Questions Review

Question 1

irritable bowel syndrome (IBS) - Rome IV diagnostic criteria

Answer 1

*recurrent abdominal pain/discomfort 1+ days/week for 3+ months & 2+ of the following:
-related to defecation (improves or worsens)
-change in stool frequency
-change in stool form

Question 2

classifications of herpes zoster pain

Answer 2

1. acute herpetic neuralgia
   -timeframe: persists up to 30 days from rash onset
   -treatment: NSAIDs, analgesics
2. subacute herpetic neuralgia
   -timeframe: persists > 30 days but resolves within 3 mo of rash onset
   -treatment: NSAIDs, analgesics
3. postherpetic neuralgia
   -timeframe: persists ? 3 months from rash onset
   -treatment: gabapentin, pregabalin, TCAs

Question 3

pancreatic adenocarcinoma - overview

Answer 3

*clinical presentation: systemic sx (weight loss, anorexia), discomfort/subacute pain (abdomen, back), jaundice, unexplained migratory superficial thrombophlebitis

*lab & imaging findings:
-cholestasis (increased alkaline phosphatase & direct bilirubin)
-increased cancer-associated antigen 19-9
-abdominal ultrasound (pancreatic head mass) or CT scan (ill-defined pancreatic mass)

Question 4

small bowel obstruction (SBO) - clinical presentation

Answer 4

*progressive abd pain, nausea/vomiting, abd distension, high-pitched bowel sounds
*abdominal x-rays demonstrating distended loops of bowel with air-fluid levels

Question 5

Meningococcal meningitis - overview

Answer 5

*epidemiology: most common in young children & young adults
*pathogen: N. meningitidis most commonly
*clinical features:
-initial: nonspecific fever, HA, vomiting, myalgia, sore throat
-within 12 to 24 hrs: petechiae/purpura, meningeal signs, AMS
*treatment: ceftriaxone

Question 6

contraindications to combined estrogen/progestin contraceptive pills

Answer 6

1. increased venous thromboembolism risk:
   -tobacco use
   -prolonged immobilization
   -prior VTE
   -thrombophilia
   -less than 3 weeks postpartum
2. increased CVD & stroke risk:
   -migraines with aura
   -uncontrolled HTN
   -ischemic heart disease
   -prior stroke
3. medical conditions negatively affected by increased estrogen:
   -active breast cancer
   -active liver disease (acute hepatitis, liver cancer)

Question 7

characteristics of benign childhood murmurs

Answer 7

*history: asymptomatic, normal growth, no significant family history
*murmur characteristics: early or midsystolic; musical/vibratory; grade 1-2 intensity; decreases or disappears with standing & Valsalva manuever
*other findings: normal vital signs, normal S1 & S2, symmetric pulses
*management: reassurance

Question 8

patellofemoral pain syndrome (PFPS)

Answer 8

*a common cause of chronic, poorly localized anterior knee pain in young women
*clinical findings: sx aggravation wtih running/stairs; atrophy/weakness of quads/hip abductors; sx reproducible with isometric quadriceps contraction (eg. squatting)
*treatment: strengthening quads & hip abductors

Question 9

empiric treatment for suspected gonorrhea / chlamydia STI

Answer 9

ceftriaxone + doxycycline
-IM ceftriaxone: covers N. gonorrhea
-oral doxycycline: covers Chlamydia and N. gonorrhea

Question 10

early Lyme disease - overview

Answer 10

*epidemiology: endemic to northeastern US; Ixodes scapularis tick transmits Borrelia burgdorgeri
*manifestations:
-erythema migrans
-systemic sx (malaise, fatigue, arthralgia)
-regional lymphadenopathy
-neuro: meningitis, cranial nerve palsy, radiculoneuritis
-carditis: atrioventricular block
*treatment: oral antibiotics (doxycycline) if skin/mild disease; IV antibiotics (ceftriaxone) if neuro or cardiac disease

Question 11

hypertrophic cardiomyopathy murmur

Answer 11

*LOUDER in standing position
*quieter in squatting position

Question 12

innocent murmurs

Answer 12

*increase with squatting
*decrease with standing & Valsalva