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Family Medicine EOR > FM EOR Review > Flashcards

FM EOR Review Flashcards

1
Q

What is the MC initial presentation of type 1 DM?

What is the 2nd MC?

A

MC = Hyperglycemia without acidosis with polyuria, polydipsia, polyphagia

2nd MC = DKA

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2
Q

What are the rapid-acting insulins?

A

Lispro (Humalog)
Aspart (Novalog)
Glulisine (Apidra)

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3
Q

What is the short-acting insulin?

A

Regular

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4
Q

What is the intermediate-acting insulin?

A

NPH

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5
Q

What are the long-acting insulins?

A

Glargine (Lantus)

Determir (Lemevir)

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6
Q

What is the MC cause of DKA?

A

Infection

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7
Q

What is the triad of DKA?

A

hyperglycemia, ketonemia, acidosis (rapid onset)

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8
Q

What is the presentation of DKA? (8)

A 
3 Ps (Polyuria, Polyphagia, Polydipsia)
Fatigue
AMS
Abdominal pain
Tachycardia
Hypotension
Fruity breath
Kussmaul respirations
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9
Q

What is the treatment of DKA? (4)

A
  1. Isotonic 0.9% NS until hypotension resolves. Then switch to 1/2 NS. When glucose level becomes less than 250, switch to D5 to prevent hypoglycemia from insulin therapy
  2. Regular insulin
  3. Potassium repletion
  4. Search for underlying cause
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10
Q

What are RF for type 2 DM?

A

Obesity, decreased physical activity, genetics

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11
Q

What are the screening guidelines for DM?

A

All adults ≥ 45 yo every 3 yrs OR any adult with BMI ≥ 25 + 1 risk factor

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12
Q

What diagnostic findings indicate DM?

A
  1. Fasting Plasma Glucose ≥ 126 (GOLD STANDARD)
  2. 2-hour Glucose Tolerance Test ≥ 200
  3. HbA1C ≥ 6.5%
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13
Q

What is the MOA of Metformin?

A

Decreases hepatic glucose production, increases insulin sensitivity

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14
Q

What are benefits of Metformin?

A

Reduces risk of CV death, lowers LDL

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15
Q

What are SE of Metformin?

A

Diarrhea, lactic acidosis, B12 deficiency

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16
Q

What are CI of Metformin?

A 
Severe renal (GFR < 30) or hepatic impairment
Heart failure
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17
Q

What is the MOA of Sulfonylureas?

A

Stimulates non glucose dependent insulin secretion

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18
Q

Which Sulfonylureas are used most commonly?

A 
2nd generation (Glipizide, Glimepiride, Glyburide)
*Glyburide has the highest risk of hypoglycemia
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19
Q

What are SE of Sulfonylureas?

A

Hypoglycemia

Weight gain

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20
Q

What is the MOA of Thiazolidinediones “-glitazone”?

A

Increase insulin sensitivity

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21
Q

What are SE of Thiazolidinediones “-glitazone”? (5)

A 
Peripheral edema
Fluid retention/weight gain
CHF
Hepatotoxicity
Increased fractures (females)
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22
Q

What are CI of Thiazolidinediones “-glitazone”? (5)

A

Heart failure
Hx of bladder cancer
Liver disease
Pregnancy

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23
Q

What is the MOA of GLP1 Receptor agonists “-tide”?

A

Increases glucose dependent insulin secretion, delays gastric emptying, decreases glucagon secretion

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24
Q

What are SE of GLP1 Receptor agonists “-tide”?

A

Hypoglycemia (less than sulfonylureas), pancreatitis

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25
Q

What are CI of GLP1 Receptor agonists “-tide”?

A

Hx of pancreatitis
Medullary thyroid carcinoma
MEN type 2

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26
Q

What DM medications can reduce risk of major CV events?

A

Liraglutide
Empagliflozin
Canagliflozin

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27
Q

Which DM medication are associated with weight loss?

A

GLP1 receptor agonists

SGLT2 inhibitors

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28
Q

What is the MOA of DPP4 Inhibitors “-gliptin”?

A

Decreases degradation of GLP-1, which increases insulin release

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29
Q

What are SE of DPP4 Inhibitors “-gliptin”?

A

Acute pancreatitis

Headaches

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30
Q

What are CI of DPP4 Inhibitors “-gliptin”?

A

Hx of pancreatitis, renal impairment (except Linagliptin)

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31
Q

What is the MOA of SGLT2 inhibitors “-gliflozin”?

A

Increased glucose excretion through urine

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32
Q

What are SE of SGLT2 inhibitors “-gliflozin”?

A

N/V
Thirst
UTI
Yeast infections

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33
Q

What are CI of SGLT2 inhibitors “-gliflozin”?

A

Renal impairment (GFR <30)

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34
Q

What is the blackbox warning for Canagiflozin?

A

Increased risk of LE amputation

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35
Q

What are the hallmarks of hyperosmolar hyperglycemic state?

A

Dehydration
Increased osmolarity (>320) Hyperglycemia (>600)
Absence of acidosis
Hypokalemia

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36
Q

What is the treatment of hyperosmolar hyperglycemic state?

A

SIPS (saline, insulin, potassium, search)

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37
Q

What is the screening recommendation for breast cancer for woman at average risk?

A

Woman ages 50-74 should get a mammogram every 2 years

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38
Q

What is the screening recommendation for colon cancer for patients at average risk?

A
  1. Colonoscopy every 10 yrs
  2. Fecal Occult Blood test annually
  3. Flex sig every 5 yrs + fecal Occult Blood test every 3 yrs

All adults 50-75 yrs old

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39
Q

Who is considered “high risk” for CRC?

A

Individuals who have a 1st degree relative with CRC or advanced stage adenoma diagnosed <60 years old OR two 1st degree relatives diagnosed at any age

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40
Q

What is the screening recommendation for colon cancer for patients at high risk?

A

Start colonoscopy screening at age 40 OR 10 years younger than the age at which the first relative was diagnosed
Repeat colonoscopy every 5 years

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41
Q

What is the screening recommendation for colon cancer for patients with Familial Adenomatous Polyposis?

A

Start annual flex sig/colonoscopy screening at age 10

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42
Q

What is the screening recommendation for colon cancer for patients with Lynch Syndrome?

A

Colonoscopy every 1-2 yrs, beginning at age 20-25 OR 5 yrs younger than the earliest age at diagnosis in the family, whichever is sooner

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43
Q

What is the screening recommendation for lung cancer?

A

Annual low-dose CT for adults age 55-80 who have a 30-pack year history and currently smoke OR have quit within the last 15 years

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44
Q

At what age should you begin screening recommendation for cervical cancer?

A

Screen women starting at age 21 (despite age of first sexual encounter)

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45
Q

What is the screening recommendation for cervical cancer for women 21-29?

A

Cytology alone every 3 years

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46
Q

What are the screening recommendations for cervical cancer for women 30-64?

A
  1. Cytology alone every 3 years
  2. Cytology and HPV DNA testing every 5 years
  3. HPV alone every 5 years
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47
Q

What are the recommendations for when to stop cervical cancer screening?

A

Stop screening at age 65 if they have had 3 prior consecutive negative results with cytology alone or have had 2 consecutive negative Co-testing results

(Most recent results need to be within 5 years, and they cannot have a history of CIN 2+ within the last 20 years)

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48
Q

What is the screening recommendation for prostate cancer?

A

Consider PSA for high risk men age 40-45

No benefit in screening past 70 years

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49
Q

What is the screening recommendation for AAA?

A

One-time screening recommended for males 65-75 who

  • Are current or past smokers
  • Have never smoked, but have a first degree relative who required repair of an AAA or died from ruptured AAA
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50
Q

What is the screening recommendation for osteoporosis?

A
  1. Postmenopausal women < 65 yo with increased risk
  2. Women ≥ 65
    (DEXA scan)
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51
Q

What is the dx?
Hyperpigmented velvety plaques, most commonly associated with obesity and disorders of insulin resistance like DM and Cushing’s

A

Acanthosis nigricans

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52
Q

What is the dx?
Inflammatory nodules and abscesses, draining sinus tracts, and fibrotic hypertrophic scars. Commonly occurs in axillary, inguinal, and anogenital regions

A

Hidradenitis Suppurativa “Acne Inversa”

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53
Q

What is the tx of Hidradenitis Suppurativa?

A

Topical Clindamycin

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54
Q

What is a CI of Isotretinoin?

A

Pregnancy

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55
Q

What is first line medical tx of papulopustular rosacea?

A

Metronidazole

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56
Q

What is the dx?

Well demarcated round velvety, warty lesion with “stuck on” appearance

A

Seborrheic Keratosis

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57
Q

What is the MC premalignant skin condition?

What can it progress to?

A

Actinic Keratosis

SCC

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58
Q

What is the dx?

Erythematous, scaly/gritty macule or papule that may be tender

A

Actinic Keratosis

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59
Q

What is the most common type of skin cancer?

A

Basal Cell Carcinoma

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60
Q

What is the dx?
Flat, firm area with small raised, translucent, pearly, or waxy papule with raised, rolled borders and central ulceration with overlying telangiectatic vessels

A

Basal Cell Carcinoma

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61
Q

Where are the most common sites for mets from melanoma?

A

Regional lymph nodes, skin, liver, lungs, and brain

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62
Q

What is the dx?
Raised well demarcated pink-red plaques or papule with thick silvery scales, commonly on extensor surfaces and yellow/brown discoloration under the nail (“oil spots”)

A

Plaque Psoriasis

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63
Q

What is Auspitz sign and what disease is it associated with?

A

Punctate bleeding with removal of plaque or scale

Psoriasis

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64
Q

What is Koebners phenomenon and what disease is it associated with?

A

New, isomorphic lesions that occur at the sites of trauma

Psoriasis

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65
Q

What is the dx?

Smaller papule with fine scale that spares the palms and soles, commonly occurring after strep pharyngitis infection

A

Guttate psoriasis

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66
Q

What is the tx of psoriasis? What should you not use?

A

High potency topical corticosteroids

*DO NOT use ORAL steroids (sx worsen after d/c)

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67
Q

What is the dx?
Tiny, painless papules that evolve into soft, fleshy cauliflower like lesions ranging from skin colored to pink or red, occurring in clusters in the genital region and oropharynx

A

Condyloma Acuminata (genital warts)

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68
Q

What is the dx?
Single or multiple firm dome-shaped, flesh colored to pearly white, waxy papule 2-5mm in diameter with central umbilication

A

Molluscum Contagiosum

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69
Q

What is the dx?
Target lesions consisting of 3 components
-Dusky central area or blister
-Dark red inflammatory zone surrounding by a pale ring of edema
-Erythematous halo on the extreme periphery of the lesion

A

Erythema Multiforme

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70
Q

What is the etiology of Erythema Infectiosum (Fifth disease)?

A

Parvovirus B19

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71
Q

What is the dx?

  • Prodrome
  • Erythematous malar rash with a “slapped cheek” appearance and circumoral pallor
  • Followed by a lacy, reticular maculopapular rash on the extremities that spares the palms and soles
  • Arthralgias in adolescents and adults
A

Erythema Infectiosum (Fifth disease)

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72
Q

What is the etiology of Rubeola?

A

Measles

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73
Q

What is the dx?

  • Prodrome with malaise, anorexia, high fever, and 3 C’s (cough, coryza, conjunctivitis)
  • Followed by Kolpik spots and morbilliform, brick red rash beginning at hairline and spreading down
A

Rubeola

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74
Q

What is the dx?

  • Prodrome
  • Oral enanthem: erythematous macule that become painful, oral vesicles surrounded by a thin halo of erythema that undergo ulceration
  • Greyish yellow vesicular macular lesions on the distal extremities often including palms and soles
A

Hand Foot and Mouth

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75
Q

What is the dx?
Localized macular erythema, not sharply demarcated, swelling, warmth, and tenderness
If systemic, fever, chills, lymphadenopathy, lymphangitis

A

Cellulitis

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76
Q

What is the tx for mild cellulitis?

A

PO Cephalexin, Dicloxacillin, or Clindamycin

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77
Q

What is the tx for rapidly progressing cellulitis?

A

IV Cefazolin, Oxacillin, or Clindamycin

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78
Q

What is the dx?

Papules, vesicles, and pustules with weeping and later development of honey-colored, golden crusts

A

Impetigo

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79
Q

What is the tx of mild and moderate/severe impetigo?

A

Mild: Topical Mupirocin

Mod/severe: PO Cephalexin or Dicloxacillin

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80
Q

What is the major electrolyte abnormality associated with hyperparathyroidism?

A

Hypercalcemia
Bones- abnormal bone remodeling and fracture risk
Stones- increased risk for kidney stones
Groans- abdominal cramping, nausea, ileus, constipation
Psychiatric overtones- lethargy, depressed mood, psychosis, cognitive dysfunction

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81
Q

What effect does Primary Adrenal Insufficiency have on

  1. Cortisol
  2. CRH
  3. ACTH
  4. MSH
  5. Na
  6. K
A
  1. Decreased cortisol
  2. Increased CRH
  3. Increased ACTH
  4. Increased MSH (hyperpigmentation)
  5. Hyponatremia
  6. Hyperkalemia
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82
Q

What is the dx

Pruritic vesicles of 1-2mm on soles, palms, and sides of fingers that appear to contain grains of tapioca?

A

Dyshidrotic eczema

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83
Q

What is the tx of Vasospastic angina?

A

CCB

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84
Q 
What type of HF is associated with:
Paroxysmal Nocturnal Dyspnea (PND)
Pulmonary congestion: cough (blood-tinged sputum), crackles, wheezes
Cyanosis 
Cheyne-stokes breathing
A

Left sided HF

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85
Q 
What type of HF is associated with:
Peripheral edema
JVD
Ascites
Weight gain/anorexia
Hepato/splenomegaly
A

Right sided HF

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86
Q

What is the tx of orthostatic hypotension?

A

Increasing salt and fluid intake

Fludrocortisone if persistent symptoms (promotes Na and water reabsorption)

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87
Q

What are the guidelines for initiating statin therapy? (5)

A
  • Patients with diabetes between ages 40-75
  • Patients without CVD ages 45-75 and >7.5% risk for having MI or stroke in next 10 years
  • Patients >21 with LDL >190
  • Any patient with atherosclerotic CVD
  • Patients <19 with familial hypercholesterolemia
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88
Q

What disease are the following associated with?

  • Osler nodes (painful nodules on pads of digits and palms)
  • Janeway lesions (painless macule on palms and soles)
  • Splinter hemorrhages
  • Roth spots (oval retinal hemorrhages with pale centers)
A

Infectious endocarditis

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89
Q

What is the dx?

Systolic crescendo-decrescendo murmur best heard at the right sternal border and radiates to the carotid

A

Aortic stenosis

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90
Q

What is the dx?

Diastolic blowing murmur best heard at the left upper sternal border

A

Aortic regurgitation

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91
Q

What is the dx?

S1 with opening snap with a mid-diastolic rumbling murmur

A

Mitral stenosis

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92
Q

What is the preferred tx for symptomatic mitral valve stenosis?

A

Percutaneous balloon valvuloplasty

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93
Q

What is the dx?

Blowing holosystolic murmur best heard at the apex with radiation to the axilla

A

Mitral regurgitation

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94
Q

What type of murmur is associated with mitral valve prolapse?

A

Mid-systolic click

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95
Q

What is the dx?
Always congenital
Mid-systolic ejection murmur that increases with inspiration

A

Pulmonic stenosis

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96
Q

What is the dx?
Always congenital
Graham-Steel murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration

A

Pulmonic regurgitation

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97
Q

What is the dx?
Harsh mid-systolic crescendo-decrescendo systolic murmur
Increases with Valsalva and decreases with squatting

A

Hypertrophic cardiomyopathy

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98
Q

What is the presentation of Emphysema/COPD?

A
  • Dyspnea
  • Minimal cough
  • Pink skin, pursed lip breathing
  • Accessory muscle use
  • Cachexia
  • Barrel chest
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99
Q

What is the presentation of Chronic Bronchitis/COPD?

A
  • Chronic productive cough
  • Purulent sputum/Hemoptysis
  • Dyspnea
  • Cyanosis
  • Peripheral edema
  • Crackles, wheezes, prolonged expiration
  • Obese
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100
Q

How is COPD dx?

A

PFTs (obstructive pattern)

CXR (hyperinflation, flattened diaphragms, increased AP diameter)

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101
Q

What type of asthma?
Symptoms less than 2 days a week, uses SABA less than 2 days a week, less than 2 nighttime awakenings
What is the tx?

A

Intermittent

SABA prn

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102
Q

What type of asthma?
Symptoms more than 2 days a week, but not daily. 3-4 nighttime awakenings a month
What is the tx?

A

Mild persistent

SABA prn + low dose ICS

103
Q

What type of asthma?
Daily symptoms and daily use of SABA. At least one nighttime awakening per week, but not nightly
What is the tx?

A

Moderate persistent

SABA prn + high dose ICS or LABA

104
Q

What type of asthma?
Symptoms throughout the day, nightly awakenings
What is the tx?

A

Severe asthma

SABA prn + high dose ICS + LABA

105
Q

What is the tx of outpatient uncomplicated PNA?

A

Macrolide, Doxycycline, or Amoxicillin

106
Q

What is the tx of inpatient PNA?

A

B-lactam + Macrolide, or Doxycycline

107
Q

What antibiotic is first-line therapy for human bite infection prophylaxis?

A

Amoxicillin-clavulanate (Augmentin)

108
Q

What is the tx of perioral dermaitis?

A

Metronidazole or erythromycin

109
Q

What is Fitz-Hugh-Curtis?

A

Peri-hepatitis - a complication of pelvic inflammatory disease

110
Q

What is the dx?

Low back pain that’s most severe at night and morning stiffness that improves with exercise or movement

A

Ankylosing Spondylitis

111
Q

What diseases associated with HLA-B27?

A

PAIR: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis

112
Q

How is lactose intolerance dx?

A

Usually clinical, lactose tolerance test, lactose breath hydrogen test

113
Q

What is the tx of poison ivy?

A

Prednisone taper over 14-21

114
Q

Which antiepileptic medication can cause hirsutism and gingival hyperplasia?

A

Phenytoin

115
Q

What is the tx of Rocky Mountain Spotted Fever?

A

Treatment is ALWAYS doxycycline, even in children

116
Q

What antibody is associated with Grave’s disease?

A

TRAb (Thyrotropin receptor antibodies)

117
Q

What antibody is associated with Hashimoto’s disease?

A 
TPO Ab (anti-thyroid peroxidase antibodies)
TgAb (anti-thyroglobulin antibodies)
118
Q

What is the dx?

  • Previous illness
  • Acute asymmetric arthritis
  • Conjunctivitis, arthritis, urethritis
  • Labs: HLA-B27
A

Reactive arthritis

119
Q

Which tetanus prophylaxis should pts overthe age of 7 receive?

A

Tdap

120
Q

What are the two tx options for H. pylori infection?

A

Triple therapy: Clarithromycin, Amoxicillin, Omeprazole (or other PPI)
Quad therapy: Bismuth, Metronidazole, tetracycline, Omeprazole (or other PPI)

121
Q

Fluorescein staining reveals a dendritic lesion over the cornea. What is the most likely diagnosis based on this finding?

A

Herpes Keratitis

122
Q 
What is the dx?
Chvostek’s sign (facial muscle contraction)
Trousseau’s sign (carpopedal spasm)
Hyperreflexia
Prolonged QT interval
A

Hypocalcemia

123
Q

Which drug class should be avoided in Vasospastic angina?

A

Beta blockers

124
Q

CXR shows cephalization, Kerley B lines, and pleural effusion. What are you suspicious of?

A

CHF

125
Q

What is the standard pharmacologic tx of heart failure?

A

Loop diuretic, ACEI, and BB

126
Q

What are the stages of HTN?

A

Pre-HTN: 120/139/80-89
Stage I: 140-159/90-99
Stage II: >160/100

127
Q

What is first line tx for HTN?

A

ACEI/ARB
Thiazide diuretic
CCB

128
Q

What is the dx for HTN urgency and emergency?

A

HTN urgency: SBP >180 and/or DBP >120 WITHOUT evidence of end organ damage
HTN emergency: SBP >180 and/or DBP >120 WITH evidence of end organ damage

129
Q

What is the dx for orthostatic hypotension?

A

Hypotension within 2-5 minutes of quiet standing defined by at least a 20mmHg fall in systolic and/or 10mmHg fall in diastolic pressure

130
Q

What are the following called and what disease are they associated with?

  1. Painful violaceous nodules on pads of digits and palms)
  2. Painless erythematous macules on palms and soles)
  3. Linear reddish-brown lesions under the nail bed)
  4. Retinal hemorrhages with pale centers)
A

Endocarditis

  1. Osler nodes
  2. Janeway lesions
  3. Splinter hemorrhages
  4. Roth spots
131
Q

What is the tx of endocarditis with native valve?

A

PNC (Nafcillin, Oxacillin) + Ceftriaxone OR Gentamicin

132
Q

What is the tx of endocarditis with prosthetic valve?

A

Vancomycin + Gentamicin + Rifampin

133
Q

What is the tx of pericarditis?

A

NSAIDs (ibuprofen or Indomethacin) or ASA

Colchicine = 2nd line

134
Q

Name the arrhythmia:

prolonged PR interval (>.20s), all P waves followed by QRS complexes

A

1st degree AV Block

135
Q

Name the arrhythmia:

constant prolonged PR interval and dropped QRS complexes

A

2nd degree AV Block type 2

136
Q

Name the arrhythmia:

progressive PR interval lengthening followed by dropped QRS complex

A

2nd degree AV Block type 1

137
Q

Name the arrhythmia:

AV dissociation; regular P-P intervals and regular R-R interval, but they are not related to each other

A

3rd degree AV Block

138
Q

Name the arrhythmia:

irregularly irregular rhythm, no discernable P waves

A

Atrial fibrillation

139
Q

Name the arrhythmia:

Regular, narrow-complex tachycardia, no discernable P waves (MC)

A

Paroxysmal Supraventricular Tachycardia (PSVT)

140
Q 
Name the arrhythmia:
delta wave (slurred QRS upstroke), shortened PR interval, wide QRS complexes
A

Wolff-Parkinson-White (WPW)

141
Q

Name the arrhythmia:

inverted or absent P waves

A

AV Junction Dysrhythmias

142
Q

Name the arrhythmia:

regular wide complex tachycardia with no discernable P waves

A

Ventricular Tachycardia

143
Q

Harsh systolic crescendo-decrescendo murmur best heard at the right sternal border
Increased intensity: leaning forward, squatting, supine

A

Aortic Stenosis

144
Q

Blowing diastolic decrescendo murmur best heard at the left sternal border
Increased intensity: leaning forward, squatting, supine

A

Aortic Regurgitation

145
Q

What murmur radiates to the carotid?

A

Aortic Stenosis

146
Q

Rumbling mid-diastolic murmur with a prominent S1 and opening snap best heard at the apex
Increased intensity: left lateral decubitus position, leaning forward, squatting, supine

A

Mitral Stenosis

147
Q

Blowing holosystolic murmur best heard at the apex

Increased intensity: left lateral decubitus position, leaning forward, squatting, supine

A

Mitral Regurgitation

148
Q

Mid-late systolic ejection click best heard at the apex

A

Mitral Valve Prolapse (MVP)

149
Q

What murmur radiates to the axilla?

A

Mitral Regurgitation

150
Q

What causes an earlier MVP click?

A

Valsalva, standing

151
Q

What causes a delayed MVP click?

A

Leaning forward, squatting, supine

152
Q

Harsh mid-systolic crescendo-decrescendo murmur beast heard at left sternal border
Increased intensity: inspiration

A

Pulmonic Stenosis

153
Q

What is the tx of Acute Arterial Occlusion?

A

Consult vascular surgery for revascularization surgery
IV heparin bolus and continuous infusion
Once stable, Warfarin for 3+ months

154
Q

What is Virchow’s triad?

A

Venous statis
Endothelial damage
Hypercoagulability
(DVT)

155
Q

What is the dx?
Unilateral leg swelling > 3 cm
Palpable cord
Normal pulses

A

DVT

156
Q

What vascular disease has the follow leg pain?
Worse with walking/elevation
Improved with dependency/rest

A

Peripheral Artery Disease (PAD)

157
Q

What vascular disease has the follow leg pain?
Leg pain worse with dependency
Improved with walking/elevation

A

Chronic Venous Insufficiency

158
Q

What is the tx of Peripheral Artery Disease (PAD)

A

Exercise, smoking cessation

Cilostazol

159
Q

In which patients would a PPD reading of 5+ mm constitute a positive test?

A

HIV +
Immunocompromised
Exposure
CXR consistent with old TB (calcified granuloma)

160
Q

In which patients would a PPD reading of 10+ mm constitute a positive test?

A 
IVDU
Homeless
Age < 4 yo
Immigrant
Recent travel
161
Q

In which patients would a PPD reading of 15+ mm constitute a positive test?

A

everyone

162
Q

Where are you most likely to see cavitations in a patient with reactivated TB?

A

Apex/upper lobes

163
Q

What are SE of Rifampin?

A

Orange colored secretions, thrombocytopenia

164
Q

What are SE of Isoniazid?

A

Hepatitis, peripheral neuropathy

165
Q

What should be given with Isoniazid to prevent peripheral neuropathy?

A

Pyridoxine (vit B6)

166
Q

What are SE of Pyrazinamide?

A

Hepatitis, hyperuricemia, photosensitivity

167
Q

What are SE of Ethambutol?

A

Optic neuritis

168
Q

What is the tx of latent TB?

A

Isoniazid + Pyridoxine (vit B6) x9 months

169
Q

What is the most common primary lung cancer?

A

Adenocarcinoma

170
Q

Which type of lung cancer is typically peripherally located?

A

Adenocarcinoma

171
Q

Which type of lung cancer is aggressive and typically presents with early metastasis?

A

Small Cell (oat) carcinoma)

172
Q

Which lung cancers are classified as non-small cell cancer?

A

Adenocarcinoma, Large cell, Squamous cell

173
Q

GERD and Barret’s esophagus are RF for which type of esophageal cancer?

A

Adenocarcinoma (MC in Caucasians)

174
Q

What is the MCC of gastroenteritis in adults in the US?

A

Norovirus

175
Q

What type of gastroenteritis is MC in unimmunized children?

A

Rotavirus

176
Q

Which types of non-invasive infectious diarrhea have a short incubation period (within 6 hours)?

A

Staphylococcus aureus Gastroenteritis

Bacillus Cereus Gastroenteritis

177
Q

Which type of non-invasive infectious diarrhea is associated with dairy products?

A

Staphylococcus aureus Gastroenteritis

178
Q

Which type of non-invasive infectious diarrhea is associated with rice?

A

Bacillus Cereus Gastroenteritis

179
Q

Which type of non-invasive infectious diarrhea is associated with an exotoxin that causes secretory diarrhea leading to profound dehydration, and hypovolemia?

A

Vibrio Cholerae

180
Q

Which type of non-invasive infectious diarrhea is associated with copious watery diarrhea- “rice water diarrhea” (grey with flecks of mucous and fishy odor, no blood)?

A

Vibrio Cholerae

181
Q

What type of non-invasive infectious diarrhea is transmitted through raw or undercooked shellfish consumption and seawater?

A

Vibrio Parahaemolyticus and Vulnificus

182
Q

What are RF for C. diff?

A

Recent abx use (esp. Clindamycin)

Advanced age

183
Q

What is the tx of C. diff?

A

Discontinue offending medication
Contact precautions and hand hygiene (spore forming!)
Oral Vancomycin = 1st line

184
Q

What should never be given to pts with invasive infectious diarrhea?

A

Anti-motility agents

185
Q

What are the types of invasive infectious diarrhea?

A

“Bloody diarrhea doesn’t sound SEECSY”

-Salmonella (Typhoid fever), E. Coli, Entamoeba, Campylobacter, Shigella, Yersinia

186
Q

What type of invasive infectious diarrhea causes pea-soup green colored diarrhea?

A

Salmonella (Typhoid fever)

187
Q

What is the tx of Salmonella (Typhoid fever)?

A

Fluoroquinolones (Ciprofloxacin, Ofloxacin)

188
Q

What type of invasive infectious diarrhea commonly transmitted via undercooked ground beef?

A

Enterohemorrhagic E Coli 0157:H7

189
Q

What is the MCC of bacterial enteritis in the US?

A

Campylobacter jejuni

190
Q

How is Campylobacter jejuni transmitted?

A

Raw/undercooked poultry (MC), puppies are common source in children

191
Q

What is the tx of Campylobacter jejuni in severe/high risk pts?

A

Macrolides (Azithromycin)

192
Q

What type of gastroenteritis causes explosive watery diarrhea that progresses to mucoid and bloody diarrhea?

A

Shigella

193
Q

What is a common manifestation of shigella in children?

A

Neurologic manifestations (febrile seizures)

194
Q

What is the tx of Shigella in severe cases?

A

Fluoroquinolones (Ciprofloxacin, Ofloxacin)

195
Q

How is Yersinia Enterocolitica commonly transmitted?

A

Contaminated pork

196
Q

What is the tx of Yersinia Enterocolitica in severe cases?

A

Fluoroquinolones (Ciprofloxacin, Ofloxacin)

197
Q

What type of gastroenteritis causes frothy, greasy, foul smelling diarrhea without blood or pus? What is the tx?

A

Giardia

Metronidazole

198
Q

What type of gastroenteritis can have GI symptoms that range from mild diarrhea to severe dysentery and is associated with liver abscess?

A

Entamoeba Histolytica

199
Q

What is the tx of Entamoeba Histolytica?

  1. Colitis
  2. Liver abscess
  3. Asymptomatic
A
  1. Metronidazole, then intraluminal parasitic (Paromomycin)
  2. Metronidazole + intraluminal parasitic (Paromomycin), then Chloroquine
  3. Intraluminal agent monotherapy (Paromomycin)
200
Q

What are Charcots triad and reynods pentad?

A

Acute Ascending Cholangitis

Charcot’s triad: Fever, RUQ pain, jaundice
Reynolds pentad: Fever, RUQ pain, jaundice, AMS, hypotension

201
Q

What is the MCC of UGI bleed?

A

PUD

202
Q

Which types of hepatitis are transmitted via fecal-oral?

A

Hep A and E

203
Q

Which type of hepatitis is most likely to develop into chronic disease?

A

Hep C

204
Q

What do the following labs indicate?

(+) HBsAg, (+) IgG

A

Chronic Hep B infection

205
Q

What do the following labs indicate?

(+) Anti-HBs

A

Vaccinated against Hep B

206
Q

What do the following labs indicate?

(+) Anti-HBs, (+) IgG

A

Recovered Hep B infection

207
Q

What do the following labs indicate?

(+) HBsAg, (+) IgM

A

Acute Hep B infection

208
Q

How is acute Cholecystitis dx?

A

US = initial test of choice

HIDA scan is most accurate

209
Q

What are Cullen’s sign and Grey Turner Sign?

A

Cullen’s sign (periumbilical ecchymosis)

Grey Turner Sign (flank ecchymosis)

210
Q

What is the dx:
Constant boring epigastric pain, that radiates to the back, N/V, fever
Worse lying supine\o Improved with leaning forward

A

Acute pancreaitis

211
Q

What is the dx:
RUQ or epigastric pain, commonly precipitated by ingesting large, fatty meals
N/V, fever, enlarged gallbladder
Murphy’s sign and Boas sign

A

Acute Cholecystitis

Murphy’s sign = RUQ pain or inspiratory arrest with palpation of gallbladder
Boas sign = Referred pain to the right shoulder (irritation of phrenic nerve)

212
Q

What skin manifestation is associated with Celiacs disease?

A

Dermatitis herpetiformis

213
Q

What is the MCC of large and small bowel obstructions?

A 
SBO = post-surgical adhesions
LBO = malignancy (CRC)
214
Q

What is the dx?

Tearing, edema, erythema, warmth to the medial nasal side of lower lid

A

Dacryocystitis

215
Q

What is the dx?
Sudden onset of severe unilateral ocular pain, halos around lights, loss of peripheral vision (tunnel vision), mid-dilated fixed pupil

A

Acute Narrow Angle-Closure Glaucoma

216
Q

What is the dx?
Photopsia (flashing lights), followed by floaters, followed by painless unilateral peripheral vision loss
“Shadow or curtain coming down”

A

Retinal detachment

217
Q

What is the dx?
Bilateral progressive central vision loss (including detailed and colored vision), metamorphopsia (straight lines appear bent)
Drusen bodies

A

Macular degeneration

218
Q

What is the tx of AOM?

A

Amoxicillin

219
Q

What is the Centor criteria for Strep pharyngitis?

A

Absence of cough
Cervical LAD
Fever
Tonsillar exudates

220
Q

What is the tx of Strep pharyngitis?

A

PNC (Amoxicillin)

221
Q

What is the MCC of conductive hearing loss?

A

Otitis media

222
Q

What is the MC type of cervical cancer? What is the MC cause?

A

Squamous cell carcinoma

HPV 16

223
Q

What is the MC type of breast CA?

A

Infiltrative Ductal carcinoma

224
Q

What is the most effective emergency contraceptive?

A

Copper IUD (within 5-7 days)

225
Q

What are CI of OCP?

A

Ischemic heart disease
DVT/PE
Breast cancer
Smokers > 35 years old

226
Q

What should be done in all women >35 years with obesity, HTN, or DM who present with postmenopausal bleeding?

A

Endometrial biopsy to rule out endometrial carcinoma

227
Q

How is menopause dx?

A 
Cessation of menses > 1 year 
FSH assay (increased FSH, increased LH, decreased estrogen)
228
Q

How is PID dx?

A 
Must have abdominal tenderness, CMT, and adnexal tenderness, PLUS one of the following: 
Positive gram stain
Fever
WBC count >10,000
Increased ESR or CRP
229
Q

What is the dx?

Laparoscopy shows “violin string” adhesions on the anterior liver surface

A

Fitz Hugh-Curtis syndrome

230
Q 
What is the dx?
Copious thin, homogenous, grayish-white vaginal discharge
Vaginal pH > 4.5
Positive whiff-amine test (fishy odor)
Clue cells on wet mount
A

Bacterial Vaginosis

231
Q

What is the dx?

Copious frothy yellow green discharge with cervical petechiae (strawberry cervix)

A

Trichomoniasis

232
Q

What is a normal fetal HR?

A

120-160bpm (detected at 10-12 weeks by doppler)

233
Q

What should the fundal height be at 20 weeks gestation?

A

at the umbilicus

234
Q

What is Naegele’s rule?

A

Estimated date of delivery (EDD)

1st day of last menstrual period plus 7 days subtract 3 months

235
Q

What weeks are associated with 1st, 2nd, and 3rd trimesters?

A

1st: 1-12
2nd: 13-27
3rd: 28-birth

236
Q

When is screening completed for gestational DM?

A

24-28 weeks

237
Q

If mother is Rh-D negative when should RhoGAM be given?

A

28 weeks AND within 72 hours of delivery

238
Q

When should Group B Streptococcus screening be completed? What is the tx if positive?

A

36-38 weeks

Prophylactic IV PNC G given during labor

239
Q

In what part of the prostate does benign prostatic hyperplasia most commonly develop?

A

Transitional zone

240
Q

What is Virchows node?

A

Palpable left supraclavicular lymph node associated with gastric and pancreatic cancers

241
Q

What is Sister Mary Joseph sign?

A

Palpable nodule bulging into the umbilicusassociated with gastric and pancreatic cancers

242
Q

What is the preferred initial diagnostic test of choice to evaluate painless vaginal bleeding in a postmenopausal patient in order to rule out endometrial (uterine) carcinoma?

A 
Transvaginal US (or endometrial biopsy)
Measure endometrial thickness
Normal
Premenopausal = < 5 mm
Postmenopausal = < 3-4mm
243
Q

What does a dendritic pattern on fluorescein examination indicate?

A

Infection with the herpes simplex virus

244
Q

Patient presents with a erythematous, scaly plaque that is annular, has raised edges, sharply marginated, with a central clearing.
What is the tx?

A 
Tinea Corporis (Ring Worm)
Topical Clotrimazole
245
Q

What is the tx of ventricular tachycardia?

A

Procainamide, amiodarone, synchronized cardioversion (refractory)

246
Q

What is the dx?
Morning stiffness that lasts > 1 hour, improves later in the day in small joints (wrist, MCP, PIP, MTP, ankle), spares DIP
Ulnar deviation

A

Rheumatoid Arthritis (RA)

247
Q

What labs are seen with lupus?

A

ANA is screening test of choice but is not specific

Anti-double stranded DNA and anti-smith are pathognomonic and specific for SLE

248
Q

What is the tx of acute gout?

A

NSAIDs, steroids, Colchicine

249
Q

What is the tx for gout prophylaxis?

A

Allopurinol or Probenecid

250
Q

What triad is associated with Parkinson’s disease?

A

Resting tremor, bradykinesia, muscle rigidity

251
Q

What is the tx of Parkinson’s disease?

A 
Levodopa-Carbidopa = 1st line
Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole
252
Q

What is the dx?

Sudden onset of hyperacusis 24-48 hours followed by unilateral facial weakness/paralysis involving the forehead

A

Bell’s Palsy

253
Q

What is tx of Guillain Barre syndrome?

A

Plasmapheresis or IVIG

254
Q

What is the tx of Alzheimer dementia?

A 
ACh inhibitors (Donepezil, Rivastigmine, Galantamine)
NMDA antagonists (Memantine)

Family Medicine EOR (1 decks)

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