Q&A Flashcards
Which cranial nerves have to do with ocular motor
3, 4, 6
Trigeminal Nerve . It is the motor nerve for the muscles of mastication and contains
proprioceptive fibers
CN 5
Facial Nerve = . Bells palsy, Besides facial muscles, the nerve affects tears, saliva, taste
CN7
Which nerve deals with shoulder shrugging?
Cranial nerve XI, the spinal accessory nerve.
Normal murmur in pregnancy and fluid overload. May be normal if heard
in young adults or children.
S3
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.
S4
S2 location
L second intercostal space
S1, S3, S4
L side, 5,4th intercostal space
Stable angina diagnostic test?
Stress test
What does a split S mean? S split during inspiration?
Normal. During inspiration and expiration is not normal.
Fixed split Heart sound?
Septal defect
BP lower on lower extremities in comparison to upper extremities
COARC
3 or #4 murmur
3: moderately loud
4: loud
Which murmur radiates to the neck?
Aortic stenosis
Which murmur radiates to axilla?
MR
What is best heard on the 4th L ICS, L sternal border?
Tricuspid valve
Which murmurs are dangerous?
Diastolic
What is the regurgitation sound like?
Harsh
Sudden pain in the chest, belly, lower back, flank, pulsating feeling in the
belly, low BP, fast HR.
symptoms of AAA
How do you rule out AAA? What test do you order?
US
Beset HTN medication for the postmenopausal female who has OA and HTN?
Thiazides
HTN meds to someone with DM?
ACE or ARBs
Elderly patient with isolated systolic hypertension. What med do you start them on?
CCB- causes dilation
BPH and HTN
Hytrin
On fundoscopic exam Copper silver arterioles with what condition?
HTN
On fundoscopic exam- cotton wool spots
DM
Peripheral arterial disease treatment?
Tobacco cessation, exercise, and a healthy diet are often successful treatments.
does PAD like exercise or rest?
exercise
test to dx PAD?
ankle brachial index
Differences between PAD and chronic venous insufficiency
Which has claudication?
PAD: Claudication, shiny leg.
Chronic venous insufficiency: Fat looking calf, erythematous, seeping.
What is the patient at risk of with very high triglycerides?
pancreatitis
What is the discoloration of the left flank called?
Grey Turner sign
- It is associated with acute hemorrhagic pancreatitis.
1st line tx for GERD
AANP: h2 blockers
ANCC: PPIs
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
Which HTN meds would you avoid if patient has GERD
CCB, because they open things up
Zollinger-Ellison
An over production of acid in the stomach. Treated with PPIs
Positive psoas maneuver
Appendicitis
Cullen sign
Hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage
Pyloric stenosis how it presents
Olive mass palpated usually pediatric patients, RUQ
Koplik spots
Rubeola white spots
Causes for hyperbilirubimia in pedi
Prematurity, trauma: cephalohematoma, vacuum
Teenager with knee pain, bony prominence on tibial tubercle
Osgood slaughter
What Tanner stage is 2nd mound
Tanner stage 4
1st line Tx for ADHD
Stimulants
Kid with white plugs on skin, belly button center
Molluscum contagiosum
Less than 2 yr old kid, kid has intermittent episodes of colic’s, diarrhea, then goes away. Sausage like mass
Intussusception
What is the percentage change if both patients have a genetic defect, chance kid will have it?
25%
Teenager female presents with lanugo and swollen hands
anorexia
Kid with diarrhea, what is the most common bug?
Rota Virus
Honey crusted lesions
Impetigo. Tx: Mupirocin
Precursor to SCC
Actinic keratosis
Rosacea location? Tx?
Folds, back of knee. Tx: metronidazole gel
Shingles tx ?
acyclovir
Induration on top of lip, bleeds easily, doesn’t heel
biopsy- cancer?
What is waxy, pearly, ulceration in the center, telangiectasias?
Basal cell cancer
ABCDE melanoma
Asymmetry, borders, color, dimension, evolving
Subungual hematoma treatment
Drill a hole and drain blood
Tx for moderate acne
PO tetracycline
Tx skin fungal infection
Clotrimazole
What should you monitor closely with antipsychotics?
High risk of obesity, DM2, hyperlipidemia
Most common side effect of Paxil
ED- give wellbutrin
First line tx for depression adults?
SSRI
What is the the SSRI with shortest list of interactions
celexa- give to elderly
What meds don’t you mix with Kava Kava
Benzos, hypnotics
Often taken for depression
Depression and elderly, what kind of test tests for memory
Minni mental exam
77 yo taking benzo long time, how do you take them off?
taper slowly
What med do you tx acute anxiety attack?
Benxo (Xanax)
Elderly patient confused. What labs do you check for
CBC, thyroid, CMP, UA
Preferred tx UTI elderly with comorbidities?
Cipro
How do you start medications with elderly?
low and slow
What does it mean if there is no lateralization with weber?
No lateralization is normal
Presbycusis: sensory or conductive?
sensory
Which cranial nerve is involved in hearing?
8th, vestibulochoclear
HIV CD count <200
AIDS
Kaposi sarcoma
RT HIV- Purple lesions inside mouth
What drugs are for abortive HA
triptans
How do you treat a migraine prophylactic?
propranolol
What is the specific drug used to treat trigeminal neuralgia?
Tegretol aka carbamazepine
Cluster HA Tx choice?
High dose O2
Thunderclap HA, what is your main concern?
subarachnoid hemorrhage
Patient with HA, photophobia, aura
Migraine due to sensory disruptions
Unilateral HA by orbital area, comes at the same time daily, injection of the eye, tearing of the eye
Cluster HA
BPH feels on DRE
symmetrical enlargement, smooth, firm
Prostatitis on DRE feels
painful, boggy
prostate cancer feels on DRE
Irregular, asymmetrical, growth, bump
Chlamydial tx:
Azithromycin
Gonorrhea tx
Rocephin and Azithromycin
Syphilis tx
PCN
BV Tx
Flagyl - avoid alcohol
Cervix is strawberry with green discharge
Trichomonas. Tx: Flagyl
Popular non itchy lesions on palms and sole of feet
Syphilis
Labs: RPR
Genital Warts
Acyclovir
PPD INTERPREATION HIV and TB test
Induration >5mm is positive
PPD INTERPREATION HIV and TB test > 10
Community like nursing homes, men in jail, immigrants of high-risk
countries, health care workers
What is positive TB test for someone who came in contact with TB
> 5 mm
Big beefy tongue
B12 anemia
Therapeutic range INR
2-3
INR 1.4 increase drug.
INR 4 skip days of tx
Which 2 anemias are macrocytic
B12 and folate
positive pregnancy signs
Fetal movement: positive if checked with US, fetal heart beat.
probable pregnancy
increased frequency urination, soft cervix, abdominal bloating/enlargement, mild uterine cramping without bleeding
Possible pregnancy
Belly is growing, tender breast, movement in belly
Nagels rule
LMP + 7 days, -3 months, add 1 yr
Pregnant woman in 3td trimester, painful vaginal bleeding
Placenta abruptio
Pregnant woman in 3td trimester, non- painful vaginal bleeding
Non painful: placenta previa
UTI tx for pregnant woman
nitrofurantoin (Macrobid)
Pre-eclampsia tx
Bed rest
Cooms test detect.
RH antibodies
When do you administer Rh?
28 weeks and 72 hrs after delivery
Fundus at 12, 20 , and 38 weeks
12 symphisis pubis
20- umbilicus
39- xyphoid process
PAP results are high grade squamous cells, what do you do?
Refer
Avoid what contraception if female is smoker and >35?
NO COC pills
Post-menopausal and palpate R ovary
Not ok. Should never palpate ovary, mass? Cancer? US
What test would differentiate between a lesion and a cyst in the breast
US
Patient comes in with fatigue fever cough, blood in cough, Xray have upper lobe infiltrates
TB
Tx Pneumonia of the young person
Macrolide
Pneumonia of older person
Fluoroquinolones
Tx acute bronchitis
don’t tx with antibiotics, use supportive tx
CURB-65
2 or more send to ED for elderly with pneumonia: Confusion, Urea >18, Resp >30, B <90/60, >65 age.
Specific drug used to treat essential familial tremors
propranolol
essential tremors = at rest
Rhomberg Test
used to test balance
T score is -1.5, what is dx? -2.5
-1.5= osteopenia
-2.5= osteoporosis
Temporal arteritis, what is standard dx?
Biopsy of artery
Tx: long term steroids of about 6 months
Stringy eye discharge
allergic conjunctivitis
purulent eye discharge
bacterial conjunctivitis
watery eye discharge
viral conjunctivitis
Red reflex white in young
Retinal blastoma kids
Red reflex white in elderly
cataracts
Tx for sprain
RICE
Tx tibial stress syndrome: runner lady with shin splints anterior aspect of shins
Stop and RICE
Patient has mass on 5th or 4th metatarsal foot
mortons neuroma
Anthrax tx:
Cipro 60 days. It’s a rare but serious spore forming bacterium that causes infection, if inhaled, is harder to treat.
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)
1st line tx for sore throat, otitis media, bacterial sinusitis?
Amoxicillin
Human/animal bite tx?
Augmentin
Tx for skin infection with and without abscess?
without abscess: Keflex.
With abscess: MRSA: Bactrim
What if a patient is allergic to Bactrim? and need to tx MRSA skin infection
BCD: Bactrim, Clindamycin, Doxy. Know the order if allergic.
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
Traveler’s diarrhea tx?
Cipro
-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.
-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
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.
-Malaria tx?
Doxy
What would you treat acute otitis media effusion with?
decongestant and abx
What is the most common causative organism for acute otitis media?
strep pneumo
-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.
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.
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
-Prego and UTI tx?
Amox and cephalosporins category B.
can use macrobid
Age Colon cancer screening recommendation?
age 50
Mammogram’s screening recommendation?
age 50-75 ish. every 2 years. Positive family history can start sooner, age 45
Papanicolaou screening recommendation?
Start at age 21 no matter sexual activity or number of partners
- Papanicolaou= GYN PAP
At what age do we start vaccinating for Singles?
60
Earliest 50
Leading cause of death ages: 0-12 mos,
-0-12mos: congenital abn
Leading cause of death ages 1-44yr
unintentional accident
Leading cause of death ages: 45-64 yrs?
cancer
Leading cause of death ages >65 yrs?
heart
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
-Post menopausal female with spotting, what to do next? Why?
Warning sign cancer. endometrial?
-Hep B vaccine schedule?
- 1mo . 6mo . Need 4 weeks between them at least.
Immigrant woman with negative Hep B antibodies and Hep B antigen, what do you do next?
vaccinate
-3 main causes of adolescent death?
-MVA, suicide, homocide
when to screen for autism
18-24 months
1st line tx for OCD, PTSD, GAD…
SSRI
*citalopram (Celexa)
* escitalopram (Lexapro)
* fluoxetine (Prozac or Oxactin)
* paroxetine (Seroxat)
* sertraline (Lustral)
Antidepressant choice for elderly?
escitalopram (Lexapro) . Due to short ½ life
citalopram (Celexa)- lest interactions
SSRIs to avoid in elderly? Why?
Prozac , due to long ½ life
Topical steroids strengths?
class 1 is super potent, class 7 least potent.
Super potent= clobetasol #1 , least potent = OTC hydrocortisone # 7 .
Impetigo tx?
muprocin
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.
Rosacea tx?
Metro gel
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
What is tinea versicolor?
fungal infection of the skin: hypopigmented oval, non pruritic spots lighter than other parts.
tx with anti-fungal
Itchy purplish, flat-topped bumps? Tx?
lichen planus. Tx: steroids.
Erysipelas causative organism?
group A streptococcal bacteria
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
1st, 2nd, 3rd, 4th line tx for COPD?
SABA, LAMA, LABA, ICS
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
Patient comes in with rusty color sputum, chills, productive cough, fever. What is the most likely diagnosis?
Bacterial pneumonia
2 main causative organisms for atypical pneumonia (walking pneumonia) ?
Chlamydia pneumonia, Mycoplasma pneumonia
Possible side effect of aspirin?
- tinnitus: Although disturbing, this side effect usually disappears when the dose is decreased
Tylenol’s max daily dose?
4g
Coumadin and Bactrim, ok to give together? Why?
not ok, increased risk of bleeding
Which abx medications are safe to give to Prego?
Penicillins, including amoxicillin, ampicillin. Cephalosporins,
including cefaclor, cephalexin. Erythromycin
Which BP meds OK for Prego? Which BP meds NOT OK?
OK: labetatlol, nifedipine, methyldopa.
* NOT OK: ACE inhibitors, statins
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
How soon do you follow up after starting someone on Synthroid?
8 weeks
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
Allergies to antibiotics order?
PCN-macrolides-doxy-levoquin.
Food’s rich in Mg?
nuts, beans, laxatives, antacids
- Food’s rich in potassium?
most fruits
- Foods to avoid with celiac disease?
avoid wheat (including spelt, farro, graham, khorasan wheat, semolina, durum, and wheatberries.), rye, barley: breads, cereals, cookies.
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
makes it hard to see things that are close
-Hyperopia (farsightedness)
makes it difficult to see things that are far away
Myopia (nearsightedness)
Patient with sudden floaters, like the curtain is closing, flashes of lights?
retinal detachment
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
Fundoscopic exam reveals microaneurysms, what is the condition?
DM
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
Triglycerides >800, what medication to give?
true emergency, give something right away to sequester fenofibrate (tricor). Serious risk of pancreatitis.
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
Acute, sudden, eye pain, injection of the eye, headache. What is the most likely diagnosis?
Closed angle glaucoma
Acute onset of calf pain, swelling, tenderness, redness. What is the most likely diagnosis?
DVT
-Goal A1C: elderly? Young adult?
A1C: goal 65 yrs and older8.0
Under 7.0 if young adult
How can you diagnose DM2?
fasting >126 x 2, random sugar grater 200, A1C > 6.5, 2 hr plasma >200.
How much and how often can you increase insulin Lantus?
2-3 units every 2-3 days
Patient comes in with bronze skin, dizziness, fatigue, nausea. Dx?
Addisons
tx= steroids
Goal TSH level?
between 0.5 to 2.5 mU/L.
-Beta Blocker side effects?
fatigue, depression
ACE/ARBs side effects?
ACE: dry cough. ARBS: HA, dizziness
Calcium Channel Blockers side effects?
HA, ankle edema
Best HTN medication for elderly? Why?
CCB open things up
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
Mid systolic click
MVP
S2 fixed split.
septal defect
What is the ASCVD? Its cutoff?
Tool for hyperlipidemia
7.5%. Above that treat for hyperlipidemia
Most likely condition with a bruit over the carotid artery?
arterial narrowing and atherosclerosis
BP goal >65? <65?
> 60 or older: <150/90. Goal
* <60, <140/90 or less.
BP goal DM or chronic kidney diseases all ages
<140/90
HTN tx non black and black pts
ACE, ARBs, CC, THZ.
Black: CC, THZ.
HTN meds for Kidney disease, dm
ACE or ARB
What is coenzyme 10 good for?
heart health
When should a patient call the provider with CHF?
weight gain 3 lbs in 24 hrs or 5 lbs 1 week
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
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
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
Low levels platelets = increased bleeding
Easy bruising, petechiae, epistaxis, gingival bleeding
ITP
decreased platelets, anything less than <100,000 consider ITP <30,000.
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.
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)
also known as spoon nails, is a nail disease that can be a
sign of hypochromic anemia, especially iron-deficiency anemia
Koilonychia
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
CAGE
C-cut down, A- annoyance, G-guilty, E-early morning
drink.
Stethoscope: when is the bell vs diaphragm used?
diaphragm used for high pitched, bell for low.
What is the drug used for trigeminal neuralgia? What is the cream used?
Tegretol
cream= capsacian
Best test to diagnose diverticulitis?
CT
Best test to diagnose cholelithiasis?
US
Best test to diagnose appendicitis?
CT
Cluster HA tx: immediate in office, prophylaxis, and abortive?
Cluster HA: O2, medication prophylaxis (CC like verapamil to open
things up) and abortive. (triptans)
Gout: long vs short term tx?
Gout: acute tx with Indocin (indomethacin). Colchicine to relieve pain.
For long term tx allopurinol.
Diagnostic test for giant cell?
Biopsy
