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Boards Basic > General Medicine > Flashcards

General Medicine Flashcards

1
Q

specificity

A

rule out a disease

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2
Q

sensitivity

A

rule in a disease

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3
Q

what happens to ppv and npv as prevalence increases

A

ppv increases and npv decreases

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4
Q

how does affect sensitivity and specificity

A

it doesn’t only predictive value

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5
Q

Influenza vaccine

A

Live attenuated, inactivated, recombinant

One dose annually (for all persons ≥18 y), including pregnant women and those with HIV infection

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6
Q

Tetanus, diphtheria, and pertussis

A

Inactivated, One dose Tdap, then Td booster every 10 y for all adults; one dose Tdap each pregnancy between 27 to 36 weeks’ gestation

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7
Q

Varicella

A

Live attenuated; For all immunocompetent persons lacking immunity

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8
Q

Herpes zoster

A

Recombinant

All nonimmunocompromised persons age ≥50 y, including those previously vaccinated with the inactivated vaccine

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9
Q

HPV

A

Inactivated; Women aged 19-26 y; men aged 11-21 y; men aged 22-26 y who are immunocompromised or who have sex with other men

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10
Q

MMR

A

Live attenuated

Adults born in 1957 or later without evidence of vaccination or immunity

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11
Q

Meningococcal (MenACWY)

A

Inactivated, First-year college students residing in dormitories, travelers to endemic areas, military recruits, and exposed persons; asplenia or complement deficiencies; boost
every 5 y if risk remains

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12
Q

Hepatitis A

A

Inactivated, Any adult requesting immunization and those at high risk

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13
Q

Hepatitis B

A

Inactivated, Any adult requesting immunization and those at high risk

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14
Q

PNA vaccine

Immunocompetent adults age ≥65

A

PCV 13
PCV 23, one year after 13
Revaccination after 5 years with PCV 23 only if vaccinated before 65

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15
Q

PNA vaccine in Immunocompetent persons with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking

A

PCV 23 only

Revaccination after 5 years with PCV 23 only if vaccinated before 65

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16
Q

PNA vaccine in Persons with functional (sickle cell disease, hemoglobinopathies) or anatomic asplenia

A

PCV 13
PCV 23
Revaccination after 5 years with PCV 23

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17
Q

PNA vaccine in Immunocompromised persons with HIV, chronic kidney disease, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, multiple myeloma, generalized malignancy, taking immunosuppressant drugs, congenital immunodeficiencies, solid organ transplant

A

PCV 13
PCV 23
Revaccination after 5 years with PCV 23

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18
Q

PNA vaccine in CSF leaks or cochlear implants

A

PCV 13

PCV 23, but no revaccination!

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19
Q

indication for asa therapy for primary prevention

A 
adults aged 50-59 years
• 10-year CVD risk ≥10%
• life expectancy ≥10 years
• no increased risk for bleeding
• willing to take low-dose aspirin daily ≥10 years
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20
Q

AAA screening

A

One-time abdominal ultrasonography in all men ages 65-75 y who have ever smoked;
selectively screen men ages 65-75 y who have never smoked

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21
Q

Depression screening

A

all adults

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22
Q

Diabetes mellitus screening

A

Ages 40-70 y who are overweight or obese as part of risk assessment for cardiovascular disease

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23
Q

Hypertension screening

A

All adults; obtain measurements outside of the clinical setting for diagnostic confirmation before
starting treatment

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24
Q

Lipid disorders screening

A

Universal lipid screening in adults aged 40-75 y as part of risk assessment for cardiovascular
disease

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25
Q

Osteoporosis screening

A

Women age ≥65 y; postmenopausal women <65 y of age when 10-year fracture risk is ≥9.3%

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26
Q

Chlamydia and gonorrhea screening

A

All sexually active women age ≤24 y; all sexually active older women at increased risk of infection

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27
Q

HCV screening

A

One-time screening for adults born from 1945-1965; all adults at high risk

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28
Q

HIV infection screening

A

One-time screening for all adults ages 15-65 y; at least annually for adults at high risk

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29
Q

Breast cancer screening

A

Biennial screening mammography for women ages 50-74 y; initiation of screening before age 50 y should be individualized

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30
Q

Cervical cancer screening

A

Women aged 21-65 y with cytology (Pap smear) every 3 y; in women aged 30-65 y who want to lengthen screening, screen with high-risk HPV testing (preferred) or cytology and high-risk HPV
testing every 5 y
Do not screen women following hysterectomy and cervix removal for benign disease.

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31
Q

Colon cancer screening

A

All adults aged 50-75 ya. USPSTF recommendations do not support one form of screening test
over another for detecting early stage colorectal cancer in average-risk patients. Available tests
include stool-based, direct visualization, and serology tests .

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32
Q

Lung cancer screening

A

Annual low-dose CT scan in high-risk patients (adults ages 55-80 y with a 30-pack-year smoking history, including former smokers who have quit in the last 15 y)

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33
Q

Prostate cancer

A

Men aged 55-69 y should make an informed decision about prostate cancer screening with their clinician. Routine screening for men ≥70 y is recommended against.

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34
Q

diagnosis: Postnasal drainage, frequent throat clearing, nasal
discharge, cobblestone appearance of the
oropharyngeal mucosa, or mucus dripping down
the oropharynx

A

Upper airway cough syndrome
-Tx with First-generation antihistamine-decongestant
combination or intranasal glucocorticoid

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35
Q

diagnose: Asthma, cough with exercise or exposure to cold

A

Cough-variant asthma

  • use methacholine or exercise challenge
  • standard asthma tx may take 6 months to take effect
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36
Q

Taking ACE inhibitor cough

A

ACE-inhibitor cough Stop ACE inhibitor, substitute ARB; takes approximately 1 month to respond

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37
Q

Normal chest x-ray findings, normal spirometry, and

negative methacholine challenge test w/ chronic cough

A

Possible nonasthmatic eosinophilic bronchitis
Diagnosis with Sputum induction or bronchial wash for eosinophils
Treat with inhaled glucocorticoids; avoid sensitizer

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38
Q

what is another term for chronic fatigue`

A

Systemic exertion intolerance disease

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39
Q

tx for SEID

A

no great tx but CBI and graded exercise can help

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40
Q

Dix hallpike findings in Peripheral vertigo

A 
Latency of nystagmus (lag time between
maneuver and onset of nystagmus)
2-40 s 
Duration of nystagmus 
<1min 
Severity of symptoms 
Severe
Fatigability (findings diminish with
repetition)
Yes
Direction of nystagmus
Horizontal with rotational component; never
vertical
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41
Q

Dix hallpike findings in central vertigo

A 
Latency of nystagmus (lag time between
maneuver and onset of nystagmus)-
None
Duration on Nystagmus - >1 min
 Severity of symptoms- Less severe
Fatigability- No
Direction of Nystagmus- Can be vertical, horizontal, or
torsional
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42
Q

BPPV findings

A 
Brief vertigo (10-30 s) and nausea associated with abrupt head movement (turning over in
bed). Treat with Epley maneuver (canalith repositioning procedure)
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43
Q

Vestibular neuronitis findings

A

Severe and longer lasting vertigo (days), nausea and often vomiting

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44
Q

Labyrinthitis findings

A

Similar to vestibular neuronitis but with hearing loss

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45
Q

Meniere disease triad

A

vertigo, hearing loss, tinnitus

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46
Q

acoustic neuroma findings

A

hearing loss, tinnitus, unsteadiness, facial nerve involvement

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47
Q

Restless legs syndrome characteristics

A

An uncomfortable or restless feeling in the legs most prominent at night and at rest, associated
with an urge to move and alleviated by movement
Look for iron deficiency

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48
Q

Periodic limb movement disorder characteristics

A

Repetitive stereotypic leg movement during sleep and during quiet wakefulness

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49
Q

Central sleep apnea syndrome characteristics

A

Repetitive pauses in breathing during sleep without upper airway occlusion
Associated history of HF or CNS disease

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50
Q

Obstructive sleep apnea syndrome characteristics

A

Upper airway obstruction during inspiration in sleep

History of snoring, witnessed pauses in respiration, large shirt collar size, and daytime sleepiness

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51
Q

Shift-work sleep disorder characteristics

A

Shift-work sleep disorder History of insomnia associated with shift work (permanent night shifts)

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52
Q

Sleep deprivation characteristics

A

Six hours or less of sleep is associated with daytime sleepiness and performance deficits

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53
Q

Narcolepsy characteristics

A

Daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently
coexisting with other sleep disorder

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54
Q

Tx for insomnia

A

• CBT (first-line therapy)
• sleep hygiene practices (regular bedtimes and waking times; spending no more than 8 hours in bed; using bed only for
sleep)
• avoiding caffeine, nicotine, alcohol, and electronic devices before sleep
• melatonin for short-term insomnia resulting from travel or shift work

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55
Q

tx for restless leg

A 
dopaminergic agents (pramipexole or ropinirole) or with levodopa-carbidopa.
Give FeS if ferritin <75
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56
Q

diagnose patient with A prodrome of nausea, diaphoresis, pallor, and brief loss of consciousness (<1 min) with rapid recovery and absence of postsyncopal confusion

A

vasovagal

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57
Q

diagnose patient with syncope preceding pressure on the carotid sinus (tight collar, sudden turning of head)

A

carotid sinus hypersensitivity

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58
Q

diagnose patient with syncope and association with specific activities (urination, cough, swallowing, defecation)

A

situational syncope

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59
Q

diagnose syncope with Brainstem neurologic signs and symptoms

A

Posterior circulation vascular disease; consider subclavian steal syndrome if preceded by upper extremity exercise

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60
Q

diagnose syncope Related to exercise or associated with angina

A

Obstruction to LV outflow: AS, HCM; also PE and PH

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61
Q

diagnose syncope Syncope with sudden loss of consciousness without prodrome

A

Arrhythmia, sinoatrial and AV node dysfunction (ischemic heart disease and associated
with use of β-blockers, calcium channel blockers, and antiarrhythmic drugs)

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62
Q

diagnose syncope after eating a meal

A

Postprandial syncope, often in older adult patients

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63
Q

what are some test you should not order when patient has syncope

A

EP study (Rarely helpful and almost always the incorrect answer), carotid vasc studies, brain imagine, cardiac enzymes and EEG

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64
Q

what is Olecranon bursitis

A

inflammation of a bursa that lies in the posterior aspect of the elbow and presents as a fluid-filled mass

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65
Q

PE distingishing character of olecranon bursitis

A

does not cause restriction or pain with range of motion of the elbow whereas joint pathology will cause pain and restricted movement.

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66
Q

tx of olecranon bursitis

A

Aspirate a bursa if tender or warm to analyze fluid for crystals and infection. NSAIDs and rest (if noninfectious) are first-line
treatments.

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67
Q

how is lateral epicondylitis caused

A

caused by overuse that involves

pronation and supination with the wrist flexed.

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68
Q

tx for lateral epicondylitis

A

stretching and strengthening exercises and avoidance of activities that cause pain. Braces may be useful when exacerbating activities cannot be avoided. Oral and topical NSAIDs provide
short-term relief. Do not inject glucocorticoids.

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69
Q

red flags of cauda equina syndrome

A
  • urinary retention or incontinence
  • diminished perineal sensation
  • bilateral motor deficits
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70
Q

signs of herniated disc

A
  • radiation down leg
  • positive straight leg raising
    • weakness of the ankle and great toe dorsiflexion (L5)
    • loss of ankle reflexes (S1)
    • less commonly, loss of knee reflex (L4)
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71
Q

spinal stenosis characterized as

A

neurogenic claudication—radiating back pain and lower extremity numbness—that is exacerbated by
walking and spinal extension but improved by sitting and leaning forward. A widebased gait and/or abnormal Romberg test are highly specific (>90%) for spinal stenosis. MRI establishes the diagnosis.

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72
Q

best tx for sciatica

A

conservative tx

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73
Q

Neoplastic epidural spinal cord compression treatment

A

a surgical emergency. Begin management by administering dexamethasone and obtaining immediate MRI of the entire spine

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74
Q

PE for patellafemoral syndrome

A

firmly compressing the patella against the femur and moving it up and down along the groove of the femur, reproducing
pain.

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75
Q

Prepatellar bursitis

A

h anterior knee pain and swelling anterior to the patella and is often caused by trauma or
repetitive kneeling. Perform a joint aspiration to rule out infection if warmth and erythema are present.

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76
Q

Anserine bursitis

A

knee pain that is worse with activity and at night. The anserine bursa is located medially about 6
cm below the joint line. Anserine bursitis is common in patients with OA.

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77
Q

tx for bursitis

A
  • rest
  • ice
  • NSAIDs
  • local glucocorticoid injection for persistent symptoms
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78
Q

Iliotibial band syndrome

A

knife-like lateral knee pain that occurs with vigorous flexion-extension activities of the knee (running

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79
Q

where is tenderness on meniscus injury

A

Tenderness usually localizes to the joint line on the affected side and with tibial rotation as the leg is extended

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80
Q

when do you do surgery on meniscus

A

Surgery for acute meniscal tears is reserved for

mechanical symptoms that persist beyond 4 weeks

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81
Q

greater trochanter pain syndrome

A

characterized by lateral point tenderness and full range of motion except for painful
resisted abduction.

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82
Q

risk factors for osteonecrosis of the hip

A

alcoholism, sickle cell disease, SLE, and prolonged glucocorticoid use.

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83
Q

early vs late diagnosis of osteonecrosis

A

Diagnose early osteonecrosis with hip MRI. Advanced disease will show flattening of the femoral head on x-ray.

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84
Q

when to get ankle xray

A

cannot bear weight or if bone pain is localized to the

lateral or medial malleolus, base of the fifth metatarsal, or the navicular bone

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85
Q

what is mortons neuroma

A

pain, numbness, and tingling in the forefoot, usually between the third and fourth
toes, aggravated by walking on hard surfaces and wearing tight
or high-heeled shoes.

86
Q

dequervian tenosinovitis

A

young women with pain on the radial side of the wrist during pinch grasping or thumb and wrist movement

87
Q

finkelstein test

A

Pain elicited by flexing the thumb into the palm, closing the fingers over the thumb, and
then bending the wrist in the ulnar direction is confirmatory

88
Q

what are secondary causes of carpal tunnel syndrome

A

hypothyroidism, diabetes mellitus, pregnancy, paraproteinemias, and RA of the wrist.

89
Q

Shoulder pain with overhead reach, limited rom without weakness likely

A

tendonitis

90
Q

shoulder pain with significant weakness

A

rotator cuff tear

91
Q

Severe shoulder pain and frank weakness (inability to maintain the arm at 90 degrees of abduction)

A

complete rotator cuff rupture

92
Q

s lateral deltoid pain that is aggravated by reaching suggests

A

impingement syndrome

93
Q

impingement pain pattern accompanied by stiffness and loss of active and passive external rotation or abduction suggests

A

frozen shoulder

94
Q

what is localized to the distal end of the clavicle and is most pronounced when the patient reaches
across the body to the opposite shoulder.

A

Acromioclavicular joint pain

95
Q

aggravated by any shoulder movement. Pain owing to biceps tendinitis is aggravated by lifting and
wrist supination.

A

Glenohumeral joint pain

96
Q

Bicep tendon rupture

A

traumatic event but may be spontaneous and presents with a visible or palpable
mass near the elbow or mid arm (“Popeye sign”) and ecchymosis

97
Q

immediate indication for surgery in shoulder injury

A

acute full-thickness tear in

younger patients

98
Q

Constant shoulder pain with normal shoulder examination

suggest

A 
referred pain (e.g., Pancoast tumor) or neuropathic
pain (e.g., cervical spine radiculopathy
99
Q

ACC indication for starting statin

A
  1. patients with clinical ASCVD,
  2. patients with an LDL cholesterol level of 190 mg/dL or higher,
  3. patients with diabetes mellitus who are aged 40 to 75 years with an LDL cholesterol level of 70 to 189 mg/dL and no clinical
    ASCVD, and
  4. patients without clinical ASCVD or diabetes and an LDL cholesterol level of 70 to 189 mg/dL and estimated 10-year
    ASCVD risk of 7.5% or higher
100
Q

lab studies when starting statin

A
  • baseline fasting lipid panel ALT level

* monitor ALT and CK only if a patient develops symptoms of hepatic or muscle disease

101
Q

complications of weight loss banding procedures

A

Intractable nausea and vomiting

Marginal ulcers, stomal obstruction

102
Q

gastric bypass complications (7)

A 
Stomal stenosis
Cholelithiasis
Nephrolithiasis
Dumping syndrome
Anatomic stricture or ulceration
Bacterial overgrowth
Micronutrient deficiencies: folate; vitamins B1, B6, B12, C, A, D, E, and K; iron; zinc; selenium; and copper
103
Q

sleeve gastrectomy complications

A

Staple-line bleeding, stenosis (dysphagia and vomiting), and staple-line leakage

104
Q

lab findings in adrogen steroid abuse

A

elevated hemoglobin and suppressed LH and FSH levels.

105
Q

contraindications for PDE5

A

nitrate therapy in any form and in men with a history of nonarteritic anterior ischemic optic neuropathy. They should be used with caution in men taking α-blockers

106
Q

alternative medication when pde5 ins contraindicated

A

Intraurethral or intracavernous alprostadil

107
Q

medication that can tackle both bph and ED

A

tadalafil

108
Q

indication for Transurethral resection of the prostate or transurethral needle ablation

A

severe urinary symptoms,

urinary retention, persistent hematuria, recurrent UTIs, or kidney disease clearly attributable to BPH

109
Q

symptoms of testicular torsion

A

Absence of the cremasteric reflex on
the affected side is nearly 99% sensitive for torsion. The testis is usually high within the scrotum and may lie transversely. Doppler
flow ultrasonography demonstrates diminished blood flow to the affected testicle. Testicular elevation will not relieve pain.

110
Q

epididymitis pain location

A

posterior and superior aspects of the testicle

111
Q

how can you differentiate epididymitis from torsion

A

in epididymitis . Pain may decrease with testicular elevatio

112
Q

US finding in orchitis and epididymitis

A

normal or increased blood flow to the testicle

and epididymis.

113
Q

orchitis character

A 
viral infection (mumps) or extension of a bacterial infection from epididymitis or UTI. The testicle
is diffusely tender.
114
Q

tx of epididymotis >35 vs < 35

A

n men younger than 35 years with epididymitis, treat with ceftriaxone and doxycycline.
In men older than 35 years or those engaging in anal intercourse, treat with ceftriaxone and a fluoroquinolone

115
Q

tx for prostitis

A

trimethoprim-sulfamethoxazole or fluoroquinolone for 4 to 6 weeks. For patients who appear toxic, hospitalize and add gentamicin to a fluoroquinolone.

116
Q

which women are candidate for breast cancer prophylaxis

A

Women age >35 years

with a 5-year breast cancer risk of ≥1.7% or with lobular carcinoma in situ

117
Q

breast cancer prophylaxis

A
  • tamoxifen before menopause

* tamoxifen and raloxifene, or exemestane after menopause

118
Q

when to test for BRCA gene

A

(one or more first-degree relatives on the same side ≤50 years with breast cancer or invasive ovarian cancer; two
or more relatives at any age with breast, prostate, or pancreatic cancer

119
Q

screening recs when patient has BRCA gene

A
  • breast cancer screening with MRI beginning at age 25 years, then mammography beginning at age 30 years
  • ovarian cancer screening with pelvic examinations, ultrasonography, and CA-125 measurement
120
Q

breast cancer screening guideline USPFTF

A

biennial screening mammography

for average-risk women beginning at age 50 years

121
Q

work up for breast lump in women < 30
Simple cyst
complex cyst

A
  1. Consider observation to assess resolution within 1 or 2 menstrual cycles
  2. If persistent, choose ultrasonography
  3. If simple cyst on ultrasound, aspirate and repeat clinical breast examination in 4-6 weeks

If complex cyst on ultrasound, perform mammography and fine-needle aspiration or
core-needle biopsy

If aspirate fluid is bloody or a mass persists following aspiration, choose mammography and biopsy

If solid on ultrasound, choose mammography and obtain tissue diagnosis

122
Q

work up for Palpable breast lump or mass and age ≥30 years

A

Mammography: If BI-RADS category 1-3 (benign or close follow-up recommended),
obtain ultrasonography and follow protocol above; if BI-RADS category 4-5
(suspicious or highly suspicious), obtain tissue diagnosis

123
Q

work up for breast skin changes < 30

A

think mastitis and tx with abx and clinical observation for 2 w if not improved consider work up if >30yo

124
Q

work up for breast skin changes >30yo

A

Perform bilateral mammography: If normal, obtain skin biopsy; if abnormal or indeterminate, obtain needle biopsy or excision (also consider skin punch biopsy)

125
Q

cervical cancer screening

A

21 to 65 years with cytology (Pap test) every 3 years. The screening interval can be increased to every 5 years in women aged 30 to 65 years by either performing high-risk HPV testing (preferred) or combining cytology and high-risk HPV testing

126
Q

contraindications for combination ocps

A 
• uncontrolled hypertension
 • breastcancer
• VTE
• liverdisease
• migraine with aura
>35yo and smokes >15 cigs
127
Q

emergency birth control options

A
  • over-the-counter levonorgestrel

* prescription ulipristal

128
Q

When can you use systemic hormone therapy in menopause

A

healthy women <60yo and within 10 years of menopause

129
Q

systemic hormone therapy for women with intact uterus should include

A

progesterone

130
Q

how to treat postmenopausal vaginal symptoms

A

vaginal lubricants or topical estrogen

131
Q

treatment with systemic hormone therapy in women >5 yrs is associated with

A

increase risk of breast ca

132
Q

ovulatory causes of abnormal uterine bleeding

A
  • thyroid disease
  • bleeding disorder
  • structural abnormalities (uterine fibroids or polyps)
133
Q

what is anovulatory bleeding

A

irregular in terms of flow and cycle duration because lack of ovulation and the resultant lack of cyclic progesterone cause endometrial hyperplasia and irregular bleeding.

134
Q

what are causes of anovulatory bleeding

A
  • PCOS
  • hypothyroidism or hyperthyroidism
  • hyperprolactinemia
  • chronic liver or kidney disease
  • medications (antidepressants, antipsychotics, chemotherapy)
135
Q

for postmenopausal patient with abnormal uterine bleed what endometrial thickness indicates biopsy

A

> 4mm

136
Q

treatment of ovulatory abnormal bleeding

A

tx endocrine causes

or surgical re sect structural abnormalities

137
Q

tx of anovulatory abnormal bleeding

A
  • for women who wish to preserve fertility
    medroxyprogesterone acetate used for the second half of the menstrual cycle
  • for women who do not wish to preserve fertility
  • combination ocp
  • levonorgestrel iud
138
Q

is all postmenopausal bleeding abnormal

A

yes

139
Q

if you see Pelvic heaviness, abnormal uterine bleeding, infertility, and enlarged uterus on bimanual examination or ultrasonography think

A

uterine fibroids

140
Q

if you see Chronic pelvic pain worse before and during menses, associated with dysmenorrhea think

A

Endometriosis

141
Q

if you see pelvic pain and History of sexual abuse and normal physical examination and ultrasonography think

A

chronic pelvic pain syndrome

142
Q

if you see Urinary frequency, urgency, nocturia, and dysuria; suprapubic pain possibly relieved with voiding; and examination that shows vestibular and suprapubic tenderness think

A

Interstitial cystitis

143
Q

testing for chronic pelvic pain

A

pregnancy and pelvic/transvag us

144
Q

how to diagnose endometriosis

A

lesions can be visualized by laparoscopy, the gold standard for diagnosis, but is not required for medical therapy if other causes have been ruled out

145
Q

tx for endometriosis

A

nsaids then ocp if nsaids are ineffective

146
Q

bacterial vaginoisis PE, pH, whiff test, microscopic and other tests

A

PE: Thin, white discharge with “fishy” odor but without irritation or pain
pH:>4.5
whiff test + after KoH
microscope: squamous epithelial cells covered with bacteria that obscure edges (“clue cells”)
other test: nucleic acid test available but not gold standard

147
Q

candida vaginitis PE, pH, whiff test, microscopic

A

PE: External and internal erythema with itching and irritation; nonodorous; white, curd-like discharge

pH: <4.5
Whiff: negative
Microscope: Budding yeast and pseudohyphae

148
Q

trichimoniasis PE, pH, whiff test, microscopic and other tests

A 
PE: Frothy, yellow discharge; erythema of the vagina and cervix (“strawberry cervix”)
pH: >4.5
Whiff: negative
microscope: motile trichomonads
other test: NAAT Gold standard
149
Q

bacterial vagninosis tx

A

Oral or topical metronidazole or clindamycin (safe during pregnancy)

150
Q

vaginal candidiasis tx

A

Topical (e.g., fluconazole, miconazole, clotrimazole)
Single dose of oral fluconazole (contraindicated during pregnancy); less effective in complicated conditions (e.g., diabetes, HIV infection)

combination if recurrent

151
Q

trich tx

A

Oral metronidazole and also for male partner (safe during pregnancy). Test for other STIs. Retest within 3 months of treatment.

152
Q

If you see Unilateral then bilateral purulent discharge without pain or visual disturbance think and tx

A

DX: Bacterial conjunctivitis
Tx: Topical fluoroquinolones or bacitracin-polymyxin; culture not needed

153
Q

if you see Conjunctivitis associated with herpes zoster rash think and tx

A

Dx Herpes zoster

Tx Emergency ophthalmology referral involving ophthalmic division of fifth cranial nerve conjunctivitis

154
Q

if you see Unilateral then bilateral conjunctivitis with daytime think and tx

A

dx Viral conjunctivitis

tx Supportive care watery or mucoid discharge

155
Q

if you see Itching and tearing of the eyes, nasal congestion think and tx

A

dx Allergic conjunctivitis

Tx Topical vasoconstrictors, NSAIDs, ocular antihistamines, cromolyn

156
Q

if you see Pain, photophobia, inflammation confined to corneal limbus, corneal irregularity, edema think and tx

A

dx: Iridocyclitis or keratitis Consider associated spondyloarthropathies, sarcoidosis, and herpes zoster;

tx: emergency
ophthalmology referral

157
Q

if you see Unilateral deep ocular pain, nausea, vomiting, fixed nonreactive pupil, shallow anterior chamber think and tx

A

dx: Acute angle-closure
glaucoma

Tx:Emergency ophthalmology referral

158
Q

if you see Severe ocular pain that worsens with eye movement and light exposure; a raised hyperemic lesion that may be
localized or diffuse and obscures the underlying vasculature think and tx

A

dx Scleritis Commonly associated with collagen vascular and rheumatoid diseases;
tx emergency ophthalmology
referral

159
Q

if you see Nonpainful red, flat, superficial lesion that allows visualization of the underlying vasculature

A

Dx: Episcleritis
Tx: Self-limited; no treatment required

160
Q

If you see Red eye with scales and crusts around the eyelashes or dandruff-like skin changes and greasy scales around the eyelashes think and tx

A

dx; Blepharitis Staphylococcus (crusting) or seborrheic dermatitis (greasy scales, dandruff);
tx warm compresses, washing with mild detergent, topical antibiotics

161
Q

dry and wet age related macular degeneration

A

dry: deposition of extracellular material (drusen) in the macular region of one or both eyes and may cause
diminished visual acuity
wet: dry AMD will progress to develop new vessel growth under the retina (wet AMD).

162
Q

retinal detachment symptoms

A

Symptoms are floaters, flashes of light (photopsias), and squiggly lines, followed by a sudden, peripheral visual field defect that resembles a black curtain and progresses across the entire visual field.
eye emergency

163
Q

central retinal artery occlusion cause by and symptoms

A

thrombi or emboli. Patients are usually elderly and present with profound and sudden painless vision loss.

164
Q

CRAO exam and tx

A

Funduscopic examination reveals an afferent pupillary defect and cherry red fovea that is accentuated by a pale retinal background. Treatment may include measures to lower the intraocular pressure and emergent ophthalmology consultation.

165
Q

CRVO cause and symptoms

A

thrombus, with sudden, painless, unilateral visual loss.

166
Q

crvo exam and tx

A

Funduscopic examination may reveal afferent pupillary defect, congested retinal veins, scattered retinal hemorrhages, and cotton wool spots in the region of occlusion. Immediate ophthalmologic consultation is necessary

167
Q

conductive hearing loss weber and rhinne and causes

A

Weber: Louder in the affected ear
rhinne :Decreased in the affected ear (bone conduction > air conduction)
causes: Cerumen impaction, foreign body,
otitis media, otosclerosis

168
Q

sensorineuro hearing loss weber rhinne and causes

A

weber:Louder in the good ear
rhinne: As loud or louder in the affected ear
(air conduction > bone conduction)
causes: Presbyacusis, Meniere disease,
acoustic neuroma, sudden
sensorineural hearing loss

169
Q

ramsey hunt syndrome

A

caused by varicella-zoster viral
infection and characterized by facial nerve paralysis, sensorineural hearing loss, and vesicular lesions on and in the ear canal

170
Q

what is malignant otitis externa

A

systemic toxicity and evidence of infection spread beyond the ear canal (mastoid bone, cellulitis) and is typically found in older adult patients with type 2 diabetes or patients who are immunocompromised. Most commonly caused by Pseudomonas aeruginosa.

171
Q

bacterial sinusitis signs

A
  • persistent symptoms (lasting >10 days)
  • severe symptoms or fever (lasting 3-4 days)
  • “double-sickness” characterized by worsening symptoms following a period of improvement over 3 to 4 days
172
Q

first line choice for sinusitis

A

augmentin or doxy if allergy not zpack

173
Q

centor criteria

A
  • fever (subjective)
  • absence of cough
  • tender anterior cervical lymphadenopathy
  • tonsillar exudates
174
Q

Management is based on the number of Centor criteria present:

A
  • <3: neither test nor treat with antibiotics

* ≥3: obtain a rapid antigen detection test (RADT); management is based on results

175
Q

what should you consider with severe pharyngitis and usually prolonged symptoms with negative RADT in adolescents and young adults

A

Fusobacterium necrophorum

176
Q

what is Lemirre syndrome

A

septic thrombophlebitis of the internal jugular vein resulting in metastatic pulmonary infections.

177
Q

tx for strep throat and fusobacterium

A

Select oral penicillin for 10 days. Choose a macrolide for patients allergic to penicillin. F. necrophorum is treated with ampicillin-sulbactam.

178
Q

duration of tx for first episode of depression

A

Initiate treatment and continue at the dosage required to achieve remission for an additional 4-9 months

179
Q

duration of tx for first recurrence

A

Increase maintenance treatment to one to two times the inter-episode interval (for example, choose 18-36 months if the second episode occurs
18 months after the first episode)

180
Q

Three or more recurrences of depression, recurrence

within 1 year of successful treatment, or suicide attempt

A

life time maintenance therapy

181
Q

serotonin syndrome signs for mild and severe diseases

A

Mild symptoms include nausea, vomiting, flushing,

and diaphoresis. Severe symptoms include hyperreflexia, myoclonus, muscular rigidity, and hyperthermia.

182
Q

drugs associated with serotonin syndrome

A

SSRIs, MAOIs, St. John’s

wort, trazodone, dextromethorphan, linezolid, tramadol, or buspirone

183
Q

Conditions which mimics bipolar syndrome

A

thyrotoxicosis, partial-complex seizures, SLE, and glucocorticoid side effects.

184
Q

what would giving ssri as monotherapy to a bipolar patient do

A

can unmask mania in patients with untreated bipolar disorder.

185
Q

Diagnostic criteria for somatic symptom disorder

A
  • at least one somatic symptom causing distress or interference with daily life
  • excessive thoughts, behaviors, and feelings related to the somatic symptom(s)
  • persistent somatic symptoms for at least 6 months
186
Q

diagnose when a patient adopts a physical symptom for the purpose of gain

A

malingering

187
Q

what to think if a patient adopts symptoms to remain in the sick role

A

factitious disorder

188
Q

what to think if a patient has abnormal sensation or motor function (such as limb weakness) that is not
explained by a medical condition and is inconsistent with physical examination findings.

A

conversion disorder

189
Q

what to think if the patient has excessive worry about general health and preoccupation with health-related activities

A

illness anxiety disorder (previously hypochondriasis)

190
Q

tx for anorexia vs bulemia

A

For anorexia nervosa, CBT is considered first-line treatment. Psychotropic drugs do not work.

Patients with bulimia respond to CBT and antidepressants (fluoxetine or imipramine).

191
Q

bulemia complication symptoms

A

normal weight

acid-induced dental disease, esophageal tears, electrolyte derangements (low chloride and potassium), and metabolic alkalosis.

192
Q

incontinence type: Daytime frequency, nocturia, bothersome urgency

A

Urge incontinence

193
Q

incontinence type Involuntary release of urine secondary to effort or exertion (sneezing, coughing, physical exertion)

A

Stress incontinence

194
Q

incontinence type Urgency and involuntary release of urine

A

mixed incontinence

195
Q

incontinence type: Unable to get to bathroom on time because of mental or physical limitations

A

functional incontinence

196
Q

Incontinence type Nearly constant dribbling of urine, incomplete
emptying of bladder, high postvoiding residual urine

A

overflow incontinence

197
Q

Urge incontinence tx

A

First-line therapy is bladder training; second-line
therapy is anticholinergic drugs (oxybutynin,
tolterodine)

198
Q

Stress incontinence tx

A

First-line therapy is pelvic floor muscle training for

women (Kegel exercises)

199
Q 
Mixed incontinence (urge
and stress incontinence) tx
A

Bladder training and pelvic floor muscle training

200
Q

Functional incontinence tx

A

Portable commode, regular prompted urination with
physical assistance to commode, treatment of
underlying disorders

201
Q

Overflow incontinence tx

A

Timed urination, intermittent bladder catheterization

202
Q

who should undergo pre-op pharmacologic stress testing

A

Patients with an elevated risk of a major adverse cardiac event ≥1% and an estimated functional capacity of <4 METs should
undergo pharmacologic stress testing if the results will change management

203
Q

other activities that equal >4 METS

A 
climbing a flight of stairs
• walking up a hill without stopping
• running a short distance
• lifting or moving heavy furniture
• participating in moderate-exertion sporting activities such as bowling or golf
204
Q

order a pre-op ekg in which patients

A

CAD
• significant arrhythmias
• cerebrovascular disease (stroke or TIA)
• PAD

Likely not needed for low risk surgeries

205
Q

examples of low risk surgeries

A

(cataract extraction, carpal tunnel release, breast biopsy, inguinal hernia repair)

206
Q

Patients with a known recent major adverse cardiac event should not undergo surgery within:

A

60 days of an MI
• 30 days of a bare-metal coronary stent implantation
• 6 months of a drug-eluting coronary stent placement

207
Q

when to stop AC prior to surgery

A

Stop warfarin 5 days before surgery.
• Stop apixaban, rivaroxaban, dabigatran 1 to 2 days before surgery if eGFR >50 mL/min/1.73 m2. Stop earlier if eGFR is
lower.

208
Q

surgeries that you dont need to stop AC

A

cataract surgery,

dermatologic procedures, endoscopic procedures without biopsy

209
Q

which patients do NOT need perioperative AC bridging

A

• Low-risk patients do not receive bridging anticoagulation (bileaflet mechanical aortic valve, AF with CHADS2 score <2,
VTE >12 months ago).

210
Q

which patients DO need perioperative AC bridging

A

High-risk patients receive bridging anticoagulation (mitral or caged ball valve or aortic tilting disc aortic mechanical
valve, AF with CHADS2 score >4, rheumatic heart disease, recent CVA or TIA, VTE within the past 3 months

211
Q

when should you stop heparin, UFH LMWH prior to surgery

A

Start heparin 36 hours after the last dose of warfarin.
• Stop UFH 4 to 6 hours before surgery.
• Stop LMWH 12 hours before surgery.

212
Q

when can you restart heparin, warfarin noac after surgery

A
  • Restart heparin 24 hours after surgery.
  • Restart warfarin 12 to 24 hours after surgery.
  • Restart dabigatran, rivaroxaban, and apixaban 24 hours after surgery

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