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Family Med > FM Practice > Flashcards

FM Practice Flashcards

1
Q

Pt presents with swan neck deformity in the digits and a malar rash. What disorder should come to mind?

A

Systemic lupus erythematosus

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2
Q

Pt collapses choking on a piece of chewed up meat that results in complete airway obstruction is called

A

Cafe coronary syndrome

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3
Q

Name the prophylactic drugs for migraines

A

Propranolol, Verapamil (CCB), Amitriptyline (TCA), Valproate/Topiramate (anticonvulsants), Botulinum toxin (last line)

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4
Q

Name treatments for acute migraines

A

Dihydroergotamine, triptans, NSAIDs, acetaminophen, antiemetics

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5
Q

First line treatment for osteoarthritis

A

NSAIDs (oral)

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6
Q

Treatments for osteoarthritis

A

Oral/topical NSAIDs, topical capsaicin, duloxetine, intra-articular corticosteroid injections

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7
Q

First line treatment for a bacterial sinus infection

A

Amoxicillin or Augmentin (if resistance)

Allergy = doxy

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8
Q

What meds are CI for acid reflux during pregnancy?

A

Antacids with sodium bicarbonate (TUMs or rollaids) and Magnesium trisillicate

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9
Q

First line for mild to moderate Alzheimer’s

A

Cholinesterase inhibitors = rivastigmine, galantamine

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10
Q

What drug can be used as monotherapy in severe Alzheimer’s?

A

NMDA receptor antagonist = memantine

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11
Q

Most sensitive screening tool to diagnose hypothyroidism?

A

TSH assay

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12
Q

MC cause of primary hypothyroidism?

A

Hashimoto thyroiditis

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13
Q

47 y/o pt presents with lengthening and irregular periods with hot flashes

A

perimenopause

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14
Q

Most effective treatment for menopausal symptoms?

A

Estrogen

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15
Q

Female in menopause wants to treat her symptoms. What are her treatment options?

A 
Uterus = E2 + progesterone
Hysterectomy = E2 unopposed
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16
Q

Pt with menopause labs will show

A

Decreased E2 and elevated FSH

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17
Q

Ocular pain, eye lid swelling, erythema, pain with eye movement

A

Orbital cellulitis

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18
Q

How to dx and treat orbital cellulitis

A

CT scan and broad spectrum abx (vanc + piperacillin-tazobactam)

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19
Q

Difference between hordeolum and chalazion

A
  • hordeolum is a PAINFUL, erythematous stye or bump on eyelid eyelash line
  • chalazion is non-tender, non-erythematous bump on eyelid
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20
Q

Difference btw pterygium and pinguecula

A 
pterygium = triangular shaped tissue that extends into cornea from sclera that may interfere with vision
Pinguecula = yellowish elevated bump that does not extend over cornea
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21
Q

Janeway lesions vs osler nodes

A

Janeway = non-tender, erythematous macules/nodules on palms or soles of feet (tiny blood clots in capillaries)
Osler: Tender, palpable lesions (immune complexes)

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22
Q

Janeway lesions (non-tender), osler nodes (tender), and roth spots on the retina should all make you think of

A

Infective endocarditis

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23
Q

2 major diagnostic criteria for infective endocardititis

A
  1. Positive blood cultures for typical microorganisms (S. aureus, S. Viridans are MC)
  2. New murmur or finding on echo
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24
Q

Elevated FSH is most likely indicative of

A

premature ovarian failure

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25
Q

First line medications for PCOS pt trying to become pregnant?

A

Clomiphene, letrozole, metformin

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26
Q

MC non-small cell lung cancer

A

adenocarcinoma

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27
Q

72 y/o male presents with cough, chest pain, SOB, and bright red sputum. EKG is normal. What is most likely the diagnosis?

A

NSCLC = adenocarcinoma of the lung

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28
Q

Pt’s age 50-80 with 20 pack year smoking history should get what annually

A

Low dose helical CT of the chest

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29
Q

Rapid, abrupt decline in mental status over 2 days

A

Delirium

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30
Q

First line med for delirium

A

Haloperidol

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31
Q

What drug is CI in delirium

A

BZDs

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32
Q

What MUST be monitored when a pt is on allopurinol?

A

Creatinine bc it’s renally excreted

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33
Q

First line med for an acute gout flare up

A

NSAIDs and ice

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34
Q

What two drugs are CI in pts with gout and WHY?

A

ASA and loop & thiazide diuretics. Both increase uric acid reuptake

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35
Q

Treatment for acute gout other than NSAIDs

A

Triamcinolone injection, prednisone, colchicine

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36
Q

Long term goat therapy

A

Allopurinol or febuxostat

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37
Q

Episodic vertigo, sensorineural hearing loss, tinnitus should make you think of what disease

A

Meniere’s disease

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38
Q

Pt presents with aural fullness, sensorineural hearing loss, tinnitus, and episodic vertigo. What is the first line treatment

A

Low sodium diet

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39
Q

Medical treatment for meniere’s disease

A

Diuretics, betahistine (increases cochlear BF), prednisone, BZDs

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40
Q

What does the epley maneuver treat?

A

BPPV

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41
Q

Cobblestoning on colonoscopy indicates

A

Crohn’s disease; skipped areas of involvement throughout SI and LI is normal

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42
Q

Complication of crohn’s that involves other systems

A

Fistulas

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43
Q

Pt presents with non-bloody diarrhea, ASCA positive (antibodies), skip lesions on colonoscopy, cobblestoning mucosa, and transmural inflammation.

A

Crohn’s disease

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44
Q

Alcoholics are at risk for the 3 D’s. What are they and what causes them

A

Dermatitis, Diarrhea, Dementia (also death) from Pellagra = niacin deficiency

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45
Q

What is measured in the blood to determine niacin status

A

N-methylnicotinamide (this will be low in alcoholics)

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46
Q

What cells are seen on biopsy in pts with non-hodgkin’s lymphoma?

A

Reed-sternberg cells

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47
Q

What is recommended for women with non-hodgkin’s lymphoma once remission has been established?

A

Mammograms at 40y/o or 5-8 years after radiation

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48
Q

USPSTF recommends mammography for who?

A

Women biennially ages 50-75

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49
Q

Describe mammary Paget’s disease

A

Eczematous skin around nipple and areola. Rare breast cancer

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50
Q

MC type of breast cancer

A

Invasive ductal carcinoma

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51
Q

Diminished S1 with a holosystolic murmur best heard at the apex is a hallmark finding for

A

Mitral regurgitation

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52
Q

Listening at the RIGHT second intercostal space allows you to listen to the

A

Aortic valve

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53
Q

Listening at the lower left sternal border =

A

Tricuspid valve

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54
Q

Listening at left second intercostal space =

A

Pulmonic valve

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55
Q

High pitched diastolic murmur heard at R 2nd intercostal space

A

Aortic regurgitation

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56
Q

Pt presents with angina upon exertion, dyspnea, and a harsh systolic ejection murmur that radiates to the carotids best heard at the right 2nd intercostal space. What murmur is this?

A

Aortic stenosis

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57
Q

Rumbling diastolic murmur best heard in the left lateral decubitus position

A

Mitral stenosis

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58
Q

How do you know a kid swallowed a battery instead of a coin?

A

Double rim on x-ray

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59
Q

What FB should be emergently removed?

A

Batteries, magnets, sharp FB, FB that will not pass

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60
Q

Foreign bodies most commonly get lodged at what level

A

C6 > T4 > T11

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61
Q

Pt presents to the ED with blood in anterior chamber, unequal pupils, and decrease in vision. What do you do?

A

Emergency consult to opthalmology

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62
Q

What is ghost cell glaucoma?

A

Increased intraocular pressure from hyphema

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63
Q

isolated thrombocytopenia with platelets of primarily normal morphology would indicate what condition

A

Primary immune thrombocytopenia

64
Q

4 y/o pt presents with petechiae, gingival bleeding, epistaxis, and easy bruising. What is your first line treatment?

A

High dose corticosteroids for immune thrombocytopenia (or low dose with IVIG)

65
Q

No active or passive movement in the shoulder is called what and how do we treat it?

A

Adhesive capsulitis = frozen shoulder

Tx: corticosteroid injection

66
Q

What two endocrine disorders are thought to correlate with adhesive capsulitis?

A

Diabetes and hypothyroidism

67
Q

What might you see on MRI with adhesive capsulitis

A

Coracohumeral ligament thickening

68
Q

Fixed PR intervals with a dropped beat is referred to a

A

Mobitz type II; second degree heart block type II

69
Q

Lengthening PR intervals with a dropped beat

A

Second degree heart block type I; Wenkebach or Mobitz I

70
Q

PR interval >200ms is a

A

first degree heart block

71
Q

Pt presents with bulbar conjuntiva (erythema of sclera) and serous discharge. Dx?

A

VIRAL conjunctivitis. MC is adenovirus

72
Q

Somatic complaints are typical in depression (T/F)

A

T

73
Q

76 y/o male presents with swelling anterior to his ear. IT’s tender and there is purulent discharge coming from the Stenson’s duct. What is the first step in management

A

Hospitalize pt and start fluids and IV abx:
Nafcillin + metronidazole
OR
pipercillin/sulbactam

74
Q

Bilateral parotitis in a 12 y/o should make you think of

A

Mumps

75
Q

Pt presents with a CVA. She had an MI 2 months ago. What is contraindicated?

A

Fibrinolytics

76
Q

When can you give fibrinolytics to a pt with a CVA?

A

Onset <4.5 hrs ago

77
Q

Name 2 disorders associated with a spontaneous pneumothorax

A

Marfan’s syndrome and Homocystinuria

78
Q

Name the 3 biggest predictors of future bone fractures

A

Age, low bone mineral density, and previous fractures

79
Q

Name 3 treatments for hyperthyroidism

A

Propranolol, propylthiouracil, methimazole

80
Q

Pt presents with constipation, anorexia, polydypsia, nephrolithiasis, and hypercalcemia. What do you think is the diagnosis?

A

Hyperparathyroidism

81
Q

Episodic headache, sweating and tachycardia….what should you think of?

A

Pheochromocytoma

82
Q

What drug should be used to treat hyperthyroidism during pregnancy?

A

PTU

83
Q

What is the gold standard diagnostic study for PAD?

A

Angiogram. (CT angio)

84
Q

Pts that are 60y/o or older are held to what standard of systolic BP according to the JNC 8?

A

<150

85
Q

MC cause of pancreatitis

A

Gallstone related disease

86
Q

How elevated are pancreatic enzymes in acute pancreatitis?

A

3x the UL of normal

87
Q

Name 2 types of bruising associated with pancreatitis

A 
Grey Turner (flank)
Cullen's sign (umbilicus)
88
Q

Pt with a first degree relative with hx of colon cancer should get their first colonoscopy at age

A

40

89
Q

Initial therapy for anal fissure

A

Topical nifedipine or nitro

90
Q

BBs that do not carry a risk associated with glucose intolerance

A

Carvedilol and nebivolol

91
Q

Scrotal mass lateral to epigastric artery is an

A

Indirect inguinal hernia

92
Q

Scrotal mass medial to epigastric artery is a

A

direct inguinal hernia (directly BEHIND the inguinal ring)

93
Q

What type of hernia passes through the inguinal ring

A

Indirect

94
Q

MDs don’t LIe stands for

A 
Medial = direct
Lateral = indirect
95
Q

What OTC drug that is used often for pain relief is known to cause tinnitus?

A

NSAIDs

96
Q

Accumulation of bile salts in the liver is called

A

Cholestasis

97
Q

What is Charcot’s triad?

A

Jaundice, fever, and abd pain from cholangitis

98
Q

Gastric vs duodenal ulcer

A 
Gastric = early satiety
Duodenal = wakens pt at night, relieved with food
99
Q

Treatment for H. Pylori

A

Omeprazole 20mg BID
Clarithromycin 500mg BID
Amoxicillin 1000mg BID
x14 days

100
Q

The genetic tendency to develop allergic diseases =

A

Atopy

101
Q

Pt presents with daily headaches, pruritis after a warm shower, and elevated Hb and HCt. What is the diagnosis and treatment?

A

Polycythemia Vera.

Tx: Hydroxyurea, ASA, or phlebotomy

102
Q

What genetic mutation is associated with polycythemia vera

A

JAK2

103
Q

What do you see on blood smear with G6P deficiency?

A

Heinz bodies

104
Q

A black male presents with fatigue. CBC shows low RBC, Hb, and HCT. Coombs test is negative. What is the likely dx?

A

G6P deficiency = non-immune mediated hemolytic anemia

105
Q

Pt is positive for the Philadelphia chromosome. What is the most likely dx?

A

Chronic myeloid leukemia

106
Q

Pt presents with TGs >150mg/dL. What blood test should you run and why?

A

TSH. Increased risk for hereditary genetic syndromes

107
Q

Pt presents with BILATERAL hand/wrist pain that begins with MORNING STIFFNESS. There is swelling in the PROXIMAL joints. What is the dx and confirmation of the dx? Tx?

A

Rheumatoid arthritis.
Dx: Confirm with anti-cyclic citrullinated antibodies
Tx: Methotrexate

108
Q

What antigen is positive with reactive arthritis?

A

HLA-B27

109
Q

42 y/o woman comes in with sudden new onset chest pain. EKG is normal. Pain is reproducible when palpating area between sternum and ribs. Dx and Tx?

A

Costochondritis

Tx: NSAIDs. Poss corticosteroids.

110
Q

Treatment for acute prostatitis in pts < and > 30y/o

A

> 30 y/o: FQ: levofloxacin or ciprofloxacin for 4-6 weeks OR Bactrim x 28 days

<30y/o: Ceftriaxone and Doxycycline x14 days

111
Q

58 y/o male presents with dysuria, urinary frequency, and fever. On DRE, his prostate is tender and boggy. UA shows WBCs (pyuria) and bacteriuria. What is the MC pathogen of this dx?

A

E. Coli is the MC cause of acute prostatitis. If sexually active, could be gonorrhea or chlamydia (treat with ceftriaxone AND doxy)

112
Q

Alkaline phosphatase is a marker of what two things

A

Bone turnover and the biliary system

113
Q

Pt presents with moon facies, buffalo hump central obesity, and purple striae. How can you confirm your diagnoses? What is the tx?

A

Dx: Urinary free cortisol, dexamethasone suppression test, late night salivary control, or CRH stim test
Tx: Eliminate steroid exposure

114
Q

What cancer is associated with ACTH/cushings

A

Small cell lung cancer

115
Q

What are the 2 first line agents in CAD and/or hypercholesterolemia

A

Atorvastatin and Rosuvastatin

116
Q

Ludwig’s angina vs saliadenitis presentation

A

Drooling vs dry mouth

Bilateral vs unilateral chin swelling

117
Q

Causes of Saliadenitis

A

Viral: mumps, HIV
Bacterial: staph aureus
Autoimmune: Sjogren syndrome

118
Q

Tx of saliadenitis

A

Warm compresses, sialogogues

Dicloxacillin 500mg 4x daily for 7-10 days

119
Q

25 y/o female presents with dysuria, frequency, pain in suprapubic region. Denies CVA tenderness. UA is positive for cystitis. What are the first line treatments?

A

Nitrofurantoin or Bactrim

120
Q

What will be positive on UA to confirm cystitis?

A

Leukocyte esterase and nitrites

121
Q

What other virus coexists with Hep B?

A

Hep D

122
Q

Unstable A-fib first line therapy is

A

Cardioversion

123
Q

When should ablation be considered for a-fib?

A

Younger pts without valve disease, pts >65y/o, pts resistant to drug therapy

124
Q

First line drug therapy for a-fib

A

Diltiazem and metoprolol

125
Q

What level of cholesterol and LDL are risk factors for heart disease

A

Cholesterol >200

LDL >190

126
Q

At what age is a FH of MI a risk factor?

A

<55 y/o for males

<65 y/o in females

127
Q

What is the first line treatment for severe salmonella?

A

FQs: Ciprofloxacin or Levofloxacin 500mg BID x7day

128
Q

What is the sign on PE when evaluating cholecystitis?

A

Murphy’s sign = pain in RUQ

129
Q

First test and definitive test for cholecystitis

A

Ultrasound and then HIDA scan

130
Q

What is Mirizzi syndrome?

A

Common cystic duct blockage = compression of common bile duct = jaundice

131
Q

TB treatment regimen

A

2 mos rifampin, isoniazid, pyrazinamide, ethambutol followed by
4 months of rifampin and isoniazid

132
Q

What fibrate should NOT be used in conjunction with a statin due to rhabdomyolysis risk

A

Gemfibrozil

133
Q

What increases your risk of fibrocystic breasts?

A

Frequent alcohol consumption

134
Q

Shistocytes on blood smear indicates

A

Hemolysis

135
Q

Howell-jolly bodies on blood smear indicates

A

Sickle cell anemia

136
Q

Iron deficiency anemia will show what type of cells on blood smear

A

Hypochromic, microcytic RBCs

137
Q

Angular chelosis, koilonychia, fatigue, and ice chip cravings are all hallmark signs of

A

Iron deficiency anemia

138
Q

Decreased serum iron and ferritin levels along with INCREASED TIBC is consistent with

A

Iron deficiency anemia

139
Q

PID in a non-pregnant woman treatment

A

Ceftriaxone + Doxy + Metronidazole

140
Q

Bulls-eye lesion with central clearing should make you think (along with fatigue and muscle aches)

A

Lyme disease

141
Q

Pt presents with fever, HA, myalgias, and petechiae. What should you be thinking of

A

RMSF

142
Q

Treatment for lyme disease and RMSF

A

Doxy

143
Q

S3 is a sign of

A

systolic HF, a normal child, pregnant woman

144
Q

S4 is a sign of

A

diastolic HF and aortic stenosis

145
Q

Drusen, or yellow deposits around the macula, are found in

A

NON-exudative macular degeneration

146
Q

Chorodial Neovascularization and subretinal fluid/hemorrhage is found in

A

Exudative macular degeneration

147
Q

Exudative age-related macular degeneration should addressed ASAP because

A

It can lead to blindness in a few months

148
Q

MC cause of blindness in teh elderly

A

Macular degeneration

149
Q

Aortic stenosis leads to an

A

S2 split and audible 4th heart sound

150
Q

MC risk factor for testicular cancer? (seminoma)

A

Cryptorchidism

151
Q

Most common hematologic disorder associated with other previous hematologic disorders

A

AML

152
Q

Fatigue, persistent infection, petechiae, and auer rod cells on blood smear all indicate the pt has

A

Acute myeloid leukemia

153
Q

Pt’s <50 who are non-smokers with COPD should be considered for

A

Alpha-1 antitrypsin deficiency

154
Q

What are the 2 interventions that lead to decreased mortality in COPD pts

A

Smoking cessation

Oxygen

155
Q

Nikolsky’s sign

A

Sloughing of skin after being touched commonly seen in SJS

156
Q

SJS vs. Toxic epidermal necrolysis

A 
SJS = <10% of the body
Necrolysis = >30% of the body

Family Med (2 decks)

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