Family Medicine EOR part 2 Flashcards
1
Q
Treatment for vasospastic angina
A
CCBs or nitroglycerina.
2
Q
Precipitating factors for vasospastic angina?
A
Early in the morning, cold weather, and emotional stress.
3
Q
Describe the typical vasospastic angina patient?
A
Female smoker >50
4
Q
Cobblestoning of the mucosa on colonoscopy in what condition?
A
Chron disease
5
Q
T/F? Ulcerative colitis has “Skip lesions” on colonoscopy.
A
False - skip lesions are found in Chron disease
6
Q
What is the most common segment of the GI tract affected by Chron disease?
A
Terminal ileum
7
Q
Skin manifestation of Chron disease?
A
Pyoderma gangrenosum and erythema nodosum
8
Q
Mainstays of treatment for Chron disease?
A
5-ASA derivatives, corticosteroids, and immunomodulators.
9
Q
When is colorectal surgery considered for Chron disease patients?
A
Fisulizing disease, cachexia, systemic symptoms, intra-abdominal abcesses.
10
Q
Between Chron’s and ulcerative colitis, which presents with bloody diarrhea and which does not.
A
UC- bloody
Chron’s - not bloody
11
Q
What antibody tests are positive in Chron’s?
A
ASCA
12
Q
What medication is notorious for causing interstitial lung disease?
A
Amiodarone
13
Q
What is the x-ray finding of interstitial lung disease?
A
Reticular opacities, ground glass opacities, honeycombing, or reticulonodular opacities.
14
Q
What is the best diagnostic test for interstitial lung disease?
A
CT
15
Q
What pear-shaped protozoan has four flagella at its anterior end and can be seen on urine microscopy?
A
Trichomonas vaginalis.
16
Q
How long after treatment for chlamydia should retesting occur?
A
3 weeks
17
Q
Does strep throat typically cause anterior or posterior cervical chain lymphadenopathy?
A
Anterior
18
Q
What are the Centor criteria?
A
Fever >100.4
Sore throat
Lack of cough
White pharyngotonsillar exudates
19
Q
How many Centor criteria should be met for patients to undergo strep testing?
A
3/4
20
Q
1st line treatment for strep throat?
A
Oral penicillin or cefuroxime
21
Q
Treatment for strep throats in patients with penicillin allergy?
A
Macrolides
22
Q
Which culture medium is used to isolate Neisseria gonorrhoeae from a throat swab?
A
Thayer-Martin medium.
23
Q
What is the definitive treatment for rectocele?
A
Surgical correction with posterior colporrhaphy.
24
Q
What is the common name of a pulmonary aneurysm found in tuberculosis that begins in the infected cavity and spreads to the bronchial arteries, causing massive hemoptysis upon rupture?
A
Rasmussen aneurysm.
25
What are two causes of a cholesteatoma?
Chronic Eustachian tube dysfunction or tympanic membrane perforation
26
Symptoms of a cholesteatoma?
Painless malodorous otorrhea and conductive hearing loss
27
Definitive treatment for cholesteatoma?
Surgical excision with tympanoplasty
28
Conductive hearing loss associated with cholesteatoma is most commonly due to erosion of which of the ossicles?
The distal portion of the incus.
29
The vast majority of testicular tumors are?
Germ cell tumors -95%
30
Risk factors for germ cell tumors?
Cryptorchidism!!, also HIV and hx of Fhx of testicular cancer
31
What are some abnormal lab findings in testicular cancer?
Elevated HCG, AFP, and LDH.
32
Diagnosis of testicular cancer is made by?
Inguinal orchiectomy.
33
Is cryptorchidism more likely to occur on the right or left side?
Right side.
34
What is the cutoff for HFrEF?
<40% EF
35
What 3 medication are used in heart failure to improve mortality?
Diuretics, ACEIs and beta blockers
36
What medication used in HFrEF improves morbidity but not mortality?
Digoxin
37
Which class does sacubitril-valsartan, a heart failure medication, belong to?
Angiotensin receptor-neprilysin inhibitor (ARNI).
38
How is orbital cellulitis differentiated from preseptal cellulitis?
Orbital cellulitis has ophthalmoplegia, pain with eye movements, and proptosis.
39
Initial treatment for orbital cellulitis?
IV vancomycin + ceftriaxone or cefotaxime.
| + metronidazole if rhinosinusitis is present
40
What anatomical structure is infected in preseptal cellulitis?
Anterior portion of the eyelid.
41
Which antibiotic is used to treat confirmed pertussis infections?
Macrolides, such as azithromycin.
42
Back pain accompanied by urinary incontinence or retention should give you concern for?
Cauda equina syndrome
43
What response with plantar stimulation is a positive Babinski sign in adults characterized by?
Dorsal extension and fanning of the toes.
44
What labs should be ordered for a patient in whom you suspect hemochromatosis?
Serum iron, TIBC, transferrin saturation (TSAT), and ferritin.
45
What is indicated in hemochromatosis patients with serum ferritin >1000ng/mL?
an MRI to estimate body iron stores and phlebotomy to prevent progression.
46
Patients with hemochromatosis have increased risk of infections with what organisms?
Siderophilic organisms
47
How much alcohol intake per day increases the risk of developing cirrhosis?
Over 30 grams.
48
Patients testing positive for APC mutation are at high risk of having?
Familial adenomatous polyposis
49
Patients with familial adenomatous polyposis have a ___% risk of developing CRC.
100%
50
How often should FAP patients get colonoscopys?
Annually beginning at 12 until a colectomy is performed
51
What orthopedic test is performed by squeezing the calf muscle and observing for plantar flexion?
Thompson test.
52
A lateral ankle sprain usually involves what ligament?
Anterior talofibular ligament
53
What is the mechanism of injury for a lateral ankle sprain?
Inversion injury
54
What grade sprain is a complete tear of a ligament"?
Grade 3
55
What rule is used to determine if a patient needs and ankle x ray?
Ottawa ankle rules
56
What BPH medication reduces the size of the prostate as well as improves symptoms?
Finasteride
57
What class of medications is finasteride?
5-alpha reductase inhibitor
58
What drug class is considered first-line pharmacotherapy for dyslipidemia that is recalcitrant to lifestyle modifications?
Statins.
59
A crescendo-decrescendo murmur hear best at the second right intercostal space describes what murmur?
Aortic stenosis
60
What is the definitive test to diagnose aortic stenosis?
echocardiogram
61
What is the definitive treatment for aortic stenosis?
Aortic valve replacement,
62
What value is considered hypertriglyceridemia?
>150mg/dL
63
Triglyceride levels greater than _____ are associated with pancreatitis.
1000
64
What medication should a patient with a triglyceride level over 500 be prescribed?
A fibrate (fenofibrate or gemfibrozil.)
65
What is Courvoisier sign?
A nontender palpable enlarged gallbladder that is associated with pancreatic cancer.
66
What procedure is also known as a pancreaticoduodenectomy and is indicated for treatment of pancreatic cancer?
Whipple procedure.
67
What x-linked inherited red blood cell enzyme deficiency makes RBCs prone to oxidative injury?
G6PD deficiency
68
Peripheral blood smear of a G6PD patient reveals?
Heinz bodies and bite cells
69
What supplement should be initiated in patients with chronic hemolysis?
Folic acid.
70
What is the most commonly used imaging modality to diagnose a PE?
CT pulmonary angiography.
71
What is the name of the triad of risk factors for PE?
Virchow triad
72
What are the components of Virchow triad?
Venous stasis, vascular injury, and hypercoagulability.
73
What 2 x ray findings, although uncommon, are associated with PE?
Westermark sign and Hampton hump.
74
Although EKG changes are rare in PE, what EKG finding is highly specific for PE?
S1Q3T3
| S wave in lead 1, q wave and t inversion in lead 3.
75
In patients with high risk for PE but have contraindications to anticoagulation, what treatment is indicated?
Inferior vena cave filter.
76
What is the treatment for stable patients with a PE?
Anticoag with heparin, direct anticoagulant, or warfarin
77
What is the treatment for an unstable patient with a PE?
Thrombolytic therapy or ebolectomy.
78
What is the McGinn-White sign?
An S1Q3T3 pattern seen on ECG in patients with acute right heart strain.
79
What is the recommended procedural treatment for patients with refractory grade II internal hemorrhoids who are on anticoagulants?
Sclerotherapy because the risk of bleeding is very low.
80
What anatomic landmark determines whether hemorrhoids are internal or external?
The dentate line.
81
Name 2 autoimmune diseases that can cause corneal ulcers.
RA and Sjogren syndrome
82
Tonic-clonic seizures are also known as?
Grand mal seizures
83
A 24 year old patient presents to the ER after having a grand mal seizure.. He has never had a seizure before. What should you order?
```
MRI of the head
EKG
EEG
Electrolytes
Glucose
```
84
Treatment for focal seizures?
Phenytoin, valproic acid, phenobarbital, or lamotrigine
85
Treatment for absence seizures?
Ethosuximide or valproic acid.
86
Treatment for tonic clonic seizures?
Carbamazepine, phenobarbital, levetiracetam, or phenytoin
87
First line treatments for status epilepticus?
IV lorazepam, diazepam, or IM midazolam.
88
What condition is characterized by a brief period of unilateral paralysis following a seizure?
Todd paralysis.
89
What is the difference between irritant contact dermatitis and allergic contact dermatitis?
Irritant causes physical, chemical, or mechanical irritation to the skin. Irritant is localized to sites of direct contact.
Allergic contact dermatitis is a type IV hypersensitivity reaction. Allergic may pccur beyond sites of direct contant.
90
Name some causes of irritant contact dermatitis.
Soaps, detergents, organic solvents
91
Name some causes of allergic contact dermatitis.
Poison ivy, poison oak, nickel, adhesive tape, topical antimicrobials.
92
Treatment for allergic contact dermatitis?
Topical corticosteroids for localized involvement and systemic corticosteroids for widespread involvement.
93
What type of hypersensitivity reaction is a transfusion reaction due to ABO incompatibility classified as?
Type II hypersensitivity reaction.
94
What is the differential diagnosis for abnormal uterine bleeding?
```
PALM (structural causes)-COEIN (nonstructural causes)
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometriosis
Iatrogenic
Not yet classified.
```
95
When do women with von Willebrand disease typically present with menorrhagia?
Near menarche or at menopause.
96
Define menorrhagia
Blood loss > 80mL during one cycle.
97
When should oral bisphosphonates be taken?
In the morning on an empty stomach, and the patient should remain upright for 30 minutes afterward.
98
What is the first line treatment for osteoporosis?
Bisphosphonates
99
What is the screening modality for osteoporosis?
DEXA scan
100
A patient with osteopenia has a T score of?
-1.0 - -2.5
101
A patient with osteoporosis has a T score of?
102
What is the second line treatment for osteoporosis for patients who cannot tolerate bisphosphonates?
SERMs such as raloxifene.
103
What is the gold standard diagnosis for active TB?
Culture of acid-fast bacilli bacteria
104
List the 4 drugs used to treat active TB.
Rifampin, isoniazid, pyrazinamide, and ethambutol.
105
Treatment for latent TB?
9 months isoniazid + pyridoxine to combat peripheral neruopathy
OR
4 months rifampin.
106
Which RIPE antibiotic (rifampin, isoniazid, pyrazinamide, and ethambutol) is associated with higher rates of hepatitis?
Isoniazid.
107
What is the first-line treatment for primary dysmenorrhea?
Nonsteroidal anti-inflammatory drugs (NSAIDs).
108
What is the triad of symptoms caused by endometriosis?
Dysmenorrhea, dyschezia,(pain with bowel movements) and dyspareunia (painful intercourse)
109
Describe the appearance of seborrheic keratosis.
Brown macules and papules with well defined borders with a stuck on appearance and are nodular and rough to the touch.
110
Are seborrheic keratoses benign of malignant?
Benign.
111
What is Zollinger-Ellison syndrome?
A gastrin producing neuroendocrine tumor that causes hypersecretion of gastric acid.
112
What disorder is Zollinger-Ellison syndrome closely associated with?
Multiple endocrine neoplasia type 1.
113
What is the most effective prescription therapy for smoking cessation?
Varenicline
114
Bupropion is effective in smoking cessation but is contraindicated in patients with?
Seizures.
115
When do nicotine withdrawal symptoms peak?
3 days.
116
What disorder is associated with blue sclerae, short stature, easy bruising, and ligamentous laxity?
Osteogenesis imperfecta.
117
Which class of medications used for the treatment of osteoporosis has been associated with osteonecrosis of the jaw?
Bisphosphonates.
118
What is Rovsing sign and what is suggestive of?
Pain in the RLQ when palpating the LLQ.
| It is suggestive of appendicitis
119
What other special tests are suggestive of appedicitis?
Psoas sign
| Obturator sign
120
Where is the Mcburney point?
2/3 of the way from the umbilicus to the anterior superior iliac spine.
121
The psoas sign if suggestive of _____ position of the appendix whereas the obturator sign is suggestive of the _____ position of the appendix.
Psoas - retrocecal
| Obturator - pelvic
122
Treatment of acute appendicitis?
Surgical appendectomy with a single dose of preoperative antibiotics
123
What is the preferred imaging study for appendicitis in pregnant women?
MRI of the abdomen and pelvis.
124
What are the two main cardiac emergencies associated with severe hypertension?
Acute heart failure and acute coronary syndrome.
125
What two medications should be given to a patient in acute heart failure?
A loop diuretic and a vasodilator such ad sodium nitroprusside or nitroglycerine.
126
Hypertensive emergency is defined as a blood pressure greater than _____ with evidence of end organ damage.?
180 systolic or 120 diastolic
127
True or false: hypertensive urgency is defined as a markedly elevated blood pressure without evidence of end-organ damage.
True.
128
What is the treatment for PTSD?
SSRI and CBT
129
What is the appropriate treatment for a patient with acute stress disorder?
Psychotherapy.
130
What is the preferred imaging modality for lumbar radiculopathy?
MRI
131
What are the most common nerve root radicilopathies?
L5 and S1
132
S1 radiculopathy pain radiates where?
Posterior thigh, leg, and lateral plantar aspect of foot.
133
L5 radiculopathy radiates where?
Buttocks wrapping around lateral aspect of thigh and calf to the medial aspect of the dorsum of the foot.
134
L4 radiculopathy radiates where?
Wraps around from buttocks to anterior thigh stopping mid shin.
135
L3 radiculopathy radiates where?
Wraps around from buttocks to anterior thigh stopped at the knee.
136
What condition is a kyphoplasty used to treat?
Vertebral compression fracture.
137
Which HPV types account for the majority of cervical cancer cases?
16 and 18
138
How often do women aged 21-30 need pap smears?
Every 3 years if testing is negative.
139
When is the HPV vaccine recommended for males and females?
11 or 12 years of age.
140
What is the recommended approach for women aged 25 and older with low-grade squamous intraepithelial lesions and a positive human papillomavirus test?
Colposcopy.
141
Are most cases of age related macular degeneration dry or wet?
Dry
142
What is the classic finding associated with dry age related macular degeneration?
Drusen bodies (proteins that appear as bright yellow spots on the retina.)
143
What are the classic findings associated with wet age related macular degeneration?
Retinal hemorrhages and neovascularization.
| Manifests as grey-green fluid in the macular area
144
Treatment for dry age related macular degeneration?
No treatment available.
145
Treatment for wet age related macular degeneration?
Combination vitamins eith C, E, lutein, zeaxanthin, zinc, copper.
Antivascular endothelial growth factors such as bevacizumab or ranibizumab.
Photodynamic therapy.
146
What is metamorphopsia?
Distortion of straight lines, such as perceiving doors or blinds as curved. Metamorphopsia can be seen in wet macular degeneration.
147
What is the main organ responsible for the conversion of T4 to T3?
The liver.
148
What is the most common cause of primary hypothyroidism?
Autoimmune Hashimoto disease.
149
A positive thyroid peroxidase antibody test is diagnostic of?
Hashimoto disease
150
First line treatment for Hashimoto disease?
Levothyroxine
151
First line treatment for acute uncomplicated cystitis?
SMX-TMP BID x 3 days
OR
Nitrofurantoin 100mg BIG x 5 days
152
UTIs are most commonly caused by?
E coli
153
First line therapy for acute bacterial rhinosinusitis?
Amoxicillin-claculanate 875/125 BID or 500/125 TID x 5-7 days
154
Second line therapy for acute bacterial rhinisinusitis?
Doxycycline 100mg BID or 200mg QD x 5-7 days
155
Most common bacterial causes of acute bacterial sinusitis?
H flu and Strep pneumo
156
What is the initial recommended treatment for acute invasive fungal sinusitis?
IV amphotericin B and surgical debridement.
157
Industrial work in the 1930s and 1940s is a risk factor for?
Asbestos exposure
158
The hallmark of asbestos related diseases seen on chest XR is?
Pleural involvement.
159
What are the six Ps of an acute arterial embolism?
Paresthesia, pain, pallor, pulselessness, paralysis, and poikilothermia.
160
What would an ECG for a patient with a coarctation of aorta show?
Left ventricular hypertrophy.
161
Coarctation of the aorta is commonly associated with _____ syndrome.
Turner
162
What murmur can be heard in severe coarctation of the aorta?
A continuous murmur heard in mid to late systole heard best on the patients midline upper back.
163
What is the gold standard diagnostic for coarctation of the aorta?
CT angiogram.
164
What is shown on a chest x ray in coarctation of the aorta and is known as a "3 sign"
Rib notching
165
Treatment for coarctation of the aorta?
Widening the narrowed area of the aorta via anastamoses, ablation, or stenting.
166
How long does morning stiffness typically last in osteoarthritis?
< 30 minutes
167
First line pharmacologic treatment for osteoarthritis?
NSAIDs
168
What pharmacologic therapy may be used for osteoarthritis in those who have contraindications to NSAIDs?
Duloxetine and topical capsaicin
169
Which orthopedic condition is associated with ulnar deviations, swan-neck deformity, and boutonnière deformity of the hand?
Rheumatoid arthritis.
170
Is OA more likely to be bilateral or unilateral?
Unilateral
171
First line therapy for obstructive sleep apnea?
CPAP
172
What is Pickwickian syndrome?
Hypoventilation due to obesity.
173
Acute community-acquired diarrhea that is productive of visible blood is called _____.
dysentery
174
What are the most common pathogens causative of dysentery?
Shigella, campylobacter, and salmonella
175
What is the empiric antibiotic used for dysentery?
Azithromycin or a fluoroquinolone
176
Which antibiotic is used for the treatment of diarrhea due to Clostridioides difficile?
Oral vancomycin.
177
Berylliosis is an occupational lung disease associated with?
Nuclear power/reactors, aerospace, dental, and metal machine shops.
178
What unique findings sets berylliosis apart from other pneumoconiosis diseases?
Cutaneous nodules
179
What is the most appropriate initial test for a patient suspected of berylliosis?
Blood beryllium lymphocyte proliferation test
180
Treatment for berylliosis?
Lifelong low-dose glucocorticoid therapy.
181
Silicosis is often seen in what ocupations?
Mining, glass manufacturing, sandblasting, quarry industries.
182
Byssinosis is commonly seen in what occupations?
Textile industries that process cotton, help, or flax.
183
Asbestosis is seen in what ocupations?
Insulation demolition, shipbuilding, textile industries
184
Does pneumoconiosis typically present with an obstructive or restrictive pattern on pulmonary function testing?
Restrictive pattern.
185
What is the most common cause of roseola?
Human herpesvirus 6.
186
Unopposed estrogen in a woman with an intact uterus can cause ______ and increase the risk of ________
endometrial hyperplasia
| Endometrial cancer
187
Treatment of perimonopausal symptoms that interfere with daily activities can be treated with?
Estrogen or estrogen-progestin combination therapy.
188
Where in the body is follicle-stimulating hormone (FSH) synthesized?
The gonadotropic cells of the anterior pituitary gland.
189
HLA-B51 is associated with?
Behçet disease
190
Behçet disease causes what symptoms?
Patients present with recurrent painful oral and genital ulcers
191
HLA-B8 is associated with?
Graves disease and myasthenia gravis
192
HLA-DR4 is associated with
RA
193
What endocrine disorder is strongly associated with HLA-DR3 and HLA-DR4?
Type 1 diabetes mellitus.
194
Patients who recently had a stent placed should be prescribed
dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (e.g., ticagrelor or clopidogrel).
195
What are macrophages called after ingesting LDL at the site of a fatty streak?
Foam cells.
196
What type of hernias ALWAYS need surgery?
Strangulated hernias
197
Which type of inguinal hernia is most common?
Indirect.
198
Urticaria is a ____ mediated reaction?
IgE
199
Individual lesions from urticaria should last how long?
< 24 hours
200
Lateral pressure on the initial lesion caused separation of the epidermis describes what sign?
Nikolsy sign
201
Nikolsky sign is indicative of?
Staphylococcal scalded skin syndrome or pemphigus vulgaris
202
What sign refers to localized urticaria caused by stroking skin lesions seen in cutaneous mastocytosis?
Darier sign.
203
What are the three types of innocent murmurs?
Still murmurs, pulmonic murmurs, and venous hums
204
Describe a Still murmur.
A soft, high-pitched, crescendo-decrescendo murmur during midsystole along the left sternal borderq
205
How can you differentiate a innocent murmur of childhood from a pathologic murmur?
Have the patient stand up. It should decrease the murmur.
206
What are the three other causes of midsystolic murmurs excluding innocent murmurs of childhood?
Hypertrophic cardiomyopathy, aortic stenosis, and pulmonic stenosis.
207
Treatment for an acute paronychia?
I and D
208
What would be a good antibiotic choice(after I and D) for an acute paronychia in an immunocompromised patient?
Dicloxacillin or cephalexin
209
What are some complications of acute paronychia in immunocompromised patients?
Eponychia, tenosynovitis, osteomyelitis, and felon formation.
210
What is the mainstay of therapy for salicylate poisoning?
Alkalinization with sodium bicarbonate.
211
What lab can be used for serial monitoring of CRC?
Carcinoembryonic antigen (CEA)
212
Basophilic stippling is associated with?
Lead poisoning, thalassemias alcohol use, and heavy metal poisoning
213
What is the most common cause of a large bowel obstruction in an older patient?
Neoplasm.
214
True or false: nitroglycerin is contraindicated in right ventricular infarction.
True.
215
What is the most appropriate treatment for secondary prevention of an ischemic stroke in a patient who just had a TIA?
Aspirin 325 and clopidogrel 75
216
A slog-growing, waxy nodule with pearly, rolled borders and telangiectasias describes what lesion?
Basal cell carcinoma
217
True or false: non-Hodgkin lymphoma is more common than Hodgkin lymphoma.
True.
218
How is the diagnosis of a BCC made?
Shave biopsy
219
What is Tietze syndrome?
an inflammatory disorder presenting with costochondral tenderness and is likely preceded by infectious, rheumatologic, or neoplastic processes.
220
How is Tietze syndrome differentiated from costochondritis?
Costochondritis involves more than one area of reproducible tenderness, and does not present with localized swelling.
221
Which ribs attach directly to the sternum via their costal cartilage?
The first seven ribs.
222
What condition presents with an expiratory monophonic wheeze best heard over larger airways?
Tracheomalacia.
223
What medication should patients with cirrhosis be on to prevent rebleeding of esophageal varices?
non selective beta blockers (nadolol, propanolol)
224
What medication is used for cirrhosis patients to reduce ascites?
furosemide.
225
What medications are used as prophylactic therapy for spontaneous bacterial peritonitis?
TMP-SMX or ciprofloxacin
226
What medication is used to treat hepatic encephalopathy?
Lactulose or lacitol +/- rifaximin
227
What side effect of lactulose makes patients non-compliant?
They shit a lot to get the ammonia out
228
What lab marker can be used to monitor for hepatocellular carcinoma?
AFP
229
Which grade of hepatic encephalopathy is characterized by asterixis?
Grade 2.
230
Reactive arthritis can occur after what type of infections?
GI or GU (chlamydia) infections
231
List some associated signs/symptoms of reactive arthritis?
bilateral injected conjunctiva, mucocutaneous lesions, nausea and vomiting.
232
Treatment for reactive arthritis?
Supportive care for nausea and vomiting, NSAIDs for arthritis.
233
What four diseases are most commonly associated with HLA-B27 positivity?
Psoriatic arthritis, ankylosing spondylitis, irritable bowel syndrome, and reactive arthritis (noted by the mnemonic PAIR).
234
Which electrolyte abnormality has the United States Food and Drug Administration associated proton pump inhibitor therapy with?
Hypomagnesemia.
235
What intravenously administered nutritional supplement has been shown to improve functional outcomes in patients with heart failure?
Iron.
236
What heart sound might you hear in a patient with acute decompensated heart failure?
S3 heart sound
237
What is the most useful study in evaluation of acute decompensated heart failure?
echo
238
What is the treatment for comedonal acne?
Topical retinoid
239
What is the treatment for mild papulopustular and mixed acne?
Topical antimicrobial and topical retinoid
or
benzoyl peroxide and topical antibiotic
240
What is the treatment for moderate papulopustular acne?
Topical retinoid and oral antibiotic and topical benzoyl peroxide.
241
What is the treatment for severe acne?
Topical retinoid and oral antibiotic and topical benzoyl peroxide or oral isotretinoin monotherapy.
242
What antibiotics are used for treatment of acne?
Oral doxycycline or tmp-smx
| topical erythromycin or clindamycin
243
What acne medications are contraindicated in pregnancy?
Retinoids and doxycylcine.
244
Which type of lesion is the hallmark of acne vulgaris?
Comedo.
245
What is the most common subtype of melanoma?
Superficial spreading melanoma
246
What type of melanoma predominantly affects dark-skinned individuals?
Acral lentiginous melanoma
247
For how long should proton pump inhibitors be discontinued prior to performing urea breath tests and fecal antigen assays for Helicobacter pylori?
7–14 days.
248
First line outpatient treatment for pyelonephritis?
Cipro or levofloxacin x 14 days
249
What type of bacteria is the most common cause of acute prostatitis?
Gram-negative rods, specifically Escherichia coli.
250
Kidney stones are most commonly composed of?
Calcium oxalate
251
What is the preferred diagnostic test for nephrolithiasis?
non contrast CT of abd and pelvis
252
Pharmacologic therapy for nephrolithiasis?
Alpha blockers such as tamsulosin at 0.4mg/day to help promote stone passage.
253
What type of stone is associated with the development of staghorn calculi?
Struvite stones.
254
What sign is characterized by referred left shoulder pain and associated with splenic rupture?
Kehr sign.
255
What blood pressure defines stage 1 hypertension?
systolic of 130-139 or a diastolic blood pressure of 80-89
256
What blood pressure defines stage 2 hypertension?
SBC >140 or DBP>90
257
hich medication is the only calcium channel blocker with established safety in patients with severe heart failure?
Amlodipine.
258
Which patients with primary hypertension should not increase dietary potassium intake to lower blood pressure?
Patients on medications that reduce potassium excretion and patients with chronic kidney disease.
259
What is the first-line treatment for major depressive disorder?
A selective serotonin reuptake inhibitor (SSRI).
260
What is the first line drug choice for generalized epileptic seizures?
Valproate, lamotrigine, or levetriacetam
261
What medication is recommended for absence seizures?
Ethosuximide
262
What medications are recommended for focal seizure disorders?
Lamotrigine, oxcarbazepine, or phenytoin.
263
What is the term used to describe periodic paralysis following a seizure?
Todd paralysis.
264
What are the parameters consistent with a healthy lipid panel?
Total cholesterol <200, HDL > 60, LDL <100, triglycerides <150.
265
What disorder is a severely elevated triglyceride level (> 1,000 mg/dL) a risk factor for?
Pancreatitis.
266
What is the most common cause of acute gastroenteritis?
Norovirus
267
What is the physiologic cause of diarrhea in infectious diarrhea?
Reduced absorption of electrolytes across the intestinal epithelium.
268
What is the treatment for viral gastroenterieis?
Supportive with oral rehydration and antiemetics
269
What type of diarrhea does ingestion of polyethylene glycol 3350 induce?
Osmotic.
270
Iron absorption is enhanced by what vitamin?
Vitamin C
271
Name 3 physical exam findings consistent with iron deficiency anemia?
Koilonychia, atrophic glossitis, and angular cheilosis
272
Iron absorption is decreased by food and drink containing?
Calcium, phosphates, phytates, and tannates
273
What is the average age of menopause in U.S. women?
Around age 50.
274
What is the most common symptoms associated with menopause?
Hot flashes
275
What will estrogen and FSH levels look like in menopause?
Decreased estrogen and high FSH.
276
What is the treatment for perimenopausal symptoms?
Estrogen or estrogen-progestin combination therapy.
277
How does alopecia areata differ from androgenetic alopecia?
Alopecia areata occurs in patche(s), whereas androgenetic alopecia causes gradual recession of the front hairline or temporal areas.
278
What is telogen effluvium?
A type of alopecia characterized by diffuse hair shedding most commonly in the scalp.
279
What is alopecia universalis?
Complete hair loss on all hair-bearing areas throughout the body.
280
What is the treatment for alopecia areata?
Intralesional corticosteroid therapy (triamcinolone) every 4-6 weeks or topical corticosteroid therapy,
281
What condition is often associated with placenta previa, particularly with the increasing number of cesarean deliveries, and should be excluded?
Placenta accreta spectrum.
282
Painless vaginal bleeding during pregnancy is typical of?
Placenta previa
283
In what trimester does placenta previa typically occur?
Third
284
Painful vaginal bleeding during the third trimester is typical of?
Placental abruption
285
Diagnosis of placenta previa is diagnosed by?
Ultrasound
286
Nephritic syndrome is characterized by what urinalysis findings?
Hematuria, proteinuria, red blood cell casts
287
Treatment for PSGN?
Loop diuretics and nifedipine for blood pressure and edema, antibiotics if infection is still present, and dialysis if high BUN or hyperkalemia
288
Persistent microscopic hematuria, bilateral sensorineural hearing loss, and ocular defects describes what syndrome?
Alport syndrome
289
What nephropathy is the most common cause of acute glomerulonephritis and most often affects young men within 2 days following a URI or GI infection?
IgA nephropathy
290
Which cytoplasmic antibodies are associated with microscopic polyangiitis?
Perinuclear antineutrophil cytoplasmic antibodies (pANCA).
291
What is the initial study in the emergency setting for patients presenting with symptoms concerning for a stroke?
Noncontrast CT of the head
292
What is the most sensitive test for evaluation of a stroke?
MRA
293
A patient must present within how many hours of symptom onset to be treated with tPA?
3-4.5 hours
294
A lateral medullary infarction resulting in an array of manifestations, including dizziness, difficulty sitting upright, diplopia, nystagmus, hypotonia and limb ataxia of the ipsilateral arm, and loss of pain and temperature sensation in the ipsilateral face and contralateral trunk and limbs describes what syndrome?
Wallenberg syndrome
295
Is Bell's palsy forehead sparing or not?
Not forehead sparing
296
Treatment for Bell's palsy?
Prednisone 60-80mg/day x 1 week
297
How does Bell's palsy affect special senses?
Causes hyperacusis and loss of taste
298
A patient presenting with Bell's palsy symptoms and hearing loss should be evaluated for?
Ramsay Hunt Syndrome
299
What is Melkersson-Rosental syndrome?
A rare condition characterized by recurrent episodes of facial swelling and facial paralysis in patients with a fissured tongue.
300
Which food craving is characteristic of primary adrenal insufficiency?
Salt.
301
What TB medication has the side effect of neuropathy?
Isoniazid
302
What may be prescribed to patients undergoing TB treatment to prevent neuropathy?
Vitamin B6
303
How many millimeters of induration will be present on a patient with HIV and tuberculosis who undergoes a tuberculin skin test?
≥ 5 mm.
304
What is the first line treatment for lyme disease?
doxycycline BID x 10-21 days
305
Second line treatment for lyme disease?
Amoxicillin
306
What is the bacterial spirochete responsible for Rocky Mountain spotted fever?
Rickettsia rickettsii.
307
What rash is pathognomonic for lyme disease?
Erythema migrans
308
What is Budd-Chiari syndrome?
A disorder that occurs when the hepatic venous outflow is obstructed due to a thrombus within a hepatic vein.
309
What gene mutation is associate with polycythemia vera?
JAK2
310
What radiographic findings are consistent with chronic obstructive pulmonary disease?
Flat diaphragm, increased retrosternal lung space, rapidly tapering vasculature, and bullae.
311
Warfarin induced skin necrosis is a complication of warfarin in patients with?
Protein C deficiency
312
Which orthopedic test detects tightness of the iliotibial band, tensor fascia lata, and gluteus maximus?
Ober test.
313
What is the first line treatment for patients with mild-to-moderate Alzheimer's disease?
Cholinesterase inhibitors such as donepezil.
314
When is memantine (NMDA antagonist) indicated in treatment of Alzheimer's disease?
Can be used in addition to a cholinesterase inhibitor or as monotherapy in patients with severe disease.
315
What is the most common cause of death in patients with severe dementia?
Aspiration pneumonia
316
How much activity is recommended to reduce cardiovascular mortality in patients with a history of coronary artery disease?
Between 30–60 minutes of moderate-intensity aerobic activity, 5 to 7 days per week.
317
What cancer has been associated with ectopic ACTH syndrome that may lead to Cushing syndrome?
Small cell lung cancer.
318
What complication of untreated hypothyroidism is considered life-threatening?
Myxedema coma.
319
What is the first test you should order for a patient in whom you suspect hypothyroidism?
TSH assay
320
What is atopy?
the genetic tendency to develop allergic diseases,
321
Asthma is characterized by three components: obstruction to airflow, bronchial hyper-reactivity, and what?
Inflammation of the airway.
322
Claudication in the lower third of the calf is due to atherosclerotic occlusion of what artery?
Popliteal artery.
323
PCOS can be confirmed by?
Ultrasound
324
What lab findings support a diagnosis of PCOS?
Elevated total free testosterone.
325
What medications are recommended to help induce ovulation in patients with polycystic ovary syndrome?
Clomiphene, letrozole, and metformin.
326
What class of diabetes medications is most likely to cause recurrent yeast infections?
SGLT2 inhibitors such as empagliflozin
327
Which class of antidiabetic drug should be avoided in patients with a family or personal history of medullary thyroid carcinoma?
Glucagon-like peptide-1 agonists.
328
What is more common, small cell or non-small cell lung cancer?
non-small cell lung cancer
329
What is the most common type of non-small cell lung cancer?
Adenocarcinoma
330
What are the USPSTF recommendations for breast cancer screening in patients with normal risk for breast cancer?
Begin at age 50, screen every 2 years, and stop screening at 75.
331
Children and adolescents who are receiving aspirin- or salicylate-containing medications are at risk of developing what syndrome if they become infected with the influenza virus?
Reye syndrome.
332
What is the first line treatment for benign essential hypertension in black patients?
CCB such as amlodipine and/or thiazide diuretics
333
What beta-blockers do not carry the risk of impaired glucose tolerance or diabetes?
Carvedilol and nebivolol.
