FM 4 Flashcards
hearing is better in loud places makes you think
conductive hering loss
hearing is btter in quiet places makes you think
sensorineural loss
WEBER TEST RESULTS
- —- lateralization to AFFECTED ear
- —-Lateralization to UNAFF ear
affected ear= conductive
unaffected ear=sensorineural
Bone conduction > Air
conductive
Air conduction > Bone
Sensorineural
labyrinthitis
- mcc
- CM
- dx
- tx
mcc=viral
- bacterial
- *infection of the inner ear
CM
-dizziness, vertigo, ear pressure, hearing loss with episodes lasting 1-2 weeks
dx=clinical
tx
*sympotamtic— antihistamines, bed rest
BACTERIAl=abx broad spectrum
acute onset of vertigo, hearing loss tinnitus lasting several days to weeks
+/- nausea vomiting fever HA
labrynthitis
Laryngitis
- mcc
- cm
- when would you do a laryngoscopy
mcc= inflammation of larynx from voice strain or virus
***follows URI
CM= voice hoarsenss or loss of voice
DO laryngoscopy if > 3 weeks
***GERD is mcc of chronic– but want to r/o CA
tx= supporitve
what is MCC of irreversible vision loss
macular degeneration
gradual painless loss of central vision
macular degen
+ metamrphopsia
WET macualr degeneration
- ** wavy or distorted vision measuring with the Amsler grid
- *curving of straight lines
difference b/w wet and dry mac degen
DRY– 85% cases
- progressive loss of vision
- atrophic changes with age— slow and gradual central vision loss–usally bilateral
CM
*drusen spots— yellow retinal deposits
*atrophy
____________________________
WET— central vision loss occuring rapidly– days to weeks– and is more severe— this leads to blindness
- metamorphopsia— curving of straight lines
- usually unilateral
CM
- neovascularization
- hemorrhages
- exudate
TX for dry and wet mac degen
BOTH= daily supplements of Zinc Oxide, Copper, Vit C, Vit E and Lutein/Zeaxanthin (Vit A)
WET
- intravitreal VEGF inhibitors—– Bevacizumab— helps decr new abnromal vessel formation
- Laser photocoagulation
Meniere Disease
Peripheral vertigo + low-frequency hearing loss aka sensorineural + tinittuis/ear fullness
MC adults 40-60
IDIOPATHIC
episodes last minutes to hours and decr with age
PE
- A > B
- weber will lateralize to unaffected side
TX
avoid triggers=== caffine, etoh
low sodium diet
Meds– diuretics (HCTZ + triamterene), histamine analogues, anticholinergic antiemetics
multiple polyps seen on exam— what do we think
cystic fibrosis
polyps look like tear drop shaped growths
Chronic congestion, decreased sense of smell
nasal polyps
tx for nasal polyps
- topical nasal corticos for 3 MO= initial tx of choice
* ***good for small ones and reduces need for surgery
OE
-rhinne test finding
B > A
**conductive hearing loss
tx for malignant OE in DM
-IV ABX bc of aspergillus
HD ciprofloxacin 6-8 weeks 1st line
causes for papilledema
malignant HTN brain tumor/abscess meningitis cerebral hemorrhage encephalitis
disc appears swollen, marigns blurred
INCR ICP*
Parotitis
mumps
parotitis
-tx
self limiting
vaccination
congatious for 9 days after onset
mcc of pharyngitis
viral
***adenovirus
+ heterophile agglutination test
monospot test
**EBV
bacterial pharyngitis mcc
group a beta hemolytic strep
centors criteria
- no cough
- exudates
- fever > 100.4
- cervical lymphadenopathy
3/4= get rapid strep test
if negative– culture is GS
tx for group a strep
PCN first line
azitrhomycin if allergic
COMPS= rheumatic fever and post strep glomerunonpehriits
which abx can cause rash if given for EBV
amoxicillin and ampicillin
elevated, superficial fleshy, triangular shaped growth/ mass in the inner corner/nasal side of eye
pterygium
ptergium assoc with
incr sun exposure, climates where wind, sand and dust
sudden vertical curtain comding down…. curtain of darkness
+/- floaters or flashes
PAINLESS
retinal detachement
PE finding for retinal detachemet
- asymmetric red reflex
* flap in the viterous humor
RF for retinal detachement
nearsightedness aka myopia
what kind of vision loss with retinal detachement
peripheral
tx for retinal detaachement
IMMED REFERAL
-stay supine with head towards the side of detachement
cherry red spot at fovea with pale opaque fundus and arterial attenuation
central artery occlusion
painless profound visual loss over a few seconds– unilateral
central artery occlusion
**amaurosis fugax
tx for retinal artery occlusion
- prompt tx
- high [ ] O2 and digital massage over eyelid
- IV Acetazolamide to decr IOP or timolol
- Anterior chamber paracentesis
- Direct infusion of thrombolytic agent into opthalmci artery
- work up and management of atherosclerotic disease
Central vein occlusion
- cm
- pe
- tx
MC than central artery
**sudden painless loss of vision
PE— “blood and thunder apperance”—dilated veins, heomrrahged and edema and exudates—–, retinal hemorrahges, optic disc swelling,
tx
TX: vision resolves with time (partially); workup for thrombosis
Neovascularization treated with intravitreal injection of VEGF inhibitors
what is leading cause of blindness in adults
retinopathy
causes of retinopathy
uncontrolled DM or HTN
what is Sialadenitis
- cm
- mcc
- dx
bacterial infection of a salivary gland causd by sialolithiasis aka obstructing stone— in salivary gland
CM
- acute swelling of the cheek that worsens with meals
- affects parotid or submandibular gland, occurs with dehydration or chronic illness (Sjogren syndrome), ductual obstruction
MCC=staph A
DX
- CT
- US
- MRI
TX
IV Nafcillin
hydration, warm compress, sialogogues (lemon drops) massage gland
PO ABX less severe cases— dicloxacillin, 1st gen cephalosporin, clindamycinn
2-3 weeks to resolve
pain, otorrhea, and hearing loss/reduction
tm perf
only class of abx that are non ototix are?
Floxin drops
Gout
- dx TOC
- tx— acute attack, chronic and then manintenance
- drugs to avoid
TOC= arthrocentesis– negatiely birefringent needle shaped crystals
tx
lifestyle: elevation, rest, decrease purines (meats, beer, seafood, alcohol), weight loss, increase protein, limit alcohol
DOC for non acute attacks is Allopurinol **** or colchicine
ACute ATTACk—- NSAIDS 1st like Indomethacin or colchicine– but bad GI SE
Maintenance is colchicine
avoid ASA and thiazide diuretics
DO NOT START SOMEONE ON ALLOPURINOL DURING ACUTE ATTACK
mcc of patellar dislocation
- cm
- dx
- *POSTERIOR MC
- *MVA
CM= deformity to knee + diffuse edema
dx
*ap and lateral xr
+ apprehension sign–
tx for fibromyalgia
- Duloxetine (cymbalta)
- Milnacipran (savella)
- Pregabalin (Lyrica)
+stress reduction
-sleep
-exercise
0
conjunctivitis, uveitis, urethritis, arthritis
reactive arthritis
Reactive Arthritis
-mcc
GC/ C ***
or
GI: salmonella, shigella, campylobac
+ HLA-B27 in 80%
TX
- NSAIDs
- Azitrhomycin for chalmy
- IM Ceftri for gon
(+) Anti-citrullinated peptide antibodies
most specific for RA
tx for RA
prompt start of DMARDS;
- Methotrexate ****
- Hydroxycholorquine— can be added to methotrexate–less effective as monotx
- Sulfasalazine– can be added to the two above for triple tx
- Leflonomide
NSAIDS prn
(+) Anti-double-stranded DNA
SLE
Anti-Smith Ab:
SLE
tx for SLE
TX: Manage with sun protection, hydroxychloroquine (for skin lesions), NSAIDs or acetaminophen for arthritis
Pulse dose steroids; cytotoxic drugs (methotrexate, cyclophosphamide)
tx for hookworm or cutaenous larva migrans
albendazole
or
self limitng
single large oval plaque with central clearing and scaly border— then later develops a diffuse pruritis erythematous plaques with central scalling
Pityriasis rosea
***christmas tree pattern
Erythematous, yellowish greasy scales, crusted lesions either on scalp or body folds
seborrheic dermatitis aka cradle cap
**infants its on the scalp
**adults/teens– body folds
tx= ketoconazole
macules that are hypo or hyperpigmented
*do not tan
tinea versicolor
*upper trunk, neck, proximal arms and areas where there is sebum–like face
A 20-year-old male with no significant past medical history presents complaining of patchy tanning. He states that he has been out in the sun without a shirt several times. Areas on his chest and back just don’t tan, and he is becoming self-conscioust
tinea versicolor
tx for tinea versicolor
selenium sulfide
bright red blood on TP
anal fissure
odynophagia, dysphagia, substernal CP
esophagitis
causes of esphagitis
INFECTIOUS
*Candida—DM or immunocomp
+/- oral thrush at the same time
*CMV—uncommon but seen in PT with AIDS—ulcerations at LES
*HSV–immunocomp or hx of HSV–vesicular lesions
NON-INFECTIOUS
- esosinophilic—– chronic, immun emediated, severe dysphagia tht can cause pt to avoid food,
- pill esophagitis–mcc seen with NSAIDs or bisphosponates
- GERD MCC*****
- Caustic Esophagitis— household cleaners— button batteries most corrosive
Punched out lesions on EGD
HSV esophagitis
Linear yellow/white plaques
Candida esophpagitis
Large solitary ulcers OR erosions on EGD
CMV esophagitis
____ ulcers worsen with food
____ ulcers get better with food
gastric ulcers worsen with food
duodenal ulcers get beteter with food
H Pylori tx
CAP
Clarythromycin
Amoxicllin–alternative metronidazole
PPI
PT has a lot of vomiting/retching–mc etoh abuse or bulemia
mallory weise tear
The 4 cardinal signs of strangulated bowel:
fever
tachycardia
leukocytosis
locazlied abd tenderness
mcc cirrhosis
2nd mc cause
mcc=etoh
*hep b and c
abdominal pain, ascites, and hepatomegaly
hepatic vein thrombosis
polyps in distal colon are MC?
benign
polyps in proximal colon are MC?
cancerous
The most common cause of painless rectal bleeding in the pediatric population
colonic polyps
once polyps ID– how often do colonoscopy
every 3-5 yrs
change in bowel habits, new iron def anemia, blood in stool
colon ca
normally how often to do colonoscopy
q 10 yrs
colon screening for avg risk pt starts when and ends when
at 45 and ends at 75
sessile vs pedunculated polyps
sessile more likely to be malignant
“Apple core” lesion on barium enema
colon ca
causes of secondary causes of constipation
dm hypothry MS dehydration meds
1st line tx for constipation
2nd
bulk forming laxatives—- psyllium (metamucil), methylcellulose,
2nd= osmotic laxatives…. PEG
Diarrhea breakout in a daycare center: ???????
Diarrhea on a Cruise Ship: ????
daycare= rotavirus
cruise=norovirus
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2 cam
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2 cam
empiric tx for e-coli diarrhea aka travelers
Cpirofloxacin 500 mg BID and Loperamide if older than 2
campy or shigella diarrhea tx
fluoroquinolone
pregnant + infectious diarrhea
azithromycin
traveler diarrhea prophylaxis
cirpofloxacin
mucous and bloody stool
shigella
shigella tx
Bactrim
or
ciprofloxacin
contamination from shellfish or seafood
cholera
rice water diarrhea
cholera
dyspepsia + abd pain common indicators of
gastritis
dyspepsia= bloating belching distenting HB
three causes of gastritis
HP infection mc
NSAIDs or ETOH
Autoimmune or hypersensitivity rx— pernicious anemia
+ schilling test + decr intrinsic factor and +parietal cell abs
pernicious anemia
Test OC for GERD
endoscopy with biopsy
when do you order upper GI series aka barium constast study for GERD
to ID complications of GERD—- strcitures/ulcers
GS for diagnosis of GERD
PH Probe
tx GERD steps
- Life style mods
+/- - Antacids—- and H2— like Famotidine can be used PRN
- after failure of above– then add Omeprazole– MAX CAN BE ON IT 8-12 weeks
- failre of all the above = Niseen Fundoplication
diarrhea after camping trip
Giardia
tx for Giardia diarrhea
Tinidazole is first line
*Metronidazole also
tx for pinworms
mebendazole or pyrantel pamote
tx for tapeworm
Praziquantal
what is tape worma ssoc with
b12 deficiency
cough, weight loss, anemia, recent travel
hookworm
tx for hookworm
mebendazole
albendazole
pyrantel
barium enema show lead pipe apperance with loss of haustral markings
UC
tx for UC
- colectomy
* Prednisone and Mesalamine
cobblestoning
Chrons
skip lesions
chrons
tx for flares of chrons
prednisone +/- mesalamine +/- metronidazole or cipro
maintenance tx for chrons
mesalamine
abx approved for IBS-D
rifaximin (Xifaxan)
Anti-HBc
means had/have infection
- IgM= acute
- IgG=not acute
Anti-HBs
immunity from vaccine
HBeAg
highly infectious
HBsAg
ongoing infection
tylenol hepatotoxicity tx
N-Acetylcysteine within 8-10 hrs
AST > ALT ratio >2:1
ETOH hepatitis
ALT > AST
fatty liver dz
HBsAg +
and
Anti-HBc IgM
acute HBV finection
Anti-HBs +
person got their immunization not infection
MC RF for developing alzheimers
old age
mc form of dementia
alzhierms
fourth most common cause of death in the United States
alzhiemers
which memory is lsot first with alzhiemers
short term— like forgetting what u had for breakfaast
tx for alzheimers
*which drug to avoid
1st: Donepezil, rivastrigmine, galantamine—— cholinesterase inhibiotrs
* memantine— for mod-severe
* AVOID ANTICHOLINERGICS
bell palsy
- cn?
- common preceding event?
CN VII
URI Preceeding
unilateral facial weakness/paralysis— upper and lower parts of face are affected– CANNOT wrinkle forehead–where stroke you can wrinkle forehead
55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
subdural hematoma
delirium vs dementia (neurocognitive disorders)
delirium= acute, reversible, caused by. medication condiiton
dementia aka neurocognitive= long term impairment in memory usually irreversible— like alzheimres
35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week
meiners
How do you differentiate labyrinthitis from Meniere’s disease
labrynthitis= assoc with recent URI and vertigo is continuous
Menieres= vertigo is episodic
vertigo without positional changes + NO hearing loss + recent URI
vestibbular neruitis
Unilateral, excruciating, sharp, searing, or piercing pain (often at night), lacrimation, and nasal congestion
cluster HA
M»_space;> F
tx for cluster HA
- oxygen
2. Sumatriptan
A headache of varying intensity, often unilateral, and accompanied by nausea and sensitivity to light and sound
migraine
tx for migraines– acute and prophlaxis
ACUTE
- Triptans— not use in haert dz
- Ergotamine (NOT in preggo)
Prophylaxs atenolol propranolol verapamil TCAs
HA that is bilateral, mild to moderate, dull pain,
Presentation: Bilateral, squeezing sensation, mild to moderate, dull pain
tension HA
tx for tension HA
NSAIDs
muscle relaxer
tx PD
<65 use dopamine agonists: bromocriptine, pramipexole, ropinirole—
*use in younger PT to delay use of Levodopa
> 65 use Sinemet (Levodopa/Carbidopa)
*AE: GI upset, NV, vivid dreams, psychosis, dyskinesias
seizure with no alternation in consciousness only see abnormal movements or sensations
focal seizure aka simple partial seizure
focal seizure with loss of awareness aka consciousness impaired
complex partial seixure
tx for focal seizure (partial and complex)
- Phenytoin
2. Carbamazepine
SE TX order
- IV benzo — diazepam or lorazepam
- Fosphenytoin or phenytoin
- Barbituate
- propofol
Trauma— lucid interval– then HA, decr consciousness
epidural
a 27-year-old mountain biker strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely.
epidural
CT finding is lenticular, unilateral convexity, usually in the temporal region
epidural
lens shaped biconvex
epidural
most specific test for hemophilia
functional assay for factor 8 and 9 to confirm diagnosis– determines type and severtiy
↑ PTT, normal PT and platelets,
hemophilia
Secondary polycythemia is caused by
natural or artifical increases in production of EPO
- altitude
- hypoxic disease (COPD, sleep apnea)
- bloodletting
- genetics
- neoplasms: pheochromocytoma, liver tuomrs
