Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clerkship decks > Family medicine rotation > Flashcards

Family medicine rotation Flashcards

1
Q

Gouty arthritis vs pseudogout?

A

Gouty arthritis: MSU crystals in joints due to excess uric acid esp in great toe

Pseudogout: Calcium pyrophosphate dehydrate crystals in joints (dx by rod-shaped, rhomboid, WEAKLY birefringence by crystal analysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Factors that can induce hyperuricemia/to take into consideration when considering gout attacks?

A

Men 30-50yo
Women 50-70yo

  • Recent increase in alcohol consumption
  • Large meal (esp if red meat, liver or seafood since they are high in purines)
  • Trauma, surgery
  • Recent h/o thiazide diuretic use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Compare calcium pyrophosphate dehydrate vs calcium hydroxyapatite vs calcium oxalate crystals

A

calcium pyrophosphate dehydrate:

  • Rod shaped
  • Rhomboid
  • Weakly positive birefringence

Calcium oxalate:

  • Bipyramidal
  • Mostly seen in ESRD pts
  • Strongly positive birefringence

Calcium hydroxyapatite:

  • Seen by electron microscopy
  • Cytoplasmic includions that are NON-birefringent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gross appearance of joint aspirate is essential/non-essential for diagnosis of septic arthritis. T/F?

A

FALSE

  • Both septic aspirate and a heavily condensed crystal-induced arthritis may have a thick, yellowish/chalky appearance
  • *Thus gross appearance of fluid is NOT very specific
  • **To dx crystal-induced arthritis you need polarizing microscopy to reveal MSU crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do labs help you distinguish crystal induced arthritis from septic joint?

A

Crystal induced joint aspirate will have avg 2,000-60,000/uL WBCs with 90% PMNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DDx for nontraumatic swollen joint?

A

Gout (or any crystal induced arthritis)
Infectious arthritis
OA
RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Likely bacteria responsible for joint infections in HIV+ patients? IVDU?

A

HIV+
- Pneumococcal, salmonella, H. influenzae

IVDU
- Streptococcal, staphylococcal, gram negative, or Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Septic joint will have a very limited ROM. T/F?

A

True; limited ROM due to pain

*Maintain ROM in cellulitis, bursitis, or osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OA is most commonly seen in people older than ____ years and is associated with ___

A 
>65yo
Associated with:
- Trauma
- Obesity (esp for knee OA)
- H/o of repetitive joint use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is an ultrasound indicated in pregnancy?

A 
Uncertain gestational age
Size/date discrepancies
Vaginal bleeding
Multiple gestations
Other high-risk situations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How much radiation is too much for a pregnant woman? Are MRIs safe?

A

> 5 rad; associated with fetal harm
(e.g. dental x ray is .00017 rad)
Fetus particularly sensitive to radiation during 2-15 weeks after conception

*MRIs are NOT shown to be harmful but not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How much folic acid should women take if they are thinking of getting pregnant?

A

Should start folic acid supplement at least 1 month prior to attempting to conceive

  • Low risk women: 400-800ug daily
  • Women who has had child with NT defect: 4mg daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you determine the estimated delivery date? When should you obtain this?

A

Obtain at initial prenatal visit

  • Get history; get first day of last menstrual period (LMP)
  • Use Naegele’s rule: from first day of LMP subtract 3 months and add 7 days
  • Make sure LMP is reliable:
  • Date is certain
  • LMP was normal
  • No contraceptive use in the past 1 year
  • Pt has had no bleeding since LMP
  • Regular menses
  • **Not reliable LMP? Get ultrasound!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should you be able to hear heart tones in a fetus?

A

10 week gestation using handheld doppler fetoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Initial lab screen for pregnant women should include which tests?

A 
CBC
Blood type
Rh status
Rubella
HIV
Hep B surface antigen
Rapid plasma reagin
UA
Urine culture
Pap smear
Cervical swab for gonorrhea and chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How often should prenatal visits happen?

A

Typical protocol:

  • Every 4 weeks until 28 weeks gestation
  • Every 2 weeks from 28-36 weeks
  • Every 1 week from 36 weeks-delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Approximate sensitivity and specificity of triple screen? When is it done and what does it screen for? Most common cause of false-positive serum screen?

A

Triple Screen

  • Sensitivity: 65-69%
  • Specificity: 93%

Between 15-20 weeks, preferably 16-18 weeks

Screens for:

  • Trisomy 18
  • Trisomy 21
  • Neural tube defects

*Most common cause of false-positive is INCORRECT GESTATIONAL AGE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Risk factors for increased risk of aneuploidy?

A
  • Women older than 35 at delivery if singleton pregnancy (32 if twins)
  • Women carrying fetus with major structural anomaly identified by US
  • Women with US markers of aneuploidy including increased nuchal thickness
  • Women with previously affected pregnancy
  • Couples with a known translocation, chromosome inversion, or aneuploidy
  • Women with positive maternal serum screen

***Offer prenatal dx by amniocentesis or chorionic villus sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most trisomy 21 fetuses are born to mothers older than 35 at time of delivery. T/F?

A

FALSE
Trisomy 21 increases with maternal age but 75% of affected fetuses are born to mothers YOUNGER than 35 at time of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should women be screened for group B strep?

A

ALL women should be offered GBS screening by vaginorectal culture at 35-37 gestation (swab lower vagina, perineal area, and rectum)

If colonized, treat with IV antibiotics at time of labor or rupture of membranes in order to reduce risk of neonatal GBS infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At what week gestation should you consider induction of labor to reduce risk of neonatal mortality and morbidity?

A 
42 weeks
(twice weekly testing for fetal wellbeing in prolonged pregnancy recommended at 42 week gestation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Influenza vaccine is safe in any stage of pregnancy. T/F?

A

True

provided they have no allergy to its components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When do you give RhoGAM to a pregnant woman?

A

Women who are Rh negative and if antibody screen or indirect Coombs test is negative –> then give RhoGAM at 28 weeks gestation and again at delivery if the baby is confirmed as Rh positive

*RhoGAM is given to prevent isoimmunization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is failure to thrive defined?

A

Weight below third or fifth percentile for age
or
Decelerations of growth that have crossed two major growth percentiles in a short period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

You should take blood pressures of children older than age 3. T/F?

A

True

If less than three, measure and plot head circumference to monitor growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

States vary in terms of which congenital diseaes to screen for but all states require testing for ______

A

PKU and congenital hypothyroidism

*since early treatment can prevent development of profound mental retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most common cause of anemia in children?

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risk factors for iron deficiency anemia in children?

A

Drinking more than 24oz of cows milk
Iron-restricted diets
Low birth weight or preterm
Mother who was iron deficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Leading cause of death in children older than 1 year?

A

Accidents and injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Until when should a child sit in a rear facing car seat?

A

Until they are both 1 year old AND weighs at least 20 bs

Older than 1 and between 20-40lbs should be in forward-facing car seat

> 40lbs, child can use booster type seat + lap and shoulder seat belt

*NO CHILD IN THE FRONT SEAT UNTIL 13yo OR OLDER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Leading cause of death in infants younger than 1 year?

A

Sudden infant death syndrome

  • Advise parents to place infant on back on firm mattress with nothing else in crib
  • *Heavy coverings and soft mattresses are associated with increased risk of SIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Leading cause of blindness worldwide?

A

Cataract disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Leading cause of severe vision loss in elderly?

A

AMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Leading cause of blindness in working-age adults in US?

A

Diabetic retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is otosclerosis? What age group do you see this in?

A

Autosomal dominant disorder of bones in the inner ear –> progressive conductive hearing loss

Onset in late 20’s to early 40’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pt has central auditory processing disorder. Would you expect them to be able to understand what you say?

A

No, they have difficulty understanding spoken language BUT may be able to hear sounds well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

____% of non institutionalized elderly fall each year.

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pt older than 80 yo has a ___% annual risk of falls

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does dementia prevalence change as you age?

A

Doubles every 5 years after 60yo

By 85yo, 30-50% of people have some degree of impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some rapid and fairly reliable office based screenings for dementia?

A

Clock draw and three-item recall

*fail? further test with MMSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Incontinence affects more men than women. T/F?

A

False
Men 11%-34%
Women 17-55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Depressive symptoms are more common in elderly vs younger populations. T/F?

A

True
Depressive symptoms = MORE prevalent vs younger populations
MDD = LESS prevalent vs younger populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the HHIE-S?

A

Hearing Handicap Inventory for the Elderly

- An initial office screening for general hearing loss with reliability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

A whispered voice test has low sensitivity when evaluating for hearing loss. T/F?

A

False;

Sensitivities and specificities range from 70-100%!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the next step if an elderly patient gives you a positive response to “Have you felt down/depressed/hopeless in the last 2 weeks? Have you felt little interest or pleasure in doing things?”

A

Follow up with a Geriatric Depression Scale

30 question instrument that is sensitive, specific, reliable for dx of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

___% of hospitalized elderly are malnourished.

A

50%

vs 15% of older outpatients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How do you assess nutritional status in elderly?

A

MOST USEFUL METHODS:
Serial weight measurements in the office
Inquiry about appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Protein undernutrition is commonly seen in the ____ setting. Protein undernutrition is associated with an increased risk of:

A

Nursing home elderly have a 17-56% prevalence of protein undernutrition.

Associated with:
Infections
Anemia
Orthostasis
Decubitus ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

_____ are the drug of choice in treating hypertension.

A

Thiazides (unless a comorbid condition makes another choice preferable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

_____ and ____ are the leading causes of death in the elderly.

A

Heart disease

Cerebrovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does stroke incidence in older adults change with age?

A

Roughly doubles every 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the 2 greatest risk factors for stroke?

A 
#1 Hypertension
#2 Atrial fibrillation (warfarin reduces risk of stroke in those with afib)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Screening elderly men for prostate cancer is routinely recommended. T/F? Why or why not?

A

False
Not definitely shown to prolong life
Risk of incontinence or erectile dysfunction caused by treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How often should an older woman get a mammography?

A

Every year until life expectancy falls below 5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How often should colon cancer screening happen?

A

Colonoscopy every 10 years OR
Annual fecal occult testing + flexible sigmoidoscopy every 5 years

Can be stopped when life expectancy is less than 5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When can you stop screening for cervical cancer?

A

Women older than 65-70 who have had 3 NORMAL PAPS over the preceding 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Osteoporosis risk factors?

A 
Older age
Female
White or Asian
Low calcium intake
Smoking
Excessive alcohol use
Chronic glucocorticoid use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How to reduce risk of osteoporotic fractures in both men and women?

A 
Calcium carbonate (500mg TID)
Vit D (400-800 IU/day)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is DEXA and when would it be used?

A

Dual-energy x-ray absorptiometry

- Tests for bone mineral density; may uncover asymptomatic osteoporosis in patients with multiple risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Who should get flu vaccines?

A

Everyone over 6mos, annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

One dose of herpes zoster vaccine is recommended at age ____

A

60 or older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Persons older than age 65 should receive at least ______ (immunizations)

A

One pneumococcal immunization

Single booster of tetanus and diphtheria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Oral advanced directives are legally binding. T/F?

A

Oral statements are ethically binding but NOT legally binding in all states

*Written AD’s are essential so as to give effect to the patient’s wishes in these matters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How effective is CPR?

A

Only ~15% of all patients who undergo CPR in the hospital survive to hospital discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CPR may result in fractured ribs, _____ and _____

A

Lacerated internal organs

Neurologic disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Presentation of presbycusis?

A

Symmetrical high-frequency hearing loss
Loss of speech discrimination
Difficulty understanding rapid speech, foreign accents, conversation in noisy areas
*Sensorineural mechanism, rather than conductive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Hallmark physical exam finding in hypertrophic cardiomyopathy?

A

Systolic murmur that DECREASES in intensity with the athlete in the supine position (increased ventricular filling, decreased obstruction)

*Functional outflow murmurs increase in intensity upon lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How would the intensity of an HCM murmur change with the Valsalva maneuver?

A

Increase!

Valsalva –> decreased ventricular filling, increased obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Most murmurs will decrease in intensity and duration with valsalva. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How is the HPV vaccine given? What does it protect against?

A

3 injections over 6 months
Immunization again 4 strains (6, 11, 16, 18)
- 6, 11 for venereal warts
- 16, 18 for cervical dysplasia/cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is GAPS?

A

Guidelines for Adolescent Preventive Services
- Series of recommendations regarding delivery of health services, promotion of well-being, screening for common conditions, and provision of immunizations for adolescents and young adults between 11-21 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

According to GAPS, all adolescents should be screen for eating disorders, obesity, tobacco/alcohol/drug use, AND hypertension. T/F?

A

True

Annual hypertension screening and treat those above 90th percentile for gender and age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Routine toxicology and lipid screening is recommended for all adolescents according to GAPS. T/F?

A

False

  • Tox screening not recommended
  • Lipid screening recommended for above-avg risk based on PMH of comorbid conditions or Family Hx of HLD, CAD, or other vascular diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Who should have TB skin testing?

A
  • Lived or living in homeless shelter or area with high prevalence of TB
  • Been or being incarcerated
  • Exposed to active TB
  • Working in health-care setting
75
Q

Pap smears should begin at age 21 OR _____

A

after the onset of sexual activity in immunocompromised pts

76
Q

Symptomatic and high risk males/females should be screened for _______ via _____

A

Gonorrhea
Chlamydia
via urine nucleic acid amplification

77
Q

Who can you offer Hep A vaccine to?

A
  • Those living in area with high infection rates
  • Travel to high-risk areas
  • Chronic liver disease
  • IVDU
  • MSM
78
Q

Who should get a MMR booster?

A

If pt did not receive a booster at 4-6 years old

79
Q

Meningococcal vaccine is recommended for:

A

Routine vaccination at 11-12 years old
Tetravalent polysaccharide-protein conjugate vaccine (MCV4)

If not previously vaccinated, vaccinate BEFORE high school! Also vaccinate:

  • College freshmen living in dorms
  • Military recruits
  • Travelers to endemic areas
  • Functionally/anatomically asplenic
80
Q

What are the two HPV vaccines and which has been approved for use in boys?

A

Gardasil and Cervarix: Both recommended for adolescent girls and young women
Gardasil: Approved for use in adolescent boys

*Both are series of 3 injections over 3 months

81
Q

Who should get HPV vaccine?

A
  • Girls as young as 9 (preferred to provide HPV vaccination PRIOR to onset of sexual activity)
  • Routinely recommended at age 11-12
  • Females 13-26 who have not completed the vaccine series
  • Those who have started sexual activity since it may protect against strains of HPV to which the pt has not been exposed
82
Q

Between Gardasil and Cervarix, why would you use one over another?

A

Both reduce the incidence of cervical cancer associated with the particular strains of HPV that are included in the vaccine

But Gardasil has also been shown to effectively reduce the incidence of genital warts

83
Q

What physical signs do you look for in Marfans? Why?

A 
Arachnodactyly
Arm span greater than height
Pectus excavatum
Tall-thin habitus
High-arched palate
Ocular lens subluxation

*Pts with Marfans can have aortic abnormalities that predispose to rupture during sports

84
Q

How would you accentuate or decrease a hypertrophic cardiomyopathy murmur?

A

Accentuated with decreased preload (e.g. standing, valsalva)

Decreased with increasing preload (e.g. squatting)

85
Q

Adolescent comes in with for a sports preparticipation exam. You think you hear a murmur. When should they be evaluated by a cardiologist prior to clearance for athletic participation?

A
  • Any adolescent with stigmata of Marfan syndrome
  • A murmur suggestive of HCM w/ grade 3/6 or louder systolic murmur
  • Any diastolic murmur
86
Q

Diagnostic study of choice for HCM?

A

Echocardiography

87
Q

Complete physical exams are advised every year in early adolescence, midadolescence and late adolescence. T/F?

A

False;

ONCE in each of those periods; more often when indicated

88
Q

Why is the medial ankle less likely to be injured vs lateral ankle?

A

Medial: Tibiotalar joint and the strong deltoid ligament complex protect the medial ankle

Lateral - in ordered of most commonly injured:

  • Anterior talofibular ligament (ATFL)
  • Calcaneofibular ligament (CFL)
  • Posterior talofibular ligament (PTFL)
89
Q

Describe a grade 1 ankle sprain

A

Grade 1 sprain:

  • Stretching of ATFL, causing pain and swelling
  • No mechanical instability and little/no functional loss
  • Pt can usually bear weight with, at most, mild pain
90
Q

Describe a grade 2 ankle sprain

A

Grade 2:

  • Partial tear of ATFL
  • Stretching of CFL
  • More severe pain, swelling, bruising
  • Mild/moderate joint instability
  • Significant pain with weight bearing
  • Loss of ROM
91
Q

Describe a grade 3 ankle sprain

A

Grade 3:

  • Complete tear of ATFL and CFL
  • Partial tearing of PTFL
  • Significant joint instability
  • Loss of function
  • Inability to bear weight
92
Q

What are the Ottawa Ankle Rules? How useful are they?

A

Decision model designed to aid physicians in determining which pts with ankle injuries need x-rays

Sensitivity approaches 100% in ruling out significant malleolar and midfoot fractures

93
Q

When should foot x-rays be done according to the Ottawa Ankle Rules?

A
  • Bony tenderness of posterior edge or tip of distal 6cm of either medial or lateral malleolus
  • Pt unable to bear weight immediately or when examinated
  • Bony tenderness over navicular bone (medial midfoot)
  • Bony tenderness over base of 5th metatarsal (lateral midfoot)
  • Pt unable to bear weight
94
Q

How do you manage ankle sprains? Strains?

A

Initial management of most acute sprains and strains is: PRICE
Protect, rest, ice, compression, elevation
NSAIDs or acetaminophen PRN for pain relief

95
Q

Sprain vs Strain?

A

Sprain: Stretching or tearing injury of ligament
Strain: Stretching or tearing injury of muscle or tendon

96
Q

What physical exam findings will help you differentiate between a fracture vs a strain?

A

Fracture: focal area of bony tenderness
Strain: Tender, tight muscle

97
Q

How can you use ROM to differentiate a dislocated joint vs torn tendon?

A

Dislocated joint or significant joint effusion:
- Limitations in both passive and active ROM

Torn tendon or muscle injury:

  • Limited active ROM
  • Preserved passive ROM
98
Q

When do you do a knee xray?

A

Follow Ottawa Knee Rules; any ONE of the following 5 criteria:

  • 55yo or older
  • Isolated patella tenderness
  • Tenderness of head of fibula
  • Inability to flex the knee to 90 degrees
  • Inability to bear weight for four steps immediately and in the exam room (regardless of limping)
99
Q

Initial imaging study of choice in evaluating an injury that is failing to improve or to acutely rule out a fracture?

A

X-ray (minimum series of 2 views at 90 degree angles)

If normal x-rays and continued sx or suspected ligament or tendon injuries of shoulder, ankle, knee, hip, use MRI
*MRI is highly sensitive and specific for articular or soft-tissue abnormalities incl ligament, tendon and cartilage tears

100
Q

When should you start ROM exercises after injury in pts with sprains or strains?

A

48-72 hours

101
Q

Most common cause of persistently stiff, painful, or unstable joints following sprains?

A

Inadequate rehabilitation

102
Q

Ottawa Ankle Rules apply to ______

A

Nonpregnant adult patients who have:

  • Normal mental status
  • No other painful injuries
  • Seen within 10 days of injury

*According to rules, xrays of ankle should be performed if there is bony tenderness of the posterior edge or tip of the distal 6cm of either medial or lateral malleolus, or if the pt is unable to bear weight immediately or when examined

103
Q

90% of low back pain patients will recover within 2 weeks of diagnosis. T/F?

A

True

Though 85% of pts who present with isolated low back pain will never be given a specific anatomical reason for the pain

104
Q

How to approach/treat low back pain?

A

Symptomatic therapies for 4-6 weeks without imaging with close f/u in 1 month

(assuming nonremarkable history)

105
Q

Define herniated disc

A

Rupture of fibrocartilage between the vertebrae leading to leakage of the nucleus pulposus that may impinge on the nerve roots causing pain

106
Q

When would you consider cauda equina syndrome?

A

Presenting sx of:

  • Increasing neuro deficits
  • Leg weakness
  • Bowel and urinary incontinence
  • Anesthesia, paraesthesia in saddle distribution
  • B/l sciatica

Physical:

  • Pain elicited by straight leg raise test
  • Reduction in anal spinchter tone
  • Decreased ankle reflexes
107
Q

What findings do you look for in back pain with possible underlying cancer?

A 
History of cancer 
Unexplained weight loss
Worsening pain at night
Failure to improve after 1 month of therapy
>50yo

–> CBC, ESR, x-rays –> MRI and/or bone scan if needed

108
Q

Sciatica improves with lying down and decreases with Valsalva. T/F?

A

False
Improves with lying down
Increases with Valsalva, sneezing, or coughing

109
Q

A contralateral leg raise test is more specific for sciatica compared to a straight leg raise. T/F

A

True
Contralateral leg raise test: 29% sensitive, 88% specific
Straight leg raise: 91% sensitive, 26% specific

110
Q

Vertebral level tested for knee strength/reflex? Great toe and foot dorsiflexion? Plantar flexion and ankle reflexes?

A

Knee: L4
Great toe/foot dorsiflexion: L5
Ankle reflexes/foot plantarflexion: S1

111
Q

Where do most lumbar disc compressions occur?

A

90% of lumbar disc compression of nerve roots occurs at L4/L5 and L5/S1

112
Q

You should not MRI sciatica pts. T/F

A

True

Not recommended unless sx last for >1mo or if pt is not a candidate for surgery or epidural injection

113
Q

How do you treat sciatica?

A

Conservative:

  • NSAIDs or acetaminophen
  • Possibly short-course steroids
  • Activity modifications
  • Opioids reserved for severe pain and exhausted non-narc options
  • PT for persistent mild-moderate sx of 3 weeks or more since majority of pts are likely to experience spontaneous improvement in first 2 weeks
  • Surgical if they suffer from disabling radicular pain of 6 weeks or more
114
Q

Common acquired causes of lumbar spinal stenosis?

A

Degenerative arthritis

Spondylolisthesis

115
Q

Congenital causes of spinal stenosis?

A

Dwarfism
Spina bifida
Myelomeningocele

116
Q

How does spinal stenosis present?

A

Low back and leg pain
Leg weakness
Pseudoclaudication with walking (vascularity of legs intact)

117
Q

Tx of spinal stenosis?

A

Initially with NSAIDs and analgesics, PT, epidural corticosteroids

118
Q

Spinal stenosis pain is worse with ____ and better with ____

A

Worse with activity

Better with bending over, squatting, lying, or sitting

119
Q

Vertebral compression fractures are more common in those with ____

A

Osteoporosis

Chronic steroid use

120
Q

How do pts with vertebral compression fractures present?

A

Acute onset of back pain after certain suddent movements such as lifting, bending, or coughingly

121
Q

Vertebral compression fractures are usual well localized to ______ segment

A

T12-L2

122
Q

How to evaluate and treat vertebral compression fracture?

A

X rays of spine

Treat with pain control, PT, calcitonin and bisphosphonates, treatment of underlying osteoporosis

123
Q

Bed rest for at >2 days is recommended for treating acute mechanical back pain. T/F?

A

False;

No significant benefit of best rest >2 days, opioids, or systemic corticosteroids

124
Q

Approach to treating acute low back pain?

A 
NSAIDs
Acetaminophen
Muscle relaxants (sedative so use at night)
Heat
Early mobility
125
Q

Lumbar support braces prevent back pain. T/F?

A

False; exercise has been proven to help prevent first episodes of back pain

126
Q

What is microscopic hematuria?

A

Presence of three or more RBCs per HPF on 2 or more properly collected urinalyses

127
Q

Best next step if patient comes in with asymptomatic microscopic hematuria?

A

Repeat urinalysis; if it persists, do imaging of upper and lower urinary tract and urine sent to cytology and culture

128
Q

How do you image the upper urinary tract?

A

Kidneys and ureters are imaged by IV pyelogram or CT scan

129
Q

How do you image the lower urinary tract?

A

Cystoscopy (endoscopic procedure)

130
Q

Incidence of cancer presenting as asymptomatic microscopic hematuria is LOW/HIGH?

A

LOW

131
Q

What makes up the ankle?

A

Distal fibula, distal tibia, talus

132
Q

What tendons stabilize the lateral aspect of the ankle?

A

Peroneus longus and brevis tendons

133
Q

What is the primary plantar flexor? Primary everters?

A

Primary plantar flexor: achilles

Primary everters: Peroneus brevis and longus tendons

134
Q

Common causes of achilles tendinosis?

A

Training errors
Running in improper shoes
Running on hills
Running on uneven/hard surfaces

135
Q

Common causes of Achilles tendon rupture?

A

Jumping sports
Complication of steroid injections
Complication of FQ antibiotics

136
Q

What does the talar tilt test test?

A

Calcaneofibular ligament stability
*Performed by stabilizing the distal lower leg in one hand while grasping each side of the foot at the talus and applying a varus stress

137
Q

What is a positive anterior drawer test of the ankle? What does it test?

A

3 mm difference between ankles suggests disruption of the anterior talofibular ligament

138
Q

What is a high ankle sprain?

A

Syndesmosis sprain

Evaluate via squeeze test that compresses the tibia and fibula together above the midpoint of the calf

139
Q

What is the Thompson test?

A

Midcal compression test that assesses the Achilles tendon

Pt prone with feet extended over edge, compress gastroc and soleus by squeezing calf and if foot plantar flexes, normal. If foot does not move, test is positive = complete or near complete rupture of the tendon

140
Q

How do you treat grade I sprains?

A

Symptomatically with RICE

Does NOT require immobilization, MOVE AROUND

141
Q

How do you treat grade II sprains?

A

RICE for 48-72 hours + immobilization in a splint for 2-7 days
Crutches if needed

142
Q

Which three ankle/feet fractures should be referred to an orthopedic surgeon?

A

Jones (base of 5th metatarsal)
Lis Franc (proximal second, third, or fourth metatarsal)
Salter-Harris (growth plate)

143
Q

How do PCL injuries commonly occur?

A

MVA when flexed knee hits dashboard

144
Q

OA can be managed with twice daily exercise programs and low impact aerobic conditioning. T/F?

A

True; remember low impact aerobic (most important factor in protecting weight bearing joints is maintaining an appropriate body weight)

Activity that causes pain lasting longer than 2 hours should be avoided

145
Q

Major environmental risk factor for RA?

A

Smoking

146
Q

OA or RA: Synovium forming a pannus of granulomatous tissue that erods cartilage, ligaments, tendons, and eventually bone.

A

RA

147
Q

Other than RA, when would see a positive RF?

A

Bacterial endocarditis
TB
Sarcoidosis
Malignancies

148
Q

How does RF relate to RA?

A

Up to 40% of RA pts are seronegative early in course when they are often likely to first present.

25% will never have a positive RF so they have “seronegative RA”

149
Q

What are the three management approaches to RA?

A

Pyramid: for milder RA; NSAIDs for sx, if no improvement in 2-3 weeks, use DMARD (methotrexate or in combo with sulfasalazine or hydroxychloroquine)

Step-down bridge: for very aggressive disease
- High dose oral corticosteroids (60mg prednisone daily) + hydroxychloroquine, sulfasalazine, and methotrexate + folic acid –> then meds withdrawn sequentially and taper corticosteroids

Sawtooth:

  • Single or combined DMARDs, usually including TNF receptor blockers
  • Local joint flare ups treated with intraarticular injections of corticosteroids
150
Q

Concern with using corticosteroids long term for RA?

A

Osteoporosis

  • Most rapid bone mineral loss occurs in first 6-12 months of therapy
  • *Use lowest dose of steroids for shortest period of time, add calcium and vit D
151
Q

What can you treat an RA pt refractory to NSAIDs, DMARDs, and low-dose corticosteroids?

A

TNF receptor blockers

e.g. infliximab, etanercept, adalimumab

152
Q

What percentage of joints that will be affected over time in an RA patient will be involved during the first year of the disease?

A

> 90%

153
Q

Poor prognostic factors in RA?

A 
Rheumatoid nodules
Extraarticular involvement
Persisting acute phase reactants
>20 joints involved
Psychological helplessness
Significant functional disability within 1 year of onset
154
Q

RA commonly goes into remission during ____

A

Pregnancy

155
Q

Most common inflammatory arthritis in men older than 40?

A

Gout (more common in men and AA)

156
Q

Contraindicated tx’s in acute gout?

A

Allopurinol
Febuxostat
Low dose aspirin therapy

157
Q

Pts with chronic gout are advised to minimize their intake of beer, liquor, and wine. T/F?

A

False

Wine is okay; the former two have purines and block renal excretion of urate

158
Q

Tx for chronic gout in urate overproducers? Underexcretors?

A

Overproduers: allopurinol, febuxostat
Underexcretors: probenecid

159
Q

How is polymyalgia rheumatica characterized?

A

Pain and stiffness in cervical spine and shoulder/hip girdles

Affects older, esp women

160
Q

Muscle relaxants are not effective in treating myofascial trigger points. T/F?

A

True

161
Q

Most common cause of chronic widespread pain in the US?

A

Fibromyalgia syndrome

162
Q

How is fibromyalgia syndrome characterized?

A

More in women

Widespread musculoskeletal pain (all four quadrants and axial skeleton + 11 of 18 tender points on physical exam)

163
Q

How to diagnose polymyalgia rheumatica?

A

Based on clinical grounds
Elevated sedimentation rate >60mm/hour
Anemia
Occasionally elevated LFTs (esp ALP)

164
Q

What is reactive arthritis?

A

Refers to rheumatic presentation that follows after certain infections of GI (Shigella, salmonella, campylobacter) or GU tract (chlamydia trachomatis)

165
Q

In which populations would you look out for reactive arthritis?

A

Young men
HLA-B27 positive
HIV+

166
Q

Triad of reactive arthritis?

A

Non-gonococcal urethritis
Conjunctivitis
Arthritis

167
Q

What medical emergency should you be concerned about in patients with polymyalgia rheumatica?

A

Giant cell arteritis (temporal arteritis)

Dx with biopsy of temporal artery
–> inflammatory swelling of temporal arteries –> headaches, loss of vision, scalp tenderness, jaw claudication, sudden blindness

Tx: immediate high-dose steroids

168
Q

What age range has the highest incidence of herniated discs?

A

30-55yo

169
Q

Key distinguishing factor between sciatica and non-radicular causes?

A

If sx radiate past the knee since non-radicular causes of LBP do not radiate below the knee

170
Q

Risk factors for osteoporosis?

A 
Female, early menopause
Northern European or Asian
Cigarette smoking
Sedentary lifestyle
Chronic steroid use
171
Q

When is low back pain considered chronic?

A

> 3 months

172
Q

Most consistently identified risk factor for low back pain?

A

History of back pain

Others:
heavy lifting
frequent bending, twisting and lifting
Repetive work with exposure to vibration
Psychosocial issues like depression, poor coping strategies, somatization, fear avoidance, etc
173
Q

Back belts and lumbar supports are recommended for preventing back pain in workers. T/F

A

False, strong evidence that it is not effective

174
Q

How many people in the US experience an MI each year?

A

1.5 million people/year

1/3 are fatal but continuous decline in mortality over past 3 decades

175
Q

What are the NYHA classifications of angina?

A

Class I - Angina with only unusually strenuous activity
Class II - w/ slightly more prolonged or slightly more vigorous activity than usual
Class III - w/ usual daily activity
Class IV - at rest

176
Q

What is unstable angina?

A

New onset angina, with angina at rest or with minimal exertion OR

Crescendo pattern of angina with episodes of increasing frequency, severity, or duration

177
Q

What is the cause of acute MI 90% of the time?

A

Atherosclerosis leading to plaque rupture and then cascading to coronary artery thrombosis

178
Q

All patients who rule in for MI should receive ____ and ____ if there are no contraindications

A

Aspirin

Antithrombotics (e.g. heparin; reduce the risk of subsequent MI and cardiac death in patients with unstable angina)

179
Q

Physical exam findings of pericarditis?

A

Sharp pain radiating to trapezius that increases with respiration, decreases with sitting forward

Look for global ST elevation noted on ECG too

180
Q

Physical exam findings of PE? Studies?

A

Sudden onset of pleuritic pain
Tachycardia
Tachypnea
Hypoxemia

D-dimer, V/Q scan, Chest CT, pulmonary angiogram

181
Q

Physical exam findings of gastroesophageal reflux? Studies?

A

Burning epigatric/substernal pain, acid taste in mouth
Increased with meals
Decreased with PPIs or antacids

Endoscopy, esophageal pH probe

182
Q

DDX of chest pain - physical exam findings of anxiety?

A

TIghtness sensation of chest
SOB
Tachycardia

183
Q

Physical exam findings of pneumothorax? Studies?

A

Unilateral sharp pleuritic pain of sudden onset
CXR findings

Unilateral decreased breath sounds and/or hyperresonance

184
Q

First line drug for new onset angina? What drug is contraindicated?

A

First line are beta blockers; increase survival
*Nitroglycerin would abate chest pain but NOT shown to impact survival

CCB like nifedipine are contraindicated because they increase mortality in multiple trials

Clerkship decks (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions