MKSAP GIM Flashcards
What are manifestations of vitamin B6 deficiency? Name 4 drugs that can lead to deficiency.
- Peripheral neuropathy, stomatitis, cheilosis, glossitis, confusion, depression
- Hydralazine, Isoniazid, Carbidopa, Levodopa
What are the indications to give PCV13 then PPSV23 (8 weeks later) before age 65? Name 2. What are the indications for PCV13 then 2 doses of PPSV23 (8 weeks later then 5 years later) before age 65? Name 6.
- Cochlear implants, CSF leak
- Sickle cell or other hemoglobinopathies, asplenia, congenital/acquired immunodeficiency, HIV, chronic renal failure, leukemia, lymphoma, metastatic cancer, iatrogenic immunosuppression including radiation therapy, multiple myeloma
What are the indications for PPSV23 before age 65? Name 6.
Alcoholism, smokers, chronic heart disease, chronic lung disease, chronic liver disease, diabetes, celiac disease
Positive LR values of 2, 5, and 10 correspond to how much of an increase in disease probability? What about negative LR values of 0.5, 0.2, and 0.1?
15%, 30%, and 45%
15%, 30%, and 45%
What is the probability of the event occurring in a group during a specified time period?
Absolute risk
Patients w/ event in group/total patients in group
What is the ratio of the probability of developing a disease w/ a risk factor present to the probability of developing the disease without the risk factor present?
Relative risk
Experimental event rate/Control event rate
What is the difference in rates of events between experimental group and control group?
Absolute risk reduction
Experimental group events - control group events
What is the ratio of absolute risk reduction to the event rate among controls?
Relative risk reduction
(Experimental group events - control group events) / control group events
What are the equations for number needed to treat and harm?
NNT = 1 / ARR - for example the drug reduced progression of CKD from 37/1000 to 12/1000; 0.037-0.012 = 0.025. NNT is 1/0.025 = 40 NNH = 1 / ARI (experimental group events-control group events when the event is an unfavorable outcome)
What are the following? TP/(TP+FN) TN/(TN+FN) TP/(TP+FP) TN/(FP+TN)
Sensitivity
Negative predictive value
Positive predictive value
Specificity
What type of bias occurs when screening detects more cases of disease with a prolonged asymptomatic phase than cases of disease w/ a short asymptomatic phase?
Length time bias
What are the ADA guidelines for diabetes screening?
Screen patients BMI >25 (BMI >23 in Asians) and at least one risk factor for diabetes (first degree relative w/ DM, African-American/Latino/NativeAmerican/Asian/Pacific islander, hx of CV disease, HTN, HDL <35, TG >250, PCOS, physical inactivity, hx of gestational diabetes)
Also screen all adults age >45, and repeat at 3 year intervals if normal
How do the breast cancer screening guidelines differ?
American College of Radiology: start annual at age 40
National Comprehensive Cancer Network: start annual at age 40
American Cancer society: offer annual at age 40, start annual screening at age 45
ACOG: offer at age 40, start annual at age 50
ACP: start biennial at age 50
UPSTF: start biennial at age 50
What are 3 second tier tests for colon cancer screening per the multi-society task force on colon cancer?
CT colonography every 5 years
FIT-fecal DNA test every 3 years
Flex sig every 5-10 years
What are the guidelines for cervical cancer screening in women who have had a hysterectomy?
No screening if hysterectomy + removal of cervix except if CIN 2 or 3 was present, in which case should continue screening for 20 years after hysterectomy
What vaccine should every pregnant woman receive between 27 and 36 weeks regardless of when it was last administered?
Tdap
Which is the recommended zoster vaccine?
Recombinant vaccine (Shingrix) for adults age >50; given in two doses, separated by 2-6 months If adult has been previously vaccinated w/ live attenuated vaccine (Zostavax) should be revaccinated w/ Shingrix after at least 8 weeks
What are the following used for and what are the side effects? Black cohosh, echinacea, evening primrose oil?
Black cohosh - menopausal hot flashes; estrogenic effect on breast, hepatotoxic
Echinacea - common cold; GI upset, allergic reaction
Evening primrose oil - breast pain, eczema, diabetic neuropathy; GI upset, risk of pregnancy complications, increased bleeding if used w/ warfarin
What are the following used for and what are the side effects? Garlic, ginger, ginkgo biloba, kava
Garlic - high cholesterol, HTN; increased bleeding
Ginger - nausea; increased bleeding
Ginkgo biloba - prevention of cognitive decline, claudication; GI upset, bleeding
Kava - anxiety; hepatotoxic
What are the following used for and what are the side effects? Milk thistle, red yeast rice, saw palmetto, soy, valerian
Milk thistle - reduces liver inflammation; GI upset, medication interaction
Red yeast rice - HLD; mylagia, increased LFTs, kidney failure, medication interactions
Saw palmetto - BPH; HA, dizziness
Soy - menopause sx; GI upset, allergic reactions
Valerian - anxiety, sleep disorders; tremor, headache, hepatotoxic
Which QI model aims to maximize value and minimize waste by eliminating non-value-added activities? Which model improves processes by identifying and removing causes of error and minimizing variability in patient care?
- Lean model
2. Six Sigma
What can be used to manage clinical depression if life expectancy is less than 6 weeks?
Methylphenidate
What anti-emetics are preferred in gut wall stretching/dilation? Motion sickness? Anticipatory nausea? Nausea associated w/ increased ICP?
- Dopamine antagonists (metoclopramide, prochlorperazine, haloperidol)
- Anticholinergics (scopolamine, diphenhydramine, promethazine)
- BDZs
- Steroids
What are the steps for investigation of chronic cough?
- Upper airway cough syndrome empiric tx - intranasal steroids if allergic rhinitis associated, first generation anti-histamines and decongestants if nonallergic related
- Asthma - investigate and tx w/ inhaled steroids
- Exclude nonasthmatic eosinophilic bronchitis w/ sputum analysis for eosinophils or exhaled NO testing; tx w/ inhaled steroids
- Empiric tx for GERD
- If above fails perform other detailed investigations
What are the 2 manifestations needed in addition to impairment in ability to engage in activities, postexertional malaise, and unrefreshing sleep for diagnosis of systemic exertion intolerance disease?
Cognitive impairment or orthostatic intolerance
Need at least 1 of these
What oculomotor assessment should be performed to help distinguish central vs. peripheral vertigo? What are the 3 components?
HINTS
Head impulse - with patient focusing on examiner move their head in either direction ~20 degrees then rapidly rotate to midline; presence of catch up saccades = peripheral cause of vertigo, absence = central
Nystagmus - unidirectional is reassuring for peripheral cause, bidirectional = central
Test of skew - alternate covering and uncovering each eye and assess for vertical adjustment or refixation; absence of this is reassuring for peripheral cause
What condition worsens w/ personal motion, upright positioning, and movement of objects in the surrounding environment? What is the treatment?
Persistent Postural-Perceptual dizziness (PPPD)
SSRIs and SNRIs
What are the 3 categories of neurally mediated syncope?
Vasovagal - provoked by stress, heat, or noxious stimuli
Situational - triggered by cough, defecation, micturition
Carotid sinus hypersensitivity - head rotation, shaving, use of tight-fitting neck collar
Name 5 drugs used for weight loss, and name some side effects/contraindications.
Liraglutide - GI upset, HA, nasopharyngitis
Lorcaserin - caution w/ meds that increase serotonin
Naltrexone-bupropion - contraindicated in epilepsy, uncontrolled HTN, or opioid use
Orlistat - diarrhea; black box for severe liver injury
Phentermine-Topiramate - contraindicated in pregnancy, glaucoma, hyperthyroidism, and MAOI use
How do you evaluate for leakage after gastric bypass?
Upper GI series or contrast CT scan
Name 2 PCSK9 inhibitors. What are their main side effects?
Alirocumab (Praluent), Evolocumab (Repatha)
Nasopharyngitis, injection site reactions, back pain
What are the main side effects of ezetimibe?
Diarrhea, abdominal pain, myositis, arthralgia
What are the 6 risk factors used in the revised cardiac risk index? When do patients need functional capacity assessment?
High risk surgery, ischemic heart disease, heart failure, diabetes (requiring insulin), cerebrovascular disease, CKD (Cr >2)
Need assessment of functional capacity if 1% or more risk of perioperative MACE (need one of the factors above)
If functional capacity exceeds 4 METs (walking 3-4 miles per hour, climbing 1-2 flights of stairs without stopping, performing vigorous housework) can proceed to surgery
When can beta blockers be initiated pre-op?
2-7 days before surgery if patient has 3 or more RCRI risk factors and those w/ intermediate or high risk myocardial ischemia on pre-op stress testing
How long after revascularization can non-cardiac surgery be performed?
14 days after balloon angioplasty
30 days after bare metal stent
6-12 months after drug eluting stent (if more urgent surgery, can do 90 days after)
What is in the STOPBANG screening tool?
Snoring, tiredness, observed apnea, pressure, BMI >35, age >50, neck circumference >40 cm, gender (male)
3 or more is increased risk for OSA
When should patients with adrenal insufficiency receive pre-op stress steroid dosing, and what is the dosing (based on procedure)?
- Primary AI, HPA axis disease, cushingoid features, prednisone >5 mg for 3 weeks during previous 3 months
- 25 mg IV hydrocortisone if minor ambulatory procedure, 50-75 mg if moderate (orthopedic), 100 mg then 50 mg q6h if high risk (CABG)
Which SSRI has highest rate of sexual dysfunction, highest rate of weight gain, and highest rate of discontinuation syndrome? Which SSRI has highest incidence of diarrhea?
- Paroxetine
2. Sertraline
Which SNRI has highest rates of nausea/vomiting, and highest rate of discontinuation syndrome?
Venlafaxine
What are the first line medications for bipolar disorder? Name 4.
Lithium, valproic acid, carbamazepine, lamotrigine
What is the first line treatment for OCD?
CBT
Can add SSRI
What are some side effects of naltrexone, and when is it contraindicated? What are some side effects of acamprosate, and when is it contraindicated?
- Nausea, headache, fatigue; contraindicated w/ concurrent opioid use, liver disease
- GI upset (diarrhea, nausea, vomiting), myalgia, rash, dizziness, palpitations; avoid in kidney impairment
What are some side effects of disulfiram and when should it be avoided?
- Drowsiness, rash; rarely can cause hepatotoxicity, optic neuritis, peripheral neuropathy
- Avoid in hepatic impairment or CV disease; has many drug-drug interactions
What are type I & II errors?
Type I: incorrectly concluding that a statistically significant difference exists
Type II: incorrectly concluding that a statistically significant difference does not exist; 1-power
What are the live vaccines? Name 5.
Smallpox, yellow fever, varicella, polio, MMR, bCG, oral typhoid
What is the management of recurrent unilateral epistaxis?
Nasal endoscopy +/- CT or MRI to evaluate for malignancy
What are some medications that can cause sensorineural hearing loss? Name 6.
Aminoglycosides, erythromycin, vancomycin, cisplatin, carboplatin, vincristine, loop diuretics, aspirin, NSAIDs, quinine
Explain the Weber and Rinne tests.
Weber test - tuning fork is applied to forehead at midline; louder in affected ear if conductive hearing loss, decreased in affected ear if sensorineural hearing loss
Rinne test - tuning fork is applied to mastoid process; louder in affected ear if sensorineural loss, decreased in affected ear if conductive hearing loss
What are the Centor criteria?
Fever, tonsillar exudates, tender anterior cervical LAD, and absence of cough; Age is also now considered
If score 3 or more get rapid strep testing +/- culture
Tx: penicillin x 10 days, macrolide for those who are allergic to penicilin
What topical medication can be used for dry eye?
Cyclosporine
What eye disorder presents w/ increased cup-to-disc ratio and disc hemorrhage?
Primary open angle glaucoma
What are the differences between atrophic (dry) age-related macular degeneration and neovascular (wet) AMD?
Dry accounts for 80-90% of cases; presents w/ slowly progressive vision loss over years
Wet presents w/ more rapid visual loss and may be accompanied by sudden worsening of central vision associated w/ straight line distortion (metamorphopsia)
What is the management of neovascular age macular degeneration or wet diabetic retinopathy?
Anti-VEGF (bevacizumab, ranibizumab)
What eye condition presents w/ hyperemia and swelling of the disc, blurring of disc margins, and distended veins?
Optic nerve papillitis
What eye condition presents w/ optic disc swelling, dilated and tortuous veins, flame-shaped retinal hemorrhages, and cotton-wool spots?
Central retinal vein occlusion
What is the FDA approved medication for cyclic breast pain? What are some side effects?
Danazol
Amenorrhea, hirsutism, acne, weight gain, adverse changes in lipid profile
Endometrial thickness greater than ___ in postmenopausal women may indicate hyperplasia or malignancy?
4 mm
What are some nonhormonal drugs that are used for vasomotor symptoms?
SSRIs (citalopram, escitalopram, paroxetine), SNRIs (venlafaxine, desvenlafaxine, duloxetine), and gabapentin
What SERM is approved by the FDA to treat dyspareunia associated w/ vulvovaginal atrophy?
Ospemifene
*Those w/ intact uterus need to take progestin with this
Which test characteristics (sensitivity, specificity) rule out vs. rule in a condition?
Sensitive tests rule out a condition (“SNOUT” Sensitive test rules OUT”)
Specific tests rule in a condition
What is the length of time needed to diagnose a sexual disorder?
6 months, and symptoms must cause significant distress and occur 75% of the time
What back disorder presents w/ severe leg pain, no pain when seated, improvement in pain when bending forward, and pseudoclaudication (worsened pain w/ walking or standing, relief with sitting)? What are 2 specific findings?
- Spinal stenosis
2. Wide based gait and/or abnormal romberg test
Name the motor deficit, sensory deficit, and involved reflex for each nerve root level: L3, L4, L5, S1
L3 - hip flexion, anteriomedial thigh, patella
L4 - knee extension, anterior leg/medial foot, patella
L5 - great toe/ankle dorsiflexion, lateral leg/dorsal foot
S1 - plantar flexion foot, posterior leg/lateral foot, achilles
What is the spurling test/what is it used for?
Put hand on patient’s head and extend laterally while applying pressure down; should reproduce pain in cervical radiculopathy
What spinal disorder presents w/ neck pain, difficulty w/ manual dexterity/fine object manipulation, and gait disturbance? What can be found on exam?
- Cervical myelopathy (compression of cervical spinal cord)
2. Increased muscle tone, hyperreflexia, and clonus
Describe the following tests for rotator cuff disease: painful arc, drop arm, hawkins.
Painful arc: during passive abduction of affected arm, pain occurs between 60-120 degrees
Drop arm: affected arm is fully passively abducted, then patient is asked to slowly lower arm. Sudden drop of arm w/ reproduction of patient’s pain (usually around 90 degrees) is positive result
Hawkins: arm is flexed to 90 degrees with elbow in 90 degrees flexion (in front of patient); examiner internally rotates the shoulder and reproduction of pain is positive
Describe the following tests for rotator cuff disease: empty can, resisted external rotation, internal rotation lag sign.
Empty can: extend arm to 90 degrees then 30 degrees in front, then examiner exerts downward force; weakness or pain is positive result (supraspinatus)
Resisted external rotation: place arms at side with elbows extended at 90 degrees, examiner exerts internal rotation force which patient resists; weakness or pain is positive (infraspinatus)
Internal rotation lag: place back of hand on lower back and examiner lifts the hand, further internally rotating the shoulder; inability to maintain hand away from back is positive (subscapularis)
What presents w/ anterior hip pain that starts insidiously and worsens w/ standing and activity in young patients? What presents w/ lateral hip pain that worsens w/ lying on affected side, and may radiate to buttock or knee?
What presents w/ posterior hip pain w/o radiation or exertional leg pain?
- Labral tear, especially when accompanied by painful clicking or catching
- Greater trochanteric bursitis syndrome
- SI joint dysfunction
What is the thessaly test?
Patient stands on one leg with knee flexed to 5 degrees with other knee flexed to 90 degrees with foot off of the floor. Patient rotates body internally and externally 3 times. Repeat with knee flexed to 20 degrees.
Positive result = joint line pain (suggests meniscal tear)
What is the McMurray test?
Flex knee and rotate tibia externally, then extend the knee with hand over medial joint. Repeat maneuver with tibia internally rotated and hand over lateral joint line
Positive result = snapping detected with extension of the knee (suggests meniscal tear)
What is the Noble test?
Place finger on lateral femoral epicondyle and repeatedly flex and extend the knee
Positive result reproduces pain and suggests iliotibial band syndrome
What presents w/ pain/swelling in the region overlying the proximal medial tibia several cm distal to the knee, and commonly occurs in athletes and patients w/ knee OA?
Pes anserine bursitis
The crescent sign is an ecchymotic area below the medial malleolus. What condition is this found in?
Ruptured bakers cyst
What is the test for achilles tendon rupture?
Thompson test - squeeze calf and lack of plantar flexion suggests complete rupture
Which test can be used to rule in plantar fasciitis?
Passive toe dorsiflexion w/ standing reproduces pain
100% specific
Besides counseling what can be used to manage premature ejaculation?
SSRIs (paroxetine, fluoxetine, sertraline) and TCAs (clomipramine) to delay ejaculation
Topical lidocaine to reduce tactile stimulation
What conditions lead to increased SHBG levels vs. decreased SHBG levels?
Increased: advanced age, liver disease, women
Decreased: obesity, diabetes, steroid use
What is the MOA of 5a-reductase inhibitors? When should it be used? How long does it take to have effect? What are the side effects?
- Blocks conversion of testosterone to DHES, leading to reduction in prostate size
- Use in patients w/ BPH refractory to alpha-blocker monotherapy who have an enlarged prostate on exam
- 6 months to take effect
- Erectile dysfunction, decreased libido, reduction in PSA up to 50%
What is the prehn sign and when is it seen? What is the cremasteric reflex and when is it absent?
Prehn sign - pain relief w/ lifting of affected testicle; seen in epididymitis
Cremasteric reflex - testis pull up when ipsilateral inner thigh is stroked; absent in testicular torsion
What testicular condition has increased fullness/pain with standing and valsava? What is the management? In whom should CT be considered?
- Varicocele
- Analgesics, scrotal support; surgery if refractory
- Consider CT in those w/ right-sided varicoceles since these are uncommon and may be associated w/ an underlying abnormality
What is the treatment for chronic pelvic pain syndrome in men?
Antibiotics x 6 weeks
Alpha blocker (tamsulosin)
Pregabalin, gabapentin, nortriptyline
What are the differences between direct & indirect inguinal hernias?
Direct goes directly through abdominal wall weakness, more common on older patients
Indirect goes through inguinal canal via the deep inguinal ring, is usually congenital, is more common
Which of the following transilluminates? Hydrocele, varicocele, testicular malignancy
Hydrocele
Varicocele and malignancy do not
What error is due to reasoning influenced by recent diagnoses? Premature closure? Pattern recognition? Accepting at face-value a diagnosis from an authority or placing too much reliance on a test?
- Availability heuristic
- Anchoring heuristic
- Representativeness heuristic
- Blind obedience
Where should an impaired physician be reported to, in order of preference?
Hospital impaired physician program -> chief of clinical service -> hospital chief of staff
When can patients be prescribed weight loss drugs (BMI)?
BMI 30 or greater, OR
BMI 27 or greater + DM, dyslipidemia, HTN, CVD, stroke, OSA, gout, OA
What medication should be held before eye surgery due to its association with floppy iris syndrome?
Alpha blockers (tamsulosin)
What eye condition can present w/ dendritic branching on cornea fluorescein staining?
Herpes simplex keratitis
Name 4 classes of meds used in glaucoma.
Prostaglandins (latanoprost), alpha agonists (brimonidine), beta blockers (timolol), carbonic anhydrase inhibitors (dorzolamide)
What is hutchinson sign in herpes zoster ophthalmicus and what does it suggest?
Involvement of rash on the tip of the nose
Suggests increased risk for corneal involvement
What condition does cobblestoning of the palpebral conjunctiva suggest?
Allergic rhinitis
What is the empiric tx regimen for epiglottitis?
Third generation cephalosporin + clindamycin or vancomycin (need MRSA coverage)
What is the treatment for acute otitis externa?
Acetic acid solution, combination antibiotic/steroid drops
At what age does screening stop for the following cancers: colon, breast, cervical, prostate, lung?
Colon - 75, Breast - 75, Cervical - 65, Prostate 70, Lung - 80
What is (1-sensitivity)/specificity? What is sensitivity/(1-specificity)?
Negative likelihood ratio
Positive likelihood ratio
What is the management for an acute full thickness rotator cuff tear?
Immediate surgery in younger patients
Conservative management in older patients
What drug can be used in concomitant BPH and erectile dysfunction?
Tadalafil
What is the management for breast skin changes in patients age >30?
Mammogram - if normal obtain skin biopsy; if abnormal or indeterminate obtain needle biopsy or excision
What is the management for palpable breast mass in patients age >30?
Mammogram; even if normal obtain U/S +/- tissue biopsy
What medications can be used for PMS and premenstrual dysphoric disorder (PMDD)?
Fluoxetine, sertraline, paroxetine
What is the vaginal pH in the following conditions: BV, candida, trichomonas?
pH >4.5 in BV and trichomonas
pH <4.5 (normal) in candida
What condition presents w/ pain, photophobia, inflammation confined to corneal limbus, corneal irregularity, and edema?
Iridocyclitis or keratitis
Associated w/ spondyloarthropathies, sarcoidosis, and herpes zoster
What is the condition in which there is refractory congestion after chronic use of topical nasal decongestants? What is the treatment?
Rhinitis medicamentosa
Tx: stop the decongestant; start oral or intranasal steroids
What are 3 drugs that can be used for PTSD tx?
Sertraline, Paroxetine, Venlafaxine
What is the treatment for bulimia nervosa? What is the treatment for anorexia?
- CBT; Fluoxetine, Imipramine
2. CBT; Olanzapine
Name a beta-agonist that can be used for urgency urinary incontinence?
Mirabegron
SE: GI upset, nasopharyngitis
What are some anti-cholinergics used for urge incontinence? Name 5.
Oxybutynin, Tolterodine, Fesoterodine, Darifenacin, Solifenacin, Trospium
With which screening test must the diet be modified to reduce false positive results? Fecal occult blood vs. FIT?
Fecal occult blood
FIT does not require dietary restriction
When should a pap smear be repeated after ASCUS and negative HPV?
3 years, with repeat HPV
What is the best method of preventing pressure injuries in high risk patients in the hospital?
Advanced static mattresses or overlays (made of sheepskin, foam, or gel)
*Repositioning, nutritional interventions, and local care have limited evidence
What are some second line treatments for ADHD when methylphenidate is contraindicated (recent substance abuse, high risk for arrhythmia or HTN)? Name 3.
Atomoxetine (SNRI), Bupropion, TCAs
What are olapatadine and ketotifen eye drops used for and what is the MOA?
Allergic conjunctivitis
Anti-histamine
What presents w/ vertigo and hearing loss with history of straining or trauma?
Perilymphatic fistula
What kind of injury has pain on compression of leg at mid calf, pain with crossing leg and having lateral malleolus of injured leg resting on the other knee, and with dorsiflexion and external rotation of the foot with the knee flexed?
High ankle sprain
How do you assess ovulatory status in a woman who doesn’t have normal menstrual cycles w/ ovulation?
Midluteal phase serum progesterone - obtain 1 week prior to expected menses; progesterone >3 ng/mL is evidence of recent ovulation
What is the time course in the definition for secondary amenorrhea?
> 3 months if previously had regular periods
>6 months if previously had irregular periods
What are some conditions associated with restless leg syndrome? Name 6.
Iron deficiency anemia, uremia, pregnancy, diabetes, parkinson disease, multiple sclerosis, anti-depressants, metoclopramide
Who requires a second MMR dose?
Post-secondary students, health care workers, household or close personal contacts of immunocompromised persons w/ no evidence of immunity, and international travelers
How are sensitivity, specificity, and predictive values related?
Higher sensitivity means less false negatives, so increased negative predictive value of test
Higher specificity means less false positives, so higher positive predictive value of test
What effect does changing the cut off value have on the sensitivity and specificity of a test?
Decreasing the cut off value increases sensitivity (because will capture more people with the disease) but will decrease specificity (because increases false positives)
Knowing the prevalence of disease, sensitivity and specificity how do you calculate the number of people that will test positive?
Calculate prevalence (for example 15% in a population of 1000 is 150 people) 150 people are positive, but with a sensitivity of 60% that is 150 x 0.6 = 90 true positives 850 are negative, but with specificity of 80% that is 850 x 0.8 = 680 true negatives
How do you calculate attributable risk?
Incidence in exposed - incidence in unexposed
Which supplement, which can be found as a pigment in certain fruits and vegetables, are associated w/ an increased risk for lung cancer and should be avoided in smokers?
Beta-carotene
How much compression should be in stockings if there are skin changes or ulceration present?
30 mmHg
Which statin has the least drug interactions? Are statins safe in pregnancy?
- Pravastatin
2. No - they are contraindicated in pregnancy
What should be given to women w/ anovulatory cycles that want to preserve fertility?
Medroxyprogesterone acetate for second half of menstrual cycle to restore cyclic withdrawal bleeding
What is an afferent pupillary defect and in which condition is it seen?
- Paradoxical dilation of the affected pupil when examining light is shifted from the unaffected to affected eye
- Optic neuritis
What are some side effects in the eye of PDE-5 inhibitors?
Bluish tinting, blurry vision, photophobia
Of the following second generation anti-psychotics, which ones have the lowest weight gain/metabolic syndrome risk, highest extrapyramidal side effects, and highest prolonged QTc risk? Aripiprazole, Clozapine, Lurasidone, Olanzapine, Quetiapine, Risperidone, Ziprasidone
Aripiprazole, Lurasidone, and Ziprasidone have lowest weight gain
Risperidone has highest extrapyramidal side effects; lurasidone has medium risk
Ziprasidone has highest QTc prolongation risk; aripiprazole and lurasidone have lowest risk, others are medium
What are some conditions that should be optimized b/c they can worsen symptoms of BPH?
Heart failure and COPD
What is the time difference between acute stress disorder and PTSD?
Acute distress disorder : <1 month
PTSD : >1 month
A bite from what presents w/ localized cyanosis, swelling, sweating, piloerection +/- HA, myalgias, malaise, abdominal pain?
Black widow spider
What presents w/ linear excoriations on the trunk concentrated around the waist and axillary folds, and hemorrhagic puncta or wheals on the skin? What conditions is it a risk factor for?
- Body lice
2. Bartonella quintana endocarditis, bacillary angiomatosis, trench fever
What vitamin deficiency presents w/ eye dryness, night blindness, dry skin, hyperkeratosis, and immune dysfunction? How does toxicity of this present?
- Vitamin A
2. Idiopathic intracranial HTN, yellowing of skin, GI upset, pruritis
What vitamin deficiency can present w/ muscle weakness, demyelination of posterior columns and spinocerebellar tract, and hemolytic anemia?
Vitamin E
What is associated with hypertriglyceridemia and has creamy white appearance of the retinal arteries and veins on exam?
Lipemia retinalis
How is phenylephrine used to differentiate episcleritis and scleritis?
If redness improves it is episcleritis
If does not improve it is scleritis
Rotator cuff disease has pain w/ abduction and external rotation. Which has weakness w/ abduction and external rotation - impingement/tendinopathy or tear?
Rotator cuff tear
What presents w/ anterior shoulder pain, and pain w/ lifting, carrying, or overhead reaching? What presents w/ gradual anterior or deep shoulder pain, decreased active and passive abduction and external rotation, and is typically caused by trauma?
- Biceps tendinopathy or rupture
2. Glenohumeral osteoarthritis
What presents w/ pain with shoulder abduction beyond 120 degrees and pain with passive shoulder adduction (positive cross arm test)?
Acromioclavicular joint degeneration
*Also have pain at AC joint
