Q&A Flashcards
1
Q
Which cranial nerves have to do with ocular motor
A
3, 4, 6
2
Q
Trigeminal Nerve . It is the motor nerve for the muscles of mastication and contains
proprioceptive fibers
A
CN 5
3
Q
Facial Nerve = . Bells palsy, Besides facial muscles, the nerve affects tears, saliva, taste
A
CN7
4
Q
Which nerve deals with shoulder shrugging?
A
Cranial nerve XI, the spinal accessory nerve.
5
Q
Normal murmur in pregnancy and fluid overload. May be normal if heard
in young adults or children.
A
S3
6
Q
ELDERLY: This sound is usually associated with a stiffened ventricle (low
ventricular compliance), and therefore is heard in patients with
ventricular hypertrophy, myocardial ischemia, or in older adults.
A
S4
7
Q
S2 location
A
L second intercostal space
8
Q
S1, S3, S4
A
L side, 5,4th intercostal space
9
Q
Stable angina diagnostic test?
A
Stress test
10
Q
What does a split S mean? S split during inspiration?
A
Normal. During inspiration and expiration is not normal.
11
Q
Fixed split Heart sound?
A
Septal defect
12
Q
BP lower on lower extremities in comparison to upper extremities
A
COARC
13
Q
3 or #4 murmur
A
3: moderately loud
4: loud
14
Q
Which murmur radiates to the neck?
A
Aortic stenosis
15
Q
Which murmur radiates to axilla?
A
MR
16
Q
What is best heard on the 4th L ICS, L sternal border?
A
Tricuspid valve
17
Q
Which murmurs are dangerous?
A
Diastolic
18
Q
What is the regurgitation sound like?
A
Harsh
19
Q
Sudden pain in the chest, belly, lower back, flank, pulsating feeling in the
belly, low BP, fast HR.
A
symptoms of AAA
20
Q
How do you rule out AAA? What test do you order?
A
US
21
Q
Beset HTN medication for the postmenopausal female who has OA and HTN?
A
Thiazides
22
Q
HTN meds to someone with DM?
A
ACE or ARBs
23
Q
Elderly patient with isolated systolic hypertension. What med do you start them on?
A
CCB- causes dilation
24
Q
BPH and HTN
A
Hytrin
25
On fundoscopic exam Copper silver arterioles with what condition?
HTN
26
On fundoscopic exam- cotton wool spots
DM
27
Peripheral arterial disease treatment?
Tobacco cessation, exercise, and a healthy diet are often successful treatments.
28
does PAD like exercise or rest?
exercise
29
test to dx PAD?
ankle brachial index
30
Differences between PAD and chronic venous insufficiency
Which has claudication?
PAD: Claudication, shiny leg.
Chronic venous insufficiency: Fat looking calf, erythematous, seeping.
31
What is the patient at risk of with very high triglycerides?
pancreatitis
32
What is the discoloration of the left flank called?
Grey Turner sign
- It is associated with acute hemorrhagic pancreatitis.
33
1st line tx for GERD
AANP: h2 blockers
ANCC: PPIs
34
What is Barret Esophagus?
Precancerous cells. Its reversible If treated with PPIs. Untreated it converts into esophageal cancer. Is usually the result of repeated exposure to stomach acid
35
Which HTN meds would you avoid if patient has GERD
CCB, because they open things up
36
Zollinger-Ellison
An over production of acid in the stomach. Treated with PPIs
37
Positive psoas maneuver
Appendicitis
38
Cullen sign
Hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage
39
Pyloric stenosis how it presents
Olive mass palpated usually pediatric patients, RUQ
40
Koplik spots
Rubeola white spots
41
Causes for hyperbilirubimia in pedi
Prematurity, trauma: cephalohematoma, vacuum
42
Teenager with knee pain, bony prominence on tibial tubercle
Osgood slaughter
43
What Tanner stage is 2nd mound
Tanner stage 4
44
1st line Tx for ADHD
Stimulants
45
Kid with white plugs on skin, belly button center
Molluscum contagiosum
46
Less than 2 yr old kid, kid has intermittent episodes of colic’s, diarrhea, then goes away. Sausage like mass
Intussusception
47
What is the percentage change if both patients have a genetic defect, chance kid will have it?
25%
48
Teenager female presents with lanugo and swollen hands
anorexia
49
Kid with diarrhea, what is the most common bug?
Rota Virus
50
Honey crusted lesions
Impetigo. Tx: Mupirocin
51
Precursor to SCC
Actinic keratosis
52
Rosacea location? Tx?
Folds, back of knee. Tx: metronidazole gel
53
Shingles tx ?
acyclovir
54
Induration on top of lip, bleeds easily, doesn’t heel
biopsy- cancer?
55
What is waxy, pearly, ulceration in the center, telangiectasias?
Basal cell cancer
56
ABCDE melanoma
Asymmetry, borders, color, dimension, evolving
57
Subungual hematoma treatment
Drill a hole and drain blood
58
Tx for moderate acne
PO tetracycline
59
Tx skin fungal infection
Clotrimazole
60
What should you monitor closely with antipsychotics?
High risk of obesity, DM2, hyperlipidemia
61
Most common side effect of Paxil
ED- give wellbutrin
62
First line tx for depression adults?
SSRI
63
What is the the SSRI with shortest list of interactions
celexa- give to elderly
64
What meds don’t you mix with Kava Kava
Benzos, hypnotics
Often taken for depression
65
Depression and elderly, what kind of test tests for memory
Minni mental exam
66
77 yo taking benzo long time, how do you take them off?
taper slowly
67
What med do you tx acute anxiety attack?
Benxo (Xanax)
68
Elderly patient confused. What labs do you check for
CBC, thyroid, CMP, UA
69
Preferred tx UTI elderly with comorbidities?
Cipro
70
How do you start medications with elderly?
low and slow
71
What does it mean if there is no lateralization with weber?
No lateralization is normal
72
Presbycusis: sensory or conductive?
sensory
73
Which cranial nerve is involved in hearing?
8th, vestibulochoclear
74
HIV CD count <200
AIDS
75
Kaposi sarcoma
RT HIV- Purple lesions inside mouth
76
What drugs are for abortive HA
triptans
77
How do you treat a migraine prophylactic?
propranolol
78
What is the specific drug used to treat trigeminal neuralgia?
Tegretol aka carbamazepine
79
Cluster HA Tx choice?
High dose O2
80
Thunderclap HA, what is your main concern?
subarachnoid hemorrhage
81
Patient with HA, photophobia, aura
Migraine due to sensory disruptions
82
Unilateral HA by orbital area, comes at the same time daily, injection of the eye, tearing of the eye
Cluster HA
83
BPH feels on DRE
symmetrical enlargement, smooth, firm
84
Prostatitis on DRE feels
painful, boggy
85
prostate cancer feels on DRE
Irregular, asymmetrical, growth, bump
86
Chlamydial tx:
Azithromycin
87
Gonorrhea tx
Rocephin and Azithromycin
88
Syphilis tx
PCN
89
BV Tx
Flagyl - avoid alcohol
90
Cervix is strawberry with green discharge
Trichomonas. Tx: Flagyl
91
Popular non itchy lesions on palms and sole of feet
Syphilis
Labs: RPR
92
Genital Warts
Acyclovir
93
PPD INTERPREATION HIV and TB test
Induration >5mm is positive
94
PPD INTERPREATION HIV and TB test > 10
Community like nursing homes, men in jail, immigrants of high-risk
countries, health care workers
95
What is positive TB test for someone who came in contact with TB
> 5 mm
96
Big beefy tongue
B12 anemia
97
Therapeutic range INR
2-3
INR 1.4 increase drug.
INR 4 skip days of tx
98
Which 2 anemias are macrocytic
B12 and folate
99
positive pregnancy signs
Fetal movement: positive if checked with US, fetal heart beat.
100
probable pregnancy
increased frequency urination, soft cervix, abdominal bloating/enlargement, mild uterine cramping without bleeding
101
Possible pregnancy
Belly is growing, tender breast, movement in belly
102
Nagels rule
LMP + 7 days, -3 months, add 1 yr
103
Pregnant woman in 3td trimester, painful vaginal bleeding
Placenta abruptio
104
Pregnant woman in 3td trimester, non- painful vaginal bleeding
Non painful: placenta previa
105
UTI tx for pregnant woman
nitrofurantoin (Macrobid)
106
Pre-eclampsia tx
Bed rest
107
Cooms test detect.
RH antibodies
108
When do you administer Rh?
28 weeks and 72 hrs after delivery
109
Fundus at 12, 20 , and 38 weeks
12 symphisis pubis
20- umbilicus
39- xyphoid process
110
PAP results are high grade squamous cells, what do you do?
Refer
111
Avoid what contraception if female is smoker and >35?
NO COC pills
112
Post-menopausal and palpate R ovary
Not ok. Should never palpate ovary, mass? Cancer? US
113
What test would differentiate between a lesion and a cyst in the breast
US
114
Patient comes in with fatigue fever cough, blood in cough, Xray have upper lobe infiltrates
TB
115
Tx Pneumonia of the young person
Macrolide
116
Pneumonia of older person
Fluoroquinolones
117
Tx acute bronchitis
don’t tx with antibiotics, use supportive tx
118
CURB-65
2 or more send to ED for elderly with pneumonia: Confusion, Urea >18, Resp >30, B <90/60, >65 age.
119
Specific drug used to treat essential familial tremors
propranolol
essential tremors = at rest
120
Rhomberg Test
used to test balance
121
T score is -1.5, what is dx? -2.5
-1.5= osteopenia
-2.5= osteoporosis
122
Temporal arteritis, what is standard dx?
Biopsy of artery
Tx: long term steroids of about 6 months
123
Stringy eye discharge
allergic conjunctivitis
124
purulent eye discharge
bacterial conjunctivitis
125
watery eye discharge
viral conjunctivitis
126
Red reflex white in young
Retinal blastoma kids
127
Red reflex white in elderly
cataracts
128
Tx for sprain
RICE
129
Tx tibial stress syndrome: runner lady with shin splints anterior aspect of shins
Stop and RICE
130
Patient has mass on 5th or 4th metatarsal foot
mortons neuroma
131
Anthrax tx:
Cipro 60 days. It's a rare but serious spore forming bacterium that causes infection, if inhaled, is harder to treat.
132
Strep throat complications
peritonsillar abscess, acute rheumatic fever which can infect heart, valves and brain. Scarlatina aka Scarlet Fever (sandpaper textured rash, sore throat, rash starts head and neck and spreads to rest of body)
133
1st line tx for sore throat, otitis media, bacterial sinusitis?
Amoxicillin
134
Human/animal bite tx?
Augmentin
135
Tx for skin infection with and without abscess?
without abscess: Keflex.
With abscess: MRSA: Bactrim
136
What if a patient is allergic to Bactrim? and need to tx MRSA skin infection
BCD: Bactrim, Clindamycin, Doxy. Know the order if allergic.
137
Mono: causative organism? Diagnostic test? tx? Meds to avoid? When can student return to contact sports? Classic triad?
-Causative organism: Epstein-Barr virus
- Diagnostic test: Mono spot
-Tx: symptomatic management
- Meds to avoid: antibiotics like penicillin due to generalized rash.
- Can return to sports 4-6 weeks
- Classic triad: fever, pharyngitis, and lymphadenopathy
138
Traveler’s diarrhea tx?
Cipro
139
-What is Non-Gonococcal Urethritis? Tx?
is an infection of the urethra caused by pathogens other than gonorrhea. The most common and serious is chlamydia. Tx: Azythromycin or Doxy.
140
-5 year old with fever, sore throat, irritability, loss of appetite, red spots on hands, feet, mouth. Oral mucosa ULCERATION. What is the most likely diagnosis?
What causes?
Hand, foot and mouth syndrome.
Cocksacie virus
141
5 year old with high fever, peeling of skin, injection of the eye, enlarged neck lymph nodes, strawberry tongue. What is the most likely diagnosis and Tx ?
Kawasaki: tx: high dose aspirin and IVIG.
142
-Malaria tx?
Doxy
143
What would you treat acute otitis media effusion with?
decongestant and abx
144
What is the most common causative organism for acute otitis media?
strep pneumo
145
-4 year old kid with slapped cheeks, what is the most likely condition? Causative organism? Prego warning?
5th disease, aka Parvovirus B12. Prego can have misscariage.
146
What is Treponema Pallidum? Best test to order? If positive order what?
-spirochaete bacterium that causes syphilis.
-Screening test: Rapid plasma reagin (RPR), confirmatory test is Venereal disease research laboratory (VDRL). A positive FTA-ABS is often a sign of a syphilis infection. This test result will remain positive for life even if syphilis has been adequately treated. Therefore, it cannot be used to monitor the treatment of syphilis or determine that you have active syphilis.
147
What are Janeway lesions? osler nodes?
-are rare, non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler's nodes. Osler's nodes are on the tip of the finger or toes and painful. Janeway lesions occur on palm and soles and are non-painful
148
-Prego and UTI tx?
Amox and cephalosporins category B.
can use macrobid
149
Age Colon cancer screening recommendation?
age 50
150
Mammogram's screening recommendation?
age 50-75 ish. every 2 years. Positive family history can start sooner, age 45
151
Papanicolaou screening recommendation?
Start at age 21 no matter sexual activity or number of partners
- Papanicolaou= GYN PAP
152
At what age do we start vaccinating for Singles?
60
Earliest 50
153
Leading cause of death ages: 0-12 mos,
-0-12mos: congenital abn
154
Leading cause of death ages 1-44yr
unintentional accident
155
Leading cause of death ages: 45-64 yrs?
cancer
156
Leading cause of death ages >65 yrs?
heart
157
Cancer causing most deaths male and female?
Cancer death female?
Cancer death male?
Most common cancer?
Most common GYN cancer?
Male and female lung
-Cancer death female: breast
-Cancer death male: prostate
-Most common cancer: basal cell
-Most common GYN cancer: cervical
158
-Post menopausal female with spotting, what to do next? Why?
Warning sign cancer. endometrial?
159
-Hep B vaccine schedule?
0. 1mo . 6mo . Need 4 weeks between them at least.
160
Immigrant woman with negative Hep B antibodies and Hep B antigen, what do you do next?
vaccinate
161
-3 main causes of adolescent death?
-MVA, suicide, homocide
162
when to screen for autism
18-24 months
163
1st line tx for OCD, PTSD, GAD…
SSRI
*citalopram (Celexa)
* escitalopram (Lexapro)
* fluoxetine (Prozac or Oxactin)
* paroxetine (Seroxat)
* sertraline (Lustral)
164
Antidepressant choice for elderly?
escitalopram (Lexapro) . Due to short ½ life
citalopram (Celexa)- lest interactions
165
SSRIs to avoid in elderly? Why?
Prozac , due to long ½ life
166
Topical steroids strengths?
class 1 is super potent, class 7 least potent.
Super potent= clobetasol #1 , least potent = OTC hydrocortisone # 7 .
167
Impetigo tx?
muprocin
168
Hidradenitis suppurativa: what it is? Tx?
severe acne under armpit, groin area. Painful large dark red nodules, abscesses, pustules. Overweight. Topical-PO-Acutane. Cloherxadine (mild) topical, antibacterial soap (topical), clindamycin solution with benzil peroxide, warm compress to mature abscess. Patient education: loose weight, exercise, avoid foods that are high glycemic: dairy, smoking.
169
Rosacea tx?
Metro gel
170
Patients come in with red spots like rash on palms/soles, fever, HA, myalgia.
Were hiking, what is the most likely diagnosis? Tx?
Mountain spotted fever
tx with doxy
life threatening so ok to give doxy to kids < 7 yrs
171
What is tinea versicolor?
fungal infection of the skin: hypopigmented oval, non pruritic spots lighter than other parts.
tx with anti-fungal
172
Itchy purplish, flat-topped bumps? Tx?
lichen planus. Tx: steroids.
173
Erysipelas causative organism?
group A streptococcal bacteria
174
1st, 2nd, 3rd, 4th line tx for Asthma?
step 1: as needed low dose ICS- Budesonide, fluticasone etc. = sx < 2x month
(or low dose ICS taken when SABA is taken)
* step 2: daily low dose ICS or as needed low dose ICS
(or daily leukotriene receptor antagonist (ex. montelukast ) or low dose ICS taken when SABA taken) = sx 2x month or more but not daily
* step 3: low dose ICS + LABA (salmeterol, fometerol ) = sx most days or waking w/ asthma 1x week or more
* step 4: med dose ICS + LABA= sx most says or waking w/ asthma 2x week or more or low lung fx
Should have short acting SABA alwyas
175
1st, 2nd, 3rd, 4th line tx for COPD?
SABA, LAMA, LABA, ICS
176
What causes whooping frequent and violent coughing that can make it hard for a person to breathe.
How to tx?
Pertussis
* paroxysmal cough
Tx with macrolide
177
Patient comes in with rusty color sputum, chills, productive cough, fever. What is the most likely diagnosis?
Bacterial pneumonia
178
2 main causative organisms for atypical pneumonia (walking pneumonia) ?
Chlamydia pneumonia, Mycoplasma pneumonia
179
Possible side effect of aspirin?
* tinnitus: Although disturbing, this side effect usually disappears when the dose is decreased
180
Tylenol’s max daily dose?
4g
181
Coumadin and Bactrim, ok to give together? Why?
not ok, increased risk of bleeding
182
Which abx medications are safe to give to Prego?
Penicillins, including amoxicillin, ampicillin. Cephalosporins,
including cefaclor, cephalexin. Erythromycin
183
Which BP meds OK for Prego? Which BP meds NOT OK?
OK: labetatlol, nifedipine, methyldopa.
* NOT OK: ACE inhibitors, statins
184
What drugs to avoid with grapefruit juice?
statins, warfarin. Too much alcohol, cranberry products, or
grapefruit products can INCREASE warfarin's effect and
increase your risk of bleeding
185
How soon do you follow up after starting someone on Synthroid?
8 weeks
186
What population would you avoid giving Wellbutrin to?
Do not give Wellbutrin to: anorexia or bulimia, or hx of seizures. Alcohol withdrawals don’t give due to increase of seizures
187
Allergies to antibiotics order?
PCN-macrolides-doxy-levoquin.
188
Food’s rich in Mg?
nuts, beans, laxatives, antacids
189
* Food’s rich in potassium?
most fruits
190
* Foods to avoid with celiac disease?
avoid wheat (including spelt, farro, graham, khorasan wheat, semolina, durum, and wheatberries.), rye, barley: breads, cereals, cookies.
191
Foods to avoid with Gout?
Skip foods and drinks that are high in purines to help lower your chances of an attack.
● Beer and grain liquors (like vodka and whiskey)
● Red meat, lamb, and pork
● Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
● Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines
High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food
192
makes it hard to see things that are close
-Hyperopia (farsightedness)
193
makes it difficult to see things that are far away
Myopia (nearsightedness)
194
Patient with sudden floaters, like the curtain is closing, flashes of lights?
retinal detachment
195
Difference between hordeolum, chalazion, pterygium?
hordeolum: stye, acute, painful, warm compress BID.
Chalazion: meibomian gland, gradual, not acute, painless, tx I&D to ophthalmologist.
Pterygium: surfer's eye, due to sun exposure, yellow triangular thickening
196
Fundoscopic exam reveals microaneurysms, what is the condition?
DM
197
Triglycerides >500, what sign are you looking for?
- at risk for pancreatic rupture, tx is niacin or phenofibrate to sequester triglicerides . Look for Cullen sign
198
Triglycerides >800, what medication to give?
true emergency, give something right away to sequester fenofibrate (tricor). Serious risk of pancreatitis.
199
A patient tests negative for hep B antibody and positive for the antigen, what do you do?
Tx with Hep B Vax and Hep B immune globulin
200
Acute, sudden, eye pain, injection of the eye, headache. What is the most likely diagnosis?
Closed angle glaucoma
201
Acute onset of calf pain, swelling, tenderness, redness. What is the most likely diagnosis?
DVT
202
-Goal A1C: elderly? Young adult?
A1C: goal 65 yrs and older8.0
Under 7.0 if young adult
203
How can you diagnose DM2?
fasting >126 x 2, random sugar grater 200, A1C > 6.5, 2 hr plasma >200.
204
How much and how often can you increase insulin Lantus?
2-3 units every 2-3 days
205
Patient comes in with bronze skin, dizziness, fatigue, nausea. Dx?
Addisons
tx= steroids
206
Goal TSH level?
between 0.5 to 2.5 mU/L.
207
-Beta Blocker side effects?
fatigue, depression
208
ACE/ARBs side effects?
ACE: dry cough. ARBS: HA, dizziness
209
Calcium Channel Blockers side effects?
HA, ankle edema
210
Best HTN medication for elderly? Why?
CCB open things up
211
Patient with sudden palpitations, dizziness, fatigue, inability to exercise, weakness, SOB?
Afib. Most common arrhythmia in US, most common cause of stroke, risk factors: HTN, nicotine. Sudden palpitations classic give away. ED
212
Mid systolic click
MVP
213
S2 fixed split.
septal defect
214
What is the ASCVD? Its cutoff?
Tool for hyperlipidemia
7.5%. Above that treat for hyperlipidemia
215
Most likely condition with a bruit over the carotid artery?
arterial narrowing and atherosclerosis
216
BP goal >65? <65?
>60 or older: <150/90. Goal
* <60, <140/90 or less.
217
BP goal DM or chronic kidney diseases all ages
<140/90
218
HTN tx non black and black pts
ACE, ARBs, CC, THZ.
Black: CC, THZ.
219
HTN meds for Kidney disease, dm
ACE or ARB
220
What is coenzyme 10 good for?
heart health
221
When should a patient call the provider with CHF?
weight gain 3 lbs in 24 hrs or 5 lbs 1 week
222
What is paroxysmal atrial tachycardia?
a type of arrhythmia, or irregular heartbeat. Paroxysmal means
that the episode of arrhythmia begins and ends abruptly. Atrial
means that arrhythmia starts in the upper chambers of the heart
(atria). Tachycardia means that the heart is beating abnormally
fast
223
INR interpretation and goal
2-3. INR low means your blood is taking longer to clot. When your PT or INR is too high, you have an increased risk of bleeding
2.5-3.5 if heart valve
224
a condition where the corners of the mouth become
inflamed, which can lead to cracking and pain at the corners of the mouth. The cracks can split and bleed; they can also make it difficult to yawn, chew, or talk.
Cheilosis
225
Low levels platelets = increased bleeding
Easy bruising, petechiae, epistaxis, gingival bleeding
ITP
decreased platelets, anything less than <100,000 consider ITP <30,000.
226
Tx for ITP
in kids?
Glucocorticoids
In children, ITP usually resolves without any treatment. Adults commonly need treatment
with medications for bleeding. Rarely the spleen may need to be removed.
227
may occur when the immune system mistakenly
attacks platelets. In children, it may follow a viral infection. In adults, it may be chronic.
Idiopathic thrombocytopenic purpura (ITP)
228
also known as spoon nails, is a nail disease that can be a
sign of hypochromic anemia, especially iron-deficiency anemia
Koilonychia
229
It is used for culturing and primarily isolating
pathogenic Neisseria bacteria, including Neisseria gonorrhoe, as the medium inhibits the growth of most other microorganisms.
Thayer-Martin agar
230
CAGE
C-cut down, A- annoyance, G-guilty, E-early morning
drink.
231
Stethoscope: when is the bell vs diaphragm used?
diaphragm used for high pitched, bell for low.
232
What is the drug used for trigeminal neuralgia? What is the cream used?
Tegretol
cream= capsacian
233
Best test to diagnose diverticulitis?
CT
234
Best test to diagnose cholelithiasis?
US
235
Best test to diagnose appendicitis?
CT
236
Cluster HA tx: immediate in office, prophylaxis, and abortive?
Cluster HA: O2, medication prophylaxis (CC like verapamil to open
things up) and abortive. (triptans)
237
Gout: long vs short term tx?
Gout: acute tx with Indocin (indomethacin). Colchicine to relieve pain.
For long term tx allopurinol.
238
Diagnostic test for giant cell?
Biopsy
