Family Medicine EOR part 2 Flashcards
Treatment for vasospastic angina
CCBs or nitroglycerina.
Precipitating factors for vasospastic angina?
Early in the morning, cold weather, and emotional stress.
Describe the typical vasospastic angina patient?
Female smoker >50
Cobblestoning of the mucosa on colonoscopy in what condition?
Chron disease
T/F? Ulcerative colitis has “Skip lesions” on colonoscopy.
False - skip lesions are found in Chron disease
What is the most common segment of the GI tract affected by Chron disease?
Terminal ileum
Skin manifestation of Chron disease?
Pyoderma gangrenosum and erythema nodosum
Mainstays of treatment for Chron disease?
5-ASA derivatives, corticosteroids, and immunomodulators.
When is colorectal surgery considered for Chron disease patients?
Fisulizing disease, cachexia, systemic symptoms, intra-abdominal abcesses.
Between Chron’s and ulcerative colitis, which presents with bloody diarrhea and which does not.
UC- bloody
Chron’s - not bloody
What antibody tests are positive in Chron’s?
ASCA
What medication is notorious for causing interstitial lung disease?
Amiodarone
What is the x-ray finding of interstitial lung disease?
Reticular opacities, ground glass opacities, honeycombing, or reticulonodular opacities.
What is the best diagnostic test for interstitial lung disease?
CT
What pear-shaped protozoan has four flagella at its anterior end and can be seen on urine microscopy?
Trichomonas vaginalis.
How long after treatment for chlamydia should retesting occur?
3 weeks
Does strep throat typically cause anterior or posterior cervical chain lymphadenopathy?
Anterior
What are the Centor criteria?
Fever >100.4
Sore throat
Lack of cough
White pharyngotonsillar exudates
How many Centor criteria should be met for patients to undergo strep testing?
3/4
1st line treatment for strep throat?
Oral penicillin or cefuroxime
Treatment for strep throats in patients with penicillin allergy?
Macrolides
Which culture medium is used to isolate Neisseria gonorrhoeae from a throat swab?
Thayer-Martin medium.
What is the definitive treatment for rectocele?
Surgical correction with posterior colporrhaphy.
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?
Rasmussen aneurysm.
What are two causes of a cholesteatoma?
Chronic Eustachian tube dysfunction or tympanic membrane perforation
Symptoms of a cholesteatoma?
Painless malodorous otorrhea and conductive hearing loss
Definitive treatment for cholesteatoma?
Surgical excision with tympanoplasty
Conductive hearing loss associated with cholesteatoma is most commonly due to erosion of which of the ossicles?
The distal portion of the incus.
The vast majority of testicular tumors are?
Germ cell tumors -95%
Risk factors for germ cell tumors?
Cryptorchidism!!, also HIV and hx of Fhx of testicular cancer
What are some abnormal lab findings in testicular cancer?
Elevated HCG, AFP, and LDH.
Diagnosis of testicular cancer is made by?
Inguinal orchiectomy.
Is cryptorchidism more likely to occur on the right or left side?
Right side.
What is the cutoff for HFrEF?
<40% EF
What 3 medication are used in heart failure to improve mortality?
Diuretics, ACEIs and beta blockers
What medication used in HFrEF improves morbidity but not mortality?
Digoxin
Which class does sacubitril-valsartan, a heart failure medication, belong to?
Angiotensin receptor-neprilysin inhibitor (ARNI).
How is orbital cellulitis differentiated from preseptal cellulitis?
Orbital cellulitis has ophthalmoplegia, pain with eye movements, and proptosis.
Initial treatment for orbital cellulitis?
IV vancomycin + ceftriaxone or cefotaxime.
+ metronidazole if rhinosinusitis is present
What anatomical structure is infected in preseptal cellulitis?
Anterior portion of the eyelid.
Which antibiotic is used to treat confirmed pertussis infections?
Macrolides, such as azithromycin.
Back pain accompanied by urinary incontinence or retention should give you concern for?
Cauda equina syndrome
What response with plantar stimulation is a positive Babinski sign in adults characterized by?
Dorsal extension and fanning of the toes.
What labs should be ordered for a patient in whom you suspect hemochromatosis?
Serum iron, TIBC, transferrin saturation (TSAT), and ferritin.
What is indicated in hemochromatosis patients with serum ferritin >1000ng/mL?
an MRI to estimate body iron stores and phlebotomy to prevent progression.
Patients with hemochromatosis have increased risk of infections with what organisms?
Siderophilic organisms
How much alcohol intake per day increases the risk of developing cirrhosis?
Over 30 grams.
Patients testing positive for APC mutation are at high risk of having?
Familial adenomatous polyposis
Patients with familial adenomatous polyposis have a ___% risk of developing CRC.
100%
How often should FAP patients get colonoscopys?
Annually beginning at 12 until a colectomy is performed
What orthopedic test is performed by squeezing the calf muscle and observing for plantar flexion?
Thompson test.
A lateral ankle sprain usually involves what ligament?
Anterior talofibular ligament
What is the mechanism of injury for a lateral ankle sprain?
Inversion injury
What grade sprain is a complete tear of a ligament”?
Grade 3
What rule is used to determine if a patient needs and ankle x ray?
Ottawa ankle rules
What BPH medication reduces the size of the prostate as well as improves symptoms?
Finasteride
What class of medications is finasteride?
5-alpha reductase inhibitor
What drug class is considered first-line pharmacotherapy for dyslipidemia that is recalcitrant to lifestyle modifications?
Statins.
A crescendo-decrescendo murmur hear best at the second right intercostal space describes what murmur?
Aortic stenosis
What is the definitive test to diagnose aortic stenosis?
echocardiogram
What is the definitive treatment for aortic stenosis?
Aortic valve replacement,
What value is considered hypertriglyceridemia?
> 150mg/dL
Triglyceride levels greater than _____ are associated with pancreatitis.
1000
What medication should a patient with a triglyceride level over 500 be prescribed?
A fibrate (fenofibrate or gemfibrozil.)
What is Courvoisier sign?
A nontender palpable enlarged gallbladder that is associated with pancreatic cancer.
What procedure is also known as a pancreaticoduodenectomy and is indicated for treatment of pancreatic cancer?
Whipple procedure.
What x-linked inherited red blood cell enzyme deficiency makes RBCs prone to oxidative injury?
G6PD deficiency
Peripheral blood smear of a G6PD patient reveals?
Heinz bodies and bite cells
What supplement should be initiated in patients with chronic hemolysis?
Folic acid.
What is the most commonly used imaging modality to diagnose a PE?
CT pulmonary angiography.
What is the name of the triad of risk factors for PE?
Virchow triad
What are the components of Virchow triad?
Venous stasis, vascular injury, and hypercoagulability.
What 2 x ray findings, although uncommon, are associated with PE?
Westermark sign and Hampton hump.
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.
In patients with high risk for PE but have contraindications to anticoagulation, what treatment is indicated?
Inferior vena cave filter.
What is the treatment for stable patients with a PE?
Anticoag with heparin, direct anticoagulant, or warfarin
What is the treatment for an unstable patient with a PE?
Thrombolytic therapy or ebolectomy.
What is the McGinn-White sign?
An S1Q3T3 pattern seen on ECG in patients with acute right heart strain.
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.
What anatomic landmark determines whether hemorrhoids are internal or external?
The dentate line.
Name 2 autoimmune diseases that can cause corneal ulcers.
RA and Sjogren syndrome
Tonic-clonic seizures are also known as?
Grand mal seizures
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
Treatment for focal seizures?
Phenytoin, valproic acid, phenobarbital, or lamotrigine
Treatment for absence seizures?
Ethosuximide or valproic acid.
Treatment for tonic clonic seizures?
Carbamazepine, phenobarbital, levetiracetam, or phenytoin
First line treatments for status epilepticus?
IV lorazepam, diazepam, or IM midazolam.
What condition is characterized by a brief period of unilateral paralysis following a seizure?
Todd paralysis.
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.
Name some causes of irritant contact dermatitis.
Soaps, detergents, organic solvents
Name some causes of allergic contact dermatitis.
Poison ivy, poison oak, nickel, adhesive tape, topical antimicrobials.
Treatment for allergic contact dermatitis?
Topical corticosteroids for localized involvement and systemic corticosteroids for widespread involvement.
What type of hypersensitivity reaction is a transfusion reaction due to ABO incompatibility classified as?
Type II hypersensitivity reaction.
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.
When do women with von Willebrand disease typically present with menorrhagia?
Near menarche or at menopause.
Define menorrhagia
Blood loss > 80mL during one cycle.
When should oral bisphosphonates be taken?
In the morning on an empty stomach, and the patient should remain upright for 30 minutes afterward.
What is the first line treatment for osteoporosis?
Bisphosphonates
What is the screening modality for osteoporosis?
DEXA scan
A patient with osteopenia has a T score of?
-1.0 - -2.5
A patient with osteoporosis has a T score of?
What is the second line treatment for osteoporosis for patients who cannot tolerate bisphosphonates?
SERMs such as raloxifene.
What is the gold standard diagnosis for active TB?
Culture of acid-fast bacilli bacteria
List the 4 drugs used to treat active TB.
Rifampin, isoniazid, pyrazinamide, and ethambutol.
Treatment for latent TB?
9 months isoniazid + pyridoxine to combat peripheral neruopathy
OR
4 months rifampin.
Which RIPE antibiotic (rifampin, isoniazid, pyrazinamide, and ethambutol) is associated with higher rates of hepatitis?
Isoniazid.
What is the first-line treatment for primary dysmenorrhea?
Nonsteroidal anti-inflammatory drugs (NSAIDs).
What is the triad of symptoms caused by endometriosis?
Dysmenorrhea, dyschezia,(pain with bowel movements) and dyspareunia (painful intercourse)
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.
Are seborrheic keratoses benign of malignant?
Benign.
What is Zollinger-Ellison syndrome?
A gastrin producing neuroendocrine tumor that causes hypersecretion of gastric acid.
What disorder is Zollinger-Ellison syndrome closely associated with?
Multiple endocrine neoplasia type 1.
What is the most effective prescription therapy for smoking cessation?
Varenicline
Bupropion is effective in smoking cessation but is contraindicated in patients with?
Seizures.
When do nicotine withdrawal symptoms peak?
3 days.
What disorder is associated with blue sclerae, short stature, easy bruising, and ligamentous laxity?
Osteogenesis imperfecta.
Which class of medications used for the treatment of osteoporosis has been associated with osteonecrosis of the jaw?
Bisphosphonates.
What is Rovsing sign and what is suggestive of?
Pain in the RLQ when palpating the LLQ.
It is suggestive of appendicitis
What other special tests are suggestive of appedicitis?
Psoas sign
Obturator sign
Where is the Mcburney point?
2/3 of the way from the umbilicus to the anterior superior iliac spine.
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
Treatment of acute appendicitis?
Surgical appendectomy with a single dose of preoperative antibiotics
What is the preferred imaging study for appendicitis in pregnant women?
MRI of the abdomen and pelvis.
What are the two main cardiac emergencies associated with severe hypertension?
Acute heart failure and acute coronary syndrome.
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.
Hypertensive emergency is defined as a blood pressure greater than _____ with evidence of end organ damage.?
180 systolic or 120 diastolic
True or false: hypertensive urgency is defined as a markedly elevated blood pressure without evidence of end-organ damage.
True.
What is the treatment for PTSD?
SSRI and CBT
What is the appropriate treatment for a patient with acute stress disorder?
Psychotherapy.
What is the preferred imaging modality for lumbar radiculopathy?
MRI
What are the most common nerve root radicilopathies?
L5 and S1
S1 radiculopathy pain radiates where?
Posterior thigh, leg, and lateral plantar aspect of foot.
L5 radiculopathy radiates where?
Buttocks wrapping around lateral aspect of thigh and calf to the medial aspect of the dorsum of the foot.
L4 radiculopathy radiates where?
Wraps around from buttocks to anterior thigh stopping mid shin.
L3 radiculopathy radiates where?
Wraps around from buttocks to anterior thigh stopped at the knee.
What condition is a kyphoplasty used to treat?
Vertebral compression fracture.
Which HPV types account for the majority of cervical cancer cases?
16 and 18
How often do women aged 21-30 need pap smears?
Every 3 years if testing is negative.
When is the HPV vaccine recommended for males and females?
11 or 12 years of age.
What is the recommended approach for women aged 25 and older with low-grade squamous intraepithelial lesions and a positive human papillomavirus test?
Colposcopy.
Are most cases of age related macular degeneration dry or wet?
Dry
What is the classic finding associated with dry age related macular degeneration?
Drusen bodies (proteins that appear as bright yellow spots on the retina.)
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
Treatment for dry age related macular degeneration?
No treatment available.
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.
What is metamorphopsia?
Distortion of straight lines, such as perceiving doors or blinds as curved. Metamorphopsia can be seen in wet macular degeneration.
What is the main organ responsible for the conversion of T4 to T3?
The liver.
What is the most common cause of primary hypothyroidism?
Autoimmune Hashimoto disease.
A positive thyroid peroxidase antibody test is diagnostic of?
Hashimoto disease
First line treatment for Hashimoto disease?
Levothyroxine
First line treatment for acute uncomplicated cystitis?
SMX-TMP BID x 3 days
OR
Nitrofurantoin 100mg BIG x 5 days
UTIs are most commonly caused by?
E coli
First line therapy for acute bacterial rhinosinusitis?
Amoxicillin-claculanate 875/125 BID or 500/125 TID x 5-7 days
Second line therapy for acute bacterial rhinisinusitis?
Doxycycline 100mg BID or 200mg QD x 5-7 days
Most common bacterial causes of acute bacterial sinusitis?
H flu and Strep pneumo
What is the initial recommended treatment for acute invasive fungal sinusitis?
IV amphotericin B and surgical debridement.
Industrial work in the 1930s and 1940s is a risk factor for?
Asbestos exposure
The hallmark of asbestos related diseases seen on chest XR is?
Pleural involvement.
What are the six Ps of an acute arterial embolism?
Paresthesia, pain, pallor, pulselessness, paralysis, and poikilothermia.
What would an ECG for a patient with a coarctation of aorta show?
Left ventricular hypertrophy.
Coarctation of the aorta is commonly associated with _____ syndrome.
Turner
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.
What is the gold standard diagnostic for coarctation of the aorta?
CT angiogram.
What is shown on a chest x ray in coarctation of the aorta and is known as a “3 sign”
Rib notching
Treatment for coarctation of the aorta?
Widening the narrowed area of the aorta via anastamoses, ablation, or stenting.
How long does morning stiffness typically last in osteoarthritis?
< 30 minutes
First line pharmacologic treatment for osteoarthritis?
NSAIDs
What pharmacologic therapy may be used for osteoarthritis in those who have contraindications to NSAIDs?
Duloxetine and topical capsaicin
Which orthopedic condition is associated with ulnar deviations, swan-neck deformity, and boutonnière deformity of the hand?
Rheumatoid arthritis.
Is OA more likely to be bilateral or unilateral?
Unilateral
First line therapy for obstructive sleep apnea?
CPAP
What is Pickwickian syndrome?
Hypoventilation due to obesity.
Acute community-acquired diarrhea that is productive of visible blood is called _____.
dysentery
What are the most common pathogens causative of dysentery?
Shigella, campylobacter, and salmonella
What is the empiric antibiotic used for dysentery?
Azithromycin or a fluoroquinolone
Which antibiotic is used for the treatment of diarrhea due to Clostridioides difficile?
Oral vancomycin.
Berylliosis is an occupational lung disease associated with?
Nuclear power/reactors, aerospace, dental, and metal machine shops.
What unique findings sets berylliosis apart from other pneumoconiosis diseases?
Cutaneous nodules
What is the most appropriate initial test for a patient suspected of berylliosis?
Blood beryllium lymphocyte proliferation test
Treatment for berylliosis?
Lifelong low-dose glucocorticoid therapy.
Silicosis is often seen in what ocupations?
Mining, glass manufacturing, sandblasting, quarry industries.
Byssinosis is commonly seen in what occupations?
Textile industries that process cotton, help, or flax.
Asbestosis is seen in what ocupations?
Insulation demolition, shipbuilding, textile industries
Does pneumoconiosis typically present with an obstructive or restrictive pattern on pulmonary function testing?
Restrictive pattern.
What is the most common cause of roseola?
Human herpesvirus 6.
Unopposed estrogen in a woman with an intact uterus can cause ______ and increase the risk of ________
endometrial hyperplasia
Endometrial cancer
Treatment of perimonopausal symptoms that interfere with daily activities can be treated with?
Estrogen or estrogen-progestin combination therapy.
Where in the body is follicle-stimulating hormone (FSH) synthesized?
The gonadotropic cells of the anterior pituitary gland.
HLA-B51 is associated with?
Behçet disease
Behçet disease causes what symptoms?
Patients present with recurrent painful oral and genital ulcers
HLA-B8 is associated with?
Graves disease and myasthenia gravis
HLA-DR4 is associated with
RA
What endocrine disorder is strongly associated with HLA-DR3 and HLA-DR4?
Type 1 diabetes mellitus.
Patients who recently had a stent placed should be prescribed
dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (e.g., ticagrelor or clopidogrel).
What are macrophages called after ingesting LDL at the site of a fatty streak?
Foam cells.
What type of hernias ALWAYS need surgery?
Strangulated hernias
Which type of inguinal hernia is most common?
Indirect.
Urticaria is a ____ mediated reaction?
IgE
Individual lesions from urticaria should last how long?
< 24 hours
Lateral pressure on the initial lesion caused separation of the epidermis describes what sign?
Nikolsy sign
Nikolsky sign is indicative of?
Staphylococcal scalded skin syndrome or pemphigus vulgaris
What sign refers to localized urticaria caused by stroking skin lesions seen in cutaneous mastocytosis?
Darier sign.
What are the three types of innocent murmurs?
Still murmurs, pulmonic murmurs, and venous hums
Describe a Still murmur.
A soft, high-pitched, crescendo-decrescendo murmur during midsystole along the left sternal borderq
How can you differentiate a innocent murmur of childhood from a pathologic murmur?
Have the patient stand up. It should decrease the murmur.
What are the three other causes of midsystolic murmurs excluding innocent murmurs of childhood?
Hypertrophic cardiomyopathy, aortic stenosis, and pulmonic stenosis.
Treatment for an acute paronychia?
I and D
What would be a good antibiotic choice(after I and D) for an acute paronychia in an immunocompromised patient?
Dicloxacillin or cephalexin
What are some complications of acute paronychia in immunocompromised patients?
Eponychia, tenosynovitis, osteomyelitis, and felon formation.
What is the mainstay of therapy for salicylate poisoning?
Alkalinization with sodium bicarbonate.
What lab can be used for serial monitoring of CRC?
Carcinoembryonic antigen (CEA)
Basophilic stippling is associated with?
Lead poisoning, thalassemias alcohol use, and heavy metal poisoning
What is the most common cause of a large bowel obstruction in an older patient?
Neoplasm.
True or false: nitroglycerin is contraindicated in right ventricular infarction.
True.
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
A slog-growing, waxy nodule with pearly, rolled borders and telangiectasias describes what lesion?
Basal cell carcinoma
True or false: non-Hodgkin lymphoma is more common than Hodgkin lymphoma.
True.
How is the diagnosis of a BCC made?
Shave biopsy
What is Tietze syndrome?
an inflammatory disorder presenting with costochondral tenderness and is likely preceded by infectious, rheumatologic, or neoplastic processes.
How is Tietze syndrome differentiated from costochondritis?
Costochondritis involves more than one area of reproducible tenderness, and does not present with localized swelling.
Which ribs attach directly to the sternum via their costal cartilage?
The first seven ribs.
What condition presents with an expiratory monophonic wheeze best heard over larger airways?
Tracheomalacia.
What medication should patients with cirrhosis be on to prevent rebleeding of esophageal varices?
non selective beta blockers (nadolol, propanolol)
What medication is used for cirrhosis patients to reduce ascites?
furosemide.
What medications are used as prophylactic therapy for spontaneous bacterial peritonitis?
TMP-SMX or ciprofloxacin
What medication is used to treat hepatic encephalopathy?
Lactulose or lacitol +/- rifaximin
What side effect of lactulose makes patients non-compliant?
They shit a lot to get the ammonia out
What lab marker can be used to monitor for hepatocellular carcinoma?
AFP
Which grade of hepatic encephalopathy is characterized by asterixis?
Grade 2.
Reactive arthritis can occur after what type of infections?
GI or GU (chlamydia) infections
List some associated signs/symptoms of reactive arthritis?
bilateral injected conjunctiva, mucocutaneous lesions, nausea and vomiting.
Treatment for reactive arthritis?
Supportive care for nausea and vomiting, NSAIDs for arthritis.
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).
Which electrolyte abnormality has the United States Food and Drug Administration associated proton pump inhibitor therapy with?
Hypomagnesemia.
What intravenously administered nutritional supplement has been shown to improve functional outcomes in patients with heart failure?
Iron.
What heart sound might you hear in a patient with acute decompensated heart failure?
S3 heart sound
What is the most useful study in evaluation of acute decompensated heart failure?
echo
What is the treatment for comedonal acne?
Topical retinoid
What is the treatment for mild papulopustular and mixed acne?
Topical antimicrobial and topical retinoid
or
benzoyl peroxide and topical antibiotic
What is the treatment for moderate papulopustular acne?
Topical retinoid and oral antibiotic and topical benzoyl peroxide.
What is the treatment for severe acne?
Topical retinoid and oral antibiotic and topical benzoyl peroxide or oral isotretinoin monotherapy.
What antibiotics are used for treatment of acne?
Oral doxycycline or tmp-smx
topical erythromycin or clindamycin
What acne medications are contraindicated in pregnancy?
Retinoids and doxycylcine.
Which type of lesion is the hallmark of acne vulgaris?
Comedo.
What is the most common subtype of melanoma?
Superficial spreading melanoma
What type of melanoma predominantly affects dark-skinned individuals?
Acral lentiginous melanoma
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.
First line outpatient treatment for pyelonephritis?
Cipro or levofloxacin x 14 days
What type of bacteria is the most common cause of acute prostatitis?
Gram-negative rods, specifically Escherichia coli.
Kidney stones are most commonly composed of?
Calcium oxalate
What is the preferred diagnostic test for nephrolithiasis?
non contrast CT of abd and pelvis
Pharmacologic therapy for nephrolithiasis?
Alpha blockers such as tamsulosin at 0.4mg/day to help promote stone passage.
What type of stone is associated with the development of staghorn calculi?
Struvite stones.
What sign is characterized by referred left shoulder pain and associated with splenic rupture?
Kehr sign.
What blood pressure defines stage 1 hypertension?
systolic of 130-139 or a diastolic blood pressure of 80-89
What blood pressure defines stage 2 hypertension?
SBC >140 or DBP>90
hich medication is the only calcium channel blocker with established safety in patients with severe heart failure?
Amlodipine.
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.
What is the first-line treatment for major depressive disorder?
A selective serotonin reuptake inhibitor (SSRI).
What is the first line drug choice for generalized epileptic seizures?
Valproate, lamotrigine, or levetriacetam
What medication is recommended for absence seizures?
Ethosuximide
What medications are recommended for focal seizure disorders?
Lamotrigine, oxcarbazepine, or phenytoin.
What is the term used to describe periodic paralysis following a seizure?
Todd paralysis.
What are the parameters consistent with a healthy lipid panel?
Total cholesterol <200, HDL > 60, LDL <100, triglycerides <150.
What disorder is a severely elevated triglyceride level (> 1,000 mg/dL) a risk factor for?
Pancreatitis.
What is the most common cause of acute gastroenteritis?
Norovirus
What is the physiologic cause of diarrhea in infectious diarrhea?
Reduced absorption of electrolytes across the intestinal epithelium.
What is the treatment for viral gastroenterieis?
Supportive with oral rehydration and antiemetics
What type of diarrhea does ingestion of polyethylene glycol 3350 induce?
Osmotic.
Iron absorption is enhanced by what vitamin?
Vitamin C
Name 3 physical exam findings consistent with iron deficiency anemia?
Koilonychia, atrophic glossitis, and angular cheilosis
Iron absorption is decreased by food and drink containing?
Calcium, phosphates, phytates, and tannates
What is the average age of menopause in U.S. women?
Around age 50.
What is the most common symptoms associated with menopause?
Hot flashes
What will estrogen and FSH levels look like in menopause?
Decreased estrogen and high FSH.
What is the treatment for perimenopausal symptoms?
Estrogen or estrogen-progestin combination therapy.
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.
What is telogen effluvium?
A type of alopecia characterized by diffuse hair shedding most commonly in the scalp.
What is alopecia universalis?
Complete hair loss on all hair-bearing areas throughout the body.
What is the treatment for alopecia areata?
Intralesional corticosteroid therapy (triamcinolone) every 4-6 weeks or topical corticosteroid therapy,
What condition is often associated with placenta previa, particularly with the increasing number of cesarean deliveries, and should be excluded?
Placenta accreta spectrum.
Painless vaginal bleeding during pregnancy is typical of?
Placenta previa
In what trimester does placenta previa typically occur?
Third
Painful vaginal bleeding during the third trimester is typical of?
Placental abruption
Diagnosis of placenta previa is diagnosed by?
Ultrasound
Nephritic syndrome is characterized by what urinalysis findings?
Hematuria, proteinuria, red blood cell casts
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
Persistent microscopic hematuria, bilateral sensorineural hearing loss, and ocular defects describes what syndrome?
Alport syndrome
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
Which cytoplasmic antibodies are associated with microscopic polyangiitis?
Perinuclear antineutrophil cytoplasmic antibodies (pANCA).
What is the initial study in the emergency setting for patients presenting with symptoms concerning for a stroke?
Noncontrast CT of the head
What is the most sensitive test for evaluation of a stroke?
MRA
A patient must present within how many hours of symptom onset to be treated with tPA?
3-4.5 hours
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
Is Bell’s palsy forehead sparing or not?
Not forehead sparing
Treatment for Bell’s palsy?
Prednisone 60-80mg/day x 1 week
How does Bell’s palsy affect special senses?
Causes hyperacusis and loss of taste
A patient presenting with Bell’s palsy symptoms and hearing loss should be evaluated for?
Ramsay Hunt Syndrome
What is Melkersson-Rosental syndrome?
A rare condition characterized by recurrent episodes of facial swelling and facial paralysis in patients with a fissured tongue.
Which food craving is characteristic of primary adrenal insufficiency?
Salt.
What TB medication has the side effect of neuropathy?
Isoniazid
What may be prescribed to patients undergoing TB treatment to prevent neuropathy?
Vitamin B6
How many millimeters of induration will be present on a patient with HIV and tuberculosis who undergoes a tuberculin skin test?
≥ 5 mm.
What is the first line treatment for lyme disease?
doxycycline BID x 10-21 days
Second line treatment for lyme disease?
Amoxicillin
What is the bacterial spirochete responsible for Rocky Mountain spotted fever?
Rickettsia rickettsii.
What rash is pathognomonic for lyme disease?
Erythema migrans
What is Budd-Chiari syndrome?
A disorder that occurs when the hepatic venous outflow is obstructed due to a thrombus within a hepatic vein.
What gene mutation is associate with polycythemia vera?
JAK2
What radiographic findings are consistent with chronic obstructive pulmonary disease?
Flat diaphragm, increased retrosternal lung space, rapidly tapering vasculature, and bullae.
Warfarin induced skin necrosis is a complication of warfarin in patients with?
Protein C deficiency
Which orthopedic test detects tightness of the iliotibial band, tensor fascia lata, and gluteus maximus?
Ober test.
What is the first line treatment for patients with mild-to-moderate Alzheimer’s disease?
Cholinesterase inhibitors such as donepezil.
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.
What is the most common cause of death in patients with severe dementia?
Aspiration pneumonia
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.
What cancer has been associated with ectopic ACTH syndrome that may lead to Cushing syndrome?
Small cell lung cancer.
What complication of untreated hypothyroidism is considered life-threatening?
Myxedema coma.
What is the first test you should order for a patient in whom you suspect hypothyroidism?
TSH assay
What is atopy?
the genetic tendency to develop allergic diseases,
Asthma is characterized by three components: obstruction to airflow, bronchial hyper-reactivity, and what?
Inflammation of the airway.
Claudication in the lower third of the calf is due to atherosclerotic occlusion of what artery?
Popliteal artery.
PCOS can be confirmed by?
Ultrasound
What lab findings support a diagnosis of PCOS?
Elevated total free testosterone.
What medications are recommended to help induce ovulation in patients with polycystic ovary syndrome?
Clomiphene, letrozole, and metformin.
What class of diabetes medications is most likely to cause recurrent yeast infections?
SGLT2 inhibitors such as empagliflozin
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.
What is more common, small cell or non-small cell lung cancer?
non-small cell lung cancer
What is the most common type of non-small cell lung cancer?
Adenocarcinoma
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.
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.
What is the first line treatment for benign essential hypertension in black patients?
CCB such as amlodipine and/or thiazide diuretics
What beta-blockers do not carry the risk of impaired glucose tolerance or diabetes?
Carvedilol and nebivolol.
