Leik Review Flashcards
A 14 year old girl with short stature, swollen hands and feet, and a webbed neck presents to the primary care clinic. She is in Tanner Stage I. What test should be ordered to confirm a diagnosis?
Karyotype! This is Turner syndrome and needs to be confirmed by genetic testing.
X-ray of Left hand is for estimated bone age in the assessment of delayed puberty, however symptoms indicate Turner Syndrome.
What is lentigines?
liver spots - benign skin condition, brown-colored macules on hands and forearms of older adults
Skin lesion: What are soft, wartlike lesions that appear on back and trunk of older adults?
Seborrheic keratoses
Skin lesion: What are rough, scaly patches that develop from years of sun exposure found on the face, lips, ears, back of hands, forearms, scalp or neck? What may this progress to?
Actinic keratosis
Most common precancerous lesion of squamous cell carcinoma
What are expected findings of Cushing’s syndrome, especially in children?
Delayed puberty and growth failure
Excess of androgens
Gynecomastia - excess cortisol
What is pseudogynecomastia?
breast budding caused by deposition of fat
What are findings commonly found with polycythemia vera? Risk factors
Chronic hypoxia causing an increase in erythropoietin
Risk factors - chronic cigarette smokers, Budd-Chiari Syndrome, >40 years old
What test should be ordered to rule out cauda equine syndrome?
MRI, patient will need to see a neuorlogist as well with these symptoms
What are expected findings of cauda equine syndrome?
new onset numbness to perineal area (saddle anesthesia)
Worsening sciatica/back pain
Decreased LE deep tendon reflexes on affected side
Bladder/bowel dysfunction - bladder retention
Leg weakness
A Snellen chart finding indicates a visual acuity as 20/80. What does this mean?
What a patient sees at 20 feet, is what a person with normal vision sees 80 feet away.
Top number is patient’s distance in feet from chart. Bottom number is distance a normal vision test can read at the same line
What is presbyopia?
loss of elasticity of the lenses, which makes it difficult to focus on close objects
typical with aging - hardening of the lens.
What are possible complications of PCOS?
coronary heart disease, type 2 diabetes mellitus, metabolic syndrome, and infertility (high androgens)
What diagnostic tool is gold standard for diagnosing bacterial pneumonia?
chest x-ray - findings of infiltrates and/or lobar consolidation
Skin lesion: Presents in fair-skinned people of older age as small, translucent papule with central ulceration, telangiectasis and rolled borders. What do you suspect?
Basal cell carcinoma
pearly white, light pink, brownish or flesh colored
A cauliflower like growth with foul-smelling discharge on otoscopic exam of an 8-year old with a history of chronic otitis media. What do you suspect?
Cholesteatoma - abnormal skin growth in middle ear behind eardrum. Develops as cysts or pouches that shed layers of old skin leading to build up. May destroy bones of middle ear leading to hearing loss.
What SSRI is most likely to cause erectile dysfunction?
Paroxetine (paxil)
What SSRI is most likely to cause serotonin syndrome?
Escitalopram (Lexapro)
What is a major complication of temporal arteritis (giant cell arteritis)?
Amaurosis fugax = transient blindness of affected eye!
Other findings of temporal arteritis include jaw claudication, elevated ESR and elevated CRP but Amaurosis fugax is the most threatening/worrisome.
A 6 year old with a systolic murmur that sounds like a musical vibration and becomes louder in the supine position. The murmur is Grade I/II in intensity with minimal radiation. What is your next step?
Record in patient’s chart to monitor on annual physical exam.
This is a Sill’s murmur Benign and common in school-age children, resolves in adolescence. Most appropriate action is to record and monitor. No need for ECHO or referral.
What would require you to delay testing a patient’s prostate-specific antigen (PSA)?
urinary retention = false-elevation
UTI = false-elevation
after DRE = false-elevation
Ejaculation within 48 hours may falsely elevate
Vigorous exercise IS ACCEPTABLE/does not need to be stopped - although discouraged before testing per Leik.
Infant’s eye presents with discharge, swelling, and redness of lacrimal ducts. Mother reports crusting. What do you suspect?
Dacryostenosis - an obstruction of lacrimal duct. Culture discharge and treat.
What antimicrobial should NOT be selected for the treatment of pertussis in an individual with myasthenia gravis?
Erythromycin and Telithromycin are contraindicated in patients with myasthenia gravis = potential respiratory collapse!
(Macrolides are the antimicrobial of choice for pertussis)
What part of the kidney is affected by polycystic kidney disease?
Renal tubules within the nephrons
What parts of the kidney is affected by disorders such as glomerulonephritis and diabetic nephropathy?
Glomerulus and Bowman’s capsules - filter blood and re-absorption back into bloodstream.
What disease commonly presents with Heberden’s nodes?
Osteoarthritis - DEGENERATIVE JOINT DISEASE.
Found on the DIP joints
What is the treatment of Fitz-Hugh-Curtis syndrome in the evaluation of STI? What if the patient is pregnant with this finding?
Ceftriaxone x Doxycycline x Metronidazole.
This is a complicated gonorrheal/chlamydia infection.
Pregnancy = NO tetracyclines. Ceftriaxone x Azithromycin
What are the expected findings of deep vein thrombosis? What sign are you going to assess for?
Swollen LE that is red and tender to touch, no recent injury, history of prolonged sitting.
Homan’s sign = calf pain with dorsiflexion of affected limb
TX: ultrasound, cbc, chest x-ray, and possible hospital for heparin therapy.
What is the treatment of a superficial thrombophlebitis?
warm compresses, elevation of affected limb, and NSAIDs
look for symptoms of tender/painful area over affected vein, redness, swelling - palpable cord-like mass for several weeks.
A chest x-ray with findings of cavitation (round black holes due to local loss of lung tissue), fibrosis, lymphadenopathy, and calcifications is mostly likely due to what finding?
Mycobacterium tuberculosis
What are common findings of infective endocarditis?
chills, fever, and malaise. New murmur. Nontender red spots on palms of both hands and soles of the feet (Janeway lesions, Osler nodes). Splinter hemorrhages on nail beds.
What presents as a sudden onset of severe, sharp, excruciating pain in the abdomen, back or flank area? Differences in upper extremity blood pressure findings and pulse findings. What syndrome may have this?
Aortic dissection
Marfan syndrome, ehlers-danlos syndrome
What ear drops are NOT considered to be ototoxic and therefore safe if the tympanic membrane is ruptured?
Ofloxacin
(aminoglycoside otic drops are TOXIC - gentamycin, tobramycin, neomycin)
A patient presenting with a low-grade fever and single eschar on his back. Complaints of burning at the sites and states, “The area was white, then red. Now there is a red spot in the center.” He recently traveled for a camping trip. What do you suspect?
Brown recluse spider bite
A tick-borne disease that has a petechial rash starting on the wrists, hands, forearms and feet and rapidly progresses up toward the trunk. What is this?
Rocky Mountain spotted fever
expect abrupt onset of high fever, chills, severe headache, photophobia, and N/V
How will early lyme disease present? Most common in what states?
early lyme = circular red rash that slowly expands as a “target” or “bulls-eye” (erythema migrans). Northeastern states.
What maculopapular rash presents with koplik spots on the mucosa, cough, coryza, conjunctivitis?
Measles
What cranial nerve is affected by bell’s palsy?
CN VII (7)
A high-pitched murmur with a loud blowing and radiation to the axilla. What murmur is this? A history of what condition may affect this heart valve?
Mitral regurgitation
Rheumatic fever - untreated strep throat
A patient complaining of painful sexual intercourse, pain with urinating, fever, and CVA tenderness. What do you suspect? What diagnostic tool may help confirm this?
Endometritis associated with PID.
Cervical culture - vaginal culture might be contaminated and ultrasound imaging would be most useful if the patient were postpartum
What are expected findings of tic douloureux type 1?
Trigeminal neuralgia - extreme, shock-like facial pain that lasts from a few seconds to 2 minutes per event and up to 2 hours total.
What are expected findigns of tic douloureux type 2? What are associated and common risk factors?
Trigeminal neuralgia - a constant, aching, burning facial pain with less intensity.
Type 2 = women, age/60s, multiple sclerosis or HSV-1
What are expected findings of osteoarthritis?
if in the hip its associated with joint pain
Always worsen with activity
Diminished ROM
Joint crepitus
Difficulty arising after long periods of rest
Finding of a raised iliac crest present on one side, is a warning sign for what condition?
Scoliosis
Erythema without induration on a PPD or tuberculin skin test indicates what?
no significance
An induration of ___mm or more in diameter indicates a positive reaction of a PPD for patient with a very high risk condition or exposure (HIV, transplant recipent, immunosuppressed, contact with TB patient).
5 mm is positive for those with high risk conditions or exposures to TB
What patient education should be included for the female patient with bacterial vaginosis on a 5-day course of metronidazole vaginal gel?
To abstain from sexual intercourse during treatment
What is the first line treatment for acne vulgaris? If this does not work/does not improve the condition over 3-6 months, what is the next recommendation?
1st line = OTC medicated soap/water with topical antibiotic gels.
2nd therapy if fails = PO tetracycline
Spirometer readings are used to assess a patient’s personal best - What is the green zone, yellow, and red?
Green is 80-100%
Yellow is 50-80%
Red <50%
What do you suspect of a patient presenting with elongated papilla of the lateral aspects on the tongue? What causes this condition?
Oral hairy leukoplakia
Epstein-Barr virus
What do you suspect of a patient presenting with complaints of bald, red areas of varying sizes surrounded by irregular white borders on the top and sides of their tongue?
Geographic tongue
What is cheilosis?
a painful inflammation and cracking of the corners of the mouth
What is the most sensitive test used to evaluate a patient for active H. pylori infection?
Urea breath test, may be repeated after treatment
What condition is treated with alpha-linolenic acid?
Ankylosing spondylosis
A pediatric patient uses a sliding scale in conjunction with a long acting insulin for management of type 1 diabetes. What insulin is best for elevated blood sugar between breakfast and lunch?
Rapid-acting insulin
Lispro (Humalog)
Aspart (NovoRapid)
Glulisine (Apidra)
no LAG! - onset 10-15 minutes, peak 1-2 hours, duration 3-5 hours
What type of insulin is a mixture of intermediate and short-acting?
Insulin Isophane and insulin regular
Not appropriate for sliding scale
How many days of antibiotic treatment should be prescribed for a 72-year old female with a complicated urinary tract infection?
minimum of 7 days - any complicated UTI, uncontrolled diabetic, pregnant, elderly, or immunocompromised patients need a minimum of 7 days.
10 days or more may causes adverse effects like C.diff
A patient presents with lethargy, weight gain, bradycardia, and a goiter, what mineral lab finding would you anticipate the patient to be deficient in?
Iodine - regulates thyroid hormones, growth, development, and metabolic rate
What should be monitored as possible side effects in a patient taking hydrochlorothiazide?
Hyperglycemia, Hypokalemia, Hyperuricemia, and Hypertriglyceridemia/hypercholesteremia, hyponatremia and hypomagnesemia
What are biguanides?
Metformin is a biguanides oral hypoglycemic medication
What cranial nerve is infected with herpes zoster opthalmicus?
CN V - Trigeminal nerve
What are 4 empiric antibiotics best for the treatment of community acquired pneumonia in a patient WITHOUT comorbid conditions?
Macrolides - Azithromycin or Clarithromycin
Tetracycline - Doxycycline
PCN - Amoxicillin
What should be the next step for a 65-year old woman who has had type 2 diabetes for 20 years and is concerned about her kidneys? She has had 3 UTIs in the past 8 months, but is currently asymptomatic.
Recheck urine during this visit, send for a culture and sensitivity, and REFER to a nephrologist.
Diabetics are at higher risk for UTIs which can lead to bladder damage and nephropathy
Decreased sperm production, is this normal with male aging?
YES! - sperm production decreases as men age as a result of decreased testosterone levels. Low testosterone is associated with low estrogen levels as well - normal.
What are 3 common risk factors of medial tibial stress syndrome? How will this present?
RF: runner, pes planus (flat feet), females especially with eating disorders and amenorrhea.
Presents as progressive bilateral leg pain due to overuse of muscles and tendons
