Missed Flashcards
1
Q
Subungual melanoma S/S
A
longitudinal brown or black band in the nail
2
Q
What is Koilonychia?
A
curved spoon-shaped nail often with soft or flared ends, which can occur in patients with iron deficiency anemia
3
Q
Actinic Keratosis S/S
A
red, pink, or brown and a rough, yellow scale is common. Leads to SQC.
4
Q
Lithium Toxicity
A
N/V, tremors, confusion, slurred speech
5
Q
Mastitis Tx
A
Dicloxacillin
6
Q
Fifth Disease S/S
A
Flushed cheeks, lacy maculopapular rash
7
Q
Fifth Disease Return to School
A
After rash appears (no longer contagious)
8
Q
McMurray Test
A
Click is meniscus tear
9
Q
Cataract Chnages
A
Bilatersl loss distance vision and night driving difficulty, foggy/cloudy vision
10
Q
A
10
Q
slipped capital femoral epiphysis
A
displacement of the proximal femoral epiphysis through the growth plate. Slater Harris Type 1 Positive Trendelenburg Test.
11
Q
Infantile Hemangioma s/s
A
lesion started out flat and small but appears to be growing. The physical exam is significant for a slightly raised, lobulated, soft, and compressible lesion that is bright red. Dilated capillaries are visible
12
Q
Infantile Hemangioma Tx
A
Only if interferes with vital function (promprnaolol). Otherwise goes away over years
13
Q
Infective Endocarditis S/S
A
Splinter Hemorrhage
Roth Spots (Retinal hemorrhages with a white center)
Osler nodes are painful, red-purple lesions on the hands and feet
14
Q
Orbital Cellulitis
A
infection of the contents of the orbit of the eye but not the globe. It presents with eye pain, erythema, edema, conjunctival swelling, and difficulty controlling eye movement. ED!!!
15
Q
Finkelstein Test
A
Flexion of the thumb within curled fingers combined with ulnar flexion of the wrist causes Pain. DeQuaverian
16
Q
5th Disease
A
low-grade fever and progresses into the development of a rash. The rash classically appears as a slapped cheek rash on the face and a lacy, reticular rash on body
17
Q
Morton Neuroma
A
Morton neuroma (B) presents as a pain at the ball of the foot and numbness to surrounding toes.
18
Q
COPD under age 45
A
Patients under the age of 45 with airflow obstruction should be tested for alpha-1 antitrypsin deficiency. inherited disorder that can cause COPD and affect the liver and skin
19
Q
Turner Syndrome
A
X chromoseom deletion
Women Only - short stature / neck / no puberty sex change
Low dose estrogen therapy
Pregnancy possible but high risk
20
Q
Temporal Arteritis
A
Vasculitis unknown cause of larger vessels. Fever, fatigue, headache, tenderness of scalp and jaw. Need steroids and referral ASAP.
21
Q
Polymyalgia Rhuematica
A
chronic system infmlammatory unknown cause. Stiff and ache in shoulder girdle, pelvic girdle, neck. Elevated ESR, CRP. Occurs often the Temporal Arteritis.
22
Q
Katz Index
A
Toileting
Bathing (except one area)
Dressing (except shoe tying)
In/Out of bed
23
Q
Sialolithiasis
A
salivary gland stone. pain/swelling of face and jaw pain when salivating. Foul taste / smell.
24
PEricarditis causes
Lupus, Gout, Flu, Epstein-barr, rhuematoid arthritis
25
aphthous stomatitis
canker sore
inside of the mouth on the oral mucosa, shallow, painful. idocaine mouthwash might help with the pain and can also shorten healing time.
26
Ovarian CA risks
Early menarche, nulliparity, and late menopause are also risk factors for ovarian cancer. Orla contraceptive use may protect.
27
Seborrheic keratosis
Seborrheic keratoses present as well-demarcated, oval lesions with a stuck-on or wart-like appearance. They most commonly develop on the trunk, arms, and face.
28
Hidradenitis suppurativa
chronic inflammatory skin condition caused by follicular occlusion in intertriginous areas,
antibiotics, such as topical clindamycin, may be prescribed to reduce symptoms
29
Enterobiasis
intestinal infection caused by pinworms. The most common symptom of enterobiasis is perianal pruritus noted primarily at night
30
Ankle-Brachial index
divide the highest ankle SBP of the leg by the highest arm SBP from either arm. Normal ABI is 1–1.3. A diagnosis of borderline PAD based on an ABI is 0.9–1. Any patient with an ABI < 0.9 is considered to have PAD
31
Diabetic Retinopathy
new small blood vessels
Tiny red dots (microanyurism)
Cotton wool spots
32
JNC 8th HTN
pharmacologic treatment should begin when a patient is < 60 years old and has a systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg
33
vesicoureteral reflux
1 - ureter
2 - ureter and collecting system
3 - ureter and dilates partly
4 - dilates ureter and collecting
5 - dilates with intrakidney or twisting
Refer all 3+
ABX for 1/2 if UTI hx or not toilet trained
34
Common Downs associated issues
Hypothyroid
Leukemia
Strabismus
35
Bowel sounds in Bowel Obstruction
Early - High Pitched
Late - Absent
36
Oral Combined Contraceptive Contraindications
Current cancer or history of breast cancer
Migraine with aura
35+ and smoker
37
AOM common causes
H. influenzae
Strep pnuemoniae
M. catarrhalis
38
idiopathic thrombocytopenic purpura
acute episode following a viral infection. It is seen most frequently in children ages 3 to 5. Clinical manifestations include a sudden onset of mucocutaneous bleeding, ecchymosis, and petechiae
39
Acyclovir S/E
GI Effects
Acute kidney injury
Headache
Dizziness, malaise
40
B12 Def. Causes
| Diet
Diet (vegan, ETOH)
PPI long term
Metformin long term
Crohn's / malabsorb
Gastric reduction
Pancreas insuff.
41
galactorrhea
bilateral milky nipple discharge
usually benign origin
Med causes - antidepressant / antipsych
Check prolactin level
Elevated prolactin - refer for MRI if no medicine cause
42
Macular Degeneration
Loss of central vision
Line distortion
Chronic and progressive, no treatment
43
Macular Degen Risk Factors
alcohol abuse
smoking
high fat diet
high red meat idiet
HTN
Obesity
44
Low MCV with High MCH
Only cause is congenital sperocytic anemia (very rare)
45
Sarcoidosis
chronic condition that causes collections of inflammatory tissue, which are called granulomas. Sarcoidosis is a systemic disease and can present in multiple body systems but most commonly occurs in the lungs. This is considered a type of restrictive lung disease,
46
condylomata acuminata
genital warts
treat with TCA, wash area
47
Iritis
ocular inflammation of the iris and often presents with acute changes in vision, photophobia, eye pain, and hyphema. Refer
48
HIV test
Enzyme linked immunoassay (HIV1/2 Immunoassay).
If positive then NAT (Differentiation test)
49
Sensorineural loss
tuning fork lateralizes to good ear
50
Conduction loss
tuning fork lateralizes to bad ear
BC>AC or BC=AC
51
Addison Findings
Hyponatremia
Hyperkalemia
Elevated BUN
Hypoglycemia
52
Genu Varum
Bow legs
normal resolves by 2 y/o
53
pansystolic murmur
A pansystolic murmur that radiates to the axilla likely indicates mitral regurgitation. The best placement to assess the mitral valve is at the apex of the heart. All mitral murmurs, diastolic or systolic, can best be heard at the apex.
54
Otosclerosis
Otosclerosis is an abnormal bony remodeling of the inner ear bones, frequently the footplate of the stapes bone. It is a form of conductive hearing loss and will need surgery
55
scarlet fever s/s
fever, sore throat, malaise, headache, and loss of appetite. The rash associated with scarlet fever develops 1–2 days after sore throat onset. It is a blanchable and erythematous rash that diffusely spreads to the face, neck, trunk, and extremities. The patient’s skin may feel like sandpaper due to small erythematous papules that also develop. Patients may also present with an erythematous tongue with a strawberry appearance.
56
Roseaca
chronic skin condition that presents as a reddened, centrofacial rash. Education regarding sun protection including sunscreen, sun avoidance, and protective hats, should be included in this patient’s plan of care.
57
Hyperparathyroid
gastrointestinal, kidney, musculoskeletal, neurologic, and cardiovascular. Common symptoms include anorexia, nausea, vomiting, constipation, polyuria, polydipsia, muscle weakness, bone pain, fatigue, decreased concentration, depression, and cardiac dysrhythmias.
58
59
Thiazide Diuretic Benefits
Stimulates osteoblasts, decrease calcium secretion. Good choice in women at risk of osteoporosis
60
Thiazides avoided in:
Elevated total cholerterol
Gout patients
Diabetes
61
Common cause of otits externa
Psuedomonas aeruginosa
Treat with ofloxacin drops
62
Long term H2 blocker use
Risk for thrombocytopenia
Get a CBC
63
64
Cholesteatoma
white, keratinized skin growth noted behind an intact tympanic membrane (B) that often resembles a cauliflower. Patients should be referred to ENT for removal
65
Medicare B covers:
outpatient
medical equipment
Flu, Pmnuemonia, HepB, and Covid vaccines
66
MMSE scores
Low = bad
24+ normal
20-23 mild
13-19 moderate
12 or less severe
67
Tdap recommendations
10+ since last - get it
5+ years and dirty wound - get it
less than 5 and dirty wound - no
less than 10 non-dirty - no
68
CN III, IV, VI
O - III - blink/focus
T - IV - down, out, in
A - VI - outward
69
retinal artery occlusion
cherry red sport and pale, swollen retina. Sudden painless vision loss.
70
Fenofibrates
start if Triglycerides > 500
71
Med for alzheimers
Donepezil
72
facial shingles rash
facial shingles rash can lead to a complicated form of shingles called herpes zoster ophthalmicus - shingles reactivation in the fifth cranial nerve. Refer! Blindness risk!
73
Blisters on TM
Bullous myringitis. Tx with augmentin
74
Auspitz sign
Auspitz sign (A) is a classic clinical finding in plaque psoriasis. It occurs when an area of plaque is removed and small, pinpoint bleeding occurs.
75
sausage shaped abdominal mass
intussusception
76
asthma controlled by medium or low dose daily ICS
Moderate persistent
77
Family Hx of Breast CA - Screenings
Annual mammo
Genetic testing
Breast exam
Consider MRI
78
Who is at risk for alpha-thalassemia?
Southeast asian
79
Who is at rick for beta-thalassemia?
Mediterrian
80
Toprimate is not good for patients with:
Anorexia
Major Depression
81
Risk factors for gall bladder"
obesity
inactivity
oral contraceptive
female sex
rapid weight cycling
pregnancy
hormone therapy
82
pulmonary TB tx
rifampin
isoniazid
pyrazinamide
ethambutol
(RIPE therapy)
83
DTaP risk
fever
84
Fibromyalgia Dx
3 months
Pain index 7+
Fatigue
No other explanation
85
rare congenital anomaly that involves the dislocation or hyperextension of one or both knees
genu recurvatum
86
systolic murmur with crescendo-decrenscendo and radiation
Aortic stenosis
87
mid-systolic click with late systolic murmur at apex
mitral valve prolapse
88
high-pitched holosystolic murmur at apex
mitral regurgitation
89
high-pitched blowing diastolic murmur at left sternal border
aortic regurgitation
90
HTN and GERD
CCBs worsen GERD
91
Folliculitis v. HS
painful, erythematous pustules on the skin. But HS is usually in higher BMI and in skin folds.
92
Measles
Measles presents initially with fever, cough, congestion, and conjunctivitis. Approximately 3–5 days after the onset of symptoms, patients will develop a rash
93
Duchenne muscular dystrophy (DMD)
inherited condition in which the muscles become progressively weaker over time. Onset of weakness typically occurs at around 2 to 3 years of age.
cognitive function. Large calf muscles, waddling gait.
94
95
iron def. in babies
full-term infants are born with enough iron stores to prevent iron deficiency anemia for approximately 4–6 months after birth. Therefore, it is most common to see iron deficiency anemia develop between 6 and 24 months (
96
Cushing disease
Pituitary caused hypercotisolism. central obesity, a moon face due to the thickening of facial fat, a buffalo hump dorsocervical fat pad, red-purple abdominal striae, hirsutism, and acne. Cushing disease is diagnosed by a measurement of > 100 mcg of cortisol in the urine in a 24-hour period. Surgical removal of tumor is needed.
97
AHA/ACC Hypertension Guide
<120/<80 is normal
Pre - 120-129
Stage 1 - 130-139 or 80-89
Stage 2 - 140+ or 90+
98
Fragile X syndrome
congenital genetic disorder associated with neurological, cognitive, and behavioral deficits. Physical findings may include poor growth, seizures, joint hyperlaxity, sleeping problems, obesity, short stature, strabismus, long narrow face, teeth crowding, and large prominent ears. Behavior and cognitive findings may include intellectual difficulties, language delays, autism, anxiety, and aggression.
99
atopic dermatitis
also known as eczema and is characterized by intensely pruritic, erythematous papules or vesicles with crusting and exudation. Patients with atopic dermatitis often have other atopic conditions, such as seasonal allergies or asthma.
100
Hemochromatosis
inherited disorder leading to iron overload. DM, skin darkening, arthirits can occur. Treated with phlebotomy.
101
Echinacea
used for immune boost and asthma. Cannot replace rescue inhaler!
102
Allopurinol labs
Cr and Liver
Uric acid for effectiveness
103
Most common cause of pnuemonia
Strep pneumoniae
104
Cholesteatoma can damage what CN?
CN VIII - Facial
105
copper intrauterine devices specific complications
heavy menstrual bleeding and menstrual pain
106
Keloid v Hypertrophic Scar
Keloids extend beyond the original scar.
HS confined to original scar
107
JNCC 8 HTN
start meds at 140/90 or more
(AHA is different)
108
Diabetic Retinopathy S/S
Cotton wool spots
neovascularization
microaneurysms
109
HRT Contraindications
Endoimetriosis
DVT / PE
Vaginal bleeding
110
Agnosia
impairment in the ability to understand information in relation to the five senses
111
turner syndrome risks
hearing loss, infertility, hypertension, osteoporosis, and kidney abnormalities
112
UTI and on coumadin
Bactrim will interfere with coumadin
113
When to step down on asthma?
FEV has improved and stable for 2-3 months
114
Mastitis still pain after Tx
Refer for ultrasound/mammo
115
Meconium ileus cause
think cystic fibrosis
116
Allergic rhinitis symptoms
cobblestoning on the posterior pharynx
infraorbital edema
allergic shiners
loss of taste and smell
upper lip transverse crease
117
Digoxin Toxicity
green-yellow halos
confusion
V Tach
N/V/D
118
Vaginal bleed in post-menopause
Endometrial Cancer. Refer.
119
Headache every AM in same spot, worsens with activity
Brain tumor
120
Heart sound only heard at base of heart
S2
121
Auscultate a split S2
At pulmonic during inspiration (2nd ICS left)
122
Measles S/S
Koplik spots
Corzya
Cough
Congestion
123
Thiazides do what?
Increase BGL
Increase uric acid
increase triglycerides
lower potassium
124
Other causes of increased BUN
HF
GI Bleed
Liver Issues
125
Laxative for elderly
Colace (docusate)
126
UTI in first trimester
Augmentin is best choice
127
Uterus height 16 weeks
Halfway between symphis pubis and umbilicus
128
Prophylactic ABX for rheumatic heart disease history helps:
future episodes of rheumatic heart fever
129
PKU diagnosis in newborn
Refer to metabolic specilaists right away, then later consider genetic testing
130
Atrial Septal Defect finding
Wide fixed split S2
131
You suspect pyloric stenosis -
ED refer right away, don't ultrasound
132
Sunken fontanelles in infants, even if all else is normal, should
be referred to the ED right away
133
Kawasaki Disease
fever lasting ≥ 5 days and 4 of:
high-grade fever, bilateral conjunctivitis;
oral mucosal changes, such as injected or fissured lips or a "strawberry tongue"; a variable rash;
and changes in the extremities, such as redness or swelling of the palms or soles and peeling skin near the nails. Additionally, cervical lymphadenopathy is usually on one side and > 1.5 cm
