosuppressive therapies.
An SLE patient comes into primary care for pre-conception counseling. What do you make sure to advise her of?
She should avoid pregnancy for 6 months after active diesase.
Which antibody is associated with drug-induced lupus erythematosus?
Antihistone antibody.
At what location is the murmur for aortic regurgitation heard?
Left upper sternal border
Symptoms of aortic regurgitation?
Exertional dyspnea, hyperdynamic apical pulse, wide pulse pressure.
What does the murmur of aortic regurgitation sound like?
Acute - low pitched, early diastolic murmur
Chronic - high-pitched, holodiastolic murmur
What should a aortic regurgitation murmur do when the patient preforms a Valsalva maneuver?
Decrease in intensity
The initial imaging test of choice for aortic regurgitation is?
Transthoracic echocardiogram
What is the definitive management for aortic regurgitation?
Surgical repair or replacement
What is the most common cause of aortic regurgitation?
Endocarditis
What medication should a patient be started on after a aortic valve replacement?
warfarin
What is the goal INR for a valve replacement patient?
2.5-3.5
What is an Austin Flint murmur?
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.
What is Duroziez sign?
What is it a sign of?
A systolic and/or diastolic thrill or murmur heard over the femoral arteries.
It is a sign of aortic regurgitation
What type of airway disease is asthma?
Obstructive
What do you expect FEV1 and FVC to be in asthma?
Increased FEV1 and decrease FVC.
What is the FEV1/FVC ratio expected in obstructive airway conditions?
<0.70
Treatment for intermitent asthma?
SABA PRN
Treatment for mild persistent asthma?
SABA + low dose ICS
Treatment for moderate persistent asthma?
LABA + low dose ICS
Treatment for severe persistent asthma?
LABA + medium dose ICS
Which class of medication is montelukast?
Leukotriene inhibitor.
Name some medications that can cause erosive esophagitis?
NSAIDs Bisphosphonates Potassium Chloride Quinidine Vit C
Symptoms of erosive esophagitis?
Dysphagia, odynophagia, retrosternal chest pain
In a patient with esophagitis, what red flags would make you want to perform an upper endoscopy?
Hematemesis, abd pain, weight loss, persistent symptoms after discontinuation of medication
What measures can be taken to prevent esophagitis caused by medications?
Standing upright for 30 minutes after taking medication, eating meal after taking the medication, taking the medication with at least 8oz water.
What is the first-line treatment for benign esophageal strictures?
Esophageal dilation.
What is the diagnostic criteria for chronic insomnia?
Difficulty falling or staying asleep at least 3 times a week for > 3 months
What is the preferred first-line treatment for insomnia?
CBT
What are some pharmacologic treatments for insomnia?
Benzos
Non-benzo receptor agonists (Z drugs)
What are the two most common relaxation-based strategies used for insomnia disorder?
Progressive muscle relaxation and diaphragmatic breathing.
What lab values are abnormal in irritable bowel syndrome?
none
What type of diet can be beneficial for IBS?
FODMAP
Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols
First line treatment for abdominal pain in IBS?
Antispasmodics such as dicyclomine of hyoscyamine.
Which COPD therapy has been shown to improve survival?
Long-term continuous oxygen therapy.
What are the two most common risk factors for CAD?
HTN and DM
What two diagnostics are important in the evaluation of CAD?
Cardiac enzymes and EKG
A lesion in which vessel is indicated by ST elevations in leads V1, V2, V3, and V4?
Left anterior descending (LAD).
What is the cause of diabetes mellitus type 1?
Pancreatic islet B cell destruction which is primarily autoimmune.
Describe the typical age of a patient at time of diagnosis of DM 1
Child to young adult
What is the cause of diabetes mellitus type 2?
Pancreatic beta cell dysfunction combined with insulin resistance.
When is DM II usually diagnosed?
Predominantly occurs in adults.
What is the most important environmental factor causing insulin resistance?
Obesity.
Symptoms of DM I?
Polyuria, polydipsia, weight loss with normal appetite.
Patients may have muscles wasting and weakness, paresthesias, and peripheral neuropathy.
Symptoms of DM II?
Typically asymptomatic because progression is slow.
Name 1 skin finding associated with insulin resistance.
Acanthosis nigricans
What is the criteria for diagnosing diabetes?
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%
What type of obesity is associated with insulin insensitivity?
Visceral obesity due to the accumulation of fat in the omental and mesenteric regions.
An acute gout attack should be treated with?
NSAID such as indomethacin
Name some medications that increase risk for hyperuricemia.
Diuretics, thiazides, aspirin, cyclosporine, niacin.
Name 2 dietary risk factors for gout.
Excessive alcohol ingestion (particularly beer) and a high-purine diet.
What joint is most commonly affected by gout?
The MTP of the great toe
The definitive diagnosis of gout is made by?
Joint fluid aspirate showing Negatively birefringent needle shaped sodium urate crystals.
What x ray finding is expected in chronic gout?
Rat bite erosions
What medications reduce the risk of recurrence of gout and what is their mechanism?
Allopurinol - decreases production of uric acid
Colchicine and probenecid increase urinary excretion of uric acid.
What diagnosis are positively birefringent, rhomboid-shaped crystals in synovial fluid consistent with?
Pseudogout, also known as calcium pyrophosphate deposition.
What are the most common side effects of metformin?
Nausea, vomiting, diarrhea, flatulence, abd cramping.
What is the mechanism of action of saxagliptin?
Saxagliptin is a dipeptidyl peptidase-4 inhibitor that prolongs incretin levels and decreases glucagon secretion.
Describe the genetic mutation known as the Philadelphia chomosome.
Reciprocal translocation on the long arms of chromosomes 9 and 22
What disorder is caused by the Philadelphia chromosome?
Chronic myelogenous leukemia
What is the age range that patients begin to develop symptoms of CML?
40-60
What are the symptoms of CML?
splenomegaly, fever, night sweats, and weight loss
Lab findings in CML?
Increased WBC count
Peripheral blood smear shows greater percentage of blast cells.
Treatment for CML?
Allogenic hematopoietic cell transplantation
What is the most common childhood leukemia?
Acute lymphocytic leukemia
Auer rods are seen in what type of leukemia?
Acute myelogenous leukemia
What is the most common adult leukemia?
Chronic lymphocytic leukemia
Smudge cells are seen in what type of leukemia?
Chronic lymphocytic leukemia
What disease causes non-caseating granulomas forming throughout the body?
Sarcoidosis
What two organs are most commonly affected by sarcoidosis?
Skin and lungs
Describe skin findings of sarcoidosis.
Erythematous, painful, warm patches and nodules that appear on the shins, arms, and buttocks.
What is the name of the rash caused by sarcoidosis?
Erythema nodosum
What are the chest x ray findings on a typical sarcoidosis patient?
Bilateral hilar adenopathy
Diagnostic test of choice for sarcoidosis?
Transbronchial lung bopsy
On what test are lambda and panda signs seen?
Gallium scintigraphy
What abnormal bloodwork is present in sarcoidosis?
Hypercalcemia and elevated serum ACE, ESR and CRP elevated.
Treatment for sarcoidosis?
steroids
When does symptom onset for parkinsons typically occur?
45-65 years
Name the common clinical manifestations of parkinsons.
Resting or pill-rolling tremor, cogwheel or lead pipe rigidity, bradykinesia, postural instability, masked facies.
What is dysdiadochokinesia?
Loss of ability to preform rapid alternating movements.
What is the mainstay of treatment of parkinsons for patients >65?
Levodopa carbidopa
What is the treatment of parkinsons for patients <65?
Dopamine agonists such as pramipexole, ropinirole, and bromocriptine
What sign seen in Parkinson disease is characterized by a sustained blink response to repetitive tapping over the bridge of the nose?
Myerson sign.
What is the most common bacterial cause of perotitis?
Staph aureus
Parotitis is particularly common in what patient population?
Elderly post op patients
Do parotitis patients need to be admited?
Yes, they need IV antibiotics because infection can spread to the deep fascial p
What culture should be preformed for parotitis patients?
Gram stain and culture of the Stensen duct
What are the empiric antibiotic recommendations for community acquired vs. hospital acquired parotitis?
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)
What are the risk factors for methicillin-resistant Staphylococcus aureus?
Intravenous drug use, residence in a long-term care facility, discharge from a hospital within the preceding 12 months, and hemodialysis.
Describe the rash caused by cellulitis.
Single, painful, erythematous patch with poorly demarcated borders and overlying warmth
What rash is described as multiple lesions with three concentric zones of color change?
Erythema multiforme
What rash is described as purple, pruritic, polygonal, planar, papular plaques?
Lichen planus
What rash is described as raised, purpuric, target-like lesions with two zones of color change?
Stevens-Johnson syndrome and toxic epidermal necrolysis.
What form of cellulitis is characterized by a bright red plaque with raised and sharply demarcated borders?
Erysipelas
What is the only antianginal agent proven to improve mortality in patients with CAD?
Beta blockers
Which reflex originates in the cardiac sensory receptors and promotes parasympathetic activity, resulting in bradycardia, vasodilation, and hypotension?
The Bezold-Jarisch reflex
What is the single most common cause of acute bacterial sinusitis?
Strep pneumo
What is the most common bacteria causing chronic sinusitis?
Staph aureus
What is a major side effect of pseudoephedrine, especially if used for more than 3 days?
Rhinitis medicamentosa
rebound congestion
What is the most sensitive test used to diagnose inflenza?
Reverse transcriptase PCR
Antiviral therapy may be considered in which influenza patients?
Patients with severe influenza, those at risk for complications, and those not at high risk who present with 48 hours of onset of illness
What medication is used to treat influenza?
Oseltamivir
What is the most common complication of influenza?
pneumonia
What is the initial treatment for frozen shoulder.
Initially treat with PT
+/- steroid injections
What is the treatment for frozen shoulder that persists past 10-12 months?
Manipulation under anesthesia or arthroscopic surgical release.
What two movements of the shoulder are most commonly affected by frozen shoulder?
External rotation and abduction
What nerve passes through the quadrangular space of the shoulder?
The axillary nerve.
What virus is responsible for warts?
Human papillomaviruses
Treatment for nongenital warts?
Liquid nitrogen cryotherapy or salicylic acid plaster after paring
Treatment for genital warts?
Liquid nitrogen cryotherapy, podophyllum resin, imiquimod 5% cream, excision and electrocautery, and laser therapy
Which two human papillomavirus types are most commonly associated with condyloma acuminata?
Human papillomavirus types 6 and 11.
What are the black dots that appear within warts?
Thrombosed capillaries
What is a positive murphy sign?
Pain and cessation of breathing upon palpation in the area of the gallbladder fossa while the patient is taking a deep breath.
What condition is defined as inflammation of the gallbladder as a result of cystic duct obstruction?
Cholecystitis.
What is the initial choice of imaging for a suspected cholecystitis?
Ultrasound
What ultrasound findings correlate with the diagnosis of cholecystitis?
Presence of stones, gallbladder wall thickening, or pericholecystic fluid.
What is the preferred definitive treatment for cholecystitis?
Cholecystectomy.
What is Charcot triad?
Jaundice, fever, and right upper quadrant abdominal pain.
What is the gold standard imaging for suspected cholecystitis?
HIDA scan
An upright Xray, CT scan, or MRI showing a retrocardiac air-fluid level is diagnostic of what condition?
Hiatal hernia
What is a type I hiatal hernia, and what are they associated with?
Type I is a sliding hernia, and it is associated with trauma, congenital malformations, and iatrogenic factors.
Type II, III, and IV hiatal hernias are known as what type of hernias?
Paraesophageal hernias
What are paraoesophageal hernias associated with?
Surgical procedures.
Treatment of hiatal hernias?
Usually just involved management of GERD symptoms.
Surgical repair reserved for symptomatic patients.
What is the most commonly performed surgical procedure to correct a hiatal hernia?
Nissen fundoplication.
What is the most common cause of bronchitis?
Viruses (influenza, coronavirus, and rhinovirus are most common)
How long does the cough associated with bronchitis typically last?
Up to 3 weeks
Treatment for bronchitis?
Throat lozenges, hot tea, honey, smoking cessation.
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?
Tactile fremitus.
What is the triad of symptoms associated with bulimia nervosa?
Caloric restriction, binge eating, and self-induced vomiting.
List some comorbid conditions associated with bulimia nervosa.
Unipolar depression and specific phobia disorder are the two most common
What emetic is often misused by patients with bulimia nervosa?
Syrup of ipecac.
Mild to moderate non-throbbing headache that is bilateral with pain in the frontal and occipital region describes what type of headache?
Tension headache
What are common associated symptoms with tension headaches?
Photophobia or phonophobia.
Treatment for tension headaches?
NSAIDs or aspirin
What is the first line preventative treatment for tension headaches?
Amytriptyline
What is the first-line acute treatment for cluster headache?
100% oxygen.
What are the two most common pathogens for otitis media?
H flu and Strep pneumo
AOM is most common in what age range?
6-24 months
What is the first line antibiotic for AOM?
What if they’ve had a beta lactam in the past 30 days?
Amoxicillin
Amox-clav if recent beta lactam use
Which antibiotics can be used to treat acute otitis media in children with anaphylactic reactions to amoxicillin?
Azithromycin or clindamycin.
Pyelonephritis with struvite stones is associated with what bacteria?
Proteus mirabilis and other urease producing bacteria
What is the most common pathogen of pyelonephritis?
E. coli
What is the empiric outpatient therapy for pyelonephritis?
1g ceftriaxone + one of the following: (trimethoprime-sulfamethoxazole) (amox-clav) (a cephalosporin) (a fluoroquinalone)
Inpatient empiric treatment for pyelonephritis?
Antipseucomonal carbapenem and vancomycin
How many colony-forming units of a single organism on urine culture are suggestive of a urinary tract infection?
10^5
100,000
What is the most common cause of heel pain in the US?
Plantar fasciitis
Treatment for plantar fasciitis?
ice, stretching, and rest
NSAIDs, acetaminophen, and orthotics may also be appropriate.
What Xray finding may be seen in plantar fasciitis?
Calcaneal spurs
What medical term is used to describe the pain that occurs after a period of rest and is associated with plantar fasciitis?
Poststatic dyskinesia.
What is Löfgren syndrome?
Combination of erythema nodosum, hilar adenopathy, migratory polyarthralgia, and fever observed in patients with sarcoidosis.
A small, round to oval ulcer with peripheral erythema and yellowish central exudate in the mouth describes the appearance of?
An aphthous ulcer (aphthous stomatitis)
Complex aphthosis is characterized by the presence of lesions where?
In the mouth AND geneital mucosa
Patients with complex aphthosis should be tested for?
Behçet syndrome
Patients with Behçet syndrome will have a postive ______ test.
Pathergy
Treatment for simple apthosis?
2% viscous lidocaine for analgesia and topical steroids at onset of symptoms
Which virus causes a flesh-colored, cauliflower-like genital lesion?
Human papillomavirus.
Treatment for Torsades?
Defib if hypotensive and mag sulfate.
Name 4 classes of laxatives and give and example of each.
Stimulant laxatives -biscodyl
Osmotic laxatives - sorbitol
Surfactant laxatives - docusate
Bulk Forming laxatives - psyllium, methylcellulose
What are the possible adverse effects of using sodium phosphate enemas in older adults?
Volume depletion, hypotension, hyperphosphatemia, hypokalemia, hyperkalemia, metabolic acidosis, and acute kidney injury.
What are the risk factors for sleep apnea. Be specific.
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
What is the gold standard test for sleep apnea?
In-laboratory polysomnography
What indicates a positive polysomnography test?
five or more obstructive respiratory events/hour
The mainstay of treatment for sleep apnea is?
CPAP
What is Cheyne-Stokes breathing?
An abnormal pattern of breathing characterized by periods of tachypnea and hyperpnea alternated by periods of apnea.
What is the first line treatment for an essential tremor?
Propanolol
What is the most common isolated focal dystonia?
Cervical dystonia.
First line treatment for Bipolar disorder?
Quetiapine or lursidone
What is the first-line treatment for bipolar disorder in pregnant patients?
Lamotrigine.
What is the typical number of leads on a traditional Holter monitor?
Three (although 12-lead monitors are available).
In long term untreated carpal tunnel syndrome, is thenar atrophy or hypothenar atrophy seen?
Thenar atrophy
What physical exam testing is associated with carpal tunnel syndrome?
Tinel sign and Phalen sign
List 3 risk factors for carpal tunnel syndrome?
Female sex, pregnancy, diabetes.
What is the first line treatment for carpal tunnel syndrome?
Night splints, NSAIDs, physical therapy, exercise, stretching.
What is the definitive therapy for carpal tunnel syndrome?
Surgical decompression.
When is Chvostek’s sign positive?
Hypocalcemia
A positive Adson test is indicative of?
Thoracic outlet syndrome
How many tendons are located within the carpal tunnel?
Nine.
Carpal tunnel syndrome is most commonly caused by the compression of what nerve?
Median nerve
Addison disease is most commonly caused by?
Autoimmune dysfunction
What hormones are chronically elevated in Addison disease?
ACTH and melanocyte stimulating hormones
Symptoms of Addison disease?
Abd pain, nausea, vomitting, diarrhea, confusion, Fatigue, weakness, weight loss, salt craving, hypotension.
Lab findings in Addison disease?
Hyponatremia and Hyperkalemia
What tests are indicative of primary adrenal insufficiency?
Cosyntropin stimulation test or corticotropin-releasing` hormone stimulation test
Treatment for Addison disease?
Corticosteroid replacement therapy with hydrocortisone and mineralocorticoid replacement therapy with fludrocortisone.
What test is used to diagnose Cushing syndrome?
Dexamethasone suppression test.
Which androgen is androstenedione converted into?
Testosterone
A warm, edematous, exquisitely tender prostate are signs of?
Prostatitis
What is the most common pathogen of prostatitis?
E. coli
Inpatient management of prostatitis?
IV ampicillin and aminoglycoside (gentamycin)
Outpatient treatment for prostatitis?
6 week course of oral antibiotics (trimethoprim-sulfa, ciprofloxacin)
What class of medications is recommended as the initial treatment for symptomatic benign prostatic hyperplasia?
Alpha-1 adrenergic antagonists (e.g., tamsulosin, terazosin).
Initial diagnostic approach for CHF?
EKG, Chest XR.
What is the most commonly used diagnostic study for CHF?
Echocardiography
What is the gold standard diagnostic for CHF?
Right heart catheterization
Therapy for CHF?
Decreasing sodium intake, ACEI, diuretic, and beta blockers
What is the name of the horizontal lines on a chest radiograph resulting from interstitial edema that may be seen in heart failure patients?
Kerley B lines.
List the symptoms of retina detachment.
painless loss of vision, floaters, flashing lights, curtain lowering sensation
What is the most common cause of epididymitis in patients younger than 35 years old?
Chlamydia trachomatis
Neisseria gonorrhoeae is 2nd
What is a positive Prehn sign?
Relief of pain with support of the testicle.
Treatment for epididymitis for patients younger than 35?
Older than 35?
Younger - ceftriaxone 250mg IM once + doxycycline 100mg BID x 10 days
Older - levofloxacin 500mg QD x 10 days
Epididymitis in patients who participate in anal sex should be treated with?
Ceftriaxone and levofloxacin
What diagnosis is the blue dot sign associated with?
Torsion of the appendix of the testicle.
List the symptoms of Meniere’s disease.
Episodic vertigo, tinnitus, and low-frequency sensorineural hearing loss
Are symptoms typically unilateral or bilateral in Meniere’s disease?
Unilateral
What dietary restrictions can you give to a patient to improve Meniere’s disease?
Limit sodium, caffeine, alcohol, nicotine, and MSG.
Pharmacologic treatment for Meniere’s disease consists of?
A diuretic or chronic betahistine +/- a benzodiazepine
Which disorder is characterized by progressive unilateral sensorineural hearing loss, disequilibrium, and facial numbness secondary to compression of the vestibulocochlear nerve?
Vestibular schwannoma, also known as acoustic neuroma
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
Adenocarcinoma
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is the classic presentation of breast cancer?
A hard immobile breast mass.
Diagnosis of breast cancer is made by?
Biopsy of breast tissue with malignant cells.
What are two factors that may reduce breast cancer risk?
Breastfeeding and increased regular physical activity.
What is the most common pathogen responsible for infective endocarditis.
Staph aureus
List the classic signs of infective endocarditis.
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)
What is the diagnostic of choice for endocarditis?
Echocardiogram
What criteria are used to diagnose endocarditis?
Duke criteria
How many criteria must be positive to diagnose a patient with endocarditis using Duke criteria?
Two major
One major and three minor
Five minor
What are the major and minor criteria?
Major: + blood cultures, evidence of endocardial involvement
Minor: IVDU, fever, vascular phenomena, immunologic phenomena, and microbiologic evidence.
Which heart valve is most affected by infective endocarditis in intravenous drug users?
Tricuspid valve.
What is the most common acute leukemia in adults?
AML
Peripheral blood smear in AML shows presence of ?
Auer rods
Diagnosis of AML is confirmed by?
Bone marrow biopsy
Bone marrow biopsy must show blast cells greater than ___% to diagnose AML.
20%
First line treatment for AML?
Combination chemotherapy most commonly with anthracycline and cytarabine in a 7+3 regimen
What are the metabolic abnormalities associated with tumor lysis syndrome?
Hyperphosphatemia, hypocalcemia, hyperuricemia, and hyperkalemia.
Give examples of two high intensity statin therapies.
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
If a patient develops endocarditis within 2 months of a valve replacement, what are the most common organisms?
Staph aureus
Gram negative bacilli
Candida
If a patient develops endocarditis 2-12 months after a valve replacement, what is the most common organism?
Staph epidermidis
If a patient develops endocarditis greater than 12 months after a valve replacement, what is the most common organism?
Strep viridans or strep bovis
What organisms make up the HACEK group of organisms?
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella.
What is a pancoast tumor?
A lung tumor (non-small cell is most common) that occurs in the superior sulcus causing dermatomal symptoms resulting from brachial plexus involvement.
What are the symptoms of a pancoast tumor?
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.
What are the two phases of the menstrual cycle?
The follicular phase and the luteal phase.
During the beginning of the follicular phase, what are the serum estradiol and progesterone levels?
Low
Low levels of estradiol and progesterone stimulate the hypothalamus to ?
Release GnRH in pulses
Increased GnRH causes?
Release of FSH and LH from the anterior pituitary.
When do estradiol levels peak?
1 day before ovulation
What amount of blood loss during a menstrual cycle defines heavy menstrual bleeding?
> 80 mL.
Hallmark symptom of classic Hodgkin lymphoma?
Diffuse lymphadenopathy
Hodgkin lymphoma is most common in what age range?
15-35
Biopsy of a lymph node in hodgkin lymphoma will show?
Reed Sternberg cells (Bilobed nucleus that looks like an owls eyes.
True or false: eosinophilia is a common finding in Hodgkin lymphoma.
True. Increased production of chemokines induces eosinophilia.
What is the most common location for a ganglion cyst?
The dorsal aspect of the wrist over the scaphlunate joint
Do ganglion cysts transilluminate?
Yes
What is the initial treatment for a ganglion cyst?
Reassurance and waiting. 50% will resolve spontaneously
What is the definitive treatment for a ganglion cyst?
Surgical excision
What condition secondary to ligamentous injury is suspected when the Terry-Thomas sign is seen on wrist X-ray?
Scapholunate dissociation.
List physical exam findings in hypertrophic cardiomyopathy.
Pulsus bisferiens (biphasic pulse due to aortic regurgitation)
Triple apical impulse
S4 gallop
Does the murmur from hypertrophic cardiomyopathy increase of decrease with valsalva?
Increase
How is hypertrophic cardiomyopathy diagnosed?
Echocardiogram
Pharmacologic treatment for hypertrophic cardiomyopathy?
beta blocker or CCB to decrease myocardial contractility.
Which gallop heard on cardiac auscultation can be a normal finding in patients < 30 years of age?
S3 gallop.
What is the only FDA approved treatment for pain associated with fibrocystic breast disease?
Danazol
Breast pain in fibrocystic breast disease is caused by what?
Fluctuating estrogen levels during menstrual cycles.
When does breast pain and tenderness peak in fibrocystic breast disease?
before each mensuration
What is the name of the fibroadenoma-like tumor with cellular stroma that grows rapidly and has a leaf-like pattern on histology?
Phyllodes tumor.
What is more common, hyper or hypothyroidism?
Hypothyroidism.
What is the most common cause of hyperthyroidism?
Graves disease
What lab studies are diagnostic of hyperthyroidism?
A low TSH and a high T4
What is the most sensitive test for diagnosing graves disease?
Antithyrotropin receptor antibody test
What are the treatments of choice for graves diease?
Methimazole or PTU
Which antithyroid modulating drug is the drug of choice in pregnant women?
PTU
What is the treatment for graves disease in patients whose symptoms are not controlled by antithyroid modulating drugs?
Radioactive iodine ablation or thyroidectomy.
What are potential complications of untreated exophthalmos?
Corneal dryness and damage, keratoconjunctivitis, compression of the optic nerve or optic artery, and blindness.
What is the most common pathogen in septic bursitis?
Staph aureus
Will a patient with septic bursitis have full passive range of motion?
Yes - because the infection is isolated to the bursa.
Diminished ROM can be a sign of septic arthritis.
What is the gold standard for diagnosis of septic bursitis?
Bursa fluid culture
What is the outpatient treatment for septic bursitis with no concerns of MRSA?
Cephalexin or dicloxacillin. x 10 days
What is the outpatient treatment for septic bursitis with concerns of MRSA?
Trimethoprim-sulfamethoxazole x 10 days
True or false: aseptic bursitis can be caused by gout.
True.
What is a common but harmless side effect of taking the tuberculosis medication rifampin?
It can cause body fluids (urine, sweat, saliva, tears) to change color to yellow, orange, red, or brown.
If a patient has a positive PPD test, what is recomended next?
A confirmatory interferon-gamma release assy (IGRA)
What vaccine can cause a positive PPD?
bacillus Calmette-Guerin vaccination
Therapy for latent TB usually includes what two medications?
Rifampin or isoniazid (alone or together)
Does psoriasis typically affect flexor or extensor surfaces?
Extensor
What are some nail findings common is psoriasis?
Nail pitting and separation from the nailbed.
What is the Koebner phenomenon?
Plaque formation at the site of prior trauma developing 1-2 weeks after the injury.
What is the auspitz sign?
Punctate bleeding spots when scales are lifted. This is a finding of psoriasis.
What is the treatment for psoriasis if <10% BSA is involved.
High-potency to ultra-high-potency topical steroids.
T/F? Psoriatic arthritis flare ups should be treated with oral corticosteroids.
False - rebound effects are are severe
What is the treatment for psoriasis if 10%-30% BSA affected?
Ultraviolet phototherapy.
What is the treatment for psoriasis if >30% BSA affected?
Narrowband ultraviolet phototherapy, Psoralen plus UVA photochemotherapy, or systemic agents such as methotrexate or biologics.
The diagnosis of Cushing syndrome is made with what tests?
24 hour urine cortisol and ACTH levels
The diagnosis of cushing disease can be made with what test?
High-dose dexamethasone suppression test
What drugs increase the metabolism of dexamethasone leading to impaired cortisol suppression?
Antiseizure drugs (e.g., phenytoin, phenobarbital) and rifampin.
What is the most common cause of cushing syndrome?
Cushing disease - ACTH secreting pituitary tumor
How often should someone with normal risk for breast cancer be screened for breast cancer? What is the preferred screening modality?
Bilateral screening mammography every 2 years
How often should someone with high risk for breast cancer be screened for breast cancer? What is the preferred screening modality?
Annual breast MRIs
When is breast ultrasound used?
Patients younger than 30 presenting with a breast mass.
What is the preferred screening modality for an AAA?
Ultrasonography
Who should receive screening for AAA?
Men ages 65-75 who have ever smoked
What are the two greatest interventions to reduce the risk for developing an abdominal aortic aneurysm?
Smoking cessation and blood pressure control.
List the deformities you would expect to see in rheumatoid arthritis.
Ulnar deviation Swan neck deformity Boutonniere deformity Bow string sign Rheumatoid nodules
What joints are commonly affected by rhemuatoid arthritis?
MCPs, PIPs, MTPs, wrists, knees, and ankles
First line treatment for rheumatoid arthritis?
DMARDs such as methotrexate.
Low dose corticosteroids as bridge until DMARD starts working.
Pencil-in-cup deformity is seen in what disease?
Psoriatic arthritis.
How long does morning stiffness last in rheumatic arthritis?
> 30 minutes
What are lab findings in RA?
Positive RF and anti-cyclic citrullinated peptide antibodies.
(but you can also have seronegative RA)
What is the classic patient presentation of acute pancreatitis?
Epigastric pain radiating to back, nausea, and vomiting.
What physical exam findings are suggestive of pancreatitis?
Grey Turner sign (flank ecchymosis) and Cullen sign (umbilical eccymosis)
Most common cause of pancreatitis?
Gallstones, then alcohol
What labs are elevated in pancreatitis?
Lipase and amylase are most reliable
also BUN, leukocytes, glucose
What can be used to assess the severity of pancreatitis?
Ranson criteria
Treatment for pancreatitis?
Bowel rest, bed rest, IV fluids, and pain control
What gastrointestinal disorder is autoimmune pancreatitis commonly associated with?
Celiac disease.
List the hallmark of glaucoma on fundoscopy?
Optic disc cupping
Cup to disc ratio >0.5
What is considered an increased IOP?
> 21 mm Hg
First line treatment for chronic glaucoma?
Prostaglandin analog such as latanoprost +/- Topical beta blocker such as timolol.
What procedure is standard for chronic open-angle glaucoma?
Trabeculectomy
What is the second line treatment for chronic gloaucoma?
Alpha 2 agonists such as brimonidine or carbonic anhydrase inhibitors such as acetazolamide
What surgical procedure is used as definitive treatment for angle-closure glaucoma?
Peripheral iridotomy.
What is the antibiotic of choice for patients with corneal abrasion?
Erythromycin ointment for non-contact lens wearers
Fluoroquinolone or aminoglycoside drops from contact lens wearers for pseudomonas coverage.
Which screening test for corneal disorders is used to evaluate for the presence of anterior chamber leakage into the cornea?
Seidel test.
True or false: montelukast is effective in treating exercise-induced asthma.
True.
Does mononucleosis cause anterior or posterior cervical chain lymphadenopathy?
Posterior
How is labyrinthitis distinguished from vestibular neuritis?
Labyrinthitis involves inflammation of the cochlear part of the vestibulocochlear nerve causing hearing loss and tinnitus.
Causes of labyrinthitis?
Viruses such as herpes simplex, varicella-zoster, and epstein-barr.
What are the symptoms of labyrinthitis?
Hearing loss, tinnitus, PERSISTENT vertigo (as compared to intermitent in BPPV), horizontal nystagmus.
What is the treatment of vestibular neuritis?
Corticosteroids (prednisone)
Antihistamines, benzodiazepines, and antiemetics can also be used for symptomatic treatment.
What are the absolute contraindications to administering alteplase in the treatment of an acute ischemic stroke?
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.
What maneuver is used to diagnose BPPV?
What maneuver is used to treat it?
Dix-halpike is the diagnosing maneuver
Epley maneuver is used to treat it.
What is the initial test of choice for gonorrhea?
nucleic acid amplification testing of first-catch urine or urethral swab in men, or a vaginal or endocervical swab in women.
What is the preferred antibiotic regimen for urethritis?
Ceftriaxone 500mg IM once and Doxycycline 100mg BID x 7 days
What inflammatory syndrome involving the Glisson capsule can occur in patients with pelvic inflammatory disease secondary to Chlamydia trachomatis and Neisseria gonorrhoeae?
Fitz-Hugh-Curtis syndrome
What is the preferred antibiotic regimen in patients with chlamydia urethritis who have had a Gonorrhea infection ruled out?
Doxycycline 100mg BID x 7 days
What is a common arrhythmia in patients with anorexia nervosa?
Sinus bradycardia
What antidepressant should be avoided in patients with eating disorders?
Bupropion, due to lowering of the seizure threshold.
Seizures can occur in patients with eating disorders due to hypoglycemia
What is the expected FEV1/FVC ratio in COPD?
Decreased
What are the 3 subtypes of COPD?
Emphysema, chronic bronchitis, and chronic obstructive asthma
What is the treatment for COPD?
inhaled bronchodilators, oxygen, and pulmonary rehabilitation.
Which hereditary disorder should patients with suspected COPD be evaluated for?
Alpha-1 antitrypsin deficiency.
Which patients are known as pink puffers and which are known as blue bloaters?
Pink Puffer emPhysema
Blue Bloater Bronchitis
Signs of retinal artery occlusion on fundoscopy?
Retinal pallor, cherry red fovea,
Is retinal artery occlusion painless or painful?
Painless
In a patient over 50 in whom you suspect CRAO, what must you rule out and how do you rule it out?
Giant cell arteritis with ESR
Vision may be spared if an retinal artery embolus can be removed within what time frame?
100 minutes
Treatment for CRAO?
Ophthalmology STAT and ocular massage
Name 3 rashes that can occur on the palms and soles of the feet.
Erythema multiforme
Coxsackie virus
Secondary syphilis
Describe the rash of erythema multiforme.
Raised blanching target shaped lesions with 3 concentric zones of color change.
Erythema multiforme is associated with what virus?
Herpes simplex virus
The rash is caused by a type IV herpsensitivity reachion.
Describe the rash associated with secondary syphilis.
Diffuse symmetric macular or papular rash affecting the trunk as well as the extremities including the palms and soles.
What is the treatment for erythema multiforme?
Oral antihistamines or low potency topical steroids.
What drugs can cause erythema multiforme?
SOAPS
Sulfa, Oral hypoglycemic, Anticonvulsants, Penicillin, nSAIDs
Describe the murmur of mitral valve prolapse.
Midsystolic click that increases with valsalvaa.
Mitral valve prolapse is diagnosed by?
Echocardiography.
Treatment for mitral valve prolapse?
Lifestyle modifications such as increasing aerobic exercise, decreased caffeine and alcohol intake, and reducing stress.
Which valvular disorder is associated with an Austin Flint murmur?
Aortic regurgitation.
What is an Austin Flint murmur?
a low-pitched rumbling heart murmur which is best heard at the cardiac apex
What is a positive Dix-Hallpike maneuver?
Vertigo beginning within 30 seconds and resolving within 30 seconds of preforming the maneuver.
What is canalithiasis?
Calcium debris in the semicircular canal.
An ABI below __ is diagnostic of PAD.
0.9
What is the gold standard for diagnosis of PAD?
Arteriography.
An ABI of <0.4 is diagnostic of what?
Critical limb ischemia
What is the pharmacologic treatment for PAD?
Cilostazol.
What is the most common artery involved in PAD?
The superficial femoral artery
What is the definitive treatment for severe PAD?
Revascularization via percutaneous transluminal angioplasty or bypass
Name the likely bacteria for each of the following sputum descriptions:
Red currant-jelly sputum
Green Sputum
Rust colored sputum
Red currant-jelly sputum - Kelbsiella pneumo
Green Sputum - haemophilus influenza or pseudomonas
Rust colored sputum - Strep pneumo
What physical exam findings suggest lobar consolidation?
egophony, whispered pectoriloquy, and tactile fremitus.
What tool is used to determine if a patient with pneumonia should be admitted?
CURB65 score
What are the components of a curb 65 score?
Confusion Urea >7 RR > 30 SBP <90 age >65 Each is worth 1 point
A CURB65 of ___ or higher needs admission.
3
What is the preferred treatment for pneumonia caused by strep pneumo
Penicillin G or amoxicillin
Pneumonia caused by what organism leads to bradycardia rather than tachycardia?
Legionella pneumophila
Which pathogen is responsible for pneumonia with mild symptoms and is commonly called walking pneumonia?
Mycoplasma pneumoniae.
What are a patients expected thyroid labs in graves disease?
Decreased TSH, increased T3 and T4.
What is the most common cause of hypothyroidism?
Hashimoto thyroiditis.
What is a Monteggia fracture?
A proximal to mid unla fracture with radial head dislocation.
What is a Galeazzi fracture?
A distal radius fracture with distal radioulnar joint dislocation
What is a Maisonneuve fracture?
Fracture of the proximal fibular and a tear of the tibiofibular sysdesmosis.
What is a Smith fracture?
A fracture of the distal radius with volar angulation.
What is the mechanism of injury for a Maisonneuve fracture?
External rotation of the foot relative to the tibia.
What is the mechanism of injury for a Smith fracture?
Fall onto a flexed wrist of direct blow to the dorsal forearm
What is the name of the radiographic finding that describes the metaphyseal triangular portion in a Salter II fracture?
Thurstan Holland fragment.
What medication has been shown to reduce suicide risk in depressed patients?
Lithium.
What is the most common pathogen in atypical pneumonia?
Mycoplasma pneumoniae
What clinical features distinguish atypical pneumonia from typical pneumonia?
Insidious onset of dry cough
What is the treatment for atypical pneumonia?
Macrolides or doxycycline.
What are the signs of trichomoniasis?
frothy greenish yellow thin discharge, strawberry cervix, pH >5.0.
Describe the wet mount findings of trichomoniasis.
Flagellated motile trichomonads.
Which test can be used to confirm the diagnosis of trichomoniasis?
Nucleic acid amplification testing.
What is the definitive diagnosis for Alheimer disease?
Brain biopsy.
What are the histopathologic findings indicative of Alzheimer disease?
Amyloid plaques, accumulation of hyperphosphorylated tau protein in neurofibrillary tangles.
Accumulation of Negri bodies in the hippocampus is associated what what disease?
Rabies.
What is finger agnosia?
The loss of the ability to recognize one’s own fingers, the fingers of others, and any drawing or representation of fingers.
Treatment for Alzheime disease?
Cholinesterase inhibitors such as donepezil or NMDA antagonists such as memantine
