FM Shelf

Question 1

The earliest sign of diabetic nephropathy is what?

Answer 1

Microalbuminuria

This is defined as Albumin/Creatinine ratio greater than 30 mg/g

If a diabetic has either Albuminuria or HTN present, ACE/ARBs are indicated to slow progression of diabetic nephropathy

Question 2

What is the first sign of puberty in most girls? what age does it typically occur?

Answer 2

Unilateral, firm, tender mass posterior to the nipple – Thelarche (Development of breast bud)

Typically age 10 but as early as age 8

Breast growth is often asymmetric

Menarche typically begins 2ish years after that

Question 3

Foods that should be avoided in children under the age of 4?

Answer 3

Whole grapes, Raw vegetables, Peanuts, Popcorn

Remain rear facing in car seat until the age of 4 as well

Question 4

Purulent vs. Nonpurulent Cellulitis MC bugs?

Answer 4

Nonpurulent = S. Pyogenes

Purulent = S. Aureus

Flat, indistinct borders

Question 5

Screening for Pheochromocytoma vs. Diagnostic testing?

Answer 5

Screen Urine/Serum Metanephrines (Breakdown of Epi & NE)

If positive – Abdominal imaging required to confirm DX

Question 6

Fibromuscular Dysplasia MC presenting symptom?

HY clues?

DX & TX?

Answer 6

Recurrent HA caused by Carotid Artery Stenosis or aneurysm (Carotid Bruit)

HTN from Renal Artery Stenosis leads to secondary Hyperaldosteroneism

A subauricular systolic bruit is highly suggestive of FMD in any age patient

DX = Duplex ultrasound, CT, MRI

TX = ACE / ARB (1st line) & definitive management with Percutaneous Transluminal Angioplasty

Question 7

Lichen Planus HY association?

TX?

Answer 7

Associated with Hepatitis C

Topical Glucocorticoids (Betamethasone)

Drug-Induced LP (ACE, Thiazides) has a much more diffuse presentation than idiopathic LP (Wrist, Oral Mucosa, Genitalia)

Question 8

Potential complications of Sjogren syndrome?

Answer 8

Non-Hodkins lymphoma

Corneal Ulceration

Question 9

Acute bacterial Prostatitis presentation?

Answer 9

Patients appear acutely ill w/ Lower UTI sx

dx is generally confirmed with DRE showing markedly swollen & tender ANTERIOR prostate

Must obtain urine culture to establish organism

tx is typically 6 weeks of TMP-SMX or Fluoroquinolone (Levofloxacin)

Question 10

What are the 2 most non-pharmacologic interventions that decrease BP?

Answer 10

Weight loss

DASH diet

Question 11

Irritant contact diaper dermatitis vs. Candida diaper dermatitis?

Answer 11

Candida is much more beefy red & involves the skinfolds

TX for Candida dermatitis is Topical Antifungal (Nystatin)

TX for contact is a topical barrier (Petrolatum, Zinc Oxide)

Question 12

What is the only trimester you can use TMP-SMX in a pregnant patient?

Answer 12

2nd Trimester

Not in the 1st d/t disruption of folic acid metabolism

Not in the 3rd d/t risk of neonatal kernicterus

Fosfomycin you can use whenever

Question 13

Trachoma caused by which bug?

How does it present?

Answer 13

Caused by Chlamydia Trachomatis (A,B,C)

Look for Inflamed Tarsal Conjunctivae – Top of the eye

Chronic infection causes inversion of eyelashes (Trichiasis) & corneal scarring (blindness)

D-K is Genital

Question 14

Patients with symptomatic carotid atherosclerotic disease should undergo endarterectomy with what % of stenosis?

Answer 14

70 %

Question 15

Inciting event of Morton Neuroma?

Answer 15

MC seen in runners

Numbness / Pain in b/t the 3rd & 4th toes

Clicking sensation

Question 16

What are the cardioprotective diabetic drugs?

Answer 16

GLP-1 Receptor Agonists (Liraglutide)

SGLT-2 Inhibitors (Canagliflozin)

Question 17

MCL Injury happens with force to what side of knee?

Answer 17

Blow to the lateral knee (Out to in)

Appreciable laxity when the leg is forced into abduction (Valgus test)

MRI most sensitive

Question 18

When infectious diarrhea is prolonged more than 2 weeks, what is typically the cause?

Answer 18

Typically parasitic rather than bacterial or viral

i.e. infection w/ Entamoeba will result in destruction of intestinal mucosa, that causes colitis, & that colitis produces bloody or mucoid stool

PE = Abdominal tenderness – specifically RLQ d/t cecal inflammation

Question 19

What in the fuck is Hidradentitis Suppurativia? Risk factor?

Answer 19

Recurrent painful nodules w/ scarred plaques in the axillae

Keratinocyte proliferation & differentiation – Inflammatory occlusion of folliculopilosebaceous units

Strong risk factor = Tobacco use

Also can have a foul odor

Question 20

OCP contraindications?

Answer 20

Smokers, prior VTE, Uncontrolled HTN, active breast cancer, greater than 35 YO

Question 21

Ganglion cyst Pathophys, presentation, treatment?

Answer 21

Mucoid degeneration of periarticular tissue

Rubbery cystic nodule

Transillumination (+)

TX = Observation for asymptomatic cysts, can aspirate but associated w/ high degree of recurrence. Next step would be surgical excision

Question 22

Step-wise approach to treatment of Acne Vulgaris?

Answer 22

Start w/ Topical Retinoid (Tretinoin) + Benzyl Peroxide

If this ineffective – Topical Clindamycin

If acne exceeds face i.e. back – Oral Doxycycline can be used as well

Question 23

Seborrheic Dermatitis presentation?

Answer 23

MC in first year of life

MC in ages 30-60 thereafter

Associated w/ Parkinsons & HIV

Malassezia species are thought to play a role – Therefore TX w/ Topical antifungals (Ketoconazole & Selenium Sulfide) are effective

Question 24

Key features of Rosecea?

Answer 24

Constant facial erythema & flushing

Telangiectasias

Can lead to permanently flushed skin

Question 25

Clinical features of epididymitis?

Answer 25

**Posterior testicular swelling** & **tenderness** **PHREGN** SIGN = Tenderness **improves** w/ **elevation** of the testes **NORMAL Cremasteric reflex** < 35 = Gonorrhea & Chlamydia > 35 = E. Coli

Question 26

What the fuck is CSF Rhinorrhea? DX? TX?

Answer 26

**Unilateral Rhinorrhea** that **increases** at times of relatively **increased ICP** i.e. Straining / bending over Usually d/t **head trauma** DX = Testing the nasal discharge for **CSF specific proteins i.e. Beta-2-Transferrin & Beta-trace protein** TX = **Inpatient management** (elevate the head) to monitor for possible meningitis