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EOR Exams > Family Medicine EOR Exam > Flashcards

Family Medicine EOR Exam Flashcards

1
Q

Stable Angina

A

Relieved by rest and/or NTG

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2
Q

Unstable Angina

A

Stable angina that increasingly occurs at rest and is more frequent

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3
Q

Prinzmetal angina

A

Coronary artery vasospasm causing transient ST-elevations
No clot

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4
Q

Narrow QRS complex with absent or inverted P wave

A

PJC - Premature Junctional Contraction

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5
Q

Narrow complex tachycardia with no discernable P waves

A

Paroxysmal supraventricular tachycardia

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6
Q

Sawtooth pattern with narrow QRS

A

Atrial flutter

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7
Q

Arrhythmia in which bradycardia alternates with tachycardia

A

Brady-tachy sick sinus syndrome

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8
Q

Sinus arrest

A

Absence of sinus activity for 3+ seconds

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9
Q

NSTEMI

A

St segment depression , t wave inversion, or both
Cardiac markers elevated!

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10
Q

STEMI

A

Elevated Cardiac biomarkers WITH ST segment elevation

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11
Q

Chest pain releived by sitting and leaning forward

A

Pericarditis

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12
Q

Severe tearing, ripping, knife like pain radiating to the back

A

Aortic dissection

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13
Q

Presentation of pulmonary embolism

A

Dyspnea is the MC symptom
Pleuritic chest pain

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14
Q

Best initial test for a PE

A

Spiral CT scan of the chest

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15
Q

Presentation of pulmonary hypertension

A

Dyspnea on exertion, fatigue, chest pain, edema and syncope

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16
Q

Murmur of pulmonary hypertension

A

Loud P2, systolic ejection click and parasternal lift

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17
Q

Dx for pulmonary hypertension

A

Right heart cath with mean pulmonary artery pressure above 25 mmHg

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18
Q

Criteria for rheumatic fever dx

A

2 major criteria or 1 major plus 2 minor

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19
Q

Titers of rheumatic fever

A

Elevated antistreptolysin titers (ASO)

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20
Q

Presentation of costochondritis

A

Pain with palpation or arm movement

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21
Q

Classic presentation of CHF

A

Exertional dyspnea progressing to at rest
Chronic nonproductive cough, worse when recumbent
Fatigue
Orthopnea
Nocturnal dyspnea
Nocturia

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22
Q

S4 in heart failure

A

DIastolic/ HFpEF

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23
Q

S3 in heart failure

A

COmpliant ventricle
Systolic/HFrEF

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24
Q

Physical exam signs of CHF

A

Cheyenne stokes breathing
Edema
Rales
S3 and S4
JVD over 8 cm
CYanosis/Coolness of extremities
Ascites

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25
Q

BNP for heart failure

A

Lower in obese patients
Differentiates SOB of HF from other SOB

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26
Q

CXR of heart failure

A

Kerley B Lines

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27
Q

Best test for CHF

A

ECHO!!!

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28
Q

NYHA Class I

A

No limitation of physical activity

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29
Q

NYHA class II

A

Slight limitation with physical activity but comfortable at rest

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30
Q

NYHA class III

A

Marked limitation of physical activity still comfortable at rest

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31
Q

NYHA class IV

A

Unable to carry on physical activity without discomfort AND have symptoms of angina at rest

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32
Q

Management for Systolic heart failure

A

ACEI, BB, Loop diuretic
NO CCB

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33
Q

Management for diastolic HF

A

ACEI with BB or Non-DHP-CCB
NO DIURETIC

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34
Q

Effect of morphine on HF

A

Reduces preload

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35
Q

Major CAD risk factors`

A

DM
Smoking
Hypertension
HLD
Family Hx
Over 45 for men and 55 for women

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36
Q

Potenital PE findings for ACS

A

Mitral regurg/S4
CHF symptoms (edema, crackles)
Signs of vascular disease (bruits, diminished pulses)

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37
Q

Why might we want a CXR in ACS

A

To rule out aortic dissection

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38
Q

Meds for use in ACS

A

MONA
May use ACEI

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39
Q

Drugs to improve mortality post MI - 4 and 1 NOT TO USE

A

Antiplatelet (Aspirin or Plavix)
Beta blocker
ACE or ARB
Statin

NO CCB’s

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40
Q

Presentation of endocarditis

A

Fever with a new onset heart murmur

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41
Q

MCC pathogen in Acute, Subacuite, IVDU, and prosthetic valve endocarditis

A

Acute and IVDU - Staph aureus
Subacute S. viridans
Prostetic valve - S epidermitis

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42
Q

Major Dukes criteria for endocarditis - 3

A

2 positive blood cultures 12 hours apart (staph for drug users strep for non drug users)
Vegetations are seen on Echo (tricuspid-IV drug users, mitral-non drug users
New regurg murmur

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43
Q

Minor Dukes criteria for endocarditis 2 + 4 skin signs

A

Risk factor
Fever 100.5
Splinter hemorrhages,
Janeway lesions
Osler node
Roth spots

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44
Q

Janeway lesions

A

Painless lesions, palms and soles. Assoc with endocarditis
Flat macules

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45
Q

Osler Node

A

Raised painful tender immunologic lesion assoc with endocarditis
Ouchy nodes!

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46
Q

Roth spots

A

Exudative lesions on the retina assoc with endocarditis. Immunologic

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47
Q

Diagnostic Duke criteria for endocarditis

A

2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

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48
Q

Tx for infective endocarditis

A

IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside

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49
Q

Drug to add to endocarditis for those with prosthetic valves

A

Rifampin

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50
Q

Prophylaxis for endocarditis in dental surgeries

A

Amoxicillin - 2 g 30-60 minutes before the procedure

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51
Q

USPSTF HLD screening guideline

A

Start at 35 for ALL adults

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52
Q

4 statin benefit groups

A

Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)

Patients with primary LDL-C levels of 190 mg per dL or greater

Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL

Patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

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53
Q

Statin for benefit group 1 - Patients with ASCVD

A

High intensity statin if under 75
Evaluate risk/benefit if over 75

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54
Q

Statin for benefit group 2 - LDL-C of 190+ or triglycerides over 500

A

High intensity statin, try to reduce LDL by 50%

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55
Q

Statin for benefit group 3 - WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189

A

Moderate intensity if ASCVD risk under 7.5%
High intensity if ASCVD risk 7.5%+
RIsk benefit for out of age range

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56
Q

Statin for benefit group 4 - WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

A

Moderate to high intensity
Moderate if risk is 5-7.5%

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57
Q

Lipid goals for LDL, HDL, and Total cholesterol

A

LDL under 100
Total under 200
HDL over 60

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58
Q

2 high intensity statins

A

Atorvastatin 40-80mg
Rosuvastatin 20-40mg

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59
Q

5 Low intensity statins

A

Simvastatin 10
Pravastatin 10-20
Lovastatin 20
Fluvastatin 20-40
Pitavistatin 1 mg (you read that right)

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60
Q

Elevated blood pressure

A

120-129 with DBP under 80

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61
Q

Stage 1 hypertension

A

130-139 with DBP 80-89

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62
Q

Stage 2 HTN

A

140+/90+

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63
Q

Elevated peds BP

A

SBP and/or DBP ≥90th percentile but <95th percentile, or 120/80 mmHg to <95th percentile (whichever is lower)

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64
Q

Stage 1 HTN for peds

A

SBP and/or DBP ≥95th percentile to <95th percentile + 12 mmHg, or 130/80 to 139/89 mmHg

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65
Q

Stage 2 HTN for peds

A

SBP and/or DBP ≥95th percentile + 12 mmHg, or ≥ 140/90 mmHg (whichever is lower)

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66
Q

ACC/AHA BP target

A

130/80

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67
Q

Tx guidelines for normal BP

A

Evaluate yearly, encourage healthy lifestyle

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68
Q

Tx guidelines for elevated BP

A

Lifestyle changes with 3-6 month reassessment

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69
Q

Management for Stage 1 hypertension with ASCVD risk <10%

A

Lifestyle management with 3-6 month follow up

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70
Q

Management for Stage 1 hypertension with ASCVD risk >10% or w/ CVD, DM, CKD

A

1 medication with 1 month follow up
Monthly follow up with adjustment until goal BP is met; 3-6 month follow up after that

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71
Q

Management for stage 2 HTN

A

2 BP medications with 1 month followed with monthly f/u until goal met then 3-6 month f/u

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72
Q

Initial agents for HTN treatment

A

ACE or ARB
Thiazide diuretic (chlorthalidone)
Long acting CCB (amlodipine)

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73
Q

Initial agents for HTN in African Americans

A

CCB and/or Thiazide diuretics

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74
Q

Contraindication for CCBs

A

Angina pectoris
Can cause leg edema

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75
Q

ACE/ARB contraindications

A

Diabetes with proteinuria

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76
Q

ACE specific contraindication

A

Cough and hyperkalemia
COntraindicated in pregnancy

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77
Q

Contrindication for spironolactone

A

Hyperkalemia

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78
Q

Contraindications for beta blockers

A

Asthma, may cause impotence

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79
Q

Hypertensive urgency

A

180/120+ BP without hypertensive urgency
Patients whould start a 2 drug regimen with frequent follow up

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80
Q

End organ damage signs that make it a hypertensive emergency - 7

A

(BP 180/120+)
retinal hemorrhages/ papilledema encephalopathy,
acute and subacute kidney injury,
intracranial hemorrhage,
aortic dissection,
pulmonary edema,
unstable angina or MI

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81
Q

Management for hypertensive emergency

A

In the first hour reduce by 10-20 percent
Reduce by 5-15 percent over then next 23 hours
First hour goal is generally under 180/120
24 hour goal is usually under 160/110

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82
Q

Management for hypertensive emergency with retinopathy or encephalopathy

A

Rapidly lower the mean arterial pressure by approximately 10 to 15 percent in the first hour and by no more than 25 percent compared with baseline by the end of the first day of treatment

Gradually reduce to under 130/80 over 2-3 months

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83
Q

Drug of choice for hypertensive urgency

A

Clonidine

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84
Q

Drug of choice for hypertensive emergency

A

Sodium nitroprusside

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85
Q

Drugs of choice for hypertenve emergency with retinopathy/encephalopathy

A

Sodium nitroprusside or clevidipine

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86
Q

Upper limits of normal, moderate, moderate to severe, and severe hypertriglyceridemia

A

Under 150
150-499
500-999
1000+

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87
Q

NCEP triglyceride screen recommendation

A

Beginning at 20 every 5 years. Fasting is best but may be non-fasting in healthy asymptomatic individuals
Yearly for CHD equivalent with fasting
Fasting should be 12-16 hours to confirm reading

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88
Q

Management option for hypertriglyceridemia

A

Lower below 500 to prevent pancreatitis
Fibrates and Niacin is isolated
Lipitor and FIsh oil may also help
Aspirin may help with HDL

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89
Q

Side effect of niacin administraction

A

May cause hyperglycemia

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90
Q

Presentation of intermittent claudication

A

Dull aching pain and numbness worse with exercise and relieved with rest
Thin skin, hair loss, and numbness of extremities

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91
Q

Diagnosis for intermittent claudication

A

ABI less than or equal to 0.9
Angiography is the gold standard

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92
Q

Management for intermittent claudication

A

Stop smoking - first line
Graduated exercise conditioning
May do angioplasty or bypass

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93
Q

3 meds for intermittent claudication

A

ASA
Clopidogrel
CIlostazol

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94
Q

Patients who need PAD screening

A

Over 70
Abnormal or absent pedal pulse
Aged 50-69 with smoking hx or DM

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95
Q

ABI range for no further testing

A

0.9-1.3

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96
Q

Management for asymptomatic PAD

A

Statin
ASA
Blood pressure control

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97
Q

Symptomatic PAD or PVD

A

Cramping, intermittent claudication with rest pain and muscle atrophy, thick toenails, hair loss
Diminished pulses

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98
Q

Diagnostics for PAD or PVD

A

ABI (0.9 or under diagnostic)
Doppler
Arteriography - Gold standard

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99
Q

Management of PAD or PVD

A

Manage chronic conditions and smoking
Graduated exercise
ASA, Cilostazol, Plavix

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100
Q

Best sugical management for PAD/PVD

A

Angioplasty is preferred

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101
Q

Cilostazol

A

Pletal - PDE-5 inhibito for peripheral vascular disease

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102
Q

Mitral valve location

A

Between left ventricle and atrium

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103
Q

Erbs point

A

Third left ICS, L sternal border

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104
Q

Murmur of aortic stenosis

A

Systolic ejection crescendo-decrescendo at the right upper sternal border
1st post with radiation to the neck
Split S2

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105
Q

Presentation of Aortic stenosis

A

Murmur is worse with squatting and expiration
Murmur decreases with valsalva
Syncope and LVH

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106
Q

Murmur of Aortic regurg

A

Early diastolic, soft-blowing decrescendo murmur with a high-pitch quality, especially when the patient is sitting and leaning forward heard at the left lower sternal border

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107
Q

Presentation of aortic regurg

A

Increases with squatting, decreases with valsalva
History of congenital heart defect or rheumatic fever

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108
Q

Murmur of mitral stenosis

A

Rumbling diastolic murmur with a split s1 that occurs following an opening snap. The rumbling is loudest at the start of diastole and is heard best at the left sternal border and apex

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109
Q

Presentation of mitral stenosis

A

Opening snap and murmur at LLSB/Apex
Left atrial hypertrophy - golden arches P wave on EKG lead II
SOB and CHF from fluid backup
Increase with squatting, decreases with valsalva

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110
Q

Murmur of mitral regurg

A

Blowing HOLOSYSTOLIC murmur at APEX with a SPLIT S2, radiates to the axilla

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111
Q

Presentation of mitral regurg

A

Previous STEMI
Low BP with tachycardia
Lung crackles

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112
Q

Murmur of pulmonic stenosis

A

Harsh systolic murmur best heard at the second and third left intercostal space; it radiates to the left shoulder

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113
Q

Presentation of pulmonic stenosis

A

SOB with split S2 and RVH
JVD. Increases with squatting and inspiration, decreases with valsalva

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114
Q

Murmur increase and expiration/inspiration

A

Right heart murmurs increase with inspiration
Left heart murmurs increase with expiration

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115
Q

Murmur of pulmonic regurgitation

A

High pitched diastolic decrescendo murmur at the LUSB that increases with inspiration

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116
Q

Presentation of pulmonic regurg

A

SOB and DOE
Increases with inspiration and squatting
Decreases with valsalva

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117
Q

Hand grip

A

Maneuver that only challenges aortic valve

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118
Q

Murmur of tricuspid stenosis

A

Diastolic rumbling murmur heard best at the left lower sternal margin and the xiphoid, augmented during inspiration

119
Q

Presentation of tricuspid stenosis

A

RIght sided heart failure - JVD and SOB
Increased with inspiration and squatting

120
Q

Significance of an opening snap

A

The valve is stenotic

121
Q

Murmur of tricuspid regurg

A

A blowing holosystolic murmur along the left sternal border

122
Q

Presentation of tricuspid regurg

A

A fib on EKG
JVD, DOE, Ascites

123
Q

Murmur of HOCM

A

High pitched mid-systolic murmur at the left lower sternal border. Increased with Valsalva and standing
Decreases with squat/hand grip

124
Q

Presentation of HOCM

A

Family history of sudden cardiac death
Syncope or presyncope with exertion

125
Q

Murmur of MVP

A

Mid systolic murmur increasing in intensity with valsalva, standing, and handgrip

126
Q

Presentation of MVP

A

Young female with palaitations during exercise
Progressive SOB

127
Q

Presentation of Asthma

A

Young patients presenting with wheezing and dyspnea due to exercise of allergen exposure

128
Q

Diagnostic criteria for asthma

A

Greater than 12% increase in FEV1 after bronchodilator therapy
FEV1/FVC ration <80%

129
Q

Mild intermittent asthma definition and tx

A

Less than 2 times per week or 3-night symptoms per month
Step 1: Short-acting beta2 agonist (SABA) PRN

130
Q

Mild persistent asthma definition and treatment

A

More than 2 times per week or 3-4 night symptoms per month
Step 2: Low-Dose inhaled corticosteroids (ICS) daily

131
Q

Moderate persistant asthma definition and treatment

A

Daily symptoms or more than 1 nightly episode per week
Step 3: Low-Dose ICS + Long-acting beta2 agonist (LABA) daily
Step 4: Medium-Dose ICS +LABA daily

132
Q

Severe persistent asthma definition and treatment

A

Symptoms several times per day and nightly
Step 5: High-Dose ICS +LABA daily
Step 6: High-Dose ICS +LABA +oral steroids daily

133
Q

6 steps of asthma tx

A

Step 1: Short-acting beta2 agonist (SABA) PRN
Step 2: Low-Dose inhaled corticosteroids (ICS) daily
Step 3: Low-Dose ICS + Long-acting beta2 agonist (LABA) daily
Step 4: Medium-Dose ICS +LABA daily
Step 5: High-Dose ICS +LABA daily
Step 6: High-Dose ICS +LABA +oral steroids daily

134
Q

Management for acute asthma attack

A

Oxygen, nebulized SABA, ipratropium bromide, and oral corticosteroids

135
Q

Presentation of Bronchitis

A

5+ days of coughing with or without sputum production
Chest discomfort, SOB may not have fever

136
Q

Management of bronchitis

A

Usually viral
NSAIDs, Cough medication, Albuterol

137
Q

Criteria for pneumonia suspicion in bronchitis - 7

A

HR >100,
RR >24,
T >38°C,
rales,
hypoxemia,
mental confusion, or
systemic illness

138
Q

Definition of chronic bronchitis

A

Chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause

139
Q

Presentation of chronic bronchitis

A

Excess mucus production that contricts airways
Blue bloaters and often smokers
Chronic hypoxia
Wheezes and inspiratory crackles

140
Q

Labs diagnostic for chronic bronchitis

A

FEV1/FVC < 0.70
May have increased Hgb and Hct
Increased pCO2 on ABG

141
Q

Management for chronic bronchitis

A

SABA for mild disease
LABA+ICS for moderate to severe disease
Smoking cessation
Antibiotics for acute exacerbations
Flu and pneumococcal vaccines are a must
Surgery: lung resection vs transplant

142
Q

Inhaler of choice for COPD

A

Ipratropium bromide is inhaler of choice for COPD

143
Q

Most important long term medication for COPD

A

Supplemental Oxygen!!

144
Q

Presentation of emphysema

A

Thin, barrell chested and breathing through pursed lips.
Hypereasonant chest
Due to smoking and alveolar destruction

145
Q

Diagnostic labs for emphysema

A

FEV1/FVC<.75
Hyperinflation and thin heart on CXR
TLC and FRC increased

146
Q

Management for emphysema

A

NOT responsive to bronchodilators
Smoking cessation and home oxygen therapy
Steroids and ABX for acute exacerbations
May us bipap/cpap

147
Q

Criteria for long term O2 in emphysema - 3

A

Pao2 55 mm Hg
O2 saturation < 88% (pulse oximetry) either at rest or during exercise
Pao2 55 59 mm Hg + polycythemia or cor pulmonale

148
Q

Presentation of Small cell lung cancer

A

15% of lung cancer cases with 99% being smokers
Recurrent pneumonia with anorexia, weight loss, and weakness

149
Q

Associated s/s of small cell lung cancer

A

Superior vena cava syndrome
Laryngeal nerve palsy
Horner syndrome
Malignant pleural effusion
Digital clubbing
Eaton lambert syndrome

150
Q

Eaton lambert syndrome

A

MC in SCLC
Similar to myasthenia gravis (proximal muscle weakness/fatigue, diminished DTRs, paresthesias (lower extremity)

151
Q

Diagnostics of SCLC

A

CXR is most important for DX
CT chest with IV contrast for staging
Definitive - Tissue biopsy—determine the histologic type
Cytologic examination of sputum if central tumor

152
Q

Management and prognosis for SCLC

A

Combination chemotherapy with 10-13% survival rate
CANNOT be treated with surgery

153
Q

3 types of NSCLC

A

Squamous cell 25-35%
Large cell - 5%
Adenocarcinoma - 35-40%

154
Q

Presentation of squamous cell carcinoma

A

Central
May cause hemoptysis
Hypercalcemia with elevated PTH

155
Q

Presentation of large cell lung cancer

A

Rapid growth with response to surgery
60% are peripheral
Gynecomastia

156
Q

Presentation of lung adenocarcinoma

A

Peripheral - associated with smoking and asbestos
Peripheral with thrombophlebitis

157
Q

Management for NSCLC

A

Stage 1-2 surgery
Stage 3 Chemo then surgery
Stage 4 palliative

158
Q

Window for differentiating CAP from Hospital acquired pneumonia

A

48 Hours

159
Q

MC pathogen for CAP

A

Strep pneumo

160
Q

Presentation of CAP

A

Fever
Gradual cough with sputum production
SOB with sweats, chills, etc.
Inspiratory crackles and dullness to percussion

161
Q

Dx for CAP

A

CXR with lobar consolidation - not needed outpatient
CT scan is more sensitive/specific
Urine test for legionella

162
Q

Indication for Prevanr 13/Pneumovax 23

A

65+ and immunocompromised give both or any chronic illness with increased risk of CAP
Immunocompromised patients at high risk should get single revaccination of 23 6-y after the first dose, regardless of age
Immunocompetent and 65+ y get the second dose of 23 if first received vaccine 6+ y ago (<65)

163
Q

MC nosocomial pneumonia pathogens - 4

A

S. aureus, K. pneumoniae, E. coli, Pseudomonas aeruginosa

164
Q

Diagnostic criteria for nosocomial pneumonia

A

Requires at least 2 of the following: Fever, leukocytosis, and purulent sputum
CXR with increased parenchymal opacity

165
Q

Labs to get for nosocomial pneumonia

A

Blood cultures × 2 CBC and CMP
Sputum culture and gram stain
ABG, thoracentesis if there is an effusion
Procalcitonin

166
Q

Outpatient management for pneumonia with no comorbidities or ABX within 90 days

A

Azithromycin
Clarithromycin
Doxycycline

167
Q

Outpatient management for pneumonia with ABX use in the last 90 days, over 65, or with comrobid illness/immune compromise

A

Levofloxacin or Moxifloxacin (Repiratory FQs)

OR

Macrolide+Beta Lactam (ie. augmentin/amoxicillin)

168
Q

Management for pneumonia in smokers

A

Cefdinir

169
Q

Inpatient or non ICU management for pneumonia without 90 day abx use or comorbidities/over 65/IC

A

IV levaquin or cipro

170
Q

Management for inpatient pneumonia with ABX use in the last 90 days, over 65, or with comrobid illness/immune compromise

A

IV macrolide and IV beta lactam (ampicillin, cefotaxime, ceftriaxone)

171
Q

MC pathogens and tx length for hospitalized/ICU patients with pneumonia

A

S. pneumoniae, Legionella, H. influenzae, Enterobacteriaceae, S. aureus, Pseudomonas
5 days min or until afebrile for 48-72 hours

172
Q

Presentation of OSA

A

Apnea, snoring, excessive daytime fatigue and sleepiness
Depression, HTN, and AM headaches
Pendulous uvula with narrow oropharynx

173
Q

Diagnosis of OSA

A

5+ obstructive events per hour of sleep with symptoms
15+ without

174
Q

Management of OSA

A

CPAP

175
Q

3 first line interventions for smoking cessation

A

Varenicline (Chantix)—best efficacy
Bupropion SR
Nicotine replacement therapy (NRT) - recommended for inpatient use

176
Q

Half life of nicotene

A

1-2 hours
Increases GABA and promotes dopamine release

177
Q

Second line tx and f/u for smoking cessation

A

Nortriptyline and Clonidine
1-2 weeks after starting medication

178
Q

LOng acting and short acting nicotene replacement

A

Long - Patch
Short - Lozenge/Gum

179
Q

Chantix (Varencicline)

A

Reduces reward aspects of smoking.
Quit smoking 1 week after starting medication

180
Q

Buproprion for smoking

A

Enhances central nervous system noradrenergic and dopaminergic release
Okay for pregnancy

181
Q

Positive TB test with 5mm induration - 5

A

If patient is: at high risk, fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB

182
Q

Positive 10mm induration TB test - 5

A

If patient is: < 4 or some risk factors = hospitals and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery

183
Q

Positive 15 mm induration TB test - 5

A

All patients

184
Q

IGRA

A

Interferon gamma release assay - blood test for TB

185
Q

CXR of TB

A

upper cavitary lesions, infiltrates, Ghon complexes in the apex of lungs

186
Q

Sputum and biopsy results for tuberculosis

A

Need three acid fast bacteria stains to be free of TB
Caseating granulomas on biopsy

187
Q

When to start empiric tx for TB

A

After PPD/IGRA and before CXR

188
Q

Management for latent TB - 3 possibilities and how you know its latent

A

Positive IGRA/PPD but negative CXR
Three months of once-weekly isoniazid plus rifapentine (3HP)
Four months of daily rifampin (4R)
Three months of daily isoniazid plus rifampin (3HR)

189
Q

2 regimens for active TB infection

A

Positive CXR and PPD/IGRA
4 months of: Rifapentine, Moxifloxacin, Isoniazid, and Pyrazinamide
OR
6-9 months of: RIPE (Rifampin, Isoniazid, Pyrazinamide, and Ethambutol)

190
Q

Baseline labs for TB therapy

A

All hepatotoxic - liver labs

191
Q

Criteria for TB therapy cessation

A

2 negative AFB smears and cx in a row

192
Q

TB prophylaxis

A

All household members for 1 year - isoniazid

193
Q

Lung cancer screening recommendation

A

50-80 with 20 pack year hx and currently smoking or within 15 years of quitting
Low dose CT

194
Q

Presentation of anal fissure

A

Rectal pain and bleeding after defecation
Severe pain with a superficial laceration that lasts for hours
Senitnel pile of mucous below fissure

195
Q

Management of anal fissure

A

Sitz bath, stool softeners
Takes 6 weeks to heal

Botox if refractory

196
Q

MC etiology for appendicitis

A

Fecalith

197
Q

Presentation of appendicitis

A

Coliky pain around the navel migrating to McBurney’s point in the LLQ
Rebound tenderness

198
Q

3 PE tests for appendicitis

A

Rovsing – RLQ pain with palpation of LLQ
Obturator sign – RLQ pain with internal rotation of the hip
Psoas sign - RLQ pain with hip extension while laying on the left side

199
Q

Diagnosis for appendicitis

A

Ultrasound or CT scan for atypical presentation
Neutrophilia supports dx

200
Q

MCC of small bowel obstruction

A

Postoperative adhesions - most often in the ileum or jejunum

201
Q

Presentation of small bowel obstruction

A

Colicky abdominal pain, hyperactive bowel sounds, and billious emesis

202
Q

Lab/Imaging findings for small bowel obstruction

A

Multiple air fluid levels
Dilated loops of bowel

203
Q

Management of small bowel obstruction

A

NG Tube for decompression
SUrgery if mechanical

204
Q

MCC of large bowel obstruction

A

Cancer
Can also be volvulus, impaction, hernia

205
Q

Presentation of large bowel obstruction

A

Increasing abdominal pain with longer intervals between episodes
Feculent vomiting
Tachycardia w/ fever may occur

206
Q

Imaging for large bowel obstruction

A

Radiographs, then CT if non-emergent
Bird beak sign with >5cm air fluid levels, haustra that do not transverse the colon
Dilated loops of bowel

207
Q

Difference of LBO from SBO

A

LBO has less vomiting, lower and less frequent pain but bouts last longer

208
Q

Presentation of cholelithiasis

A

RUQ pain, radiating to the scapula (Boas sign) worse after meals and at night
Tx is elective - cholecystectomy if severe/recurrent

209
Q

Presentation of cholecystitis

A

5 F’s - Female, Fat, Fourty, Fertile, Fair Skinned
Positive Murphy sign with RUQ pain after fatty meal
Low grade fever, leukocytosis, jaundice

210
Q

Initial imaging for cholecystitis

A

US showing 3+cm gallbladder wall w/ gallstones and percholecystic fluid

211
Q

Gold standard for cholecystitis dx

A

HIDA scan (may use a CT to r/o other issues

212
Q

Choledocolithiasis w/ gold standard

A

Stones in common bile duct - dx with ERCP

213
Q

Porcelain gallbladder

A

Indicates chronic cholelithiasis

214
Q

Presentation of hepatic cirrhosis

A

AST>ALT
Abdominal pain, ascites, hepatomegaly
Asterixis (flapping tremor) from ammonia accumulation
pulmonary edema/effusion, esophageal varices, Terry’s nails (white nail beds)

215
Q

MCC and 2nd MCC of cirrhosis

A

Alcohol followed by hepatitis

216
Q

Management for CIrrhosis

A

Quit alcohol
Restrict salt
Transplant

217
Q

Monitoring for cirrhosis

A

Labs every 3-4 months
US every 6-12 months

218
Q

Location of more malignant concerning polyps and time to next colonoscopy post removal of polyps

A

Proximal colon
3-5 years

219
Q

Screening and management for patients with a first degree relative with familial adenomatous polyposis

A

Begin at 10 years - genetic screen
12 years-sigmoidoscopy
Prophylactic colectomy recommended

220
Q

Presentation of colon cancer

A

Painless rectal bleeding and altered bowel habits in an individual aged 50-80
Apple core lesion on barium enema

221
Q

MC type of colon cancer

A

Adenomatous

222
Q

Colon cancer screening

A

45-75 years old
Colonoscopy 10 years
Sigmoid/CT - 5 years
Stool test - 1 year

223
Q

Definition of constipation

A

Less than 3 bowel movements per week or any two of: Straining, lumpy hard stools, sensation of incomplete evacuation - last 3 months with onset 6 months before diagnosis

224
Q

Diagnosis of constipation

A

Rectal exam and assessment for secondaty cause

225
Q

Management for constipation

A

20-25 g fiber per day
Exercise and hydration
Further investigation if not resolved in 2 weeks

226
Q

Laxatives for constipation

A

Bulk forming first line - Psyllium, methocellulose
Osmotic such as - Polyethylene glycol
Stimulant laxatives

227
Q

Presentation of E. coli travelers diarrhea

A

Occurs in the first 2 weeks and lasts 4 days without treatment
3+ unformed stools with one of: fever, nausea, vomiting, abdominal cramps, tenesmus, bloody stools

228
Q

Empiric treatment for travellers diarrhea

A

Ciprofloxacin and Loperamide (if over 2)

229
Q

Abx for campylobacter or shigella

A

FQ

230
Q

Abx for travelers diarrhea in pregnant, FQ resistant, or under 2

A

Z-max

231
Q

Prophylaxis for travelers diarrhea

A

FQ - 90% effective
Bismuth - 50% effective

232
Q

Etiology of viral gastoenteritis

A

Daycare - Rotavirus
Cruise ship - Norovirus

233
Q

Presentation of viral gastoenteritis

A

Lasts 48-72 hours but symptoms may linger up to one week
Myalgias, malaise, possible low-grade fever
Headache, watery diarrhea, abdominal pain, nausea, and vomiting
Supportive tx

234
Q

Presentation of salmonella enteric fever

A

Raw poultry, pork, or egg consumption
Flu like with GI symptoms
Pea soup diarrhea
Rose spots on trunk

235
Q

Presentation of salmonella gastroenteritis

A

1/10,000 egg yolks
Inflammatory diarrhea 24-48 hours after consumption

236
Q

Management for salmonella infection and when to treat vs. support

A

Rocephin or sometimes Azithromycin or FQ
Only treat in immune compromised

237
Q

Presentation of shigellosis

A

Primarily affects children
Abdominal pain and inflammatory diarrhea with mucous and tenesmus
Large amounts of fecal leukocytes

238
Q

Management for shigellosis

A

Bactrim may us FQ
Do not use antidiarrheals

239
Q

EHEC/ETEC

A

Undercooked ground beef
12-60 hour onset
May have bloody or non-bloody stool
No fecal laukocytes
Abx if severe
HUS - Hemolysis with thrombocytopenia

240
Q

Presentation of cholera

A

Life threatening rice water diarrhea
Seafood consumption
24-48 hour incubation

241
Q

Abx for cholera - 5 options

A

Doxycycline, azithromycin, furazolidone, bactrim, or ciprofloxacin

242
Q

Presentation and management for infectious esophagitis

A

In AIDS, transplant, and leukemia patients
Yellow white plaques = Candida = Fluconazole
Punch lesions/ulcers = Viral = Gancyclovire for CMV

243
Q

Drug induced esophagitis causes and management

A

ALendronate or NSAIDs. Odynophagia and dysphagia with deep ulcers
Sit upright for 30 minutes after taking bisphosphonates

244
Q

Eosinophilic esophagitis presentation

A

Patients with asthma symptoms and GERD unresponsive to antacids.
Dysphagia and impaction

245
Q

Eosinophilic esophagitis dx and management

A

Stacked circular rings with eosinophilic infiltrations - ribbed on enema.
Remove foods and topical steroid via inhaler

246
Q

Management of radiation or corrosive esophagitis

A

Dilation of radiation
Steroids for corrosion

247
Q

Location and management of H pylori gastritis

A

Antrum and body of stomach
CAP! Clarithromycin, Amoxicillin, PPI (may add flagyl; may add pepto-bismol)

248
Q

Location and management of NSAID gastritis

A

Stomach and duodenum
Stop NSAID
PPI for 4-8 weeks
May also be alcohol caused

249
Q

Autoimmune gastritis

A

Pernicious anemia
Identified by schilling test
Fundus and stomach body

250
Q

Gold standard for GERD dx

A

pH probe

251
Q

Dividing line between upper and lower GI bleed

A

Ligament of treitz

252
Q

Management for an upper GI bleed

A

PPI until cause is known
NPO with fluids
Blood if hgb under 7, or comorbid with 9

253
Q

Presentation, Dx of giardiasis

A

Drinking from outdoor streams
Bulky foul stool
Stool for cysts and trophozooites

254
Q

Tx for giardiasis

A

Tinidazole - first line
Flagyl also an option

255
Q

Pinworm

A

Enterobius vermicularis
Itching with scotch tape test
Mebendazole

256
Q

Tapeworm

A

Taenia saginata
GI symptoms and weight loss
Eating undercooked beef
B12 defficiency
Eggs in stool
Praziquantel to tx

257
Q

Hookworm

A

Water contact, cough from lungs to GI tract
Eosinophilia and anemia, serpiginous rash
Stool for worms
Tx mebendazole or pyrantel

258
Q

Roundworm

A

Pancreatic duct, common bile duct, and bowel obstruction
MC intestinal worm
Stool for eggs or worms
Albendazole, mebendazole, or pyrantel pamoate

259
Q

Amebiasis

A

Entamoeba histolytica cysts and trophozoites
Metronidazole for the acute phase, followed by Paromomycin to eliminate any remaining cysts
Causes liver cysts

260
Q

Schistosomiasis

A

Contaminated water
Rash, abdominal pain, bloody stools
Eggs in urine/Feces
PRaziquantel to treat

261
Q

Defining line between external and internal hemorrhoids

A

Dentate line

262
Q

Thrombosed and unthrombosed hemorrhoids w/ tx

A

Bleed if not thrombosed
Significant pain and pruritus but no bleeding
Treat with excision
May use sitz bath, hydration, fiber and topical anesthetic for nonthrombosed or mild

263
Q

Presentation and management of internal hemorrhoids

A

Bright red blood per rectum, pruritus and rectal discomfort
Fiber, sitz bath, ice packs, bed rest, stool softeners, topical steroids
Rubber band ligation If protrudes with defecation, enlargement, or intermittent bleeding
Closed hemorrhoidectomy if permanently prolapsed

264
Q

Hiatal hernia presentation and management

A

Symptoms of GERD that are worse with lying down
Barium or endoscopy
PPI with surgery needed 15% of cases
Rolling vs. Sliding (rolling is worse)

265
Q

Presentation and dx of ulcerative colitis

A

Just the colon and rectum
More superficial
Hematochezia and pus-filled diarrhea, fever, tenesmus (feeling of incomplete defecation), anorexia, weight loss
Barium enema: Lead pipe appearance (loss of haustral markings) -> may lead to toxic megacolon
Colectomy is curative

266
Q

2 medications for UC

A

Mesalamine and Prednisone

267
Q

Presentation and dx for crohn’s disease

A

Deep lesions from mouth to anus
MC in terminal ileum
Abdominal pain, nonbloody diarrhea, cobblestoning of colon

268
Q

Management for crohn disease

A

Surgery NOT curative
Prednisone +/- Mesalamine +/- Metronidazole or Ciprofloxacin

269
Q

Presentation of IBS

A

Recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria:
Related to defecation
Associated with a change in stool frequency
Associated with a change in stool form (appearance)
No organic cause

270
Q

Management of IBS

A

Low FODMAP diet
Fiber
Antidiarrheals/spasmodics
CBT may help

271
Q

Billirubin level associated with scleral icterus

A

2+ mg/dL
Next site to show is under the tongue

272
Q

Diagnostics when jaundice is present

A

Serum total and unconjugated bilirubin
Urinary bilirubin
CBC, LFTs, albumin, PT/INR, GGT, alkaline-phosphatase, hepatitis panel
Abdominal ultrasound (preferred) or CT abdomen Liver biopsy (definitive)

273
Q

4 prehepatic auses for conjugated hyperbilirubinemia

A

Alcohol
Infectious hepatitis
Drug reaction
Autoimmune

274
Q

3 causes of unconjugated hyperbilirubinemia

A

Hemolysis
Hematoma
Gilbert syndrome

275
Q

Presentation of acute pancreatitis

A

Epigastric pain radiating to the back, with nausea and vomiting, and elevated lipase
Cullen or Grey Turner sign

276
Q

Ransons criteria for poor acute pancreatitis prognosis - 5

A

Age > 55
Leukocyte: >16,000
Glucose: >200
LDH: >350
AST: >250

277
Q

Management for acute pancreatitis

A

IV fluids - most important
Analgesics and bowel rest

278
Q

Classic triad and tx for chronic pancreatitis

A

Pancreatic calcification
Steattorrhea
Diabetes
Reduce alcohol and dietary fat intake

279
Q

Presentation of PUD

A

Abdominal discomfort that is worse with meals and gets better an hour or so later after eating

280
Q

Duodenal ulcer

A

Often better after eating with lass pain than a stomach ulcer
More likely to be H pylori

281
Q

Stomach ulcer

A

Gnawing burning pain that is worse with meals
Often caused by H pylori

282
Q

Diagnostics for stomach ulcers

A

Upper endoscopy with biopsy if malignant appearing

283
Q

Management for PUD

A

PPI 4-8 weeks
CAP tx for H pylori
d/c NSAIDs

284
Q

Tests for H pylori

A

Breath or Stool test

285
Q

HBe serology meaning

A

Positive ANTIGEN means they are acutely infectious

286
Q

HBs serology interpretation

A

ANTIGEN - Ongoing infection
ANTIBODY - Immune

287
Q

HBc serology interpretation

A

ANTIBODY - Have or have had an infection

288
Q

Hepatitis C

A

Chronic with IVDU
Anti-HCV antibodies
Antiretrovirals to tx

289
Q

Hepatitis D

A

Coinfection with Hep B
Suspect in severe HBV case

290
Q

Hepatitis E

A

High risk of fetal mortality - 3rd world
HIV tx, HCV tx

291
Q

ALT/AST ratio for alcoholic hepatitis

A

1:2
Fatty liver is usually the other way around with ALT>AST

292
Q

Management for tylenol poisoning

A

N-acetyl-cysteine

293
Q

Serology of chronic HBV

A

Anti HBC with HBs antigent and NO HBs antibodies

EOR Exams (4 decks)

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