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Shelf Prep > Family Medicine Shelf > Flashcards

Family Medicine Shelf Flashcards

1
Q

Four combinations of the tetanus vaccine

A

Children under 7yo: DTaP and DT

Children over 7 and adults: Tdap and Td

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2
Q

When do we give tetanus immunoglobulin

A

Only if the wound is severe or dirty AND the patient has not been vaccinated in the last 5 years against tetanus

  • if the wound is clean and/or minor, no IG
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3
Q

When do we screen all pregnant women for asymptomatic bacteruria?

A

12-16 weeks

*bc it can progress to acute cystitis, acute pyelonephritis –> preterm birth, LBW

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4
Q

Treatment for asymptomatic bacteruria or acute cystitis in pregnant women

A

Nitrofurantoin 5-7 days
Amoxicillin or Augmentin 3-7 days
Fosfomycin single dose

*absolutely no Fluoroquinolones (cartilage) or TMP/SMX (congenital abnormalities, kernicterus)

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5
Q

Treatment for acute pyelonephritis in pregnant women

A

Hospitalize!
Give IV antibiotics (beta-lactams, meropenem)
Switch to 10-14 day course of oral antibiotics once she is afebrile for 24 hours

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6
Q

Treatment of acute cystitis or asymptomatic bacteria in pregnant women, if persistent after two more courses of antibiotics

A

Daily suppressive antibiotic therapy (nitrofurantoin) for the duration of pregnancy

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7
Q

Treatment for generalized social anxiety – pharm (2)

A

SSRIs (PAROXETINE) or SNRIs

+Cognitive behavioral therapy

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8
Q

Treatment for performance only social anxiety

A

Benzodiazepines or beta blocker 30 to 60 minutes before the performance
Cognitive behavioral therapy

*Avoid benzodiazepines if patient has history of substance abuse or does not want sedation

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9
Q

Sudden onset severe HA; worst HA Of my life

A

Subarachnoid hemorrhage

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10
Q

Three most common causes of clubbing

A
  1. Lung malignancy –> look for occult malignancy!!!
  2. Cystic fibrosis
  3. Right to left cardiac shunts
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11
Q

Pathophysiology of clubbing

A

Because of problems in pulmonary circulation –> Megakaryocytes failed to undergo normal fragmentation into smaller parts –> get stuck in the digital circulation –> begin to release PDGF and VEGF –> connective tissue hypertrophy + increased vascularity and permeability = clubbing

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12
Q

Zileuton (Zyflo)

A

5-lipoxygenase (Leukotriene) inhibitor

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13
Q

Montelukast (Singulair)

A

Leukotriene receptor antagonist

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14
Q

Jarisch-Herxheimer Reaction

A

Flu-like syndrome after starting antibiotics bc the killed bacteria start to release pyrogens (fever-inducing substances)
*classically seen in tx of spirochetes (syphillis, Lyme disease, leptospirosis, Q fever)

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15
Q

Blood on dipstick, but no RBCs seen on microscopy

A

Rhabdomyolysis

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16
Q

Normal body temp (Celsius vs Fahrenheit)

A 
Celsius = 36-37.5
Fahrenheit = 96.8-99.5
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17
Q

Temp in heat stroke vs fever

A

Heat stroke temp > 104F (41C)

Fever temp >100.4

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18
Q

Uncontrolled effluent of calcium from sarcoplasmic reticulum = mechanism of what pathology?

A

Malignant hyperthermia

After admin of inhaled aesthetics like halothane and succinylcholine

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19
Q

Temps seen in malignant hyperthermia

A

> 113F (45C)

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20
Q

Main difference between anorexia nervosa and bulimia nervosa5

A

Anorexia = low body weight, BMI

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21
Q

Treatment for anorexia (3)

A

CBT
Nutritional rehabilitation
Olanzapine (if the first two don’t work)

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22
Q

Olanzapine - brand name and drug class

A 
Olanzapine = Zyprexa
Atypical antipsychotic (dopamine antagonist)
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23
Q

Treatment for bulimia nervosa

A

CBT
Nutritional rehab
SSRI (Fluoxetine = Prozac)

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24
Q

Russell’s sign (eating disorders)

A

Scars/calluses on hands/knuckles seen with repeated self-induced vomiting (hand scrapes against incisors)

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25
Q

Main difference btn bulimia nervosa and binge eating disorder

A

Bulimia has compensatory behavior (purging)

Binge eating disorder has NO compensatory behavior –> pt likely to be overweight

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26
Q

The three most common trisomies (# and name)

A

Trisomy 13 - Patau syndrome
Trisomy 18 - Edward Syndrome
Trisomy 21 - Down Syndrome

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27
Q

Trisomy 18 (Edwards Syndrome) signs (6)

A 
Low birth weight
Clenched fists (index overlaps 3rd digit, 5th digit overlaps 4th)
Microcephaly
Prominent occiput (back of head)
Micrognathia (small jaw)
Rocker bottom feet
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28
Q

Trisomy 13 (Patau syndrome) signs (5)

A 
Cleft lip
Flexed fingers + polydactyly
Ocular hypotelorism (eyes close together)
Bulbous nose
Low-set malformed ears
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29
Q

Chromosomal deletion disease in which protruding metopic suture is characteristic

A

Cri-du-chat

5p deletion

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30
Q

Clomiphene citrate mechanism of action

A

Selective estrogen receptor modulator (SERM)
Antagonist at estrogen receptors in hypothalamus.
Prevents normal feedback inhibition of estrogen against LH/FSH –> causes increased release of LH and FSH from pituitary –> stimulates ovulation.
Used to treat infertility due to anovulation (e.g., PCOS).
May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, and visual disturbances.

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31
Q

Ménière’s disease pathophys & signs

A

Abnormal fluid and ion homeostasis in inner ear –> distention of endolymphatic compartment in inner ear
Signs =
Episodic (20mins-24hours) Vertigo + sensorineural hearing loss and tinnitus
Horizontal nystagmus during acute attack
+/- postural instability & vomiting with the vertigo

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32
Q

Triggers of episodes in Meniere’s dz

A

Anything that causes endolymphatic retention!
Alcohol
Caffeine
Nicotine
**high salt foods (low salt intake is one of the lifestyle modifications)

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33
Q

Printzmental (variant) angina EKG changes

A

ST elevations during episode that return to baseline when episode ends

  • contrast to MI where we have longer lasting ST elevations
  • contrast to unstable angina where we have ST depressions
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34
Q

Young female patient with amenorrhea and other signs suspicious for Turner syndrome. First step in assessment

A

Pelvic ultrasound

Can show streak ovaries and infantile uterus

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35
Q

Mechanism of exercise induced amenorrhea

A

Low caloric intake:output –> low levels of GnRH and LH –> estrogen deficiency
**Hence why you get amenorrhea/infertility but ALSO, vaginal atrophy, breast atrophy, and osteopenia

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36
Q

Normal/acceptable PSA value

A

7ng/dL

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37
Q

Volume of urine seen on bladder scan that should make you think obstruction

A

> 100ml

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38
Q

Tamsulosin mechanism of action

A

Alpha-1 blocker –> causes smooth muscle relaxation –> hence use in BPH to allow urination
***selective for alpha receptors in prostate vs vascular alpha receptors

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39
Q

Finasteride mechanism of action

A

5-alpha reductive inhibitor –> blocks this enzyme that converts testosterone to DHT
*can be used in combination with alpha-1 blockers in BPH

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40
Q

Abnormal grid test: what is abnl, what pathology?

A

Grid test = grid of parallel vertical & horizontal lines
If patient sees the lines as wavy instead of straight = abnl result
Think MACULAR DEGENERATION (most common cause of visual loss in industrialized world)

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41
Q

NF2 signs (3)

A

Subcutaneous neurofibromas
Cafe-au-last spots
Hearing loss (usually bilateral, due to acoustic neuromas)

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42
Q

Inspiratory stridor that begins in neonatal period and is loudest by 4-8mos that is worse supine and better when prone

A

Laryngomalacia

Laxity of supraglottic structures causing stridor, reflux

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43
Q

Diagnosis and tx of laryngomalacia

A

Diagnosis - just clinical OR direct laryngoscopy
Tx - keep upright after feeds, acid reducers if reflux
**Reassurance - Most will spontaneously resolve by 18mos!!

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44
Q

Vitamin deficiency that causes pellagra

A

Niacin (B3)

Pellagra = diarrhea + dermatitis + dementia

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45
Q

Thiamine (B1) deficiency causes Wernicke-Korsakoff and what other pathology?

A

Beriberi

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46
Q

Riboflavin (B2) deficiency signs (6)

A
  1. Cheilosis
  2. Glossitis
  3. Seborrheic dermatitis (on the genitals only)
  4. Pharyngitis
  5. Edema
  6. Erythema of the mouth
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47
Q

Pyridoxine (B6) deficiency signs

A
  1. Depression/irritability
  2. Dermatitis
  3. Stomatitis
  4. Elevated homocysteine –> venous thromboembolic dz and atherosclerosis
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48
Q

Four immune deficiency disorders and affect both B and T cells

A

Severe combined immunodeficiency (SCID)
Ataxia–telangiectasia
Hyper–IgM syndrome
Wiskott-Aldrich syndrome

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49
Q

SCID pathophysiology

A

Genetic defect (in IL-2R gamma chain or adenosine deaminase deficiency) –> failure of T cells to develop –> B cell dysfunction due to absent T cells

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50
Q

SCID inheritance patterns (2)

A

IL-2R defect = X-linked recessive (more common)

Adenosine deaminase deficiency = Autosomal recessive

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51
Q

Treatment for SCID

A

Bone marrow transplant

*the earlier the better –> hence why SCID is included in newborn screen in US

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52
Q

Signs of SCID

A

Recurrent, severe viral, fungal, opportunistic infections
Failure to thrive (low weight %ile)
Chronic diarrhea

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53
Q

In early infancy - eczema and bleeding (eg. post circumcision, bleeding from umbilical stump) due to thrombocytopenia

A

Wiskott-Aldrich syndrome

*Mutation in WAS gene –> T-cells unable to recognize actin cytoskeleton AND fewer/smaller platelets

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54
Q

Most common childhood systemic vasculitis–name and pathophysiology

A

Henoch-Schonlein purpura

IgA mediated vasculitis of the small vessels, usually after URI

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55
Q

Signs of Henoch-Schönlein purpura (4)

A
  1. Palpable purpura (symmetric, over her lower legs, buttocks, arms) **palpable ie we can feel the raised lesions of the purpura + its non-blanching
  2. Arthritis/arthralgia (most commonly knees and ankles)
  3. Colicky abdominal pain (due to local vasculitis)
  4. Renal sx if pt develops nephropathy
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56
Q

Tx for Henoch Schonlein purpura (mild v severe)

A
  1. Supportive = NSAIDS + hydration

2. If severe (nephrotic syndrome, HTN, acute renal failure) = hospitalize and give systemic glucocorticoids

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57
Q

What to use to remove foreign bodies in pre-pubertal girl (ex. toilet paper, toys) that is causing vulvovaginitis (2)

A

Warm water irrigation OR calcium alginite swab

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58
Q

Genu varum v genu valgum

A

Genu varum = bow-legged

Genu valgum = knock-kneed

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59
Q

Treatment for rickets in newborn (drug and dose)

A

Vitamin D repletion with 1000-2000 IU daily

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60
Q

Four main acute causes of hemiplegia in children

A
  1. Seizure (=Todd paralysis - postictal period); sx resolve on their own
  2. Hemiplegic migraine; sx resolve on their own
  3. Ischemic stroke (antithrombin III deficiency, PFO)
  4. Intracranial hemorrhage (hemophilia)
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61
Q

CT vs MRI, which is better at what?

A

CT better at showing bone (plus more easily available/faster in emergencies)
MRI better ar showing soft-tissue (plus has no ionizing radiation)

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62
Q

Nocturnal headaches and morning vomiting

A

Signs of elevated intracranial pressure!
Inc ICP worse at night bc of supine position
The inc ICP puts pressure on medullary vomiting center –> N&V

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63
Q

Inflammation of the larynx and trachea due to parainfluenza viral infection

A

CROUP = Laryngotracheitis

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64
Q

Clinical signs of croup (3)

A

Inspiratory stridor
Barky, seal-like cough
Hoarse voice

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65
Q

Tx of croup (mild vs severe)

A 
Mild = stridor not happening at rest (ex. only when child cries) = oral glucocorticoids to dec edema/swelling 
Severe = stridor at rest/resp distress = oral glucocorticoids + nebulized epinephrine  to constrict arterioles in the mucosa --> altering hydrostatic pressure --> decreases edema
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66
Q

Four modifiable risk factors for breast cancer

A

HRT
Nulliparity
Inc maternal age at first live birth
Alcohol consumption (>2 drinks/day or >7 drinks/week)

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67
Q

Two drugs of choice for absence seizures

A 
Ethosuximide (Zarontin)
Valproic acid (Depakote)
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68
Q

Clozapine only = risk of agranulocytosis. But both clozapine (Clozaril) and olanzapine (Zyprexa) are notorious for what other side effect?

A

Metabolic syndrome = weight gain, dyslipidemia, hyperglycemia (new onset diabetes)
–> at baseline and follow up: check BMI, fasting glucose/lipids, BP, waist circumference

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69
Q

What are the routine labs to measure in pt taking lithium?

A

Kidney (creatinine, BUN) - bc of nephrogenic diabetes insipidus & chronic interstitial nephritis
Thyroid (TSH, T4) - bc of risk of HYPOthyroidism

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70
Q

Main antipsychotic associated with prolonged QT at higher doses.

A

Ziprasidone (Geodon)

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71
Q

Pertussis vaccine schedule

A

Five doses of DTaP from 2mos-6yrs
TdaP booster in adolescence (11-18)
TdaP booster in pregnancy

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72
Q

Pertussis/whooping cough tx

A

Macrolides! (azithro, erythro, clarithro)

Give empirically even before you confirm diagnosis with bacterial culture/PCR

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73
Q

Difference in age of onset of Myasthenia Gravis in men v women

A

Women: 20s-30s
Men: 60s-80s

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74
Q

Patient after surgery has bilateral (or one eye worse than other) ptosis. Gets better with ice on the lids for few minutes. Pathology?

A

Myasthenia Gravis
Ice pack test –> slows down ACh breakdown in the synapse –> more ACh available to the few receptors still present
*still need to confirm with ACh autoantibody test

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75
Q

Other than the ocular signs (ptosis, diplopia), two other systems affected in myasthenia gravis?

A 
Bulbar (dysphagia, dysarthria)
Respiratory muscles (myasthenic crisis)
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76
Q

Tx for myasthenia gravis – medicine (1), surgical (1)?

A

Pyridostigimine (Achesterase inhibitor)
+/- immunotherapy (steroids, azathioprine)
Thymectomy

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77
Q

In pt with myasthenia gravis, why do chest CT?

A

To evaluate for thymoma! The autoantibodies are usually due to thymic abnormalities esp hyperplasia

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78
Q

Inflammation and edema of the facial nerve

A

Bell’s palsy

Often due to herpes simplex reactivation

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79
Q

Disruption of the oculosympathetic chain

A

Horner syndrome

  1. Ipsilateral ptosis
  2. Miosis
  3. Anhidrosis
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80
Q

Lambert-Eaton syndrome, pathophys

A

Autoantibodies to pre-synaptic calcium channels –> Decreased ACh release
**contrast to myasthenia gravis = autoantibodies against post synaptic ACh receptor

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81
Q

Lambert-Eaton highly associated with what pathology?

A

Small cell lung cancer (its a paraneoplastic syndrome)

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82
Q

Ranson criteria (5) - used to assess what path? When to assess?

A

Used to assess prognosis in pancreatitis. Assessed in first 48 hrs. Poor prognosis:

  1. Age >55
  2. WBC >16,000
  3. Glucose >200
  4. LDH >350
  5. AST >250
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83
Q

WBC normal value

A

4500-10,000

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84
Q

Imiquimod - class and used to tx what?

A

“Immune response modifier” drug

Used to treat: actinic keratosis, superficial BCC & genital warts

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85
Q

Pain radiates where in pancreatitis?

A

To the back

*plus N&V

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86
Q

Pain radiates where in gallbladder dzs

A

To the scapula

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87
Q

Pain radiates where in esophageal spasm?

A

Higher up in the chest

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88
Q

Pain radiates where in GERD

A

*trick question

Typically, there is no pain radiation in GERD

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89
Q

Pain radiates where in renal calculi dz?

A

To the groin

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90
Q

Murphy sign - what is it and indicative of?

A

Cessation of inspiratory effort on deep palpation of RUQ

Indicative of acute cholecystitis

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91
Q

Gnawing abdominal pain in center of upper abdomen associated with sensation of hunger

A

Peptic ulcer disease

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92
Q

PUD two top causes

A 
#1 - H pylori infection 
#2 - Excessive use of NSAIDS
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93
Q

When to conduct an esophagogastroduodenoscopy (EGD) in a patient with suspected GERD (3) ? *since first step is usually?

A

First step is usually - trial with PPI, H2 receptor blocker

Do EGD if: bleeding, weight loss or dysphagia

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94
Q

Patient has biliary colic, + Murphy sign, plus elevated liver enzymes, amylase or lipase. Next step in workup?

A

ERCP to look for for choledocolithiasis

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95
Q

Top two causes of pancreatitis (in order)?

A 
#1 - Gallstones! ~60%
#2 - Alcohol ~30%
#3 - Idiopathic 10-30%
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96
Q

Dyspepsia - what is it? most common etiology?

A

Chronic or recurrent discomfort centered in upper abdomen

  • *Most commonly idiopathic!!! - no etiology found 60% of the time
  • otherwise, due to PUD, GERD, gastric/pancreatic cancer
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97
Q

RDW (red cell distribution width) - what does it tell us?

A

Measures variation in red blood cell size or red blood cell volume.
–> high RDW = high variation in the size of the RBCs

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98
Q

Total iron binding capacity (TIBC)

A

Indirect measure of transferrin
Tf = transport protein for iron in serum
If “iron binding capacity” is HIGH = transferrin has lots of empty slots on it

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99
Q

Ferritin

A

Form of iron STORED in our cells

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100
Q

Rash that begins as pinks pots on extremities which later coalesce and become purple/purpuric

A

Rocky Mountain Spotted Fever

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101
Q

Tx for Lyme disease - early local disease vs early disseminated disease

A

Early local = Doxycycline or Amoxicillin 14-21 days

Early Disseminated = IV Ceftriaxone/Cefotaxime/Chloramphenicol 14-21 days

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102
Q

Mammogram test results categories

A

BI-RADS (Breast Imaging Reporting And Data System)
0 - incomplete test
1/2 - benign –> routine testing
3 - probably benign –> repeat in 6 mos
4 - suspicious for cancer –> biopsy
5 - highly suggestive of cancer –> biopsy

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103
Q

Tinea cruris

A

Jock itch

Fungal infection of the groin area

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104
Q

Two most common causes of small bowel obstruction

A

Abdominal surgery - adhesions

Hernia

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105
Q

Most common cause of iron deficiency anemia

A

Blood loss

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106
Q

RDW in thalessemia

A

Normal RDW with low MCV (microcytic)

*contrast with iron def anemia where RDW is high

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107
Q

Two prophylactic interventions proven to reduce number of pain crises

A
  1. Adequate hydration

2. Adequate oxygenation

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108
Q

Tx for Rocky Mountain Spotted Fever – non-pregnant adults/children vs pregnant women

A

Doxycycline (non-pregnant adults, children)

Chloramphenicol (pregnant women)

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109
Q

Treatment for tularemia

A

Streptomycin

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110
Q

Erythematous papules on scalp with small black bulbs (nits) at the base of the hair follicles

A

Head lice

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111
Q

Tx for head lice (first, second, third line)

A

First - Permethrin 1% (Elimite)
Second - Permethrin 5%
Third - Lindane 1%

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112
Q

Pruritic erythematous papules in between fingers, wrists, or around waist (areas where clothes fit tightly) - bite from?

A

Scabies (Sarcoptes scabiei)

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113
Q

Clusters of pruritic erythematous papules on the lower extremities (ankles, legs) - bite from?

A

Flea bites

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114
Q

Teenage boy presents with bilateral gynecomastia. Workup?

A

Unless you find other abnormalities (ex. small/absent testes) no need to workup further. Benign gynecomastia common in puberty –> usually resolves within 1 year

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115
Q

Two most common bugs implicated in acute mastitis

A

Strep and staph

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116
Q

Bug most commonly implicated in cellulitis after cat bite

A

Pasteurella multocida

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117
Q

Crescendo-decrescendo (diamond shaped) murmur

A

Aortic stenosis

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118
Q

Acute bronchitis - when to give antibiotics?

A

Normally do not treat uncomplicated cases with antibiotics!

Only tx if pt also has COPD or CHF, the elderly or very illl appearing

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119
Q

Tx for pertussis

A

Erythromycin 14 days OR
Azithromycin 5 days
**doesn’t alter course unless administered very early in dz
**but it does reduce transmission & hence reduces isolation time from 4 weeks to 1 week

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120
Q

Bug most commonly implicated in travelers diarrhea

A

Enterotoxigenic E. Coli

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121
Q

Tx for travelers diarrhea?

A

Fluoroquinolones (cipro, norfloxacin, ofloxacin)

Alts: TMP/SMX or azithromycin

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122
Q

How to differentiate btn peripheral vs central causes of vertigo (3 factors)?

A

Dix Hallpike maneuver
Peripheral: Vertigo reproduced after ~3-10 secs + nystagmus fixed in same direction regardless of how you turn the head + repeating maneuver lessens sx
Central (i.e. stroke): Vertigo reproduced immediately + nystagmus changes direction when you turn head + sx same even after repeating

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123
Q

In peripheral vestibular disorders, first line therapy?

A

Antihistamines (ex. meclizine)

They suppress vestibular end-organ receptors and inhibit activation of vagal response.

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124
Q

ANP vs BNP - where are they secreted from? Used in diagnosis of what condition?

A

ANP - released from atria (and partly ventricles)
BNP - released from ventricles
Both released in response to increased filling pressures/wall stress –> CHF

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125
Q

CHF is almost 100% unlikely if BNP level is below what value?

A
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126
Q

D-dimer sensitivity vs specificity and implication?

A

High sensitivity; low specificity

So mainly useful when negative! i.e. if negative, there is a very low chance patient has a DVT/PE

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127
Q

Drug proven to relieve dyspnea in patients with end-stage cancer

A

Opioids

*unknown mechanism

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128
Q

What four factors/signs/sx correlate significantly with diagnosis of acute bacterial cystitis

A
  1. Dysuria
  2. Increased frequency
  3. Hematuria
  4. Back pain (back pain isn’t exclusive to pyelo!)
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129
Q

Key sign seen in pyelo that you may not see in acute bacterial cystitis?

A

FEVER!

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130
Q

What four signs/sx if present/absent make you think UTI is UNLIKELY?

A
  1. No dysuria
  2. No back pain
  3. Vaginal discharge
  4. Vaginal irritation
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131
Q

When do you need to do a urine culture for a patient with suspected UTI?

A

If the urine dipstick or microscopic evaluation (looking for leukocytes) is negative and so the diagnosis is in question.

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132
Q

What do leukocyte esterase and nitrites tell us respectively when we do urinalysis for suspected UTI?

A

Leukocyte esterase corresponds to pyuria

Nitrites tell us presence of enterobacteria that can convert urinary nitrate to nitrite

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133
Q

Woman with frequent UTIs (most commonly postcoital!) - start with what behavioral changes?

A

Urinating/voiding right after intercourse
Acidification of urine (oral ascorbic acid/vit C, cranberry juice)
*Don’t use things like diaphragm

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134
Q

Prophylactic antibiotic therapy for women with recurrent UTIs (first v second v third line)?

A
  1. First line: single dose postcoital antibiotics
  2. Second line (if above doesn’t work): Daily single dose antibiotics for 3-6 months
  3. Third line (if UTIs reoccur after stopping daily dosing for 3-6 months): Daily single dose antibiotics for 1-2 years
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135
Q

Woman with recurrent (>4 episodes) dysuria, hematuria but negative dipsticks (other than blood), & negative urine cultures but episodes resolve with antibiotics? Should be thinking what path? What is next step in workup?

A

Interstitial cystitis (aka bladder pain syndrome)!
Do a cystoscopy (looking for ulcerations/fissures in bladder wall)
**tx is very complex as this can’t necessarily be cured

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136
Q

Male patient in his 30s-50s with urinary frequency, urgency, back pain, fever and marked pyuria. No penile discharge and he is acutely ill. Most likely etiology?

A

Acute prostatitis!

  • We know UTIs are uncommon in men
  • Urethritis (gono or non-gono) not likely to cause fever/systemic illness like this
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137
Q

For how long is it normal to have ear effusions after tx of AOM? What to do if it lasts longer than that duration?

A

Nl to have effusions up to 3 months

If longer –> refer to ENT

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138
Q

Tx for AOM: First line (mild vs moderate/sever) & Second Line

A

First line mild : amoxicillin
First line mod/severe (otalgia and/or fever >102.5F): high dose Augmentin (90mg/kg/day divided into two doses)
Second line: azithromycin

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139
Q

Tx for external otitis (swimmers ear) - topical or oral antibiotics?

A

Topical antibiotics and corticosteroids

*don’t need oral antibiotics unless refractory to topicals

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140
Q

Patient has bilateral LEE. Three main systems/paths we are thinking?

A

CHF – is there dyspnea, JVD, rales? –> get CXR then echo
Liver dz – is there ascites? –> check LFTs
Kidney dz (nephritic syndrome, ATN) – if none of the above signs –> check urinalysis

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141
Q

Acute Unilateral LLE –> what to do/think if (1) no trauma/signs of infection versus (2) yes, signs of inflammation/infection like erythema

A

If no sign of infection –> think DVT –> order doppler

If sign of inflammation/infection –> think cellulitis –> tx with antibiotics

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142
Q

Chronic (on/off) unilateral LEE, but no dyspnea, no trauma, no signs of inflammation –> what are we thinking? Tx?

A

Venous insufficiency –> Compression stockings

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143
Q

Most effective, proven cure for enuresis

A

Bed wetting alarms

*medications more effective in short term - but relapse common when discontinued

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144
Q

Nl bladder capacity in children (oz)

A

child’s age + 2 oz

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145
Q

Nl post void residual in bladder?

A

100ml

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146
Q

Signs of esophageal reflux in an infant (3)? Diagnosis?

A

Wet burps
Coughing during & after feeding
Occasional wheezing
*Diagnose with esophageal pH probe

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147
Q

Signs of lactose intolerance in infant (4)?

A

Diarrhea
Abdominal pain
Bloating
Foul-smelling stools

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148
Q

Signs of pyloric stenosis in infant

A

Projectile non-bilious vomitting
Abdominal distention
+/- palpable mass in abdomen

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149
Q

Simultaneous decrease in weight AND height in infant

A

Familial short stature

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150
Q

Weight decreases first, and then height (2) paths

A

Failure to thrive

Constitutional growth delay

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151
Q

Hypothyroidism - changes on growth chart (height vs weight)?

A

Height velocity decreases first

then the weight changes happen

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152
Q

Two red flag signs for severe malnutrition/failure to thrive?

A

Vital abnormalities:
Hypotension + bradycardia
*must be hospitalized

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153
Q

What happens when you give patient with mono penicillin?

A

They get a diffuse symmetrical rash

  • this normally happens bc we misdiagnose mono as strep throat and try to tx with penicillins (amox, ampi)
  • correct tx = SUPPORTIVE CARE (EBV)
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154
Q

Two main causes of GI bleeding in children (in order)? how to differentiate?

A 
#1 Meckel's diverticulum (painless)
#2 Intussusception (very painful)
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155
Q

Meckel’s diverticulum rule of 2’s (5)

A 
Occurs in 2% of population
Male to female ratio 2:1
Occurs 2 ft from ileocecal valve
Usually 2in long 
2% of cases have complications
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156
Q

Test to diagnose Meckel’s diverticulum

A

Nuclear technetium scan (Meckel scan)

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157
Q

Meckel’s diverticulum pathyophys

A

Congenital - Persistence of the vitelline duct

**has heterotopic epithelia = gastric & pancreatic tissue

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158
Q

Management of thrombosed external hemorrhoid?

A

Excision

  • external = below dentate line
  • thrombosed = hard/nodular appearance
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159
Q

Management of internal hemorrhoids

A

Rubber-band ligation

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160
Q

Pt with bright red blood after painful bowel movement, followed by dull ache/spasm in anal canal that resolves after several hours; no abnormalities seen on external examination

A

Anal fissure

*key is that the pain resolved; in thrombosed internal hemorrhoid may have pain but it would not resolve

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161
Q

Only calcium channel blocker proven to work in migraine prophylaxis

A

Verapamil

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162
Q

Most studied prophylactic agent for migraines

A

Beta blockers

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163
Q

Which TCA has strongest efficacy evidence for migraine prophylaxis?

A

Amitriptyline

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164
Q

Two main migraine abortives

A

1st line - triptans

2nd line - ergot derivatives

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165
Q

Cluster headaches prophylaxis (4)

A
  • *only give the drugs during cluster!!!
    1. Nifedipine (calcium channel blocker)
    2. Prednisone
    3. Indomethacin
    4. Lithium
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166
Q

Mainstay treatment of cluster headaches (during attack)?

A

100% Oxygen via nasal cannula!

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167
Q

Managagement of tension-type headaches?

A

Trial of NSAIDs and follow up if that doesn’t work

*try to avoid opioids bc TTH is usually chronic

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168
Q

Painless hematuria without other sx

A

Bladder carcinoma

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169
Q

Risk factors for bladder carcinoma

A

Male
Smoking
Working with aromatic amines (dye, paint, aluminum, textiles, rubber)

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170
Q

Pseudohematuria (looks like there’s blood but there isn’t) caused by what foods (2)?

A

Beets
Blackberries
Food dyes

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171
Q

Pseudohematuria (looks like there’s blood but there isn’t) caused by what meds ?

A
  1. Chloroquine
  2. Metronidazole
  3. Phenytoin
  4. Rifampin
  5. Sulfasalazine (UC)
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172
Q

ASO titer

A

?

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173
Q

Two sleep aids useful for sleep ONSET problems

A

Zolpidem (Ambien)

Eszopiclone (Lunesta)

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174
Q

Sleep aid useful for sleep MAINTENANCE problems

A

Zaleplon (Sonata)

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175
Q

In Hep A, patients have prodrome flu-like illness followed by jaundice. At which stage are they most infectious?

A

During the prodrome

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176
Q

Baby born to mom with positive HBsAg. Likely to develop chronic dz or not?

A

When acquired early in life, the majority of those infected are likely to develop chronic disease!

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177
Q

Functional (urinary) incontinence

A

Incontinence due to a limitation that does not allow patient to void in the bathroom ex. paralysis, severe dementia ie. nothing to do with anatomy

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178
Q

Urge (urinary) incontinence

A 
**most common type of incontinence in the elderly
Detrusor muscle (muscle surrounding bladder) hyperactivity --> strong urge followed by involuntary loss of urine
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179
Q

Stress (urinary) incontinence

A

Loss of urine when pt has increased intra-abdominal pressure bc of weak pelvic floor muscles ex. coughing, sneezing, laughing, exercising
*women>men for obv reasons

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180
Q

Overflow (urinary) incontinence

A

Urine loss due to overdistention of the bladder
Think post-void residual > 200mL
Think BPH, neurogenic bladder (due to longstanding diabetes, alcoholism, degenerative disc dz)

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181
Q

Normal post-void residual

A

200mL is abnl

50-200mL = indeterminate

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182
Q

Which type of urinary incontinence is most responsive to pelvic floor strengthening (Kegel) exercises

A

Stress incontinence

*makes sense bc it is due to weak pelvic floor musculature

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183
Q

Medical management for urge incontinence (drug class + two examples)

A

Anticholinergics! ie prevent detrusor muscle hyperactivity!
Oxybutynin (Ditropan)
Tolterodine (Detrol)

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184
Q

Medical management for overflow incontinence due to BPH (two exs)

A

(1) Finasteride (5-alpha-reductase inhibitor) –> block DHEA to testosterone –> reduces the prostatic hyperplasia
(2) Terazosin (alpha-1 selective blocker) –> muscle relaxation

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185
Q

Thiazide diuretics – will cause urinary leakage, urgency or both or retention?

A

Urgency (and frequency) bc of increased filling

BUT NOT leakage (bc does not affect the sphincters)

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186
Q

Calcium channel blockers – will cause urinary leakage, urgency or both or retention?

A

Will cause urinary RETENTION (bc blocking contraction of detrusor muscle, PLUS the sphincters)

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187
Q

Alpha blockers – will cause urinary leakage, urgency or both or retention?

A

Leakage
BUT NOT urgency (bc the drug will cause relaxation of the sphincters; leakage throughout day so never builds up to cause urgency)

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188
Q

Beta blockers – will cause urinary leakage, urgency or both or retention?

A

Both!

*need to read up on explanation

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189
Q

The four hereditary hyperbilirubinemias (in order of descent through hepatocyte)

A
  1. Gilbert
  2. Crigler-Najjar
  3. Dubin-Johnson
  4. Rotor
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190
Q

Pathophys of Gilbert hyperbilirubinemia? –> unconj or conj hyperbilirubinemia?

A

Mildly low UDP-glucoronyltransferase –> back up –> decreased bilirubin uptake INTO the hepatocyte –> unconj hyperbili

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191
Q

Pathophys of Crigler-Najjar hyperbilirubinemia? –> unconj or conj hyperbilirubinemia?

A

ABSENT UDP-glucoronyltransferase –> NO bili conjugation –> unconj hyperbili

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192
Q

Pathophys of Dubin-Johnson hyperbilirubinemia? –> unconj or conj hyperbilirubinemia?

A

Problem getting conjugated bili OUT of the hepatocyte –> conj hyperbili

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193
Q

Pathophys of Rotor hyperbilirubinemia? –> unconj or conj hyperbilirubinemia?

A

Same as Dubin-Johnson BUT even milder

Problem getting conjugated bili OUT of the hepatocyte –> conj hyperbili

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194
Q

Jaundice, kernicterus, and increased unconj bili early in life

A

Crigler-Najjar Type I

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195
Q

Difference btn Type I and Type II Crigler-Najjar

A

Type II is less severe than Type I

Type II responds to PHENOBARBITAL (mech: increases synthesis of UDP-glucoronyltransferase in the liver)

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196
Q

Tx for Crigler-Najjar Type I (2)

A

Plasmapharesis + Phototherapy

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197
Q

Mostly asymptomatic or mild jaundice + increased unconj bili only with fasting or stress

A

Gilbert Syndrome

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198
Q

Grossly black liver, hyperbilirubinemia?

A

Dubin-Johnson

*bc the conj bili cannot be excreted –> builds up in the liver

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199
Q

Wilson disease –> pathophys

A

Problem excreting copper from hepatocytes –> [form of copper in circulation = ceruloplasmin] –> low serum ceruloplasmin + copper accumulation in the liver/brain/cornea/kidneys/joints

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200
Q

Signs of Wilson dz (8)

A 
Cirrhosis
Corneal deposits (Kayser-Fleischer rings)
Hepatocellular Carcinoma
Asterixis
Hemolytic anemia 
Dementia
Dyskinesia
Dysarthris
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201
Q

Tx for Wilson disease (2)

A

Copper chelation!

Penicillamine or Trientine

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202
Q

G6PD deficiency –> unconj or conj hyperbili?

A

Unconjugated

*think back up due to intravascular hemolysis

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203
Q

Most common cause of conjugated hyperbili in pts

A

Viral hepatitis

**Accounts for 75% of jaundice in pts

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204
Q

Most common cause of conjugated hyperbili in pts >60yo

A

Extrahepatic obstruction (gallstones, pancreatic cancer)

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205
Q

Functional hypothalamic amenorrhea causes (4)

A

Anorexia
Rapid weight loss
Rigourous exercise
Significant emotional stress

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206
Q

Pt with amenorrhea, given Provera (medroxyprogesterone acetate) challenge 7 days, and then has period –> most likely etiology?

A

PCOS
Fact that patient is bleeding means they have no problems with estrogen BUT they have a problem making progesterone –> prob bc they are not ovulating = no corpus luteum to secrete progesterone

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207
Q

Pt with amenorrhea, initial workup negative –> progestin challenge = no withdrawal bleeding –> estrogen-progestin challenge = still no withdrawal bleeding. Most likely etiology?

A

Outflow tract obstruction / Anatomic defect

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208
Q

Signs of amphetamine withdrawal (4)

A

Psychomotor slowing: Hypersomnolence + Anhedonia

BUT also increased appetite + Existential crisis

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209
Q

Withdrawal of what drug causes hyperalert confusion

A

Alcohol

*overly sensitive to environmental stimuli, startled very easily

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210
Q

Which antidepressant has the longest half-life and therefore is less likely to cause discontinuation syndrome/withdrawal compared to the others?

A

Fluoxetine [Prozac] (half life = 84-144hrs)

*compare to other avg 20hrs

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211
Q

Pt with chronic N&V, longstanding DM2, N&V worse after eating, sometimes vomits undigested food –> etiology?

A

Gastroparesis

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212
Q

Best antiemetic for gastroparesis (name, mechanism, main adverse effect)

A

Metoclopramide (Reglan)
D2 receptor antagonist –> inc resting tone and contractility of gut
Adverse: Blocks dopamine –> parkisonism

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213
Q

Best antiemetic for chemo patients or post op (name, mechanism)

A

Ondansetron (Zofran)

5-HT antagonist –> CENTRAL-ACTING antiemetic (ie acts on area postrema (vomiting center in medulla)

214
Q

Best antiemetic for motion sickness (name, mechanism)

A

Scopolamine (Transderm Scop)

Anticholinergic

215
Q

Promethazine (Trade name, mechanism)

A

Promethazine = Phenergan

H1 blocker

216
Q

Coming up with differential for N&V – N&V in the mornings before eating, differential (4)

A
  1. Pregnancy
  2. Uremia
  3. Alcohol withdrawal
  4. Increased ICP (+dizziness, HA)
217
Q

Coming up with differential for N&V – N&V after any meal (regardless of meal content, differential (2)

A
  1. Gastroparesis
  2. Pancreatitis
    * Cholelithiasis if after FATTY meals only
218
Q

Coming up with differential for N&V – N&V without any clear association with food, differential (2)

A

Vestibular disorders

219
Q

Best imaging technique to visualize herniated disc

A

MRI

220
Q

Best imaging technique to visualize spinal stenosis

A

CT scan

221
Q

Spurling maneuver (what is it and what does it test for)?

A

Neck compression test – pt bends head to side and rotates toward side of pain and you exert downward pressure
Should reproduce NERVE ROOT INJURY/SX

222
Q

Spurling maneuver that does not reproduce nerve root sx but only causes neck discomfort – etiology

A

Non-specific mechanical pain

223
Q

Tx for cervical dystonia with the best evidence

A

Botox

*helps but less evidence: PT, neck collar, stretching techniques, ice/heat

224
Q

Pt with palpitations – xtics that lead you to think it is of cardiac etiology rather than other (4)?

A
  1. Male sex
  2. Describing the sx as feeling like an ‘irregular heartbeat’
  3. Personal h/o heart dz
  4. Event duration >5mins
    * FMH NOT a factor
225
Q

Pt with palpitations that she describes as a “flip-flop” in her chest - which cardiac arrhythmia?

A

Ventricular premature beats

*random, episodic, instantaneous beats

226
Q

Pt with sudden rapid BUT regular heart beat that lasts a long time

A

Paroxysmal Supraventricular Tachycardia (PSVT)

*most common causes: Wolff Parkinson White, Digitalis toxicty

227
Q

What kind of arrythmia would stimulant overuse cause?

A

Sinus tachy

228
Q

Pt says he can “feel his heartbeat”, + has holosystolic murmur that increases with Valsalva
Hint: but is not aortic stenosis

A

Hypertrophic obstructive cardiomyopathy

229
Q

Delta waves on EKG (path + tx)

A

Wolff-Parkinson-White syndrome

  • pts have accessory pathway which directly connects the atria and ventricles, thereby allowing electrical activity to bypass the AV node
  • tx only if symptomatic –> ablation
230
Q

When should you admit and tx inpatient for PID?

A

Woman is:

(1) Pregnant
(2) Severe = fever + vomiting
(3) Can’t rule out surgical emergency

231
Q

Outpatient tx for PID?

A

Ceftriaxone 250mg IM
+ Doxycycline 100mg BID for 14 days
+/- metronidazole 500mg BID for 14 days

232
Q

3 most likely culprits of PID

A

Neisseria gonorrhea + Chlamydia trachomatis (most common)

Anaerobes (E. Coli)

233
Q

Pt with sore throat, fever+aches+fatigue, exudative pharyngitis + soft palate petechiae + posterior cervical adenopathy

A

Infectious mononucleosis

234
Q

7yo with sore throat – fever/chills +myalgia+pain on swallowing, plus ANTERIOR adenopathy, erythematous tonsils and edema of the uvula – etiology?

A

Group A strep pharyngitis
*edema of the uvula is very specific to GAS
All the other sx/signs simply point to pharyngitis

235
Q

First line tx for GAS pharyngitis in children? Second line?

A

Liquid amoxicillin (could technically use penicillin but liq penicillin tastes nasty)
If allergic to penicillin: 2nd line: Cephalosporin/Macrolide
**GAS is highly resistant to tetracycline, sulfonamides, fluoroquinolones

236
Q

Management of asymptomatic child with recurrent positive rapid strep antigen test?

A

No antibiotics
20% of school age kids are GAS carriers!
*No need to tx bc these kids almost never have complications from the infection and they (asymptomatic) don’t really contribute to transmission

237
Q

Tx for combined laryngitis + pharyngitis

A

Supportive!

It is most commonly viral

238
Q

Centor criteria

A 
For Group A strep infection
1. Tonsillar exudates
2. Tender anterior cervical adenopathy
3. Fever
4. NO cough
If all 4 --> tx with penicillin --> no need for further testing
If 3 --> 40-60% chance it is GAS
239
Q

Epididymitis – most common cause in men

A

Ascending urethritis from gonorrhea or chlamydia

240
Q

Epididymitis – most common cause in men >35yo

A

Ascending prostatitis from enteric gram-negative rods (Enterobacter)

241
Q

Cremasteric reflex

A

You pinch or brush the inner thigh –> the testicle on the same side should retract toward the inguinal canal
*this will be absent in testicular torsion

242
Q

Prehn sign

A 
Positive Prehn sign = pt with testicular pain:
pain is relieved when you elevate the testicle while the patient is supine 
if positive (ie pain is relieved) --> think epididymitis
if negative (ie pain not relieved) --> think torsion
243
Q

What foods play a role in increasing acne in teenagers

A

None! All myths. Contributory factors:

  1. Occlusion/pressure on skin (ex leaning on hands, touching face)
  2. Emotional stress
  3. Medications
244
Q

First line tx for mild acne

A

COMBINATION therapy!
Topical antibiotics + benzoyl peroxide gel + topical retinoids
*antibiotic & benzoyl peroxide during day, retinoid at night

245
Q

When do we use ORAL retinoids for acne?

A

Acne resistant to all other therapies including ORAL/SYSTEMIC antibiotics

246
Q

Isoretinoin can cause what severe advere effect? and therefore should not be combined with what other drug that does the same?

A

Pseudotumor cerebri!

Must avoid combining with TETRACYLCINE (often used as topical antibiotic for acne)

247
Q

First line tx for rosacea (drug class + 2 exs)

A

Oral antibiotics!

Minocycline or Doxycycline

248
Q

Skin nodule that ‘popped’ and has been growing rapidly ever since + kind of looks like molluscum or BCC

A

Keratoacanthoma
*clue is that it is fast growing; BCC is slow growing & the the central popped part is much bigger in keratoacanthoma than in molluscum

249
Q

Herald patch, followed days later by Christmas tree distributed rash – path and tx?

A

Pityriasis rosea
Self-limited –> resolves in 6-8 weeks
Symptomatic relief: antihistamines or topical steroids to help with itching

250
Q

Impetigo – micro culprit?

A

Staph aureus

*minority of cases due to GAS

251
Q

Impetigo – tx?

A

Topical antibiotics – MUPIROCIN (Bactroban)

252
Q

Hot tub folliculitis – bug? tx?

A

Pseudomonas!
USUALLY ONLY DO SUPPORTIVE CARE (SELF-LIMITING)
Only tx if severe or pt is immunocompromised
Tx = ciprofloxacin 500mg BID

253
Q

Best management for recurrent oral herpes?

A

Chronic suppression with valacyclovir or famciclovir
*Pulse dosing (ie treating at first sign of outbreak) may shorten or reduce severity of the outbreak but overall, chronic suppression can prevent outbreaks to begin with so better choice depending on frequency

254
Q

Antiviral therapy for herpes zoster/shingles most effective in reducing duration of lesion and pain if administered in first __ hrs?

A

First 72 hours

255
Q

Management of postherpetic neuralgia?

A

Often have to use narcotics

*Corticosteroids given during outbreak DO NOT help prevent postherpetic neuralgia

256
Q

Kid with 3 days low grade fever, runny nose and then later gets slapped cheeks rash – micro culprit?

A

Parvovirus 19 = Erythema infectiosum = Fifth dz of childhood

257
Q

Tx for tinea capitis

A

SYSTEMIC antifungals:
1st line: Oral Griseofulvin (6-12 wks) or Terbinafine (4-6 weeks
*Terbinafine preferred bc shorter tx course

258
Q

Tinea corporis – micro culprit?

A

Trichophyton rubrum

259
Q

Well demarcated plaque with central scaling

A

Tinea corporis

260
Q

Main difference in appearance of BCC vs molluscum?

A

BCC will be surrounded by telangiectasia

261
Q

Molluscum – micro culprit?

A

Poxvirus

  • in adults this is most often sexually transmitted [skin-to-skin contact]
  • also see in kids, but not sexually transmitted
262
Q

Tx for molluscum contagiosum?

A

Most will resolve on their own within months

BUT can remove with cryotherapy, cautery, or curettage

263
Q

Is it typical to have pain with conjunctivitis?

A

No!
Typical sx = redness, itching, tearing, discharge
*If pain present –> think something more serious ex. uveitis, acute angle glaucoma, scleritis, foreign body, corneal abrasion

264
Q

Most common viral culprit in conjunctivitis? Transmission?

A

Adenovirus

  • can be transmitted through ocular AND respiratory secretions
  • also by fomites on towels/equipment
265
Q

Palpable preauricular adenopathy + conjunctivitis

A

VIRAL conjunctivitis
*most commonly, adenovirus
Viral conjunctivitis > bacterial (85%:15%)

266
Q

Signs of bacterial conjunctivitis (4)

A

Purulent discharge
Pain
Photophobia
Gritty sensation in the eye

267
Q

Tx for nonherpetic viral conjunctivitis

A

Cold compresses + lubricating eye drops

268
Q

What do you see on fluorescein staining in herpetic conjunctivitis? Treatment?

A

Fluroescein: Corneal dendrites
Tx: Antiviral eye drops

269
Q

Bugs most commonly implicated in bacterial conjunctivitis?

A

Strep and Staph

*contrast to viral = adenovirus

270
Q

Pt with suspected bacterial conjunctivitis (purulent discharge etc) but not responding to cipro opthalmic solution. Next step in tx?

A

Pt may have MRSA conjunctivitis!

Tx same way as MRSA in other parts of body –> TMP-SMX (Bactrim)

271
Q

Eye infection often associated with systemic autoimmune processes ex RA, Wegeners that manifests as decreased vision + deep, boring pain in the eye BUT nl pupillary response

A

Scleritis

272
Q

Signs of acute glaucoma

A

Pain
Decreased vision
Redness
Dilated pupil

273
Q

Acute sinusitis – most common micro culprit?

A

Strep pneumo

274
Q

Tx for shoulder dislocation

A

Relocation, immobilization for 7-10 days and PT with ROM and muscle strengthening exercises

275
Q

Lateral knee pain in cyclists or long distance runners that worsens with activity

A

Iliotibial band syndrome

  • think athletes who do repetitive knee flexion activities
  • will also have pain/tightness over the IT band
276
Q

Leg/knee twisting injury –> feeling ‘pop’ –> immediate knee effusion BUT still able to bear weight

A

ACL tear

*contrast to PCL tear –> need direct force to the knee

277
Q

Ottawa ankle rules

A

Guide as to whether or not to get xrays after an ankle sprain

  1. Pt unable to walk 4 steps immediately after injury or in office (ie inability to bear weight)
  2. Tenderness over distal 6cm of tibia/fibula (incl malleolus)
  3. Midfoot or navicular tenderness
  4. Tenderness over the proximal 5th metatarsal
278
Q

In which pts do we do a tilt table test? Abnl result indicates what path?

A

Pts with unexplained recurrent syncope, in whome we’ve ruled out cardiac causes (incl arrythmias)
Abnl result –> vasovagal syncope

279
Q

Glabellar reflex / Myerson sign

A

You tap on patients forehead repeatedly –> Orbicularis oculi muscle contracts causing blinking, but this should stop after 5-10 taps
If blinking continues = Myerson Sign
Commonly seen in Parkinson pts

280
Q

Only drug proven to delay functional impairment and dz progression in Parkinson dz

A

Selegiline = Eldepril (MAOI)

All the others (incl carbidopa-levodopa) provide symptomatic relief only

281
Q

Strawberry cervix

A

Red macules on cervix
Seen in TRICHOMONAS
+yellow-green discharge

282
Q

Tx for BV

A

Metronidazole

283
Q

When do we do peak flow measurements in pt with SOB + wheezing

A

If they have known asthma and no fever/sputum/rhonchi

284
Q

Inability to achieve erection - most common cause

A

Vascular problems!

*more common than psych stressors

285
Q

Male patient with complaints of low libido (desire/interest) but no other sx. Test to order?

A

Morning FREE testosterone

286
Q

Antidepressant least likely to cause sexual dysfunction?

A

Buproprion

287
Q

Drug to give in premature ejaculation

A

SSRIs! Since they increase orgasmic threshold – use the side effect to your advantage
*premature ejaculation is the most common sexual dysfunction in men (up to 29% of men)

288
Q

Man with ED in whom we get morning free T which is low, next step?

A

Test FSH, LH and prolactin

  • If FSH/LH low; prolactin nl = pituitary/hypothalamic failure
  • If FSH/LH high; prolactin nl = testicular failure
  • If FSH/LH low; prolactin high = pituitary adenoma –> order CT/MRI!
289
Q

Hypoactive sexual desire disorder (low desire/libido) – two most common causes (other than meds)

A
  1. Relationship problems

2. Androgen deficiency

290
Q

First line tx for orgasmic dysfunction in women

A

Directed self-stimulation

291
Q

GGT sensitivity vs specificity in alcohol abuse (low v high)?

A 
Sensitivity = high 
Specificity = low (also elevated in NAFLD, DM, pancreatitis, hyperthyroid, CHF, anticonvulsant use)
292
Q

Ethyl glucuronide (EtG) – what does it test for?

A

(Urine test) Tests for RECENT alcohol consumption

*but doesn’t tell us anything about level of consumption or abuse (like GGT)

293
Q

Most specific test for alcohol abuse

A

MCV!

*Elevated MCV is 96% specific for alcohol abuse (vs GGT is 76% specific)

294
Q

Naltrexone mech of action in alcohol abuse

A

Reduces the reinforcing effects of alchol – prevents pts from becoming DRUNK

295
Q

Most effective med in preventing relapse in alcoholics?

A

Acamprosate

*affects GABA and glutamine neurotransmission – has greater and longer lasting effect than naltrexone

296
Q

Patient who wants to quit smoking but failed on nicotine patch – next step?

A

Combine patch with gum (or other nicotine replacement method)
*pt probably just needs higher baseline level of nicotine to replace their old level from smoking

297
Q

Varenicline mech of action

A

Varenicline = Chantix

Selective nicotinic receptor partial agonist

298
Q

Buproprion not safe in patients with what med hx?

A

Seizure disorder

*buproprion has been shown to induce seizures

299
Q

Signs of cocaine withdrawal

A

**doesn’t have many physiologic sx like other drugs

Mainly a “crash” = depression, fatigue

300
Q

Diaphoresis, restlessness, irritability, severe pain, abdominal cramps, diarrhea – signs of withdrawal from what drug?

A

Opiates (long-acting ones)

*short-acting ones like heroin = lacrimation, rhinorrhea, excessive yawning

301
Q

First line tx for rheumatoid arthritis

A

Disease Modifying Anti-Rheumatic Drugs (DMARDs)
– Methotrexate, Sulfasalazine, TNF-alpha inhibitors
MUST refer to rheumatology asap to start these - earlier tx with DMARDs reduces progression/devt of deformity

302
Q

Difference in appearance of joint aspirate of gout vs pseudogout

A

Gout - needles; NEGATIVE birefrengence

Pseudogout - rhomboids; POSITIVE birefrengence

303
Q

Difference in substance that precipitates in gout vs pseudogout

A 
Gout = Mono Sodium Urate crystals  
Pseudogout = Calcium Pyrophosphate crystals
304
Q

Gout, pseudogout & infectious arthritis will all have cloudy aspirate and +/- elevated WBC. How can you differentiate infectious arthritis (other than polarizing microscope)

A

Low glucose!

Infectious arthritis will have low glucose, but glucose will be normal in gout/pseudogout

305
Q

Both OA and RA will have clear joint aspirate with overall WBC count in nl range – how to differentiate the two from the aspirate?

A

PMN count
In RA, >50% PMNs
In OA,

306
Q

First line for gout ATTACK

A

NSAIDs or colchicine

307
Q

First line for gout PREVENTION

A

Allopurinol or Probenecid

308
Q

Mechanism of action of allopurinol vs probenecid

A

Allopurinol inhibits xanthine oxidase –> decrease conversion of xanthine to uric acid
Probenecid inhibits reabsorption of uric acid in the PCT

309
Q

What organ systems are most commonly involved in extra-articular manifestation of RA (3)?

A

Vessels –> Vasculitis
Lungs –> Interstitial lung dz (look for cough/dyspnea)
Eyes –> chronic dry eye

310
Q

Four categories of asthma severity

A

Intermittent
Mild persistent
Moderate persistent
Severe persistent

311
Q

Daytime sx in intermittent vs mild p vs mod p vs severe p asthma

A

Intermittent - 2days/wk but not daily
Moderate persistent - Daily
Severe persistent - Throughout the day

312
Q

Nighttime sx in intermittent vs mild p vs mod p vs severe p asthma

A

Intermittent - 1x/week but not nightly

Severe persistent - Nightly

313
Q

Pt with asthma who uses SABA daily – severity classification?

A

Moderate persistent

*also makes sense bc for this category, daytime sx daily

314
Q

Patient with peak flow (FEV1) 80% predicted. Next step?

A

Review meds, technique and decide whether or not to step up
FEV1 81-100% = green zone –> maintain
FEV1 50-80% = yellow zone –> review +/- step up
FEV1 pt needs immediate attn

315
Q

Tx for intermittent asthma

A

SABA inhaler PRN

316
Q

Tx for mild persistent asthma

A

SABA +
Low-dose inhaled steroid
once you move up from intermittent to any of the persistent categories, you MUST add a steroid
**you never use a LABA without a steroid!!!!!

317
Q

Tx for moderate persistent asthma

A

SABA + Low-dose inhaled steroid + LABA
OR
SABA + medium-dose inhaled steroid

318
Q

Tx for severe persistent asthma

A

SABA + high-dose inhaled steroid + LABA

319
Q

Pt with persistent asthma but intolerant of side effects of inhaled corticosteroids – what to add to SABA?

A

Leukotriene receptor antagonist

*also good for kids with asthma exacerbated by allergies

320
Q

Spondylolisthesis - what is it? most at risk population?

A

Anterior displacement of a vertebrae in relation to the one below it
*most common cause of low back pain in pts/athletes

321
Q

Description of the low back pain in spondylolisthesis

(3)?

A

No inciting event
No increase in pain with movement
No radiation to legs

322
Q

Which antidepressants have been proven effective in helping chronic pain when used as adjuvant to other analgesics (ex. opioids, NSAIDs)?

A

TCAs

**SSRIs are not as effective

323
Q

Chronic bronchitis - clinical definition

A

Productive cough lasting at least 3 consecutive months over 2 consecutive years
*Falls under COPD! = chronic bronchitis, emphysema

324
Q

Pt with productive cough suggestive of chronic bronchitis - first test to order to establish diagnosis?

A

Office spirometry = cornerstone of diagnosis for all COPD

Also helps assess severity, and monitor response to tx

325
Q

Single most important intervention that improves natural history of COPD (other than smoking cessation in smokers)?

A

Supplemental oxygen

**COPD does not respond to steroids!! –> inc risk of pneumonia

326
Q

First line therapy for COPD (improves sx etc, not natural hx)

A

Bronchodilators:

ipratropium > albuterol bc ipratropium (Atrovent) has longer duration + no sympathomimetic effects

327
Q

(It is recommended to give patients with COPD antibiotics during exacerbations (improves outcomes). Which antibiotics recommended (3)?

A

Azithromycin
Ciprofloxacin
Augmentin
*NOT reg amox, TMP-SMX, doxy

328
Q

The 2 most significant risk factors for chronic renal insufficiency/dz

A

Diabetes & HTN

329
Q

Best lab indicator of renal failure?

A

GFR
**DO NOT use creatinine bc this can be nl in elderly people with chronic renal dz (bc they have less muscle mass to begin with)

330
Q

What is the first lab abnormality you will see in patient with low GFR/chronic renal dz?

A

Anemia! (low epo induced anemia @ GFR 60mL/min
*Other electrolyte abnormalities ex. hyponatremia, hyperkalemia, hyperphosphatemia &metabolic acidosis due to loss of bicarb) seen LATE dz - GFR below 30mL/min

331
Q

List the criteria for Stage I-V CKD

A 
Stage I - GFR >90 but proteinuria, hematuria, microalbuminuria
Stage II - GFR 60-89
Stage III - 30-59
Stage IV - 15-29
Stage V -
332
Q

First line drug to prevent progression of kidney damage in pt with HTN

A

ACE inhibitor

**regardless of whether they are normotensive!!

333
Q

Most common cause of death in patients with chronic kidney disease?

A

Cardiovascular dz

*often happens before they even reach need for dialysis – reason unclear, most likely uremic mileu

334
Q

Allodynia

A

Severe pain from innocuous stimuli ex. bedsheet brushing against skin

335
Q

Other than anticonvulsants like gabapentin, what other drug class can you use to tx neuropathic pain?

A

TCAs – amitriptyline

336
Q

Pt on max dose of long-acting opioid + NSAIDs + anticonvulsant but still has uncontrolled pain – next step in mgmt?

A

Switch to lower dose of different opioid
Pt has most likely developed tolerance to the opioid bc of upregulation of NMDA receptors
*could also add TCA but changing the opioid will provide better control

337
Q

Which liver tests reflect hepatocellular injury (versus hepatic function) (4)?

A

AST, ALT, LDH, alk phos

*abnl values suggest ACUTE processes

338
Q

Which liver tests reflect hepatic (synthetic) function (versus hepatocellular injury ) (4)?

A

Albumin
Prothrombin time
Bilirubin
*abnl values suggest CHRONIC processes (bc it takes time to liver to be damaged enough to cause synthetic dysfunction)

339
Q

Most common cause of death in patients with cirrhosis

A

Bleeding varices

340
Q

List the criteria for Class I-IV of CHF

A

Class I - No limitation of activity
Class II - Comfortable @rest, but sx (fatigue/dyspnea/ palpitations/angina with ordinary activity
Class III - Comfortable @rest, but sx with less-than-ordinary activities
Class IV - sx at rest and increased sx with activity

341
Q

What intervention (non-pharm) has been shown to improve function in CHF

A

Alcohol cessation if CHF due to alcoholic cardiomyopathy
*smoking cessation, controlling BP, DM, is always good, but does not lead to functional improvement/improve damage already sustained

342
Q

Two first-line tx that should been given to ALL CHF pts unless there is contraindication

A 
#1 ACE inhibitor --> reduces preload, afterload, cardiac output AND blocks RAAS
#2 Diuretics
343
Q

Name of diuretic to combine with loop diuretics (usually) furosemide in pts with CHF but refractory edema

A

Metolazone (thiazide-like diuretic)

344
Q

CHF is most commonly caused by what two etiologies?

A

Coronary artery disease

Hypertension

345
Q

Consensus on using beta-blockers in CHF?

A

**admin of beta-blockers at high doses in acute CHF can worsen sx
BUT, when titrated in small doses over weeks, can reduce sympathetic tone + reduce cardiac muscle remodeling
*only use in NYHA Class II or III, EF

346
Q

Most useful test in diagnosing Alzheimers

A

MMSE with clock drawing

*neuroimaging and blood work is to rule out other cause

347
Q

What are the three drugs approved for tx of mild-moderate Alzheimers? What drug class/mechanism?

A
  1. Donepezil (Aricept)
  2. Galantamine (Reminyl)
  3. Rivastigmine (Exelon)
    Mech: Acetylcholinesterase inhibitors (make ACh [which is reduced in Alzheimers] last longer in the synapse
    **improve sx but DO NOT slow down neurodegeneration
348
Q

What drug proven to have benefit in advanced Alzheimers? Drug class?

A

Memantine (Namenda)

NMDA receptor antagonist

349
Q

Diagnostic criteria for DM - Random glucose?

A

> =200mg/dL **PLUS symptoms*

*JUST NEED ONE MEASUREMENT

350
Q

Diagnostic criteria for DM - fasting glucose?Prediabetes?

A

> =126mg/dL (no caloric intake at least 8 hrs)

  • **NEED 2 DIFF MEASUREMENTS
  • 100-125 = prediabetes
351
Q

Diagnostic criteria for DM - 2-hr plasma glucose?Prediabetes?

A

> =200mg/dL (after 75g glucose load)

  • JUST NEED ONE MEASUREMENT
  • 140-200 =insulin insensitivity/prediabetes
352
Q

Diagnostic criteria for DM - A1C? Prediabetes?

A

> =6.5%

*5.7-6.5 = prediabetes

353
Q

Which lipid drug best for decreasing TGs?

A

Niacin

  • will also increase HDL and lower LDL BUT can increase insulin resistance
  • statins not as great at lowering TGs but some effect - always the best answer; can use in combination with niacin
354
Q

SGA vs IUGR

A
  • SGA diagnosed at time of birth! Baby is less than the 3rd percentile to less than the 10th percentile for weight
  • IUGR diagnosed DURING pregnancy. Fetus has not reached its growth potential
355
Q

When in pregnancy do we screen for GBS?

A

35-37 weeks

*if +ve –> give peniciliin/ampicillin intrapartum prophylaxis

356
Q

When do we get APGARS (mins)?

A

1 min and 5 mins

357
Q

APGAR components

A 
Appearance
Pulse (palpate umbilical cord)
Grimace
Activity (muscle tone)
Respiratory effort
*Virginia Apgar :)
358
Q

Ballard assessment tool

A

uses signs of physical and neuromuscular maturity to estimate gestational age –> helpful if there is no early prenatal ultrasound to help confirm dates, or if the gestational age is in question because of uncertain maternal dates.
http://www.medcalc.com/ballard.html

359
Q

What three complications are SGA newborns at risk for?

A

Hypothermia
Hypoglycemia (from heat loss, poss hypoxia)
Polycythemia (chronic hypoxia)

360
Q

TORCH infections

A 
Toxoplasmosis
Other (HIV, Hep B, syphilis, varicella-zoster, parvovirus B19)
Rubella
CMV
Herpes
*can see HSmegaly in all of these
361
Q

How do we test for TORCH infections (Hep B, Rubella, Toxo, CMV)? Incl whether sample comes from mom or baby

A

Hepatitis B - Maternal hepatitis B surface antigen (HBsAg)
Rubella - Maternal and infant rubella titer
Toxoplasma - Infant toxoplasma titer
CMV - Infant urine culture

362
Q

We give erythromycin/tetracycline/silver nitrate eye antibiotics as prophylaxis against __?

A

Gonoccocal conjunctivitis!
*though chlamydia conjunctivitis is more common, it typically occurs at 7–14 days after birth, and neonatal prophylaxis does little to prevent chlamydia conjunctivitis

363
Q

Three signs on CT of CMV infection in newborn

A

Intracranial calcifications
Diminished number of gyri and abnormally thick cortex (= lissencephaly)
Enlarged ventricles

364
Q

Main complications of congenital CMV

A 
Developmental delay (think calcifications and lissencephaly)
Hearing loss (progressive)
365
Q

Tx of congenital CMV

A

Parenteral ganciclovir or oral valganciclovir for 6 mos

Ideal if started in first month of life –> can help decrease progression of hearing loss

366
Q

Breastfeeding reduces maternal risk of what 3 paths?

A

Breast cancer
Ovarian cancer
Osteoporosis

367
Q

Why dont we give cows milk to infants? What age is it okay?

A

Risk of colitis –> microscopic bleeding!

Don’t give cow’s milk until 12 months

368
Q

Most babies lose a little weight right after birth. When is the latest time we expect them to atleast have regained their birth weight?

A

By 2 weeks old

369
Q

What is the caloric requirement of a healthy term baby per day?

A

100-120 calories/kg/day

370
Q

Average daily weight gain for a term infant (g)?

A

20-30g

371
Q

What is the caloric requirement of a preterm baby per day?

A

115-130 calories/kg/day

372
Q

What is the caloric requirement of a VLBW baby per day?

A

150 calories/kg/day

373
Q

What are the two most common rashes seen in newborns?

A 
Neonatal acne (hormonal stimulation of sebaceous glands)
Seborrheic dermatitis (cradle cap!)
374
Q

Earliest time babies can start eating solids?

A

4 mos (like cereals)

375
Q

Children should not sit in the front seat until age ___?

A

13yo

*ofcourse its really about height/weight requirements but age 13 is typically when these are met

376
Q

Car seats should face the rear until age ___?

A

2yo

377
Q

Which two vaccines are not given at all till 12mos?

A

MMR and HepA

378
Q

What 6 vaccines are given at the 2 month visit?

A 
DTaP
Hib
IPV 
PCV13
RotaV 
HepB (2nd dose)
*all rest are first dose
379
Q

By what ages should an infant double and triple his or her birth weight?

A

Double by 5 months, triple by 12 months

380
Q

Absence of a red reflex can indicate which 4 most common paths?

A

Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis

381
Q

How far away should you hold the fundoscope from the eye to evaluate red reflex in child?

A

10 inches

382
Q

Why is it not recommended to give prophylactic acetaminophen vaccinations?

A

Use of acetaminophen causes a lower antibody response for some immunizations
*can give therapeutic if necessary

383
Q

Most commonly diagnosed cancer in infants?

A

Neuroblastoma
painless mass in the neck, chest, or abdomen
**small cell rosettes (Homer Wright) on path

384
Q

Beckwith-Wiedemann syndrome

A

Genetic overgrowth syndrome. Features:

omphalocele, hemihypertrophy, hypoglycemia, LGA, and other dysmorphic features

385
Q

Which cancer is commonly seen in Beckwith-Wiedemann syndrome (kids)

A

Wilm’s tumor (abdominal mass that doesn’t cross midline)

386
Q

Which of the bipolar medications need to be taken with food.

A

Geodan (ziprazodone), Latuda (lorazedone)

need at least 300-400 calories for the drug to be effcetive

387
Q

Which bipolar medication is FDA approved for acute mania?

A

Seroquel (quetiapine)

388
Q

side effect of theophyline

A

Tachycardia –> arrythmias

389
Q

What is the long acting therapy for chronic COPD (2)

A

LABA or LAMA (long acting muscarinic (anticholinergic)) (=tiotropium ie Spiriva)

390
Q

Who qualifies for the low dose spiral CT screening for lung cancer

A 
Current smokers (or have quit within the last 15 years) aged 55 to 79 years old who have a smoking history of 30 pack-years or greater.
[number of packs of cigarettes smoked per day by the number of years the person has smoked; 1 pack=20cigs]
391
Q

Sulfonylureas mechanisms of action? Examples?

A

Increase pancreatic secretion of insulin

Glypizide, Glyburide

392
Q

What are the 2 main mechanisms of action of biguanides? Examples?

A
  1. Suppresses hepatic gluconeogenesis
  2. Increases peripheral insulin sensitivity –> enhances peripheral glucose utilisation/uptake
    Example = METFORMIN
393
Q

Who do we screen for DM2? (3)

A

> =45yo
BMI >=25
Pts with HTN

394
Q

DPP4 inhitors = orals for DM2 examples?

A

_gliptins (sitagliptin = JANUVIA)

395
Q

You newly diagnose pt with DM2. What are the steps in mgmt (Visit 1, 2, 3, if you check A1C and still not controlled)

A

Visit 1 - Lifestyle modification + metformin
Visit 2 still uncontrolled - Add 2nd agent (no specific one is best! must choose based on preferences)
Visit 3 - Start insulin

396
Q

Three contraindications to metformin

A

CKD (creatinine >1.5)
CHF
Liver disease
*all bc of lactic acidosis

397
Q

Expected drop in A1C by oral meds vs insulin?

A 
Orals = 3% at most (metformin)
Insulin = 7%
398
Q

In what newly diagnosed patients do we jump straight to insulin as tx?

A

If A1C is >9%

*bc oral agents are not going to be enough to get them to goal

399
Q

Main risk with sulfonylureas?

A

Hypoglycemia

*remember, they increase pancreatic secretion of insulin so its almost like giving insulin

400
Q

Thiazolidinedione (TZDs) mechanisms of action? examples? side effects?

A

Increase insulin sensitivity

_glitazones –> pioglitazone, rosiglitazone

401
Q

Thiazolidinedione (TZDs) mechanisms of action? examples? side effects?

A

Increase insulin sensitivity
Ex. _glitazones –> pioglitazone, rosiglitazone
Side effects: WEIGHT GAIN

402
Q

What is our goal A1C for DM2 pts?

A

A1C

403
Q

What is our goal A1C for DM2 pts?

A

A1C

404
Q

Big three end organs DM2 goes after slash that we should screen every year

A

Eyes (retinopathy), kidneys (proteinuria/CKD), feet (peripheral neuropathy)

405
Q

Screening test for diabetic kidney damage?

A

Urinalysis: microalbumin:creatinine ratio

406
Q

What are the three long acting insulins (basal)

A

Lantus (glargine)
Levemir (detemir)
*both start with ‘L’!!
plus NPH (which has to be given BID unlike the above that are once)

407
Q

What are the three rapid acting insulins?

A

NovoLOG (aspart)
HumaLOG (lispro)
*both end in ‘LOG’
plus REGULAR INSULIN

408
Q

What are NovoLIN and HumaLIN ?

A

Mixed insulins!

ie. long acting (NPH) and short acting (Reg Insulin) combined

409
Q

How many units of long acting insulin do we give? When do they take it?

A
  1. 1U/kg at BEDTIME

* but titrate based on patient’s morning glucose –> until you get to goal or up to 50units

410
Q

Major side effect of the _glitazones

A

Fluid retention/edema

411
Q

If patient has angioedema with ACE inhibitor can you switch to an ARB?

A

No!
There is crossreactivity so pt will likely still have it with ARB
*unlike cough, where you can switch to an ARB

412
Q

Hypoglycemia blood sugar cut off?

A
413
Q

Tx for hypoglycemia if pt is awake vs coma?

A

Awake –> oral glucose (or some food/drink with rapid sugar)

Comatose –> IV D50

414
Q

Tmax of glucose in the kidneys?

A

180mg/dL

415
Q

What 4 tests to order to dx DKA?

A

BS –> 300-500
Urinalysis (or serum is better but takes longer) –> +ketones
ABG –> acidosis
BMP –> anion gap, K+

416
Q

In treating DKA, what 3 lab values do we need to continuously monitor

A

Glucose
Anion gap
K+

417
Q

How do we treat the high glucose in DKA?

A

IV insulin bolus

FOLLOWED BY continuous Insulin Drip

418
Q

What do you always need to check before you give insulin to pt in DKA? Values/mgmt?

A

Potassium!
*remember if you give insulin, K+ shifts INTO cells, so if pt is already HYPOkalemic, you make it worse.
If K+ give IV K+

419
Q

Remember, pts in DKA are going to be extremely dehydrated from osmotic diuresis from the high sugars. How do we tx the dehydration?

A

Vigorous rehydration!

BOLUS NS or LR

420
Q

Unlike DKA, pts with HHS won’t present as acutely, but sugars will be higher = MORE dehydrated! BS values seen in HHS?

A

800-1000

*they shouldn’t have any ketones or acidosis!

421
Q

Tx for HHS?

A

Same as DKA = insulin +fluids

*only difference is you are not monitoring anion gap and reacting to it.

422
Q

According to USPSTF guidelines, who should be put on aspirin for primary prevention of CVD and colorectal cancer?

A

Adults 50 to 59 yo who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding

423
Q

Which patients need to be on a statin?

A
  1. Vascular dz (CAD, MI, periph vasc dz)
  2. LDL >=190
  3. LDL 70-189, but have (1) DM, (2) AGE 40-75, (3) CVD risk factors (smoking, HTN, obesity)
    * only pts who dont get a statin = LDL
424
Q

We always want to put patients on a high intensity statin if possible (rather than mod or low intensity). What are the 2 high intensity statins?

A

Atorvastatin
Rosuvastatin
*both also available as moderate intensity (by giving lower dose)

425
Q

What are my three statins that are available as moderate and low intensity statins?

A

Simvastatin
Pravastatin
Lovastatin

426
Q

In which patients do we have to use a moderate intensity statin (as opposed to high intensity)? (4)

A

CKD
Liver disease
Age >75
Can’t tolerate statin

427
Q

The 2 major side effects of statins

A

Muscle injury

Liver dysfunction

428
Q

What do you do if patient develops muscle injury or liver dysfunction from statin?

A

Stop the statin BUT once the event resolves, restart them on a lower dose.

429
Q

If we cant give a pt a statin, cholesterol drug that is best next in line? What do they lower/increase?

A

Fibrates
Lower TGs, Increase HDL
*also cause myositis/inc LFTs (like statins)

430
Q

Ezetimibe - What does it lower/increase? Side effect?

A

Only lowers LDL
Side effect = diarrhea (bc they block cholesterol absorption from gut –> osmotic encoperesis)
(all same as bile acid sequestrants)

431
Q

Niacin – pathognomonic side effect and how to handle?

A

Flushing!

Prophylaxis with aspirin

432
Q

Niacin – what does it increase/decrease?

A

Lowers LDL, Increases HDL

*sounds like the magic pill but doesn’t actually work that well.

433
Q

First line tx for N&V in pregnancy?

A

Unisom (Doxylamine) + Pyridoxine (B6)

  • try diet/lifestyle modification first – eating smaller, blander meals
  • doxylamine = first gen antihistamine
434
Q

Which type of calcium supplement good for patients with GERD on PPI?

A

Calcium citrate

*vs calcium carbonate which is cheaper, but needs stomach acid to be absorbed

435
Q

Ketorolac – drug class? brand name?

A

NSAID

*Toradol

436
Q

New onset paralysis below T9 (or other spinal level) in diabetic?

A

Spinal epidural abcess –> get an MRI

437
Q

Antibiotic of choice for invasive (bloody) travelers diarrhea from Campylobacter

A

Azithromycin

438
Q

Antibiotic of choice for diarrhea from Entamoeba or Giardia?

A

Metronidazole

439
Q

Antibiotic of choice for diarrhea from Salmonella or Shigella?

A

Ciprofloxacin

440
Q

All NSAIDs except whic one have been proven to increase risk of MI?

A

Naproxen

441
Q

Tx for gonorrhea, with negative chlamydia test

A

Ceftriaxone (gono) + azithromycin or doxycycline (chl)

*still tx for the chlamydia even if test is negative!

442
Q

Preferred antibiotic for CAP in children 5yrs

A

5yo = azithromycin

443
Q

Signs of retinal vein occlusion (3)? commonly seen in what pt popltn? (2)

A

Sudden, painless loss/distortion of vision
Tortuous veins on fundoscopic exam
Cotton wool spots on fundoscopic exam
*Think diabetics and HTN

444
Q

First line tx for keloids

A

Intralesional corticosteroid injection

445
Q

Four drugs that can cause false positives on opioid drug screen

A

Dextromethorphan
diphenhydramine
ibuprofen
fluoroquinolones

446
Q

Proximal muscle weakness, elevated serum creatine kinase and aldolase, sx improve significantly with corticosteroids…?

A

Polymyositis (inflammatory myopathy)

447
Q

Which of the uterotonic drugs is contraindicated in postpartum hemorrhage in pt with HTN?

A

Ergot derivatives

*cause smooth muscle contraction including vessels

448
Q

First line therapy for ulcerative colitis?

A

Sulfasalazine

*make sure to also screen for colorectal cancer

449
Q

Tramadol (Ultram) contraindicated in patients with what history?

A

Seizures

*other drug same = Buproprion; lowers seizure threshold

450
Q

Spirometry cut off of FEV1/FVC ratio to qualify as COPD

A

FEV1/FVC ratio

451
Q

For patient on lithium monotherapy, monitoring labs should include (3) other than lithium trough?

A
  • Creatinine, BUN
  • TSH (lithium can cause HYPOthyroidism)
  • Calcium (can cause HYPERcalcemia –> hyperparathyroidism)
452
Q

Bamboo spine

A

Appearance of lumbar spine on xray in ankylosing spondylitis

453
Q

Most common extraarticular manifestation of ankylosing spondylitis? tx?

A

Uveitis –> tx with steroids

454
Q

Pt with heel pain, on examination pain over medial plantar region of the heel, pain is aggravated by passive ankle dorsiflexion -> dx?

A

Plantar fasciitis

*do not need any imaging to confirm

455
Q

Doxycycline not used in kids

A

Teeth staining

Exceptions = anthrax, tick-borne diseases

456
Q

Between the two sulfonylureas (Glypizide v Glyburide), which one is more likely to cause hypoglycemia? why?

A

Glyburide more likely to cause hypoglycemia because it has a longer half life than Glypizide

457
Q

What is the preferred screening test for TB in pts who have received the bCG vaccine?

A

Interferon-gamma release assays (IGRA)

*too many false positives with the TST

458
Q

What finding is most specific for heart failure (lab or physical exam findings)?

A

S3 heart sound

more specific than BNP

459
Q

Two paths most commonly treated with hyperbaric oxygen with proven long term benefit

A 
Decompression sickness (divers, nitrogen bubbles)
Crush/severe wound injuries
460
Q

Likelihood ratio

A

= the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.
*so if LR = 1, the test is crap, >1 means dz is likely,

461
Q

Which opioid is the only one metabolized in the liver, so safe to give pts with renal disease?

A

Fentanyl

462
Q

Giving corticosteroids to pregnant woman before delivery is beneficial only if given before ___ weeks?

A

34 weeks

463
Q

mech of action of _gliptins (ex Januvia)

A

Prolongs activity of endogenously released GLP-1 (gut derived hormone that stimulates insulin secretion/suppresses glucagon secretion, delays gastric emptying, & reduces appetite)

464
Q

Which is faster acting – Aspart/Lispro vs regular insulin?

A

Aspart/Lispro (15-30mins)

  • vs regular insulin = 30-60 mins
  • good way to remember = synthetic ones doe everything better
465
Q

Which is longer acting – NPH vs Lantus/Detemir?

A

Lantus/Detemir (24h)

  • vs NPH = 20 hrs
  • good way to remember = synthetic ones doe everything better
466
Q

Which test in the lipid panel (LDL, HDL, TGs. tot cholesterol) is most predictive of adverse outcomes?

A

Low HDL

467
Q

Smoking cessation will affect which of the values in the lipid panel?

A

Will increase HDL
*smoking cessation incs it by 5-10
Exercise increases it by ~15

468
Q

What amount of induration is a positive TST in healthy individuals vs immunocompromised ex HIV

A

Healthy = 15mm

HIV, etc = 5mm

469
Q

We begin prophylaxis for PCP in HIV pts if CD4 count drops below what value?

A
470
Q

We begin prophylaxis for Mycobacterium avium complex (MAC) in HIV pts if CD4 count drops below what value?

A
471
Q

Tx for PCP?

A

TMP-SMX (+glucocorticoids if severe)

472
Q

Which one lifestyle modification is MOST beneficial in lowering systolic blood pressure?

A

Weight loss!

followed by DASH diet, followed by lowering sodium

473
Q

JNC8 tx guidelines for HTN - black pts

A

Thiazide (1st) or Ca Channel Blocker or BOTH

*thiazides in both black/nonblack BUT no ACEI in blacks

474
Q

JNC8 tx guidelines for HTN - NONblack pts

A

Thiazide (1st) or CCB or ACEI or combination

475
Q

JNC8 tx guidelines for HTN - pts with CKD

A

ACEI or ARB alone or in combo with other drug

476
Q

Pt with high blood pressure on cuff but weak femoral pulses?

A

Coarctation of aorta

477
Q

Newly diagnosed pt with HTN, what do we test for in serum?

A

Serum = electrolytes, glucose, creatinine, eGFR

478
Q

Newly diagnosed pt with HTN, what three other tests to run (other than serum)?

A

Lipids
Urinalysis (hematuria, albumin/creatinine)
EKG

479
Q

BMI classifications (4)

A

Underweight 30 (morbid >40)

480
Q

What value from a DEXA scan indicates osteoporosis?

A

T-score -2.5 or less

*ie. 2.5 or more std deviations below mean

481
Q

Bisphosphonates mech of action?

A

They bind to surface of bone and are eaten up by osteoclasts, and once inside they inhibit enzyme in the osteoclasts

482
Q

Two FDA approved drugs for PTSD

A

Sertraline (Zoloft)

Paroxetine (Paxil)

483
Q

Tx for acute mania (ex. after giving antidpressants to manic pt)

A

Antipsychotics!

*can use lithium, valproate, etc for maintenance

484
Q

Subclinical hypothyroidism criteria?

A

Elevated TSH but normal free T4

*do not treat, continue to monitor, only 4-8% will progress to true hypothyroid

485
Q

Graves dz causes hypo or hyper thyroid?? mechanism?

A

Most common cause of HYPERthyroidism. Autoantibodies (IgG) STIMULATE TSH receptors on thyroid

486
Q

After fall, patient with pain out of proportion and tenderness with passive flexion of muscle, but normal appearing limb

A

Suspect compartment syndrome –> fasciotomy!
*Before the classic findings develop “Five Ps” (pain, paresthesia, pallor, pulselessness, and paralysis) those are the signs

487
Q

Tx for GAS pharyngitis?

A

Penicillin

*Penicillin-resistant group A Streptococcus has never been documented

488
Q

Pt post camping trip, rash anywhere on the body, including the palms and soles, but the face is spared?

A

Rocky Mountain Spotted Fever

489
Q

First line pharm agents for managing hypotension in pt with sepsis v cardiogenic shock v hemorrhagic shock?

A

Sepsis = dopamine
Cardiogenic shock = dobutamine
Hemorrhagic shock = packed RBCs

490
Q

Pt with cancer, who now has hypostension and a ton of electrolyte abnormalities – diagnosis? tx?

A

Adrenal crisis from mets to adrenals!

Tx = IV hydrocortisone

491
Q

elevated AST level in the absence of alcohol or drug-induced liver disease strongly suggests what path?

A

Nonalcoholic fatty liver disease (NAFLD)

492
Q

Best tx for NAFLD that reduces AST, but also improves liver histology?

A

Healthy diet, weight loss, and exercise

493
Q

Diabetes insipidus pathophys

A

Deficiency in the secretion or renal action of arginine vasopressin (AVP)=antidiuretic hormone –> profound urinary volume, increased frequency of urination, and thirst (but NORMAL sugars)

494
Q

Carnett’s sign

A

Have patient lay supine, and raise their legs –> tenses abdominal wall muscles
Positive = pain increases – abd wall is the source of the pain (ex. hematoma is rectus sheath)
Negative = pain decreases – intrabdominal issue

495
Q

Mild cognitive impairment – what is it? major risk factor?

A

intermediate stage between normal cognitive function and dementia
Risk factor = APO E4 allele

496
Q

Personality disorders mnemonic for the clusters

A

Weird (A), Wild (B), Worried (C)

497
Q

Cluster A personality disorders (weird) (3)

A

Paranoid
Schizoid
Schizotypal

498
Q

Cluster B personality disorders (wild) (4)

A

Borderline
Narcissistic
Histrionic
Antisocial

499
Q

Cluster C personality disorders (worried)

A

Avoidant
Dependent
OCD

500
Q

Tx for tinea capitis

A

Oral griseofulvin

501
Q

You have a pt with some signs worrisome of a PE or DVT, but very low risk. Next step in evaluation?

A

D-dimer

  • its a high SENSITIVITY test, so if its negative, you can trust pt doesn’t have PE/DVT
  • if its +ve do CT for PE, US for DVT
502
Q

First line tx for neuropathic pain

A

TCAs or calcium channel alpha 2-delta ligands (gabapentin and pregabalin=Lyrica)

503
Q

Stillbirth is defined as fetal death occurring at or after __ weeks gestation?

A

20 weeks

504
Q

First-line drugs for essential tremor (2)

A

Primidone (anticonvulsant) and propranolol

505
Q

The threshold for transfusion of red blood cells should be a hemoglobin level of __ g/dL in adults and most children.

A

7 g/dL

506
Q

How do ACE inhibitors cause hyperkalemia?

A

Reduce aldosterone! (R-> A->A->S)

*recall aldosterone increases K+ excretion in principle & intercalated cells

507
Q

treatment of choice for menorrhagia due to endometrial hyperplasia without atypia?

A

Progestins

*cyclic oral medroxyprogesterone, given 14 days per month, or IUD

508
Q

Which of the child vaccinations does not have a catch up period?

A

Rotavirus

509
Q

Which bone in the hand is most commonly injured in a dorsiflexion injury/FOOSH?

A

Scaphoid

510
Q

First line drug for hypertension in pregnancy?

A

Labetalol

511
Q

Remember infectious endocarditis vegetation on the tricuspid valve likely to be seen in what pateints + by what bug?

A

IV drug users – STAPH AUREUS

512
Q

Are corticosteroids better in treating Crohns or UC?

A

Crohns! = rule of c’s

*UC benefits more from 5-ASA preps ex. sulfasalazine

513
Q

At what age do we start doing DEXA scans?

A

65yo

*or younger if pt has increased fracture risk

514
Q

Pneumonia caused by what microorganism starts off with nonspecific systemic symptoms (ex. high-grade fever, malaise, myalgias, anorexia, and headache) and are then followed by respiratory sx?

A

Legionella pneumophila

515
Q

chronic daily cough; thick, malodorous sputum, bronchial wall thickening and luminal dilation

A

Bronchiectasis

516
Q

Antidote to magnesium toxicity in pregnant woman with preeclampsia given mag infusion

A

Calcium gluconate

517
Q

FVC and FEV1/FVC changes in restrictive lung disease?

A

Reduced FVC with a normal or increased FEV1/FVC ratio

*contrast to asthma: reduced FEV1 and a decreased FEV1/FVC ratio

518
Q

Other than insulin, what other common drug increases potassium uptake into cells –> hypokalemia?

A

Beta-agonists (ex. albuterol)

519
Q

Red man syndrome is seen after infusion with what drug?

A

Vancomycin

520
Q

Antibody test for celiac disease?

A

IgA antiendomysial antibody

521
Q

Pts who are super tall (Men taller than 72in and women taller than 70in) + other manifestations suspicious for Marfans should get what screening?

A

Echo!

*high risk for cystic medial necrosis of the aorta –> look for aortic incompetence and dissecting aortic aneurysms

522
Q

When should children with bacterial conjunctivitis be allowed to return to school?

A

Once treatment is started

523
Q

Colonoscopy – every 10 years if normal and no family hx. how often if fam hx of colon cancer?

A

q5 yrs

524
Q

How often should colonoscopy be repeated if benign polyps are found?

A

q3 yrs

525
Q

Best study for confirming the diagnosis of a urinary tract stone in a patient with acute flank pain?

A

helical CT scan of the abdomen and pelvis without contrast

526
Q

Side effects of lithium (4)

A

Postural tremor
Polyuria/Thirst
Weight gain
Diarrhea

527
Q

List the 6 most common atypical antipsychotics with brand name

A 
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Risperdone (Risperdal)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
528
Q

Rash seen in strep throat infection?

A

Scarlet fever
*Punctate, erythematous, blanching, sandpaper-like rash found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastia’s lines).

529
Q

To diagnose ADHD, must be at least ___ years old?

A

6 years old

530
Q

To diagnose ADHD, sx must be present before child is __ years old?

A

12 years old

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